End of Life, Palliative Care, Spirituality, and Pain

Mr. Smith's wife is in the terminal stage of chronic obstructive pulmonary disease (COPD). He is very anxious that his wife be comfortable during her last hours. The nurse finds him tearful in the hall outside the room. Which communication should the nurse use first?

"I can see you are upset, Mr. Smith. Would you like to talk about it?"

A hospitalized client tells the nurse that a living will is being prepared and that the lawyer will be bringing the will to the hospital today for witness signatures. The client asks the nurse for assistance in obtaining a witness to the will. Which is the most appropriate response to the client?

"I will call the nursing supervisor to seek assistance regarding your request."

The nurse questions the order for a bulk-forming laxative for the person who is near death because the patient would need a minimum fluid intake of _____ mL to tolerate this type of drug.

2000

Professional health care providers may neglect to educate patients about end-of-life care because they:

Believe that death is a personal failure on their part

A 67-year old woman was recently diagnosed with inoperable pancreatic cancer. Before the diagnosis she was very active in her neighborhood association. Her husband is concerned because his wife is staying at home and missing her usual community activities. Which common EOL psychologic manifestation is she most likely demonstrating?

Decreased socialization

The daughter of a dying patient is distressed about oversedation related to her mother's receiving 2 mg of morphine sulfate every hour. The nurse clarifies that this small dose of morphine is helpful in controlling the end-of-life symptom of:

Dyspnea

The nurse is aware that end-of-life planning is often neglected because __________. (Select all that apply.)

End-of-life planning is a relative new concept, people are uncomfortable talking about death, young people do not see the need for end-of-life planning, and many persons are not really sure what they want to do

An 80-year-old patient is receiving palliative care for heart failure. What are the primary purposes of her receiving palliative care (select all that apply)?

Improve her quality of life and focus on reducing the severity of disease symptom

A characteristic of a chronic illness is that (Select All That Apply)

Is associated with many stable and unstable phases and results in permanent deviation from normal

A nursing instructor delivers a lecture to nursing students regarding the issue of client's rights and asks a nursing student to identify a situation that represents an example of invasion of client privacy. Which situation, if identified by the student, indicates an understanding of a violation of this client right?

Observing care provided to the client without the client's permission

The nurse understands that moral distress may result in which of the following? Select all that apply:

Poor sleep patterns, Disagreements among staff, Anger at providers, Physical exhaustion, and Anger at family

The primary purpose of hospice is to:

Provide comfort and support for dying patients and their families

When the dying patient becomes delirious, the nurse encourages the family to:

Touch the patient, call the patient by name, and speak in reassuring tones

An important nursing action to help a chronically ill older adult is to:

Treat the patient as a competent manager of the disease

The charge nurse on an oncology unit encourages the staff to complete a values clarification exercise to identify __________. (Select all that apply.)

Values that many cause an ethical dilemma, their own values, and values that influence care decisions

The family attorney informed a patient's adult children and wife that the patient did not have an advance directive after he suffered a serous stroke. Who is responsible for making the decision about End-of-Life (EOL) measures when the patient cannot communicate his or her specific wishes?

Wife and adult children

A resident in the long-term care facility has just expired at 2 AM, and the family is on the way to say their last goodbyes. Before the arrival of the family, the nurse should __________. (Select all that apply.)

apply a diaper to catch draining body fluids, remove equipment (e.g., IV poles and tubing, feeding tubes, oxygen equipment), dress the resident in a clean gown and cover him or her with a clean sheet, and provide privacy by drawing the curtain or moving the other resident to an unoccupied room

The nurse notes that a cardiovascular sign of impending death is:

bluish mottling of extremities

To reduce the threat of aspiration in the unconscious patient who is near death, the nurse should:

place the patient in a side-lying position, with the head turned to the side

Nursing interventions directed at health promotion in the older adult are primarily focused on:

teaching positive health behaviors