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14. A client involved in a motor vehicle accident is rushed to the healthcare facility in an unconscious state. The nurse frequently changes the client's position. What are the purposes for the frequent position changes? 1. Promote comfort 2. Prevent skin breakdown 3. Ease breathing 4. Kept client clean and dry A)1, 2, 3 B)1, 2, 4 C)1, 3, 4 D)2, 3, 4

Ans: A Feedback: Changing the client's position frequently may promote comfort, prevent skin breakdown, and ease breathing. Pain relief may provide comfort and may help ease the dying process. The dying client who is incontinent needs to be kept as clean and dry as possible.

1. The nurse caring for a client with terminal illness observes that the client is unresponsive and in the final detachment stage of dying. Basic human needs are a priority for the dying person. What is the highest priority for nursing care at this time? A) Emotional needs B) Physical needs C) Spiritual needs D) Social needs

Ans: B Feedback: Nursing care should be primarily directed toward the physical needs. Because the client is unresponsive and gradually separating from the world, the client does not have any emotional, spiritual, or social needs.

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20. The nurse is taking care of a dying child. The nurse is trying to locate the child's listed religion to make sure whether mandatory baptism must be performed. Based on this information, which religions have mandatory baptism? 1. Roman Catholic 2. Russian Orthodox 3. Greek Orthodox 4. Quakers A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4

Ans: A Feedback: Roman Catholics, Greek Orthodox, and Russian Orthodox have mandatory baptism. Quakers have no belief in afterlife and do not have mandatory baptism.

23. A nurse is taking care of a client in the depression stage of dying. Based on this information, what suggestion for helping the individual cope does the nurse need to make sure is present in the nursing care plan? A) Allow the person to rest. B) Encourage family support. C) Try to assist in client's wishes. D) Provide physical care.

Ans: A Feedback: A good suggestion to help a person cope in the depression stage of dying is allowing the client to rest. Encouraging family support and trying to assist in client's wishes are appropriate suggestions for helping the person cope in the bargaining stage of dying. Providing physical care is an appropriate suggestion for the acceptance stage of dying.

19. The nurse and primary care provider have to ask the family of a young victim of a motor vehicle accident about obtaining an autopsy. The nurse is a recent graduate and remembers reviewing culture, ethnicity, and religious beliefs and practice related to death. Based on this information, which client's family would the nurse anticipate that the autopsy cannot be performed? A) Christian Science B) Episcopal C) Greek Orthodox D) Hindu

Ans: A Feedback: An autopsy is forbidden for the Christian Science religion. Episcopal, Greek Orthodox, and Hindu religion do not forbid an autopsy.

17. A nurse is working with a dying client. The nurse best demonstrates support of dying with dignity when completing which nursing action? A) Allows the client to make as many decisions as possible about care B) Tells the client own views about the afterlife C) Does not talk about the impending death and only focuses on current care needed D) Completes most of physical care for the client

Ans: A Feedback: Assisting the client to die with dignity involves the client participating and choosing the remainder of life and supporting the acceptance stage of dying. Sharing the nurse's own views about life after death does not support the client's own influence of culture, ethnicity, or religious beliefs. Only when a client requests assistance should the nurse provide it, because otherwise the nurse is not supporting the client's acceptance of the final stage of growth and development.

18. The family of a client that just died tells the nurse that they will take care of the body and that the funeral will be held at home. Based on this information about traditional religious beliefs and practices related to death, what most likely will the nurse find listed in the electronic medical record as the client's religion? A) Amish B) Baptist C) Buddhist D) Christian Science

Ans: A Feedback: The Amish and Mennonite religion's practices include that the family cares for the body and the funeral is often at the home. Baptists practice prayer and communion. Buddhists have a priest perform last rites and chanting rituals. The Christian Science has a reader called with no last rites.

5. A client dying of terminal illness is in the acceptance stage of dying. The family is worried that the client is devoid of all feelings and has given up everything associated with life. How can the nurse explain the client's behavior to the family? A) The client is resolving emotional conflicts about death. B) The client is not willing to communicate with family. C) The client is trying to escape the reality of death. D) The client is concentrating on past losses.

Ans: A Feedback: The nurse explains to the family that the client is resolving emotional conflicts about death and accepting impending death. It would not be correct to say that the client is unwilling to communicate with the family because he or she is not in the anger and rage stage of dying. The client is not trying to escape reality of death because he or she is not in the stage of preparatory depression. The client is not concentrating on past losses because he or she is not in the reactive depression stage of dying.

5. The nurse documents that the client has a written living will. What is the best description of a living will? A) Document in which the client states the types of treatment desired to receive or not to receive if a terminal situation arises B) Designates a person of the client's choice to make healthcare decisions should the client become incompetent C) Document in which healthcare personnel are informed that if the person experiences cardiopulmonary arrest, that a "code blue" should not be called D) Document in which healthcare personnel are informed not to start tube feeding and to keep the client as comfortable as possible

Ans: A Feedback: A living will is a document in which clients state the types of treatment they desire to receive or not to receive if a terminal situation arises or if they are unable to make decisions or express their wishes. A durable power of attorney for healthcare designates a person of the client's choice to make these healthcare decisions should the client become incompetent. An individual may have a do not resuscitate (DNR), do not intubate (DNI), or both orders in his or her health record. Healthcare personnel are thus informed that if this person experiences cardiopulmonary arrest, a "code blue" (or the code name for arrest in that facility) should not be called. The use of tube feedings may also be specified as a treatment the client wants or does not want. Clients who are DNR or DNI or who refuse tube feedings will be kept as comfortable as possible and given emotional support.

16. A 90-year-old client diagnosed with intestinal carcinoma is being cared for at a healthcare facility. The client's relatives are experiencing emotional trauma and difficulty coping with the situation. What nursing measures must the nurse ensure to implement care and support the dying client and his family members? 1. Establish a supportive and trusting relationship with the client and family. 2. Explain the client's condition and treatment to the client and family. 3. Express warmth, care, and concern when interacting with the client and family. 4. Ensure that the client's higher-level needs are met. A)1, 2, 3 B)1, 2, 4 C)1, 3, 4 D)2, 3, 4

Ans: A Feedback: Establish a supportive and trusting relationship with the client and family. Express warmth, care, and concern when interacting with the client and family. Explain the client's condition and treatment to the client and the family. Ensure that the client's basic physiologic needs are met.

25. A client's family asks the nurse about the changes noted in the client's respirations. Various breathing patterns may be seen in the client who is dying. What is the best description to provide to the family by the nurse of Kussmaul's breathing? A)Respiratory rate greater than 20 breaths/minute B)Shallow breathing C)Absence of breathing D)Often occurs if a person experiences alkalosis

Ans: A Feedback: Kussmaul's breathing often occurs if a person experiences acidosis. This type of breathing is fast, greater than 20 breaths/minute, labored, and deep. Cheyne-Stokes respiration occurs as heart failure is evident and is characterized by periods of absence of breathing and rapid breathing.

