End of Life Issues Mastery Ques
Which of the following is a sign of approaching death? a) Clear sensorium b) Insomnia c) Increase in urinary output d) Irregular breathing patterns
Irregular breathing patterns Explanation: Irregular breathing patterns are a sign of impending death. Other signs of approaching death include decreased urinary output, mental confusion, and sleeping for longer periods.
A 6-year-old client is in the last stage of leukemia. Despite your administration of prescribed pain medication, she is still in pain due to fear and anxiety. Which nursing intervention should you use to increase the efficacy of the pain medication and make the client more comfortable? a) Offer small amounts of nourishment frequently b) Gentle massaging of the arms and legs c) Encourage the client to fall asleep d) Utilize imagery, humor, and progressive relaxation
Utilize imagery, humor, and progressive relaxation Explanation: Imagery, humor, and progressive relaxation are the various techniques to potentiate the effects of pain medication.
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 patient's daughter approaches you and asks what hospice care is. What would this lack of knowledge about hospice care be perceived as? a) Lack of an American education of the patient and her family b) A barrier to hospice care for this patient c) Inability to grasp American concepts of health care d) A language barrier to hospice care for this patient
A barrier to hospice care for this patient Explanation: Historical mistrust of the health care system and unequal access to even basic medical care may underlie the beliefs and attitudes among ethnically diverse populations. In addition, lack of education or knowledge about end-of-life care treatment options and language barriers influence decisions among many socioeconomically disadvantaged groups. The scenario does not indicate whether the patient's family has an American education, whether they are unable to grasp American concepts of health care, or whether they can speak or understand English.
For individuals known to be dying by virtue of age and/or diagnoses, which of the following signs indicate approaching death? a) Increased restlessness b) Increased eating c) Increased wakefulness d) Increased urinary output
As the oxygen supply to the brain decreases, the patient may become restless. As the body weakens, the patient will sleep more and begin to detach from the environment. For many patients, refusal of food is an indication that they are ready to die. Based on decreased intake, urinary output generally decreases in amount and frequency.
You are caring for a 50-year-old male diagnosed with multiple myeloma; he has just been told that his prognosis is poor. He is tearful and trying to express his feelings, but he is having difficulty. What should you do first? a) Offer to call pastoral care. b) Tell him that you will leave for now but will be back. c) Tell him that you can understand how he is feeling. d) Ask if he would like you to sit with him while he collects his thoughts.
Ask if he would like you to sit with him while he collects his thoughts.
A client and his loved ones are in the grieving period of his dying, and you want to offer the best possible support to them in the process. Which is the best intervention you could perform during the grieving period? a) Allowing a period of privacy b) Avoiding criticism or giving advice c) Spending time with client d) Providing palliative care
Avoiding criticism or giving advice Explanation: The nurse should listen in a nonjudgmental manner and should avoid criticism or giving advice during the grieving period when caring for dying clients. This particular intervention does not facilitate the grieving process for the client and his loved ones. The nurse is responsible for facilitating the grieving process and helping the client and family deal with their emotions. To do this, nurses may empathetically share perceptions of what the client and family is experiencing.
While offering end-of-life nursing care to Brooks Johnson, a 72-year-old male with late stage bone cancer, you visit him at home four times weekly. As his nurse, you assess him each visit, monitoring the efficacy of his pain medications, adjusting doses within physician ordered parameters and discussing potential needs with his wife - who is his primary caregiver. What is another very important assessment you perform in his home? a) None of the options are correct b) Grief assessment c) Caregiver's physical and emotional health d) Hospice assessment
Caregiver's physical and emotional health Explanation: A negative factor of home care is the burden it places on the primary caregiver. If prolonged, the role of primary caregiver can be very isolating and physically exhausting because the responsibility for providing care continues 24 hours a day, day after day. Home care nurses periodically need to assess the toll on the caregiver's physical and emotional health.
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? a) Depression b) Anger c) Denial d) Resignation
Depression Explanation: Loss, grief, and intense sadness indicate depression. Denial is indicated by the refusal to admit the truth or reality. Anger is indicated by rage and resentment. Acceptance is indicated by a gradual, peaceful withdrawal from life.
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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. By encouraging family members to express their feelings and listening to them in their frank communication, family members may feel more prepared to carry on a similarly honest dialogue with the dying patient. It is not advisable for the nurse to encourage conversations on the impending death of the patient. Being a silent observer or encouraging the family members to spend time with the dying patient may not help the family members to express their feelings.
