Med-Surg: Ch 10 Chapter 10: End-of-Life Care
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
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 nurse evaluates that a dying client is in the anger stage of reacting to her prognosis. Which of the following statements is most consistent with this interpretation?
"I took care of myself and it's not fair that this has happened."
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."
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 month."
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."
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?
Administer bronchodilators and corticosteroids, as prescribed.
A young client dies suddenly in the ER after suffering from a brief illness, and the nurse has been asked to obtain authorization for an autopsy from the client's parents. Being mindful of cultural diversity and beliefs about death, which ethnic group would be most likely to agree to an autopsy?
African American
While palliative care can be offered in a multitude of settings (home, inpatient hospice, etc.), there are instances where institutionally based palliative care is most appropriate. Which factors contribute to the decision of whether to use institutional palliative care?
All of the options are correct
Within a care team meeting in your long-term care facility, discussions continue with family members of a 59-year-old client regarding his deteriorating condition. The physician has indicated that the client's condition is terminal and his family doesn't want the client to know the gravity of his condition - they don't want him to worry. As his nurse, why do you advocate that the client needs to know the truth?
All of the options are correct.
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?
Restorative measures
A nurse who works in the specialty of palliative care frequently encounters issues and situations that constitute ethical dilemmas. What issue has most often presented challenging ethical issues, especially in the context of palliative care?
Ability of technology to prolong life beyond meaningful quality of life
Which intervention should a nurse perform during the grieving period when caring for a dying client?
Avoiding criticizing or giving advice
Which term refers to the period of time during which mourning of a loss takes place?
Bereavement
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 palliative care as giving up
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?
Rules concerning completion of all cure-focused medical treatment
Which term is used to describe the personal feelings that accompany an anticipated or actual loss?
Grief
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?
Depression
The nurse is admitting a client with a diagnosis of ovarian cancer. She has just been told that her ovarian cancer is terminal. What question should the nurse include in a spiritual assessment?
Does she have a sense of peace of mind and a purpose to her life?
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
Which is also known as a proxy directive?
Durable power of attorney for health care
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.
Encourage the client to explain his wishes. Advise the client's physician of the client's condition. Control the client's pain with prescribed medication.
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 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 organization of a client's care on the palliative care unit is based on interdisciplinary collaboration. How does interdisciplinary collaboration differ from multidisciplinary practice?
It is based on communication and cooperation between disciplines.
A patient with end-stage heart failure has participated in a family meeting with the interdisciplinary team and opted for hospice care. On what belief should the patient's care in this setting be based?
Meaningful living during terminal illness is best supported in the home.
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?
Mottling of the lower limbs
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
A group of nursing students is reviewing information about palliative care. The students demonstrate a need for additional review when they identify which of the following?
Palliative care is the same as hospice care
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?
Provide gentle oral care after each meal.
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?
Providing realistic emotional preparation for death
A woman experienced the death of her husband from a sudden myocardial infarction 5 weeks ago. The nurse recognizes that the woman will be going through the process of mourning for an extended period of time. What processes of mourning will allow the woman to accommodate the loss in a healthy way? Select all that apply.
Reinvesting in new relationships at the appropriate time Reminiscing about the relationship she had with her husband Relinquishing old attachments to her husband at the appropriate time
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
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.
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.
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?
The client and family should be viewed as a single unit of care.
A clinic nurse is providing client education prior to a client's scheduled palliative radiotherapy to her spine. At the completion of the client teaching, the client continues to ask the same questions that the nurse has already addressed. What is the plausible conclusion that the nurse should draw from this?
The client has not achieved the desired learning outcomes.
When providing palliative care to a 95 year-old terminally ill client, what should a nurse keep in mind when coming to terms with the client's approaching death? Select all that apply.
The client may have some unfinished life goals. The client has the right to decide how to spend the rest of his or her life. The client should be informed about advance directives.
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?
The perception that palliative care constitutes "giving up"
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?
The stages are applicable to any loss.
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?
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?
Uplifting memories
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?
Use imagery, humor, and progressive relaxation
A 6-year-old client is in the last stage of leukemia. Despite the nurse's administration of prescribed pain medication, the client is still in pain due to fear and anxiety. Which nursing intervention should the nurse use to increase the efficacy of the pain medication and make the client more comfortable?
Use imagery, humor, and progressive relaxation.
The nurse has observed that an older adult client with a diagnosis of end-stage kidney disease seems to prefer to have his eldest son make all of his health care decisions. While the family is visiting, the client explains that this is a cultural practice and very important to him. How should the nurse best respond?
Work with the team to negotiate informed consent.
While offering end-of-life nursing care to a 72-year-old male with late stage bone cancer, the nurse visits him at home four times weekly. At each visit the nurse assess the client, monitoring the efficacy of pain medications, adjusting doses within physician ordered parameters and discussing potential needs with the client's spouse- who is the primary caregiver. What is another very important assessment the nurse performs in this home?
assessment of caregiver's physical and emotional health
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
A nurse who has just taken a new nursing position at an inpatient hospice begins to question if they are "strong enough" to withstand the continual dying of clients. The nurse's mentor relates the most effective method of dealing with client loss. What action is instrumental to being able to offer effective care and comfort to dying clients?
exploring personal mortality and feelings on death and dying
Why might a client who is approaching death suddenly vomit?
intestinal distention
As a client approaches death, respirations become noisy. This is the result of which type physical event?
musculoskeletal change
A type of comprehensive care for clients whose disease is not responsive to cure is
palliative care.
A client is dying. Place the following steps in the usual sequence of grieving that the nurse would anticipate for the client.
• Denial • Anger • Bargaining • Depression • Acceptance
