351 exam 2 (ELNEC)

You are asking a nursing student to describe the assessment of a patient for dyspnea as part of end-of-life care. Which statement by the student indicates understanding of the best method to assess for dyspnea? "I will auscultate my patient's chest." "I will take my patient's respiratory rate." "I will ask my patient about his breathing." "I will check my patient's oxygen saturation."

"I will ask my patient about his breathing."

You are talking with the wife of a patient who died recently. Which statement can you make that would be most helpful? "I know exactly how you are feeling." "It must be hard to accept that this has happened." "His suffering is over. He's in a better place now." "I'm here for you. Call me if you need anything."

"It must be hard to accept that this has happened."

1. You are doing a spiritual assessment on Mrs. H. Which of the following questions are the most important to understanding her spirituality? "What religion do you belong to?" "Do you go to your church regularly?" "Do you want me to call our chaplain?" "What gives your life meaning?"

"What gives your life meaning?"

Which of the following statements about dyspnea in patients at end of life is true? Dyspnea is a rare problem in patients with advanced serious illness. Dyspnea may be relieved by a cool fan blowing on the patient. Dyspnea is best treated by putting the patient on oxygen. Dyspnea is assessed primarily by the patient's respiratory rate.

Dyspnea may be relieved by a cool fan blowing on the patient.

Which of the following demonstrates good self-care that may help you in preventing compassion fatigue and burnout when taking care of many patients with serious illness and their families? Establish healthy eating, sleeping, and exercise habits especially when rotating shifts. Volunteer for extra shifts to cover your overworked colleagues. Ask to take care of all the very ill patients and families because you have the expertise many of your colleagues don't have. Make sure you go to every funeral and service for all the deceased patients you have cared for.

Establish healthy eating, sleeping, and exercise habits especially when rotating shifts.

You are caring for a 55-year-old female patient with metastatic breast cancer. During a home visit, you find the patient's 22-year-old daughter weeping at the kitchen table. The daughter explains that she just realized that her mother will not be alive when she gets married or has children of her own. Recognizing anticipatory grief in the young woman, the best first intervention is:

Provide active listening and therapeutic presence.

Mr. C's family tells you they are very worried about his granddaughter who is 13 years old. She has lived with her mother and grandparents since she was three and seems to be having a hard time accepting that her grandfather is near end of life. The granddaughter is acting out in school, not doing her homework, and has been bullying friends. Mr. C has end-stage heart failure and will be discharged home tomorrow with home hospice care. What should you say to Mr. C's family regarding his granddaughter? "Don't worry, this is probably just a phase she is going through because she sees you all are sad and upset. She will get over it with time." "I would recommend you schedule an appointment with the pediatrician as soon as possible; it sounds like something is seriously wrong with her since she is acting out like this." "Some children display a change in their behavior when they are experiencing grief. Would you like me to contact our child life worker to speak with you today?" "It sounds like Mr. C's granddaughter is looking for attention and needs to be disciplined for her difficult behavior."

"Some children display a change in their behavior when they are experiencing grief. Would you like me to contact our child life worker to speak with you today?"

Mr. C, whose wife of 14 years died five months ago, returns to your unit to thank you all for your great care. He states, "I still can't get through a week without crying sometimes. I know I should be at least starting to move on a bit." Your best response would be: "Most people find it takes six months before things get back to normal." "It is still so soon after your wife's death; I am sure you will be feeling better soon." "This is very hard; can you tell me a bit about what moving on means to you?" "Perhaps you would like to have individual counseling for more intensive therapy."

"This is very hard; can you tell me a bit about what moving on means to you?"

Which of the following patients are you most concerned may have an undiagnosed depression? The 62-year-old with metastatic prostate cancer who now plays only nine holes of golf rather than 18 holes with his buddies every week. A 90-year-old woman with early stage dementia who participates in the craft activities at the nursing facility. The 40-year-old with end stage liver disease who has fatigue and doesn't feel like eating much when he attends his weekly men's church club meetings A 71-year-old grandmother with pancreatic cancer who reports trouble sleeping, fatigue, and doesn't care to see her grandchildren on the weekends anymore.

A 71-year-old grandmother with pancreatic cancer who reports trouble sleeping, fatigue, and doesn't care to see her grandchildren on the weekends anymore.

You are making a bereavement visit to the 35-year-old daughter and primary caregiver of a female patient who died three months ago. The daughter reports she is experiencing mild breathlessness, loss of appetite, and difficulty concentrating. You should recognize that the daughter is experiencing: A normal grief reaction A complicated grief reaction An abnormal grief reaction A dysfunctional grief reaction

A normal grief reaction

Which of the following patients' statements suggest that the patient is experiencing an existential crisis? A. "I am so afraid that God has abandoned me in my time of need." B. "I am mad that my minister has not come by to see me in the hospital." C. "I believe strongly that God never gives a person more than they can handle." D. "I find great comfort when I spend time among my flowers in my garden."

