Exam 4 - End of Life
The children of a male client with late-stage Alzheimer disease have informed the nurse on the unit that their father possesses a living will. The nurse should recognize that this document is most likely to:
specify the treatment measures that the client wants and does not want.
Palliative care is a structured system for care delivery. What is its aim?
to prevent and relieve suffering
Following surgery, the surgeon informed the client's spouse that invasive cancer was found during the procedure and the client may only have days to live. The client's spouse has told the health care provider and the nurse that they do not want the client to know the severity of the diagnosis. How will the nurse respond?
understanding that this directive would violate the client's rights
The nurse is giving palliative care to a client with a diagnosis of COPD. What is the goal of palliative care?
to improve the client's and family's quality of life
The condition of a client with a traumatic brain injury continues to deteriorate despite medical efforts. The decision is made to terminally wean the client from mechanical ventilation. Which statement by the nurse is most significant in educating the family regarding terminal weaning?
"All efforts will be taken to make sure your loved one is comfortable and out of pain."
A client has been receiving dialysis for years and now states, "I have been thinking about this for a long time. I no longer wish to continue dialysis. I just want to die." What is the most appropriate statement by the nurse?
"Can you tell me about why you've made this decision?"
The cardiac nurse, who has been caring for a hospitalized, terminally ill client for 3 days, finds that the client has expired. The nurse manager knows that the nurse can legally care for these clients when the nurse makes which statement?
"Hospitals are mandated to notify transplant programs of potential donors."
The nurse is caring for a client with terminal illness who is refusing food and fluids. The family is concerned and suggests that a feeding tube be used. Which is the best response by the nurse?
"When clients are in this stage, food and fluid are unnecessary."
A nurse recommends palliative care for a client who is being discharged following a diagnosis of cancer. What is the chief focus of this type of care?
Relief from physical, mental, and spiritual distress
The nurse provides postmortem care for a client who is not undergoing an autopsy. To achieve the desired outcome of this procedure, which nursing actions should be included? Select all that apply.
Remove any tubes and replace soiled dressings. Place an identification tag on the client's ankle. Provide emotional support to the client's family. Ensure the death certificate has been signed.
Which situation is most likely to warrant an autopsy?
A client's death involves an allegation of a medical error.
With the help of the nurse, the parents of an infant who died shortly after birth arrange for a funeral service. Which stage of grief, according to Engel, involves the rituals surrounding loss, including funeral services?
Restitution
Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning?
Administer sedation and analgesia.
Assisted suicide is expressly prohibited under statutory or common law in the overwhelming majority of states. Yet public support for assisted suicide has resulted in a number of state ballot initiatives. The issue of assisted suicide is opposed by nursing and medical organizations as a violation of the ethical traditions of nursing and medicine. Which scenario would be an example of assisted suicide?
Administering a lethal dose of medication
The nurse is caring for a client who has just expired. Which action will the nurse perform?
Allow the client's family to see the client's body before it is discharged.
The health care provider notified the client and the spouse that the client's condition was terminal. The spouse has been crying since the interaction with the health care provider. The nurse is going to talk with the spouse about the spouse's feelings. What action(s) would the nurse do to promote a positive impression with the spouse? Select all that apply.
Sit at eye level with the spouse. Maintain eye contact more than half of the time. Tilt the head to the side. Lean forward slightly. Hold the spouse's hands during the interaction.
A nurse volunteers to serve on the hospital ethics committee. Which action should the nurse expect to take as a member of the ethics committee?
Assist in decision making based on the client's best interests.
Which statement regarding perceptions of death by children is accurate?
At about age 9, the child perceives death as irreversible.
A nurse working in a coronary care unit resuscitates a client who had expressed wishes not to be resuscitated. Which tort has the nurse committed?
Battery
A client at a health care facility has died after a prolonged illness. A nurse is assigned to perform postmortem care for the client. Which intervention should the nurse perform when providing postmortem care?
Cleanse drainage from the skin.
The hospice nurse is caring for a client who is dying. Which intervention(s) should be included in the plan of care?
Cluster nursing activities. Provide cool foods and fluids. Gently massage the arms and legs. Routinely administer pain medications.
A client in the last stages of pancreatic cancer tells the nurse, "I am tired of fighting. I am ready to die." What is the nurse's best action?
Collaborate with other disciplines to plan end-of-life care for the client.
A nurse is caring for an older adult client in a long term care facility. The resident is reminiscing about his life and his achievements. The nurse understands the client is in which of the following stages of Erik Erikson's Psychosocial Development theory?
Ego Integrity
A nurse is caring for a client with terminal cancer. The family would like the client to continue aggressive treatment but the client has told the nurse that he would prefer comfort care. The nurse speaks to the family about the client's wishes, condition, and terminal state. This action is most likely derived from which nursing obligation?
Ethical principles
The nurse is receiving a change of shift report on a client who has a terminal illness and has exhibited a slow and progressive decline in the health status over the past several days. Which data supports the client's impending death? Select all that apply.
