Chapter 13: Palliative and End-of-Life Care

The nursing director of a hospice program has observed increasing levels of emotional exhaustion and poor work performance in the nursing staff and believes the staff are suffering from burnout. Which actions can the nursing director take to reduce burnout in the nursing staff? Select all that apply. A. Encourage a work-life balance. B. Support autonomy for nurses in decision-making. C. Assist nurses in identifying personal strengths. D. Mandate personal leave days after a client dies. E. Develop programs to increase nurse resilience.

A. Encourage a work-life balance. B. Support autonomy for nurses in decision-making. C. Assist nurses in identifying personal strengths. E. Develop programs to increase nurse resilience.

Clients who are enrolled in hospice care are often believed to suffer unnecessarily because they do not receive adequate attention for their symptoms of the underlying illness. What factor most contributes to this phenomenon?

B. Rules concerning completion of all cure-focused medical treatment

A nurse is caring for an 87-year-old Mexican-American female patient who is in end-stage renal disease. The physician has just been in to see the patient and her family to tell them that nothing more can be done for the patient and that death is not far. The physician offers to discharge the patient home to hospice care, but the patient and family refuse. After the physician leaves, the patient's daughter approaches you and asks what hospice care is. What would this lack of knowledge about hospice care be perceived as?

C. A barrier to hospice care for this patient

A hospice nurse is well aware of how difficult it is to deal with others' pain on a daily basis. This nurse should put healthy practices into place to guard against what outcome?

C. Emotional exhaustion

The organization of a client's care on the palliative care unit is based on interdisciplinary collaboration. How does interdisciplinary collaboration differ from multidisciplinary practice?

C. It is based on communication and cooperation between disciplines.

A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important positive action that can come from a grief support group?

D. Normalization of feelings and experiences

The nurse is admitting a 52-year-old father of four into hospice care. The client has a diagnosis of Parkinson disease, which is progressing rapidly. The client has made clear his preference to receive care at home. What intervention should the nurse prioritize in the plan of care?

D. Supporting the client's and family's values and choices

The hospice nurse is caring for a 45-year-old parent of three young children in the client's home. During the most recent visit, the nurse has observed that the client has a new onset of altered mental status, likely resulting from recently diagnosed brain metastases. Which goal of nursing interventions should the nurse identify?

D. Teaching family members how to interact with, and ensure safety for, the client with impaired cognition

A clinic nurse is providing patient education prior to a patient's scheduled palliative radiotherapy to her spine. At the completing of the patient teaching, the patient continues to ask the same questions that the nurse has already addressed. What is the plausible conclusion that the nurse should draw from this?

D. The patient has not achieved the desired learning outcomes.

A client with cancer, who has just learned that the cancer has spread to distant organs, tells the nurse, "I am not sure how many more treatments I can put up with." The nurse responds by saying, "You have been through so many treatments for your cancer." Using the NURSE framework for responding to emotions, which empathic response did the nurse use?

D. UNDERSTAND the emotion.

The family of a client receiving palliative care for end-stage congestive heart failure is upset that the client is not eating. Which intervention should the nurse recommend to the family?

A. Remove unpleasant odors and sights during meals.

The nurse is describing palliative care and hospice services to a client with end-stage congestive heart failure. The client and family have many questions about the differences between palliative care and hospice. Which statement should the nurse provide the family?

A. "Hospice is the application of palliative care at the end of life."

A nurse who sits on the hospital's ethics committee is reviewing a complex case that has many of the characteristics of assisted suicide. Which of the following would be an example of assisted suicide?

A. Administering a lethal dose of medication to a client whose death is imminent

The nurse in a pediatric ICU is caring for a child who is dying of sickle cell anemia. The child's mother has been unable to eat or sleep and can talk only about her impending loss and the guilt she feels about the child's pain and suffering. What intervention has the highest priority?

A. Allowing the patient to express her feelings without judging her

You are caring for a 50-year-old man diagnosed with multiple myeloma; he has just been told by the care team that his prognosis is poor. He is tearful and trying to express his feelings, but he is having difficulty. What should you do first?

A. Ask if he would like you to sit with him while he collects his thoughts.

The nurse is assessing a 73-year-old client who was diagnosed with metastatic prostate cancer. The nurse notes that the client is exhibiting signs of loss, grief, and intense sadness. Based on this assessment data, the nurse will document that the client is most likely in what stage of death and dying?

A. Depression

A client with cancer has just been told that the disease is now terminal. The client tearfully states, "I can't believe I am going to die. Why me?" What is the nurse's best response to elicit more information from the client?

