EF - End of Life Care

Question 1

• end-of-life care,
• aims to

Answer 1

relieve client suffering.

Question 2

palliative care / hospice care:
o Both support

Answer 2

o improvement of quality of life

Question 3

Hospice Care

Answer 3

• provision of medical / psychosocial care
• support clients - terminal illness

Question 4

Hospice Care
• allow them to live last days of life HOW

Answer 4

 best they can,
 long as they can.

Question 5

hospice care provided when

Answer 5

treatment - no longer cure / control illness;

Question 6

focus – Hospice Care

Answer 6

o providing comfort,
o dignity,
o personal growth as client faces death

Question 7

Originally hospice care - offered clients diagnosed w/ ___________ONLY

Answer 7

TERMINAL CANCER
o has grown - to include clients w/ life-limiting illnesses.

Question 8

When enroll in hospice care - asked to select

Answer 8

primary caregiver
o usually family member / close friend

Question 9

Hospice Care USUALLY PROVIDED WHERE

Answer 9

client’s /family members home
o may also be delivered in other settings, such as a
 hospital
 extended-care facility
 inpatient hospice centers

Question 10

Hospice Care - ADMISSION CRITERIA

Answer 10

primary care provider - diagnosis life expectancy < 6 months

Question 11

· Centers for Medicare & Medicaid Services developed specific criteria

Answer 11

 hospice provider / primary care provider - officially state client terminally ill
 client must agree to palliative care as opposed to curing illness
 client required to sign statement - choosing hospice care in place of other benefits to treat their illness.

Question 12

· Palliative care - focuses on

Answer 12

o relief / prevention of suffering /
o improving quality of life - clients / their families/caregivers.

Question 13

· If client lives beyond 6-months

Answer 13

o approved hospice provider - need to recertify client is terminally ill

Question 14

client can stop hospice services

Answer 14

at any time
o if their condition improves
o illness goes into remission

Question 15

· Other considerations client / family should considering when enrolling in hospice care

Answer 15

o client’s readiness to discontinue treatments aimed at prolonging life
o client’s rate of deterioration despite medical treatment received.

Question 16

• A nurse is admitting a client into hospice care. What is the admission criterion for the length of life expectancy of a client who is admitted into hospice care?

Answer 16

o Six months or less.
o client meeting specific criteria, includes a life expectancy < 6 months.

Question 17

Modern hospice care - provided by interdisciplinary team, consisting of

Answer 17

o providers,
o nurses,
o assistive personnel,
o social workers,
o spiritual leaders,
o other health care professional services necessary to meet client needs.

Question 18

interdisciplinary team approach - allows for

Answer 18

o holistic care of whole person,
o considering client’s mental, social, physical, spiritual considerations w/in dying experience.
o team focuses on –
 significance of quality of life rather than
 not delaying dying process.

Question 19

· Hospice care - volunteers provide respite care support TO
INCLUDE HELP WITH

Answer 19

o family/caregivers,
o including help w/
 running errands,
 housekeeping,
 transportation,
 childcare assistance, and
 visitation.

Question 20

Other HOSPICE services - include complementary medicine

Answer 20

o aromatherapy
o Therapeutic Touch

Question 21

expertise in managing pain / other manifestations - required to

Answer 21

serve purpose of hospice care.

Question 22

· acute awareness of intrapersonal / interpersonal undercurrents also necessary DUE TO

Answer 22

lot of family shit happening

Question 23

• Hospice care provides supportive services - up to_________following death of the client FOR WHO

Answer 23

o For those individuals identified as family and in primary caregiver role.

Question 24

hospice care – holistic - treats whole person including

Answer 24

caregivers / family members.

Question 25

client’s family / friends typically serve as

Answer 25

caregivers
o play vital role w/ health care team.

Question 26

• hospice nurse - essential role in education / support of family caregivers.
o assist family caregivers in

Answer 26

meeting client’s daily care needs
 administration of medications
 help w/ ADL’s.

Question 27

• hospice nurse
o Assist family / caregivers understand

Answer 27

 what to anticipate as client’s condition deteriorates,
 how to meet changing needs of loved one
 what can do - keep client comfortable as client’s condition worsens

Question 28

· hospice nurse - become someone w/whom caregivers confide regarding

Answer 28

o fears,
o anxiety,
o doubts in caring for client.
o Awareness of caregivers’ possible feelings - doubt / fear
 assist nurse in providing care.

