Nokea
The hospice nurse recommends that the patient prepare the document that provides guidance to the family concerning the patient's wishes regarding life-support measures and organ donation. What is this document called?
- A. Power of attorney
- B. Living will
- C. Advance directive
- D. Conservatorship
Correct Answer: C
Rationale: An advance directive is a document prepared while the patient is alive and competent that provides guidance to the family and health care team in the event the person can no longer make decisions.
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Which are signs and symptoms of approaching death?
- A. Mottled extremities
- B. Significant increase in urine output
- C. Increased restlessness and pulling at bed linens
- D. Alteration in rhythmic respiration
- E. Increased pulse rate
Correct Answer: A,C,D,E
Rationale: Mottled extremities, a significant decrease in urine output, an increased restlessness, alteration in rhythmic respirations, and increased pulse rate are all symptoms of approaching death.
The hospice nurse instructs caregivers in repositioning the patient because the patient spends most of the time reclining. What problem can this cause?
- A. Contractures
- B. Pressure injuries
- C. Bruising
- D. Excoriation
Correct Answer: B
Rationale: Increased weakness is noted in the last stages of a terminal illness. With increased weakness, activity intolerance increases, and the patient spends most of the time reclining. This leads to risk for skin impairment and the formation of pressure injuries.
Why is it important for the hospice nurse to provide time to confer with the patient and family?
- A. To show concern
- B. To report changes in the plan of care designed by the team
- C. To confirm the ongoing reimbursement
- D. To plan for changes in the scope of care
Correct Answer: D
Rationale: No changes should be made to the patient's plan of care without first discussing it with the entire family. The family should be involved in planning the changes in the scope of care.
The hospice nurse instructs the family that they have access to a hospice pharmacist, who is available for consultation on the drugs the hospice patient may be taking. What other role does the hospice pharmacist fill?
- A. Administer all drugs necessary for pain alleviation.
- B. Evaluate drug interactions with food and other medications.
- C. Evaluate the safety of the drug storage in the patient's home.
- D. Monitor drug effectiveness by frequent phone interviews with the family.
Correct Answer: B
Rationale: The hospice pharmacist is available to consult about drug interactions with other drugs or food. The pharmacist does not administer the drugs. The nurse would evaluate the safety of drug storage in the home and monitor the drug effectiveness.
The nurse should educate the patient and caregiver that large doses of narcotics are required to control pain. What is the optimal dose for pain medications?
- A. The smallest amount possible to achieve some effects
- B. The dose that provides pain relief
- C. The dose that is not addictive
- D. The dose that works for most people
Correct Answer: B
Rationale: The patient and caregiver should understand that pain can be controlled and that using large doses of opioids is common and necessary to achieve that control. It is good to educate the patient and caregiver that the dose that works is the dose that works.