NU371 Week 3 HESI Case Study: Hospice

The nurse observes the client's emotional responses when discussing their desires about death. Which emotional response is uncommon? o Anger. o Denial or disbelief. o Anxiety. o Confusion and disorientation.

o Confusion and disorientation. · Confusion and disorientation are not common responses to grief and the nurse should assess the client for delirium or possible dementia.

The client tells the nurse that they are worried about falling in the bathroom when bathing or showering. The nurse assesses the client's ability to perform activities of daily living. Which action should the nurse take first when addressing the client's fear of falling in the shower? o Schedule unlicensed assistive personnel to visit twice weekly. o Determine if safety equipment is needed for bathing or showering. o Suggest a routine for completing daily hygienic activities. o Teach the client's family how to support the client in the bathtub.

o Determine if safety equipment is needed for bathing or showering. · Safety is the first priority to protect the client from injury. The facility used for bathing and showering should be inspected by the nurse.

Over the next few weeks, the nurse collaborates with the client's family to continue to offer comforting interventions. The nurse notices that the client's partner appears to be losing weight. The nurse discovers that they have only been sleeping about 2 hours per night. When questioned, the partner reports feeling as if they might collapse if they are not able to take a break from caring for the client. Which action should the nurse take? o Discuss with the family the possibility of a brief hospitalization for respite care. o Explain to the family that a client cannot be hospitalized while receiving palliative or hospice care. o Tell the partner how important it is to offer the client 24 hour care in this time of need. o Recommend maintaining the current plan of care to promote stabilization for the client.

o Discuss with the family the possibility of a brief hospitalization for respite care. · Respite care can allow caregivers time to regain needed strength and mental health.

The nurse collaborates with the primary healthcare provider, who prescribes the client a 50 mcg/hr transdermal fentaynl patch to be changed every 72 hours. Which medication does the nurse expect to give to prevent a common side effect of the fentanyl patch? o Diphenhydramine. o Furosemide. o Docusate sodium. o Cyanocobalamin.

o Ducusate sodium. · This is a stool softener and it is given to help prevent constipation, a common side effect of this medication.

The nurse assists the client with advance care planning. The client expresses interest in obtaining the help of a volunteer to write letters and make some short videos to be passed along to the children and partner after the client's death. Which of the following statements by the nurse identifies the purpose of advance care planning? o During advance care planning, I will help you identify what you want your healthcare team to do if you cannot speak for yourself o During advance care planning, I will help you outline what you want done with your property after your death. o During advance care planning, I will help you identify the person you want to make decisions for you if you cannot speak for yourself. o During advance care planning, I will help you decide where you wish to die.

o During advance care planning, I will help you identify what you want your healthcare team to do if you cannot speak for yourself · This is the correct definition of advance care planning.

Which intervention by the nurse will facilitate the anticipatory grieving process? o Recommend that the children leave the room before the client dies. o Report vital signs to the family every 15 minutes until death occurs. o Encourage their partner to verbally give the client permission to die. o Place a noninvasive monitor on the client so the family can determine when the heart stops.

o Encourage their partner to verbally give the client permission to die. · Giving a loved one permission to die is therapeutic for both the family member and the client. It may help alleviate feelings of guilt for both the client and the family.

The client tells the nurse that the new pain regimen is working much better but they have started having burning, electric-like pain in their hands and feet. The nurse collaborates with the primary healthcare provider who prescribes an additional medication for the client. Which medication would the nurse expect the healthcare provider to prescribe to treat the type of pain the client described? o Meperidine hydrochloride. o Gabapentin. o Naloxone hydrochloride. o Propoxyphene.

o Gabapentin. · This drug is an anticonvulsant commonly used to treat neuropathic pain because of its effect on the central nervous system. The exact mechanism of action is unknown.

The nurse has worked with hospice clients for 5 years and has experience communicating therapeutically with the dying client. The nurse explains some of the common expressions of grief and asks what the client has experienced. The nurse schedules a home visit with the family unit to discuss common expressions of grief. What information should the nurse include during the discussion about the grieving process? Select all that apply. o It is common to have several emotional responses to grief and loss. o Grief is a normal reaction to loss. o Grief includes both physiologic and psychological responses. o Each person experiences grief in the same way. o Grief is a complex and intense emotional experience.

o It is common to have several emotional responses to grief and loss. · It is common for individuals to experience a variety of emotions during the grieving process. o Grief is a normal reaction to loss. · This is an accurate statement. o Grief includes both physiologic and psychological responses. · Grief does manifest itself physiologically and psychological. o Grief is a complex and intense emotional experience. · Grief is complex and those who lose a loved one experience intense emotions during the process.