Question 29

Nurse - team member - most

Answer 29

direct contact w/ client
o nurse shares information w/ other team members
 enabling them - adapt plan of care as needed.

Question 30

• Respite care - provides

Answer 30

brief break for primary caregivers,
o can last - hours, days, weeks.
o Caregivers can request loved one admitted - professional care facility
 maximum 5 days.
o provides caregivers opportunity to rest
o knowing loved one cared for by hospice-trained professionals.

Question 31

HOSPICE CARE - nurse in collaboration w/ other team members
o changes care plan to meet specific needs of WHO ELSE BESIDE CLIENT

Answer 31

caregivers

Question 32

• As a nurse caring for a client who is receiving hospice care, what are some interventions you can use in supporting the family and caregivers?

Answer 32

 assisting w/ medication administration
 activities of daily living,
 educating family - what to expect as client’s condition deteriorates
 how to meet changing needs of loved one,
 explaining to family / caregivers - not unusual - feelings of doubt / fear,
 providing emotional support to family/caregivers.

Question 33

Palliative Care

Answer 33

• holistic care provided for clients throughout lifespan - experiencing severe medical illness,
• particularly for clients approaching end of life.
• initially concentrated on lessening client’s distress at end of life.

Question 34

Today - best practice dictates - palliative care be implemented WHEN

Answer 34

earlier in course of life-threatening health events.

Question 35

In past, palliative care - generally provided - ___________
Now provided to ____________

Answer 35

clients w/ cancer diagnosis,
o now offered - clients suffering w/ any life-threatening health event / chronic illness.

Question 36

• Goal - palliative care

Answer 36

· improve quality of life for client / family / caregivers.

Question 37

· Ex’s diseases - palliative care may be appropriate

Answer 37

o advanced stages of cancer,
o refractory cardiac disease (heart failure),
o renal or respiratory failure,
o neurodegenerative conditions
 Alzheimer’s disease / Parkinson’s disease.

Question 38

· Palliative care - been shown to

Answer 38

o improve client’s quality of life,
o reduce time in hospital
o improve client satisfaction.

Question 39

· Palliative care differs from hospice care

Answer 39

o palliative care - provided while client still receiving curative treatments.
o palliative care not subject to time constraints.
o Palliative care services may be suitable / provided long before client identified w/ terminal illness.
o Any client w/ life-limiting disease, regardless of projected life expectancy / prognosis - eligible to palliative care.

Question 40

key aspect - palliative care -

Answer 40

holistic approach—caring for client as whole person,
o treating both physical / psychosocial needs.

Question 41

palliative care uses what kind of team approach

Answer 41

interprofessional team approach
o providers,
o nurses,
o other associated health care personnel
o to meet client’s needs.

Question 42

terminal phase of client’s life - referred to as

Answer 42

“actively dying” or “imminent death”.

Question 43

Physiological Changes - when ‘actively dying’ AKA ‘imminent death’
Breathing and Respirations

Answer 43

• dyspnea - shortness of breath
o “death rattle” - retention of secretions in respiratory tract
• Cheyne-Stokes respirations - irregular respiratory rate fluctuating between several quick breaths and periods of apnea.

Question 44

• Dyspnea may be related to

Answer 44

o advanced-stage cancer,
o ascites,
o chronic obstructive respiratory disease - a physical decline in respiratory functioning, CONFIRM
o pneumonia.

Question 45

dyspnea

Answer 45

DIFFICULT OR LABORED BREATHING

Question 46

WHAT IS FIRST MED CHOICE TO TREAT DYSPNEA
WHY?

Answer 46

• Opioids, - morphine,
o increase peripheral vasodilation (widening of the blood vessels),
o permits increased blood flow),
o reduce client’s sense of breathing difficulty,
o decrease anxiety.

Question 47

Oxygen therapy PROVIDES WHAT BENEFIT

Answer 47

relieve dyspnea / provides psychological comfort to client’s family

Question 48

· death imminent, comfort measures INCLUDE

Answer 48

o positioning,
o using fan - facilitate movement of air,
o reducing exertion
o relaxation techniques should be focus.

Question 49

• Anxiolytics such as __________
o relieve

Answer 49

benzodiazepines

Question 50

• Death rattle –
o caused by

Answer 50

accumulation of secretions in lungs / throat,
o causing congestion
o “rattling” sound as secretions become trapped - client unable to clear secretions.

