AVR Chapter 10 PrepU

A mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement best communicates a spirit of hopefulness to this client?

Correct response: "Let's take this one day at a time; remember you have your daughter's dance recital next month." Explanation: Helping a client to find reasons to live and look forward to events promotes positive attitudes and ability to live for the moment, which in turn communicates a spirit of hopefulness. The statement about a second opinion is inappropriate because it gives the client false hope that her current diagnosis is inaccurate. Althought he client may choose another medical opinion, she needs to come to that decision without the nurse's advice. Reponses should not convey false hope to the client. Nurses and clients should not confuse hope with unrealistic optimism.

A client is in a hospice receiving palliative care for lung cancer which has metastasized to the client's liver and bones. For the past several hours, the client has been experiencing dyspnea. What nursing action is most appropriate?

Correct response: Administer bronchodilators and corticosteroids, as prescribed. Explanation: Bronchodilators and corticosteroids help to improve lung function, as do low doses of opioids. Low-flow oxygen often provides psychological comfort to the client and family. A fluid bolus is unlikely to be of benefit.

Question 10 See full question 13s As a staff member in a local hospice, a nurse deals with death and dying on a frequent basis. Where would be the safe venue for the nurse to express her feelings of frustration and grief about a client who has recently died?

Correct response: At a staff meeting Explanation: In hospice settings, where death, grief, and loss are expected outcomes of patient care, interdisciplinary colleagues rely on each other for support, using meeting time to express frustration, sadness, anger, and other emotions; to learn coping skills from each other; and to speak about how they were affected by the lives of those patients who have died since the last meeting. Public settings are inappropriate places to express frustration about the death of a patient.

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 a means for managing the client's symptoms?

Correct response: Client's goals Explanation: When managing the symptoms of a client with a terminal illness, the client's goals take precedence over the clinician's goals to relieve all symptoms at all costs. Although the length and invasiveness of the treatment may influence decision making, ultimately it is the client's goals that determine what will be done.

A patient diagnosed with terminal pancreatic cancer is unaware of the diagnosis and his daughter has requested that he not be told. What awareness context does the nurse determine this is?

Correct response: Closed awareness Explanation: In closed awareness, the patient is unaware of his or her terminal state, whereas others are aware. In suspected awareness, the patient suspects what others know and attempts to find out details about his or her condition. In mutual pretense awareness, the patient, the family, and the health care professionals are aware that the patient is dying, but all pretend otherwise. In open awareness, the patient, the family, and the health care professionals are aware that the patient is dying and openly acknowledge that reality.

A nurse is providing hospice care in Portland, Oregon to a client with terminal liver cancer. The client confides to the nurse, "I'm in agony all the time. I want this to be over now—please help me." Which interventions should the nurse implement? Select all that apply. Advise the client's health care provider of the client's condition. Control the client's pain with prescribed medication. Comfort the client by saying it will all be over soon. Encourage the client to explain his or her wishes. Recommend that the client consider physician-assisted suicide.

Correct response: Control the client's pain with prescribed medication. Advise the client's health care provider of the client's condition. Encourage the client to explain his or her wishes. Explanation: This client lives in Oregon, one of five states that have decriminalized physician-assisted suicide, the practice of providing a means by which a client can end his or her own life. This practice is controversial, with proponents arguing the client has a right to self-determination and a relief from suffering when there is no other means of palliation. Opponents, on the other hand, find it contrary to the Hippocratic Oath. In this scenario, the nurse should determine exactly what the client is asking and then support his or her wishes. It is not the nurse's role to suggest physician-assisted suicide voluntarily, however.

A woman experienced the death of her husband from a sudden myocardial infarction 5 weeks ago. The nurse recognizes that the woman will be going through the process of mourning for an extended period of time. What processes of mourning will allow the woman to accommodate the loss in a healthy way? Select all that apply. Relinquishing old attachments to her husband at the appropriate time Reiterating her anger at her husband's care team Reinvesting in new relationships at the appropriate time Reminiscing about the relationship she had with her husband Renewing her lifelong commitment to her husband

Correct response: Reinvesting in new relationships at the appropriate time Reminiscing about the relationship she had with her husband Relinquishing old attachments to her husband at the appropriate time Explanation: Six key processes of mourning allow people to accommodate to the loss in a healthy way: 1.) Recognition of the loss 2.) Reaction to the separation, and experiencing and expressing the pain of the loss 3.) Recollection and re-experiencing the deceased, the relationship, and the associated feelings 4.) Relinquishing old attachments to the deceased 5.) Readjustment to adapt to the new world without forgetting the old 6.) Reinvestment Reiterating her anger and renewing her lifelong commitment may be counterproductive to the mourning process.

A client has been declared to have a terminal illness. What intervention will a nurse perform regarding the final decision of a dying client?

Correct response: Respect the client's and family members' choices Explanation: In the final decisions of a dying client, the nurse will present options for terminal care and respect the client's and family members' choices. Sharing emotional pain is a role in providing care and comfort to dying clients and their families. When the client has a living will, physicians must abide by the client's wishes. The nurse should ask the family members about spiritual care only if the client wants someone associated with his or her religion.

The adult daughter of a terminally ill client tells the nurse that the client had a dream that they would die the following Tuesday. What would the nurse tell the daughter, who is visibly shaken by her parent's dream?

Correct response: to prepare for the client's death as many people have similar premonitions Explanation: Nearing death awareness is a phenomenon characterized by a dying client's premonition of the approximate time or date of death. With hypoxia, the brain is less sensitive to accumulating levels of carbon dioxide; therefore, the client may experience periods of apnea (no breathing). It does not necessarily cause vivid dreams. Some clients seem to forestall dying when they feel that their loved ones are not yet prepared to deal with their death, described as the waiting for permission phenomenon. This example does not include enough information to support this answer choice. This example does not include enough information to support the client's wish to spend more time with the daughter.

The spouse of a terminally ill client is confused by the new terminology being used during discussions regarding the client's treatment. The nurse should explain that palliative care is:

orrect response: care that will reduce the client'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 is part of hospice care.