Question 1

The nurse is caring for a dying client who becomes very agitated.What is the nurse's best response?

Accepted Answer

Dying clients become agitated when they are in pain or have some discomfort.Before administering medications or other therapies to decrease discomfort,the nurse should assess for potential causes of discomfort including urinary retention.

Question 2

The health care provider suggests inpatient hospice for a client.The family members are concerned that their loved one will receive only custodial care.What is the nurse's best response?

Accepted Answer

Palliative care provides an increased level of personal care designed to manage symptom distress.The focus is on pain control and helping the relative die with dignity.

Question 3

The terminally ill client is prescribed morphine to help cope with increasing discomfort.A family member expresses concern that the client is on "too much morphine." What is the nurse's best response?

Accepted Answer

Asking family members to explain what they mean by "too much morphine" serves to gain more information for the nurse.The other questions will not help the nurse obtain more information about the client's care or the family's concerns.

Question 4

A dying client's family members are spending time with the client.What instruction is best to give to family members regarding noise in the client's room?

Accepted Answer

The sense of hearing may remain intact,even when it appears that the client is totally unresponsive to any sort of stimuli.The family member should speak to the client as if she were fully aware.

Question 5

An experienced hospice nurse is training a new nurse in the practices of palliative care.What statement by the new nurse indicates understanding about drug therapy for end-of-life care?

Accepted Answer

Palliative care nurses follow protocols when administering medications.These protocols are standing prescriptions from the provider that identify the appropriate medication,dose,and situation for administration.The nurse cannot administer more than is prescribed.The medications are given to promote comfort and if administered per protocol will not hasten death.

Question 6

A client who is near death appears to be having difficulty breathing.What is the nurse's highest-priority intervention?

Accepted Answer

Morphine sulfate is the standard treatment for dyspnea near death; it relieves the psychological and physiologic distress that accompanies breathlessness.Suctioning or intubation may cause the client discomfort.Documentation is important,but it is not the priority intervention because it does nothing to relieve the client's distress.

Question 7

The wife is concerned because her terminally ill husband does not want to eat.What is the nurse's best response?

Accepted Answer

When family members understand that the client is not suffering from hunger and is not "starving to death," they may allow the client to determine when,what,or if to eat.Often,as death approaches,metabolic needs decrease and clients do not feel the sensation of hunger.Forcing them to eat frustrates the client and the family.

Question 8

The nurse is discussing advance directives with a client.Which statement by the client indicates good understanding of the purpose of an advance directive?

Accepted Answer

An advance directive is a written document prepared by a competent individual that specifies what,if any,extraordinary actions a person would want taken when he or she can no longer make decisions about personal health care.It does not address issues such as the client's residence in his or her own home.

Question 9

The spouse of a dying client states that she is concerned that her husband is choking to death.What is the nurse's best response?

Accepted Answer

The choking sound or "death rattle" is common in dying clients.The nurse should acknowledge the spouse's concerns and provide interventions that will reduce the choking sounds.Repositioning the client onto one side with a towel under the mouth to collect secretions is the best intervention.Morphine will assist with comfort but will not decrease the choking sounds.Nasal tracheal suctioning is not appropriate in a dying client.The nurse should not minimize the spouse's concerns.

Question 10

The family members of a client with a terminal illness tell a nurse that the client keeps asking if she is dying.What is the nurse's best response?

Accepted Answer

Being honest and truthful at such a time is important.It helps the client develop trust in those caring for her.Changing the subject will frustrate the client and may make her distrustful.Providing false hope is not a realistic intervention.Asking a pointed question often will not elicit the information that you want from the client.It is better to ask open-ended questions.

Question 11

A hospitalized American Indian client is approaching death.Family members who are standing vigil in the client's room begin to divide up his possessions among themselves as his symptoms progress.What is the nurse's most important intervention?

Accepted Answer

American Indians often disperse material possessions before or after death to friends and family members.Recognizing this culturally appropriate activity would not be consistent with removing the family,stopping the activity,or reporting the client's family's behaviors.

