Ch. 13 Palliative Care Flashcards
One of the physical changes in the respiratory system that is commonly seen as death approaches is alternating periods of apnea and deep, rapid breathing. How should the nurse document this finding? a. The death rattle b. Agonal breathing c. Apneustic breathing d. Cheyne-Stokes respiration
ANS: D
An abnormal pattern of respiration characterized by alternating periods of apnea and deep, rapid breathing is termed Cheyne-Stokes respiration.
When caring for a patient close to death, when does the nurse recognize that death legally occurs?
a.
When the cerebral cortex function ceases
b.
When respirations cease
c.
When coma, absence of brainstem reflexes, and apnea occur
d.
When cardiopulmonary resuscitative efforts are not effective
ANS: C
The diagnosis of death is based on brain death; therefore, death has occurred when the patient has irreversible loss of all brain functions, including brainstem functions that control respirations and brainstem reflexes.
Which of the following refers to care that is provided in the last days or weeks of the patient’s life? a. Hospice care b. Palliative care c. Respite care d. End-of-life care
ANS: D
End-of-life care is the care that is provided in the last days or weeks of life.
A 48-year-old man has been diagnosed with metastatic malignant melanoma and has a poor prognosis. He plans an extensive trip around the country to visit family he has not seen or talked with in years. What psychosocial response does the nurse recognize that the patient is manifesting? a. Restlessness b. Saying goodbye c. Unfinished business d. Altered decision making
ANS: C
One of the psychosocial manifestations of approaching death is anxiety about unfinished business (including asking for forgiveness and forgiving others).
For two months after a patient was diagnosed with pancreatic cancer, she did not admit that she was ill and in need of health care. What is the emotional response associated with this stage of grief? a. Yearning and protest b. Acceptance and accommodation c. Denial, disbelief, and avoidance d. Anger, despair, and confrontation
ANS: C
Many different theories explaining grief and the grieving process have been articulated over the years. Kübler-Ross (1969), Martocchio (1985), and Rando (1993) have all identified stages of grief and indicate that the first stage includes denial, disbelief, and avoidance.
The wife of a patient with terminal lung cancer visits daily and cheerfully talks with the patient about vacation plans for the next year. When the nurse asks how she is feeling, the patient’s wife says, “I’m busy at work, but otherwise things are fine.” What is an appropriate nursing diagnosis for the wife?
a.
Caregiver role strain related to feeling overwhelmed
b.
Disabled family coping related to lack of grieving
c.
Anxiety related to complicated grieving process
d.
Hopelessness related to knowledge deficit about cancer
ANS: B
The wife’s behaviour and statements indicate the presence of avoidance, which may lead to impaired adjustment as the patient progresses toward death.
As the nurse admits a patient with acquired immune deficiency syndrome (AIDS) who has cryptococcal meningitis, the patient tells the nurse that she does not want to be resuscitated if she stops breathing. What should the nurse do with this information?
a.
Document the patient’s request in the patient’s record.
b.
Ask the patient if she has discussed this decision with her physician.
c.
Inform the patient that unless she has a written, notarized advance directive, resuscitation must be performed.
d.
Advise the patient to designate a person to make health care decisions on her behalf in the event that she cannot make her own decisions.
ANS: B
As a physician’s order should be written to include the information concerning the patient’s or the family’s wishes for the use of cardiopulmonary resuscitation, it is imperative that the nurse assess whether the patient has discussed this with his or her physician.
A patient who is very close to death is very restless and repeats, “I am not ready to die.” What is the most appropriate nursing intervention at this time?
a.
Call the hospital chaplain to visit the patient.
b.
Sit with the patient, and ask him if he wants to talk.
c.
Inform the patient that everything possible is being done for him.
d.
Ask the patient what he needs to do to come to acceptance of his death.
ANS: B
A simple, caring presence provides support and comfort. Neither words nor actions are necessary unless the patient wants to talk. Holding hands, touching, and listening are considered to be high-quality nursing responses. Simply providing companionship allows the dying person a sense of security.
The nurse consults with the physician to arrange a referral for hospice care for a patient with end-stage kidney disease, based on what knowledge regarding when hospice care is indicated?
a.
Family members can no longer care for dying patients at home.
b.
Patients and families are having difficulty coping with grief reactions.
c.
Preparation for death with palliative care and comfort are the goals of care.
d.
Patients have unmanageable pain and suffering as a result of their condition.
ANS: C
Palliative care is defined as care aimed at relief of suffering and improving the quality of life for persons who are living with or dying from advanced illness or are bereaved. The goal of palliative care is comfort and dignity for the person living with the illness and the best quality of life for both this person and his or her family.
10. Which sense is usually the last one to disappear before death? a. Touch b. Sight c. Smell d. Hearing
ANS: D
Hearing is usually the last sense to disappear before death.
Which of the following is a lay term used to describe instructions about future medical care? a. DNR orders b. Living will c. Advance directive d. Power of attorney for personal care
ANS: B
A living will is a lay term used to describe any number of documents that give instructions about future medical care and treatment.
A patient near death has withdrawn from his family and the physical hospice environment. The nurse’s response is based upon which of the following nursing management guidelines?
a.
Encourage family to tell the dying person it is okay to die.
b.
Inform the family that the patient is about to die, as he has withdrawn from this world.
c.
Reinforce that this is a normal part of the dying process, and support the family.
d.
Encourage the dying person and the family to verbalize their feelings.
ANS: C
A patient nearing death may withdraw from others and from the physical environment, and the nurse bases her interaction on the nursing management guideline to reinforce that this is a normal part of the dying process and support the family. Conversely, s if the patient is alert, using a soft voice and gentle touch.
Which of the following health care providers is legally qualified to complete a certification of death? a. Paramedic b. Physician c. Registered nurse d. Licensed practical nurse
ANS: B
Certification of death can only be undertaken by a physician or coroner. In many jurisdictions in Canada, registered nurses are legally able to provide a pronouncement of death, but not certification of death.
