Ch 16 PrepU End of Life Care
Which of the following does NOT coincide with Kübler-Ross's stages related to a dying client? a) The client may be in several stages at once. b) Some client regress, then move forward again. c) Clients don't always follow the stages in order. d) The dying client usually exhibits anger first.
D. The dying client does not usually exhibit anger first. The client may be in several stages at once, clients don't always follow the stages in order, and some regress and then move forward.
All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason? Allows the nurse to express his or her feelings Allows for the nurse to facilitate the grieving process Allows for the nurse to understand when the grieving process should be concluded Allows for the nurse to take the client through in the appropriate order
B. Grieving is a painful yet normal reaction that helps clients cope with loss and leads to emotional healing. The nurse is responsible for facilitating the grieving process and helping the client and family deal with their emotions.
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?"
B. When responding to the client, the nurse needs to acknowledge the client's fears. Having the client tell the nurse what's on his or her mind acknowledges the client's feelings and opens the way for more discussion. Asking the client about what makes him or her think he or she is dying is probing and does not address the client's feelings or needs. Telling the client that he or she will be fine gives the client false reassurance and does not address his or her fears. Asking about what the physician has told the client redirects the conversation away from the client's feelings and is inappropriate.
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? Importance and influence Community Faith and belief Address in care
C. The question about what gives life meaning provides information about the client's faith and belief. Importance and influence are addressed by questions focusing on the role faith plays in the client's life and how his or her beliefs affect the way the client cares for self and illness. Community is addressed by questions focusing on the client's participation in a spiritual or religious community and the support obtained from it. Address in care focuses on how the nurse would integrate the issues involving spirituality in the client's care.
The nurse is providing care to a terminally ill client and his family who practice the Islamic faith. Which of the following concepts would the nurse need to integrate into this client's plan of care? Select all that apply. a) Pain is viewed as a mechanism for cleansing. b) Death occurs through God's permission. c) The caste of the client and family will determine their view of death. d) The family will create a new ethereal body the first 10 days after death. e) The way a person dies is of great individual importance.
A, B, E According to Islamic beliefs, everyone will face death and the way a person dies is of great individual importance. Death cannot happen except by God's permission. People adhering to Islamic beliefs also view pain as a cleansing instrument from God and as a compensation for sin. In Hinduism, each caste system has a different view of death, and relatives must create a new ethereal body during the first 10 days after death.
Despite having been administered prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and help reduce the dyspnea? Offer small amounts of nourishment frequently Encourage the patient to sleep Use imagery, humor, and progressive relaxation Gently massage the arms and legs
C. Imagery, humor, and progressive relaxation are the various techniques to potentiate the effects of pain medication and to reduce dyspnea. Offering small amounts of nourishment frequently will not help potentiate the effects of pain medication. Gentle massaging of the arms and legs helps to regulate body temperature. Encouraging the client to fall asleep will not help in potentiate the effects of pain medication.
A nurse is caring for a client with end-stage testicular cancer who has been referred to hospice care. Which criterion indicates that the client requires more teaching about hospice care? a) The physician orders weekly blood transfusions to be given at home. b) The client explains that he isn't ready to complete his will. c) The client doesn't want to discuss death around his girlfriend. d) The client entered a clinical trial through the National Cancer Institute.
D. The client involved in a clinical trial needs additional teaching about hospice care. This treatment option suggests that the client isn't ready for palliative care, which is a criterion for hospice care. Preferring not to discuss death around the girlfriend and not feeling ready to complete a will are normal responses to the grieving process. Blood transfusions are considered palliative care.
Which of the following should the nurse report so that the team can consider alternative nutritional and fluid administration routes for a dying client? Irregular eating habits Altered gastrointestinal function Drop in blood pressure and rapid heart rate Weight loss and inadequate food intake
D. The nurse should report weight loss and inadequate food intake so that the team can consider alternative nutritional and fluid administration routes for a dying client. The nurse need not report altered gastrointestinal function because it is a normal part of the dying process. A nurse should also not report a drop in blood pressure and rapid heart rate or irregular eating habits.
Which of the following may be contained in an "emergency kit" for a hospice patient exhibiting restlessness? Oral morphine liquid Atropine sulfate drops Acetaminophen Benzodiazepine
D. A kit might contain small doses of oral morphine liquid for pain or shortness of breath, a benzodiazepine for restlessness, and an acetaminophen suppository for fever. Atropine sulfate drops may be used for excess respiratory secretions.
A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse? a) "It will hasten the death of the patient." b) "It will prolong life in a dignified manner." c) "It will enable the patient to remain home if that is what is desired." d) "It will use artificial means of life support if the patient requests it."
C. The goal of hospice is to enable the patient to remain at home, surrounded by the people and objects that have been important to him or her throughout life. The patient and family make up the unit of care. Hospice care does not seek to hasten death or encourage the prolongation of life through artificial means.
