Chapter 39: Hospice Care My Nursing Test Banks

Chapter 39: Hospice Care

Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition

MULTIPLE CHOICE

1.What is the overall objective of hospice service?

a. Relieve symptoms of terminal disease
b. Educate the patient about the process of death
c. Keep the patient comfortable as death approaches
d. Relieve the family of the stress of death

ANS: C

Hospice is a philosophy of care that provides support and comfort to patients who are dying.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1209

OBJ: 1 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

2.Who was responsible for renewing the hospice philosophy in the 1960s?

a. Cicely Saunders
b. Lillian Wald
c. Dorothea Dix
d. Florence Nightingale

ANS: A

The idea of hospice originated in Europe. Dame Cicely Saunders renewed the idea of hospice in the 1960s.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1209

OBJ: 1 TOP: Hospice KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

3.The hospice nurse clarifies that hospice service is initiated when what type of treatment is no longer effective?

a. Proactive
b. Palliative
c. Alternative
d. Curative

ANS: D

Hospice care is appropriate when curative treatment is no longer effective. Hospice service is palliative, proactive, and an alternative to curative treatment.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1210

OBJ: 2 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

4.The nurse differentiates between curative and palliative care. What is true of curative treatment?

a. Curative treatment is centered on symptom control.
b. Curative treatment is focused on prolonging life.
c. Curative treatment is not concerned with dying.
d. Curative treatment is the only care covered by health insurance.

ANS: B

Curative treatment is aggressive care that aims to cure disease and prolong life. Palliative care is not curative in nature and is centered on symptom control. Both types of care are typically covered by health insurance.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1211

OBJ: 2 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

5.Because the family is confused about the meaning of palliative care, the hospice nurse needs to explain the focus of care. What is the focus of palliative care?

a. An aggressive approach to prolong life
b. A protocol of pain relief
c. A form of organized care, which relieves the family of responsibility
d. An integrated service of support for alleviation of symptoms

ANS: D

Palliative care is not curative but is an integrated plan designed to relieve pain and control symptoms. The goal is not to prolong life. While pain relief may be one aspect of hospice care, it is not what treatment is centered upon. The family is not relieved of their responsibility.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1211

OBJ: 2 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

6.The hospice nurse explains that to qualify for admission to a hospice, the attending physician must certify that the patient has a life expectancy of fewer than how many months?

a. 2 months
b. 3 months
c. 4 months
d. 6 months

ANS: D

The patient must meet certain criteria to be admitted to hospice, such as a prognosis of 6 months or fewer to live.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1211

OBJ: 3 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

7.The hospice nurse requests that the patient designate a primary caregiver for himself. What is true of the primary caregiver?

a. Must be a relative
b. Has complete control over the patients care
c. Assumes ongoing responsibility for health maintenance of the patient
d. Must have power of attorney

ANS: C

A primary caregiver is one who assumes responsibility for health maintenance and therapy. It is not necessary that the primary caregiver be a relative. The primary caregiver does not have complete control over the patients care, and it is not necessary for the primary caregiver to have power of attorney.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1212

OBJ: 3 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

8.Why is it important for the hospice nurse to provide time to confer with the patient and family?

a. To show concern
b. To report changes in the plan of care designed by the team
c. To confirm the ongoing reimbursement
d. To plan for changes in the scope of care

ANS: D

No changes should be made to the patients plan of care without first discussing it with the entire family. The family should be involved in planning the changes in the scope of care.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1212

OBJ: 1 TOP: Hospice KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

9.The patient informs the hospice nurse, Im not sold on this hospice thing. Im not looking for Jesus, Im just dying. What would be the most therapeutic response by the nurse?

a. Spiritualism is as you define it.
b. Rejecting the spiritual aspect of yourself may not be in your best interest.
c. Hospice service is about how to make your remaining time meaningful.
d. Based on what you say, hospice service may not answer your needs.

