Transition Exam 4
A dying patient wants to talk to the nurse. The patient states, "I know I'm dying, aren't I?" What would an appropriate nursing response be?
"This must be very difficult for you."
A patient with end-stage chronic obstructive pulmonary disease is admitted to a hospice facility and asks the admitting nurse, "How long will I be allowed to stay here?" What is the best response by the nurse?
"When your stay reaches 6 months, you will be recertified for a continued stay."
Which of the following nursing interventions should a nurse perform to promote the dignity and self-esteem of a dying client?
Keep the client clean and well groomed
Which term best describes a living will?
Medical directive
Which of the following is a term that refers to individual, family, group, and cultural expressions of grief and associated behaviors?
Mourning
When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following?
Proxy directive
Which action by the nurse demonstrates an effective method to assess the client and the client's family's ability to cope with end-of-life interventions?
Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care
A client has been declared to have a terminal illness. What intervention will a nurse perform regarding the final decision of a dying client?
Respect the client's and family members' choices
A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client?
Respect the client's and family members' choices.
The client has been diagnosed with terminal COPD. The client and the client's family have not yet agreed on the final arrangements and are discussing options. How can the nurse best intervene in these final decisions?
Respect the client's autonomy and right to determine how to spend the rest of his or her life.
Which is one level of hospice care covered under Medicare and Medicaid hospice benefits, includes a 5-day inpatient stay, and is provided occasionally to relive the family caregivers?
Respite care
Despite having been administered prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and help reduce the dyspnea?
Use imagery, humor, and progressive relaxation
When assessing a terminally ill client, the nurse notices that the client has copious secretions at the back of the throat and in the mouth. The nurse is preparing a teaching plan for the family about caring for these secretions. Which of the following would be least appropriate to include?
Using a soft toothbrush to vigorously clean the mouth
Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice. However, the median length of stay in a hospice program is just 21.3 days. Which reason explains the underuse of hospice care services?
Clients and families view palliative care as giving up
Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice. However, the median length of stay in hospice program is just 21.3 days. Which reason explains the underuse of hospice care services?
Clients and families view palliative care as giving up
Glaser and Strauss (1965) identified four "awareness contexts." Which awareness context occurs when the client is unaware of their terminal state, whereas others are aware?
Closed awareness
The family members of a dying patient are finding it difficult to verbalize feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations?
Encourage the family members to express their feelings and listen to them in their frank
A patient is diagnosed with a terminal illness and has been given less than 6 months to live. What type of referral should the nurse make to assist this patient and family at home?
Hospice
A nurse is developing a teaching plan for a terminally ill client and his family about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in teaching plan?
The stages are applicable to any loss
Which of the following should the nurse report so that the nurse report so that the team can consider alternative nutritional and fluid adminstration routes for a dying client?
Weight loss and inadequate food intake
Which of the following should the nurse report so that the team can consider alternative nutritional and fluid administration routes for a dying client?
Weight loss and inadequate food intake
A type of comprehensive care for clients whose disease is not responsive to cure is
Pallative care
Which of the following should the nurse report so that the team can consider alternative nutritional and fluid adminstration routes for a dying client
Weight loss and inadequate food intake
A nurse is assessing a terminally ill female client. Which client statement indicates that the client is in the bargaining stage of dying?
"I just want to see my daughter graduate from college. That's all."
A terminally ill patient in pain asks the nurse to administer enough pain medication to end the suffering forever. What is the best response by the nurse?
"I will notify the physician that the current dose of medication is not relieving your pain."
A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse?
"It will enable the patient to remain home if that is what is desired."
A terminally ill patient is admitted to the hospital. The patient grabs the nurse's hand and asks, "Am I dying?" What response would be best for the nurse to give?
"Tell me more about what's on your mind."
The family of a terminally ill client tells the nurse that the client has been breathing irregularly and, at times, it appears that he is not breathing at all. The client's daughter states, "He moans when he breathes, Is he in pain?" Which response by the nurse would be most appropriate.
"The moaning you hear is from air moving over very relaxed vocal cords."
The nurse is providing care to a family who is facing a life-threatening illness. The nurse is assessing how family members bond and how the family works as a team. The nurse is assessing which of the following?
Cohesion and boundaries
A nurse is providing in-home hospice care to a terminally ill client. The client experiences a medical crisis requiring monitoring and medication administration. Which level of hospice care would the nurse implement?
Continuous Care
A nurse is providing in-home hospice care to a terminally ill client. the client experiences a medical crisis requiring monitoring and medication adminstration. Which level of hospice care would the nurse implement?
Continuous Care
Which is a known as a proxy directive?
Durable power of attorney for health
A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using?
Durable power of attorney for health care
Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death?
Dusky appearance
A client with a brain tumor recently stopped radiation and chemotherapy for treatment of the cancer. The client recently reported dry mouth. Which intervention by the hospice nurse demonstrates that the nurse understands treatment measures for dry mouth?
Provide gentle oral care after each meal.
A nurse is caring for terminally ill client inquiring about physician-assisted suicide. Which statement, made by the nurse, would correctly advocate for the practice.
The physician provides the means for the clients to take their life
The nurse is caring for a client who just learned of his terminal diagnosis. After the physician leaves, the nurse remains to answer further questions so that the client can make an informed decision about further treatment. By providing all available information, the nurse is promoting which ethical principle?
The principle of autonomy
A nurse is developing a teaching plan for a terminally ill client and his family about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in the teaching plan?
The stages are applicable to any lose
Nursing students are reviewing information about the signs and symptoms of impending death. The students demonstrate the need for additional review when they identify which of the following as a sign?
Muscle wasting
Which "awareness context" is characterized by the client, family, and health care professionals understanding the client is dying, but all pretend otherwise?
