Test 10 Q

Which client's statement confirms they reached the integrity versus despair stage according to Erikson's theory of psychosocial development? Select all that apply. One, some, or all responses may be correct. 1. "Looking back at my entire life, I find that I have actually achieved nothing." 2. " was in love, but my partner ditched me for someone who is good-looking." 3. "In the twilight of my life, I regret not fulfilling the promises I made to my wife." 4. "Could you prescribe some good medications that can help me get back to work as soon as possible, because I need money to support my family?" 5. "Now that I am at the end of the road, I think I am the luckiest person on earth because God has given me everything that I asked for."

1. "Looking back at my entire life, I find that I have actually achieved nothing." 3. "In the twilight of my life, I regret not fulfilling the promises I made to my wife." 5. "Now that I am at the end of the road, I think I am the luckiest person on earth because God has given me everything that I asked for." Rationale According to Erikson's theory of psychosocial development, the integrity versus despair stage occurs in older adults who view their lives with a sense of satisfaction or consider themselves failures. A client who says he realizes that he achieved nothing is in the integrity versus despair stage. Another example of this stage is a client who states he regrets not fulfilling the promises made to his partner. A further example is a client who savs she believes that she is the luckiest person on earth because God has given her everything she asked for. A client who says he was in love, but that his partner ditched him for someone who was good-looking, is in the intimacy versus isolation stage. A client who requests good medications that can help her get back to work as soon as possible to support her family is in the generativity versus self-absorption stage.

The student nurse is describing palliative care to a client's family. Which statement made by the student nurse indicates a need for correction by the registered nurse (RN)? 1. "Palliative care is the same as hospice care." 2. "Palliative care focuses on the care of the client." 3. "Palliative care includes symptom management in the client." 4. "Palliative care is an interprofessional approach to the delivery of care."

1. "Palliative care is the same as hospice care." Rationale The student nurse should not confuse palliative care with hospice care. Palliative care can be provided to any client at the time of diagnosis of a serious disease, whereas hospice care is provided to clients only at the very end of life. Palliative care is focused mainly on client care and symptom management to improve the quality of life. The entire health care team is involved in delivering palliative care to the client.

Which information would the nurse provide about respite care services? Select all that apply. One, some, or all responses may be correct. 1. "Services are offered at home, in a daycare setting, or in a health care institution that provides overnight care." 2. "They include services such as laundry, assistance with meals and personal care, 24-hour oversight, and housekeeping. 3. " group of residents live together, but each resident has their own room and shares dining and social activity areas." 4. "Medicare health care plans do not cover this service, and Medicaid has strict requirements for services and eligibility." 5. "it is a service that provides short-term relief or 'time off' for people, providing home care to an ill, disabled, or frail older adult."

1. "Services are offered at home, in a daycare setting, or in a health care institution that provides overnight care." 4. "Medicare health care plans do not cover this service, and Medicaid has strict requirements for services and eligibility." 5. "it is a service that provides short-term relief or 'time off' for people, providing home care to an ill, disabled, or frail older adult." Rationale Respite care service is offered at home, in day care settings, or in a health care institution that provides overnight care. Currently, Medicare does not cover respite care service, and Medicaid has strict requirements for services and eligibility. Respite care services provide short-term relief or "time off" for people, providing home care to an ill, disabled, or frail older adult. Assisted living includes services such as laundry, assistance with meals and personal care, 24-hour oversight, and housekeeping. In assisted living, a group of residents live together, but each resident has their own room and shares dining and social activity areas.

Which nursing assessment questions assess the faith, belief, fellowship, and community aspect of a client's spirituality? Select all that apply. One, some, or all responses may be correct. 1. "What gives meaning to your life?" 2. "What is your source of power, hope, and belief during difficult times?" 3. "In what way do your beliefs help or strengthen you for coping with illness?" 4. "How has the illness affected your capability to express what is essential in life?" 5. "How do you feel the changes caused by the illness are affecting or will affect your life?"

1. "What gives meaning to your life?" 2. "What is your source of power, hope, and belief during difficult times?" 3. "In what way do your beliefs help or strengthen you for coping with illness?" Rationale The nurse can assess the faith, belief, fellowship, and community aspect of a client's spirituality by asking a client what gives meaning to life; about the source of power, hope, or belief during difficult times; and about how beliefs help or strengthen for coping with illness. When the nurse asks the client in what way illness affects capability to express what is essential in life, it helps in assessing the vocation aspect of spirituality. When the nurse asks the client about feelings related to the changes that have been caused by the illness, it helps in assessing the life and self-responsibility aspect of spirituality.

