nursing care for end of life

A family member of a dying client asks the nurse how they can tell when death is very close. The nurse should instruct the family to watch for which initial indication of an impending death? 1. Low temperature 2. Signs of death rattle 3. Clear, yellow urine 4. Periods of being very alert

2

The family of a client with terminal cancer asks the nurse to explain hospice care. Which response by the nurse is most appropriate? 1. "Hospice is a place where a client resides to be kept comfortable." 2. "Hospice is a service that will provide care to the terminally ill client." 3. "Hospice is for clients who have a chance for a cure to receive treatments." 4. "Hospice is a service provided only in hospitals to offer comfort care."

2

The nurse is caring for a client who is dying and showing signs of respiratory distress. Which clinical manifestations will the nurse expect to find? 1. Decreased respiratory rate 2. Increased respiratory effort 3. Increased oxygen saturation 4. Respiratory rate of 12 bpm

2

The nurse is caring for a terminally ill client in hospice care who states that they no longer wish to participate in hospice but rather resume aggressive treatment. Which response by the nurse is most appropriate? 1. "You cannot terminate your agreement with hospice at this point." 2. "I will call your health-care provider (HCP) so you can inform them." 3. "Hospice is a good choice for you; I think you should continue." 4. "There is no cure for your illness; hospice is the only option."

2

The nurse is caring for an unconscious dying client. The family is not speaking to the client because they believe the client cannot hear. Which action is the most appropriate for the nurse to take? 1. Support the family in their decision to avoid speaking to the client since the client cannot hear 2. Explain to the family that hearing is the last sense to go and encourage them to talk to the client 3. Tell the family the client cannot hear them and they can say anything they would like in their presence 4. Inform the family they no longer have to visit the client since the client will be unaware of their presence.

2

The nurse is sitting in a room with the family of a client who just died. The nurse is nervous about speaking to the family. Which action will the nurse take? 1. Leave the room quickly while the family is occupied 2. Sit quietly and listen to the family discuss their feelings 3. Ask another nurse comfortable with death to come sit in the room 4. Document care provided while in the room with the family

2

The nurse is visiting with the wife of a client who died 3 mo ago. The nurse determines that the wife is in stage 1 of the grief process. Which answer accurately describes this stage? 1. Feeling of anger at the loved one who left them behind 2. Poor daily functioning 3. Lack of interest in daily life 4. Participation in social events

2

Which document instructs health-care providers about specific preferences when a client is unable to communicate? 1. Durable power of attorney 2. Living will 3. Do not resuscitate 4. Order to cease treatment

2

Which of the following describes a member of the hospice team who makes routine visits, assesses client needs, and implements the plan of care? 1. Health-care provider (HCP) 2. Nurse 3. Social worker 4. Chaplain

2

Below is a list of client needs. Which of these needs are appropriate for the terminally ill client and their families? Select all that apply. 1. Enrolling in a study to provide a cure 2. Adequate pain and symptom management 3. Reducing emotional and financial burden on their families 4. Ability to use remaining time to spend with loved ones 5. Avoidance of prolongation of the dying process

2, 3, 4, 5

The nurse is assessing for clinical manifestations of respiratory distress on a client who is dying. The nurses will expect to document which findings? Select all that apply. 1. Bradypnea 2. Facial grimacing 3. Agitation 4. Use of accessory muscles to breathe 5. Dyspnea

2, 3, 4, 5

The nurse is preparing to reinforce teaching to a client with a terminal illness. Which action will the nurse take first? 1. Refer the client to a local support group 2. Encourage the client to avoid anger 3. During discussions, correct a client's denial of the diagnosis 4. Determine what the client knows about their diagnosis

4

Below are the steps of postmortem care. Place the steps according to the order of care starting from step 1. 1Bathe and dress the client 2Allow the family to view the body 3Position the body in proper alignment 4Remove all tubes, medical supplies, and equipment

4, 1, 3, 2

The nurse is communicating with a hospice client. Which technique is used for a nonverbal communication? 1. Making eye contact 2. Answering questions honestly 3. Asking open-ended questions 4. Inquiring about end-of-life choices

1

The nurse is reinforcing teaching for a client inquiring about hospice. Which statement made by the client indicates a need for further teaching? 1. "A nurse will remain in my home 24 hours per day." 2. "I can have hospice care provided at my own home." 3. "Medication will be given so I will be comfortable." 4. "Hospice will help my family take care of my needs."

