Chapter 15 Pallative Care

The nurse is caring for a client who has diminished lung function due to emphysema. The terminally ill client is short of breath on exertion and reports difficulty sleeping in bed. The client states, "I am so afraid of getting any worse." Which statement, by the nurse, assists the client in sustaining hope? "Do not worry, I will be here for you to help you with your needs." "Your grandchild is almost here, and you will enjoy seeing him." "I hear you say that you are not sleeping well." "I will talk with the health care provider to determine the next step in your care."

"I will talk with the health care provider to determine the next step in your care."

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

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

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. Each client experiences each of the stages. Typically, the stages occur in succession. Most clients reach acceptance by the time of death.

The stages are applicable to any loss.

Which is also known as a proxy directive? Treatment directive Durable power of attorney for health care Living will Medical directive

Durable power of attorney for health care

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 standard addendum to a will An advance directive A living will A proxy directive

A proxy directive

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.) Neurologic dysfunction Alterations in carbohydrate, fat, and protein metabolism Endocrine dysfunction Bladder incontinence Anemia

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

Which intervention should a nurse perform during the grieving period when caring for a dying client? Providing palliative care Spending time with the client Avoiding criticizing or giving advice Allowing a period of privacy

Avoiding criticizing or giving advice

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: an alternative therapy that uses massage and progressive relaxation for pain relief. 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. 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 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 Length of required treatment Physician's orders Invasiveness of the treatment

Client's goals

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? A workshop on caring for the client who is dying Use evidence-based practice in daily care regimen. Participate in a support group to learn clients' feeling on care. Explore own feelings on mortality and death and dying.

Explore own feelings on mortality and death and dying.

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

Faith and belief

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. Pain provides the client with an opportunity for repentance. Pain is considered a positive aspect that leads to rebirth. Pain must be controlled regardless of the client's wishes.

Pain is viewed as a means of cleansing by God

Which of the following does not coincide with Kübler-Ross's stages related to a dying client? The client may be in several stages at once. Some client regress, then move forward again. The dying client usually exhibits anger first. Clients don't always follow the stages in order.

The dying client usually exhibits anger first.

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

Clients and families view hospice care as giving up

A client in hospice has end-stage renal failure. The client states that, of late, he has lost his appetite and feels like everyday situations have become more stressful. The client reports feeling restless. In addition, the client's spouse notices that the client is becoming more confused. What is the most important nursing intervention that needs to be carried out at this point? Make arrangements with the physician to administer immunosuppressants. Make arrangements for the client to receive nutritional counseling. Provide the spouse with an emergency kit that contains small doses of oral morphine liquid. Immediately administer drug therapy to restore renal function.

Provide the spouse with an emergency kit that contains small doses of oral morphine liquid.

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? Routine home care General inpatient care Continuous care Inpatient respite care

Continuous care

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? "Let me explain to you what is happening." "You know you're dying?" "This must be very difficult for you." "I'm so sorry. I know how you must feel."

"This must be very difficult for you."

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. Respite care Radiation Palliative care Angiogenesis

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? Inpatient respite care Continuous care Palliative care General inpatient care

Palliative care

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." "It is likely that the medication caused the body systems to slow, which precipitated the death." "Do you remember what the medication was that you think caused the death?" "There is always a chance that pain medication will cause death in a client with a terminal illness."

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

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 week." "I know another client with the same diagnosis who has been in remission for 10 years." "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."

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

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? "He is getting less oxygen to the brain, so the moaning means he is dreaming." "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."

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

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? Denial Acceptance Bargaining Anger

Anger

Which of the following interventions should the nurse perform while providing spiritual care for a dying client? Encourage family members in their frank communication. Ask the family members about spiritual care. Allow a period of privacy. Provide spiritual books.

Ask the family members about spiritual care

Which term refers to the period of time during which mourning of a loss takes place?

Bereavement

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. Encourage the client to explain his or her wishes. Control the client's pain with prescribed medication. Recommend that the client consider physician-assisted suicide. Advise the client's health care provider of the client's condition. Comfort the client by saying it will all be over soon.

Control the client's pain with prescribed medication. Advise the client's health care provider of the client's condition. Encourage the client to explain his or her wishes.

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

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

Grief

Which of the following is a term that refers to individual, family, group, and cultural expressions of grief and associated behaviors? Spirituality Bereavement Mourning Grief

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 Closed awareness Open awareness Suspected awareness

Mutual pretense awareness

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

Palliative care is the same as hospice care

A client with a terminal illness who is incapacitated is experiencing intractable pain that is no longer effectively addressed by conventional pharmacology. Which type of pain management will the nurse anticipate for this client? Conscious sedation Palliative sedation Patient-controlled analgesia Barbiturate coma

Palliative sedation

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. Integrates spirituality Provides pain relief Enhances quality of life Offers a team approach to care Hastens death Includes chemotherapy

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

The client has been diagnosed with terminal COPD. The client and the client's family have not yet agreed on the final arrangements and are discussing options. How can the nurse best intervene in these final decisions? Remind the family that the client needs to focus energy on recovery. Ask the family members about coordinating spiritual care for the client. Respect the client's autonomy and right to determine how to spend the rest of his or her life. Persuade the client to follow their family's preferences for end-of-life care.

Respect the client's autonomy and right to determine how to spend the rest of his or her life

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? Impaired physical mobility related to sedative effects of the drug Risk for constipation related to the effects of an opioid Risk for ineffective cerebral tissue perfusion related to central nervous system effects of the drug Caregiver role strain related to the need for around-the-clock pain control

Risk for constipation related to the effects of an opioid

As the moment of death approaches, which of the following does the nurse encourage the family to do? Rub the client's hand and arm to comfort the client. Lie next to the client and hold the client. Speak to the client in a calm and soothing voice. Have the family sit in front of the client so they can be seen.

Speak to the client in a calm and soothing voice

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? The physician orders weekly blood transfusions to be given at home. The client explains that he isn't ready to complete his will. The client entered a clinical trial through the National Cancer Institute. The client doesn't want to discuss death around his girlfriend.

The client entered a clinical trial through the National Cancer Institute

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 Performing gentle suctioning of the mouth Administering a prescribed anticholinergic agent Positioning the client on the side with the head supported with a pillow

Using a soft toothbrush to vigorously clean the mouth