MedSurg Ch 16 End of Life
A 50-year-old client is an alcoholic. The client has been diagnosed with pancreatic cancer and underwent surgery to remove the tumor. Despite the tumor being removed, the physician informs the client that chemotherapy needs to be started immediately. Using evidence-based practice, which intervention might the nurse expect the physician to include, with the goal of improving quality of life, mood, and median survival. Radiation Palliative care Respite care Angiogenesis
Palliative care Explanation: In a study of referral to palliative care for clients newly diagnosed with a disease with very poor prognosis, researchers found that those clients receiving palliative care plus standard oncology demonstrated improved quality of life and mood and had longer median survival. Radiation is primarily used when a cancer spreads to other organs, and it has not been proven to affect mood. Angiogenesis is the growth of new capillaries from the tissue of origin. This process helps malignant cells obtain needed nutrients and oxygen to promote growth. Respite care is provided on an occasional basis to relieve the family caregivers.
A nurse has been providing in-home hospice care to an older adult client with lung cancer for more than six months. The family asks the nurse how long the Medicare hospice services will continue. What is the nurse's best response? The client must begin to pay for other home health services since six months of hospice care have been received. The hospice services need to end now that the client has had the services for six months. The Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition. Medicare hospice services end at the seventh month of care.
The Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition. Explanation: Eligibility for the Medicare Hospice Benefit includes physician and hospice medical director confirmation that the client is terminally ill, with a life expectancy of 6 months or less if the disease follows its natural course. The condition must be considered or classified as terminal, not just serious and progressive. The hospice services do not end at the sixth or seventh month of care. The client does not have to find other home health services as long as the Medicare certification process from the physician and hospice medical director was obtained.
While providing care to a terminally ill client, the client's niece asks the nurse about the client's condition and prognosis. Which of the following would be most appropriate? Ask the client's consent before sharing any information with the niece. Refer the niece to the client's physician for information. Provide the niece with the information that she is requesting. Check with the client's immediate family members about sharing information.
Ask the client's consent before sharing any information with the niece. Explanation: Before disclosing any health information about a client to family members, nurses should follow the agency's policy for obtaining consent from the client in accordance with the Health Insurance Portability and Accountability Act (HIPAA) rules. Information is shared only with the client's consent.
The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to dying clients and their families is to first do which of the following? Participate in a support group to learn clients' feeling on care. Use evidence-based practice in daily care regimen. A workshop on caring for the dying client Explore own feelings on mortality and death and dying.
Explore own feelings on mortality and death and dying. Explanation: To care for others in the dying process, the nurse must explore his or her own feelings about mortality and death and dying. Understanding self provides a perspective to cope with and then support clients and families experiencing pain and grief. The other options are helpful in determining appropriate nursing care but not the first step.
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." "What has your physician told you about your condition?" "What makes you think that you might be dying?" "You're just having a bit of a set-back. You'll be fine."
"Tell me some more about what is on your mind." Explanation: When responding to the client, the nurse needs to acknowledge the client's fears. Having the client tell the nurse what's on his or her mind acknowledges the client's feelings and opens the way for more discussion. Asking the client about what makes him or her think he or she is dying is probing and does not address the client's feelings or needs. Telling the client that he or she will be fine gives the client false reassurance and does not address his or her fears. Asking about what the physician has told the client redirects the conversation away from the client's feelings and is inappropriate.
The family of a client in hospice decides to place their loved one in a long-term care facility to establish an effective pain control regimen. Which aspects of hospice care is the family using? Inpatient respite care General inpatient care Palliative care Continuous care
Palliative care Explanation: Long-term care is increasing as a setting to provide palliative care that addresses management of symptoms such as pain. Inpatient respite care is a 5-day inpatient stay provided on an occasional basis to relieve the family caregivers. Continuous care is provided in the home to manage a medical crisis. General inpatient care provides inpatient stay for symptoms management that cannot be provided in the home.
