PrepU M-S: Chapter 13: Palliative care
A client nearing the end of life is experiencing delirium. Which action will the nurse take to help this client? Encourage family to visit. Apply restraints as needed. Increase environmental stimulation. Add additional lighting to the room.
Encourage family to visit. Explanation: Delirium can develop in the client who is near the end of life and may be due to an underlying treatable condition or the effects of the disease process. Actions should be taken to identify the underlying cause and provide appropriate interventions. The presence of familiar faces helps reduce the anxiety caused by the delirium. Restraints are not identified as an appropriate intervention for the client with delirium. Environmental stimuli should be reduced and harsh lighting avoided as these can increase the anxiety associated with delirium.
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? a.Encourage the family members to express their feelings and listen to them in their frank communication. b.Encourage conversations on the impending death of the patient. c.Be a silent observer and allow the patient to communicate with the family members. d.Encourage the patient's family members to spend time with the patient.
Encourage the family members to express their feelings and listen to them in their frank communication. Explanation: Family members usually find it difficult to communicate frankly with a dying person. By encouraging family members to express their feelings and listening to them in their frank communication, family members may feel more prepared to carry on a similarly honest dialogue with the dying patient. It is not advisable for the nurse to encourage conversations on the impending death of the patient. Being a silent observer or encouraging the family members to spend time with the dying patient may not help the family members to express their feelings.
Which term is used to describe the personal feelings that accompany an anticipated or actual loss? Bereavement Grief Mourning Spirituality
Grief Explanation: Grief is defined as the personal feelings that accompany an anticipated or actual loss. Bereavement is a period during which mourning for a loss take place. Mourning is an expression of grief and associated behaviors. Spirituality is a personal belief system that focuses on a search for meaning and purpose of life.
nurse is caring for a client with end-stage testicular cancer who has been referred to hospice care. Which criterion indicates that the client requires more teaching about hospice care? The client doesn't want to discuss death around his girlfriend. The client entered a clinical trial through the National Cancer Institute. The physician orders weekly blood transfusions to be given at home. The client explains that he isn't ready to complete his will.
The client entered a clinical trial through the National Cancer Institute. Explanation: The client involved in a clinical trial needs additional teaching about hospice care. This treatment option suggests that the client isn't ready for palliative care, which is a criterion for hospice care. Preferring not to discuss death around the girlfriend and not feeling ready to complete a will are normal responses to the grieving process. Blood transfusions are considered palliative care.
Which of the following is an appropriate method of assessing the dying client? a.Focus on the client's basic needs. b.Sedate the client before completing range-of-motion exercises. c.Repeat assessments as necessary. d.Stimulate the client every 30 minutes.
Focus on the client's basic needs. Explanation: Initially, nurses focus assessment on the client's basic physical needs, such as pain, breathing, nutrition, hydration, and elimination. The other options are inappropriate in the assessment of the dying client.
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. Share emotional pain. Abide by the dying client's wishes. Ask the family members about spiritual care.
Respect the client's and family members' choices. Explanation: In the final decisions of a dying client, the nurse will present options for terminal care and respect the client's and family members' choices. Sharing emotional pain is a role in providing care and comfort to dying clients and their families. When the client has a living will, physicians must abide by the client's wishes. The nurse should ask the family members about spiritual care only if the client wants someone associated with his or her religion.
When describing the term "grief" to a group of students, which of the following would the instructor include? A part of the life cycle in the form of change, growth, and transition The response experienced by anyone who has suffered a loss A feeling of connectedness with one's self and others Feelings of apprehension or worry in response to a situation
The response experienced by anyone who has suffered a loss Explanation: Grief refers to the universal response to any loss. It is experienced by anyone suffering any type of loss. Loss is part of the life cycle and occurs in the form of change, growth, and transition. Spirituality refers to the feeling of connectedness with self, others, a life force, or God that allows people to find meaning in life. Anxiety refers to feelings of apprehension or worry in response to or about a situation.
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? Each client experiences each of the stages. Typically, the stages occur in succession. The stages are applicable to any loss. Most clients reach acceptance by the time of death.
