Prep U Palliative and End-of-Life Care Ch. 13

A nurse is assessing a terminally ill female client. Which client statement indicates that the client is in the bargaining stage of dying?

"I just want to see my daughter graduate from college. That's all."

Which statement, made by the nurse, can be most helpful when caring for a client in the third stage of Kubler-Ross' emotional reactions to dying?

"I understand that it would be wonderful to see your daughter's graduation."

The nurse arrives to the home of a client with a terminal illness who has just passed away. Which response will the nurse make when the family member states that the last dose of pain medication provided caused the death?

"It is possible that your family member died close to the time of the medication but the medication did not cause the death."

When describing the term "grief" to a group of students, which of the following would the instructor include?

The response experienced by anyone who has suffered a loss

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?

Anger

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."

The family of a terminally ill client tells the nurse that the client has been breathing irregularly and, at times, it appears that he is not breathing at all. The client's daughter states, "He moans when he breathes. Is he in pain?" Which response by the nurse would be most appropriate?

"The moaning you hear is from air moving over very relaxed vocal cords."

The nurse manager of an oncology unit is concerned that the staff are experiencing symptoms of chronic loss caused by the death of many long-term clients. Which action will the manager take to support the staff's resilience? Select all that apply.

-Allow flexibility in scheduling -Promote collaborative relationships -Ensure fairness with assignments

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.)

-Alterations in carbohydrate, fat, and protein metabolism -Endocrine dysfunction -Anemia

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.

-Provides pain relief -Integrates spirituality -Offers a team approach to care -Enhances quality of life

All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason?

Allows for the nurse to facilitate the grieving process

The nurse identifies a nursing diagnosis of Imbalanced nutrition: less than body requirements for a terminally ill client who is near the end of life. Which of the following would the nurse expect to include in the client's plan of care?

Advice for the family to have fruit juices readily available at the client's bedside.

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?

Anger

A terminally ill client has feelings of rage toward the nurse. According to Elisabeth Kübler-Ross, the patient is in which stage of dying?

Anger

Which of the following interventions should the nurse perform while providing spiritual care for a dying client?

Ask the family members about spiritual care.

The nurse is caring for a 90-year-old client who has never completed an advance directive. The client has a child but has not seen the child in several years. A neighbor has assisted the client with meals and housecleaning for many years. The neighbor states that the client expressed only wanting to have comfort measures. The estranged offspring wants the client to be treated aggressively. Which would be the nurse's initial step?

Assess the client's ability to state wishes.

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?

Atropine

The nurse is caring for a dying client in a hospice setting. The family is unsure whether to go home for rest or spend the night with the client. Which body system would the nurse assess to provide the first data on decline?

Cardiovascular system

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

Which of the following remains the greatest barrier to improving end-of-life care?

Clinician's attitudes toward the terminally ill

A client approaching end-of-life reports dyspnea as being 7 on a scale from 0 to 10. Which action will the nurse take to assist this client?

Coach to use pursed lip breathing.

A nurse is providing in-home hospice care to a terminally ill client. The client experiences a medical crisis requiring monitoring and medication administration. Which level of hospice care would the nurse implement?

Continuous care

Which is also known as a proxy directive?

Durable power of attorney for health care

Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death?

Dusky appearance

A client nearing the end of life is experiencing delirium. Which action will the nurse take to help this client?

Encourage family to visit.

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?

Encourage the family members to express their feelings and listen to them in their frank communication.

The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to clients who are dying and their families is to first do which of the following?

Explore own feelings on mortality and death and dying.

A nurse is conducting a spiritual assessment of a terminally ill client using the four step FICA process and asks the question, "What gives your life meaning?" The nurse is assessing which of the following?

Faith and belief

Which of the following is an appropriate method of assessing the dying client?

Focus on the client's basic needs.

Which term is used to describe the personal feelings that accompany an anticipated or actual loss?

Grief

Which term best describes a living will?

Medical directive

A nurse is providing care to a terminally ill client who follows Islamic traditions and is experiencing pain. When developing a plan of care for this client, an understanding of which of the following would the nurse need to integrate into the plan?

Pain is viewed as a means of cleansing by God.

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 client with a terminal illness who is incapacitated is experiencing intractable pain that is no longer effectively addressed by conventional pharmacology. Which type of pain management will the nurse anticipate for this client?

Palliative sedation

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.

When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following?

Proxy directive

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

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?

Risk for constipation related to the effects of an opioid

As the moment of death approaches, which of the following does the nurse encourage the family to do?

Speak to the client in a calm and soothing voice.

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?

There remains a conspiracy of silence about dying despite progress in the area.

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.

A nurse is evaluating a client with a terminal illness. What should the nurse report so that the health care team can consider alternative nutritional approaches and fluid administration routes for the client at the end of life?

weight loss and inadequate food intake