prep u- ch 13: end of life
Which statement, made by the nurse, can be most helpful when caring for a client in the third stage of Kubler-Ross' emotional reactions to dying? - "Let's review the laboratory results and compare them with the diagnostic tests." - "I like your idea of living for today and enjoying those around you." - "What makes you most angry about getting the disease?" - "I understand that it would be wonderful to see your daughter's graduation."
"I understand that it would be wonderful to see your daughter's graduation."
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 interventions should the nurse perform while providing spiritual care for a dying client?
Ask the family members about spiritual care.
Which of the following may be contained in an "emergency kit" for a hospice patient exhibiting restlessness? - Atropine sulfate drops - Laxative - Benzodiazepine - Oral sucrose
Benzodiazepine Explanation: A kit might contain small doses of oral morphine liquid for pain or shortness of breath, a benzodiazepine for restlessness, and an acetaminophen suppository for fever. Atropine sulfate drops may be used for excess respiratory secretions.
Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death? - Increased body temperature - Absence of incontinence - Flushed appearance
Dusky appearance
A type of comprehensive care for clients whose disease is not responsive to cure is
palliative care.
Nursing students are reviewing information about attitudes related to death and dying. The students demonstrate understanding of the information when they identify which of the following as most accurate? - There remains a conspiracy of silence about dying despite progress in the area. - Most clinicians are very open to talking about disease and dying with clients. - Clients, for the most part, would gain hope if they were told about a poor prognosis. - Clients would ask for information if they really had a desire to know
There remains a conspiracy of silence about dying despite progress in the area.
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: - 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. - 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.
A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client?
Respect the client's and family members' choices.
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 - Type 2 diabetes mellitus - Coronary artery disease - Carcinoma-in-situ
- End-stage renal disease
As a client approaches death, respirations become noisy. This is the result of which type physical event? - musculoskeletal change - gastrointestinal impairment - cardiac dysfunction - central nervous system alterations
- musculoskeletal change
A nurse is providing hospice care in Portland, Oregon to a 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 interventions should the nurse implement? Select all that apply.
Control the client's pain with prescribed medication. Advise the client's health care provider of the client's condition. Encourage the client to explain his or her wishes.
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? - Be a silent observer and allow the client to communicate with the family members - Encourage the family members to express their feelings and listen to them in their frank communication - Encourage the client's family members to spend time with the client - Encourage conversations about the impending death of the client
Encourage the family members to express their feelings and listen to them in their frank communication
A client nearing the end of life is experiencing delirium. Which action will the nurse take to help this client? - Encourage family to visit. - Add additional lighting to the room. - Apply restraints as needed. - Increase environmental stimulation.
Encourage family to visit.
A client is diagnosed with a terminal illness and has been given less than 6 months to live. What type of referral should the nurse make to assist this patient and family at home? -Hospice - Adult day care - A rehabilitation center - Physical therapy
Hospice
For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death? - Increased wakefulness - Increased urinary output - Increased restlessness - Increased eating
Increased restlessness Explanation: As the oxygen supply to the brain decreases, the patient may become restless. As the body weakens, the client will sleep more and begin to detach from the environment. For many clients, refusal of food is an indication that they are ready to die. Based on decreased intake, urinary output generally decreases in amount and frequency
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. - 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. - Nurses may administer medications prescribed by physicians to hasten end of life.
Participating in assisted suicide violates the Code of Ethics for Nurses.
As the moment of death approaches, which of the following does the nurse encourage the family to do? - Speak to the client in a calm and soothing voice. - Lie next to the client and hold the client. - Rub the client's hand and arm to comfort the client. - Have the family sit in front of the client so they can be seen.
Speak to the client in a calm and soothing voice. Explanation: Sight and touch diminish as the client approaches death; however, hearing tends to remain intact. Speaking to the client calmly is most appropriate.
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? - 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 client must begin to pay for other home health services since six months of hospice care have been received. - Medicare hospice services end at the seventh month of care.
The Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition.
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? - Encourage loved ones to express their feelings. - Disengage to give the grieving individuals privacy. - Provide palliative care to the client. - Spend time alone with the client.
- Encourage loved ones to express their feelings.
