Evolve - Palliative/End of Life Care EAQ
A patient whose sibling died two years ago is still in the denial stage. What type of grief would the nurse identify in the patient?
Prolonged grief
A patient whose parent recently died feels sad and guilty about the death. According to the Grief Wheel model, which stage of grief does the patient belong to?
Protest
A person who has recently lost a family member has powerful feelings of anger, guilt, and fear. The nurse notices that the person yearns and starts searching for the dead person. Which state of grief does the nurse identify in the person according to the grief wheel model?
Protest
The nurse reviews a patient's advanced directive form. What is the purpose of the advanced directive?
Provide instructions about future medical care and treatments if the patient becomes unable to communicate
A patient with bronchial carcinoma reports anorexia and nausea. What measures should the nurse implement to help this patient?
Provide small portions of favorite foods.
The nurse is providing palliative care to a patient who is in the last stage of cancer. What does the nurse monitor in the patient as part of neurologic assessment?
Pupil response Presence of reflexes Level of consciousness
A terminally ill patient has become very restless and is wandering around the room. All the family members in the room are very worried. What should a nurse do to calm down the patient?
Put soothing music on in the room. Limit the number of people in the room.
The nurse is caring for a patient admitted to the palliative care unit. Which patient behaviors and statements would indicate to the nurse that the patient is experiencing spiritual distress?
The patient states that God has failed him or her and that he or she no longer believes in a loving God. The patient tells the nurse he or she is angry with the priest because the priest only offers empty promises. The patient asks the nurse to notify the hospital clergy that he or she would like to meet with them soon.
When the nurse assesses the patient, what manifestation indicates to the nurse that the patient is very near death?
The patient's skin is mottled and wax-like. `
The family attorney informed a patient's adult children and wife that the patient did not have an advance directive after he suffered a serious stroke. The nurse recognizes that the person who is responsible for making the decision about end-of-life measures when the patient cannot communicate his or her specific wishes is which of these?
The patient's wife
The hospice nurse visits an elderly patient whose death is imminent, and finds that the patient's caregivers, his wife and two daughters, have not left the bedside for the past 36 hours. The hospice nurse assesses the family; what findings indicate the potential for an abnormal grief reaction to occur?
The wife has a history of depression. The patient's son died six months ago. A daughter is going through a difficult divorce.
A nurse observes a patient in the last stages of life. In the ICU the patient is talking to people who are not around. How should the nurse explain the condition of the patient to the caregivers?
This experience is a part of the transition from this life.
What do the psychologic responses to grief include?
Anxiety Sadness Depression
To meet both family and patient needs, what does the hospice nurse need? .
Flexibility Compassion Cultural competence Excellent communication skills
The nurse is providing home care for a group of patients in the community. Which patients are exhibiting a diagnosis of spiritual distress?
Patient B Patient D
A nurse finds that a terminally ill patient has cold, clammy, and wax-like skin. What should the nurse infer from this assessment?
The patient is going to die soon.
Which criteria must be present in order for the patient to receive hospice care in the nursing home?
A certification from two physicians saying the patient's prognosis is terminal with less than six months to live
A patient is receiving 10 mg of Morphine intravenously every 2 hours as needed for pain. The patient begins jerking and twitching for a short period of time and becomes very distressed about the incident. The nurse should contact the primary health care provider to receive a prescription for what?
A change in the opioid drug
A patient is admitted to a hospital with Cheyne-Stokes respirations. What would the nurse expect the assessments findings to reveal?
Alternating periods of apnea and deep, rapid breathing
The caregiver of a patient with chronic illness experiences grief after the death of the patient. The caregiver recollects positive memories of the deceased patient, and the nurse notices that the caregiver is accepting the reality of the death of the client. What type of grief does the nurse identify in the caregiver?
Adaptive grief
The nurse finds that a terminally ill patient is experiencing nausea and vomiting. Which would be an appropriate nursing action?
Administer antiemetic drugs before meals, as ordered.
A terminally ill patient, who has been on bed rest for the past six months, is receiving corticosteroids for an acute asthma attack. The patient is also taking morphine for pain. The blood reports indicate anemia and eosinophilia. The nurse recognizes that the patient has which risk factors for skin breakdown?
