Adult 3 Exam 3 part 1

One of the functions of nursing care of the terminally ill is to support the patient and his or her family as they come to terms with the diagnosis and progression of the disease process. How should nurses support patients and their families during this process? SATA

-Try to appreciate and understand the illness from the patients perspective -assist patients with performing a life review -provide interventions that facilitate end-of-life closure

A 35-year-old male is admitted to the hospital complaining of severe headaches, vomiting, and testicular pain. His blood work shows reduced numbers of platelets, leukocytes, and erythryocytes, with a high proportion of immature cells. The nurse caring for this patient suspects a diagnosis of what?

MDS

A nurse who provides care on an acute medical unit has observed that physicians are frequently reluctant to refer patients to hospice care. What are contributing factors that are known to underlie this tendency? SATA

-financial pressures on health care providers -patient reluctance to accept this type of care -advances in curative treatment in late-stage illness

A 67-year-old woman experienced the death of her husband from a sudden myocardial infarction 5 weeks ago. The nurse recognizes that the woman will be going through the process of mourning for an extended period of time. What processes of mourning will allow the woman to accommodate the loss in a healthy way? SATA

-reinvesting in new relationships at the appropriate time -reminiscing about the relationship she had with her husband -relinquishing old attachments to her husband at the appropriate time

A pediatric nurse is emotionally distraught by the death of a 9-year-old girl who received care on the unit over the course of many admissions spanning several years. What action is the most appropriate response to the nurses own grief?

attend the patients memorial service

An oncology nurse is caring for a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patients most recent blood tests, the nurse should anticipate what imbalance?

Hypercalcemia

A patient with non-Hodgkins lymphoma is receiving information from the oncology nurse. The patient asks the nurse why she should stop drinking and smoking and stay out of the sun. What would be the nurses best response?

Its important to reduce other factors that increase the risk of second cancers

A nurse is caring for an 87-year-old Mexican-American female patient who is in end-stage renal disease. The physician has just been in to see the patient and her family to tell them that nothing more can be done for the patient and that death is not far. The physician offers to discharge the patient home to hospice care, but the patient and family refuse. After the physician leaves, the patients daughter approaches you and asked what hospice care is. What would this lack of knowledge about hospice care be perceived as?

a barrier to hospice care for this patient

A 66-year-old patient is in hospice receiving palliative care for lung cancer which has metastasized to the patients liver and bones. For the past several hours, the patient has been experiencing dyspnea. What nursing action is most appropriate to help to relive the dyspnea the patient is experiencing?

administer bronchodilators and corticosteroids, as ordered

The nurse in a pediatric ICU is caring for a child who is dying of sickle cell anemia. The childs mother has been unable to eat or sleep and can talk only about her impending loss and the guilt she feels about the childs pain and suffering. What intervention has the highest priority?

allowing the patient to express her feelings without judging her

diagnostic testing has resulted in a diagnosis of acute myeloid leukemia in an adult patient who is otherwise healthy. The patient and the care team has collaborated and the patient will soon begin induction therapy. The nurse should prepare the patient who the patient for which of the following?

an aggressive course of chemotherapy

A patient with advanced leukemia is responding poorly to treatment. The nurse finds the patient tearful and trying to express his feelings, but he is clearly having difficulty. What is the nurses most appropriate action?

ask if he would like you to sit with him while he collects his thoughts

You are caring for a 50-year-old man diagnosed with multiple myeloma; he has just been told by the care team that his prognosis is poor. He is tearful and trying to express his feelings, but he is having difficulty. What should you do first?

ask if he would like you to sit with him while he collects his thoughts.

As a staff member in a local hospice, a nurse deals with death and dying on a frequent basis. Where would be the safe venue for the nurse to express her feelings of frustration and grief about a patient who has recently died?

at a staff meeting

A nurse is caring for a patient who has been diagnosed with leukemia. The nurses most recent assessment reveals the presence of ecchymoseson the patients sacral area and petechiae in her forearms. In addition to informing the patients primary care provider, the nurse should perform what action?

check the patients most recent platelet level

A patient with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the patient?

chew with care to avoid inadvertently biting the tongue

A nurse is caring for a patient with Hodgkin lymphoma at the oncology clinic. The nurse should be aware of what main goal of care?

cure of the disease

A nurse is planning the care of a patient who has been admitted to the medical to the medical unit with a diagnosis of multiple myeloma. In the patients care plan, the nurse has identified a diagnosis of risk for injury. What pathophysiology effect of multiple myeloma most contributes to this risk?

decreased bone density

The nurse is assessing a 73-year-old patient who was diagnosed with metastatic prostate cancer. The nurse notes that the patient is exhibiting signs of loss, grief, and intense sadness. Based on this assessment data, the nurse will document that the patient is most likely in what stage of death and dying?

depression

You are caring for a patient who has just been told that his illness is progressing and nothing more can be done for him. After the physician leaves, the patient asks you to stay with him for a while. The patient becomes tearful and tries several times to say something, but cannot get the words out. What would be an appropriate response for you to make at this time?

do you need more time to think about this?

You are caring for a patient, a 42-year-old mother of two children, with a diagnosis of ovarian cancer. She has just been told that her ovarian cancer is terminal. When you admitted this patient, you did a spiritual assessment. What question would it have been most important for you to evaluate during this assessment?

does she have sense of peace of mind and a purpose to her life?

