Chronic Disease & Dying NCLEX

Which intervention would the nurse use during the initial interaction with a 76-year-old widower who is terminally ill, very quiet, and unwilling to have visitors? 1 Assess what the client knows about grief and loss related to the death and the dying process. 2 Avoid talking about his health condition and isolation unless he initiates the discussion. 3 Encourage him to accept phone calls from those who are concerned and wish to visit with him. Correct4 Explore what he understands about his situation and what the implications mean to him.

A starting point for working with all clients is ascertaining their understanding of their situation and its meaning to them. Understanding grief, loss, death, and the dying process is less important than the individual's feelings about the current situation. Encouraging conversation about health or isolation tends to decrease anxiety. If the client doesn't want visitors, then phone calls from others are meeting the needs of others, rather than the client.

In caring for a dying client and his wife, which factor will be a major determinant in the mourning outcome for the wife? 1 Duration of the relationship shared by the couple 2 Age of the wife at the time of the husband's death 3 Health of the wife at the time of the husband's death Correct4 Importance of the deceased as a source of support

If the wife was very dependent on her husband for emotional or financial support, the grieving process will be more difficult. The duration of the couple's relationship and the age of the wife at the time of the man's death are not major influences on the mourning outcome. The health of the surviving spouse at the time of the death may or may not be a major factor in the mourning outcome; the spouse may be healthy and still be dependent on the partner.

A client who had been receiving palliative care for cancer has deteriorated and now needs end-of-life care. The nurse identifies that which types of care will now be removed from the treatment plan? Select all that apply. One, some, or all responses may be correct. Correct1 Chemotherapy 2 Repositioning 3 Regular oral care Correct4 Blood transfusion Correct5 Radiation therapy

Palliative care is a combination of care provided when cure is not possible for a chronic disease. It may include symptom management and comfort measures. Chemotherapy, radiation therapy, and blood transfusions are a part of palliative care meant to alleviate symptoms and promote well-being. These therapies may not be required in a client who is about to die and is receiving end-of-life care. End-of-life care comprises measures to make the client as comfortable as possible. It may include measures such as regular oral care and repositioning.

Which question is the most therapeutic to ask the parents of a 3-year-old child who has just died? 1 "Do you feel ready to allow us to move your child to the morgue?" 2 "Would you like to discuss your decision about organ donation?" 3 "Would you like to talk about how you'll tell your other children?" Correct4 "Can I be of any help with traditional practices that are important to you?"

The nurse should be sensitive to any cultural or religious beliefs that may help the parents cope with their grief. Immediately discussing the morgue or organ donation is insensitive to the parents' grief. The parents are too involved with their own grief at this time to consider their other children's grief.

Which response would the nurse make to a client whose spouse recently died and who says, "What's the use in talking? I'd rather be dead. I can't go on without my spouse"? 1 "Would you rather be dead?" 2 "What does death mean to you?" Correct3 "Are you thinking about killing yourself?" 4 "Do you understand why you feel that way?"

The nurse would ask, "Are you thinking about killing yourself?" This response is the most important assessment to make, because suicide is a possibility with every depressed client. Saying, "Would you rather be dead?" addresses only part of the client's statement and does not address the possibility of suicide. The response, "What does death mean to you?" is a philosophical approach that will not encourage discussion of feelings and changes the subject. Saying, "Do you understand why you feel that way?" is a closed-ended question that can block communication and the use of "why" should be avoided because it places the client on the defensive.

Which interventions would the nurse perform while caring for an actively dying client? Select all that apply. One, some, or all responses may be correct. Admit the client in hospice care. 2 Perform aggressive laboratory tests. Correct3 Provide client and family reassurance. 4 Keep the client undisturbed for a long time. Correct5 Perform symptom management for the client

The nurse would provide comfort care in an actively dying client. In comfort care, the nurse would reassure the client and family to reduce their emotional anxiety. The nurse would perform symptom management to improve the client's quality of life. The client should not be admitted into hospice care if he or she is actively dying. A client is admitted to hospice care if death is expected within 6 months. The client may not require aggressive laboratory tests when death is imminent. He or she should be repositioned as needed for comfort.

n older adult client is diagnosed with cancer and fears death. Which nursing intervention would demonstrate caring? Correct1 Touch 2 Reminiscence 3 Reality orientation 4 Therapeutic communication

Touch is a therapeutic tool that helps induce relaxation, provides physical and emotional comfort, and shows caring to an older adult. Reminiscence helps bring meaning and understanding to the client's present situation and resolves current conflicts by recollecting the past. Reality orientation involves making an older adult more aware of time, place, and person. Therapeutic communication helps perceive and respect the older adult's health care expectations.

When working with palliative care clients, which objective data is most helpful to monitor in the debilitated client with terminal liver cancer? 1 Description of the client's pain 2 Assessment of hunger 3 Inspection of bowel patterns Correct4 Record of daily weights

Weight is objective information that aids in determining the extent of ascites; 1 L of retained fluid equals approximately 2.2 lb (1 kg). Ascites can develop in the late stages of liver cancer, and the effects of cancer and dying cause weight loss. The client's description of pain, hunger, and bowel patterns are helpful but not objective.

Place the stages of the grieving process according to Kübler-Ross in the correct order. Correct1.Denial Correct2.Anger Correct3.Bargaining Correct4.Depression

he initial response is shock, disbelief, and denial, and the client seeks additional opinions to negate the diagnosis. When negating the diagnosis is unsuccessful, the client becomes angry and negative. Bargaining for wellness follows in an attempt to prolong life. As the reality of the situation becomes more apparent, depression sets in and the client may become withdrawn.

Which approach would the nurse use for a client with an inoperable temporal lobe tumor who is experiencing frightening auditory hallucinations, especially when alone? Moving the client to a room closer to the nurses' station Correct2 Suggesting that the client turn on the radio or television when alone 3 Working out a schedule for visitors so the client will never be alone 4 Having family or friends remain with the client until the hallucinations stop

he nurse would suggest that the client turn on the radio or television when alone. Stimuli such as a television or radio encourage the client to remain reality oriented; research has shown that competing stimuli are useful in controlling hallucinations. Moving the client to a room closer to the nurses' station does not ensure that the client's needs will be met; the problem is controlling the hallucinations, not observation. Working out a schedule for visitors so the client will never be alone or having family or friends remain with the client until hallucinations stop is not realistic and fosters greater dependency; both solutions are focused on the client's inability to cope with the problem and will increase the client's fear of being alone.