MEDSURG II: Saunders End of Life Care

The community health nurse is providing an educational session to a group of community members regarding the issue of organ donation. A member of the group asks the nurse, "How old does someone have to be to provide consent for organ donation?" Which response should the nurse make? 1."Written consent is never required to become a donor." 2."A donor must be 18 years of age or older to provide consent." 3."A person can sign papers to become a donor at 16 years of age." 4."The family is responsible for decision making about organ donation at the time of death."

Answer: 2 Rationale: Any person 18 years of age or older may become an organ donor by written consent. In the absence of appropriate documentation, a family member or legal guardian may authorize donation of the decedent's organs. Therefore, the statements in the remaining options are incorrect.

The nurse is caring for a terminally ill client who is experiencing delirium. When caring for this client, the nurse should take which action? 1.Provide a dark room. 2.Provide a well-lighted room. 3.Reorient the client every 8 hours. 4.Withhold benzodiazepines and sedatives.

Answer: 2 Rationale: Delirium may occur during the last days of life. Nursing management of a terminally ill client experiencing delirium includes providing a room that is quiet, well lighted, and familiar to reduce the effects of delirium; reorienting the dying client to client, place, and time with each encounter; and administering prescribed benzodiazepines and sedatives as needed.

While the nurse is caring for a client with severe cardiac disease, the client states, "If anything should happen to me, please make sure that the doctors do not try to push on my chest and revive me." Which nursing action is appropriate? 1.Tell the client that the family must agree with this decision. 2.Notify the health care provider (HCP) of the client's request. 3.Consult with the ethics committee to assist the client and family. 4.Plan a nursing staff conference to discuss the client's statement.

Answer: 2 Rationale: External cardiac massage is a type of treatment that a client can refuse. The most appropriate nursing action is to notify the HCP because a written do not resuscitate (DNR) prescription from the HCP must be present on the client's record. The DNR prescription must be reviewed or renewed on a regular basis per agency policy. Telling the client that the family must agree with the decision and consulting with the ethics committee are incorrect and violate the client's rights. A nursing staff conference may be appropriate but only after the HCP is contacted and notified of the client's request.

A client brought to the emergency department is dead on arrival (DOA). The family of the client tells the health care provider (HCP) that the client had terminal cancer. The HCP examines the client and asks the nurse to contact the medical examiner regarding an autopsy. Family members of the client tell the nurse that they do not want an autopsy performed. Which response to the family is appropriate? 1."The decision is made by the medical examiner." 2."An autopsy is mandatory for any client who is DOA." 3."I will contact the medical examiner regarding your request." 4."It is required by federal law. Why don't we talk about it, and why don't you tell me why you don't want the autopsy done?"

Answer: 3 Rationale: An autopsy is required by state law in certain circumstances, including the sudden death of a client and a death that occurs under suspicious circumstances. A client may have provided oral or written instructions regarding an autopsy after death. If an autopsy is not required by law, these oral or written requests will be granted. If no oral or written instructions were provided, state law determines who has the authority to consent for an autopsy. Most often, the decision rests with the surviving relative or next of kin.

A client with terminal cancer arrives at the emergency department dead on arrival (DOA). After an autopsy is prescribed, the client's family requests that no autopsy be performed. Which response to the family is most appropriate? 1."The decision is made by the medical examiner." 2."An autopsy is mandatory for any client who is DOA." 3."I will contact the medical examiner regarding your request." 4."It is required by federal law. Tell me why you don't want the autopsy done."

Answer: 3 Rationale: An autopsy is required by state law in certain circumstances, including the sudden death of a client and a death that occurs under suspicious circumstances. A client may have provided oral or written instructions regarding an autopsy after death. If an autopsy is not required by law, these oral or written requests will be granted. If no oral or written instructions were provided, state law determines who has the authority to consent for an autopsy. Most often, the decision rests with the surviving relative or next of kin.