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? a) Respiratory system b) Gastrointestinal system c) Cardiovascular system d) Central nervous system
C. The key word is first. Failing of cardiac functioning is one of the first signs that a condition is worsening. Symptoms within the other systems can also denote deterioration over time.
When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following? Proxy directive Treatment directive Living will Standard addendum to a will
A. Durable power of attorney for health care is a legal document through which the signer appoints and authorizes another individual to make medical decisions on his or her behalf when he or she is no longer able to speak for him- or herself. This is also known as a health care power of attorney or a proxy directive.
The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to dying clients and their families is to first do which of the following? Use evidence-based practice in daily care regimen. A workshop on caring for the dying client Participate in a support group to learn clients' feeling on care. Explore own feelings on mortality and death and dying.
D. To care for others in the dying process, the nurse must explore his or her own feelings about mortality and death and dying. Understanding self provides a perspective to cope with and then support clients and families experiencing pain and grief. The other options are helpful in determining appropriate nursing care but not the first step.
A patient with end-stage chronic obstructive pulmonary disease is admitted to a hospice facility and asks the admitting nurse, "How long will I be allowed to stay here?" What is the best response by the nurse? "You will be able to stay for 2 months before being discharged." "There is no time limit for your stay. You can stay until you die." "When your stay reaches 6 months, you will be recertified for a continued stay." "You will be able to stay only for approximately 1 month and then you will be discharged."
C. Federal rules for hospices require that eligibility be reviewed periodically. Patients who live longer than 6 months under hospice care are not discharged, provided that their physician and the hospice medical director continue to certify that they are terminally ill with a life expectancy of 6 months or less (assuming that the disease continues its expected course).
While providing care to a terminally ill client, the client's niece asks the nurse about the client's condition and prognosis. Which of the following would be most appropriate? Ask the client's consent before sharing any information with the niece. Provide the niece with the information that she is requesting. Refer the niece to the client's physician for information. Check with the client's immediate family members about sharing information.
A. Before disclosing any health information about a client to family members, nurses should follow the agency's policy for obtaining consent from the client in accordance with the Health Insurance Portability and Accountability Act (HIPAA) rules. Information is shared only with the client's consent.
Glaser and Strauss (1965) identified four "awareness contexts." Which awareness context occurs when the client is unaware of their terminal state, whereas others are aware? Closed awareness Mutual pretense awareness Suspected awareness Open awareness
A. Closed awareness occurs when the client is unaware of their terminal state, whereas others are aware. Suspected awareness occurs when the client suspects what others know and attempts to find out details about the condition. Open awareness occurs when the client, the family, and the health care professionals are aware that the client is dying and openly acknowledge that reality. Mutual pretense awareness occurs then the client, the family, and the health care professionals are aware that the client is dying but all pretend otherwise.
A nurse is assessing a client with a terminal illness and finds that the client has cachexia. The nurse interprets this as indicating which of the following? Extreme anorexia Severe asthenia Starvation Profound protein loss
D. Cachexia is associated with anabolic and catabolic changes in metabolism that relate to activity of neurohormones and proinflammatory cytokines, resulting in profound protein loss. Although anorexia may exacerbate cachexia, it is not a primary cause. Starvation refers to simple food deprivation and is not cachexia. Anorexia-cachexia syndrome, characterized by disturances in carbohydrate, protein, and fat metabolism, endocrine dysfunction, and anemia results in severe asthenia (loss of energy).
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? Invasiveness of the treatment Length of required treatment Physician's orders Client's goals
D. When managing the symptoms of a client with a terminal illness, the client's goals take precedence over the clinician's goals to relieve all symptoms at all costs. Although the length and invasiveness of the treatment may influence decision making, ultimately it is the client's goals that determine what will be done.
For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death? Increased eating Increased wakefulness Increased urinary output Increased restlessness
D. As the oxygen supply to the brain decreases, the client may become restless. As the body weakens, the client will sleep more and begin to detach from the environment. For many clients, refusal of food is an indication that they are ready to die. Based on decreased intake, urinary output generally decreases in amount and frequency.
Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice. However, the median length of stay in a hospice program is just 21.3 days. Which reason explains the underuse of hospice care services? Clients and families view palliative care as giving up Difficulty obtaining Medicare certification for hospice services Lack of Medicare/Medicaid funding for hospice Lack of fully credentialed and trained hospice nurses
A. Clients often equate hospice with giving up and are reluctant to accept hospice care. Lack of fully credentialed and trained hospice nurses is not a barrier to hospice care. Lack of Medicare funding and lack of certification for hospice service providers have not been documented as barriers to access of hospice services.
