ramont2e rev tif ch17

8/20/2019 Ramont2e Rev TIF Ch17

http://slidepdf.com/reader/full/ramont2e-rev-tif-ch17 1/60

Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test

Bank

Chapter 17Question 1

Type: MCSA

The nurse interacts with clients experiencing loss in a variety of settings, and understands that the most traumaticgrieving is usually associated with

1. Loss of safety or freedom

2. Divorce

. Empty nesting

!. Loss of life as you have nown it

Corre"t #ns$er: !

Rationa%e 1" #hen lives are affected $y civil or national strife, they may grieve the loss of safety, freedom, or

democracy%

Rationa%e 2" Divorce is a situational loss of a valued relationship%

Rationa%e " Maturational loss, such as changing life roles causes people to experience grief%

Rationa%e !" The most traumatic grieving is usually associated with the loss of one&s own life 'as you have nowit( or that of a loved one%

&%o'a% Rationa%e:

Cogniti(e )e(e%: Analy)ing

C%ient Need: *sychosocial +ntegrity

C%ient Need *u':

Nursing+ntegrated Con"epts: ursing *rocess" Diagnosis

)earning -ut"ome:

Question 2

Type: MCSA

As the nurse counsels the parents of a child who has lost a si$ling, an appropriate comment would $e

1. -Allowing children to decide how to participate in funerals will help them in the grieving process.

2. -Children are permanently scarred $y loss.

/amont, iedringhous, Comprehensive Nursing Care 0nd Edition 1pdate Test 2an

Copyright 0340 $y *earson Education, +nc%



. -Children need to go to funerals to help them get over loss.

!. -Children get over loss $est $y going to therapy.

Corre"t #ns$er: 4

Rationa%e 1" Allowing children to mae decisions a$out participating in funerals will help them process the even

Rationa%e 2" Children are resilient, $ut will learn to live with the loss%

Rationa%e " Children may or may not need to go to the funeral to process the loss5 they should $e allowed to

mae the decision themselves%

Rationa%e !" Children and adolescents may process $est with a variety of approaches, such as play, art, dance,music%

&%o'a% Rationa%e:


C%ient Need: *sychosocial +ntegrityC%ient Need *u':


)earning -ut"ome:

Question

Type: MCMA

The nurse understands that culture and religious traditions and practices"

*tandard Tet: Select all that apply%

1. Should $e supported $y the healthcare team

2. 6ften determine expression of grief

. Encourage outward expressions of grief

!. Are diverse in the 1nited States

/. /e7uire individuali)ed care

Corre"t #ns$er: 4,0,!,8

Rationa%e 1" Supporting these traditions comfort survivors%

Rationa%e 2" The customs of the culture help people cope with death, dying, and the grieving process%

Rationa%e " Expressions of grief vary from culture to culture, from stoic to demonstrative%





Rationa%e !" The 1nited States has a diverse num$er of cultures in $oth clients and nursing staff%

Rationa%e /" +ndividuali)ed care $y nurses ensure maximum support for clients and their families%

&%o'a% Rationa%e:



C%ient Need *u':Nursing+ntegrated Con"epts: ursing *rocess" Diagnosis

)earning -ut"ome:

Question !

Type: MCSA

The nurse woring with a group of students whose friend committed suicide distinguishes $etween the stages of

grief each student is exhi$iting% The nurse identifies a student as $eing in denial when she says

1. -She was so sad.

2. -She ran away.

. 9+f we tell you how we feel, can we leave:.

!. -+ don&t want to $e here.

Corre"t #ns$er: 0

Rationa%e 1" +dentifying the sadness is a sign of acceptance%

Rationa%e 2" The client refuses to $elieve that the loss is happening%

Rationa%e " This is an example of $argaining%

Rationa%e !" The student who says something lie this is expressing anger%

&%o'a% Rationa%e:




)earning -ut"ome:

Question /

Type: MCMA





#hen leading a support group for clients who have lost a lim$, the nurse explains the following as $eing element

in the grief process"


1. ot everyone goes through the stages of grief in the same order

2. 6nce a person experiences a stage of grief, he or she moves on to the next stage

. The client can expect to reach the acceptance stage within ; months

!. Counseling may $e necessary of the depression stage is not experienced within ; months

/. The amount of time a person spends in each stage differs from person to person

Corre"t #ns$er: 4,8

Rationa%e 1" Those experiencing grief will process the event in their own order%

Rationa%e 2" +ndividuals may move $ac and forth $etween stages%

Rationa%e " *eople may need profession counseling if they do not experience the 8 stages within ; months of a

grief event%

Rationa%e !" The depression stage needs to $e wored through as part of the grief process%

Rationa%e /" The grieving client will move $etween the stages of grief at own pace%

&%o'a% Rationa%e:

Cogniti(e )e(e%: Analy)ingC%ient Need: *sychosocial +ntegrity

C%ient Need *u':


)earning -ut"ome:

Question 0

Type: MCMA

The nurse descri$es #olfelt&s mourner&s needs to a widow as including"


1. A support person who will encourage her to <get over& the grief 7uicly

2. The need to allow oneself periods of time to feel the grief completely

. The need to find reasons for going on with life





!. The need to acnowledge the reality of the loved one&s death

/. Maintaining a relationship with the deceased person as part of the past

Corre"t #ns$er: 0,=,!,8

Rationa%e 1" Seeing mourning as something to -get over. leads to repression rather than resolution of grief%

Rationa%e 2" Allowing oneself to feel the pain followed $y periods of not dwelling in the grief will assist insuccessful resolution of grief%

Rationa%e " The grieving person will need to create a new self>identity that does not include the deceased%

Rationa%e !" The grieving person needs to acnowledge the reality of the death in order to recover%

Rationa%e /" The mourner needs to maintain the relationship as part of the past in order to $e open to newexperiences in the future%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 7

Type: MCMA

A client is seen in the family practice clinic after losing 48 pounds ? months after the death of her mother% The

nurse 7uestions the client regarding the loss% #hich of the following reported $ehaviors may indicate complicated

grieving:


1. Living in the past

2. Self>isolation

. Shoc

!. /ead@usting her routine

/. olding on to the grief

Corre"t #ns$er: 4,0,8





Rationa%e 1" A client who is not maing new memories $y ? months after the loss may $e at ris for complicatedgrieving%

Rationa%e 2" The client who reports loss of interest in outside activities and relationships may $e experiencing

complicated grieving%

Rationa%e " Shoc is usually experienced during the initial stages of grief%

Rationa%e !" The client who is read@usting her routine to incorporate the new reality is showing signs ofsuccessful resolution of grief%

Rationa%e /" The client who is holding on to her grief ? months after the loss may $e experiencing complicated

grieving%

&%o'a% Rationa%e:



C%ient Need *u':

Nursing+ntegrated Con"epts: ursing *rocess" Diagnosis)earning -ut"ome:

Question

Type: MCMA

#hen caring for client&s who have experience paralysis due to acute spinal cord in@ury, the nurse remem$ers

guidelines that may help those who are grieving"


1. Taling will help the mourner heal

2. Brief may $ring mixed emotions

. Brieving taes a great deal of energy

!. Brief is a process

/. *owerful surges of grief are dysfunctional

Corre"t #ns$er:4,0,=,!

Rationa%e 1" Taling with supportive others will help with the resolution of the grieving process%

Rationa%e 2" Brief may $ring feelings that may seem inappropriate5 the mourner needs to find listeners who will

accept feelings without @udgment%

Rationa%e " The mourner needs to rest and eat well>$alanced meals%





Rationa%e !" Brief is not an event5 it will tae time to resolve%

Rationa%e /" *owerful surges of grief are normal and natural%

&%o'a% Rationa%e:




)earning -ut"ome:

Question

Type: MCMA

urses are re7uired to $e familiar with facility policies, including those regarding directives and medical orders%

The *atient Self>Determination Act of 44 re7uires all healthcare facilities receiving Medicare and Medicaid

reim$ursement to"


1. As clients whether they have advance directives

2.