ANS: C

The holistic approach of hospice pertains to the total patient care including physical, emotional, social, economic, and spiritual needs of the patient with no particular emphasis on any one of those aspects.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1212

OBJ: 1 TOP: Hospice KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

10.What is the role of the hospice medical director?

a. To design and direct the plan of care
b. To evaluate the appropriateness of the care
c. To function as mediator between the team and the attending physician
d. To take the place of the patients attending physician

ANS: C

The medical director is a mediator between the interdisciplinary team and the attending physician. The interdisciplinary team designs the plan of care. The primary team, along with the interdisciplinary team, evaluates the appropriateness of care. The medical director does not take the place of the attending physician, but instead acts as a consultant for the attending physician.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1213

OBJ: 4 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

11.The hospice nurse tells the family that the nurse coordinator, an RN, will visit them. What is the role of the nurse coordinator?

a. Collect initial fees for the hospice service
b. Officially admit the patient to the hospice service
c. Assist with accessing community resources
d. Assist with funeral planning

ANS: B

The role of the nurse coordinator is to do the initial assessment, admit the patient, and develop the plan of care with the interdisciplinary team. The nurse coordinator would not be responsible for collecting fees at the initiation of services. The social worker would assist with community resources. The spiritual coordinator would assist with funeral planning.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1213

OBJ: 4 TOP: Hospice KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

12.The social worker evaluates and assesses the psychosocial needs of the patient. To work in a hospice, the social worker must have at least which degree?

a. Associate
b. Bachelors
c. Masters
d. Doctorate

ANS: B

The hospice social worker must have at least a bachelors degree.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1213, Table 39-1

OBJ: 4 TOP: Hospice KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

13.The hospice spiritual coordinator can be affiliated with any religion, assists with the spiritual assessment of the patient, and develops the plan of care regarding spiritual matters. To work in a hospice, what degree should the spiritual coordinator possess?

a. Bachelors degree
b. Masters degree
c. Seminary degree
d. Associate degree

ANS: C

The hospice spiritual coordinator must have a seminary degree.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1213, Table 39-1

OBJ: 4 TOP: Hospice KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

14.The hospice nurse introduced the family to the volunteer coordinator who will assign a volunteer to the patient. What can a hospice volunteer do for a patient and caregiver?

a. Give the family respite
b. Give necessary medication in the absence of the nurse
c. Be at the familys disposal 16 hours a week
d. Bathe the patient

ANS: A

The volunteer coordinator assigns volunteers to the family to give the family respite. The volunteer cannot give medication. A dedicated number of hours per week is not mandated. It is not the role of the volunteer to provide personal care.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1214

OBJ: 4 TOP: Hospice KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

15.The hospice nurse instructs the family that they have access to a bereavement coordinator who follows the plan of care focused on the caregiver after the death of the patient. For how long of a period of time will the caregiver and family have access to the bereavement coordinator?

a. One week
b. One month
c. One year
d. Two years

ANS: C

The bereavement coordinator follows the plan of care for the caregiver for at least a year following the death of the patient.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1214

OBJ: 4 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

16.The hospice nurse instructs the family that they have access to a hospice pharmacist, who is available for consultation on the drugs the hospice patient may be taking. What other role does the hospice pharmacist fill?

a. Administer all drugs necessary for pain alleviation
b. Evaluate drug interactions with food and other medications
c. Evaluate the safety of the drug storage in the patients home
d. Monitor drug effectiveness by frequent phone interviews with the family

ANS: B

The hospice pharmacist is available to consult about drug interactions with other drugs or food. The pharmacist does not administer the drugs. The nurse would evaluate the safety of drug storage in the home and monitor the drug effectiveness.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1215

OBJ: 4 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

17.Who conducts the nutritional assessment at the time of admission to hospice care?

a. Physician
b. Hospice nurse
c. Caregiver
d. Nursing assistant

ANS: B

The hospice nurse does the nutritional assessment during admission.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1215