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 General inpatient care Inpatient respite care Routine home care
A. Continuous care is provided in the home for management of medical crisis. Routine home care would be used to provide the usual services to a client, such as nursing care, medical social services, counseling, home health aide/homemaker servies, and various therapies. Inpatient respite care would be used for a 5-day stay to provide relief for family caregivers. General inpatient care is used for symptom management that cannot be provided in the home.
Which of the following would be inconsistent with a normal grief reaction? Anger Elation Fear Denial
B. Denial, sadness, anger, fear, and anxiety are normal grief reactions in people with life-threatening illness and those close to them. Elation would not be a normal grief reaction.
! A hospice nurse is visiting the home of a client who was recently diagnosed with a terminal illness. The nurse is developing the client's plan of care and is assessing beliefs and preferences about end-of-life care. The nurse would expect to complete this assessment at which time? During the initial visit As the client's condition begins to deteriorate When the client exhibits signs of imminent death Over the course of several visits
D. Information about end-of-life care beliefs, preferences, and practices should be gathered in short segments over a period of time, such as over several visits. Trying to elicit the information in one visit would be overwhelming. Waiting until the client's condition begins to deteriorate or when signs of imminent death appear would be too late. The nurse needs to integrate the client's beliefs, preferences, and practices into the plan of care.
Which of the following interventions should the nurse perform while providing spiritual care for a dying client? a) Encourage family members in their frank communication. b) Ask the family members about spiritual care. c) Allow a period of privacy. d) Provide spiritual books.
B. When clients are too ill to express their wishes, the nurse should ask the family members about spiritual care. Encouraging family members in their frank communication and providing spiritual books may not be helpful in providing spiritual care for a dying client. Allowing a period of privacy may not be helpful. The nurse allows a period of privacy to the client's family members after the death of the client.
According to federal guidelines, hospices may provide no more than what percentage of the aggregate annual patient-days at the inpatient level? 40 20 10 30
B. 20 According to federal guidelines, hospices may provide no more than 20% of the aggregate annual patient-days at the inpatient level. The other numerical values are incorrect.
Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death? Flushed appearance Dusky appearance Absence of incontinence Increased body temperature
B. The body becomes dusky or bluish, waxen-appearing, and cool; blood darkens and pools in dependent areas of the body, and urine and stool may be evacuated.
The nurse is caring for a client at the end of life. The client is ordered a regular dosage of narcotics and short-acting narcotics for breakthrough pain. When administering the narcotics, the nurse is correct to realize which of the following? a) Dosages are restricted. b) Death is imminent. c) Side effects must be treated. d) Patient may become sedated.
C. The nurse who is administering narcotics at the end of life still must realize that there are side effects from the narcotics which must be addressed. Depending on the status of the client, death may be days or weeks away, not imminent. Pain medications are liberally given at the end of life to ensure that the client is comfortable. Typically, pain medications relax the client as the pain level is eased. The client is not sedated.
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? a) Bargaining b) Acceptance c) Denial d) Anger
D. Anger is the second stage and is exhibited by statement similar to "Why me?" Denial occurs when the person refuses to believe certain information. Bargaining is an attempt to postpone death. During the acceptance stage, the dying clients accept their fate and make peace spiritually and with those to whom they are close.
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 Continuous care General inpatient care Palliative care
D. Long-term care is increasing as a setting to provide palliative care that addresses management of symptoms such as pain. Inpatient respite care is a 5-day inpatient stay provided on an occasional basis to relieve the family caregivers. Continuous care is provided in the home to manage a medical crisis. General inpatient care provides inpatient stay for symptoms management that cannot be provided in the home.
Which statements made by the nurse demonstrates that the nurse is providing spiritually sensitive care? "Mourning may be demonstrated by emotional feelings of sadness, anger, guilt, and numbness." "Denial, sadness, anger, fear, and anxiety are normal grief reactions." "A key component of hospice care is following your family for up to a year after your death." "Tell me who or what gives you strength."
D. Spirituality is a personal belief system that focuses on a search for meaning and purpose of life. Assessment of people or things that provide strength to a terminally ill client is one way the nurse provides spiritually sensitive patient care. Grief is defined as the personal feelings that accompany an anticipated or actual loss. Bereavement is a period during which mourning for a loss take place. Mourning is an expression of grief and associated behaviors.
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.) a) Anemia b) Neurologic dysfunction c) Endocrine dysfunction d) Bladder incontinence e) Alterations in carbohydrate, fat, and protein metabolism
A, C, E Anorexia and cachexia are common in the seriously ill. The profound changes in the patient's appearance and a lack of interest in the socially important rituals of mealtime are particularly disturbing to families. The approach to the problem varies depending on the patient's stage of illness, level of disability associated with the illness, and desires. The anorexia- cachexia syndrome is characterized by disturbances in carbohydrate, protein, and fat metabolism; endocrine dysfunction; and anemia. The syndrome results in severe asthenia (loss of energy).
