Chapter 13: Palliative and End-of-Life Care
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?
Durable power of attorney for health care
As a client approaches death, respirations become noisy. This is the result of which type physical event?
musculoskeletal change
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 will notify the physician that the current dose of medication is not relieving your pain."
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."
A client with a terminal illness says, "I can't take these treatments anymore." Which response will the nurse make when using the NURSE communication framework?
"It sounds like you are tired of having the treatments."
A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse?
"It will enable the patient to remain home if that is what is desired."
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.
"Tell me more about what's on your mind." "This must be very difficult for you."
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."
A dying patient wants to talk to the nurse. The patient states, "I know I'm dying, aren't I?" What would an appropriate nursing response be?
"This must be very difficult for you."
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?
"We'll try adding powdered milk to milk and other foods to make them more nutritious."
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?
"When your stay reaches 6 months, you will be recertified for a continued stay."
A patient authorizes a son to make medical decisions and brings the completed forms for the nurse to place on the chart. What form does the nurse understand this is?
A proxy directive
A client nearing the end of life is experiencing delirium. Which action will the nurse take to help this client?
Add additional lighting to the room.
Based on the most common concern of a dying patient, the hospice nurse should:
Administer pain medication on a schedule that prevents pain from intensify
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.
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
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
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
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
Which of the following may be contained in an "emergency kit" for a hospice patient exhibiting restlessness?
Benzodiazepine
Which term refers to the period of time during which mourning of a loss takes place?
Bereavement
A family of a dying client reports that their loved one is experiencing more shortness of breath. Which nursing intervention is most appropriate at this time?
Call the health care provider to obtain an oxygen order
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 hospice care as giving up
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.
Which is also known as a proxy directive?
Durable power of attorney for health care
A client who has been demonstrating signs of impending death is awake, alert, and wants to see grandchildren after they attend school. Which action will the nurse take to support this client's request?
Contact the family to ask for grandchildren to come to visit the client.
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 the initial stage of grief, according to Kübler-Ross?
Denial
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.
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.
A nurse is working with a family of a deceased client and assisting them in working through their grief and mourning. Which of the following would be the priority to promote healthy accommodation of the loss by the family?
Helping the family recognize the loss has occurred
Which of the following is a term that refers to individual, family, group, and cultural expressions of grief and associated behaviors?
Mourning
Which "awareness context" is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise?
Mutual pretense awareness
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.
A 50-year-old client is an alcoholic. The client has been diagnosed with pancreatic cancer and underwent surgery to remove the tumor. Despite the tumor being removed, the physician informs the client that chemotherapy needs to be started immediately. Using evidence-based practice, which intervention might the nurse expect the physician to include, with the goal of improving quality of life, mood, and median survival.
Palliative care
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 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
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.
A nurse is developing a teaching plan for a terminally ill client and his family 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.
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?
Use imagery, humor, and progressive relaxation
In spite of administering the 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?
Use imagery, humor, and progressive relaxation
When assessing a terminally ill client, the nurse notices that the client has copious secretions at the back of the throat and in the mouth. The nurse is preparing a teaching plan for the family about caring for these secretions. Which of the following would be least appropriate to include?
Using a soft toothbrush to vigorously clean the mouth
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 type of comprehensive care for clients whose disease is not responsive to cure is
palliative care
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 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?
Add haloperidol to the client's treatment plan
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."
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.
Offers a team approach to care Integrates spirituality Enhances quality of life
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 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?
Participating in assisted suicide violates the Code of Ethics for Nurses.
When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following?
Proxy directive
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?
Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care
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
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 Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition.
Which of the following does not coincide with Kübler-Ross's stages related to a dying client?
The dying client usually exhibits anger first
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 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 client in the hospital is nearing the end of life, is unconscious, and is experiencing gurgling from the respiratory tract. Which route will the nurse use to provide the client atropine?
intravenous