The stages are applicable to any loss. Explanation: The five stages of dying describe the five emotional reactions applicable to the experience of any loss. Not every client or family member experiences every stage. Many clients never reach a stage of acceptance. Clients and family fluctuate on a sometimes daily basis in their emotional
The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to clients who are dying and their families is to first do which of the following? A workshop on caring for the client who is dying Use evidence-based practice in daily care regimen. Explore own feelings on mortality and death and dying. Participate in a support group to learn clients' feeling on care.
Explore own feelings on mortality and death and dying. Explanation: To care for others in the dying process, the nurse must explore their own feelings about mortality and death and dying. Understanding the self provides a perspective to cope with and then support clients and families experiencing pain and grief. The other options are helpful in determining appropriate nursing care but not the first step.
four-step spiritual assessment process using the acronym FICA involves asking the following questions: -Faith and belief -Importance and Influence -Community -Address in care
Faith and belief: Do you consider yourself to be a spiritual or religious person? What is your faith or belief? What gives your life meaning? Importance and Influence: What importance does faith have in your life? Have your beliefs influenced the way you take care of yourself and your illness? What role do your beliefs play in regaining your health? Community: Are you a part of a spiritual or religious community? Is this of support to you and how? Is there a group of people you really love or who are important to you? Address in care: How would you like me to address these issues in your health care?
The nurse identifies a nursing diagnosis of Imbalanced nutrition: less than body requirements for a terminally ill client who is near the end of life. Which of the following would the nurse expect to include in the client's plan of care? a.Arrangements for the client to eat meals while others are out of the home. b.Advice for the family to have fruit juices readily available at the client's bedside. c.Suggestions that the family offer the client foods that are hot. d.Encouragement of the family to serve the client meat, especially beef.
b.Advice for the family to have fruit juices readily available at the client's bedside. Explanation: To promote nutrition in the terminally ill, the nurse would encourage the family to have fruit juices and milkshakes readily available at the bedside so that the client can access them frequently. Cool foods may be better tolerated than hot foods. Cheese, eggs, peanut butter, mild fish, chicken, and turkey are often better choices than meat such as beef that may taste bitter and unpleasant. Meals should be scheduled when family members are present to provide company and stimulation.
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: A.care that will reduce the client's physical discomfort and manage clinical symptoms. B.care that is provided at the very end of an illness to ease the dying process. C.an alternative therapy that uses massage and progressive relaxation for pain relief. D.offered to terminally ill clients who wish to remain in their homes in lieu of hospice care.
care that will reduce the client's physical discomfort and manage clinical symptoms. Explanation: Palliative care is used in conjunction with other end-of-life treatments and has many principles. Its aim is to reduce physical discomfort and other distressing symptoms but does not alter a disease's progression. Palliative care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life. Palliative care of a terminally ill client not only provides relief from pain and other distressing symptoms but it integrates other facets of patient care as well, including psychological and spiritual aspects. Palliative care is part of hospice care.
A type of comprehensive care for clients whose disease is not responsive to cure is a terminal illness. palliative care. euthanasia. interdisciplinary collaboration.
palliative care. Explanation: Palliative care is a type of comprehensive care for clients whose disease is not responsive to cure. Terminal illness is a progressive, irreversible illness that despite cure-focused medical treatment will result in the client's death. Euthanasia means the intentional killing by act or omission of a dependent human being for his or her alleged benefit. Interdisciplinary collaboration is communication and cooperation among members of diverse health care disciplines jointly to plan, implement, and evaluate care.
The nurse manager of an oncology unit is concerned that the staff are experiencing symptoms of chronic loss caused by the death of many long-term clients. Which action will the manager take to support the staff's resilience? Select all that apply. Allow flexibility in scheduling. Assign support groups between staff. Encourage picking up shifts. Promote collaborative relationships. Ensure fairness with assignments.
Allow flexibility in scheduling. Promote collaborative relationships. Ensure fairness with assignments. Explanation: Burnout is defined as the triad of emotional exhaustion, cynicism, and ineffectiveness at work. By the time one notices burnout it is usually too late. In order to prevent burnout, there is a body of work to promote resilience, thereby providing clinicians with the skills needed to have work-life balance and the opportunity to remain productive and satisfied with their career. Actions that the manager can take to promote resilience with the staff include allowing flexibility in scheduling, supporting staff autonomy, promoting collaborative relationships, and ensuring fairness with assignments. Limiting time away from work is not an action to support staff resilience. Assigning staff to form support groups is not supporting autonomy.
