Hinkle Ch. 16 End Of Life Care

A nurse is assessing a terminally ill female client. Which client statement indicates that the client is in the bargaining stage of dying? "Why is this happening to me. I've led a good life. Why is God punishing me?" "I just want to see my daughter graduate from college. That's all." "I don't know how my husband is going to manage things when I'm gone." "I can't believe this. I'm going to get a second opinion."

"I just want to see my daughter graduate from college. That's all."

Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice. However, the median length of stay in a hospice program is just 21.3 days. Which reason explains the underuse of hospice care services? Difficulty obtaining Medicare certification for hospice services Lack of Medicare/Medicaid funding for hospice Lack of fully credentialed and trained hospice nurses Clients and families view hospice care as giving up

Clients and families view hospice care as giving up

Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death? Flushed appearance Dusky appearance Absence of incontinence Increased body temperature

Dusky appearance

The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which intervention should a nurse perform in such a situation? Encourage the family members to express their feelings and listen to them in their frank communication Encourage conversations about the impending death of the client Be a silent observer and allow the client to communicate with the family members Encourage the client's family members to spend time with the client

Encourage the family members to express their feelings and listen to them in their frank communication

A mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement best communicates a spirit of hopefulness to this client? "Let's take this one day at a time; remember you have your daughter's dance recital next week." "You should seek a second medical opinion about your diagnosis." "I believe that you will fight hard to beat this and see your babies grow up." "I know another client with the same diagnosis who has been in remission for 10 years."

"Let's take this one day at a time; remember you have your daughter's dance recital next week."

Which statements made by the nurse demonstrates that the nurse is providing spiritually sensitive care? "Mourning may be demonstrated by emotional feelings of sadness, anger, guilt, and numbness." "A key component of hospice care is following your family for up to a year after your death." "Tell me who or what gives you strength." "Denial, sadness, anger, fear, and anxiety are normal grief reactions."

"Tell me who or what gives you strength."

A patient with end-stage chronic obstructive pulmonary disease is admitted to a hospice facility and asks the admitting nurse, "How long will I be allowed to stay here?" What is the best response by the nurse? "You will be able to stay only for approximately 1 month and then you will be discharged." "You will be able to stay for 2 months before being discharged." "There is no time limit for your stay. You can stay until you die." "When your stay reaches 6 months, you will be recertified for a continued stay."

"When your stay reaches 6 months, you will be recertified for a continued stay.

All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason? Allows for the nurse to understand when the grieving process should be concluded Allows the nurse to express his or her feelings Allows for the nurse to take the client through in the appropriate order Allows for the nurse to facilitate the grieving process

Allows for the nurse to facilitate the grieving process

While providing care to a terminally ill client, the client's niece asks the nurse about the client's condition and prognosis. Which of the following would be most appropriate? Check with the client's immediate family members about sharing information. Provide the niece with the information that she is requesting. Ask the client's consent before sharing any information with the niece. Refer the niece to the client's physician for information.

Ask the client's consent before sharing any information with the niece.

For a client to use the Medicare Hospice Benefit, life expectancy needs to be what length of time? 6 months 2 months 4 months 8 months

6 months

The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition. End-stage renal disease Coronary artery disease Carcinoma-in-situ Type 2 diabetes mellitus

End-stage renal disease

Which is a sign of approaching death? Irregular breathing patterns Increase in urinary output Clear sensorium Insomnia

Irregular breathing patterns

A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse? "It will enable the patient to remain home if that is what is desired." "It will use artificial means of life support if the patient requests it." "It will hasten the death of the patient." "It will prolong life in a dignified manner."

It will enable the patient to remain home if that is what is desired."

A nurse is caring for a client with a terminal illness. The client asks the nurse to help him end his own life to alleviate his suffering and that of his family. When responding to the client, the nurse integrates knowledge of which of the following? Nurses may administer medications prescribed by physicians to hasten end of life. Participating in assisted suicide violates the Code of Ethics for Nurses. Most states have enacted laws that allow for physician-assisted suicide. A client has the right to make independent decisions about the timing of his or her death.

Participating in assisted suicide violates the Code of Ethics for Nurses.

Which action by the nurse demonstrates an effective method to assess the client and the client's family's ability to cope with end-of-life interventions? Providing evidenced-based advice for end-of-life care based on the nurse's experiences with previous clients in hospice Offering reassurance that the nurse has had 5 years of assisting clients in hospice and their families care for loved ones at the end of life Filling voids in conversation with information related to death and dying to avoid awkward moments during the admission interview Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care

Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care

When describing the term "grief" to a group of students, which of the following would the instructor include? The response experienced by anyone who has suffered a loss A part of the life cycle in the form of change, growth, and transition A feeling of connectedness with one's self and others Feelings of apprehension or worry in response to a situation

The response experienced by anyone who has suffered a loss

The nurse identifies a nursing diagnosis of Imbalanced nutrition: less than body requirements for a terminally ill client who is near the end of life. Which of the following would the nurse expect to include in the client's plan of care? Advice for the family to have fruit juices readily available at the client's bedside. Suggestions that the family offer the client foods that are hot. Arrangements for the client to eat meals while others are out of the home. Encouragement of the family to serve the client meat, especially beef.

