CHAPTER 13 BAH

a) Continuous care Pg. 373 Continuous care is provided in the home for management of medical crisis. Routine home care would be used to provide the usual services to a client, such as nursing care, medical social services, counseling, home health aide/homemaker services, and various therapies. Inpatient respite care would be used for a 5-day stay to provide relief for family caregivers. General inpatient care is used for symptom management that cannot be provided in the home.

1. 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? a) Continuous care b) General inpatient care c) Inpatient respite care d) Routine home care

a) Respect the client's and family members' choices Pg. 369 In the final decisions of a dying client, the nurse will present options for terminal care and respect the client's and family members' choices. Sharing emotional pain is a role in providing care and comfort to dying clients and their families. When the client has a living will, physicians must abide by the client's wishes. The nurse should ask the family members about spiritual care only if the client wants someone associated with his or her religion.

10. A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client? a) Respect the client's and family members' choices b) Abide by the dying client's wishes c) Ask the family members about spiritual care d) Share emotional pain

b) Avoiding criticizing or giving advice Pg. 382-383 The nurse should listen in a nonjudgmental manner and should avoid criticizing or giving advice during the grieving period when caring for dying clients. Allowing a period of privacy is necessary to help family members cope with the death of a client and is not necessary during the grieving period. Spending time with the client and providing palliative care are not required nursing interventions during the grieving period. Palliative care is provided to a dying client when the client is unable to live independently.

11. Which intervention should a nurse perform during the grieving period when caring for a dying client? a) Providing palliative care b) Avoiding criticizing or giving advice c) Allowing a period of privacy d) Spending time with client

a) Dusky appearance Pg. 381 The body becomes dusky or bluish, waxen-appearing, and cool; blood darkens and pools in dependent areas of the body, and urine and stool may be evacuated.

20. Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death? a) Dusky appearance b) Increased body temperature c) Flushed appearance d) Absence of incontinence

a) Use imagery, humor, and progressive relaxation Pg. 378-379 Imagery, humor, and progressive relaxation are the various techniques to potentiate the effects of pain medication. Offering small amounts of nourishment frequently will not help potentiate the effects of pain medication. Gentle massaging of the arms and legs helps to regulate body temperature. Encouraging the client to fall asleep will not help potentiate the effects of pain medication.

31. In spite of administering the 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? a) Use imagery, humor, and progressive relaxation b) Gently massage the arms and legs c) Offer small amounts of nourishment frequently d) Encourage the patient to sleep

b) Client's goals Pg. 376-377 When managing the symptoms of a client with a terminal illness, the client's goals take precedence over the clinician's goals to relieve all symptoms at all costs. Although the length and invasiveness of the treatment may influence decision making, ultimately it is the client's goals that determine what will be done.

32. A nurse is providing care to a client experiencing symptoms associated with terminal illness. Which of the following would be most appropriate to use as a means for managing the client's symptoms? a) Length of required treatment b) Client's goals c) Physician's orders d) Invasiveness of the treatment

d) Durable power of attorney for health care Pg. 376 A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. The other options are incorrect.

33. Which is also known as a proxy directive? a) Medical directive b) Treatment directive c) Living will d) Durable power of attorney for health care

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. Depression Rationale: Loss, grief, and intense sadness indicate depression. Denial is indicated by the refusal to admit the truth or reality. Anger is indicated by rage and resentment. Acceptance is indicated by a gradual, peaceful withdrawal from life. P 381

c) Care that will reduce the client's physical discomfort and manage clinical symptoms Pg. 368-369 Palliative care is used in conjunction with other end-of-life treatments and has many principles. Its aim is to reduce physical discomfort and other distressing symptoms but does not alter a disease's progression. Palliative care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life. Palliative care of a terminally ill client not only provides relief from pain and other distressing symptoms but it integrates other facets of patient care as well, including psychological and spiritual aspects. Palliative care is part of hospice care.

12. 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: a) Offered to terminally ill clients who wish to remain in their homes in lieu of hospice care b) An alternative therapy that uses massage and progressive relaxation for pain relief c) Care that will reduce the client's physical discomfort and manage clinical symptoms d) Care that is provided at the very end of an illness to ease the dying process

c) Focus on the client's basic needs Pg. 386 Initially, nurses focus assessment on the client's basic physical needs, such as pain, breathing, nutrition, hydration, and elimination. The other options are inappropriate in the assessment of the dying client.

13. Which of the following is an appropriate method of assessing the dying client? a) Repeat assessments as necessary b) Stimulate the client every 30 minutes c) Focus on the client's basic needs d) Sedate the client before completing range-of-motion exercises

c) Participating in assisted suicide violates the Code of Ethics for Nurses Pg. 387 The American Nurses Association Position Statement on Assisted Suicide acknowledges the complexity of the assisted suicide debate but clearly states that nursing participation in assisted suicide is a violation of the Code for Nurses. Legally, nurses are not allowed to administer medications even if prescribed by a physician if that medication will hasten the client's end of life. Proponents of physician-assisted suicide argue that terminally ill people should have a legally sanctioned right to make independent decisions about the value of their lives and the timing and circumstances of their deaths. However, this is not the case at the present time. Two states have enacted legislation for physician-assisted suicide. These laws provide access to physician-assisted suicide by terminally ill clients under very controlled circumstances

14. A nurse is caring for a client with a terminal illness. The client asks the nurse to help him end his own life to alleviate his suffering and that of his family. When responding to the client, the nurse integrates knowledge of which of the following? a) Most states have enacted laws that allow for physician-assisted suicide b) A client has the right to make independent decisions about the timing of his or her death c) Participating in assisted suicide violates the Code of Ethics for Nurses d) Nurses may administer medications prescribed by physicians to hasten end of life

d) Denial Pg. 384 The stages of grief include denial, anger, bargaining, depression, and acceptance. Anger is the second stage of the process. Bargaining is the third stage of the process. Depression is the fourth stage of the process.