Gurgling sounds emanating from the client's throat with each breath Distended abdomen with last bowel movement documented 7 days ago Cyanotic nail beds in hands and feet bilaterally
A hospitalized client with advanced metastatic lung cancer states, "I want to go home. I don't have much time left. I want to be with my family." Which type of care referral by the nurse is most appropriate?
Hospice
A nurse at the health care facility cares for several clients. Some of the clients may require end-of-life care. Which case may require the service of a coroner?
The client did not have any recent medical consultation.
A client diagnosed with advanced lung cancer has a nursing diagnosis of Ineffective Coping. What assessment data would provide evidence to the nurse for this diagnosis?
The client states, "I am sure the doctors have misdiagnosed me."
A client severely injured in a motor vehicle accident is rushed to the health care facility with severe head injuries and profuse loss of blood. Which sign indicates approaching death?
The client's breathing becomes noisy.
A nurse is providing postmortem care. Which of the following nursing actions is a legal responsibility?
placing ID tags on the shroud and ankle
When planning care for a 55-year-old client with newly diagnosed terminal pancreatic cancer, which nursing concern is most appropriate for the care plan?
death anxiety
A client's son is named to make decisions for his mother in the event she cannot speak for herself. This is an example of a(an):
durable power of attorney.
The nurse is providing care for a client that is terminally ill with cancer. The client states to the nurse, "Am I going to die?" What is the most therapeutic response by the nurse?
"What have you been told?"
A nursing instructor has finished presenting information to a group of nursing students on the factors that influence the grieving process. Which statement by a student would indicate a need for further education?
"A death that occurs as a result of natural causes is just as stressful as a death from homicide or suicide."
A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education?
"In hospice care, the nurses make most of the care decisions for the clients."
After the health care provider has discussed euthanasia with a terminal client and family, the nurse assesses their understanding of the topic. Which statement by the family indicates that learning has occurred?
"It is all right to stop dialysis."
A terminally ill client asks the nurse what assisted suicide is. Which response is best for the nurse to provide?
"It is when a lethal combination of drugs is made available to the client wishing to die."
The nurse is caring for a client at the end stage of life. The client is crying and states to the nurse, "I just cannot believe I am going to be leaving my children without a parent. I am not ready to go." What response by the nurse demonstrates the expression of empathy to the client?
"It sounds as though you are most concerned about how your children will feel."
The nursing student is learning how to care for clients whose death is expected within a limited period of time. Which statement makes the faculty member believe the student has mastered this topic?
"Many clients know they have a terminal illness by picking up on nonverbal communication."
During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving?
"My parent is suffering with cancer and death will be a relief of the pain."
A client diagnosed with a terminal illness is displaying periods of depression and anger alternating with acceptance. The client's spouse is concerned about the client's labile mood. When talking with the client's spouse, which statement made by the nurse best addresses principles of loss and grieving?
"Not everyone experiences grief in the same way and your loved one needs our support."
Family members of a dying client are in the room with their loved one. As the client nears death, what should the nurse tell the family?
"Please stay with your loved one and talk to him."
The nurse is caring for a client who recently found out he has a terminal illness. The nurse notes that the client is hostile and yelling. Which statement by the nurse shows that she has understanding of the Kübler-Ross emotional responses to impending death?
"Sometimes a person returns to a previous stage."
The new hospice nurse is reviewing the concepts of loss and grief with the preceptor. Which statement leads the preceptor to believe that the nurse has an understanding of grief and loss?
"The client who is isolating himself from social contact after the death of his spouse is demonstrating a social expression of grief."
When preparing for palliative care with the dying client, the nurse should provide the family with which explanation?
"The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms."
"My father has been dead for over a year and my mother still can't talk about him without crying. Is that normal?" What is the best response by the nurse?
"The inability to talk about your dad without crying, even after a year, is still considered normal."
When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response?
"This must be very difficult for you."
A client is admitted to the hospital with a medical diagnosis of terminal lung cancer. Which question is most important for the nurse to ask first?
"What have you been told about your condition?"
When preparing for the death of a client, the nurse should provide the client's family with which interventions? Select all that apply.
Listen to concerns, fears, and worries. Encourage rest and proper nutrition. Explain the dying process and allow grieving. Utilize therapeutic communication techniques.
A nurse is conducting grief resolution for a client who lost his wife in a motor vehicle accident in which he was the driver. Which interventions best accomplish this goal? Select all that apply.
Listen to expressions of grief. Include significant others in discussions and decisions as appropriate. Communicate acceptance of discussing the loss.
A school nurse is providing a health education class for a group of high school students. When discussing the issue of safety, which area would the nurse identify as the leading cause of death in adolescents?
Motor vehicle crashes
Which signs assessed in a dying client would the nurse recognize as signs of death? Select all that apply.