. *rovide written information to clients a$out their right to declare personal wishes a$out treatment

!. Mae certain that clients have an advance directive in place

/. +nform clients of their right to refuse medical treatment

Corre"t #ns$er: 4,0,=,8

Rationa%e 1" All facilities are re7uired to either chec the client&s chart or as clients whether they have advance

directives%

Rationa%e 2" All facilities and healthcare staff are re7uired to recogni)e and a$ide $y advance directives%

Rationa%e " All facilities must provide, in writing, information to clients a$out their right to mae treatmentdecisions%

Rationa%e !" All facilities are re7uired to as, $ut clients are not re7uired to have an advance directive in place%

Rationa%e /" All facilities are re7uired to provide written information to clients a$out their right to refuse medica

treatment%

&%o'a% Rationa%e:





Cogniti(e )e(e%: /emem$ering


C%ient Need *u':

Nursing+ntegrated Con"epts: ursing *rocess" Assessment

)earning -ut"ome:

Question 13

Type: MCSA

The nurse understands that the living will

1. *rovide specific instructions a$out what medical treatment the client chooses to omit or refuse

2. +s the same as a healthcare proxy

. *rovides for a designated person to see that the client&s wishes are honored when the client can no longer spea

for him

!. /e7uires a physician&s order

Corre"t #ns$er: 4

Rationa%e 1" The living will is referenced $efore C*/, intu$ation or $reathing support are $egun, so that specificinstructions from the client are followed%

Rationa%e 2" A healthcare proxy is also nown as a dura$le power of attorney%

Rationa%e " A dura$le power of attorney provides for a designated person to see that the client&s wishes are

honored when the client can no longer spea for him>or herself%

Rationa%e !" A do not resuscitate 'D/( order re7uires a physician order%

&%o'a% Rationa%e:

Cogniti(e )e(e%: 1nderstanding


C%ient Need *u':


)earning -ut"ome:

Question 11Type: MCSA

#hen reviewing a client&s chart prior to $eginning care, the nurse notes a do not resuscitate order on file% This

order

1. *revents the client from receiving anti$iotics





2. *revents the client from receiving + fluids

. *revents interventions the client does not wish to have performed when death approaches

!. *revents surgery from $eing performed

Corre"t #ns$er: =

Rationa%e 1" A D/ generally prevents resuscitation in the event of respiratory or cardiac arrest, $ut does not prohi$it the administration of anti$iotics%

Rationa%e 2" The D/ would prevent C*/, $ut not + fluids, unless specified in a -comfort measures only.

order%

Rationa%e " The D/ generally prevents the initiation of resuscitation measures in the event of a respiratory or

cardiac arrest%

Rationa%e !" The D/ does not prevent surgery from $eing performed%

&%o'a% Rationa%e:

Cogniti(e )e(e%: Applying


C%ient Need *u':


)earning -ut"ome:

Question 12

Type: MCMA

The hospice nurse is discussing indications of death with a client&s family% +ndications of clinical death include"


1. Total lac of response to external stimuli

2. +na$ility to $reathe independently

. A$sent reflexes

!. o voluntary muscular movement

/. +na$ility to open eyes

Corre"t #ns$er: 4,=,!

Rationa%e 1" Total lac of response to external stimuli is one clinical indication of death%





Rationa%e 2" +na$ility to $reathe independently is not a clinical indication of death $y itself%

Rationa%e " A$sent reflexes indicate destruction of $rain function%

Rationa%e !" o voluntary muscular movement is a clinical indication of death, especially when $reathing is

a$sent%

Rationa%e /" +na$ility to open eyes is not a clinical indication of death $y itself%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 1

Type: MCSA

A 4 year old client is admitted to the emergency room after a severe motor vehicle accident% The client&s driver&

license has an organ donation code specified% The nurse explains to the family that

1. The client will have organs harvested within 0! hours

2. The client must experience heart>lung death $efore organs can $e harvested

. The client is too young to $ecome an organ donor

!. The presence of two electroencephalograms showing no $rain activity over 0! hours is re7uired prior todeclaration of death

Corre"t #ns$er: !

Rationa%e 1" The client will not have the organ donation process started without specific criteria $eing met%

Rationa%e 2" Specific criteria must $e met prior to the client $eing declared dead5 with artificial life support, the

client may not have heart>lung death%

Rationa%e " The client is of age to $ecome an organ donor%

Rationa%e !" The presence of two EEBs showing no $rain activity over 0! hours is re7uired $efore the client may $e declared dead, and organ or tissue donation process can $egin%

&%o'a% Rationa%e:







C%ient Need *u':


)earning -ut"ome:

Question 1!

Type: MCSA

The nurse notes the term palliative management on a client&s chart, and recogni)es that the treatment goals

1. Are to let the client die peacefully

2. Are to optimi)e 7uality of life

. Depend on the results of tests

!. Are to mae sure the client gets plenty of fluids to stay hydrated

Corre"t #ns$er: 0

Rationa%e 1" *alliative care may $e instituted for clients who are not terminally ill%

Rationa%e 2" The goals of palliative management is to optimi)e 7uality of life, with providing relief from

suffering rather than curing a disease%

Rationa%e " Diagnostic tests and other invasive procedures are minimi)ed, unless they are liely to alleviatesymptoms, or provide information that will facilitate symptom management%

Rationa%e !" Clients eat if they are hungry and drin if they are thirsty5 feeding and fluids are not forced%

&%o'a% Rationa%e:



C%ient Need *u':

Nursing+ntegrated Con"epts: ursing *rocess" *lanning

)earning -ut"ome:

Question 1/

Type: MCMA

The home health nurse is explaining the principles of palliative care to the client and the family% These principlesinclude"


1. either hastening nor prolonging death





2. 1se of heroic treatment measures is discouraged

. *ain medication is given on a strict schedule

!. The hopes and desires of the family are fulfilled as much as possi$le

/. eeding and fluids are not forced


Rationa%e 1" Death is regarded as a natural process that is not prolonged or hastened%

Rationa%e 2" The use of heroic measures is discouraged, with the client usually having a do not resuscitate order

in place%

Rationa%e " The client is the expert on whether pain is ade7uately relieved, and the right dose is the dose that provides pain relief without unaccepta$le side effects%

Rationa%e !" Care is individuali)ed to meet the emotional, social, spiritual, and existential needs of the client%

Rationa%e /" The clients eat if they are hungry, and drin if they are thirsty5 food and fluids are not forced%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 10Type: MCSA

As the family of a client with a terminal illness weighs the options of future care, the nurse explains the differenc

$etween hospice care and palliative care as follows"

1. The focus of hospice care is to prolong life

2. All hospice care is palliative, $ut not all palliative care is hospice

. *alliative care is provided for terminally ill clients with a prognosis of ; months or less survival time

!. ospice care is never provided in a hospital

Corre"t #ns$er: 0

Rationa%e 1" The focus of hospice is to improve the 7uality of life, rather than to prolong it%





Rationa%e 2" *alliative care may $e provided to clients who are not terminal, however hospice is provided forterminally ill clients, and incorporates the holistic concepts of palliative management%

Rationa%e " ospice care is provided for terminally ill clients with a prognosis of ; months or less survival time

Rationa%e !" ospice care can $e provided in many settings, included a hospital%

&%o'a% Rationa%e:



C%ient Need *u':

Nursing+ntegrated Con"epts: ursing *rocess" +mplementation

)earning -ut"ome:

Question 17

Type: MCMA

The nurse is reviewing the terminally ill client&s chart and notes a referral for hospice care% Characteristics of

hospice care include"


1. Medicare pays an all inclusive $enefit related to the terminal illness or symptom management

2. Care is delivered $y an interdisciplinary team

. A nurse can mae a referral for hospice care

!. Clients may have Medicare claims denied if they live longer than ; months

/. ospice care can $e carried out in a variety of settings


Rationa%e 1" Medicare pays an all>inclusive $enefit that provides the client with dura$le medical e7uipment, and

all medication and treatment related to the terminal illness and symptom management%

Rationa%e 2" The interdisciplinary hospice team consists of the dying person, family and caregivers, physicians,

nurses, aides, chaplains, social worers, $ereavement specialists and volunteers%

Rationa%e " Entrance or admission into a hospice program re7uires a physician&s certification of terminal illness

Rationa%e !" Medicare claims are not denied, as long as clients continue to meet the Medicare -conditions of

participation. in a hospice%

Rationa%e /" ospice care is commonly carried out in the client&s home or an extended care facility5 independent

hospice and hospital $ased palliative care units are $ecoming more widely availa$le%%





&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 1Type: SEF

The hospice movement was founded in the 03th century% *lace the following in se7uence from earliest to most

recent events

*tandard Tet: Clic and drag the options $elow to move them up or down%

Choi"e 1. Canadian *alliative Care Association

Choi"e 2. Gale>ew aven ospital ospice

Choi"e . London hospice

Choi"e !. Medicare ospice $enefit

Choi"e /.

