Chapter 13: Palliative and End-of-Life Care

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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 physican and hospice director agree about the client's terminal condition.

A client tells the nurse the client been dating someone for three months after finalizing divorce one year ago. According to Rando (1984), the client is engaging in which grieving task?

re-investing

A nurse is working with a group of parents whose children have died from cystic fibrosis. The group is talking about "acceptance." Two parents discuss their unwillingness to accept their child's death. The nurse should understand that:

some individuals find the idea of "accepting" the death of a loved one unachievable.

a progressive, irreversible illness that despite cure-focused medical treatment will result in the patient's death

terminal illness

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."

A patient near the end of life is experiencing anorexia-cachexia syndrome. What characteristics of the syndrome does the nurse recognize? (Select all that apply.)

* Alterations in carbohydrate, fat, and protein metabolism * Endocrine dysfunction * Anemia

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

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.

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

A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action?

Place the client in a private room. Explanation: Safety precautions are used for the client with a radioactive implant. They include assigning the client to a private room, seeing that visitors maintain a 6-foot distance from the radiation source, prohibiting visits by children, and preventing exposure to those who may be or are pregnant. Staff needs to wear dosimeters. Family may visit for up to 30 minutes per day.

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.

37. The nurse is teaching an in-service on legal issues in nursing. Which situation is an example of battery, an intentional tort? 1. The nurse threatens the client who is refusing to take a hypnotic medication. 2. The nurse forcibly inserts a Foley catheter in a client who refused it. 3. The nurse tells the client a nasogastric tube insertion is not painful. 4. The nurse gives confidential information over the telephone. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 672). F.A. Davis Company. Kindle Edition.

37. 1. This is an example of assault, which is a mental or physical threat without touching the client. 2. When a mentally competent adult is forced to have a treatment he or she has refused, battery occurs. 3. This is fraud, a willful and purposeful misrepresentation which could cause harm to a client. 4. This is called defamation, a divulgence of privileged information or communication. This is a violation of the Health Insurance Portability and Accountability Act (HIPAA). TEST-TAKING HINT: If the test taker knows battery is "bad," it may lead to selecting option "2," which has "forcibly" in the stem. The test taker could attempt to eliminate options based on knowledge. For example, breaking confidentiality is a violation of HIPAA; thus option "4" can be eliminated. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 684). F.A. Davis Company. Kindle Edition. 2

51. The client diagnosed with septicemia expired, and the family tells the nurse the client is an organ donor. Which intervention should the nurse implement? 1. Notify the organ and tissue organizations to make the retrieval. 2. Explain a systemic infection prevents the client from being a donor. 3. Call and notify the health-care provider of the family's request. 4. Take the body to the morgue until the organ bank makes a decision. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 673). F.A. Davis Company. Kindle Edition.

51. 1. Many states require tissue and organ banks to be notified of all deaths, but the systemic infection eliminates this client from becoming a donor. 2. Septicemia is a systemic infection and will prevent the client from donating tissues or organs. 3. There is no reason to notify the HCP. 4. If the client were to be an organ donor, then the client's body would remain in the intensive care unit on the ventilator and with IV medication support until the organ bank team arrives and takes the client to the operating room. TEST-TAKING HINT: Option "3" could be eliminated from consideration because the nurse should be able to handle this situation. Option "4" could be eliminated because the client would have to stay on life support if the organ bank were to retrieve viable organs. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 687). F.A. Davis Company. Kindle Edition. 2

55. The nurse is caring for a client who received a kidney transplant from an unrelated cadaver donor. Which interventions should be included in the plan of care? Select all that apply. 1. Collect a urine culture every other day. 2. Prepare the client for dialysis three (3) times a week. 3. Monitor urine osmolality studies. 4. Monitor intake and output every shift. 5. Check abdominal dressing every four (4) hours. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 674). F.A. Davis Company. Kindle Edition.

55. 1. Urine cultures are performed frequently because of the bacteriuria present in the early stages of transplantation. 2. A cadaver kidney may have undergone acute tubular necrosis and may not function for two (2) to three (3) weeks, during which time the client may experience anuria, oliguria, or polyuria and require dialysis. 3. Serum creatinine and BUN levels are monitored, but there is no need to monitor the urine osmolality. 4. Hourly outputs are monitored and compared with the intake of fluids. 5. The dressing is a flank dressing. TEST-TAKING HINT: The test taker should notice time frames. Anytime a specific time reference is provided, the test taker must determine if the time frame is the appropriate interval for performing the activity. In option "4," "every shift" is not appropriate. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 688). F.A. Davis Company. Kindle Edition. 1,2

67. The nurse is caring for the family of the client who has just died. Which is the nurse's priority action? 1. Be with the family. 2. Call the funeral home. 3. Notify the minister. 4. Fill out the death certificate. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 675). F.A. Davis Company. Kindle Edition.

67. 1. When a death occurs the need is for the nurse's presence; just being there with the family is what will help the family grieve. 2. The nurse may need to notify the funeral home, but the family is the priority need. 3. If the family wants the minister to be called, the nurse could do this, but, frequently, the family has a relationship with the minister and will need to speak directly with the minister to arrange the services. 4. The death certificate is completed by the physician signing it, not the nurse. TEST-TAKING HINT: The test taker could eliminate all options besides "1" because none of these will assist the grieving process. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 691). F.A. Davis Company. Kindle Edition. 1

7. The 78-year-old Catholic client is in end-stage congestive heart failure and has a DNR order. The client has AP 50, RR 10, and BP 80/50, and Cheyne-Stokes respirations. Which action should the nurse implement? 1. Bring the crash cart to the bedside. 2. Apply oxygen via nasal cannula. 3. Notify a priest for last rites. 4. Turn the bed to face the sunset. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 692). F.A. Davis Company. Kindle Edition.

7. 1. The client has a DNR; therefore, there is no need to bring the crash cart to the bedside. 2. The client has a DNR and the nurse needs to help the client die peacefully. 3. The Catholic religion requires last rites be performed immediately before or after death. 4. The client is Catholic, and there is no specific way for the bed to be placed. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 697). F.A. Davis Company. Kindle Edition. 3

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.

Advise 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 nurse is caring for a 90-year-old male who has never completed an advanced directive. The man has a son but has not seen him in several years. A neighbor has assisted him with meals and housecleaning for many years. The neighbor states that the client expressed only wanting to have comfort measures. The estranged son wants his father to be treated aggressively. Which would be the nurse's initial step?

Assess the client's ability to state wishes.

Which term refers to the period of time during which mourning of a loss takes place?

Bereavement (Bereavement is the period of time during which mourning of a loss takes place. Grief is defined as the personal feelings that accompany an anticipated or actual loss. Mourning is defined as the individual, family, group, and cultural expressions of grief and associated behaviors. Hospice is a coordinated program of interdisciplinary care and services provided primarily in the home to terminally ill clients and their families.)

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

A nurse is providing in-home hospice care to a 75-year-old client with lung cancer. The nurse determines that the client is eligible for Medicare hospice benefits based on which of the following?

Client has a life expectancy of 6 months or less.

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

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?

Clients and families view hospice care as giving up

During unplanned, spontaneous moments, dying clients usually discuss fears or concerns that nurses should not ignore or rush. What is the nurse's 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. Explanation: The nurse can communicate interest and a willingness to listen by sitting down, leaning forward in the client's direction, and making direct eye contact. Nodding, responsive comments such as "Yes" or brief periods of silence encourage the client to continue verbalizing. Calling out to the client's family members and asking them to sit next to the client may not be the best intervention. It is important for nurses to be flexible and to interrupt physical care if and when the client indicates a need for companionship, support, and communication. This client is seeking companionship and communication, not rest.

C* O M F O R T

Communication: (compassion, non-verbal immediacy, presence)

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

Correct response: Attitude of health care professionals toward terminal illness. Explanation: Clinicians' attitudes toward the terminally ill and dying remain the greatest barrier to improving care at the end of life. Clinicians' reluctance to discuss disease and death openly with patients stems from their own anxieties about death, as well as misconceptions about what and how much patients want to know about their illnesses

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? Severe asthenia Profound protein loss Extreme anorexia Starvation

Correct response: Profound protein loss Explanation: Cachexia is associated with anabolic and catabolic changes in metabolism that relate to activity of neurohormones and proinflammatory cytokines, resulting in profound protein loss. Although anorexia may exacerbate cachexia, it is not a primary cause. Starvation refers to simple food deprivation and is not cachexia. Anorexia-cachexia syndrome, characterized by disturbances in carbohydrate, protein, and fat metabolism, endocrine dysfunction, and anemia results in severe asthenia (loss of energy).

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? Begin 9% normal saline IV at 125 mL/hr. Place two drops of atropine ophthalmic 1% solution sublingually. Gently suction the client's mouth and buccal cavity. Provide gentle oral care after each meal.

Correct response: Provide gentle oral care after each meal. Explanation: Dry mouth can generally be managed through nursing measures such as mouth care. The use of artificial hydration (IV fluids) carries considerable risks and does not contribute to comfort at the end of life. Atropine ophthalmic 1% drops administered sublingually help to reduce oral secretions. Gentle oral suctioning reduces the production of secretions.

A nurse is caring for a terminally ill client inquiring about physician-assisted suicide. Which statement if made by the nurse would correctly inform the client of this practice? The health care provider provides the means for the clients to take their life. The health care provider provides the means and waits to pronounce them dead. The health care provider provides counseling and has a third party physician assist in the suicide. The health care provider administers a lethal dose of medication via IV.

Correct response: The health care provider provides the means for the clients to take their life. Explanation: Physician-assisted suicide is the practice of providing a means by which a client can end his or her life. Much controversy exists concerning the practice. California, Vermont, Oregon, Washington, and Montana are the only states that permit physician-assisted suicide. The physician does not personally administer the dose, wait until the client is dead, or have a third party physician involved.

Which is also known as a proxy directive?

Durable power of attorney for health care

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

Increased restlessness

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.

The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy?

It removes a wedge of tissue for diagnosis. Explanation: The three most common biopsy methods are excisional, incisional, and needle. In an incisional biopsy, a wedge of tissue is removed from the tumor and analyzed. In an excisional biopsy, the surgeon removes the tumor and the surrounding marginal tissues. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.

Which of the following would not be consistent with promoting nutrition in terminally ill patients?

Maintaining a balanced diet

Which of the following would not be consistent with promoting nutrition in terminally ill patients?

Maintaining a balanced diet One should not be overly concerned about a "balanced" diet for terminally ill patients. Offering small portions of favorite foods, avoiding arguments at mealtime, and offering cool foods rather that hot foods are all tips that promote nutrition in terminally ill patients

C O M* F O R T

Mindfulness: (stay in the moment, adapt to rapid changes)

As a client approaches death, her respirations become noisy. This is the result of which type physical event?

Musculoskeletal change

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

C O M F O* R T

Openings (seek a higher level of understanding of disease, culture, family, ect)

C O* M F O R T

Orientation: (cultural sensitivity, support health literacy)

A hospice nurse is visiting the home of a client who was recently diagnosed with a terminal illness. The nurse is developing the client's plan of care and is assessing beliefs and preferences about end-of-life care. The nurse would expect to complete this assessment at which time?

Over the course of several visits

what is the preferred method of administering analgesics to a hospice patient for pain?

PO, sublingual, or rectal

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.

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

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?

Palliative care

Which of the following patients would least likely be experiencing loss?

Patient who is abusing substances

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

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?

Perform a thorough pain assessment.

During which phase of Bowlby's grief process does the bereaved person begin to reestablish a sense of personal identity, direction, and purpose for living?

Phase of recognition

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?

Profound protein loss

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.

A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection?

Stage 3 pressure ulcer on the left heel Explanation: A stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count and temperature are within normal limits. Eating 75% of meals is normal and doesn't increase the client's risk for infection. A client who is malnourished is at a greater risk for infection.

The nurse is admitting a 52-year-old father of four into hospice care. The client has a diagnosis of Parkinson disease, which is progressing rapidly. The client has made clear his preference to receive care at home. What interventions should the nurse prioritize in the plan of care?

Supporting the client's and family's values and choices Explanation: Nurses need to develop skill and comfort in assessing clients' and families' responses to serious illness and planning interventions that support their values and choices throughout the continuum of care. To be admitted to hospice care, the client must have come to terms with the fact that he is dying. The scenario states that the client wants to be cared for at home, not in a long-term setting. The children may be able to participate in their father's care, but they should not be assigned responsibility for planning it.

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.

A client diagnosed with advanced lung cancer has a nursing diagnosis of Ineffective Coping. What assessment data would provide evidence to the nurse for this diagnosis?

The client states, "I am sure the doctors have misdiagnosed me."

How does a nurse who has been providing home care to a terminally ill client know that her client's condition is beginning to deteriorate?

The client's apical pulse reaches 100 beats/minute.

The nurse is assessing an older adult client with lower back pain. In the course of assessment, the nurse learns that the client lost a spouse 10 weeks ago. The client laughs inappropriately and states, "My spouse just up and left me!" Which is the nurse's best response?

The nurse should recognize the incongruity between content and behavior and find ways of exploring further.

The husband of a client who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. What type of grief is the husband experiencing?

Unresolved grief

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

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

In spite of administering 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

Evidence-based medical and nursing research has identified cardiovascular disease as the most prevalent chronic disease in the United States. Under this classification, one condition is the most common. Using this information, a nurse practitioner, treating a 50-year-old man, would do which of the following?

Write a prescription for a serum cholesterol level.

in a care-focused perspective, there is ____ ____ that can be done

always more

How does a nurse who has been providing home care to a terminally ill client know that the client's condition is beginning to deteriorate?

apical pulse reaches 100 beats/minute

what is a key factor in acceptance of and planning for death

awareness of the prognosis

why have families become increasingly distanced from the death experience?

because place of death has shifted from home to hospitals

A widow develops cancer within 6 months of her husband's death. This may be a result of:

bereavement. (Physical health and psychosocial adjustment are intricately intertwined. The bereaved are known to be at greater risk for mortality and morbidity than are comparable non-bereaved people.)

A client who is in the process of divorce tells the nurse the client will require some time off from work due to the inability to concentrate. According to Bowlby's phases of grieving, which phase best reflects this client's current experience?

disorganization and despair

why are clinicicians reluctant to discuss disease and death openly with patients?

it feeds their own anxieties about death as well as misconceptions about what and how much patients want to know about their illnesses

As a client approaches death, respirations become noisy. This is the result of which type physical event? musculoskeletal change cardiac dysfunction central nervous system alterations gastrointestinal impairment

musculoskeletal change Explanation: As death approaches, a client's reflexes become hypoactive. The jaw and facial muscles also relax. As the tongue falls to the back of the throat, respirations become noisy.

the patient, family, and health care providers are aware the patient is dying but all pretend otherwise

mutual pretense awareness

In the Parkes model, a person uses denial as a psychological defense in the stage of:

numbness. (which is usually brief, trauma so overwhelms the bereaved survivor that he or she must use denial as a psychological defense)

the patient, family and health care providers are aware the patient is dying and openly acknowledge that reality

open awareness

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

palliative care

A patient authorizes a son to make medical decisions and brings the completed forms for the nurse to place on the chart. What form does the nurse understand this is?

A proxy 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

Which of the following is a term that refers to individual, family, group, and cultural expressions of grief and associated behaviors?

Mourning

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

palliative care

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

palliative care.

The client tells the doctor that he and his family have accepted the terminal diagnosis of pancreatic cancer. The client further explains that he is interested in being comfortable and that he no longer wishes to fight the cancer. This approach to end-of-life care is known as

palliative care.

based on an individuals beliefs related to death and dictate what they believe their patients want to know

personal mythologies

the patient suspects what others know and attempts to learn the details; may be triggered by inconsistencies between family and health-care providers

suspected awareness

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."

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."

A nurse is caring for a 5-year-old child with end-stage acquired immunodeficiency syndrome (AIDS). The child confides that the child is ready to go to heaven and see Grandpa. The nurse knows that the child's parents aren't comfortable with the idea of discontinuing treatment. What should the nurse do?

Talk with the parents about the dying process and make the parents aware of what the child has confided.

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?

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

Which statement is typical of the first stage of grieving described by Engel?

"No, not me." (According to Engel, the first stage of grief is shock and disbelief. In this initial stage, the surviving family members often refuse to accept the fact of the loss, followed by a stunned or numb response of "no, not me.")

Caregivers of a 9-year-old client in the terminal phase of a fatal illness ask the nurse for guidance in discussing death with the client. Which response is appropriate?

"At this developmental stage, most children have an adult concept of death and should be encouraged to discuss it." (By age 9 or 10, most children have an adult concept of death. Therefore, caregivers should discuss death with them in terms consistent with their developmental stage. In addition, school-age children respond well to concrete explanations about death and dying. Preschoolers, not school-age children, typically view death as temporary and reversible. While school-age children may fantasize about the unknown aspects of death, these fantasies may actually increase their anxiety. Although a child may fear death, accurate information about death can ease anxiety. )

What question should nurses ask themselves to determine if the care they provide to the grieving client has been both therapeutic and client focused?

"Do I have the strength to be present and to facilitate the client who is grieving?"

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."

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

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 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?

"Let's take this one day at a time; remember you have your daughter's dance recital next (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 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?

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

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?

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

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."

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."

Which statements made by the nurse demonstrates that the nurse is providing spiritually sensitive care?

"Tell me who or what gives you strength."

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?"

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."

"We'll try adding powdered milk to milk and other foods to make them more nutritious."

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?

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

When talking with 10-year-old children about death, the nurse should incorporate which guidelines? Select all that apply.

-The children will be curious about the physical aspects of death. -The children will know that death is inevitable and irreversible. -Attitudes of the adults in their lives will influence the children.

A community mental health nurse has come to know that the mother of a long-term client has passed away. What are ways for the nurse to determine if the client will be at risk for complicated grief? Select all that apply.

-The client has low self-esteem. - The client is unable to trust others. -The client has attempted suicide in the past.

According to federal guidelines, hospices may provide no more than what percentage of the aggregate annual patient days at the inpatient level?

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?

Accept the client's denial of the situation.

A nurse is caring for a terminally ill client who is receiving chemotherapy and radiation for an aggressive lung cancer. The treatment success is limited in shrinking the tumor, and the treatments are making the client very ill. The client states, "I feel that I would like to stop treatments. I would like to enjoy the time that I have remaining with my family." Which emotional reaction does the nurse recognize that the client is experiencing?

Acceptance Explanation: In the final stage, dying clients accept their fate and makes peace spiritually and with those to whom they are close. Clients begin to detach themselves socially and wish to be with only a small group of close friends and family. The other options are stages that occur earlier in the process.

A client is arranging a funeral ceremony for the client's child. According to the Worden's tasks of grieving, which task is being accomplished?

Acceptance of the reality of the loss

The physician is attending to a 72-year-old patient with a malignant brain tumor. Family members report that the patient rarely sleeps and frequently reports seeing things that are not real. Which of the following interventions is an appropriate request for the hospice nurse to suggest to the physician?

Add haloperidol (Haldol) to the patient's treatment plan.

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?

Add haloperidol to the client's treatment plan.

Based on the most common concern of a dying patient, the hospice nurse should:

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

The nurse most effectively explains to a terminally ill client's spouse that the frustration and anger the client is exhibiting is associated with what aspect of dying?

An expression of a universally held need of the dying (The nurse most effectively explains to a terminally ill client's spouse that the frustration and anger the client is exhibiting are an expression of a universally held need of the dying. They are not signs of the anger stage of grieving, a symptom of poor acceptance of inevitable death, or an unconscious means of facilitating separation with loved ones.)

Which is an example of a perceived loss?

An older client grieves for the loss of independence

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

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

A client with a terminal illness has feelings of rage toward the nurse. According to Kubler-Ross, the client is in which stage of dying?

Anger

A terminal patient has feelings of rage toward the nurse. According to Kubler-Ross, the patient is in which stage of dying?

Anger

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?

Ask the client's consent before sharing any information with the niece.

Which of the following interventions should the nurse perform while providing spiritual care for a dying client?

Ask the family members about spiritual care.

Which of the following interventions should the nurse perform while providing spiritual care for a dying client? Encourage family members in their frank communication. Provide spiritual books. Ask the family members about spiritual care. Allow a period of privacy.

Ask the family members about spiritual care. Explanation: When clients are too ill to express their wishes, the nurse should ask the family members about spiritual care. Encouraging family members in their frank communication and providing spiritual books may not be helpful in providing spiritual care for a dying client. Allowing a period of privacy may not be helpful. The nurse allows a period of privacy to the client's family members after the death of the client

Which of the following may be contained in an "emergency kit" for a hospice patient exhibiting restlessness?

Benzodiazepine

Which term describes the process by which a person experiences grief?

Bereavement (Grieving, also known as bereavement, is the process by which a person experiences the grief. Homeostasis is the return to normal. Mourning is the outward expression of grief. Attentive presence is being with the client and focusing intently on communicating with and understanding him or her.)

A group of nursing students is reviewing information about grief and bereavement. The students demonstrate understanding of the information when they state:

Bereavement is the process of mourning and grief is the emotional reaction. (Grief is an intense, emotional reaction to the loss of a loved one. The reaction is a biopsychosocial response that often includes spontaneous expression of pain, sadness, and desolation. Bereavement is the process of mourning and coping with the loss of a loved one. It begins immediately after the loss, but it can last months or years. Individual differences and cultural practices influence grieving and bereavement.)

Which of the following remains the greatest barrier to improving end-of-life care?

Clinician's attitudes toward the terminally ill

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?

Closed awareness

Glaser and Strauss (1995) identified four "awareness contexts". Which awareness context occurs when the patient is unaware of his or her terminal state, but others are aware?

Closed awareness

The nurse is caring for a client whose spouse passed away several years ago. Upon assessment, the nurse finds that the client has a history of signs and symptoms of depression since the spouse's death. Which term correctly describes the client's response to the loss?

Complicated Grief

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?

Continuous care

Question 10 Type: MCSA A terminally ill patient is experiencing secretions pooling in the back of the throat. What can the nurse do to help this patient feel more comfortable? 1. Raise the head of the bed. 2. Gently massage the patient. 3. Provide frequent small sips of fluids. 4. Provide oral care.

Correct Answer: 1 Rationale 1: The nurse should reposition the patient and raise the head of the bed if fluids accumulate in the upper airways and back of the throat. Rationale 2: Gentle massage helps with accumulating edema of the extremities. Rationale 3: Small sips of fluids help with the discomfort of drying oral mucous membranes. Rationale 4: Oral care helps with the discomfort of drying oral mucous membranes. Global Rationale: The nurse should reposition the patient and raise the head of the bed if fluids accumulate in the upper airways and back of the throat. Gentle massage helps with accumulating edema of the extremities. Small sips of fluids and oral care help with the discomfort of drying oral mucous membranes.

Question 28 Type: FIB A patient being treated for terminal cancer is prescribed morphine sulfate through a continuous intravenous infusion. The pharmacy is requesting the patient's current weight in kilograms. During the last measurement, the patient's weight was documented as 128 lbs. What should the nurse calculate this patient's weight in kg to be?

Correct Answer: 58.1 Rationale: To calculate the patient's weight in kilograms, the nurse should divide the weight in pounds by 2.2. This calculation would be 128/2.2 = 58.1 kg.

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." "I hear you say that you are not sleeping well." "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."

Correct response: "I will talk with the health care provider to determine the next step in your care." Explanation: The client is assisted in hopefulness by believing that the healthcare team will make his remaining days meaningful. By conveying a sense that the nurse will discuss the client's condition with the health care provider, the client recognizes that the healthcare team will use whatever treatment and comfort measures are available. Telling a client not to worry is not therapeutic and is condescending. Waiting for a grandchild does not address the client's thought. Reflecting what the client said for clarification opens communication but does not instill hopefulness.

During a home care visit to a client in hospice, the client's spouse reveals to the nurse an understanding that the client's death is inevitable. Recognizing the spouse is exemplifying the Kübler-Ross stage of acceptance, which statement by the nurse is most appropriate? "Have you thought about what you will do when you find your spouse after he has died?" "Make sure you have made previous arrangements with the funeral home for burial arrangements." "Tell me how you plan to react when you first realize that your spouse is breathless and has no pulse." "I would make arrangements to have all your children present for the death vigil."

Correct response: "Tell me how you plan to react when you first realize that your spouse is breathless and has no pulse." Explanation: Anticipating and planning interventions is a cornerstone of end-of-life care. The nurse encourages communication and anticipatory grieving by using open-ended statements such as "Tell me. . . ." Effective communication techniques include the avoidance of closed-ended statements and giving advice

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 Assisting in establishing long-term goals Arranging for appropriate psychosocial counseling Helping to obtain support from the community Avoiding the sharing of information and feelings

Correct response: Arranging for appropriate psychosocial counseling Encouraging the client to participate in care to foster control Helping to obtain support from the community Explanation: To enable, support, and foster hope in terminally ill clients and their families, nurses should encourage and support the client's control over circumstances, choices, and environment whenever possible, make referrals for psychosocial and spiritual counseling, and assist with developing supports in the home and community when none exist. Goals set should be realistic, rather than long-term. Information and feelings should be shared. The information provided also should be accurate.

A nurse is providing care to a terminally ill client who is experiencing dyspnea. Which of the following would be most appropriate to do to assess the severity of the client's complaint? Question the client about when the dyspnea eases or worsens. Have the client state if the dyspnea is mild, moderate, or severe. Auscultate the client's lung sounds for changes. Ask the client to rate the dyspnea on a scale of 0 to 10.