The patient tells the doctor that he and his family have accepted the terminal diagnosis of pancreatic cancer. The patient further explains that he is interested in being comfortable and that he no longer wishes to fight the cancer. This approach to end-of-life care is known as which of the following? a) Interdisciplinary care b) Terminal care c) Palliative care d) Euthanasia care
Palliative care Explanation: Palliative care is a type of comprehensive care for patients whose disease is not responsive to cure. Terminal illness is a progressive, irreversible illness that despite cure-focused medical treatment will result in the patient'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.
Medicare and Medicaid hospice benefits criteria allow patients with a life expectancy of 6 months or less to be admitted to the hospice. However, the median length of stay in a hospice program is just 21.3 days. Which of the following reasons explains underuse of hospice care services? a) Difficulty obtaining Medicare certification for hospice services b) Lack of Medicare/Medicaid funding for hospice c) Lack of fully credentialed and trained hospice nurses d) Patients/families view palliative care as giving up
Patients/families view palliative care as giving up Explanation: Lack of fully credentialed and trained hospice patients is not a barrier to hospice care. Patients equate hospice with "giving up" and are reluctant to accept hospice. Lack of Medicare funding or certification for hospice service providers has not been documented as a barrier to access of hospice services.
A patient with brain tumor recently stopped radiation and chemotherapy for treatment of his cancer. Of late, he is complaining of dry mouth. Which of the following interventions by the hospice nurse demonstrates the nurse understands treatment measures for dry mouth? a) Begin IV fluids of 9% normal saline at 125 mL/hr. b) Provide gentle mouth care after each meal. c) Place two drops of Atropine ophthalmic 1% solution sublingually. d) Gently suction the patient's mouth, and buccal cavity.
Provide gentle mouth care after each meal. Explanation: The use of artificial hydration (IV fluids) carry considerable risks and do not contribute to comfort at end of life Atropine ophthalmic 1% drops when administered sublingually helps reduce oral secretions. Dry mouth can generally be managed through nursing measures such as mouth care. Gentle oral suctioning reduces the production of secretions.
Which of the following is one of the levels of hospice care covered under Medicare and Medicaid hospice benefits that includes a 5-day inpatient stay and is provided on an occasional basis to relive the family caregivers? a) General inpatient care b) Continuous care c) Routine home care d) Respite care
Respite care Explanation: Inpatient respite care is a 5-day inpatient stay, provided on an occasional basis to relieve the family caregivers. Routine home care entails that all services provided are included in the daily rate to the hospice. Continuous care is provided in the home for management of a medical crisis. General inpatient care provides inpatient stay for symptoms management that cannot be provided in the home.
Which of the following is one of the levels of hospice care covered under Medicare and Medicaid hospice benefits that includes a 5-day inpatient stay and is provided on an occasional basis to relive the family caregivers? a) Respite care b) General inpatient care c) Continuous care d) Routine home care
Respite care Explanation: Inpatient respite care is a 5-day inpatient stay, provided on an occasional basis to relieve the family caregivers. Routine home care entails that all services provided are included in the daily rate to the hospice. Continuous care is provided in the home for management of a medical crisis. General inpatient care provides inpatient stay for symptoms management that cannot be provided in the home.
Palliative care is a structured system for care delivery that has what as its aim? a) To give traditional medical care. b) To provide care while there is still hope. c) To bridge between curative care and hospice care. d) To prevent and relieve suffering.
To prevent and relieve suffering
Despite having been administered the prescribed pain medication, a dying patient is still in pain due to fear and anxiety. Which of the following nursing interventions should a nurse use to potentiate the effects of pain medication? a) Offering small amounts of nourishment frequently b) Encouraging the patient to fall asleep c) Using imagery, humor, and progressive relaxation d) Gently massaging the arms and legs
Using imagery, humor, and progressive relaxation Explanation: Imagery, humor, and progressive relaxation are the various techniques to potentiate the effects of pain medication. Offering small amounts of nourishment frequently will not help in potentiating the effects of pain medication. To regulate the body temperature, gentle massaging of the arms and legs is done. Encouraging the patient to fall asleep will not help in potentiating the effects of pain medication.
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 loved him but that it was OK to let go if that's what he wanted." The nurse would identify this as what phenomenon for the daughter? a) Waiting for permission b) Bargaining for acceptance c) Moving on with love d) Near death experience
Waiting for permission Explanation: Some clients seem to forestall dying when they feel that their loved ones are not yet prepared to deal with their death. This has been described as the waiting for permission phenomenon, because death often occurs shortly after a significant family member communicates that he or she is strong enough and ready to ''let go.''
