MEDSURG1 Chapter 13: Palliative and End-of-Life Care PREPU

Which statements made by the nurse demonstrates that the nurse is providing spiritually sensitive care?

"Tell me who or what gives you strength."

Which of the following does not coincide with Kübler-Ross's stages related to a dying client?

The dying client usually exhibits anger first.

The nurse is caring for a client who just learned of a terminal diagnosis. After the physician leaves, the nurse remains to answer further questions so that the client can make an informed decision about further treatment. By providing all available information, the nurse is promoting which ethical principle?

The principle of autonomy

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

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.

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.

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?

There remains a conspiracy of silence about dying despite progress in the area.

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

Which of the following may be contained in an "emergency kit" for a hospice patient exhibiting restlessness?

Benzodiazepine

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?

Client's goals

A patient diagnosed with terminal pancreatic cancer is unaware of the diagnosis and his daughter has requested that he not be told. What awareness context does the nurse determine this is?

Closed awareness

A client approaching end-of-life reports dyspnea as being 7 on a scale from 0 to 10. Which action will the nurse take to assist this client?

Coach to use pursed lip breathing.

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?

Faith and belief

Which of the following is an appropriate method of assessing the dying client?

Focus on the client's basic needs.

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

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.

Palliative care

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?

Palliative care

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.

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?

Palliative sedation

A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client?

Respect the client's and family members' choices.

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 constipation related to the effects of an opioid

The nurse is caring for a client with Huntington chorea who has decided to refuse all food and beverages. For which type of suffering will the nurse assess the client before supporting the client's decision? Select all that apply.

Social Physical Spiritual Grieving Psychological

As the moment of death approaches, which of the following does the nurse encourage the family to do?

Speak to the client in a calm and soothing voice.

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 Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition.

A terminally ill patient in pain asks the nurse to administer enough pain medication to end the suffering forever. What is the best response by the nurse?

"I will notify the physician that the current dose of medication is not relieving your pain."

The nurse is caring for a client who has diminished lung function due to emphysema. The terminally ill client is short of breath on exertion and reports difficulty sleeping in bed. The client states, "I am so afraid of getting any worse." Which statement, by the nurse, assists the client in sustaining hope?

"I will talk with the health care provider to determine the next step in your care."

A terminally ill patient is admitted to the hospital. The patient grabs the nurse's hand and asks, "Am I dying?" What response would be best for the nurse to give?

"Tell me more about what's on your mind."

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?

"This must be very difficult for you."

According to federal guidelines, hospices may provide no more than what percentage of the aggregate annual patient-days at the inpatient level?

20

The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to clients who are dying and their families is to first do which of the following?

Explore own feelings on mortality and death and dying.

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.

Encourage the client to explain his or her wishes. Comfort the client by saying it will all be over soon. Control the client's pain with prescribed medication.

Based on the most common concern of a dying patient, the hospice nurse should:

Administer pain medication on a schedule that prevents pain from intensifying.

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?

Advice for the family to have fruit juices readily available at the client's bedside.

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 facilitate the grieving process

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?

Anger

A client with a terminal illness has feelings of rage toward the nurse. According to Kubler-Ross, the client is in which stage of dying?

Anger

The family members of a dying patient are finding it difficult to verbalize feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations?

Encourage the family members to express their feelings and listen to them in their frank communication.

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?

Continuous care

A client nearing the end of life is experiencing delirium. Which action will the nurse take to help this client?

Encourage family to visit.

Which is the initial stage of grief, according to Kübler-Ross?

Denial

Which is also known as a proxy directive?

Durable power of attorney for health care

When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following?

Proxy directive

Which cardiovascular findings indicate to the nurse that the condition of the client who is dying is worsening?

Pulse 104 beats/minute in the morning, 62 beats/minute in the afternoon with mottled feet and ankles

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?

Use imagery, humor, and progressive relaxation

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

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:

care that will reduce the client's physical discomfort and manage clinical symptoms.

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?

weight loss and inadequate food intake