Chapter 13: Palliative and End-of-Life Care

The organization of a client's care on the palliative care unit is based on interdisciplinary collaboration. How does interdisciplinary collaboration differ from multidisciplinary practice? A. It is based on the participation of clinicians without a team leader. B. It is based on clinicians of varied backgrounds integrating their separate plans of care. C. It is based on communication and cooperation between disciplines. D. It is based on medical expertise and client preference with the support of nursing.

C. It is based on communication and cooperation between disciplines.

A hospice nurse is well aware of how difficult it is to deal with others' pain on a daily basis. This nurse should put healthy practices into place to guard against what outcome? A. Inefficiency in the provision of care B. Illness C. Emotional exhaustion D. Social withdrawal

C. Emotional exhaustion

The nurse is describing palliative care and hospice services to a client with end-stage congestive heart failure. The client and family have many questions about the differences between palliative care and hospice. Which statement should the nurse provide the family? A. "Hospice is the application of palliative care at the end of life." B. "Palliative care requires hospitalization." C. "Hospice occurs in a facility with specially trained staff." D. "Curative care can continue in hospice."

A. "Hospice is the application of palliative care at the end of life."

The nurse is assessing a 73-year-old client who was diagnosed with metastatic prostate cancer. The nurse notes that the client is exhibiting signs of loss, grief, and intense sadness. Based on this assessment data, the nurse will document that the client is most likely in what stage of death and dying? A. Depression B. Denial C. Anger D. Resignation

A. Depression

The nursing director of a hospice program has observed increasing levels of emotional exhaustion and poor work performance in the nursing staff and believes the staff are suffering from burnout. Which actions can the nursing director take to reduce burnout in the nursing staff? Select all that apply. A. Encourage a work-life balance. B. Support autonomy for nurses in decision-making. C. Assist nurses in identifying personal strengths. D. Mandate personal leave days after a client dies. E. Develop programs to increase nurse resilience.

A. Encourage a work-life balance. B. Support autonomy for nurses in decision-making. C. Assist nurses in identifying personal strengths. E. Develop programs to increase nurse resilience

A nurse who provides care on an acute medical unit has observed that health care providers are frequently reluctant to refer clients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply. A. Financial pressures on health care providers B. Client reluctance to accept this type of care C. Strong association of hospice care with prolonging death D. Advances in "curative" treatment in late-stage illness E. Ease of making a terminal diagnosis

A. Financial pressures on health care providers B. Client reluctance to accept this type of care D. Advances in "curative" treatment in late-stage illness

A client with end-stage kidney disease who immigrated to the United States several years ago is receiving care from family at home. When discussing the option of hospice care with a health care provider, the client and family explain through an interpreter that they do not want hospice care. Which factors are potential barriers to care for this client and family? Select all that apply. A. Lack of an understanding of hospice care B. A language barrier C. Mistrust of the health care system D. Wanting to care for the client at home E. Uncertainty about how long the client will live

A. Lack of an understanding of hospice care B. A language barrier C. Mistrust of the health care system

The nurse is assessing a client whose spouse died 16 months ago. The client tells the nurse about joining a hiking group, volunteering as a college mentor, and thinking about dating again. The nurse determines that the client is in which stage of Rando's processes of mourning? A. Reinvestment B. Recognition of the loss C. Recollection and reexperiencing the deceased D. Relinquishing old attachments to the deceased

A. Reinvestment

The family of a client receiving palliative care for end-stage congestive heart failure is upset that the client is not eating. Which intervention should the nurse recommend to the family? A. Remove unpleasant odors and sights during meals. B. Withhold antiemetics prior to a meal. C. Coax and cajole the client to eat more. D. Weigh the client daily to assess for weight gain.

A. Remove unpleasant odors and sights during meals.

A medical nurse is providing end-of-life care for a client with metastatic bone cancer. The nurse notes that the client has been receiving oral analgesics for pain with adequate effect, but is now having difficulty swallowing the medication. What should the nurse do? A. Request the health care provider to prescribe analgesics by an alternative route. B. Crush the medication in order to aid swallowing and absorption. C. Administer the client's medication with the meal tray. D. Administer the medication rectally.

