Hospice

Which intervention should the nurse implement? - Provide vigorous nasotracheal suctioning. - Teach the client's partner to count and record the client's respirations. - Assess the client's response to noxious stimuli. - Administer prescribed atropine drops sublingually.

- Administer prescribed atropine drops sublingually. (Atropine will reduce terminal secretions and quiet the noisy breathing.)

Which explanation should the nurse offer to the family about this change in status? - This is a rare occurrence and may indicate that the client's condition is improving. - An unexpected alertness, referred to as 'a rally,' sometimes occurs when a client is near death. - Cheyne-Stoke respirations temporarily increase oxygenation and cause this condition. - This is the client's way of telling others that they are ready to die.

- An unexpected alertness, referred to as 'a rally,' sometimes occurs when a client is near death. (This is not an uncommon occurrence. Nurses prepare families for the possibility of a rally, but a rally does not mean that there is an improvement in the client's condition.)

How should the nurse respond to the client about their family concerns? - Perhaps you should take your daughter out of school so she can spend more time with you. - Anger is part of the grieving process. I would suggest you encourage her to talk about her feelings. - I will talk to your daughter and let her know that her behavior is upsetting you. - Just give your daughter time to work out her feelings on her own; she'll be fine.

- Anger is part of the grieving process. I would suggest you encourage her to talk about her feelings. (A variety of strong emotions may be experienced during the grieving process. Family members should be encouraged to talk about their feelings of grief.)

Which action should the nurse take? - Discuss with the family the possibility of a brief hospitalization for respite care. - Explain to the family that a client cannot be hospitalized while receiving palliative or hospice care. - Tell the partner how important it is to offer the client 24 hour care in this time of need. - Recommend maintaining the current plan of care to promote stabilization for the client.

- Discuss with the family the possibility of a brief hospitalization for respite care. (Respite care can allow caregivers time to regain needed strength and mental health.)

Which medication does the nurse expect to give to prevent a common side effect of the fentanyl patch? - Diphenhydramine. - Furosemide. - Ducusate sodium. - Cyanocobalamin.

- Ducusate sodium. (This is a stool softener and it is given to help prevent constipation, a common side effect of this medication.)

Which nursing intervention is therapeutic for the family immediately after the client dies? - Suggest that family members join a support group for bereaved family members. - Allow the family to spend as much time as they request at the client's bedside. - Encourage family members to assist with post-mortem care. - Place a limit on the amount of time the family spends at the bedside after death occurs.

- Allow the family to spend as much time as they request at the client's bedside. (Family members should be given as much time as they request with the client to say goodbye. This may help with the grieving process.)

Which of the following statements by the nurse identifies the purpose of advance care planning? - During advance care planning, I will help you identify what you want your healthcare team to do if you cannot speak for yourself - During advance care planning, I will help you outline what you want done with your property after your death. - During advance care planning, I will help you identify the person you want to make decisions for you if you cannot speak for yourself. - During advance care planning, I will help you decide where you wish to die.

- During advance care planning, I will help you identify what you want your healthcare team to do if you cannot speak for yourself (This is the correct definition of advance care planning.)

Which intervention by the nurse will facilitate the anticipatory grieving process? - Recommend that the children leave the room before the client dies. - Report vital signs to the family every 15 minutes until death occurs. - Encourage their partner to verbally give the client permission to die. - Place a noninvasive monitor on the client so the family can determine when the heart stops.

- Encourage their partner to verbally give the client permission to die. (Giving a loved one permission to die is therapeutic for both the family member and the client. It may help alleviate feelings of guilt for both the client and the family.)

How should the nurse respond to the partner's concern? - It is impossible to overdose someone who is dying because they have built up a tolerance to the medication. - We can collaborate with the primary care provider to try to find a dose of pain medication that works for your partner. - It is very difficult for people with terminal illness to have their pain relieved, so they may have to endure pain during the night. - You may give the pain medication anytime unless your partner's respirations are less than 12 breaths per minute.