A patient with brain tumor recently stopped radiation and chemotherapy for treatment of his cancer. Of late, he is complaining of dry mouth. Which of the following interventions by the hospice nurse demonstrates the nurse understands treatment measures for dry mouth? a) Provide gentle mouth care after each meal. b) Place two drops of Atropine ophthalmic 1% solution sublingually. c) Begin IV fluids of 9% normal saline at 125 mL/hr. d) Gently suction the patient's mouth, and buccal cavity.
A. The use of artificial hydration (IV fluids) carry considerable risks and do not contribute to comfort at end of life Atropine ophthalmic 1% drops when administered sublingually helps reduce oral secretions. Dry mouth can generally be managed through nursing measures such as mouth care. Gentle oral suctioning reduces the production of secretions.
Evidence-based medical and nursing research (2009) has identified cardiovascular disease as the most prevalent chronic disease in the United States. Under this classification, one condition is the most common. Using this information, a nurse practitioner, treating a 50-year-old man, would do which of the following? a) Write a prescription for a serum cholesterol level. b) Teach the patient how to assess his blood pressure weekly. c) Make certain that the patient was aware of the signs of coronary artery disease. d) Suggest activity modifications and treatments to help minimize the physical limitations of dyspnea.
A. Hypercholesterolemia is the most prevalent chronic disease in the United States, with 37.5% of all adults affected. Refer to Table 3-1 in the text.
Which of the following is the nurse's primary concern when providing end-of-life care for a client and the family?Select all that apply. a) Encouraging fluids b) Maintaining client comfort c) Arranging plans for after death d) Completing a head-to-toe assessment e) Supporting family members f) Providing personal care
B, E, F Nursing care of dying clients focuses on providing palliative care to the client and supporting family members. Arranging the plans after death is not a priority at this time. Completing a head-to-toe assessment may be completed for information but is not a priority at the end of life. There is no need to encourage fluids.
A nurse is developing a teaching plan for a terminally ill client and his family about about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in the teaching plan? The stages are applicable to any loss. Each client experiences each of the stages. Typically, the stages occur in succession. Most clients reach acceptance by the time of death.
A. The five stages of dying describe the five emotional reactions applicable to the experience of any loss. Not every client or family member experiences every stage. Many clients never reach a stage of acceptance. Clients and family fluctutate on a sometimes daily basis in their emotional responses.
Which cardiovascular findings indicate to the nurse that the condition of the dying client is worsening? Pulse 60 beats/minute, blood pressure 90/42mm Hg, difficult to arouse Pulse 104 beats/minute in the morning, 62 beats/minute in the afternoon with mottled feet and ankles Pulse 72 beats/minute, irregular; client confused and agitated Pulse 100 beats/minute, blood pressure 100/60 mm Hg, pale with poor skin turgor
B. Earlier, a client with failing cardiac function exhibits a higher pulse as the body attempts to circulate oxygen. Next, cardiac output is decreased due to ineffective filling of the chambers, impairing circulation, and diminishing the heart's own oxygen supply. The heart rate and blood pressure then decrease. Peripheral circulation is impaired with the feet and ankles becoming pale and mottled.
Which is one level of hospice care covered under Medicare and Medicaid hospice benefits, includes a 5-day inpatient stay, and is provided occasionally to relive the family caregivers? General inpatient care Respite care Continuous care Routine home care
B. Inpatient respite care is a 5-day inpatient stay, provided on an occasional basis to relieve the family caregivers. Routine home care entails that all services provided are included in the daily rate to the hospice. Continuous care is provided in the home for management of a medical crisis. General inpatient care provides an inpatient stay for symptoms management that cannot be provided in the home.
A terminally ill patient in pain asks the nurse to administer enough pain medication to end the suffering forever. What is the best response by the nurse? "I can't do that, I will go to jail." "I will see if the physician will order enough for that to occur." "I will notify the physician that the current dose of medication is not relieving your pain." "I am surprised that you would ask me to do something like that."
C. Palliative sedation is distinguished from euthanasia and physician-assisted suicide in that the intent of palliative sedation is to relieve symptoms, not to hasten death. Palliative sedation is most commonly used when the patient exhibits intractable pain, dyspnea, seizures, or delirium, and it is generally considered appropriate in only the most difficult situations.
Which of the following interventions should a nurse perform during the grieving period when caring for dying patients? a) Providing palliative care b) Spending time with the patient c) Allowing a period of privacy d) Avoiding criticism or giving advice
D. The nurse should listen in a nonjudgmental manner and should avoid criticism or giving advice during the grieving period when caring for dying patients. Allowing a period of privacy is necessary to help the family members cope with the death of a patient and is not necessary during the grieving period. Spending time with the patient and providing palliative care are not the required nursing interventions during the grieving period. Palliative care is provided to a dying patient when the patient is unable to live independently.
