NURS 401, Quiz 14: End of Life Care; Chronicity, Advocacy, and Collaboration

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 metered-dose inhaler

A. 5 mg of morphine sulfate

Which statements are correct principles for performing an intermittent catheterization? SATA A. A catheter is inserted every few hours B. It is usually performed after the Valsalva or Crede maneuver C. A residual of less than 100-150 mL increases the interval between catheterization D. The maximum time interval between catheterizations is 4 hours E. The patient uses sterile technique at home F. A specialized appliance to help perform the procedure can be used at home when problems with manual dexterity occur

A. A catheter is inserted every few hours B. It is usually performed after the Valsalva or Crede maneuver C. A residual of less than 100-150 mL increases the interval between catheterization F. A specialized appliance to help perform the procedure can be used at home when problems with manual dexterity occur

Which factors will the nurse assess when implementing a position change schedule for an older adult? SATA A. Ability of the patient to change positions B. Condition of the patient's skin with each position change C. Presence of abnormal breath sounds D. Type of injury the patient sustained E. Age of the patient F. Frailty in older adults

A. Ability of the patient to change positions B. Condition of the patient's skin with each position change D. Type of injury the patient sustained E. Age of the patient F. Frailty in older adults

Which responsibilities are part of the nurse's role as a member of the rehabilitation team? SATA A. Advocates for the patient and family B. Creates a therapeutic rehabilitation milieu C. Delegates patient care only to the unlicensed assistive personnel (UAP) D. Plans for continuity of care when the patient is discharged E. Coordinates rehabilitation team activities F. Directs all members of the rehabilitation team

A. Advocates for the patient and family B. Creates a therapeutic rehabilitation milieu D. Plans for continuity of care when the patient is discharged E. Coordinates rehabilitation team activities

What is the first step to patient safety when providing gait training with assistive devices such as walkers and canes? A. Apply a transfer belt around the patient's waist B. Guide the patient to a standing position C. Ensure that the patient's body is well-balanced D. Instruct the patient to take small steps

A. Apply a transfer belt around the patient's waist

What best describes the purpose of a vocational assessment of a patient in rehabilitation? A. Assist the patient to find meaningful training, education, or employment after discharge from rehabilitation setting B. Evaluate and restrain patients with deficits that distort consonant and vowel sound production C. Identify resources to assist with patient injuries that cause deficits in cognition D. Demonstrate improvements in physical, social, cognitive, and emotional functions

A. Assist the patient to find meaningful training, education, or employment after discharge from rehabilitation setting

A 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 and regain strength." Which stage of grieving does the nurse conclude the client is in? A. Bargaining B. Frustration C. Depression D. Rationalization

A. Bargaining

Which of the following are activities of daily living? SATA A. Bathing B. Using a telephone C. Dressing D. Ambulating E. Preparing food F. Using a toilet

A. Bathing C. Dressing D. Ambulating F. Using a toilet

Which methods to prevent pressure ulcers resulting from immobility are best to teach patients and their significant others? SATA A. Change position often to relieve pressure on all bony prominences B. Maintain good skin care by keeping the skin clean and dry C. Inspect the skin at least once a day for problems such as reddened areas that do not fade readily D. Use pressure relieving devices as a substitute for changing position E. Eat foods high in protein, carbohydrates, and vitamins for sufficient nutrition F. Massage reddened areas to facilitate blood flow with oxygen and nutrient delivery

A. Change position often to relieve pressure on all bony prominences B. Maintain good skin care by keeping the skin clean and dry C. Inspect the skin at least once a day for problems such as reddened areas that do not fade readily E. Eat foods high in protein, carbohydrates, and vitamins for sufficient nutrition

For which priority common gastrointestinal problem should the nurse create a plan to prevent for a rehab patient? A. Constipation B. Diarrhea C. Emaciation D. Electrolyte imbalance