The nurse is caring for a terminally ill client who is experiencing Cheyne-Stokes respirations. Which assessment finding should the nurse expect to note? 1.Continuous rapid regular breathing 2.Periods of apnea followed by bradypnea 3.Periods of apnea followed by deep rapid breathing 4.Periods of bradypnea followed by periods of tachypnea

Answer: 3 Rationale: Cheyne-Stokes respirations are characterized by alternating periods of apnea and deep rapid breathing. The descriptions in the remaining options are incorrect.

The hospice nurse visits a client who is dying of ovarian cancer. During the visit, the client says, "If I can just live long enough to celebrate my daughter's sweet-16 birthday party, I'll be ready to die." The nurse notes that the client is experiencing which phase of coping? 1.Anger 2.Denial 3.Bargaining 4.Depression

Answer: 3 Rationale: Denial, bargaining, anger, depression, and acceptance are recognized stages that a client facing a life-threatening illness experiences. Bargaining identifies a behavior in which the individual is willing to do anything to avoid loss or change the prognosis or fate. Anger also may be a first response to upsetting news, and the predominant theme is "Why me?" or blaming others. Denial is expressed as shock and disbelief and may be the first response to hearing bad news. Depression may be manifested by hopelessness, weeping openly, or remaining quiet or withdrawn.

The nurse is caring for a terminally ill client who is experiencing dyspnea. When caring for this client, the nurse should place the client in which position? 1.Prone 2.Supine 3.Lateral 4.Trendelenburg's

Answer: 3 Rationale: Dyspnea may occur during the last days of life. Nursing management of a terminally ill client experiencing dyspnea includes elevating the head and/or positioning the client on the side (lateral) to improve chest expansion. The positions noted in the remaining options will increase the dyspnea.

A client who suffered a severe head injury has had vigorous treatment to control cerebral edema. Brain death has been determined. The nurse prepares to carry out which measure to maintain viability of the kidneys before organ donation? 1.Assessing lung sounds 2.Monitoring temperature 3.Administering intravenous (IV) fluids 4.Performing range-of-motion exercises to the extremities

Answer: 3 Rationale: Perfusion to the kidney is affected by blood pressure, which in turn is affected by blood vessel tone and fluid volume. Therefore, the client who was previously dehydrated with medications to control intracranial pressure is now in need of rehydration to maintain perfusion to the kidneys. The nurse should prepare to infuse IV fluids as prescribed and continue to monitor urine output. The remaining options will not maintain viability of the kidneys.

The nurse is supervising the postmortem care of a client. Which action by the unlicensed assistive personnel (UAP) performing the care is appropriate? 1.Keeps the client's body in a flat, supine position 2.Closes the client's eyes by taping the eyelids shut 3.Elevates the head of the bed 30 degrees as soon as possible after death 4.Removes the client's dentures and places them in a denture cup with the client's name on the lid

Answer: 3 Rationale: The nurse may delegate postmortem care to UAPs, but the nurse must supervise the postmortem care. The care given must protect the client's body from damage or disfigurement. Elevating the head of bed immediately after the client's death can help reduce facial discoloring from livor mortis. Using tape may damage the delicate eyelid tissues; dentures should be placed inside the client's mouth during postmortem care to maintain facial structure.

The nurse is caring for a client with terminal cancer who is close to death. On reviewing the plan of care, the nurse determines that which intervention is the priority? 1.Keep the client well sedated so that the client is totally unaware of what is happening. 2.Make sure the family has privacy and is kept informed of what is happening at all times. 3.Maintain the client's dignity and self-esteem, and make the client as comfortable as possible. 4.Carry out the health care provider's (HCP's) prescriptions so that all prescribed treatments are done on time.

Answer: 3 Rationale: The nurse needs to focus on the needs of the client, keep the client comfortable, and maintain the client's dignity and self-esteem. Although the nurse needs to provide adequate control of pain, it is not necessary to keep the client sedated so that the client is totally unaware of what is happening. The client should be able to interact with family members and make care decisions. Family needs are important, but the client's needs are more important. Prescribed treatment needs to be carried out, but making the client comfortable and maintaining dignity are the priority.