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." "He has secretions that are collecting at the back of the throat." "His moaning does indicate pain, so we'll increase his pain medication." "He is getting less oxygen to the brain, so the moaning means he is dreaming."
A. As a client approaches death, certain signs appear. The family is reporting irregular breathing with periods of apnea. The moaning that they hear reflects the sound of air passing over very relaxed vocal cords. It does not signify pain or distress. Therefore, no additional pain medication would be needed. Secretions collecting at the back of the throat are noted by a rattling or gurgling sound. Decreased oxygen to the brain would lead to confusion, which may be reported by the client as strange dreams or visions.
A nurse is providing in-home hospice care to a 75-year-old client with lung cancer. The nurse determines that the client is eligible for Medicare hospice benefits based on which of the following? Client has a life expectancy of 6 months or less. Client has family members to provide the care. Client has a serious and progressive illness. Client has no other insurance to pay for the care.
A. Eligibility for the Medicare Hospice Benefit includes physician certification of a client as terminally ill, with a life expectancy of 6 months or less if the disease follows its natural course. The condition must be considered or classified as terminal, not just serious and progressive. Although the presence of family members in the home is helpful, their presence is not a criterion for eligibility. Lack of other insurance also is not a criterion for eligibility.
A nurse is providing hospice care in Portland, Oregon to a client with terminal liver cancer. The client confides to the nurse, "I'm in agony all the time. I want this to be over now—please help me." Which interventions should the nurse implement? Select all that apply. Comfort the client by saying it will all be over soon. Control the client's pain with prescribed medication. Encourage the client to explain his or her wishes. Recommend that the client consider physician-assisted suicide. Advise the client's physician of the client's condition.
B, C, E This client lives in Oregon, one of five states that have decriminalized physician-assisted suicide, the practice of providing a means by which a client can end his or her own life. This practice is controversial, with proponents arguing the client has a right to self-determination and a relief from suffering when there is no other means of palliation (Quill & Greenlaw, 2008). Opponents, on the other hand, find it contrary to the Hippocratic Oath. In this scenario, the nurse should determine exactly what the client is asking and then support his or her wishes. It is not the nurse's role to suggest physician-assisted suicide voluntarily, however.
A type of comprehensive care for clients whose disease is not responsive to cure is euthanasia. palliative care. interdisciplinary collaboration. a terminal illness.
B. Palliative care is a type of comprehensive care for clients whose disease is not responsive to cure. Terminal illness is a progressive, irreversible illness that despite cure-focused medical treatment will result in the client's death. Euthanasia means the intentional killing by act or omission of a dependent human being for his or her alleged benefit. Interdisciplinary collaboration is communication and cooperation among members of diverse health care disciplines jointly to plan, implement, and evaluate care.
The family of a dying client being cared for at home is requesting information on how best to prepare food. Which suggestion by the nurse may stimulate appetite? a) Eating alone so the client can eat at his own pace and not be hurried b) Preparing cool or cold foods that may be better tolerated c) Providing several choices on the plate so that the client has what may appeal to him d) Offering high caloric foods to build fat and muscle
B. Preparing cool or cold foods may be tolerated better by the client and thus stimulate appetite. Hot foods may have an aroma that may cause nausea. Clients may enjoy a mealtime companion making the eating experience more pleasurable. Offering small portions is appropriate because large, multiple portions/choices may shut down the appetite. Although weight loss may be significant, clients should have the ability to pick and choose foods that interest them.
A nurse is assessing a terminally ill female client. Which client statement indicates that the client is in the bargaining stage of dying? "I don't know how my husband is going to manage things when I'm gone." "I just want to see my daughter graduate from college. That's all." "Why is this happening to me. I've led a good life. Why is God punishing me?" "I can't believe this. I'm going to get a second opinion."
B. Bargaining is manifested by pleading for more time to reach an important goal. This is reflected in the client's statement about wanting to see her daughter's college graduation. The statement about going to get a second opinion reflects denial. The statement about why reflects anger. The statement about not knowing how the husband will manage reflects the depression stage.
The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which intervention should a nurse perform in such a situation? Be a silent observer and allow the client to communicate with the family members Encourage the client's family members to spend time with the client Encourage conversations about the impending death of the client Encourage the family members to express their feelings and listen to them in their frank communication
D. Family members usually find it difficult to communicate frankly with a dying person. When a nurse encourages family members to express their feelings and listens to them as they frankly communicate, family members may feel more prepared to carry on a similarly honest dialogue with the dying client. It is not advisable for the nurse to encourage conversations about the impending death of the client. Being a silent observer or encouraging the family members to spend time with the dying client may not help the family members express their feelings.