A. Constipation

As a result of a car accident, an adult patient is unable to perform certain activities of daily living (ADLs) such as bathing without assistance. This is an example of which concept? A. Disability B. Handicap C. Impairment D. Rehabilitation

A. Disability

In the long-term care setting, which are foci for the coordinated efforts of restorative nursing programs? SATA A. Dressing B. Passive range of motions C. Communication D. Nutrition E. Walking F. Bed mobility

A. Dressing C. Communication E. Walking F. Bed mobility

The unlicensed assistive personnel (UAP) is assisting a rehab patient with activities of daily living (ADLs) in the morning. What is the priority instruction the nurse should give the UAP? A. Encourage the patient to do as much self-care as possible B. Bathe the patient but let the patient dress and feed himself C. Let the patient inform you about the help he needs D. Stress to the patient that his ADLs need to be completed as soon as possible

A. Encourage the patient to do as much self-care as possible

A patient with decreased cardiac output is entering a rehabilitation program. What will the nurse expect to find during the assessment of this patient? A. Fatigue and need for rest periods B. Ability to ambulate without angina C. Feeling rested upon awakening from sleep D. Ability to move from sitting to standing position easily

A. Fatigue and need for rest periods

Which statements correctly describes the Functional Independence Measure (FIM)? SATA A. It is a basic indicator of the severity of a disability B. It tries to measure what a person should do, whatever the diagnosis or impairment C. It tries to measure what a person actually does, whatever the diagnosis or impairment D. The assessment may be performed by various health care disciplines E. Categories for assessment are self-care, sphincter control, mobility and locomotion, communication, and cognition F. Evaluations may be done at specified times during therapy t determine patient progress

A. It is a basic indicator of the severity of a disability C. It tries to measure what a person actually does, whatever the diagnosis or impairment D. The assessment may be performed by various health care disciplines E. Categories for assessment are self-care, sphincter control, mobility and locomotion, communication, and cognition F. Evaluations may be done at specified times during therapy t determine patient progress

A patient with a neurogenic bladder is to be taught how to perform intermittent self-catheterization. Before beginning the teaching-learning sessions, what will the nurse assess in this patient first? A. Motor function of both upper extremities B. Type of neurogenic bladder the patient has C. Client's gender D. Age of the client

A. Motor function of both upper extremities

For which patient with constipation does the nurse avoid performing digital stimulation? A. Patient with myocardial infarction who is starting cardiac rehabilitation B. Patient with bowel incontinence resulting from cognition deficit C. Patient with a spinal cord injury resulting from a diving accident D. Patient with a spinal cord injury resulting from a motor vehicle accident

A. Patient with myocardial infarction who is starting cardiac rehabilitation

A patient with impaired physical mobility must be monitored for which early potential complication? A. Pressure ulcers B. Renal calculi C. Osteoporosis D. Fractures

A. Pressure ulcers

When assisting a patient with hemiplegia to dress, what does the nurse instruct the patient to do when putting on his shirt? A. Put on a shirt by first placing the affected arm in the sleeve, followed by the unaffected arm B. Put on a shirt by first placing the unaffected arm in the sleeve, followed by the affected arm C. Button on the buttons; then slide the shirt over the head and put on both sleeves D. Use the strong arm to lift the shirt over both arms and then pull the shirt over the head

A. Put on a shirt by first placing the affected arm in the sleeve, followed by the unaffected arm

To maintain the skin integrity of a patient in a rehabilitation unit, what does the nurse assess? SATA A. Sensation of the skin B. Placement of clear dressings over reddened areas C. Ability to move extremities D. Presence or absence of exudate and odor E. Ability to change position as needed F. Photographs taken of patient skin on admission

A. Sensation of the skin C. Ability to move extremities D. Presence or absence of exudate and odor E. Ability to change position as needed

The terminally ill patient is nearing death. His wife expresses concern that he has no appetite and eats very little. What is the nurse's best response to this concern? A. Teach the wife about risk of aspiration and 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 that 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 of aspiration and explain that loss of appetite is normal when a patient nears death