Anemia Immobility
A patient died from sepsis while in the hospital. The patient's spouse is now blaming the primary health care provider for the patient's death and is shouting at the staff. According to the Kubler-Ross model of grief, which stage is the spouse in?
Anger
An elderly patient presents to the emergency room with complaints of chest pain. The patient states, "My wife was just diagnosed with breast cancer, and I don't know what I will do if something happens to her." What does the nurse suspect the patient is experiencing?
Anticipatory grief
A patient is pronounced brain dead following a massive stroke. Which criteria are included when pronouncing brain death?
Apnea Unresponsiveness Absence of brainstem reflexes
The nurse is caring for a comatose patient admitted following cardiopulmonary arrest. The patient is intubated, mechanically ventilated, and receiving vasopressors to maintain the pulse and blood pressure. The nurse knows a clinical diagnosis of brain death requires what?
Apnea Comatose or unresponsive Absence of brainstem reflexes
The nurse is caring for a patient with terminal cancer receiving high dosages of opioid medication for pain. The patient complains of jerking and involuntary twitching of the extremities. What is the nurse's best course of action?
Call the prescriber to discuss the opioid dosage adjustments.
A patient has been receiving palliative care for the past several weeks in light of a worsening condition following a series of strokes. The caregiver has rung the call bell, stating that the patient now "stops breathing for a while, then breathes fast and hard, and then stops again." What should the nurse recognize that the patient is experiencing?
Cheyne-Stokes respirations
The nurse assesses the breathing pattern of a terminally ill patient. The patient is displaying apnea alternated with periods of deep, rapid breathing. How does the nurse document this breathing pattern?
Cheyne-stokes respirations
An elderly patient in hospice care is not responding to a nurse's questions and seems to be withdrawn. Which nursing action is the most appropriate?
Continue talking as though the patient were alert.
A patient is near death and is withdrawn from the physical environment. The patient has the ability to hear but is not able to respond. What is the most appropriate nursing intervention to support this patient?
Converse normally with the patient in a soft voice.
The nurse is caring for a patient who is at the end stage of a life-threatening condition. The patient feels uneasy and is unable to remain at rest. What nursing management should be performed to provide physical care to this patient?
Use soothing music. Assess for spiritual distress. Limit the number of people near the bedside.
The nurse cares for a patient in the terminal stage of leukemia who has opted for hospice care. When is the patient considered to be eligible for hospice care?
When two primary health care providers certify that the patient has less than six months to live
A patient is hospitalized at the request of his wife and teenage daughter, following severe complications of end-stage renal disease. The nurse finds that the patient is incapable of making decisions due to various neurologic deficits. In the absence of any advance directives from the patient, who should make decisions concerning end-of-life care for the patient?
Wife
A nurse is caring for a patient in a terminal stage of cancer. The spouse has been staying with the patient. Two of their adult children come, and the nurse observes them recalling good memories with their parent. The youngest child states, "I can't come in tomorrow. I have my divorce hearing." Who is at a greater risk of experiencing abnormal grief reaction?
Youngest child
A patient arrives at the hospital with complaints of chest pain and shortness of breath. Myocardial infarction is confirmed by the patient's echocardiogram results and lab testing. Despite this, the patient states, "There is no way I had a heart attack. It was just indigestion." According to Elizabeth Kubler-Ross's model of grief, what is the patient displaying?
denial
Which organization supports the patient's right to self-determination and the belief that nurses have a primary role in supporting the patient's and family's decision?
American Nurses Association (ANA)
A Filipino American patient in the hospital is terminally ill and is on ventilator support. The health care provider tells a nurse that the patient would not survive if the ventilator support is removed. What would be the next most appropriate nursing action?
Discuss the present condition of the patient with the family members.
A patient is referred to palliative care services. The patient asks, "Will I have to stay here in the hospital to get that care or can I go home?" What is the correct response by the nurse?
"Palliative care is available in many settings including home, long-term care, hospitals, mental health facilities, rehabilitation centers, and prisons."
What will goals of a palliative care management plan include?
Enhancing the quality of life Providing relief of symptoms Providing care that does not hasten death or shorten life
A nursing student is discussing spirituality with the nursing instructor. Which statement by the nursing student indicates a need for clarification regarding spirituality?