Nausea, flatus, abdominal distention Cheyne-Stokes respirations Loss of movement, sensation, and reflexes
A client has been declared brain dead following a fall from a roof. The client's advance directives state they do not wish to have prolonged life measures, and that only the heart, kidneys, and liver should be donated. The client's spouse wants to also donate the client's corneas. What is the appropriate nursing action?
Contact the organ procurement team to discuss organ donation with the spouse.
The nurse is caring for an adolescent verbalizing a desire to seek counseling for grief related to the death of a close friend. The nurse determines that an appropriate nursing diagnosis for this client is Readiness for Enhanced Coping. What type of nursing diagnosis is Readiness for Enhanced Coping?
Health promotion nursing diagnosis
A client who is on hospice care and has no immediate family has been given less than 1 week to live. The nurse caring for the client recognizes that providing presence is most important, especially when a client is dying. What would be the best way for this nurse to provide presence to this client?
Hold the client's hand and sit by the bedside as often as possible.
A nurse is providing supportive care to a client diagnosed with a terminal illness who is not expected to live past the next 3 months or so. The nurse is likely working in which setting?
Hospice care
The wife of a man who is dying tells the nurse: "Harold was so good to me. He was like a saint with his patience. I will miss him terribly" Which stage of grief is this woman experiencing, according to Engel?
Idealization
A home hospice client who has Medicare is experiencing extreme pain at home and is refusing to receive inpatient care due to concerns over the cost of inpatient care. What teaching will the nurse include in the plan of care?
Inpatient pain management for hospice clients is covered by Medicare.
An adolescent on life support after a diving accident has no brain wave activity. The parents tell the nurse they are sure their child will wake up soon. Which nursing diagnosis would the nurse identify to assist the parents of the child?
Interrupted Family Processes related to inability to accept their child's inevitable death as evidenced by the parents' statement that their child will wake soon
A nurse is preparing a presentation for a group of staff nurses about spirituality and the importance of meeting clients' spiritual needs. As part the presentation, the nurse plans to address the major religious groups. Which characteristic would the nurse identify as being common to the major religions? Select all that apply.
Involvement of a sacred word or scripture Ideas related to after death Ethical code for right and wrong An identity as a group
The nurse is caring for a client that is at the end of life. After the client is pronounced dead, what actions by the nurse are essential components of care? Select all that apply.
Removing all tubes according to agency policy, unless an autopsy is to be performed Placing identification tags on the client's dentures or other prostheses Arranging for family members to view the body before it is discharged to the mortician
A client who was brought to the emergency room for gunshot wounds dies in intensive care 15 hours later. Which statement concerning the need for an autopsy would apply to this client?
The coroner must be notified to determine the need for an autopsy.
Which does not coincide with Kübler-Ross's stages related to a dying client?
The dying client usually exhibits anger first.
Which are signs of a "good death"? Select all that apply.
The person dies with dignity. The person is prepared for death. The person has a sense of completion of life.
The nurse is assisting a client and family with the death and dying process. Which is the first thing the nurse does to prepare to provide culturally competent care?
Understand the client's beliefs.
The husband of a client who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. What type of grief is the husband experiencing?
Unresolved grief
The nurse should explain to the client's family member that a comfort-measures-only order is being implemented to obtain which expected outcome?
a comfortable, dignified death for the client
A client has recently lost a parent. The client spent about 6 months deeply mourning the loss and is just now able to function at the pre-loss level. During this process, a strong social support network was able to assist the client. What developmental stage of life does the nurse identify the client is in?
adult
A hospice nurse has developed a care plan for a client with liver cancer. The care plan focuses on providing palliative care for this client. The goal of palliative care is best described as providing clients with life-threatening illnesses a dignified quality of life through which means?
aggressive management of symptoms
A 73-year-old client has been the primary caregiver for their spouse, who had multiple sclerosis (MS). After 30 years with the disease, the spouse has died and the client has become increasingly withdrawn and refuses to leave the house. Which nursing concern is most appropriate for the nurse to identify for care planning?
altered personal identity related to the unresolved crisis of their spouse's death
A client with end-stage renal disease decides against further treatment and requests a "Do Not Resuscitate" (DNR) order. The DNR status is part of the change-of-shift report. The client stops breathing and a nurse begins cardiopulmonary resuscitation. The family is upset and makes a complaint to the charge nurse. The charge nurse appropriately identifies that nurse has committed:
battery
A client has a diagnosis of bladder cancer with metastasis. The client asks the nurse about the characteristics of hospice care. The nurse should explain that:
care is premised on the fact that dying is a normal process.
A client who practices Islam dies at the hospital surrounded by family members. Which action by the nurse demonstrates cultural sensitivity related to the client's death?
consulting the family member prior to performing post-mortem care
A client diagnosed with liver failure in hospice care died 10 hours ago. The client's spouse is having difficulty leaving the room and is crying uncontrollably. What situation does the nurse identify is happening with this client's spouse?
grief reaction
The nurse anticipates a dying client to exhibit which signs of impending death? Select all that apply.
incontinence restlessness loss of sensation Cheyne-Stokes respirations
