Deck 21: Perspectives in Palliative Care

Question 1

A client on the hospice service develops dyspnea related to the disease process. The nurse checks the order sheet for a(n) (Select all that apply)

A) anti-anxiety agent.
B) bronchodilator.
C) corticosteroid.
D) opioid analgesic.

Answer 1

anti-anxiety agent.
bronchodilator.
corticosteroid.

Question 2

A hospice client is clearly dehydrated and the family is arguing over whether or not the client should receive intravenous fluids. The nurse would guide this discussion based on what knowledge about dehydration in the terminally ill client?

A) If the terminally ill client complains of thirst, he/she is dehydrated.
B) Peripheral edema in the terminally ill client indicates fluid overload.
C) The emphasis of all treatments should be on comfort and reduction of symptoms.
D) The only choices for hydration are oral and intravenous.

Answer 2

The emphasis of all treatments should be on comfort and reduction of symptoms.

Question 3

A client on the hospice service is experiencing nausea and vomiting as the result of pain management using opioids. The nurse should attempt to minimize this adverse effect by using the

A) intramuscular route.
B) intravenous route.
C) oral route.
D) subcutaneous route.

Answer 3

oral route.

Question 4

The individual(s) who are widely known for the development of hospice care in the United States is/are (Select all that apply)

A) Dame Cicely Saunders.
B) Elisabeth Kübler-Ross.
C) Florence Nightingale.
D) Florence Wald.

Question 5

A client using a new opioid analgesic for pain becomes drowsy after the first two doses. The nurse explains to the client and family that the dose may be too high if this persists for more than

A) 1 day.
B) 2 to 3 days.
C) 5 to 7 days.
D) 7 to 10 days.

Question 6

In a bedtime routine for a palliative care client who is having difficulty falling asleep, the least helpful intervention to incorporate would be

A) black tea with sugar.
B) massage.
C) progressive muscle relaxation.
D) warm milk.

Question 7

A hospice nurse explains to a client that one of the underlying reasons for the underutilization of hospice services is the difficulty in determining life expectancy prognoses of

A) 1 year or less.
B) 8 months or less.
C) 6 months or less.
D) 3 months or less.

Question 8

The family member of a client who had a terminal illness and died 18 months ago is still actively grieving over the loss. The nurse assesses that this individual may be experiencing

A) a psychological disorder.
B) delayed grief.
C) exaggerated grief.
D) normal grief.

Question 9

A client on hospice service reports experiencing a "colicky" type of pain. To relieve this clinical manifestation, the hospice nurse would request an order for a(n)

A) anticholinergic.
B) nonsteroidal anti-inflammatory drug.
C) opioid analgesic.
D) salicylate.

Question 10

A hospice nurse reevaluates the pain management plan for a client who requires more than

A) four rescue doses in a 24-hour period.
B) one rescue dose in a 48-hour period.
C) three rescue doses in a 48-hour period.
D) two rescue doses in a 24-hour period.

Question 11

The hospice nurse requests the drug temazepam (Restoril) for a client who has difficulty in

A) falling asleep.
B) falling asleep and staying asleep.
C) sleeping without nightmares.
D) staying asleep.

Question 12

The hospice nurse supports the family coping task of establishing a relationship with the health care team by

A) discussing the functioning of the family unit without the loved one.
B) explaining the roles of all interdisciplinary team members.
C) giving permission to take time to maintain friendships.
D) providing brief explanations about the care being delivered.

Question 13

In a client with delirium the nurse knows that the manifestation that is inconsistent with the DSM-IV criteria is

A) change in cognition not accounted for by a pre-existing or evolving dementia.
B) development of mental status changes over several months.
C) disturbance of consciousness; reduced ability to focus, sustain, or shift attention.
D) tendency to fluctuate attention and orientation during the course of the day.

Question 14

The nurse caring for a terminally ill client with cancer would assess a key indicator of clinical depression as being the client's

A) anger over the pain experience.
B) anorexia and weight loss.
C) feelings of hopelessness.
D) inability to provide physical self-care.

Question 15

The nurse suggests that the client should try a mu-agonist type of opioid, which is often effective in managing pain, such as

A) acetaminophen.
B) hydromorphone.
C) ibuprofen.
D) naproxen.

Question 16

A nurse working with clients on a hospice service understands that a client's quality of life is often linked to

A) projections about the amount of time that the client can expect to live.
B) strength and remaining physical ability to perform self-care.
C) symptom distress and the meanings attached to these physical sensations.
D) the number of family and friends who remain as a support system.

Question 17

A client near the end of life is experiencing dyspnea, which causes anxiety. To plan holistic care for this client, the best decision by the nurse would be to

A) get an order for liberal doses of anxiolytics.
B) have the family stay with the client.
C) prepare the client for a morphine infusion.
D) use an interdisciplinary approach.

Question 18

The nurse alerts a family member about the client's imminent death because the nurse has assessed the cardiovascular indicator of

A) bradycardia.
B) fluctuating blood pressure.
C) irregular heart rate.
D) narrowing pulse pressure.