OBJ: 4 TOP: Hospice KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

18.When a deficiency in nutritional status of a patient is assessed, what action should be taken by the hospice nurse?

a. Make a comprehensive grocery list for the caregiver
b. Alert the licensed medical nutritionist
c. Seek culturally appropriate methods to increase nutrition
d. Instruct the caregiver to give the patient multivitamins

ANS: B

The hospice nurse can call on the nutritionist for assistance for the patient who is assessed as having a nutritional deficit. The nutritionist can then provide assistance with meal planning and diet counseling.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1215

OBJ: 4 TOP: Hospice KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

19.What symptom of hospice patients is the most dreaded and feared, and should be a priority of symptom management?

a. Fear
b. Anger
c. Grief
d. Pain

ANS: D

While hospice patients experience all of these symptoms, pain is the most dreaded and feared. Pain disrupts the quality, activities, and enjoyment of life. Pain should be a priority of symptom management in hospice care.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1216

OBJ: 5 TOP: Hospice KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

20.During a pain assessment, the patient tells the nurse that the pain is aching, stabbing, and throbbing. What type of pain is the patient describing?

a. Visceral
b. Neuropathic
c. Somatic
d. Psychogenic

ANS: C

Somatic pain arises from the musculoskeletal system and is aching, stabbing, or throbbing. Visceral pain arises from the internal organs and is described as cramping, dull, or squeezing. Neuropathic pain arises from the neurologic system and is described as tingling, burning, or shooting.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1216

OBJ: 6 TOP: Hospice KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

21.What are the drugs of choice when caring for the hospice patient?

a. Nonsteroidal anti-inflammatory drugs
b. Anticholinergic drugs
c. Duragesic patches
d. Morphine derivatives

ANS: D

Morphine derivatives are popular drugs of choice when dealing with the hospice patient because they have a wide variety of modes of administration and provide good pain control.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1217

OBJ: 6 TOP: Pain KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

22.The nurse should educate the patient and caregiver that large doses of narcotics are required to control pain. What is the optimal dose for pain medications?

a. The smallest amount possible to achieve some effects
b. The dose that provides pain relief
c. The dose that is not addictive
d. The dose that works for most people

ANS: B

The patient and caregiver should understand that pain can be controlled and that using large doses of opioids is common and necessary to achieve that control. It is good to educate the patient and caregiver that the dose that works is the dose that works.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1217

OBJ: 6 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

23.The nurse warns that nausea is a common side effect with opioid treatment. What is the best treatment for nausea caused by opioids?

a. Antiemetics
b. Ice chips
c. Dry crackers
d. Ginger ale

ANS: A

Rather than discontinuing the opioid, the nausea should be treated with an antiemetic.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1218

OBJ: 6 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

24.When educating a patient concerning ways to prevent nausea, the nurse suggests that eating slowly in a pleasant atmosphere will help, as well as taking an antiemetic before meals. How many minutes before meals should the patient take the antiemetic?

a. 10
b. 20
c. 30
d. 60

ANS: C

Taking an antiemetic 30 minutes before meals reduces nausea and increases appetite.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1218

OBJ: 5 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

25.What is the most common problem of the terminally ill patient that is caused by narcotics?

a. Malnutrition
b. Constipation
c. Fluid retention
d. Dehydration

ANS: B

One of the most common opioid-induced problems of the terminally ill patient is constipation.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1219

OBJ: 5 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

26.The hospice nurse documents an assessment finding of cachexia in the patient record. What does cachexia describe?

a. Deep sleep and unresponsiveness
b. Marked weakness and emaciation
c. Total addiction to opioids
d. Renewed energy

ANS: B

Malnutrition marked by weakness and emaciation is called cachexia.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1219

OBJ: 5 TOP: Hospice KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

27.Which of the following is an expected part of the end-of-dying process?