A. Request the health care provider to prescribe analgesics by an alternative route.

An adult oncology client has a diagnosis of bladder cancer with metastasis and the client has asked the nurse about the possibility of hospice care. Which principle is central to a hospice setting? A. The client and family should be viewed as a single unit of care. B. Persistent symptoms of terminal illness should not be treated. C. Each member of the interdisciplinary team should develop an individual plan of care. D. Terminally ill clients should die in the hospital whenever possible.

A. The client and family should be viewed as a single unit of care.

A medical nurse is providing palliative care to a client with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse's care? A. To improve the client's and family's quality of life B. To support aggressive and innovative treatments for cure C. To provide physical support for the client D. To help the client develop a separate plan with each discipline of the health care team

A. To improve the client's and family's quality of life

The nurse is assessing a client with end-stage liver failure for the presence of hope. What should the nurse identify as a hope-fostering category? A. Uplifting memories B. Ignoring negative outcomes C. Envisioning one specific outcome D. Avoiding an actual or potential threat

A. Uplifting memories

The nurse is caring for a client who is having difficulty adjusting to a terminal diagnosis. The nurse notes the client's tears and sits down by the bedside. The client tells the nurse, "There are so many things I still want to accomplish." Which response would be most therapeutic and appropriate for the nurse to make? A. "Can I give you some advice?" B. "Tell me what's most important to you now." C. "Do you want me to call the chaplain?" D. "I have cared for lots of clients in your position. It will get easier."

B. "Tell me what's most important to you now."

The nurse learns that a computed tomography scan a client underwent to investigate new seizure activity revealed a brain tumor. When the client later asks about the results of the scan, which therapeutic response should the nurse give the client? A. "No, I have not seen the report." B. "What is your understanding of your condition?" C. "Yes, but I can't discuss the results with you." D. "Try not to worry; the doctor will be in later to talk with you."

B. "What is your understanding of your condition?"

A client with a terminal diagnosis has asked the nurse about "helping me end my suffering." What is the nurse's responsibility in the domain of assisted suicide? A. Educating the client about the moral implications of assisted suicide B. Discussing concerns and fears with the client C. Identifying resources that meet the client's desire to die D. Telling the client the request is not acceptable

B. Discussing concerns and fears with the client

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

B. Reinvesting in new relationships at the appropriate time C. Reminiscing about the relationship the client had with her spouse D. Relinquishing old attachments to the spouse at the appropriate time

As the American population ages, nurses expect to see more clients admitted to long-term care facilities in need of palliative care. Regulations now in place that govern how the care in these facilities is both organized and reimbursed emphasize what aspect of care? A. Ongoing acute care B. Restorative measures C. Mobility and socialization D. Incentives to palliative care

B. Restorative measures

Clients who are enrolled in hospice care are often believed to suffer unnecessarily because they do not receive adequate attention for their symptoms of the underlying illness. What factor most contributes to this phenomenon? A. Unwillingness to overmedicate the dying client B. Rules concerning completion of all cure-focused medical treatment C. Unwillingness of clients and families to acknowledge the client is terminal D. Lack of knowledge by clients and families regarding availability of care

B. Rules concerning completion of all cure-focused medical treatment

A client's rapid cancer metastases have prompted a shift from active treatment to palliative care. When planning this client's care, the nurse should identify what primary aim? A. To prioritize emotional needs B. To prevent and relieve suffering C. To bridge between curative care and hospice care D. To provide care while there is still hope

B. To prevent and relieve suffering

A client has just died following urosepsis that progressed to septic shock. The client's spouse says, "I knew this was coming, but I feel so numb and hollow inside." The nurse should know that these statements are characteristic of what phase? A. Complicated grief and mourning B. Uncomplicated grief and mourning C. Depression stage of dying D. Acceptance stage of dying