15. Which is the initial stage of grief, according to Kübler-Ross? a) Bargaining b) Anger c) Depression d) Denial

c) "This must be very difficult for you" Pg. 382 Using open-ended questions allows the nurse to elicit the patient's and family's concerns, explore misconceptions and needs for information, and form the basis for collaboration with physicians and other team members. For example, a seriously ill patient may ask the nurse, "Am I dying?" The nurse should avoid making unhelpful responses that dismiss the patient's real concerns or defer the issue to another care provider. In response to the question "Am I dying?" the nurse could establish eye contact and follow with a statement acknowledging the patient's fears ("This must be very difficult for you") and an open-ended statement or question ("Tell me more about what is on your mind").

16. 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? a) "Let me explain to you what is happening" b) "I'm so sorry. I know how you must feel" c) "This must be very difficult for you" d) "You know you're dying?"

c) "When your stay reaches 6 months, you will be recertified for a continued stay" Pg. 372 Federal rules for hospices require that eligibility be reviewed periodically. Patients who live longer than 6 months under hospice care are not discharged, provided that their physician and the hospice medical director continue to certify that they are terminally ill with a life expectancy of 6 months or less (assuming that the disease continues its expected course).

17. 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? a) "You will be able to stay for 2 months before being discharged" b) "You will be able to stay only for approximately 1 month and then you will be discharged" c) "When your stay reaches 6 months, you will be recertified for a continued stay" d) "There is no time limit for your stay. You can stay until you die"

d) Palliative sedation Pg. 386 Effective control of symptoms can be achieved under most conditions; however, some clients may experience distressing, intractable symptoms and other clients may be incapacitated. Although palliative sedation remains controversial, it is offered in some settings to clients who are close to death or who have symptoms that do not respond to conventional pharmacologic and nonpharmacologic approaches, resulting in unrelieved suffering. Palliative sedation is distinguished from euthanasia and physician-assisted suicide in that the intent of palliative sedation is to relieve symptoms, not to hasten death. Proportionate palliative sedation uses the minimum drug necessary to relieve the symptom while preserving consciousness, whereas palliative sedation induces unconsciousness, which is more controversial. Barbiturate coma is a technique used to induce a coma in clients with specific conditio

18. A client with a terminal illness who is incapacitated is experiencing intractable pain that is no longer effectively addressed by conventional pharmacology. Which type of pain management will the nurse anticipate for this client? a) Conscious sedation b) Patient-controlled analgesia c) Barbiturate coma d) Palliative sedation

a) Codeine Pg. 376-377 Morphine is a potent narcotic that relieves pain and diminishes anxiety, thus managing respirations. Concentrated morphine solution can be very effectively delivered by the sublingual route, because the small liquid volume is well tolerated even if swallowing is not possible.

19. A hospice nurse should be aware that the most effective pain medication used at the end of life that also relieves dyspnea and anxiety is which of the following? a) Codeine b) Demerol c) Percodan d) Morphine

c) "I just want to see my daughter graduate from college. That's all" Pg. 384 Bargaining is manifested by pleading for more time to reach an important goal. This is reflected in the client's statement about wanting to see her daughter's college graduation. The statement about going to get a second opinion reflects denial. The statement about why reflects anger. The statement about not knowing how the husband will manage reflects the depression stage.

2. A nurse is assessing a terminally ill female client. Which client statement indicates that the client is in the bargaining stage of dying? a) "I can't believe this. I'm going to get a second opinion" b) "I don't know how my husband is going to manage things when I'm gone" c) "I just want to see my daughter graduate from college. That's all" d) "Why is this happening to me. I've led a good life. Why is God punishing me?"

a) There remains a conspiracy of silence about dying despite progress in the area Pg. 388 Despite the progress on many fronts associated with attitudes toward death and dying, there still is a belief in a conspiracy of silence about dying. Although a growing number of clinicians are becoming more comfortable with assessing clients' and families' information needs, many still avoid the topic in the hope that the client will ask or find out on his or her own. In addition, there are misconceptions that clients would subsequently lose all hope, give up, or be psychologically harmed by disclosure of a serious or terminal illness and that clients would ask for information if they really wanted to know.

21. 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? a) There remains a conspiracy of silence about dying despite progress in the area b) Clients would ask for information if they really had a desire to know c) Clients, for the most part, would gain hope if they were told about a poor prognosis d) Most clinicians are very open to talking about disease and dying with clients

a) Encourage the family members to express their feelings and listen to them in their frank communication Pg. 386-388 Family members usually find it difficult to communicate frankly with a dying person. By encouraging family members to express their feelings and listening to them as they frankly communicate, you may help family members feel more prepared to carry on a similarly honest dialogue with the dying client. It is not advisable for the nurse to encourage conversations about the impending death of the client. Being a silent observer or encouraging the family members to spend time with the dying client may not help the family members to express their feelings.

22. The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which nursing interventions should a nurse perform in such a situation? a) Encourage the family members to express their feelings and listen to them in their frank communication b) Encourage conversations about the impending death of the client c) Be a silent observer and allow the client to communicate with the family members d) Encourage the client's family members to spend time with the client

b) End-stage renal disease Pg. 155 Certain illnesses require advanced technology for survival, or intensive care for periods of weeks or months, as in end-stage renal disease (ESRD). People with this condition are chronically critical and progressively ill. Some chronic illnesses have little effect on quality of life, but others, like ESRD, have a considerable effect because it can result in a chronic progressive deterioration.