Corre"t #ns$er: =,0,!,4

Rationa%e 1" The Canadian *alliative Care Association was founded in 44 to promote the hospice care

movement%

Rationa%e 2" Modern>day hospice came to the 1nited States in 4H! with the opening of a hospice unit at Gale> ew aven ospital in Connecticut%

Rationa%e " The hospice movement was founded in London in 4;H%

Rationa%e !" The enactment of the Medicare ospice $enefit occurred in 4?=%

Rationa%e /"

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:





Question 1

Type: MCMA

The L*IL can provide care for the client and family when in hospice care $y"


1. *roviding comfort assistance

2. Jeeping the family informed a$out the client&s status

. /einforcing information that the family mem$ers may not have $een a$le to a$sor$

!. Leaving the client alone, and not $othering them

/. Encouraging the client to ver$ali)e positive expectations for the future


Rationa%e 1" The nurse cares for the family $y providing comfort assistance to the client%

Rationa%e 2" Jeeping the family informed a$out the client&s status and letting them now what changes indicate

impending death will help the family and client cope%

Rationa%e " Moderate to severe anxiety interferes with comprehension, learning, and memory%

Rationa%e !" *ersonal care should $e given to the client as any client5 clients wishes should $e respected%

Rationa%e /" Encouraging the client to ver$ali)e positive expectations for the future will eep the daily focus

positive%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 23

Type: MCMA

The nurse caring for the terminally ill client and the family collects data a$out loss and grieving during the

admission interview% +nformation important to collect includes"


1. *revious losses/amont, iedringhous, Comprehensive Nursing Care 0nd Edition 1pdate Test 2an




2. Awareness of approaching loss

. ow grief was handled previously

!. Medications $eing taen for coping

/. istory of alcohol a$use

Corre"t #ns$er: 4,0,=,!

Rationa%e 1" Assessing previous loss is important to determine coping techni7ues%

Rationa%e 2" The level of awareness of the approaching loss is important when planning care and communicating

with caregivers%

Rationa%e " A history of previous difficulty with loss will assist the nurse in planning care for the client andfamily%

Rationa%e !" Jnowledge of the use of drugs, such as anxiolytics, will assist the nurse in caring for the client and

family%

Rationa%e /" Asing the client or family a$out alcohol a$use would not $e appropriate at the admission interview

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 21

Type: MCSA

#hen o$serving the terminally ill client and family are interacting, the nurse hears the client&s daughter say, -

when you get $etter, we&ll go shopping%. This is an example of

1. Closed awareness

2. 6pen pretense

. 6pen awareness

!. Mutual pretense

Corre"t #ns$er: !

Rationa%e 1" +n closed awareness, the client and family are unaware of impending death%





Rationa%e 2" 6pen pretense is not a level of awareness%

Rationa%e " +n open awareness, the client and others now a$out the impending death, and feel comforta$lediscussing it even though it is difficult%

Rationa%e !" +n mutual pretense, the client, family, and health personnel now that the prognosis is terminal5

however they do not tal a$out it, and try not to raise the su$@ect%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 22

Type: MCMA

The hospice nurse is teaching the family of a terminally ill client the signs of approaching death, including


1. Loss of muscle tone

2. 2ounding pulse

. Decreased urinary output

!. oisy respirations

/. Sta$le $lood pressure


Rationa%e 1" Loss of muscle tone, including incontinence, constipation, nausea may $e a sign of approachingdeath%

Rationa%e 2" The pulse may $ecome slow, wea, or thready as death approaches%

Rationa%e " 1rinary output usually decreases as death approaches%

Rationa%e !" oisy respirations, decreased or irregular respirations may $e a sign of approaching death%

Rationa%e /" 2lood pressure may decrease as circulation slows%

&%o'a% Rationa%e:







C%ient Need *u':


)earning -ut"ome:

Question 2

Type: MCMA

The nurse identifies actions that may assist the family of the terminally ill client including"


1. Suggesting placement in a hospice unit instead of home care

2. Allowing family to visit ad li$

. /einforcing information that family mem$ers may not have a$sor$ed

!. /eorient the client who is hallucinating

/. As direct 7uestions a$out needs


Rationa%e 1" Clients and family wishes regarding hospice care need to $e respected%

Rationa%e 2" amily mem$ers should not $e limited to regular visiting hours%

Rationa%e " Moderate to severe anxiety that may $e part of confronting death interferes with comprehension,learning, and memory%

Rationa%e !" Dying clients may hallucinate, and this experience should $e treated with respect%

Rationa%e /" The nurse should not assume client or family needs5 direct 7uestions are the appropriate way to

determine needs%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 2!

Type: MCSA





The ma@or nursing responsi$ility for clients who are dying is

1. To maintain the client&s comfort and dignity

2. To assist the client to a peaceful death

. To maintain a sense of hopefulness

!. To help the family accept the death

Corre"t #ns$er: 0

Rationa%e 1" Maintaining the client&s comfort and dignity is a nursing responsi$ility for all clients, including thedying person%

Rationa%e 2" Assisting the client to a peaceful death, using the Dying *erson&s 2ill of /ights as a guide%

Rationa%e " Maintaining a sense of hopefulness with the client helps the client to mae peace with their death $u

is not the ma@or nursing responsi$ility for the dying client%

Rationa%e !" The nurse assists the client and family in accepting the death, $ut is not the ma@or nursingresponsi$ility%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 2/

Type: MCMA

The terminally ill client is crying as the family leaves the room% The nurse identifies the following nursing

diagnoses as liely reasons for the clients tears"


1. ear

2. opelessness

. *owerlessness

!. /is for Caregiver /ole Strain

/. Brieving






Rationa%e 1" The client may fear $eing alone when the family leaves%

Rationa%e 2" The client may feel a sense of hopelessness at the terminal diagnosis%

Rationa%e " The client may feel powerless over the situation%

Rationa%e !" The client will not $e at ris for caregiver role strain5 the family is at ris%

Rationa%e /" The client may $e grieving the impending death, loss of health, leaving family5 these potential

reasons need to $e verified%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 20

Type: MCMA

The nurse acnowledges and respects the terminal client&s right to approach death in his or her own way $y"


1. Active listening

2. Allowing the client to mae treatment decisions

. Allowing the client to maintain self>care duties as possi$le

!. Allowing the client to express emotions without @udgment

/. Telling the client that a positive attitude is more helpful than crying


Rationa%e 1" Active listing shows respect for the client&s feelings and actions%

Rationa%e 2" Allowing the client to mae treatment decisions will increase emotional comfort%

Rationa%e " Allowing the client to maintain self care activities as desired will maintain the dignity and autonomy

Rationa%e !" Active listening, and presencing will assist the client in retaining individuality and autonomy%





Rationa%e /" /especting the client&s right to express emotions without expectations or @udgment includes allowinand encouraging the client to grieve impending or actual losses%

&%o'a% Rationa%e:



C%ient Need *u':


Question 27

Type: MCSA

The elderly wife of a hospice client has reported experiencing difficulty sleeping, and a decreased appetite% The

priority nursing diagnosis most liely to apply is

1. Brieving

2. ear

. /is for Caregiver /ole Strain

!. +nterrupted family process

Corre"t #ns$er: =

Rationa%e 1" The client may $e grieving, however this is not the priority diagnosis%

Rationa%e 2" The wife may $e afraid of the impending death, however this is not the priority diagnosis%

Rationa%e " The wife is reporting symptoms common to caregiver role strain%

Rationa%e !" The wife is not reporting symptoms that would point at this diagnosis%

&%o'a% Rationa%e:



C%ient Need *u':


Question 2

Type: MCMA

#hen planning care with clients who are confronting a loss or death, the nurse remem$ers to"






1. Treat the client as a living human $eing until death

2. Allow the client to participate in decisions concerning care

. Assist the client with pain control

!. Discuss negative changes in the condition with the family so the client will maintain hope

/. Answer the client&s 7uestions honestly

Corre"t #ns$er: 4,0,=

Rationa%e 1" The client should $e cared for as all clients, with respect, compassion and competence%

