UNIT 12

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? Lack of fully credentialed and trained hospice nurses Clients and families view palliative care as giving up Lack of Medicare/Medicaid funding for hospice Difficulty obtaining Medicare certification for hospice services

Clients and families view palliative care as giving up

A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse? "It will hasten the death of the patient." "It will prolong life in a dignified manner." "It will use artificial means of life support if the patient requests it." "It will enable the patient to remain home if that is what is desired."

It will enable the patient to remain home if that is what is desired."

A client who is resuscitated reports to the nurse having had a "near-death experience." Which of the following characteristics would the nurse expect the client to report? Select all that apply. Seeing familiar people who have already died Feeling cold and scared Being told that it is not time yet for them to die Regretting having to return to their resuscitated body Moving slowly toward a black hole

Seeing familiar people who have already died Being told that it is not time yet for them to die Regretting having to return to their resuscitated body

The nurse is performing postmortem care for a client who died after being brought to the emergency department after an alleged attack and rape in a grassy field. Which nursing action is appropriate? Clean the fingernails and brush the hair. Notify the coroner. Use gentle soap to remove dirt and blood from the body. File the death certificate with the proper authorities.

Notify the coroner.

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? Inpatient respite care Palliative care Continuous care General inpatient care

Palliative care

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 is prepared to die because he or she has lived a full life. The client will not understand the seriousness of his or her condition. The client should be informed about advance directives.

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.

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 avoiding emotional involvement with clients remaining distant to prevent emotional pain None of the options is correct.

exploring personal mortality and feelings on death and dying

After failing a nursing exam, the nursing student states, "That exam was written terribly." What coping strategy would the nursing instructor identify? rationalization denial repression suppression

rationalization

During a counseling session a client states, "I just try to forget about my spouse hitting me." Which coping mechanism should the nurse document on the basis of this client's statement? reaction formation rationalization repression regression

repression

A client is on a stress management program. She states that she is open to trying a guided meditation class. When helping her get started, a nurse tells her that which of the following is notimportant? a quiet environment an open attitude soft music a focus of attention

soft music

A 93-year-old client is in end-stage renal failure. The client frequently relates memories of early childhood, including the unforgettable event of the client's grandmother's death when the client was quite young. It is the client's wish to die in the same manner as "Gramma." Which option would you expect the client to relate? "Gramma died at home surrounded by family." "Gramma died en route to the hospital." "Gramma died in a convalescent home." "Gramma died in hospice."

"Gramma died at home surrounded by family."

A 25-year-old client with cancer who is experiencing unrelieved pain rated a 9 on the pain scale requests that the hospice nurse induce a state of unconsciousness until the client dies. Which statement by the nurse demonstrates an understanding of a key difference between conscious sedation and euthanasia? "I cannot legally administer pain medications that will induce unconsciousness to relieve your pain.: "Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death." "Total sedation is a commonly practiced method used in this situation; I will contact your physician and begin treatment as soon as possible." "I need to perform a complete pain assessment to confirm the amount of pain you are experiencing before recommending sedation."

"Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death."

For a client to use the Medicare Hospice Benefit, life expectancy needs to be what length of time? 2 months 4 months 6 months 8 months

6

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? Increased cultural diversity Staffing shortages in health care and questions concerning quality of care Increased costs of health care coupled with inequalities in access Ability of technology to prolong life beyond meaningful quality of life

Ability of technology to prolong life beyond meaningful quality of life

A pediatric nurse is emotionally distraught by the death of a 9-year-old girl who received care on the unit over the course of many admissions spanning several years. What action is the most appropriate response to the nurse's own grief? Take time off from work to mourn the death. Post mementos of the client on the unit. Solicit emotional support from the client's family. Attend the client's memorial service.

Attend the client's memorial service.

A hospice nurse is well aware of how difficult it is to deal with others' pain on a daily basis. This nurse should put healthy practices into place to guard against what outcome? Inefficiency in the provision of care Illness Emotional exhaustion Social withdrawal

Emotional exhaustion

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. Remind the daughter of the client's impending death and the importance of expressing herself. Remain focused on the client's needs and care because these are your main responsibilities. Insist that the daughter try her best to make the client's final days happy ones.