Which statement by a nursing student providing care for a patient with impaired skin integrity on a pressure-relieving mattress requires intervention by the clinical instructor? A. "The purpose of this mattress is to reduce pressure on the patient's skin" B. "Because my patient is on a pressure relieving mattress, I will only turn her every 6 hours" C. "I will do a careful skin assessment while giving my patient her morning bath" D. "With assistance, I will get my patient up in the chair as ordered by the health care provider"

B. "Because my patient is on a pressure relieving mattress, I will only turn her every 6 hours"

Which statement best describes a chronic health problem? A. A physical or mental problem that causes disability B. A health condition that has existed for at least 3 months C. A specialty focused on the care of patients with long-term care problems D. A condition that occurs in patients over the age of 65 years

B. A health condition that has existed for at least 3 months

A client who reached the stage of acceptance in the grieving process appears peaceful, but demonstrates a lack of involvement with the environment. How should the nurse address this behavior? A. Ignore the client's behavior when possible B. Accept the behavior the client is exhibiting C. Explore the reality of the situation with the client D. Encourage participation within the client's environment

B. Accept the behavior the client is exhibiting

The nurse is caring for a 92-year-old post-surgical 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 family member calls the nurse into the patient's room and says, "I think Mom just died." What should the nurse do first? A. Notify the nursing supervisor to have the body moved to the morgue B. Ascertain that the patient does not rouse to verbal or tactile stimuli C. Make sure that the healthcare provider has completed and signed the death certificate D. Provide privacy for the family and significant others with the deceased

B. Ascertain that the patient does not rouse to verbal or tactile stimuli

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 for transfer to the hospital B. Assess 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. Assess for pain, provide analgesics, and make the patient as comfortable as possible

A patient has a lower motor neuron injury below T12. This injury results in which type of neurogenic bladder? A. Reflex or spastic B. Flaccid C. Uninhibited D. Inhibited

B. Flaccid

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. Has pancreatitis

B. Has Alzheimer's disease

A dying patient is receiving morphine for severe pain. The healthcare 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 metabolite? 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 suctioning to remove the secretions D. Administer an ordered anticholinergic drug to dry the secretions E. Assist the patient to cough and deep-breath to mobilize the secretions F. Reposition the patient onto one side to reduce gurgling

B. Place a small towel under the patient's mouth D. Administer an ordered anticholinergic drug to dry the secretions F. Reposition the patient onto one side to reduce gurgling

The nurse reviews with a patient the results of manual muscle testing performed by physical therapy. What ability of the patient does this procedure determine? A. Body flexibility and muscle strength B. Range of motion and resistance against gravity C. Muscle strength and amount of pain on movement D. Voluntary versus involuntary muscle movement

B. Range of motion and resistance against gravity

Which intervention would the nurse delegate to an unlicensed assistive personnel (UAP) when caring for a patient with an overactive bladder? A. Perform an intermittent catheterization every 4 hours B. Toilet the patient every 2 hours during the day and every 3 to 4 hours at night C. Assess the patient's bladder for fullness after each voiding D. Perform a bladder scan at the bedside after each intermittent catheterization

B. Toilet the patient every 2 hours during the day and every 3 to 4 hours at night

Which assistive device is useful for a patient in rehabilitation who becomes easily fatigued while walking? A. Broad-based cane B. Walker with a seat C. Wheelchair D. Scooter

B. Walker with a seat

Which patient statement best represents the symptom that is the 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"

To qualify for Medicare hospice benefits, a criterion for admission is that the patient's prognosis must be limited to what amount of time? A. 2 weeks or less B. 3 months of less C. 6 months of less D. 1 year or less

C. 6 months of less

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

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 performing a psychosocial assessment on a patient newly admitted to the rehabilitation unit, the nurse discovers that the patient's only support system is a married son who lives 2,500 miles away. Which priority complication must the nurse monitor for? A. Anxiety B. Fear C. Depression D. Panic