23. 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. a) Type 2 diabetes mellitus b) End-stage renal disease c) Coronary artery disease d) Carcinoma-in-situ

c) Durable power of attorney for health care Pg. 376 A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. It allows another individual to make medical decisions on the client's behalf. The other options are incorrect.

30. 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? a) End-of-life treatment directive b) Medical directive by proxy c) Durable power of attorney for health care d) Living will declaration

a) Durable power of attorney for health care Pg. 376 A durable power of attorney (DPOA) for health care or healthcare proxy is the person the client designates to make medical decisions on the client's behalf when the client no longer can do so. It allows competent clients to identify exactly what life-sustaining measures they want to be implemented, avoided, or withdrawn and offers reassurance that others will carry out their wishes. Power of attorney is a legal term used in a different context. A living will is a written or printed statement describing a person's wishes concerning medical care and life-sustaining treatments that are wanted or unwanted in the event that a person is unable to personally make those decisions. Although a living will describes a person's wishes, it does not designate decision-making power to another person in the same was as a DPOA. Designated signer is not a term used in healthcare.

24. 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? a) Durable power of attorney for health care b) Power of attorney c) Designated signer d) Living will

d) Ask the client to rate the dyspnea on a scale of 0 to 10 Pg. 378 The most appropriate method for assessing the severity of the client's dyspnea is to have the client rate the severity using a scale from 0 to 10, with 0 indicating no dyspnea and 10 indicating the worst imaginable dyspnea. This provides an objective indicator of the severity. Asking the client to identify the complaint as mild, moderate, or severe, although somewhat helpful, is not the best means for assessing the severity because these terms are difficult to quantify. Questioning the client about easing or worsening of the complaint would be helpful to determine the possible underlying cause and obtain a more complete picture of the complaint, but it would not help determine severity. Dyspnea can occur for many reasons, including anxiety and fear. Therefore, auscultating the lungs would provide information only about respiratory involvement as a

25. A nurse is providing care to a terminally ill client who is experiencing dyspnea. Which of the following would be most appropriate to do to assess the severity of the client's complaint? a) Auscultate the client's lung sounds for changes b) Question the client about when the dyspnea eases or worsens c) Have the client state if the dyspnea is mild, moderate, or severe d) Ask the client to rate the dyspnea on a scale of 0 to 10

a) Advice for the family to have fruit juices readily available at the client's bedside Pg. 386 To promote nutrition in the terminally ill, the nurse would encourage the family to have fruit juices and milkshakes readily available at the bedside so that the client can access them frequently. Cool foods may be better tolerated than hot foods. Cheese, eggs, peanut butter, mild fish, chicken, and turkey are often better choices than meat such as beef that may taste bitter and unpleasant. Meals should be scheduled when family members are present to provide company and stimulation.

26. 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? a) Advice for the family to have fruit juices readily available at the client's bedside b) Suggestions that the family offer the client foods that are hot c) Arrangements for the client to eat meals while others are out of the home d) Encouragement of the family to serve the client meat, especially beef

c) Administer pain medication on a schedule that prevents pain from intensifying Pg. 377-378 Pain management is the most common concern for the dying patient. Medication should be given on a PRN schedule that keeps the patient comfortable.

27. Based on the most common concern of a dying patient, the hospice nurse should: a) Position the patient to prevent difficulties with breathing b) Offer supplemental fluids to prevent dehydration c) Administer pain medication on a schedule that prevents pain from intensifying d) Turn the patient every 2 hours to prevent decubitus ulcers

d) Weight loss and inadequate food intake Pg. 386 The nurse should report weight loss and inadequate food intake so that the team can consider adding appetite stimulants and the nutritionist can alter the meal plan to give more satisfying meals as a comfort measure. The nurse knows that changes of gastrointestinal function such as irregular eating or bowel changes occur as part of the dying process and are not relevant to the desired intervention. Deteriorating vital signs are part of the dying process so that these signs are not relevant to the desired intervention.

28. A nurse is evaluating a client with a terminal illness. What should the nurse report so that the health care team can consider alternative nutritional approaches and fluid administration routes for the client at the end of life? a) Altered gastrointestinal function b) Drop in blood pressure and rapid heart rate c) Irregular eating habits d) Weight loss and inadequate food intake

b) Anger Pg. 384 Anger is the second stage and is exhibited by statement similar to "Why me?" Denial occurs when the person refuses to believe certain information. Bargaining is an attempt to postpone death. During the acceptance stage, the dying clients accept their fate and make peace spiritually and with those to whom they are close.

29. 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? a) Acceptance b) Anger c) Bargaining d) Denial

b) Clients and families view hospice care as giving up Pg. 372-373 Clients often equate hospice with giving up and are reluctant to accept hospice care. Lack of fully credentialed and trained hospice nurses is not a barrier to hospice care. Lack of Medicare funding and lack of certification for hospice service providers have not been documented as barriers to access of hospice services.

3. 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? a) Lack of Medicare/Medicaid funding for hospice b) Clients and families view hospice care as giving up c) Difficulty obtaining Medicare certification for hospice services d) Lack of fully credentialed and trained hospice nurses

a) "The moaning you hear is from air moving over very relaxed vocal cords" Pg. 379 As a client approaches death, certain signs appear. The family is reporting irregular breathing with periods of apnea. The moaning that they hear reflects the sound of air passing over very relaxed vocal cords. It does not signify pain or distress. Therefore, no additional pain medication would be needed. Secretions collecting at the back of the throat are noted by a rattling or gurgling sound. Decreased oxygen to the brain would lead to confusion, which may be reported by the client as strange dreams or visions.

