PU CH13 PALLIATIVE CARE PART I

Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice. However, the median length of stay in a hospice program is just 21.3 days. Which reason explains the underuse of hospice care services? A. Lack of fully credentialed and trained hospice nurses B. Clients and families view hospice care as giving up C. Lack of Medicare/Medicaid funding for hospice D. Difficulty obtaining Medicare certification for hospice services

B

Which term is used to describe the personal feelings that accompany an anticipated or actual loss? A. Bereavement B. Grief C. Mourning D. Spirituality

B

While providing care to a terminally ill client, the client asks, "Am I dying?" Which response by the nurse would be most appropriate? A. "What makes you think that you might be dying?" B. "Tell me some more about what is on your mind." C. "You're just having a bit of a set-back. You'll be fine." D. "What has your physician told you about your condition?"

B

While providing care to a terminally ill client, the client's niece asks the nurse about the client's condition and prognosis. Which of the following would be most appropriate? A. Provide the niece with the information that she is requesting. B. Ask the client's consent before sharing any information with the niece. C. Check with the client's immediate family members about sharing information. D. Refer the niece to the client's physician for information.

B

A client approaching end-of-life reports dyspnea as being 7 on a scale from 0 to 10. Which action will the nurse take to assist this client? A. Lower the head of the bed. B. Restrict the intake of oral fluids. C. Coach to use pursed lip breathing. D. Increase the air temperature in the room.

C

A nurse is developing a teaching plan for a terminally ill client and his family about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in the teaching plan? A. Each client experiences each of the stages. B. Typically, the stages occur in succession. C. The stages are applicable to any loss. D. Most clients reach acceptance by the time of death.

C

A nurse is part of a team involved with informing a client and his wife about the spread of his cancer. When communicating with the client and wife, which of the following would be most appropriate? A. Arranging to meet with the client and wife in the waiting room of the facility B. Providing them with extensive details of the findings and proposed treatment C. Allowing time for the client and wife to absorb and respond to the information D. Using technical terminology when describing the condition

C

As the moment of death approaches, which of the following does the nurse encourage the family to do? A. Have the family sit in front of the client so they can be seen. B. Rub the client's hand and arm to comfort the client. C. Speak to the client in a calm and soothing voice. D. Lie next to the client and hold the client.

C

Which is the initial stage of grief, according to Kübler-Ross? A. Anger B. Bargaining C. Denial D. Depression

C

Which of the following does not coincide with Kübler-Ross's stages related to a dying client? A. Clients don't always follow the stages in order. B. Some client regress, then move forward again. C. The dying client usually exhibits anger first. D. The client may be in several stages at once.

C

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? A. Megestrol B. Dexamethasone C. Dronabinol D. Atropine

D

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? A. Importance and influence B. Community C. Address in care D. Faith and belief

D

A 50-year-old client is an alcoholic. The client has been diagnosed with pancreatic cancer and underwent surgery to remove the tumor. Despite the tumor being removed, the physician informs the client that chemotherapy needs to be started immediately. Using evidence-based practice, which intervention might the nurse expect the physician to include, with the goal of improving quality of life, mood, and median survival. A. Palliative care B. Radiation C. Angiogenesis D. Respite care

A

A dying patient wants to talk to the nurse. The patient states, "I know I'm dying, aren't I?" What would an appropriate nursing response be? A. "This must be very difficult for you." B. "Let me explain to you what is happening." C. "I'm so sorry. I know how you must feel." D. "You know you're dying?"

A

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? A. Palliative care is the same as hospice care. B. Palliative care developed after hospice care developed. C. Palliative care is conceptually broader than hospice care. D. Palliative care is often provided along with disease-lessening treatments.

A

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? A. Pain is viewed as a means of cleansing by God. B. Pain must be controlled regardless of the client's wishes. C. Pain is considered a positive aspect that leads to rebirth. D. Pain provides the client with an opportunity for repentance.

A

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? A. Risk for constipation related to the effects of an opioid B. Risk for ineffective cerebral tissue perfusion related to central nervous system effects of the drug C. Caregiver role strain related to the need for around-the-clock pain control D. Impaired physical mobility related to sedative effects of the drug

A

Nursing students are reviewing information about attitudes related to death and dying. The students demonstrate understanding of the information when they identify which of the following as most accurate? A. There remains a conspiracy of silence about dying despite progress in the area. B. Most clinicians are very open to talking about disease and dying with clients. C. Clients, for the most part, would gain hope if they were told about a poor prognosis. D. Clients would ask for information if they really had a desire to know.

A

When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following? A. Treatment directive B. Living will C. Standard addendum to a will D. Proxy directive

D

The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which intervention should a nurse perform in such a situation? A. Encourage the family members to express their feelings and listen to them in their frank communication B. Encourage conversations about the impending death of the client C. Be a silent observer and allow the client to communicate with the family members D. Encourage the client's family members to spend time with the client

A

The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which nursing interventions should a nurse perform in such a situation? A. Encourage the family members to express their feelings and listen to them in their frank communication. B. Encourage conversations about the impending death of the client. C. Be a silent observer and allow the client to communicate with the family members. D. Encourage the client's family members to spend time with the client.

A

Which cardiovascular findings indicate to the nurse that the condition of the client who is dying is worsening? A. Pulse 104 beats/minute in the morning, 62 beats/minute in the afternoon with mottled feet and ankles B. Pulse 72 beats/minute, irregular; client confused and agitated C. Pulse 100 beats/minute, blood pressure 100/60 mm Hg, pale with poor skin turgor D. Pulse 60 beats/minute, blood pressure 90/42mm Hg, difficult to arouse

A

Which of the following is a term that refers to individual, family, group, and cultural expressions of grief and associated behaviors? A. Mourning B. Grief C. Bereavement D. Spirituality

A

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? A. Ineffective coping B. Complicated grieving C. Grieving D. Stress overload

B

A nurse is providing in-home hospice care to a terminally ill client. The client experiences a medical crisis requiring monitoring and medication administration. Which level of hospice care would the nurse implement? A. Routine home care B. Continuous care C. Inpatient respite care D. General inpatient care

B

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? A. Denial B. Anger C. Bargaining D. Acceptance

B

A client with a terminal illness says, "I can't take these treatments anymore." Which response will the nurse make when using the NURSE communication framework? A. "If you stop the treatments you might not survive." B. "It sounds like you are tired of having the treatments." C. "There's no reason for you to be tired of the treatments." D. "I'm surprised you are complaining about the treatments now."

B

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? A. Barbiturate coma B. Palliative sedation C. Conscious sedation D. Patient-controlled analgesia

B

A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse? A. "It will hasten the death of the patient." B. "It will prolong life in a dignified manner." C. "It will use artificial means of life support if the patient requests it." D. "It will enable the patient to remain home if that is what is desired."

D