C. Depression

Which description characterizes the uninhibited bowel pattern dysfunction? A. Defecation occurring suddenly and without warning B. Defecation occurring infrequently and in small amounts C. Frequent defecation, urgency, and complaints of hard stool D. Intermittent constipation and diarrhea

C. Frequent defecation, urgency, and complaints of hard stool

Which assistive-adaptive device would be recommended for a patient with a weak hand grasp? A. Gel pad B. Foam buildups C. Hook-and-loop fastener straps D. Buttonhook

C. Hook-and-loop fastener straps

Which practices are followed by and taught to staff for safe patient handling and mobility (SPHM)? A. Maintain a narrow, stable base with your feet B. Put the bed at the correct height, hip level while providing direct care and waist level when moving patients C. Keep the patient or work directly in front of you to prevent your spine from rotating D. Keep the patient about 2 to 3 feet from your body to prevent reaching

C. Keep the patient or work directly in front of you to prevent your spine from rotating

The older patient has a diagnosis of hypertension for which he is prescribed antihypertensive drugs. Before assisting this patient to rise from bed, which priority assessment should be completed by the nurse? A. Blood pressure in both arms B. Gait assessment C. Orthostatic vital signs D. Chest pain with activity

C. Orthostatic vital signs

Which mediation would a patient with a mild overactive bladder most likely be given? A. Dantrolene sodium B. Bethanechol chloride C. Oxybutynin D. Trimethoprim

C. Oxybutynin

The terminally ill patient has an advanced directive living will, which indicates that no heroic measures such as cardiopulmonary resuscitation (CPR) and intubation should be performed. She also has a do not resuscitate (DNR) order in her chart written by the healthcare provider. As the patient nears death, her daughter tells the nurse that she wants everything possible done to save her mother's life. What is the nurse's best action? A. Call a code and bring the crash cart to the patient's bedside B. Inform the healthcare provider of this 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 except an RN to provide around-the-clock nursing care

C. The dying patient and family want to focus on facilitating quality of life

Which statement best describes the primary goal of the rehabilitation team? A. To rely on a specific plan of care standardized to the medical diagnosis B. To identify and use on conceptual framework to serve as the sole model for the practice of rehabilitation nursing C. To restore and maintain the patient's function to the best extent possible D. To enable patients and their families to identify strategies to successfully meet short-term goals

C. To restore and maintain the patient's function to the best extent possible

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

The patient is at risk for impaired skin integrity. For which action performed by the unlicensed assistive personnel (UAP) must the nurse intervene? A. UAP assists the patient to turn in bed every 2 hours B. UAP carefully cleans and dries skin after incontinence episode C. UAP rubs and massages a reddened area on the patient's hip D. UAP uses pillows to support the patient when turned on his side

C. UAP rubs and massages a reddened area on the patient's hip

Which assistive device would the nurse recommend for a rehabilitation patient who can no longer tie shoes? A. Hook-and-loop fastener B. Long-handled reacher C. Velcro shoe closer D. Extended shoehorn

C. Velcro shoe closer

Which patient is most likely to have a flaccid bladder dysfunction? A. 28-year-old man with a crushed pelvis B. 54-year-old man with Guillain-Barre syndrome C. 18-year-old woman with a displaced cervical fracture D. 48-year-old woman who has multiple sclerosis

D. 48-year-old woman who has multiple sclerosis

Which problem is the leading cause of trauma and death in young and middle-aged adults? A. Stroke B. Cancer C. Arthritis D. Accidents

D. Accidents

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

D. Asking for a second opinion

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 morphine0

A patient with paraplegia is entering a rehabilitation program. What does the nurse focus on first in assessing this patient? A. Family and cultural background B. Baseline hemoglobin and hematocrit measurements C. Habits of bowel elimination before illness D. Manual dexterity, muscle control, and mobility

D. Manual dexterity, muscle control, and mobility

The nurse is reviewing the dying patient's medication record and sees that one tablet of hyoscyamine 0.125 mg was administered 2 hour 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 or wet-sounding respirations