While talking with a client who has been diagnosed with a terminal illness, the client asks, " Am I dying?" Which response from the nurse would be appropriate? Select all that apply. "This must be very difficult for you." "Tell me more about what's on your mind." "I know just how you must feel." "Let's focus on what your doctor has planned." "You still have time for a good life."
A, B The nurse needs to listen effectively and empathetically, acknowledging the client's fears and concerns. Statements such as "This must be very difficult for you" and "Tell me more about what's on your mind" address the client's concerns and help to focus the discussion on the client. Telling the client that the nurse knows how the client feels ignores the client's concerns. Saying that there is still time for a good life or telling the client to focus on what the doctor has planned ignores the client's feelings and blocks communication.
Which term refers to the period of time during which mourning of a loss takes place? Bereavement Grief Hospice Mourning
A. Bereavement is the period of time during which mourning of a loss takes place. Grief is defined as the personal feelings that accompany an anticipated or actual loss. Mourning is defined as the individual, family, group, and cultural expressions of grief and associated behaviors. Hospice is a coordinated program of interdisciplinary care and services provided primarily in the home to terminally ill clients and their families.
How does a nurse who has been providing home care to a terminally ill client know that her client's condition is beginning to deteriorate? a) The client's apical pulse reaches 100 beats/minute. b) The client's facial muscles contract. c) The client's skin appears red and flushed. d) The client's urine output increases.
A. Failing cardiac function is one of the first signs that a client's condition is worsening. At first, heart rate increases in a futile attempt to deliver oxygen to cells. The apical pulse rate may reach 100 or more beats/minute. In clients who are dying, the skin becomes pale or mottled, nail beds and lips may appear blue, and the client may feel cold. In clients who are dying, urine volume decreases. In clients who are dying, the jaw and facial muscles relax.
As a client approaches death, her respirations become noisy. This is the result of which type physical event? a) Cardiac dysfunction b) Musculoskeletal change c) Gastrointestinal impairment d) Central nervous system alterations
B. As death approaches, a client's reflexes become hypoactive. The jaw and facial muscles also relax. As the tongue falls to the back of the throat, respirations become noisy.
The physician is attending to a 72-year-old client with a malignant brain tumor. Family members report that the client rarely sleeps and frequently reports seeing things that are not real. Which intervention is an appropriate request for the hospice nurse to suggest to the physician? Obtain a biopsy to analyze the lymph nodes. Add haloperidol to the client's treatment plan. Perform surgery to remove the tumor from the brain. Begin radiation therapy to prevent cellular growth.
B. Haloperidol may reduce hallucinations. Radiation therapy helps prevent cellular growth. It may be used to cure the cancer or to control malignancy when the tumor cannot be removed or when lymph node involvement is present, and it can be used prophylactically to prevent spread. Biopsy is used to analyze the lymph nodes or to destroy the tissues surrounding the tumor.
Based on the most common concern of a dying patient, the hospice nurse should: Position the patient to prevent difficulties with breathing. Administer pain medication on a schedule that prevents pain from intensifying. Offer supplemental fluids to prevent dehydration. Turn the patient every 2 hours to prevent decubitus ulcers.
B. Pain management is the most common concern for the dying patient. Medication should be given on a PRN schedule that keeps the patient comfortable.
Nursing students are reviewing information about the signs and symptoms of impending death. The students demonstrate the need for additional review when they identify which of the following as a sign? a) Restlessness b) Mental confusion c) Muscle wasting d) Reduced urinary output
C. Muscle wasting occurs as the client's condition deteriorates. It is not a sign of impending death. Mental confusion, reduced urinary output, and restlessness occur as a client approaches death.
As the moment of death approaches, which of the following does the nurse encourage the family to do? Lie next to the client and hold the client. Have the family sit in front of the client so they can be seen. Speak to the client in a calm and soothing voice. Rub the client's hand and arm to comfort the client.
C. Sight and touch diminish as the client approaches death; however, hearing tends to remain intact. Speaking to the client calmly is most appropriate.
The client tells the doctor that he and his family have accepted the terminal diagnosis of pancreatic cancer. The client further explains that he is interested in being comfortable and that he no longer wishes to fight the cancer. This approach to end-of-life care is known as terminal care. interdisciplinary care. palliative care. euthanasia care.
C. Palliative care is a type of comprehensive care for clients whose disease is not responsive to cure. Terminal illness is progressive and irreversible and, despite cure-focused medical treatment, will result in the client's death. Euthanasia means the intentional killing by act or omission of a dependent human being for his or her alleged benefit. Interdisciplinary collaboration is communication and cooperation among members of diverse health care disciplines jointly to plan, implement, and evaluate care.
