Ch. 16: End-of-Life Care

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?

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

For individuals known to be dying by virtue of age and/or diagnoses which of the following signs indicate approaching death?

Increased restlessness

For individuals known to be dying by virtue of age and/or diagnoses, which of the following signs indicate approaching death?

Increased restlessness

Which of the following interventions should a nurse perform during the grieving period when caring for dying patients?

Avoiding criticism or giving advice

During unplanned, spontaneous moments, dying clients usually discuss fears or concerns that nurses should not ignore or rush. What is the nurses' best response in such situations?

Communicate interest and a willingness to listen by sitting down, leaning forward in the client's direction, and making direct eye contact.

Which of the following is also known as a proxy directive?

Durable power of attorney for health 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

A patient has been declared to have a terminal illness. What is the nursing intervention a nurse will perform in the final decision of a dying patient?

Respect the patient and family members' choices

A patient is declared to have a terminal illness. What is the nursing intervention a nurse will perform in the final decision of a dying patient?

Respect the patient and family members' choices.

Which of the following is one of the levels of hospice care covered under Medicare and Medicaid hospice benefits that includes a 5-day inpatient stay and is provided on an occasional basis to relive the family caregivers?

Respite care

The family members of a dying patient are finding it difficult to verbalize their feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations?

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

The family members of a dying patient are finding it difficult to verbalize feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations?

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

The family members of a dying patient are finding it difficult to verbalize their feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations?

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

Which of the following terms is used to describe the personal feelings that accompany an anticipated or actual loss?

Grief

A type of comprehensive care for patients whose disease is not responsive to cure is:

palliative care.

A terminally ill patient has feelings of rage toward the nurse. According to Elisabeth Kübler-Ross, the patient is in which stage of dying?

Anger

Which of the following is an appropriate method of assessing the dying client?

Focus on the client's basic needs.

A nurse is assessing a terminally ill female client. Which client statement indicates that the client is in the bargaining stage of dying?

"I just want to see my daughter graduate from college. That's all."

A terminally ill patient in pain asks the nurse to administer enough pain medication to end the suffering forever. What is the best response by the nurse?

"I will notify the physician that the current dose of medication is not relieving your pain."

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.

-Maintaining client comfort -Supporting family members -Providing personal care

Which of the following is the initial stage of grieving according to Kubler-Ross?

Denial

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."

A terminally ill patient is admitted to the hospital. The patient grabs the nurse's hand and asks, "Am I dying?" What response would be best for the nurse to give?

"Tell me more about what's on your mind."

Which of the following is an appropriate intervention for the client with pulmonary edema?

Administer the prescribed sedative to decrease anxiety.

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.

All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason?

Allows for the nurse to facilitate the grieving process

The family of a dying client is noticing that their loved one is short of breath, restless in bed, and appears to be trying to tell them something. Which nursing intervention is appropriate at this time?

Call the physician to obtain an anxiolytic.

The nurse is caring for a dying client in a hospice setting. The family is unsure whether to go home for rest or spend the night with the client. Which body system would the nurse assess to provide the first data on decline?

Cardiovascular system

Your client, the mother of three young children, has been diagnosed with stage III breast cancer and is distraught. Which of the following statements best communicates a spirit of hopefulness to your client?

Let's take this one day at a time; remember you have your daughter's dance recital next month.

You are providing home care to a dying client and have noticed over the course of several weeks that the client's daughter is usually quiet and withdrawn when in the client's room. Which of the following nursing interventions should you perform in this situation?

Sit with the client's daughter privately and encourage her to express her feelings frankly.

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.

According to Kubler-Ross, when the dying patient pleas for more time to reach an important goal, the patient is using:

bargaining

The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to dying clients and their families is to first do which of the following?

Explore own feelings on mortality and death and dying.

Despite having been administered the prescribed pain medication, a dying patient is still in pain due to fear and anxiety. Which of the following nursing interventions should a nurse use to potentiate the effects of pain medication?

Using imagery, humor, and progressive relaxation

Which of the following should the nurse report so that the team can consider alternative nutritional and fluid administration routes for a dying client?

Weight loss and inadequate food intake

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

Medicare and Medicaid hospice benefits criteria allow patients with a life expectancy of 6 months or less to be admitted to the hospice. However, the median length of stay in a hospice program is just 21.3 days. Which of the following reasons explains underuse of hospice care services?

Patients/families view palliative care as giving up

When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following?

Proxy directive

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?

Client's goals

What barrier to end-of-life care is the dying patient demonstrating when making the following statement? "I don't need hospice. Hospice is for people who are dying."

Denial

Your 90-year-old home care clientdesignated her son to make decisions regarding her medical care when she is no longer able to do so. As she nears the end of her life, her son is consulted on an ever-increasing basis. What is the name of the legal instrument that activates her son's decision-making designation?

Durable power of attorney

A patient 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 of the following proxy directives is the patient using?

Durable power of attorney for health care

The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition.

End-stage renal disease

A patient with brain tumor recently stopped radiation and chemotherapy for treatment of his cancer. Of late, he is complaining of dry mouth. Which of the following interventions by the hospice nurse demonstrates the nurse understands treatment measures for dry mouth?

Provide gentle mouth care after each meal.

What major complication is associated with oral intake in the client with a decreased level of consciousness?

Aspiration

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.

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

A nurse is providing hospice care in Portland, Oregon,to 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 of the following interventions is the best for the nurse to implement? Select all that apply.

-Control the client's pain with prescribed medication. -Advise the client's physician of the client's condition. -Encourage the client to explain his wishes.

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

The family of a patient in hospice decides to place their loved one in a long-term care setting to establish an effective pain control regimen. Which of the following aspects of hospice care is the family utilizing?

Palliative care

Which of the following statements when made by the nurse demonstrates the nurse is providing spiritually sensitive care?

"Tell me who or what gives you strength?"

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

The wife of your terminally ill client is confused by the new terminology being used during discussions regarding her husband's treatment. How would you explain palliative care to her?

It is care that will reduce her husband's physical discomfort and manage clinical symptoms.

Which of the following nursing actions by the nurse demonstrates an effective method to assess the patient and the patient's family's ability to cope with end-of-life interventions?

Remaining silent, allowing the patient and family to respond after asking a question related to end-of-life care

The nurse is caring for a client who just learned of his 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 autonomy