Which intervention should a nurse perform during the grieving period when caring for a dying client? Allowing a period of privacy Avoiding criticizing or giving advice Spending time with client Providing palliative care
Avoiding criticizing or giving advice Explanation: The nurse should listen in a nonjudgmental manner and should avoid criticizing or giving advice during the grieving period when caring for dying clients. Allowing a period of privacy is necessary to help family members cope with the death of a client and is not necessary during the grieving period. Spending time with the client and providing palliative care are not required nursing interventions during the grieving period. Palliative care is provided to a dying client when the client is unable to live independently.
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? Offer the bedpan to urinate or defecate Call the health care provider to obtain an oxygen order Get the client out of bed to the chair. Offer the client sips to drink.
Call the health care provider to obtain an oxygen order Explanation: Obtaining an oxygen order can reduce the client's shortness of breath and help the family feel more comfortable. It is difficult for families to see the client with shortness of breath. The dying client and family need support, and the bedpan, sitting in a chair, or offering sips to drink do not address the feelings of shortness of breath.
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? Physician's orders Client's goals Length of required treatment Invasiveness of the treatment
Client's goals Explanation: When managing the symptoms of a client with a terminal illness, the client's goals take precedence over the clinician's goals to relieve all symptoms at all costs. Although the length and invasiveness of the treatment may influence decision making, ultimately it is the client's goals that determine what will be done.
Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice. However, the median length of stay in a hospice program is just 21.3 days. Which reason explains the underuse of hospice care services? Lack of fully credentialed and trained hospice nurses Clients and families view hospice care as giving up Lack of Medicare/Medicaid funding for hospice Difficulty obtaining Medicare certification for hospice services
Clients and families view hospice care as giving up Explanation: Clients often equate hospice with giving up and are reluctant to accept hospice care. Lack of fully credentialed and trained hospice nurses is not a barrier to hospice care. Lack of Medicare funding and lack of certification for hospice service providers have not been documented as barriers to access of hospice services.
A patient diagnosed with terminal pancreatic cancer is unaware of the diagnosis and his daughter has requested that he not be told. What awareness context does the nurse determine this is? Suspected awareness Mutual pretense awareness Closed awareness Open awareness
Closed awareness Explanation: In closed awareness, the patient is unaware of his or her terminal state, whereas others are aware. In suspected awareness, the patient suspects what others know and attempts to find out details about his or her condition. In mutual pretense awareness, the patient, the family, and the health care professionals are aware that the patient is dying, but all pretend otherwise. In open awareness, the patient, the family, and the health care professionals are aware that the patient is dying and openly acknowledge that reality.
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? Medical directive by proxy Living will declaration Durable power of attorney for health care End-of-life treatment directive
Durable power of attorney for health care Explanation: A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. It allows another individual to make medical decisions on the client's behalf. The other options are incorrect.
Which is also known as a proxy directive? Medical directive Living will Durable power of attorney for health care Treatment directive
Durable power of attorney for health care Explanation: A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. The other options are incorrect.
For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death? a.Increased wakefulness b.Increased restlessness c.Increased eating d.Increased urinary output
Increased restlessness Explanation: As the oxygen supply to the brain decreases, the client may become restless. As the body weakens, the client will sleep more and begin to detach from the environment. For many clients, refusal of food is an indication that they are ready to die. Based on decreased intake, urinary output generally decreases in amount and frequency.
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? Engage the client in conversation to provide distraction. Explain to the client that the nurse understands how he or she must feel. Listen nonjudgmentally while allowing time for client reflection. Attempt to help the client make decisions about care.
Listen nonjudgmentally while allowing time for client reflection. Explanation: A client needs time to adjust to and cope with the information that he or she has just learned. The nurse's most appropriate action is to listen effectively, without making any judgments or attempting to solve the client's problems. Engaging the client in conversation and telling the client the nurse understands do not address the client's needs at this time. The client needs time to make sense of the information before he or she makes and decisions.
Which "awareness context" is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise? Mutual pretense awareness Closed awareness Suspected awareness Open awareness
Mutual pretense awareness Explanation: In mutual pretense awareness, the client, the family, and the health care professionals are aware that the client is dying, but all pretend otherwise. In closed awareness, the client is unaware of his or her terminal state, whereas others are aware. In suspected awareness, the client suspects what others know and attempts to find it out. In open awareness, all are aware that the client is dying and are able to acknowledge that reality openly.
