Chapter 3 -PrepU - Chronic Illness and End-of-Life Care
After multiple treatment plans, a client with cancer has been told that the tumors continue to grow and have metastasized. The nurse is assisting with arranging hospice care for the client. The nurse assesses the client is in which phase of the Trajectory Model of Chronic Illness? 1- Dying 2- Downward 3- Comeback 4- Unstable
1
Which cardiovascular findings indicate to the nurse that the condition of the dying client is worsening? 1- Pulse 104 beats/minute in the morning, 62 beats/minute in the afternoon with mottled feet and ankles 2- Pulse 72 beats/minute, irregular; client confused and agitated 3- Pulse 100 beats/minute, blood pressure 100/60 mm Hg, pale with poor skin turgor 4- Pulse 60 beats/minute, blood pressure 90/42mm Hg, difficult to arouse
1
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? 1- Denial 2- Anger 3- Bargaining 4- Depression
2
A dying patient has sudden onset of confusion, waxing and waning consciousness, and loss of orientation, thinking she is at home when she is in the hospital. The nurse recognizes this as ______________ and knows that the most appropriate pharmacologic treatment for it includes ______________. 1- Dementia, acetylcholinesterase inhibitor 2- Delirium, benzodiazepine 3- Delirium, haloperidol 4- Dementia, haloperidol
2
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? 1- Physician's orders 2- Client's goals 3- Length of required treatment 4- Invasiveness of the treatment
2
Which of the following should the nurse report so that the team can consider alternative nutritional and fluid administration routes for a dying client? 1- Altered gastrointestinal function 2- Drop in blood pressure and rapid heart rate 3- Weight loss and inadequate food intake 4- Irregular eating habits
3
When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following? 1- Treatment directive 2- Living will 3- Standard addendum to a will 4- Proxy directive
4
Which is a sign of approaching death? 1- Increase in urinary output 2- Clear sensorium 3- Insomnia 4- Irregular breathing patterns
4
You are the nurse giving palliative care to a patient with a diagnosis of chronic obstructive pulmonary disease (COPD). What is the primary goal of palliative care? 1- Improve the patient's and family's quality of life. 2- Support aggressive treatment for cure. 3- Provide physical support for the patient. 4- The patient may develop a separate plan with each discipline of the health care team.
1
A cause related to the increasing number of people with chronic conditions is 1- an increase in mortality from infectious disease. 2- improved screening and diagnostic procedures. 3- a tendency for these conditions to develop in younger people. 4- shorter lifespans.
2
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? 1- Inpatient respite care 2- Palliative care 3- Continuous care 4- General inpatient care
2
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. 1- "I know just how you must feel." 2- "This must be very difficult for you." 3- "Tell me more about what's on your mind." 4- "You still have time for a good life." 5- "Let's focus on what your doctor has planned."
2,3
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? 1- A workshop on caring for the dying client 2- Use evidence-based practice in daily care regimen. 3- Explore own feelings on mortality and death and dying. 4- Participate in a support group to learn clients' feeling on care.
3
Which of the following does not coincide with Kübler-Ross's stages related to a dying client? 1- Clients don't always follow the stages in order. 2- Some client regress, then move forward again. 3- The dying client usually exhibits anger first. 4- The client may be in several stages at once.
3
Which phase in the trajectory model of chronic illness is characterized by the reactivation of an illness in remission? 1- Pretrajectory 2- Stable 3- Unstable 4- Crisis
3
Which statement provides accurate information related to chronic illness? 1- Most people with chronic conditions take on a sick role identity. 2- Chronic conditions do not result from injury. 3- Most people with chronic conditions do not consider themselves sick or ill. 4- Most chronic conditions are easily controlled.
3
Chronic illnesses are characterized by which of the following? Select all that apply. 1- A nonreversible pathology. 2- A slow, progressive decline in normal physiologic function. 3- A decreasing prevalence nationally and internationally. 4- Necessitating long-term surveillance.