Mutual pretense awareness
The nurse identifies a nursing diagnosis of Imbalanced nutrition: less than body requirements for a terminally ill client who is near the end of life. Which of the following would the nurse expect to include in the client's plan of care?
Advice for the family to have fruit juices readily available at the client's bedside.
All nurses care for clients whoa re grieving. It is important for the nurse to understanding the grieving process for which reason?
Allows for the nurse to facilitate the grieving process
Which of the following may be contained in an "emergency kit" for a hospice patient exhibiting restlessness?
Benzodiazepine
Which term refers to the period of time during which mourning of a loss takes place?
Bereavement
The family of a dying client is noticing that their loved one is short of breath, restless in bed, and appears to be trying to tell them something. which nursing intervention is appropriate at this time?
Call the physician to oobtain an antianxiety sedative
A nurse is providing in-home hospice care to a 75-year-old client with lung cancer. The nurse determines that the client is eligible for Medicare hospice benefits based on which of the following?
Client has a life expectancy of 6 months or less.
The spouse of a terminally ill client is confused by the new terminology being used during discussions regarding the client's treatment. The nurse should explain that palliative care is:
care that will reduce the client's physical discomfort and manage clinical symptoms.
Which is the initial stage of grief, according to Kübler-Ross?
denial
A 90-year-old home care client's son has been designated to make decisions regarding the client's medical care when the client is no longer able to do so. As the client nears the end of life, the son is consulted on an ever-increasing basis. What legal instrument activates the son's decision-making designation?
durable power of attorney
A mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement best communicates a spirt of hopefulness to this client?
"Let's take this one day at a time; remember you have your daughter's dance recital next month'
A terminally ill patient is admitted to the hospital. The patient grabs the nurse's hand and ask, "Am I dying?" what response would be best for the nurse to give?
"Tell me more about what's on your mind."
The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition.
End-stage renal disease
A nurse is conducting a spiritual assessment of a terminally ill client using the four step FICA process and asks the question, "What gives your life meaning?" The nurse is assessing which of the following?
Faith and belief
Which of the following is an appropriate method of assessing the dying client?
Focus on the client's basic needs.
Which of the following nursing interventions will a nurse perform to transfer heat and improve circulation in a dying client?
Gently massage the arms and legs.
Which of the following nursing interventions is appropriate with regard to pain control in the dying client?
Give pain medications on a routine schedule.
Which term is used to describe the personal feelings that accompany an anticipated or actual loss?
Grief
Which of the following is the nurse's primary concern when providing end-of-life care for a client and the family? Select all that apply.
Maintaining client comfort Supporting family members Providing personal care
As the moment of death approaches, which of the following does the nurse encourage the family to do?
speak the client in a calm and soothing
Despite having been administered prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and help reduce to dyspnea?
use imagery, humor, and progressive
A nurse is providing hospice care in Portland, Oregon to a client with terminal liver cancer. The client confides to the nurse, "I'm in agony all the time. I want this to be over now—please help me." Which interventions should the nurse implement? Select all that apply.
-Control the client's pain with prescribed medication. -Advise the client's physician of the client's condition. -Encourage the client to explain his or her wishes
A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage according to Kübler-Ross?
Anger
A client states, "My children still need me. why did I get cancer? I am only 30." This client is exhibiting which stage according to Kubler-Ross?
Anger
A nurse is providing care to a terminally ill client who follows Islamic traditions and is experiencing pain. When developing a plan of care for this client, an understanding of which of the following would the nurse need to integrate in the plan?
Pain in viewed as a means of cleansing by God
The family of a client in hospice decides to place their loved one in a long-term care facility to establish an effective pain control regimen. Which aspects of hospice care is family using?
Palliative Care
The family of a client in hospice decides to place their loved one in a long-term care facility to establish an effective pain control regimen. Which aspects of hospice care is the family using?
Palliative care
Which of the following does not coincide with Kubler-Ross's stages related to a dying client?
The dying client usually exhibits anger
A 50-year-old client is an alcoholic. The client has been diagnosed with pancreatic cancer and underwent surgery to remove the tumor. Despite the tumor being removed, the physician informs the client that chemotherapy needs to be started immediately. Using evidence-based practice, which intervention might the nurse expect the physician to include, with the goal of improving quality of life , mood and median survival.
Palliative care
Which of the following is an outcome of being frank with a dying client when informing him or her of the seriousness of the illness?
Promotes meaningful communicaiton between the client and his or her family members
A terminally ill client is receiving morphine around-the-clock for pain control. As part of the client's plan of care focusing on pain management, which nursing diagnosis would the nurse most likely identify?
Risk for constipation related to the effects of an opioid
While providing care to a client near death, the nurse is helping the family to prepare by teaching them what to expect. Which of the following would the nurse include in the teaching plan as a sign of approaching death? Select all that apply.
Gurgling as the client breathes through the mouth Decrease in amount of urine produced Refusal to ingest food or fluids
A group of nursing students is reviewing information about palliative care. The students demonstrate a need for additional review when they identify which of the following?
Palliative care is the same as hospice care.
Nursing students are reviewing information about attitudes related to death and dying. The students demonstrate understanding of the information when they identify which of the following are most accurate?
There remains a conspiracy of silence about dying despite progress in the area
Nursing students are reviewing information about attitudes related to death and dying. The students demonstrate understanding of the information when they identify which of the following as most accurate?
There remains a conspiracy of silence about dying despite progress in the area.
The client tells the doctor that he and his family have accepted the terminal diagnosis of pancreatic cancer. The client further explains that he is interested in being comfortable and that he no longer wishes to fight the cancer. This approach to end-of-life care is known as
palliative care.