"Belief in a higher power is a vital aspect of spirituality."
A nurse is a caring for a patient who is diagnosed with a terminal form of leukemia. After talking to the patient, the nurse finds that the patient is in the bargaining stage of grief. Which statement made by the patient would have led the nurse to make this determination?
"Dear God, I swear to serve your people if you take away this disease."
Why does a nurse encourage a dying patient's family to talk to the patient even though he or she is unresponsive?
"Hearing is often the last sense to disappear and that talking to the patient may be comforting and relaxing."
A family member of a dying patient states that he or she is unable to feel emotions. In fact, the family member is angry and sad but is hiding the feelings beneath a strong external appearance. Which stage of grief does the nurse anticipate in the family member according to the Kubler-Ross model of grief?
Depression
The student nurse is completing an assessment on a patient newly admitted to a hospice unit. The patient strongly indicates he or she is not affiliated with and does not participate in any specific religion. Which statement by the nursing student to the nursing instructor is most reflective of this situation?
"I need to ask questions concerning potential spiritual needs and what provides the patient with strength and hope."
A nurse is caring for a patient in palliative care. The nurse recommends the patient and family consult with pastoral care, but they refuse. What is the most appropriate response by the nurse?
"I respect your choice. Let me know if you need anything."
A patient whose parent died recently states, "I am responsible for this. I just feel like staying in my room all day." According to the Kubler-Ross model of grief, the patient is in which stage?
Depression
The family of a patient who has reached the end stages of pancreatic cancer is concerned that the patient has suddenly become very religious, despite rarely having participated in religion throughout his or her life. Which therapeutic statement by the nurse provides the best explanation of this behavior?
"It is common for patients facing death to turn to religion to help provide order to the world."
A terminally ill patient tearfully tells the nurse; "My life has had no meaning, I have no children, I am leaving nothing behind that had an impact." What statement by the nurse would be most therapeutic?
"Please tell me more about your thoughts and feelings about your concern that your life has had no meaning."
A family is considering hospice for a patient who is terminally ill. Which explanation by the nurse about the primary purpose of hospice is correct?
"The hospice provides comfort and support for dying patients and their families."
A patient with terminal cancer tells the nurse, "I know I am going to die pretty soon, perhaps in the next month." What is the most appropriate response by the nurse?
"What are your feelings about being so sick and thinking you may die soon?"
A nurse is caring for a 45-year-old patient admitted to hospice with metastatic breast cancer. Which is an appropriate question to ask when performing a spiritual assessment?
"What are your spiritual goals?" "Do you use prayer in your life?" "Who or what provides your strength and hope?" "What helps you get through the healthcare experience?"
The goal of relieving pain and suffering has been a long-time aim of health care practitioners. Palliative care became an established option in the healthcare setting during what decade?
1960s
A patient with bone cancer is inquiring about hospice care. The nurse understands that for patients to be candidates for hospice, maximum life expectancy must be what?
6 months
The nurse is caring for a patient who has been admitted to the hospital while receiving home hospice care. The nurse interprets that the patient has a general prognosis of
6 months or less to live
The home health nurse visits a 40-year-old patient with metastatic ovarian cancer who is receiving palliative care. The patient is experiencing pain at a level of 8 (on a 10-point scale). In prioritizing activities for the visit, which action would the nurse do first?
Administer as needed (PRN) pain medication.
A terminally ill patient has become confused, disoriented, and restless. The patient is incoherent and has clouding of consciousness. The nurse identifies that the patient has had constipation for three days. What action should the nurse take next?
Administer laxatives to treat constipation.
The dying patient is experiencing confusion, restlessness, and skin breakdown. What nursing interventions will best meet this patient's needs?
Assess for pain, constipation, and urinary retention.
A patient receiving end-of-life care complains of difficulty breathing. Which are the most appropriate nursing actions?
Assess respiratory status regularly. Use a fan to facilitate movement of cool air. Administer supplemental oxygen as prescribed.
How should the nurse provide appropriate cultural and spiritual care for the patient and family to best help them when nearing the end of the patient's life?
Assess the beliefs and preferences of the patient and family.
