Chapter 16 Prep-U
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 statements made by the nurse demonstrates that the nurse is providing spiritually sensitive care?
"Tell me who or what gives you strength."
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."
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
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 intervention should a nurse perform during the grieving period when caring for a dying client?
Avoiding criticizing or giving advice
Which of the following may be contained in an "emergency kit" for a hospice patient exhibiting restlessness?
Benzodiazepine
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 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
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 (1965) identified four "awareness contexts." Which awareness context occurs when the client is unaware of their terminal state, whereas others are aware?
Closed awareness
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
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.
A nurse has been providing in-home hospice care to an older adult client with lung cancer for more than six months. The family asks the nurse how long the Medicare hospice services will continue. What is the nurse's best response?
The Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition
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 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?
"This must be very difficult for you."
Which of the following would be inconsistent with a normal grief reaction?
Elation
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 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.
Which is the initial stage of grief, according to Kübler-Ross?
Denial
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?
Durable power of attorney for health care
The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition.
End-stage renal disease
For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death?
Increased restlessness
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
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.