Sit with the client's daughter privately and encourage her to express her feelings frankly.

While providing care to a terminally ill client, the client asks, "Am I dying?" Which response by the nurse would be most appropriate? "What makes you think that you might be dying?" "Tell me some more about what is on your mind." "You're just having a bit of a set-back. You'll be fine." "What has your physician told you about your condition?"

Tell me some more about what is on your mind."

A client with advanced lymphoma is confused by the different options for advance directives. The nurse should communicate which of the following information to the client? The Five Wishes document includes information on the way a client wishes to be treated at the end of life. A living will needs to be signed, dated, and witnessed by family members to become a legal document. The client may designate their physician as a durable power of attorney for healthcare. A written living will documents state the client's wishes in every possible life-threatening scenario.

The Five Wishes document includes information on the way a client wishes to be treated at the end of life.

A client has been brought to the health care facility with accident-related injuries. During the initial interview, the client becomes agitated and upset and is unable to answer any more of the nurse's questions. What does the nurse conclude about the condition of the client? The client's mind is preparing for a fight-or-flight response as he relates the incident. The client's mind is numb, and he is not able to react to further questions from the nurse. The brain is receiving less oxygen with each passing minute, which does not allow him to speak. The brain is sending chemicals to the bloodstream that make the client afraid of the questions.

The client's mind is preparing for a fight-or-flight response as he relates the incident.

What is the term for the change that takes place in response to a stressor? rehabilitation adaptation positive movement negative movement

adaption

A student nurse has learned about the role of endorphins in stress management and their potential to foster a sense of well-being. A client with a history of depression has initiated a discussion with the student about nonpharmacologic stress management techniques. What activity should the nurse recommend that may result in the release of endorphins? aerobic exercise adequate night-time sleep socialization with other clients meditation

aerobic exercise

An adolescent describes a dysfunctional home life to the nurse and reports smoking marijuana to help cope with the situation. How will the nurse identify this form of coping? beneficial maladaptive generational cultural

maladaptive Maladaptation results when people use nontherapeutic coping strategies such as mind- and mood-altering substances, hostility and aggression, excessive sleep, avoidance of conflict, and abandonment of social activities.

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. care that is provided at the very end of an illness to ease the dying process. an alternative therapy that uses massage and progressive relaxation for pain relief. offered to terminally ill clients who wish to remain in their homes in lieu of hospice care.

care that will reduce the client's physical discomfort and manage clinical symptoms.

A client has been prescribed a medication that affects their levels of the neurotransmitter serotonin. Serotonin may contribute to adaptation in what way? by protecting the client from infection by altering the client's stress response by stabilizing the client's mood by promoting healthy immune function

clients mood

A client's daughter has asked the nurse about "helping him end his terrible suffering." What is the nurse's responsibility in the domain of assisted suicide? Educating families about the moral implications of assisted suicide Identifying client and family concerns and fears Identifying resources that meet the client's desire to die Supporting effective means to honor the client's desire to die

Identifying client and family concerns and fears

A 35-year-old woman comes to the local health center with a large mass is her right breast. She has felt the lump for about a year but was afraid come to the clinic because she was sure it was cancer. What is the most appropriate nursing diagnosis for this client? Self-Esteem Disturbance Ineffective Individual Coping Altered Family Process Chronic Confusion

Ineffective Individual Coping

Which term best describes a living will? Proxy directive Medical directive Health care power of attorney Durable power of attorney for health care

Medical directive

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 Slow, steady pulse Bowel incontinence Increased swallowing

Mottling of the lower limbs not able to pump blood efficient

A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important accomplishment available by attending a grief support group? Providing a framework for incorporating the old life into the new life Normalizing adaptation to a continuation of the old life Aiding in adjusting to using old, familiar social skills Normalization of feelings and experiences

Normalization of feelings and experiences

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. Share emotional pain. Abide by the dying client's wishes. Ask the family members about spiritual care.

Respect the client's and family members' choices.

A nurse has been providing in-home hospice care to an older adult client with lung cancer for more than six months. The family asks the nurse how long the Medicare hospice services will continue. What is the nurse's best response? The hospice services need to end now that the client has had the services for six months. The Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition. Medicare hospice services end at the seventh month of care. The client must begin to pay for other home health services since six months of hospice care have been received.

The Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition.

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 Ignoring negative outcomes Envisioning one specific outcome Avoiding an actual or potential threat

Uplifting memories

he nurse teaches a client about the use of yoga as a stress management intervention. Which client statement indicates to the nurse that learning has taken place? "It eases tense muscles by clearing the mind of stressful thoughts." "It alters a negative physiologic response through the power of suggestion." "It uses the mind to visualize calming, pleasurable, and positive experiences." "It reduces physical and emotional tension through postural changes and focused concentration."

"It reduces physical and emotional tension through postural changes and focused concentration."

mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement bestcommunicates 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." "You should seek a second medical opinion about your diagnosis." "I believe that you will fight hard to beat this and see your babies grow up." "I know another client with the same diagnosis who has been in remission for 10 years."

"Let's take this one day at a time; remember you have your daughter's dance recital next month."

A young mother tells the nurse, "I can't stop smoking. That is what I do to make myself feel better." What is the term used to describe this behavior? defense mechanism coping mechanism caregiver burden crisis

coping mechanism

Which physiologic events may happen in the alarm phase of the General Adaptation Syndrome? decreased sympathetic nervous system stimulation increased sympathetic nervous system stimulation blood pressure decreases constriction of the bronchi

increased sympathetic nervous system stimulation

A type of comprehensive care for clients whose disease is not responsive to cure is a terminal illness. palliative care. euthanasia. interdisciplinary collaboration.

palliative care.

The client is a child age 5 years hospitalized for a surgical procedure. The client is bedwetting. The parents report this is a new behavior and their child is toilet trained. The nurse assesses the client is exhibiting the defense mechanism of: compensation. displacement. reaction formation. regression.

regression

Which neurotransmitter induces sleep and stabilizes mood? dopamine serotonin norepinephrine acetylcholine

serotonin

The nurse walks into the client's room and finds her sobbing uncontrollably. When the nurse asks what the problem is, the client responds, "I am so scared. I have never known anyone who goes into a hospital and comes out alive." On this client's care plan, the nurse notes a nursing diagnosis of Ineffective Coping related to stress. What is the best outcome the nurse can expect for this client? Client will adapt relaxation techniques to reduce stress. Client will be stress free. Client will avoid stressful situations. Client will start on an antianxiety agent.

Client will adapt relaxation techniques to reduce stress.

A nurse who provides care on an acute medical unit has observed that physicians are frequently reluctant to refer clients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply. Financial pressures on health care providers Client reluctance to accept this type of care Strong association of hospice care with prolonging death Advances in "curative" treatment in late-stage illness Ease of making a terminal diagnosis

Financial pressures on health care providers Client reluctance to accept this type of care Advances in "curative" treatment in late-stage illness

A client on the medical unit is dying and the nurse has determined that the family's psychosocial needs during the dying process need to be addressed. What is a cause of many client care dilemmas at the end of life? Poor communication between the family and the care team Denial of imminent death on the part of the family or the client Limited visitation opportunities for friends and family Conflict between family members

Poor communication between the family and the care team

An 84-year-old client with a do-not-resuscitate order has just died on the subacute unit of the hospital. When providing postmortem care, what action should the nurse perform? Remove tubes, catheters, and IV access devices from the body. Remove the hospital gown and dress the body in regular clothing if available. Perform a thorough bed bath with the assistance of a colleague. Cover the body with a sheet and roll the bed out of the room and into the hallway.

Remove tubes, catheters, and IV access devices from the body.

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 To support aggressive and innovative treatments for cure To provide physical support for the client To help the client develop a separate plan with each discipline of the health care team

To improve the client's and family's quality of life

The client is under immediate stress. The nurse assesses which sign as an effect of the sympathetic system? blood sugar of 65 mg/dL (3.61 mmol/L) heart rate of 102 bpm increased bowel sounds cool, clammy skin

HR 102

For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death? Increased wakefulness Increased eating Increased restlessness Increased urinary output

Increased restlessness

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 requires technologic interventions. Meaningful living during terminal illness is best supported in designated facilities. Meaningful living during terminal illness is best supported in the home. Meaningful living during terminal illness is best achieved by prolonging physiologic dying

Meaningful living during terminal illness is best supported in the home.