Advice for the family to have fruit juices readily available at the client's bedside.

The nurse is caring for a 90-year-old male who has never completed an advanced directive. The man has a son but has not seen him in several years. A neighbor has assisted him with meals and housecleaning for many years. The neighbor states that the client expressed only wanting to have comfort measures. The estranged son wants his father to be treated aggressively. Which would be the nurse's initial step? Follow the neighbor's directive. Assess the client's ability to state wishes. Notify the physician of the discrepancy. Follow the son's directive.

Assess the client's ability to state wishes.

A family of a dying client reports that their loved one is experiencing more shortness of breath. Which nursing intervention is most appropriate at this time? Get the client out of bed to the chair. Offer the client sips to drink. Call the health care provider to obtain an oxygen order Offer the bedpan to urinate or defecate

Call the health care provider to obtain an oxygen order

A nurse is providing care to a client experiencing symptoms associated with terminal illness. Which of the following would be most appropriate to use as a means for managing the client's symptoms? Length of required treatment Client's goals Invasiveness of the treatment Physician's orders

Client's goals

Which "awareness context" is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise? Mutual pretense awareness Open awareness Closed awareness Suspected awareness

Mutual pretense awareness

A client in hospice has end-stage renal failure. The client states that, of late, he has lost his appetite and feels like everyday situations have become more stressful. The client reports feeling restless. In addition, the client's spouse notices that the client is becoming more confused. What is the most important nursing intervention that needs to be carried out at this point? Provide the spouse with an emergency kit that contains small doses of oral morphine liquid. Make arrangements for the client to receive nutritional counseling. Make arrangements with the physician to administer immunosuppressants. Immediately administer drug therapy to restore renal function.

Provide the spouse with an emergency kit that contains small doses of oral morphine liquid.

A terminally ill patient in pain asks the nurse to administer enough pain medication to end the suffering forever. What is the best response by the nurse? "I am surprised that you would ask me to do something like that." "I can't do that, I will go to jail." "I will notify the physician that the current dose of medication is not relieving your pain." "I will see if the physician will order enough for that to occur."

"I will notify the physician that the current dose of medication is not relieving your pain.

A 90-year-old home care client's son has been designated to make decisions regarding the client's medical care when the client is no longer able to do so. As the client nears the end of life, the son is consulted on an ever-increasing basis. What legal instrument activates the son's decision-making designation? durable power of attorney for health care designated signer power of attorney living will

durable power of attorney for health care

During a home care visit to a client in hospice, the client's spouse reveals to the nurse an understanding that the client's death is inevitable. Recognizing the spouse is exemplifying the Kübler-Ross stage of acceptance, which statement by the nurse is most appropriate? "Have you thought about what you will do when you find your spouse after he has died?" "I would make arrangements to have all your children present for the death vigil." "Tell me how you plan to react when you first realize that your spouse is breathless and has no pulse." "Make sure you have made previous arrangements with the funeral home for burial arrangements."

"Tell me how you plan to react when you first realize that your spouse is breathless and has no pulse."

A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using? Living will declaration Durable power of attorney for health care End-of-life treatment directive Medical directive by proxy

Durable power of attorney for health care

A client is dying, and the client and loved ones are in the grieving period. The nurse wants to support them in the grieving process. Which is the best intervention the nurse could perform? Spend time alone with the client. Disengage to give the grieving individuals privacy. Encourage loved ones to express their feelings. Provide palliative care to the client.

Encourage loved ones to express their feelings.

The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to dying clients and their families is to first do which of the following? A workshop on caring for the dying client Participate in a support group to learn clients' feeling on care. Explore own feelings on mortality and death and dying. Use evidence-based practice in daily care regimen.

Explore own feelings on mortality and death and dying.

A nurse has been providing in-home hospice care to an older adult client with lung cancer for more than six months. The family asks the nurse how long the Medicare hospice services will continue. What is the nurse's best response? Medicare hospice services end at the seventh month of care. The client must begin to pay for other home health services since six months of hospice care have been received. The Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition. The hospice services need to end now that the client has had the services for six months.

The Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition

The spouse of a terminally ill client is confused by the new terminology being used during discussions regarding the client's treatment. The nurse should explain that palliative care is: an alternative therapy that uses massage and progressive relaxation for pain relief. care that will reduce the client's physical discomfort and manage clinical symptoms. offered to terminally ill clients who wish to remain in their homes in lieu of hospice care. care that is provided at the very end of an illness to ease the dying process.

care that will reduce the client's physical discomfort and manage clinical symptoms.