1, 2, 4
What percentage of deaths due to chronic disease occur in low- and middle-income countries? 1- 60 2- 70 3- 80 4- 90
3
Which of the following would not be consistent with promoting nutrition in terminally ill patients? 1- Maintaining a balanced diet 2- Offering small portion of favorite foods 3- Avoiding arguments at mealtime 4- Offering cool foods rather than hot foods
1
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.) 1- Alterations in carbohydrate, fat, and protein metabolism 2- Endocrine dysfunction 3- Anemia 4- Neurologic dysfunction 5- Bladder incontinence
1,2,3
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Despite various medication regimes, the client's symptoms are gradually increasing. The nurse realizes that this client is which phase of the Trajectory Model of Chronic Illness? 1- Unstable 2- Acute 3- Downward 4- Dying
3
According to the U.S. Census (2010), what percentage of people are diagnosed with a disability? 1- 5 2- 10 3- 14 4- 20
4
Which "awareness context" is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise? 1- Mutual pretense awareness 3- Closed awareness 3- Suspected awareness 4- Open awareness
1
A nurse is developing a teaching plan for a terminally ill client and his family about about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in the teaching plan? 1- Each client experiences each of the stages. 2- Typically, the stages occur in succession. 3- The stages are applicable to any loss. 4- Most clients reach acceptance by the time of death.
3
A nurse, working in a health clinic, treats a variety of conditions on a daily basis. One disorder that is rapidly increasing and is the leading cause of secondary morbidity is: 1- Kidney disease 2- Coronary heart disease 3- Obesity 4- Pneumonia
3
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? 1- Suspected awareness 2- Open awareness 3- Closed awareness 4- Mutual pretense awareness
3
Nursing care of patients with chronic illness is varied and occurs in a variety of settings. Care must be direct and supportive. To provide supportive care, a nurse would do which of the following? 1- Manage the medication regime. 2- Assess the patient's physical status. 3- Make referrals for additional care. 4- Provide treatments.
3
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? 1- Megestrol 2- Dexamethasone 3- Dronabinol 4- Atropine
4
The nurse is working with a client with a chronic condition. The nurse includes which elements in the plan of care? Select all that apply. 1- Assessment for identity changes 2- Assessment for spontaneous resolution 3- Interventions to manage symptoms 4- Interventions to prevent complications
1,3,4
A client who is obese and the nurse have established a goal for the client to achieve a weight loss of 1 pound each week. One month later, the nurse evaluates that the client has lost 2 pounds. The nurse first states 1- "You need to work harder to achieve your goal." 2- "You have succeeded in making positive progress." 3- "You are not achieving satisfactory weight loss." 4- "We will have to re-evaluate your goal."
2
According to federal guidelines, hospices may provide no more than what percentage of the aggregate annual patient-days at the inpatient level? 1- 10 2- 20 3- 30 4- 40
2
The family of a dying client is noticing that their loved one is short of breath, restless in bed, and appears to be trying to tell them something. Which nursing intervention is appropriate at this time? 1- Offer the bedpan to urinate. 2- Call the physician to obtain an antianxiety sedative. 3- Get the client out of bed to the chair. 4- Offer the client sips to drink.
2
The nurse is caring for a client in the unstable phase of the Trajectory Model of Chronic Illness. The nurse should focus on providing which type of care? 1- Emotional 2- Direct 3- Guidance 4- Rehabilitation
3
A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse? 1- "It will hasten the death of the patient." 2- "It will prolong life in a dignified manner." 3- "It will use artificial means of life support if the patient requests it." 4- "It will enable the patient to remain home if that is what is desired."
4
The most important health-promoting behavior that can prevent chronic illness or significantly improve the quality of life for those with a chronic condition is: 1- A balanced diet. 2- Physical exercise. 3- Smoking cessation. 4- Stress reduction.
2
Which term is used to describe the personal feelings that accompany an anticipated or actual loss? 1- Bereavement 2- Grief 3- Mourning 4- Spirituality
2
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? 1- Medical directive by proxy 2- Living will declaration 3- Durable power of attorney for health care 4- End-of-life treatment directive
3
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? 1- "We'll try to give him regularly scheduled meals throughout the day." 2- "We'll make sure that he is nearby the kitchen so he can smell the foods cooking." 3- "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." 4- "We'll try adding powdered milk to milk and other foods to make them more nutritious."
4
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. 1- Control the client's pain with prescribed medication. 2- Advise the client's health care provider of the client's condition. 3- Comfort the client by saying it will all be over soon. 4- Encourage the client to explain his or her wishes. 5- Recommend that the client consider physician-assisted suicide.