The nurse is preparing to care for a dying client, and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply. 1.Discourage reminiscing. 2.Make the decisions for the family. 3.Encourage expression of feelings, concerns, and fears. 4.Explain everything that is happening to all family members. 5.Touch and hold the client's or family member's hand if appropriate. 6.Be honest and let the client and family know they will not be abandoned by the nurse.

Answer: 3,5,6 Rationale: The nurse must determine whether there is a spokesperson for the family and how much the client and family want to know. The nurse needs to allow the family and client the opportunity for informed choices and assist with the decision-making process if asked. The nurse should encourage expression of feelings, concerns, and fears and reminiscing. The nurse needs to be honest and let the client and family know they will not be abandoned. The nurse should touch and hold the client's or family member's hand, if appropriate.

A client brought to the emergency department is dead on arrival (DOA). The health care provider (HCP) examines the client and asks the nurse to contact the medical examiner regarding an autopsy. The spouse of the client tells the nurse that she does not want an autopsy performed. Which response should the nurse make? 1."We won't have one done if you don't want one." 2."There is not much choice here. If they want to do it you need to let them." 3."Let's talk about why you don't want one done. This can help medical science and research." 4."Let me contact your husband's HCP and you can discuss your concerns with him. I will stay with you when you do this."

Answer: 4 Rationale: An autopsy is required by state law in certain circumstances, including the sudden death of a client and a death that occurs under suspicious circumstances. The client may have provided oral or written instructions regarding an autopsy following death. If an autopsy is not required by law, these oral or written requests will be granted. If no oral or written instructions were provided, state law determines who has the authority to consent for an autopsy. Most often, the decision rests with the surviving relative or next of kin. The correct option addresses the client's (the spouse) feelings and addresses the issue. In addition, the nurse acts as an advocate and is compassionate in telling the client that he or she will stay with the spouse when she speaks to the HCP.

The nurse is caring for a client who has a medical diagnosis of end-stage chronic obstructive pulmonary disease (COPD). The client is in severe respiratory distress and tells the nurse, "Put me on the machine." The client's family says, "No, we are not going to do this again." The client has a do not resuscitate (DNR) prescription. What is the nurse's priority action? 1.Prepare the client for intubation and mechanical ventilation. 2.Talk to the family about the client's right to change his mind. 3.Administer an antianxiety medication to the client to ease his breathing. 4.Notify the health care provider (HCP) that the client is rescinding the DNR prescription.

Answer: 4 Rationale: COPD cannot be cured. End-of-life issues are important for clients and families to understand; however, the client always has the right to rescind {withdraw; overturn} the decision as long as he or she is mentally competent. The nurse needs the HCP to reverse the DNR prescription on the chart. The HCP also needs to be informed about the conflict between the client and his family. Option 1 is incorrect because the decision to take this action is determined by the HCP. Option 2 is incorrect because the HCP should handle this. The action identified in option 3 can help but could alter the client's mental capacity to make decisions. Some states offer DNR Comfort Care and DNR Comfort Care Arrest protocols. Protocols in these instances list specific actions that health care providers will take when providing cardiopulmonary resuscitation.

The nurse is caring for a dehydrated client who is terminally ill. When caring for this client, the nurse should take which action? 1.Force the client to eat. 2.Force the client to drink. 3.Provide the unconscious client with ice chips. 4.Use moist cloths and swabs for mouth comfort.

Answer: 4 Rationale: Dehydration may occur during the last days of life. Hunger and thirst are rarely experienced in the last days of life, and as the end approaches the client tends to take in less food and fluid. Nursing management includes assessing the condition of mucous membranes frequently to prevent excessive dryness, maintaining complete regular oral care, not forcing the client to eat or drink, encouraging consumption of ice chips and sips of fluids in the conscious client, and the use of moist cloths and swabs in the unconscious client to prevent aspiration.

