NUR 109 Module 4
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.
The experience of parting with an object, person, belief, or relationship that one values is defined as:
Loss
Which term best describes a living will?
Medical directive
Which of the following is a term that refers to individual, family, group, and cultural expressions of grief and associated behaviors?
Mourning
A type of comprehensive care for clients whose disease is not responsive to cure is
Palliative 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 client in a long-term care facility has signed a form stating that he does not want to be resuscitated. He develops an upper respiratory infection that progresses to pneumonia. His health rapidly deteriorates, and he is no longer competent. The client's family states that they want everything possible done for the client. What should happen in this case?
The client should be treated with antibiotics for pneumonia.
The home health nurse is visiting a client who has been living alone for the past 5 years following the death of the spouse. Which behavior suggests the client may be experiencing abnormal grief?
The client talks as if the loss just happened.
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.
Which of the following does not coincide with Kübler-Ross's stages related to a dying client?
The dying client usually exhibits anger first.
During unplanned, spontaneous moments, dying clients usually discuss fears or concerns that nurses should not ignore or rush. What is the nurse's best response in such situations?
The nurse can communicate interest and a willingness to listen by sitting down, leaning forward in the client's direction, and making direct eye contact.
What is Kübler-Ross's third stage of grief?
bargaining
A widow develops cancer within 6 months of her husband's death. This may be a result of:
bereavement.
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 nurse is caring for a client whose spouse died more than 4 years ago. What assessment question will the nurse ask to determine if the client is experiencing abnormal grief?
"Have you gone through and donated your spouse's clothing?"
When reviewing a client's chart, the nurse notes that the client is in the disorganization stage of grief. Which assessment finding would support this diagnosis?
"I feel like I have absolutely no idea what to do next."
A client with end-stage chronic obstructive pulmonary disease (COPD) has reached the end of the 6-month period for hospice services and the family caregiver states, "I don't know what we will do if they cut off our hospice services." What is the best response by the hospice nurse?
"I will contact the health care provider to extend services since your family member meets the criteria."
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 is trying to help the client cope with the dying process. Which nursing statement is most appropriate?
"It must be very difficult for you."
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."
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."
When assessing a person who is grieving using the grief cycle model, which concept would be most important for the nurse to keep in mind? Select all that apply.
- People vary widely in their responses to loss. - Some people actually skip some stages of grief altogether. - Stages occur at varying rates among people.
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.
- Provide emotional support to the client's family. - Remove any tubes and replace soiled dressings. - Place an identification tag on the client's ankle. - Ensure the death certificate has been signed.
The nurse visits the home of a client with terminal illness. Which assessment findings indicate to the nurse that the client might die within a few months? Select all that apply.
- Refuses to eat - Reports feeling fatigued - Onset of generalized weakness - Does not want to visit with family members
Which are signs of a "good death"? Select all that apply.
- The person has a sense of completion of life. - The person dies with dignity. - The person is prepared for death.
The nurse makes a home visit for a client whose 12-year-old child died 4 years ago. The nurse finds the child's room with all belongings still intact. The client also speaks as if the child is still alive. Which action would the nurse take in this situation?
Arrange for individual counseling for the client.
Which statement regarding perceptions of death by children is accurate?
At about age 9, the child perceives death as irreversible.
Which of the following may be contained in an "emergency kit" for a hospice patient exhibiting restlessness?
Benzodiazepine
A graduate nurse enters a client's room and finds the client unresponsive, not breathing, and without a carotid pulse. The graduate nurse is aware that the client has mentioned that he does not wish to be resuscitated, but there is no DNR order on the client's chart. What is the nurse's best action?
Call a code and begin resuscitating the client.
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
Which of the following remains the greatest barrier to improving end-of-life care?
Clinician's attitudes toward the terminally ill
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
Which is also known as a proxy directive?
Durable power of attorney for health care
Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death?
Dusky appearance
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 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
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 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.
- 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.
A client and family are dealing with the client's recent terminal diagnosis. A nurse identifies a nursing diagnosis of hopelessness. Which of the following would be most helpful in supporting hope for this family? Select all that apply.
- Encouraging the client to participate in care to foster control - Arranging for appropriate psychosocial counseling - Helping to obtain support from the community
A nurse is providing care to a terminally ill client. Which finding would alert the nurse to the fact that the client is dying? Select all that apply.