1,2,4
The sounds of breathing, including terminal bubbling, at the time of death may be distressing for families to hear. When the nurse hears these sounds, she should do which of the following? Select all that apply. 1- Reposition the patient in an attempt to move secretions out of the oropharynx. 2- Educate the family about what they are hearing and that the sound does not mean that the patient is in any distress. 3- Suction the patient deeply and often to rid the oropharynx of the build-up of secretions. 4- Suggest to the provider that now is the time for an anticholinergic drug (such as glycopyrrolate).
1,2,4
When educating patients about chronic diseases, such as diabetes, which of the following should the nurse include in the rationale for effective management of the disease? Select all that apply. 1- An unmanaged chronic disease may lead to the development of other chronic illnesses. 2- When a patient is admitted to the ICU with a comorbid chronic disease, that patient faces a greater risk of morbidity and mortality. 3- Although chronic disease affects the entire family system, management of the disease is the patient's sole responsibility. 4- By managing a chronic disorder early in the disease process, the patient may be able to save him- or herself the high costs associated with the sequelae of unmanaged disease. 5- Chronic illness management is not influenced by life style changes.
1,2,4
A client with multiple sclerosis is being discharged. The nurse understands that living with chronic conditions imposes many challenges, including the need for which accomplishments? Select all that apply. 1- Alleviate and manage symptoms 2- Validate individual self-worth 3- Ignore threats to identity 4- Return to a better state of health than prior 5- Validate family functioning
1,2,5
A patient is nearing death from metastatic cancer and is receiving hospice care in the home. The home care nurse visits. The patient's family caregiver states that the patient has not eaten well for the last several days and rarely wishes to drink, only sucking on ice now and then. The caregiver thinks that it is cruel to let the dying patient starve to death, or die from dehydration. What would the nurse's best response be? 1- "I think it is cruel, too. If this were my mother, I would not let her die like that." 2- "Tell me why you feel that way?" 3- "It's okay, because this may hasten death and relieve suffering." 4- "This is what happens when people die."
2
A patient is nearing death from metastatic cancer and is receiving hospice care in the home. The home care nurse visits. The patient's family caregiver states that the patient has not eaten well for the last several days and rarely wishes to drink, only sucking on ice now and then. The caregiver thinks that it is cruel to let the dying patient starve to death, or die from dehydration. What would the nurse's best response be? 1- "I think it is cruel, too. If this were my mother, I would not let her die like that." 2-"Tell me why you feel that way?" 3- "It's okay, because this may hasten death and relieve suffering." 4- "This is what happens when people die."
2
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? 1- "Do not worry, I will be here for you to help you with your needs." 2- "I will talk with the health care provider to determine the next step in your care." 3- "Your grandchild is almost here, and you will enjoy seeing him." 4- "I hear you say that you are not sleeping well."
2
Which of the following is a true statement regarding characteristics of chronic conditions? 1- Managing chronic conditions must be an individual process. 2- Difficult ethical issues arise in the care of people with chronic conditions. 3- Keeping chronic conditions under control requires occasional adherence to therapeutic regimens. 4- Managing chronic conditions is becoming less costly.
2
A client who will undergo emergency surgery suffers from chronic depression. The nurse is performing client teaching prior to the surgery. To make the client more comfortable, which of the following actions should the nurse take? Select all answers that apply. 1- Omit teaching if the client does not appear to be listening. 2- Wait for the client to complete speaking even when answers are slow. 3- Face the client when speaking to the client. 4- Address the client by title and last name. 5- Allow extra time for this client.
2,3,4,5
A client has learned of a terminal illness and impending death. The client asks the nurse to explain the concepts and care that are provided under the definition of palliative care. Which of the following would the nurse include in the explanation for this client? Select all that apply. 1- Provides pain relief 2- Includes chemotherapy 3- Integrates spirituality 4- Hastens death 5- Offers a team approach to care 6- Enhances quality of life
1,3,5,6,
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? 1- Denial 2- Anger 3- Bargaining 4- Acceptance
2
The hospice nurse understands that many factors directly or indirectly affect how a person dies. Which of the following is a changeable factor that can be influenced by the nurse when dealing with the dying patient? 1- Cultural attitude toward death 2- Relationship with the health care providers 3- Disease progression 4- Previous experiences with illness
2
Which aspect of a healthy lifestyle can the nurse encourage a patient to improve that can significantly enhance quality of life with a chronic condition? 1- Diet 2- Exercise 3- Hydration 4- Rest
2
While providing care to a terminally ill client, the client asks, "Am I dying?" Which response by the nurse would be most appropriate? 1- "What makes you think that you might be dying?" 2- "Tell me some more about what is on your mind." 3- "You're just having a bit of a set-back. You'll be fine." 4- "What has your physician told you about your condition?"