A client with advanced bone cancer is experiencing cachexia. The nurse reviews the nutritional components of palliative care with the client's family members. The nurse recognizes that the teaching is designed to achieve which outcome? 1. Enhance the quality of the client's life 2. Reduce the likelihood of a respiratory infection 3. Prevent malabsorption syndrome 4. Cure the cachexia that results from bone cancer and chemotherapy

1. Enhance the quality of the client's life Rationale Nutritional interventions to decrease cachexia will not necessarily contribute to survival, but they may enhance the client's quality of life. Palliative care focuses on reducing symptoms and increasing quality; it does not focus on finding a cure. Nutritional interventions cannot prevent the occurrence of respiratory infections; this requires mobilization of respiratory secretions to prevent stasis. Malabsorption cannot be prevented with teaching; it may or may not occur depending upon the disease process and function of the client's gastrointestinal tract.

A client suffering from cancer is near the end of life. Which actions) would be performed by the nurse to support the client's family members? Select all that apply. One, some, or all responses may be correct. 1. Helping the family set up hospice 2. Taking time to make sure that the family understands care options 3. Staying with the client in the absence of family members 4. Giving the family information about the dying process 5. Making sure that the family knows what to do at the time of death

1. Helping the family set up hospice 2. Taking time to make sure that the family understands care options 3. Staying with the client in the absence of family members 4. Giving the family information about the dying process 5. Making sure that the family knows what to do at the time of death Rationale When the client is at the last stage of life, the nurse would help the family set up hospice and other appropriate resources, including grief support. The family members should be informed about the dying process. Make sure that the family knows what to do at the time of death and understands their care options. When the client is hospitalized, stay with the client in the absence of their family members.

Which health care system focuses on palliative care? 1. Hospice 2. Rehabilitation 3. Assisted living 4. Extended care facilities

1. Hospice Rationale A hospice is a system of family-centered care that allows clients to continue living at home with comfort, independence, and dignity while easing the pain of a terminal illness. The focus of hospice care is palliative care, not curative treatment. Rehabilitation restores a person to his or her fullest possible physical, mental, social, vocational, and economic potential. Assisted living offers an attractive long-term care setting with an environment reminiscent of home and with some resident autonomy. An extended care facility provides intermediate medical, nursing, or custodial care to clients recovering

Which member of the interprofessional team in a palliative care setting serves as the client advocate, evaluating the physical, emotional, and spiritual needs of the client? 1. Nurse 2. Pharmacist 3. Music therapist 4. Primary health care provider

1. Nurse Rationale In a palliative care setting, the health care team would comprise professionals of various disciplines to help achieve care outcomes. The nurse on the interprofessional team evaluates the physical, emotional, and spiritual needs of the client. The nurse also advocates for the client and provides referrals to other members of the team. The pharmacist supports the care of the client and the needs of the family regarding medications. Music therapists help increase the comfort of the client. The primary health care provider assesses the clinical manifestations of the client.

The nurse is working in a palliative care setting. Which members of the health care team would the nurse identify as providing ancillary services to clients? Select all that apply. One, some, or all responses may be correct. 1. Pharmacists 2. Spiritual advisors 3. Occupational therapists 4. Primary health care providers 5. Unlicensed assistive personnel (UAP)

1. Pharmacists 3. Occupational therapists 5. Unlicensed assistive personnel (UAP) Rationale Pharmacists, unlicensed assistive personnel, and occupational therapists provide ancillary services to the client. They support the care of the client and the needs of the client's family. The primary health care provider evaluates and assesses clinical manifestations, diagnoses the client's illness, and provides treatment. Spiritual advisors provide spiritual care to the client.

Which nursing action establishes the nurse as a caregiver for a client in spiritual distress? 1. Provides therapeutic treatment to the client 2. Teaches the client about signs of spiritual distress 3. Communicates the wishes of the client to family members 4. Collaborates with the agency chaplain to pursue the best treatment plan

1. Provides therapeutic treatment to the client Rationale The nurse serves as a caregiver by meeting all the health care requirements of the client by providing measures that restore a client's emotional, spiritual, and social well-being. In the given scenario, the nurse provides therapeutic treatment to the client as a caregiver. As an educator, the nurse teaches the client about the signs of spiritual distress. As a client's advocate, the nurse communicates the wishes of the client to family members. The nurse follows the principle of accountability by collaborating with the agency chaplain to pursue the best treatment plan.

Which situation accurately describes hospice care? 1. A resident's temporary or permanent home, where the surroundings have been made as homelike as possible 2. Offers an attractive long-term care setting with an environment akin to the client's home, which offers the client greater autonomy 3. Service that provides short-term relief for people providing home care to an ill, disabled, or frail older adult 4. System of family-centred care that allows clients to remain at home in comfort while easing the pains of terminal illness

4. System of family-centered care that allows clients to remain at home in comfort while easing the pains of terminal illness Rationale Hospice care is a system of family-centered care that allows clients to remain at home in comfort while easing the pain of terminal illness. A nursing center is a resident's temporary or permanent home, where the surroundings are made as homelike as possible. Assisted living offers an attractive long-term care setting with an environment that is like the client's home and offers the client greater autonomy. Respite care is a service that provides short-term relief for people providing home care to an ill, disabled, or frail older adult.