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 Does not want to visit with family members Reports feeling fatigued Onset of generalized weakness Sleeps most of the day
Refuses to eat Does not want to visit with family members Reports feeling fatigued Onset of generalized weakness Explanation: There are specific stages to the dying process. The first stage begins months before the actual death and includes a decreased appetite or refusal to eat. Other symptoms of this stage are the development of fatigue and generalized weakness. The one final symptom of this stage is social isolation or not wanting to visit with family members. An increase in sleeping is a symptom associated with the stage of dying that occurs weeks before actual death.
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? Filling voids in conversation with information related to death and dying to avoid awkward moments during the admission interview Providing evidenced-based advice for end-of-life care based on the nurse's experiences with previous clients in hospice Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care Offering reassurance that the nurse has had 5 years of assisting clients in hospice and their families care for loved ones at the end of life
Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care Explanation: A key to effective listening includes allowing the client and family sufficient time to reflect and respond after asking a question. Hospice nurses with effective listening skills resist the impulse to fill the empty space in communication with talk, avoid the impulse to give advice, and avoid responses indicating, "I know just how you feel."
As the moment of death approaches, which of the following does the nurse encourage the family to do? a.Speak to the client in a calm and soothing voice. b.Rub the client's hand and arm to comfort the client. c.Have the family sit in front of the client so they can be seen. d.Lie next to the client and hold the client.
Speak to the client in a calm and soothing voice. Explanation: Sight and touch diminish as the client approaches death; however, hearing tends to remain intact. Speaking to the client calmly is most appropriate.
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 hospice services need to end now that the client has had the services for six months. The Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition. Medicare hospice services end at the seventh month of care. The client must begin to pay for other home health services since six months of hospice care have been received.
The Medicare hospice services can continue as long as the physician and hospice director agree about the client's terminal condition. Explanation: Eligibility for the Medicare Hospice Benefit includes physician and hospice medical director confirmation that the client is terminally ill, with a life expectancy of 6 months or less if the disease follows its natural course. The condition must be considered or classified as terminal, not just serious and progressive. The hospice services do not end at the sixth or seventh month of care. The client does not have to find other home health services as long as the Medicare certification process from the physician and hospice medical director was obtained.
Which of the following does not coincide with Kübler-Ross's stages related to a dying client? a.Clients don't always follow the stages in order. b.Some client regress, then move forward again. c.The dying client usually exhibits anger first. d.The client may be in several stages at once.
The dying client usually exhibits anger first. Explanation: The dying client does not usually exhibit anger first. The client may be in several stages at once, clients don't always follow the stages in order, and some regress and then move forward.
The nurse is caring for a client who just learned of a terminal diagnosis. After the physician leaves, the nurse remains to answer further questions so that the client can make an informed decision about further treatment. By providing all available information, the nurse is promoting which ethical principle? The principle of justice The principle of nonmaleficence The principle of fidelity The principle of autonomy
The principle of autonomy Explanation: By promoting open discussion and informed decision making, the nurse is empowering the client to make decisions independently. The principle of justice requires fairness and justice to all clients. The principle of nonmaleficence requires that nurse does not intentionally or unintentionally inflict harm on others. The principle of fidelity maintains that nurses are faithful to the care of the clients.
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? altered gastrointestinal function drop in blood pressure and rapid heart rate weight loss and inadequate food intake irregular eating habits
weight loss and inadequate food intake Explanation: The nurse should report weight loss and inadequate food intake so that the team can consider adding appetite stimulants and the nutritionist can alter the meal plan to give more satisfying meals as a comfort measure. The nurse knows that changes of gastrointestinal function such as irregular eating or bowel changes occur as part of the dying process and are not relevant to the desired intervention. Deteriorating vital signs are part of the dying process so that these signs are not relevant to the desired intervention.
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. a.Control the client's pain with prescribed medication. b.Advise the client's health care provider of the client's condition. c.Comfort the client by saying it will all be over soon. d.Encourage the client to explain his or her wishes. e.Recommend that the client consider physician-assisted suicide.
a,b,d Explanation: This client lives in Oregon, one of five states that have decriminalized physician-assisted suicide, the practice of providing a means by which a client can end his or her own life. This practice is controversial, with proponents arguing the client has a right to self-determination and a relief from suffering when there is no other means of palliation. Opponents, on the other hand, find it contrary to the Hippocratic Oath. In this scenario, the nurse should determine exactly what the client is asking and then support his or her wishes. It is not the nurse's role to suggest physician-assisted suicide voluntarily, however.
