PrepU: End-of-life Care (CC4)

Which client admitted to the emergency department might require the nurse to include interventions aimed at addressing culture shock in the plan of care? a. A client who recently immigrated and fell from a ladder b. A client who is bilingual and has a history of asthma c. A client whose parents were immigrants and is admitted with flu-like symptoms d. A client who immigrated 25 years ago reporting chest pain

a. A client who recently immigrated and fell from a ladder

A client is diagnosed with a terminal illness and has been given less than 6 months to live. What type of referral should the nurse make to assist this patient and family at home? a. A rehabilitation center b. Adult day care c. Hospice d. Physical therapy

c. Hospice

While providing care to a client near death, the nurse is helping the family to prepare by teaching them what to expect. Which of the following would the nurse include in the teaching plan as a sign of approaching death? Select all that apply. a. Gurgling as the client breathes through the mouth b. Refusal to ingest food or fluids c. Breathing that is very rapid d. Decrease in amount of urine produced e. Increase in visual and auditory abilities

a. Gurgling as the client breathes through the mouth b. Refusal to ingest food or fluids d. Decrease in amount of urine produced

Which of the following is the major long-term goal associated with end-of-life care? a. Client comfort b. Pain control c. Dying with dignity d. Relief of fear and anxiety

c. Dying with dignity

The nurse is assessing an older adult who immigrated at the age of 3 years. The client speaks the dominant language and lives in a neighborhood with many households from the country of origin. Which action by the nurse is most appropriate? a. Contact a traditional healer as part of culturally competent care of the client. b. Avoid direct eye contact with the client when speaking. c. Contact the client's oldest son to assist with health care decision making. d. Ask the client about special cultural beliefs or practices.

d. Ask the client about special cultural beliefs or practices.

The nurse is caring for a client 4 days after total hip arthroplasty and notes the client has lost weight. The unlicensed assistive personnel reports the client's food intake has decreased. Which question will the nurse ask the client to determine if cultural causes are responsible for the weight loss? a. "What type of food do you like to eat at home?" b. "Is there something wrong with the food?" c. "Would you like to speak with a nutritionist?" d. "Can you ask your family to bring you something you like?"

a. "What type of food do you like to eat at home?"

Which of the following remains the greatest barrier to improving end-of-life care? a. Clinician's attitudes toward the terminally ill b. Advances in technology available to prolong life c. Focus on managing acute illness to achieve a cure d. Client and family denial about the seriousness of terminal illness

a. Clinician's attitudes toward the terminally ill

A client who does not speak the dominant language is admitted to the hospital. Which cultural intervention would be most appropriate by the nurse? a. Call for an interpreter who is familiar with health care. b. Ask the closest family member to interpret. c. Minimize eye contact to avoid being offensive. d. Speak loudly and slowly so that the client can better understand.

a. Call for an interpreter who is familiar with health care.

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. a. Encouraging the client to participate in care to foster control b. Arranging for appropriate psychosocial counseling c. Assisting in establishing long-term goals d. Helping to obtain support from the community e. Avoiding the sharing of information and feelings

a. Encouraging the client to participate in care to foster control b. Arranging for appropriate psychosocial counseling d. Helping to obtain support from the community

The nurse is caring for a client who is interested in learning about hospice care. Which of the eligibility criteria would the nurse stress? a. Serious, progressive illness b. Choice of palliative care over cure focused c. Physician-certified illness d. Limited life expectancy

b. Choice of palliative care over cure focused

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? a. Call the client's family members and ask them to sit next to the client to listen. b. Change the subject and talk about other things to distract the dying client. c. Offer the client a sedative to help the them rest more easily. d. Communicate interest and a willingness to listen by sitting down, leaning forward in the client's direction, and making direct eye contact.

d. Communicate interest and a willingness to listen by sitting down, leaning forward in the client's direction, and making direct eye contact.

A hospice nurse performs a follow-up telephone call to the spouse of a client who died about 1 year ago. The spouse tells the nurse, "I'm always feeling so sad. Life just doesn't feel worth living." Further conversation reveals that the spouse is having trouble sleeping and eating since her husband's death and that the spouse is "drinking more since he died." The nurse identifies which nursing diagnosis as the priority? a. Ineffective coping b. Stress overload c. Grieving d. Complicated grieving

d. Complicated grieving

A 60-year-old client who has been fighting cancer for more than 20 years has just been diagnosed with metastases to the brain. The client finds it difficult to get out of bed in the morning, has no interest in eating, and no longer finds fulfillment in favorite hobbies. Within which emotional reaction is the client functioning? a. Anger b. Denial c. Bargaining d. Depression

d. Depression

The nurse is assessing a client for pain and suspects that the client's culture may be affecting the pain response. What nonverbal indicator of pain would the nurse expect to observe? a. The client is praying with members of the clergy. b. The client requests to take a walk outside. c. The client is laughing loudly with family. d. The client is holding pressure on the abdomen when speaking.

d. The client is holding pressure on the abdomen when speaking.