The nurse manager appointed a registered nurse (RN) to provide hospice care for a client and explained the tasks to be performed. Which tasks has the nurse manager delegated to the RN? Select all that apply. One, some, or all answers may be correct. 1. Providing total client care 2. Performing all the hygiene tasks 3. Teaching the client and family members 4. Teaching the client about personal hygiene 5. Assisting the client in performing daily activities

1. Providing total client care 3. Teaching the client and family members 4. Teaching the client about personal hygiene Rationale The RN provides total client care, teaches the family about the client's care, and teaches the client about personal hygiene. The RN may not perform all the hygiene tasks and daily activities. These tasks are delegated to the unlicensed assistive personnel.

Which nursing intervention is an example of the nurse as a caregiver? Select all that apply. One, some, or all responses may be correct. 1. Encouraging the client to exercise daily 2. Setting goals for the client to reduce weight 3. Arranging for the client to meet a spiritual advisor 4. Evaluating the client's understanding of prescribed diet 5. Demonstrating the procedure to self-administer insulin injection

1. Encouraging the client to exercise daily 2. Setting goals for the client to reduce weight 3. Arranging for the client to meet a spiritual advisor Rationale The nurse acts as a caregiver by encouraging the client to exercise daily. The nurse's role as a caregiver involves helping the client maintain and regain health. As a caregiver, the nurse also sets goals and helps the client and family achieve them. The duties of a caregiver involve restoring a client's emotional, spiritual, and social well-being. The nurse arranges for the client to meet a spiritual advisor to meet the client's spiritual needs. The nurse as an educator evaluates the client's understanding of prescribed diet. As an educator, the nurse demonstrates the procedure for administering insulin injection. The nurse also reinforces and evaluates learning.

The registered nurse (RN) is assigning tasks to the health care team to provide care for a group of clients in hospice care. In assisting the health care team in attaining an effective outcome in hospice care, which action should the RN take? 1. Assist the health care team in planning. 2. Assist the health care team in interpreting. 3. Assist the health care team in enhancing ability. 4. Assist the health care team in achieving optimal functioning. counseling.

1. Assist the health care team in planning. Rationale The RN assisting the health care team in planning a task is beneficial in managing the effective outcomes of the hospice care. Assisting with interpreting is beneficial in affirming the outcome. Assisting the health care team with enhancing their abilities will help in renewing the outcome. Assisting the team in achieving optimal functioning will be beneficial to achieving workable unity.

A client who had been receiving palliative care for cancer has deteriorated and now needs end-of-life care. The nurse identifies that which type of care will now be removed from the treatment plan? Select all that apply. One, some, or all responses may be correct. 1. Chemotherapy 2. Repositioning 3. Regular oral care 4. Blood transfusion 5. Radiation therapy

1. Chemotherapy 4. Blood transfusion 5. Radiation therapy Rationale End-of-life care comprises measures to make the client as comfortable as possible. It may include measures such as repositioning and regular oral care. Palliative care is a combination of care provided when a cure is not possible for a chronic disease. Chemotherapy, radiation therapy, and blood transfusions are a part of palliative care meant to alleviate symptoms and promote well-being. These therapies may not be required in a client who is about to die and is receiving end-of-life care.

Which problems would the nurse plan to address when dealing with ethical issues specifically related to end-of-life care? Select all that apply. One, some, or all responses may be correct. 1. Clients may be unable to communicate effectively. 2. All interventions for helping the clients seem futile. 3. Clients are often unfamiliar with the concept of autonomy. 4. Multiple medications affect the cognitive ability of the clients. 5. Predictions regarding health outcomes are not always accurate.

1. Clients may be unable to communicate effectively. 2. All interventions for helping the clients seem futile. 5. Predictions regarding health outcomes are not always accurate. Rationale Clients who need end-of-life care may be unable to communicate effectively. The nurse would evaluate the ability of the client to make important decisions about care. During end-of-life care, all interventions for helping the clients may seem to be futile. As such, the caregivers, the client, and the health care workers would focus on providing palliative care. Predictions regarding health outcomes may not always be accurate. There may also be differences of opinion regarding the worth of an outcome. Clients may be unfamiliar with the concept of autonomy. As such, they may find it difficult to contradict primary health care providers and nurses. This problem is not restricted to end-of-life care situations. Clients may also face problems such as diminished cognitive ability due to the intake of multiple medications. This problem is also not limited to end-of-life care.

Place the five stages of grieving identified and described by Elisabeth Kübler-Ross in order of progression from first to last. - Bargaining - Acceptance - Denial - Anger - Depression

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance Rationale Initially when someone is coping with grief, there is a refusal to believe that the loss has occurred or is going to occur (denial), and individuals are in a state of shock. As awareness of the loss increases, people usually become angry and cannot understand why this is happening. Coping then moves into the stage of bargaining, in which the dying or grieving person attempts to avoid the loss by gaining more time. This is followed by depression, when loss and grief become undeniable. Finally, individuals may progress to the stage of acceptance after coming to terms with the loss.