34. 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? a) "The moaning you hear is from air moving over very relaxed vocal cords" b) "His moaning does indicate pain, so we'll increase his pain medication" c) "He has secretions that are collecting at the back of the throat" d) "He is getting less oxygen to the brain, so the moaning means he is dreaming"

d) Speak to the client in a calm and soothing voice Pg. 382 Sight and touch diminish as the client approaches death; however, hearing tends to remain intact. Speaking to the client calmly is most appropriate.

35. As the moment of death approaches, which of the following does the nurse encourage the family to do? a) Lie next to the client and hold the client b) Rub the client's hand and arm to comfort the client c) Have the family sit in front of the client so they can be seen d) Speak to the client in a calm and soothing voice

b) "Let's take this one day at a time; remember you have your daughter's dance recital next week" Pg. 382 Helping a client to find reasons to live and look forward to events promotes positive attitudes and ability to live for the moment, which in turn communicates a spirit of hopefulness. The statement about a second opinion is inappropriate because it gives the client false hope that her current diagnosis is inaccurate. Although he client may choose another medical opinion, she needs to come to that decision without the nurse's advice. Reponses should not convey false hope to the client. Nurses and clients should not confuse hope with unrealistic optimism.

4. A mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement best communicates a spirit of hopefulness to this client? a) "You should seek a second medical opinion about your diagnosis" b) "Let's take this one day at a time; remember you have your daughter's dance recital next week" c) "I believe that you will fight hard to beat this and see your babies grow up" d) "I know another client with the same diagnosis who has been in remission for 10 years"

d) Call the health care provider to obtain an oxygen order Pg. 377-378 Obtaining an oxygen order can reduce the client's shortness of breath and help the family feel more comfortable. It is difficult for families to see the client with shortness of breath. The dying client and family need support, and the bedpan, sitting in a chair, or offering sips to drink do not address the feelings of shortness of breath.

5. A family of a dying client reports that their loved one is experiencing more shortness of breath. Which nursing intervention is most appropriate at this time? a) Get the client out of bed to the chair b) Offer the bedpan to urinate or defecat c) Offer the client sips to drink d) Call the health care provider to obtain an oxygen order

d) Add haloperidol to the client's treatment plan Pg. 381 Haloperidol may reduce hallucinations. Radiation therapy helps prevent cellular growth. It may be used to cure the cancer or to control malignancy when the tumor cannot be removed or when lymph node involvement is present, and it can be used prophylactically to prevent spread. Biopsy is used to analyze the lymph nodes or to destroy the tissues surrounding the tumor.

6. The physician is attending to a 72-year-old client with a malignant brain tumor. Family members report that the client rarely sleeps and frequently reports seeing things that are not real. Which intervention is an appropriate request for the hospice nurse to suggest to the physician? a) Obtain a biopsy to analyze the lymph nodes b) Begin radiation therapy to prevent cellular growth c) Perform surgery to remove the tumor from the brain d) Add haloperidol to the client's treatment plan

d) The response experienced by anyone who has suffered a loss Pg. 384-385 Grief refers to the universal response to any loss. It is experienced by anyone suffering any type of loss. Loss is part of the life cycle and occurs in the form of change, growth, and transition. Spirituality refers to the feeling of connectedness with self, others, a life force, or God that allows people to find meaning in life. Anxiety refers to feelings of apprehension or worry in response to or about a situation.

7. When describing the term "grief" to a group of students, which of the following would the instructor include? a) A part of the life cycle in the form of change, growth, and transition b) Feelings of apprehension or worry in response to a situation c) A feeling of connectedness with one's self and others d) The response experienced by anyone who has suffered a loss

a) Increased restlessness Pg. 376-380 As the oxygen supply to the brain decreases, the patient may become restless. As the body weakens, the client will sleep more and begin to detach from the environment. For many clients, refusal of food is an indication that they are ready to die. Based on decreased intake, urinary output generally decreases in amount and frequency.

8. For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death? a) Increased restlessness b) Increased urinary output c) Increased eating d) Increased wakefulness

a) Allows for the nurse to facilitate the grieving process Pg. 384-386 Grieving is a painful yet normal reaction that helps clients cope with loss and leads to emotional healing. The nurse is responsible for facilitating the grieving process and helping the client and family deal with their emotions.

9. All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason? a) Allows for the nurse to facilitate the grieving process b) Allows for the nurse to understand when the grieving process should be concluded c) Allows for the nurse to take the client through in the appropriate order d) Allows the nurse to express his or her feelings

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. "Hospice is the application of palliative care at the end of life." Rationale: Palliative care focuses on symptom management and quality of life in clients with serious symptoms and life-limiting diseases. Hospice is a type of palliative care that focuses on comfort at the end of life. Palliative care can take place in a number of settings; it does not need to take place in the inpatient hospital setting. Hospice care may also occur in a variety of settings, or it can take place in a client's home without the need for a special facility. The client in hospice care is no longer receiving curative treatment. P 372

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. Administering a lethal dose of medication to a client whose death is imminent Rationale: Assisted suicide refers to providing another person the means to end his or her own life. This is not to be confused with the ethically and legally supported practices of withholding or withdrawing medical treatment in accordance with the wishes of the terminally ill individual. The other listed options do not fit this accepted definition of assisted suicide. P 387

The nursing director of a hospice program has observed increasing levels of emotional exhaustion and poor work performance in the nursing staff and believes the staff are suffering from burnout. Which actions can the nursing director take to reduce burnout in the nursing staff? Select all that apply. A. Encourage a work-life balance. B. Support autonomy for nurses in decision-making. C. Assist nurses in identifying personal strengths. D. Mandate personal leave days after a client dies. E. Develop programs to increase nurse resilience.