Correct response: Ask the client to rate the dyspnea on a scale of 0 to 10. Explanation: The most appropriate method for assessing the severity of the client's dyspnea is to have the client rate the severity using a scale from 0 to 10, with 0 indicating no dyspnea and 10 indicating the worst imaginable dyspnea. This provides an objective indicator of the severity. Asking the client to identify the complaint as mild, moderate, or severe, although somewhat helpful, is not the best means for assessing the severity because these terms are difficult to quantify. Questioning the client about easing or worsening of the complaint would be helpful to determine the possible underlying cause and obtain a more complete picture of the complaint, but it would not help determine severity. Dyspnea can occur for many reasons, including anxiety and fear. Therefore, auscultating the lungs would provide information only about respiratory involvement as a potential cause. It would not help determine the severity of the dyspnea.

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 Dronabinol Dexamethasone Atropine

Correct response: Atropine Explanation: Atropine is used to manage excessive oral and respiratory secretions when death is imminent. Dexamethasone, megestrol, and dronabinol may be used to stimulate appetite in clients who are at the end of life

A client and their loved ones are in the grieving period of the client's dying, and the nurse wants to offer the best possible support to them in the process. Which is the best intervention the nurse could perform during the grieving period? Allow a period of privacy. Provide palliative care. Spend time with client. Avoid criticism or giving advice.

Correct response: Avoid criticism or giving advice. Explanation: The nurse should listen in a nonjudgmental manner and should avoid criticism or giving advice during the grieving period when caring for dying clients. Spending time with the client does not facilitate the grieving process for the client and his or her loved ones. The nurse is responsible for facilitating the grieving process and helping the client and family deal with their emotions. To do this, nurses may empathetically share perceptions of what the client and family are experiencing.

The nurse is evaluating bloodwork results of a client with cancer who is receiving chemotherapy. The client's platelet count is 60,000/mm3. Which is an appropriate nursing action?

Correct response: Avoiding the use of products containing aspirin Explanation: Clients with a platelet count of 60,000/mm3 are at mild risk for bleeding. Appropriate nursing interventions include avoiding the use of products such as aspirin that may interfere with the client's clotting systems; avoiding taking temperature rectally and administering suppositories; providing the client with an electric shaver for shaving; and avoiding commercial mouthwashes because of their potential to dry out oral mucosa, which can lead to cracking and bleeding.

Which term refers to the period of time during which mourning of a loss takes place? Bereavement Grief Mourning Hospice

Correct response: Bereavement Explanation: Bereavement is the period of time during which mourning of a loss takes place. Grief is defined as the personal feelings that accompany an anticipated or actual loss. Mourning is defined as the individual, family, group, and cultural expressions of grief and associated behaviors. Hospice is a coordinated program of interdisciplinary care and services provided primarily in the home to terminally ill clients and their families

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

Correct response: Choice of palliative care over cure focused Explanation: An important focus of hospice care is that care is palliative in nature. No further aggressive treatment to find a cure for the illness is administered. The client must accept this philosophy of care. The other options are factual and agreed on.

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? End-of-life treatment directive Durable power of attorney for health care Living will declaration Medical directive by proxy

Correct response: Durable power of attorney for health care Explanation: A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. It allows another individual to make medical decisions on the client's behalf. The other options are incorrect.

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

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? A workshop on caring for the dying client Use evidence-based practice in daily care regimen. Participate in a support group to learn clients' feeling on care. Explore own feelings on mortality and death and dying.

Correct response: Explore own feelings on mortality and death and dying. Explanation: To care for others in the dying process, the nurse must explore his or her own feelings about mortality and death and dying. Understanding self provides a perspective to cope with and then support clients and families experiencing pain and grief. The other options are helpful in determining appropriate nursing care but not the first step

Which of the following nursing interventions is appropriate with regard to pain control in the dying client? Explain that morphine will be avoided because of its sedative effects. Give pain medications on a routine schedule. Explain that narcotics can cause addiction. Explain that oxygen will eventually be used.

Correct response: Give pain medications on a routine schedule. Explanation: The nurse usually gives pain medication on a routine schedule around the clock to avoid causing intense discomfort followed by a period of heavy sedation. Morphine may be used. Oxygen eventually may be used.

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? Pain Humor Abandonment Isolation

Correct response: Humor Explanation: Hope-fostering categories include love of family and friends, spirituality and faith, goal setting, maintenance of independence, positive relationships with clinicians, humor, personal characteristics, and uplifting memories. Hope-hindering categories include abandonment, isolation, uncontrollable pain or discomfort, and devaluation of personhood.

A 36-year-old mother of three was recently diagnosed with a chronic illness. The nurse prepared information for the patient on how to manage her illness. To help her cope with the shock and resentment that she was experiencing, the nurse gave her facts about her illness with honesty and empathy. Which of the following are the best comments that the nurse can include when talking to the patient about chronic illness? Select all that apply. It can be associated with exacerbations and remissions. It can require short-term management (<3 months). It is characterized by a progressive decline in normal physiologic function It results in residual disability due to non-reversible pathology. It is defined as long-term with the possibility of a cure if intervention is rapid and timely.

Correct response: It is characterized by a progressive decline in normal physiologic function It can be associated with exacerbations and remissions. It results in residual disability due to non-reversible pathology. Explanation: Chronic illnesses are often defined as medical illnesses or health problems with associated symptoms or disabilities that require long-term management (3 months or longer). Chronic illness refers to diseases that are caused by non-reversible pathology; are characterized by a slow progressive decline in normal physiological function; are permanent with cure unlikely; and require long-term surveillance, leaving residual disability.

Which of the following would not be consistent with promoting nutrition in terminally ill patients? Avoiding arguments at mealtime Maintaining a balanced diet Offering cool foods rather than hot foods Offering small portion of favorite foods

Correct response: Maintaining a balanced diet Explanation: One should not be overly concerned about a "balanced" diet for terminally ill patients. Offering small portions of favorite foods, avoiding arguments at mealtime, and offering cool foods rather that hot foods are all tips that promote nutrition in terminally ill patients

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. Encouraging fluids Supporting family members Arranging plans for after death Maintaining client comfort Completing a head-to-toe assessment Providing personal care

Correct response: Maintaining client comfort Supporting family members Providing personal care Explanation: Nursing care of dying clients focuses on providing palliative care to the client and supporting family members. Arranging the plans after death is not a priority at this time. Completing a head-to-toe assessment may be completed for information but is not a priority at the end of life. There is no need to encourage fluids

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

Correct response: Medical directive Explanation: A living will is a type of advance medical directive in which the individual, who is of sound mind, documents treatment preferences. A proxy directive and health care power of attorney are other names for a durable power of attorney for health care, in which one individual is appointed and authorized to make medical decisions on behalf of another person when that person is no longer able to speak for him or herself.

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? Perform a thorough pain assessment. 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.

Correct response: Perform a thorough pain assessment. Explanation: An effective combined approach to clinical depression includes relief of physical symptoms such as pain. Clinical depression should not be accepted as an inevitable consequence of dying. Researchers have linked the psychological effects of cancer pain to suicidal thought and, less frequently, to carrying out a planned suicide. An effective combined approach to clinical depression includes relief of physical symptoms and pharmacologic intervention with tricyclic antidepressants.

Which cardiovascular findings indicate to the nurse that the condition of the dying client is worsening? Pulse 60 beats/minute, blood pressure 90/42mm Hg, difficult to arouse Pulse 72 beats/minute, irregular; client confused and agitated 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

Correct response: Pulse 104 beats/minute in the morning, 62 beats/minute in the afternoon with mottled feet and ankles Explanation: Earlier, a client with failing cardiac function exhibits a higher pulse as the body attempts to circulate oxygen. Next, cardiac output is decreased due to ineffective filling of the chambers, impairing circulation, and diminishing the heart's own oxygen supply. The heart rate and blood pressure then decrease. Peripheral circulation is impaired with the feet and ankles becoming pale and mottled.

Which is the initial stage of grief, according to Kübler-Ross?

Denial

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

Denial

The nurse assesses that extravasation of a chemotherapy agent has occurred. What is the nurse's initial action?

Discontinue the infusion. Explanation: If extravasation is suspected, the medication administration is stopped immediately, and depending on the drug, the nurse may attempt to aspirate any remaining drug from the extravasation site. The other actions listed may be appropriate to perform, but should occur after discontinuing the infusion.

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?

Dusky appearance

Which occurs in the second phase of Bowlby's grieving process?

Emotional yearning for the loved one

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?

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 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.

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 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

C O M F* O R T

Family (patient AND family comprise the unit of care

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

Focus on the client's basic needs.

Nursing students are reviewing information about grieving and its assessment findings. The students demonstrate an understanding of the information when they identify which of the following as a behavioral indicator?

Forgetfulness

Which of the following nursing interventions is appropriate with regard to pain control in the dying client?

Give pain medications on a routine schedule. Explanation: The nurse usually gives pain medication on a routine schedule around the clock to avoid causing intense discomfort followed by a period of heavy sedation. Morphine may be used. Oxygen eventually may be used.

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

Grief

A nurse is working with a family of a deceased client and assisting them in working through their grief and mourning. Which of the following would be the priority to promote healthy accommodation of the loss by the family?

Helping the family recognize the loss has occurred

A benign tumor of the blood vessels is a(n)

Hemangioma Explanation: A hemangioma is a benign tumor of the blood vessels. An osteoma is a tumor of the connective tissue. A neuroma is a tumor of the nerve cells. A chondroma is a tumor of the cartilage.

A client is diagnosed with a terminal illness and has been given less than 6 months to live. What type of referral should the nurse make to assist this patient and family at home?

Hospice Explanation: Hospice is palliative care provided to terminally ill persons and their families in the last 6 months of the client's life. None of the other interventions would be as appropriate or effective for this patient.

A mental health nurse is caring for a client with schizophrenia. The nurse observes the client laughing about the recent death of the client's father. The nurse would correctly document this mood as what?

Incongruent (The correct answer is incongruent affect or lack of harmony between one's voice and movements with one's speech or verbalized thoughts. Blunted affect is a severe reduction or limitation in the intensity of one's affective responses to a situation. Flat affect describes absence or near absence of any signs of affective responses. Labile affect is the abnormal fluctuation of one's expressions.)

For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death?

Increased restlessness

It results in residual disability due to non-reversible pathology. It is characterized by a progressive decline in normal physiologic function It can be associated with exacerbations and remissions.

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.

The patient tells the doctor that he and his family have accepted the terminal diagnosis of pancreatic cancer. The patient further explains that he is interested in being comfortable and that he no longer wishes to fight the cancer. This approach to end-of-life care is known as which of the following?

Palliative care

A nurse is caring for a client with a terminal illness. The client asks the nurse to help him end his own life to alleviate his suffering and that of his family. When responding to the client, the nurse integrates knowledge of which of the following?

Participating in assisted suicide violates the Code of Ethics for Nurses.

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.

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

Proxy directive

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

A client is crying continuously from having lost a friend in an accident. According to the tasks of grieving by Rando, which task of grief is expected to be accomplished next?

Recollect and reexperience

A 90-year-old home care client's son has been designated to make decisions regarding the client's medical care when the client is no longer able to do so. As the client nears the end of life, the son is consulted on an ever-increasing basis. What legal instrument activates the son's decision-making designation?

durable power of attorney

C O M F O R* T

Relating (communication is non-linear, prioritize the turning point in illness)

Palliation refers to

Relief of symptoms of disease and promotion of comfort and quality of life. Explanation: Palliation is the goal for care of clients with terminal cancer. Alopecia is the term that refers to hair loss. Metastasis is the term that refers to the spread of cancer cells from the primary tumor to distant sites. Nadir is the term that refers to the lowest point of white blood cell depression after therapy that has toxic effects on bone marrow.

Which action by the nurse demonstrates an effective method to assess the client and the client's family's ability to cope with end-of-life interventions?

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

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

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

Respect the client's and family members' choices

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

Respect the client's and family members' choices.

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 nurse is assessing a client and attempting to differentiate if the client is experiencing grief or depression. Which of the following would the nurse identify as indicative of grief?

Self-blame (Blaming one's self or others is characteristic of grief. Sleep problems occur with depression and grief. Weight gain or loss and feelings of worthlessness are associated with depression.)

The nurse is providing home care to a dying client and has noticed over the course of several weeks that the client's daughter is usually quiet and withdrawn when in the client's room. Which intervention should the nurse perform in this situation?

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

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.

Which of the following does not coincide with Kübler-Ross's stages related to a dying client?

The dying client usually exhibits anger first.

"My father has been dead for over a year and my mother still can't talk about him without crying. Is that normal?" What is the best response by the nurse?

The inability to talk about your dad without crying, even after a year, is still considered normal."

A nurse is caring for a terminally ill client inquiring about physician-assisted suicide. Which statement, made by the nurse, would correctly advocate for the practice.

The physician provides the means for the clients to take their life.

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

In spite of administering the 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? Encourage the patient to sleep Offer small amounts of nourishment frequently Use imagery, humor, and progressive relaxation Gently massage the arms and legs

Use imagery, humor, and progressive relaxation Explanation: Imagery, humor, and progressive relaxation are the various techniques to potentiate the effects of pain medication. Offering small amounts of nourishment frequently will not help potentiate the effects of pain medication. Gentle massaging of the arms and legs helps to regulate body temperature. Encouraging the client to fall asleep will not help potentiate the effects of pain medication

A client was recently in a motor vehicle accident, which resulted in an amputation of the right leg. The client is withdrawn, doesn't want to get out of bed, and has been crying a lot. What behaviors is the client demonstrating?

bereavement (The client is exhibiting a symptom of bereavement that includes emotional, physical, social, and cognitive responses.)

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.

the patient is unaware of their terminal state, whereas others are; characterized by a conspiracy between family and health care providers to guard the "secret"

closed awareness

Which type of grief occurs when a person is stuck in a state of chronic grieving?

complicated grief

Which nursing activity supports the principles of palliative care for a dying infant and the infant's family?

creating a therapeutic, homelike environment for the infant and the infant's family (The goal of palliative care is to make the infant and the infant's family as comfortable as possible. )

The nurse is providing individual support to a female client who attends a group for people who have experienced loss of a family member to suicide. The client's son committed suicide one month ago. The client was not aware that her son experienced depression. Which risk factors for complicated grief are most likely for this client? (Select all that apply.)

death of a child sudden, unexpected death death by suicide

term that states that the health care system has been built on management of acute illness and the use of technology to cure (when possible) and to extend life

death-denying

Which is the initial stage of grief, according to Kübler-Ross?

denial

A 60-year-old client who has been fighting cancer for more than 20 years has just been diagnosed with metastases to the brain. The client finds it difficult to get out of bed in the morning, has no interest in eating, and no longer finds fulfillment in favorite hobbies. Within which emotional reaction is the client functioning?

depression

A widow has just returned home from the funeral of her husband. She feels alone in her home. Her family has left to go back to their home in another area of the country. What stage of Engel's model does this represent?

developing awareness

drugs that stimulate appetite in patients with anorexia:

dexamethasone (Decadron), megestrol acetate (Megace), and dronabinol (Marinol)

what is the anorexia-cachexia syndrome characterized by?

disturbances in carbohydrate, protein, and fat metabolism; endocrine dysfunction, and anemia

what is the goal in care for the terminally ill?

to promote autonomy

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

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.

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

A nurse is working with the family of a terminally ill client, providing them with suggestions about how to manage the client's anorexia. Which statement by the family indicates that they have understood the instructions? "We'll try to give him regularly scheduled meals throughout the day." "We'll make sure that any foods that we give him are mashed up or in liquid form instead so he doesn't have to chew." "We'll make sure that he is nearby the kitchen so he can smell the foods cooking." "We'll try adding powdered milk to milk and other foods to make them more nutritious."

"We'll try adding powdered milk to milk and other foods to make them more nutritious." Explanation: Increasing the nutritional value of foods, such as by adding powdered milk to milk and other foods, is appropriate. The client should be allowed and encouraged to eat when he is hungry regardless of the regular meal times. Cooking odors should be eliminated or reduced because they can precipitate nausea, vomiting, or anorexia. Unless there is a definite problem with chewing or swallowing, foods do not need to be pureed (mashed) or in liquid form

The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the anger stage of grief is the one who states:

"Why did this have to happen to me?"

A client has just expelled a hydatidiform mole. She's visibly upset over the loss and wants to know when she can try to become pregnant again. How should the nurse respond?

"You must wait at least 1 year before becoming pregnant again."

focus of care on the dying is motivated by:

-aging population -life-threatening illnesses -prolonged chronic illnesses due to advanced medicine and technology

what do you do in response to the question "Am I dying?

-establish eye contact -acknowledge the patient's fears, followed by an open ended question -listen, ask additional open ended questions, and provide only realistic reassurance

1. The client tells the nurse, "Every time I come in the hospital you hand me one of these advance directives (AD). Why should I fill one of these out?" Which statement by the nurse is most appropriate? 1. "You must fill out this form because Medicare laws require it." 2. "An AD lets you participate in decisions about your health care." 3. "This paper will ensure no one can override your decisions." 4. "It is part of the hospital admission packet and I have to give it to you." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 668). F.A. Davis Company. Kindle Edition.

1. 1. Advance directives (AD) are not legally required. It is a standard of the Joint Commission, and any facility which accepts federal funds must ask and offer the AD. 2. ADs allow the client to make personal health-care decisions about end-of-life issues, including cardiopulmonary resuscitation (CPR), ventilators, feeding tubes, and other issues concerning the client's death. 3. This is not a legal document guaranteed to stand up in a court of law; therefore, the client should make sure all family members know the client's wishes. 4. It is part of the hospital admission requirements, but it is not the reason why the client should complete an AD. TEST-TAKING HINT: The test taker could eliminate option "1" because the nurse cannot make the client do anything. The client has a right to say no. Option "3" is an absolute, and unless the test taker knows for sure this is correct information, the test taker should not select this option. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 676). F.A. Davis Company. Kindle Edition. 2

1. The 38-year-old client was brought to the emergency department with CPR in progress and expired 15 minutes after arrival. Which intervention should the nurse implement for postmortem care? 1. Do not allow significant others to see the body. 2. Do not remove any tubes from the body. 3. Prepare the body for the funeral home. 4. Send the client's clothing to the hospital laundry. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 692). F.A. Davis Company. Kindle Edition.

1. 1. There is no reason the family members should not be able to see the client; this is important to allow the significant others closure. 2. This death should be reported to the medical examiner because the death occurred less than 24 hours after hospital admission and an autopsy may be required. Therefore, the nurse must leave all tubes in place; the medical examiner will remove the tubes. 3. This is a medical examiner case, and the nurse should not prepare the body by removing tubes or washing the body prior to taking the client to a funeral home. 4. The client's clothing should be given to the family or to the police if foul play is suspected. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 696). F.A. Davis Company. Kindle Edition. 2

1. According to the World Health Organization, palliative care is an approach that improves quality of life for patients and their families who face problems associated with life-threatening illnesses. From the list below, identify the specific goals of palliative care (select all that apply). a. Regard dying as a normal process. b. Minimize the financial burden on the family. c. Provide relief from symptoms, including pain. d. Affirm life and neither hasten nor postpone death. e. Prolong the patient's life with aggressive new therapies. f. Support holistic patient care and enhance quality of life. g. Offer support to patients to live as actively as possible until death. h. Assist the patient and family to identify and access pastoral care services. i. Offer support to the family during the patient's illness and their own bereavement. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 33). Elsevier Health Sciences. Kindle Edition.

1. a, c, d, f, g, i. Table 10-1 lists the goals of palliative care. Overall, goals of palliative care are to prevent and relieve suffering and to improve the quality of life for the patient. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 328). Elsevier Health Sciences. Kindle Edition.

10. The male client requested a DNR per the AD, and the HCP wrote the order. The client's death is imminent and the client's wife tells the nurse, "Help him please. Do something. I am not ready to let him go." Which action should the nurse take? 1. Ask the wife if she would like to revoke her husband's AD. 2. Leave the wife at the bedside and notify the hospital chaplain. 3. Sit with the wife at the bedside and encourage her to say good-bye. 4. Request the client to tell the wife he is ready to die, and don't do anything. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 669). F.A. Davis Company. Kindle Edition.

10. 1. Only the client can revoke the AD. 2. The wife should not be left alone, and the hospital chaplain may not be available for the client and his wife. 3. At the time of death, loved ones become scared and find it difficult to say good-bye. The nurse should support the client's decision and acknowledge the wife's psychological state. Research states hearing is the last sense to go, and talking to the dying client is therapeutic for the client and the family. 4. The client is dying and should not be asked to exert himself for his wishes to be carried out. TEST-TAKING HINT: Logic would suggest option "4" is not a viable answer. Leaving a grieving spouse would not be appropriate in any situation; therefore, the test taker should eliminate option "2." Option "1" denies the client's autonomy and is not an ethical or a legal choice. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 678). F.A. Davis Company. Kindle Edition. 3

10. A patient is receiving care to manage symptoms of a terminal illness when the disease no longer responds to treatment. What is this type of care known as? a. Terminal care c. Supportive care b. Palliative care d. Maintenance care Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 34). Elsevier Health Sciences. Kindle Edition.

10. b. Palliative care is aimed at symptom management rather than curative treatment for diseases that no longer respond to treatment and is focused on caring interventions rather than curative treatments. "Palliative care" and "hospice" are frequently used interchangeably. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 328). Elsevier Health Sciences. Kindle Edition.

11. Priority Decision: A patient in the last stages of life is experiencing shortness of breath and air hunger. Based on practice guidelines, what is the most appropriate action by the nurse? a. Administer oxygen. b. Administer bronchodilators. c. Administer antianxiety agents. d. Use any methods that make the patient more comfortable. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 34). Elsevier Health Sciences. Kindle Edition.

11. d. There currently are no clinical practice guidelines to relieve the shortness of breath and air hunger that often occur at the end of life. The principle of beneficence would encourage any of the options to be tried, based on knowing that whatever gives the patient the most relief should be used. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 328). Elsevier Health Sciences. Kindle Edition.

12. End-of-life palliative nursing care involves a. constant assessment for changes in physiologic functioning. b. administering large doses of analgesics to keep the patient sedated. c. providing as little physical care as possible to prevent disturbing the patient. d. encouraging the patient and family members to verbalize their feelings of sadness, loss, and forgiveness. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 34). Elsevier Health Sciences. Kindle Edition.

12. d. In assisting patients with dying, end-of-life care promotes the grieving process, which involves saying goodbye. Physical care is very important for physical comfort but assessment should be limited to essential data related to the patient's symptoms. Analgesics should be administered for pain but patients who are sedated cannot participate in the grieving process. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 329). Elsevier Health Sciences. Kindle Edition.

13. The dying patient and family have many interrelated psychosocial and physical care needs. Which ones can the nurse begin to manage with the patient and family (select all that apply)? a. Anxiety d. Care being provided b. Fear of pain e. Anger toward the nurse c. The dying process f. Feeling powerless and hopeless Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 35). Elsevier Health Sciences. Kindle Edition.

13. a, b, c, d, e, f. Teaching, along with support and encouragement, can decrease some of the anxiety. Teaching about pain relief, the dying process, and the care provided will help the patient and family know what to expect. Allowing the patient to make decisions will help to decrease feelings of powerlessness and hopelessness. The nurse who is the target of anger needs to not react to this anger on a personal level. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 329). Elsevier Health Sciences. Kindle Edition.

14. A deathly ill patient from a culture different than the nurse's is admitted. Which question is appropriate to help the nurse provide culturally competent care? a. "If you die, will you want an autopsy?" b. "Are you interested in learning about palliative or hospice care?" c. "Do you have any preferences for what happens if you are dying?" d. "Tell me about your expectations of care during this hospitalization." Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 35). Elsevier Health Sciences. Kindle Edition.

14. d. Using the open-ended statement to seek information related to the patient's and family's perspective and expectations will best guide the plan of care for this patient. This will open the discussion about palliative or hospice care and preferences for end-of-life care. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 329). Elsevier Health Sciences. Kindle Edition.

2. Priority Decision: The husband and daughter of a Hispanic woman dying from pancreatic cancer refuse to consider using hospice care. What is the first thing the nurse should do? a. Assess their understanding of what hospice care services are. b. Ask them how they will care for the patient without hospice care. c. Talk directly to the patient and family to see if she can change their minds. d. Accept their decision since they are Hispanic and prefer to care for their own. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 33). Elsevier Health Sciences. Kindle Edition.

2. a. The family may not understand what hospice care is and may need information. Some cultures and ethnic groups may underuse hospice care because of a lack of awareness of the services offered, a desire to continue with potentially curative therapies, and concerns about a lack of minority hospice workers. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 328). Elsevier Health Sciences. Kindle Edition.

what percent of patients experience pain in the last 4 months of life?

46%

8. A terminally ill man tells the nurse, "I have never believed there is a God or an afterlife, but now it is too terrible to imagine that I will not exist. Why was I here in the first place?" What does this comment help the nurse recognize about the patient's needs? a. He is experiencing spiritual distress. b. This man most likely will not have a peaceful death. c. He needs to be reassured that his feelings are normal. d. This patient should be referred to a clergyman for a discussion of his beliefs. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 34). Elsevier Health Sciences. Kindle Edition.

8. a. Spiritual distress may surface when an individual is faced with a terminal illness and it is characterized by verbalization of inner conflicts about beliefs and questioning the meaning of one's own existence. Individuals in spiritual distress may be able to resolve the problem and die peacefully with effective grief work but referral to spiritual leaders should be the patient's choice. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 328). Elsevier Health Sciences. Kindle Edition.

