ATI LPN
Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition
Chapter 10 : End-of-Life Care Questions
Question 1 of 5
The nurse is caring for a 90-year-old client who has never completed an advanced directive. The client has a child but has not seen the child in several years. A neighbor has assisted this client with meals and housecleaning for many years. The neighbor states that the client expressed only wanting to have comfort measures. The estranged child wants the client to be treated aggressively. Which would be the nurse's initial step?
Correct Answer: C
Rationale: It cannot be assumed that the client is unable to make decisions independently just because of advanced age. Before any other person is asked about the client's wishes, the client needs to be asked first. The physician, who has a healthcare relationship with the client, may also have documented information about wishes.
Question 2 of 5
The family of a terminally ill client is deciding between home care and a hospice facility. When comparing options, which factor of home care needs regular assessment?
Correct Answer: B
Rationale: A negative factor of homecare is the burden it places on the primary caretaker. If prolonged, the role can be isolating and tiring. Regular assessment, by the nurse, is needed to ensure care for both client and family. Pain control is the same in home care or at a hospice facility. Although a comfortable environment is important and transportation to appointments may be needed, it is not as important.
Question 3 of 5
The nurse is caring for a client at the end of life. The client is prescribed a regularly scheduled dose of narcotics and a short-acting narcotic for breakthrough pain. Which action should the nurse take when administering narcotics to manage this client's pain?
Correct Answer: B
Rationale: The nurse who is administering narcotics at the end of life still must realize that any side effects must be addressed. In end-of-life care there is no need to assess for signs of drug dependence. The nurse will also reassure the client that frequent use of opioid analgesia will not cause addiction when administered in a life-limiting illness. In this case, dosing will not be restricted and medications will be administered on a routine schedule not a PRN basis. Administering the narcotic on routine schedule around the clock avoids causing intense discomfort followed by a period of heavy sedation.
Question 4 of 5
A nurse is caring for a client who is terminally ill and is inquiring about physician-assisted suicide. Which statement if made by the nurse would correctly inform the client of this practice?
Correct Answer: B
Rationale: Physician-assisted suicide is the practice of providing a means by which a client can end their life. Much controversy exists concerning the practice. California, Vermont, Oregon, Washington, and Montana are the only states that permit physician-assisted suicide. Administering analgesics at a level that renders the client unconscious is referred to as passive euthanasia as it is believed to facilitate death by letting 'nature take its course.' It is different than a provider providing the means for the client to take their own life. The health care provider may provide the means for the client to end their life, but the nurse does not assist the client in the act. Nurse practice prohibit nurses from assisting clients to die. Health care provider-assisted suicide is not considered part of palliative care. Palliative care is an approach that improves the quality of life of those at the end of life. It neither hastens nor postpones death; it provides relief from pain and discomfort, addresses spiritual needs, and provides emotional support to the client and family.
Question 5 of 5
Which cardiovascular findings indicate to the nurse that the condition of the client who is dying is worsening?
Correct Answer: A
Rationale: Earlier, a client with failing cardiac function exhibits a higher pulse as the body attempts to circulate oxygen. Next, cardiac output is decreased due to ineffective filling of the chambers, impairing circulation, and diminishing the heart's own oxygen supply. The heart rate and blood pressure then decrease. Peripheral circulation is impaired with the feet and ankles becoming pale and mottled.