A nurse is providing care to a client who has just been diagnosed with a terminal illness. Which of the following would be most appropriate for the nurse to do? a. Attempt to help the client make decisions about care. b. Explain to the client that the nurse understands how he or she must feel. c. Engage the client in conversation to provide distraction. d. Listen nonjudgmentally while allowing time for client reflection.

d. Listen nonjudgmentally while allowing time for client reflection.

The nurse anticipates a dying client to exhibit which signs of impending death? Select all that apply. a. Incontinence b. Restlessness c. Cheyne-Stokes respirations d. Flushed extremities e. Increased body temperature f. Loss of sensation

a. Incontinence b. Restlessness c. Cheyne-Stokes respirations f. Loss of sensation

For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death? a. Increased restlessness b. Increased eating c. Increased urinary output d. Increased wakefulness

a. Increased restlessness

Which nursing intervention reflects culturally appropriate care when addressing a client? a. "You can sit in this chair, Sally." b. "Good morning, Mr. Smith. I am your nurse, John." c. "I see you are here because you have a sinus infection." d. "Thank you for coming to the clinic today."

b. "Good morning, Mr. Smith. I am your nurse, John."

The hospice nurse is caring for a client with allow natural death (AND) orders. The nurse assesses that the client has a slow, irregular heart rate, has cooling of the extremities, and is agitated. Which interventions can the nurse implement? Select all that apply. a. Implement a slow code in the case of cardiopulmonary or respiratory arrest. b. Allow the client to stop drinking fluids. c. Do not perform cardiopulmonary resuscitation. d. Administer a lethal dose of barbiturates. e. Use medication to lower client consciousness to limit awareness of suffering.

b. Allow the client to stop drinking fluids. c. Do not perform cardiopulmonary resuscitation. e. Use medication to lower client consciousness to limit awareness of suffering.

A preconceived and untested belief about an individual or group of individuals is: a. Cultural relativity. b. Stereotyping. c. Culturally competent care. d. Racism.

b. Stereotyping

What barrier to end-of-life care does a dying client demonstrate with the statement, "I don't need hospice. Hospice is for people who are dying." a. Bargaining b. Acceptance c. Denial d. Anger

c. Denial

A family has recently immigrated. All members are quickly learning the language and the children are all in public school. Both parents are working and adapting to the new culture. What is this family demonstrating? a. Cultural assimilation b. Cultural blindness c. Culture shock d. Cultural imposition

a. Cultural assimilation

The oncology nurse is learning to care for dying clients. Which ideals should guide the nurse in facilitating a good death for these clients? Select all that apply. a. Care for dying clients should focus on pharmacologic relief of pain. b. The care of the dying client should be guided by the values and preferences of the nurse. c. The characteristics of a good death vary for each client. d. A good death is one that allows a person to die on his family's terms. e. Independence and dignity are central issues for many dying clients.

c. The characteristics of a good death vary for each client. e. Independence and dignity are central issues for many dying clients.

When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response? a. "Yes, this is a terrible diagnosis you've received." b. "Have you talked with your spiritual leader about your fears?" c. "I'm sure you are angry and sad." d. "This must be very difficult for you."

d. "This must be very difficult for you."

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. An advance directive b. A living will c. A standard addendum to a will d. A proxy directive

d. A proxy directive

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

a. Provides pain relief c. Integrates spirituality d. Enhances quality of life e. Offers a team approach to care

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? a. "Can you tell me about why you've made this decision?" b. "Does your family agree with this decision?" c. "Have you discussed this with your health care provider?" d. "Once you've started treatment, it's important to continue."

a. "Can you tell me about why you've made this decision?"

A client believes in the use of herbal therapy and asks the nurse if he can continue to use a herbal tea therapy. What is the most culturally appropriate nursing response? a. "There is no reason the tea cannot be used as long as the ingredients do not interfere with the medication." b. "Avoid the use of herbal teas and consider trying acupuncture instead." c. "Most of those teas have caffeine in them, and you don't need extra caffeine." d. "Herbal tea and medications do not mix well. I would avoid this practice."

a. "There is no reason the tea cannot be used as long as the ingredients do not interfere with the medication."

