1. .

With which newly admitted client does the nurse initiate a conversation about advance directives and a living will? (Select all that apply.)
A. Correct Correct: The Patient Self-Determination Act of 1990 requires that all patients admitted to any health care facility be asked if they have written advance directives. Those who do not have advance directives should be given information about the process and implications of having (or not having) these in place, and should be assisted in drafting them.

Client with a non'life-threatening illness B.

C.

Client with advanced directives

Correct Correct: The Patient Self-Determination Act of 1990 requires that all patients admitted to any health care facility be asked if they have written advance directives. Those who do not have advance directives should be given information about the process and the implications of having (or not having) these in place, and should be assisted in drafting them.

Client with end-stage kidney disease D. 2. 2. The client admitted with a non'life-threatening illness says, ''They wanted me to fill out an advance directive when I was admitted. I was too stressed to consider it then. What was it all about?'' Which is the best response by the nurse? A. ''Advance directives are only for those who are severely ill.'' Incorrect: Advance directives should be in place before the client becomes severely ill. B.
Correct''Advance directives guide physicians in planning care for seriously ill individuals.''

Client with severe brain injury

Correct: This is a true statement and best addresses the client's comments. C. ''Most Americans have an advance directive in place.'' Incorrect: Most Americans do not have advance directives in place. D. ''You should have completed the paperwork before you were admitted.''

Incorrect: Although completing paperwork pertaining to advance directives before admission would be ideal, any time is a good time to do this. Correct 3. 3. The client who is dying is having difficulty swallowing the ordered daily PO medications. Which nursing intervention is best for this client? A. Ask the pharmacy for an intramuscular equivalent. Incorrect: The intramuscular route is almost never used for clients at the end of life because this method is invasive, painful, and can cause infection. B.
CorrectAsk the provider if the medication can be discontinued or substituted.

Correct: Reassess the need for the client's medication. Collaborate with the prescriber about discontinuing drugs that are not needed to control pain, dyspnea, agitation, nausea, vomiting, cardiac workload, or seizures. C. Crush the pills and open the sustained-release capsules. Mix with a spoonful of applesauce. Incorrect: Although some pills may be crushed, drugs such as sustained-release capsules should not be taken apart. D. Do not give the medication and chart ''inability to swallow.'' Incorrect: Withholding medication will create more problems than it solves. Correct 4. 4. The family of the unconscious dying client realizes that their loved one will die soon. The client's children are having a difficult time letting go. Which statement by the nurse is best to say to the family? A. ''Don't be upset. She wouldn't want it that way.'' Incorrect: The client or family member's pain of loss should never be minimized. Such comments can actually be barriers to demonstrating care and concern. B. ''She will be in a better place soon.''

Incorrect: Never try to explain a client's death or impending death in philosophic or religious terms. Such statements are not helpful when the bereaved person has yet to express feelings of anguish or anger. C.
Correct''This must be difficult for you.''

Correct: Accept whatever the grieving person says about the situation. Remain present, be ready to listen attentively, and guide gently. In this way, the nurse can help the bereaved prepare for the necessary reminiscence and integration of the loss. D. ''Things will be fine.'' Incorrect: The client or family member's pain of loss should never be minimized. Trite assurances such as saying ''Things will be fine'' should be avoided. Correct 5. 5. The dying client says, ''I am afraid to die. I was wrong.'' What is the nurse's best response? A. ''God will forgive.'' Incorrect: This response assumes that the client is religious and minimizes the client's concerns. B. ''I'm sure it is nothing to worry about.'' Incorrect: This response minimizes the client's concerns. C.
Correct''Tell me about it.''

Correct: A response such as saying ''Tell me about it'' acknowledges the client's spiritual pain and encourages verbalization. D. ''Why? What did you do wrong?'' Incorrect: This response assumes that the client did something wrong, which may not be the case. Correct 6. 6. The hospitalized client from Southeast Asia is dying. What does the nurse tell the health care team pertaining to this client's cultural beliefs about death?

A.

Death is viewed as a direct result of life. Incorrect: Latino and Hispanic cultures view death as a direct result of life.

B.

Direct eye contact with the client shows respect. Incorrect: Direct eye contact is considered impolite in Southeast Asian cultures.

C.

CorrectDiscussing dying brings bad luck.

Correct: For Southeast Asians, discussion of death brings bad luck. D. Many visitors may be in the room during this time. Incorrect: Some Southeast Asians, especially if uneducated, are likely to avoid visiting terminally ill family members for fear of contracting the disease. Correct 7. 7. The daughter of the dying client says, ''I don't want my mother to be uncomfortable.'' What is the nurse's best response? A. ''Do you want to talk to the bereavement nurse?'' Incorrect: The daughter's comment does not require the expertise of a bereavement nurse. B.
Correct''Your mother will be closely monitored and cared for.''

Correct: This response provides support and comfort to the client's daughter. C. ''Your mother will be kept sedated.'' Incorrect: This response is not typically true of the client who is dying. D. ''We will send her to hospice when the time comes.'' Incorrect: This response does not address the daughter's concern about her mother's comfort. Correct 8. 8.

