Chapter 21: Perspectives in Palliative Care Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 21: Perspectives in Palliative Care

MULTIPLE CHOICE

1. 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.

ANS: C

Reasons for the underutilization of hospice services include difficulty in determining life expectancy prognoses in terms of 6 months or less.

DIF: Comprehension/Understanding REF: p. 388 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-End of Life Care

2. A nurse working with clients on a hospice service understands that a clients 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.

ANS: C

A persons quality of life is often linked to the experience of symptom distress and the meaning that the person assigns to these physical sensations.

DIF: Comprehension/Understanding REF: p. 387 OBJ: Assessment

MSC: Psychosocial Integrity Psychosocial Adaptation-Quality of Life

3. 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.

ANS: B

Morphine, hydromorphone, fentanyl, and oxycodone are examples of mu-agonist opioids frequently used in the treatment of pain.

DIF: Comprehension/Understanding REF: p. 389 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Pain Management

4. 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.

ANS: C

A client is less likely to experience nausea when opioids are administered orally rather than parenterally.

DIF: Application/Applying REF: pp. 389-390 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Pain Management

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.

ANS: B

As with the other side effects of opioids, tolerance to sedation develops after the first 2 to 3 days. If the client is difficult to arouse or the sedation lasts more than 2 to 3 days, however, the opioid dose may be too high for the intensity of the pain.

DIF: Comprehension/Understanding REF: p. 390 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Pain Management

6. 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.

ANS: A

People who report colicky pain may be experiencing the discomfort of smooth muscle spasm. This type of pain is best treated with an anticholinergic medication.

DIF: Application/Applying REF: p. 390 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Pain Management

7. 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.

ANS: A

As a rule, a client who requires more than four rescue doses during a 24-hour period or is awakened from sleep experiencing pain should be reevaluated.

DIF: Application/Applying REF: p. 391 OBJ: Evaluation

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Pain Management

8. 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.

ANS: B

Diagnostic and Statistical Manual of Mental Disorders (fourth edition, DSM-IV) criteria for delirium are (a) disturbance of consciousness with reduced ability to focus, sustain, or shift attention; (b) change in cognition (e.g., memory deficit, disorientation, language disturbance) or development of a perceptual disturbance that is not better accounted for by pre-existing, established, or evolving dementia; and (c) development of the disturbance over a short time (usually hours to days) and a tendency to fluctuate over the course of the day.

DIF: Analysis/Analyzing REF: p. 393 OBJ: Assessment

MSC: Psychosocial Integrity Psychosocial Adaptation-Psychopathology

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

a.

anger over the pain experience.

b.

anorexia and weight loss.

c.

feelings of hopelessness.

d.

inability to provide physical self-care.

ANS: C

Key indicators of clinical depression in the terminally ill are (a) alterations in mood; (b) feelings of hopelessness, worthlessness, or excessive guilt; and (c) recurrent death wishes, including suicidal ideation.

DIF: Application/Applying REF: p. 395 OBJ: Assessment

MSC: Psychosocial Integrity Psychosocial Adaptation-Psychopathology

10. 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.

ANS: A

The client should avoid stimulants (e.g., caffeine, nicotine). Depending on individual preferences, a relaxation routine may consist of massage, progressive muscle relaxation, imagery, music, and warm milk or herbal (not black) tea.

DIF: Application/Applying REF: p. 397 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Rest and Sleep

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.

ANS: C

With an intermediate half-life (6-15 hours), lorazepam (Ativan), oxazepam (Serax), and temazepam (Restoril) are helpful for promoting sleep onset and maintenance of sleep.

DIF: Analysis/Analyzing REF: p. 397 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Rest and Sleep

12. The nurse alerts a family member about the clients 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.

ANS: C

Cardiovascular indicators of imminent death include tachycardia, irregular heart rate, lowered blood pressure of significant widening between systolic and diastolic pressures, and dehydration.

DIF: Application/Applying REF: p. 400 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

13. 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.

ANS: B

To establish a relationship with the health care team, the nurse should explain the roles of all interdisciplinary team members, establish trust, and maintain open lines of communication.

DIF: Application/Applying REF: pp. 399, 400 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

14. 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.

ANS: A

Most people adapt to the grieving process successfully. But for some, it can become complicated. If response to a loss is prolonged, it may indicate a psychiatric disorder and should be investigated further.

DIF: Application/Applying REF: p. 400 OBJ: Assessment

MSC: Psychosocial Integrity Coping and Adaptation-Grief and Loss

15. 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.

ANS: C

This is an area of controversy in hospice care and arguments can be made on both sides of the topic. Thirst may be a side effect of medications. Peripheral edema may be an indicator of the pathologic process. Clients can be hydrated via hypodermoclysis, which is subcutaneous administration of fluids. Families and clients need much information to make decisions regarding hydration, but in hospice, all interventions should be directed towards comfort and symptom reduction.

DIF: Analysis/Analyzing REF: p. 394 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-End of Life Care

16. 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.

ANS: D

Interdisciplinary support is vital in treating dyspnea because of the myriad of both physical and psychosocial contributors to the problem. The other three options may be valid, depending on the cause of the dyspnea and the teams assessment of what would be most beneficial.

DIF: Analysis/Analyzing REF: p. 392 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Collaboration with Interdisciplinary Team

MULTIPLE RESPONSE

1. 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 Kbler-Ross.

c.

Florence Nightingale.

d.

Florence Wald.

ANS: A, B, D

Dame Cicely Saunders help found the hospice movement in England in the 1960s and Elizabeth Kbler Ross wrote the popular book On Death and Dying and testified in favor of home care for the terminally ill in front of Congress. Both are widely known and credited for their work in hospice. Another valid choice is Florence Wald, who as Dean of the Yale University School of Nursing invited Dame Saunders to visit, although Wald is not as commonly known. Wald also helped integrate the British hospice movement into the first home care hospice in New Haven, Connecticut, in 1974.

DIF: Knowledge/Remembering REF: p. 385 OBJ: N/A

MSC: Physiological Integrity Basic Care and Comfort-Palliative/Comfort Care

2. 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.

ANS: A, B, C

Corticosteroids are often used in the palliative care setting to treat dyspnea. These medications are believed to influence the manifestation of dyspnea by decreasing inflammation in the pulmonary tissue and increasing bronchodilation. Anti-anxiety agents and corticosteroids may also be used, depending on the circumstances. Option d is wrong because it does not specify morphine, and opioids other than morphine are not used.

DIF: Application/Applying REF: p. 392 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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