C. "Tell me more about how you feel about this news."

A nurse who provides care on an acute medical unit has observed that health care providers are frequently reluctant to refer clients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply. A. Financial pressures on health care providers B. Client reluctance to accept this type of care C. Strong association of hospice care with prolonging death D. Advances in "curative" treatment in late-stage illness E. Ease of making a terminal diagnosis

A. Financial pressures on health care providers B. Client reluctance to accept this type of care D. Advances in "curative" treatment in late-stage illness

The nurse is admitting a client to palliative care and notices that the client has health care provider orders for life-sustaining treatment (POLST). Which concepts regarding POLST will the nurse use to develop a plan of care for this client? Select all that apply. A. It can be used in any health care setting. B. It names the durable power of health care attorney. C. It specifies preferences for artificial nutrition and hydration. D. It expresses the client's wishes toward cardiopulmonary resuscitation (CPR). E. It specifies the client's preferences for funeral arrangements.

A. It can be used in any health care setting. C. It specifies preferences for artificial nutrition and hydration. D. It expresses the client's wishes toward cardiopulmonary resuscitation (CPR).

A client with end-stage kidney disease who immigrated to the United States several years ago is receiving care from family at home. When discussing the option of hospice care with a health care provider, the client and family explain through an interpreter that they do not want hospice care. Which factors are potential barriers to care for this client and family? Select all that apply. A. Lack of an understanding of hospice care B. A language barrier C. Mistrust of the health care system D. Wanting to care for the client at home E. Uncertainty about how long the client will live

A. Lack of an understanding of hospice care B. A language barrier C. Mistrust of the health care system

The nurse is caring for a client who has terminal lung cancer and is unconscious. Which assessment finding would most clearly indicate to the nurse that the client's death is imminent?

A. Mottling of the lower limbs

A client on the medical unit is dying and the nurse has determined that the family's psychosocial needs during the dying process need to be addressed. What is a cause of many client care dilemmas at the end of life?

A. Poor communication between the family and the care team

A nurse on a medical unit in the hospital often provides palliative care to clients with a variety of diagnoses. Which activities describe the primary palliative care functions of this nurse? Select all that apply. A. Provides assessment of symptoms B. Manages basic nursing problems C. Handles difficult conversations with clients D. Uses therapeutic communication skills with clients E. Identifies multifactorial symptoms

A. Provides assessment of symptoms B. Manages basic nursing problems D. Uses therapeutic communication skills with clients

The nurse is assessing a client whose spouse died 16 months ago. The client tells the nurse about joining a hiking group, volunteering as a college mentor, and thinking about dating again. The nurse determines that the client is in which stage of Rando's processes of mourning?

A. Reinvestment

A medical nurse is providing end-of-life care for a client with metastatic bone cancer. The nurse notes that the client has been receiving oral analgesics for pain with adequate effect, but is now having difficulty swallowing the medication. What should the nurse do?

A. Request the health care provider to prescribe analgesics by an alternative route.

An adult oncology client has a diagnosis of bladder cancer with metastasis and the client has asked the nurse about the possibility of hospice care. Which principle is central to a hospice setting?

A. The client and family should be viewed as a single unit of care.

The nurse is caring for a patient who has been recently diagnosed with late stage pancreatic cancer. The patient refuses to accept the diagnosis and refuses to adhere to treatment. What is the most likely psychosocial purpose of this patient's strategy?

A. The patient may be trying to protect loved ones from the emotional effects of the illness.

A patient who is receiving care for osteosarcoma has been experiencing severe pain since being diagnosed. As a result, the patient has been receiving analgesics on both a scheduled and PRN basis. For the past several hours, however, the patient's level of consciousness has declined and she is now unresponsive. How should the patient's pain control regimen be affected?

A. The patient's pain control regimen should be continued.

After caring for several clients who died in the hospital, the nurse has identified some lapses in the care that many of these clients received toward the end of their lives. What have research studies identified as a potential deficiency in the care of the dying in hospital settings?

A. The perception that palliative care constitutes "giving up."

A medical nurse is providing palliative care to a client with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse's care?

A. To improve the client's and family's quality of life

The nurse is assessing a client with end-stage liver failure for the presence of hope. What should the nurse identify as a hope-fostering category?

A. Uplifting memories

As the American population ages, nurses expect to see more clients admitted to long-term care facilities in need of palliative care. Regulations now in place that govern how the care in these facilities is both organized and reimbursed emphasize what aspect of care?

B. Restorative measures

The nurse is admitting a client with a diagnosis of ovarian cancer. The client has just been told that her ovarian cancer is terminal. What question should the nurse include in a spiritual assessment of the client?

B. "Do you have a sense of peace of mind and a purpose to your life?"

You are caring for a patient who has just been told that his illness is progressing and nothing more can be done for him. After the physician leaves, the patients asks you to stay with him for a while. The patient becomes tearful and tries several times to say something, but cannot get the words out. What would be an appropriate response for you to make at this time?

B. "Do you need more time to think about this?"

The nurse is caring for a client who is having difficulty adjusting to a terminal diagnosis. The nurse notes the client's tears and sits down by the bedside. The client tells the nurse, "There are so many things I still want to accomplish." Which response would be most therapeutic and appropriate for the nurse to make?