25. The nurse is administering pain medications to clients with severe pain related to end-stage diseases. Which of the following is the first route of choice for these clients? A) Oral B) Intramuscular C) Subcutaneous D) Intravenous

Ans: A Feedback: Oral medications are the first choice for pharmacologic pain management. Clients usually administer their own oral medications, based on pain severity. Some oral medications are very effective for mild pain; NSAIDs and combination medications, such as oxycodone with ASA (aspirin, Percodan), are commonly used. When oral, rectal, or transdermal medications no longer control pain, parenteral medications may be administered subcutaneously, intramuscularly, intravenously, or intrathecally.

18. A 90-year-old client diagnosed with intestinal carcinoma is being cared for at a healthcare facility. The client's relatives are experiencing emotional trauma and difficulty coping with the situation. What measures must the nurse take to prepare and plan for the client and relatives to cope with the situation? 1. Tell them that they should feel free to express needs, fears, and emotions. 2. Identify preferences concerning death. 3. Demonstrate positive methods of coping. 4. Discourage client to participate in self-care. A)1, 2, 3 B)1, 2, 4 C)1, 3, 4 D)2, 3, 4

Ans: A Feedback: Planning during the end of life care is as follows: A plan of care is designed to ensure that the client and family members will be able to verbalize their fears, needs, and emotions. The plan should help in identifying preferences concerning death. The client and family members are shown positive methods of coping. The client is encouraged to participate in self-care to the extent possible.

11. Which of the following hospice care team members provides a constant liaison between the client and the hospice team and may suggest approaches to care that meet with everyone's approval? A) Caregiver B) Primary care provider C) Nurse D) Home health aide

Ans: A Feedback: Primary (family) caregivers are vital to the client's care. They provide a constant liaison between the client and the hospice team and may suggest approaches to care that meet with everyone's approval. Caregivers often can identify changes in the client's condition that might not be noticeable to others.

21. A 42-year-old male client with metastatic renal carcinoma complains of disturbed sleep. What nursing measure would improve his sleep? A) Listening to soft music and relaxation tapes B) Avoiding physical exertion C) Taking short naps during the day D) Consuming a low-carbohydrate diet

Ans: A Feedback: Soft music and relaxation tapes may help improve the client's sleep. The client should not avoid physical exertion, but should perform sufficient activities during the day. The client should avoid taking short naps during the day because the goal of hospice care is for clients to sleep adequately at night and maintain normal activity during the day. Consuming a low-carbohydrate diet will not improve sleep.

7. A client with end-stage renal failure is being admitted to a hospice program. Which of the following is a requirement for admission to this type of program? A) The client must have a diagnosis of a progressive, terminal illness. B) Life expectancy must be under 1 year. C) In most cases the client agrees to life-saving resuscitation. D) Once started, hospice cannot be discontinued by the client or family.

Ans: A Feedback: The criteria for hospice care includes a diagnosis of progressive, terminal illness in which the primary care provider, client, and family agree that control of symptoms is the primary goal, after determining no curative treatment is available or desirable. The life expectancy is usually no more than 6 months and, in most cases, the client agrees to DNR/DNI status. Hospice care can be discontinued with the agreement of the client, family, and primary care provider.

3. A hospice nurse is caring for a 62-year-old female client with metastatic endometrial carcinoma. What is the nursing consideration to be followed when caring for this client in a hospice setting? A) Help control the client's symptoms. B) Emphasize a focus on the problems. C) Stay with the client when she asks to be alone. D) Help in solving family disputes.

Ans: A Feedback: The hospice nurse should focus on helping with control of the client's symptoms. The nurse should emphasize the positives rather than focusing on problems. The nurse should allow the client to be alone when she asks to be alone. The nurse should not get involved in family disputes.

4. Healthcare facilities that receive federal funds must ask every client on admission if they have an advance directive. The client's response must be entered into the client's health record. Advance directives can take several forms. What are the most common advance directives? 1. Living will 2. Durable power of attorney for healthcare 3. DNR 4. DNI A) 1, 2 B) 1, 4 C) 2, 3 D) 3, 4

Ans: A Feedback: The most common advance directives are a living will and durable power of attorney for healthcare. The advance directive informs healthcare personnel about procedures the client requests to be performed or not to be performed if he or she becomes terminally ill, several healthcare codes are involved in these instructions that include DNR and DNI.

26. A client admitted to a hospice facility for breast carcinoma is prescribed morphine for pain relief. What adverse effect should the nurse monitor for in a client receiving morphine? A) Decreased respirations B) Watery diarrhea C) Hyperactivity D) Hyperthermia

Ans: A Feedback: The nurse should monitor for decreased respirations in a client receiving morphine. Sedation, rather than hyperactivity, will be seen in this client. Constipation, not diarrhea, is a side effect of morphine treatment. Hypothermia, not hyperthermia, should be monitored for in this client.

24. A family member has heard about the rule of threes and asks the nurse what it means. What would be the best response about the rule of threes? A)A person can live 3 minutes without oxygen. B)A person can live 3 hours without water. C)A person can live 3 days without food. D)A person can live 3 weeks without warmth.

Ans: A Feedback: The rule of threes is that a person can live 3 minutes without oxygen; 3 hours without warmth; 3 days without water; and 3 weeks without food.

15. A client with end-stage lung cancer who is in hospice care is experiencing severe depression. Which of the following medications might be prescribed to alleviate this symptom? Select all that apply. A) Bupropion (Wellbutrin) B) Citalopram (Celexa) C) Buspirone (BuSpar) D) Eszopiclone (Lunesta) E) Furosemide (Lasix) F) Paroxetine (Paxil, Pexeva)

Ans: A, B, F Feedback: Bupropion (Wellbutrin), citalopram (Celexa), and paroxetine (Paxil, Pexeva) are prescribed for depression. Buspirone (BuSpar) is prescribed for anxiety, eszopiclone (Lunesta) is a sleep medication, and furosemide (Lasix) is used for edema.

5. The hospice nurse provides palliative care for clients. Which of the following are clinical practice guidelines for this type of care? Select all that apply. A) Assessing pain B) Researching new treatment modalities C) Performing life-saving resuscitation measures D) Treating pain E) Providing symptom relief F) Coordinating care

Ans: A, D, E, F Feedback: The term "palliative care" encompasses nursing care and medical treatments that relieve or reduce physical and psychological symptoms, to make the client more comfortable. It does not aim to "cure" a disease. Principles of palliative care aid the terminally ill person toward the end of his or her life.