Question 51

IS DEATH RATTLE INDICATION OF CLIENT DISCOMFORT

Answer 51

o not an indication of client discomfort.
o is indication of approaching death, often w/in hours / days.
o can upset family members / caregivers,

Question 52

WHAT POSITIONING TECHNIQUE CAN HELP RELIEVE DEATH RATTLE

Answer 52

o Turning client’s head to side or rolling client to side - can assist w/ drainage of secretions from throat / lungs.

Question 53

WHAT MEDS CAN HELP DRY UP SECRETIONS CAUSING DEATH RATTLE

Answer 53

oral atropine drops or scopolamine patches

Question 54

WHAT INTERVENTIONS CAN BE DONE TO DRY UP SECRETIONS - DEATH RATTLE

Answer 54

o moist washcloth / oral suctioning - used to eliminate secretions from mouth.

Question 55

WILL DEEP SUCTIONING DRY UP SECRETIONS - DEATH RATTLE

Answer 55

NO - ineffective removing accumulated secretions pooled in lungs.

Question 56

Cheyne-Stokes respirations

Answer 56

visible changes in client’s pattern of breathing
o typically occurs w/in three days of impending death
o client’s rate of respiration becomes irregular
o fluctuating between several quick breaths
o followed by periods of apnea

Question 57

NURSING INTERVENTIONS PROVIDE RELEIF FOR CHEYNE-STOKES RESPIRATIONS

Answer 57

 positioning a fan to blow lightly in direction of client.
 family should be educated - this type of breathing pattern - typical / expected.

Question 58

· Nurses promote management of pain through means considered

Answer 58

o safe,
o sufficient,
o successful in providing relief
o when client actively dying.

Question 59

Pain - experienced by __________older adult hospice clients w/ cancer.

Answer 59

60%

Question 60

hospice care and palliative care aim

Answer 60

improve end-of-life experience, therefore
o pain management - critical –

Question 61

PAIN MANAGEMENT IS CRITICAL TO ENSURE

Answer 61

 ensuring clients receive adequate relief from pain
 do not suffer unnecessarily.

Question 62

· Guidelines suggest - combination of approaches - most effective CONTROLLING PAIN AND INCLUDE

Answer 62

o administration of scheduled medications,
o as-needed (PRN) medications, and
o nonpharmacologic interventions.

Question 63

· Clients may experience pain - end of life from

Answer 63

o nerve injury, an
o organ being stretched / compressed, and
o bone pain.

Question 64

not unusual for nurse to hesitate about__________
WHY?

Answer 64

providing pain medication to such clients
o fear of reducing respiratory rate or
o hastening client’s death.

Question 65

• According to American Nurses Association position statement NURSE HAS»>

Answer 65

o nurse has ethical responsibility to alleviate pain / suffering,
o individualize interventions, and to
o use variety of methods, including interprofessional approaches, to relieve pain.

Question 66

· Pharmacologic treatment - pain includes

Answer 66

nonopioids and opioids.

Question 67

Palliative care guidelines suggest WHAT WHEN ADMINSITERING PAIN MANAGEMENT MEDS

Answer 67

three-step ladder

Question 68

three-step ladder

Answer 68

o nonsteroidal anti-inflammatory drugs (NSAIDs) - nonopioid medications.
o If pain unrelieved / increases in intensity - codeine / tramadol recommended.
o When pain rated as moderate – severe - morphine is prescribed.

Question 69

Nurses - responsible supporting nonpharmacologic interventions - managing pain, INCLUDE

Answer 69

o psychological approaches,
o physical measures,
o integrative therapies,
o interventional techniques.

Question 70

Nurses - responsible supporting nonpharmacologic interventions - managing pain, EXAMPLES OF INTERVENTIONS

Answer 70

o diversion,
o relaxation exercises,
o imagery;
o massage therapy;
o breathing exercises;
o music therapy;
o spiritual practices;
o changes in lighting / noise;
o repositioning;
o heat or cold therapy.

Question 71

As client nears death - nervous system’s ability to regulate

Answer 71

body temperature diminishes,
o causing episodes of both increased / decreased temperature.

Question 72

· Other causes - temperature changes

Answer 72

o infection,
 sweating is normal, especially if fever present
o cancer,
 cancerous tumor itself - can cause client to have elevated temperature.
o cancer therapy.
 Chemotherapy - decreases immune system’s ability to respond to infection,
o can lead to sepsis.
o use of opioids,
o blood transfusion reactions,
o pain,
o hypoxia,
o fear,
o anxiety,
o warm environment
o result in temperature changes.