A nurse is caring for a client with a terminal illness. The client asks the nurse to help him end his own life to alleviate his suffering and that of his family. When responding to the client, the nurse integrates knowledge of which of the following? A client has the right to make independent decisions about the timing of his or her death. Nurses may administer medications prescribed by physicians to hasten end of life. Participating in assisted suicide violates the Code of Ethics for Nurses. Most states have enacted laws that allow for physician-assisted suicide.
C. The American Nurses Association Position Statement on Assisted Suicide acknowledges the complexity of the assisted suicide debate but clearly states that nursing participation in assisted suicide is a violation of the Code for Nurses. Legally, nurses are not allowed to administer medications even if prescribed by a physician if that medication will hasten the client's end of life. Proponents of physician-assisted suicide argue that terminally ill people should have a legally sanctioned right to make independent decisions about the value of their lives and the timing and circumstances of their deaths. However, this is not the case at the present time. Two states have enacted legislation for physician-assisted suicide. These laws provide access to physician-assisted suicide by terminally ill clients under very controlled circumstances.
A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using? End-of-life treatment directive Medical directive by proxy Living will declaration Durable power of attorney for health care
D. A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. It allows another individual to make medical decisions on the client's behalf. The other options are incorrect.
A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client? Abide by the dying client's wishes. Share emotional pain. Ask the family members about spiritual care. Respect the client's and family members' choices.
D. In the final decisions of a dying client, the nurse will present options for terminal care and respect the client's and family members' choices. Sharing emotional pain is a role in providing care and comfort to dying clients and their families. When the client has a living will, physicians must abide by the client's wishes. The nurse should ask the family members about spiritual care only if the client wants someone associated with his or her religion.
A 36-year-old mother of three was recently diagnosed with a chronic illness. The nurse prepared information for the patient on how to manage her illness. To help her cope with the shock and resentment that she was experiencing, the nurse gave her facts about her illness with honesty and empathy. Which of the following are the best comments that the nurse can include when talking to the patient about chronic illness? Select all that apply. a) It results in residual disability due to non-reversible pathology. b) It is characterized by a progressive decline in normal physiologic function c) It can be associated with exacerbations and remissions. d) It can require short-term management (<3 months). e) It is defined as long-term with the possibility of a cure if intervention is rapid and timely.
A, B, C Chronic illnesses are often defined as medical illnesses or health problems with associated symptoms or disabilities that require long-term management (3 months or longer). Chronic illness refers to diseases that are caused by non-reversible pathology; are characterized by a slow progressive decline in normal physiological function; are permanent with cure unlikely; and require long-term surveillance, leaving residual disability.
While providing care to a client near death, the nurse is helping the family to prepare by teaching them what to expect. Which of the following would the nurse include in the teaching plan as a sign of approaching death? Select all that apply. a) Decrease in amount of urine produced b) Breathing that is very rapid c) Refusal to ingest food or fluids d) Gurgling as the client breathes through the mouth e) Increase in visual and auditory abilities
A, C, D As death approaches, a client typically has secretions that collect in the back of the throat and rattle or gurgle as the client breathes through the mouth. Breathing may become irregular with periods of no breathing. Urine output may decrease in amount and frequency, and loss of bladder and bowel control may occur. The person approaching death shows less interest in eating and drinking; for many, refusal of food is an indicator that they are ready to die. Vision and hearing may be somewhat impaired and speech may be difficult to understand.
A mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement best communicates a spirit of hopefulness to this client? "Let's take this one day at a time; remember you have your daughter's dance recital next month." "You should seek a second medical opinion about your diagnosis." "I know another client with the same diagnosis who has been in remission for 10 years." "I believe that you will fight hard to beat this and see your babies grow up."
A. Helping a client to find reasons to live and look forward to events promotes positive attitudes and ability to live for the moment, which in turn communicates a spirit of hopefulness. The statement about a second opinion is inappropriate because it gives the client false hope that her current diagnosis is inaccurate. Although he client may choose another medical opinion, she needs to come to that decision without the nurse's advice. Responses should not convey false hope to the client. Nurses and clients should not confuse hope with unrealistic optimism.
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.
A. Palliative care is used in conjunction with other end-of-life treatments and has many principles. Its aim is to reduce physical discomfort and other distressing symptoms but does not alter a disease's progression. Palliative care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life. Palliative care of a terminally ill client not only provides relief from pain and other distressing symptoms but it integrates other facets of patient care as well, including psychological and spiritual aspects. Palliative care is part of hospice care.
The nurse is caring for a client who just learned of his terminal diagnosis. After the physician leaves, the nurse remains to answer further questions so that the client can make an informed decision about further treatment. By providing all available information, the nurse is promoting which ethical principle? The principle of justice The principle of nonmaleficence The principle of autonomy The principle of fidelity
C. By promoting open discussion and informed decision making, the nurse is empowering the client to make his own decisions leading to autonomy. The principle of justice requires fairness and justice to all clients. The principle of nonmaleficence requires that nurse does not intentionally or unintentionally inflict harm on others. The principle of fidelity maintains that nurses are faithful to the care of the clients.