- We can collaborate with the primary care provider to try to find a dose of pain medication that works for your partner. (It is important to collaborate to find a pain regimen that will keep the client's pain under control, even in the middle of the night.)

Based on the client's concern about their daughter, which nursing diagnosis should the nurse add to the plan of care? - Spiritual distress related to lack of faith in possible recovery. - Actual grieving related to loss of parent. - Imbalanced nutrition related to terminal condition. - Anticipatory grieving related to potential loss of parent.

- Anticipatory grieving related to potential loss of parent. (Grieving for the client's death is still anticipatory at this time.)

Which is the best response to the client's concerns about their children? - Urge the client not to give up hope because a cure is always a possibility. - Ask the client if they are interested in having a volunteer help record their thoughts. - Assure the client that their partner will be there for the children when they are not.

- Ask the client if they are interested in having a volunteer help record their thoughts. (This is a service offered by trained hospice volunteers that helps clients pass along information to their family and friends.)

The nurse observes the client's emotional responses when discussing their desires about death. Which emotional response is uncommon? - Anger - Denial or disbelief - Anxiety - Confusion and disorientation.

- Confusion and disorientation. (Confusion and disorientation are not common responses to grief and the nurse should assess the client for delirium or possible dementia.)

Which action should the nurse take first when addressing the client's fear of falling in the shower? - Schedule unlicensed assistive personnel to visit twice weekly. - Determine if safety equipment is needed for bathing or showering. - Suggest a routine for completing daily hygienic activities. - Teach the client's family how to support the client in the bathtub.

- Determine if safety equipment is needed for bathing or showering. (Safety is the first priority to protect the client from injury. The facility used for bathing and showering should be inspected by the nurse.)

Which medication would the nurse expect the healthcare provider to prescribe to treat the type of pain the client described? - Meperidine hydrochloride. - Gabapentin. - Naloxone hydrochloride. - Propoxyphene.

- Gabapentin. (This drug is an anticonvulsant commonly used to treat neuropathic pain because of its effect on the central nervous system. The exact mechanism of action is unknown.)

The morphine sulfate elixir is supplied 5 mg per mL. What is the maximum volume in mL that the client can receive per day? (Enter numeric value only. If rounding is required, round to the tenth.) ** 8mg ever 4hrs daily

9.6 (5 mg/8mg x 1 mL = 1.6 mL x 6 doses (every 4 hours = 6 times max per 24 hours) = 9.6 mL)

A primary care provider makes a referral to the nurse. Which statement by the client indicates an understanding of palliative care? - All of my treatments and medications will need to be discontinued. - I will discontinue any treatments and only take medications that will help my pain. - Treatments and medications will be utilized to control my pain and increase my comfort. - I will continue the previous course of treatment with the help of a nurse.

Treatments and medications will be utilized to control my pain and increase my comfort. (Interventions will be utilized to control pain, to increase comfort, and to improve quality of life and quality of death for the client and family.)

The nurse schedules a home visit with the family unit to discuss common expressions of grief. What information should the nurse include during the discussion about the grieving process? (Select all that apply. One, some, or all options may be correct.) - It is common to have several emotional responses to grief and loss. - Grief is a normal reaction to loss. - Grief includes both physiologic and psychological responses. - Each person experiences grief in the same way. - Grief is a complex and intense emotional experience.

- It is common to have several emotional responses to grief and loss. (It is common for individuals to experience a variety of emotions during the grieving process.) - Grief is a normal reaction to loss. (This is an accurate statement.) - Grief includes both physiologic and psychological responses. (Grief does manifest itself physiologically and psychological.) - Grief is a complex and intense emotional experience. (Grief is complex and those who lose a loved one experience intense emotions during the process.)

The client qualifies for in-home county support services and the family hire a home care aide. Which information about the client's care should the nurse convey to the home care aide? - While providing personal care, encourage the client to communicate during periods of silence to facilitate working through grief stages. - Perform as much of the client's care as possible, conserving the client's energy. - Be sure to layer the client's clothing due to changes in temperature regulation and the integumentary system. - Place hygienic supplies within the client's reach when the client is using the shower chair.