Rationa%e 2" The client is a$le to mae decisions a$out ADLs, food choices, etc% in order to maintain dignity%

Rationa%e " The client has the right to $e free from pain%

Rationa%e !" All changes in condition need to $e discussed with the client first, if conscious%

Rationa%e /" Client 7uestions should $e answered honestly, even if the answers are difficult%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 2

Type: MCMA

ursing interventions for the physiological needs of the client $y"


1. Administering pain medication

2. Assisting with ADLs

. orcing fluids

!. Allowing unlimited visitors

/. Maintaining respiratory status






Rationa%e 1" elping the client to control pain is a $asic nursing intervention%

Rationa%e 2" Assisting with ADLs and position changes addresses the comfort needs of the client%

Rationa%e " 6ffering fluids, and supporting nutrition needs without pressure is an appropriate nursing

intervention%

Rationa%e !" Monitoring the client for sensory overload, including too many visitors, is a nursing intervention tha

meets the physiological needs of dying clients%

Rationa%e /" Maintaining respiratory status is a $asic nursing intervention%

&%o'a% Rationa%e:



C%ient Need *u':

Nursing+ntegrated Con"epts: ursing *rocess" +mplementation)earning -ut"ome:

Question 3

Type: MCMA

ursing interventions that are appropriate for supporting the client and family during the grieving process include


1. Encourage the family to participate in physical care of dying person

2. Tell children exactly what to expect when visiting

. Mae sure the client doesn&t have to mae any decisions

!. 1se communication techni7ues such as evaluating and analy)ing

/. 1se communication techni7ues such as 7uestioning, paraphrasing and clarifying


Rationa%e 1" Assisting the dying person may relieve anxiety and reduce the feeling of helplessness%

Rationa%e 2" +t may $e unsettling for a child to see an unresponsive person or loved one attached to medicale7uipment5 having information ahead of time will mae the situation less frightening%

Rationa%e " +nvolvement in decision maing is empowering and helps the client $egin to organi)e the

experience%





Rationa%e !" Evaluating and analy)ing are less helpful in allowing clients to explore their own feelings%

Rationa%e /" These techni7ues, in addition to active and attentive listening, allow clients to explore their ownfeelings%

&%o'a% Rationa%e:




)earning -ut"ome:

Question 1

Type: MCSA

A client who was widowed 4? months ago is seen in the internal medicine office% She mentions that she started

crying when she came across a picture of her late hus$and% An appropriate response for the nurse would $e"

1. -+t seems to $e a long time for you to still $e crying% ave you considered counseling:.

2. -+t is very normal for anniversaries, pictures and holidays to trigger feelings of loss%.

. -Do you have a pet: *ets often can help people move on from a loss%.

!. -Are you eeping $usy: Gou need to develop new interests to eep from crying.

Corre"t #ns$er: 0

Rationa%e 1" This response does not acnowledge the client&s feelings%

Rationa%e 2" Events such as holidays and anniversaries can trigger painful feelings of loss, and are not indicativeof complicated grieving%

Rationa%e " This response does not acnowledge the client&s feelings%

Rationa%e !" This response does not acnowledge the clients feelings, and sends the message that crying is not

accepta$le%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:





Question 2

Type: MCMA

The family of the dying client ass the nurse if there are any complementary therapies that might help the client

with the fear and anxiety $eing experienced% The nurse explains the following complementary and alternative

medicine techni7ues as possi$ly helpful"


1. +maging

2. Medication

. *hysical therapy

!. Music

/. Meditation

Corre"t #ns$er: 4,!,8

Rationa%e 1" +maging is a techni7ues designed to replace unpleasant thoughts and feelings with positive ones%

Rationa%e 2" Medication is not a CAM therapy%

Rationa%e " *hysical therapy is not a CAM therapy%

Rationa%e !" Music therapy is classified under mind>$ody medicine, and may encourage relaxation and pain

relief%

Rationa%e /" Meditation and prayer are classified as mind>$ody medicine, and may encourage relaxation and painrelief%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question

Type: MCMA

The nurse explains the clinical signs of death for the client who is not on artificial life support as including"






1. Cessation of apical pulse

2. Cessation of respirations

. Cessation of $lood pressure

!. Total lac of response to external stimuli

/. A$sence of electric currents from the $rain


Rationa%e 1" Traditional clinical signs of death included cessation of apical pulse%

Rationa%e 2" Traditional clinical signs of death included cessation of respirations%

Rationa%e " Traditional clinical signs of death included cessation of $lood pressure%

Rationa%e !" Total lac of response to external stimuli is included in the parameters for clinical death in the case

of the client having artificial means to maintain respiration and $lood%

Rationa%e /" A$sence of electric currents from the $rain are included in the clinical indications of death in the

case of the client having artificial means to maintain respiration and $lood%

&%o'a% Rationa%e:


C%ient Need: *hysiological +ntegrity

C%ient Need *u':


)earning -ut"ome:

Question !

Type: MCSA

The nurse explains the traditional clinical signs of death as $eing referred to as

1. 2rain death

2. eart>lung death

. Cere$ral death

!. Clinical death

Corre"t #ns$er: 0

Rationa%e 1" The traditional signs of death are not referred to as $rain death%





Rationa%e 2" The traditional clinical signs of death are also referred to as heart>lung death%

Rationa%e " The traditional clinical signs of death are not referred to as cere$ral death%

Rationa%e !" The traditional clinical signs of death are not referred to as clinical death%

&%o'a% Rationa%e:

Cogniti(e )e(e%: 1nderstandingC%ient Need: *hysiological +ntegrity

C%ient Need *u':


)earning -ut"ome:

Question /

Type: MCSA

The nurse who wors with the organ donation team explains the definition of death prior to tissue harvesting as

$eing"

1. A$sence of reflexes

2. Total lac of response to external stimuli

. *resence of two EEBs showing no $rain activity

!. o voluntary muscular movement

Corre"t #ns$er: =

Rationa%e 1" A$sence of reflexes is an indication of clinical death $ut not an accepta$le indication of death%

Rationa%e 2" Total lac of response to external stimuli is not an accepta$le indication of death to proceed with

organ harvesting%

Rationa%e " The presence of two EEBs showing no $rain activity over 0!>hour period is re7uired $efore the

client may $e declared dead and organ or tissue donation process can $egin%

Rationa%e !" o voluntary muscular movement is not an accepta$le indication of death to proceed with organ

harvesting%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:





Question 0

Type: MCSA

The nurse who holds $ac from clients emotionally is exhi$iting

1. *resencing

2. Distancing

. Summari)ing

!. Denial

Corre"t #ns$er: 0

Rationa%e 1" *resencing is the act of $eing availa$le and with clients%

Rationa%e 2" Distancing is an unconscious response of professionals in which they hold $ac emotionally from

clients, especially dying client%

Rationa%e " Summari)ing is a communication techni7ue to verify understanding of an interaction%

Rationa%e !" Denial is refusing to $elieve that the loss is happening%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 7

Type: MCSA

Caring for sic and dying clients without maintaining $alance in the nurse&s personal life puts the nurse at ris for

1. Depression

2. Distancing

. Compassion fatigue

!. Coping

Corre"t #ns$er: =





Rationa%e 1" The nurse who cares for sic and dying clients is at ris for other emotional im$alance%

Rationa%e 2" Distancing is prevalent when the client is unaware of the diagnosis and can enhance loneliness andfear in the client%

Rationa%e " Compassion fatigue may occur if the nurse gives and gives without maintaining his or her own well

$eing%

Rationa%e !" Coping is a positive response%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question

Type: MCMA

Characteristics of nurses who successful care for clients in hospice include"


1. Discipline

2. Dedication

. Compassion

!. Distancing

/. *ower


Rationa%e 1" The nurse must $e a$le to prioriti)e care, and remem$er that client and family emotions are notdirected at the nurse, $ut at the loss%

Rationa%e 2" Caring for hospice clients and their families re7uires dedication to the process and the people, as the

end result is loss%

Rationa%e " The needs of the dying client and his or her family include emotional support, and allowing them toexpress feelings, as well as providing a calm presence%

Rationa%e !" Distancing may assist the nurse in staying unemotional, $ut is not the hallmar of a successful

hospice professional %





Rationa%e /" *ower is not a characteristic of a hospice nurse%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question

Type: MCMA

ospice nurses who identify the $eginnings of compassion fatigue in their $ehavior can"