25. A nurse is taking care of a client who is beginning to recognize that this was the last summer he will be able to play golf because he has this feeling that the bladder cancer is getting worse rapidly. Based on the data that the nurse collected during the visit to the primary care provider, which stage of dying is this client most likely experiencing? A) Anger B) Bargaining C) Depression D) Acceptance

Ans: B Feedback: During the bargaining—not anger, depression, or acceptance—stage of dying the client feels guilty and is developing an awareness of the diagnosis.

24. A nurse is taking care of a client in the denial stage of dying. The student nurse is preparing a short postclinical report about the stages of dying and wants to include a brief description of the stages of death. The student nurse has to be able to describe each stage in one word. Which word by the student nurse would best describe the denial stage of dying? A) Rage B) Shock C) Guilt D) Grief

Ans: B Feedback: During the denial stage of dealing with death, the individual experiences shock. Rage occurs in the anger stage; guilt occurs in the bargaining stage and grief is present in the depression stage.

3. The nurse is caring for an aged client who is dying. The client has accepted death and interacts with the nurse. Which is the most likely statement by the client to the nurse at this time? A) "No, not me!" B) "I am at peace with the diagnosis." C) "Yes me, but why did this happen to me?" D) "If I could just live just two more weeks, I can see my daughter get married."

Ans: B Feedback: The most likely statement by the client would be, "I am at peace with the diagnosis" because the client has already accepted death. The client would not say, "No, not me!", because the client is not denying death. The client would not say, "Yes me, but why did this happen to me?" or "If I could just live just two more weeks, I can see my daughter get married." because the client is not bargaining for time and is not developing an awareness of death.

13. A nurse is caring for a dying male client who belongs to an organized religious group. How can the nurse best help the client to draw strength from his religious faith? A) Limit visitors to immediate family during prayer sessions. B) Arrange for individuals from the client's religious group to pray with the client. C) Have the hospital chaplain visit with the client each day. D) Find out what religious materials would be of help to the client.

Ans: B Feedback: The nurse can best help the client by arranging for people from the client's religious group to visit and pray with the client so that he is able to draw strength from God and prayer. Limiting prayer to family members who may or may not have the client's same beliefs limits the opportunities for support of others for the client. The hospital chaplain can assist with prayer, but may not know the client well or hold the same religious beliefs as the client. Religious materials can be helpful, but they do not provide the social support of others.

9. A male client with terminal pancreatic cancer is aware that he's dying. The family members are unable to confront the situation. Based on this information, which suggestion should the nurse offer the family? A) Appear cheerful before the client. B) Talk honesty and clearly about death. C) Provide hope and encouragement. D) Discuss future plans for the client.

Ans: B Feedback: The nurse should advise the family to talk to the client honestly and clearly about death. It would not be right for the family to appear cheerful before the client because it may confuse him. If the family provides hope and encouragement or discusses future plans; the client would be misled into believing of recovering soon.

15. A client's family tells the nurse that their cultural and ethnic beliefs will not allow their father's body to be left alone at any time before burial. The mortuary is unable to pick up the body until morning because of a terrible storm that prohibits proper transportation. The policy of the hospital is that all bodies must be stored in the hospital morgue until pickup of the body is possible. Based on the influence of culture and ethnic beliefs of the family, what is the best way for the nurse to resolve this situation? A) Explain the policy of the hospital to the family members and arrange to have the body moved to the morgue. B) Contact the nursing supervisor to find out if there is some other way to resolve the issue. C) Contact the client's primary care provider to talk to the family about the situation. D) Locate an unoccupied room and move the deceased client to the room with someone to stay with the body.

Ans: B Feedback: When possible, a modification of agency policy that demonstrates respect for individual culture and ethnic beliefs is important to explore. The primary care provider is unable to modify the implementation of stated agency policies. Utilizing an empty room with an employee to sit with the deceased is not an appropriate option.

7. An elderly client is admitted to the healthcare facility with acute respiratory distress. The client's health record has a DNR or "do not resuscitate" order. Which must the nurse perform if the client suddenly develops cardiopulmonary arrest? A) A full code is initiated at the earliest. B) The client is allowed to die naturally. C) Cardiopulmonary resuscitation without medications is initiated. D) The code team is called with intervention delayed until the physician arrives.

Ans: B Feedback: A DNR code indicates that the client is allowed to die naturally without mechanical or chemical intervention if cardiopulmonary arrest develops. This code is an advance instruction to healthcare personnel, which is decided by the attending physician, the client, or the family members regarding the need for chemical or mechanical assistance to the dying client. A full code means that the cardiopulmonary resuscitation team is to be called in case of cardiopulmonary arrest, although death is imminent in the client. The nurse should not initiate cardiopulmonary resuscitation without drugs or call the code team with intervention delayed until the physician arrives.

6. The nurse documents that the client has a durable power of attorney for healthcare. What is the best description of a durable power of attorney for healthcare? A) Document in which the client states the types of treatment desired to receive or not to receive if a terminal situation arises B) Designates a person of the client's choice to make healthcare decisions should the client become incompetent C) Document that informs healthcare personnel that if the person experiences cardiopulmonary arrest, a "code blue" should not be called D) Document in which healthcare personnel are informed not to start tube feeding and to keep the client as comfortable as possible

Ans: B Feedback: A durable power of attorney for healthcare designates a person of the client's choice to make these healthcare decisions should the client become incompetent. A living will is a document in which clients state the types of treatment they desire to receive or not to receive if a terminal situation arises or if they are unable to make decisions or express their wishes. An individual may have a do not resuscitate (DNR), do not intubate (DNI), or both orders in his or her health record. Healthcare personnel are thus informed that if this person experiences cardiopulmonary arrest, a "code blue" (or the code name for arrest in that facility) should not be called. The use of tube feedings may also be specified as a treatment the client wants or does not want. Clients who are DNR or DNI or who refuse tube feedings will be kept as comfortable as possible and given emotional support.

6. A client who is diagnosed with anaplastic thyroid cancer asks a home nurse whether he is eligible to join a hospice program. What is a criterion for the client to be admitted to a hospice? A) A person agrees to take care of the client 12 hours a day. B) Curative treatment is not desired by the client's family. C) Admission is directed toward meeting only the family needs. D) Life expectancy is at least 2 years from date of admission.

Ans: B Feedback: Admission to a hospice program can be directed if the physician, client, and family cooperatively decide no curative treatment is available or desirable. A client can be admitted to hospice if someone agrees to be responsible for the client for 24 hours a day, not 12 hours. Admission is directed not solely by the client's family. It is primarily directed toward needs of family and the client. The life expectancy of the client is usually not more than 6 months from date of admission.

14. The hospice nurse is administering dolasetron mesylate (Anzemet) to a client who is in hospice care. Which of the following is a symptom that this medication is designed to control? A) Pain B) Nausea C) Diarrhea D) Constipation

Ans: B Feedback: Dolasetron mesylate (Anzemet) is a medication used to control nausea. An example of a medication to control pain is morphine; for diarrhea, it is loperamide HCl (Imodium, Kaopectate), and for constipation, it is calcium polycarbophil (Fiberall, FiberCon, Konsyl Fiber).

