Chapter 29- Caring for Older Adults at the End of Life
10. A hospice nurse admits an older adult after the metastasis of malignant melanoma. Which of the following health problems should the nurse anticipate? A) Necrosis of extremities B) Hemoptysis C) Hyperglycemia D) Dyspnea
Ans D Dyspnea is a common accompaniment to the dying process. Hyperglycemia, hemoptysis, and tissue necrosis are less common.
4. A nurse cares for an older adult who is nonresponsive and surrounded by family. Which of the following statements by the nurse is most appropriate? A) "I am here for you, how can I be helpful?" B) "I know just how you feel, my mother died last month." C) "I'll leave you alone so that you can grieve in private." D) "She was a really nice lady; she did a good job raising you."
Ans: A Nurses can help people who are dying and their caregivers express their needs by using open, honest, direct, and empathetic communication. Nurses use ongoing assessment to meet the needs of their clients. The statements by the nurse should center on the client and not the nurse. Presence is an appropriate intervention; the nurse should not assume that they desire to be alone
11. An emergency room nurse cares for the family of a 70-year-old African American woman who died unexpectedly. In the waiting room, upon hearing of the death, two family members kneel to the floor moaning and do not respond. Which intervention by the nurse is most appropriate at this time? A) Allow the family to grieve in this manner directing others away. B) Assess these family members' vital signs and neurologic status. C) Bring these family members to the body of their loved one. D) Call an emergency response team to care for these family members.
Ans: A Recognize that this "falling out" is a culturally based response and not an emergency medical condition; provide support. There is no need to assess these clients for emergency assistance. Bringing all of the family members is appropriate when the family is ready (note: family members may also "fall out" then too)
7. A nurse in an intensive care unit prepares to perform postmortem care on an older Jewish client. Family members are at his bedside. Which of the following actions by the nurse is appropriate? A) Allow the family to remain with the client. B) Liaise with the hospital chaplain to visit the family in the chapel. C) Address the man's oldest son when discussing the client's cares. D) Determine which family member(s) will be staying at the bedside during the cares
Ans: A With the Jewish faith, the dying person should not be left alone. Ask the closest relative specifically about postmortem practices. The other noted interventions are not particular to the Jewish culture
6. A nurse cares for a 100-year-old man in hospice. The client contemplates his perspectives regarding end-of-life care. Which of the following historical perspectives most likely represent how this client's life experiences have had a formative influence on his views on death and dying? (Select all that apply.) A) I never thought that I would be this old. B) My brother died in a work-related accident. C) I outlived my children and my two wives. D) My family shouldn't have to take care of me. E) I lost an infant to small pox.
Ans: A, B, C, E Concepts related to death, dying, and end of life have changed since the early 1900s. At that time, death was a common occurrence in infants, children, youth, and young adults. Communicable diseases were common. Families provided care. Accidental deaths were common, and death was accepted as an inevitable and normal part of life
13. A quality control nurse for a large group of long-term care facilities assesses the quality of care at the end of life for the residents. Which of the following measures indicate quality care? (Select all that apply.) A) Increase in the number of deaths in the hospital B) Increase in the number of residents who refuse treatments at the end of life C) Increase in the percent of residents with advanced dementia D) Increase in the use of hospice services E) Increasing number of staff trained in palliative care
Ans: D, E Studies confirm the need for staff education related to symptom management and other aspects of palliative care. Two measures of quality care at the end of life for nursing home residents are use of hospice services and avoiding death in the hospital. There are a large number of residents with advanced dementia (the desire is that more of these become clients of hospice)
12. A nurse manager of an intensive care unit develops plans to improve end-of-life care for clients in the unit. Which of the following actions is the priority? A) Create a script for nurses to use when discussing hospice and palliative care. B) Guide staff to improve communication with families about end-of-life decision making. C) Increase communication between professionals about end-oflife decision making. D) Survey clients and families about their end-of-life needs.
Ans: B In recent years, nurses and other health care professionals raised concerns about the need to improve end-of-life care in hospitals. Much of this concern is associated with poor communication between professionals and families about end-of-life decision making. Creating a script can help with that specific need, but the clients continue to experience pain, indignity, social isolation, and uncomfortable symptoms related to ineffective and unwanted life-sustaining treatments, particularly in intensive care units. Interprofessional communication will also help; the priority is between staff and families.