1. Attend memorial services for their clients

2. Allow themselves to cry

. Tae a leave of a$sence

!. Distance themselves from their clients

/. Tae a wal


Rationa%e 1" Attending services may assist nurses with closure for the loss%

Rationa%e 2" /ecogni)ing one&s grief is a healthy way do process loss%

Rationa%e " Taing a leave of a$sence does not assist in processing the grief%

Rationa%e !" Distancing from clients does not assist the client, and does not allow for emotional $alance in the

nurse&s life%

Rationa%e /" Taing care of oneself physically is a step towards $alance %

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:





Question !3

Type: MCMA

The nurse identifies the challenge of $eing a hospice nurse as including"


1. 2eing empathetic

2. 2eing mentally healthy

. 2eing spiritually healthy

!. 2eing professionally healthy

/. 2eing self>protective


Rationa%e 1" The nurse must $e empathetic with the client and family in order to assist them with death anddying%

Rationa%e 2" The nurse must $e mentally healthy, aware of sadness or depression in self in order to $e effectivewith the client and family%

Rationa%e " The nurse must $e aware of his or her own views a$out death and dying in order to affectively care

for the dying client and family%

Rationa%e !" *rofessional health is not one of the challenges for the hospice nurse%

Rationa%e /" Self>protection will not assist the nurse in caring for the dying client and family%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question !1

Type: MCSA

The nurse interacts with clients experiencing loss in a variety of settings, and understands that the most traumaticgrieving is usually associated with"

1. Loss of safety or freedom%

2. Divorce%





. Empty nesting%

!. Loss of life as you have nown it%

Corre"t #ns$er: !

Rationa%e 1" #hen lives are affected $y civil or national strife, clients might grieve the loss of safety, freedom, o

democracy%

Rationa%e 2" Divorce is a situational loss of a valued relationship%

Rationa%e " Maturational loss, such as changing life roles, causes people to experience grief%

Rationa%e !" The most traumatic grieving is usually associated with the loss of one&s own life 'as you have nowit( or that of a loved one%

&%o'a% Rationa%e:




)earning -ut"ome:

Question !2

Type: MCSA

As the nurse counsels the parents of a child who has lost a si$ling, an appropriate comment would $e"

1. -Allowing children to decide how to participate in funerals will help them in the grieving process%.

2. -Children are permanently scarred $y loss%.

. -Children need to go to funerals to help them get over loss%.

!. -Children get over loss $est $y going to therapy%.

Corre"t #ns$er: 4

Rationa%e 1" Allowing children to mae decisions a$out participating in funerals will help them process the even

Rationa%e 2" Children are resilient, and will learn to live with the loss%

Rationa%e " Children might not need to go to the funeral to process the loss5 they should $e allowed to mae thedecision themselves%

Rationa%e !" Children and adolescents might process $est with a variety of approaches, such as play, art, dance,

and music%





&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question !Type: MCMA

The nurse understands that cultural and religious traditions and practices"


1. Should $e supported $y the healthcare team%

2. 6ften determine expression of grief%

. Encourage outward expressions of grief%

!. Are diverse in the 1nited States%

/. /e7uire individuali)ed care%

Corre"t #ns$er: 4,0,!,8

Rationa%e 1" Supporting these traditions comforts survivors%

Rationa%e 2" The customs of the culture help people cope with death, dying, and the grieving process%

Rationa%e " Expressions of grief vary from culture to culture, from stoic to demonstrative%

Rationa%e !" The 1nited States has a diverse num$er of cultures among $oth clients and nursing staff%

Rationa%e /" +ndividuali)ed care $y nurses ensures maximum support for clients and their families%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question !!

Type: MCSA

The nurse woring with a group of students whose friend committed suicide distinguishes $etween the stages of

grief each student is exhi$iting% The nurse identifies a student as $eing in denial when she says"





1. -She was so sad%.

2. -She ran away%.

. 9+f we tell you how we feel, can we leave:.

!. -+ don&t want to $e here%.

Corre"t #ns$er: 0

Rationa%e 1" +dentifying the sadness is a sign of acceptance%

Rationa%e 2" The client refuses to $elieve that the loss is happening%

Rationa%e " This is an example of $argaining%

Rationa%e !" The student who says something lie this is expressing anger%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question !/

Type: MCMA

#hen leading a support group for clients who have lost a lim$, the nurse lists the following as elements in the

grief process"


1. ot everyone goes through the stages of grief in the same order%

2. 6nce a person experiences a stage of grief, he moves on to the next stage%

. The client can expect to reach the acceptance stage within ; months%

!. Counseling might $e necessary if the depression stage is not experienced within ; months%

/. The amount of time spent in each stage differs from person to person%

Corre"t #ns$er: 4,8

Rationa%e 1" Those experiencing grief will process the event in their own order%

Rationa%e 2" +ndividuals might move $ac and forth $etween stages%





Rationa%e " *eople might need professional counseling if they do not experience the five stages within ; monthsof a grief event%

Rationa%e !" The depression stage needs to $e wored through as part of the grief process%

Rationa%e /" The grieving client will move $etween the stages of grief at his own pace%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question !0

Type: MCMA

The nurse descri$es #olfelt&s mourner&s needs to a widow as including"


1. A support person who will encourage her to <get over& the grief 7uicly%

2. The need to allow oneself periods of time to feel the grief completely%

. The need to find reasons for going on with life%

!. The need to acnowledge the reality of the loved one&s death%

/. Maintaining a relationship with the deceased person as part of the past%


Rationa%e 1" Seeing mourning as something to -get over. leads to repression rather than resolution of grief%

Rationa%e 2" Allowing oneself to feel the pain followed $y periods of not dwelling on the grief will assist in

successful resolution of grief%

Rationa%e " The grieving person will need to create a new self>identity that does not include the deceased%

Rationa%e !" The grieving person needs to acnowledge the reality of the death in order to recover%

Rationa%e /" The mourner needs to maintain the relationship as part of the past in order to $e open to newexperiences in the future%

&%o'a% Rationa%e:







C%ient Need *u':


)earning -ut"ome:

Question !7

Type: MCMA

A client is seen in the family practice clinic after losing 48 pounds ? months after the death of her mother% The

nurse 7uestions the client regarding the loss% #hich of the following reported $ehaviors might indicatecomplicated grieving:


1. Living in the past

2. Self>isolation

. Shoc

!. /ead@usting her routine

/. olding on to the grief


Rationa%e 1" A client who is not maing new memories $y ? months after the loss might $e at ris for

complicated grieving%

Rationa%e 2" The client who reports loss of interest in outside activities and relationships might $e experiencingcomplicated grieving%

Rationa%e " Shoc is usually experienced during the initial stages of grief%

Rationa%e !" The client who is read@usting her routine to incorporate the new reality is showing signs of

successful resolution of grief%

Rationa%e /" The client who is holding on to her grief ? months after the loss might $e experiencing complicatedgrieving%

&%o'a% Rationa%e:

Cogniti(e )e(e%: Analy)ingC%ient Need: *sychosocial +ntegrity

C%ient Need *u':


)earning -ut"ome:

Question !





Type: MCMA

#hen caring for clients who have experienced paralysis due to acute spinal cord in@ury, the nurse remem$ers thefollowing guidelines that might help those who are grieving"


1. Taling will help the mourner heal%

2. Brief can $ring mixed emotions%

. Brieving taes a great deal of energy%

!. Brief is a process%

/. *owerful surges of grief are dysfunctional%


Rationa%e 1" Taling with supportive others will help with the resolution of the grieving process%

Rationa%e 2" Brief can $ring feelings that might seem inappropriate5 the mourner needs to find listeners who will

accept feelings without @udgment%

Rationa%e " The mourner needs to rest and eat well>$alanced meals%

Rationa%e !" Brief is not an event5 it will tae time to resolve%

Rationa%e /" *owerful surges of grief are normal and natural%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question !