The nurse monitors a terminally ill client for which physical signs of approaching death? Select all that apply. 1.Increased appetite 2.Loss of consciousness 3.Loss of bowel control 4.Loss of bladder control 5.Decreased blood pressure 6.Decreased tactile sensation

Answer: 2,3,4,5,6 Rationale: Physical signs of approaching death include decreased appetite and thirst, decreased blood pressure, loss of consciousness, loss of bowel and bladder control, and decreased tactile sensation.

The nurse is caring for a terminally ill child who is receiving palliative care. When explaining the purpose of palliative care to the child's caregiver, the nurse recognizes the need for additional instruction when the caregiver makes which statement? 1."Palliative care interventions hasten death." 2."Palliative care promotes optimal functioning." 3."Palliative care will provide pain management." 4."Palliative care will provide symptom management."

Answer: 1 Rationale: Palliative care interventions do not serve to hasten death; rather, they provide pain and symptom management, attention to issues faced by the child and family with regard to death and dying, and promotion of optimal functioning and quality of life.

The nurse is caring for a terminally ill adolescent client. When caring for this client the nurse should implement which intervention? 1.Comply with the client's wishes at all times. 2.Encourage the client to be dependent on hospital staff. 3.Refuse to answer questions related to impending death. 4.Encourage the client to maintain maximum self-control.

Answer: 4 Rationale: Interventions appropriate when caring for a terminally ill adolescent include avoiding alliances with either the parent or the child, structuring hospital admission to allow for maximum self-control and independence, and answering the adolescent's questions honestly. Complying with the client's wishes at all times is not therapeutic.

The nurse is preparing a plan of care for a client who just delivered a dead fetus. Which initial action should the nurse include in the client's plan of care to meet the emotional needs of the client and spouse? 1.Allow family members to name the infant. 2.Encourage the client to talk about the dead fetus. 3.Allow the client and the spouse to hold the infant. 4.Assess the client's and the spouse's perception of the event.

Answer: 4 Rationale: The initial intervention in planning to meet the emotional needs of the client and her spouse is to assess their perception of the event. Although the actions in the remaining options are likely to be components of the plan of care, the initial intervention in planning is to assess the perception of the event.

The nurse is caring for a dying client who adheres to Judaism. The nurse demonstrates cultural sensitivity when caring for this client by taking which action? 1.Encouraging a rabbi to sit with the client 2.Encouraging the client to have time alone 3.Asking the family if they would like an autopsy done 4.Encouraging the family to agree to removal of life support

Answer: 1 Rationale: When caring for a client who adheres to Judaism, end-of-life care includes recognizing that prolongation of life is important (a client on life support must remain so until death). A dying client should not be left alone (a rabbi's presence is desired), and autopsy and cremation are forbidden.

The nurse is caring for a client who is dying. The nurse recognizes that which intervention is likely to facilitate therapeutic communication between the dying client and his or her family? Select all that apply. 1.The nurse encourages the client and family to identify and discuss feelings openly. 2.The nurse assists the client and family in carrying out spiritually meaningful practices. 3.The nurse makes decisions for the client and family to relieve them of unnecessary demands. 4.The nurse maintains a calm attitude and one of acceptance when the family or client expresses anger. 5.The nurse is supportive and nonjudgmental of the client's or family's verbalized concerns and feelings.

Answer: 1,2,4,5 Rationale: The incorrect option describes an intervention in which the nurse removes autonomy and decision-making from the client and family, who are already experiencing feelings of loss of control in that they cannot change the process of dying. This is an ineffective intervention and could further impair communication. Maintaining effective and open communication among family members affected by death and grief is of the greatest importance. Encouraging discussion of feelings is likely to enhance communications. Spiritual practices give meaning to life and have an impact on how people react to crisis, so it is also an effective intervention. The client and family need to know that someone will be there who is supportive and nonjudgmental.