Question 73

· client’s body temperature can be managed w/

Answer 73

o cold / hot compresses,
o warm sponge baths,
o hypothermia blankets,
o adjusting air conditioning,
o using a fan,
o antipyretic medications,

Question 74

antipyretic medications INCLUDE

Answer 74

acetaminophen, ibuprofen, naproxen, or aspirin.

Question 75

Mottling

Answer 75

expected / ordinary physical change
o occurs hours / days before death.
o upper / lower extremities become cool to touch,
o purple / reddish marbling of skin.
o result of heart’s inability to pump blood effectively,
 leading to decreased blood perfusion throughout body.
o often begins in feet and moves up legs.
o indication of impending death.
o client does not feel any discomfort from mottling,
o client but may feel cold.

Question 76

MOTTLINGInterventions

Answer 76

providing warm blankets.

Question 77

Vision and Hearing CHANGES AT END OF LIFE

Answer 77

• Clients may experience hallucinations - sensation something is there when it is not, including
o hearing / seeing those already dead
• can include all senses: hearing, sight, taste, touch, smell (5)
• client may
o hear voices
o see an item / person unseen by others
 Ex: client may be seen speaking w/ family member already dead
 see places others do not see.

Question 78

When client experiences hallucination - avoid

Answer 78

contradicting what client believes to be true.
o Denying occurrence of hallucinations
 cause distress
 aggravate client who is actively dying.

Question 79

clients can hear - even if

Answer 79

in deep comatose state,
o talk to them
o provide reassurance—
o can help those who are experiencing hallucinations.

Question 80

ARE Reorientation approaches USEFUL AT COMATOSE STATE OR HALLUCINATIONS

Answer 80

little benefit
• provide support / reassurance, - family may become unsettled when client experiences hallucinations.

Question 81

Interventions aimed at HALLUCINATIONS are to ensure

Answer 81

ensuring client safety / preventing client injury.

Question 82

Providing end of life care - can be

Answer 82

· physically / emotionally demanding

Question 83

preventing / relieving suffering - essential part of medical care for

Answer 83

· dying clients

Question 84

• Increased Temperature
o Manage with

Answer 84

antipyretic medications and warm baths

Question 85

• Mottling
o Purple or reddish marbling of the skin tone
o Managed by

Answer 85

o providing warm blankets

Question 86

• Cheyne-Stokes Respirations
o An irregular breathing pattern with periods of apnea
o Managed by

Answer 86

having a fan blow in the clients direction
providing air movement in some way
see other flash card for other interventions

Question 87

• Hallucinations
o Seeing, hearing, or experiencing something that is not reality
o Manage by

Answer 87

reassurance; avoid denial of the sensations

Question 88

• Death Rattle
o Accumulation of secretions in the lungs and throat
o Manage by

Answer 88

turning the client to their side

Question 89

absence of social contact - leads to

Answer 89

social isolation,
o cause loneliness
o adversely affect health.

Question 90

· Loneliness - emotional condition in which there is perception

Answer 90

o insufficient love,
o closeness,
o social communication w/ others.

Question 91

Social isolation - is

Answer 91

inadequate contact / relationships w/ people.

Question 92

Constant tiredness, pain - influence client’s ability to

Answer 92

socially interact act w/ others.

Question 93

people rely upon social environment -

Answer 93

give meaning to their life,
o separation from family, community, religious / spiritual support system
o can increase client suffering.

Question 94

palliative care services - designed to facilitate

Answer 94

social support - clients whose lives limited by disease.
• provided through home visits, telephone, Internet.
• in-person face-face connections - most beneficial to client,
• other methods of facilitating social support
o social media platforms
o texting to help client actively dying - stay in touch w/ friends/family.
• Members of online support groups
o can validate feelings of isolation
o offer encouragement
o understand what it is like to experience loneliness.
• Volunteers through hospice organization
o can visit w/ clients/family members
o develop enduring relationships for those whose social contacts decreasing near end of life.

Question 95

• support groups - assist family members / caregivers –
o recently lost loved one to

Answer 95

o meet others also experiencing conflict, pain, loss.

Question 96

• Nurse - can assist in prevemting social isolation by

Answer 96

having visitors come at time when client’s pain management / other adverse physical manifestations are controlled,
o should enable client be more comfortable when interacting w/ others.