A. "I am so afraid that God has abandoned me in my time of need."

You are teaching the son of a 65-year-old male patient with cancer about his father's anorexia. Which statement by the son reassures you that the son understands your teaching and ways to help his father? A. "We can offer Dad small, frequent feedings rather than large, overwhelming meals." B. "We need to limit Dad to a high protein diet so he gets good calories in." C. "I need to insist that Dad eat at least half of every meal we give him, even if he doesn't feel like eating." D. "Since Dad isn't eating, it's probably time to put in a feeding tube, whether he agrees or not."

A. "We can offer Dad small, frequent feedings rather than large, overwhelming meals."

You are caring for the following four patients. Which patient is at the highest risk for developing constipation? A. A 48-year-old with metastatic cancer of the breast on high doses of opioids for pain. B. A 76-year-old who has had a recent history of diarrhea associated with a C-difficile infection. C. An 85-year-old with hepatic encephalopathy who is receiving lactulose to manage high ammonia levels. D. A 62 year-old with ulcerative colitis.

A. A 48-year-old with metastatic cancer of the breast on high doses of opioids for pain.

Geraldine is an 80-year-old woman with Parkinson's disease. She is still functioning at home and is able to safely care for herself. Ever since her diagnosis she has been extremely anxious about her disease and how debilitated she might get as it progresses. Which of the following interventions is most appropriate to help treat her anxiety? A. A benzodiazepine like valium B. Active listening and presence as she talks about her fears and concerns C. Activities to distract her from her anxiety so she won't dwell on the future D. Suggest she go to an exercise class to preserve her balance and strength

B. Active listening and presence as she talks about her fears and concerns

John's lung cancer is causing him severe shortness of breath. Which pharmacologic intervention would be of most benefit for his dyspnea? A. A benzodiazepine like lorazepam B. An opioid like morphine sulfate C. A cough syrup containing a cough suppressant D. A diuretic like furosemide.

B. An opioid like morphine sulfate

Symptom management in older adults with serious illness is complicated because: A. They never take their medications correctly. B. Many have multiple comorbidities. C. They tend to ignore their symptoms. D. They like to over-report the severity of their symptoms.

B. Many have multiple comorbidities.

You have been assigned to care for a woman who was recently admitted for advanced cancer, and who reports ongoing fatigue. Her husband offers observations about his wife's fatigue. Which statement by the husband indicates the most correct understanding of his wife's fatigue? A. "She sleeps quite a bit, so she shouldn't be as tired as she is." B. "She's lost some weight. I know she'll feel better if she eats more." C. "She's been in pain. If we control that maybe, she'll have more energy." D. "She seems moody, so we need to cheer her up and make her laugh."

C. "She's been in pain. If we control that maybe, she'll have more energy."

Mr. Tate tells you that he is very worried about dying. He knows his disease is terminal and he only has a few months to live. He tells you he has done "some bad things" in his younger days and thinks God is going to make him suffer with pain now because of his past. After listening to his story, what is your best response? A. "Oh don't worry Mr. Tate, that was a long time ago." B. "Some people have pain at the end of life, but we can help you manage the pain." C. "Would you like me to contact our chaplain? He's very good at helping people who have concerns like yours?" D. "I know that God doesn't make people suffer and I am sure that you will not suffer at end of life for your past."

C. "Would you like me to contact our chaplain? He's very good at helping people who have concerns like yours?"

Mrs. F., a 78-year-old Italian woman, is caring for her husband who has end-stage COPD and is experiencing anorexia and cachexia. She tells you that she is so upset that he won't eat her pasta anymore, which was "always his favorite." She cannot understand why he doesn't like it anymore. Which of the following is your best response? A. "I don't know why he wouldn't eat it. You have brought some to our unit and it is wonderful." B. "Don't take it personally Mrs. F - maybe you should stop pushing him to try to eat." C. "Maybe you should change your recipe and try making it a little blander for him." D. "Food is such an important way that we show we care; it must be so hard for you that he doesn't feel like eating."

D. "Food is such an important way that we show we care; it must be so hard for you that he doesn't feel like eating."

Mrs. Smith has end-stage COPD and is admitted with severe dyspnea and is started on morphine sulfate. Which of the following statements by her husband demonstrates he understands the use of morphine in patients with COPD? A. "Morphine is addictive and I am worried that she will become an addict." B. "We have to be really careful with this drug because I have heard it could make her stop breathing." C. "My wife has a lung condition and morphine prevents her lungs from causing her pain." D. "The morphine is being used to treat her shortness of breath."

D. "The morphine is being used to treat her shortness of breath."

You are caring for a patient in end-stage renal disease. The patient has no apparent family or support systems. The patient is taking prescribed opioid analgesics for pain management yet continues to complain of feeling tired. The patient states, "I wish it would all end." Which action should you take first? Evaluate the patient further for depression. Obtain an order to increase pain medication. Provide diversionary activities to improve his quality of life. Assess the patient's spiritual needs.

Evaluate the patient further for depression.

