RN End-of-Life Assessment

A nurse is caring for a client who is actively dying and notes the client's feet are purple and marbled. Which of the following findings should the nurse expect?

Mottling is visible on the client's legs. (The nurse should expect to see mottling on the client's legs. It often begins in the feet, then travels up the legs.)

A nurse is caring for a client who is nearing the end of life. Which of the following responses by the nurse supports the client's dignity? (Select all)

1. "What would you like to know about your medications?" is correct. The nurse should provide the client with accurate information about their care and medications. 2. "What can I do to help you feel more independent?" is correct. The nurse should support the client's dignity by demonstrating caring behaviors.

A nurse is teaching a client about hospice care. Which of the following information should the nurse include? (select all that apply. )

1. "You must have a terminal illness," is correct. Diagnosis of a terminal illness is an admission criterion for hospice care. 2. "You accept palliative care for comfort," is correct. The Centers for Medicare and Medicaid Services (CMS) have specific criteria that must be met for a client to be eligible for hospice services, including that a hospice provider and the primary care provider must officially state the client is terminally ill and the client must agree to palliative care as opposed to curing their illness. 3. "The health care provider must officially state that you are terminally ill," is correct. The Centers for Medicare and Medicaid Services (CMS) have specific criteria that must be met for a client to be eligible for hospice services, including that a hospice provider and the primary care provider must officially state the client is terminally ill and the client must agree to palliative care as opposed to curing their illness.

A nurse is providing post mortem care for a client. Which of the following actions should the nurse take? (select all)

1.Document where the body is being moved is correct. The nurse should document where the body is being moved, such as to a funeral home. 2.Include the name of anyone notified in the medical record is correct. The nurse should document the name of anyone notified of the client's death in the medical record. 3.Document the date and time of death is correct. The nurse should document the date and time of the client's death. 4.Ensure the client's belongings are accounted for is correct. The nurse should ensure the client's belongings are accounted for.

A nurse is caring for a client who is actively dying. the client's caregiver asks the nurse about the client's noisy respirations. Which of the following information should the nurse include? (Select all)

1.They can be an indication of approaching death. (Noisy respirations are caused by retention of secretions in the respiratory tract, also known as "death rattle" and Cheyne-Stokes respirations.) 2.Turning the client's head to the side can assist with drainage. (Turning the client's head to the side can assist with drainage of the secretions from the throat and lungs. ) 3.Medications can be administered to help dry up the secretions. (Medications such as oral atropine drops or scopolamine patches are used to assist with drying up the oral secretions.) 4.The client is unable to clear the secretions themselves. (The accumulation of secretions in the lungs and throat causes congestion and a "rattling" sound as the secretions become trapped. The sound of "rattling" caused the family members to become upset. The nurse should tell the family that this is not an indication that the client is experiencing any discomfort.)

A nurse is caring for a client who is actively dying and is discussing pain management with the client's caregiver. Which of the following information should the nurse include?

A combination of approaches is suggested to manage pain symptoms. (Pharmacological treatment of pain includes the use of both nonopioids and opioids. A combination of approaches is suggested to manage pain symptoms. This includes pharmacological treatment of pain, which includes the use of non-opioids, opioids, as well as nonpharmacological interventions.)

A nurse is caring for a client who has a terminal illness and reports feeling isolated from family and friends. Which of the following actions should the nurse take?

Assist in scheduling friends and family to visit. (The nurse should assist the client with scheduling visitors to promote a sense of belonging.)

A nurse is caring for a client who has a terminal illness and states that they want to experience a "good death". Which of the following actions should the nurse take?

Determine the client's definition of a "good death" (The nurse should determine the client's definition of a "good death" because clients can have varying definitions and expectations of what constitutes a "good death." A "good death" is individualistic and is influenced by the client's perception.)

A nurse is caring for a client who is actively dying. Which of the following actions should the nurse take for alterations in breathing pattern?

Educate the family about the expected respiratory changes. (As the client approaches the end of life, common physiological changes include shortness of breath, retention of secretions in the respiratory tract, and an irregular respiratory rate fluctuating between several quick breaths and periods of apnea. The nurse should provide education to family members and caregivers that many of the physiological respiratory changes are predictable as the client is dying.)

A hospice nurse is caring for a client who is hallucinating and talking to someone who is not there. Which of the following actions should the nurse take?

Ensure client safety and prevent injury. (The nurse should ensure the client's safety and the prevention of client injury.)

A nurse is reviewing hospice care services with a group of newly hired nurses. Which of the following information should the nurse include?

Hospice care is an interdisciplinary team effort. (Hospice care is an interdisciplinary team effort. The interdisciplinary team is made up of providers, nurses, assistive personnel, social workers, spiritual leaders, and other health care professional services required to meet client needs.)

A nurse is discussing culturally competent care with another nurse. Which of the following information should the nurse include?

It is culturally insensitive to talk about impending death in some cultures. (In some cultures, it is culturally insensitive to talk about impending death. The nurse should understand the cultural beliefs of the individual before discussing a poor prognosis with a client and their family.)

A nurse is caring for a client who is actively dying. The client's caregivers state they are interested in donating the client's organs. Which of the following actions should the nurse take?

Make a referral to an organ procurement organization. (Health care professionals who have completed a course provided or endorsed by an organ procurement organization are responsible for discussing organ donation.)

A nurse is discussing hospice care services with the caregiver of a client who is terminally ill. Which of the following information should the nurse include?

Nursing support will be provided in meeting the client's daily needs, including the administration of medications. (The nurse will support the caregiver in meeting the client's daily needs, including the administration of medications and activities of daily living. The hospice nurse supports the family's and caregiver's needs by assisting them to anticipate changes as the client's condition deteriorates, including measures to meet the changing needs of their loved one.)

A nurse is discussing the benefits of palliative care with a newly licensed nurse. Which of the following information should the nurse include?

Palliative care improves the client's quality of life. (Palliative care has been shown to improve a client's quality of life, reduce hospitalization times, and improve client satisfaction. Palliative care services can be provided long before a client has been diagnosed with a terminal illness. Any client who has a life-limiting disease, regardless of projected life expectancy or prognosis, is eligible to receive palliative care.)

A nurse is discussing palliative care with a client who has colon cancer. Which of the following information should the nurse include?

Palliative care uses a holistic approach. (Palliative care uses a holistic approach, caring for the client as a whole person and providing treatment of physical and psychosocial needs. It uses an interprofessional team approach with providers, nurses, and other associated health care personnel to meet the needs of the client.)

A nurse is grieving following the death of a client who had a terminal illness and is having difficulty sleeping and concentrating. Which of the following actions should the nurse take?

Participate in an exercise program. (Self-care activities such as exercising, eating a healthy diet, and setting boundaries are initial steps the nurse can take to help with the grieving process.)

A nurse is discussing the concept of spirituality with a newly licensed nurse. Which of the following information should then nurse include?

Spirituality focuses on the significance and purpose of life.

A nurse is planning care for a client who is terminally ill and speaks a different language than the nurse. Which of the following actions should the nurse take?

Use the health care facility's interpreter services. (Use the health care facility's interpreter services is correct. The nurse is legally obligated to use a qualified interpreter when providing care for a client who speaks a different language than the nurse.)