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FINAL ANSWER SHEET
End of Life Care Review
- A nurse is caring for a client who has terminal lung cancer. The nurse observes the client's family assisting with all ADLs. Which of the following rationales for self-care should the nurse communicate to the family?
A. Allowing the client to function independently will strengthen her muscles and promote healing. B. The client needs to be given privacy at times for self-reflecting and organizing her life.
C. The client's sense of loss can be lessened through retaining control of certain areas of her life. D. Performing ADLs is required prior to discharge from an acute care facility.
- A nurse is caring for a client who has stage IV lung cancer and is 3 days postoperative following a wedge resection. The client states, "I told myself that I would go through with the surgery and quit smoking, if I could just live long enough to
attend my daughter's wedding." Based on Kübler-Ross' model, which stage of grief is the client experiencing?
A. Anger B. Denial C. Bargaining
D. Acceptance
- A nurse is consoling the partner of a client who just expired after a long battle with liver cancer. The partner is displaying grief and states, "I hate him for leaving me." Which of the following statements by the nurse successfully facilitate mourning for the grieving partner? (Select all that apply.)
A. "Would you like me to contact the chaplain to come speak with you?" B "You will feel better soon. You have been expecting this for a while now. C. "Let's talk about your children and how they are going to react." D."You know, it is quite normal to feel anger toward your husband at this time."
E "Tell me more about how you are feeling.
- A nurse is caring for a client who has a terminal illness. Death is expected within 24 hr. The client's family is at the bedside and asks the nurse about anticipated findings at this time. Which of the following findings should the nurse
include in the discussion?
A. Regular breathing patterns B. Warm extremities C. Increased urine output
D. Decreased muscle tone
- A nurse is assisting a newly licensed nurse with postmortem care of a client. The family wishes to view the body. Which of the following statements by the newly licensed nurse indicate an understanding of the procedure? (Select all that apply.)
A. "I will remove the dentures from the body. B. "I will make sure the body is lying completely flat." C."I will apply fresh linens and place a clean gown on the body." D. "I will remove all equipment from the bedside
E. "I will dim the lights in the room.
During Skills Activity -
Group remaining in the classroom, work on answering the following question:
Active Learning Scenario
A nurse educator is teaching a module on palliative care to a group of newly licensed nurses.
List five physical care interventions and five psychological care interventions appropriate for the care of a client
who is dying.
Compare your answers to these below:
NURSING INTERVENTIONS FOR THE GRIEVING
Answer sheet:
1.A nurse is caring for a client who has terminal lung cancer. The nurse observes the client's family assisting
with all ADLs. Which of the following rationales for self-care should the nurse communicate to the family?**
Correct Answer: C. The client's sense of loss can be lessened through retaining control of certain
areas of her life.
Rationale: Maintaining autonomy and control over personal care can help preserve a client's dignity and self-
esteem, particularly in the context of terminal illness. It allows the individual to feel more in control of their
situation and can reduce feelings of helplessness and dependency.
- A nurse is caring for a client who has stage IV lung cancer and is 3 days postoperative following a wedge
resection. The client states, "I told myself that I would go through with the surgery and quit smoking, if I could
just live long enough to attend my daughter's wedding." Based on Kübler-Ross' model, which stage of grief is
the client experiencing?**
Correct Answer: C. Bargaining
- Rationale: The bargaining stage involves making deals or promises, often to a higher power, in
an attempt to postpone or alter the reality of death. The client's statement reflects a hope that certain
actions might lead to a prolonged life, characteristic of the bargaining phase of grief.
End of Life Care Class Review
Discussion Questions
Select True or False for the following Statements:
- Patients admitted to health care agencies must be asked if they have executed an advanced directive.
- Physician offices must initiate advance directive inquiries with patients planning to be admitted to a clinical facility.
- For those patients who have not executed an Advance Directive (AD), health care agencies must provide them with information regarding the value of Ads.
- For those patients who have not executed an AD, health care agencies must provide them with the opportunity to complete the state required forms.
- AD require an attorney for completion.
- The patient must have written permission from the attending physician to enact a presented AD.
- To retain health care decision-making responsibilities, which criteria must be met by the patient? Select all that apply.
A. The patient must be alert and oriented x 4.
B. The patient must be able to receive information provided by health care providers.
C. The patient must be able to communicate treatment choices.
D. The patient must have the cognitive ability to evaluate treatment options.
8. As a 10 year old child, the grand daughter would often think of her grandmother dying and cry herself to sleep, imagining the loss. For several years, especially when hearing of someone else dying, the grand daughter would grieve the death of her grandmother. The grandmother lived for another 30+ years. The grand daughter, quickly accepted the fact when her grandmother died, showing very little sign of mourning.
What aspect of the scenario relates to:
- Anticipatory loss
- Perceived loss
- Actual loss
- Discuss the stages of grieving
- Distinguish between functional and dysfunctional grieving
Give two definitions of death.