Which of the following does not coincide with Kübler-Ross's stages related to a dying client? The client may be in several stages at once. Clients don't always follow the stages in order. The dying client usually exhibits anger first. Some client regress, then move forward again.
The dying client usually exhibits anger first. Explanation: The dying client does not usually exhibit anger first. The client may be in several stages at once, clients don't always follow the stages in order, and some regress and then move forward.
Based on the most common concern of a dying patient, the hospice nurse should: Turn the patient every 2 hours to prevent decubitus ulcers. Position the patient to prevent difficulties with breathing. Administer pain medication on a schedule that prevents pain from intensifying. Offer supplemental fluids to prevent dehydration.
Administer pain medication on a schedule that prevents pain from intensifying. Explanation: Pain management is the most common concern for the dying patient. Medication should be given on a PRN schedule that keeps the patient comfortable.
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? Acceptance Bargaining Denial Anger
Anger Explanation: 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.
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? Morphine Codeine Demerol Percodan
Morphine Explanation: 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.
Which of the following is a term that refers to individual, family, group, and cultural expressions of grief and associated behaviors? Grief Mourning Spirituality Bereavement
Mourning Explanation: Mourning refers to individual, family, group, and cultural expressions of grief and associated behaviors. Grief refers to the personal feelings that accompany an anticipated or actual loss. Bereavement refers to the period of time during which mourning takes place. Spirituality is a personal belief system that focuses on a search for meaning and purpose of life.
As the moment of death approaches, which of the following does the nurse encourage the family to do? Have the family sit in front of the client so they can be seen. Rub the client's hand and arm to comfort the client. Speak to the client in a calm and soothing voice. Lie next to the client and hold the client.
Speak to the client in a calm and soothing voice. Explanation: Sight and touch diminish as the client approaches death; however, hearing tends to remain intact. Speaking to the client calmly is most appropriate.
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? "I'm so sorry. I know how you must feel." "You know you're dying?" "Let me explain to you what is happening." "This must be very difficult for you."
"This must be very difficult for you." Explanation: 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").
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? Positioning the client on the side with the head supported with a pillow Performing gentle suctioning of the mouth Using a soft toothbrush to vigorously clean the mouth Administering a prescribed anticholinergic agent
Using a soft toothbrush to vigorously clean the mouth Explanation: Secretions are often more distressing to the family than their presence is to the client. Gentle mouth care with a moistened swab or very soft toothbrush helps maintain the integrity of the client's mucous membranes. Other helpful measures include positioning the client on the side with the head supported with pillows to allow secretions to drain freely from the mouth, gently suctioning the oral cavity, and administering prescribed anticholinergic agents sublingually or transdermally. Deeper suctioning may cause significant discomfort to the dying client and rarely is of benefit because secretions tend to reaccumulate quickly.
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? Suggestions that the family offer the client foods that are hot. Encouragement of the family to serve the client meat, especially beef. Advice for the family to have fruit juices readily available at the client's bedside. Arrangements for the client to eat meals while others are out of the home.
Advice for the family to have fruit juices readily available at the client's bedside. Explanation: 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.
What barrier to end-of-life care does a dying client demonstrate with the statement, "I don't need hospice. Hospice is for people who are dying." Bargaining Denial Anger Acceptance
Denial Explanation: Patient denial about the seriousness of terminal illness has been cited as a barrier to discussions about end-of-life treatment options. Denial includes feelings of isolation. Bargaining occurs when a client and/or family pleads for more time to reach an important goal. Anger includes feelings of rage or resentment. Acceptance occurs when the client and/or family are neither angry nor depressed.
Which is also known as a proxy directive? Durable power of attorney for health care Medical directive Treatment directive Living will
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.
Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death? Flushed appearance Increased body temperature Absence of incontinence Dusky appearance
Dusky appearance Explanation: 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.
