End Of Life Care

A female client has a terminal illness, and her spouse is distraught about the unrelenting pain she experiences. Which should the nurse implement as the most effective measure to alleviate the spouse's distress?

Answer: Engage the spouse in providing comfort. Rationale: The most effective method of alleviating the spouse's distress is to provide comfort for both individuals. By helping the spouse to comfort the client, the spouse helps to alleviate the client's discomfort and thus helps to attenuate his own distress. This is because providing comfort to the client gives the spouse a sense of purpose, control, and value.

A female client's spouse becomes distraught when thinking about his wife's grave prognosis. Which should the nurse implement to promote hope for the spouse?

Answer: Encourage formation of achievable goals. Rationale: The nurse assists the spouse in developing realistic, achievable goals to promote the contextual dimension of hope

A nurse is caring for an older client who is terminally ill. Which of the following signs indicates to the nurse that death may be imminent?

Answer: Irregular, noisy breathing and cold, clammy skin Rationale: The clinical signs of impending or approaching death include inability to swallow; pitting edema; decreased gastrointestinal and urinary tract activity; bowel and bladder incontinence; loss of motion, sensation, and reflexes; cold or clammy skin; cyanosis; lowered blood pressure; NOISY-IRREGULAR BREATH; and Cheyne-Stokes respirations.

A client has died, and a nurse asks a family member about the funeral arrangements. The family member refuses to discuss the issue. The nurse's appropriate action is to:

Answer: Remain with the family member without discussing funeral arrangements. Rationale: The family member is exhibiting the first stage of grief (denial), and the nurse should remain with the family member.

A nurse recognizes that which of the following interventions is unlikely to facilitate effective communication between a dying client and his or her family?

Answer: The nurse makes decisions for the client and family in order to relieve them of unnecessary demands.

A 39-year-old man learned today that his 36-year-old wife has an incurable cancer and is expected to live not more than a few weeks. The nurse identifies which of these responses by the husband as indicative of effective individual coping?

Answer: He expresses his anger at God and the health care providers for allowing this to happen. Rationale: The expression of anger is known to be a normal response to impending loss, and the anger may be directed toward the self, the dying person, God or other spiritual being, or the caregivers.

A nurse is caring for a client with terminal cancer who is close to death. In reviewing the plan of care, the nurse determines that a priority is to:

Answer: Maintain the client's dignity and self-esteem, and make the client as comfortable as possible. Rationale: The client should be able to interact with family members and make care decisions. Family needs are important, but the client needs are most important. Prescribed treatment needs to be carried out, but making the client comfortable and maintaining dignity is the priority.

A client and her husband are being discharged from the hospital after delivering a stillborn infant. They ask about the possibility of attending a bereavement support group in the community. The nurse is aware that this request from the parents is an indication of:

Answer: Normal grieving Rationale: A perinatal bereavement support group can help the parents work through their pain by nonjudgmental sharing of feelings.

A client who was struck by a car while jogging is brought to the emergency department by the ambulance team. The client is unconscious, and a ruptured spleen is suspected. Emergency measures are instituted but are unsuccessful. The client's fiancée is with the client and tells the nurse that the client is an organ donor. In anticipation that the client's eyes will be donated, which should the nurse implement initially?

Answer: Close the deceased client's eyes and place a small ice pack on the eyes. Rationale: When a corneal donation is anticipated, the client's eyes are closed and gauze pads with a small ice pack are placed on the client's eyes. The head of the bed should be elevated. Antibiotic eye drops also may be prescribed. These actions will assist in preventing infection and edema. Within 2 to 4 hours the eyes are enucleated. The cornea is usually transplanted within 24 to 48 hours.

A licensed practical nurse (LPN) is providing instructions to a nursing assistant who is preparing to care for a deceased client whose eyes will be donated. The nurse intervenes if the nursing assistant does which of the following?

Answer: Closes the client's eyes and places a dry sterile dressing over the eyes Rationale: When a corneal donor dies, the eyes are closed and gauze pads wet with saline are placed over them with a small ice pack. Within 2 to 4 hours the eyes are enucleated. The cornea is usually transplanted within 24 to 48 hours.