MED SURG CHAPTER 3

A group of nursing students is reviewing information about palliative care. The students demonstrate a need for additional review when they identify which of the following?

Palliative care is the same as hospice care.

While providing care to a terminally ill client, the client asks, "Am I dying?" Which response by the nurse would be most appropriate?

"Tell me some more about what is on your mind."

Which term refers to the period of time during which mourning of a loss takes place?

Bereavement

Which "awareness context" is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise?

Mutual pretense awareness EXPLANATION: In mutual pretense awareness, the client, the family, and the health care professionals are aware that the client is dying, but all pretend otherwise. In closed awareness, the client is unaware of his or her terminal state, whereas others are aware. In suspected awareness, the client suspects what others know and attempts to find it out. In open awareness, all are aware that the client is dying and are able to openly acknowledge that reality.

Which statement is a misconception about chronic disease?

Chronic illnesses cannot be prevented.

Which is also known as a proxy directive?

Durable power of attorney for health care EXPLANATION: 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.

A nurse who provides care on a palliative unit of a busy urban hospital performs numerous task and roles in the provision of holistic care to patients and their families. Which of the following tasks is essential for nurses to manage patients at the end of life? Select all that apply.

Educate patients and families about end-of-life decision making. Contribute to a coordinated, interdisciplinary plan of care. Manage pain and symptoms.

Which aspect of a healthy lifestyle can the nurse encourage a patient to improve that can significantly enhance quality of life with a chronic condition?

Exercise

The nurse is caring for a client with COPD who was recently admitted to the hospital with an acute exacerbation of the illness. What indicates to the nurse that the client is in the comeback phase of the Trajectory Model of Chronic Illness?

The client gradually returns back to an acceptable way of life within the limits imposed by the illness.

Which statement, made by the nurse, can be most helpful when caring for a client in the third stage of Kubler-Ross' emotional reactions to dying?

"I understand that it would be wonderful to see your daughter's graduation." EXPLANATION: The third stage of Elisabeth Kubler-Ross' series of reactions is bargaining. Confirming the intention to live to a certain time is common in this stage. Reviewing laboratory and diagnostic tests occurs in the first stage, denial. Talking about anger occurs in the second stage, anger. Living for the day is an idea which occurs in the final stage, acceptance.

The nurse is working with a client with a chronic condition. The nurse includes which elements in the plan of care? Select all that apply.

Assessment for identity changes Interventions to manage symptoms Interventions to prevent complications

Which statement provides accurate information related to chronic illness?

Most people with chronic conditions do not consider themselves sick or ill.

A hospice nurse is visiting the home of a client who was recently diagnosed with a terminal illness. The nurse is developing the client's plan of care and is assessing beliefs and preferences about end-of-life care. The nurse would expect to complete this assessment at which time?

Over the course of several visits

You are part of the health care team at an oncology center. Your patient has been diagnosed with leukemia and the prognosis is poor. The patient is unaware of the prognosis. How can the bad news best be conveyed to the patient?

The prognosis should be delivered with the patient at eye level.

A nurse is developing a teaching plan for a terminally ill client and his family about about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in the teaching plan?

The stages are applicable to any loss.

An elderly female patient who experienced a hemorrhagic stroke has a poor prognosis and multiple functional deficits, including dysphagia. A family meeting has been organized to discuss the possibility of tube feeding, and the patient's daughter is incredulous that a tube feed has not yet been introduced, stating, "The only thing worse than dying of a stroke would be to starve to death." What principle should underlie a response to the daughter?

There are potential benefits to withholding artificial hydration and nutrition.

The nurse is caring for a patient who had a stroke and has right-sided hemiparesis. The patient is receiving physical therapy that will continue when discharged through home health care services. After what minimum period of time could this patient's medical condition be termed chronic?

3 months

When assessing a terminally ill client, the nurse notices that the client has copious secretions at the back of the throat and in the mouth. The nurse is preparing a teaching plan for the family about caring for these secretions. Which of the following would be least appropriate to include

Using a soft toothbrush to vigorously clean the mouth

While talking with a client who has been diagnosed with a terminal illness, the client asks, " Am I dying?" Which response from the nurse would be appropriate? Select all that apply.

This must be very difficult for you." "Tell me more about what's on your mind."