Funds N272: End-of-Care
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 25-year-old client with cancer who is experiencing unrelieved pain rated a 9 on the pain scale requests that the hospice nurse induce a state of unconsciousness until the client dies. Which statement by the nurse demonstrates an understanding of a key difference between conscious sedation and euthanasia?
"Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death."
Which of the following may be contained in an "emergency kit" for a hospice patient exhibiting restlessness?
Benzodiazepine (A kit might contain small doses of oral morphine liquid for pain or shortness of breath, a benzodiazepine for restlessness, and an acetaminophen suppository for fever. Atropine sulfate drops may be used for excess respiratory secretions.)
A client has been declared to have a terminal illness. What intervention will a nurse perform regarding the final decision of a dying client?
Respect the client's and family members' choices
The nurse is providing care to a family who is facing a life-threatening illness. The nurse is assessing how family members bond and how the family works as a team. The nurse is assessing which of the following?
Cohesion and boundaries
A hospice nurse performs a follow-up telephone call to the spouse of a client who died about 1 year ago. The spouse tells the nurse, "I'm always feeling so sad. Life just doesn't feel worth living." Further conversation reveals that the spouse is having trouble sleeping and eating since her husband's death and that the spouse is "drinking more since he died." The nurse identifies which nursing diagnosis as the priority?
Complicated grieving (Complicated grieving is characterized by prolonged feelings of sadness and feelings of general worthlessness or hopelessness that persist long after the death, prolonged symptoms that interfere with activities, or self-destructive behaviors such as alcohol or substance abuse and suicidal ideation or attempts. Thus, the nursing diagnosis of complicated grieving would be the priority and most appropriate. Although the client may be having trouble coping or experiencing stress, complicated grieving is more applicable. Although there is no time table to denote grieving, the nursing diagnosis of grieving would be more appropriate in the period surrounding the husband's death, rather than 1 year later.)
Which of the following would not be consistent with promoting nutrition in terminally ill patients?
Maintaining a balanced diet
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 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 nurse is assessing a client with a terminal illness and finds that the client has cachexia. The nurse interprets this as indicating which of the following?
Profound protein loss
A client in hospice has end-stage renal failure. The client states that, of late, he has lost his appetite and feels like everyday situations have become more stressful. The client reports feeling restless. In addition, the client's spouse notices that the client is becoming more confused. What is the most important nursing intervention that needs to be carried out at this point?
Provide the spouse with an emergency kit that contains small doses of oral morphine liquid.
Which cardiovascular findings indicate to the nurse that the condition of the dying client is worsening?
Pulse 104 beats/minute in the morning, 62 beats/minute in the afternoon with mottled feet and ankles
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
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.
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
Evidence-based medical and nursing research (2009) has identified cardiovascular disease as the most prevalent chronic disease in the United States. Under this classification, one condition is the most common. Using this information, a nurse practitioner, treating a 50-year-old man, would do which of the following?
Write a prescription for a serum cholesterol level.
How does a nurse who has been providing home care to a terminally ill client know that the client's condition is beginning to deteriorate?
apical pulse reaches 100 beats/minute
Stages of Kubler-Ross
denial, anger, bargaining, depression, acceptance
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 client who is interested in learning about hospice care. Which of the eligibility criteria would the nurse stress?
Choice of palliative care over cure focused
A nurse is providing care to a terminally ill client who follows Islamic traditions and is experiencing pain. When developing a plan of care for this client, an understanding of which of the following would the nurse need to integrate into the plan?
Pain is viewed as a means of cleansing by God.
A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse?
"It will enable the patient to remain home if that is what is desired."
During a home care visit to a client in hospice, the client's spouse reveals to the nurse an understanding that the client's death is inevitable. Recognizing the spouse is exemplifying the Kübler-Ross stage of acceptance, which statement by the nurse is most appropriate?
"Tell me how you plan to react when you first realize that your spouse is breathless and has no pulse."
A nurse has been working in hospice care for 10 years. Based on her experience, she drafts her plan of care with the understanding that the most significant barrier to improving care at the end of life is the:
Attitude of health care professionals toward terminal illness.
Which intervention should a nurse perform during the grieving period when caring for a dying client?
Avoiding criticizing or giving advice (The nurse should listen in a nonjudgmental manner and should avoid criticizing or giving advice during the grieving period when caring for dying clients. Allowing a period of privacy is necessary to help family members cope with the death of a client and is not necessary during the grieving period. Spending time with the client and providing palliative care are not the required nursing interventions during the grieving period. Palliative care is provided to a dying client when the client is unable to live independently.)
Which "awareness context" is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise?
Mutual pretense awareness
A client is experiencing anorexia and the physician is to order a medication to stimulate the client's appetite. Which of the following would the nurse least likely expect the physician to prescribe?
Atropine
A nurse is working with a family of a deceased client and assisting them in working through their grief and mourning. Which of the following would be the priority to promote healthy accomodation of the loss by the family?
Helping the family recognize the loss has occurred
A client with long-term breast cancer who was recently enrolled in a hospice program demonstrates signs and symptoms of clinical depression. Which action by the hospice nurse is appropriate?
Perform a thorough pain assessment.
A nurse is caring for a client with end-stage testicular cancer who has been referred to hospice care. Which criterion indicates that the client requires more teaching about hospice care?
The client entered a clinical trial through the National Cancer Institute.
As a client approaches death, respirations become noisy. This is the result of which type physical event?
musculoskeletal change
A nurse assesses a client with a terminal illness and determines that the client is in denial about the condition. Which of the following would be most important for the nurse to do when developing the client's plan of care?
Accept the client's denial of the situation.
The client is 45 years old and has a family history of breast cancer. The client was diagnosed with breast cancer 2 months ago. During a routine visit, the physician prescribes dexamethasone to be taken over a 3-week period. Which symptom would prompt the physician to add dexamethasone to the client's treatment plan?
An 8-lb (3.6-kg) weight loss
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 nurse is providing care to a terminally ill client who is experiencing dyspnea. Which of the following would be most appropriate to do to assess the severity of the client's complaint? You Selected:
Ask the client to rate the dyspnea on a scale of 0 to 10.
Which of the following interventions should the nurse perform while providing spiritual care for a dying client?
Ask the family members about spiritual care.
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 (The question about what gives life meaning provides information about the client's faith and belief. Importance and influence are addressed by questions focusing on the role faith plays in the client's life and how his or her beliefs affect the way the client cares for self and illness. Community is addressed by questions focusing on the client's participation in a spiritual or religious community and the support obtained from it. Address in care focuses on how the nurse would integrate the issues involving spirituality in the client's care.)
While providing care to a client near death, the nurse is helping the family to prepare by teaching them what to expect. Which of the following would the nurse include in the teaching plan as a sign of approaching death? Select all that apply.
Gurgling as the client breathes through the mouth. Decrease in amount of urine produced. Refusal to ingest food or fluids. (As death approaches, a client typically has secretions that collect in the back of the throat and rattle or gurgle as the client breathes through the mouth. Breathing may become irregular with periods of no breathing. Urine output may decrease in amount and frequency, and loss of bladder and bowel control may occur. The person approaching death shows less interest in eating and drinking; for many, refusal of food is an indicator that they are ready to die. Vision and hearing may be somewhat impaired and speech may be difficult to understand.)
The nurse is caring for a client at the end of life. The client is ordered a regular dosage of narcotics and short-acting narcotics for breakthrough pain. When administering the narcotics, the nurse is correct to realize which of the following?
Side effects must be treated.