2. A client's family often goes through the same stages of grief and loss related to the dying experience as does the client. Not all people go through the grief experience in the same sequence in the same way. A client's family keeps repeating over and over "why is this happening to my father?" What stage of dying is being expressed by the client's family? A) Denial and isolation B) Anger and rage C) Bargaining and developing awareness D) Detachment

Ans: B Feedback: Kübler-Ross' stages of dying are still generally accepted today. These stages are: Denial and isolation ("This isn't happening to me!"). Anger and rage ("Why is this happening to me?"). Bargaining and developing awareness ("I promise I will be a better person if only . . ."). Depression ("I don't care anymore."). Acceptance and peace ("I'm ready for whatever happens."). Detachment (withdrawal from life).

17. A 90-year-old client diagnosed with intestinal carcinoma is being cared for at a healthcare facility. The client's relatives are experiencing emotional trauma and difficulty coping with the situation. What nursing measures must the nurse ensure to implement care and support the dying client and his family members? 1. Maintain open communication among all concerned. 2. Provide appropriate pain relief. 3. Do not talk often with the nonresponsive or comatose client. 4. Arrange for spiritual counseling, if requested. A)1, 2, 3 B)1, 2, 4 C)1, 3, 4 D)2, 3, 4

Ans: B Feedback: Maintain open communication among all concerned. Provide appropriate pain relief. Talk with the client often, even if the client is nonresponsive or comatose. Arrange for spiritual counseling, if requested.

23. A 56-year-old male client with metastatic lung cancer rates his pain as a 5 on a pain assessment scale. What type of pain medication would be appropriate for this client? A) Strong opioid B) Weak opioid C) Acetaminophen D) NSAID

Ans: B Feedback: Pain rated as moderate (4-6) usually responds to a weak opioid. Severe pain (7-10) usually requires a strong opioid, such as SQ morphine. Acetaminophen and NSAIDs are used for mild to moderate pain (1-3).

20. The hospice nurse is initiating measures to help with nutrition for a client who has anorexia related to a terminal illness. Which of the following is a recommended guideline when providing nutrition to the terminally ill? A) Do not encourage eating or drinking anything unless the client desires it. B) Most clients benefit from low oral intake in the last stages of illness. C) A large glass of wine may be beneficial to help the client eat. D) Vitamins are more effective if taken about 1 hour following a meal.

Ans: B Feedback: Studies indicate that most clients benefit from low oral intake in late stages of illness. Clients may be encouraged to eat or take fluids to preserve strength and improve quality of life. Vitamins, tranquilizers, antidepressants, antiemetics (antinausea medications), appetite stimulants, or small amounts of alcohol may help people to eat. They are most effective if received about half an hour before meals.

15. A 90-year-old client diagnosed with intestinal carcinoma is being cared for at a health care facility. The client's relatives are experiencing emotional trauma and difficulty coping with the situation. What nursing measure must the nurse ensure for implementation of care and support to the dying client and his family members? A)Provide detailed explanations of what is done and what is expected. B)Support the client and family and avoid being judgmental. C)Discourage the client and family members from being actively involved in planning and providing care. D)Discourage family members from expressing needs and encourage respite time for them.

Ans: B Feedback: Support the client and family and avoid being judgmental. Provide simple explanations of what is done and what is expected. Encourage the client and family members to be actively involved in planning and providing care. Encourage family members to express needs and encourage respite time for them.

23. The nurse needs to recognize the signs of approaching death to provide the required care and to support the client and the client's family members. What is the correct sequence of steps that occurs during the last stage of life and indicates approaching death? 1. The client's sense of hearing is slowly lost. 2. The client experiences sweating. 3. The client's extremities feel colder to touch. 4. The client's sense of touch is gradually diminished. A)1, 2, 3, 4 B)2, 3, 4, 1 C)3, 4, 1, 2 D)4, 1, 2, 3

Ans: B Feedback: The client experiences sweating. The client's extremities feel colder to the touch. The client's sense of touch is gradually diminished. The client's sense of hearing is slowly lost.

1. The nurse is caring for clients in a hospice setting. Which of the following best describes this type of healthcare? A) It is a specific care setting for the dying client. B) It is a philosophy of care for dying clients. C) It is based on finding a cure for terminal illnesses. D) It is based on keeping the dying client as drug-free as possible.

Ans: B Feedback: The term hospice does not signify a specific care setting, but rather a philosophy of care. Hospice is based on the concept that most people want to die at home, free of pain, and among their loved ones. Physical and emotional comfort and quality of life are primary concerns of hospice, not cure. Hospice programs care for terminally ill persons, allowing them to die with dignity. The goal of hospice care is to provide as much pain relief as possible, while helping the client to meet basic needs.

9. A woman taking care of her mother who is in a home hospice program is experiencing "compassion fatigue." Which of the following are signs of this caregiver condition? Select all that apply. A) Being oversympathetic to client needs B) Having a sense of hopelessness C) Making decisions quickly D) Having trouble concentrating E) Decreasing use of alcohol or tobacco F) Considering suicide

Ans: B, D, F Feedback: The signs and symptoms of compassion fatigue include reduced ability to be sympathetic to client needs, nightmares and/or flashbacks, exhaustion, irritability, depression and hopelessness, difficulty making decisions, and problems concentrating. Some caregivers increase their use of drugs, alcohol, and tobacco, and some may even consider suicide.

4. The nurse is caring for an aged client who is dying. The client has not accepted death and is acting out in interactions with the nurse. Which is the most likely statement by the client to the nurse at this time? A) "No, not me!" B) "I am at peace with the diagnosis." C) "Yes me, but why did this happen to me?" D) "If I could just live just two more weeks, I can see my daughter get married."

Ans: C Feedback: The most likely statement by the client would be, "Yes me, but why did this happen to me?" The client would not say "I am at peace with the diagnosis" because the client has not already accepted death. The client would not say, "No, not me!", because the client is not denying death. or "If I could just live just two more weeks, I can see my daughter get married" because the client is not bargaining for time and is not developing an awareness of death.

2. The nurse is caring for a young client who was in a motor vehicle accident. The client is dying and the family is inconsolable. The nurse understands that the client and the family are not rooted in any organized religion. What is the best kind of spiritual support that the nurse can provide to the client and the family? A) Suggest spiritual readings B) Encourage religious rituals C) Provide compassionate care D) Ask client's family to join a religious group

Ans: C Feedback: The nurse can provide the best kind of spiritual support to the client and the family by providing compassionate care. Asking the client's family to join a religious group, encouraging religious rituals, or discourses by a spiritual person are not appropriate interventions, because the client and the family are not rooted in any organized religion.