2
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? 1- Suspected awareness 2- Mutual pretense awareness 3- Closed awareness 4- Open awareness
3
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? 1- Offer small amounts of nourishment frequently 2- Gently massage the arms and legs 3- Use imagery, humor, and progressive relaxation 4- Encourage the patient to sleep
3
A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client? 1- Respect the client's and family members' choices. 2- Share emotional pain. 3- Abide by the dying client's wishes. 4- Ask the family members about spiritual care.
1
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? 1- apical pulse reaches 100 beats/minute 2- skin appears red and flushed 3- urine output increases 4- facial muscles contract
1
Which disability model is most appropriate for the nurse to use as a guide for planning care? 1- Biopsychosocial Model 2- Interface Model 3- Medical and Rehabilitation Model 4- Social Model
2
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. 1- Palliative care 2- Radiation 3- Angiogenesis 4- Respite care
1
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? 1- Avoid criticism or giving advice. 2- Spend time with client. 3- Provide palliative care. 4- Allow a period of privacy.
1
Which of the following is a true statement regarding characteristics of chronic conditions? 1- Managing chronic conditions must be an individual process. 2- Difficult ethical issues arise in the care of people with chronic conditions. 3- Keeping chronic conditions under control requires occasional adherence to therapeutic regimens. 4- Managing chronic conditions is becoming less costly.
2
All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason? 1- Allows for the nurse to facilitate the grieving process 2- Allows for the nurse to take the client through in the appropriate order 3- Allows for the nurse to understand when the grieving process should be concluded 4- Allows the nurse to express his or her feelings
1
Which of the following is a term that refers to individual, family, group, and cultural expressions of grief and associated behaviors? 1- Mourning 2- Grief 3- Bereavement 4- Spirituality
1
A diabetes nurse is performing health education with a 44-year-old woman who has recently learned that she has type 2 diabetes. The nurse is teaching the patient the importance of adhering to her prescribed treatment regimen. When providing this health education, the nurse should emphasize: 1- The patient's independent responsibility for making informed changes to her treatment regimen 2- The fact that adherence to a prescribed treatment regimen usually requires careful planning 3- The fact that well-intending friends and family members usually challenge the validity of the treatment regimen 4- The need to avoid online information sources because they tend to contradict evidence-based regimens
2
Which is a true statement regarding hospice care? 1- Clients have a life expectancy of 6 months or less. 2- It is cure-focused. 3- It encourages the prolongation of life through artificial means. 4- Patients have an acute illness.
1
As the moment of death approaches, which of the following does the nurse encourage the family to do? 1- Have the family sit in front of the client so they can be seen. 2- Rub the client's hand and arm to comfort the client. 3- Speak to the client in a calm and soothing voice. 4- Lie next to the client and hold the client.
3
A female patient with a diagnosis of breast cancer had a unilateral mastectomy with axillary node biopsy. The results of the biopsy have just come back positive, and the nurse and a coworker are discussing the patient's possible response to this news. Which of the following statements by the coworker should the nurse correct or respond to with teaching? 1- "If she finds out about this too quickly, she might lose hope in her battle with cancer." 2- "All considered, it's best if she's told this sooner rather than later." 3- "Ideally, her family will be around when she learns about her biopsy results." 4- "This will be hard to hear, but she deserves to know as much detail as she wants."
1
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: 1- Attitude of health care professionals toward terminal illness. 2- Lack of social support systems for the dying patient. 3- Fear of over-medicating the patient when pain is severe. 4- Patient's resistance to accepting care.