Which term is used to describe the personal feelings that accompany an anticipated or actual loss? Spirituality Mourning Bereavement Grief
Grief Explanation: Grief is defined as the personal feelings that accompany an anticipated or actual loss. Bereavement is a period during which mourning for a loss take place. Mourning is an expression of grief and associated behaviors. Spirituality is a personal belief system that focuses on a search for meaning and purpose of life.
Which term best describes a living will? Durable power of attorney for health care Medical directive Proxy directive Health care power of attorney
Medical directive Explanation: A living will is a type of advance medical directive in which the individual, who is of sound mind, documents treatment preferences. A proxy directive and health care power of attorney are other names for a durable power of attorney for health care, in which one individual is appointed and authorized to make medical decisions on behalf of another person when that person is no longer able to speak for him or herself.
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 Suspected awareness Open awareness Closed awareness
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.
A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse? "It will hasten the death of the patient." "It will use artificial means of life support if the patient requests it." "It will enable the patient to remain home if that is what is desired." "It will prolong life in a dignified manner."
"It will enable the patient to remain home if that is what is desired." Explanation: The goal of hospice is to enable the patient to remain at home, surrounded by the people and objects that have been important to him or her throughout life. The patient and family make up the unit of care. Hospice care does not seek to hasten death or encourage the prolongation of life through artificial means.
For a client to use the Medicare Hospice Benefit, life expectancy needs to be what length of time? 8 months 2 months 4 months 6 months
6 months Explanation: The client who wishes to use his or her Medicare Hospice Benefit must be certified by a health care provider as terminally ill, with a life expectancy of 6 months or less if the disease follows its natural course.
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? Add haloperidol to the client's treatment plan. Obtain a biopsy to analyze the lymph nodes. Begin radiation therapy to prevent cellular growth. Perform surgery to remove the tumor from the brain.
Add haloperidol to the client's treatment plan. Explanation: 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.
All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason? Allows for the nurse to take the client through in the appropriate order Allows for the nurse to understand when the grieving process should be concluded Allows for the nurse to facilitate the grieving process Allows the nurse to express his or her feelings
Allows for the nurse to facilitate the grieving process Explanation: 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.
The nurse is caring for a client who is interested in learning about hospice care. Which of the eligibility criteria would the nurse stress? Physician-certified illness Limited life expectancy Serious, progressive illness Choice of palliative care over cure focused
Choice of palliative care over cure focused Explanation: An important focus of hospice care is that care is palliative in nature. No further aggressive treatment to find a cure for the illness is administered. The client must accept this philosophy of care. The other options are factual and agreed on.
The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which intervention should a nurse perform in such a situation? Be a silent observer and allow the client to communicate with the family members Encourage the family members to express their feelings and listen to them in their frank communication Encourage conversations about the impending death of the client Encourage the client's family members to spend time with the client
Encourage the family members to express their feelings and listen to them in their frank communication Explanation: Family members usually find it difficult to communicate frankly with a dying person. When a nurse encourages family members to express their feelings and listens to them as they frankly communicate, family members may 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 express their feelings.
A nurse is conducting a spiritual assessment of a terminally ill client using the four step FICA process and asks the question, "What gives your life meaning?" The nurse is assessing which of the following? Importance and influence Faith and belief Community Address in care
Faith and belief Explanation: The question about what gives life meaning provides information about the client's faith and belief. Importance and influence are addressed by questions focusing on the role faith plays in the client's life and how his or her beliefs affect the way the client cares for self and illness. Community is addressed by questions focusing on the client's participation in a spiritual or religious community and the support obtained from it. Address in care focuses on how the nurse would integrate the issues involving spirituality in the client's care.
A client with a brain tumor recently stopped radiation and chemotherapy for treatment of the cancer. The client recently reported dry mouth. Which intervention by the hospice nurse demonstrates that the nurse understands treatment measures for dry mouth? Place two drops of atropine ophthalmic 1% solution sublingually. Begin 9% normal saline IV at 125 mL/hr. Gently suction the client's mouth and buccal cavity. Provide gentle oral care after each meal.
