Chapter 16 Palliative Care

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Chapter 16  Palliative Care

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

MULTIPLE CHOICE

1. The patient has a history of terminal cancer but is being admitted for treatment of a pressure ulcer. The patient’s wife has been caring for him at home and refuses to discuss admission to a nursing home. The wife looks extremely tired and is near the point of exhaustion. What could the nurse suggest?
a.
A consult for hospice care
b.
Continuing with the plan of care as is
c.
That the doctor order the patient into a nursing home
d.
That the wife stay away while the patient is hospitalized

ANS: A
Hospice benefits include respite for family caregivers. The current plan of care may be the reason for the decubiti and may lead to the patient’s wife’s becoming ill. Palliative and hospice care place a primary focus on the patient’s values, quality of life, and care preferences.

DIF: Cognitive Level: Application REF: Text reference: p. 375
OBJ: Describe hospice care. TOP: Respite Care
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

2. The patient is being admitted to the hospital for injuries received when a hurricane destroyed her home. She is upset from the loss of her home and possessions. What type of loss is this considered?
a.
Necessary loss
b.
Maturational loss
c.
Situational loss
d.
Perceived loss

ANS: C
Situational losses include loss from sudden, unpredictable external events such as a hurricane that destroys one’s home or city. Necessary losses, such as leaving friends after high school graduation, are a natural part of life. Such losses usually are replaced by something different or better. Some necessary losses are more difficult and never seem acceptable, such as the loss of a loved one through death. Life goes on, but replacements for these losses do not appear. Maturational losses include changes that occur as a part of normal life development. For instance, a parent feels loss when a child marries and moves away from home. Perceived losses are interpreted uniquely by the individual and often are not obvious to others. For example, one person perceives failure to get into a preferred college as a loss of all opportunity, while another person views the same experience as a relief.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 378
OBJ: Discuss principles of palliative care. TOP: Loss
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

3. The nurse recognizes that anticipatory grieving can be most beneficial for a patient or family because it can:
a.
be done in a private setting.
b.
be discussed with other individuals.
c.
promote separation of the ill patient from the family.
d.
allow time for the process of grief.

ANS: D
The benefit of anticipatory grief is that it allows for a gradual disengagement from the loss. Anticipatory grief may help people move through the stages of grief, allowing time to grieve in private, to discuss the anticipated loss with others, and then to “let go” of the loved one.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 378
OBJ: Identify the nurse’s role in assisting patients and families in grief and at the end of life.
TOP: Grief KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

4. The nurse is preparing to assist the patient at the end stage of her life. To provide comfort for the patient in response to anticipated symptom development, the nurse plans to:
a.
decrease the patient’s fluid intake.
b.
limit the use of pain medication.
c.
provide larger meals with more seasoning.
d.
determine patient wishes and select appropriate therapies.

ANS: D
Have the patient identify what she wants to accomplish, and use strategies to conserve energy for meeting those goals. This provides the patient with a sense of well-being and purpose to meet important personal goals. Decreasing the patient’s fluid intake may make the terminally ill patient more prone to dehydration and constipation. The nurse should take measures to help maintain oral intake, such as administering antiemetics, applying topical analgesics to oral lesions, and offering ice chips. The use of analgesics should not be limited. Controlling the terminally ill patient’s level of pain is a primary concern in promoting comfort. Nausea, vomiting, and anorexia may increase the terminally ill patient’s likelihood of inadequate nutrition. The nurse should serve smaller portions and bland foods, which may be more palatable.

DIF: Cognitive Level: Analysis
REF: Text reference: p. 373|Text reference: p. 376|Text reference: pp. 383-384
OBJ: Identify the nurse’s role in assisting patients and families in grief and at the end of life.
TOP: Caring for the Dying Patient KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

5. A nurse-initiated or independent activity for promotion of respiratory function in a terminally ill patient is to:
a.
limit PO fluid intake.
b.
position the patient in semi-Fowler’s or Fowler’s position.
c.
reduce narcotic analgesic use.
d.
administer bronchodilators.

ANS: B
Position the patient in semi-Fowler’s or Fowler’s position. This promotes maximal ventilation, lung expansion, and drainage of secretions. Limiting fluids may not promote respiratory function, and unless a patient is on a fluid-restricted diet, the nurse should not do so. Reducing narcotic analgesic use is not a nurse-initiated activity to promote respiratory function. Respiratory rate should be assessed before narcotics are administered, to prevent further respiratory depression. Management of air hunger involves judicious administration of morphine and anxiolytics for relief of respiratory distress. The administration of bronchodilators would require a physician’s order. It is not an independent nursing activity.

DIF: Cognitive Level: Application REF: Text reference: p. 383
OBJ: Identify the nurse’s role in assisting patients and families in grief and at the end of life.
TOP: Caring for the Dying Patient KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

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