Question 97

American Nurses Association’s Code of Ethics for Nurses states, ‘ the nurse practices»»

Answer 97

with compassion and respect for the inherent dignity, worth, and unique attributes of every person”.

Question 98

Dignity - regarded everyday necessity essential to

Answer 98

well-being of all clients.

Question 99

Most concerns related to nursing care at end of life - associated w/

Answer 99

o breakdown in communication
o lack of attention / consideration,
 diminishes client’s sense of dignity.

Question 100

· Nurses can support clients’ dignity

Answer 100

o managing client manifestations,
 pain / respiratory issues;
o advocating independence,
o privacy,
o social assistance;
o providing care w/ an optimistic attitude;
o listening;
o providing correct information;
o demonstrating caring behaviors including empathy.

Question 101

· Other needs to preserve client dignity include

Answer 101

spiritual
everyday concerns

Question 102

spiritual needs to preserve dignity include

Answer 102

 client’s need to be acknowledged as a person until they die
 client’s need to be told truth about illness.
 Spirituality more than religion
 it is attempting to be present,
 to acknowledge client’s viewpoint sincerely,
 provide holistic care - emphasizes dignity before everything else.

Question 103

everyday concerns to preserve dignity include

Answer 103

 illness contributes to loss of control,
• lessens sense of dignity.

Question 104

Control refers to

Answer 104

client’s perception / ability to take care of life situations.
• essential to involve clients in decision-making process
• ask for input about how they desire to be cared for
• how they would like to die.

Question 105

Nurses should advocate for client when client

Answer 105

unable to handle matters themselves,
o includes being truthful w/ family members / caregivers.

Question 106

· Spirituality - difficult to define because

Answer 106

universally recognized definition is lacking.

Question 107

“religion” / “spirituality” often used

Answer 107

interchangeably, BUT
o mean different things.

Question 108

Religion - based on

Answer 108

• specific beliefs / values shared w/in a community in worship of higher power.
o For some religion includes spirituality / relationship w/ God / higher power;
for others, it does not.

Question 109

Spirituality speaks to

Answer 109

person’s existence
o centered on significance / purpose of life.
o about relationship w/ others, nature, higher power.

Question 110

· Spiritual happiness - several benefits for clients,

Answer 110

o improved quality of life;
o better handling of illness, diagnosis, manifestations;
o averting depression, hopelessness,
o wish to hasten death.

Question 111

· not uncommon - clients - end of life TO REVISIT&raquo_space;»

Answer 111

o revisit faith / spirituality
o make happiness priority while looking forward to peaceful death.

Question 112

Spirituality can offer clients - approach to coping w/

Answer 112

impending death,
• provides hope for life after death.

Question 113

• If clients do not believe in afterlife,
o may experience worldly / horizontal hope,

Answer 113

 people / things - offer meaning in assisting person in reaching end-of-life goals.
 Ex: clients may hope to be pain-free when die or
 to repair damaged relationships before they die. CONFIRM

Question 114

end of life imminent - not unusual - clients change

Answer 114

what they hope for when actively dying.

Question 115

spiritual care - part of nurse’s role - TO ENSURE

Answer 115

delivering holistic, client-centered care.
o nurse must be sensitive to avoid offending client and maintain the client–nurse relationship.

Question 116

Before offering spiritual care - essential to ask clients if

Answer 116

they desire spiritual care.

Question 117

nurse should demonstrate WHAT QUALITIES IN CARING FOR CLIENT / FAMILY

Answer 117

understanding, warmth, compassion
o this approach - improves relationship / communication between nurse /client,
o both of which - critical when providing spiritual care.

Question 118

If clients identify a religious affiliation with their spirituality, it is essential to

Answer 118

· accommodate their religious beliefs.

Question 119

Accommodating religious beliefs includes

Answer 119

· making contact with religious figures and other followers within their religious group.

Question 120

Nonreligious spiritual care should be offered to those clients who

Answer 120

· do not identify religious beliefs with spirituality.

Question 121

• Although nurses can provide spiritual care, in-depth spiritual counseling should be provided by

Answer 121

spiritual leaders.

Question 122

• When a client is actively dying, health care providers, family, and caregivers are instrumental in providing

Answer 122

“good death” for the client.

Question 123

definition of “dying well” is

Answer 123

different for every client, as various factors influence the perception of a “good death”.