9. Which interventions should the nurse implement at the time of a client's death? Select all that apply. 1. Allow gaps in the conversation at the client's bedside. 2. Avoid giving the family advice about how to grieve. 3. Tell the family the nurse understands their feelings. 4. Explain this is God's will to prevent further suffering. 5. Allow the family time with the body in private. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 693). F.A. Davis Company. Kindle Edition.

9. 1. The nurse needs to be sensitive to the family, and simply being present to support the family emotionally is important; the nurse does not have to talk. 2. The nurse should avoid the impulse to give advice; each person grieves in his or her own way. 3. The nurse should not tell the family he or she understands; even if the test taker has lost a loved one, the test taker should never select an option which says the nurse understands another person's feelings. 4. This is projecting the nurse's personal religious beliefs on the family and could cause more anger at God when the family needs to be able to draw on their own spiritual beliefs. 5. The family needs time for closure, and allowing the family to stay at the bedside is meeting the family's need to say good-bye. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 697). F.A. Davis Company. Kindle Edition. 1,2,5

9. In most states, directives to physicians, durable power of attorney for health care, and medical power of attorney are included in which legal documents? a. Natural death acts c. Advance care planning b. Allow natural death d. Do Not Resuscitate order Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 34). Elsevier Health Sciences. Kindle Edition.

9. a. Natural death acts in each state have their own requirements. Allow natural death is the new term being used for the Do Not Resuscitate order. Advance care planning is the process of having patients and their families think through their values and goals for treatment and document those wishes as advance directives. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 328). Elsevier Health Sciences. Kindle Edition.

Avoid criticism or giving advice.

Which intervention should a nurse perform during the grieving period when caring for a dying client?

Avoiding criticizing or giving advice

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

Avoiding criticizing or giving advice Explanation: The nurse should listen in a nonjudgmental manner and should avoid criticizing or giving advice during the grieving period when caring for dying clients. Allowing a period of privacy is necessary to help family members cope with the death of a client and is not necessary during the grieving period. Spending time with the client and providing palliative care are not required nursing interventions during the grieving period. Palliative care is provided to a dying client when the client is unable to live independently.

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

Avoiding criticizing or giving advice Explanation: The nurse should listen in a nonjudgmental manner and should avoid criticizing or giving advice during the grieving period when caring for dying clients. Allowing a period of privacy is necessary to help family members cope with the death of a client and is not necessary during the grieving period. Spending time with the client and providing palliative care are not the required nursing interventions during the grieving period. Palliative care is provided to a dying client when the client is unable to live independently

Clients and families view palliative care as giving up

Question 15 Type: MCSA A terminally ill patient and the family agree that the physician will write a do-not-resuscitate order for the patient. The nurse understands that what should be implemented when following this order? 1. Do not call a code if the patient stops breathing or the heart stops beating. 2. Call a code only if the patient stops breathing. 3. Call a code only if the patient's heart stops beating. 4. Withhold food and fluids but provide pain medication

Correct Answer: 1 Rationale 1: A do-not-resuscitate order is written by the physician for the patient who has a terminal illness or is near death. Rationale 2: This order is based on the wishes of the patient and family that no cardiopulmonary resuscitation be performed for respiratory or cardiac arrest. Rationale 3: When implementing this order, the nurse would not call a code if the patient stops breathing or the heart stops beating. Rationale 4: Withholding food and fluids but providing pain medication would be elements of a comfort-measures-only order. Global Rationale: A do-not-resuscitate order is written by the physician for the patient who has a terminal illness or is near death. This order is based on the wishes of the patient and family that no cardiopulmonary resuscitation be performed for respiratory or cardiac arrest. When implementing this order, the nurse would not call a code if the patient stops breathing or the heart stops beating. Withholding food and fluids but providing pain medication would be elements of a comfort-measures-only order.

Question 37 Type: MCSA A patient tells the nurse, "I dread going on after the divorce is final. I have no idea how I am going to manage financially or emotionally." The nurse realizes this patient is demonstrating which aspect of Caplan's stress and loss theory? 1. living without the assets and guidance 2. psychic pain 3. reduced problem-solving ability 4. emotional turmoil

Correct Answer: 1 Rationale 1: According to Caplan's theory of stress and loss, there are three factors that influence a person's ability to deal with a loss. This patient is demonstrating the factor of "living without the assets and guidance of the lost person or resource." Rationale 2: Psychic pain encompasses the loss of the bond and the pain associated with coming to terms with the loss. Rationale 3: The patient is not demonstrating an inability to handle her problems according to the data provided. Rationale 4: Emotional turmoil is not a specific factor cited in Caplan's theory. Global Rationale: According to Caplan's theory of stress and loss, there are three factors that influence a person's ability to deal with a loss. This patient is demonstrating the factor of "living without the assets and guidance of the lost person or resource." Psychic pain encompasses the loss of the bond and the pain associated with coming to terms with the loss. The patient is not demonstrating an inability to handle her problems according to the data provided. Emotional turmoil is not a specific factor cited in Caplan's theory.

Question 3 Type: MCSA A patient tells the nurse that since his wife died he has not been able to sleep and sees no reason to continue living. According to Freud's theory on grief and loss, what should the nurse realize this patient is experiencing? 1. depression 2. grieving 3. emancipation 4. denial

Correct Answer: 1 Rationale 1: According to Freud's theory of grief and loss, the inability to grieve a loss results in depression. This is what the patient is experiencing by the inability to sleep and seeing no reason to continue living without his spouse. Rationale 2: Grieving is the inner labor of mourning a loss. The patient is not grieving. Rationale 3: Emancipation is not an element of Freud's theory of grief and loss. Rationale 4: Denial is not element of Freud's theory of grief and loss. Global Rationale: According to Freud's theory of grief and loss, the inability to grieve a loss results in depression. This is what the patient is experiencing by the inability to sleep and seeing no reason to continue living without his spouse. Grieving is the inner labor of mourning a loss. The patient is not grieving. Emancipation and denial are not elements of Freud's theory of grief and loss.

Question 9 Type: MCSA After an unsuccessful resuscitation attempt, a patient dies. What should the nurse do first? 1. Document the time of death. 2. Notify the funeral home. 3. Contact the physician. 4. Contact the orderly for transport to the morgue

Correct Answer: 1 Rationale 1: After death, the time must be recorded in the patient's record. Rationale 2: Notification of the funeral home must wait pending a decision about the need for an autopsy as well as a review of the family's wishes. Rationale 3: After documentation is completed, the attending physician will require notification. Rationale 4: The body can be transported to the morgue after family members have been notified and allowed to see their loved one. Global Rationale: After death, the time must be recorded in the patient's record. After documentation is completed, the attending physician will require notification. Notification of the funeral home must wait pending a decision about the need for an autopsy as well as a review of the family's wishes. The body can be transported to the morgue after family members have been notified and allowed to see their loved one.

Question 5 Type: MCSA A 30-year-old terminally ill patient is concerned about how her 7-year-old child will perceive her death. What advice from the nurse would be most beneficial? 1. Children this age recognize that death is permanent. 2. Children this age emotionally distance themselves from the death. 3. Because the child fears separation the patient can prepare the child by explaining that death is permanent. 4. Children this age think death is sleeping

Correct Answer: 1 Rationale 1: Age is a great determinant of beliefs about death. Children this age understand the finality of death. Rationale 2: At the age of 7, children do not have the emotional maturity to distance themselves from death. Rationale 3: The ability to understand separation has been mastered by the age of 7. Rationale 4: Children this age do not think that death is sleeping. Global Rationale: Age is a great determinant of beliefs about death. Children this age understand the finality of death. At the age of 7, children do not have the emotional maturity to distance themselves from death. The ability to understand separation has been mastered by the age of 7. Children this age do not think that death is sleeping

Question 7 Type: MCSA A patient tells the nurse that her estranged husband died a little over a year ago and states, "I am not sure why this is so difficult. I really couldn't stand him near the end." Which response by the nurse is most appropriate? 1. "Sometimes a rocky relationship with someone at the time of their death can affect your ability to grieve." 2. "You seem angry." 3. "You should contact a therapist." 4. "You are just entering the grief process. Things will get better."

Correct Answer: 1 Rationale 1: An ambivalent relationship prior to the loss can affect a person's ability to grieve. Rationale 2: The patient does not seem angry. Rationale 3: It is inappropriate for the nurse to refer the patient to a therapist. Rationale 4: As the death occurred over a year ago, the patient is experiencing impaired grieving. Global Rationale: An ambivalent relationship prior to the loss can affect a person's ability to grieve. The patient does not seem angry. It is inappropriate for the nurse to refer the patient to a therapist. As the death occurred over a year ago, the patient is experiencing impaired grieving

The brother of a terminally ill patient states, "I'll donate a million dollars to the hospital if they cure my brother." The nurse realizes this statement indicates which phase of Kübler-Ross's stages of loss? 1. bargaining 2. denial 3. anger 4. acceptance

Correct Answer: 1 Rationale 1: Bargaining is an attempt to postpone or in some way affect the reality of the loss. Rationale 2: The brother is not expressing denial. Rationale 3: The brother does not appear to be angry. Rationale 4: The brother is not expressing acceptance. Global Rationale: Bargaining is an attempt to postpone or in some way affect the reality of the loss. The brother is not expressing denial or acceptance and does not appear to be angry.

Question 8 Type: MCSA A terminally ill patient is demonstrating signs of spiritual distress. Which should the nurse do first to assist this patient? 1. Use the FICA assessment. 2. Help the patient with guided imagery. 3. Offer to pray with the patient. 4. Leave the patient alone with her thoughts

Correct Answer: 1 Rationale 1: Because the nurse often feels uncertain about implementing interventions that would be helpful to the patient responding to a loss, the FICA assessment can be used to assess a patient's spiritual or religious practices. Rationale 2: The nurse should first use the FICA assessment before implementing guided imagery, offering to pray with the patient, or leaving the patient alone to be with her thoughts. Rationale 3: The nurse should first use the FICA assessment before implementing guided imagery, offering to pray with the patient, or leaving the patient alone to be with her thoughts. Rationale 4: The nurse should first use the FICA assessment before implementing guided imagery, offering to pray with the patient, or leaving the patient alone to be with her thoughts. Global Rationale: Because the nurse often feels uncertain about implementing interventions that would be helpful to the patient responding to a loss, the FICA assessment can be used to assess a patient's spiritual or religious practices. The nurse should use the FICA assessment before implementing guided imagery, offering to pray with the patient, or leaving the patient alone to be with her thoughts.

Question 12 Type: MCSA A terminally ill patient nearing end of life is dehydrated and complains of being thirsty. What can the nurse do to make the patient more comfortable? 1. Provide oral care every 2 hours. 2. Increase intravenous fluids. 3. Raise the head of the bed. 4. Begin enteral feedings.

Correct Answer: 1 Rationale 1: Dehydration in the patient nearing death causes discomfort primarily from dry mouth and thirst. The patient should be given oral care at least every 2 hours, and more often if the patient is breathing through the mouth. Rationale 2: Increasing intravenous fluids could cause peripheral and lung edema. Rationale 3: Raising the head of the bed helps with dyspnea, not dehydration. Rationale 4: Enteral feedings could cause discomfort and would not help with the discomfort of a dry mouth and thirst. Global Rationale: Dehydration in the patient nearing death causes discomfort primarily from dry mouth and thirst. The patient should be given oral care at least every 2 hours, and more often if the patient is breathing through the mouth. Increasing intravenous fluids could cause peripheral and lung edema. Raising the head of the bed helps with dyspnea, not dehydration. Enteral feedings could cause discomfort and would not help with the discomfort of a dry mouth and thirst.

Question 4 Type: MCSA A patient has decided to join a support group for surviving spouses of victims of violent crime. According to Engel's theory of grief and loss, the nurse identifies that this patient is in which stage? 1. restitution 2. acute grief 3. shock and disbelief 4. denial

Correct Answer: 1 Rationale 1: During restitution the mourner continues to feel a painful void, is preoccupied with thoughts of the loss, and may join a support group or seek other social support for coping with the loss. Rationale 2: Acute grief is initiated by shock and disbelief. Rationale 3: Acute grief is initiated by shock and disbelief. Rationale 4: Acute grief is initiated by shock and disbelief, which may manifest as denial. Global Rationale: During restitution the mourner continues to feel a painful void, is preoccupied with thoughts of the loss, and may join a support group or seek other social support for coping with the loss. The patient who is joining a support group is in the stage of restitution. Acute grief is initiated by shock and disbelief, which may manifest as denial.

Question 38 Type: MCSA A patient who is a recent widow states, "I wanted to ask him for a divorce and then he died." What should the nurse realize this patient is at risk for developing? 1. an accelerated grief reaction 2. a dysfunctional grief reaction 3. a typical grief reaction process 4. psychosomatic disorders

Correct Answer: 1 Rationale 1: Factors that can interfere with a successful grieving reaction include ambivalent relationships prior to the loss. Rationale 2: This statement does not necessarily indicate that a dysfunctional grief reaction. Rationale 3: The patient's intentions may prevent a typical grief reaction. Rationale 4: This statement does not necessarily indicate that the patient may develop a psychosomatic disorder. Global Rationale: Factors that can interfere with a successful grieving reaction include ambivalent relationships prior to the loss. This statement does not necessarily indicate a dysfunctional grief reaction or the likelihood of a psychosomatic disorder. The patient's intentions may prevent a typical grief reaction.

Question 44 Type: MCSA A dying patient tells the nurse, "Don't let my family leave me." What should the nurse realize this patient is demonstrating? 1. fear of dying alone 2. the anticipation of improving in health 3. the need for the family to see the patient improve 4. the desire to prolong life

Correct Answer: 1 Rationale 1: Family members are often afraid to be present at the time of death, yet dying alone is the greatest fear expressed by patients. Rationale 2: There is no information provided to indicate there will be a recovery or improvement in the patient's condition. Rationale 3: There is no information provided to indicate there will be a recovery or improvement in the patient's condition. Rationale 4: While the patient may wish to live longer, these behaviors are consistent with a fear of dying alone. Global Rationale: Family members are often afraid to be present at the time of death, yet dying alone is the greatest fear expressed by patients. There is no information provided to indicate there will be a recovery or improvement in the patient's condition. While the patient may wish to live longer, these behaviors are consistent with a fear of dying alone.

Question 17 Type: MCSA While preparing for the discharge of a terminally ill older adult patient, the family asks for information concerning the most appropriate time to become involved with a hospice agency. Which action by the nurse is most correct? 1. Assist the family with making contact with a hospice agency at this time. 2. Determine the patient's life expectancy to gauge when the contact should be made. 3. Encourage the family to "hold off" making the contact until death is very close. 4. Determine what expectations the family has of the hospice agency.

Correct Answer: 1 Rationale 1: Hospice agencies provide vital services to patients who are facing death and to their families. Questions concerning available supportive services should be met with facts. Referrals for older patients should be prompt. Rationale 2: It is inappropriate to try to determine life expectancy. This is an inaccurate measurement of the degree of services needed. Rationale 3: Waiting until the time of death nears does not leave much time for the hospice agency to assist the family. Rationale 4: Determining the family's expectations concerning hospice is an inappropriate action for the nurse. Global Rationale: Hospice agencies provide vital services to patients who are facing death and to their families. Questions concerning available supportive services should be met with facts. Referrals for older patients should be prompt. It is inappropriate to try to determine life expectancy. This is an inaccurate measurement of the degree of services needed. Waiting until the time of death nears does not leave much time for the hospice agency to assist the family. Determining the family's expectations concerning hospice is an inappropriate action for the nurse.

Question 46 Type: MCSA A patient who has recently loss his spouse states, "I just can't cry." What should the nurse realize this patient is at risk for developing? 1. psychological issues 2. depression 3. overemotionality 4. somatic symptoms

Correct Answer: 4 Rationale 1: There is no indication this patient will face an increased risk for the development of psychological issues. Rationale 2: There is no indication this patient will face an increased risk for the development of depression. Rationale 3: Crying is considered a typical and expected part of the grief reaction in most grief theories. Rationale 4: The inability to express grief can lead to the onset of somatic, or physical, symptoms. Global Rationale: The inability to express grief can lead to the onset of somatic, or physical, symptoms. Crying is considered a typical and expected part of the grief reaction in most grief theories. There is no indication this patient will face an increased risk for the development of psychological issues or depression.

Question 19 Type: MCSA A patient asks the nurse what it means to have hospice care at home. What should the nurse respond to this patient? 1. "Hospice makes sure that you are comfortable at home." 2. "Hospice care helps cure your illness." 3. "Hospice care is for patients who will be sick for longer than a year." 4. "Hospice care means your physical needs will be met."

Correct Answer: 1 Rationale 1: Hospice care focuses on comfort care versus curative care. Rationale 2: The focus of hospice is on care, not cure. It is care for patients with limited life expectancy. Rationale 3: Patients receiving hospice care are generally defined as those who have a prognosis of 6 months or less if their terminal disease runs a normal course. Rationale 4: The care plan includes both the patient and family/caregiver as the unit of care, and the care plan is written to meet their values and goals. Global Rationale: Hospice care focuses on comfort care versus curative care. It is care for patients with limited life expectancy. The care plan includes both the patient and family/caregiver as the unit of care, and the care plan is written to meet their values and goals. Patients receiving hospice care are generally defined as those who have a prognosis of 6 months or less if their terminal disease runs a normal course.

Question 34 Type: MCSA A patient who had a below-the-knee amputation 2 months ago is seen walking with a new limb prosthesis and returning to work. What does the nurse realize about this patient? 1. The patient has completed the work of mourning the loss of the leg. 2. The patient is having difficulty with grief. 3. The patient is in denial. 4. The patient is forgetting about the disease that caused the loss of the limb.

Correct Answer: 1 Rationale 1: In one theory of the process of loss, the person gradually withdraws attachment to the lost object or person. The period of mourning, or work of mourning, ends and the person reaches a state of completion. This is the time when the patient may be ready to move on and make a change such as using a prosthesis or return to activities they were involved in before the loss. Rationale 2: The patient's actions indicate a positive adaptation, not an inability to manage grief. Rationale 3: Denial is manifested by behaviors or statements indicating the patient cannot believe the event has occurred. Rationale 4: There is inadequate information provided to infer the patient has forgotten about the disease which caused the loss of the limb. Further, forgetting an event of this magnitude is extremely unlikely. Global Rationale: In one theory of the process of loss, the person gradually withdraws attachment to the lost object or person. The period of mourning, or work of mourning, ends and the person reaches a state of completion. This is the time when the patient may be ready to move on and make a change such as using a prosthesis or return to activities they were involved in before the loss. The patient's actions indicate a positive adaptation, not an inability to manage grief. Denial is manifested by behaviors or statements indicating the patient cannot believe the event has occurred. There is inadequate information provided to infer the patient has forgotten about the disease which caused the loss of the limb. Further, forgetting an event of this magnitude is extremely unlikely.

Question 20 Type: MCSA A patient with a chronic illness asks the nurse if the new medication is going to cure the disease. Which is the nurse's best response? 1. "It will help you be more comfortable. I don't think it's going to cure the disease." 2. "Of course it's going to cure the disease." 3. "If you believe it will cure the disease, then it will." 4. "I don't think it's going to help or hurt at this time."

Correct Answer: 1 Rationale 1: In palliative care, the nurse needs to be honest with the patient and explain that the medication will help with comfort, but will not cure the chronic illness. Rationale 2: In palliative care, the nurse needs to be honest with the patient and explain that the medication will not cure the disease. Rationale 3: The nurse should not approach care as curative because this could rob the patient of time and closure at the end of life. Rationale 4: The nurse has no way of knowing whether the medication will help or hurt the patient. Global Rationale: In palliative care, the nurse needs to be honest with the patient and explain that the medication will help with comfort, but will not cure the chronic illness. The nurse should not approach care as curative because this could rob the patient of time and closure at the end of life. The nurse has no way of knowing whether the medication will help or hurt the patient.

Question 2 Type: MCSA A patient tells the nurse that her husband passed away a year ago and she is now beginning to realize that he is truly gone. The patient is planning to begin a new job and possibly move to a new community. The nurse realizes that this patient is in which stage of Bowlby's theory of attachment? 1. detachment 2. protest 3. despair 4. anger

Correct Answer: 1 Rationale 1: In the stage of detachment the person realizes the permanence of the loss and expresses readiness to move forward. This is what the patient is doing when planning to begin a new job and move to a new community. Rationale 2: The protest phase is marked by a lack of acceptance of the loss. Rationale 3: In despair, the person's behavior becomes disorganized. Rationale 4: Anger is not a stage within Bowlby's theory of attachment. Global Rationale: In the stage of detachment the person realizes the permanence of the loss and expresses readiness to move forward. This is what the patient is doing when planning to begin a new job and move to a new community. The protest phase is marked by a lack of acceptance of the loss. In despair, the person's behavior becomes disorganized. Anger is not a stage in Bowlby's theory of attachment

Question 11 Type: MCSA A terminally ill patient is experiencing dyspnea and tells the nurse that he feels like he is suffocating. What can the nurse do to assist this patient? 1. Keep the room cool with a slight breeze. 2. Increase the heat in the room. 3. Provide additional intravenous fluids. 4. Assist the patient to a sitting position out of bed.

Correct Answer: 1 Rationale 1: Nursing care to improve respirations includes keeping the head of the bed elevated, keeping the room cool, and providing a breeze from a fan. Rationale 2: Raising the temperature in the room will not reduce the feeling of suffocation. Rationale 3: Providing additional intravenous fluids may contribute to fluid accumulation in the lungs and contribute to the feeling of suffocation. Rationale 4: The patient is terminally ill with dyspnea and therefore should not be ambulating or sitting out of bed. Global Rationale: Nursing care to improve respirations includes keeping the head of the bed elevated, keeping the room cool, and providing a breeze from a fan. Raising the temperature in the room will not reduce the feeling of suffocation. Providing additional intravenous fluids may contribute to fluid accumulation in the lungs and contribute to the feeling of suffocation. The patient is terminally ill with dyspnea and therefore should not be ambulating or sitting out of bed.

For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death? Increased urinary output Increased eating Increased wakefulness Increased restlessness

Correct response: Increased restlessness Explanation: As the oxygen supply to the brain decreases, the patient may become restless. As the body weakens, the client will sleep more and begin to detach from the environment. For many clients, refusal of food is an indication that they are ready to die. Based on decreased intake, urinary output generally decreases in amount and frequency.

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? Muscle wasting Restlessness Reduced urinary output Mental confusion

Correct response: Muscle wasting Explanation: Muscle wasting occurs as the client's condition deteriorates. It is not a sign of impending death. Mental confusion, reduced urinary output, and restlessness occur as a client approaches death

Question 14 Type: MCSA At the time of admission, a patient with a terminal illness tells the nurse that her daughter will be allowed to make health-related decisions if she becomes incapacitated. What should the nurse realize this patient is specifically describing? 1. healthcare surrogate 2. living will 3. durable power of attorney 4. advance directive

Correct Answer: 1 Rationale 1: The healthcare surrogate is an individual who will make medical decisions in the event the patient becomes unable to do so. Rationale 2: The living will provides written directions about life-prolonging decisions. Rationale 3: The durable power of attorney delegates the authority to make health, financial, and/or legal decisions on an individual's behalf. Rationale 4: Advance directives are legal documents that allow a person to plan for healthcare and/or financial affairs in the event of incapacity. They include living wills, health care surrogates, and durable power of attorney. Global Rationale: The healthcare surrogate is an individual who will make medical decisions in the event the patient becomes unable to do so. The living will provides written directions about life-prolonging decisions. The durable power of attorney delegates the authority to make health, financial, and/or legal decisions on an individual's behalf. Advance directives are legal documents that allow a person to plan for healthcare and/or financial affairs in the event of incapacity. They include living wills, healthcare surrogates, and durable power of attorney.

Question 13 Type: MCSA A competent older adult patient has a living will stating that resuscitation and heroic life support measures are to be avoided. The family members are not supportive of this directive. Which action by the nurse is the most appropriate? 1. Place the document on the chart. 2. Contact the Social Services department. 3. Notify the hospital attorney. 4. Explain to the patient that the conflict could invalidate the document.

Correct Answer: 1 Rationale 1: The patient is competent, and the wishes of the patient must take priority. The document should first be placed on the chart and the physician notified. Rationale 2: If there are concerns about the authenticity of the document, the Social Services department will need to be contacted. Rationale 3: If there are concerns about the authenticity of the document, the unit supervisor or hospital attorney will need to be contacted. Rationale 4: A lack of support by the family does not invalidate the document. Global Rationale: The patient is competent, and the wishes of the patient must take priority. The document should first be placed on the chart and the physician notified. If there are concerns about the authenticity of the document, the Social Services department, hospital attorney, or unit supervisor will need to be contacted. A lack of support by the family does not invalidate the document.

Question 18 Type: MCSA A terminally ill patient is receiving palliative care. What does the nurse understand the purpose of this type of care to be? 1. alleviating suffering and enhancing quality of life 2. reducing pain and preventing medical complications 3. controlling side effects of illness while postponing death 4. withdrawing all medical care to allow natural death

Correct Answer: 1 Rationale 1: The purpose of palliative care is to provide comprehensive care focused on alleviating suffering and enhancing quality of life. Rationale 2: Medical complications can be controlled but not prevented. Rationale 3: The purpose is not specifically to postpone death. Rationale 4: Withdrawing all medical care would be inappropriate as it would cause more suffering. Global Rationale: The purpose of palliative care is to provide comprehensive care focused on alleviating suffering and enhancing quality of life. Medical complications can be controlled but not prevented. The purpose is not specifically to postpone death. Withdrawing all medical care would be inappropriate as it would cause more suffering.

