End of Life Care RSQ

The nurse is caring for a client who is dying and wants to be at home. The nurse suggests that hospice be contacted to help care for the client. What is the best response to the family about hospice? "It's a model of care rather than a place." "It's designed for clients with serious chronic diseases." "It's a special place of care." "It's a lifelong type of care."

"It's a model of care rather than a place." Rationale: Hospice care is designed for clients with terminal illnesses and is a model of care rather than a place. Hospice care is not lifelong and is not designed for those with serious chronic illnesses.

The nurse is training a new RN to work in the hospice setting. What is the nurse's best explanation about treating end-of-life pain? "Nurses should not administer opioids to the dying client." "There is no maximum allowable dose for opioids during end-of-life care." "As the client nears death, no pain is perceived and pain medication is not needed." "It is important to withhold pain medications if the client has respiratory changes."

"There is no maximum allowable dose for opioids during end-of-life care." Rationale: It is important to manage pain at all times of life, especially in end-of-life care. Terminal illnesses cause great pain and the goal of the nurse is to help provide quality to the client's remaining time. Pain is perceived even near death, and medication is not withheld due to respiratory changes. Opioids may be the only medication that relieves the pain and are, therefore, given as needed.

A hospice nurse is working with the family of a dying client and tells the family that death is imminent. The family asks how the nurse knows this. The nurse tells the family that which of the following is a sign of imminent death? Increased respirations Coolness of extremities Increased blood pressure Calmness in the client

Coolness of extremities Rationale: Coolness of extremities denotes decreasing cardiac output and decreased blood pressure. The client respirations become slow and irregular, blood pressure decreases, and the client may become agitated.

The hospice nurse is visiting an 85-year-old dying client when the family sitting nearby begins to talk about what to do about the client's belongings when the client dies. The nurse should ask the family to discuss the subject out of the client's room for which reason? Although near death, the client can probably hear the conversation. The talk might increase the client's anxiety level. The client might get upset by the conversation. The client might be able see who is in the room.

Although near death, the client can probably hear the conversation. Rationale: The nurse removes the family from the room because the client is most likely still able to hear. It is thought that hearing is the last sense lost in the dying client. The client who is near death, or for whom death is imminent, does not need to hear talk about belongings. The client will not likely open the eyes. Becoming agitated or anxious would be the result of the client's hearing the conversation.

A hospice nurse is planning care for the dying client and family. Which nursing diagnosis is appropriate for this family? Readiness for Enhanced Family Processes Caregiver Role Strain Grieving Risk for Complicated Grieving

Grieving Rationale: The family who is caring for the client in the home will be experiencing some form of grief that should be addressed by the nurse. There is no evidence of complicated grieving, caregiver role strain, or readiness for enhanced family processes.

A client tells the nurse that the client wants "everything done if my heart stops and I'm unable to tell you what I want." Which legal document is appropriate for the clinical manifestations the client is describing? Durable power of attorney Living will Healthcare surrogate No-code order

Living will Rationale: A living will expresses the exact wishes of a client regarding expectations for medical care. It addresses what a client is willing or not willing to endure to sustain life. A living will describes the client's treatment preferences about life-prolonging procedures, including the use of mechanical breathing, feeding tubes, and resuscitation. Durable power of attorney is a document the client signs giving another person the right to make healthcare decisions. No-code order is an order written by the attending physician stating that the client will not be resuscitated. A healthcare surrogate is a person who will make healthcare decisions if the client is unable to do so.

A client nearing death requests that no medication be given that would cause loss of consciousness, including pain medication. What would the nurse do to provide the best end-of-life care for this client? Give half the ordered dose to provide compassionate care. Give the medication; comfort is the highest priority. Respect the client's wishes and withhold the pain medications. Discuss this with family members and follow their wishes.

Respect the client's wishes and withhold the pain medications. Rationale: Nurses develop partnerships with clients regarding their care. End-of-life care is no exception. It is necessary to respect the client's wishes and withhold medications. It would be inappropriate to give half the dose, the whole dose, or to talk to family members. Unless the client is experiencing cognitive impairment or there is a living will to the contrary, the client's wishes should be upheld.

The nurse plans care for a dying client and her family. Which outcome is the priority? The family should give the client privacy in order to get her affairs in order. The client and family will experience reduced anxiety by completing legal documents. The client will have to leave all personal effects with a lawyer in order to reduce family grieving and anxiety. The client and family will engage in normal grief work to help them through the dying process.

The client and family will experience reduced anxiety by completing legal documents. Rationale: Fear of dying and resultant anxiety is a priority for the client and family. The nurse plans care in an effort to help the client reduce anxiety. Simple interventions for the client might include taking time to listen, holding the client's hand, and providing information about the dying process. Keeping family members informed helps prepare them for the client's dying process and reduces stress. Interventions to reduce death anxiety include reducing suffering and loneliness; the family should not leave the client alone. Engaging in normal grief work is an outcome for the client experiencing complicated grieving.