Chapter 7Palliative Care My Nursing Test Banks

Chapter 7Palliative Care

MULTIPLE CHOICE

1.The nurse believes that a client is eligible as a participant for The National Hospice Reimbursement Act of 1986. This act mandated that:

1.

clients with terminal illnesses are reimbursed.

2.

a physician must order hospice to be reimbursed.

3.

to receive reimbursement that client must be eligible for Medicare.

4.

to receive benefits, the physician must certify that the client has a limited life expectancy of 6 months or less.

ANS: 4

The Medicare hospice benefit is a reimbursement benefit for those with a prognosis of 6 months or less to live (certified by a physician). The act does not mandate reimbursement to clients with terminal illnesses, physicians do not have to order hospice for reimbursement, nor does a client have to be eligible for Medicare for hospice eligibility.

PTS: 1 DIF: Analyze REF: History and Overview of Hospice Care

2.After a Native American client has died, the family begins the practice of purifying the body. The nurse realizes that the deceased client may stay with the family for what period of time?

1.

12 hours

2.

24 hours

3.

36 hours

4.

48 hours

ANS: 3

Native Americans believe that the soul departs from the body 36 hours after death. The family may want the body to remain at the place of death for this period. The other choices are incorrect lengths of time according to Native American culture.

PTS:1DIF:Analyze

REF: Table 7-1 Cultural Considerations Related to Dying

3.A client is receiving care for symptoms; however, the treatment will not alter the course of the disease. This client is receiving which type of care?

1.

Hospital-based

2.

Managed

3.

Palliative

4.

Therapeutic

ANS: 3

Palliative care, or comfort care, is directed at providing relief to a terminally ill client through symptom and pain relief. The goal is not curative. Care for symptoms that will not alter the course of the disease does not need to be provided in the hospital. Managed care is guided through the direction of a primary care physician. Therapeutic is a type of care that focuses on a specific treatment for a health problem.

PTS: 1 DIF: Analyze REF: Overview of Palliative Care

4.A client diagnosed with a terminal illness is receiving an opioid/acetaminophen combination for pain control. The nurse realizes this client is being managed at which step of the World Health Organization approach to pain management?

1.

Step 1

2.

Step 2

3.

Step 3

4.

Step 4

ANS: 2

The World Health Organization approach to pain management involves three steps. Step 1: Clients are treated with around-the-clock doses of nonopioids. Step 2: The use of opioid/acetaminophen combinations are used to treat mild to moderate pain. Step 3: Strong opioids are used. There is no Step 4 in the World Health Organizations approach to pain management.

PTS:1DIF:Analyze

REF: Figure 7-2 Conceptual Model of Ladder Approach to Pain Management

5.A dying client is surrounded by family and friends at home. The hospice nurse talks with the spouse of the dying client to ensure that everything the family needs during this time is being done. The nurse is providing support to:

1.

the client.

2.

the bereaved.

3.

ensure compliance with the hospice rules and regulations.

4.

determine if the spouse understands that the client is dying.

ANS: 2

Supporting the familys rituals and cultural practices gives structure to support the bereaved through this painful process when people are vulnerable and feel off balance. The nurse is not providing support to the client. The nurse is not providing support to ensure compliance with the hospice rules and regulations. The nurse is also not providing support to determine if the spouse understands that the client is dying.

PTS: 1 DIF: Analyze REF: Role of the Hospice and Palliative Care Nurse

6.A client of the Hispanic culture is nearing death and the family requests that the client be prepared for discharge. The nurse realizes that the reason the family and client want to return home is because:

1.

individuals within this culture do not trust hospital caregivers.

2.

the family wants to have a spiritual healer care for the client.

3.

it is bad luck to die in the hospital.

4.

the spirit may get lost if the client dies in the hospital, and it will not be able to find its way home.

ANS: 4

Within the Hispanic culture, the client and family may not want to die in the hospital because the spirit may get lost and will not be able to find its way home. The reason the family and client want to return home is not because of a distrust of hospital caregivers. The family may want to have a spiritual healer conduct a ceremony for the client, but this does not need to be done in the home. Members of the Hispanic culture do not believe that it is bad luck to die in the hospital.

PTS:1DIF:Analyze

REF: Table 7-1 Cultural Considerations Related to Dying

7.During the period of time when a client diagnosed with a terminal illness became comatose, a health care proxy made decisions about the clients care. When the client regained consciousness a few days later, the nurse consulted whom regarding the clients ongoing care decisions?