A. Encourage a work-life balance. B. Support autonomy for nurses in decision-making. C. Assist nurses in identifying personal strengths. E. Develop programs to increase nurse resilience. Rationale: Burnout in nursing staff may occur in the hospice setting, where death, grief, and loss are expected outcomes of client care. Burnout leads to emotional exhaustion, cynicism, and ineffectiveness in care. Interventions to reduce burnout include developing a balance between work and personal life, promoting nurse autonomy, identifying personal strengths, and encouraging participation in programs that increase resiliency. Mandating personal leave days does not promote nurse autonomy in decision-making or use of personal judgement. P 389

A nurse who provides care on an acute medical unit has observed that health care providers are frequently reluctant to refer clients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply. A. Financial pressures on health care providers B. Client reluctance to accept this type of care C. Strong association of hospice care with prolonging death D. Advances in "curative" treatment in late-stage illness E. Ease of making a terminal diagnosis

A. Financial pressures on health care providers B. Client reluctance to accept this type of care D. Advances in "curative" treatment in late-stage illness Rationale: Health care providers are reluctant to refer clients to hospice, and clients are reluctant to accept this form of care. Reasons include the difficulties in making a terminal prognosis (especially for those clients with noncancer diagnoses), the strong association of hospice with death, advances in "curative" treatment options in late-stage illness, and financial pressures on health care providers that may cause them to retain rather than refer hospice-eligible clients. P 373

The nurse is admitting a client to palliative care and notices that the client has health care provider orders for life-sustaining treatment (POLST). Which concepts regarding POLST will the nurse use to develop a plan of care for this client? Select all that apply. A. It can be used in any health care setting. B. It names the durable power of health care attorney. C. It specifies preferences for artificial nutrition and hydration. D. It expresses the client's wishes toward cardiopulmonary resuscitation (CPR). E. It specifies the client's preferences for funeral arrangements.

A. It can be used in any health care setting. C. It specifies preferences for artificial nutrition and hydration. D. It expresses the client's wishes toward. Rationale: POLST is a form that translates client's preferences expressed in advance directives into medical orders that are transferable across settings. The POLST form specifies client preferences related to CPR, intubation, artificial nutrition and hydration, antibiotics, and other medical interventions. The durable power of attorney for health care is a legal document authorizing another individual to make medical decisions on behalf of the client when the client is no longer able to make these decisions and is not specified on the POLST form. POLST does not specify a client's wishes for funeral arrangements. P 376

A client with end-stage kidney disease who immigrated to the United States several years ago is receiving care from family at home. When discussing the option of hospice care with a health care provider, the client and family explain through an interpreter that they do not want hospice care. Which factors are potential barriers to care for this client and family? Select all that apply. A. Lack of an understanding of hospice care B. A language barrier C. Mistrust of the health care system D. Wanting to care for the client at home E. Uncertainty about how long the client will live

A. Lack of an understanding of hospice care B. A language barrier C. Mistrust of the health care system Rationale: Historical mistrust of the health care system and unequal access to even basic medical care may underlie the beliefs and attitudes among ethnically diverse populations. In addition, lack of education or knowledge about end-of-life care treatment options and language barriers influence decisions among many socioeconomically disadvantaged groups. Because the goal of hospice is to enable the client to be at home, the family wanting to care for the client at home is not a barrier. Uncertainty about the time until death in a client in the end stages of a terminal disease is not a barrier to a client entering hospice. P 382

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. Mottling of the lower limbs Rationale: The time of death is generally preceded by a period of gradual diminishment of bodily functions in which increasing intervals between respirations, weakened and irregular pulse, and skin color changes or mottling may be observed. The client will not be able to swallow secretions, so suctioning, frequent and gentle mouth care, and possibly the administration of a transdermal anticholinergic drug are appropriate actions. Bowel incontinence may or may not occur. P 377

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. Poor communication between the family and the care team Rationale: Many dilemmas in client care at the end of life are related to poor communication between team members and the client and family, as well as to failure of team members to communicate with each other effectively. Regardless of the care setting, the nurse can ensure a proactive approach to the psychosocial care of the client and family. Denial of death may be a response to the situation, but it is not classified as a need. Visitation should accommodate wishes of the family member as long as client care is not compromised. P 369

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. Provides assessment of symptoms B. Manages basic nursing problems D. Uses therapeutic communication skills with clients Rationale: A primary palliative care nurse uses fundamental nursing skills to care for clients in palliative care, such as basic assessment of symptoms, management of basic care, and use of therapeutic communication skills. A nurse who is a specialist in palliative care assesses and manages complex and multifactorial symptoms and engages in difficult end-of-life conversations with clients and families. P 369

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. Reinvestment Rationale: Rando identified six processes of mourning that involve the detachment from ties that bind the mourner to the deceased and learning to live in a world without the deceased. By engaging in new activities and forming emotional attachments to new people, the client is reinvesting in a life without the spouse. Recognizing the loss refers to acknowledging the death of the spouse. Recollection and reexperiencing involve reviewing and reminiscing about the deceased spouse and the relationship. Relinquishing old attachments to the spouse involves letting go of the attachment to an old way of life. P 385

The family of a client receiving palliative care for end-stage congestive heart failure is upset that the client is not eating. Which intervention should the nurse recommend to the family? A. Remove unpleasant odors and sights during meals. B. Withhold antiemetics prior to a meal. C. Coax and cajole the client to eat more. D. Weigh the client daily to assess for weight gain.

