Med Surg. Chapter 16

The physician is attending to a 72-year-old patient with a malignant brain tumor. Family members report that the patient rarely sleeps and frequently reports seeing things that are not real. Which of the following interventions is an appropriate request for the hospice nurse to suggest to the physician?

Add haloperidol (Haldol) to the patient's treatment plan.

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?

Client's goals

A hospice nurse is visiting the home of a client who was recently diagnosed with a terminal illness. The nurse is developing the client's plan of care and is assessing beliefs and preferences about end-of-life care. The nurse would expect to complete this assessment at which time?

Over the course of several visits

According to federal guidelines, hospices may provide no more than what percentage of the aggregate annual patient days at the inpatient level?

20

Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death?

Dusky appearance

A nurse is providing hospice care in Portland, Oregon,to client with terminal liver cancer. The client confides to the nurse, "I'm in agony all the time. I want this to be over now—please help me." Which of the following interventions is the best for the nurse to implement? Select all that apply.

• Advise the client's physician of the client's condition. • Encourage the client to explain his wishes. • Control the client's pain with prescribed medication.

A type of comprehensive care for patients whose disease is not responsive to cure is

palliative care.

The family of a terminally ill client tells the nurse that the client has been breathing irregularly and, at times, it appears that he is not breathing at all. The client's daughter states, "He moans when he breathes. Is he in pain?" Which response by the nurse would be most appropriate?

"The moaning you hear is from air moving over very relaxed vocal cords."

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."

Which of the following statements when made by the nurse demonstrates the nurse is providing spiritually sensitive care?

"Tell me who or what gives you strength?"

A nurse is working with the family of a terminally ill client, providing them with suggestions about how to manage the client's anorexia. Which statement by the family indicates that they have understood the instructions?

"We'll try adding powdered milk to milk and other foods to make them more nutritious."

Based on the most common concern of a dying patient, the hospice nurse should:

Administer pain medication on a schedule that prevents pain from intensifying.

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.

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage according to Kübler-Ross?

Anger

A terminal patient has feelings of rage toward the nurse. According to Kubler-Ross, the patient is in which stage of dying?

Anger

Which of the following interventions should the nurse perform while providing spiritual care for a dying client?

Ask the family members about spiritual care.

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?

Assess the client's ability to state wishes.

A patient diagnosed with terminal pancreatic cancer is unaware of the diagnosis and his daughter has requested that he not be told. What awareness context does the nurse determine this is?

Closed awareness

Glaser and Strauss (1995) identified four "awareness contexts". Which awareness context occurs when the patient is unaware of his or her terminal state, but others are aware?

Closed awareness

The family members of a dying patient are finding it difficult to verbalize their feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations?

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

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?

Explore own feelings on mortality and death and dying.

Which of the following is an appropriate method of assessing the dying client?

Focus on the client's basic needs.

For individuals known to be dying by virtue of age and/or diagnoses which of the following signs indicate approaching death?

Increased restlessness

Your client, the mother of three young children, has been diagnosed with stage III breast cancer and is distraught. Which of the following statements best communicates a spirit of hopefulness to your client?

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

A hospice nurse should be aware that the most effective pain medication used at the end of life that also relieves dyspnea and anxiety is which of the following?

Morphine

As a client approaches death, her respirations become noisy. This is the result of which type physical event?

Musculoskeletal change

The patient tells the doctor that he and his family have accepted the terminal diagnosis of pancreatic cancer. The patient further explains that he is interested in being comfortable and that he no longer wishes to fight the cancer. This approach to end-of-life care is known as which of the following?

Palliative care

A patient with brain tumor recently stopped radiation and chemotherapy for treatment of his cancer. Of late, he is complaining of dry mouth. Which of the following interventions by the hospice nurse demonstrates the nurse understands treatment measures for dry mouth?

Provide gentle mouth care after each meal.

Which of the following nursing actions by the nurse demonstrates an effective method to assess the patient and the patient's family's ability to cope with end-of-life interventions?

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

A patient has been declared to have a terminal illness. What is the nursing intervention a nurse will perform in the final decision of a dying patient?

Respect the patient and family members' choices

A patient is declared to have a terminal illness. What is the nursing intervention a nurse will perform in the final decision of a dying patient?

Respect the patient and family members' choices.

Which of the following is one of the levels of hospice care covered under Medicare and Medicaid hospice benefits that includes a 5-day inpatient stay and is provided on an occasional basis to relive the family caregivers?

Respite care

You are providing home care to a dying client and have noticed over the course of several weeks that the client's daughter is usually quiet and withdrawn when in the client's room. Which of the following nursing interventions should you perform in this situation?

Sit with the client's daughter privately and encourage her to express her feelings frankly.

How does a nurse who has been providing home care to a terminally ill client know that her client's condition is beginning to deteriorate?

The client's apical pulse reaches 100 beats/minute.

The nurse is caring for a client who just learned of his terminal diagnosis. After the physician leaves, the nurse remains to answer further questions so that the client can make an informed decision about further treatment. By providing all available information, the nurse is promoting which ethical principle?

The principle of autonomy

When assessing a terminally ill client, the nurse notices that the client has copious secretions at the back of the throat and in the mouth. The nurse is preparing a teaching plan for the family about caring for these secretions. Which of the following would be least appropriate to include?

Using a soft toothbrush to vigorously clean the mouth

A nurse assesses a client with a terminal illness and determines that the client is in denial about the condition. Which of the following would be most important for the nurse to do when developing the client's plan of care?

Accept the client's denial of the situation.

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?

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

A nurse is providing in-home hospice care to a 75-year-old client with lung cancer. The nurse determines that the client is eligible for Medicare hospice benefits based on which of the following?

Client has a life expectancy of 6 months or less.

Which of the following is the initial stage of grieving according to Kubler-Ross?

Denial

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?

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

A patient 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 of the following proxy directives is the patient using?

Durable power of attorney for health care

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?

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

Medicare and Medicaid hospice benefits criteria allow patients with a life expectancy of 6 months or less to be admitted to the hospice. However, the median length of stay in a hospice program is just 21.3 days. Which of the following reasons explains underuse of hospice care services?

Patients/families view palliative care as giving up

Despite having been administered the prescribed pain medication, a dying patient is still in pain due to fear and anxiety. Which of the following nursing interventions should a nurse use to potentiate the effects of pain medication?

Using imagery, humor, and progressive relaxation

In spite of administering the prescribed pain medication, a dying patient is still in pain due to fear and anxiety. Which of the following nursing interventions should a nurse use to potentiate the effects of pain medication?

Using imagery, humor, and progressive relaxation

Which of the following should the nurse report so that the team can consider alternative nutritional and fluid administration routes for a dying client?

Weight loss and inadequate food intake

The wife of your terminally ill client is confused by the new terminology being used during discussions regarding her husband's treatment. How would you explain palliative care to her?

It is care that will reduce her husband's physical discomfort and manage clinical symptoms.