CH 13: Palliative and End-of-Life 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? A) Palliative care is the same as hospice care. B) Palliative care is conceptually broader than hospice care. C) Palliative care developed after hospice care developed. D) Palliative care is often provided along with disease-lessening treatments.
A
Which term is used to describe the personal feelings that accompany an anticipated or actual loss? A) Bereavement B) Mourning C) Grief D) Spirituality
C
A nurse is providing in-home hospice care to a terminally ill client. The client experiences a medical crisis requiring monitoring and medication administration. Which level of hospice care would the nurse implement? A) Continuous care B) Inpatient respite care C) General inpatient care D) Routine home care
A
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? A) Typically, the stages occur in succession. B) The stages are applicable to any loss. C) Each client experiences each of the stages. D) Most clients reach acceptance by the time of death.
B
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? A) Explore own feelings on mortality and death and dying. B) A workshop on caring for the client who is dying C) Participate in a support group to learn clients' feeling on care. D) Use evidence-based practice in daily care regimen.
A
All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason? A) Allows for the nurse to understand when the grieving process should be concluded B) Allows for the nurse to take the client through in the appropriate order C) Allows the nurse to express his or her feelings D) Allows for the nurse to facilitate the grieving process
D
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? A) Megestrol B) Dronabinol C) Atropine D) Dexamethasone
C
A type of comprehensive care for clients whose disease is not responsive to cure is A) interdisciplinary collaboration. B) euthanasia. C) palliative care. D) a terminal illness.
C
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? A) "Let's review the laboratory results and compare them with the diagnostic tests." B) "I like your idea of living for today and enjoying those around you." C) "I understand that it would be wonderful to see your daughter's graduation." D) "What makes you most angry about getting the disease?"
C
Which is also known as a proxy directive? A) Treatment directive B) Living will C) Medical directive D) Durable power of attorney for health care
D
Which is the initial stage of grief, according to Kübler-Ross? A) Anger B) Depression C) Bargaining D) Denial
D
Which term best describes a living will? A) Durable power of attorney for health care B) Health care power of attorney C) Proxy directive D) Medical directive
D
The nurse is visiting the home of a client who has refused all medical treatment for a terminal illness. Which assessment findings indicate to the nurse that the client will die within a few hours? Select all that apply. A) Irregular pulse B) Apnea lasting 45 seconds C) Systolic blood pressure of 80 mm Hg with no diastolic reading D) Verbalizing incoherent phrases E) Mottled extremities
A, B, and E
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? A) Conscious sedation B) Patient-controlled analgesia C) Palliative sedation D) Barbiturate coma
C
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: A) an alternative therapy that uses massage and progressive relaxation for pain relief. B) offered to terminally ill clients who wish to remain in their homes in lieu of hospice care. C) care that will reduce the client's physical discomfort and manage clinical symptoms. D) care that is provided at the very end of an illness to ease the dying process.
C
The physician is attending to a 72-year-old client with a malignant brain tumor. Family members report that the client rarely sleeps and frequently reports seeing things that are not real. Which intervention is an appropriate request for the hospice nurse to suggest to the physician? A) Perform surgery to remove the tumor from the brain. B) Obtain a biopsy to analyze the lymph nodes. C) Add haloperidol to the client's treatment plan. D) Begin radiation therapy to prevent cellular growth.
A
Which of the following is the nurse's primary concern when providing end-of-life care for a client and the family? Select all that apply. A) Providing personal care B) Arranging plans for after death C) Completing a head-to-toe assessment D) Maintaining client comfort E) Encouraging fluids F) Supporting family members
A, D, and F
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? A) "He is getting less oxygen to the brain, so the moaning means he is dreaming." B) "His moaning does indicate pain, so we'll increase his pain medication." C) "The moaning you hear is from air moving over very relaxed vocal cords." D) "He has secretions that are collecting at the back of the throat."
C
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? A) weight loss and inadequate food intake B) irregular eating habits C) altered gastrointestinal function D) drop in blood pressure and rapid heart rate
A
A nurse is conducting a spiritual assessment of a terminally ill client using the four step FICA process and asks the question, "What gives your life meaning?" The nurse is assessing which of the following? A) Importance and influence B) Faith and belief C) Community D) Address in care
B
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? A) Invasiveness of the treatment B) Client's goals C) Physician's orders D) Length of required treatment
B
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. A) Palliative care B) Radiation C) Respite care D) Angiogenesis
A
A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse? A) "It will prolong life in a dignified manner." B) "It will use artificial means of life support if the patient requests it." C) "It will hasten the death of the patient." D) "It will enable the patient to remain home if that is what is desired."
A
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? A) Acceptance B) Anger C) Denial D) Bargaining
B
A client nearing the end of life is experiencing delirium. Which action will the nurse take to help this client? A) Apply restraints as needed. B) Add additional lighting to the room. C) Increase environmental stimulation. D) Encourage family to visit.