1
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? 1- Risk for constipation related to the effects of an opioid 2- Risk for ineffective cerebral tissue perfusion related to central nervous system effects of the drug 3- Caregiver role strain related to the need for around-the-clock pain control 2- Impaired physical mobility related to sedative effects of the drug
1
An elderly female client who has dizziness and osteoporosis fell at home and fractured her hip. She underwent surgical intervention for repair of the fractured hip and is now being discharged to a subacute care facility. In the comeback phase of the Trajectory Model of Chronic Illness, the nurse 1- Acknowledges the client's achievement when she walks to the bedside commode with her walker 2- Discontinues the intravenous needle and changes the surgical dressing prior to discharge from the hospital 3- Teaches the client about osteoporosis 4- Assesses postural blood pressures
1
During which phase of the Trajectory Model of chronic illness is the focus of nursing care on reinforcing positive behaviors and offering ongoing monitoring? 1- Stable 2- Pretrajectory 3- Trajectory onset 4- Unstable
1
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. 1- Maintaining client comfort 2- Arranging plans for after death 3- Supporting family members 4- Providing personal care 5- Completing a head-to-toe assessment 6- Encouraging fluids
1,3,4
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? 1- There remains a conspiracy of silence about dying despite progress in the area. 2- Most clinicians are very open to talking about disease and dying with clients. 3- Clients, for the most part, would gain hope if they were told about a poor prognosis. 4- Clients would ask for information if they really had a desire to know.
1
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? 1- Encourage the family members to express their feelings and listen to them in their frank communication. 2- Encourage conversations about the impending death of the client. 3- Be a silent observer and allow the client to communicate with the family members. 4- Encourage the client's family members to spend time with the client.
1
The nurse is with a client who has a chronic illness and is reinforcing positive behaviors and teaching about health promotion. For which phase of the trajectory model of chronic illness are these nursing actions appropriate? 1- Stable 2- Acute 3- Comeback 4- Downward
1
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? 1- "You will be able to stay only for approximately 1 month and then you will be discharged." 2- "You will be able to stay for 2 months before being discharged." 3- "There is no time limit for your stay. You can stay until you die." 4- "When your stay reaches 6 months, you will be recertified for a continued stay."
4
Which term refers to the period of time during which mourning of a loss takes place? 1- Grief 2- Mourning 3- Hospice 4- Bereavement
4
A nurse is caring for a client with a chronic disease. What statement made by the client indicates that additional teaching is necessary? 1- "Certain chronic diseases only affect men." 2- "Chronic disease does not typically cause sudden death." 3- "Most chronic disease can be traced to modifiable risk factors." 4- "The majority of chronic diseases are known."
1
A nurse practitioner would be applying the pre-trajectory model of chronic illness when she: 1- Advised a woman, whose mother has Huntington's chorea, and who is considering pregnancy, to get genetic testing. 2- Explained the significance of a serum glucose level of 160 mg/dL. 3- Encouraged a post-fracture patient to continue physical therapy. 4- Suggested home health care to a stroke victim.
1
Which "awareness context" is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise? 1- Mutual pretense awareness 2- Closed awareness 3- Suspected awareness 4- Open awareness
1
Your patient has a diagnosis of bladder cancer with metastasis. The patient asks you about hospice. Which principle underlies hospice care? 1- Death must be accepted. 2- Symptoms of terminal illness should not be treated. 3- Each member of the interdisciplinary team develops an individual plan of care for the patient. 4- Terminally ill patients should die in the hospital.
1
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? 1- The health care provider administers a lethal dose of medication via IV. 2- The health care provider provides the means for the clients to take their life. 3- The health care provider provides the means and waits to pronounce them dead. 4- The health care provider provides counseling and has a third party physician assist in the suicide.
2
A client has constant pain and peripheral neuropathy following chemotherapy for cancer. The nurse assesses the following behavior as a common characteristic of a person with a chronic illness: 1- The client and family do not allow the chronic illness to be the focal point of their lives. 2- The client stops taking some medications due to side effects that are disturbing to the client. 3- The client does not believe that the illness threatens self identity and body image. 4- The client adheres to the prescribed therapeutic regimen.
2
A hospice nurse performs a follow-up telephone call to the spouse of a client who died about 1 year ago. The spouse tells the nurse, "I'm always feeling so sad. Life just doesn't feel worth living." Further conversation reveals that the spouse is having trouble sleeping and eating since her husband's death and that the spouse is "drinking more since he died." The nurse identifies which nursing diagnosis as the priority? 1- Ineffective coping 2- Complicated grieving 3- Grieving 4- Stress overload
2
A 70-year-old woman is in the end stages of colorectal cancer and has tended to defer decision making to her oldest son, in accordance with the norms of her culture. The woman's health care provider has discussed the possibility of palliative radiotherapy with the patient and her family, and the patient has asked her son to make the decision whether to pursue or forego this treatment measure. How should the care team best respond? 1- Arrange a family meeting that includes social work and spiritual care. 2- Accommodate the patient's wishes and elicit a decision from the son. 3- Discuss the matter with the patient at a later time when the son is absent from the bedside. 4- Encourage the patient and her son to make a decision collaboratively.