a. Denial
b. Despair
c. Anorexia
d. Depression

ANS: C

The nurse often has to reassure the patient and caregiver that anorexia is part of the end-of-dying process.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1219

OBJ: 5 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

28.Which medication relaxes the patients respiratory effort and thus increases the efficiency of the patients respiratory status?

a. Aminophylline
b. Theophylline
c. Epinephrine
d. Morphine

ANS: D

Respiratory distress may be relieved by morphine.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1220

OBJ: 5 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

29.Why should the hospice nurse delay the use of oropharyngeal suctioning?

a. It will decrease mucus production
b. It will be uncomfortable for the patient
c. It is not necessary
d. It puts the patient at risk for infection

ANS: B

Suctioning should only occur if the patient is choking because it causes an increase in mucus production and is uncomfortable for the patient.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1220

OBJ: 5 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

30.The hospice nurse recommends that the patient prepare the document that provides guidance to the family concerning the patients wishes regarding life-support measures and organ donation. What is this document called?

a. Power of attorney
b. Living will
c. Advance directive
d. Conservatorship

ANS: C

An advance directive is a document prepared while the patient is alive and competent that provides guidance to the family and health care team in the event the person can no longer make decisions.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1222

OBJ: 8 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

31.The hospice nurse instructs caregivers in repositioning the patient because the patient spends most of the time reclining. What problem can this cause?

a. Contractures
b. Pressure ulcers
c. Bruising
d. Excoriation

ANS: B

Increased weakness is noted in the last stages of a terminal illness. With increased weakness, activity intolerance increases, and the patient spends most of the time reclining. This leads to risk for skin impairment and the formation of pressure ulcers.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1220

OBJ: 5 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

32.When air hunger is assessed in the dying patient, the nurse can perform which intervention(s)? (Select all that apply.)

a. Circulate the air with a fan
b. Use a tranquilizer to decrease anxiety
c. Provide good oral hygiene
d. Perform careful suctioning
e. Raise the head of the bed 30 degrees

ANS: A, B, C, E

Circulating the air with a fan, administering a tranquilizer to decrease anxiety, providing good oral hygiene, and raising the head of the bed 30 degrees are all interventions that can aid in relieving air hunger in the dying patient.  Suctioning will increase mucus production, which will make the dyspnea worse.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1220

OBJ: 5 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

33.The hospice nurse educates the patient and family about the members of the interdisciplinary team. Which caregivers are included? (Select all that apply.)

a. Medical director
b. Nurse coordinator
c. Social worker
d. Spiritual coordinator
e. Psychologist

ANS: A, B, C, D

The hospice interdisciplinary team includes the medical director, nurse coordinator, social worker, and spiritual coordinator.  The interdisciplinary team does not include a psychologist.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1212

OBJ: 4 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

34.Which are signs and symptoms of approaching death? (Select all that apply.)

a. Mottled extremities
b. Significant increase in urine output
c. Increased restlessness and pulling at bed linens
d. Alteration in rhythmic respiration
e. Increased pulse rate

ANS: A, C, D, E

Mottled extremities, a significant decrease in urine output, an increased restlessness, alteration in rhythmic respirations, and increased pulse rate are all symptoms of approaching death.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1221, Table 39-4

OBJ: 7 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

35.What are the goals of hospice service? (Select all that apply.)

a. Alleviating symptoms of approaching death
b. Educating and supporting primary caregivers
c. Using family input for designing a plan of care
d. Encouraging patients and caregivers to enjoy life
e. Focusing on the desires of the family in the plan of care

ANS: A, B, C, D

The plan of care should focus on the desires of the patient, not the desires of the family members.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1212

OBJ: 1 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

COMPLETION

36.When the dying patient becomes confused, the nurse should ____________ him or her.

ANS:

reorient

Reorientation regarding time, date, and location is the least distressing to the dying patient.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1221, Table 39-4

OBJ: 5 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

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