End of life care

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?

durable power of attorney for health care

Mr. Hosa is a 68-year-old man who is in the end stages of pancreatic cancer. His care team has suggested the possibility of hospice care but Mr. Hosa is opposed, stating, "A hospice is just a place to wait to die." Which of the following statements should underlie the nurse's response to Mr. Hosa?

Meaningful living can take place despite terminal illness

while offering end of life nursing care to a 72 year old client with late stage bone cancer, the nurse visits the client at home four times weekly. The nurse assesses the client each visit, monitoring the efficacy of pain medications, adjusting doses within physician ordered parameters, and discussing potential needs with the client's spouse, who is the primary caregiver. What is another very important assessment the nurse performs in the client's home?

caregiver's physical and emotional health

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 means for managing the client's symptoms?

client's goals

the hospice nurse is caring for a 45 year old parent of three young children in the client's home. During the most recent visit, the nurse observed that the client has a new onset of altered mental status, likely resulting from recently diagnosed brain metastases. Which goal of nursing interventions should the nurse identify?

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

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

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

request the health care provider to prescribe analgesics by an alternative route.

the nurse is providing home care to a dying client and has noticed over the course of several weeks that the client's daughter is usually quiet and withdrawn when in the client's room. Which intervention should the nurse perform in this situation?

sit with the client's daughter privately and encourage her to express her feelings frankly.

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?

remaining silent, allowing the client and family to respond after asking a question about end of life care

a terminally ill patient is admitted to the hospital. The patient grabs nurse's hand and asks, " am i dying?" what responses would be best for the nurse to give?

tell me more about what's on your mind

a nurse has been providing in home hospice care to an older client with lung cancer for more than six months. the family asks for 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

the nurse is caring for a dying patient. The family asks the nurse why there is a rattling in their loved one's chest. Which response is most appropriate?

there is an accumulation of fluid in the pulmonary circulation and secretions throughout the respiratory tract.

in which scenario would the nurse, caring for the palliative care client, encourage the treatment of chemotherapy?

when the chemotherapy can assist in managing distressing clinical symptoms

a patient with end-stage chronic obstructive pulmonary disease is admitted to a hospice facility and asks the admitting nurse, "How long will I be allowed to stay here?" What is the best response by the nurse?

When your stay reaches 6 months, you will be recertified for a continued stay

While palliative care can be offered in a multitude of settings (home, inpatient hospice, etc.), there are instances where institutionally based palliative care is most appropriate. Which of the following are factors that contribute to the decision of whether to use institutional palliative care?

all of the options are correct

a family of a dying client reports that their loved one is experiencing more shortness of breath. Which nursing intervention is most appropriate at this time?

call the health care provider to obtain an oxygen order

a client approaching end of life reports dyspea 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 client who has been demonstrating signs of impending death is awake, alert, and wants to see grandchildren after they attend school. which action will the nurse take to support this client's request?

contact the family to ask for grandchildren to come visit the client

a nurse is assessing a terminally ill female client. which client statement indicates that the client is in the bargaining stage of dying?

i just want to see my daughter graduate from college, that's all

for individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death?

increased restlessness

why might a client who is approaching death suddenly vomit?

intestinal distention

a pt. family member asks the nurse what the purpose of hospice is. What is the best response by the nurse?

it will enable the pt to remain home if that is what is desired

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?

provide gentle oral care after each meal

a 6 year old is in the last stage of leukemia. Despite the nurse's administration of prescribed pain medication, the client is still in pain due to fear and anxiety. Which nursing intervention should the nurse use to increase the efficacy of the pain medication and make the client more comfortable?

use imagery, humor, and progressive relaxation

shortly after a client's death from a long term illness, his daughter says to the nurse, " things changed so suddenly. I told him yesterday how much i love him but that it was okay to let go if that's what he wanted." The nurse would identify this as what phenomenon for the daughter?

waiting for permission

which of the following should the nurse report so that the team can consider alternative nutritional and fluid administration routes for a client who is dying?

weight loss and inadequate food intake

the nurse learns that a computed tomography scan a client underwent to investigate new seizure activity revealed a brain tumor. When the client later asks about the results of the scan, which therapeutic response should the nurse give the client?

what is your understanding of your condition?

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

The nurse is describing palliative care and hospice services to a client with end-stage congestive heart failure. The client and family have many questions about the difference between palliative care and hospice. Which statement should the nurse provide the family?

Hospice is the application of palliative care at the end of life

the nurse evaluates that a dying client is in the anger stage of reacting to her prognosis. Which of the following statements is most consistent with this interpretation?

I took care of myself and its not fair that this has happened

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

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

To prevent and relieve suffering

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

Within a care team meeting in your long-term care facility, discussions continue with family members of a 59-year-old client regarding his deteriorating condition. The physician has indicated that the client's condition is terminal and his family doesn't want the client to know the gravity of his condition - they don't want him to worry. As his nurse, why do you advocate that the client needs to know the truth?

its important that the nurse client relationship is based on honesty

which of the following nursing interventions will a nurse perform to transfer heat and improve circulation in a dying client?

gently massage the arms and legs

which term is used to describe personal feelings that accompany an anticipated or actual loss?

grief

the hospice nurse is visiting the client at home. The client is comfortable with talking to the nurse. Which of the following statements, made by the client, demonstrates that the spiritual needs are being met?

i believe there is a better place