Question 6 Type: MCSA A patient of Native American descent is expected to die. The family arrives at the hospital and wants to observe their religious and cultural traditions. Which intervention by the nursing staff would be most appropriate? 1. Offer the family a private room to sit together. 2. Discourage the family from sitting with their loved one prior to death. 3. Discuss the possibility of transferring the patient home for the death. 4. Encourage the family to consider a DNR order.

Correct Answer: 1 Rationale 1: Traditional Native Americans prefer to mourn in private, away from the dying patient. Rationale 2: It is not appropriate for the nurse to discourage the family from spending time with the patient at this critical point. Rationale 3: The severity of the patient's condition does not allow for transfer at this time. Rationale 4: Some tribes prefer not to openly discuss DNR decisions. Global Rationale: Traditional Native Americans prefer to mourn in private, away from the dying patient. It is not appropriate for the nurse to discourage the family from spending time with the patient at this critical point. The severity of the patient's condition does not allow for transfer at this time. Some tribes prefer not to openly discuss DNR decisions.

Question 16 Type: MCSA A terminally ill patient who does not have an advance directive or do-not-resuscitate order in place stops breathing. What should the nurse do to assist this patient? 1. Call a code. 2. Initiate a slow code. 3. Contact the physician to assess the patient for death. 4. Contact the nursing supervisor.

Correct Answer: 1 Rationale 1: Without an advance directive or do-not-resuscitate order, the nurse is legally responsible for calling a code on the terminally ill patient who has stopped breathing. Rationale 2: To initiate a slow code would be malpractice. Rationale 3: The nurse needs to call a code, not call the physician. Rationale 4: The nurse needs to call a code, not call the nursing supervisor. Global Rationale: Without an advance directive or do-not-resuscitate order, the nurse is legally responsible to call a code on the terminally ill patient who has stopped breathing. To initiate a slow code would be malpractice. The nurse needs to call a code, not call the physician or the nursing supervisor.

Question 22 Type: MCMA The nurse is caring for a patient who is nearing death from a terminal illness. The patient is experiencing secretions in the back of the throat and dyspnea. Which medications should the nurse provide to assist this patient? Standard Text: Select all that apply. 1. Oxygen 2. Morphine 3. Atropine 4. Scopolamine 5. Demerol

Correct Answer: 1, 2, 3, 4 Rationale 1: As death nears, respirations often become fast or slow, shallow, and labored. The patient may have apnea or Cheyne-Stokes respirations. Fluid may accumulate in the lungs, causing crackles, especially in patients who are well hydrated, and in those who are having difficulty swallowing or coughing. These manifestations may be treated with oxygen. Rationale 2: As death nears, respirations often become fast or slow, shallow, and labored. The patient may have apnea or Cheyne-Stokes respirations. Fluid may accumulate in the lungs, causing crackles, especially in patients who are well hydrated, and in those who are having difficulty swallowing or coughing. These manifestations may be treated with opioids. Rationale 3: As death nears, respirations often become fast or slow, shallow, and labored. The patient may have apnea or Cheyne-Stokes respirations. Fluid may accumulate in the lungs, causing crackles, especially in patients who are well hydrated, and in those who are having difficulty swallowing or coughing. These manifestations may be treated with medications that reduce secretions, such as atropine. Rationale 4: As death nears, respirations often become fast or slow, shallow, and labored. The patient may have apnea or Cheyne-Stokes respirations. Fluid may accumulate in the lungs, causing crackles, especially in patients who are well hydrated, and in those who are having difficulty swallowing or coughing. These manifestations may be treated with medications that reduce secretions, such as scopolamine. Rationale 5: Meperidine (Demerol) is not useful for chronic pain because it has a short half-life and a toxic metabolite that can cause irritability and seizures. Global Rationale: As death nears, respirations often become fast or slow, shallow, and labored. The patient may have apnea or Cheyne-Stokes respirations. Fluid may accumulate in the lungs, causing crackles, especially in patients who are well hydrated, and in those who are having difficulty swallowing or coughing. These manifestations may be treated with oxygen, opioids, and medications that reduce secretions, such as atropine and scopolamine. Meperidine (Demerol) is not useful for chronic pain because it has a short half-life and a toxic metabolite that can cause irritability and seizures.

Question 48 Type: MCMA A patient with a terminal illness says that when the pain becomes too unbearable he plans to take an overdose of pain medication and end it all. How should the nurse respond to this patient's plan? Standard Text: Select all that apply. 1. "Do you have a living will?" 2. "Have you assigned durable power of attorney to anyone?" 3. "Have you considered a healthcare surrogate?" 4. "Have you researched methods for self-euthanasia?" 5. "Have you talked with your healthcare provider about orders for life-sustaining treatment?"

Correct Answer: 1, 2, 3, 5 Rationale 1: A living will is a document that provides written directions about life-prolonging procedures to follow when an individual can no longer communicate in a life-threatening situation. Rationale 2: Durable power of attorney is a document that can delegate the authority to make healthcare decisions. Rationale 3: A healthcare surrogate is a person selected to make medical decisions when the patient is no longer able to do so. Rationale 4: Euthanasia is not supported by the American Nurses Association and would be inappropriate to discuss with the patient. Rationale 5: A physician order for life-sustaining treatment (POLST) is a form for patients with serious, progressive, chronic illnesses that translates their wishes regarding life-sustaining treatment into actionable medical orders. Global Rationale: A living will is a document that provides written directions about life-prolonging procedures to follow when an individual can no longer communicate in a life-threatening situation. Durable power of attorney is a document that can delegate the authority to make healthcare decisions. A healthcare surrogate is a person selected to make medical decisions when the patient is no longer able to do so. A physician order for life-sustaining treatment (POLST) is a form for patients with serious, progressive, chronic illnesses that translates their wishes regarding life-sustaining treatment into actionable medical orders. Euthanasia is not supported by the American Nurses Association and would be inappropriate to discuss with the patient.

Question 49 Type: MCMA A patient who nearing the end of life is irritable and uncomfortable in bed. Which actions should the nurse take to make the patient more comfortable? Standard Text: Select all that apply. 1. Raise the head of the bed. 2. Apply bed pads over the linens. 3. Gently massage the extremities. 4. Reduce the amount of pain medication. 5. Use a draw sheet to turn the patient.

Correct Answer: 1, 2, 3, 5 Rationale 1: Actions to help this patient achieve comfort include raising the head of the bed. Rationale 2: Actions to help this patient achieve comfort include applying bed pads over the linens. Rationale 3: Actions to help this patient achieve comfort include gently massaging the extremities. Rationale 4: Reducing the amount of pain medication can increase this patient's level of pain. Rationale 5: Actions to help this patient achieve comfort include using a draw sheet when turning. Global Rationale: Actions to help this patient achieve comfort include raising the head of the bed, applying bed pads over the linens, gently massaging the extremities, and using a draw sheet when turning. Reducing the amount of pain medication can increase this patient's level of pain.

Question 52 Type: MCMA During a home visit the nurse determines that a patient whose spouse died 10 months ago is demonstrating signs of grief resolution. What did the nurse assess to come to this conclusion? Standard Text: Select all that apply. 1. Not living in the past 2. Breaking ties with the lost person 3. Asking for help to end the pain of the loss 4. Experiencing waves of sadness when looking at a picture 5. Wishing that death had occurred at the same time the spouse died

Correct Answer: 1, 2, 4 Rationale 1: Evidence that grief is resolving includes not living in the past. Rationale 2: Evidence that grief is resolving includes breaking ties with the lost person. Rationale 3: Asking for help to end the pain of the loss indicates that grief resolution is not occurring. Rationale 4: Evidence that grief is resolving includes experiencing waves of sadness when looking at a picture. Rationale 5: Wishing for death at the same time that the spouse died indicates that grief resolution is not occurring. Global Rationale: Evidence that grief is resolving includes not living in the past, breaking ties with the lost person, and experiencing waves of sadness when looking at a picture. Asking for help to end the pain of the loss and wishing for death at the same time that the spouse died indicates that grief resolution is not occurring.

Question 51 Type: MCMA A patient whose spouse passed away 5 years ago becomes severely depressed on holidays, anniversaries, and birthdays. What should the nurse do to help this patient? Standard Text: Select all that apply. 1. Encourage the patient to talk with family or spiritual support systems. 2. Explain that these feelings are a sign of chronic depression. 3. Help the patient talk about the loss and hopes for the future. 4. Explain that these feelings will last as long as the patient is alive. 5. Role-play ways for the patient to get through the days when depression is the worst.

Correct Answer: 1, 3, 4, 5 Rationale 1: For the patient with chronic sorrow the nurse should encourage the patient to talk with family or others in the patient's spiritual support system. Rationale 2: These feelings are not a sign of chronic depression. Rationale 3: For the patient with chronic sorrow the nurse should encourage the patient to talk about the loss and hopes for the future. Rationale 4: For the patient with chronic sorrow the nurse should explain that these feelings will last as long as the patient is alive. Rationale 5: For the patient with chronic sorrow the nurse should role-play ways for the patient to get through the days when the depression is the worst. Global Rationale: For the patient with chronic sorrow the nurse should encourage the patient to talk with family or others in the patient's spiritual support system, help the patient talk about the loss and hopes for the future, explain that these feelings will last as long as the patient is alive, and role-play ways for the patient to get through the days when the depression is the worst. These feelings are not a sign of chronic depression.

Question 29 Type: FIB A patient diagnosed with pancreatic cancer is prescribed strict intake and output. During the last shift, the patient received 1 liter of 0.9% normal saline; two 50-milliliter doses of morphine sulfate in 0.9% normal saline; 3 ounces water. What should the nurse calculate this patient's total intake for the previous shift to be?

Correct Answer: 1,190 Rationale: To calculate the patient's total intake, 1 liter of 0.9% normal saline is 1,000 mL. Add this to 100 mL for the two doses of morphine sulfate to equal 1,100 mL. The oral intake of 3 ounces is converted to 90 mL (1 ounce = 30 mL). The patient's total intake for the previous shift was 1,190 mL.

Question 23 Type: MCMA The sibling of a patient who is nearing death has insisted on intravenous fluids because "My brother wants to live." Which findings should the nurse expect when assessing this patient? Standard Text: Select all that apply. 1. The nurse notes the presence of inspiratory and expiratory crackles in all lung fields. 2. The nurse notes that there is increasing edema in the patient's ankles and feet bilaterally. 3. The patient has developed ascites. 4. The patient has lost 6 pounds from last week. 5. The nurse learns during shift report that the patient vomited three times during the night shift.

Correct Answer: 1,2,3,5 Rationale 1: Initiating intravenous fluids for hydration purposes in the dying patient may increase fluid in the lungs. Rationale 2: Initiating intravenous fluids for hydration purposes in the dying patient may lead to peripheral edema. Rationale 3: Initiating intravenous fluids for hydration purposes in the dying patient may lead to ascites. Rationale 4: The patient is much less likely to lose weight at this time. Rationale 5: Initiating intravenous fluids for hydration purposes in the dying patient may lead to vomiting. Global Rationale: Initiating intravenous fluids for hydration purposes in the dying patient may increase fluid in the lungs, peripheral edema, ascites, and vomiting. The patient is much less likely to lose weight at this time.

Question 31 Type: MCMA A patient diagnosed with terminal cancer tells the nurse that she knows everything about a living will. Upon assessment, the nurse realizes the patient needs additional instruction on this type of advance directive when the patient makes which statements? Standard Text: Select all that apply. 1. "A living will is a document in which I designate someone to make healthcare-related decisions for me in the event I become unconscious." 2. "A living will is a document in which I designate someone to make healthcare and legal decisions for me in the event I become unconscious." 3. "A living will is a document in which I designate my personal wishes and which directions to follow in the event I become unconscious." 4. "A living will is a document in which I designate which directions to follow in the event I become unconscious, but the directions can be modified by my family." 5. "A living will is a document in which my family designates someone to make decisions for me in the event I become unconscious."

Correct Answer: 1,2,4,5 Rationale 1: A healthcare surrogate is an individual that the patient designates to make healthcare decisions for the patient in the event the patient is unable to do so. Rationale 2: Durable power of attorney is a document that delegates the authority to make legal, healthcare, and financial decisions for the patient in the event the patient is unable to do so because of a change in health status. Rationale 3: A living will is a document in which the patient designates those wishes and directions to follow in the event of terminal illness or permanent unconsciousness. Rationale 4: A living will cannot be modified by the patient's family. A living will is not created for another person; therefore, the family cannot make a living will for a patient. Rationale 5: A living will is not created by the patient's family. Global Rationale: A living will is a document in which the patient designates those wishes and directions to follow in the event of terminal illness or permanent unconsciousness. A healthcare surrogate is an individual that the patient designates to make healthcare decisions for the patient in the event the patient is unable to do so. Durable power of attorney is a document that delegates the authority to make legal, healthcare, and financial decisions for the patient in the event the patient is unable to do so because of a change in health status. A living will is not created by the patient's family and cannot be modified by the family. A living will is not created for another person; therefore, the family cannot make a living will for a patient.

Question 24 Type: MCMA A patient of Mexican American descent is dying. Which statements by the patient's only son are expected? Standard Text: Select all that apply. 1. "We have already notified our priest about Dad's condition." 2. "When the time of death gets closer, we would like him transferred to the inpatient hospice unit at the hospital." 3. "My sister is pregnant, so she really can't help with his care." 4. "My family members will be here at the house a lot right now." 5. "We don't want to worry him, so if there is any change in his condition, please talk to me about it."

Correct Answer: 1,3,4,5 Rationale 1: It is important that the patient's priest be notified. Rationale 2: It would be unusual for the family of this patient to express the wish to transfer the patient from home to a hospital. Mexican American families often prefer that the patient die at home. Rationale 3: Pregnant women do not care for dying persons or attend funerals. Rationale 4: Extended family members are obligated to pay respects to the sick and dying. Rationale 5: Based on the belief that worry may make health worse, the family may want to protect the patient from the seriousness of illness. The information is often handled by an older daughter or son. Global Rationale: It is important that the patient's priest be notified. Pregnant women do not care for dying persons or attend funerals. Extended family members are obligated to pay respects to the sick and dying. Based on the belief that worry may make health worse, the family may want to protect the patient from the seriousness of illness. The information is often handled by an older daughter or son. It would be unusual for the family of this patient to express the wish to transfer the patient from home to a hospital. Mexican American families often prefer that the patient die at home.

Question 30 Type: MCMA The nurse suspects a patient is in the final stages of the dying process. What manifestations did the nurse assess in this patient? Standard Text: Select all that apply. 1. change in level of consciousness 2. sudden increase in taste and smell 3. urinary incontinence 4. increased blood pressure 5. irregular heart rate

Correct Answer: 1,3,5 Rationale 1: Assessment findings consistent with the late stages of the dying process include a change in level of consciousness. Rationale 2: There is a decrease, not an increase, in taste and smell. Rationale 3: Assessment findings consistent with the late stages of the dying process include incontinence of bowel and bladder. Rationale 4: Blood pressure will decrease. Rationale 5: Assessment findings consistent with the late stages of the dying process include an irregular heart rate. Global Rationale: Assessment findings consistent with the late stages of the dying process include a change in level of consciousness, incontinence of bowel and bladder, and an irregular heart rate. There is a decrease, not an increase, in taste and smell. Blood pressure will decrease.

Question 40 Type: MCSA The nurse is assessing a dying patient's spiritual beliefs about death. Which acronym represents topics the nurse can use to help with this assessment process? 1. ABC 2. FICA 3. DABDA 4. RACE

Correct Answer: 2 Rationale 1: ABC represents airway, breathing, and circulation, and is not related to assessing a dying patient's spiritual beliefs about death. Rationale 2: Faith, influence, community, and address form the acronym FICA. These topics can help the nurse move through the spiritual assessment process with a patient. Rationale 3: DABDA represents denial, anger, bargaining, despair, and acceptance and are Kübler-Ross's stages of grieving. Rationale 4: RACE represents the emergency evacuation procedure during a fire: remove, activate, confine, and extinguish. This acronym is not related to this situation. Global Rationale: Faith, influence, community, and address form the acronym FICA. These topics can help the nurse move through the spiritual assessment process with a patient. ABC represents airway, breathing, and circulation, and is not related to assessing a dying patient's spiritual beliefs about death. DABDA represents denial, anger, bargaining, despair, and acceptance and are Kübler-Ross's stages of grieving. RACE represents the emergency evacuation procedure during a fire: remove, activate, confine, and extinguish. This acronym is not related to this situation.

Question 42 Type: MCSA The family of a dying patient wants to help relieve the patient's progressive dyspnea. What should the nurse instruct the family to do for the patient? 1. Lower the head of the bed. 2. Raise the head of the bed. 3. Suction the patient as much as possible. 4. Perform chest physiotherapy.

Correct Answer: 2 Rationale 1: Nursing care to improve respirations does not include lowering the head of the bed. Rationale 2: Nursing care to improve respirations includes raising the head of the bed. Rationale 3: Suctioning would be considered an advanced care measure and is not indicated in the scenario. Rationale 4: Chest physiotherapy would be considered an advanced care measure and is not indicated in the scenario. Global Rationale: Nursing care to improve respirations includes raising, not lowering, the head of the bed. Suctioning and chest physiotherapy would be considered advanced care measures and are not indicated in the scenario.

Question 36 Type: MCSA The spouse of a former patient tells the nurse that he has joined a support group to help with the loss of his wife. The nurse realizes this patient is in which phase of Engel's grief process? 1. acute 2. restitution 3. long-term 4. resolution

Correct Answer: 2 Rationale 1: The acute phase is initiated by shock and disbelief, manifested by denial. Rationale 2: According to Engel, there are three phases of the grief process: acute, restitution, and long-term. It is during restitution that the surviving spouse might join a support group to help cope with the loss. Rationale 3: During the long-term phase, the individual begins to come to terms with the loss and renew activities. Rationale 4: Resolution is associated with the acceptance of the loss but is not one of the phases in Engel's grief process. Global Rationale: According to Engel, there are three phases of the grief process: acute, restitution, and long-term. It is during restitution that the surviving spouse might join a support group to help cope with the loss. The acute phase is initiated by shock and disbelief, manifested by denial. During the long-term phase, the individual begins to come to terms with the loss and renew activities. Resolution is associated with the acceptance of the loss but is not one of the phases in Engel's grief process.

Question 41 Type: MCSA The patient states, "My husband is the person you should talk with if I am not able to make decisions about my care." What should the nurse realize the spouse has been designated to be? 1. the person who has the patient's living will 2. the healthcare surrogate 3. the person with the durable power of attorney 4. nothing more than the spouse

Correct Answer: 2 Rationale 1: The patient would have been asked to provide a copy of a living will or documentation of any legal designations, such as a durable power of attorney for health care. Rationale 2: A healthcare surrogate is the person selected by the patient to make medical decisions when the patient is no longer able to make them for him- or herself. Rationale 3: Durable power of attorney does not confer decision-making power related to health. This specifically needs to be a healthcare power of attorney. Rationale 4: A healthcare surrogate is the person selected to make medical decisions when a person is no longer able to make them for him- or herself. The patient would have been asked to provide a copy of a living will or documentation of any legal designations, such as a durable power of attorney for health care. Global Rationale: A healthcare surrogate is the person selected by the patient to make medical decisions when the patient is no longer able to make them for him- or herself. The patient would have been asked to provide a copy of a living will or documentation of any legal designations, such as a durable power of attorney for health care. Durable power of attorney does not confer decision-making power related to health. This specifically needs to be a healthcare power of attorney

Question 50 Type: MCMA A patient with a terminal illness is experiencing severe nausea and vomiting. Which medications should the nurse consider appropriate for the patient at this time? Standard Text: Select all that apply. 1. Furosemide (Lasix) 2. Ondansetron (Zofran) 3. Meperidine (Demerol) 4. Morphine sulfate (Morphine) 5. Prochlorperazine (Compazine

Correct Answer: 2, 5 Rationale 1: Furosemide (Lasix) is a diuretic. Rationale 2: Nausea, with or without vomiting, is a common problem in dying patients. If the patient is conscious and complains of nausea, antiemetics such as prochlorperazine (Compazine) or ondansetron (Zofran) should be administered. Rationale 3: Meperidine (Demerol) is an analgesic that can metabolize into products that could lead to seizure activity. Rationale 4: Morphine sulfate (Morphine) is an analgesic, which could be causing this patient's nausea and vomiting. Rationale 5: Nausea, with or without vomiting, is a common problem in dying patients. If the patient is conscious and complains of nausea, antiemetics such as prochlorperazine (Compazine) or ondansetron (Zofran) should be administered. Global Rationale: Nausea, with or without vomiting, is a common problem in dying patients. If the patient is conscious and complains of nausea, antiemetics such as prochlorperazine (Compazine) or ondansetron (Zofran) should be administered. Furosemide (Lasix) is a diuretic. Meperidine (Demerol) is an analgesic that can metabolize into products that could lead to seizure activity. Morphine sulfate (Morphine) is an analgesic, which could be causing this patient's nausea and vomiting.

Question 35 Type: MCMA A patient who has just lost her spouse asks the nurse how long it will be until she feels like living again. The nurse realizes this patient has to work through which phases of the grieving process according to Bowlby? Standard Text: Select all that apply. 1. denial 2. despair 3. detachment 4. protest 5. restitution

Correct Answer: 2,3,4 Rationale 1: Denial is associated with feelings of disbelief. Rationale 2: The theorist Bowlby believes that a person needs to work through the three phases of grief before being able to move beyond the grief process. These three phases are protest, despair, and detachment. The patient's responses indicate she has acknowledged the event. Rationale 3: The theorist Bowlby believes that a person needs to work through the three phases of grief before being able to move beyond the grief process. These three phases are protest, despair, and detachment. The patient's responses indicate she has acknowledged the event. Rationale 4: The theorist Bowlby believes that a person needs to work through the three phases of grief before being able to move beyond the grief process. These three phases are protest, despair, and detachment. The patient's responses indicate she has acknowledged the event. Rationale 5: Restitution is a stage in Engel's theory of loss. Global Rationale: The theorist Bowlby believes that a person needs to work through the three phases of grief before being able to move beyond the grief process. These three phases are protest, despair, and detachment. The patient's responses indicate she has acknowledged the event. Denial is associated with feelings of disbelief. Restitution is a stage in Engel's theory of loss.

Question 32 Type: MCMA The nurse is instructing others on the use of hospice care. Which statements would indicate to the nurse that the teaching session has been effective? Standard Text: Select all that apply. 1. "Hospice care is designed for individuals with a terminal prognosis who cannot stay at the hospital." 2. "Hospice care is designed for individuals with a terminal prognosis who decide to spend their final days at home with their families." 3. "Hospice care is designed for individuals with a terminal prognosis who decide to stay in the hospital for symptom management." 4. "Hospice care is designed for individuals with a terminal prognosis who have to go into a hospice center for proper symptom management." 5. "Hospice care is designed for individuals with a terminal prognosis who decide to receive treatment for their symptoms at home, the hospital, or the hospice center."

Correct Answer: 2,3,5 Rationale 1: Hospice care can be received in the home, hospital, hospice center, or community. Rationale 2: Hospice care is a philosophy of care designed for the individual with a terminal prognosis and the individual's family members. Hospice care can be received in the home, hospital, hospice center, or community. Hospice services begin when the patient has 6 months or less to live and ends with the family 1 year after the death of the patient. Rationale 3: Hospice care can be received in the home, hospital, hospice center, or community. Hospice services begin when the patient has 6 months or less to live and ends with the family 1 year after the death of the patient. Rationale 4: Hospice care can be received in the home, hospital, hospice center, or community. Rationale 5: Hospice care can be received either at home, the hospital, hospice center, or the community. Global Rationale: Hospice care is a philosophy of care designed for the individual with a terminal prognosis and the individual's family members. Hospice care can be received in the home, hospital, hospice center, or community. Hospice services begin when the patient has 6 months or less to live and ends with the family 1 year after the death of the patient

Question 33 Type: MCMA A young adult male patient diagnosed with terminal pancreatic cancer tells the nurse that if he lets his hair grow, God will cure him. What should the nurse realize this patient is demonstrating? Standard Text: Select all that apply. 1. The patient is having delusions and is using religious beliefs to block his loss. 2. The patient is bargaining and is postponing his loss. 3. The patient is in denial, and his religious beliefs block his loss. 4. The patient is normal; bargaining with God for physical healing reflects a stage of grieving. 5. The patient is feeling anger and is using his religious beliefs to project his loss.

Correct Answer: 2,4 Rationale 1: The patient is not delusional and is not using religious beliefs to block the loss. Rationale 2: Bargaining is one stage within Kübler-Ross's stages of grieving in which the person makes a bargain with God and expresses the willingness to do anything to postpone the reality of the loss or change the prognosis. Rationale 3: The patient is also not in denial and using his religious beliefs to block the loss. Rationale 4: Bargaining is one stage within Kübler-Ross's stages of grieving in which the person makes a bargain with God and expresses the willingness to do anything to postpone the reality of the loss or change the prognosis. Rationale 5: Bargaining with God is not a demonstration of anger. Global Rationale: Bargaining is one stage within Kübler-Ross's stages of grieving in which the person makes a bargain with God and expresses the willingness to do anything to postpone the reality of the loss or change the prognosis. The patient is not delusional or in denial and is not using religious beliefs to block the loss. Bargaining with God is not a demonstration of anger.