Question 12

The client's family members are concerned that the client should have a urinary catheter placed because of her decreasing urinary output.What is the hospice nurse's best response?

Accepted Answer

Insertion of an indwelling catheter is acceptable if the client is unable to void,has a distended bladder,and would be more comfortable not moving.The other statements are not appropriate uses for an indwelling catheter in a hospice setting.

Question 13

The nurse is providing care for a hospice client who is in the last stages of the dying process.The client develops a pressure ulcer on her sacrum,and family members tell the nurse that they would like a specialist consulted to treat the ulcer.When the nurse discusses this with the client,the client states that the ulcer does not bother her,that it is not causing her pain,and that she'd rather not have additional caregivers at this time.What should the hospice nurse do next?

Accepted Answer

When palliative care is provided to the dying client,symptoms will be actively treated only if they are causing the client distress.In this case,the client has stated that the pressure ulcer is not causing her distress,and she does not want further intervention.

Question 14

The nurse is being trained in hospice care.Which intervention by the nurse is most compatible with the goals of end-of-life care for the client?

Accepted Answer

When a client is near the end of life,nursing interventions should be focused toward facilitating peaceful death by granting the client's wishes and identifying his or her needs.Allowing a client who wishes to have something that is not permitted in the diet can be comforting if he or she has a craving or a desire for that food.There is no reason to withhold it at this time.

Question 15

A terminally ill client has just died in a hospital setting with family members at the bedside.The health care provider is also present.What should be the nurse's priority intervention as postmortem care begins?

Accepted Answer

Before moving the client's body to the funeral home,the nurse should ask family members if they would like to be alone with the client.Emergency assistance will not be necessary.Although it is important to ensure that a death certificate has been completed before the client is moved to the mortuary,the nurse first should ask family members if they would like to be alone with the client.The client's family should not be expected to prepare the body for the funeral home.

Question 16

The client tells the nurse that even though it has been 4 months since her sister's death,she frequently finds herself crying uncontrollably.The client is afraid that she is "losing her mind." What is the nurse's best response?

Accepted Answer

Frequent crying is not an abnormal response.The nurse should let the client know that this is normal and okay.Although the client may benefit from talking with a grief counselor,it is not unusual for her to still be grieving after a few months.The other responses are not as therapeutic because they justify or minimize the client's response.

Question 17

The nurse is caring for a client who is considering being admitted to hospice.What is the nurse's best response?

Accepted Answer

As both a philosophy and a system of care,hospice care uses an interdisciplinary approach to assess and address the holistic needs of clients and families to facilitate quality of life and a peaceful death.This holistic approach neither hastens nor postpones death but provides relief of symptoms experienced by the dying client.

Question 18

An older client was admitted to hospice owing to impending death in approximately 6 weeks.After 2 months,the family remains at the bedside but is becoming increasingly impatient and irritable.What is the best nursing intervention?

Accepted Answer

Death cannot be accurately predicted.The nurse should sit with the family and listen to their concerns.The nurse should not provide false hope or reassurance.Family members should remain with the client as long as they would like.The chaplain should be consulted if the family requests.

Question 19

The nurse is teaching a family member about various types of complementary therapies that might be effective for relieving the dying client's anxiety and restlessness.Which statement by the family member indicates understanding of the nurse's teaching?

Accepted Answer

Music therapy is a complementary therapy that may produce relaxation by quieting the mind and removing a client's inner restlessness.Complementary therapies are used in conjunction with traditional therapy.The complementary therapy would not replace pain or anxiety medication but may help decrease the need for these medications.Hiring an around-the-clock sitter does not demonstrate that the client's family understands complementary therapies.

Question 20

The nurse is assessing the dying client.Which manifestations of a dying client should the nurse assess to determine whether the client is near death?

Accepted Answer

All of these assessments should be performed during the dying process.As the peripheral circulation decreases,the client's level of consciousness and bowel sounds decrease.The client is unable to provide a numeric number on a pain scale.The nurse should continue to assess respiratory rate throughout the dying process.As the rate drops significantly and breathing becomes agonal,death is near.

Quiz 9: End-Of-Life Care