Chapter 40 hospice care Flashcards
(31 cards)
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.
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 is originated in Europe. Dame Cicely Saunders renewed the idea of
hospice in the 1960s.
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.
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.
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.
The hospice nurse explains that to qualify for admission to a hospice, the attending health
care provider 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.
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 patient’s 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 patient’s care, and it is not necessary for the primary
caregiver to have power of attorney.
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 patient’s 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.
The patient informs the hospice nurse, “I’m not sold on this hospice thing. I’m not looking
for Jesus, I’m just dying.” What would be the most therapeutic response by thenurse?
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.
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 health care provider
d. To take the place of the patient’s attending health care provider
ANS;C
The medical director is a mediator between the interdisciplinary team and the attending
health care provider. 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 health care provider, but instead acts as a
consultant for the attending health care provider.
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.
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. Bachelor’s
c. Master’s
d. Doctorate
ANS: B
The hospice social worker must have at least a bachelor’s degree.
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. Bachelor’s degree
b. Master’s degree
c. Seminary degree
d. Associate degree
ANS: C
The hospice spiritual coordinator must have a seminary degree.
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 family’s 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 are not mandated.
It is not the role of the volunteer to provide personal care.
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.
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 patient’s 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.
Who conducts the nutritional assessment at the time of admission to hospice care?
a. Health care provider
b. Hospice nurse
c. Caregiver
d. Unlicensed assistive personnel
ANS: B
The hospice nurse does the nutritional assessment during admission.
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.
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.
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.
What are the drugs of choice when caring for the hospice patient?
a. Nonsteroidal antiinflammatory 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.
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.
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.
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.