Question 43 Type: MCSA The family of a dying patient states, "She has to be in pain, because all she does is moan." What should the nurse realize this family is doing? 1. overreacting 2. asking for more pain medication for the patient 3. not understanding that moaning can be agitation in the patient 4. considering moaning to be a sign the patient is recovering

Correct Answer: 3 Rationale 1: The responses by the family are typical and do not reflect excessive concern. Rationale 2: There is no indication that the family is requesting pain medication. Rationale 3: Moaning, groaning, and grimacing often accompany agitation and may be misinterpreted as pain. Rationale 4: The family thinks she is in pain, which would not indicate an improvement in status. Global Rationale: Moaning, groaning, and grimacing often accompany agitation and may be misinterpreted as pain. The family thinks she is in pain, which would not indicate an improvement in status. The responses by the family are typical and do not reflect excessive concern. There in no indication that the family is requesting pain medication.

Question 47 Type: MCSA A preoperative patient says to the nurse, "I hope I wake up after surgery. I don't know what my family would do if I didn't." The nurse realizes this patient is demonstrating which potential problem? 1. coping 2. chronic sorrow 3. anticipatory grieving 4. death anxiety

Correct Answer: 3 Rationale 1: This patient is expressing a feeling, not demonstrating coping. Rationale 2: This patient is not demonstrating chronic sorrow, which is a "cyclical, recurring, and potentially progressive pattern of pervasive sadness experienced in response to continual loss, throughout the trajectory of an illness or disability." Rationale 3: Anticipatory grieving is a combination of intellectual and emotional responses and behavior by which people adjust their self-concept in the face of a potential loss. Rationale 4: This patient is not experiencing death anxiety, which is worry or fear related to death or dying. It may be present in patients who have an acute life-threatening illness, who have a terminal illness, who have experienced the death of a family member or friend, or who have experienced multiple deaths in the same family. Global Rationale: Anticipatory grieving is a combination of intellectual and emotional responses and behavior by which people adjust their self-concept in the face of a potential loss. This patient is expressing a feeling, not demonstrating coping. This patient is not demonstrating chronic sorrow, which is a "cyclical, recurring, and potentially progressive pattern of pervasive sadness experienced in response to continual loss, throughout the trajectory of an illness or disability." This patient is not experiencing death anxiety, which is worry or fear related to death or dying. It may be present in patients who have an acute life-threatening illness, who have a terminal illness, who have experienced the death of a family member or friend, or who have experienced multiple deaths in the same family.

Question 39 Type: MCSA A patient tells the nurse, "My husband left me to be with God." What should the nurse realize this patient is demonstrating? 1. coping 2. denial 3. a regional difference in the way death is expressed 4. a cultural rite related to death

Correct Answer: 3 Rationale 1: This patient statement does not indicate coping. Rationale 2: This patient statement does not indicate denial. Rationale 3: Regional differences in the way death is expressed in the United States include "passed away," "went to be with God," and "passed from this life." Rationale 4: This patient statement does not reflect a cultural rite. Global Rationale: Regional differences in the way death is expressed in the United States include "passed away," "went to be with God," and "passed from this life." This statement does not reflect coping, denial, or a cultural rite.

Question 21 Type: SEQ A patient is explaining her experiences after the sudden death of her daughter a few years ago. If Elizabeth Kübler-Ross's sequence is applied, in which order did the patient experience the stages of death and dying? Rank the patient's statements in the order they would have been made. Standard Text: Click and drag the options below to move them up or down. Choice 1. "I have to admit I tried to make a deal with God to bring her back to me." Choice 2. "I'm going to try to use my experience with her illness to help other parents." Choice 3. "I cannot get my mind around it. I still keep waiting for her to come home from school." Choice 4. "I can hardly get out of bed because I just want to sleep." Choice 5. "I just feel so mad at her for leaving me!"

Correct Answer: 3,5,1,4,2 Rationale 1: Elizabeth Kübler-Ross's research about death and dying provided a framework for gaining insight about the stages of coping with an impending or actual loss. Bargaining is the third stage. Rationale 2: Elizabeth Kübler-Ross's research about death and dying provided a framework for gaining insight about the stages of coping with an impending or actual loss. Acceptance is the final stage. Rationale 3: Elizabeth Kübler-Ross's research about death and dying provided a framework for gaining insight about the stages of coping with an impending or actual loss. Denial is the first stage. Rationale 4: Elizabeth Kübler-Ross's research about death and dying provided a framework for gaining insight about the stages of coping with an impending or actual loss. Depression is the fourth stage. Rationale 5: Elizabeth Kübler-Ross's research about death and dying provided a framework for gaining insight about the stages of coping with an impending or actual loss. Anger is the second stage. Global Rationale: Elizabeth Kübler-Ross's research about death and dying provided a framework for gaining insight about the stages of coping with an impending or actual loss. The stages are denial, anger, bargaining, depression, and finally acceptance.

Question 45 Type: MCSA The nurse who provided care to a terminally ill patient does not want to spend any time with the grieving family and begins to provide care to another patient. What is this nurse demonstrating? 1. empathy 2. apathy 3. overemotionality 4. blunting

Correct Answer: 4 Rationale 1: Empathy refers to the provision of emotional support that promotes a feeling of acceptance to the patient. Rationale 2: Apathy is an emotion characterized by a lack of concern and involvement. Rationale 3: Overemotionality is not a recognized term. Rationale 4: Blunting is a problem often experienced by nurses who provide care to the terminally ill. The nurse may not be able to handle his or her emotions appropriately right after the death, and this is a coping mechanism. Global Rationale: Blunting is a problem often experienced by nurses who provide care to the terminally ill. The nurse may not be able to handle his or her emotions appropriately right after the death, and this is a coping mechanism. Empathy refers to the provision of emotional support that promotes a feeling of acceptance to the patient. Apathy is an emotion characterized by a lack of concern and involvement. Overemotionality is not a recognized term.

Question 27 Type: SEQ A patient diagnosed with testicular cancer tells the nurse that he does not believe he has cancer. The nurse realizes that the patient may be progressing through the stages of grief. Place in order the stages of grief. Standard Text: Click and drag the options below to move them up or down. Choice 1. depression Choice 2. acceptance Choice 3. anger Choice 4. denial Choice 5. bargaining

Correct Answer: 4,3,5,1,2 Rationale 1: The fourth stage, depression, occurs when the patient realizes the full impact of the loss. Rationale 2: The final stage is acceptance and occurs when the patient accepts the conditions of the illness and begins to plan or hope for the future. A patient may or may not experience all of the stages in this process. Rationale 3: The second stage is anger, when the patient demonstrates anger over the situation. Rationale 4: The patient is currently in the stage of denial by refusing to accept the diagnosis. Kübler-Ross's stages of grieving begin with denial. Rationale 5: The third stage is bargaining, in which the patient may make an agreement with God or another supreme being. Global Rationale: The patient is currently in the stage of denial by refusing to accept the diagnosis. Kübler-Ross's stages of grieving begin with denial. The second stage is anger, when the patient demonstrates anger over the situation. The third stage is bargaining, in which the patient may make an agreement with God or another supreme being. The fourth stage, depression, occurs when the patient realizes the full impact of the loss. The final stage is acceptance and occurs when the patient accepts the conditions of the illness and begins to plan or hope for the future. A patient may or may not experience all of the stages in this process.

A nurse is assessing a terminally ill female client. Which client statement indicates that the client is in the bargaining stage of dying? "I don't know how my husband is going to manage things when I'm gone." "I can't believe this. I'm going to get a second opinion." "Why is this happening to me. I've led a good life. Why is God punishing me?" "I just want to see my daughter graduate from college. That's all."

Correct response: "I just want to see my daughter graduate from college. That's all." Explanation: Bargaining is manifested by pleading for more time to reach an important goal. This is reflected in the client's statement about wanting to see her daughter's college graduation. The statement about going to get a second opinion reflects denial. The statement about why reflects anger. The statement about not knowing how the husband will manage reflects the depression stage.

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. "Let's focus on what your doctor has planned." "I know just how you must feel." "Tell me more about what's on your mind." "This must be very difficult for you." "You still have time for a good life."

Correct response: "This must be very difficult for you." "Tell me more about what's on your mind." Explanation: The nurse needs to listen effectively and empathetically, acknowledging the client's fears and concerns. Statements such as "This must be very difficult for you" and "Tell me more about what's on your mind" address the client's concerns and help to focus the discussion on the client. Telling the client that the nurse knows how the client feels ignores the client's concerns. Saying that there is still time for a good life or telling the client to focus on what the doctor has planned ignores the client's feelings and blocks communication.

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? "You know you're dying?" "I'm so sorry. I know how you must feel." "Tell me more about what's on your mind." "This must be very difficult for you."

Correct response: "This must be very difficult for you." Explanation: Using open-ended questions allows the nurse to elicit the patient's and family's concerns, explore misconceptions and needs for information, and form the basis for collaboration with physicians and other team members. For example, a seriously ill patient may ask the nurse, "Am I dying?" The nurse should avoid making unhelpful responses that dismiss the patient's real concerns or defer the issue to another care provider. In response to the question "Am I dying?" the nurse could establish eye contact and follow with a statement acknowledging the patient's fears ("This must be very difficult for you") and an open-ended statement or question ("Tell me more about what is on your mind")

According to federal guidelines, hospices may provide no more than what percentage of the aggregate annual patient-days at the inpatient level? 20 40 10 30

Correct response: 20 Explanation: According to federal guidelines, hospices may provide no more than 20% of the aggregate annual patient-days at the inpatient level. The other numerical values are incorrect.

Which of the following is an appropriate intervention for the client with pulmonary edema? Use chest percussion. Administer the prescribed sedative to decrease anxiety. Position the client supine. Suction as needed to clear the lungs.

Correct response: Administer the prescribed sedative to decrease anxiety. Explanation: Suctioning will not clear the lungs or ease breathing if the client has pulmonary edema. In this situation, the physician may prescribe a sedative to relieve the anxiety created by the feeling of suffocation.

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. Comfort the client by saying it will all be over soon. Recommend that the client consider physician-assisted suicide. Advise the client's health care provider of the client's condition. Encourage the client to explain his or her wishes. Control the client's pain with prescribed medication.

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

Which factor is likely to have the greatest impact on how a client responds to grief?

Cultural influences (Both the physical and emotional manifestations of grief may be culturally influenced. Culture also influences a how a person expresses their of grief.)

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

Correct response: Use imagery, humor, and progressive relaxation Explanation: Imagery, humor, and progressive relaxation are the various techniques to potentiate the effects of pain medication and to reduce dyspnea. Offering small amounts of nourishment frequently will not help potentiate the effects of pain medication. Gentle massaging of the arms and legs helps to regulate body temperature. Encouraging the client to fall asleep will not help in potentiate the effects of pain medication

Evidence-based medical and nursing research (2009) has identified cardiovascular disease as the most prevalent chronic disease in the United States. Under this classification, one condition is the most common. Using this information, a nurse practitioner, treating a 50-year-old man, would do which of the following? Make certain that the patient was aware of the signs of coronary artery disease. Write a prescription for a serum cholesterol level. Suggest activity modifications and treatments to help minimize the physical limitations of dyspnea. Teach the patient how to assess his blood pressure weekly.

Correct response: Write a prescription for a serum cholesterol level. Explanation: Hypercholesterolemia is the most prevalent chronic disease in the United States, with 37.5% of all adults affected. Refer to Table 3-1 in the text.

How does a nurse who has been providing home care to a terminally ill client know that the client's condition is beginning to deteriorate? urine output increases apical pulse reaches 100 beats/minute facial muscles contract skin appears red and flushed

Correct response: apical pulse reaches 100 beats/minute Explanation: Failing cardiac function is one of the first signs that a client's condition is worsening. At first, heart rate increases in a futile attempt to deliver oxygen to cells. The apical pulse rate may reach 100 or more beats/minute. In clients who are dying, the skin becomes pale or mottled, nail beds and lips may appear blue, and the client may feel cold. In clients who are dying, urine volume decreases, and the jaw and facial muscles relax.

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 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.

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

Grief (Grief is defined as the personal feelings that accompany an anticipated or actual loss. Bereavement is a period during which mourning for a loss take place. Mourning is an expression of grief and associated behaviors. Spirituality is a personal belief system that focuses on a search for meaning and purpose of life.)

A client with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high-dose radiation (HDR). What safety measure should the nurse include in this client's plan of care?

Limit the time that visitors spend at the client's bedside. Explanation: To limit radiation exposure, visitors should generally not spend more than 30 minutes with the client. Pregnant nurses or visitors should not be near the client, but there is no reason to limit care to nurses who are male. All necessary care should be provided to the client and a single room should be used.

Provide gentle oral care after each meal.

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 is one level of hospice care covered under Medicare and Medicaid hospice benefits, includes a 5-day inpatient stay, and is provided occasionally to relive the family caregivers?

Respite care

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

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 constipation related to the effects of an opioid

C O M F O R T*

Team (assures continuity of care, patient and family are a part of the team)

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?

The stages are applicable to any loss.

Use imagery, humor, and progressive relaxation

durable power of attorney for health care

a patient, family/illness barrier of discussion of end-of-life treatment

the lack of discussion

10. The male client asks the nurse, "Should I designate my wife as durable power of attorney for health care?" Which statement would be the nurse's best response? 1. "Yes, she should be because she is your next of kin." 2. "Most people don't allow their spouse to do this." 3. "Will your wife be able to support your wishes?" 4. "Your children are probably the best ones for the job." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 693). F.A. Davis Company. Kindle Edition.

10. 1. The client can designate anyone he wishes to be the durable power of attorney. 2. This is not true; many spouses are designated as the durable power of attorney for health care. 3. No matter who the client selects as the power of attorney, the most important aspect is to make sure the person, whether it be the wife, child, or friend, will honor the client's wishes no matter what happens. 4. The children must be at least 18 years old and willing to honor the client's wishes. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 697). F.A. Davis Company. Kindle Edition. 3

11. Which situation would cause the nurse to question the validity of an AD when caring for the elderly client? 1. The client's child insists the client make his or her own decisions. 2. The nurse observes the wife making the husband sign the AD. 3. A nurse encouraged the client to think about end-of-life decisions. 4. A friend witnesses the client's signature on the AD form. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 669). F.A. Davis Company. Kindle Edition.

11. 1. This is appropriate for completing an AD and would not make the nurse question the validity of the AD. 2. This is coercion and is illegal when signing an AD. The AD must be signed by the client's own free will; an AD signed under duress may not be valid. 3. The nurse encouraging the client to think about ADs is an excellent intervention and would not make the AD invalid. 4. A friend can sign the AD as a witness; this would not cause the nurse to question its validity. TEST-TAKING HINT: This is an "except" question. The test taker could ask, "Which situation is valid for an AD?" Remember, three answers are valid information for the AD and only one is not. The test taker should read all answer options and not jump to conclusions. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 678). F.A. Davis Company. Kindle Edition. 2

11. The client has been declared brain dead and is an organ donor. The nurse is preparing the wife of the client to enter the room to say good-bye. Which information is most important for the nurse to discuss with the wife? 1. Inform the wife the client will still be on the ventilator. 2. Instruct the wife to only stay a few minutes at the bedside. 3. Tell the wife it is all right to talk to the client. 4. Allow another family member to go in with the wife. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 693). F.A. Davis Company. Kindle Edition.

11. 1. This is the most important action because, when the wife walks in the room, the client's chest will be rising and falling, the monitor will show a heartbeat, and the client will be warm. Many family members do not realize this and think the client is still alive. The organs must be perfused until retrieved for organ donation. 2. The wife should be encouraged to stay a short time and leave the facility before the client is taken to the operating room, but it is not the most important intervention. 3. It is all right for the wife to talk to the client, but because the client is brain dead and cannot hear her, it is not the most important intervention. 4. It is all right for another family member to go into the room, but it is not the most important intervention. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 697). F.A. Davis Company. Kindle Edition. 1

12. Which client would the nurse exclude from being a potential organ/tissue donor? 1. The 60-year-old female client with an inoperable primary brain tumor. 2. The 45-year-old female client with a subarachnoid hemorrhage. 3. The 22-year-old male client who has been in a motor-vehicle accident. 4. The 36-year-male client recently released from prison. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 693). F.A. Davis Company. Kindle Edition.

12. 1. Primary brain tumors rarely metastasize outside the skull, and this client can be a donor; cancers other than primary brain tumors prevent organ/tissue donation. 2. This is an excellent potential donor because all other organs are probably healthy. 3. This is an excellent candidate because this is a young person with a traumatic death, not a chronic illness. 4. A male client who has been in prison is at risk for being HIV positive, which excludes him from being an organ/tissue donor. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 698). F.A. Davis Company. Kindle Edition. 4

12. The nurse is aware the Patient Self-Determination Act of 1991 requires the health-care facility to implement which action? 1. Make available an AD on admission to the facility. 2. Assist the client with legally completing a will. 3. Provide ethically and morally competent care to the client. 4. Discuss the importance of understanding consent forms. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 669). F.A. Davis Company. Kindle Edition.

12. 1. The Patient Self-Determination Act of 1991 requires health-care facilities which receive Medicare or Medicaid funding to make ADs available to clients on admission into the facility. 2. This act is not concerned with completing a legal will. 3. Client care is not based on this act. 4. Consent forms are legal documents, which are not discussed in this act. TEST-TAKING HINT: The test taker should examine the word "self-determination" in the stem of the question, which matches the advance directive in option "1." The words "legally," "ethically," and "morally" in options "2" and "3" apply to the nurse in the healthcare setting, not the client. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 678). F.A. Davis Company. Kindle Edition. 1

13. The spouse of a client dying from lung cancer states, "I don't understand this death rattle. She has not had anything to drink in days. Where is the fluid coming from?" Which is the hospice care nurse's best response? 1. "The body produces about two (2) teaspoons of fluid every minute on its own." 2. "Are you sure someone is not putting ice chips in her mouth?" 3. "There is no reason for this, but it does happen from time to time." 4. "I can administer a patch to her skin to dry up the secretions if you wish." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 669). F.A. Davis Company. Kindle Edition.

13. 1. The respiratory tract cells produce liquid as a defense mechanism against bacteria and other invaders. About nine (9) mL a minute are produced. The "death rattle" can be disturbing to family members, and the nurse should intervene but not with suctioning, which will increase secretions and the need to suction more. 2. This is a natural physical phenomenon and should be addressed. 3. There is an explanation. 4. The scopolamine patch applied to the skin helps to limit the secretions, but this does not answer the question. TEST-TAKING HINT: The test taker could eliminate option "3" because it states there is no reason, option "4" because it does not answer the question, and option "2" because it is attempting to fix blame. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 678). F.A. Davis Company. Kindle Edition. 1

13. The intensive care nurse is caring for a deceased client who is an organ donor, and the organ donation team is en route to the hospital. Which statement would be an appropriate goal of treatment for the client? 1. The urinary output is 20 mL/hr via a Foley catheter. 2. The systolic blood pressure is greater than 90 mm Hg. 3. The pulse oximeter reading remains between 88% and 90%. 4. The telemetry shows the client in sinus tachycardia. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 693). F.A. Davis Company. Kindle Edition.

13. 1. The urinary output should be at least 30 mL/hr. 2. The systolic blood pressure must be maintained at this rate to keep the client's organs perfused until removal. 3. The pulse oximeter should be greater than 93%. 4. The client's heart must be beating, but it can be normal sinus rhythm or even sinus bradycardia. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 698). F.A. Davis Company. Kindle Edition. 2

14. The nurse is discussing placing the client diagnosed with chronic obstructive pulmonary disease (COPD) in hospice care. Which prognosis must be determined to place the client in hospice care? 1. The client is doing well but could benefit from the added care by hospice. 2. The client has a life expectancy of six (6) months or less. 3. The client will live for about one (1) to two (2) more years. 4. The client has about eight (8) weeks to live and needs pain control. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 669). F.A. Davis Company. Kindle Edition.

14. 1. Hospice care does not assume care of a client with a prognosis of more than six (6) months and who is doing well. 2. The HCP must think that, without lifeprolonging treatment, the client has a life expectancy of six (6) months or less. The client may continue receiving hospice care if the client lives longer. 3. The client may live this long, but the HCP must think life expectancy is much shorter. 4. Hospice will attempt to manage symptoms of pain, nausea, and any other discomfort the client is experiencing, but the life expectancy is six (6) months. TEST-TAKING HINT: This is a knowledgebased question requiring an understanding of hospice. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 679). F.A. Davis Company. Kindle Edition. 2

14. The nurse is teaching a class on ethical principles in nursing. Which statement supports the definition of beneficence? 1. The duty to prevent or avoid doing harm. 2. The duty to actively do good for clients. 3. The duty to be faithful to commitments. 4. The duty to tell the truth to the clients. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 693). F.A. Davis Company. Kindle Edition.

14. 1. This is the ethical principle of nonmalfeasance. 2. This is the ethical principle of beneficence. 3. This is the ethical principle of fidelity. 4. This is the ethical principle of veracity. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 698). F.A. Davis Company. Kindle Edition. 2

15. Which action by the unlicensed assistive personnel (UAP) would warrant immediate intervention by the nurse? 1. The UAP is holding the phone to the ear of a client who is a quadriplegic. 2. The UAP refuses to discuss the client's condition with the visitor in the room. 3. The UAP put a vest restraint on an elderly client found wandering in the hall. 4. The UAP is assisting the client with arthritis to open up personal mail. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 693). F.A. Davis Company. Kindle Edition.

15. 1. The client has a right to private phone conversations but, because the client is a quadriplegic, holding the phone to the ear does not require immediate intervention. 2. This is the appropriate action for the UAP and should be praised. 3. Restraints are not allowed unless there is a health-care provider's order with documentation by the nurse of the client being a danger to himself or others. The UAP's putting the client in restraints warrants immediate intervention because it is battery. 4. The client has a right to send and receive mail, and the UAP is helping the client open the mail; therefore, this does not require immediate intervention. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 698). F.A. Davis Company. Kindle Edition. 3

15. The client diagnosed with end-stage congestive heart failure and type 2 diabetes is receiving hospice care. Which action by the nurse demonstrates an understanding of the client's condition? 1. The nurse monitors the blood glucose four (4) times a day. 2. The nurse keeps the client on a strict fluid restriction. 3. The nurse limits the visitors the client can receive. 4. The nurse brings the client a small piece of cake. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 669). F.A. Davis Company. Kindle Edition.

15. 1. This would be basic care, but it does not indicate the nurse is aware of the client's terminal prognosis. 2. This does not indicate an understanding of the client's terminal status. 3. The nurse should encourage visitors. There is not much time left for making memories, which will assist those left behind in dealing with the loss and allow the client time to say good-bye. 4. The client may have diabetes, but the client is also terminal, and allowing some food for pleasure is understanding of the client's life expectancy. TEST-TAKING HINT: This question requires the test taker to look not only at the disease processes but also at the descriptive words "end-stage" and "hospice" and ask, "What do these descriptors mean to the disease process?" Not limiting the client in small ways indicates the nurse is aware the client has a limited time to live. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 679). F.A. Davis Company. Kindle Edition. 4

17. The client with chronic low back pain is having trouble sleeping at night. Which nonpharmacological therapy should the nurse teach the client? 1. Acupuncture. 2. Massage therapy. 3. Herbal remedies. 4. Progressive relaxation techniques. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 693). F.A. Davis Company. Kindle Edition.

17. 1. Acupuncture is an alternative therapy, but a nurse cannot teach it and the client cannot do this to himself or herself. 2. A client cannot perform massage therapy on himself or herself. 3. The nurse should not prescribe herbal remedies. 4. Progressive relaxation techniques involve visualizing a specific muscle group and mentally relaxing each muscle; this can be taught to the client, and it will allow the client to relax, which will foster sleep. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 698). F.A. Davis Company. Kindle Edition. 4

16. The nurse is teaching a class on chronic pain to new graduates. Which information is most important for the nurse to discuss? 1. The nurse must believe the client's report of pain. 2. Clients in chronic pain may not show objective signs. 3. Alternate pain-control therapies are used for chronic pain. 4. Referral to a pain clinic may be necessary. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 693). F.A. Davis Company. Kindle Edition.

16. 1. The most important information for a nurse caring for a client with acute or chronic pain is to believe the client. Pain is subjective, and the nurse should not be judgmental. 2. This is a true statement because the client's sympathetic nervous system cannot remain in a continual state of readiness. This results in no objective data to support the pain and a normal pulse and blood pressure. However, it is not the most important information a new graduate should know. 3. Transcutaneous electrical nerve stimulation (TENS), distraction, imagery, acupuncture, and acupressure are all alternate pain therapies which may be used for chronic pain, but it is not the most important information the new graduate should know. 4. Pain clinics treat clients with chronic pain, but it is not the most important information a new graduate should know. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 698). F.A. Davis Company. Kindle Edition.

16. The hospice care nurse is conducting a spiritual care assessment. Which statement is the scientific rationale for this intervention? 1. The client will ask all of his or her spiritual questions and get answers. 2. The nurse is able to explain to the client how death will affect the spirit. 3. Spirituality provides a sense of meaning and purpose for many clients. 4. The nurse is the expert when assisting the client with spiritual matters. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 669). F.A. Davis Company. Kindle Edition.