An older adult says, "I regret so many of the choices l've made during my life." Which developmental conflict has the client failed to accomplish according to Erikson's psychosocial stages of development? 1. Ego integrity versus despair 2. Identity versus role confusion 3. Generativity versus stagnation 4. Autonomy versus shame and doubt

1. Ego integrity versus despair Rationale The sense of ego integrity comes from satisfaction with life and acceptance of what has been and what is. Despair reflects guilt or remorse over what might have been. During puberty adolescents attempt to find themselves and integrate their own values with those of society; an inability to solve conflict results in confusion and hinders mastery of future roles. During early and middle adulthood the individual is concerned with the ability to produce and to care for that which is produced or created; failure during this stage leads to self-absorption or stagnation. Autonomy, the ability to control the body and environment, is developed during the toddler period; doubt may result when the child is made to feel ashamed or embarrassed.

Which action would the nurse take initially to advocate for the client and achieve resolution when caring for a client with terminal cancer who desires to receive hospice care at home rather than pursue further treatment against the advice of both the health care provider and the immediate family? 1. Help the client clarify their values prioritize actions. 2. Brainstorm possible alternative solutions for this issue. 3. Empower the client to decide to resolve the situation. 4. Provide support and reassurance as the client makes decisions.

1. Help the client clarify their values prioritize actions. Rationale The nursing process as a problem-solving approach can be used by the nurse to help the client resolve value or ethically laden issues. In the first step of the process, the nurse would help the client illuminate values because values influence behaviors, feelings, and goals. Brainstorming occurs in the planning phase and helps generate alternatives. In the implementation stage, the nurse empowers the client to make decisions, providing support and reassurance.

The nurse is caring for clients who are in the terminal stage of illness. The nurse begins feeling depressed when coming to work. Which would the nurse do? 1. Talk with other nurses on the unit. 2. Take several personal days off from work. 3. Limit emotional involvement with the clients. 4. Request a transfer to another area of the hospital.

1. Talk with other nurses on the unit. Rationale Talking with nurses who cope with similar issues allows the nurse to share feelings and obtain constructive emotional support. Avoidance may provide an immediate solution, but it works only for a short time. The nurse will eventually have to work through feelings. Limiting emotional involvement with the clients avoids personal feelings about death and dying and is an unacceptable attitude when caring for dying clients. Emotional withdrawal may be perceived by the clients as rejection. The nurse will eventually have to work through feelings.

Which focus would the nurse associate with hospice care? 1. To ease the pain from illness 2. To provide curative treatment 3. To assist with activities of daily living 4. To adapt to the limitations due to an illness

1. To ease the pain from illness Rationale The focus of hospice care is palliative care to ease the pain caused by the illness. It is a system of family-centered care that allows clients to live at home with dignity. Hospice care does not provide curative treatment. The health care team follows an individualized plan of care for the client. Assisted living facilities offer long-term care for the older client in settings with a homelike environment. These facilities assist the client with activities of daily living. Rehabilitation facilities provide restorative care that helps the client adapt to the limitations caused by the illness.

Which interventions would the nurse perform while caring for an actively dying client? Select all that apply. One, some, or all responses may be correct. 1. Admit the client in hospice care. 2. Perform aggressive laboratory tests. 3. Provide client and family reassurance. 4. Keep the client undisturbed for long periods of time. 5. Offer symptom management to the client.

3. Provide client and family reassurance. 5. Offer symptom management to the client. Rationale The nurse would provide comfort care in an actively dying client. In comfort care, the nurse would reassure the client and family to reduce their emotional anxiety. The nurse would perform symptom management to improve the client's quality of life. The client should not be admitted into hospice care if the client is actively dying. A client is admitted to hospice care if death is expected within 6 months. The client may not require aggressive laboratory tests when death is imminent. The client should be repositioned as needed for comfort.

Which intervention would the nurse include as a priority action when preparing to provide grief counseling to a client? 1. Provide essential information honestly 2. Inquire about the client's spiritual beliefs 3. Know the reason why the loss happened in his or her family 4. Provide an environment for the client to express their feelings

4. Provide an environment for the client to express their feelings Rationale While counseling a grieving client, the nurse first provides an environment for the client to express feelings such as anger, fear, and guilt because this reduces emotional distress in the client. The nurse can give essential information after reducing emotional distress in the client. Inquiring about spiritual beliefs of the client is not a priority nursing intervention while providing grief counseling. The nurse can learn about the reason for the loss after reducing emotional distress in the client.