1

A client asks the nurse the meaning of do not resuscitate (DNR). Which response by the nurse is most appropriate? 1. "DNR means if your heart should stop, CPR will not be performed." 2. "DNR means you will no longer receive medications, bloodwork, or vital signs." 3. "DNR means only chest compressions will be performed if your heart should stop." 4. "DNR means if your heart stops, everything will be done to keep you alive."

1

A nurse who works on an inpatient hospice unit becomes distant and withdrawn from clients. Which action by the charge nurse is most appropriate to help the nurse? 1. Encourage the nurse to seek counseling immediately 2. Ensure the nurse continues to care for the client 3. Tell the nurse to quit working on the hospice unit 4. Assign the nurse to care for clients who are not dying

1

The family of a dying client asks the nurse what to expect at the moment close to death. Which response by the nurse is most appropriate? 1. "I will go over what you could expect with you." 2. "You shouldn't concern yourself with that." 3. "It is best not to watch for signs and just sit with the client." 4. "Most people don't give any notice that they are dying; they just die."

1

The family of a dying client is upset that the client is no longer eating or drinking and wants the nurse to provide water. Which statement by the nurse is most appropriate? 1. "Dehydration is generally not uncomfortable once the initial thirst subsides." 2. "The only effective intervention at this point will be to initiate enteral feeding." 3. "If you don't give the client food or water, they will typically die faster." 4. "If you just pour some water into their mouth, they will drink it rather than choke."

1

The nurse is caring for a client receiving palliative care for lung cancer. The client reports a pain level of 8 on a scale of 0-10. Which action will the nurse take first? 1. Administer prescribed pain medication 2. Assess lung sounds and chest movement 3. Offer the client sips of water 4. Reposition the client in bed

1

The nurse is caring for a client with fever who is dying. Which intervention will the nurse implement first? 1. Administer acetaminophen suppository. 2. Apply a cold wash cloth to the forehead. 3. Provide the client with an electric blanket. 4. Call the lab to draw blood to check white blood cells.

1

The nurse is caring for a conscious client with dry mucous membranes who reports feeling thirsty. Which intervention will the nurse implement first? 1. Offer the client ice chips 2. Swab the mouth with sponge-tipped toothettes 3. Place lanolin on the tongue 4. Use a soft brush on the client's teeth regularly

1

The nurse is caring for a dying client. During a state of confusion, the client is making statements that that are upsetting the family. Which statement made by the family requires correction by the nurse? 1. "I need to correct him because he is seeing things that aren't here." 2. "I will talk to him and encourage him to talk about what he sees." 3. "The nurse told us this may happen, and this a normal part of dying." 4. "I am going to hold his hand and let him know that I am here."

1

The nurse is caring for a dying client. While discussing care with the health-care provider, which unnecessary procedures will the nurse will suggest be discontinued? 1. Daily blood draws 2. Routine bed baths 3. Turning the client 4. Applying oxygen

1

Which of the following are chronic illnesses that contribute to death? Select all that apply. 1. Renal failure 2. Heart disease 3. Motor vehicle accident (MVA) 4. Stroke 5. Gunshot wound

1, 2, 4

Which findings are signs death has occurred? Select all that apply. 1. Pupils are fixed. 2. Eyes remain open. 3. Skin becomes cyanotic. 4. Heartbeat is absent. 5. Skin appears waxen.