A year after the loss of her son to suicide, Mrs. Phelps expresses to you that she is still terrified that her surviving son will also commit suicide. Mrs. Phelps reports continuing to have nightmares in which this happens. What type of grief is Mrs. Phelps experiencing? Normal grief Delayed grief Exaggerated grief Masked grief

Exaggerated grief

John is a 70-year-old male whose wife died from COPD two months ago. They were very close, married for 52 years, and had no children. He comes by the nursing unit to bring you all candy and a thank you note for all the times you cared for her the past year. He tells you he is struggling to want to eat since she always was the cook, and is just not ready to go out to dinner with his buddies, even though they keep asking him. Your assessment is that John is: Experiencing normal grief after his wife died two months ago Depressed because he doesn't want to go out with his buddies At high risk for complicated grief because his wife died in the hospital Is doing poorly alone at home because he is not eating well and needs counseling

Experiencing normal grief after his wife died two months ago

You and your nurse colleagues on your unit have all been talking about how hard it is in the ICU to see so many patients who have stated they didn't want any more aggressive treatment be admitted to the ICU. You found one of your colleagues was crying in the bathroom stating, "I can't stand this anymore - I just admitted another patient who told me last time he never wanted to come back here." Your best intervention is to: Comfort her and tell her you all feel that way but it will be ok. Listen to her and suggest you both talk with the ICU manager about the unit needing the chaplain or psychiatric nurse liaison for emotional support. Tell her you are here for her and the two of you will get through this together. Suggest that if she really can't stand it anymore, maybe she should consider changing jobs.

Listen to her and suggest you both talk with the ICU manager about the unit needing the chaplain or psychiatric nurse liaison for emotional support.

Mr. Jones is struggling with fatigue from his advanced heart failure. Which of the following referrals would you recommend to help him with this debilitating symptom? Occupational therapy Social work Psychology Respiratory therapy

Occupational therapy

You are developing a plan of care for a patient with cancer-related pain who is taking sustained-release morphine sulfate 30 mg twice a day, along with 15 mg of immediate release morphine sulfate every three hours as needed for breakthrough pain. Which goal is important to include in the patient's plan of care? Patient will remain continent of urine and stool. Patient will have a bowel movement at least once every three days. Patient will not experience dyspnea. Patient will not use more than two doses of breakthrough pain medication per day.

Patient will have a bowel movement at least once every three days.

You have been working on the end-stage heart failure unit for eight months. Many of your patients have died awaiting transplant. You are aware that you are not sleeping well at night and dread going to work each day. Many of your colleagues are irritating you and you are moody when at home. Which of the following would be best to do first? Start looking on the jobs board for a transfer to another unit. Take up yoga and enroll in daily Pilates classes for more exercise. Acknowledge that these are normal feelings when you have only been working for eight months. Speak with your nurse manager about how you are feeling and ask for help.

Speak with your nurse manager about how you are feeling and ask for help.

You are caring for a 77-year-old patient at the end of life who has not had a bowel movement in five days. Which sign should you assess the patient for to determine if a fecal impaction is present? Foul-smelling diarrhea Sudden onset of liquid stool Fatty-looking stools Blood and mucous strands in stool

Sudden onset of liquid stool

The hospice interdisciplinary team is creating a bereavement plan for the family of Mr. A, a 50-year-old patient with advanced HIV/AIDS. The patient defines his family as consisting of his partner, his parents, four siblings, as well as his two closest friends. In creating the plan, each member of the interdisciplinary team understands that bereavement interventions must: Focus mainly on the patient's parents and siblings. Include a referral to a bereavement support group or spiritual support group. Take into account each survivor's cultural practices in mourning and grief reactions. Occur at regular intervals for the initial six months after the death of the patient.

Take into account each survivor's cultural practices in mourning and grief reactions.

Which of the following family members is at greatest risk for complicated grief? The wife of 60 years who has provided care for three years to her husband with Alzheimer's disease The son who lives out of town and has only been able to see his dad once a week for the past six months. The female partner of a woman whose family has embraced her as family. The daughter who has a long history of substance use and has just recently returned home to be at her dying mother's bedside.

The daughter who has a long history of substance use and has just recently returned home to be at her dying mother's bedside.

You are caring for a 65-year-old male patient who has just died. In planning for follow-up bereavement care, which person is at risk for disenfranchised grief? The daughter who lives in a different state The son who was with the patient when he died The ex-wife of the patient who lives nearby The 16-year-old grandchild of the patient

The ex-wife of the patient who lives nearby

The parents of a 2-year-old child who is dying from leukemia tell you they are so afraid that they will forget who their child was years after he dies. How should you respond? "Don't worry, you will always remember him and will never forget him." "There is little that can be done now that he is actively dying, but I am here with you." "Would you like me to call our child life team who can help you with some memory making activities?" "Have you taken any pictures of him so that you can look back at them in years to come?"

Would you like me to call our child life team who can help you with some memory making activities?"