Type: MCSA

The nurse understands that the living will"

1. *rovides specific instructions a$out what medical treatment the client chooses to omit or refuse%

2. +s the same as a healthcare proxy%

. *rovides for a designated person to see that the client&s wishes are honored when the client no longer can spea

for him%





!. /e7uires a physician&s order%

Corre"t #ns$er: 4

Rationa%e 1" The living will is referenced $efore C*/, intu$ation, or $reathing support is $egun, so that specificinstructions from the client are followed%

Rationa%e 2" A healthcare proxy is also nown as a dura$le power of attorney%

Rationa%e " A dura$le power of attorney provides for a designated person to see that the client&s wishes are

honored when the client no longer can spea for herself%

Rationa%e !" A do not resuscitate 'D/( order re7uires a physician order%

&%o'a% Rationa%e:



C%ient Need *u':

Nursing+ntegrated Con"epts: ursing *rocess" Assessment)earning -ut"ome:

Question /3

Type: MCSA

#hen reviewing a client&s chart prior to $eginning care, the nurse notes a do not resuscitate order on file% Thisorder"

1. *revents the client from receiving anti$iotics%

2. *revents the client from receiving + fluids%

. *revents interventions the client does not wish to have performed when death approaches%

!. *revents surgery from $eing performed%

Corre"t #ns$er: =

Rationa%e 1" A D/ generally prevents resuscitation in the event of respiratory or cardiac arrest, $ut does not

prohi$it the administration of anti$iotics%

Rationa%e 2" The D/ would prevent C*/, $ut not + fluids, unless specified in a -comfort measures only.

order%

Rationa%e " The D/ generally prevents the initiation of resuscitation measures in the event of a respiratory or

cardiac arrest%

Rationa%e !" The D/ does not prevent surgery from $eing performed%





&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question /1Type: MCMA

The hospice nurse is discussing indications of death with a client&s family% +ndications of clinical death include"


1. Total lac of response to external stimuli%

2. +na$ility to $reathe independently%

. A$sent reflexes%

!. o voluntary muscular movement%

/. +na$ility to open the eyes%


Rationa%e 1" Total lac of response to external stimuli is one clinical indication of death%

Rationa%e 2" +na$ility to $reathe independently is not a clinical indication of death $y itself%

Rationa%e " A$sent reflexes indicate destruction of $rain function%

Rationa%e !" Total lac of voluntary muscular movement is a clinical indication of death, especially when $reathing is a$sent%

Rationa%e /" +na$ility to open the eyes is not a clinical indication of death $y itself%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question /2

Type: MCSA





A 4>year>old client is admitted to the Emergency Department after a severe motor vehicle accident% The client&sdriver&s license has an organ donation code specified% The nurse explains to the family that"

1. The client will have organs harvested within 0! hours%

2. The client must experience heartKlung death $efore organs can $e harvested%

. The client is too young to $ecome an organ donor%

!. The presence of two electroencephalograms showing no $rain activity over 0! hours is re7uired prior to

declaration of death%

Corre"t #ns$er: !

Rationa%e 1" The client will not have the organ donation process started without specific criteria $eing met%

Rationa%e 2" Specific criteria must $e met prior to the client&s $eing declared dead5 with artificial life support, the

client might not have heart>lung death%

Rationa%e " The client is of age to $ecome an organ donor%

Rationa%e !" The presence of two EEBs showing no $rain activity over 0! hours is re7uired $efore the client may $e declared dead and organ or tissue donation process can $egin%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question /

Type: MCSA

The nurse notes the term palliative management on a client&s chart, and recogni)es that the treatment goal"

1. +s to let the client die peacefully%

2. +s to optimi)e 7uality of life%

. Depends on the results of tests%

!. +s to mae sure the client gets plenty of fluids to stay hydrated%

Corre"t #ns$er: 0

Rationa%e 1" *alliative care may $e instituted for clients who are not terminally ill%





Rationa%e 2" The goal of palliative management is to optimi)e 7uality of life, providing relief from sufferingrather than curing a disease%

Rationa%e " Diagnostic tests and other invasive procedures are minimi)ed, unless they are liely to alleviate

symptoms, or provide information that will facilitate symptom management%

Rationa%e !" Clients eat if they are hungry and drin if they are thirsty5 feeding and fluids are not forced%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question /!

Type: MCMA

The home health nurse is explaining the principles of palliative care to the client and the family% These principles

include"


1. either hastening nor prolonging death%

2. 1se of heroic treatment measures is discouraged%

. *ain medication is given on a strict schedule%

!. The hopes and desires of the family are fulfilled as much as possi$le%

/. eeding and fluids are not forced%


Rationa%e 1" Death is regarded as a natural process that is not prolonged or hastened%

Rationa%e 2" The use of heroic measures is discouraged, with the client usually having a do not resuscitate orderin place%

Rationa%e " The client is the expert on whether pain is ade7uately relieved, and the right dose is the dose that

provides pain relief without unaccepta$le side effects%

Rationa%e !" Care is individuali)ed to meet the emotional, social, spiritual, and existential needs of the client%

Rationa%e /" The clients eat if they are hungry, and drin if they are thirsty5 food and fluids are not forced%

&%o'a% Rationa%e:







C%ient Need *u':


)earning -ut"ome:

Question //

Type: MCSAAs the family of a client with a terminal illness weighs the options of future care, the nurse explains the differenc

$etween hospice care and palliative care as follows"

1. The focus of hospice care is to prolong life%

2. All hospice care is palliative, $ut not all palliative care is hospice%

. *alliative care is provided for terminally ill clients with a prognosis of ; months or less survival time%

!. ospice care is never provided in a hospital%

Corre"t #ns$er: 0

Rationa%e 1" The focus of hospice is to improve the 7uality of life, rather than to prolong it%

Rationa%e 2" *alliative care may $e provided to clients who are not terminal5 however, hospice is provided for

terminally ill clients, and incorporates the holistic concepts of palliative management%

Rationa%e " ospice care is provided for terminally ill clients with a prognosis of ; months or less survival time

Rationa%e !" ospice care can $e provided in many settings, including a hospital%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question /0

Type: MCMAThe nurse is reviewing the terminally ill client&s chart, and notes a referral for hospice care% Characteristics of

hospice care include"


1. Medicare pays an all>inclusive $enefit related to the terminal illness or symptom management%





2. Care is delivered $y an interdisciplinary team%

. A nurse can mae a referral for hospice care%

!. Clients can have Medicare claims denied if they live longer than ; months%

/. ospice care can $e carried out in a variety of settings%


Rationa%e 1" Medicare pays an all>inclusive $enefit that provides the client with dura$le medical e7uipment and

all medication and treatment related to the terminal illness and symptom management%

Rationa%e 2" The interdisciplinary hospice team consists of the dying person, family and caregivers, physicians,nurses, aides, chaplains, social worers, $ereavement specialists, and volunteers%

Rationa%e " Entrance or admission into a hospice program re7uires a physician&s certification of terminal illness

Rationa%e !" Medicare claims are not denied as long as clients continue to meet the Medicare -conditions of

participation. in a hospice%

Rationa%e /" ospice care is commonly carried out in the client&s home or an extended care facility5 independenthospice and hospital>$ased palliative care units are $ecoming more widely availa$le%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question /7

Type: SEF

The hospice movement was founded in the 03th century% *lace the following in se7uence from earliest to mostrecent developments"

*tandard Tet: Clic and drag the options $elow to move them up or down%

Choi"e 1. Canadian *alliative Care Association

Choi"e 2. GaleKew aven ospital ospice

Choi"e . London hospice

Choi"e !. Medicare ospice $enefit

Corre"t #ns$er: !,0,4,=





Rationa%e 1" The Canadian *alliative Care Association was founded in 44 to promote the hospice caremovement%

Rationa%e 2" Modern>day hospice came to the 1nited States in 4H! with the opening of a hospice unit at GaleK

ew aven ospital in Connecticut%

Rationa%e " The hospice movement was founded in London in 4;H%

Rationa%e !" The enactment of the Medicare ospice $enefit occurred in 4?=%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question /

Type: MCMAThe L*IL can provide care for the client and family when in hospice care $y"


1. *roviding comfort assistance%

2. Jeeping the family informed a$out the client&s status%

. /einforcing information that the family mem$ers might not have $een a$le to a$sor$%

!. Leaving the client alone, and not $othering her%

/. Encouraging the client to ver$ali)e positive expectations for the future%


Rationa%e 1" The nurse cares for the family $y providing comfort assistance to the client%

Rationa%e 2" Jeeping the family informed a$out the client&s status and letting them now what changes indicate

impending death will help the family and client cope%

Rationa%e " Moderate>to>severe anxiety interferes with comprehension, learning, and memory%

Rationa%e !" *ersonal care should $e given to the client, as any client wishes should $e respected%