1, 2, 4, 5,

When talking to a dying client, which techniques for effective communication will the nurse implement? Select all that apply. 1. Maintain eye contact with clients 2. Encourage the client not to speak 3. Do not repeat what the client says 4. Use respectful body language 5. Stand while speaking to the client

1, 4

A client asks the nurse to explain a durable power of attorney (POA). Which response by the nurse is most appropriate? 1. "A document that gives the nurse permission to make decisions on your behalf." 2. "It is a document instructing the health-care provider about your preferences if you cannot communicate." 3. "This is a person who will speak for you when you can no longer speak regarding medical decisions." 4. "This means that once you sign the document, you will no longer receive treatment."

3

During a family discussion of a do-not-resuscitate (DNR) order, which statement made by the family requires correction by the nurse? 1. "Dad has terminal cancer and would not benefit from CPR." 2. "Dad would want to be kept comfortable and not to remain alive on machines." 3. "Dad will no longer receive treatment once we agree to a DNR." 4. "Dad can have medication for comfort as he previously asked."

3

The nurse is assessing a client who is dying and notes that the lower extremities are cool, cyanotic, and mottled. The nurse knows this is indicative of which assessment? 1. The client has skin breakdown. 2. This is a normal finding. 3. Death is very close. 4. The client is cold.

3

The nurse is calculating intake for a client who is dying and notes that the client has consumed 30 mL of water and 60 mL of juice. What is the client's total intake? 1. 40 2. 50 3. 90 4.30

3

The nurse is caring for a client experiencing agitation. Which medication will the nurse expect to administer? 1. Fentanyl 2. Hyoscyamine 3. Lorazepam 4. Scopolamine

3

The nurse is preparing to administer hydromorphone 1mg intravenously to a client with cancer pain. The available dose is hydromorphone 2mg/mL. How many milliliters will the nurse administer? 1. 1mL 2. 3 mL 3. 0.5 mL 4. 2 mL

3

When a client is recognized as having entered the dying phase, what type of care is the focus of interventions? 1. Cure 2. Nutrition 3. Comfort 4. Fluid and electrolyte balance

3

Which appropriate discipline is included in a collaborative hospice team? 1. Physical therapist 2. Occupational therapist 3. Bereavement counselor 4. Diabetic educator

3

Which client illness will be most appropriate for hospice care? 1. A client with early diagnosis of Alzheimer's disease 2. A client newly diagnosed with Parkinson's disease 3. A client with heart failure given a 4-mo prognosis 4. A client with stage I breast cancer who is depressed

3

Which medication will the nurse plan to administer to a client with excessive secretions? 1. Haloperidol 2. Morphine 3. Scopolamine 4. Hydromorphone

3

A client is receiving palliative care for chronic obstructive pulmonary disease (COPD). Which of these are appropriate reasons for receiving palliative care? Select all that apply. 1. Recommend a cure for the disease 2. Offer additional teaching about the disease 3. Improve client's quality of life 4. Reduce the severity of disease symptoms 5. Provide care that the family refuses to give

3, 4

On average, how soon do clients die after being admitted to a nursing home? 1. Within 5 years 2. Within 3 years 3. Within 2 years 4. Within 1 year

4

The family of a client who is dying of lung cancer has declined artificial feeding. Which reason is NOT advantageous when withholding artificial feeding and hydration during the dying process? 1. Fewer pharyngeal and lung secretions 2. Reduction of swelling 3. Decreased urination 4. Increase in pain around the tumor

4

The nurse is caring for a client who is near death. The nurse will teach the family to look for which signs of impending death? 1. Warm extremities 2. Increased urine output 3. Ease in breathing 4. Restlessness

4

The nurse is caring for a dying client experiencing dyspnea. Which intervention will the nurse plan to implement? 1. Place a heater safely at the bedside 2. Suction the client 3. Lower the head of the bed 4. Administer diuretics as prescribed

4

The nurse is preparing to apply a fentanyl patch to a client with cancer pain. Which answer is correct regarding the preparation for this medication? 1. Cut the patch in half prior to administration 2. Apply heat over the patch to increase absorption of medication 3. Leave the old patch on the skin until the new one begins to work 4. Wear a pair of gloves when handling the patch

4