2
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? 1- Make arrangements for the client to receive nutritional counseling. 2- Immediately administer drug therapy to restore renal function. 3- Make arrangements with the physician to administer immunosuppressants. 4- Provide the spouse with an emergency kit that contains small doses of oral morphine liquid.
4
A nursing instructor is discussing the causes of the increasing number of people with chronic conditions. Which of the following would the nurse correctly identify as a cause? 1- Lowered stress and increased physical activity lifestyles 2- Shorter lifespans 3- An increased mortality rate from infectious diseases 4- Early detection and treatment of diseases
4
A patient has had a traumatic amputation of the left leg above the knee following an industrial accident. What type of disability does this patient have? 1- Chronic disability 2- Impaired disability 3- Developmental disability 4- Acquired disability
4
The client is 45 years old and has a family history of breast cancer. The client was diagnosed with breast cancer 2 months ago. During a routine visit, the physician prescribes dexamethasone to be taken over a 3-week period. Which symptom would prompt the physician to add dexamethasone to the client's treatment plan? 1- Frequent bloody discharge from the breast 2- Massive swelling in the arm 3- Coarse skin around the breast 4- An 8-lb (3.6-kg) weight loss
4
The nurse is caring for a client with COPD who was recently admitted to the hospital with an acute exacerbation of the illness. What indicates to the nurse that the client is in the comeback phase of the Trajectory Model of Chronic Illness? 1- Unrelieved symptoms of the illness results in the interruption of the client's everyday life activities. 2- The illness course and symptoms are under control and the client's everyday life activities are managed. 3- The client begins to cope with implications of the illness. 4- The client gradually returns back to an acceptable way of life within the limits imposed by the illness.
4
Which statement is a misconception about chronic disease? 1- Almost half of chronic deaths occur prematurely in people 2- Chronic illness typically does not result in sudden death. 3- The major cause of chronic disease is known. 4- Chronic illnesses cannot be prevented.
4
Which statement is a misconception about chronic disease? 1- Almost half of chronic disease-related deaths occur prematurely in people 2- Chronic illness typically does not result in sudden death. 3- The major cause of chronic disease is known. 4- Chronic illnesses cannot be prevented.
4
A client is a paraplegic, lives alone, and just had a total shoulder arthroplasty. In planning for discharge, the nurse arranges for 1- A home health nurse to assess the client's living situation 2- Physical therapy to provide exercises for the client three times each week 3- Admittance to a rehabilitation unit 4- A nursing assistant who provides care every day during the day
3
A nurse is developing a teaching plan for a terminally ill client and his family about about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in the teaching plan? 1- Each client experiences each of the stages. 2- Typically, the stages occur in succession. 3- The stages are applicable to any loss. 4- Most clients reach acceptance by the time of death
3
A nurse is preparing a presentation for a local community group addressing the influences on health care delivery. Which of the following would the nurse include in presentation when describing disease patterns? 1- Most infectious diseases have been controlled or eradicated. 2- The prevalence of chronic illness is decreasing due to the emphasis on healthy living. 3- Obesity along with conditions associated with it has become a major health concern. 4- People with acute illnesses are considered the largest group of health care consumers.
3
According to evidence-based research, patients in the pre-death period need three types of experiences. They need to understand what is happening to them, to experience the pain of "feeling bad," and participate in decisions about their care. Therefore, the primary nursing responsibility during the pre-death period is to: 1- Help the family understand the reality of impending death. 2- Adjust the patient's medications to provide a pain-free experience. 3- Establish a trusting relationship with the patient. 4- Verify that all legal matters are being addressed according to the patient's wishes.
3
A client has had multiple admissions for heart failure. The client is now on continuous oxygen, bedridden, and provided care by his family. The nurse discusses end-of-life preferences with the client. The nurse assesses the client is in the phase of the Trajectory Model of Chronic Illness known as 1- Stable 2- Acute 3- Crisis 4- Downward
4