D. Observe for oral secretions or wet-sounding respirations

The patient needs help with self-feeding, bathing, and dressing. Which rehabilitation team member would best help the patient to develop these skills? A. Physical therapist B. Rehabilitation nurse C. Rehabilitation case manager D. Occupational therapist

D. Occupational therapist

The dying patient reports shortness of breath and has an oxygen saturation of 90%. He refuses oxygen therapy but requests that 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 that the use of a fan will not increase the oxygen saturation level B. Try a nonpharmacologic intervention, such as position change or distraction C. Call the healthcare 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 bead 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

A client with a terminal illness reaches the stage of acceptance. How can the nurse best help the client during this stage? A. Accept the client's crying B. Encourage unrestricted family visits C. Explain details of the care being given D. Stay nearby without initiating conversations

D. Stay nearby without initiating conversations

The rehab patient wears street clothes and makes decisions about how her day will be planned. Which type of rehab setting is this patient in? SATA A. Custodial nursing home B. Short-term rehabilitation facility C. Skilled nursing facility D. Acute care facility E. Assisted living facility F. Specialized rehabilitation clinic

A. Custodial nursing home C. Skilled nursing facility E. Assisted living facility

What are the nurse's responsibilities regarding the skin care assessment of the rehabilitation patient? SATA A. Identification of actual or potential interruptions of skin integrity B. Keeping track of patient urination patterns and bowel movements C. Assessment of the skin for all patients under his or her care D. Education of the patient on how to inspect his or her own skin E. Thorough documentation of the integrity of the skin F. Measuring depth and diameter of any open skin areas

A. Identification of actual or potential interruptions of skin integrity C. Assessment of the skin for all patients under his or her care D. Education of the patient on how to inspect his or her own skin E. Thorough documentation of the integrity of the skin F. Measuring depth and diameter of any open skin areas

The nurse's facility allows a no-lift or limited-lift policy to prevent musculoskeletal injury to staff. Which methods for patient transfer can the nurse use? SATA A. Independent movement of the patient when he or she is able B. Mechanical full-body lift that is either ceiling- or wall-mounted or portable C. Following facility guidelines for safe patient transfer D. No transfers for patients who are unable to move independently E. Multiple staff assistance when physically lifting a patient F. Use of electric-powered, portable sit-to-stand devices

A. Independent movement of the patient when he or she is able B. Mechanical full-body lift that is either ceiling- or wall-mounted or portable C. Following facility guidelines for safe patient transfer F. Use of electric-powered, portable sit-to-stand devices

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 0400 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 0400 in a comatose state

Which patient is a candidate for proportionate palliative sedation? A. Patient is having refractory symptoms of distress that are not responding to treatments B. Patient is seeking options and alternatives to passive euthanasia C. Patient is extremely anxious that pain and suffering will not be adequately addressed D. Patient is convinced that established palliative protocols will hasten death

B. Patient is seeking options and alternatives to passive euthanasia

Which statement is true about the use of mechanical pressure-relieving devices? A. They effectively eliminate the need to turn patients B. Patients still require regular repositioning C. They prevent pressure ulcers in debilitated patients D. They have been shown to be ineffective against pressure ulcers

B. Patients still require regular repositioning

A patient with a flaccid bladder will have which urinary elimination problem? A. Incontinence and inability to empty the bladder completely B. Incontinence caused by inability to wait until on a commode or bedpan C. Urinary retention and dribbling because of overflow of urine D. Incontinence due to loss of sensation

C. Urinary retention and dribbling because of overflow of urine

When teaching a patient with hemiplegia about energy conservation techniques, which method does the nurse include? A. Using a walker instead of a cane B. Scheduling physical therapy immediately before eating C. Using a bedside commode to facilitate defecation D. Scheduling recreational activities in the afternoon or evening

C. Using a bedside commode to facilitate defecation