14. A nurse is caring for a dying client who belongs to an organized religious group. Why is spirituality important for individuals faced with death? A) Family and friends are unable to support an individual's organized religious beliefs. B) Spirituality helps individuals to find answers to their queries regarding the meaning of death. C) Religion can support spirituality and the existence of the soul. D) Organized religion can ensure what will occur before the afterlife.

Ans: C Feedback: People who are dying need the support of family and friends and, most of all, a spiritual foundation on which they can. Spirituality helps them to find answers to their queries regarding the meaning of life, the existence of the soul, and the possibility of an afterlife.

10. An older adult client is dying and tells the nurse of hoping to live to see his daughter receive her promotion to full professor. The nurse understands the client's frame of mind. Based on this information, what information should the nurse put on in sign-off report about which stage of dying is the client going through? A) Denial B) Anger C) Bargaining D) Depression

Ans: C Feedback: The client is going through the bargaining stage of dying, because the client is trying to make a deal in the hope of postponing death. The client is not undergoing depression, because the client is not concentrating on past losses. The client is not in the denial stage of dying, because the client is not ignoring reality. The client is not denying the diagnosis of terminal illness and, thus, is not going through a denial stage.

11. A female client is angry and unable to comprehend dying. How can the nurse caring for the client best ensure that the client reaches a stage of acceptance and peace? A) Convince the client that she is dying B) Ask the client to seek comfort in prayer C) Allow the client to take her own time D) Explain that all people eventually die

Ans: C Feedback: The nurse should allow the client to take her own time in moving through the dying process, rather than hastening her through it, because this will not help the client. The nurse should not try to convince the client that she is dying or explain to the client that all people eventually die, because the client is aware of these facts, but is not willing to accept them at the moment. It would not be appropriate for the nurse to ask the client to seek comfort in prayer, because she needs to accept the situation first.

18. A client admitted to a hospice program for metastatic osteosarcoma and complaining of intense bone pain is given corticosteroids. What is a consequence of corticosteroid administration? A) Mood depression B) Spinal cord edema C) Appetite stimulation D) Unresolving emesis

Ans: C Feedback: Corticosteroids are responsible for appetite stimulation. Corticosteroids cause mood elevation rather than mood depression. Corticosteroids do not cause, but reduce, spinal cord edema. Corticosteroids have an antiemetic activity and, therefore, are unlikely to cause unresolving emesis.

6. A young male client is diagnosed with terminal cancer. The client is violent when the nurse approaches and is experiencing anger and rage as a result of the impending death. Based on the data collected, how does the nurse best explain the client's reaction? A) Client is angry with the nurse. B) Client is upset with the family. C) Client is rebelling against helplessness. D) Client is denying the diagnosis.

Ans: C Feedback: The nurse understands that the client is rebelling against helplessness. The client is going through anger and rage because of the difficulty of the situation. The client is not angry with the nurse, because the nurse is not responsible for the illness. The client is not upset with the family, because they also are helpless. The client is not denying the diagnosis, because the client has accepted that he is dying and that is why he is experiencing helplessness.

21. A client with terminal cardiovascular disease shouts at everyone who comes into the room. The visitors express to the nurse that they are hurt and upset. What is the best advice to the visitors by the nurse? A) Do not argue with the client. B) Answer the client's questions honestly. C) Listen to what the client is saying. D) Try to assist with the client's wishes despite the anger.

Ans: C Feedback: This client is in the anger stage of dealing with death. The best suggestion for helping the person cope is to listen to what the client is saying. No arguing and answering the client's questions honestly are good ways to help the person who is the denial stage of dealing with death. Trying to assist in client's wishes is an appropriate way to help the person in the bargaining stage of the diagnosis of death.

28. A nurse places a saline lock to administer IV pain relief medications to a 65-year-old client admitted to home care hospice with a diagnosis of transitional cell carcinoma of the bladder. For what should the nurse use a saline lock? A) Faster delivery of medication B) Avoidance of medication leak C) Avoidance of repeated venipuncture D) Prevention of electrolyte imbalance

Ans: C Feedback: A saline lock is placed to avoid repeated venipuncture. Medications are administered through the lock and flushed. A saline lock does not increase the speed of medication delivery, nor does it prevent medication leak or electrolyte imbalance.

10. A nurse is caring for a 69-year-old client in the advanced stage of breast cancer. Which nursing consideration must the nurse perform to facilitate emotional support to the client and family members? A) Tell client and family members that recovery may be possible. B) Request family members to avoid talking about their own lives to the client. C) Encourage family members to stay with the client, especially at night. D) Ask the family members not to express their sorrow in front of the client.

Ans: C Feedback: As clients move closer to death, they often appear fearful if left alone, especially during the night. Therefore, client's family members are requested to stay with the client during the nights. The nurse should be honest with the client and support her in her own way of coping, rather than provide false hopes of a recovery. Family members talking about their own lives after the client's death is usually beneficial because it helps in understanding the client's impact on the family and also promotes reassurance between the client and family members. Expressing sorrow and emotions in front of the client will bring a sense of importance to the client and also shows the client that they care deeply for her.

13. The nurse is providing bereavement care for a family who lost a loved one. Which of the following is a role of the nurse in this process? A) Set up a memorial service for the client. B) Urge family members not to reminisce about their loved one. C) Visit the family after the client's death to evaluate how they are coping. D) Follow-up with bereavement care for 3 months following the client's death.

Ans: C Feedback: Bereavement (grieving) is part of the process of dealing with a loved one's death. Usually, hospice staff members attend memorial services, but do not arrange them. They urge family members to reminisce and talk about their loved one and to share feelings. Often, staff members make home visits after a client's death to evaluate how family members are coping and assist in their adjustment. Hospice protocol includes bereavement follow-up for at least a full year after a client's death.

12. An 84-year-old female client with a brain tumor is admitted to the healthcare facility following an epileptic attack. Which nursing consideration should the nurse follow when providing end-of-life care for the client? A)Avoid placing the client in a low Fowler's or orthopneic position. B)Ensure that the client's head is not elevated when placing her on her back. C)Encourage clients lying on their backs to assume other positions. D)Avoid disturbing the client with frequent change in position.

Ans: C Feedback: Clients often prefer to lie on their back. However, they must be encouraged to assume various other positions, because lying on the back may cause secretions to pool in the back of the client's throat, leading to choking or aspiration into the lungs. The partial sitting position (low Fowler's) or sitting upright (orthopneic position) are often preferred positions for dying clients because they can minimize breathing complications. Usually, it is helpful and much safer if the client's head is elevated when lying on back, because this helps prevent the obstruction of the client's throat with secretions in the mouth. Frequent position change, along with gentle suction, may be beneficial in relieving the "death rattle" sound caused because of the collection of mucus and secretions in the client's throat.