A hospice nurse is well aware of how difficult it is to deal with others pain on a daily basis. This nurse should put healthy practices into place to guard against what outcome?

emotional exhaustion

A 77-year-old male is admitted to a unit with a suspected diagnosis of acute myeloid leukemia. When planning this patients care, the nurse should be aware of what epidemiologic fact?

five-year survival for patients over 75 years old is less than 2%

A home health nurse is caring for a patient with multiple myeloma. Which of the following interventions should the nurse prioritize when addressing the patients severe bone pain?

helping the patient manage the opioid analgesic regimen

A patient diagnosed with acute myelogenous leukemia has just been admitted to the oncology unit. When writing this patients care plan, what potential complication should the nurse address?

hemorrhage

A patients daughter has asked the nurse about helping him end his terrible suffering. The nurse is aware of the ANA Position Statement on Assisted Suicide, which clearly states that nursing participation in assisted suicide is a violation of the Code of Nurses. What does the Position Statement further stress?

identifying patient and family concerns and fears

An older adult patient is undergoing diagnostic testing for chronic lymphocytic leukemia. What assessment finding is certain to be present if the patient has CLL?

increased lymphocyte levels

A nurse practitioner is assessing a patient who has a fever, malaise, and a white blood cell count that is elevated. Which of the following principles should guide the nurses management of the patients care?

infection is the most likely cause of the patients change in health status

The organization of a patients care on the palliative care unit is based on interdisciplinary collaboration. How does interdisciplinary collaboration differ from multidisciplinary practice?

it is based on communication and cooperation between disciplines

A patient with end-stage heart failure has participated in a family meeting with the interdisciplinary team and opted for hospice care. On what belief should the patients care in this setting be based?

meaningful living during terminal illness is best supported in the home

A nurse is caring for a patient who has a diagnosis of acute leukemia. What assessment most directly addresses the most common cause of death among patients with leukemia?

monitoring for infection

The nurse is caring for a patient who has terminal lung cancer and is unconscious. Which assessment finding would most clearly indicate to the nurse that the patients death is imminent?

mottling of the lower limbs

An emergency department nurse is triaging a 77-year-old man who presents with uncharacteristic fatigue as well as back and rib pain. The patient denies any recent injuries. The nurse should recognize the need for this patient to be assessed for what health problem?

multiple myeloma

A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important accomplishment available by attending a grief support group?

normalization of feelings and experiences

A patient on the medical unit is dying and the nurse has determined that the familys psychosocial needs during the dying process need to be addressed. What is a cause of many patient care dilemmas at the end of life?

poor communication between the family and the care team

An adult patient has presented to the health clinic with a complaint of a firm, painless cervical lymph node. The patient denies any recent infectious diseases. What is the nurses most appropriate response to the patients complaint?

promptly refer the patient for medical assessment

A patient with a diagnosis of acute myeloid leukemia is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the patients care plan?

protective isolation and vigilant use of standard precaution

A hospice nurse is caring for a 22-year-old with a terminal diagnosis of leukemia. When updating this patients plan of nursing care, what should the nurse prioritize?

providing realistic emotional preparation for death

A medical nurse is providing end-of-life care for a patient with metastatic bone cancer. The nurse notes that the patient has been receiving oral analgesics for her pain with adequate effect, but is now having difficulty swallowing the medication. What should the nurse do?

request the physician to order analgesics by an alternative route

As the American population ages, nurses expect to see more patients admitted to long-term care facilities in need of palliative care. Regulations now in place that govern how the care in these facilities is both organized and reimbursed emphasize what aspect of care?

restorative measures

A nursing student is caring for a patient with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this patient, the student should assign the highest priority to which nursing diagnoses?

risk for infection

Patients who are enrolled in hospice care through Medicare are often felt to suffer unnecessarily because they do not receive adequate attention for their symptoms of the underlying illness. What factor most contributes to this phenomenon?

rules concerning completion of all cure-focused medical treatment

The nurse is admitting a 52-year-old father of four into hospice care. The patient has a diagnosis of Parkinsons disease, which is progressing rapidly. The patient has made clear his preference to receive care at home. What interventions should the nurse prioritize in the plan of care?

supporting the patients and familys values and choice

The hospice nurse is caring for a 45-year-old mother of three young children in the patients home. During the most recent visit, the nurse has observed that the patient has a new onset of altered mental status, likely resulting from recently diagnosed brain metastases. What goal of nursing interventions should the nurse identify?

teaching family members how to interact with, and ensure safety for, the patient with impaired cognition

An oncology nurse is providing health education for a patient who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia?

the different leukemias all involve unregulated proliferations of white blood cells.

A 60-year-old patient with chronic myeloid leukemia will be treated in the home setting and the nurse is preparing appropriate health education. What topic should the nurse emphasize?

the importance of adhering to the prescribed drug regimen

A patient has been found to have an indolent neoplasm. The nurse should recognize what implication of this condition?

the patient faces a significant risk of malignancy

A patient who is receiving care for osteosarcoma has been experiencing severe pain since being diagnosed. As a result, the patient has been receiving analgesics on both a scheduled and PRN basis. For the past several hours, however, the patients level of consciousness has declined and she is now unresponsive. How should the patients pain control regimen be affected?

the patients pain control regime should be continued

A patients rapid cancer metastases have prompted a shift from action treatment to palliative care. When planning this patients care, the nurse should identify what primary aim?

to prevent and relieve suffering

A patient has just died following urosepsis that progressed to septic shock. The patients spouse says, I knew this was coming, but I feel so numb and hollow inside. The nurse should know that these statements are characteristics of what?

uncomplicated grief and mourning