A. Remove unpleasant odors and sights during meals. Rationale: To make food more palatable, the nurse should teach the family to remove any unpleasant odors (such as trash cans) and unpleasant sights (such as a bedpan) from the eating area. If the client is nauseated, administering antiemetics may help the client feel better and improve appetite. The nurse should also teach the family not to pressure the client to eat, because a lack of appetite is normal at the end of life. There is no need to weigh the client daily because weight gain is not a goal of palliative care. P 380

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. Request the health care provider to prescribe analgesics by an alternative route. Rationale: A change in medication route is indicated and must be made by a health care provider's prescription. Many pain medications cannot be crushed and given to a client. Giving the medication with a meal is not going to make it any easier to swallow. Rectal administration may or may not be an option. P 378

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 client and family should be viewed as a single unit of care. Rationale: Hospice care requires that the client and family be viewed as a single unit of care. The other listed principles are wholly inconsistent with the principles of hospice care. P 372

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. The perception that palliative care constitutes "giving up." Rationale: One of the principal objections to palliative care is that palliative care is equated with "giving up." Oversedation, lack of communication, and lack of care are not noted to be deficiencies to the same degree. P 389

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. To improve the client's and family's quality of life Rationale: The goal of palliative care is to improve the client's and the family's quality of life. The support should include the client's physical, emotional, and spiritual well-being. Each discipline should contribute to a single care plan that addresses the needs of the client and family. The goal of palliative care is not aggressive support for curing the client. Providing physical support for the client is also not the goal of palliative care. Palliative care does not strive to achieve separate plans of care developed by the client with each discipline of the health care team. P 368

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. Uplifting memories Rationale: Hope is a multidimensional construct that provides comfort as a person endures life threats and personal challenges. Uplifting memories are noted as a hope-fostering category, whereas the other listed options are not identified as such. P 382

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. "Do you have a sense of peace of mind and a purpose to your life?" Rationale: In addition to assessment of the role of religious faith and practices, important religious rituals, and connection to a religious community, the nurse should further explore with the client the presence or absence of a sense of peace of mind and purpose in life; other sources of meaning, hope, and comfort; and spiritual or religious beliefs about illness, medical treatment, and care of the sick. Telling the client's family and letting her spouse move on are not parts of a spiritual assessment. Bargaining is a stage of death and dying, not part of a spiritual assessment. P 383

The nurse is caring for a client who is having difficulty adjusting to a terminal diagnosis. The nurse notes the client's tears and sits down by the bedside. The client tells the nurse, "There are so many things I still want to accomplish." Which response would be most therapeutic and appropriate for the nurse to make? A. "Can I give you some advice?" B. "Tell me what's most important to you now." C. "Do you want me to call the chaplain?" D. "I have cared for lots of clients in your position. It will get easier."

B. "Tell me what's most important to you now." Rationale: Asking the client what is most important at this point in life allows the nurse to learn about the client's values and goals. Giving advice is not a therapeutic response and does not allow the client to talk about what is most important to the client. Asking if the client wants to speak with a chaplain might be appropriate, but it is not a therapeutic response that encourages the client to verbalize concerns and preferences. Giving false reassurances and platitudes also is not therapeutic. P 375

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. "What is your understanding of your condition?" Rationale: By asking what the client knows, the nurse conveys acknowledgement of the client's question and establishes a baseline of knowledge for further discussion. Telling the client that the nurse has not seen the report is not therapeutic or supportive of the client and violates the tenet of veracity. Telling the client that the nurse knows the results but cannot discuss it, while true, is not therapeutic. Telling the client not to worry is dismissive of the client's feelings and is not therapeutic. P 375

A client with a terminal diagnosis has asked the nurse about "helping me end my suffering." What is the nurse's responsibility in the domain of assisted suicide? A. Educating the client about the moral implications of assisted suicide B. Discussing concerns and fears with the client C. Identifying resources that meet the client's desire to die D. Telling the client the request is not acceptable

B. Discussing concerns and fears with the client Rationale: Although the 2013 position statement by the American Nurses Association titled Euthanasia, Assisted Suicide, and Aid in Dying prohibits nurses from participating in assisted suicide, it encourages nurses to support symptom management, contribute to environments for care that honor client and family wishes, and identify client and family concerns and fears. Discussion of moral implications would normally be beyond the purview of the individual nurse and should be addressed by the interdisciplinary team. Telling the client that the request is not acceptable does not encourage discussions that can help the client have a more peaceful death. It is not the nurse's responsibility to identify resources that meet the client's desire to die. P 387

A client experienced the death of a spouse from a sudden myocardial infarction 5 weeks ago. The nurse recognizes that the client will be going through the process of mourning for an extended period of time. What process(es) of mourning will allow the client to accommodate the loss in a healthy way? Select all that apply. A. Reiterating the client's anger at the spouse's care team B. Reinvesting in new relationships at the appropriate time C. Reminiscing about the relationship the client had with her spouse D. Relinquishing old attachments to the spouse at the appropriate time E. Renewing lifelong commitments to the spouse

B. Reinvesting in new relationships at the appropriate time C. Reminiscing about the relationship the client had with her spouse D. Relinquishing old attachments to the spouse at the appropriate time Rationale: Six key processes of mourning allow people to accommodate to the loss in a healthy way: (1) Recognition of the loss; (2) Reaction to the separation, and experiencing and expressing the pain of the loss; (3) Recollection and re-experiencing the deceased, the relationship, and the associated feelings; (4) Relinquishing old attachments to the deceased; (5) Readjustment to adapt to the new world without forgetting the old; (6) Reinvestment, as reiterating anger and renewing a lifelong commitment may be counterproductive to the mourning process. P 385