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. Palliative care developed after hospice care developed. Palliative care is conceptually broader than hospice care. Palliative care is often provided along with disease-lessening treatments.

Palliative care is the same as hospice 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 is not listening effectively. The client is noncompliant with the plan of care. The client may have a low intelligence quotient or a cognitive deficit. The client has not achieved the desired learning outcomes.

The client has not achieved the desired learning outcomes.

The nurse is caring for a client who has been recently diagnosed with late stage pancreatic cancer. The client refuses to accept the diagnosis and refuses to adhere to treatment. What is the most likely psychosocial purpose of this client's strategy? The client may be trying to protect loved ones from the emotional effects of the illness. The client is being noncompliant in order to assert power over caregivers. The client may be skeptical of the benefits of the Western biomedical model of health. The client thinks that treatment does not provide him comfort.

The client may be trying to protect loved ones from the emotional effects of the illness.

A nurse is trying to assess a client's stress type; however, the client is very depressed and quiet and does not reply to the nurse's questions. The nurse is unable to maintain her calm while repeating the questions. Where is the nurse going wrong in assessing the client? The nurse should not assess the client's stress type. The nurse should demonstrate confidence and expertise. The nurse should take help from the senior physician. The nurse should calm him first by giving him a sedative.

The nurse should demonstrate confidence and expertise.

A client's rapid cancer metastases have prompted a shift from active treatment to palliative care. When planning this client's care, the nurse should identify what primary aim? To prioritize emotional needs To prevent and relieve suffering To bridge between curative care and hospice care To provide care while there is still hope

To prevent and relieve suffering

Which client would the nurse expect to have negative coping skills? a 19-year-old diagnosed with schizophrenia who is heading off to college a 13-year-old diabetic who joins a softball league a 37-year-old factory worker who is laid off for the summer a 72-year-old retiree who needs to take an expensive new chemotherapeutic agent

a 19-year-old diagnosed with schizophrenia who is heading off to college Negative coping strategies may provide immediate temporary relief from a stressor, but they eventually cause problems when used for the long term.

A client responds to bad news regarding test results by crying uncontrollably. What is the term for this response to a stressor? adaptation homeostasis coping mechanism defense mechanism

coping mechanism

x A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse? "It will hasten the death of the patient." "It will prolong life in a dignified manner." "It will use artificial means of life support if the patient requests it." "It will enable the patient to remain home if that is what is desired.

"It will enable the patient to remain home if that is what is desired.

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? Privately ask the son to allow the client to make his own health care decisions. Explain to the client that he is responsible for his own decisions. Work with the team to negotiate informed consent. Avoid divulging information to the eldest son.

Work with the team to negotiate informed consent.

A client is informed about the results of a biopsy, which indicate a malignant tumor that has spread. The client states, "Well once you remove the tumor, I will be just fine." What stage of the grief process does the nurse identify the client is experiencing? denial anger bargaining acceptance

denial

The condition of a client with a traumatic brain injury continues to deteriorate despite medical efforts. The decision is made to terminally wean the client from mechanical ventilation. Which statement by the nurse is most significant in educating the family regarding terminal weaning? "Once the endotracheal tube is removed, your loved one will no longer be able to breathe." "All efforts will be taken to make sure your loved one is comfortable and out of pain." "If you change your mind after we remove the breathing tube, just tell us and it will be reinserted." "Your loved one will not feel or be aware of anything that is happening once the breathing tube is removed."

"All efforts will be taken to make sure your loved one is comfortable and out of pain."

The client tells the nurse she has never "gotten over" the loss of her husband 2 years ago. The client states she is drinking alcohol to excess every day and has started smoking, saying both help her cope. What is the best response by the nurse? "You need to decrease your alcohol consumption and stop smoking for your overall health." "It may be time for you to consider a comprehensive treatment program." "As you learn to better cope, you will see a decrease in your need for these substances." "This is the way you are coping with the stress. Everyone copes in their own way."

"It may be time for you to consider a comprehensive treatment program