A patient with metastatic liver carcinoma is receiving morphine for palliation. The patient reports that the pain is not subsiding and is restless and anxious. The nurse tells the patient, "It is too soon for your next morphine dose. You are receiving the maximum dose each time you get it. I will come back when it is time for another dose." How would this nursing response be classified?
Below the expected standard of care
A hospice nurse is caring for a patient with a terminal disease. Although the patient's sensory system has started failing, complete loss of sensory function has not taken place yet. Which sense is most likely to be intact in the patient?
Hearing
A nurse is teaching a group of nursing students about the physical manifestations of approaching death. Which is usually the last sense to disappear?
Hearing
A patient with an understanding of his or her terminal illness refuses further treatment. Although the nurse internally believes the patient should accept treatment, he or she does not try to persuade the patient otherwise. Of what is this is an example?
Decisional capacity
Spiritual beliefs and practices may surface during terminal illness. Positive spirituality has been associated with what?
Decreased despair at the end of life
A 67-year-old woman recently was diagnosed with inoperable liver cancer. Before the diagnosis she was very active in her neighborhood association. Her husband is concerned because his wife is staying at home and missing her usual community activities. The nurse recognizes that she most likely is demonstrating which common end-of-life psychologic manifestation?
Decreased socialization
A terminally ill patient has asked the primary health care provider to not be put on an artificial ventilator if the patient stops breathing. The request was made in the presence of two witnesses who are the patient's friends. What is the responsibility of the nurse when the patient stops breathing?
Do not put the patient on an artificial ventilator.
The family members of a patient who died an hour ago in the ICU are shouting at a nurse. What should the nurse do?
Do not react to the family members at a personal level.
A terminally ill patient asks the nurse for paperwork to consent to a "No Code" status. The nurse should provide which type of document?
Do not resuscitate
While providing psychosocial care to a patient at the end of life, the nurse notices that the patient becomes restless, agitated, and performs repetitive tasks. Which nursing management is most appropriate for this patient?
Encourage the family to talk with and reassure the dying person
Which act is in direct violation of the American Nurses Association (ANA) Code for Nurses, ethical traditions and goals of the profession, and the profession's covenant with society?
Euthanasia
A nurse has been working full time with terminally ill patients for four years. The nurse has been experiencing irritability and mixed emotions when expressing sadness since three patients died on the same day. Which strategy would help the nurse to optimize the quality of nursing care?
Examining patterns for dealing with grief
When providing palliative care to a patient, the nurse helps the patient and his or her family identify the positive qualities of the patient's life. Which psychosocial manifestation of the patient is the nurse dealing with?
Fear of meaninglessness
A patient has died of metastatic lung cancer. A nurse finds organ donation marked on the patient's driver's license. What should the nurse do?
Get permission from family members for organ donation.
The nurse provides care on an oncology unit and is discussing the difference between hospice care and palliative care with the patient's family. What is an appropriate explanation by the nurse?
Hospice care is provided after a person decides to forgo curative treatment.
The student nurse learns that empathy is an essential component in communication among health care team members, the patient, and the family during chronic illness. What is empathy?
Identifying with and understanding another person's situation
A 78-year-old patient is receiving palliative care after being diagnosed with terminal cancer. The nurse reviews the primary purpose(s) of receiving palliative care, including which of these?
Improve quality of life. Focus on preventing and relieving suffering.
A nurse providing end-of-life care finds that the patient is very restless. Which intervention would be the best for the nurse to implement in response to this issue?
Use slow and soft music to soothe the patient.
A patient is diagnosed with end-stage kidney disease. Which information should the nurse include when counseling the patient about palliative care?
It aims to provide relief from symptoms, including pain. It offers support to the family during the patient's illness. It supports holistic patient care and enhances quality of life.
The nurse is caring for a patient who has had a traumatic brain injury. The family wishes to withdraw life support. The patient has been identified as an organ donor. What is the nurse's priority action for this patient's care?
Notify the primary healthcare provider that the patient is an organ donor.
When a patient's code status is do not resuscitate, and death is imminent, what is care that induces restfulness called?