Provide gentle oral care after each meal. Explanation: Dry mouth can generally be managed through nursing measures such as mouth care. The use of artificial hydration (IV fluids) carries considerable risks and does not contribute to comfort at the end of life. Atropine ophthalmic 1% drops administered sublingually help to reduce oral secretions. Gentle oral suctioning reduces the production of secretions.
When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following? Standard addendum to a will Living will Treatment directive Proxy directive
Proxy directive Explanation: Durable power of attorney for health care is a legal document through which the signer appoints and authorizes another individual to make medical decisions on his or her behalf when he or she is no longer able to speak for him- or herself. This is also known as a health care power of attorney or a proxy directive.
Which action by the nurse demonstrates an effective method to assess the client and the client's family's ability to cope with end-of-life interventions? Filling voids in conversation with information related to death and dying to avoid awkward moments during the admission interview Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care Providing evidenced-based advice for end-of-life care based on the nurse's experiences with previous clients in hospice Offering reassurance that the nurse has had 5 years of assisting clients in hospice and their families care for loved ones at the end of life
Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care Explanation: A key to effective listening includes allowing the client and family sufficient time to reflect and respond after asking a question. Hospice nurses with effective listening skills resist the impulse to fill the empty space in communication with talk, avoid the impulse to give advice, and avoid responses indicating, "I know just how you feel."
The nurse is caring for a client at the end of life. The client is ordered a regular dosage of narcotics and short-acting narcotics for breakthrough pain. When administering the narcotics, the nurse is correct to realize which of the following? Side effects must be treated. Dosages are restricted. Death is imminent. Client may become sedated.
The nurse is caring for a client at the end of life. The client is ordered a regular dosage of narcotics and short-acting narcotics for breakthrough pain. When administering the narcotics, the nurse is correct to realize which of the following? You Selected: Side effects must be treated. Correct response: Side effects must be treated. Explanation: The nurse who is administering narcotics at the end of life still must realize that there are side effects from the narcotics which must be addressed. Depending on the status of the client, death may be days or weeks away, not imminent. Pain medications are liberally given at the end of life to ensure that the client is comfortable. Typically, pain medications relax the client as the pain level is eased. The client is not sedated.
A nurse is developing a teaching plan for a terminally ill client and his family 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. Each client experiences each of the stages. Typically, the stages occur in succession. Most clients reach acceptance by the time of death.
The stages are applicable to any loss. Explanation: The five stages of dying describe the five emotional reactions applicable to the experience of any loss. Not every client or family member experiences every stage. Many clients never reach a stage of acceptance. Clients and family fluctuate on a sometimes daily basis in their emotional responses.
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: an alternative therapy that uses massage and progressive relaxation for pain relief. offered to terminally ill clients who wish to remain in their homes in lieu of hospice care. care that is provided at the very end of an illness to ease the dying process. care that will reduce the client's physical discomfort and manage clinical symptoms.
care that will reduce the client's physical discomfort and manage clinical symptoms. Explanation: 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.
A nurse assesses a client with a terminal illness and determines that the client is in denial about the condition. Which of the following would be most important for the nurse to do when developing the client's plan of care? Correct the client's misconceptions about the illness and treatment goals. Seek help from other health care team members to address the client's denial. Explain to the client that denial of the situation is unhealthy. Accept the client's denial of the situation.
Accept the client's denial of the situation. Explanation: When working with terminally ill clients, nurses need to understand that denial is often a useful coping mechanism that enables the client to gain temporary emotional distance from a situation that is too painful to think about. Therefore, nurses must accept clients regardless of the degree to which they are in denial about their illness and work with other health care providers to present the same message. Consulting with other team members would be helpful to ensure that all members present the same information to the client. Denial is a coping mechanism and only becomes unhealthy if the client or family refuses to acknowledge a diagnosis or refuse to hear about treatment options. Correcting the client's misconceptions would disrupt the client's coping mechanism of denial and possibly lead to greater upset.
