End of Life

It results in residual disability due to non-reversible pathology. It is characterized by a progressive decline in normal physiologic function It can be associated with exacerbations and remissions.

A 36-year-old mother of three was recently diagnosed with a chronic illness. The nurse prepared information for the patient on how to manage her illness. To help her cope with the shock and resentment that she was experiencing, the nurse gave her facts about her illness with honesty and empathy. Which of the following are the best comments that the nurse can include when talking to the patient about chronic illness? Select all that apply.

durable power of attorney for health care

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?

Pain is viewed as a means of cleansing by God.

A nurse is providing care to a terminally ill client who follows Islamic traditions and is experiencing pain. When developing a plan of care for this client, an understanding of which of the following would the nurse need to integrate into the plan?

Focus on the client's basic needs.

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

Benzodiazepine

Which of the following may be contained in an "emergency kit" for a hospice patient exhibiting restlessness?

"Tell me some more about what is on your mind."

While providing care to a terminally ill client, the client asks, "Am I dying?" Which response by the nurse would be most appropriate?

"Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death."

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?

Palliative care

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.

Durable power of attorney for health care

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?

Respect the client's and family members' choices.

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

Provide gentle oral care after each meal.

A client with a brain tumor recently stopped radiation and chemotherapy for treatment of the cancer. The client recently reported dry mouth. Which intervention by the hospice nurse demonstrates that the nurse understands treatment measures for dry mouth?

Morphine

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?

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

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?

Faith and belief

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?

weight loss and inadequate food intake

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?

Client's goals

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?

"It will enable the patient to remain home if that is what is desired."

A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse?

"I will notify the physician that the current dose of medication is not relieving your pain."

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?

Allows for the nurse to facilitate the grieving process

All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason?

Speak to the client in a calm and soothing voice.

As the moment of death approaches, which of the following does the nurse encourage the family to do?

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

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

Use imagery, humor, and progressive relaxation

Despite having been administered 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?

Write a prescription for a serum cholesterol level.

Evidence-based medical and nursing research has identified cardiovascular disease as the most prevalent chronic disease in the United States. Under this classification, one condition is the most common. Using this information, a nurse practitioner, treating a 50-year-old man, would do which of the following?

Dusky appearance

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

Clients and families view hospice care as giving up

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?

There remains a conspiracy of silence about dying despite progress in the area.

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?

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

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?

Explore own feelings on mortality and death and dying.

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?

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

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

Palliative care

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?

The principle of autonomy

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?

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

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?

End-stage renal disease

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.

Add haloperidol to the client's treatment plan.

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?

care that will reduce the client's physical discomfort and manage clinical symptoms.

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:

Proxy directive

When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following?

Mutual pretense awareness

Which "awareness context" is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise?

Durable power of attorney for health care

Which is also known as a proxy directive?

The dying client usually exhibits anger first.

Which of the following does not coincide with Kübler-Ross's stages related to a dying client?