13. A client involved in a motor vehicle accident is rushed to the healthcare facility in an unconscious state. The healthcare provider has diagnosed the situation as critical with little hope of survival. The unconscious client suddenly regains consciousness and becomes alert. Which nursing measure must the nurse employ when caring for the dying client's family members? A)Inform the family that the client may soon be out of danger. B)Request the family members not to talk about death to the client. C)Immediately call the family members to bid farewell to the client. D)Provide respite care to the client's family members.

Ans: C Feedback: Clients who have been unconscious may abruptly become lucid and alert when they are about to die. Therefore, if possible, the family members are asked to meet the client at this time so that they can have a chance to say a final goodbye. The nurse should not provide any false hope to the client's family and tell them that the client may soon be out of danger. The nurse should not ask the client's family members to avoid talking about death because it will weaken the client's feeling of having made an impression on the world and that he or she will be missed deeply. Respite care, in the form of personal rest and refreshment to the family members, is usually provided when the client is resting or out of danger.

21. An elderly client who was admitted to the healthcare facility passes away as a result of a cardiopulmonary arrest. The nurse attending to the client is deeply traumatized by the incident. What should the nurse do to obtain support and comfort following the death of the client? A)Request the coroner not to order an autopsy. B)Avoid the situation by walking away from it. C)Express sadness to the medical team and client's family. D)Try to assist the client's family members in the funeral.

Ans: C Feedback: Expressing sadness to coworkers, supervisors, spouse, spiritual advisors, and to the client's family members is appropriate for achieving support and comfort in dealing with the death of the client. When death is a result of a cardiopulmonary attack and no foul play is suspected, the family members may request that an autopsy not be performed. However, the nurse cannot make such a request. One of the nurse's duties following the death of the client also includes providing assistance to the client's family members in preparing for the funeral, such as calling the chaplain, providing a list of funeral homes or crematoriums, and arranging transportation of the body; however, this is a duty and a measure of expressing support and concern to the family members, but may not help the nurse in recovering from the psychological trauma of the client's death.

8. An elderly client at an assisted living facility is in acute respiratory distress. The client's health record has a DNH order. What is the best description for a DNH order? A) The individual will be allowed to die naturally without mechanical or chemical intervention. B) The individual will have a tube feeding initiated as soon as possible. C) Client does not wish to be hospitalized or resuscitated if the individual's condition becomes critical. D) The ambulance is to be called immediately in the event of cardiopulmonary arrest, even though natural death is imminent.

Ans: C Feedback: In the nursing home or in the client's home, the nurse may see a do not hospitalize (DNH) order, in addition to a DNR or DNI order. An individual may have a do not resuscitate (DNR), do not intubate (DNI), or both orders in his or her health record. Healthcare personnel are thus informed that if this person experiences cardiopulmonary arrest, a "code blue" (or the code name for arrest in that facility) should not be called. The person will be allowed to die naturally, without mechanical or chemical intervention. The use of tube feedings may also be specified as a treatment the client wants or does not want. Clients need to inform their families and significant others of their wishes regarding hospitalization and resuscitation. When a client does not wish to be hospitalized or resuscitated, the family needs maximum support in the home if the person's condition becomes critical. Some individuals with terminal illnesses are on full code, meaning that the CPR team is to be called in the event of cardiopulmonary arrest, even though natural death is imminent.

11. A 90-year-old client with carcinoma of the prostate complains of severe, excruciating pain in his lower limbs and hips. The attending physician has prescribed heavy doses of narcotics to relieve the pain. Which must the nurse keep in mind when caring for the client? A) Client may have an increased concern of drug abuse and dependency. B) The client's pain may suddenly increase, indicating impending death. C) Client may be allowed to self-administer narcotics, if he is capable of doing so. D) Alternative therapies, such as homeopathy and herbal remedies, are avoided.

Ans: C Feedback: Patient-controlled analgesia (PCA) may be used, so the client can self-administer opiates. Even though large doses of narcotics are given, physicians usually do not feel the need for concern about drug abuse or dependency. Generally, just before death, pain may ease or disappear and not increase, often indicating impending death. Alternative medicines, such as homeopathy, use of flower essences or essential oils, herbal remedies, or various traditional cultural remedies, have proved helpful for many clients.

12. The hospice nurse provides emotional support to clients in hospice care. Which of the following is the greatest fear of most clients in these programs? A) Having unbearable pain B) Losing control of body functions C) Dying alone D) Losing control of emotions

Ans: C Feedback: The greatest fear of most clients is that they will be left alone to die. Caregivers must be alert to this fear and provide more support as illness progresses. Volunteers can assist by staying with clients so they are not alone. The second greatest fear of most clients is that of having uncontrolled pain. Pain can usually be managed successfully.

22. A nurse is assessing the pain of a client who is in hospice. Which of the following is the most reliable indicator of pain? A) Vital signs B) Patient cues C) Patient self-report D) Inability to sleep

Ans: C Feedback: The nurse should assess pain frequently as the fifth vital sign and listen to the client's self-report, which is considered the most reliable indicator of pain. Only the client knows how the pain feels, what measures make it worse, and which give relief. Pain and its level of interference with activities, rest, and general comfort are evaluated.

30. An end-stage human immunodeficiency virus (HIV)-positive client admitted to a hospice with metastatic Kaposi sarcoma is found to be unresponsive when the nurse approaches the client for assessing the vitals. The client is declared dead after examination. What is the nurse's responsibility after the death of the client? A) Discontinue hospice program following client's death. B) Avoid showing grief to the family members. C) Refer the family to a bereavement support group. D) Return the client's narcotics to the family members.

Ans: C Feedback: The nurse should immediately refer the family to a bereavement support group. Hospice protocol includes bereavement follow-up for a full year after a client's death. The nurse should express grief because family members often appreciate staff members who are able to express their grief. The nurse should count the client's narcotics and dispose of them per agency policy.

17. The nurse is caring for clients in a hospice program. Which of the following is a recommended nursing care guideline when caring for this population? A) Focus on problems. B) Try to predict the exact time of death. C) Maintain a sense of humor. D) Do not allow the client to be alone.

Ans: C Feedback: The nurse should maintain a sense of humor, emphasize the positive, and focus on what can be done, not on the problem. The nurse should not try to predict the exact time of death. The nurse should also allow the client to be alone or stay with the client, depending on what he or she desires.

8. A client diagnosed with end-stage leukemia is placed in hospice care. In a hospice setting, who is in control of client care? A) The physician B) The nurse C) The family D) The client

Ans: D Feedback: In hospice care, the client is in control of his or her care. This is "autonomous" decision making at the end-of-life. The client and the family, along with the hospice team, decide on the most appropriate care once the client has agreed on care.

