End of Life Care

The client with cancer of the lung says to the nurse, "if I could just be free of pain for a few days, I might be able to eat more an regain strength." Which stage of grieving does the nurse conclude the client is in? Bargaining frustration depression rationalization

Bargaining

A nurse is assessing the needs of a client who just learned that a tumor is malignant, has metastasized to several organs comma and that the illness is terminal. What behavior does the nurse expect the client to exhibit during the initial stage of grieving? Crying uncontrollably criticizing medical care refusing to receive visitors asking for a second opinion

asking for a second opinion

Family member calls the nurse into the patient's room and says, "I think my mom just died." What should the nurse do first? a. Notify the nursing supervisor to have the body moved to the morgue b. a certain at the patient does not rouse to verbal or tactile stimuli c. make sure that the health care provider has completed and signed the death certificate d. provide privacy for the family and significant others with the deceased

b. a certain at the patient does not rouse to verbal or tactile stimuli

Under what circumstances should the nurse contact the patient's health care proxy? a. Patient has a sudden and unexpected episode of dizziness b. patient is discovered at 4:00 AM in a comatose state c. patient refuses to eat unless he gets a beer with dinner d. patient needs catheterization for a urine specimen

b. patient is discovered at 4:00 AM in a comatose state

Which patient statement best represents the symptom that is most distressing and feared by terminally ill patients? a. "I get really nervous when I can't catch my breath " b. "my family will be so upset if I can't recognize them " c. "I'm hoping my doctor prescribes a lot of pain medication " d. "when I get nauseated, I won't be able to eat or drink "

c. "I'm hoping my doctor prescribes a lot of pain medication "

The unlicensed assistive personnel (UAP) Tells the nurse that the dying patient is manifesting a death rattle. Which action would the nurse perform? a. Instruct the UAP to initiate postmortem care b. notify the family that the patient has died c. turn the patient on the side to reduce gurgling d. tell the UAP that this is expected, and nothing can be done

c. turn the patient on the side to reduce gurgling

A client who has reached the stage of acceptance in the grieving process appears peaceful, but demonstrates a lack of involvement in the environment. How should the nurse address this behavior? ignore the clients behavior when possible except the behavior the client is exhibiting explore the reality of the situation with the client encourage participation within the client's environment

except the behavior the client is exhibiting

A client with a terminal illness reaches a stage of acceptance. How can the nurse best help the client during this stage? Except the clients crying encourage unrestricted family visits explain details of the care being given stay nearby without initiating conversation

stay nearby without initiating conversation

The nurse is caring for a terminally ill cancer patient who is near death. the patient reports an uncomfortable feeling of breathlessness. Which therapy is the nurse most likely to administer? a. 5 mg of morphine sulfate b. 10 mg of furosemide c. 2 liters of oxygen per nasal cannula d. albuterol via a metered dose inhaler

a. 5 mg of morphine sulfate

The terminally ill patient is nearing death. His wife expresses concern that he has no appetite and eats very little. What is the nurses best response to this concern? a. Teach the wife about risk for aspiration an explain that loss of appetite is normal when a patient nears death b. encourage the wife to feed the patient as much as he will take to maintain adequate nutrition c. request at the health care provider order a dietary nutrition consult to include foods that the patient prefers d. keep fluids and finger foods at the bedside for easy access whenever the patient is hungry or thirsty

a. Teach the wife about risk for aspiration an explain that loss of appetite is normal when a patient nears death

What's patient is a candidate for proportionate palliative sedation? a. patient is having refractory symptoms of distress that are not responding to treatment b. patient is seeking options and alternatives to passive euthanasia c. patient is extremely anxious that pain and suffering will not be adequately addressed patient is convinced that established palliative protocols will hasten death

a. patient is having refractory symptoms of distress that are not responding to treatment

The nurse is caring for a 92-year-old postsurgical patient who has a do-not-attempt-to-resuscitate (DNAR) order. When the nurse assesses the patient, he is diaphoretic and hyperalert and reports mild left anterior chest pain with shortness of breath. What should the nurse do first? a. Sit with the patient, talk calmly, and be gently present b. Administer oxygen and alert the rapid response team c. Notify the person who has durable power of attorney for health d. Monitor for cardiac or respiratory arrest and call the family

b. Administer oxygen and alert the rapid response team

A Hospice patient is deteriorating, and the family is concerned about his restlessness and agitation. Which intervention should the nurse perform? a. notify the Primary Health care provider and request orders to transfer to the hospital b. assassin for pain, provide analgesics, and make the patient as comfortable as possible c. initiate IV hydration to provide the patient with necessary fluids d. encourage the family to assist the patient to eat in order to gain energy

b. assassin for pain, provide analgesics, and make the patient as comfortable as possible