D
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? A) General inpatient care B) Inpatient respite care C) Continuous care D) Palliative care
D
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? A) "I believe that you will fight hard to beat this and see your babies grow up." B) "I know another client with the same diagnosis who has been in remission for 10 years." C) "Let's take this one day at a time; remember you have your daughter's dance recital next week." D) "You should seek a second medical opinion about your diagnosis."
C
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? A) Most states have enacted laws that allow for physician-assisted suicide. B) A client has the right to make independent decisions about the timing of his or her death. C) Participating in assisted suicide violates the Code of Ethics for Nurses. D) Nurses may administer medications prescribed by physicians to hasten end of life.
C
Which "awareness context" is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise? A) Suspected awareness B) Mutual pretense awareness C) Closed awareness D) Open awareness
B
Which of the following is an appropriate method of assessing the dying client? A) Repeat assessments as necessary. B) Focus on the client's basic needs. C) Stimulate the client every 30 minutes. D) Sedate the client before completing range-of-motion exercises.
B
A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client? A) Respect the client's and family members' choices. B) Share emotional pain. C) Abide by the dying client's wishes. D) Ask the family members about spiritual care.
A
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? A) "I will notify the physician that the current dose of medication is not relieving your pain." B) "I will see if the physician will order enough for that to occur." C) "I can't do that, I will go to jail." D) "I am surprised that you would ask me to do something like that."
A
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? A) The client explains that he isn't ready to complete his will. B) The physician orders weekly blood transfusions to be given at home. C) The client entered a clinical trial through the National Cancer Institute. D) The client doesn't want to discuss death around his girlfriend.
C
The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which nursing interventions should a nurse perform in such a situation? A) Encourage the family members to express their feelings and listen to them in their frank communication. B) Encourage conversations about the impending death of the client. C) Be a silent observer and allow the client to communicate with the family members. D) Encourage the client's family members to spend time with the client.
A
Which of the following is a term that refers to individual, family, group, and cultural expressions of grief and associated behaviors? A) Bereavement B) Mourning C) Spirituality D) Grief
B
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? A) Risk for constipation related to the effects of an opioid B) Impaired physical mobility related to sedative effects of the drug C) Risk for ineffective cerebral tissue perfusion related to central nervous system effects of the drug D) Caregiver role strain related to the need for around-the-clock pain control
A
As the moment of death approaches, which of the following does the nurse encourage the family to do? A) Speak to the client in a calm and soothing voice. B) Rub the client's hand and arm to comfort the client. C) Lie next to the client and hold the client. D) Have the family sit in front of the client so they can be seen.
A
For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death? A) Increased restlessness B) Increased eating C) Increased urinary output D) Increased wakefulness
A
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? A) Use imagery, humor, and progressive relaxation B) Offer small amounts of nourishment frequently C) Encourage the patient to sleep D) Gently massage the arms and legs
A
The nurse arrives to the home of a client with a terminal illness who has just passed away. Which response will the nurse make when the family member states that the last dose of pain medication provided caused the death? A) "It is possible that your family member died close to the time of the medication but the medication did not cause the death." B) "There is always a chance that pain medication will cause death in a client with a terminal illness." C) "Do you remember what the medication was that you think caused the death?" D) "It is likely that the medication caused the body systems to slow, which precipitated the death."
A
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? A) Using a soft toothbrush to vigorously clean the mouth B) Performing gentle suctioning of the mouth C) Positioning the client on the side with the head supported with a pillow D) Administering a prescribed anticholinergic agent
A
Which of the following does not coincide with Kübler-Ross's stages related to a dying client? A) The dying client usually exhibits anger first. B) Clients don't always follow the stages in order. C) Some client regress, then move forward again. D) The client may be in several stages at once.
A
Which statements made by the nurse demonstrates that the nurse is providing spiritually sensitive care? A) "Tell me who or what gives you strength." B) "Denial, sadness, anger, fear, and anxiety are normal grief reactions." C) "A key component of hospice care is following your family for up to a year after your death." D) "Mourning may be demonstrated by emotional feelings of sadness, anger, guilt, and numbness."
A
Which term refers to the period of time during which mourning of a loss takes place? A) Bereavement B) Mourning C) Grief D) Hospice
A
While providing care to a terminally ill client, the client asks, "Am I dying?" Which response by the nurse would be most appropriate? A) "Tell me some more about what is on your mind." B) "What makes you think that you might be dying?" C) "What has your physician told you about your condition?" D) "You're just having a bit of a set-back. You'll be fine."