The client becomes unconscious. Their pulse becomes weak and thready, and they begin to sweat profusely. Mucous collects in their airway, and respirations become extremely noisy. Which intervention should the nurse implement? o Provide vigorous nasotracheal suctioning. o Teach the client's partner to count and record the client's respirations. o Assess the client's response to noxious stimuli. o Administer prescribed atropine drops sublingually.

o Administer prescribed atropine drops sublingually. · Atropine will reduce terminal secretions and quiet the noisy breathing.

The family members cry and the client's partner reports they are ready to let the client die. Shortly thereafter, the client stops breathing and shows no signs of life. The hospice nurse is legally qualified to pronounce the client's death in the state where they live. Which nursing intervention is therapeutic for the family immediately after the client dies? o Suggest that family members join a support group for bereaved family members. o Allow the family to spend as much time as they request at the client's bedside. o Encourage family members to assist with post-mortem care. o Place a limit on the amount of time the family spends at the bedside after death occurs.

o Allow the family to spend as much time as they request at the client's bedside. · Family should be given as much time as they request with the client to say goodbye. This may help with the grieving process.

The client's respirations quiet. Despite having Cheyne-Stokes respirations for 2 hours while unconscious, the client suddenly regains consciousness. Which explanation should the nurse offer to the family about this change in status? o This is a rare occurrence and may indicate that the client's condition is improving. o An unexpected alertness, referred to as 'a rally,' sometimes occurs when a client is near death. o Cheyne-Stoke respirations temporarily increase oxygenation and cause this condition. o This is the client's way of telling others that they are ready to die.

o An unexpected alertness, referred to as 'a rally,' sometimes occurs when a client is near death. · This is not an uncommon occurrence. Nurses prepare families for the possibility of a rally, but a rally does not mean that there is an improvement in the client's condition.

During the initial assessment, the nurse asks the client about their family. The client cries and reports they have two daughters, ages 19 and 15, and a 12-year-old son. The 15-year-old is having the hardest time with the client's prognosis. She seems irritable and angry when she is with the client and has recently been disruptive in school. How should the nurse respond to the client about their family concerns? o Perhaps you should take your daughter out of school so she can spend more time with you. o Anger is part of the grieving process. I would suggest you encourage her to talk about her feelings. o I will talk to your daughter and let her know that her behavior is upsetting you. o Just give your daughter time to work out her feelings on her own; she'll be fine.

o Anger is part of the grieving process. I would suggest you encourage her to talk about her feelings. · A variety of strong emotions may be experienced during the grieving process. Family members should be encouraged to talk about their feelings of grief.

The nurse revises the family's plan of care. Based on the client's concern about their daughter, which nursing diagnosis should the nurse add to the plan of care? o Spiritual distress related to lack of faith in possible recovery. o Actual grieving related to loss of parent. o Imbalanced nutrition related to terminal condition. o Anticipatory grieving related to potential loss of parent.

o Anticipatory grieving related to potential loss of parent. · Grieving for the client's death is still anticipatory at this time.

Which is the best response to the client's concerns about their children? o Urge the client not to give up hope because a cure is always a possibility. o Encourage the client to focus on their own needs and not to worry about the children. o Ask the client if they are interested in having a volunteer help record their thoughts. o Assure the client that their partner will be there for the children when they are not.

o Ask the client if they are interested in having a volunteer help record their thoughts. · This is a service offered by trained hospice volunteers that helps clients pass along information to their family and friends.

When the client is awake and conscious, they are often restless and agitated. The nurse assesses possible causes and offers several relief measures. Which interventions provided during the end of life are secondary prevention interventions? Select all that apply. o Assessing level of consciousness. o Asking the family members about their stress levels using a scale of 1-10. o Positioning pillows around the client when they are restless in bed to prevent injury. o Using the faces pain rating scale to determine the client's level of pain. o Keeping a stage 1 pressure ulcer on the coccyx clean and dry.

o Assessing level of consciousness. · This is a secondary prevention intervention. o Asking the family members about their stress levels using a scale of 1-10. · This is a secondary prevention intervention. o Using the faces pain rating scale to determine the client's level of pain. · This is a secondary prevention intervention.