Rationa%e /" Encouraging the client to ver$ali)e positive expectations for the future will eep the daily focus

positive%





&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question /Type: MCMA

The nurse caring for the terminally ill client and the family collects data a$out loss and grieving during theadmission interview% +nformation important to collect includes"


1. *revious losses%

2. Awareness of approaching loss%

. ow grief was handled previously%

!. Medications $eing taen for coping%

/. istory of alcohol a$use%


Rationa%e 1" Assessing previous loss is important to determine coping techni7ues%

Rationa%e 2" The level of awareness of the approaching loss is important when planning care and communicating

with caregivers%

Rationa%e " A history of previous difficulty with loss will assist the nurse in planning care for the client and

family%

Rationa%e !" Jnowledge of the use of drugs, such as anxiolytics, will assist the nurse in caring for the client andfamily%

Rationa%e /" Asing the client or family a$out alcohol a$use would not $e appropriate at the admission interview

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:





Question 03

Type: MCSA

#hen o$serving the terminally ill client and family interacting, the nurse hears the client&s daughter say, -#hen

you get $etter, we&ll go shopping%. This is an example of"

1. Closed awareness%

2. 6pen pretense%

. 6pen awareness%

!. Mutual pretense%

Corre"t #ns$er: !

Rationa%e 1" +n closed awareness, the client and family are unaware of impending death%

Rationa%e 2" 6pen pretense is not a level of awareness%

Rationa%e " +n open awareness, the client and others now a$out the impending death, and feel comforta$lediscussing it even though it is difficult%

Rationa%e !" +n mutual pretense, the client, family, and health personnel now that the prognosis is terminal5however, they do not tal a$out it, and they try not to raise the su$@ect%

&%o'a% Rationa%e:



C%ient Need *u':


Question 01

Type: MCMA

The hospice nurse is teaching the family of a terminally ill client the signs of approaching death, including"


1. Loss of muscle tone%

2. 2ounding pulse%

. Decreased urinary output%

!. oisy respirations%

/. Sta$le $lood pressure%






Rationa%e 1" Loss of muscle tone, including incontinence5 constipation5 and nausea can $e signs of approachingdeath%

Rationa%e 2" The pulse can $ecome slow, wea, or thready as death approaches%

Rationa%e " 1rinary output usually decreases as death approaches%

Rationa%e !" oisy, decreased, or irregular respirations can $e a sign of approaching death%

Rationa%e /" 2lood pressure can decrease as circulation slows%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 02

Type: MCMA

The nurse identifies actions that might assist the family of the terminally ill client, including"


1. Suggesting placement in a hospice unit instead of home care%

2. Allowing family to visit ad li$%

. /einforcing information that family mem$ers might not have a$sor$ed%

!. /eorienting the client who is hallucinating%

/. Asing direct 7uestions a$out needs%


Rationa%e 1" Client and family wishes regarding hospice care need to $e respected%

Rationa%e 2" amily mem$ers should not $e limited to regular visiting hours%

Rationa%e " Moderate>to>severe anxiety that can $e part of confronting death interferes with comprehension,

learning, and memory%

Rationa%e !" Dying clients can hallucinate, and this experience should $e treated with respect%





Rationa%e /" The nurse should not assume client or family needs5 direct 7uestions are the appropriate way todetermine needs%

&%o'a% Rationa%e:



C%ient Need *u':


Question 0

Type: MCSA

The ma@or nursing responsi$ility for clients who are dying is"

1. To maintain the client&s comfort and dignity%

2. To assist the client to a peaceful death%

. To maintain a sense of hopefulness%

!. To help the family accept the death%

Corre"t #ns$er: 0

Rationa%e 1" Maintaining the client&s comfort and dignity is a nursing responsi$ility for all clients, including the

dying person%

Rationa%e 2" Assist the client to a peaceful death, using the Dying *erson&s 2ill of /ights as a guide%

Rationa%e " Maintaining a sense of hopefulness with the client helps the client to mae peace with his death $utis not the ma@or nursing responsi$ility for the dying client%

Rationa%e !" The nurse assists the client and family in accepting the death, $ut this is not the ma@or nursing

responsi$ility%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 0!

Type: MCMA

The terminally ill client is crying as the family leaves the room% The nurse identifies the following nursingdiagnoses as liely reasons for the client&s tears"






1. ear

2. opelessness

. *owerlessness

!. /is for Caregiver /ole Strain

/. Brieving


Rationa%e 1" The client might fear $eing alone when the family leaves%

Rationa%e 2" The client might feel a sense of hopelessness at the terminal diagnosis%

Rationa%e " The client might feel powerless over the situation%

Rationa%e !" The client will not $e at ris for caregiver role strain5 the family is at ris%

Rationa%e /" The client might $e grieving the impending death, loss of health, and leaving family5 these potential

reasons need to $e verified%

&%o'a% Rationa%e:



C%ient Need *u':


Question 0/

Type: MCMA

The nurse acnowledges and respects the terminal client&s right to approach death in her own way through"


1. Active listening%

2. Allowing the client to mae treatment decisions%

. Allowing the client to maintain self>care duties as possi$le%

!. Allowing the client to express emotions without @udgment%

/. Telling the client that a positive attitude is more helpful than crying%






Rationa%e 1" Active listing shows respect for the client&s feelings and actions%

Rationa%e 2" Allowing the client to mae treatment decisions will increase emotional comfort%

Rationa%e " Allowing the client to maintain self>care activities as desired will maintain dignity and autonomy%

Rationa%e !" Active listening and presencing will assist the client in retaining individuality and autonomy%

Rationa%e /" /especting the client&s right to express emotions without expectations or @udgment includes allowin

and encouraging the client to grieve impending or actual losses%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 00

Type: MCSA

The elderly wife of a hospice client has reported experiencing difficulty sleeping and a decreased appetite% The

priority nursing diagnosis most liely to apply is"

1. Brieving%

2. ear%

. /is for Caregiver /ole Strain%

!. +nterrupted amily *rocess%

Corre"t #ns$er: =

Rationa%e 1" The client might $e grieving5 however, this is not the priority diagnosis%

Rationa%e 2" The wife might $e afraid of the impending death5 however, this is not the priority diagnosis%

Rationa%e " The wife is reporting symptoms common to caregiver role strain%

Rationa%e !" The wife is not reporting symptoms that would point to this diagnosis%

&%o'a% Rationa%e:







C%ient Need *u':


)earning -ut"ome:

Question 07

Type: MCMA

#hen planning care with clients who are confronting a loss or death, the nurse remem$ers to"


1. Treat the client as a living human $eing until death%

2. Allow the client to participate in decisions concerning care%

. Assist the client with pain control%

!. Discuss negative changes in the condition with the family so the client will maintain hope%

/. Answer the client&s 7uestions honestly%


Rationa%e 1" The client should $e cared for as all clients are cared for, with respect, compassion, and competence

Rationa%e 2" The client is a$le to mae decisions a$out ADLs, food choices, etc% in order to maintain dignity%

Rationa%e " The client has the right to $e free from pain%

Rationa%e !" All changes in condition need to $e discussed with the client first, if conscious%

Rationa%e /" Client 7uestions should $e answered honestly, even if the answers are difficult%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 0

Type: MCMA

ursing interventions for the physiological needs of the client include"


1. Administering pain medication%





2. Assisting with ADLs%

. orcing fluids%

!. Allowing unlimited visitors%

/. Maintaining respiratory status%


Rationa%e 1" elping the client to control pain is a $asic nursing intervention%

Rationa%e 2" Assisting with ADLs and position changes addresses the comfort needs of the client%

Rationa%e " 6ffering fluids and supporting nutrition needs without pressure are appropriate nursing

interventions%

Rationa%e !" Monitoring the client for sensory overload, including too many visitors, is a nursing intervention tha

meets the physiological needs of dying clients%

Rationa%e /" Maintaining respiratory status is a $asic nursing intervention%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 0Type: MCMA

ursing interventions that are appropriate for supporting the client and family during the grieving process include


1. Encourage the family to participate in the physical care of the dying person%

2. Tell children exactly what to expect when visiting%

. Mae sure the client doesn&t have to mae any decisions%

!. 1se communication techni7ues such as evaluating and analy)ing%

/. 1se communication techni7ues such as 7uestioning, paraphrasing, and clarifying%






Rationa%e 1" Assisting the dying person can relieve anxiety and reduce the feeling of helplessness%

Rationa%e 2" +t might $e unsettling for a child to see an unresponsive person or loved one attached to medicale7uipment5 having information ahead of time will mae the situation less frightening%

Rationa%e " +nvolvement in decision maing is empowering, and helps the client $egin to organi)e the

experience%

Rationa%e !" Evaluating and analy)ing are less helpful in allowing clients to explore their own feelings%

Rationa%e /" These techni7ues, in addition to active and attentive listening, allow clients to explore their ownfeelings%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 73

Type: MCSA

A client who was widowed 4? months ago is seen in the internal medicine office% She mentions that she started

crying when she came across a picture of her late hus$and% An appropriate response for the nurse would $e"

1. -+t seems to $e a long time for you to still $e crying% ave you considered counseling:.