Question 124

• Fundamental aspects relate to recurring topics that many clients believe to be essential for a “good death”

Answer 124

o pain management,
o planning for death,
o closure at the end of life,
o clear decision making, and
o contributing to others.

Question 125

Elements that influence clients’ perception of death include

Answer 125

culture, religion, age, life events, illness, and financial concerns

Question 126

Nurses affect lives - dying people –

Answer 126

o applying personal views of what constitutes “good death.”
o Need to recognize own personal beliefs
 risk of using them in forming own perception - good / bad death.

Question 127

role of nurse - end of life

Answer 127

provide client-centered care
 encompasses client, family, caregivers.
 supports client comfort
 serve as resource - clients / family members
 decisions prior to end of life during in dying process.

Question 128

Managing illness of clients in hospice care - includes integration -

Answer 128

· spiritual services.

Question 129

· Hospice spiritual leaders –

Answer 129

o professionals who provide services - various settings to clients, families, staff.
o offer spiritual care - people - all religions / denominations.

Question 130

· If client - member of religious organization

Answer 130

o spiritual leader - follow end-of-life rituals associated w/ that specific religion.
• Spiritual services include
o spending time listening to client,
o performing religious ceremonies, and
o prayer.

Question 131

· nurse’s role - collaborate w/ other members of hospice care team to

Answer 131

o provide support for client, family, caregivers.
o address spiritual needs of client by
 working w/ team to ensure client’s religious / spiritual needs met.

Question 132

Culture - social structure that shapes

Answer 132

client’s views, behavior, preferences.

Question 133

· Quality of care - enhanced when nurse acknowledges client’s

Answer 133

o perspectives, experiences, values.

Question 134

• Nurses knowledgeable about distinctions of culture
o more effective in

Answer 134

managing client’s pain
o assisting family in adjusting to dying process.

Question 135

In some cultures - deemed improper / culturally insensitive to

Answer 135

talk about impending death
o before nurse discusses poor prognosis w/ client / family,
o essential to understand beliefs / culture of individual.

Question 136

culture / religion - significant role in client’s

Answer 136

health care decisions,
o nurses should keep in mind
o they can impact both evaluation / treatment of pain / palliative care.

Question 137

Pain - client’s religious / cultural beliefs

Answer 137

· should guide nurse in pain management.

Question 138

Many cultures - do not agree w/ use of

Answer 138

· opioids,

Question 139

several myths associated w/ use opioids can

Answer 139

influence client’s / family willingness to agree to use
o Ex: using opioids is same as euthanasia,
o suggests death is imminent, is
o addictive, and
o will leave fewer options available in future if prescribed early on

Question 140

nurse should educate client / family - dosage

Answer 140

opioids can be increased,
• no limit on amount a client can receive.
•

Question 141

Alternative pain management therapies should be included - as long as

Answer 141

not detrimental to client.

Question 142

LEP

Answer 142

LIMITED ENGLISH PROFICIENCY
utilize translator to communicate w/ a client w/ limited English proficiency (LEP).

Question 143

• may be convenient to use family member - translator, BUT

Answer 143

o doing so → miscommunication.
o EX: culture - shuns talking about death
o family translator may hesitate - translate word “death” -
o Family members - used only in emergencies
 family members may alter information during exchange.

Question 144

· not uncommon - assistive personnel / housekeeping staff t asked to interpret, BUT

Answer 144

o may lack necessary medical terminology - translate accurately.

Question 145

• smartphone application only applications authorized by employer should be used, BECAUSE

Answer 145

o will have been evaluated by employer / deemed compliant w/ Health Insurance Portability and Accountability Act.

Question 146

LEP clients - legal right

Answer 146

provided w/ language services

Question 147

Under U.S. law, health care organizations required to provide interpreter services

Answer 147

· LEP clients.

Question 148

Legally / ethically, nurse obligated provide_____for LEP clients

Answer 148

qualified interpreters

Question 149

culturally competent care – end of life care-requires

Answer 149

evaluate client’s cultural needs.

Question 150

Individual clients’ beliefs sometimes differ from

Answer 150

espoused by their culture,

Question 151

cultural views influenced by

Answer 151

client’s history, experience, education.

