Prep U: Chapter 38- End of Life Care

During a hospice visit, the client's spouse suddenly begins to cry and says, "I am so tired. I just can't do this anymore. I am not getting to sleep and I just eat sandwiches when I can." What is the nurse's best intervention?

Arrange for short-term inpatient care for the client.

A client with a terminal illness is overheard by the nurse saying, "If I promise never to smoke another cigarette in my life, please let me recover from this lung cancer." How will the nurse document this stage of grief according to the Kübler-Ross model?

bargaining

Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief?

coping strategies

The condition of a client with a traumatic brain injury continues to deteriorate despite medical efforts. The decision is made to terminally wean the client from mechanical ventilation. Which statement by the nurse is most significant in educating the family regarding terminal weaning?

"All efforts will be taken to make sure your loved one is comfortable and out of pain."

A client has been receiving dialysis for years and now states, "I have been thinking about this for a long time. I no longer wish to continue dialysis. I just want to die." What is the most appropriate statement by the nurse?

"Can you tell me about why you've made this decision?"

The nurse is caring for a client with pancreatic cancer. Which client statement reflects bargaining?

"Dear God, if you get me through this, I will go to church all the time."

A nurse is caring for a client whose spouse died more than 4 years ago. What assessment question will the nurse ask to determine if the client is experiencing abnormal grief?

"Have you gone through and donated your spouse's clothing?"

A client with end-stage chronic obstructive pulmonary disease (COPD) has reached the end of the 6-month period for hospice services and the family caregiver states, "I don't know what we will do if they cut off our hospice services." What is the best response by the hospice nurse?

"I will contact the health care provider to extend services since your family member meets the criteria."

A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education?

"In hospice care, the nurses make most of the care decisions for the clients."

The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate?

"It must be very difficult for you."

Which phrase can do much to instill hope in the dying client?

"Let me tell you about your illness."

During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving?

"My parent is suffering with cancer and death will be a relief of the pain."

A client diagnosed with a terminal illness is displaying periods of depression and anger alternating with acceptance. The client's spouse is concerned about the client's labile mood. When talking with the client's spouse, which statement made by the nurse best addresses principles of loss and grieving?

"Not everyone experiences grief in the same way and your loved one needs our support."

When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response?

"This must be very difficult for you."

A client is admitted to the hospital with a medical diagnosis of terminal lung cancer. Which question is most important for the nurse to ask first?

"What have you been told about your condition?"

The nurse is providing care for a client that is terminally ill with cancer. The client states to the nurse, "Am I going to die?" What is the most therapeutic response by the nurse?

"What have you been told?"

Which assessment finding would best support a nursing concern of disordered grieving?

A client is unable to return to work after their sibling's death 18 months ago.

A death certificate is being handed over to the relatives of a client who died following carcinoma of the intestine. What is the purpose of a death certificate? Select all that apply.

-attests that the person named in the form is dead -provides statistics to identify trends and needs in the field of health -provides information to compile mortality statistics

Which situation is most likely to warrant an autopsy?

A client's death involves an allegation of a medical error.

A terminally ill client reports excruciating pain in the back. Which intervention should the nurse adopt to control pain in the client?

Administer opioids.

Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning?

Administer sedation and analgesia.

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage, according to Küb

Anger

The nurse is providing care for a confused client who no longer is able to make health care decisions. Which document will the nurse review on the client's medical record to determine the designated person to make decisions on the client's behalf?

Durable power of attorney form

A hospitalized client with advanced metastatic lung cancer states, "I want to go home. I don't have much time left. I want to be with my family." Which type of care referral by the nurse is most appropriate?

Hospice

A nurse is providing care to a client recently admitted to the health care facility for treatment of an infection. The client experienced a traumatic brain injury several months ago that resulted in paralysis of both lower extremities and difficulty swallowing and speaking. The client's spouse is the primary caregiver. The client's spouse says to the nurse, "It's been really tough this last month caring for my spouse. Even though I have an aide who comes in to help for a couple of hours a week, I'm just spent, physically and emotionally." A referral for which service would be appropriate?

Respite care

The family of a client who is terminally ill asks the nurse about respite care. What education should the nurse provide the family regarding respite care?

Respite care is often provided by volunteers.

The client who is terminally ill has unrelieved and intractable pain. The nurse is administering hydromorphone intravenously. The client states, "I want you to give me additional medication so I will die. I cannot go on any longer." What action would the nurse take?

State, "This is not something I or any of the nurses can do."

A nurse at the health care facility cares for several clients. Some of the clients may require end-of-life care. Which case may require the service of a coroner?

The client did not have any recent medical consultation.

The hospice nurse is assessing the wife of a client who died 14 months ago. The nurse is concerned that the wife is still grieving the death of her husband. Which objective assessment finding would suggest that the wife is not still grieving?

The wife's hair is clean and styled.

The nurse should explain to the client's family member that a comfort-measures-only order is being implemented to obtain which expected outcome?

a comfortable, dignified death for the client

A nurse is providing end-of-life care to a client who spends most of the time praying and talking about a "spiritual connection." The nurse interprets this as indicating which stage of grief?

acceptance

A client has recently lost a parent. The client spent about 6 months deeply mourning the loss and is just now able to function at the pre-loss level. During this process, a strong social support network was able to assist the client. What developmental stage of life does the nurse identify the client is in?

adult

A client is diagnosed with terminal kidney failure. The spouse demonstrates loss and grief behaviors. What type of loss is the spouse experiencing?

anticipatory loss

A widow develops cancer within 6 months of her husband's death. This may be a result of:

bereavement.

According to the Harvard University Medical School committee, what function must be irreversibly lost to define death?

brain function

A client is being discharged from the hospital with terminal brain cancer and a life expectancy of 1 month. When planning this client's discharge, it is most important for the nurse to include a referral to which agency?

hospice

A terminally ill client is being cared for at home and receiving hospice care. The hospice nurse is helping the family cope with the client's deteriorating condition, educating them on the signs of approaching death. Which sign would the nurse include in this education plan?

difficulty swallowing

Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal?

leaving the wife's room and belongings intact

An 81-year-old client is exhibiting many characteristic signs and symptoms of imminent death. What individual should the nurse first inform of the client's change in status?

the client's health care provider