Which interventions should the nurse take for a deceased client whose eyes will be donated? Select all that apply. 1.Close the client's eyes. 2.Elevate the head of the bed. 3.Place a warm compress on the eyes. 4.Place a dry sterile dressing over the eyes. 5.Place wet saline gauze pads and a cool pack on the eyes.

Answer: 1,2,5 Rationale: When a cornea donor dies, the eyes are closed, the head of the bed is elevated to prevent edema, and gauze pads wet with saline are placed over the eyes with a cool pack or small ice pack. Antibiotic eyedrops may also be prescribed. A warm compress will promote edema. Placing dry sterile dressings over the eyes serves no useful purpose. Within 2 to 4 hours the eyes are enucleated. The cornea is usually transplanted within 24 to 48 hours.

The nurse is caring for a terminally ill client. The nurse has developed a close relationship with the family of the client. Which interventions should the nurse employ? Select all that apply. 1.Making decisions for the family 2.Encouraging family discussion of feelings 3.Accepting the family's expressions of anger 4.Allowing spiritual practices identified by the family 5.Preserving the family's sense of self-direction and control

Answer: 2,3,4,5 Rationale: Maintaining effective and open communication among family members affected by death and grief is of utmost importance. The nurse needs to maintain and enhance communication, as well as preserve the family's sense of self-direction and control. Option 2 is likely to enhance communications. Option 3 is also an effective technique, and the family needs to know that someone will be there who is supportive and nonjudgmental. Option 4 is also an effective intervention, because spiritual practices give meaning to life and have an impact on how people react to crisis. Option 5 is also therapeutic. Option 1 removes autonomy and decision making from the family at a time when they are already experiencing feelings of loss of control. This is an ineffective intervention that can impair communication.

During morning rounds the nurse comes into the room of a client who is unresponsive and near death. Two unlicensed assistive personnel (UAPs) are bathing the client, and their conversation centers on their plans for a weekend party. How should the nurse best intervene? 1.Say nothing, but check the client's vital signs and level of consciousness. 2.Tell the UAPs, "You need to be focusing on the client right now, not your party." 3.Remind the UAPs, "Remember that Mr. Smith can hear everything you are saying!" 4.Speak to the client and touch his hand, saying, "Hello, Mr. Smith, we will be finished with your bath shortly."

Answer: 3 Rationale: Even though clients who are near death are often not responsive, it is thought that the sense of hearing remains intact until death occurs. Therefore, conversation in the presence of the client must occur as if the client can hear. It is not wrong to remind the UAPs to alter their conversation while in the client's room, but it would be better to remind them out of the client's earshot. The correct answer has the nurse modeling the correct behavior to the UAPs.

The nurse is caring for a client with cancer. The client tells the nurse that a lawyer will be arriving today to prepare a living will and asks the nurse to act as one of the witnesses for the will. What is the most appropriate nursing action? 1.Agree to act as a witness. 2.Call the health care provider (HCP). 3.Ask another nurse to serve as a witness. 4.Ask the client who might be available to serve as a witness.

Answer: 4 Rationale: A living will addresses the withdrawal or withholding of life-sustaining interventions that unnaturally prolong life. It identifies the client who will make care decisions if the client is unable to take action. It is witnessed and signed by 2 people who are unrelated to the client. Nurses or employees of a facility in which the client is receiving care and beneficiaries of the client must not serve as a witness. There is no reason to call the HCP.

The nurse is caring for a client who is terminally ill. When assessing the client, the nurse recognizes which as the most common distress symptom near the end of life? 1.Pain 2.Anxiety 3.Depression 4.Withdrawal

Answer: 2 Rationale: Anxiety is the most common distress symptom near the end of life. Anxiety is an uneasy feeling whose cause is not easily identified. Pain, depression, and withdrawal may occur but are not the most common distress symptom.

