15H PALLIATIVE AND END-OF-LIFE CARE PART II

A nurse who sits on the hospital's ethics committee is reviewing a complex case that has many of the characteristics of assisted suicide. Which of the following would be an example of assisted suicide? A. Administering a lethal dose of medication to a client whose death is imminent B. Administering a morphine infusion without assessing for respiratory depression C. Granting a client's request not to initiate enteral feeding when the client is unable to eat D. Neglecting to resuscitate a client with a "do not resuscitate" order

A

The nurse is assessing a client whose spouse died 16 months ago. The client tells the nurse about joining a hiking group, volunteering as a college mentor, and thinking about dating again. The nurse determines that the client is in which stage of Rando's processes of mourning? A. Reinvestment B. Recognition of the loss C. Recollection and reexperiencing the deceased D. Relinquishing old attachments to the deceased

A

The nurse is assessing a client with end-stage liver failure for the presence of hope. What should the nurse identify as a hope-fostering category? A. Uplifting memories B. Ignoring negative outcomes C. Envisioning one specific outcome D. Avoiding an actual or potential threat

A

A medical nurse is providing palliative care to a client with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse's care? A. To improve the client's and family's quality of life B. To support aggressive and innovative treatments for cure C. To provide physical support for the client D. To help the client develop a separate plan with each discipline of the health care team

A

A client on the medical unit is dying and the nurse has determined that the family's psychosocial needs during the dying process need to be addressed. What is a cause of many client care dilemmas at the end of life? A. Poor communication between the family and the care team B. Denial of imminent death on the part of the family or the client C. Limited visitation opportunities for friends and family D. Conflict between family members

A

A medical nurse is providing end-of-life care for a client with metastatic bone cancer. The nurse notes that the client has been receiving oral analgesics for pain with adequate effect, but is now having difficulty swallowing the medication. What should the nurse do? A. Request the health care provider to prescribe analgesics by an alternative route. B. Crush the medication in order to aid swallowing and absorption. C. Administer the client's medication with the meal tray. D. Administer the medication rectally.

A

The nurse is admitting a client with a diagnosis of ovarian cancer. The client has just been told that her ovarian cancer is terminal. What question should the nurse include in a spiritual assessment of the client? A. "Can you tell your family about negative test results?" B. "Do you have a sense of peace of mind and a purpose to your life?" C. "Can you let go of her spouse so the spouse can start a new life?" D. "Do you need time and space to bargain with God for a cure?"

B

The nurse learns that a computed tomography scan a client underwent to investigate new seizure activity revealed a brain tumor. When the client later asks about the results of the scan, which therapeutic response should the nurse give the client? A. "No, I have not seen the report." B. "What is your understanding of your condition?" C. "Yes, but I can't discuss the results with you." D. "Try not to worry; the doctor will be in later to talk with you."

B

The nurse has observed that an older adult client with a diagnosis of end-stage kidney disease seems to prefer to have the client's eldest child make all of the health care decisions. While the family is visiting, the client explains that this is a cultural practice and very important that it occurs. How should the nurse best handle this situation? A. Privately ask the child to allow the client to make the health care decisions. B. Explain to the client that the client is responsible for all decisions. C. Work with the team to negotiate informed consent. D. Avoid divulging information to the eldest child.

C

A client with cancer has just been told that the disease is now terminal. The client tearfully states, "I can't believe I am going to die. Why me?" What is the nurse's best response to elicit more information from the client? A. "I know how you are feeling." B. "You have lived a long life; that should bring you peace." C. "Tell me more about how you feel about this news." D. "Life can be so unfair."

C

A client is in a hospice receiving palliative care for lung cancer which has metastasized to the client's liver and bones. For the past several hours, the client has been experiencing dyspnea. What nursing action is most appropriate? A. Administer a bolus of normal saline, as prescribed. B. Initiate high-flow oxygen therapy. C. Administer high doses of opioids. D. Administer bronchodilators and corticosteroids, as prescribed.

D

A client with cancer, who has just learned that the cancer has spread to distant organs, tells the nurse, "I am not sure how many more treatments I can put up with." The nurse responds by saying, "You have been through so many treatments for your cancer." Using the NURSE framework for responding to emotions, which empathic response did the nurse use? A. NAME the emotion B. SUPPORT the client C. EXPLORE the emotion. D. UNDERSTAND the emotion

D

In recent decades, nursing has moved into the forefront in providing care for the dying. Which phenomenon has most contributed to this increased focus of care of the dying? A. Increased incidence of infections and acute illnesses B. Increased focus of health care providers on disease prevention C. Larger numbers of people dying in hospital settings D. Demographic changes in the population

D

After caring for several clients who died in the hospital, the nurse has identified some lapses in the care that many of these clients received toward the end of their lives. What have research studies identified as a potential deficiency in the care of the dying in hospital settings? A. The perception that palliative care constitutes "giving up." B. Clients are too sedated to achieve adequate pain control. C. Clients are not given opportunities to communicate with caregivers. D. Clients are ignored by the care team toward the end of life.

A

An adult oncology client has a diagnosis of bladder cancer with metastasis and the client has asked the nurse about the possibility of hospice care. Which principle is central to a hospice setting? A. The client and family should be viewed as a single unit of care. B. Persistent symptoms of terminal illness should not be treated. C. Each member of the interdisciplinary team should develop an individual plan of care. D. Terminally ill clients should die in the hospital whenever possible.

A

The nurse is assessing a 73-year-old client who was diagnosed with metastatic prostate cancer. The nurse notes that the client is exhibiting signs of loss, grief, and intense sadness. Based on this assessment data, the nurse will document that the client is most likely in what stage of death and dying? A. Depression B. Denial C. Anger D. Resignation

A

The nurse is caring for a client who has terminal lung cancer and is unconscious. Which assessment finding would most clearly indicate to the nurse that the client's death is imminent? A. Mottling of the lower limbs B. Slow, steady pulse C. Bowel incontinence D. Increased swallowing

A

The nurse is describing palliative care and hospice services to a client with end-stage congestive heart failure. The client and family have many questions about the differences between palliative care and hospice. Which statement should the nurse provide the family? A. "Hospice is the application of palliative care at the end of life." B. "Palliative care requires hospitalization." C. "Hospice occurs in a facility with specially trained staff." D. "Curative care can continue in hospice."

A

A nurse on a medical unit in the hospital often provides palliative care to clients with a variety of diagnoses. Which activities describe the primary palliative care functions of this nurse? Select all that apply. A. Provides assessment of symptoms B. Manages basic nursing problems C. Handles difficult conversations with clients D. Uses therapeutic communication skills with clients E. Identifies multifactorial symptoms

A B D

Which issue has most often presented challenging ethical issues, especially in the context of palliative care? A. Increased cultural diversity B. Staffing shortages in health care and questions concerning quality of care C. Increased costs of health care coupled with inequalities in access D. Ability of technology to prolong life beyond meaningful quality of life

D