A client who recently was told by her primary health care provider that she has extensive terminal metastatic carcinoma of the breast tells the nurse that she believes an error has been made. She states that she does not have breast cancer, and she is not going to die. Which stage of death and dying is the client experiencing? 1. Anger 2. Denial 3. Bargaining 4. Acceptance

2. Denial Rationale The client has difficulty accepting the inevitability of death and is attempting to of it. In the anger stage the client strikes out with "Why me?" and "How could God do this?" types of statements. The client is angry at life and still angrier to be removed from it by death. In the bargaining stage the client tries to bargain for more time. The reality of death is no longer denied, but the client attempts to manipulate and extend the remaining time. In the acceptance stage the client accepts the inevitability of death and peacefully awaits it.

After reviewing a client's reports, the primary health care provider suggests palliative care for the client. Which conditions would qualify the client for this type of care? Select all that apply. One, some, or all responses may be correct. 1. Peptic ulcer disease 2. Chronic renal failure 3. Appendicitis 4. Congestive heart failure 5. Chronic obstructive lung disease

2. Chronic renal failure 4. Congestive heart failure 5. Chronic obstructive lung disease Rationale Palliative care aims to minimize client suffering and reduce the undesirable effects resulting from an incurable disease or condition. Disease conditions such as severe chronic renal failure, congestive heart failure, and chronic obstructive lung disease cannot be cured completely with medications, but palliative care may reduce client suffering from the beginning of the therapy to the end stages. Conditions such as peptic ulcer disease and appendicitis can be completely reversed by medications or surgery; therefore these clients do not require palliative care.

Which action would the nurse take postoperatively when providing care for a client who has a permanent biliary drainage tube (T-tube) inserted to provide palliative care? 1. Maintain intermittent low suction to limit trauma. 2. Cleanse the area around the insertion site to prevent skin breakdown. 3. Attach the tube to a negative-pressure drainage system to promote drainage. 4. Reposition the client frequently to increase the flow of bile through the tube.

2. Cleanse the area around the insertion site to prevent skin breakdown. Rationale Bile is irritating to the skin; cleansing the area around the I-tube to prevent skin breakdown is a priority. Suction is contraindicated; drainage is via gravity. The T-tube is attached to a bag for straight drainage via gravity, not suction that uses negative pressure. Repositioning the client is vital to prevent venous and pulmonary stasis, not for facilitating the drainage of bile.

Which interventions would the nurse implement for a dying client and the family? Select all that apply. One, some, or all responses may be correct. 1. Arrange for restorative care. 2. Help the family set up home care if required. 3. Refrain from telling the family that the client is dying. 4. Determine the client and family's strengths and weaknesses. 5. Arrange for church or community support for the family.

2. Help the family set up home care if required. 4. Determine the client and family's strengths and weaknesses. 5. Arrange for church or community support for the family. Rationale Because some dying clients prefer to be at home with the family during their last days, the nurse would help the family set up home care if required. The nurse would also know the client and family well enough to be able to provide client-centered care. The nurse would arrange for church or community support to help the client and family during this difficult time. A dying client may be in pain and require hospice care, not restorative care. The nurse must maintain the trust in the nurse-client relationship and prepare the family for the client's death. The nurse would inform the family about the dying process.

An older client states, "I've lived a good life. I don't want to die, but I accept it as a part of life." Which developmental task has the client achieved according to Erikson's psychosocial stages of development? 1. Identity 2. Integrity 3. Despair 4. Generativity

2. Integrity Rationale Integrity is the last stage of life, identified by the acceptance of life as lived and the inevitability of death. Identity is a developmental task of adolescence. Despair occurs when an older adult is unable to find satisfaction and peace with life and choices that were made. Generativity is a developmental task of middle-aged people.

Which action is appropriate for the registered nurse regarding assisted suicide? 1. Nurses may have an open attitude toward the client's end of life. 2. Nurses' participation in assisted suicide violates the code of ethics. 3. Nurses may listen to the client's expressions of fear and attempt to control the client's pain. 4. Nurses can participate in assisted suicide only if the individual could make an oral and written request.

2. Nurses' participation in assisted suicide violates the code of ethics. Rationale According to the American Nurses Association (ANA), the nurse's participation in assisted suicide would violate their code of ethics. According to the American Association of Colleges of Nursing (AACN) and the International Council of Nurses, the nurse may have an open attitude toward the client's end of life. According to the AACN and the International Council of Nurses, nurses may listen to the client's expressions of fear and to attempt to control the client's pain. According to the Oregon Death with Dignity Act (1994), the primary health care provider in the state of Oregon can participate in assisted suicide only if an individual with terminal disease makes an oral and written request to end life in a humane and dignified manner.

Which nursing intervention would be the priority for a client in hospice care with symptoms of dyspnea? 1. Administer benzodiazepines 2. Apply wet cloths on the client's face 3. Encourage imagery and deep breathing 4. Provide prescribed oxygen by nasal cannula

4. Provide prescribed oxygen by nasal cannula Rationale A client in the end stage of life usually experiences symptoms of dyspnea. Providing prescribed oxygen by nasal cannula is the priority nursing care, because it relieves symptoms of dyspnea and provides comfort. Benzodiazepines are administered to reduce fear and anxiety. Applying wet cloths to the client's face and encouraging imagery and deep breathing are low-priority nonpharmacological interventions that provide comfort to a client with dyspnea.