The nurse is caring for a Hindu client who has just died. The nurse demonstrates cultural awareness when providing postmortem care by taking which action? 1.Washing the body after death 2.Removing sacred threads from the body 3.Prohibiting family members from viewing the body 4.Instructing the unlicensed assistive personnel (UAP) to not wash the body

Answer: 4 Rationale: When caring for a Hindu client, end-of-life care includes rituals such as tying a thread around the neck or wrist of the dying client and sprinkling the client with special water. After death, the sacred threads are not removed and the body is not washed. It is culturally acceptable for the family members to view the body.

A terminally ill client asks the nurse about hospice care and the nurse educates the client about the hospice program. Which statement by the client indicates that teaching has been effective? 1."Clients have a prognosis of 6 months or less to live." 2."Clients have a prognosis of 10 months or less to live." 3."Clients have a prognosis of 12 months or less to live." 4."Clients have a prognosis of 18 months or less to live."

Answer: 1 Rationale: For admission to hospice care, the client must desire the services and the client to be admitted has a prognosis of 6 months or less to live. In hospice care, care is provided when curative treatment such as chemotherapy has been stopped. Care is provided in 60- and 90-day periods with an opportunity to continue if eligibility criteria are met. Ongoing care is provided by registered nurses, social workers, chaplains, and volunteers. Therefore, the lengths of times in the remaining options are incorrect.

The mother of 6-year-old twins says to the nurse, "My mother-in-law doesn't think our children should come to the funeral service for their grandfather. What do you advise?" The nurse should respond by making which statement? 1."What do you and your husband believe is the right thing for your children?" 2."By all means have them attend. Not to do so would promote postmortem grief." 3."It's a difficult decision, but given their young age, perhaps omitting the wake and just including the funeral would be best." 4."I agree with your mother-in-law. Your mother-in-law is upset enough as it is. Tell your children that their grandfather is in heaven."

Answer: 1 Rationale: The most appropriate therapeutic response is the one that encourages open expression of feelings and empowers the grieving relative. Values, beliefs, and practices differ depending on the client's ethnic and spiritual backgrounds, and the nurse should not push a decision based on the nurse's own belief system. Options 2, 3, and 4 are nontherapeutic. Option 2 provides incorrect information related to postmortem grieving. Options 3 and 4 offer the nurse's opinion and impose the nurse's own beliefs.

The spouse of a terminally ill client steps out of his room in tears. The spouse tells the nurse, "I don't know what I'm going to do when he's gone!" What is the nurse's best response? 1."This must be very hard for you." 2."Don't worry, things will be fine." 3."I know. It will get easier with time." 4."You need to be strong for him! Don't cry."

Answer: 1 Rationale: When a family member or caregiver is expressing the pain of loss, the nurse should not minimize that person's feelings. It is important to avoid general or trite assurances. Simply listening to the spouse and acknowledging how difficult this situation is, as in responding "This must be very hard for you," is the best example of therapeutic communication. Responses that belittle or minimize the family member's feelings or those that place the client's feelings on hold are not therapeutic.

The nurse recognizes that which interventions are likely to facilitate effective communication between a dying client and family? Select all that apply. 1.The nurse encourages the client and family to identify and discuss feelings openly. 2.The nurse assists the client and family in carrying out spiritually meaningful practices. 3.The nurse removes autonomy from the client to alleviate any unnecessary stress for the client. 4.The nurse makes decisions for the client and family to relieve them of unnecessary demands. 5.The nurse maintains a calm attitude and one of acceptance when the family or client expresses anger.

Answer: 1,2,5 Rationale: Maintaining effective and open communication among family members affected by death and grief is of the greatest importance. Option 1 describes encouraging discussion of feelings and is likely to enhance communication. Option 2 is also an effective intervention because spiritual practices give meaning to life and have an impact on how people react to crisis. Option 5 is also an effective technique because the client and family need to know that someone will be there who is supportive and nonjudgmental. The remaining options describe the nurse removing autonomy and decision making from the client and family, who are already experiencing feelings of loss of control in that they cannot change the process of dying. These are ineffective interventions that could impair communication further.