16. 1. The nurse is not able to provide all spiritual answers to the client. 2. The nurse can explain physical aspects of death, but no one is able to tell the client with absolute knowledge what will happen to the soul or spirit at death. The beliefs of the client may differ greatly from those of the nurse. 3. Clients facing death may wish to find meaning and purpose in life through a higher power. This gives the clients hope, even if the life on earth will be temporary. 4. The nurse is not the expert but should be comfortable with his or her own beliefs to be able to allow the client to discuss personal beliefs and hopes. The experts would be chaplains and spiritual advisers from the client's faith. TEST-TAKING HINT: The test taker should recognize the nurse's expertise is not in the spiritual realm, although the nurse is frequently the one called on to perform the assessment and refer to the appropriate person. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 679). F.A. Davis Company. Kindle Edition. 3

17. The nurse is caring for a dying client and the family. The male client is Muslim. Which intervention should the female nurse implement at the time of death? 1. Allow the wife to stay in the room during postmortem care. 2. Call the client's imam to perform last rites when the client dies. 3. Place incense around the bed, but do not allow anyone to light it. 4. Do not touch the body, and have the male family members perform care. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 670). F.A. Davis Company. Kindle Edition.

17. 1. No female is allowed to perform the postmortem care on a male Muslim client; this should be performed by a man. 2. Last rites are performed by a Catholic priest, not a Muslim imam. 3. Hindus use incense to pray, but Muslims do not. 4. Females, including the spouse, are not allowed to touch a male's body after death. The nurse should respect this and allow the male members of the family or mosque to perform postmortem care. TEST-TAKING HINT: The question is requiring culturally sensitive knowledge. The test taker must be aware of the different beliefs of the clients being cared for. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 679). F.A. Davis Company. Kindle Edition. 4

18. The client diagnosed with cancer is unable to attain pain relief despite receiving large amounts of narcotic medications. Which intervention should be included in the plan of care? 1. Ask the HCP to increase the medication. 2. Assess for any spiritual distress. 3. Change the client's position every two (2) hours. 4. Turn on the radio to soothing music. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 694). F.A. Davis Company. Kindle Edition.

18. 1. The client is already receiving large amounts of medication. The nurse should assess for other causes of pain. 2. Pain has many components, and spiritual distress or psychosocial needs will affect the client's perception of pain; remember, assessment is the first step of the nursing process. 3. Usually clients will naturally assume the most comfortable position, and forcing them to move may increase their pain. 4. The client may or may not like this type of music, but it would not be the first intervention. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 699). F.A. Davis Company. Kindle Edition. 2

18. The nurse writes a client problem of "spiritual distress" for the client who is dying. Which statement is an appropriate goal? 1. The client will reconcile self and the higher power of his or her beliefs. 2. The client will be able to express anger at the terminal diagnosis. 3. The client will reconcile self to estranged members of the family. 4. The client will have a dignified and pain-free death. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 670). F.A. Davis Company. Kindle Edition.

18. 1. The primary goal of spiritual care is to allow the client to be able to reconcile himself or herself with a higher being, maybe God. This goal is based on the belief that life comes from God, and to some degree for many people the process of living includes some separation from God. In the Western world, 95% of the people claim some belief in God. 2. This could be a goal for a diagnosis of anger, but it does not recognize the spiritual aspect of the client. 3. This would be a goal for altered family functioning. 4. This is the physiological goal for any client who is dying, but it is not a goal for spiritual distress. TEST-TAKING HINT: The identified problem is "spiritual distress," and the goal must have information which addresses the spiritual. This would eliminate option "4." Personal relationships with family members (option "3") could also be eliminated. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 680). F.A. Davis Company. Kindle Edition. 1

19. The client diagnosed with chronic pain is laughing and joking with visitors. When the nurse asks the client to rate the pain on a 1-to-10 scale, the client rates the pain as 10. According to the FACES® pain scale, how would the nurse chart the client's pain (See figure below)? 1. The client's pain is between a zero (0) and two (2) on the FACES® scale. 2. The client's pain is a "10" on a 1-to-10 pain scale. 3. The client is unable to accurately rate the pain on a scale. 4. The client's pain is moderate on the pain scale. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 694). F.A. Davis Company. Kindle Edition.

19. 1. The Faces pain scale was devised to help children identify pain when they are unable to understand the concept of numbers. The nurse can use this pain scale when caring for adults who are unable to use the 1-to-10 numerical scale. This client rated the pain at a 10. 2. Pain is whatever the client says it is and occurs whenever the client says it does. Pain is a wholly subjective symptom, and the nurse should not question the client's perception of pain. The client's pain is a 10. 3. The client did rate the pain on the pain scale. Laughing and talking with visitors may occur with excruciating chronic pain. The client in chronic pain must learn to adapt to pain and try to live as normal a life as possible. 4. The client rated the pain at a 10. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 699). F.A. Davis Company. Kindle Edition. 2

19. The hospice care nurse is planning the care of an elderly client diagnosed with end-stage renal disease. Which interventions should be included in the plan of care? Select all that apply. 1. Discuss financial concerns. 2. Assess any comorbid conditions. 3. Monitor increased visual or auditory abilities. 4. Note any spiritual distress. 5. Encourage euphoria at the time of death. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 670). F.A. Davis Company. Kindle Edition.

19. 1. The elderly are frequently on fixed incomes, and financial concerns are important for the nurse to address. A social services referral may be needed. 2. The elderly may have many comorbid conditions, which affect the type and amount of medications the client can tolerate and the client's quality of life. 3. Visual and auditory senses decrease with age; they do not increase. 4. The client may feel some spiritual distress at the terminal diagnosis. Even if the client possesses a strong faith, the unknown can be frightening. 5. A type of euphoria may accompany dehydration prior to death. This is a natural physiological occurrence the nurse should recognize, but it is not an intervention the nurse can implement. TEST-TAKING HINT: The test taker can decide on three (3) of the answer options based on the descriptive word "elderly." Option "5" is not a nursing intervention. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 680). F.A. Davis Company. Kindle Edition. 1,2,4

2. The primary nurse caring for the client who died is crying with the family at the bedside. Which action should the charge nurse implement? 1. Request the primary nurse to come out in the hall. 2. Refer the nurse to the employee assistance program. 3. Allow the nurse and family this time to grieve. 4. Ask the chaplain to relieve the nurse at the bedside. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 692). F.A. Davis Company. Kindle Edition.

2. 1. The nurse is providing care for the family and should not have to leave the bedside. 2. An employee assistance program is available at many facilities for counseling employees who are having psychosocial issues, but this nurse is being humane. 3. Crying was once considered unprofessional, but today it is recognized as simply an expression of empathy and caring. 4. The chaplain may come to the client's room and offer support but should not relieve the nurse who has developed a therapeutic nurse- client relationship with the client. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 696). F.A. Davis Company. Kindle Edition. 3

2. The nurse is presenting an in-service discussing do not resuscitate (DNR) orders and advance directives. Which statement should the nurse discuss with the class? 1. Advance directives must be notarized by a notary public. 2. The client must use an attorney to complete the advanced directive. 3. Once the DNR is written, it can be used for every hospital admission. 4. The health-care provider must write the DNR order in the client's chart. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 668). F.A. Davis Company. Kindle Edition.

2. 1. This is not true; someone who is not family or directly involved in the client's care must witness the AD, but the document does not have to be notarized. 2. This form can be filled out without the use of an attorney; copies of an AD can be obtained at hospitals or online from various sources. 3. The DNR order must be written on each admission. 4. The HCP writes the DNR order in the client's chart, and the client completes the AD. TEST-TAKING HINT: Options "1" and "2" involve other legal entities outside the healthcare arena, which would make the test taker eliminate them. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 676). F.A. Davis Company. Kindle Edition. 4

20. The nurse is orienting to a hospice organization. Which statement does not indicate a right of the terminal client? The right to: 1. Be treated with respect and dignity. 2. Have particulars of the death withheld. 3. Receive optimal and effective pain management. 4. Receive holistic and compassionate care. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 670). F.A. Davis Company. Kindle Edition.

20. 1. The client has the right to be cared for with respect and dignity. 2. The client has the right to discuss his or her feelings and direct his or her care. Withholding information would be lying to the client. 3. The client has the right to the best care available and to have pain treated, regardless of the potential for hastening death. 4. All clients, even if they are not dying, have the right to holistic and compassionate care. TEST-TAKING HINT: This is an "except" question. All of the answer options except one have correct information. The test taker should read the stem carefully to recognize this type of question. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 680). F.A. Davis Company. Kindle Edition. 2

20. The client diagnosed with diabetes mellitus type 2 wants to be an organ donor and asks the nurse, "Which organs can I donate?" Which statement is the nurse's best response? 1. "It is wonderful you want to be an organ donor. Let's discuss this." 2. "You can donate any organ in your body, except the pancreas." 3. "You have to donate your body to science to be an organ donor." 4. "You cannot donate any organs, but you can donate some tissues." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 694). F.A. Davis Company. Kindle Edition.

20. 1. This is not answering the client's question. 2. A client with type 2 diabetes has organ damage as a result of the high glucose over time; therefore, most organs are not usable. 3. This is a false statement. The client does not have to will his or her body to science to be a tissue/organ donor. 4. The client can donate corneas, skin, and some joints, but organ donation from clients with type 2 diabetes mellitus usually is not allowed. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 699). F.A. Davis Company. Kindle Edition. 4

21. The client is on the ventilator and has been declared brain dead. The spouse refuses to allow the ventilator to be discontinued. Which collaborative action by the nurse is most appropriate? 1. Discuss referral of the case to the ethics committee. 2. Pull the plug when the spouse is not in the room. 3. Ask the HCP to discuss the futile situation with the spouse. 4. Inform the spouse what is happening is cruel. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 670). F.A. Davis Company. Kindle Edition.

21. 1. The nurse should discuss using the ethics committee with the HCP to assist the family in making the decision to terminate life support. Many families feel there may be a racial or financial reason the HCP wants to discontinue life support. 2. This would be an illegal act on the part of the nurse and would destroy the nurse-client relationship with the family. 3. The stem already indicates the spouse is aware of the situation. 4. This is expressing a personal bias on the part of the nurse. TEST-TAKING HINT: The test taker could eliminate option "2" based on the legal and ethical issues. Option "3" is asking the HCP to do something which has already been done. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 680). F.A. Davis Company. Kindle Edition. 1

21. The client with multiple sclerosis who is becoming very debilitated tells the home health nurse the Hemlock Society sent information on euthanasia. Which question should the nurse ask the client? 1. "Why did you get in touch with the Hemlock Society?" 2. "Did you know this is an illegal organization?" 3. "Who do you know who has committed suicide?" 4. "What religious beliefs do you practice?" Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 694). F.A. Davis Company. Kindle Edition.

21. 1. The nurse should not ask the client "why" he or she does something; this is judgmental. 2. This answer option is giving erroneous information because it is not illegal; it is an organization which supports active euthanasia. 3. This question is not relevant to the situation. 4. This question must be asked because Judeo-Christian belief supports the view that suicide is a violation of natural law and the laws of God. The tenets of the Hemlock Society are in direct opposition to Judeo-Christian beliefs. If the client is agnostic, then this organization may be helpful to the client. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 699). F.A. Davis Company. Kindle Edition. 4

22. The client has been in a persistent vegetative state for several years. The family, who have decided to withhold tube feedings because there is no hope of recovery, asks the nurse, "Will the death be painful?" Which intervention should the nurse implement? 1. Tell the family the death will be painful but the HCP can order medications. 2. Inform the family dehydration provides a type of natural euphoria. 3. Relate other cases where the clients have died in excruciating pain. 4. Ask the family why they are concerned because they want the client to die anyway. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 670). F.A. Davis Company. Kindle Edition.

22. 1. Death from dehydration occurs when the client is unable to take in fluids, but dehydration is not painful. 2. Death from dehydration occurs when the client is unable to take in fluids. A natural euphoria occurs with dehydration. This is the body's way of allowing comfort at the time of death. 3. This is needless. 4. Families who make this decision usually do so from a deep sense of love and commitment. It is an extremely difficult decision to make, and the nurse should not condemn the family decision. TEST-TAKING HINT: The test taker could examine options "3" and "4" and eliminate them based on the needless information or the nurse stepping outside of professional boundaries. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 680). F.A. Davis Company. Kindle Edition. 2

22. Which intervention should the nurse implement to provide culturally sensitive health care to the European-American Caucasian elderly client who is terminal? 1. Discuss health-care issues with the oldest male child. 2. Determine if the client will be cremated or have an earth burial. 3. Do not talk about death and dying in front of the client. 4. Encourage the client's autonomy and answer questions truthfully. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 694). F.A. Davis Company. Kindle Edition.

22. 1. Many Middle Eastern cultures practice this, but the Caucasian culture does not. 2. Caucasians as a culture do not necessarily have a preference, but this does not affect culturally sensitive health care. 3. Frequently Caucasians do not like to talk about death and dying, but this is an individual preference of the client and the nurse should allow the discussion. 4. The western Caucasian society values autonomy and truth telling in individual decision making. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 699). F.A. Davis Company. Kindle Edition. 4

23. Which action by the primary nurse would require the unit manager to intervene? 1. The nurse uses a correction fluid to correct a charting mistake. 2. The nurse is shredding the worksheet at the end of the shift. 3. The nurse circles an omitted medication time on the MAR. 4. The nurse documents narcotic wastage with another nurse. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 694). F.A. Davis Company. Kindle Edition.

23. 1. The client's chart is a legal document, and if a mistake occurs, it should be corrected by marking one line through the entry in such a way the entry can still be read in a court of law. Erasing, using a correction fluid, or obliterating the entry is illegal. 2. This is the correct method for disposing of any paper which has client information on it which is not a part of the client's permanent medical record. 3. This is the correct method to indicate a medication was not administered to the client; the circle means the person should go to the nurse's notes to read the reason why the medication was not administered. 4. All narcotics not administered to the client must be verified when being wasted and then documented. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 699). F.A. Davis Company. Kindle Edition. 1

23. The family is dealing with the imminent death of the client. Which information is most important for the nurse to discuss when planning interventions for the grieving process? 1. How angry are the family members about the death? 2. Which family member will be making decisions? 3. What previous coping skills have been used? 4. What type of funeral service has been planned? Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 670). F.A. Davis Company. Kindle Edition.

23. 1. The family may or may not be angry and this would need to be addressed, but it is not the most important. 2. Who makes the decisions is not as important as discovering which coping skills the family uses when under stress. 3. The nurse should assess previous coping skills used by the family and build on those to assist the family in dealing with their loss. Coping mechanisms are learned behaviors and should be supported if they are healthy behaviors. If the client and family use unhealthy coping behaviors, then the nurse should attempt to guide the family to a counselor or support group. 4. The type of funeral service may help the family to grieve, but it is not the most important intervention. TEST-TAKING HINT: The test taker must prioritize the interventions listed. All of the interventions could be addressed in option "3." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 681). F.A. Davis Company. Kindle Edition. 3

24. The client who is terminally ill called the significant others to the room and said goodbye, then dismissed them and now lies quietly and refuses to eat. The nurse understands the client is in what stage of the grieving process? 1. Denial. 2. Anger. 3. Bargaining. 4. Acceptance. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 670). F.A. Davis Company. Kindle Edition.

24. 1. The client is not denying death; the client has said good-bye. 2. Anger is the second stage of the grieving process, but this client appears to have accepted death. 3. There is no evidence of bargaining in the client's actions. 4. The client has accepted the imminent death and is withdrawing from the significant others. TEST-TAKING HINT: There are five (5) stages to Dr. Elisabeth Kübler-Ross's grieving process, and some authorities list several more, but this behavior could only be withdrawal or acceptance. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 681). F.A. Davis Company. Kindle Edition. 4

24. Which action should the nurse implement for the Chinese client's family who are requesting to light incense around the dying client? 1. Suggest the family bring potpourri instead of incense. 2. Tell the client the door must be shut at all times. 3. Inform the family the scent will make the client nauseated. 4. Explain the fire code does not allow any burning in a hospital. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 695). F.A. Davis Company. Kindle Edition.

24. 1. The nurse must support the client's culture. Potpourri provides the scent without having the burning incense, which is against fire code, and thus is a compromise which supports the client's culture. 2. Having the door shut does not matter; open flames are not allowed in any health-care facility. 3. This is not necessarily true, and if it is part of the cultural beliefs about dying, then the nurse should medicate the client if he or she becomes nauseated. 4. This is a fact, but the nurse should attempt to compromise and support the client and family's cultural needs, especially at the time of death. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 700). F.A. Davis Company. Kindle Edition. 1

25. The nurse is assessing a client diagnosed with chronic pain. Which characteristics would the nurse observe? 1. The client's blood pressure is elevated. 2. The client has rapid shallow respirations. 3. The client has facial grimacing. 4. The client is lying quietly in bed. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 670). F.A. Davis Company. Kindle Edition.

25. 1. Blood pressure elevates in acute pain. Chronic pain, by definition, lasts more than six (6) months, lasts far beyond the expected time for the pain to resolve, and may have an unclear onset. Changes in vital signs result from the fight-or-flight response by the body. The body cannot maintain this response and must adjust. 2. Rapid shallow respirations might be attributed to acute pain if it was painful to breathe. The client with a chest injury or pain will splint the area and slow the respirations or attempt to breathe shallowly and rapidly. 3. Facial grimacing will occur in acute pain and is an objective sign the nurse can identify. Clients with chronic pain may be laughing and still be in pain. Remember, pain is whatever the client says it is and occurs whenever the client says it does. 4. The client in chronic pain will have adapted to living with the pain, and lying quietly may be the best way for the client to limit the feeling of pain. TEST-TAKING HINT: The test taker must be able to differentiate between acute and chronic pain. Options "1," "2," and "3" are objective symptoms of acute pain. If the test taker were aware of this, then choosing the only option left would be a good choice. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 681). F.A. Davis Company. Kindle Edition. 4

25. The nurse is caring for the client who has active tuberculosis of the lungs. The client does not have a DNR order. The client experiences a cardiac arrest, and there is no resuscitation mask at the bedside. The nurse waits for the crash cart before beginning resuscitation. According to the ANA Code of Ethics for Nurses (see Table 18-1), which disciplinary action should be taken against the nurse? 1. Report the action to the State Board of Nurse Examiners. 2. The nurse should be terminated for failure to perform duties. 3. No disciplinary action should be taken against the nurse. 4. Refer the nurse to the American Nurses Association. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 695). F.A. Davis Company. Kindle Edition.

25. 1. There is no need to report this action to the state board; this is not malpractice. 2. This action does not warrant the nurse being terminated. 3. The Code states, "The nurse owes the same duty to self as to others, including the responsibility to preserve integrity and safety." Therefore, if the nurse realizes he or she could contract TB if unprotected mouth-to-mouth resuscitation is performed, then not doing this action does not violate the Code of Ethics. 4. The ANA cannot discipline nurses; it is a voluntary nurse's organization. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 700). F.A. Davis Company. Kindle Edition. 3

26. The client had a mastectomy and lymph node dissection three (3) years ago and has experienced postmastectomy pain (PMP) since. Which intervention should the nurse implement? 1. Have the client see a psychologist because the pain is not real. 2. Tell the client the pain is the cancer coming back. 3. Refer the client to a physical therapist to prevent a frozen shoulder. 4. Discuss changing the client to a more potent narcotic medication. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 670). F.A. Davis Company. Kindle Edition.

26. 1. Pain is whatever the client says it is and occurs whenever the client says it does. The nurse should never deny the client's pain exists. 2. This has been occurring for the past three (3) years and does not mean the cancer has come back. Many clients will fear the cancer has recurred and delay treatment; denial is a potent coping mechanism. 3. PMP is characterized as a constriction accompanied by a burning sensation or prickling in the chest wall, axilla, or posterior arm resulting from movement of the arm. Because of this, the client limits movement of the arm and the shoulder becomes frozen. 4. There are many problems associated with long-term narcotic use. Other strategies should be attempted prior to resigning the client to a lifetime of taking narcotic medications. TEST-TAKING HINT: The test taker could eliminate option "1" because it violates all principles of pain management. Option "2" is not in the realm of the nurse's responsibility. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 681). F.A. Davis Company. Kindle Edition. 3

26. The wife of a client receiving hospice care being cared for at home calls the nurse to report the client is restless and agitated. Which interventions should the nurse implement? List in order of priority. 1. Request an order from the health-care provider for antianxiety medications. 2. Call the medical equipment company and request oxygen for the client. 3. Go to the home and assess the client and address the wife's concerns. 4. Reassure and calm the wife over the telephone. 5. Notify the chaplain about the client's change in status. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 695). F.A. Davis Company. Kindle Edition.

26. In order of priority: 4, 3, 2, 1, 5. 4. The nurse should calm and reassure the wife over the telephone. 3. The nurse should then visit the client immediately to assess the change in condition. 2. Restlessness and agitation are symptoms of lack of oxygen. Therefore, calling the medical equipment company to send oxygen would be the next intervention. 1. Terminal restlessness is difficult for the family to watch and the client to experience, so antianxiety medications would be the next logical intervention. 5. Referral to the chaplain is needed because death may be imminent. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 700). F.A. Davis Company. Kindle Edition.

27. The male client diagnosed with chronic pain since a construction accident which broke several vertebrae tells the nurse he has been referred to a pain clinic and asks, "What good will it do? I will never be free of this pain." Which statement is the nurse's best response? 1. "Are you afraid of the pain never going away?" 2. "The pain clinic will give you medication to cure the pain." 3. "Pain clinics work to help you achieve relief from pain." 4. "I am not sure. You should discuss this with your HCP." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

27. 1. This is a therapeutic response and the client is requesting information. 2. Pain clinics do not cure pain; they do help identify measures to relieve pain. 3. Pain clinics use a variety of methods to help the client to achieve relief from pain. Some measures include guided imagery, transcutaneous electrical nerve stimulation (TENS) units, nerve block surgery or injections, or medications. 4. This is not an appropriate answer, even if the nurse is not sure. The nurse should attempt to discover the information for the client and then give factual information. TEST-TAKING HINT: The test taker should answer a question with factual information. If the stem asks for a therapeutic response, then the test taker should choose one which addresses feelings. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 682). F.A. Davis Company. Kindle Edition. 3

28. The client diagnosed with cancer is experiencing severe pain. Which regimen would the nurse teach the client about to control the pain? 1. Nonsteroidal anti-inflammatory drugs (NSAIDs) around the clock with narcotics used for severe pain. 2. Morphine sustained release, a narcotic, routinely with a liquid morphine preparation for breakthrough pain. 3. Extra-Strength Tylenol, a nonnarcotic analgesic, plus therapy to learn alternative methods of pain control. 4. Demerol, an opioid narcotic, every six (6) hours orally with a suppository when the pain is not controlled. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

28. 1. NSAIDs around the clock are dangerous because of the potential for gastrointestinal ulceration. NSAIDs are not the drug of choice for cancer pain. 2. Morphine is the drug of choice for cancer pain. There is no ceiling effect, it metabolizes without harmful by-products, and it is relatively inexpensive. A sustainedrelease formulation, such as MS Contin, is administered every six (6) to eight (8) hours, and a liquid fast-acting form is administered sublingually for any pain which is not controlled. 3. Tylenol is not strong enough for this client's pain. The maximum adult dose within a 24-hour period is four (4) g. Tylenol is toxic to the liver in higher amounts. 4. Meperidine (Demerol) metabolizes into normeperidine and is not cleared by the body rapidly. A buildup of normeperidine can cause the client to seize. TEST-TAKING HINT: The test taker must be aware of medications and their uses. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 682). F.A. Davis Company. Kindle Edition. 2

29. The client is being discharged from the hospital for intractable pain secondary to cancer and is prescribed morphine, a narcotic. Which statement indicates the client understands the discharge instructions? 1. "I will be sure to have my prescriptions filled before any holiday." 2. "There should not be a problem having the prescriptions filled anytime." 3. "If I run out of medications, I can call the HCP to phone in a prescription." 4. "There are no side effects to morphine I should be concerned about." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

29. 1. Narcotic medications require handwritten prescription forms (Drug Enforcement Agency rules) which must be filled within a limited time frame from the time the prescription is written. Many local pharmacies will not have the medication available or may not have it in the quantities needed. The client should anticipate the needs prior to any time when the HCP may not be available or the pharmacy may be closed. 2. There can be several reasons a legitimate prescription is not filled. 3. Morphine needs a handwritten prescription on a triplicate form. 4. All medications have side effects; most notably, narcotics slow peristalsis and cause constipation. TEST-TAKING HINT: The test taker could eliminate both options "1" and "2" because they are opposites. Option "4" is untrue of all medications. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 682). F.A. Davis Company. Kindle Edition. 1

3. In which client situation would the AD be consulted and used in decision making? 1. The client diagnosed with Guillain-Barré who is on a ventilator. 2. The client with a C6 spinal cord injury in the rehabilitation unit. 3. The client in end-stage renal disease who is in a comatose state. 4. The client diagnosed with cancer who has Down syndrome. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 668). F.A. Davis Company. Kindle Edition.

3. 1. A client diagnosed with Guillain-Barré syndrome is mentally competent, and being on a ventilator does not indicate the client has lost his or her decision-making capacity. 2. A client in the rehabilitation unit would be alert, and spinal cord injuries do not cause the client to lose decision-making capacity. 3. The client must have lost decision-making capacity as a result of a condition which is not reversible or must be in a condition specified under state law, such as a terminal, persistent vegetative state; an irreversible coma; or as specified in the AD. 4. A client with Down syndrome may have some mental challenges, but unless the client has been declared legally incompetent in a court of law, the client can complete an AD and participate in his/her own case. TEST-TAKING HINT: If the test taker knows what an AD is, then the words "end-stage" and "comatose" would lead the test taker to select option "3" as a correct answer. Remember, clients with congenital or genetic disorders are not incompetent, even if they are mentally challenged. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 676). F.A. Davis Company. Kindle Edition. 3

3. The nurse is discussing advance directives with the client. The client asks the nurse, "Why is this so important to do?" Which statement would be the nurse's best response? 1. "The federal government mandates this form must be completed by you." 2. "This will make sure your family does what you want them to do." 3. "Don't you think it is important to let everyone know your final wishes?" 4. "Because of technology, there are many options for end-of-life care." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 692). F.A. Davis Company. Kindle Edition.

