ch 59

14. A client involved in a motor vehicle accident is rushed to the healthcare facility in an unconscious state. The nurse frequently changes the client's position. What are the purposes for the frequent position changes? 1. Promote comfort 2. Prevent skin breakdown 3. Ease breathing 4. Kept client clean and dry A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4

a

16. A 90-year-old client diagnosed with intestinal carcinoma is being cared for at a healthcare facility. The client's relatives are experiencing emotional trauma and difficulty coping with the situation. What nursing measures must the nurse ensure to implement care and support the dying client and his family members? 1. Establish a supportive and trusting relationship with the client and family. 2. Explain the client's condition and treatment to the client and family. 3. Express warmth, care, and concern when interacting with the client and family. 4. Ensure that the client's higher-level needs are met. A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4

a

18. A 90-year-old client diagnosed with intestinal carcinoma is being cared for at a healthcare facility. The client's relatives are experiencing emotional trauma and difficulty coping with the situation. What measures must the nurse take to prepare and plan for the client and relatives to cope with the situation? 1. Tell them that they should feel free to express needs, fears, and emotions. 2. Identify preferences concerning death. 3. Demonstrate positive methods of coping. 4. Discourage client to participate in self-care. A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4

a

24. A family member has heard about the rule of threes and asks the nurse what it means. What would be the best response about the rule of threes? A) A person can live 3 minutes without oxygen. B) A person can live 3 hours without water. C) A person can live 3 days without food. D) A person can live 3 weeks without warmth.

a

25. A client's family asks the nurse about the changes noted in the client's respirations. Various breathing patterns may be seen in the client who is dying. What is the best description to provide to the family by the nurse of Kussmaul's breathing? A) Respiratory rate greater than 20 breaths/minute B) Shallow breathing C) Absence of breathing D) Often occurs if a person experiences alkalosis

a

4. Healthcare facilities that receive federal funds must ask every client on admission if they have an advance directive. The client's response must be entered into the client's health record. Advance directives can take several forms. What are the most common advance directives? 1. Living will 2. Durable power of attorney for healthcare 3. DNR 4. DNI A) 1, 2 B) 1, 4 C) 2, 3 D) 3, 4

a

5. The nurse documents that the client has a written living will. What is the best description of a living will? A) Document in which the client states the types of treatment desired to receive or not to receive if a terminal situation arises B) Designates a person of the client's choice to make healthcare decisions should the client become incompetent C) Document in which healthcare personnel are informed that if the person experiences cardiopulmonary arrest, that a "code blue" should not be called D) Document in which healthcare personnel are informed not to start tube feeding and to keep the client as comfortable as possible

a

15. A 90-year-old client diagnosed with intestinal carcinoma is being cared for at a health care facility. The client's relatives are experiencing emotional trauma and difficulty coping with the situation. What nursing measure must the nurse ensure for implementation of care and support to the dying client and his family members? A) Provide detailed explanations of what is done and what is expected. B) Support the client and family and avoid being judgmental. C) Discourage the client and family members from being actively involved in planning and providing care. D) Discourage family members from expressing needs and encourage respite time for them.

b

17. A 90-year-old client diagnosed with intestinal carcinoma is being cared for at a healthcare facility. The client's relatives are experiencing emotional trauma and difficulty coping with the situation. What nursing measures must the nurse ensure to implement care and support the dying client and his family members? 1. Maintain open communication among all concerned. 2. Provide appropriate pain relief. 3. Do not talk often with the nonresponsive or comatose client. 4. Arrange for spiritual counseling, if requested. A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4

b

2. A client's family often goes through the same stages of grief and loss related to the dying experience as does the client. Not all people go through the grief experience in the same sequence in the same way. A client's family keeps repeating over and over "why is this happening to my father?" What stage of dying is being expressed by the client's family? A) Denial and isolation B) Anger and rage C) Bargaining and developing awareness D) Detachment

b

23. The nurse needs to recognize the signs of approaching death to provide the required care and to support the client and the client's family members. What is the correct sequence of steps that occurs during the last stage of life and indicates approaching death? 1. The client's sense of hearing is slowly lost. 2. The client experiences sweating. 3. The client's extremities feel colder to touch. 4. The client's sense of touch is gradually diminished. A) 1, 2, 3, 4 B) 2, 3, 4, 1 C) 3, 4, 1, 2 D) 4, 1, 2, 3

b

6. The nurse documents that the client has a durable power of attorney for healthcare. What is the best description of a durable power of attorney for healthcare? A) Document in which the client states the types of treatment desired to receive or not to receive if a terminal situation arises B) Designates a person of the client's choice to make healthcare decisions should the client become incompetent C) Document that informs healthcare personnel that if the person experiences cardiopulmonary arrest, a "code blue" should not be called D) Document in which healthcare personnel are informed not to start tube feeding and to keep the client as comfortable as possible

b

7. An elderly client is admitted to the healthcare facility with acute respiratory distress. The client's health record has a DNR or "do not resuscitate" order. Which must the nurse perform if the client suddenly develops cardiopulmonary arrest? A) A full code is initiated at the earliest. B) The client is allowed to die naturally. C) Cardiopulmonary resuscitation without medications is initiated. D) The code team is called with intervention delayed until the physician arrives.