A client with a terminal illness who is incapacitated is experiencing intractable pain that is no longer effectively addressed by conventional pharmacology. Which type of pain management will the nurse anticipate for this client? - Patient-controlled analgesia - Barbiturate coma - Conscious sedation - Palliative sedation
Palliative sedation Explanation: Barbiturate coma is a technique used to induce a coma in clients with specific conditions. Conscious sedation is used for some diagnostic tests and procedures. Clients who are incapacitated are not likely candidates for patient-controlled analgesia.
The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to clients who are dying and their families is to first do which of the following? - Explore own feelings on mortality and death and dying. - A workshop on caring for the client who is dying - Use evidence-based practice in daily care regimen. - Participate in a support group to learn clients' feeling on care.
Explore own feelings on mortality and death and dying. Explanation: To care for others in the dying process, the nurse must explore their own feelings about mortality and death and dying. Understanding the self provides a perspective to cope with and then support clients and families experiencing pain and grief. The other options are helpful in determining appropriate nursing care but not the first step.
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 facilitate the grieving process - Allows for the nurse to understand when the grieving process should be concluded - Allows for the nurse to take the client through in the appropriate order - Allows the nurse to express his or her feelings
Allows for the nurse to facilitate the grieving process
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? - "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." - "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."
"Let's take this one day at a time; remember you have your daughter's dance recital next week." Explanation: Helping a client to find reasons to live and look forward to events promotes positive attitudes and ability to live for the moment, which in turn communicates a spirit of hopefulness. The statement about a second opinion is inappropriate because it gives the client false hope that her current diagnosis is inaccurate. Although he client may choose another medical opinion, she needs to come to that decision without the nurse's advice. Reponses should not convey false hope to the client. Nurses and clients should not confuse hope with unrealistic optimism.
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." - "He is getting less oxygen to the brain, so the moaning means he is dreaming." - "He has secretions that are collecting at the back of the throat." - "His moaning does indicate pain, so we'll increase his pain medication."
"The moaning you hear is from air moving over very relaxed vocal cords."
A 25-year-old client with cancer who is experiencing unrelieved pain rated a 9 on the pain scale requests that the hospice nurse induce a state of unconsciousness until the client dies. Which statement by the nurse demonstrates an understanding of a key difference between conscious sedation and euthanasia? - "I cannot legally administer pain medications that will induce unconsciousness to relieve your pain." - "Total sedation is a commonly practiced method used in this situation; I will contact your physician and begin treatment as soon as possible." - "Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death." - "I need to perform a complete pain assessment to confirm the amount of pain you are experiencing before recommending sedation."
"Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death."
A nurse is providing care to a client who has just been diagnosed with a terminal illness. Which of the following would be most appropriate for the nurse to do? - Engage the client in conversation to provide distraction. - Explain to the client that the nurse understands how he or she must feel. - Attempt to help the client make decisions about care. - Listen nonjudgmentally while allowing time for client reflection.
- Listen nonjudgmentally while allowing time for client reflection.
A nurse is developing a teaching plan for a terminally ill client and his family about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in the teaching plan? - Most clients reach acceptance by the time of death. - Each client experiences each of the stages. - Typically, the stages occur in succession. - The stages are applicable to any loss.
- The stages are applicable to any loss.
A 50-year-old client is an alcoholic. The client has been diagnosed with pancreatic cancer and underwent surgery to remove the tumor. Despite the tumor being removed, the physician informs the client that chemotherapy needs to be started immediately. Using evidence-based practice, which intervention might the nurse expect the physician to include, with the goal of improving quality of life, mood, and median survival. - Respite care - Radiation - Angiogenesis - Palliative care
Palliative care
A group of nursing students is reviewing information about palliative care. The students demonstrate a need for additional review when they identify which of the following? - Palliative care is the same as hospice care. - Palliative care developed after hospice care developed. - Palliative care is often provided along with disease-lessening treatments. - Palliative care is conceptually broader than hospice care.
Palliative care is the same as hospice care.