3. 1. Advance directives (AD) are not mandated by the federal government. The nurse must discuss this with the client, but the client does not have to complete it. 2. ADs can be overridden by the family because the health-care provider is worried about being sued by family survivors. 3. This response is not answering the client's question and it is argumentative. 4. Technology now allows for the body to maintain life functions indefinitely in some futile situations. ADs allow clients to make decisions, which hopefully will be honored at the time of their death. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 696). F.A. Davis Company. Kindle Edition. 4

3. List the two criteria for admission to a hospice program. a. b. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 33). Elsevier Health Sciences. Kindle Edition.

3. a. Patient must desire services and agree in writing that only hospice care can be used to treat the terminal illness (palliative care) b. Patient must meet eligibility, which is less than 6 months to live, certified initially by two physicians Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 328). Elsevier Health Sciences. Kindle Edition.

30. The client diagnosed with intractable pain is receiving an IV constant infusion of morphine, a narcotic opioid. The concentration is 50 mg of morphine in 250 mL of normal saline. The IV is infusing at 10 mL/hr. The client has required bolus administration of two (2) mg IVP × two (2) during the 12-hour shift. How much morphine has the client received during the shift? _________ Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

30. 28 mg of morphine. First, determine how many milligrams of morphine are in each milliliter of saline: 50 ÷ 250 mL = 0.2 mg/mL Then determine how many milliliters are given in a shift: 10 mL/hr × 12 hour = 120 mL infused 1 shift = 120 mL infused If each milliliter contains 0.2 milligram of morphine, then 0.2 mg × 120 mL = 24 mg by constant infusion Then determine the amount given IVP: 2 × 2 = 4 mg given IVP Finally, add the bolus amount to the amount constantly infused: 24 + 4 = 28 mg TEST-TAKING HINT: The nurse is responsible for being knowledgeable of all medications and the amount the client is receiving. The test taker can use the drop-down calculator on the NCLEX-RN examination or ask the examiner for scratch paper. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 682). F.A. Davis Company. Kindle Edition.

31. The male client who has made himself a do not resuscitate (DNR) order is in pain. The client's vital signs are P 88, R 8, and BP 108/70. Which intervention should be the nurse's priority action? 1. Refuse to give the medication because it could kill the client. 2. Administer the medication as ordered and assess for relief from pain. 3. Wait until the client' respirations improve and then administer the medication. 4. Notify the HCP the client is unstable and pain medication is being held. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

31. 1. The client is in pain and has the right to have pain-control measures taken. 2. The client is in pain. The American Nurses Association Code of Ethics states clients have the right to die as comfortably as possible even if the measures used to control the pain indirectly hasten the impending death. The Dying Client's Bill of Rights reiterates this position. The client should be allowed to die with dignity and with as much comfort as the nurse can provide. 3. The client may be splinting to prevent the pain from being too severe. The client's respirations actually may improve when the nurse administers the pain medication. 4. The HCP is aware the client is unstable because the HCP must write the DNR order on the chart. There is no reason to withhold needed medication. TEST-TAKING HINT: The position of administering medication which could hasten a client's death is a difficult one and requires the nurse to be aware of ethical position statements. Nurses never administer medications for the purpose of hastening death but sometimes must administer medications to provide what nurses do best, comfort. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 683). F.A. Davis Company. Kindle Edition. 2

32. The charge nurse is making assignments on an oncology floor. Which client should be assigned to the most experienced nurse? 1. The client diagnosed with leukemia who has a hemoglobin of 6 g/dL. 2. The client diagnosed with lung cancer with a pulse oximeter reading of 89%. 3. The client diagnosed with colon cancer who needs the colostomy irrigated. 4. The client diagnosed with Kaposi's sarcoma who is yelling at the staff. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

32. 1. This hemoglobin is low but would be expected for a client diagnosed with leukemia. A less experienced nurse could care for this client. Leukemia affects production of all cells produced by the bone marrow—either there is too much production of immature cells overpowering the ability of the bone marrow to use the pluripotent cells to produce other needed blood cells or because the bone marrow is not producing enough cells as needed. It effectively produces a pancytopenia. 2. This represents an arterial blood gas of less than 60%; this client should be assigned to the most experienced nurse. 3. A client who needs a colostomy irrigated could be assigned to a less experienced nurse. 4. Psychological problems come second to physiological ones. TEST-TAKING HINT: This is a priority question. The test taker should realize option "1" is expected and may even be good for this client; option "3" is expected and not life threatening; and option "4," although not expected, is not life threatening. By doing this, the test taker could then look at what was determined for each option and realize option "2" needs the most experienced nurse. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 683). F.A. Davis Company. Kindle Edition. 2

33. The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients in a pain clinic. Which intervention would be inappropriate to delegate to the UAP? 1. Assist the client diagnosed with intractable pain to the bathroom. 2. Elevate the head of the bed for a client diagnosed with back pain. 3. Perform passive range of motion for a client who is bedfast. 4. Monitor the potassium levels on a client about to receive medication. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

33. 1. The UAP could perform this function. 2. The UAP could perform this function. 3. The UAP could perform this function. 4. The nurse should monitor any laboratory work needed to administer a medication safely. TEST-TAKING HINT: The rules for delegation state assessment, teaching, evaluating, or anything requiring nursing judgment cannot be delegated. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 683). F.A. Davis Company. Kindle Edition. 4

34. The client diagnosed with chronic back pain is being placed on a transcutaneous electrical nerve stimulation (TENS) unit. Which information should the nurse teach? 1. The TENS unit will deaden the nerve endings, and the client will not feel pain. 2. The TENS unit could cause paralysis if the client gets the unit wet. 3. The TENS unit stimulates the nerves in the area, blocking the pain sensation. 4. The TENS unit should be left on for an hour, and then taken off for an hour. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 671). F.A. Davis Company. Kindle Edition.

34. 1. The TENS unit does not deaden nerve endings; this would be accomplished through local anesthesia. 2. The unit could stop functioning if it got wet, but this would not cause paralysis. 3. The TENS unit works on the gate control theory of pain control and works by flooding the area with stimulation and blocking the pain impulses from reaching the brain. 4. The TENS unit should be applied and left in place unless the client is showering. TEST-TAKING HINT: A medical device which causes paralysis so easily would not be approved for use by the general population, so option "2" could be eliminated. The test taker would need to be aware of the gate control theory of pain control to eliminate the other options. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 683). F.A. Davis Company. Kindle Edition. 3

35. The nurse is caring for clients on a medical floor. Which client should the nurse assess first after the shift report? 1. The client with arterial blood gases of pH 7.36, Paco2 40, HCO3 26, Pao2 90. 2. The client with vital signs of T 99˚F, P 101, R 28, and BP 120/80. 3. The client complaining of pain at a "10" on a 1-to-10 scale who can't localize it. 4. The client who is postappendectomy with pain at a "3" on a 1-to-10 scale. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 672). F.A. Davis Company. Kindle Edition.

35. 1. These are normal arterial blood gases. 2. These temperature, pulse, and respiration rates are only slightly elevated, and the blood pressure is normal. 3. This is typical of clients with chronic pain. They cannot localize the pain and frequently describe the pain as always being there, as disturbing rest, and as demoralizing. This client should be seen, and appropriate pain-control measures should be taken. 4. This is considered mild pain, and this client can be seen after the client in chronic pain. TEST-TAKING HINT: Options "1" and "2" could be eliminated because the values are within normal limits or only slightly above normal. Option "4" could be eliminated because three (3) is low on the 1-to-10 pain scale. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 683). F.A. Davis Company. Kindle Edition. 3

36. The female client in the oncology clinic tells the nurse she has a great deal of pain but does not like to take pain medication. Which action should the nurse implement first? 1. Tell the client it is important for her to take her medication. 2. Find out how the client has been dealing with the pain. 3. Have the HCP tell the client to take the pain medications. 4. Instruct the client not to worry—the pain will resolve itself. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 672). F.A. Davis Company. Kindle Edition.

36. 1. This could be appropriate once the nurse assesses the situation further. 2. The nurse should assess the situation fully. The client may be afraid of becoming addicted or may have been using alternative forms of treatment, such as music therapy, distraction techniques, acupuncture, or guided imagery. 3. This is not appropriate. It is in the nurse's realm of responsibility to investigate the client's reasons for not wanting to take pain medication. 4. Chronic cancer pain does not resolve on its own. TEST-TAKING HINT: Option "1" is advising without assessing. Assessment is the first step of the nursing process and should be implemented first in most situations unless a direct intervention treats the client in an emergency. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 684). F.A. Davis Company. Kindle Edition. 2

38. Which act protects the nurse against a malpractice claim when the nurse stops at a motor-vehicle accident and renders emergency care? 1. The Health Insurance Portability and Accountability Act. 2. The State Nurse Practice Act. 3. The Emergency Rendering Aid Act. 4. The Good Samaritan Act. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 672). F.A. Davis Company. Kindle Edition.

38. 1. The Health Insurance Portability and Accountability Act (HIPAA) is a federal act protecting the client's privacy while receiving health care. 2. The state Nurse Practice Acts provides the laws which control the practice of nursing in each state. 3. There is no such law as this act. 4. The Good Samaritan Act protects healthcare practitioners against malpractice claims for care provided in emergency situations. TEST-TAKING HINT: The test taker should be knowledgeable of the Good Samaritan Act and its implications in the nurse's professional career. The NCLEX-RN often asks questions on this act. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 684). F.A. Davis Company. Kindle Edition. 4

39. The family has requested a client with terminal cancer not be told of the diagnosis. The client tells the nurse, "I think something is really wrong with me, but the doctor says everything is all right. Do you know if there is something wrong with me?" Which response by the nurse would support the ethical principle of veracity? 1. "I think you should talk to your doctor about your concerns." 2. "What makes you think something is really wrong?" 3. "Your family has requested you not be told your diagnosis." 4. "The doctor would never tell you incorrect information." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 672). F.A. Davis Company. Kindle Edition.

39. 1. This response does not support veracity. 2. This response does not support veracity. 3. The principle of veracity is the duty to tell the truth. This response is telling the client the truth. 4. This response does not support veracity. TEST-TAKING HINT: The test taker must know certain ethical principles, such as veracity, beneficence, nonmalfeasance, fidelity, autonomy, and justice, to name a few. Without knowing the definition of veracity, the test taker would not be able to answer this question correctly. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 684). F.A. Davis Company. Kindle Edition. 3

4. The nurse is moving to another state which is part of the multistate licensure compact. Which information regarding ADs should the nurse be aware of when practicing nursing in other states? 1. The laws regarding ADs are the same in all the states. 2. Advance directives can be transferred from state to state. 3. A significant other can sign a loved one's advance directive. 4. Advance directives are state regulated, not federally regulated. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 668). F.A. Davis Company. Kindle Edition.

4. 1. Individual states are responsible for specific legal requirements for ADs. 2. Moving from one state to another does not nullify or honor the AD; the nurse must be aware of the individual state's requirements. 3. Only the individual can complete and sign an AD. The significant other may be asked to implement the AD. 4. The state determines the definition of terms and requirements for an AD; individual states are responsible for specific legal requirements for ADs. TEST-TAKING HINT: The test taker should know the registered nurse must obtain a copy of the Nurse Practice Act of the state he or she is practicing in. The test taker should realize every state has different regulations regarding ADs and other health-care issues. Option "4" is the only option which reflects this thought. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 676). F.A. Davis Company. Kindle Edition. 4

4. The client who is of the Jewish faith died during the night. The nurse notified the family, who do not want to come to the hospital. Which intervention should the nurse implement to address the family's behavior? 1. Take no further action because this is an accepted cultural practice. 2. Notify the hospital supervisor and report the situation immediately. 3. Call the local synagogue and request the rabbi go to the family's home. 4. Assume the family does not care about the client and follow hospital protocol. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 692). F.A. Davis Company. Kindle Edition.

4. 1. Many of the Jewish faith do not believe in viewing or touching the dead body. The body is sent to the funeral home for burial within 24 hours, and a closed casket is preferred. 2. The hospital supervisor does not need to be notified the family did not want to come to the hospital. 3. The nurse needs to take care of the client, not the family, and should not call to request a rabbi to go visit the family. 4. The nurse must be aware of cultural differences and not be judgmental. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 696). F.A. Davis Company. Kindle Edition. 1

4. For each of the following body systems, identify three physical manifestations that the nurse would expect to see in a patient approaching death. Respiratory a. b. c. Skin a. b. c. Gastrointestinal a. b. c. Musculoskeletal a. b. c. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 33). Elsevier Health Sciences. Kindle Edition.

4. Respiratory a. Cheyne-Stokes respiration b. Death rattle (inability to cough and clear secretions) c. Increased, then slowing, respiratory rate (Also: irregular breathing, terminal gasping) Skin a. Mottling on hands, feet, and legs that progresses to the torso b. Cold, clammy skin c. Cyanosis on nose, nail beds, and knees (Also: waxlike skin when very near death) Gastrointestinal a. Slowing of the gastrointestinal tract with accumulation of gas and abdominal distention b. Loss of sphincter control with incontinence c. Bowel movement before imminent death or at time of death Musculoskeletal a. Loss of muscle tone with sagging jaw b. Difficulty speaking c. Difficulty swallowing (Also: loss of ability to move or maintain body position, loss of gag reflex) Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 328). Elsevier Health Sciences. Kindle Edition.

40. The nurse is obtaining the client's signature on a surgical permit form. The nurse determines the client does not understand the surgical procedure and possible risks. Which action should the nurse take first? 1. Notify the client's surgeon. 2. Document the information in the chart. 3. Contact the operating room staff. 4. Explain the procedure to the client. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 672). F.A. Davis Company. Kindle Edition.

40. 1. The surgeon is responsible for explaining the surgical procedure to the client; therefore, the nurse should first notify the surgeon. 2. This information should be documented on the chart, but it is not the first intervention. 3. The operating room staff may or may not need to be notified based on when or if the permit is being signed, but it is not the first intervention. 4. The nurse is not responsible for explaining the surgical procedure. The nurse is responsible for making sure the client understands and for obtaining the consent. TEST-TAKING HINT: The nurse is responsible for getting the permit signed and on the chart prior to going to surgery, but the nurse is not responsible for explaining the procedure to the client. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 684). F.A. Davis Company. Kindle Edition. 1

41. The client is in the psychiatric unit in a medical center. Which action by the psychiatric nurse is a violation of the client's legal and civil rights? 1. The nurse tells the client civilian clothes can be worn on the unit. 2. The nurse allows the client to have family visits during visiting hours. 3. The nurse delivers unopened mail and packages to the client. 4. The nurse listens to the client talking on the telephone to a friend. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 672). F.A. Davis Company. Kindle Edition.

41. 1. Wearing their own clothes, keeping personal items, and having a small amount of money are civil rights of clients in a psychiatric unit. 2. Seeing visitors is a civil right of the client. 3. Receiving and sending unopened mail is a civil right of the client, but any packages must be inspected when the client is opening them to check for sharp items, weapons, or any type of medications. 4. This is a violation of the client's rights. The client has a right to have reasonable access to a telephone and the opportunity to have private conversations by telephone. TEST-TAKING HINT: The test taker must be aware of the client's legal and civil rights. The client in the psychiatric unit has the same rights as the client in the medical unit. Clients in a psychiatric hospital do not have to wear hospital gowns; they can wear their own clothes. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 685). F.A. Davis Company. Kindle Edition. 4

42. The client receiving dialysis for end-stage renal disease wants to quit dialysis and die. Which ethical principle supports the client's right to die? 1. Autonomy. 2. Self-determination. 3. Beneficence. 4. Justice. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 672). F.A. Davis Company. Kindle Edition.

42. 1. Autonomy implies the client has the right to make choices and decisions about his or her own care even if it may result in death or is not in agreement with the healthcare team. 2. Self-determination is not an ethical principle. 3. Beneficence is the duty to actively do good for clients. 4. Justice is the duty to treat all clients fairly. TEST-TAKING HINT: The test taker should be aware of ethical principles which mandate a nurse's behavior. Clients have rights, and autonomy is an important principle which the nurse must ensure every client has. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 685). F.A. Davis Company. Kindle Edition. 1

43. Which document is the best professional source to provide direction for a nurse when addressing ethical issues and behavior? 1. The Hippocratic Oath. 2. The Nuremberg Code. 3. Home Health Care Bill of Rights. 4. ANA Code of Ethics. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 672). F.A. Davis Company. Kindle Edition.

43. 1. The Hippocratic Oath is the oath taken by medical doctors. 2. The Nuremberg Code identifies the need for voluntary informed consent when medical experiments are conducted on human beings. This source does not provide direction for the nurse addressing ethical issues. 3. This document informs clients and families receiving home health care of the ethical conduct they can expect from home care agencies and their employees when they are in the home. This source is not the best professional source for all nurses. 4. The American Nurses Association (ANA) Code of Ethics outlines to society the values, concerns, and goals of the nursing profession. The code provides direction for ethical decisions and behavior by emphasizing the obligations and responsibilities which are entailed in the nurse-client relationship. TEST-TAKING HINT: The test taker must be aware of the word "best" to be able to answer this question. All four (4) answer options may or may not be potential answers, but the test taker must select the option which addresses all nurses. Option "3" should be eliminated as a possible answer because it only addresses home health care. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 685). F.A. Davis Company. Kindle Edition. 4

44. Which element is not necessary to prove nursing malpractice? 1. Breach of duty. 2. Identify the ethical issues. 3. Injury to the client. 4. Proximate cause. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 672). F.A. Davis Company. Kindle Edition.

44. 1. Breach of duty is one (1) of the four (4) elements necessary to prove nursing malpractice. It is failure to perform according to the established standard of conduct. 2. This is one (1) of the four (4) steps in ethical decision making. It is not one (1) of the four (4) elements necessary to prove nursing malpractice. 3. Failure to meet the standard of care resulting in an actual injury or damage to the client is required to prove nursing malpractice. 4. A connection must exist between conduct and the resulting injury to prove nursing malpractice. TEST-TAKING HINT: This is a knowledge-based question, but the test taker should realize ethical issues and legal issues are two different concerns and that malpractice is a legal concern. The test taker should also know the four (4) elements necessary to prove nursing malpractice: (1) The nurse has a duty to the client. (2) The duty has been breached. The nurse failed to uphold a standard of care. (3) There is some harm to the client. (4) The breach of duty caused the harm. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 685). F.A. Davis Company. Kindle Edition. 2

45. The nurse is caring for a client who is confused and fell trying to get out of bed. There is no family at the client's bedside. Which action should the nurse implement first? 1. Contact a family member to come and stay with the client. 2. Administer a sedative medication to the client. 3. Place the client in a chair with a sheet tied around him or her. 4. Notify the health-care provider to obtain a restraint order. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 673). F.A. Davis Company. Kindle Edition.

45. 1. This action should be taken, but this is not the first action to keep the client safe. 2. This is a form of chemical restraint, and the nurse must have a health-care provider's order. 3. This is a form of restraint and is against the law unless the nurse has a health-care provider's order. 4. The nurse must notify the health-care provider before putting the client in restraints. Restraints are used in an emergency situation and for a limited time and must be for the protection of the client. TEST-TAKING HINT: The test taker must realize when the stem asks which action is first; more than one option may be appropriate for the situation, but only one is implemented first. Restraining a client is considered battery and is against the law unless the client is a danger to self and there is a health-care provider's order. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 686). F.A. Davis Company. Kindle Edition. 4

46. Which entity mandates the registered nurse's behavior when practicing professional nursing? 1. The state's Nurse Practice Act. 2. Client's Bill of Rights. 3. The United States legislature. 4. American Nurses Association. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 673). F.A. Davis Company. Kindle Edition.

46. 1. Nurse Practice Acts provide the laws which control the practice of nursing in each state. All states have Nurse Practice Acts. 2. The Client's Bill of Rights, also known as "Your Rights as a Hospital Patient," is a document which explains the client's rights to participate in his or her own health care; it does not address the nurse's behavior. 3. Each state, not the U.S. Congress, is responsible for writing and implementing the state's Nurse Practice Act. 4. The American Nurses Association is a voluntary organization which provides standards of care and a code of ethics. It addresses issues in nursing, but it does not mandate the registered nurse's behavior. TEST-TAKING HINT: This is a knowledgebased question which the test taker must know. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 686). F.A. Davis Company. Kindle Edition. 1

47. The nurse must be knowledgeable of ethical principles. Which is an example of the ethical principle of justice? 1. The nurse administers a placebo, and the client asks if it will help the pain. 2. The nurse accepts a work assignment in an area in which he or she is not experienced. 3. The nurse refuses to tell a family member the client has a positive HIV test. 4. The nurse provides an indigent client with safe and appropriate nursing care. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 673). F.A. Davis Company. Kindle Edition.

47. 1. This addresses the ethical principle of veracity. Should the nurse tell the client truthfully a placebo will not help the pain? 2. This is an example of nonmalfeasance, the duty to prevent or avoid doing harm, whether intentional or unintentional. Is it harmful for a nurse to work in an area where he or she is not experienced? 3. This is an example of the ethical principle of fidelity, the duty to be faithful to commitments. It involves keeping promises and information confidential and maintaining privacy. 4. Justice involves the duty to treat all clients fairly, without regard to age, socioeconomic status, or any other variables. Providing safe and appropriate nursing care to all clients is an example of justice. TEST-TAKING HINT: The test taker must be knowledgeable of ethical principles; they are part of the NCLEX-RN blueprint. The word "justice" should make the test taker think about fairness, which might lead the test taker to select option "4" as the correct answer. The test taker should not automatically think, "I don't know the answer." Think about the words before selecting the correct answer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 686). F.A. Davis Company. Kindle Edition. 4

48. The nurse is discussing malpractice issues in an in-service class. Which situation is an example of malpractice? 1. The nurse fails to report a neighbor who is abusing his two children. 2. The nurse does not intervene in a client who has a BP of 80/50 and AP of 122. 3. The nurse is suspected of taking narcotics prescribed for a client. 4. The nurse falsifies vital signs in the client's medical records. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 673). F.A. Davis Company. Kindle Edition. 48. The nurse is discussing malpractice issues in an in-service class. Which situation is an example of malpractice? 1. The nurse fails to report a neighbor who is abusing his two children. 2. The nurse does not intervene in a client who has a BP of 80/50 and AP of 122. 3. The nurse is suspected of taking narcotics prescribed for a client. 4. The nurse falsifies vital signs in the client's medical records. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 673). F.A. Davis Company. Kindle Edition.

48. 1. The law states child abuse or suspected child abuse must be reported. The nurse is legally responsible to report child abuse or suspected child abuse. This is a legal issue, not malpractice. 2. Malpractice is a failure to meet the standards of care which results in harm to or death of a client. Failing to heed warnings of shock is an example of malpractice. 3. Stealing narcotics is a legal situation, not a malpractice issue. The nurse could have his or her nursing license revoked for this illegal behavior. 4. Falsifying documents is against the law. It is not a malpractice issue. TEST-TAKING HINT: The test taker must be knowledgeable of malpractice. Legal issues are dealt with by the laws of the state and federal government, and malpractice issues are dealt with in the state Nurse Practice Acts and in lawsuits in courts of law. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 686). F.A. Davis Company. Kindle Edition. 2,3,4

49. The mother of a 20-year-old African American male client receiving dialysis asks the nurse, "My son has been on the transplant list longer than that white woman. Why did she get the kidney?" Which statement is the nurse's best response? 1. "The woman was famous, and so more people will donate organs now." 2. "I understand you are upset your son is ill. Would you like to talk?" 3. "No one knows who gets an organ. You just have to wait and pray." 4. "The tissues must match or the body will reject the kidney and it will be wasted." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 673). F.A. Davis Company. Kindle Edition.

49. 1. There is a feeling during times of stress that organs may be distributed unfairly. Tissue and organ banks use the United Network of Organ Sharing (UNOS) to be as fair as possible in the allocation of organs and tissues. Organs will be given to the best match for the organ in the community where the donor dies. If no match is found in that area, then the search for an HLA match will be expanded to other areas of the country. The recipient is chosen based on HLA match, not fame or fortune. 2. The client is asking for information, which the nurse should provide. 3. There is a definite method of allocation of organs. 4. There are 27 known human leukocyte antigens (HLAs). HLAs have become the principal histocompatibility system used to match donors and recipients. The greater the number of matches, the less likely the client will reject the organ. Different races have different HLAs. TEST-TAKING HINT: Option "2" can be eliminated because the client asked for information. Option "1" can be eliminated because the statement supports an unethical situation. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 687). F.A. Davis Company. Kindle Edition. 4

5. Which client would be most likely to complete an advance directive? 1. A 55-year-old Caucasian person who is a bank president. 2. A 34-year-old Asian licensed practical nurse. 3. A 22-year-old Hispanic lawn care worker. 4. A 65-year-old African American retired cook. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 668). F.A. Davis Company. Kindle Edition.