1.

The client

2.

The health care proxy

3.

The clients family

4.

The clients physician

ANS: 1

A health care proxy is in effect whenever the client is unable to communicate and ceases to be in effect as soon as the client regains decision-making capacity. The nurse should consult with the client regarding the clients ongoing care decisions. The nurse should not consult with the health care proxy, the family, or the physician.

PTS:1DIF:Apply

REF: Ethics in Practice: Legal and Ethical Considerations Related to Dying

8.The nurse is concerned that the spouse of a terminally ill client is experiencing Anticipatory Grieving when which of the following is assessed?

1.

Confidence in the ability to care for the ill client at home

2.

Expressing anger about the clients pending death and crying throughout the day

3.

Large social support system

4.

Knowledge of equipment function

ANS: 2

Anticipatory grieving is the intellectual and emotional responses and behaviors by which individuals work through the process of modifying self-concept based on the perception of potential loss. Anger and crying about the clients pending death are signs of Anticipatory Grieving. The other assessment findings are evidence that the spouse is accepting the caregiver role.

PTS:1DIF:AnalyzeREF:Nursing Diagnoses

9.The nurse administers additional intravenous medication to a hospice client with uncontrollable pain. After receiving the additional medication, the client demonstrates apneic periods and bradycardia. Which of the following does this nurses actions suggest?

1.

Euthanasia

2.

Assisted suicide

3.

Double effect

4.

Malpractice

ANS: 3

The principle of double effect means that increasing the dose of medication to achieve pain control, even if death is hastened, is ethically justified. Euthanasia is the administration of medication to purposefully cause anothers death. Assisted suicide is the practice of providing medication to a client with the intent that the client use the medication to voluntarily commit suicide. Malpractice is conducting some aspect of care that causes a client harm.

PTS:1DIF:AnalyzeREF:Managing Pain

10.A client with a terminal illness was ingesting morphine sulfate 10 mg by mouth every 6 hours for pain. To ensure that the client receives the same degree of pain control when delivering the same medication through the intravenous route, which of the following should the nurse do?

1.

Provide morphine sulfate 10 mg intravenous every 6 hours.

2.

Provide morphine sulfate 20 mg intravenous every 4 hours.

3.

Provide a different medication since morphine sulfate cannot be given through the intravenous route.

4.

Consult a dose equivalent table to determine the dose of morphine sulfate the client will need through the intravenous route.

ANS: 4

Dose equivalent tables should be used by the nurse when analgesics or the routes of administration are changed. The nurse should not provide the same dosage of the medication through the intravenous route since this may be too much. Morphine sulfate can be administered through the intravenous route.

PTS:1DIF:ApplyREF:Managing Pain

11.A terminally ill client is experiencing nausea. Which of the following interventions can be used to help the client at this time?

1.

Administer diphenhydramine (Benadryl) as prescribed.

2.

Provide three regular meals.

3.

Limit mouth care.

4.

Restrict iced fluids.

ANS: 1

Diphenhydramine (Benadryl) acts on the vomiting center in the medulla. This is the intervention that would be the most helpful to the client at this time. The client should be provided with small, frequent meals. Mouth care should be provided when necessary. Iced fluids are helpful for dry mouth.

PTS:1DIF:Apply

REF:Managing Loss of Appetite, Constipation, Nausea, and Vomiting

12.A terminally ill client is more alert and talkative, and she is requesting specific foods to eat. The nurse should caution the family regarding the clients behavior because this could indicate:

1.

total remission of the disease process.

2.

final surprising rally before retreating.

3.

the client is cured of the terminal illness.

4.

the client was misdiagnosed.

ANS: 2

Nurses should prepare the family of a terminally ill client for an occasional final surprising rally in which the client becomes temporarily more alert and responsive before retreating. The period of alertness does not indicate total remission of the disease process, the clients being cured of the terminal illness, or the clients being misdiagnosed.

PTS: 1 DIF: Apply REF: Providing Care in the Active Phase of Dying

13.The nurse is concerned that a hospice client is approaching death when which of the following is assessed?

1.

Respiratory rate 16 and regular

2.

Blood pressure 110/60 mmHg

3.

Restlessness, irritability, and anxiety

4.