A 93-year-old client is in end-stage renal failure. The client frequently relates memories of early childhood, including the unforgettable event of the client's grandmother's death when the client was quite young. It is the client's wish to die in the same manner as "Gramma." Which option would the nurse expect the client to relate? a. "Gramma died in a nursing home." b. "Gramma died at home surrounded by family." c. "Gramma died en route to the hospital." d. "Gramma died in hospice."

b. "Gramma died at home surrounded by family."

A client is admitted to the hospital and the nurse is attempting to complete an admission assessment. The client reports that the spiritual healer will be coming in soon and is upset by the admission questions. What is the most appropriate response by the nurse? a. "We can wait for your healer, but the healer cannot do anything to provide care in this care environment." b. "We can wait for your healer to come and then work together to answer these questions." c. "These questions are important and must be answered." d. "When your spiritual healer gets here, please have him or her complete this admission information."

b. "We can wait for your healer to come and then work together to answer these questions."

Classification of illness can occur with cultural practice. What is an example of an unnatural illness? a. Chemicals in the water caused the client to develop diarrhea. b. Evil forces caused a client to develop schizophrenia. c. Impurities in the air caused a client to develop lung disease. d. Cold air caused a client to develop a cold.

b. Evil forces caused a client to develop schizophrenia.

A nurse is working with a family of a deceased client and assisting them in working through their grief and mourning. Which of the following would be the priority to promote healthy accommodation of the loss by the family? a. Assisting the family in expressing their feelings of loss b. Helping the family recognize the loss has occurred c. Encouraging the family to remember the relationship they had with the client d. Urging them to give up their old attachments to the client

b. Helping the family recognize the loss has occurred

Which of the following is an eligibility criterion for hospice care? a. Informed choice of cure-focused treatment b. Diagnosis of acute illness c. Limited life expectancy d. Use of advanced life support

c. Limited life expectancy

Which of the following nursing interventions will encourage the dying client to continue verbalizing? a. Listen in a nonjudgmental manner. b. Agree with everything the client says. c. Nod and use responsive comments such as "Yes." d. Talk about the client's problems.

c. Nod and use responsive comments such as "Yes."

The spouse of a client asks the nurse whether the spouse may bring in a cream from home to apply to the client's skin. The spouse says, "Whenever anyone gets sick, we always use this cream." The nurse interprets this as: a. Stereotyping. b. Ethnocentrism. c. Subculture. d. Ritual.

d. Ritual

Which is a sign of approaching death? a. Increase in urinary output b. Clear sensorium c. Irregular breathing patterns d. Insomnia

c. Irregular breathing patterns

Which of the following nursing interventions should a nurse perform to promote the dignity and self-esteem of a dying client? a. Share emotional pain. b. Help the client live according to his or her wishes. c. Keep the client clean and well groomed. d. Communicate hopefulness.

c. Keep the client clean and well groomed.

The nurse is discussing end-of-life decisions with a patient who has terminal cancer. Which statements describe the patient's options? (Select all that apply.) a. Living wills provide specific instructions about the kinds of health care that should be provided or foregone in particular situations. b. The Patient Self-Determination Act of 1990 requires all hospitals to inform their patients about advance directives. c. In a living will, a patient appoints an agent that he or she trusts to make decisions if he or she becomes incapacitated. d. Legally, all attempts must be made by the health care team to resuscitate a terminal patient. e. Nurses are legally responsible for arranging for a durable power of attorney for all terminal patients. f. The status of advance directives varies from state to state.

a. Living wills provide specific instructions about the kinds of health care that should be provided or foregone in particular situations. b. The Patient Self-Determination Act of 1990 requires all hospitals to inform their patients about advance directives. f. The status of advance directives varies from state to state.

The nurse is caring for a client at the end of life. The client is ordered a regular dosage of narcotics and short-acting narcotics for breakthrough pain. When administering the narcotics, the nurse is correct to realize which of the following? a. Side effects must be treated. b. Client may become sedated. c. Death is imminent. d. Dosages are restricted.

a. Side effects must be treated

For a client to use the Medicare Hospice Benefit, life expectancy needs to be what length of time? a. 8 months b. 6 months c. 2 months d. 4 months

b. 6 months