B. "Tell me what's most important to you now."

The nurse learns that a computed tomography scan a client underwent to investigate new seizure activity revealed a brain tumor. When the client later asks about the results of the scan, which therapeutic response should the nurse give the client?

B. "What is your understanding of your condition?"

As aa staff member in a local hospice, a nurse deals with death and dying on a frequent basis. Where would be the safe venue for the nurse to express her feelings of frustration and grief about a patient who has recently died?

B. At a staff meeting

A client with a terminal diagnosis has asked the nurse about "helping me end my suffering." What is the nurse's responsibility in the domain of assisted suicide?

B. Discussing concerns and fears with the client

You are caring for a patient, 42-year-old mother of two children, with a diagnosis of ovarian cancer. She has just been told that her ovarian cancer is terminal. When you admitted this patient, you did a spiritual assessment. What question would have been most important for you to evaluate during this assessment?

B. Does she have a sense of peace of mind and a purpose to her life?

A patient's daughter has asked the nurse about "helping him end his terrible suffering." The nurse is aware of the ANA Position Statement on Assisted Suicide, which clearly states that nursing participation in assisted suicide is a violation of the Code for Nurses. What does the Position Statement further stress?

B. Identifying patient and family concerns and fears

A client experienced the death of a spouse from a sudden myocardial infarction 5 weeks ago. The nurse recognizes that the client will be going through the process of mourning for an extended period of time. What process(es) of mourning will allow the client to accommodate the loss in a healthy way? Select all that apply. A. Reiterating the client's anger at the spouse's care team B. Reinvesting in new relationships at the appropriate time C. Reminiscing about the relationship the client had with her spouse D. Relinquishing old attachments to the spouse at the appropriate time E. Renewing lifelong commitments to the spouse

B. Reinvesting in new relationships at the appropriate time C. Reminiscing about the relationship the client had with her spouse D. Relinquishing old attachments to the spouse at the appropriate time

The nurse is part of the health care team at an oncology center. A patient has been diagnosed with leukemia and the prognosis is poor, but the patient is not yet aware of the prognosis. How can the bad news best be conveyed to the patient? A) Family should be given the prognosis first. B) The prognosis should be delivered with the patient at eye level. C) The physician should deliver the news to the patient alone. D) The appointment should be scheduled at the end of the day.

B. The prognosis should be delivered with the patient at eye level.

A client's rapid cancer metastases have prompted a shift from active treatment to palliative care. When planning this client's care, the nurse should identify what primary aim?

B. To prevent and relieve suffering

A client has just died following urosepsis that progressed to septic shock. The client's spouse says, "I knew this was coming, but I feel so numb and hollow inside." The nurse should know that these statements are characteristic of what phase?

B. Uncomplicated grief and mourning

A patient with end-stage heart failure has participated in a family meeting with the interdisciplinary team and opted for hospice care. On what belief should the patient's care in this setting be based?

C. Meaningful living during terminal illness is best supported in the home.

A hospice nurse is caring for a young adult client with a terminal diagnosis of leukemia. When updating this client's plan of nursing care, what should the nurse prioritize?

C. Providing realistic emotional preparation for death

One of the functions of nursing care of the terminally ill is to support the client and his or her family as they come to terms with the diagnosis and progression of the disease process. How should nurses support clients and their families during this process? Select all that apply. A. Describe their personal experiences in dealing with end-of-life issues. B. Encourage the client and family to "keep fighting" as a cure may come. C. Try to appreciate and understand the illness from the client's perspective. D. Assist clients with performing a life review. E. Provide interventions that facilitate end-of-life closure.

C. Try to appreciate and understand the illness from the client's perspective. D. Assist clients with performing a life review. E. Provide interventions that facilitate end-of-life closure.

The nurse has observed that an older adult client with a diagnosis of end-stage kidney disease seems to prefer to have the client's eldest child make all of the health care decisions. While the family is visiting, the client explains that this is a cultural practice and very important that it occurs. How should the nurse best handle this situation?

C. Work with the team to negotiate informed consent.

Which issue has most often presented challenging ethical issues, especially in the context of palliative care?

D. Ability of technology to prolong life beyond meaningful quality of life

A client is in a hospice receiving palliative care for lung cancer which has metastasized to the client's liver and bones. For the past several hours, the client has been experiencing dyspnea. What nursing action is most appropriate?

D. Administer bronchodilators and corticosteroids, as prescribed.

A pediatric nurse is emotionally distraught by the death of a 9-year-old client who received care on the unit over the course of many admissions spanning several years. What action is the most appropriate response to the nurse's own grief?

D. Attend the client's memorial service.

In recent decades, nursing has moved into the forefront in providing care for the dying. Which phenomenon has most contributed to this increased focus of care of the dying?

D. Demographic changes in the population