The primary healthcare provider also prescribes morphine sulfate elixir 8 mg by mouth every 4 hours as needed for breakthrough pain. The morphine sulfate elixir is supplied 5 mg per mL. What is the maximum volume in mL that the client can receive per day? (Enter numeric value only. If rounding is required, round to the tenth.)

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After assessing the client's abilities, the nurse determines that a shower chair is needed. The nurse collaborates with the primary healthcare provider to obtain a prescription for durable medical equipment. The nurse explores with the family whether they can assist with the client's care. The nurse offers them referrals to community resources and assists them to access public assistance if the client is eligible for services. The client qualifies for in-home county support services and the family hire a home care aide. Which information about the client's care should the nurse convey to the home care aide? o While providing personal care, encourage the client to communicate during periods of silence to facilitate working through grief stages. o Perform as much of the client's care as possible, conserving the client's energy. o Be sure to layer the client's clothing due to changes in temperature regulation and the integumentary system. o Place hygienic supplies within the client's reach when the client is using the shower chair.

o Place hygienic supplies within the client's reach when the client is using the shower chair. · This will promote independence and decrease the risk for falls.

The nurse offers which of the following statements about complementary therapies? o Reimbursement for complementary therapies is lacking. o Complementary therapies are not evidence based. o Any healthcare provider can offer a variety of complementary therapies. o There is evidence that complementary therapies cure disease.

o Reimbursement for complementary therapies is lacking. · Coverage for complementary therapies is limited.

After much discussion, the client is admitted to a hospice respite care program. During the hospital stay, the nurse encourages the family members to rest. The nurse maintains communication with the family, providing them with updates about the client's condition. After a few days, the client returns home and, 4 months after hospice care was started, they begin to lapse in and out of consciousness. The nurse recognizes end of life signs and prepares the family for the client's imminent death. What intervention should the nurse implement at this time? o Reinforce prior education about the dying process. o Anticipate the need for a referral for grief counseling. o No intervention is necessary at this time. o Encourage the family to consider re-hospitalizing the client.

o Reinforce prior education about the dying process. · Anticipatory guidance and ongoing education about death and dying are needed at this time.

The nurse teaches the client's partner how to apply the transdermal fentanyl patch. Which information is most important for the nurse to teach the client's partner? o Rotate patch sites with each change every 72 hours. o Remove the old patch before applying the new patch. o Do not apply to an area that has hair unless hair is shaved. o Eat a well-balanced diet high in B-complex vitamins.

o Remove the old patch before applying the new patch. · It is most important to remove the old patch prior to applying a new one to prevent an overdose.

Which technique should the nurse use when communicating with the client about their terminal illness? o Utilize practiced responses to questions and statements by the client. o Avoid using humor when communicating with the client. o Do not show feelings of vulnerability when communicating with the dying client. o Respect the client's pattern of communication and ways of dealing with stress.

o Respect the client's pattern of communication and ways of dealing with stress. · The nurse should respect the client's readiness to talk about and deal with the illness while offering support when needed.

The client's consciousness lasts about 15 minutes, but they are able to recognize their partner and children who are at the bedside. Until now, the 15-year-old daughter has been distant, but she is able to use this time to tell the client they are loved and will be missed. The client again becomes unconscious, their respirations deteriorate, and their pupils become fixed and dilated. The client's partner begins to panic and tells the nurse to revive the client if they stop breathing. Which response by the nurse is therapeutic, given the partner's anxiety? o Hospice nurses are not allowed to provide resuscitative measures. o Tell me about the conversations you had with your partner about this moment. o Reviving your partner would only serve your interests and would not be of benefit to them. o I will call contact the primary healthcare provider to get the do-not-resuscitate order reversed.

o Tell me about the conversations you had with your partner about this moment. · This response will elicit a conversation that will remind the partner of the client's wishes.