A type of comprehensive care for patients whose disease is not responsive to cure is a) euthanasia. b) a terminal illness. c) interdisciplinary collaboration. d) palliative care.
palliative care. Explanation: Palliative care is a type of comprehensive care for patients whose disease is not responsive to cure. Terminal illness is a progressive, irreversible illness that despite cure-focused medical treatment will result in the patient'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
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? a) "This cannot be happening to me." b) "I took care of myself and it's not fair that this has happened." c) "I just want to make it until the end of this year." d) "I don't even want to get out bed anymore--what's the point?"
"I took care of myself and it's not fair that this has happened." Explanation: Option B reflects anger--the client feels that her situation is unfair and is reacting against the circumstances. Option A reflects denial; option C is bargaining; and option D is consistent with depression.
A terminally ill patient has feelings of rage toward the nurse. According to Elisabeth Kübler-Ross, the patient is in which stage of dying? a) Denial b) Anger c) Bargaining d) Depression
Anger Explanation: Anger includes feelings of rage or resentment. Denial includes feelings of isolation. Bargaining occurs when a patient and/or family plead for more time to reach an important goal. Depression includes sadness, grief, and mourning for an impending loss.
A nurse is providing in-home hospice care to a 75-year-old client with lung cancer. The nurse determines that the client is eligible for Medicare hospice benefits based on which of the following? a) Client has a serious and progressive illness. b) Client has no other insurance to pay for the care. c) Client has family members to provide the care. d) Client has a life expectancy of 6 months or less.
Client has a life expectancy of 6 months or less. Explanation: Eligibility for the Medicare Hospice Benefit includes physician certification of a client as 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. Although the presence of family members in the home is helpful, their presence is not a criterion for eligibility. Lack of other insurance also is not a criterion for eligibility.
The wife of your terminally ill client is confused by the new terminology being used during discussions regarding her husband's treatment. How would you explain palliative care to her? a) It is care that will reduce her husband's physical discomfort and manage clinical symptoms. b) It is an alternative therapy that uses massage and progressive relaxation for pain relief. c) It is care that is provided at the very end of an illness to ease the dying process. d) It is offered to terminally ill clients who wish to remain in their homes in lieu of hospice care.
It is care that will reduce her husband'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 reduces physical discomfort without altering a disease's progression and is part of hospice care, which emphasizes helping clients live however they wish until they die.
Why might a client who is approaching death suddenly vomit? a) Loss of urinary and rectal sphincter control b) Low cardiac output c) Slowed peristalsis d) Generalized hypoxia
Slowed peristalsis Explanation: This may cause an accumulation of intestinal contents that stimulate the vomiting center. This might cause incontinence of urine and stool but not vomiting. Low cardiac output causes urine volume to diminish and toxic waste products to accumulate. Hypoxia may lead to periods of apnea (no breathing).
A medical nurse is providing palliative care to a patient with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse's care? a) To help the patient develop a separate plan with each discipline of the health care team b) To provide physical support for the patient c) To improve the patient's and family's quality of life d) To support aggressive and innovative treatments for cure
To improve the patient's and family's quality of life Explanation: The goal of palliative care is to improve the patient's and the family's quality of life. The support should include the patient's physical, emotional, and spiritual well-being. Each discipline should contribute to a single care plan that addresses the needs of the patient and family. The goal of palliative care is not aggressive support for curing the patient. Providing physical support for the patient is also not the goal of palliative care. Palliative care does not strive to achieve separate plans of care developed by the patient with each discipline of the health care team.
A patient's rapid cancer metastases have prompted a shift from active treatment to palliative care. When planning this patient's care, the nurse should identify what primary aim? a) To provide care while there is still hope b) To prevent and relieve suffering c) To bridge between curative care and hospice care d) To prioritize emotional needs
To prevent and relieve suffering Explanation: Palliative care, which is conceptually broader than hospice care, is both an approach to care and a structured system for care delivery that aims to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Palliative care goes beyond simple prioritization of emotional needs; these are always considered and addressed. Palliative care is considered a "bridge," but it is not limited to just hospice care. Hope is something patients and families have even while the patient is actively dying.
In the past three to four decades, nursing has moved into the forefront in providing care for the dying. Which phenomenon has most contributed to this increased focus of care of the dying? a) Increased focus of health care providers on disease prevention b) Demographic changes in the population c) Increased incidence of infections and acute illnesses d) Larger numbers of people dying in hospital settings
Demographic changes in the population Explanation: The focus on care of the dying has been motivated by the aging of the population, the prevalence of, and publicity surrounding, life-threatening illnesses (e.g., cancer and AIDS), and the increasing likelihood of a prolonged period of chronic illness prior to death. The salience of acute infections, prevention measures, and death in hospital settings are not noted to have had a major influence on this phenomenon.