A
While talking with a client who has been diagnosed with a terminal illness, the client asks, " Am I dying?" Which response from the nurse would be appropriate? Select all that apply. A) "This must be very difficult for you." B) "I know just how you must feel." C) "You still have time for a good life." D) "Let's focus on what your doctor has planned." E) "Tell me more about what's on your mind."
A and E
The nurse is preparing to conduct a spiritual assessment with a client diagnosed with a terminal illness. Which question(s) will the nurse ask to complete this assessment? Select all that apply. A) "Are you a member of a spiritual community?" B) "What is your faith or belief?" C) "Do you believe in God?" D) "What importance does faith have in your life?" E) "What gives your life meaning?"
A, B, D, and E
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. A) Control the client's pain with prescribed medication. B) Advise the client's health care provider of the client's condition. C) Comfort the client by saying it will all be over soon. D) Recommend that the client consider physician-assisted suicide. E) Encourage the client to explain his or her wishes.
A, B, and E
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? A) Medical directive by proxy B) Durable power of attorney for health care C) End-of-life treatment directive D) Living will declaration
B
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? A) "I'm so sorry. I know how you must feel." B) "This must be very difficult for you." C) "You know you're dying?" D) "Let me explain to you what is happening."
B
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? A) Most clinicians are very open to talking about disease and dying with clients. B) There remains a conspiracy of silence about dying despite progress in the area. C) Clients, for the most part, would gain hope if they were told about a poor prognosis. D) Clients would ask for information if they really had a desire to know.
B
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? A) Suggestions that the family offer the client foods that are hot. B) Advice for the family to have fruit juices readily available at the client's bedside. C) Arrangements for the client to eat meals while others are out of the home. D) Encouragement of the family to serve the client meat, especially beef.
B
The nurse is caring for a client who is interested in learning about hospice care. Which of the eligibility criteria would the nurse stress? A) Limited life expectancy B) Choice of palliative care over cure focused C) Physician-certified illness D) Serious, progressive illness
B
The nurse is providing home care to a dying client and has noticed over the course of several weeks that the client's daughter is usually quiet and withdrawn when in the client's room. Which intervention should the nurse perform in this situation? A) Remain focused on the client's needs and care because these are your main responsibilities. B) Sit with the client's daughter privately and encourage her to express her feelings frankly. C) Remind the daughter of the client's impending death and the importance of expressing herself. D) Insist that the daughter try her best to make the client's final days happy ones.
B
When describing the term "grief" to a group of students, which of the following would the instructor include? A) A feeling of connectedness with one's self and others B) The response experienced by anyone who has suffered a loss C) Feelings of apprehension or worry in response to a situation D) A part of the life cycle in the form of change, growth, and transition
B
The nurse manager of an oncology unit is concerned that the staff are experiencing symptoms of chronic loss caused by the death of many long-term clients. Which action will the manager take to support the staff's resilience? Select all that apply. A) Assign support groups between staff. B) Allow flexibility in scheduling. C) Promote collaborative relationships. D) Ensure fairness with assignments. E) Encourage picking up shifts.
B, C, and D
While providing care to a client near death, the nurse is helping the family to prepare by teaching them what to expect. Which of the following would the nurse include in the teaching plan as a sign of approaching death? Select all that apply. A) Breathing that is very rapid B) Refusal to ingest food or fluids C) Increase in visual and auditory abilities D) Decrease in amount of urine produced E) Gurgling as the client breathes through the mouth
B, D, and E
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? A) "Total sedation is a commonly practiced method used in this situation; I will contact your physician and begin treatment as soon as possible." B) "I need to perform a complete pain assessment to confirm the amount of pain you are experiencing before recommending sedation." C) "Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death." D) "I cannot legally administer pain medications that will induce unconsciousness to relieve your pain."
C
A nurse is assessing a terminally ill female client. Which client statement indicates that the client is in the bargaining stage of dying? A) "I can't believe this. I'm going to get a second opinion." B) "Why is this happening to me. I've led a good life. Why is God punishing me?" C) "I just want to see my daughter graduate from college. That's all." D) "I don't know how my husband is going to manage things when I'm gone."
C
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? A) "There is no time limit for your stay. You can stay until you die." B) "You will be able to stay only for approximately 1 month and then you will be discharged." C) "When your stay reaches 6 months, you will be recertified for a continued stay." D) "You will be able to stay for 2 months before being discharged."
C
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? A) Difficulty obtaining Medicare certification for hospice services B) Lack of fully credentialed and trained hospice nurses C) Clients and families view hospice care as giving up D) Lack of Medicare/Medicaid funding for hospice
C
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? A) Be a silent observer and allow the client to communicate with the family members B) Encourage conversations about the impending death of the client C) Encourage the client's family members to spend time with the client D) Encourage the family members to express their feelings and listen to them in their frank communication
D
When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following? A) Treatment directive B) Living will C) Standard addendum to a will D) Proxy directive
D
