ch. 13 palliative care

Which statement, made by the nurse, can be most helpful when caring for a client in the third stage of Kubler-Ross' emotional reactions to dying? "I understand that it would be wonderful to see your daughter's graduation." "Let's review the laboratory results and compare them with the diagnostic tests." "What makes you most angry about getting the disease?" "I like your idea of living for today and enjoying those around you."

"I understand that it would be wonderful to see your daughter's graduation."

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

"It will enable the patient to remain home if that is what is desired."

Glaser and Strauss (1965) identified four "awareness contexts." Which awareness context occurs when the client is unaware of their terminal state, whereas others are aware? Closed awareness Mutual pretense awareness Open awareness Suspected awareness

Closed awareness

Which is also known as a proxy directive? Durable power of attorney for health care Treatment directive Medical directive Living will

Durable power of attorney for health care

The client has been diagnosed with terminal COPD. The client and the client's family have not yet agreed on the final arrangements and are discussing options. How can the nurse best intervene in these final decisions? Persuade the client to follow their family's preferences for end-of-life care. Ask the family members about coordinating spiritual care for the client. Remind the family that the client needs to focus energy on recovery. Respect the client's autonomy and right to determine how to spend the rest of his or her life.

Respect the client's autonomy and right to determine how to spend the rest of his or her life.

Which of the following nursing interventions will a nurse perform to transfer heat and improve circulation in a dying client? Administer warm intravenous fluids. Change the position frequently. Gently massage the arms and legs. Administer intramuscular injections.

Gently massage the arms and legs.

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

Palliative care is the same as hospice care.

A type of comprehensive care for clients whose disease is not responsive to cure is interdisciplinary collaboration. euthanasia. a terminal illness. palliative care.

palliative care.

When describing the term "grief" to a group of students, which of the following would the instructor include? A part of the life cycle in the form of change, growth, and transition The response experienced by anyone who has suffered a loss Feelings of apprehension or worry in response to a situation A feeling of connectedness with one's self and others

The response experienced by anyone who has suffered a loss

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

"Tell me some more about what is on your mind."

Which statements made by the nurse demonstrates that the nurse is providing spiritually sensitive care? "Mourning may be demonstrated by emotional feelings of sadness, anger, guilt, and numbness." "Denial, sadness, anger, fear, and anxiety are normal grief reactions." "A key component of hospice care is following your family for up to a year after your death." "Tell me who or what gives you strength."

"Tell me who or what gives you strength."

The family of a terminally ill client tells the nurse that the client has been breathing irregularly and, at times, it appears that he is not breathing at all. The client's daughter states, "He moans when he breathes. Is he in pain?" Which response by the nurse would be most appropriate? "He has secretions that are collecting at the back of the throat." "He is getting less oxygen to the brain, so the moaning means he is dreaming." "The moaning you hear is from air moving over very relaxed vocal cords." "His moaning does indicate pain, so we'll increase his pain medication."

"The moaning you hear is from air moving over very relaxed vocal cords."

The physician is attending to a 72-year-old client with a malignant brain tumor. Family members report that the client rarely sleeps and frequently reports seeing things that are not real. Which intervention is an appropriate request for the hospice nurse to suggest to the physician? Begin radiation therapy to prevent cellular growth. Obtain a biopsy to analyze the lymph nodes. Add haloperidol to the client's treatment plan. Perform surgery to remove the tumor from the brain.

Add haloperidol to the client's treatment plan.

The nurse identifies a nursing diagnosis of Imbalanced nutrition: less than body requirements for a terminally ill client who is near the end of life. Which of the following would the nurse expect to include in the client's plan of care? Advice for the family to have fruit juices readily available at the client's bedside. Suggestions that the family offer the client foods that are hot. Arrangements for the client to eat meals while others are out of the home. Encouragement of the family to serve the client meat, especially beef.

Advice for the family to have fruit juices readily available at the client's bedside.