As the American population ages, nurses expect to see more clients admitted to long-term care facilities in need of palliative care. Regulations now in place that govern how the care in these facilities is both organized and reimbursed emphasize what aspect of care? A. Ongoing acute care B. Restorative measures C. Mobility and socialization D. Incentives to palliative care

B. Restorative measures Rationale: Regulations that govern how care in these facilities is organized and reimbursed tend to emphasize restorative measures and serve as a disincentive to palliative care. Long-term care facilities do not normally provide acute care for their clients. Regulations for long-term care facilities do not primarily emphasize mobility and socialization. P 371

Clients who are enrolled in hospice care are often believed to suffer unnecessarily because they do not receive adequate attention for their symptoms of the underlying illness. What factor most contributes to this phenomenon? A. Unwillingness to overmedicate the dying client B. Rules concerning completion of all cure-focused medical treatment C. Unwillingness of clients and families to acknowledge the client is terminal D. Lack of knowledge by clients and families regarding availability of care

B. Rules concerning completion of all cure-focused medical treatment Rationale: Because of rules concerning completion of all cure-focused medical treatment before the Medicare hospice benefit may be accessed, many clients delay enrollment in hospice programs until very close to the end of life. Hospice care does not include an unwillingness to medicate the client to keep him or her from suffering. Clients must accept that they are terminal before being admitted to hospice care. Lack of knowledge is common; however, this is not why some clients do not receive adequate attention for the symptoms of their underlying illness. P 373

A client's rapid cancer metastases have prompted a shift from active treatment to palliative care. When planning this client's care, the nurse should identify what primary aim? A. To prioritize emotional needs B. To prevent and relieve suffering C. To bridge between curative care and hospice care D. To provide care while there is still hope

B. To prevent and relieve suffering. Rationale: Palliative care, which is conceptually broader than hospice care, is both an approach to care and a structured system for care delivery that aims to prevent and relieve suffering and to support the best possible quality of life for clients and their families, regardless of the stage of the disease or the need for other therapies. Palliative care goes beyond simple prioritization of emotional needs; these are always considered and addressed. Palliative care is considered a "bridge," but it is not limited to just hospice care. Hope is something clients and families have even while the client is actively dying. P 368

A client has just died following urosepsis that progressed to septic shock. The client's spouse says, "I knew this was coming, but I feel so numb and hollow inside." The nurse should know that these statements are characteristic of what phase? A. Complicated grief and mourning B. Uncomplicated grief and mourning C. Depression stage of dying D. Acceptance stage of dying

B. Uncomplicated grief and mourning Rationale: Uncomplicated grief and mourning are characterized by emotional feelings of sadness, anger, guilt, and numbness; physical sensations, such as hollowness in the stomach and tightness in the chest, weakness, and lack of energy; cognitions that include preoccupation with the loss and a sense of the deceased as still present; and behaviors such as crying, visiting places that are reminders of the deceased, social withdrawal, and restless overactivity. Complicated grief and mourning occur at a prolonged time after the death. The spouse's statement does not clearly suggest depression or acceptance. P 384

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. "Tell me more about how you feel about this news." Rationale: The most important intervention the nurse can provide is listening empathetically. To elicit more information about the client's feelings, the nurse should ask exploratory questions that encourage the client to relate a personal narrative. The other statements deflect, ignore, or offer false sympathy and should be avoided. P 382

A hospice nurse is well aware of how difficult it is to deal with others' pain on a daily basis. This nurse should put healthy practices into place to guard against what outcome? A. Inefficiency in the provision of care B. Illness C. Emotional exhaustion D. Social withdrawal

C. Emotional exhaustion Rationale: Well before the nurse exhibits symptoms of stress or burnout, he or she should acknowledge the difficulty of coping with others' pain on a daily basis and put healthy practices in place that guard against emotional exhaustion. Emotional exhaustion is more likely to have deleterious effects than inefficiency, social withdrawal, or illness, though these may signal emotional exhaustion. P 389

The organization of a client's care on the palliative care unit is based on interdisciplinary collaboration. How does interdisciplinary collaboration differ from multidisciplinary practice? A. It is based on the participation of clinicians without a team leader. B. It is based on clinicians of varied backgrounds integrating their separate plans of care. C. It is based on communication and cooperation between disciplines. D. It is based on medical expertise and client preference with the support of nursing.

C. It is based on communication and cooperation between disciplines. Rationale: Interdisciplinary collaboration, which is different from multidisciplinary practice, is based on communication and cooperation among the various disciplines, each member of the team contributing to a single integrated care plan that addresses the needs of the client and family. Multidisciplinary care refers to participation of clinicians with varied backgrounds and skill sets, but without coordination and integration. Interdisciplinary collaboration is not based on client preference and should not prioritize medical expertise over other disciplines. P 368

A hospice nurse is caring for a young adult client with a terminal diagnosis of leukemia. When updating this client's plan of nursing care, what should the nurse prioritize? A. Interventions aimed at maximizing quantity of life B. Providing financial advice to pay for care C. Providing realistic emotional preparation for death D. Making suggestions to maximize family social interactions after the client's death

C. Providing realistic emotional preparation for death Rationale: Hospice care focuses on quality of life but, by necessity, it usually includes realistic emotional, social, spiritual, and financial preparation for death. Financial advice and actions aimed at post-death interaction would not be appropriate priorities. P 372

One of the functions of nursing care of the terminally ill is to support the client and his or her family as they come to terms with the diagnosis and progression of the disease process. How should nurses support clients and their families during this process? Select all that apply. A. Describe their personal experiences in dealing with end-of-life issues. B. Encourage the client and family to "keep fighting" as a cure may come. C. Try to appreciate and understand the illness from the client's perspective. D. Assist clients with performing a life review. E. Provide interventions that facilitate end-of-life closure.