B. Uncomplicated grief and mourning

A hospice nurse is caring for a young adult client with a terminal diagnosis of leukemia. When updating this client's plan of nursing care, what should the nurse prioritize? A. Interventions aimed at maximizing quantity of life B. Providing financial advice to pay for care C. Providing realistic emotional preparation for death D. Making suggestions to maximize family social interactions after the client's death

C. Providing realistic emotional preparation for death

One of the functions of nursing care of the terminally ill is to support the client and his or her family as they come to terms with the diagnosis and progression of the disease process. How should nurses support clients and their families during this process? Select all that apply. A. Describe their personal experiences in dealing with end-of-life issues. B. Encourage the client and family to "keep fighting" as a cure may come. C. Try to appreciate and understand the illness from the client's perspective. D. Assist clients with performing a life review. E. Provide interventions that facilitate end-of-life closure.

C. Try to appreciate and understand the illness from the client's perspective. D. Assist clients with performing a life review. E. Provide interventions that facilitate end-of-life closure.

A client is in a hospice receiving palliative care for lung cancer which has metastasized to the client's liver and bones. For the past several hours, the client has been experiencing dyspnea. What nursing action is most appropriate? A. Administer a bolus of normal saline, as prescribed. B. Initiate high-flow oxygen therapy. C. Administer high doses of opioids. D. Administer bronchodilators and corticosteroids, as prescribed.

D. Administer bronchodilators and corticosteroids, as prescribed.

A pediatric nurse is emotionally distraught by the death of a 9-year-old client who received care on the unit over the course of many admissions spanning several years. What action is the most appropriate response to the nurse's own grief? A. Take time off from work to mourn the death. B. Post mementos of the client on the unit. C. Solicit emotional support from the client's family. D. Attend the client's memorial service.

D. Attend the client's memorial service.

In recent decades, nursing has moved into the forefront in providing care for the dying. Which phenomenon has most contributed to this increased focus of care of the dying? A. Increased incidence of infections and acute illnesses B. Increased focus of health care providers on disease prevention C. Larger numbers of people dying in hospital settings D. Demographic changes in the population

D. Demographic changes in the population

A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important positive action that can come from a grief support group? A. Providing a framework for incorporating the old life into the new life B. Normalizing adaptation to a continuation of the old life C. Aiding in adjusting to using old, familiar social skills D. Normalization of feelings and experiences

D. Normalization of feelings and experiences

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 intervention should the nurse prioritize in the plan of care? A. Aggressively continuing to fight the disease process B. Moving the client to a long-term care facility when it becomes necessary C. Including the children in planning their father's care D. Supporting the client's and family's values and choices

D. Supporting the client's and family's values and choices

The hospice nurse is caring for a 45-year-old parent of three young children in the client's home. During the most recent visit, the nurse has observed that the client has a new onset of altered mental status, likely resulting from recently diagnosed brain metastases. Which goal of nursing interventions should the nurse identify? A. Helping the family to understand why the client needs to be sedated B. Making arrangements to promptly move the client to an acute-care facility C. Explaining to the family that death is near and the client needs around-the-clock nursing care D. Teaching family members how to interact with, and ensure safety for, the client with impaired cognition

D. Teaching family members how to interact with, and ensure safety for, the client with impaired cognition

A client with cancer, who has just learned that the cancer has spread to distant organs, tells the nurse, "I am not sure how many more treatments I can put up with." The nurse responds by saying, "You have been through so many treatments for your cancer." Using the NURSE framework for responding to emotions, which empathic response did the nurse use? A. NAME the emotion B. SUPPORT the client C. EXPLORE the emotion. D. UNDERSTAND the emotion

D. UNDERSTAND the emotion

A nurse who sits on the hospital's ethics committee is reviewing a complex case that has many of the characteristics of assisted suicide. Which of the following would be an example of assisted suicide? A. Administering a lethal dose of medication to a client whose death is imminent B. Administering a morphine infusion without assessing for respiratory depression C. Granting a client's request not to initiate enteral feeding when the client is unable to eat D. Neglecting to resuscitate a client with a "do not resuscitate" order