The nurse reviews the medical record of a client who is eligible to receive hospice care. Which are the criteria for a client to receive this type of care? Select all that apply. One, some, or all responses may be correct. 1. When the death of the client is imminent 2. When the expected death of the client is within 6 months 3. When the client seeks no aggressive disease management 4. When a family member has signed an informed consent form 5. When the client has been issued a "do not resuscitate" order

2. When the expected death of the client is within 6 months 3. When the client seeks no aggressive disease management 5. When the client has been issued a "do not resuscitate" order Rationale Clients who do not seek aggressive disease management and are expected to die in a span of 6 months are eligible for hospice care. The client may require hospice care when he or she has signed a "do not resuscitate" order. A client who is nearing death may not receive hospice care; instead, the client receives comfort care. An informed consent form signed by a family member is not necessary for the client to receive hospice care.

During an assessment, which client statement may indicate to the nurse that the client is experiencing spiritual distress? 1. " want to find out whether any divine force truly exists in this world." 2. "I am sure that God is with me; otherwise I could have suffered a lot more." 3. "I deserve a better life than this. I don't understand why God decided to make me ill." 4. "I wish I didn't need help with daily activities, but I am grateful the universe gave me a strong support system.

3. "I deserve a better life than this. I don't understand why God decided to make me ill." Rationale Spiritual distress is a disturbance in a client's belief system that can cause a loss of faith and an inability to experience and integrate life's meaning and purpose. The client expressing anger at God for causing an illness is questioning spirituality, which indicates the client is in spiritual distress. The client searching for a divine existence, the client who expresses faith that God is with them, and the client who is grateful for support systems are showing signs of positive spiritual health.

The nurse is educating the caregivers of an elderly adult with advanced Parkinson disease about continuing care. Which information would the nurse provide? Select all that apply. One, some, or all responses may be correct. 1. "Home care is a type of continuing care in which the primary objectives are health promotion and education." 2. "Continuing care is necessary for clients who are recovering from an acute or chronic illness or disability." 3. "Adult day care centers are ideal for clients whose caregivers have to be away from home during the day." 4. "Hospice care is a continuing care system that allows terminal clients to live at home with comfort, independence, and dignity." 5. "Nursing centers provide 24-hour custodial care to help residents achieve and maintain their highest level of functioning."

3. "Adult day care centers are ideal for clients whose caregivers have to be away from home during the day." 4. "Hospice care is a continuing care system that allows terminal clients to live at home with comfort, independence, and dignity." 5. "Nursing centers provide 24-hour custodial care to help residents achieve and maintain their highest level of functioning.' Rationale Adult day care centers are ideal for providing continuing care to clients whose caregivers have to be away from home during the day. Hospice care is a type of continuing care that provides palliative care to terminal clients within the comfort, dignity, and independence of their homes. Clients also go to nursing centers to receive continuing care. Nursing centers provide 24-hour custodial care. They help clients achieve and maintain their highest level of functioning. The primary objectives of providing restorative care are health promotion and education. Clients recovering from chronic or acute illnesses or disabilities require restorative care. Continuing care is necessary for clients who are suffering from a terminal disease, who are disabled, or who were never functionally independent.

Which statements made by a terminally ill client address primary goals regarding end-of-life (EOL) nursing care? Select all that apply. One, some, or all responses may be correct. 1. " want my children and my grandchildren to carry my casket." 2. 'I've prepaid all my funeral costs so there's no burden on my family." 3. "My living will states that I want no heroic measures to prolong life." 4. "Pain is a concern, so I've discussed that thoroughly with my doctor." 5. 'I've made arrangements to spend my final days in my own home."

3. "My living will states that I want no heroic measures to prolong life." 4. "Pain is a concern, so I've discussed that thoroughly with my doctor." 5. 'I've made arrangements to spend my final days in my own home." Rationale The goals for EOL care are to (1) provide comfort and supportive care during the dying process, (2) improve the quality of the client's remaining life, (3) help ensure a dignified death, and (4) provide emotional support to the family. A living will outlines the type of care that an individual desires when dying. Pain control is often a major area of concern. The client clearly states a desire to die at home. Actual funeral and financial arrangements are not considered topics related to EOL nursing care.