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? Lack of Medicare/Medicaid funding for hospice Lack of fully credentialed and trained hospice nurses Clients and families view hospice care as giving up Difficulty obtaining Medicare certification for hospice services

Clients and families view hospice care as giving up

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? Inpatient respite care General inpatient care Routine home care Continuous care

Continuous care

A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using? Medical directive by proxy Durable power of attorney for health care Living will declaration End-of-life treatment directive

Durable power of attorney for health care

Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death? Absence of incontinence Increased body temperature Flushed appearance Dusky appearance

Dusky appearance

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? Be a silent observer and allow the client to communicate with the family members. Encourage conversations about the impending death of the client. Encourage the client's family members to spend time with the client. Encourage the family members to express their feelings and listen to them in their frank communication.

Encourage the family members to express their feelings and listen to them in their frank communication.

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? Encourage the client's family members to spend time with the client. Encourage the family members to express their feelings and listen to them in their frank communication. Encourage conversations about the impending death of the client. Be a silent observer and allow the client to communicate with the family members.

Encourage the family members to express their feelings and listen to them in their frank communication.

The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to clients who are dying and their families is to first do which of the following? Explore own feelings on mortality and death and dying. Use evidence-based practice in daily care regimen. A workshop on caring for the client who is dying Participate in a support group to learn clients' feeling on care.

Explore own feelings on mortality and death and dying.

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? Importance and influence Faith and belief Community Address in care

Faith and belief

A nursing instructor is preparing a class discussion about hope and end-of-life care. Which of the following would the instructor include as an example of a hope-fostering activity? Isolation Abandonment Pain Humor

Humor

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 Closed awareness Open awareness Suspected awareness

Mutual pretense awareness

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. Integrates spirituality Includes chemotherapy Enhances quality of life Hastens death Offers a team approach to care Provides pain relief

Offers a team approach to care Enhances quality of life Integrates spirituality Provides pain relief

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. Pain is considered a positive aspect that leads to rebirth. Pain must be controlled regardless of the client's wishes. Pain provides the client with an opportunity for repentance.

Pain is viewed as a means of cleansing by God.

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

Palliative care is the same as hospice care.

The nurse is caring for a client who just learned of a terminal diagnosis. After the physician leaves, the nurse remains to answer further questions so that the client can make an informed decision about further treatment. By providing all available information, the nurse is promoting which ethical principle? The principle of justice The principle of autonomy The principle of nonmaleficence The principle of fidelity

The principle of autonomy

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? Typically, the stages occur in succession. Most clients reach acceptance by the time of death. Each client experiences each of the stages. The stages are applicable to any loss.

The stages are applicable to any loss.

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? Clients, for the most part, would gain hope if they were told about a poor prognosis. Most clinicians are very open to talking about disease and dying with clients. There remains a conspiracy of silence about dying despite progress in the area. Clients would ask for information if they really had a desire to know.

There remains a conspiracy of silence about dying despite progress in the area.

A nurse is evaluating a client with a terminal illness. What should the nurse report so that the health care team can consider alternative nutritional approaches and fluid administration routes for the client at the end of life? weight loss and inadequate food intake altered gastrointestinal function irregular eating habits drop in blood pressure and rapid heart rate

weight loss and inadequate food intake

Which term best describes a living will? Durable power of attorney for health care Medical directive proxy directive health care power of attorney

Medical directive

A hospice nurse should be aware that the most effective pain medication used at the end of life that also relieves dyspnea and anxiety is which of the following? Morphine Demerol Codeine Percodan

Morphine

While talking with a client who has been diagnosed with a terminal illness, the client asks, " Am I dying?" Which response from the nurse would be appropriate? Select all that apply. "This must be very difficult for you." "I know just how you must feel." "Tell me more about what's on your mind." "You still have time for a good life." "Let's focus on what your doctor has planned."

"This must be very difficult for you." "Tell me more about what's on your mind."

A patient with end-stage chronic obstructive pulmonary disease is admitted to a hospice facility and asks the admitting nurse, "How long will I be allowed to stay here?" What is the best response by the nurse? "There is no time limit for your stay. You can stay until you die." "You will be able to stay for 2 months before being discharged." "You will be able to stay only for approximately 1 month and then you will be discharged." "When your stay reaches 6 months, you will be recertified for a continued stay."

"When your stay reaches 6 months, you will be recertified for a continued stay."

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." "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." "I cannot legally administer pain medications that will induce unconsciousness to relieve your pain."