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? "Let's review the laboratory results and compare them with the diagnostic tests." "I understand that it would be wonderful to see your daughter's graduation." "What makes you most angry about getting the disease?" "I like your idea of living for today and enjoying those around you."
"I understand that it would be wonderful to see your daughter's graduation." Explanation: The third stage of Elisabeth Kubler-Ross' series of reactions is bargaining. Confirming the intention to live to a certain time is common in this stage. Reviewing laboratory and diagnostic tests occurs in the first stage, denial. Talking about anger occurs in the second stage, anger. Living for the day is an idea which occurs in the final stage, acceptance.
According to federal guidelines, hospices may provide no more than what percentage of the aggregate annual patient-days at the inpatient level? 10 20 30 40
20 Explanation: According to federal guidelines, hospices may provide no more than 20% of the aggregate annual patient-days at the inpatient level. The other numerical values are incorrect.
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 Allows for the nurse to take the client through in the appropriate order Allows for the nurse to understand when the grieving process should be concluded Allows the nurse to express his or her feelings
Allows for the nurse to facilitate the grieving process Explanation: Grieving is a painful yet normal reaction that helps clients cope with loss and leads to emotional healing. The nurse is responsible for facilitating the grieving process and helping the client and family deal with their emotions.
Which statements made by the nurse demonstrates that the nurse is providing spiritually sensitive care? "A key component of hospice care is following your family for up to a year after your death." "Denial, sadness, anger, fear, and anxiety are normal grief reactions." "Mourning may be demonstrated by emotional feelings of sadness, anger, guilt, and numbness." "Tell me who or what gives you strength."
"Tell me who or what gives you strength." Explanation: Spirituality is a personal belief system that focuses on a search for meaning and purpose of life. Assessment of people or things that provide strength to a terminally ill client is one way the nurse provides spiritually sensitive patient care. Grief is defined as the personal feelings that accompany an anticipated or actual loss. Bereavement is a period during which mourning for a loss take place. Mourning is an expression of grief and associated behaviors.
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? "His moaning does indicate pain, so we'll increase his pain medication." "The moaning you hear is from air moving over very relaxed vocal cords." "He has secretions that are collecting at the back of the throat." "He is getting less oxygen to the brain, so the moaning means he is dreaming."
"The moaning you hear is from air moving over very relaxed vocal cords." Explanation: As a client approaches death, certain signs appear. The family is reporting irregular breathing with periods of apnea. The moaning that they hear reflects the sound of air passing over very relaxed vocal cords. It does not signify pain or distress. Therefore, no additional pain medication would be needed. Secretions collecting at the back of the throat are noted by a rattling or gurgling sound. Decreased oxygen to the brain would lead to confusion, which may be reported by the client as strange dreams or visions.
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 can't do that, I will go to jail." "I am surprised that you would ask me to do something like that." "I will see if the physician will order enough for that to occur." "I will notify the physician that the current dose of medication is not relieving your pain."
"I will notify the physician that the current dose of medication is not relieving your pain." Explanation: Palliative sedation is distinguished from euthanasia and physician-assisted suicide in that the intent of palliative sedation is to relieve symptoms, not to hasten death. Palliative sedation is most commonly used when the patient exhibits intractable pain, dyspnea, seizures, or delirium, and it is generally considered appropriate in only the most difficult situations
The nurse is caring for a client who has diminished lung function due to emphysema. The terminally ill client is short of breath on exertion and reports difficulty sleeping in bed. The client states, "I am so afraid of getting any worse." Which statement, by the nurse, assists the client in sustaining hope? "Do not worry, I will be here for you to help you with your needs." "I will talk with the health care provider to determine the next step in your care." "Your grandchild is almost here, and you will enjoy seeing him." "I hear you say that you are not sleeping well."