When assessing a client who is receiving palliative care, which question regarding spiritual health is correct? 1. "Are you afraid of death?" 2. "After hearing about your condition, didn't you lose faith?" 3. "What is your source of spiritual strength during hard times?" 4. "May I ask the chaplain to visit you to help you cope? "

3. "What is your source of spiritual strength during hard times?" Rationale When assessing a client who is receiving palliative care, it is appropriate for the nurse to ask about the client's source of spiritual strength during hard times. This helps the nurse understand the client's spiritual practices, facilitating quality care. The nurse would not ask about fear of death because this is not supportive. Assuming a client has lost faith as a result of diagnosis is inappropriate and unsupportive. Because not all clients identify with a religion, it is not appropriate to ask to call the hospital chaplain unless the client requests this.

A client decides to have hospice care rather than an extensive surgical procedure. Which ethical principle does the client's behavior illustrate? 1. Justice 2. Veracity 3. Autonomy 4. Beneficence

3. Autonomy Rationale The client is exhibiting the freedom to make a personal decision, and this reflects the concept of autonomy. Justice refers to fairness. Veracity refers to truthfulness. Beneficence refers to implementing actions that benefit others.

The nurse is caring for a client who has developed dysphagia and is unable to swallow. The client is receiving around-the-clock opioid pain medications for cancer pain, and hospice has recently begun to care for the client. Which is the best nursing intervention in preparing for the client's discharge? 1. Contact the client's health care provider to ask to substitute a liquid form of medications for the pill form. 2. Teach the client and family members to crush the pills and administer them with applesauce. 3. Contact the client's healthcare provider to discuss use of transdermal medications for pain control. 4. Teach the client and family members about addiction that may occur as a result of regular opioid use.

3. Contact the client's healthcare provider to discuss use of transdermal medications for pain control. Rationale The client will be discharged home with hospice, and there is no chance that dysphagia will be relieved by surgery or will improve by other measures. Considering that the client is approaching death and the client's condition is deteriorating, the transdermal route of administration of the pain medications is less invasive and provides comfort. The liquid form of pain medication or crushing the pills and administering them with applesauce is not possible because the client has dysphagia. The client is approaching the end of life and requires comfort measures; therefore, opioid addiction is not a nursing concern for the dying client.

Which information will the nurse provide to a client in a hospice home care program who is prescribed morphine? 1. Medication addiction is a concern with this medication. 2. Request the medication before the pain becomes severe. 3. Dosages of the medication will be given automatically at regular intervals around the clock. 4. Intermittent administration of the medication is possible after an intermittent lock is inserted.

3. Dosages of the medication will be given automatically at regular intervals around the clock. Rationale The medication will be given routinely to maintain a continuous therapeutic blood level to keep the terminally ill client comfortable. Addiction is not a major concern for the terminally ill client. The client should not have to request this medication; it should be given regularly. Morphine is not administered intermittently; usually, it is prescribed in liquid form and is taken orally when administered in the home.

A client with chronic renal failure stops responding to the treatment. On examination, the primary healthcare provider determines that the client is terminally ill. Which is the correct nursing intervention in this situation? 1. Provide information to the family members about getting a second opinion. 2. Suggest that the family members continue to try different treatments. 3. Encourage the family members to provide palliative care to the client. 4. Inform the family members that the disease is no longer curable and the client will die shortly.

3. Encourage the family members to provide palliative care to the client. Rationale Clients who are terminally ill and no longer respond to treatment are in need of palliative care. Palliative care promotes client comfort and provides important interventions to support the client and family in symptom management. There is no need to get a second opinion from another primary health care provider, because the client is terminally ill. Continuing to attempt different treatments until the death of the client may cause more client suffering. It is not advisable to inform the family members that the client will die soon because it may lead to emotional stress. The palliative care team will help prepare the family for the client's death.

The nurse is assisting with the end-of-life care of a client. Which activity is performed when the nurse views family as context? 1. Assess the resources available to the family. 2. Meet the client's family's comfort and nutritional needs. 3. Meet the client's comfort, hygiene, and nutritional needs. 4. Determine the family's need for rest and their stage of coping.

3. Meet the client's comfort, hygiene, and nutritional needs. Rationale When viewing family as context, the nurse mainly focuses on the client's comfort, hygiene, and nutritional needs. Family as context means focusing on the health and development of a client. When viewing family as a system, the nurse mainly focuses on assessing the resources available to the family. Family as a system includes both family as context and family as a client. When viewing family as a client, the client's family comfort and nutritional needs are focused on, and the nurse determines the family's needs for rest and their stage of coping.

A client on hospice care is receiving palliative treatment. Which is the goal of palliative care for this client? 1. Restore the client's health. 2. Promote the client's recovery. 3. Relieve the client's discomfort. 4. Support the client's significant others.

3. Relieve the client's discomfort. Rationale Palliative measures are aimed at relieving discomfort without curing the problem. A cure or recovery is not part of palliative care; with a terminal disease the other goals are unrealistic. Although support of significant others is indicated, palliative care is related directly to relieving the client's discomfort.