Palliation sedation
A patient is admitted to the hospital with exacerbation of chronic obstructive pulmonary disease (COPD). The focus of the patient's plan of care is to reduce the severity of wheezing and ease the work of breathing. What is this type of care termed?
Palliative
The nurse is arranging discharge for a patient with a history of congestive heart failure and suggests a consultation with the palliative care team. How does palliative care differ from hospice care?
Palliative care permits the patient to receive simultaneous curative care.
What is the focus of the nurse in nursing management related to physical care at the end of life?
Patient comfort Symptom management Oxygen need assessment
A patient has been declared brain dead. In spite of the total loss of brain function, which sign would the nurse most likely find in this patient?
Presence of a heartbeat
About what may a terminally ill patient and family need information?
Resuscitation Advanced directives Mechanical ventilation Feeding tube placement
The patient's right to decide whether he or she wants cardiopulmonary resuscitation (CPR) performed is an example of what?
Self-determination
A hospice nurse is caring for a patient who has a malignant brain tumor. The patient expresses regret at having wasted life and a concern that life has held no meaning. What is the most appropriate nursing action to support this patient?
Show photo albums and important mementos to the patient and family.
The nurse is caring for a patient near the end of life. The patient is no longer verbally responding to the nurse or family members. In this situation, what should the nurse do?
Speak to the patient as though he or she is alert, using a soft voice and gentle touch.
`A patient diagnosed with terminal cancer wishes to receive hospice care. Which information should the nurse include in the counseling session?
Spiritual care and family support are important components of hospice.
A man died at the age of 71 following a myocardial infarction that he experienced while performing yard work. What would indicate that his wife is experiencing prolonged grief disorder?
Stating that she expects him home soon on the anniversary of his death
The nurse is providing physical care to the end-of-life patient who remains in a state of confusion, incoherence, and anxiety and who often hallucinates. The nurse anticipates that the patient's condition is caused by the administration of opioids and corticosteroids. What nursing management does the nurse implement for this patient?
Stay physically close to the frightened patient. Provide a room that is quiet, well-lit, and familiar.
Which aspects of anticipatory grief are associated with positive outcomes for the caregiver of a palliative patient?
Strong spiritual beliefs Acceptance of the expected death of the patient Adequate time for the caregiver to prepare for the death
The nurse is providing palliative care to a patient who has feelings of hopelessness and powerlessness due to chronic renal failure. Which nursing intervention is most appropriate to provide psychosocial care?
Supporting the patient's involvement in decision making about care
A family member of a patient who is nearing death says that the patient is making audible and irregular breath sounds. Which explanation to the family member is appropriate?
The issue is caused by accumulation of mucus in the airways.
A nurse observes a parent who has recently lost a child in an accident. The parent is a pastor. The nurse concludes that the parent is in a state of spiritual distress. Which behavior would have led the nurse interpret this?
The parent has started having atheistic views since the death.
There has been improvement in the health of an elderly patient who has been in hospice care for six months. What should the nurse suggest to this patient?
The patient can withdraw from hospice care and can receive other health services.
A nurse is caring for a patient who is in the terminal stage of colon cancer. Two primary health care providers have certified that the patient's prognosis is terminal, with less than six months to live. The manager of a hospice care program reports that the patient is not eligible to receive hospice care. What is the most likely reason the manager has made this determination?
The patient does not agree to hospice care.
A health care provider has written a do-not-resuscitate (DNR) order for a patient with heart disease. Based on assessment findings, a nurse speculates that the patient would survive a cardiac arrest if proper cardiopulmonary resuscitation (CPR) is given. What is the reason for the health care provider to give the DNR?
The patient had expressed the desire to not receive cardiopulmonary resuscitation.
A nurse reviews the medications prescribed for a patient who is in the terminal stage of cancer. The nurse finds that the patient has been prescribed medications for symptom relief, and no anticancer drug has been prescribed. What is the most appropriate reason for the health care provider to give such a prescription?
The patient has expressed the wish to have a natural death.
While providing psychosocial care to a patient at the end of life, the nurse anticipates that the patient has characteristics of withdrawal. Which behavior of the patient supports the nurse's conclusion?
The patient has the ability to hear but is unable to respond.