A. Administering a lethal dose of medication to a client whose death is imminent

The nurse is caring for a client who has terminal lung cancer and is unconscious. Which assessment finding would most clearly indicate to the nurse that the client's death is imminent? A. Mottling of the lower limbs B. Slow, steady pulse C. Bowel incontinence D. Increased swallowing

A. Mottling of the lower limbs

The nurse is admitting a client to palliative care and notices that the client has health care provider orders for life-sustaining treatment (POLST). Which concepts regarding POLST will the nurse use to develop a plan of care for this client? Select all that apply. A. It can be used in any health care setting. B. It names the durable power of health care attorney. C. It specifies preferences for artificial nutrition and hydration. D. It expresses the client's wishes toward cardiopulmonary resuscitation (CPR). E. It specifies the client's preferences for funeral arrangements.

A. It can be used in any health care setting. C. It specifies preferences for artificial nutrition and hydration. D. It expresses the client's wishes toward cardiopulmonary resuscitation (CPR).

A client on the medical unit is dying and the nurse has determined that the family's psychosocial needs during the dying process need to be addressed. What is a cause of many client care dilemmas at the end of life? A. Poor communication between the family and the care team B. Denial of imminent death on the part of the family or the client C. Limited visitation opportunities for friends and family D. Conflict between family members

A. Poor communication between the family and the care team

A nurse on a medical unit in the hospital often provides palliative care to clients with a variety of diagnoses. Which activities describe the primary palliative care functions of this nurse? Select all that apply. A. Provides assessment of symptoms B. Manages basic nursing problems C. Handles difficult conversations with clients D. Uses therapeutic communication skills with clients E. Identifies multifactorial symptoms

A. Provides assessment of symptoms B. Manages basic nursing problems D. Uses therapeutic communication skills with clients

After caring for several clients who died in the hospital, the nurse has identified some lapses in the care that many of these clients received toward the end of their lives. What have research studies identified as a potential deficiency in the care of the dying in hospital settings? A. The perception that palliative care constitutes "giving up." B. Clients are too sedated to achieve adequate pain control. C. Clients are not given opportunities to communicate with caregivers. D. Clients are ignored by the care team toward the end of life.

A. The perception that palliative care constitutes "giving up."

The nurse is admitting a client with a diagnosis of ovarian cancer. The client has just been told that her ovarian cancer is terminal. What question should the nurse include in a spiritual assessment of the client? A. "Can you tell your family about negative test results?" B. "Do you have a sense of peace of mind and a purpose to your life?" C. "Can you let go of her spouse so the spouse can start a new life?" D. "Do you need time and space to bargain with God for a cure?"

B. "Do you have a sense of peace of mind and a purpose to your life?"

A client with cancer has just been told that the disease is now terminal. The client tearfully states, "I can't believe I am going to die. Why me?" What is the nurse's best response to elicit more information from the client? A. "I know how you are feeling." B. "You have lived a long life; that should bring you peace." C. "Tell me more about how you feel about this news." D. "Life can be so unfair."

C. "Tell me more about how you feel about this news."

The nurse has observed that an older adult client with a diagnosis of end-stage kidney disease seems to prefer to have the client's eldest child make all of the health care decisions. While the family is visiting, the client explains that this is a cultural practice and very important that it occurs. How should the nurse best handle this situation? A. Privately ask the child to allow the client to make the health care decisions. B. Explain to the client that the client is responsible for all decisions. C. Work with the team to negotiate informed consent. D. Avoid divulging information to the eldest child.

C. Work with the team to negotiate informed consent.

Which issue has most often presented challenging ethical issues, especially in the context of palliative care? A. Increased cultural diversity B. Staffing shortages in health care and questions concerning quality of care C. Increased costs of health care coupled with inequalities in access D. Ability of technology to prolong life beyond meaningful quality of life

D. Ability of technology to prolong life beyond meaningful quality of life