The primary health care provider instructs the nurse to manage fluid replacement therapy in a client with cancer. Which type of care is the client receiving? 1. Palliative care 2. Comfort care 3. Supportive care 4. End-of-life care

3. Supportive care Rationale In oncology departments, medical professionals use supportive care to improve the client's quality of life. Supportive care is based mainly on the use of medical interventions to support client health. Medical interventions during supportive care include managing fluid replacement therapy, providing blood transfusions, and administering bone marrow-stimulating agents. Palliative care, comfort care, and end-of-life care do not involve supporting client health. Instead, they focus mainly on the comfort of terminally ill clients.

Which information regarding palliative care as opposed to hospice care would the nurse provide during a home visit to a client with heart failure who asks about this option? 1. To receive palliative care, a provider must certify that you have 6 months or less to live. 2. The goal of palliative care is to humanize the end-of-life experience, allowing you to die with dignity. 3. The focus of palliative care is to enhance you and your family's quality of life despite your heart failure. 4. By making the choice to begin palliative care, you must no longer pursue life-extending or curative medical treatment.

3. The focus of palliative care is to enhance you and your family's quality of life despite your heart failure. Rationale Palliative care is specialized medical care for clients and families that focuses on quality of life. Hospice care requires that a provider certify that the client has 6 months or less to live. The goal of hospice care is to humanize the end-of-life experience, allowing the client to choose how they will die and where. Clients receiving palliative care can still opt for life-extending or curative treatment, while those receiving hospice services cannot.

A client has an intravenous (IV) solution of 5% dextrose in water (D 5W) 250 mL to which 100 mg of morphine is added. The health care provider prescribes 14 mg of morphine per hour for end-of-life palliative treatment of a client. At how many milliliters per hour will the nurse set the IV pump? Record your answer using a whole number in mL/h

35mL/h

When working with palliative care clients, which objective data is most helpful to monitor in the debilitated client with terminal liver cancer? 1. Description of the client's pain 2. Assessment of hunger 3. Inspection of bowel patterns 4. Record of daily weights

4. Record of daily weights Rationale Weight is objective information that aids in determining the extent of ascites; I L of retained fluid equals approximately 2.2 lb (1 kg). Ascites can develop in the late stages of liver cancer, and the effects of cancer and dying cause weight loss. The client's description of pain, hunger, and bowel patterns are helpful but not obiective.

An older client is able to perform activities of daily living, but has vague physical complaints and has experienced multiple deaths of friends and family and has lost their social roles. Which question is the most therapeutic? 1. "Can you cope with being alone?" 2. "Have you considered assisted living?" 3. "What is the main problem today?" 4. "How do you feel about your life now?"

4. "How do you feel about your life now?" Rationale An open-ended question is the most therapeutic invitation to encourage the client to discuss hopes and frustrations without being threatening or probing. Closed questions (Can you cope? Have you considered?) provide little information and are not the best choice for clients who need encouragement to verbalize feelings and needs. Focusing on one main problem suggests that the client must limit his communication.

Which parent is expressing anticipatory grief? 1. "My daughter died 4 years ago and I'm still crying and walking around like I'm in a dream." 2. "My 4-year-old was diagnosed with diabetes mellitus, but I'm sure she'll outgrow it." 3. "My son's treatments are painful. I'm so angry. Most days I just want to take him and run away." 4. "My son was diagnosed with terminal cancer 2 months ago and they can't stop my son from dying.

4. "My son was diagnosed with terminal cancer 2 months ago and they can't stop my son from dying. Rationale Anticipatory grief is an intellectual and emotional response to an event (e.g., death related to terminal cancer) that will happen in the future. Complicated grief is prolonged (more than 1 year) and interferes with functional ability. According to Elisabeth Kubler-Ross' phases of grief and loss, denial is the first phase and anger is the second. The parent who is sure that child will outgrow the condition is expressing denial. The parent who wants to run away is expressing anger.

Which factor is most important in predicting a person's reaction to imminent loss and grief? 1. Family interactions 2. Social support system 3. Emotional relationships 4. Earlier experiences with grief

4. Earlier experiences with grief Rationale How a person has handled grief in the past provides clues to how they will cope with grief in the present. Although family interactions, social support system, and emotional relationships are all important, they are less predictive for a client's reaction to grief.

Which intervention would the nurse use during the initial interaction with a 76-year-old widower who is terminally ill, very quiet, and unwilling to have visitors? 1. Assess what the client knows about grief and loss related to the death and the dying process. 2. Avoid talking about his health condition and isolation unless he initiates the discussion. 3. Encourage him to accept phone calls from those who are concerned and wish to visit with him. 4. Explore what he understands about his situation and what the implications mean to him.

4. Explore what he understands about his situation and what the implications mean to him. Rationale A starting point for working with all clients is ascertaining their understanding of their situation and its meaning to them. Understanding grief, loss, death, and the dying process is less important than the individual's feelings about the current situation. Encouraging conversation about health or isolation tends to decrease anxiety. If the client doesn't want visitors, then phone calls from others are meeting the needs of others, rather than the client.