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

Based on the most common concern of a dying patient, the hospice nurse should: Offer supplemental fluids to prevent dehydration. Turn the patient every 2 hours to prevent decubitus ulcers. Administer pain medication on a schedule that prevents pain from intensifying. Position the patient to prevent difficulties with breathing.

Administer pain medication on a schedule that prevents pain from intensifying.

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

Grief

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. Palliative care Radiation Respite care Angiogenesis

Palliative care

The family of a client in hospice decides to place their loved one in a long-term care facility to establish an effective pain control regimen. Which aspects of hospice care is the family using? General inpatient care Continuous care Inpatient respite care Palliative care

Palliative care

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? 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 Offering high caloric foods to build fat and muscle 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

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? Starvation Severe asthenia Extreme anorexia Profound protein loss

Profound protein loss

A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client? Abide by the dying client's wishes. Respect the client's and family members' choices. Ask the family members about spiritual care. Share emotional pain.

Respect the client's and family members' choices.

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

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? Have the family sit in front of the client so they can be seen. Speak to the client in a calm and soothing voice. Rub the client's hand and arm to comfort the client. Lie next to the client and hold the client.

Speak to the client in a calm and soothing voice.

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. The client explains that he isn't ready to complete his will. The physician orders weekly blood transfusions to be given at home. The client doesn't want to discuss death around his girlfriend.

The client entered a clinical trial through the National Cancer Institute.

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? Dronabinol Atropine Dexamethasone Megestrol

Atropine

Which intervention should a nurse perform during the grieving period when caring for a dying client? Providing palliative care Allowing a period of privacy Avoiding criticizing or giving advice Spending time with the client

Avoiding criticizing or giving advice

A family of a dying client reports that their loved one is experiencing more shortness of breath. Which nursing intervention is most appropriate at this time? Get the client out of bed to the chair. Offer the client sips to drink. Call the health care provider to obtain an oxygen order Offer the bedpan to urinate or defecate

Call the health care provider to obtain an oxygen order

Which is the initial stage of grief, according to Kübler-Ross? Bargaining Depression Anger Denial

Denial

Which is a sign of approaching death? Increase in urinary output Irregular breathing patterns Clear sensorium Insomnia

Irregular breathing patterns

Which of the following nursing interventions should a nurse perform to promote the dignity and self-esteem of a dying client? Communicate hopefulness. Help the client live according to his or her wishes. Keep the client clean and well groomed. Share emotional pain.

Keep the client clean and well groomed.

A client with a brain tumor recently stopped radiation and chemotherapy for treatment of the cancer. The client recently reported dry mouth. Which intervention by the hospice nurse demonstrates that the nurse understands treatment measures for dry mouth? Place two drops of atropine ophthalmic 1% solution sublingually. Gently suction the client's mouth and buccal cavity. Begin 9% normal saline IV at 125 mL/hr. Provide gentle oral care after each meal.

Provide gentle oral care after each meal.

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

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

A nurse has been providing in-home hospice care to an older adult client with lung cancer for more than six months. The family asks the nurse how long the Medicare hospice services will continue. What is the nurse's best response? The Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition. The hospice services need to end now that the client has had the services for six months. The client must begin to pay for other home health services since six months of hospice care have been received. Medicare hospice services end at the seventh month of care.

The Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition.

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: care that will reduce the client's physical discomfort and manage clinical symptoms. care that is provided at the very end of an illness to hasten the dying process. an alternative therapy that uses massage and progressive relaxation for pain relief. offered to terminally ill clients instead of hospice care.

care that will reduce the client's physical discomfort and manage clinical symptoms.

Despite having been administered 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? Gently massage the arms and legs Offer small amounts of nourishment frequently Use imagery, humor, and progressive relaxation Encourage the patient to sleep

Use imagery, humor, and progressive relaxation

When assessing a terminally ill client, the nurse notices that the client has copious secretions at the back of the throat and in the mouth. The nurse is preparing a teaching plan for the family about caring for these secretions. Which of the following would be least appropriate to include? Using a soft toothbrush to vigorously clean the mouth Administering a prescribed anticholinergic agent Positioning the client on the side with the head supported with a pillow Performing gentle suctioning of the mouth

Using a soft toothbrush to vigorously clean the mouth