Periods of wakefulness are greater than periods of sleep

ANS: 3

Symptoms of hypoxia include restlessness, irritability, and anxiety. Respirations of 16 and regular is a normal respiratory rate. Blood pressure of 110/60 mmHg is within normal limits. Periods of wakefulness being greater than periods of sleep is also a normal physiological finding.

PTS: 1 DIF: Analyze REF: Table 7-2 Physiology of Dying

MULTIPLE RESPONSE

1.The nurse is discussing end-of-life wishes with a client and his family. Since the client is not sure of what type of care he wants, the nurse provides the document Five Wishes because this document provides which of the following types of information? (Select all that apply.)

1.

What the client wants his loved ones to know

2.

The level of comfort that the client wants

3.

Comments and ideas for health care providers

4.

The person designated by the client to make health care decisions

5.

The kinds of medical treatment that the client wants or does not want

6.

The way in which the client wants to be treated

ANS: 1, 2, 4, 5, 6

The Five Wishes document helps clients express themselves if they are seriously ill and unable to communicate their wishes for themselves. It looks at all of a clients needs: medical, personal, emotional, and spiritual. Comments and ideas for health care providers is not a part of the Five Wishes document.

PTS: 1 DIF: Apply REF: Role of the Hospice and Palliative Care Nurse

2.The nurse is making a home visit to a client receiving hospice care. Which of the following symptoms will the nurse assess in the client during the visit? (Select all that apply.)

1.

Aggression

2.

Anxiety

3.

Confusion

4.

Depression

5.

Increased appetite

6.

Urinary continence

ANS: 2, 3, 4

Common symptoms of the client receiving hospice care include pain, dyspnea, nausea, vomiting, constipation, loss of appetite, urinary urgency and incontinence, insomnia, confusion, delirium, anxiety, and depression. Aggression, increased appetite, and urinary continence are not symptoms typically assessed in a client receiving hospice care.

PTS:1DIF:Apply

REF:Assessment of the Patient Receiving Hospice and Palliative Care

3.The nurse, assessing pain in a client receiving hospice care, uses the ABCDE model to guide pain management. Which of the following is a part of this pain management approach? (Select all that apply.).

1.

Ask about the pain regularly.

2.

Believe the patient and family in their reports of pain.

3.

Confront the patient if you believe pain control was not achieved.

4.

Deliver interventions only when requested.

5.

Enable the patient to control her course of pain management to the greatest extent possible.

6.

Utilize complementary alternative medicine approaches first.

ANS: 1, 2, 5

The ABCDE model is a guide to pain management. For A, the nurse should regularly ask about pain. For B, the nurse should believe the patient and family in their reports of pain and what relieves it. For C, the nurse should choose pain control options that are appropriate for the patient. The nurse should not confront the patient about pain control since this is not therapeutic. For D, interventions should be delivered in a timely, logical, and coordinated manner and not only when requested. For E, patients and families should be empowered. Complementary alternative medicine approaches should not be used first.

PTS: 1 DIF: Apply REF: Box 7-2 ABCDE Guide to Pain Assessment

4.The nurse is providing a terminally ill client with morphine for pain control. In addition to this medication, which of the following can be provided to enhance analgesic effect? (Select all that apply.)

1.

Antihypertensive

2.

Antidepressant

3.

Antibiotic

4.

Antiemetic

5.

Anticonvulsant

6.

Corticosteroid

ANS: 2, 5, 6

Adjuvant medications can enhance analgesic effect and include antidepressants, anticonvulsants, and corticosteroids. Antihypertensives, antibiotics, and antiemetics are not considered adjuvant medications for pain control.

PTS:1DIF:ApplyREF:Managing Pain

5.A client with a terminal illness refuses pain medication. The nurse realizes that the client may decline pain medication for which of the following reasons? (Select all that apply.)

1.

Fear that the pain means the disease is worse

2.

Insufficient health plan benefits to pay for the medication

3.

Cultural background prevents the use of pain medication

4.

Fear of becoming addicted to pain medication

5.

Fear of side effects

6.

Concern about being labeled as a bad client

ANS: 1, 4, 5, 6

Client barriers to sufficient pain management include fear that the disease is worse, fear of becoming addicted to pain medication, fear of side effects, and concern about being labeled as a bad client. Insufficient health plan benefits to pay for the medication and cultural background preventing the use of pain medication are not identified client barriers to sufficient pain management.

PTS: 1 DIF: Analyze REF: Box 7-4 Barriers to Pain Management

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