Pain/EOL prepU 17/20

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? Seek help from other health care team members to address the client's denial. Explain to the client that denial of the situation is unhealthy. Accept the client's denial of the situation. Correct the client's misconsceptions about the illness and treatment goals.

Accept the client's denial of the situation.

Which of the following nursing interventions will encourage the dying client to continue verbalizing? Talk about the client's problems. Agree with everything the client says. Nod and use responsive comments such as "Yes." Listen in a nonjudgmental manner.

Nod and use responsive comments such as "Yes."

Which of the following is the nurse's primary concern when providing end-of-life care for a client and the family? Select all that apply. Supporting family members Encouraging fluids Maintaining client comfort Providing personal care Completing a head-to-toe assessment Arranging plans for after death

b) Maintaining client comfort e) Supporting family members f) Providing personal 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." "I cannot legally administer pain medications that will induce unconsciousness to relieve your pain.: "Total sedation is a commonly practiced method used in this situation; I will contact your physician and begin treatment as soon as possible." "I need to perform a complete pain assessment to confirm the amount of pain you are experiencing before recommending sedation."

"Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death."

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? Megestrol Atropine Dexamethasone Dronabinol

Atropine

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? Grieving Complicated grieving Ineffective coping Stress overload

Complicated grieving

A client and family are dealing with the client's recent terminal diagnosis. A nurse identifies a nursing diagnosis of hopelessness. Which of the following would be most helpful in supporting hope for this family? Select all that apply. Encouraging the client to participate in care to foster control Arranging for appropriate psychosocial counseling Helping to obtain support from the community Avoiding the sharing of information and feelings Assisting in establishing long-term goals

Encouraging the client to participate in care to foster control Arranging for appropriate psychosocial counseling Helping to obtain support from the community

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: Fear of over-medicating the patient when pain is severe. Attitude of health care professionals toward terminal illness. Patient's resistance to accepting care. Lack of social support systems for the dying patient.

Fear of over-medicating the patient when pain is severe.

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? Explain that antidepressants are not indicated for the client. Ask the client whether she is planning to hurt herself. Educate the client that depression is expected. Perform a thorough pain assessment.

Perform a thorough pain assessment.

A patient on the medical unit is dying and the nurse has determined that the family's psychosocial needs during the dying process need to be addressed. What is a cause of many patient care dilemmas at the end of life? Conflict between family members Limited visitation opportunities for friends and family Denial of imminent death on the part of the family or the patient Poor communication between the family and the care team

Poor communication between the family and the care team

The family of a dying client being cared for at home is requesting information on how best to prepare food. Which suggestion by the nurse may stimulate appetite? Offering high caloric foods to build fat and muscle Preparing cool or cold foods that may be better tolerated Providing several choices on the plate so that the client has what may appeal to him Eating alone so the client can eat at his own pace and not be hurried

Preparing cool or cold foods that may be better tolerated

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 Pulse 100 beats/minute, blood pressure 100/60 mm Hg, pale with poor skin turgor Pulse 72 beats/minute, irregular; client confused and agitated Pulse 60 beats/minute, blood pressure 90/42mm Hg, difficult to arouse

Pulse 104 beats/minute in the morning, 62 beats/minute in the afternoon with mottled feet and ankles

Which of the following is the major long-term goal associated with end-of-life care? Client comfort Pain control Dying with dignity Relief of fear and anxiety

Pain control

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? Dosages are restricted. Death is imminent. Side effects must be treated. Client may become sedated.

Side effects must be treated.

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." "Your grandchild is almost here, and you will enjoy seeing him." "Do not worry, I will be here for you to help you with your needs." "I hear you say that you are not sleeping well."

"I will talk with the health care provider to determine the next step in your care."

Anorexia and cachexia are common problems at the end of life. The nurse plays an important role in managing symptoms and preventing complications. Which of the following are appropriate nursing interventions for these problems? Select all that apply. Suggest a daily weighing time to monitor treatment plan. Encourage the patient to eat in an upright position. Teach the patient how to increase the nutritional value of meals (i.e., add dry milk powder to milk). Advise the patient and family about the importance of a balanced diet. Recommend that the patient eat when hungry, regardless of usual meal times.

1. Encourage the patient to eat in an upright position. 2. Recommend that the patient eat when hungry, regardless of usual meal times. 3. Teach the patient how to increase the nutritional value of meals (i.e., add dry milk powder to milk).

Nursing students are reviewing information about the signs and symptoms of impending death. The students demonstrate the need for additional review when they identify which of the following as a sign? Restlessness Reduced urinary output Muscle wasting Mental confusion

Muscle wasting

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. Make arrangements for the client to receive nutritional counseling. Make arrangements with the physician to administer immunosuppressants. Immediately administer drug therapy to restore renal function.

Provide the spouse with an emergency kit that contains small doses of oral morphine liquid.

The nurse is caring for a client who is interested in learning about hospice care. Which of the eligibility criteria would the nurse stress? Serious, progressive illness Choice of palliative care over cure focused Limited life expectancy Physician-certified illness

Serious, progressive illness

A client has learned of a terminal illness and impending death. The client asks the nurse to explain the concepts and care that are provided under the definition of palliative care. Which of the following would the nurse include in the explanation for this client? Select all that apply. Hastens death Integrates spirituality Includes chemotherapy Provides pain relief Offers a team approach to care Enhances quality of life

a) Enhances quality of life c) Integrates spirituality d) Offers a team approach to care f) Provides pain relief