2. -+t is very normal for anniversaries, pictures, and holidays to trigger feelings of loss%.

. -Do you have a pet: *ets often can help people move on from a loss%.

!. -Are you eeping $usy: Gou need to develop new interests to eep from crying%.

Corre"t #ns$er: 0

Rationa%e 1" This response does not acnowledge the client&s feelings%

Rationa%e 2" Events such as holidays and anniversaries can trigger painful feelings of loss, and are not indicative

of complicated grieving%

Rationa%e " This response does not acnowledge the client&s feelings%

Rationa%e !" This response does not acnowledge the clients feelings, and sends the message that crying is notaccepta$le%

&%o'a% Rationa%e:







C%ient Need *u':


)earning -ut"ome:

Question 71

Type: MCMA

The family of the dying client ass the nurse whether there are any complementary therapies that might help theclient with the fear and anxiety the client is experiencing% The nurse explains the following complementary andalternative medicine techni7ues as potentially helpful"


1. +maging

2. Medication

. *hysical therapy

!. Music

/. Meditation

Corre"t #ns$er: 4,!,8

Rationa%e 1" +maging is a techni7ue designed to replace unpleasant thoughts and feelings with positive ones%

Rationa%e 2" Medication is not a CAM therapy%

Rationa%e " *hysical therapy is not a CAM therapy%

Rationa%e !" Music therapy is classified under mindK$ody medicine, and can encourage relaxation and pain relie

Rationa%e /" Meditation and prayer are classified as mindK$ody medicine, and can encourage relaxation and painrelief%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 72

Type: MCMA

The nurse lists the clinical signs of death for the client who is not on artificial life support, including"






1. Cessation of apical pulse%

2. Cessation of respirations%

. Cessation of $lood pressure%

!. Total lac of response to external stimuli%

/. A$sence of electric currents from the $rain%


Rationa%e 1" Traditional clinical signs of death include cessation of apical pulse%

Rationa%e 2" Traditional clinical signs of death include cessation of respirations%

Rationa%e " Traditional clinical signs of death include cessation of $lood pressure%

Rationa%e !" Total lac of response to external stimuli is included in the parameters for clinical death in the case

of the client utili)ing artificial means to maintain respiration and $lood%

Rationa%e /" A$sence of electric currents from the $rain is included in the clinical indications of death in the case

of the client utili)ing artificial means to maintain respiration and $lood%

&%o'a% Rationa%e:



C%ient Need *u':Nursing+ntegrated Con"epts: ursing *rocess" Assessment

)earning -ut"ome:

Question 7

Type: MCSA

The nurse reefers to the traditional clinical signs of death as"

1. 2rain death%

2. eartKlung death%

. Cere$ral death%

!. Clinical death%

Corre"t #ns$er: 0





Rationa%e 1" The traditional signs of death are not referred to as $rain death%

Rationa%e 2" The traditional clinical signs of death are also referred to as heartKlung death%

Rationa%e " The traditional clinical signs of death are not referred to as cere$ral death%

Rationa%e !" The traditional clinical signs of death are not referred to as clinical death%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 7!

Type: MCSA

The nurse who wors with the organ donation team explains the definition of death prior to tissue harvesting as

$eing"

1. A$sence of reflexes%

2. Total lac of response to external stimuli%

. *resence of two EEBs showing no $rain activity%

!. o voluntary muscular movement%

Corre"t #ns$er: =

Rationa%e 1" A$sence of reflexes is an indication of clinical death $ut not an accepta$le indication of death fororgan harvesting%

Rationa%e 2" Total lac of response to external stimuli is not an accepta$le indication of death to proceed with

organ harvesting%

Rationa%e " The presence of two EEBs showing no $rain activity over a 0!>hour period is re7uired $efore theclient may $e declared dead and the organ or tissue donation process may $egin%

Rationa%e !" Lac of voluntary muscular movement is not an accepta$le indication of death to proceed with orga

harvesting%

&%o'a% Rationa%e:



C%ient Need *u':






)earning -ut"ome:

Question 7/

Type: MCSA

The nurse who holds $ac from clients emotionally is exhi$iting"

1. *resencing%

2. Distancing%

. Summari)ing%

!. Denial%

Corre"t #ns$er: 0

Rationa%e 1" *resencing is the act of $eing availa$le and with clients%

Rationa%e 2" Distancing is an unconscious response of professionals in which they hold $ac emotionally fromclients, especially dying clients%

Rationa%e " Summari)ing is a communication techni7ue to verify understanding of an interaction%

Rationa%e !" Denial is refusing to $elieve that the loss is happening%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 70

Type: MCSA

Caring for sic and dying clients without maintaining $alance in the nurse&s personal life puts the nurse at ris for

1. Depression%

2. Distancing%

. Compassion fatigue%

!. Coping%

Corre"t #ns$er: =





Rationa%e 1" The nurse who cares for sic and dying clients is at ris for other emotional im$alance%

Rationa%e 2" Distancing is prevalent when the client is unaware of the diagnosis, and can enhance loneliness andfear in the client%

Rationa%e " Compassion fatigue can occur if the nurse gives and gives without maintaining her own well>$eing%

Rationa%e !" Coping is a positive response%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 77

Type: MCMA

Characteristics of nurses who successfully care for clients in hospice include"


1. Discipline%

2. Dedication%

. Compassion%

!. Distancing%

/. *ower%


Rationa%e 1" The nurse must $e a$le to prioriti)e care and remem$er that client and family emotions are not

directed at the nurse, $ut at the loss%

Rationa%e 2" Caring for hospice clients and their families re7uires dedication to the process and the people, as the

end result is loss%

Rationa%e " The needs of the dying client and his family include emotional support, and allowing them toexpress feelings, as well as providing a calm presence%

Rationa%e !" Distancing can assist the nurse in staying unemotional, $ut is not the hallmar of a successful

hospice professional %

Rationa%e /" *ower is not a characteristic of a hospice nurse%





&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 7Type: MCMA

ospice nurses who identify the $eginnings of compassion fatigue in their $ehavior can"


1. Attend memorial services for their clients%

2. Allow themselves to cry%

. Tae a leave of a$sence%

!. Distance themselves from their clients%

/. Tae a wal%


Rationa%e 1" Attending services can assist nurses with closure for the loss%

Rationa%e 2" /ecogni)ing one&s grief is a healthy way to process loss%

Rationa%e " Taing a leave of a$sence does not assist in processing the grief%

Rationa%e !" Distancing from clients does not assist the client, and does not allow for emotional $alance in thenurse&s life%

Rationa%e /" Taing care of oneself physically is a step towards $alance%

&%o'a% Rationa%e:



C%ient Need *u':


)earning -ut"ome:

Question 7

Type: MCMA

The nurse identifies the challenges of $eing a hospice nurse as including"






1. 2eing empathetic%

2. 2eing mentally healthy%

. 2eing spiritually healthy%

!. 2eing professionally healthy%

/. 2eing self>protective%


Rationa%e 1" The nurse must $e empathetic with the client and family in order to assist them with death and

dying%

Rationa%e 2" The nurse must $e mentally healthy, aware of sadness or depression in himself, in order to $e

effective with the client and family%

Rationa%e " The nurse must $e aware of his own views a$out death and dying in order to affectively care for the

dying client and family%

Rationa%e !" *rofessional health is not one of the challenges for the hospice nurse%

Rationa%e /" Self>protection will not assist the nurse in caring for the dying client and family%

&%o'a% Rationa%e:




)earning -ut"ome:

ramont2e rev tif ch17

Documents