A patient has been diagnosed with a terminal illness and refuses hospice care. The patient is a firm believer in God. What is a likely reason that the patient is unwilling to accept hospice care?
The patient relies on God to help cope with the disease.
An elderly patient admitted to the hospital for terminal stage breast cancer experiences shortness of breath. Which nursing interventions will benefit the patient?
Turn a fan on in the room. Elevate the head of the bed. Put the patient in lateral position.
A patient in the terminal stage of acute myeloid leukemia has become unconscious. On examination, a nurse finds that the patient's mouth is very dry. How would the nurse help the patient to restore the moisture?
Use moist cloths for the oral mucosa. Provide complete and regular oral care. Apply lubricant to the lips and oral mucous membrane as needed.
A home visit nurse observes that a patient, who lost his or her mother to cancer a month ago, is back to his normal life. The patient has donated the mother's belongings to charity so that somebody else can make better use of them. The patient says that his or her mother would also have done the same because she was very kind. What is the patient experiencing?
adaptive grief
A terminally ill patient is hospitalized with severe bone pain. The patient cries and moans with any movement and is able to express severe pain. The health care provider increases the dosage of morphine. What is the nurse's priority action?
administer the medication
When going to the hospital, which forms should patients be encouraged to bring with them in case end-of-life care becomes an ethical or legal issue?
advance directives
The nurse admitting a patient with metastatic breast cancer would assess for which of the following as a key sign of clinical depression?
apathy
A nurse who does not believe in God is caring for a terminally ill patient. The patient asked the nurse to arrange for a pastoral visit. What action should the nurse take?
arrange for a chaplain
A nurse takes the vital signs of a patient who is in the hospital in the terminal stages of bronchial carcinoma. The nurse finds that there is no heartbeat. The nurse reviews the medical records and locates a do-not-resuscitate (DNR) order that the primary health care provider has signed. What should the nurse do next?
avoid giving CPR
The nurse is caring for a patient whose spouse died two weeks ago. The nurse observes that the patient does not engage in active conversation and looks sad. Which stage of grief is the patient in?
depression
A terminally ill and dying patient fears that his or her loved ones are unable to cope with his or her imminent death and will stop visiting. The nurse provides companionship for the patient, holds the patient's hand, and listens to the patient. With which of the patient's fears is the nurse dealing in this situation?
fear of abandonment
Information on what topic may be provided to patients and families struggling with decisions during terminal illness?
feeding tube placement
During admission of a patient diagnosed with metastatic lung cancer, for what should the nurse assess as a key indicator of clinical depression related to terminal illness?
feelings of hopelessness
A hospice nurse is caring for a patient who is in the terminal stages of bone cancer. The nurse notices that the patient has occasional involuntary jerking of the lower extremities. What could be the reason for this sign in the patient?
opioids
A nurse is caring for a patient who is in the terminal stage of breast cancer at a hospice care center. Which mode of treatment would be included in the hospice care for this patient?
opioids
A patient with a brain tumor is restless and moaning. The family requests pain medication to be administered to the patient. The nurse assesses the patient and agrees that pain medication may help ease the patient's suffering; however, the medication may depress the patient's breathing effort. In this situation, it is permissible for the nurse to administer a medication that has potential to do harm if the intent is to relieve suffering. Of what is this situation an example?
principle of double effect
A mother who lost her child five years ago refuses to give her son's clothes to charity. She sits near the child's closet and cries and talks to her long-dead child. Which type of response is the mother exhibiting?
prolonged grief disorder
A nurse is assessing a patient who has recently lost family members in an accident. The patient has completely lost hope in life, is extremely passive, and is confused most of the time. According to the grief wheel, which stage of grief is indicated by these behavioral symptoms?
stage of disorganization
While caring for her dying husband, who is still coherent, the wife states that her husband is Methodist but she is a devout Roman Catholic. When assessing spiritual preferences concerning end-of-life care for the dying husband, which is considered the nurse's best resource?
the dying husband
The nurse is providing psychosocial care to a patient at the end of life. The patient maintains the ability to hear the nurse but is unable to respond to the nurse. The nurse converses with the patient as though the patient is alert, using a soft voice and gentle touch. Which end-of-life symptom is the nurse addressing with these actions?
withdrawal