State at least five clinical signs of impending death:
A patient was diagnosed with a terminal illness and has a prognosis of three months. The patient’s daughter states that her neighbor has been receiving palliative care and wants to know why the Physician is referring for a hospice consult.
- Explain to the family member the difference between hospice care and palliative care.
- Discuss factors the nurse should consider when caring for: A. The dying patient B. The family C. Discuss special consideration for children
The patient states that he would rather die now.
- How do passive euthanasia and active euthanasia differ?
- What is meant by Full Code, DNR, Allow Natural Death (AND)?
- What is an Advanced Directive?
- What is a Living Will?
- Discuss the legal considerations of 1-4 above.
Reference
Fundamental of Nursing Chapter 43
- Facilitate the understanding of information regarding disease progression and treatment
choices.
- Facilitate communication between the client, family, and provider.
- Encourage the client to participate in religious practices that bring comfort and strength, if
appropriate.
- Assist the client in clarifying personal values in order to facilitate effective decision-making.
- Encourage the client to use coping mechanisms that have worked in the past.
- Be sensitive to comments made in the presence of clients who are unconscious because
hearing is the last sensation lost.
Answer Sheet
End of Life Care Class Review Discussion Questions
Select True or False for the following Statements:
- Patients admitted to health care agencies must be asked if they have executed an advanced directive. ● Answer: True ● Rationale: It is a requirement under the Patient Self-Determination Act to ask patients about their advance directives to ensure their wishes regarding medical treatment and end-of-life care are known and respected.
- Physician offices must initiate advance directive inquiries with patients planning to be admitted to a clinical facility. ● Answer: True ● Rationale: Early discussion about advance directives ensures that the patient's wishes are understood and can be followed throughout their care, including any future admissions to clinical facilities.
- For those patients who have not executed an Advance Directive (AD), health care agencies must provide them with information regarding the value of ADs. ● Answer: True ● Rationale: Health care agencies have an obligation to inform patients about advance directives to support informed decision-making and patient autonomy.
- For those patients who have not executed an AD, health care agencies must provide them with the opportunity to complete the state-required forms. ● Answer: True ● Rationale: Providing the opportunity to complete advance directive forms is part of the responsibility of healthcare agencies to facilitate patient autonomy and legal rights.
- AD require an attorney for completion. ● Answer: False ● Rationale: While legal advice can be helpful, most states offer forms that individuals can complete on their own to create an advance directive.
- The patient must have written permission from the attending physician to enact a presented AD. ● Answer: False ● Rationale: An advance directive is a legal document that goes into effect based on the terms it contains and the situation at hand, not on a physician's permission.
- To retain health care decision-making responsibilities, which criteria must be met by the patient?
Select all that apply.
● Answer: A, B, C, D ● Rationale: The patient must be mentally capable to make informed decisions about their health care, which includes being alert, receiving and understanding information, communicating choices, and evaluating treatment options.
- As a 10 year old child, the grand daughter would often think of her grandmother dying and cry
herself to sleep, imagining the loss. For several years, especially when hearing of someone else dying,
● Answer : Hospice care is specialized care for those with a life expectancy of six months or less, focusing on comfort and quality of life rather than curative treatment. Palliative care can be provided at any stage of illness and focuses on relieving symptoms and stress of serious illness, regardless of the stage or prognosis.
Discuss factors the nurse should consider when caring for: A. The dying patient B. The family C. Special consideration for children ● Answe r: The nurse should consider pain and symptom management, emotional support, dignity, communication of information, support for grief, involvement in care decisions, and age-appropriate communication and support for children.
The patient states that he would rather die now.
How do passive euthanasia and active euthanasia differ? ● Answer: Passive euthanasia involves withholding or withdrawing life-sustaining treatments, allowing the illness to take its natural course. Active euthanasia involves taking deliberate action to cause a patient's death.
What is meant by Full Code, DNR, Allow Natural Death (AND)?
● Answer: ● Full Code refers to the use of all possible life-saving measures in the event of cardiac or respiratory arrest. ● DNR (Do Not Resuscitate) means that no attempts should be made to restart the heart or breathing if they stop. ● AND (Allow Natural Death) focuses on comfort care and does not include any resuscitation efforts.
What is an Advanced Directive? ● Answer: An Advanced Directive is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions due to illness or incapacity.
What is a Living Will? ● Answer: A Living Will is a type of Advanced Directive that outlines a person's wishes regarding medical treatments and life-sustaining measures in the event they are unable to communicate their decisions.
Discuss the legal considerations of 1-4 above. ● Answer: Legal considerations include ensuring that the documents are clearly written, the person creating them is of sound mind, and they are completed in accordance with state laws, which may include witnessing or notarization. It's also important that these documents are accessible to healthcare providers when needed.