A nurse is working with the family of a terminally ill client, providing them with suggestions about how to manage the client's anorexia. Which statement by the family indicates that they have understood the instructions? a) "We'll make sure that any foods that we give him are mashed up or in liquid form instead so he doesn't have to chew." b) "We'll try to give him regularly scheduled meals throughout the day." c) "We'll try adding powdered milk to milk and other foods to make them more nutritious." d) "We'll make sure that he is nearby the kitchen so he can smell the foods cooking."
C. Increasing the nutritional value of foods, such as by adding powdered milk to milk and other foods, is appropriate. The client should be allowed and encouraged to eat when he is hungry regardless of the regular meal times. Cooking odors should be eliminated or reduced because they can precipitate nausea, vomiting, or anorexia. Unless there is a definite problem with chewing or swallowing, foods do not need to be pureed (mashed) or in liquid form.
A patient in hospice has end-stage renal failure. He says that, of late, he has lost his appetite and feels like everyday situations have become more stressful. He reports feeling restless. In addition, his wife notices that he is more and more confused. What is the most important nursing intervention that needs to be carried out at this point? a) Immediately administer drug therapy to restore renal function. b) Make arrangements for the patient to have nutritional counseling. c) Provide the wife with an emergency kit with small doses of oral morphine liquid. d) Make arrangements with the physician to administer immunosuppressants.
C. One of the most important aspects of the care of the patient at the end of life is anticipating and planning interventions for symptoms. Both patients and family members cope more effectively with new symptoms and exacerbations of existing symptoms when they know what to expect and how to manage them. Nutritional counseling, involving the family in the plan of care, and providing psychosocial support to the patient are all relevant nursing interventions that form a part of the nursing management process for a patient with chronic renal failure. Nutritional counseling, administration of drug therapy to restore renal functions, and administration of immunosuppressant drugs are medical management tasks.
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? Suggestions that the family offer the client foods that are hot. Arrangements for the client to eat meals while others are out of the home. Advice for the family to have fruit juices readily available at the client's bedside. Encouragement of the family to serve the client meat, especially beef.
C. To promote nutrition in the terminally ill, the nurse would encourage the family to have fruit juices and milkshakes readily available at the bedside so that the client can access them frequently. Cool foods may be better tolerated than hot foods. Cheese, eggs, peanut butter, mild fish, chicken, and turkey are often better choices than meat such as beef that may taste bitter and unpleasant. Meals should be scheduled when family members are present to provide company and stimulation.
Which action by the nurse demonstrates an effective method to assess the client and the client's family's ability to cope with end-of-life interventions? Providing evidenced-based advice for end-of-life care based on the nurse's experiences with previous clients in hospice Filling voids in conversation with information related to death and dying to avoid awkward moments during the admission interview Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care Offering reassurance that the nurse has had 5 years of assisting clients in hospice and their families care for loved ones at the end of life
C. A key to effective listening includes allowing the client and family sufficient time to reflect and respond after asking a question. Hospice nurses with effective listening skills resist the impulse to fill the empty space in communication with talk, avoid the impulse to give advice, and avoid responses indicating, "I know just how you feel."
A terminally ill patient is admitted to the hospital. The patient grabs the nurse's hand and asks, "Am I dying?" What response would be best for the nurse to give? "Why do you think that?" "Did someone tell you that you are dying?" "Tell me more about what's on your mind." "I am not at liberty to disclose that information."
C. In response to the question "Am I dying?" the nurse could establish eye contact and follow with a statement acknowledging the patient's fears ("This must be very difficult for you") and an open-ended statement or question ("Tell me more about what is on your mind"). The nurse then needs to listen intently, ask additional questions for clarification, and provide reassurance only when it is realistic.
The wife of your terminally ill client is confused by the new terminology being used during discussions regarding her husband's treatment. How would you explain palliative care to her? a) It is an alternative therapy that uses massage and progressive relaxation for pain relief. b) It is offered to terminally ill clients who wish to remain in their homes in lieu of hospice care. c) It is care that is provided at the very end of an illness to ease the dying process. d) It is care that will reduce her husband's physical discomfort and manage clinical symptoms.
D. Palliative care is used in conjunction with other end-of-life treatments and has many principles. Its aim is to reduce physical discomfort and other distressing symptoms but does not alter a disease's progression. Palliative care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life. Palliative care of a terminally ill client not only provides relief from pain and other distressing symptoms but it integrates other facets of patient care as well, including psychological and spiritual aspects. Palliative care reduces physical discomfort without altering a disease's progression and is part of hospice care, which emphasizes helping clients live however they wish until they die.