Question 152

• evaluate cultural needs of client,
o nurse can ask following essential questions:

Answer 152

o “What cultural rituals do you adhere to in coping with death?”
o “How is the deceased person’s body handled?”
o “What are the family’s views regarding what happens after death?”
o “What are the family roles in coping with death?”
o can learns specific information - provide nursing care - individualized for client / meets client’s cultural needs.

Question 153

Postmortem care

Answer 153

physical care performed after client died to - prepare body for
 viewing,
 autopsy, or
 release to funeral home.
• performed by nurses - closed doors.
• following organization’s policy,
• universal interventions apply.

Question 154

Postmortem care - nurse documents

Answer 154

 date / time of death,
 name of anyone notified,
 location of client’s belongings, and
 where client’s body is moved (e.g., funeral home name).

Question 155

Postmortem interventions include

Answer 155

o washing body,
o making sure client’s possessions accounted for, and
o placing identification tags
 minimum - two areas (toe, arm, outside of body bag).
o removal - invasive devices (ie. intravenous catheters / indwelling urinary catheters) - vary according to specific policy of health care agency

Question 156

• Nurses spend great deal time w/ client / family,
o developing bond that,
o when ended, results in feeling of loss.
o Providing postmortem care allows

Answer 156

o nurse time to achieve closure.

Question 157

Health care personnel providing direct client care - constrained from introducing dialogue regarding

Answer 157

organ / tissue donation w/ client / family.
o policy protects nurse from an alleged conflict of interest

Question 158

OPO

Answer 158

ORGAN PRODCUREMENT ORGANIZATION

Question 159

• Health care professionals - completed course provided / endorsed by organ procurement organization (OPO) –
o best suited to

Answer 159

initiate ORGAN / TISSUE request of client / surrogate.

Question 160

· When client / family member voluntarily requests to initiate organ/tissue donation, .WHAT DOES NURSE DO

Answer 160

o nurse makes a referral to OPO.
o organ procurement coordinator (OPC) will contact client / surrogate to discuss the option of donation

Question 161

OPC ROLE IN ORGAN / TISSUE DONATION

Answer 161

o organ procurement coordinator (OPC) will contact client / surrogate to discuss the option of donation.
 OPC answers all questions, clarifies misinformation.
 nurse should be prepared
 discuss issues involved
 educate client / surrogate when requested

Question 162

NURSES ROLE ORGAN / TISSUE DONATION

Answer 162

assist families who are dealing w/ this challenging decision.

Question 163

ORGAN / TISSUE DONATION VOLUNTARY - DONOR MUST DO WHAT

Answer 163

give authorization before death,
o surrogate can give permission when client not previously consented to organ/tissue donation.

Question 164

· nurse can support client / family IN ORGAN / TISSUE DONATION SITUATIONS BY

Answer 164

o facilitating meeting w/ OPC in quiet setting;
o evaluating religious / cultural beliefs,
 which can influence knowledge / ideas about donation;
o providing accurate information to alleviate mistaken beliefs;
o telling family do not know answer to a question
 letting them know will find the answer;
 allowing time for the discussion of client and family feelings; and utilizing other interprofessional team members, such as the chaplain, when needed.

Question 165

· Because nurse often spends extended amount of time w/ client, it is NOT UNUSUAL FOR

Answer 165

bond to develop,
 intensifying nurse’s feelings of loss when client dies.

Question 166

Common physical manifestations nurse may experience in response to grief include

Answer 166

 feeling of tightness in the chest
 inability to breathe,
 muscle discomfort,
 headaches,
 agitation,
 sleep disturbances,
 gastrointestinal problems, and
 heart palpitations.

Question 167

· Psychological manifestations include nurse may experience in response to grief include

Answer 167

 anger,
 irritation,
 unhappiness,
 sleeplessness,
 exhaustion,
 difficulty staying focused, and
 altered eating patterns.

Question 168

· strategies to cope w/ death of client.

Answer 168

SELF CARE
TALKING TO OTHER NURSES / HEALTH CARE PROFESSIONALS

Question 169

more experienced nurses who can provide understanding

Answer 169

/ coping methods;
• being present for the family;
• attending client’s funeral,
• can provide closure; and
• seeking professional help.

Question 170

Summary

Answer 170

Summary

Question 171

· Hospice care embodies

Answer 171

the holistic approach to client care and includes the family and caregivers as part of the care team.

Question 172

· Palliative care can be provided while clients are

Answer 172

actively seeking curative treatments.