Which patient has a disorder that would be considered among the leading causes of death in the United States? a. has a history of alcohol abuse b. has Alzheimer's disease c. is positive for human immunodeficiency virus (HIV) d. person has pancreatitis

b. has Alzheimer's disease

A dying patient is receiving morphine for severe pain. The health care provider informs the nurse that the patient is at risk for acute renal failure. What assessment will the nurse perform in order to determine if the kidney is failing to excrete the morphine metabolites? a. assess the patient for adequate pain relief b. observe for signs of confusion or delirium c. auscultate the lungs for crackles or wheezes d. observe the color, clarity, and amount of urine

b. observe for signs of confusion or delirium

The terminally ill patient who is near death has loud, wet respirations that are disturbing to the family. Which interventions by the nurse are appropriate at this time? SATA a. auscultate lung sounds and obtain an order for a chest x-ray b. place a small towel under the patient's mouth c. use oropharyngeal suction to remove the secretions d. administer an ordered anticholinergic drug to dry the secretions e. assist the patient to cough and eat breathe to mobilize secretions f. reposition the patient on to one side to reduce gargling

b. place a small towel under the patient's mouth d. administer an ordered anticholinergic drug to dry the secretions f. reposition the patient on to one side to reduce gargling

To qualify for Medicare Hospice benefits, a criterion for admission is that a patient's prognosis must be limited to what amount of time? a. 2 weeks or less b. 3 months or less c. 6 months or less d. one year or less

c. 6 months or less

When the nurse assesses the dying patient, inadequate perfusion is suspected because the patient's lower extremities are cold, mottled, and cyanotic. Which intervention should the nurse perform? a. Place the lower extremities in a dependent position b. give warm oral or intravenous fluids c. Cover the patient with a warm blanket d. gently rub the extremities to stimulate circulation

c. Cover the patient with a warm blanket

While caring for a patient of the Orthodox Jewish faith who is dying, what cultural concept should the nurse keep in mind? a. traditionally, Jewish cultures are male dominated b. expression of grief is open, especially among women c. a person who is extremely ill and dying should not be left alone d. family members are likely to avoid visiting the terminally ill family member

c. a person who is extremely ill and dying should not be left alone

The terminally ill patient has an advanced directive living will, which indicates that no heroic measures such as CPR and intubation should be performed. She also has a do not resuscitate (DNR) order in her chart written by the health care provider. As the patient nearest death, her daughter tells the nurse that she wants everything possible done to save her mother's life. What is the nurses best action? a. call a code and bring the crash card to the patient's bedside b. inform the health care provider of the change in the plan of care c. respect the patient's wishes and ask the chaplain to stay with the daughter d. inform the daughter that further interventions are not warranted

c. respect the patient's wishes and ask the chaplain to stay with the daughter

Which patient and family have the best understanding of home Hospice? a. family believes that the dying patient receives care at home if there are no funds for hospitalization b. family expects that the patient will resist hospice therefore an involuntary order is requested c. the dying patient and family want to focus on facilitating quality of life d. the patient and family expect an RN to provide around the clock nursing care

c. the dying patient and family want to focus on facilitating quality of life

Which action is an example of active euthanasia for a dying patient? a. Discontinuing the mechanical ventilator b. Terminating the intravenous fluids c. Suspending telemetry heart monitoring d. Giving a large dose of intravenous morphine

d. Giving a large dose of intravenous morphine

The nurse is reviewing the dying patient's medication record and sees that one tablet of hyoscyamine 0.125 mg was administer 2 hours ago. which assessment will the nurse perform in order to determine if the medication is effective? a. assess for agitation and restlessness b. ask the patient if the nausea has decreased c. palpate the bladder to assess for urinary retention d. observe for oral secretions are wet sounding respiration

d. observe for oral secretions are wet sounding respiration

The dying patient reports shortness of breath and has oxygen saturation of 90%. He refuses oxygen therapy but requests at the nurse obtain a fan to increase the circulation of air. Based on the concept of comfort what should the nurse do first? a. explain the use of a fan will not increase oxygen saturation level b. try a nonpharmacologic intervention such as position change or distraction c. call the health care provider and report the refusal of oxygen therapy d. offer morphine and advise the patient that a fan will be provided

d. offer morphine and advise the patient that a fan will be provided

Which intervention should be done when performing postmortem care? a. place the head of the bed at 30 degrees b. remove pillows from under the head c. remove dentures and carefully clean and store them d. place pads under the hips and around the perineum

d. place pads under the hips and around the perineum