- Place hygienic supplies within the client's reach when the client is using the shower chair. (This will promote independence and decrease the risk for falls.)

What intervention should the nurse implement at this time? - - Reinforce prior education about the dying process. - Anticipate the need for a referral for grief counseling. - No intervention is necessary at this time. - Encourage the family to consider re-hospitalizing the client.

- Reinforce prior education about the dying process. (Anticipatory guidance and ongoing education about death and dying are needed at this time.)

Which information is most important for the nurse to teach the client's partner? - Rotate patch sites with each change every 72 hours. - Remove the old patch before applying the new patch. - Do not apply to an area that has hair unless hair is shaved. - Eat a well-balanced diet high in B-complex vitamins.

- Remove the old patch before applying the new patch. (It is most important to remove the old patch prior to applying a new one to prevent an overdose.)

Which technique should the nurse use when communicating with the client about their terminal illness? - Utilize practiced responses to questions and statements by the client. - Avoid using humor when communicating with the client. - Do not show feelings of vulnerability when communicating with the dying client. - Respect the client's pattern of communication and ways of dealing with stress.

- Respect the client's pattern of communication and ways of dealing with stress. (The nurse should respect the client's readiness to talk about and deal with the illness while offering support when needed.)

Which response by the nurse is therapeutic, given the partner's anxiety? - Hospice nurses are not allowed to provide resuscitative measures. - Tell me about the conversations you had with your partner about this moment. - Reviving your partner would only serve your interests and would not be of benefit to them. - I will call contact the primary healthcare provider to get the do-not-resuscitate order reversed.

- Tell me about the conversations you had with your partner about this moment. (This response will elicit a conversation that will remind the partner of the client's wishes.)

When talking with the family, what information should the nurse include? (Select all that apply. One, some, or all options may be correct.) - The care provided is client and family-focused. - Hospice nurses regard dying as a normal process. - Bereavement follow-up is provided after the client's death. - Visitation and respite services are provided by licensed personnel. - Interdisciplinary care focuses on symptom management. - Clients are discharged if they are still alive 6 months after starting hospice.

- The care provided is client and family focused. (Hospice care is focused on the client and family.) - Hospice nurses regard dying as a normal process. (Dying is viewed as a normal process.) - Bereavement follow-up is provided after the client's death. (Bereavement care is a component of hospice care.) - Interdisciplinary care focuses on symptom management. (Interdisciplinary care is primarily focused on symptom management.)

In conducting a home visit with a new client, which problem should the hospice nurse address first? - The client's bowel and urinary elimination pattern, which was the priority concern of the referring provider. - The problem that the client identifies as the first priority, the problem that most concerns the client. - The client's need for help with activities of daily living, the primary nursing diagnosis identified by the nurse. - The stages of grief the family will face, and any difficulty with grieving reported by the family.

- The problem that the client identifies as the first priority, the problem that most concerns the client. (Highest value should be placed on the problem the client identifies as the first priority.)

The client asks the nurse what physical experiences occur at the end of life. Which of the following physical occurrences are likely at end of life? (Select all that apply. One, some, or all options may be correct.) - Hearing and touch are absent. - There is a decreased perception of pain. - There is a gradual increase in urine output. - Mottling on hands, feet, arms, and legs occur. - Breathing becomes slowed and irregular.

- There is a decreased perception of pain. (Clients do experience a decreased perception of pain.) - Mottling on hands, feet, arms, and legs occur. (As body systems deteriorate, mottling on hands, feet, arms, and legs begin to appear.) - Breathing becomes slowed and irregular. (As major systems begin to fail, clients experience irregular breathing patterns until eventually breathing ceases.)

Which nursing intervention describes the use of guided imagery to control pain? - Encourage the client to listen to favorite songs or sounds to distract from pain. - Utilize therapeutic touch to release pain. - Visualize a pain free mental scenario while achieving a deep state of relaxation. - Consult an acupuncturist to provide home visits for the client.

- Visualize a pain free mental scenario while achieving a deep state of relaxation. (This describes the use of guided imagery for pain control.)