"I will talk with the health care provider to determine the next step in your care." Explanation: The client is assisted in hopefulness by believing that the healthcare team will make his remaining days meaningful. By conveying a sense that the nurse will discuss the client's condition with the health care provider, the client recognizes that the healthcare team will use whatever treatment and comfort measures are available. Telling a client not to worry is not therapeutic and is condescending. Waiting for a grandchild does not address the client's thought. Reflecting what the client said for clarification opens communication but does not instill hopefulness.
patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse? "It will hasten the death of the patient." "It will prolong life in a dignified manner." "It will use artificial means of life support if the patient requests it." "It will enable the patient to remain home if that is what is desired."
"It will enable the patient to remain home if that is what is desired." Explanation: The goal of hospice is to enable the patient to remain at home, surrounded by the people and objects that have been important to him or her throughout life. The patient and family make up the unit of care. Hospice care does not seek to hasten death or encourage the prolongation of life through artificial means.
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? a."Let's take this one day at a time; remember you have your daughter's dance recital next week." b."You should seek a second medical opinion about your diagnosis." c."I know another client with the same diagnosis who has been in remission for 10 years." d."I believe that you will fight hard to beat this and see your babies grow up."
"Let's take this one day at a time; remember you have your daughter's dance recital next week." Explanation: Helping a client to find reasons to live and look forward to events promotes positive attitudes and ability to live for the moment, which in turn communicates a spirit of hopefulness. The statement about a second opinion is inappropriate because it gives the client false hope that her current diagnosis is inaccurate. Although he client may choose another medical opinion, she needs to come to that decision without the nurse's advice. Reponses should not convey false hope to the client. Nurses and clients should not confuse hope with unrealistic optimism.
While talking with a client who has been diagnosed with a terminal illness, the client asks, " Am I dying?" Which response from the nurse would be appropriate? Select all that apply. "I know just how you must feel." "This must be very difficult for you." "Tell me more about what's on your mind." "You still have time for a good life." "Let's focus on what your doctor has planned."
"This must be very difficult for you." "Tell me more about what's on your mind." Explanation: The nurse needs to listen effectively and empathetically, acknowledging the client's fears and concerns. Statements such as "This must be very difficult for you" and "Tell me more about what's on your mind" address the client's concerns and help to focus the discussion on the client. Telling the client that the nurse knows how the client feels ignores the client's concerns. Saying that there is still time for a good life or telling the client to focus on what the doctor has planned ignores the client's feelings and blocks communication.
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? "You will be able to stay only for approximately 1 month and then you will be discharged." "You will be able to stay for 2 months before being discharged." "There is no time limit for your stay. You can stay until you die." "When your stay reaches 6 months, you will be recertified for a continued stay."
"When your stay reaches 6 months, you will be recertified for a continued stay." Explanation: Federal rules for hospices require that eligibility be reviewed periodically. Patients who live longer than 6 months under hospice care are not discharged, provided that their physician and the hospice medical director continue to certify that they are terminally ill with a life expectancy of 6 months or less (assuming that the disease continues its expected course).
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? "I cannot legally administer pain medications that will induce unconsciousness to relieve your pain." "Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death." "Total sedation is a commonly practiced method used in this situation; I will contact your physician and begin treatment as soon as possible." "I need to perform a complete pain assessment to confirm the amount of pain you are experiencing before recommending sedation."
"Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death." Explanation: When a terminally ill client or the client's legal proxy requests palliative sedation, the use of pharmacologic agents to induce sedation or near sedation when symptoms have not responded to other management measures), the purpose is not to hasten the client's death but to relieve intractable symptoms. Palliative sedation may be controversial, but it is not illegal. Total sedation is rarely indicated in hospice care to provide comfort. Continuous pain assessments are not indicated at this stage; the client requires intervention/treatment.
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? Bargaining Denial Anger Acceptance
Anger Explanation: Anger is the second stage and is exhibited by statement similar to "Why me?" Denial occurs when the person refuses to believe certain information. Bargaining is an attempt to postpone death. During the acceptance stage, the dying clients accept their fate and make peace spiritually and with those to whom they are close.
While providing care to a terminally ill client, the client's niece asks the nurse about the client's condition and prognosis. Which of the following would be most appropriate? a.Provide the niece with the information that she is requesting. b.Check with the client's immediate family members about sharing information. c.Refer the niece to the client's physician for information. d.Ask the client's consent before sharing any information with the niece.
Ask the client's consent before sharing any information with the niece. Explanation: Before disclosing any health information about a client to family members, nurses should follow the agency's policy for obtaining consent from the client in accordance with the Health Insurance Portability and Accountability Act (HIPAA) rules. Information is shared only with the client's consent.