C. Try to appreciate and understand the illness from the client's perspective. D. Assist clients with performing a life review. E. Provide interventions that facilitate end-of-life closure. Rationale: Nurses are responsible for educating clients about their illness and for supporting them as they adapt to life with the illness. Nurses can assist clients and families with life review, values clarification, treatment decision making, and end-of-life closure. The only way to do this effectively is to try to appreciate and understand the illness from the client's perspective. The nurse's personal experiences should not normally be included and a cure is often not a realistic hope. P 377

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. Work with the team to negotiate informed consent. Rationale: In the case of a client who wishes to defer decisions to his oldest child, the nurse can work with the team to negotiate informed consent, respecting the client's right not to participate in decision making and honoring his family's cultural practices. P 382

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. Ability of technology to prolong life beyond meaningful quality of life Rationale: The application of technology to prolong life has raised several ethical issues.The major question is, "Because we can prolong life through increasingly sophisticated technology, does it necessarily follow that we must do so?" The increase in cultural diversity has not raised ethical issues in health care. Similarly, costs and staffing issues are relevant, but not central to the most common ethical issues surrounding palliative care. P 389

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. Administer bronchodilators and corticosteroids, as prescribed. Rationale: Bronchodilators and corticosteroids help to improve lung function, as do low doses of opioids. Low-flow oxygen often provides psychological comfort to the client and family. A fluid bolus is unlikely to be of benefit. P 378

A pediatric nurse is emotionally distraught by the death of a 9-year-old client who received care on the unit over the course of many admissions spanning several years. What action is the most appropriate response to the nurse's own grief? A. Take time off from work to mourn the death. B. Post mementos of the client on the unit. C. Solicit emotional support from the client's family. D. Attend the client's memorial service.

D. Attend the client's memorial service. Rationale: In many settings, staff members organize or attend memorial services to support families and other caregivers who find comfort in joining each other to remember and celebrate the lives of clients. Taking time off should not be necessary, and posting mementos would be inappropriate. It would be highly inappropriate to solicit emotional support from the client's family during their time of loss. P 390

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. Demographic changes in the population Rationale: The focus on care of the dying has been motivated by the aging of the population, the prevalence of, and publicity surrounding, life-threatening illnesses (e.g., cancer and AIDS), and the increasing likelihood of a prolonged period of chronic illness prior to death. The salience of acute infections, prevention measures, and death in hospital settings are not noted to have had a major influence on this phenomenon. P 368

A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important positive action that can come from a grief support group? A. Providing a framework for incorporating the old life into the new life B. Normalizing adaptation to a continuation of the old life C. Aiding in adjusting to using old, familiar social skills D. Normalization of feelings and experiences

D. Normalization of feelings and experiences. Rationale: Although many people complete the work of mourning with the informal support of families and friends, many find that talking with others who have had a similar experience, such as in formal support groups, normalizes the feelings and experiences and provides a framework for learning new skills to cope with the loss and create a new life. The other listed options are incorrect because they indicate the need to hold onto the old life and not move on. P 385

The nurse is admitting a 52-year-old father of four into hospice care. The client has a diagnosis of Parkinson disease, which is progressing rapidly. The client has made clear his preference to receive care at home. What intervention should the nurse prioritize in the plan of care? A. Aggressively continuing to fight the disease process B. Moving the client to a long-term care facility when it becomes necessary C. Including the children in planning their father's care D. Supporting the client's and family's values and choices

D. Supporting the client's and family's values and choices Rationale: Nurses need to develop skill and comfort in assessing clients' and families' responses to serious illness and planning interventions that support their values and choices throughout the continuum of care. To be admitted to hospice care, the client must have come to terms with the fact that he is dying. The scenario states that the client wants to be cared for at home, not in a long-term care setting. The children may be able to participate in their father's care, but they should not be assigned responsibility for planning it. P 374

The hospice nurse is caring for a 45-year-old parent of three young children in the client's home. During the most recent visit, the nurse has observed that the client has a new onset of altered mental status, likely resulting from recently diagnosed brain metastases. Which goal of nursing interventions should the nurse identify? A. Helping the family to understand why the client needs to be sedated B. Making arrangements to promptly move the client to an acute-care facility C. Explaining to the family that death is near and the client needs around-the-clock nursing care D. Teaching family members how to interact with, and ensure safety for, the client with impaired cognition

D. Teaching family members how to interact with, and ensure safety for, the client with impaired cognition Rationale: Nursing interventions should be aimed at accommodating the change in the client's status and maintaining client safety. The scenario does not indicate the need either to sedate the client or to move the client to an acute-care facility. If the family has the resources, there is no need to bring in nurses to be with the client around-the-clock, and the scenario does not indicate that death is imminent. P 373

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. UNDERSTAND the emotion. Rationale: The NURSE framework provides a structure for nurses to use when responding to client's emotions. The response of "You have been through so many treatments for your cancer" represents the empathic response of UNDERSTAND the emotion. An example of NAME the emotion would be the nurse saying, "It sounds like you are worried." An example of SUPPORT the client includes, "I will be by your side through more treatments." An example of EXPLORE the emotion might be, "Tell me what's bothering you." P 375