10. A caregiver of a client in hospice tells the nurse that if she "doesn't get a break from the situation, she will no longer be able to care for her family member." The nurse recommends respite care. What generally occurs when respite care is initiated? A) A new family caregiver is assigned to the client for the duration of hospice care. B) The nurse replaces the caregiver for the duration of the hospice care. C) The caregiver "takes a break," usually for a period of less than 30 days. D) The client who is being cared for will be rehospitalized for the duration of care.

Ans: C Feedback: The term respite means that caregivers "take a break," usually for a period of less than 30 days. Respite care is accomplished by admitting clients to inpatient hospices, hospitals, or nursing homes or by arranging for supplemental home care.

12. The Kübler-Ross stages of grief and loss typically occur in individuals who are close to the person who has died or is expected to die. These stages have also been identified and used for a multiplicity of life's situations. The stages are in random order. What is the correct sequence for these stages? 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance 6. Detachment A) 6, 1, 2, 3, 4, 5 B) 4, 3, 5, 2, 1, 6 C) 2, 1, 3, 4, 5, 6 D) 1, 2, 3, 4, 5, 6

Ans: D Feedback: The correct sequences of stages are denial, anger, bargaining, depression, acceptance, and detachment.

8. A terminally ill client realizes that death is near and dwells on past losses. Based on this information, which stage of dying should the nurse identify in the electronic medical record that this client going through? A) Denial B) Anger C) Bargaining D) Depression

Ans: D Feedback: A client concentrating on past losses is passing through the depression stage of dying. The client is not undergoing denial, because the client has no doubts regarding the diagnosis. The client is not lashing out at family members or the healthcare personnel, so the client is not going through anger. The client is not trying to daydream or escape reality by bargaining.

7. A female client with terminal illness tells the nurse that she is so sad and has no hope for recovery. The client sleeps a great deal as if trying to escape from reality. Which is the highest priority way for the nurse to help the client? A) Encouragement B) Reassurance C) Casual talk D) Gentle touch

Ans: D Feedback: A gentle touch of the hand indicating the presence of someone close is very helpful for clients experiencing preparatory depression. Encouragement or reassurance does not help, because the client has already resigned to the impending death. The client tries to evade reality by sleeping a great deal. In such a situation, the client is not willing to participate in casual talk. Thus, encouraging casual talk with the client is not an appropriate intervention, because it could cause her discomfort.

16. A nursing care plan includes the desired outcome of "quality of life" for a client with cancer who is likely to die within a few years. Which is the best example that would indicate that the outcome has been met for the client? A) The client believes that there is adequate financial resources to pay for own healthcare and healthcare for the surviving spouse. B) The client spends the majority of time in spiritual reflection. C) The client has no signs or symptoms of preventive complication of the cancer at this time. D) The client verbalizes satisfaction regarding relationships with family members.

Ans: D Feedback: Although financial stability is present, spiritual peace evident, and no current physical complications to be considered, the most important thing in meeting the desired outcome is that the client expresses satisfaction regarding relationships with family members. Quality of life is demonstrated when the client expresses satisfaction with a variety of aspects of life.

22. A client is dying and tells the nurse that she hopes to stay alive until her son returns from overseas in the military in one month. The client wants to see the son's captain insignia on his uniform. What is the best suggestion for helping the client to cope by the nurse? A) Answer questions honestly about the request. B) Allow the individual to talk to the primary care provider about the realities of the wish. C) Do not argue with the client about whether the wish is appropriate. D) Try to assist the client with making the wish a reality.

Ans: D Feedback: The client is in the bargaining stage of dying. Trying to assist in the client's wishes is the best way to help the person cope at this time. Answering questions honestly, allowing the individual to talk to the primary care provider, and not arguing are appropriate ways to deal with a client in the denial stage of dying.

19. The nurse is providing comfort measures for a client who is in hospice for terminal cancer of the liver. Which of the following is the most important factor in promoting client comfort? A) Controlling nausea B) Controlling diarrhea C) Maintaining adequate hydration D) Maintaining a patent airway

Ans: D Feedback: Although all the comfort measures listed above are important, maintaining a patent (open) airway is probably the most important factor in promoting client comfort. Many clients have lung involvement, causing dyspnea. Stress reduction and position changes help provide maximum comfort. Using a fan to circulate air or an air conditioner to cool the room and elevating the head of the bed may also help.

4. A hospice must meet certain criteria to legitimately be called a hospice. Which of the following is one of these criteria? A) The goal must be curative measures, not just palliative care. B) The hospice must be administered by a hospital staff. C) The hospice care is based on a client's financial resources. D) Bereavement care must be provided for the family for at least 1 year.

Ans: D Feedback: Hospice services must be extended to the family during the time of bereavement (following the client's death) for at least 1 year. The goal of hospice care is symptom control (intensive palliative care), not curative measures. Clients should remain as alert and comfortable as possible. The hospice must be a centrally administered, autonomous program. Staff members and family caregivers primarily provide care, with backup inpatient services. Hospice services must be based on a client's needs, not on financial resources.

2. The nurse caring for clients in hospice notes that which of the following is the disease state most commonly seen in this program? A) Dementia B) Heart disease C) Lung disorders D) Cancer

Ans: D Feedback: In 2006, cancer accounted for 44.1% of reasons for hospice. Other disorders combined (including end-stage heart disease, dementia, general debility, lung disorders, and end-stage kidney disease) made up 55.9%.

3. A client's family often goes through the same stages of grief and loss related to the dying experience as does the client. Not all people go through the grief experience in the same sequence in the same way. A client says to family members "I don't care anymore about living. This is not living to me." What stage of dying is being expressed by the client? A) Denial and isolation B) Anger and rage C) Bargaining and developing awareness D) Depression

Ans: D Feedback: Kübler-Ross' stages of dying are still generally accepted today. These stages are: Denial and isolation ("This isn't happening to me!"). Anger and rage ("Why is this happening to me?"). Bargaining and developing awareness ("I promise I will be a better person if only . . ."). Depression ("I don't care anymore."). Acceptance and peace ("I'm ready for whatever happens."). Detachment (withdrawal from life)

19. A 65-year-old involved in a car accident is rushed to the healthcare facility with severe head injuries and profuse loss of blood. Which sign of approaching death will the nurse observe in the client that needs to be shared with family members who might want to be present? A)Frequency of urination decreases B)Arms and legs are warm to touch C)Client is calm and peaceful D)Breathing becomes noisy

Ans: D Feedback: Noisy breathing is common during the final stages of dying because of the accumulation of secretions in the mouth or lungs. Reduced urination is not seen during the final stages of dying. Instead, the client develops loss of control over bladder and bowels because of loss of neurologic control. The peripheral parts of the client's body, such as the arms and the legs, are cold to touch and not warm, because the circulation is directed away from the periphery and toward the core of the body. Clients in the last stages of dying are usually not calm and peaceful; they occasionally exhibit sudden restlessness as a result of hunger for oxygen.