The dying client becomes increasingly withdrawn and begins to refuse to eat or drink. What intervention is best for the nurse to implement? A. Brings in the client's favorite Chinese take-out food Incorrect: The dying client's metabolic needs will have decreased, so the client will not want any food. B. Calls the family to come in right away Incorrect: Calling the family is not yet necessary in this client's case. C. Gives intravenous hydration Incorrect: Because the dying client's metabolic needs will have decreased, invasive procedures are not necessary at this point. D.
CorrectOffers ice chips

Correct: The dying client should not be forced to eat or drink, but small sips of liquids or ice chips at frequent intervals can be offered if the client is alert and able to swallow. Correct 9. 9. Which condition in the dying client requires a nursing intervention? A. Alternating apnea and rapid breathing Incorrect: Alternating apnea and rapid breathing are normal in the dying client. B. Anorexia Incorrect: Anorexia is normal in the dying client. C. Cool extremities Incorrect: Cool extremities are normal in the dying client. D.
CorrectMoaning

Correct: Moaning indicates pain and requires pain medication. Correct

10. 10. The dying client exhibits signs of agitation. The Foley catheter has drained 100 mL in the last 3 hours, and the last bowel movement was yesterday evening. What is the priority nursing intervention? A.
CorrectAdministers analgesics

Correct: Agitation may be indicative of pain, which must be addressed in the dying client. B. Arranges for a consultation with a bereavement counselor Incorrect: Arranging for consultation with a counselor is not the priority in this situation. C. Assesses the client for impaction Incorrect: The dying client's metabolism has slowed, so assessing for impaction may not be necessary. D. Changes the Foley catheter to ensure adequate drainage Incorrect: The Foley catheter should not be changed, but the tubing should be assessed to ensure that there are no kinks. Correct 11. 11. The nurse skilled in complementary and alternative medicine (CAM) therapies works on a cancer unit. Which client symptoms does the nurse use these therapies for? A. Constipation Incorrect: CAM is not typically used for constipation. B. Cool extremities Incorrect: CAM is not typically used to deal with cool extremities. C.
CorrectIncreased pain

Correct: CAM can help relieve pain and agitation, minimizing the need for increased opioids. D. Memory loss

Incorrect: Memory loss is not a symptom that should receive priority in the dying client. Correct 12. 12. The dying cancer client is receiving high doses of opioids. Which intervention may be the most effective for this client? A. Additional pain medication Incorrect: The client is already receiving high doses of opioids. A complementary or alternative therapy can replace the need for increased pain medication. B. Deep muscle massage Incorrect: The dying client who is frail may not tolerate an extensive massage. C.
CorrectShort, light massage

Correct: Massage has been shown to decrease pain in individuals with cancer. Light pressure is best, and deep or intense pressure should be avoided. D. Classical music Incorrect: Although music therapy may be effective, the type of music played should be the client's choice. It shouldn't be assumed that the client wants to hear classical music. Correct 13. 13. For which goal does the nurse coordinate palliative care interdisciplinary interventions? A. Avoiding symptoms of distress Incorrect: Symptoms of distress cannot be avoided, but can be controlled. B. Expedited death Incorrect: Expedited death is not a goal of palliative care. C. Meeting all client needs

Incorrect: Identifying client needs is a goal of palliative care, but it is not always possible to meet all the client's needs (e.g., to prevent death). D.
CorrectPeaceful death

Correct: Facilitating a peaceful death for the client is one of the goals of palliative care. Correct 14. 14. The client has died after a long hospital stay. The family was present at the time of the client's death. Which postmortem action does the nurse implement? A.
CorrectAsks the family if they wish to help wash the client

Correct: The nurse may ask the family if they wish to be involved in washing the client after the client's death. B. Asks the family to leave Incorrect: The family should be allowed to grieve at the bedside of the client. C. Raises the head of the bed and open the client's eyes Incorrect: The head of the bed should be flat and the client's eyes closed. D. Removes dentures and any prosthetics Incorrect: The client's dentures and prosthetics should be replaced. Correct 15. 15. The client diagnosed with lung cancer 6 months ago is now ventilator-dependent and unresponsive. The family wants to remove the ventilator, antibiotics, and intravenous fluids. What does the nurse do next? A.
CorrectRequests a meeting with the family and health care team

Correct: Withdrawing or withholding life-sustaining therapy involves discontinuing one or more therapies that might prolong the life of a person who cannot be cured by the therapy. To do this, a meeting is required between the family and health care team.

B.

Removes the interventions per the family's wishes Incorrect: Withdrawing life support requires more than simply following the family's wishes.

C.

Tells the family that removing the interventions is not legal Incorrect: This is not true except in cases of active euthanasia or physician-assisted euthanasia.

D.

Waits to obtain the client's wishes Incorrect: The client will most likely not regain consciousness.

Correct