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The hospice care nurse is planning the care of an elderly client diagnosed with end-stage renal disease. Which interventions should be included in the plan of care? Select all that apply.
- A. Discuss financial concerns.
- B. Assess any comorbid conditions.
- C. Monitor increased visual or auditory abilities.
- D. Note any spiritual distress.
- E. Encourage euphoria at the time of death.
Correct Answer: A,B,D
Rationale: Financial concerns, comorbidities, and spiritual distress are relevant for holistic hospice care in end-stage renal disease. Visual/auditory increases or euphoria are not typical interventions.
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The male client requested a DNR per the AD, and the HCP wrote the order. The client's death is imminent and the client's wife tells the nurse, 'Help him please. Do something. I am not ready to let him go.' Which action should the nurse take?
- A. Ask the wife if she would like to revoke her husband's AD.
- B. Leave the wife at the bedside and notify the hospital chaplain.
- C. Sit with the wife at the bedside and encourage her to say good-bye.
- D. Request the client to tell the wife he is ready to die, and don't do anything.
Correct Answer: C
Rationale: Sitting with the wife and encouraging closure supports her emotionally while respecting the DNR. Revoking AD, notifying chaplain, or requesting client communication is inappropriate.
The nurse is caring for the client who has active tuberculosis of the lungs. The client does not have a DNR order. The client experiences a cardiac arrest, and there is no resuscitation mask at the bedside. The nurse waits for the crash cart before beginning resuscitation. According to the ANA Code of Ethics for Nurses, which disciplinary action should be taken against the nurse?
- A. Report the action to the State Board of Nurse Examiners.
- B. The nurse should be terminated for failure to perform duties.
- C. No disciplinary action should be taken against the nurse.
- D. Refer the nurse to the American Nurses Association.
Correct Answer: C
Rationale: Waiting for a mask during TB resuscitation prioritizes nurse safety, aligning with ANA Code ethics (self-protection). Reporting, termination, or ANA referral is unwarranted.
The hospice care nurse is conducting a spiritual care assessment. Which statement is the scientific rationale for this intervention?
- A. The client will ask all of his or her spiritual questions and get answers.
- B. The nurse is able to explain to the client how death will affect the spirit.
- C. Spirituality provides a sense of meaning and purpose for many clients.
- D. The nurse is the expert when assisting the client with spiritual matters.
Correct Answer: C
Rationale: Spirituality offers meaning and purpose, supporting holistic hospice care. Clients may not ask all questions, nurses aren’t spiritual experts, and death’s spiritual impact is subjective.
The client has been in a persistent vegetative state for several years. The family, who have decided to withhold tube feedings because there is no hope of recovery, asks the nurse, 'Will the death be painful?' Which intervention should the nurse implement?
- A. Tell the family the death will be painful but the HCP can order medications.
- B. Inform the family dehydration provides a type of natural euphoria.
- C. Relate other cases where the clients have died in excruciating pain.
- D. Ask the family why they are concerned because they want the client to die anyway.
Correct Answer: B
Rationale: Dehydration in end-of-life care often leads to a natural euphoria, reducing pain perception, per hospice evidence. Painful death, case comparisons, or questioning motives is unhelpful.
The nurse is discussing advance directives with the client. The client asks the nurse, 'Why is this so important to do?' Which statement would be the nurse's best response?
- A. The federal government mandates this form must be completed by you.
- B. This will make sure your family does what you want them to do.
- C. Don't you think it is important to let everyone know your final wishes?
- D. Because of technology, there are many options for end-of-life care.
Correct Answer: D
Rationale: ADs address varied end-of-life options due to medical technology, ensuring client wishes are followed. Federal mandates, family compliance, or rhetorical questions are less accurate.