5. An older adult client on a palliative care unit divulges to his nurse that he fears being in pain during the dying process. How can the nurse best respond to the client's admission? A) "It sounds like you're understandably anxious about this. How can I help you to relax?" B) "A lot of clients do have pain at the end, and we will do all we can to control it for you." C) "We will do all we can to address it, and you'll be able to have a peaceful passing." D) "Pain during the dying process actually is not nearly as common as many people believe."
Ans: B Acknowledging that a lot of clients do have pain at the end and that staff will do all they can to control it both acknowledges the client's specific concern and provides a realistic response that the pain will be treated as effectively as possible, but does not guarantee a pain-free dying process. Acknowledging the anxiety and offering relaxation assistance do not address the specific concern about pain. Stating that the client will have a peaceful passing makes a promise that is not possible to guarantee. Pain is a common accompaniment to the dying process
2. A nurse cares for an 87-year-old client from India who has noted Hinduism as religious preference on admission records. This client is transferred to the hospice unit. Which of the following actions by the nurse best shows caring? A) Ask the family to tell you about Hinduism. B) Assess the client's spiritual needs. C) Notify the family's pastor. D) Pray with the client and family.
Ans: B Spiritual assessment should take place on admission and throughout the client's time in palliative care. Spiritual care is within the scope of nursing, and prayer would be appropriate if it were chosen based on a sound assessment of the client's needs and belief system. Nurses should be prepared to refer to whatever spiritual leader the client expresses a desire to speak with. Now is not the time to query, it is the time to listen.
3. A nurse explores resources available to assist a client. Which of the following older adults meets the eligibility requirements for hospice care? A) A client who is immobilized and unable to afford specialized nursing care B) A client who has experienced a stroke and been given 3 months to live C) A client with cancer who is living with uncontrolled persistent pain D) A client with acquired immunodeficiency syndrome who lacks family support to provide needed care
Ans: B The eligibility requirements for hospice care include physician referral and a life expectancy of less than 6 months. Financial need, high pain levels, and lack of family support are not explicit qualifiers for hospice care
8. A nurse who works in a palliative setting is aware of the need to facilitate a "good death" for as many clients as possible. Which of the following interventions should be included? A) Discuss openly and explicitly the client's strengths and weaknesses. B) Ensure that a minimum of nursing interventions are performed. C) Empower the client and family to maintain as much control as possible. D) Emphasize spiritual needs rather than physical comfort and medical needs
Ans: C A "good death" is fostered by enabling a sense of control for the client and his or her family over a challenging situation. Nursing interventions are chosen carefully, but not necessarily minimized. A discussion of the client's strengths and weaknesses is inappropriate and spiritual needs are not mutually exclusive of comfort and appropriate biomedical interventions
9. A 79-year-old experienced a severe stroke several days ago. The client's spouse has been told by the care team that he is unlikely to survive more than a few days and that aggressive treatment would likely be futile. The nurse has just entered the client's room to find the spouse softly crying at the bedside, and makes no attempt to acknowledge the nurse's presence. What is the nurse's most therapeutic response to the client's wife? A) "Do you feel like he was able to live a full life?" B) "Did you feel like you were able to discuss his treatment options thoroughly?" C) "What is it that makes you the saddest about your husband's situation?" D) "I am here; should I leave you alone for now?"
Ans: D In light of the fact that the wife is grieving quietly and has not acknowledged the nurse's presence, it is likely appropriate to offer to leave her alone. Alluding to treatment options, a "full life," or particularly sad aspects of the situation is inappropriate
14. A quality care nurse assesses the care given by a hospice. Which of the following statements by the client best reflects dignified end-of-life care? A) "I'm glad that my family is making all the decisions; it's too much for me." B) "I'm not ready to die yet; I've got a few more in me." C) "It is fine sharing a room; I like the company." D) "They listened to me and stopped the therapy."
Ans: D Some characteristics of dignified care include being involved in decision making, having privacy and a safe environment, being listened to and having needs and wishes respected, and feeling peaceful and ready to die
1. A nurse on a geriatric medical care unit consults hospice for a client. Which of the following nursing interventions should the nurse anticipate after the client begins hospice care? A) Administering chemotherapy to a client with a diagnosis of pancreatic cancer B) Assessing the deep tendon reflexes of a client with neurologic impairment C) Infusing total parenteral nutrition to a client with dysphagia D) Providing an opioid analgesic to a client with bone metastases
Ans: D The focus of hospice care is on the relief of suffering rather than cure of disease. Relief of suffering often encompasses providing pain relief to clients. Active curative treatments, such as chemotherapy, and parenteral feeding often are forgone. Health assessments that do not assess the client's comfort, such as the assessment of deep tendon reflexes, are not the priority of palliative/hospice care