The nurse is monitoring ongoing care for a potential organ donor who has been diagnosed with brain death. Which finding indicates to the nurse that the standard for ongoing care has been maintained? 1.PaO2 70 mm Hg 2.Urine output 100 mL/hr 3.Heart rate 52 beats/min 4.Blood pressure 90/48 mm Hg

Answer: 2 Rationale: Adequate perfusion must be maintained to all vital organs in order for the client to remain viable as an organ donor. Guidelines may be used to maintain organ viability, but adequate perfusion is necessary. The correct option is the only one that indicates adequate perfusion. The incorrect options identify lower than normal values, thus adequate perfusion would not be maintained.

The nurse caring for a terminally ill client has developed a close relationship with the client's family. Which interventions should the nurse include in dealing with the family during this difficult time? Select all that apply. 1.Making decisions for the family 2.Encouraging family discussion of feelings 3.Accepting the family's expressions of anger 4.Preserving the family's sense of self-direction and control 5.Maintaining open communication among family members 6.Facilitating the use of spiritual practices identified by the family

Answer: 2,3,4,5,6 Rationale: Maintaining effective and open communication among family members affected by death and grief is of utmost importance. The nurse needs to maintain and enhance communication as well as preserve the family's sense of self-direction and control. The incorrect option removes autonomy and decision-making from the family at a time when they are already experiencing feelings of loss of control. This is an ineffective intervention that could impair communication. Encouraging family discussion of feelings and maintaining open communication among family members are likely to enhance communication. Spiritual practices give meaning to life and have an impact on how people react to crisis, so this option should be included. Accepting the family's expression of anger and preserving the family's sense of self-direction and control are effective techniques, so that the family knows there is someone there who is supportive and nonjudgmental.

A client who has been diagnosed with a terminal illness has an advance directive form, needs it to be signed, and asks the nurse to sign it as a witness. What is the nurse's best action? 1.Sign the form as requested. 2.Request the client's son to sign as a witness. 3.Ask a nonmedical client, such as a social worker, to witness the form. 4.Ask another nurse who is not assigned to the client to witness the form.

Answer: 3 Rationale: An advance directive is a legal document that relays a client's decisions about future medical care. When implementing a legal document, the best person to act as a witness is someone who is not connected to the client either by relation (such as the client's son), or as a caregiver or potential caregiver. In this situation the witness should not be a caregiver, medical personnel, or anyone related to the client. A nonmedical witness is the best choice.

The nurse is caring for a terminally ill client who is unresponsive to verbal stimuli. The client's spouse asks if her husband can still hear her. Which is the best response by the nurse? 1."Why do you want to know that?" 2."I don't know the answer to your question." 3."Assume that your husband can still hear you." 4."Your husband is unresponsive. He can't hear you anymore."

Answer: 3 Rationale: When a client is approaching death, hearing is usually the last sense to disappear. Telling the spouse that you don't know or that the husband cannot hear anymore due to unresponsiveness is incorrect. Asking the spouse why she wants to know is a nontherapeutic response.

The hospice nurse is visiting a client in the client's home. The client has had several episodes of dyspnea, and there is a prescription for morphine elixir. The client's wife states, "I don't understand why he needs morphine. He tells me he's not in pain." What should the nurse include in the explanation of the purpose of the morphine? 1.It reduces the secretions in the bronchi. 2.It causes dilation of the bronchial smooth muscles. 3.It relieves pain, which helps to reduce the dyspnea. 4.It helps to reduce anxiety and oxygen consumption.

Answer: 4 Rationale: Dyspnea is a terrifying and yet common symptom in clients who are near death. The use of opioids is considered standard treatment for dyspnea in clients who are near death. It helps to reduce dyspnea by reducing anxiety, thus reducing the consumption of oxygen and altering the client's perception of dyspnea. Morphine does not reduce secretions or cause dilation of smooth muscles in the bronchi. Although morphine does relieve pain, this client is not experiencing any pain.