During the initial visit, the nurse explains the purpose of palliative and hospice nursing care to the client and their family. When talking with the family, what information should the nurse include? Select all that apply. o The care provided is client and family focused. o Hospice nurses regard dying as a normal process. o Bereavement follow-up is provided after the client's death. o Visitation and respite services are provided by licensed personnel. o Interdisciplinary care focuses on symptom management. o Clients are discharged if they are still alive 6 months after starting hospice.

o The care provided is client and family focused. · Hospice care is focused on the client and family. o Hospice nurses regard dying as a normal process. · Dying is viewed as a normal process. o Bereavement follow-up is provided after the client's death. · Bereavement care is a component of hospice care. o Interdisciplinary care focuses on symptom management. · Interdisciplinary care is primarily focused on symptom management.

The nurse completes a comprehensive assessment of the client and family. In conducting a home visit with a new client, which problem should the hospice nurse address first? o The client's bowel and urinary elimination pattern, which was the priority concern of the referring provider. o The problem that the client identifies as the first priority, the problem that most concerns the client. o The client's need for help with activities of daily living, the primary nursing diagnosis identified by the nurse. o The stages of grief the family will face, and any difficulty with grieving reported by the family.

o The problem that the client identifies as the first priority, the problem that most concerns the client. · Highest value should be placed on the problem the client identifies as the first priority.

The client tells the nurse they feel as if they have been stamped with an expiration date. They are concerned because their healthcare provider anticipated they had 4 to 6 months left to live. The client explains that they feel overwhelmed. There is so much they would like to do with their children before they die. The client asks the nurse what physical experiences occur at the end of life. Which of the following physical occurrences are likely at end of life? Select all that apply. o Hearing and touch are absent. o There is a decreased perception of pain. o There is a gradual increase in urine output. o Mottling on hands, feet, arms, and legs occur. o Breathing becomes slowed and irregular.

o There is a decreased perception of pain. · Clients do experience a decreased perception of pain. o Mottling on hands, feet, arms, and legs occur. · As body systems deteriorate, mottling on hands, feet, arms, and legs begin to appear. o Breathing becomes slowed and irregular. · As major systems begin to fail, clients experience irregular breathing patterns until eventually breathing ceases.

Community/public health nurses often make visits to client's homes. Home visiting nursing services are offered to new parents, children with special needs and their families, older homebound adults, and client's discharged home from the hospital who require ongoing care. Palliative and hospice care are often delivered by nurses working in the community. The goal of palliative and hospice care is to support the client and family through the dying process. A primary care provider makes a referral to the nurse. Which statement by the client indicates an understanding of palliative care? o All of my treatments and medications will need to be discontinued. o I will discontinue any treatments and only take medications that will help my pain. o Treatments and medications will be utilized to control my pain and increase my comfort. o I will continue the previous course of treatment with the help of a nurse.

o Treatments and medications will be utilized to control my pain and increase my comfort. · Interventions will be utilized to control pain, to increase comfort, and to improve quality of life and quality of death for the client and family.

The client's primary healthcare provider adds an additional medication to the pain care regimen to help alleviate neuropathic pain. The nurse also encourages the use of nonpharmacological complimentary therapies to increase comfort and improve quality of life. The client learns to use guided imagery to help with pain control. Which nursing intervention describes the use of guided imagery to control pain? o Encourage the client to listen to favorite songs or sounds to distract from pain. o Utilize therapeutic touch to release pain. o Visualize a pain free mental scenario while achieving a deep state of relaxation. o Consult an acupuncturist to provide home visits for the client.

o Visualize a pain free mental scenario while achieving a deep state of relaxation. · This describes the use of guided imagery for pain control.

The nurse continues to manage hospice care for the client and family. Over the next 2 months, the client's physical condition deteriorates and they become unable to get out of bed. The bed the client and their partner shared for 23 years is replaced with a hospital bed, and the partner chooses to sleep in a recliner at the bedside. The partner explains to the nurse that the client wakes up in the middle of the night in pain. The partner is afraid that if the client takes pain medication at night, they might not wake up in the morning. How should the nurse respond to the partner's concern? o It is impossible to overdose someone who is dying because they have built up a tolerance to the medication. o We can collaborate with the primary care provider to try to find a dose of pain medication that works for your partner. o It is very difficult for people with terminal illness to have their pain relieved, so they may have to endure pain during the night. o You may give the pain medication anytime unless your partner's respirations are less than 12 breaths per minute.

o We can collaborate with the primary care provider to try to find a dose of pain medication that works for your partner. · It is important to collaborate to find a pain regimen that will keep the client's pain under control, even in the middle of the night.