b

10. A nurse is caring for a 69-year-old client in the advanced stage of breast cancer. Which nursing consideration must the nurse perform to facilitate emotional support to the client and family members? A) Tell client and family members that recovery may be possible. B) Request family members to avoid talking about their own lives to the client. C) Encourage family members to stay with the client, especially at night. D) Ask the family members not to express their sorrow in front of the client.

c

11. A 90-year-old client with carcinoma of the prostate complains of severe, excruciating pain in his lower limbs and hips. The attending physician has prescribed heavy doses of narcotics to relieve the pain. Which must the nurse keep in mind when caring for the client? A) Client may have an increased concern of drug abuse and dependency. B) The client's pain may suddenly increase, indicating impending death. C) Client may be allowed to self-administer narcotics, if he is capable of doing so. D) Alternative therapies, such as homeopathy and herbal remedies, are avoided.

c

12. An 84-year-old female client with a brain tumor is admitted to the healthcare facility following an epileptic attack. Which nursing consideration should the nurse follow when providing end-of-life care for the client? A) Avoid placing the client in a low Fowler's or orthopneic position. B) Ensure that the client's head is not elevated when placing her on her back. C) Encourage clients lying on their backs to assume other positions. D) Avoid disturbing the client with frequent change in position.

c

13. A client involved in a motor vehicle accident is rushed to the healthcare facility in an unconscious state. The healthcare provider has diagnosed the situation as critical with little hope of survival. The unconscious client suddenly regains consciousness and becomes alert. Which nursing measure must the nurse employ when caring for the dying client's family members? A) Inform the family that the client may soon be out of danger. B) Request the family members not to talk about death to the client. C) Immediately call the family members to bid farewell to the client. D) Provide respite care to the client's family members.

c

21. An elderly client who was admitted to the healthcare facility passes away as a result of a cardiopulmonary arrest. The nurse attending to the client is deeply traumatized by the incident. What should the nurse do to obtain support and comfort following the death of the client? A) Request the coroner not to order an autopsy. B) Avoid the situation by walking away from it. C) Express sadness to the medical team and client's family. D) Try to assist the client's family members in the funeral.

c

8. An elderly client at an assisted living facility is in acute respiratory distress. The client's health record has a DNH order. What is the best description for a DNH order? A) The individual will be allowed to die naturally without mechanical or chemical intervention. B) The individual will have a tube feeding initiated as soon as possible. C) Client does not wish to be hospitalized or resuscitated if the individual's condition becomes critical. D) The ambulance is to be called immediately in the event of cardiopulmonary arrest, even though natural death is imminent.

c

1. A nurse is providing end-of-life care for an 89-year-old male diabetic client with acute renal failure. Which nursing consideration must the nurse employ when catering to the basic needs of the client and his family members? A) Try to convince the client and family members to agree to organ or tissue donation. B) Provide nursing care to the client, without regard to the nurse's own feelings. C) Discourage the client from talking to family members about his death. D) Offer to secure spiritual counseling, if requested, for the client and family members.

d

19. A 65-year-old involved in a car accident is rushed to the healthcare facility with severe head injuries and profuse loss of blood. Which sign of approaching death will the nurse observe in the client that needs to be shared with family members who might want to be present? A) Frequency of urination decreases B) Arms and legs are warm to touch C) Client is calm and peaceful D) Breathing becomes noisy

d

20. An elderly client who was admitted with a severe head injury passes away at the healthcare facility. Which nursing procedure should the nurse consider when caring for the client's body and family members? A) Place a clean sheet over the client's body and face. B) Light the room brightly when the family members visit. C) Allow the family members to see the body immediately. D) Allow family members to stay in the room as long as they wish.

d

22. A 79-year-old client at the healthcare facility died following a case of gastric cancer and multiple metastases to the lungs and liver, with severe bouts of hematemesis. Which nursing measure must the nurse perform during the postmortem care of the body? A) Pronounce the client dead and sign the death certificate. B) Avoid repositioning the client's body immediately following death. C) Transfer the client's body as "coroner's case" for an autopsy. D) Pad and tie the client's wrists and ankles together.

d

3. A client's family often goes through the same stages of grief and loss related to the dying experience as does the client. Not all people go through the grief experience in the same sequence in the same way. A client says to family members "I don't care anymore about living. This is not living to me." What stage of dying is being expressed by the client? A) Denial and isolation B) Anger and rage C) Bargaining and developing awareness D) Depression

d

9. An elderly client at an assisted living facility is in acute respiratory distress. The client's health record has a full code order. What is the best description for a full code order? A) The individual will be allowed to die naturally without mechanical or chemical intervention. B) The individual will have a tube feeding initiated as soon as possible. C) Client does not wish to be hospitalized or resuscitated if the individual's condition becomes critical. D) The ambulance is to be called immediately in the event of cardiopulmonary arrest, even though natural death is imminent.

d