A terminally ill client is receiving morphine around-the-clock for pain control. As part of the client's plan of care focusing on pain management, which nursing diagnosis would the nurse most likely identify? - Risk for constipation related to the effects of an opioid - Risk for ineffective cerebral tissue perfusion related to central nervous system effects of the drug - Caregiver role strain related to the need for around-the-clock pain control - Impaired physical mobility related to sedative effects of the drug
Risk for constipation related to the effects of an opioid Explanation: When an opioid is used for around-the-clock pain management, the nursing diagnosis, risk for constipation, would be most likely because of the opioid's effect on the gastrointestinal system. Therefore, a regimen to combat constipation is key. Although opioids depress the central nervous system and cause sedation, a risk for infection and impaired physical mobility would be less likely. Other factors involved in the client's care, not just the around-the-clock pain control, would contribute to caregiver role strain.
A nurse is caring for a client with end-stage testicular cancer who has been referred to hospice care. Which criterion indicates that the client requires more teaching about hospice care? - The client doesn't want to discuss death around his girlfriend. - The client explains that he isn't ready to complete his will. - The physician orders weekly blood transfusions to be given at home. - The client entered a clinical trial through the National Cancer Institute.
The client entered a clinical trial through the National Cancer Institute. Explanation: The client involved in a clinical trial needs additional teaching about hospice care. This treatment option suggests that the client isn't ready for palliative care, which is a criterion for hospice care. Preferring not to discuss death around the girlfriend and not feeling ready to complete a will are normal responses to the grieving process. Blood transfusions are considered palliative care.
Which of the following does not coincide with Kübler-Ross's stages related to a dying client?
The dying client usually exhibits anger first.
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? a) Patients/families view palliative care as giving up b) Lack of fully credentialed and trained hospice nurses c) Difficulty obtaining Medicare certification for hospice services d) Lack of Medicare/Medicaid funding for hospice .
a) Patients/families view palliative care as giving up Lack of fully credentialed and trained hospice patients is not a barrier to hospice care. Patients equate hospice with "giving up" and are reluctant to accept hospice. Lack of Medicare funding or certification for hospice service providers has not been documented as a barrier to access of hospice services
The nurse is caring for a dying client in a hospice setting. The family is unsure whether to go home for rest or spend the night with the client. Which body system would the nurse assess to provide the first data on decline? - Respiratory system - Cardiovascular system - Gastrointestinal system - Central nervous system
- Cardiovascular system
The nurse is providing care to a terminally ill client and his family who practice the Islamic faith. Which of the following concepts would the nurse need to integrate into this client's plan of care? Select all that apply. - The way a person dies is of great individual importance. - The family will create a new ethereal body the first 10 days after death. - Pain is viewed as a mechanism for cleansing. - Death occurs through God's permission. - The caste of the client and family will determine their view of death.
The way a person dies is of great individual importance. Pain is viewed as a mechanism for cleansing. Death occurs through God's permission.
In spite of administering the prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and help reduce the dyspnea? - Use imagery, humor, and progressive relaxation - Offer small amounts of nourishment frequently - Encourage the patient to sleep - Gently massage the arms and legs
Use imagery, humor, and progressive relaxation
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 l- iving will - power of attorney - designated signer
durable power of attorney for health care
A dying patient wants to talk to the nurse. The patient states, "I know I'm dying, aren't I?" What would an appropriate nursing response be? - "Let me explain to you what is happening." - "This must be very difficult for you." - "You know you're dying?" - "I'm so sorry. I know how you must feel."
"This must be very difficult for you." Explanation: Using open-ended questions allows the nurse to elicit the patient's and family's concerns, explore misconceptions and needs for information, and form the basis for collaboration with physicians and other team members. For example, a seriously ill patient may ask the nurse, "Am I dying?" The nurse should avoid making unhelpful responses that dismiss the patient's real concerns or defer the issue to another care provider. In response to the question "Am I dying?" the nurse could establish eye contact and follow with a statement acknowledging the patient's fears ("This must be very difficult for you") and an open-ended statement or question ("Tell me more about what is on your mind").