The nurse is caring for a 90-year-old client who has never completed an advance directive. The client has a child but has not seen the child in several years. A neighbor has assisted the client with meals and housecleaning for many years. The neighbor states that the client expressed only wanting to have comfort measures. The estranged offspring wants the client to be treated aggressively. Which would be the nurse's initial step? a.Notify the physician of the discrepancy. b.Follow the child's directive. c.Follow the neighbor's directive. d.Assess the client's ability to state wishes.
Assess the client's ability to state wishes. Explanation: It cannot be assumed that the client is unable to make decisions independently because of advanced age. Before any other person is asked about the client's wishes, the client needs to be asked first. The physician, who has a healthcare relationship with the client, may also have documented information about wishes.
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? Lower the head of the bed. Restrict the intake of oral fluids. Coach to use pursed lip breathing. Increase the air temperature in the room.
Coach to use pursed lip breathing. Explanation: Dyspnea is one of the most prevalent symptoms at the end of life and is considered a highly subjective symptom. To determine the intensity of dyspnea, the client can be asked to report the severity on a scale from 0 to 10, similar to using a pain rating scale. Interventions to reduce the subjective feeling of dyspnea includes the use of purse-lipped breathing. The head of the bed should be elevated or help the client assume a forward-learning posture. Oral fluids should not be restricted as this will help keep pulmonary secretions thin. The air temperature in the room should be cool as this helps facilitate breathing.
A client who has been demonstrating signs of impending death is awake, alert, and wants to see grandchildren after they attend school. Which action will the nurse take to support this client's request? Suggest the family bring one grandchild per day to visit the client. Contact the family to ask for grandchildren to come to visit the client. Tell the family that the client will most likely not last until the end of the day. Remind the client that they need rest and the grandchildren can visit another time.
Contact the family to ask for grandchildren to come to visit the client. Explanation: Days before death the client will demonstrate neurologic changes that include somnolence, restlessness, dulled senses, and a possible "rally" in energy. The client demonstrating signs of impending death who is now awake, alert, and asking to see grandchildren is experiencing a rally which should be supported by asking the family to bring the grandchildren to see the client. Bringing one grandchild per day to visit would not be appropriate because the rally is not going to last for several days and the client might die before all grandchildren have an opportunity to visit. A rally does not indicate impending death but rather death will most likely occur in a few days. The client's rally should be supported and not discouraged by reminding them to rest and visit with grandchildren another day.
Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death? Dusky appearance Increased body temperature Flushed appearance Absence of incontinence
Dusky appearance Explanation: The body becomes dusky or bluish, waxen-appearing, and cool; blood darkens and pools in dependent areas of the body, and urine and stool may be evacuated.
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. Gurgling as the client breathes through the mouth Breathing that is very rapid Decrease in amount of urine produced Refusal to ingest food or fluids Increase in visual and auditory abilities
Gurgling as the client breathes through the mouth Decrease in amount of urine produced Refusal to ingest food or fluids Explanation: As death approaches, a client typically has secretions that collect in the back of the throat and rattle or gurgle as the client breathes through the mouth. Breathing may become irregular with periods of no breathing. Urine output may decrease in amount and frequency, and loss of bladder and bowel control may occur. The person approaching death shows less interest in eating and drinking; for many, refusal of food is an indicator that they are ready to die. Vision and hearing may be somewhat impaired and speech may be difficult to understand.
Which of the following would not be consistent with promoting nutrition in terminally ill patients? Maintaining a balanced diet Offering small portion of favorite foods Avoiding arguments at mealtime Offering cool foods rather than hot foods
Maintaining a balanced diet Explanation: One should not be overly concerned about a "balanced" diet for terminally ill patients. Offering small portions of favorite foods, avoiding arguments at mealtime, and offering cool foods rather that hot foods are all tips that promote nutrition in terminally ill patients.