5. 1. ADs are more frequently completed by white, middle- to upper-class individuals. 2. Many nurses do not have ADs, although they discuss them with clients daily. 3. Culturally, Hispanics allow their family members to make decisions for them. 4. Many cultures, including the African American culture, often distrust the health-care system and believe necessary care will be withheld if an AD is completed. TEST-TAKING HINT: If the test taker were not aware of the research, the test taker could examine the occupations and ask themselves, "Which client would want to direct his or her own care and make his or her own decisions?" Nurses may want this but many do not have ADs. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 677). F.A. Davis Company. Kindle Edition. 1

5. The hospice nurse is making the final visit to the wife whose husband died a little more than a year ago. The nurse realizes the husband's clothes are still in the closet and chest of drawers. Which action should the nurse implement first? 1. Discuss what the wife is going to do with the clothes. 2. Refer the wife to a grief recovery support group. 3. Do not take any action because this is normal grieving. 4. Remove the clothes from the house and dispose of them. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 692). F.A. Davis Company. Kindle Edition.

5. 1. The nurse must first confront the wife about moving on through the grieving process. After one (1) year, the wife should be seriously thinking about what to do with her husband's belongings. 2. This is an appropriate intervention, but the nurse must first talk directly to the client. 3. After one (1) year, the wife should be progressing through the grieving process and needs encouragement to remove her husband's belongings. 4. This will need to be done at some point, but it is not the nurse's responsibility. This action is crossing professional boundaries unless the wife asks the nurse to do this. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 696). F.A. Davis Company. Kindle Edition. 1

5. Priority Decision: A terminally ill patient is unresponsive and has cold, clammy skin with mottling on the extremities. The patient's husband and two grown children are arguing at the bedside about where the patient's funeral should be held. What should the nurse do first? a. Ask the family members to leave the room if they are going to argue. b. Take the family members aside and explain that the patient may be able to hear them. c. Tell the family members that this decision is premature because the patient has not yet died. d. Remind the family that this should be the patient's decision and to ask her if she regains consciousness. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 34). Elsevier Health Sciences. Kindle Edition.

5. b. Hearing is often the last sense to disappear with declining consciousness and conversations can distress patients even when they appear unresponsive. Conversation around unresponsive patients should never be other than that which one would maintain if the patients were alert. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 328). Elsevier Health Sciences. Kindle Edition.

6. The nurse is giving an in-service on end-of lifeissues. Which activity should the nurse encourage the participants to perform? 1. Discuss with another participant the death of a client. 2. Review the hospital postmortem care policy. 3. Justify not putting the client in a shroud after dying. 4. Write down their own beliefs about death and dying. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 692). F.A. Davis Company. Kindle Edition.

6. 1. This activity will not help the nurse address his or her own fear of death. 2. This activity will not help the nurse address his or her own fear of death. 3. This activity will not help the nurse address his or her own fear of death. 4. Many nurses are reluctant to discuss death openly with their clients because of their own anxieties about death. Therefore, coming face to face with the nurse's own mortality will address the fear of death. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 697). F.A. Davis Company. Kindle Edition. 4

50. The nurse is discussing the HCP's recommendation for removal of life support with the client's family. Which information concerning brain death should the nurse teach the family? 1. Positive waves on the electroencephalogram (EEG) mean the brain is dead and any further treatment is futile. 2. When putting cold water in the ear, if the client reacts by pulling away, this demonstrates brain death. 3. Tests will be done to determine if any brain activity exists before the machines are turned off. 4. Although the blood flow studies don't indicate activity, the client can still come out of the coma. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 673). F.A. Davis Company. Kindle Edition.

50. 1. Positive brain waves on the EEG indicate brain activity, and the client is not brain dead. 2. This is called the oculovestibular test. If the client reacts, then it indicates brain activity and the client is not brain dead. 3. The Uniform Determination of Brain Death Act states brain death is determined by accepted medical standards which indicate irreversible loss of all brain function. Cerebral blood flow studies, EEG, and oculovestibular and oculocephalic tests may be done. 4. If the cerebral blood flow studies do not show acceptable blood flow to the brain, the client will not come out of the vegetative state. TEST-TAKING HINT: If the test taker examined all answer options and did not understand options "1," "2," and "4," then reading option "3" again would prove it to be the best choice because it simply states the machine won't be turned off until brain death has been proved. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 687). F.A. Davis Company. Kindle Edition. 3

52. The client has received a kidney transplant. Which assessment would warrant immediate intervention by the nurse? 1. Fever and decreased urine output. 2. Decreased creatinine and BUN levels. 3. Decreased serum potassium and calcium. 4. Bradycardia and hypotension. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 673). F.A. Davis Company. Kindle Edition.

52. 1. Oliguria, fever, increasing edema, hypertension, and weight gain are signs of organ rejection. 2. A decrease in serum creatinine and BUN would indicate the transplanted kidney is functioning well. 3. Potassium and calcium are not monitored for rejection. 4. The client with a fever might have tachycardia. Hypertension is a sign of rejection. TEST-TAKING HINT: Option "2" could be eliminated because of the word "decreased." If the test taker were aware of the role the kidneys play in controlling blood pressure, then option "4" could be eliminated. Decreased urine output in option "1" would make the most sense to choose because the kidneys produce urine. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 687). F.A. Davis Company. Kindle Edition. 1

53. The client received a liver transplant and is preparing for discharge. Which discharge instruction should the nurse teach? 1. The immune-suppressant drugs must be tapered off when discontinuing them. 2. There may be slight foul-smelling drainage on the dressing for a few days. 3. Notify the HCP immediately if a cough or fever develops. 4. The skin will turn yellow from the antirejection drugs. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 673). F.A. Davis Company. Kindle Edition.

53. 1. The client must take an immune-suppressant medication forever unless a rejection occurs, and then the client would die without another transplant. 2. Foul-smelling drainage would indicate infection and is not expected. This would be an emergency situation. 3. Clients should be taught to notify the HCP immediately of any signs of an infection. The immune-suppressant drugs will mask the sign of an infection and superinfections can develop. 4. The skin turns yellow in liver failure; the antirejection drugs do not cause jaundice. TEST-TAKING HINT: Standard postoperative instructions include teaching the client to watch for any sign of an infection. Foulsmelling drainage is never normal. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 688). F.A. Davis Company. Kindle Edition. 3

54. The pregnant client asks the nurse about banking the cord blood. Which information should the nurse teach the client? 1. The procedure involves a lot of pain with a very poor result. 2. The client must deliver at a large public hospital to do this. 3. The client will be charged a yearly storage fee on the cells. 4. The stem cells can be stored for about four (4) years before they ruin. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 674). F.A. Davis Company. Kindle Edition.

54. 1. There is no pain associated with storing cord blood. The blood is taken from the separated placenta at birth. Forty to 150 mL of stem cells can be retrieved from the umbilical vein. 2. All hospitals which have an obstetrics department should be able to assist with the collection of stem cells. The client should notify the HCP to be prepared with the kit to obtain the specimens and to be able to send the stem cells to the Cord Blood Registry for processing and storage. 3. There is an initial fee to process the stem cells and a yearly fee to maintain the stored stem cells until needed. Stem cells may be used by the infant in case of a devastating illness or can be donated at the discretion of the owner. 4. This is true of stem cells which have been stored for more than 20 years. TEST-TAKING HINT: The test taker should recognize pain could not be associated with tissue which is no longer a part of the body. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 688). F.A. Davis Company. Kindle Edition. 3

56. The client is three (3) hours post-heart transplantation. Which data would support a complication of this procedure? 1. The client has nausea after taking the oral antirejection medication. 2. The client has difficulty coming off the heartlung bypass machine. 3. The client has saturated three (3) ABD dressing pads in one (1) hour. 4. The client complains of pain at a "6" on a 1-to-10 scale. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 674). F.A. Davis Company. Kindle Edition.

56. 1. The client would be NPO at this time and would be receiving parenteral antirejection medications. 2. The client would have been taken off the heart-lung bypass machine in the operating room. 3. Saturating three (3) dressing pads in one (1) hour would indicate hemorrhage. 4. Pain is expected and is not a complication of the procedure. TEST-TAKING HINT: The test taker should notice the time frame provided in the stem—in this case, three (3) hours after surgery. This could eliminate options "1" and "2." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 688). F.A. Davis Company. Kindle Edition. 3

57. The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a postoperative transplant unit. Which task should the nurse delegate to the UAP? 1. Assess the hourly outputs of the client who is post-kidney transplantation. 2. Raise the head of the bed for a client who is post-liver transplantation. 3. Monitor the serum blood studies of a client who has rejected an organ. 4. Irrigate the nasogastric tube of the client who had a pancreas transplant. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 674). F.A. Davis Company. Kindle Edition.

57. 1. Assessment is always the nurse's responsibility and cannot be delegated. Hourly outputs are monitored to determine kidney function. 2. The UAP can perform this function. There is no nursing judgment required. 3. This requires nursing judgment and is outside the UAP's expertise. 4. Irrigating a nasogastric tube for a client who has undergone a pancreas transplant should be done by the nurse; this is a high-level nursing task. TEST-TAKING HINT: When asked to choose a task which can be delegated, the test taker should determine which task requires the least amount of judgment and choose that option. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 688). F.A. Davis Company. Kindle Edition. 2

58. The experienced medical-surgical nurse is being oriented to the transplant unit. Which client should the charge nurse assign to this nurse? 1. The client who donated a kidney to a relative three (3) days ago and will be discharged in the morning. 2. The client who had a liver transplantation three (3) days ago and was transferred from the intensive care unit two (2) hours ago. 3. The client who received a corneal transplant four (4) hours ago and has developed a cough and is vomiting. 4. The client who had a pancreas transplantation and has a fever, chills, and a blood glucose monitor reading of 342. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 674). F.A. Davis Company. Kindle Edition.

58. 1. This client is ready for discharge and is presumably stable. The client donated the kidney and still has one functioning kidney. An experienced medical-surgical nurse could care for this client. 2. This client must be observed closely for rejection of the organ and is newly transferred from the intensive care unit; therefore, a more experienced nurse in transplant care should care for this client. 3. This client has developed symptoms of a problem unrelated to the corneal transplant, but these symptoms will increase intracranial pressure, resulting in indirect pressure to the cornea. Therefore, a more experienced transplant nurse should care for this client. 4. This client is showing symptoms of organ rejection, which is a medical emergency and requires a more experienced transplant nurse. TEST-TAKING HINT: The test taker should choose the client with the fewest potential problems. The nurse is experienced as a medical-surgical nurse, but transplant recipients require more specialized knowledge. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 689). F.A. Davis Company. Kindle Edition. 1

59. The 6-year-old client diagnosed with cystic fibrosis (CF) needs a lung transplant. Which individual would be the best donor for the client? 1. The 20-year-old brother who does not have cystic fibrosis. 2. The 45-year-old father who carries the cystic fibrosis gene. 3. The 18-year-old who died in an MVA who matches on four (4) points. 4. The 5-year-old drowning victim who is a three (3)-point match. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 674). F.A. Davis Company. Kindle Edition.

59. 1. Living donors are able to donate some organs. The kidneys, a portion of the liver, and a lung may be donated, and the donor will still have functioning organs. An identical twin is the best possible match. However, in the situation in this question, the identical twin would also have CF because the genes would be identical. The next best chance for a compatible match comes from a sibling with both parents in common. 2. The father would have only half of the genetic makeup of the child. 3. There are at least 27 HLA types. A match requires at least 7, and preferably 10 to 11 points. 4. This is not an acceptable match; the client would reject the organ. TEST-TAKING HINT: If the test taker did not know the rationale, then a choice between options "1" and "2" would be the best option because of the direct familial relationships. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 689). F.A. Davis Company. Kindle Edition. 1

6. The client with an AD tells the nurse, "I have changed my mind about my AD. I really want everything possible done if I am near death since I have a grandchild." Which action should the nurse implement? 1. Notify the health information systems department to talk to the client. 2. Remove the AD from the client's chart and shred the document. 3. Inform the client he or she has the right to revoke the AD at any time. 4. Explain this document cannot be changed once it is signed. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 668). F.A. Davis Company. Kindle Edition.

6. 1. This department has nothing to do with the AD. 2. The most appropriate action would be for the nurse to have the client write on the AD he or she is revoking the document; the nurse cannot shred legal documents from the client's chart. 3. The client must be informed the AD can be rescinded or revoked at any time for any reason verbally, in writing, or by destroying his or her own AD. The nurse cannot destroy the client's AD, but the client can destroy his or her own. 4. This is an incorrect answer because the client always has the right to change his or her mind. TEST-TAKING HINT: Option "4" can be eliminated by remembering statements with absolutes should not be selected as correct answers unless the test taker knows for sure the answer is correct. The client's chart is a legal document, and these papers cannot be shredded or altered by using anything that obscures the writing or by erasing information. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 677). F.A. Davis Company. Kindle Edition. 3

6. A 20-year-old patient with a massive head injury is on life support, including a ventilator to maintain respirations. What three criteria for brain death are necessary to discontinue life support? a. b. c. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 34). Elsevier Health Sciences. Kindle Edition.

6. a. Coma b. Absent brainstem reflexes c. Apnea Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 328). Elsevier Health Sciences. Kindle Edition.

60. Which tissue or organ can be repeatedly donated to clients needing a transplant? 1. Skin. 2. Bones. 3. Kidneys. 4. Bone marrow. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 674). F.A. Davis Company. Kindle Edition.

60. 1. Skin is taken from cadaver donors, so it is given once. 2. Bones are taken from cadaver donors, so it is given once. 3. A kidney can be donated while the donor is living or both can be donated as cadaver organs, but either way the donation is only once. 4. The human body reproduces bone marrow daily. There is a bone marrow registry for participants willing to undergo the procedure to donate to clients when a match is found. TEST-TAKING HINT: The test taker could eliminate option "3" because the stem asks for repeated times and the client cannot live without kidney function. The client would have to be placed on dialysis or he or she would die. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 689). F.A. Davis Company. Kindle Edition. 4

61. The nurse is admitting a client to the medicalsurgical unit. Which is required to be offered to the client if the hospital accepts Medicare reimbursement? 1. The opportunity to make an advance directive. 2. The client must be referred to a case manager. 3. The client must apply for a Medicare supplement insurance. 4. The opportunity to discuss end-of-life issues. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 675). F.A. Davis Company. Kindle Edition.

61. 1. In the 1990s, Congress added the requirement for health-care facilities to offer clients the opportunity to receive an advance directive form and to be able to complete it to provide the health-care team with knowledge of the clients' wishes. It was added to a Medicare funding bill. 2. The client has to refuse or accept or alert the facility of an intact document about advanced decisions made by the client, but referral to a case manager is not attached to Medicare funding, 3. The client does not have to apply for supplemental insurance. 4. The opportunity may include end-of-life issues but it is not limited to end of life; it does include issues of irreversible situations and surrogate decision makers. TEST-TAKING HINT: The test taker could eliminate option "3" because the nurse cannot make the client do anything. The client has a right to say no. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 690). F.A. Davis Company. Kindle Edition. 1

62. The nurse pronounced Dr. Smith's client to be clinically dead. Which should the nurse document on the client's chart? 1. Brain scan indicates no brain wave activity, client pronounced deceased. Family refuses to talk with organ bank. 2. Cardiac arrest noted, CPR initiated but unsuccessful. Pronounced dead. 3. Pulse, respirations, and blood pressure absent at 0900, pronounced dead. Dr. Smith to sign death certificate. 4. Client found without pulse, body cold to touch. Pronounced deceased at 0900. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 675). F.A. Davis Company. Kindle Edition.

62. 1. Clinical death is the absence of pulse, respirations, and blood pressure. It does not include radiology or other diagnostic tests. 2. If cardiopulmonary resuscitation is unsuccessful, the nurse cannot pronounce death. A physician must determine the reason for the death. 3. For it to be legal for a nurse to pronounce death, the client must have a disease process that could lead to death. The physician must write a clear order that the nurse can pronounce and be willing to document the cause of death on the death certificate. The observed clinical signs must be documented and the time pronounced. 4. This is an incomplete entry. TEST-TAKING HINT: The test taker could eliminate option "1" because clinical death is the absence of clinical signs of life. Option "3" is a complete documentation; the nurse states the facts without embellishment in documentation. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 690). F.A. Davis Company. Kindle Edition. 3

63. The nurse is caring for an 82-year-old female client who is crying and asking for her mother to come to see her. Which statement represents the ethical principle of nonmalfeasance? 1. "You must miss your mother very much. Can you tell me about her?" 2. "You are 82 years old. Your mother is dead and can't come see you." 3. "Why do you need your mother? Can I get something for you?" 4. "Your mother would not want you to worry. I will tell her you want to see her." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 675). F.A. Davis Company. Kindle Edition.

63. 1. The nurse is caring for a client who is at best disoriented; challenging this cognitive deficiency will only create frustration and anxiety in the client. Nonmalfeasance is the duty to prevent or do no harm. This is a therapeutic response that validates the client's concern but does not include lying to the client. 2. This is veracity, to tell the truth. 3. The client does not owe the nurse an explanation of why she wishes to see her mother. "Why" is not appropriate in this situation. 4. This is the opposite of veracity; it is lying to the client. If the nurse believes the client's mother to be dead, then how will the nurse contact her? TEST-TAKING HINT: The test taker could eliminate option "2" because it is veracity and "4" because it is lying. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 690). F.A. Davis Company. Kindle Edition. 1

64. The hospice nurse is admitting a client. Which question concerning end-of-life care is most important for the nurse to discuss with the client and family? 1. Encourage the client and family to make funeral arrangements. 2. Assess the client's pain medication regimen for effectiveness. 3. Determine if the client has made an advance directive or living will. 4. Ask what durable medical equipment is in place in the home. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 675). F.A. Davis Company. Kindle Edition.

64. 1. The nurse could possibly help the family to guide them about the need for eventual arrangements, but it is not appropriate during the admission process. 2. The client may or may not have pain; nothing indicates pain is an issue in the stem of the question. 3. Advance directives provide guidance for end-of-life care; the nurse needs this information in order to plan the care per the client's wishes. 4. This could be determined, but the priority is knowing the client's wishes. TEST-TAKING HINT: The test taker should recognize timing when reading a stem or option in a question. "On admission," "every day," "every two hours" will help to determine a correct answer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 690). F.A. Davis Company. Kindle Edition. 3

65. The client is dying and wants to talk to the nurse about heaven. Which is the nurse's best nursing action? 1. Make a referral to the chaplain to come to see the client. 2. Tell the client that nurses are not allowed to discuss spiritual matters. 3. Ask the client to describe heaven and hell. 4. Allow the client to discuss the beliefs about heaven. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 675). F.A. Davis Company. Kindle Edition.

65. 1. Chaplains work with all faiths and are spiritual advisors. If the nurse feels comfortable with discussing heaven and if the client wishes to talk with the nurse, it is appropriate. 2. Nurses are not prohibited from discussing spiritual issues with a client; the nurse should not challenge the client's personal beliefs. 3. Hell is not what the client wants to talk about. 4. The nurse should allow the client to verbalize his/her feeling regarding what to expect when death occurs. TEST-TAKING HINT: The nurse student is taught in first-level courses to allow the client to verbalize feeling; the test taker should recognize this as basic nursing skills. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 691). F.A. Davis Company. Kindle Edition. 4

66. The male client in the long-term care facility has been told that he will not live for many more months. The client has been estranged from his daughter for years. He tells the nurse that he could die a happy man if he could talk to his daughter just one more time. Which statement is the nurse's best response? 1. "You should not feel bad. Things will work out for the best before your death." 2. "What did you do to make your daughter not talk to you all this time?" 3. "If you would like I can try to contact your daughter and ask her to come see you." 4. "Tell me more about being unhappy that you don't have a relationship with your daughter." Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 675). F.A. Davis Company. Kindle Edition.

66. 1. This is false reassurance. 2. The blame for the lack of communication may not be the client's; it could be all on the daughter. This is an accusatory statement. 3. The nurse is asking permission to divulge the client's location and health status to the daughter; this is appropriate for complying with HIPAA and is addressing the voiced concerns of the client. 4. The nurse can perform an intervention that directly affects the client's situation. A therapeutic conversation might be used if the client's daughter is not willing to reconcile with the client. TEST-TAKING HINT: The test taker could eliminate option "1" because it is advising the client about how he should feel. Option "2" asks why and blames the client. Option "4" does not address the client's need. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 691). F.A. Davis Company. Kindle Edition. 3

7. The client has just signed an AD at the bedside. Which intervention should the nurse implement first? 1. Notify the client's health-care provider about the AD. 2. Instruct the client to discuss the AD with significant others. 3. Place a copy of the advance directive in the client's chart. 4. Give the original advance directive to the client. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 668). F.A. Davis Company. Kindle Edition.

7. 1. The HCP should be made aware of the AD, but this is not the first intervention. 2. This is the most important intervention because the legality of the document is sometimes not honored if the family members disagree and demand other action. If the client's family is aware of the client's wishes, then the health-care team can support and honor the client's final wishes. 3. Copies of the AD should be placed in the chart and given to significant others, the client's attorney, and all health-care providers. 4. The original should be given to the client and a copy should be placed in the chart, but this is not the first intervention. TEST-TAKING HINT: This is a priority-setting question, and the test taker should read all the answer options and try to rank them in order of priority. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 677). F.A. Davis Company. Kindle Edition. 2

7. A patient with end-stage liver failure tells the nurse, "If I can just live to see my first grandchild who is expected in 5 months, then I can die happy." The nurse recognizes that the patient is demonstrating which of the following stages of grieving? a. Prolonged grief disorder b. Kübler-Ross's stage of bargaining c. Kübler-Ross's stage of depression d. The new normal stage of the Grief Wheel Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 34). Elsevier Health Sciences. Kindle Edition.

7. b. Bargaining is demonstrated by "if-then" grief behavior that is described by Kübler-Ross. Kübler-Ross's stage of depression is seen when the person says "yes me, and I am sad." Prolonged grief disorder is seen when there is a dysfunctional reaction to loss and the individual is unable to move forward after the death of a loved one. In the Grief Wheel model, the new normal stage is when the grief is resolved but the normal state, because of the loss, is not the same as before. Lewis, Sharon L.; Lewis, Sharon L.; Bucher, Linda; Bucher, Linda; Dirksen, Shannon Ruff; Dirksen, Shannon Ruff. Study Guide for Medical-Surgical Nursing - E-Book (Study Guide for Medical-Surgical Nursing: Assessment & Management of Clinical Problem) (Page 328). Elsevier Health Sciences. Kindle Edition.

8. The HCP has notified the family of a client in a persistent vegetative state on a ventilator of the need to "pull the plug." The client does not have an AD or a durable power of attorney for health care, and the family does not want their loved one removed from the ventilator. Which action should the nurse implement? 1. Refer the case to the hospital ethics committee. 2. Tell the family they must do what the HCP orders. 3. Follow the HCP's order and "pull the plug." 4. Determine why the client did not complete an AD. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 668). F.A. Davis Company. Kindle Edition.

8. 1. The ethics committee is composed of health-care workers and laypeople from the community to objectively review the situation and make a recommendation which is fair to both the client and health-care system. The family has the right to be present and discuss their feelings. 2. The nurse is legally obligated to be a client advocate. 3. This action could create a multitude of ramifications, including a lawsuit and possible criminal charges. 4. It really doesn't matter at this point why the client didn't complete an AD; the client cannot do it now. TEST-TAKING HINT: The test taker must be aware of the ethics committee and its role in helping resolve ethical dilemmas. Any answer option which has the word "why" should be evaluated closely before selecting it as the correct answer. Removing the endotracheal tube or turning off the ventilator ("pulling the plug") is a medical responsibility; therefore, option "3" could be eliminated as the correct answer. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 677). F.A. Davis Company. Kindle Edition. 1

8. The Hispanic client who has terminal cancer is requesting a curandero to come to the bedside. Which intervention should the nurse implement? 1. Tell the client it is against policy to allow faith healers. 2. Assist with planning the visit from the curandero. 3. Refer the client to the pastoral care department. 4. Determine the reason the client needs the curandero. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 692). F.A. Davis Company. Kindle Edition.

8. 1. The hospital should not prevent the client from practicing his or her culture, and denying faith healers would be denying the client's spiritual guidance. 2. The nurse should support the client's culture as long as it is not contraindicated in the client's care. This client is terminal; therefore, allowing the curandero, who is a folk healer and religious person in the Hispanic culture, would be appropriate. 3. There is no reason to refer this client to the pastoral care department; the nurse can assist the client. 4. The nurse does not need to know why the client wants the curandero; the nurse should support the client's request without prejudice. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 697). F.A. Davis Company. Kindle Edition. 2

9. The client asks the nurse, "When will the durable power of attorney for health care take effect?" On which scientific rationale would the nurse base the response? 1. It goes into effect when the client needs someone to make financial decisions. 2. It will be effective when the client is under general anesthesia during surgery. 3. The client must say it is all right for it to become effective and enforced. 4. It becomes valid only when the clients cannot make their own decisions. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 669). F.A. Davis Company. Kindle Edition.

9. 1. It is a power of attorney executed by a lawyer which allows a delegated other person to make financial decisions. That document has nothing to do with a durable power of attorney for health care. 2. The client has not lost the capacity to make decisions; therefore, a durable power of attorney cannot be used by the assigned person to make decisions. 3. The client must not be able to make his or her own decisions before this document can be used. 4. The client must have lost decision-making capacity as a result of a condition which is not reversible or must be in a condition which is specified under state law, such as a terminal, persistent vegetative state; an irreversible coma; or as specified in the AD. TEST-TAKING HINT: The test taker should not confuse a power of attorney and a durable power of attorney for health care. These are two separate, yet very important, documents with similar names. Colgrove, Kathryn Cadenhead. Med-Surg Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 678). F.A. Davis Company. Kindle Edition. 4

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