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? Arrangements for the client to eat meals while others are out of the home. Advice for the family to have fruit juices readily available at the client's bedside. Encouragement of the family to serve the client meat, especially beef. Suggestions that the family offer the client foods that are hot.
Advice for the family to have fruit juices readily available at the client's bedside. Explanation: 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.
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? Physician's orders Length of required treatment Invasiveness of the treatment Client's goals
Client's goals Explanation: 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.
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? Medical directive by proxy Living will declaration End-of-life treatment directive Durable power of attorney for health care
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. It allows another individual to make medical decisions on the client's behalf. The other options are incorrect.
Which of the following is the nurse's primary concern when providing end-of-life care for a client and the family? Select all that apply. Completing a head-to-toe assessment Encouraging fluids Arranging plans for after death Maintaining client comfort Supporting family members Providing personal care
Maintaining client comfort Supporting family members Providing personal care Explanation: Nursing care of dying clients focuses on providing palliative care to the client and supporting family members. Arranging the plans after death is not a priority at this time. Completing a head-to-toe assessment may be completed for information but is not a priority at the end of life. There is no need to encourage fluids.
A type of comprehensive care for clients whose disease is not responsive to cure is interdisciplinary collaboration. palliative care. euthanasia. a terminal illness.
palliative care. Explanation: Palliative care is a type of comprehensive care for clients whose disease is not responsive to cure. Terminal illness is a progressive, irreversible illness that despite cure-focused medical treatment will result in the client's death. Euthanasia means the intentional killing by act or omission of a dependent human being for his or her alleged benefit. Interdisciplinary collaboration is communication and cooperation among members of diverse health care disciplines jointly to plan, implement, and evaluate care.
A nurse is caring for a terminally ill client inquiring about physician-assisted suicide. Which statement if made by the nurse would correctly inform the client of this practice? The health care provider provides the means for the clients to take their life. The health care provider administers a lethal dose of medication via IV. The health care provider provides the means and waits to pronounce them dead. The health care provider provides counseling and has a third party physician assist in the suicide.
The health care provider provides the means for the clients to take their life. Explanation: Physician-assisted suicide is the practice of providing a means by which a client can end his or her life. Much controversy exists concerning the practice. California, Vermont, Oregon, Washington, and Montana are the only states that permit physician-assisted suicide. The physician does not personally administer the dose, wait until the client is dead, or have a third party physician involved.
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? "The moaning you hear is from air moving over very relaxed vocal cords." "His moaning does indicate pain, so we'll increase his pain medication." "He is getting less oxygen to the brain, so the moaning means he is dreaming." "He has secretions that are collecting at the back of the throat."
"The moaning you hear is from air moving over very relaxed vocal cords." Explanation: 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.
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? Clients would ask for information if they really had a desire to know. Clients, for the most part, would gain hope if they were told about a poor prognosis. Most clinicians are very open to talking about disease and dying with clients. There remains a conspiracy of silence about dying despite progress in the area.
There remains a conspiracy of silence about dying despite progress in the area. Explanation: 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.
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? "I know another client with the same diagnosis who has been in remission for 10 years." "Let's take this one day at a time; remember you have your daughter's dance recital next week." "I believe that you will fight hard to beat this and see your babies grow up." "You should seek a second medical opinion about your diagnosis."
"Let's take this one day at a time; remember you have your daughter's dance recital next week." Explanation: 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 fal
According to federal guidelines, hospices may provide no more than what percentage of the aggregate annual patient-days at the inpatient level? 10 40 20 30
20 Explanation: According to federal guidelines, hospices may provide no more than 20% of the aggregate annual patient-days at the inpatient level. The other numerical values are incorrect.