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? Barbiturate coma Palliative sedation Conscious sedation Patient-controlled analgesia
Palliative sedation Explanation: Effective control of symptoms can be achieved under most conditions; however, some clients may experience distressing, intractable symptoms and other clients may be incapacitated. Although palliative sedation remains controversial, it is offered in some settings to clients who are close to death or who have symptoms that do not respond to conventional pharmacologic and nonpharmacologic approaches, resulting in unrelieved suffering. Palliative sedation is distinguished from euthanasia and physician-assisted suicide in that the intent of palliative sedation is to relieve symptoms, not to hasten death. Proportionate palliative sedation uses the minimum drug necessary to relieve the symptom while preserving consciousness, whereas palliative sedation induces unconsciousness, which is more controversial. Barbiturate coma is a technique used to induce a coma in clients with specific conditions. Conscious sedation is used for some diagnostic tests and procedures. Clients who are incapacitated are not likely candidates for patient-controlled analgesia.
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. Nurses may administer medications prescribed by physicians to hasten end of life. A client has the right to make independent decisions about the timing of his or her death. Most states have enacted laws that allow for physician-assisted suicide.
Participating in assisted suicide violates the Code of Ethics for Nurses. Explanation: The American Nurses Association Position Statement on Assisted Suicide acknowledges the complexity of the assisted suicide debate but clearly states that nursing participation in assisted suicide is a violation of the Code for Nurses. Legally, nurses are not allowed to administer medications even if prescribed by a physician if that medication will hasten the client's end of life. Proponents of physician-assisted suicide argue that terminally ill people should have a legally sanctioned right to make independent decisions about the value of their lives and the timing and circumstances of their deaths. However, this is not the case at the present time. Two states have enacted legislation for physician-assisted suicide. These laws provide access to physician-assisted suicide by terminally ill clients under very controlled circumstances.
A client with a brain tumor recently stopped radiation and chemotherapy for treatment of the cancer. The client recently reported dry mouth. Which intervention by the hospice nurse demonstrates that the nurse understands treatment measures for dry mouth? Begin 9% normal saline IV at 125 mL/hr. Place two drops of atropine ophthalmic 1% solution sublingually. Provide gentle oral care after each meal. Gently suction the client's mouth and buccal cavity.
Provide gentle oral care after each meal. Explanation: Dry mouth can generally be managed through nursing measures such as mouth care. The use of artificial hydration (IV fluids) carries considerable risks and does not contribute to comfort at the end of life. Atropine ophthalmic 1% drops administered sublingually help to reduce oral secretions. Gentle oral suctioning reduces the production of secretions.
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. Most clinicians are very open to talking about disease and dying with clients. Clients, for the most part, would gain hope if they were told about a poor prognosis. Clients would ask for information if they really had a desire to know..
There remains a conspiracy of silence about dying despite progress in the area. Explanation: Despite the progress on many fronts associated with attitudes toward death and dying, there still is a belief in a conspiracy of silence about dying. Although a growing number of clinicians are becoming more comfortable with assessing clients' and families' information needs, many still avoid the topic in the hope that the client will ask or find out on his or her own. In addition, there are misconceptions that clients would subsequently lose all hope, give up, or be psychologically harmed by disclosure of a serious or terminal illness and that clients would ask for information if they really wanted to know.
In spite of administering the 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? Offer small amounts of nourishment frequently Gently massage the arms and legs Use imagery, humor, and progressive relaxation Encourage the patient to sleep
Use imagery, humor, and progressive relaxation Explanation: Imagery, humor, and progressive relaxation are the various techniques to potentiate the effects of pain medication. Offering small amounts of nourishment frequently will not help potentiate the effects of pain medication. Gentle massaging of the arms and legs helps to regulate body temperature. Encouraging the client to fall asleep will not help potentiate the effects of pain medication.
When assessing a terminally ill client, the nurse notices that the client has copious secretions at the back of the throat and in the mouth. The nurse is preparing a teaching plan for the family about caring for these secretions. Which of the following would be least appropriate to include? Positioning the client on the side with the head supported with a pillow Using a soft toothbrush to vigorously clean the mouth Performing gentle suctioning of the mouth Administering a prescribed anticholinergic agent
Using a soft toothbrush to vigorously clean the mouth Explanation: Secretions are often more distressing to the family than their presence is to the client. Gentle mouth care with a moistened swab or very soft toothbrush helps maintain the integrity of the client's mucous membranes. Other helpful measures include positioning the client on the side with the head supported with pillows to allow secretions to drain freely from the mouth, gently suctioning the oral cavity, and administering prescribed anticholinergic agents sublingually or transdermally. Deeper suctioning may cause significant discomfort to the dying client and rarely is of benefit because secretions tend to reaccumulate quickly.