- Irregular heart rate - Pale, cool skin - Decreased urine output
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. - Utilize therapeutic communication techniques. - Encourage rest and proper nutrition. - Explain the dying process and allow grieving.
The nurse is caring for several clients in the home care setting. Which client, when found deceased, will the nurse report as a case for the medical examiner?
a client found with an empty bottle for a newly-prescribed opioid by the bedside
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.
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."
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
A terminally ill client told her family, "I am ready to die." Her family is very upset that she has given up and wants the nurse to intervene. Which nursing intervention is most appropriate?A terminally ill client told her family, "I am ready to die." Her family is very upset that she has given up and wants the nurse to intervene. Which nursing intervention is most appropriate?
Explain to the family that acceptance is part of the grieving process.
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 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 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."
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 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."
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."
The nurse is caring for a client who recently lost an older adult parent. Which client statement alerts the nurse that the stage of depression may have started within the grief process?
"Please go away; I just want to be left alone."
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."
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."
"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."
The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the anger stage of grief is the one who states:
"Why did this have to happen to me?"
A 25-year-old client with cancer who is experiencing unrelieved pain rated a 9 on the pain scale requests that the hospice nurse induce a state of unconsciousness until the client dies. Which statement by the nurse demonstrates an understanding of a key difference between conscious sedation and euthanasia?
"Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death."
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.
- Cyanotic nail beds in hands and feet bilaterally - Distended abdomen with last bowel movement documented 7 days ago - Gurgling sounds emanating from the client's throat with each breath
The husband of a client with terminal cancer is afraid of hurting his wife during sexual intercourse. Which action by the nurse is likely to be most helpful in reducing this client's fears?
Encourage discussion between the husband and wife regarding their intimacy needs
Which term is used to describe the personal feelings that accompany an anticipated or actual loss?
Grief
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.
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.
The nurse is taking care of a client who was hospitalized for an ulcerative colitis exacerbation. Recently, the client's parent died from colon cancer. Which question would be essential to ask this client at the start of the assessment of her loss reaction?
What type of relationship did you have with your parent?
Evidence-based medical and nursing research 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?
Write a prescription for a serum cholesterol level.
A client with a terminal illness is overheard by the nurse saying, "If I promise never to smoke another cigarette in my life, please let me recover from this lung cancer." How will the nurse document this stage of grief according to the Kübler-Ross model?
bargaining
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
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 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 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.
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.
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.
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 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
The family members of a dying patient are finding it difficult to verbalize feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations?
Encourage the family members to express their feelings and listen to them in their frank communication.
The nurse practitioner has four patients with chronic illness that require consistent medical and nursing management. Select the condition that is the best example of a "chronically critical and progressively ill" condition.
End-stage renal disease
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 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
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.
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.
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
The hospice nurse is caring for a client with lung cancer. The client's daughter states, "My mom isn't happy with anything I do for her. She is constantly yelling at me." The nurse understands that the client is in which stage of grief according to Kübler-Ross?
anger
Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief?
coping strategies
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.
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
A critical care nurse is aware of the legislation that surrounds organ donation. When caring for a potential organ donor, the nurse is aware that:
hospitals are mandated to notify transplantation programs of potential donors.
The nurse is talking with the adult child of a client with end-stage acute kidney injury and late-stage dementia. The client can no longer live at home, and the child states, "I live 500 miles away. I do not know what to do." About which type of living arrangement will the nurse teach the child?
residential care
Which stage of grieving is exhibited by the husband of a victim of sudden death who refuses to accept that she is dead?
shock
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.
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
Palliative care is a structured system for care delivery. What is its aim?
to prevent and relieve suffering
A nurse is evaluating a client with a terminal illness. What should the nurse report so that the health care team can consider alternative nutritional approaches and fluid administration routes for the client at the end of life?
weight loss and inadequate food intake
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 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
The spouse of a recently deceased client states, "I just can't believe he left me. He swore he would never leave me and I feel betrayed!" Using Kübler-Ross stages of grief, what stage does the nurse identify the client is experiencing?
Anger
A nurse caring for a client with a terminal illness understands which statement to be true?
Recovery is not expected.
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
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.