A client has learned of a terminal illness and impending death. The client asks the nurse to explain the concepts and care that are provided under the definition of palliative care. Which of the following would the nurse include in the explanation for this client? Select all that apply. - Provides pain relief - Includes chemotherapy - Integrates spirituality - Hastens death - Offers a team approach to care - Enhances quality of life
Provides pain relief - Integrates spirituality - Offers a team approach to care - Enhances quality of life
A client is experiencing anorexia and the physician is to order a medication to stimulate the client's appetite. Which of the following would the nurse least likely expect the physician to prescribe? - Atropine - Dexamethasone - dronabinol - Megestrol
Atropine Explanation: Atropine is used to manage excessive oral and respiratory secretions when death is imminent. Dexamethasone, megestrol, and dronabinol may be used to stimulate appetite in clients who are at the end of life.
Which term refers to the period of time during which mourning of a loss takes place?
Bereavement Explanation: Bereavement is the period of time during which mourning of a loss takes place. Grief is defined as the personal feelings that accompany an anticipated or actual loss. Mourning is defined as the individual, family, group, and cultural expressions of grief and associated behaviors. Hospice is a coordinated program of interdisciplinary care and services provided primarily in the home to terminally ill clients and their families. Reference:
Which term best describes a living will? - Health care power of attorney - Durable power of attorney for health care - Medical directive - Proxy directive
Medical directive Explanation: A living will is a type of advance medical directive in which the individual, who is of sound mind, documents treatment preferences. A proxy directive and health care power of attorney are other names for a durable power of attorney for health care, in which one individual is appointed and authorized to make medical decisions on behalf of another person when that person is no longer able to speak for him or herself
Nursing students are reviewing information about the signs and symptoms of impending death. The students demonstrate the need for additional review when they identify which of the following as a sign? - Mental confusion - Reduced urinary output - Restlessness - Muscle wasting
Muscle wasting Explanation: Muscle wasting occurs as the client's condition deteriorates. It is not a sign of impending death. Mental confusion, reduced urinary output, and restlessness occur as a client approaches death.
Which "awareness context" is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise? - Closed awareness - Mutual pretense awareness - Open awareness - Suspected awareness
Mutual pretense awareness Explanation: In mutual pretense awareness, the client, the family, and the health care professionals are aware that the client is dying, but all pretend otherwise. In closed awareness, the client is unaware of his or her terminal state, whereas others are aware. In suspected awareness, the client suspects what others know and attempts to find it out. In open awareness, all are aware that the client is dying and are able to openly acknowledge that reality
The family of a client in hospice decides to place their loved one in a long-term care facility to establish an effective pain control regimen. Which aspects of hospice care is the family using? - General inpatient care - Inpatient respite care - Continuous care - Palliative care
Palliative care Explanation: Long-term care is increasing as a setting to provide palliative care that addresses management of symptoms such as pain. Inpatient respite care is a 5-day inpatient stay provided on an occasional basis to relieve the family caregivers. Continuous care is provided in the home to manage a medical crisis. General inpatient care provides inpatient stay for symptoms management that cannot be provided in the home.
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.
The nurse is caring for a client who just learned of a 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 - The principle of fidelity - The principle of justice - The principle of nonmaleficence
The principle of autonomy Explanation: By promoting open discussion and informed decision making, the nurse is empowering the client to make decisions independently. The principle of justice requires fairness and justice to all clients. The principle of nonmaleficence requires that nurse does not intentionally or unintentionally inflict harm on others. The principle of fidelity maintains that nurses are faithful to the care of the clients
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? - Performing gentle suctioning of the mouth - Using a soft toothbrush to vigorously clean the mouth - Administering a prescribed anticholinergic agent - Positioning the client on the side with the head supported with a pillow
Using a soft toothbrush to vigorously clean the mouth Explanation: Secretions are often more distressing to the family than their presence is to the client. Gentle mouth care with a moistened swab or very soft toothbrush helps maintain the integrity of the client's mucous membranes. Other helpful measures include positioning the client on the side with the head supported with pillows to allow secretions to drain freely from the mouth, gently suctioning the oral cavity, and administering prescribed anticholinergic agents sublingually or transdermally. Deeper suctioning may cause significant discomfort to the dying client and rarely is of benefit because secretions tend to reaccumulate quickly.
A nurse is evaluating a client with a terminal illness. What should the nurse report so that the health care team can consider alternative nutritional approaches and fluid administration routes for the client at the end of life? - drop in blood pressure and rapid heart rate - altered gastrointestinal function - irregular eating habits - weight loss and inadequate food intake
weight loss and inadequate food intake