Question 173

· Knowledge of the physiological changes that occur during the dying process enables the nurse to utilize

Answer 173

appropriate interventions to provide comfort and support.

Question 174

· Pain management (including pharmacologic and nonpharmacologic) is an integral aspect of

Answer 174

client care.

Question 175

· As loneliness and social isolation can negatively affect the dying client, the nurse should facilitate interventions that

Answer 175

provide social support.

Question 176

· Including the client and their family/caregiver in decision making assists with

Answer 176

maintaining the client’s dignity while providing a “good death” for the client.

Question 177

· A major role of the nurse during hospice care is to provide

Answer 177

client comfort and serve as a resource for the family/caregiver as well as the client.

Question 178

· Awareness of cultural diversity allows the nurse to

Answer 178

manage client care more effectively.

Question 179

Self-care strategies can be used by the nurse to

Answer 179

cope with the physiological and psychological manifestations that arise following the loss of a client.

Question 180

Cheyne-Stokes respirations

Answer 180

Breathing pattern of cycles that begin with rapid, shallow breaths, increase to deep breaths, ending with periods of apnea.

Question 181

death rattle

Answer 181

Sound produced as a result of an accumulation of secretions in the lung and the throat leading to congestion; secretions become trapped as the client is unable to clear the secretions.

Question 182

dyspnea

Answer 182

The sensation of difficult or labored breathing.

Question 183

hallucinations

Answer 183

A sensation that something is there when it is not; includes all five of the senses.

Question 184

hospice care

Answer 184

Care services for clients and families that focus on comfort and support;not curative when it is determined the client has less than six months to live.

Question 185

mottling

Answer 185

Physical change of the skin marked by purple or reddish marbling; caused by the heart’s inability to pump blood effectively, leading to decreased blood perfusion throughout the body.

Question 186

palliative care

Answer 186

A multidisciplinary care approach that is focused on the management of symptoms for chronic or life-threatening illnesses while maintaining the highest level of quality of life possible for the client.

Question 187

postmortem care

Answer 187

Physical care performed after the client has died; includes washing the body, accounting for the client’s possessions, removing invasive devices, and placing identification tags on the body.

Question 188

respite care

Answer 188

A service or agency that provides primary caregivers with a short-term break from the responsibilities of client care.

Question 189

A nurse is caring for a client who has a terminal illnes and states that they want to experience a “gooddeath.” Which of the following actions should thenurse take?

Answer 189

Determine the client’s definition of a “good death.”

Question 190

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

Answer 190

Palliative care improves The client’s quality of life.

Question 191

3. 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?

Answer 191

Assist in scheduling friends and family to visit.

Question 192

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

Answer 192

Hospice care is an interdisciplinary team effort.

Question 193

5. 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 that apply.)

Answer 193

They can be an indication of approaching death.
Turning the client’s head to the side can assist with drainage.
Medications can be administered to help dry up the secretions.
The client is unable to clear the secretions themselves.

Question 194

6. 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?

Answer 194

Nursing support will be provided in meeting
the client’s daily needs, including the administration of medications.

Question 195

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

Answer 195

“You must have a terminal illness.”
“You accept palliative care for comfort.”
“The health care provider must officially
state that you are terminally ill.”

Question 196

8. 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?

Answer 196

Mottling is visible on the client’s legs.

Question 197

9. 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?

Answer 197

Participate in an exercise program.

Question 198

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

Answer 198

Spirituality focuses on the significance and purpose of life.

Question 199

11. 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 that apply.)

Answer 199

“What would you like to know about your medications?”
“What can I do to help you feel more independent?”

Question 200

12. 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?

Answer 200

Use the health care facility’s interpreter services.

Question 201

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

Answer 201

Palliative care uses a holistic approach.

Question 202

14. 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?

Answer 202

A combination of approaches is suggested to manage pain symptoms.

Question 203

15. A nurse is providing postmortem care for a client. Which of the following actions should the nurse take? (Select all that apply.)

Answer 203

Document where the body is being moved.
Include the name of anyone notified in the medical record.
Document the date and time of death.
Ensure the client’s belongings are accounted for.

Question 204

16. 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?

Answer 204

Make a referral to an organ procurement organization.

Question 205

17. 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?

Answer 205

Educate the family about the expected respiratory changes.

Question 206

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

Answer 206

It is culturally insensitive to talk about impending death in some cultures.

Question 207

19. 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?

Answer 207

Ensure client safety and prevent injury.