22. A 79-year-old client at the healthcare facility died following a case of gastric cancer and multiple metastases to the lungs and liver, with severe bouts of hematemesis. Which nursing measure must the nurse perform during the postmortem care of the body? A)Pronounce the client dead and sign the death certificate. B)Avoid repositioning the client's body immediately following death. C)Transfer the client's body as "coroner's case" for an autopsy. D)Pad and tie the client's wrists and ankles together.

Ans: D Feedback: Padding and tying the client's wrists and ankles loosely together makes handling of the body much easier and prevents the arms and legs from falling down. Nurses do not pronounce the death of the client, nor do they sign the death certificate. The healthcare provider generally does this. The client's body must be repositioned immediately following death, to avoid any difficulties as a result of the stiffening of the body a few hours following death. The nurse need not transfer the client's body as a "coroner's case" for an autopsy; a "coroner's case" is one in which a foul play has been suspected in the sudden death of a client.

9. An elderly client at an assisted living facility is in acute respiratory distress. The client's health record has a full code order. What is the best description for a full code order? A) The individual will be allowed to die naturally without mechanical or chemical intervention. B) The individual will have a tube feeding initiated as soon as possible. C) Client does not wish to be hospitalized or resuscitated if the individual's condition becomes critical. D) The ambulance is to be called immediately in the event of cardiopulmonary arrest, even though natural death is imminent.

Ans: D Feedback: Some individuals with terminal illnesses are on full code, meaning that the CPR team is to be called in the event of cardiopulmonary arrest, even though natural death is imminent. An individual may have a do not resuscitate (DNR), do not intubate (DNI), or both orders in his or her health record. Healthcare personnel are thus informed that if this person experiences cardiopulmonary arrest, a "code blue" (or the code name for arrest in that facility) should not be called. The person will be allowed to die naturally, without mechanical or chemical intervention. The use of tube feedings may also be specified as a treatment the client wants or does not want. In the nursing home or in the client's home, the nurse may see a do not hospitalize (DNH) order, in addition to a DNR or DNI order. Clients need to inform their families and significant others of their wishes regarding hospitalization and resuscitation. When a client does not wish to be hospitalized or resuscitated, the family needs maximum support in the home if the person's condition becomes critical.

20. An elderly client who was admitted with a severe head injury passes away at the healthcare facility. Which nursing procedure should the nurse consider when caring for the client's body and family members? A)Place a clean sheet over the client's body and face. B)Light the room brightly when the family members visit. C)Allow the family members to see the body immediately. D)Allow family members to stay in the room as long as they wish.

Ans: D Feedback: The client's family members are allowed to sit next to the client's body as long as they wish, because this helps the family members to make the transition to bereavement and grieve for their loss. The client's body is covered with a clean sheet; however, the face must be left uncovered so that the family members can see it. The room where the client's body is placed for the family members to see must be provided with muted light to provide a comforting environment. The client's family members are not allowed to see the client's body immediately because the nurse has to clean the client's body and prepare it for the family members to see it. The nurse's duties also include removing the medical equipment, intravenous (IV) lines, and nasogastric tubes around the client's body before the family members can see the body.

27. A client with pancreatic carcinoma complains of severe abdominal pain radiating to the back. The healthcare provider prescribes a narcotic analgesic for pain relief. What should the nurse take into account when administering pain relief medications? A) Dosage will not change with change in route of administration. B) Titration of the drug dosage is not necessary on discontinuation. C) Pain medication is unaffected by tolerance to other medications. D) Dosage of pain medication should be increased gradually.

Ans: D Feedback: The dosage of pain relief medications should be increased gradually to avoid any adverse effects. Dosage of pain relief medications will change with change in the route of administration. Gradual titration of the drug dosage is necessary on discontinuation to reduce withdrawal symptoms. Tolerance to other medications may cause clients to require higher or lower doses of pain relief medications.

24. The nurse is administering pain medications to clients in a hospice program. Which of the following is a recommended guideline for this procedure? A) Try the highest dose of medication first. B) Do not increase dosages of narcotic drugs. C) Dosages of opiates should decrease quickly if discontinuing the medication. D) Correlate the medication to the client's report of pain intensity.

Ans: D Feedback: The nurse should consider several points when administering medications to hospice clients, including the following: the appropriate dose, route, and interval of administration are carefully chosen; the lowest dose of medication is tried first; pain medications are chosen to correspond with the client's report of pain intensity; and the dose of a narcotic (opiate) may be aggressively increased, if necessary (called "titration-up" of the dose), and dosages of opiates should decrease slowly ("tapering down") if the medication is to be changed.

29. A 5-year-old child is admitted to a hospice facility with a diagnosis of a metastatic brain tumor. What nursing consideration should be made when dealing with dying children? A) Avoid involving them in decision making. B) Discourage them from talking about death. C) Explain death as similar to going to sleep. D) Explain death in terms of the child's religious beliefs.

Ans: D Feedback: The nurse should explain death to the child in terms of the child's religious beliefs. Children should be involved in decisions regarding their own care. Children need to express their feelings about death. If they are discouraged, children may not bring up the subject again. The nurse should not explain death as similar to going to sleep because this may cause the child to be afraid to go to sleep at night.

16. A client admitted to home care hospice with terminal stage cervical cancer complains of constipation. What should the nurse provide, with orders, to manage constipation in this client? A) Low-residue diet B) Belladonna suppository C) Kaolin and pectin mixture D) Milk of Magnesia

Ans: D Feedback: The nurse should provide Milk of Magnesia, with orders, to manage constipation in this client. A low-residue diet lessens stimulation and should not be given; instead, a high-residue diet is preferred. A kaolin and pectin mixture is given for diarrhea, not for constipation. Belladonna suppositories are given for bladder spasm, not for constipation.

1. A nurse is providing end-of-life care for an 89-year-old male diabetic client with acute renal failure. Which nursing consideration must the nurse employ when catering to the basic needs of the client and his family members? A) Try to convince the client and family members to agree to organ or tissue donation. B) Provide nursing care to the client, without regard to the nurse's own feelings. C) Discourage the client from talking to family members about his death. D) Offer to secure spiritual counseling, if requested, for the client and family members.

Ans: D Feedback: When caring for a dying client, it is often helpful if the nurse offers to secure spiritual counseling, if requested, for the client and family members. Nurses who dedicate their careers to end-of-life care must be compassionate and caring and must understand their own feelings regarding life and death. The nurse must not force or try to convince the client or family members to agree to organ donation, because some people feel very vulnerable and they should not feel pressured into consenting to organ or tissue donation. The client should not be restricted from talking about death with his family members. Otherwise, it may make him feel unimportant and unwanted by the family.