A nurse is providing hospice care in Portland, Oregon to a client with terminal liver cancer. The client confides to the nurse, "I'm in agony all the time. I want this to be over now—please help me." Which interventions should the nurse implement? Select all that apply. Advise the client's health care provider of the client's condition. Comfort the client by saying it will all be over soon. Control the client's pain with prescribed medication. Encourage the client to explain his or her wishes. Recommend that the client consider physician-assisted suicide.
Control the client's pain with prescribed medication. Advise the client's health care provider of the client's condition. Encourage the client to explain his or her wishes. Explanation: This client lives in Oregon, one of five states that have decriminalized physician-assisted suicide, the practice of providing a means by which a client can end his or her own life. This practice is controversial, with proponents arguing the client has a right to self-determination and a relief from suffering when there is no other means of palliation. Opponents, on the other hand, find it contrary to the Hippocratic Oath. In this scenario, the nurse should determine exactly what the client is asking and then support his or her wishes. It is not the nurse's role to suggest physician-assisted suicide voluntarily, however.
Which is the initial stage of grief, according to Kübler-Ross? Bargaining Depression Denial Anger
Denial Explanation: 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.
Which of the following is an appropriate method of assessing the dying client? Sedate the client before completing range-of-motion exercises. Stimulate the client every 30 minutes. Repeat assessments as necessary. Focus on the client's basic needs.
Focus on the client's basic needs. Explanation: 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.
For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death? Increased restlessness Increased wakefulness Increased eating Increased urinary output
Increased restlessness Explanation: As the oxygen supply to the brain decreases, the client 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.
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 developed after hospice care developed. Palliative care is often provided along with disease-lessening treatments. Palliative care is conceptually broader than hospice care. Palliative care is the same as hospice care.
Palliative care is the same as hospice care. Explanation: Palliative care is not synonymous with hospice care. All hospice care is palliative but not all palliative care is hospice care. Palliative care is conceptually broader than hospice care and is an approach to care as well as a structured system for delivering care. Palliative care followed the development of hospice care. It does not begin when cure-focused treatment ends but is most helpful when provided along with disease-remitting treatment.
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? Nurses may administer medications prescribed by physicians to hasten end of life. Participating in assisted suicide violates the Code of Ethics for Nurses. A client has the right to make independent decisions about the timing of his or her death. Most states have enacted laws that allow for physician-assisted suicide.
Participating in assisted suicide violates the Code of Ethics for Nurses. Explanation: 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.
A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client? Abide by the dying client's wishes. Ask the family members about spiritual care. Share emotional pain. Respect the client's and family members' choices.
Respect the client's and family members' choices. Explanation: 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.
A terminally ill client is receiving morphine around-the-clock for pain control. As part of the client's plan of care focusing on pain management, which nursing diagnosis would the nurse most likely identify? Risk for ineffective cerebral tissue perfusion related to central nervous system effects of the drug Risk for constipation related to the effects of an opioid Impaired physical mobility related to sedative effects of the drug Caregiver role strain related to the need for around-the-clock pain control
Risk for constipation related to the effects of an opioid Explanation: When an opioid is used for around-the-clock pain management, the nursing diagnosis, risk for constipation, would be most likely because of the opioid's effect on the gastrointestinal system. Therefore, a regimen to combat constipation is key. Although opioids depress the central nervous system and cause sedation, a risk for infection and impaired physical mobility would be less likely. Other factors involved in the client's care, not just the around-the-clock pain control, would contribute to caregiver role strain.
When describing the term "grief" to a group of students, which of the following would the instructor include? The response experienced by anyone who has suffered a loss Feelings of apprehension or worry in response to a situation A feeling of connectedness with one's self and others A part of the life cycle in the form of change, growth, and transition
The response experienced by anyone who has suffered a loss Explanation: 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.
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?
durable power of attorney for health care 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.
