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The nurse is giving an in-service on end-of-life issues. Which activity should the nurse encourage the participants to perform?
- A. Discuss with another participant the death of a client.
- B. Review the hospital postmortem care policy.
- C. Justify not putting the client in a shroud after dying.
- D. Write down their own beliefs about death and dying.
Correct Answer: D
Rationale: Writing personal beliefs fosters self-awareness, enhancing end-of-life care competence. Client death discussions, policy review, or shroud justification are less introspective.
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The client tells the nurse, 'Every time I come in the hospital you hand me one of these advance directives (AD). Why should I fill one of these out?' Which statement by the nurse is most appropriate?
- A. You must fill out this form because Medicare laws require it.
- B. An AD lets you participate in decisions about your health care.
- C. This paper will ensure no one can override your decisions.
- D. It is part of the hospital admission packet and I have to give it to you.
Correct Answer: B
Rationale: Advance directives allow clients to specify their health care preferences, ensuring participation in decisions, per the Patient Self-Determination Act. Medicare requires offering, not completing, ADs; no document guarantees non-override; and packet inclusion is procedural, not the reason.
Which intervention should the nurse implement to provide culturally sensitive health care to the European-American Caucasian elderly client who is terminal?
- A. Discuss health-care issues with the oldest male child.
- B. Determine if the client will be cremated or have an earth burial.
- C. Do not talk about death and dying in front of the client.
- D. Encourage the client's autonomy and answer questions truthfully.
Correct Answer: D
Rationale: Encouraging autonomy and honesty respects individual preferences, common in European-American culture, per patient-centered care. Family roles, burial plans, or avoiding death talk are less universal.
The nurse is admitting a client to the medical surgical unit. Which is required to be offered to the client if the hospital accepts Medicare reimbursement?
- A. The opportunity to make an advance directive.
- B. The client must be referred to a case manager.
- C. The client must apply for a Medicare supplement insurance.
- D. The opportunity to discuss end-of-life issues.
Correct Answer: A
Rationale: The Patient Self-Determination Act mandates offering ADs on admission for Medicare-funded hospitals. Case management, insurance, or end-of-life discussions are not required.
The client diagnosed with cancer is unable to attain pain relief despite receiving large amounts of narcotic medications. Which intervention should be included in the plan of care?
- A. Ask the HCP to increase the medication.
- B. Assess for any spiritual distress.
- C. Change the client's position every two (2) hours.
- D. Turn on the radio to soothing music.
Correct Answer: B
Rationale: Spiritual distress can exacerbate pain perception; assessing it addresses holistic care, per pain management principles. Increasing medication, repositioning, or music is less targeted.
The client diagnosed with cancer is experiencing severe pain. Which regimen would the nurse teach the client about to control the pain?
- A. Nonsteroidal anti-inflammatory drugs (NSAIDs) around the clock with narcotics used for severe pain.
- B. Morphine sustained release, a narcotic, routinely with a liquid morphine preparation for breakthrough pain.
- C. Extra-Strength Tylenol, a nonnarcotic analgesic, plus therapy to learn alternative methods of pain control.
- D. Demerol, an opioid narcotic, every six (6) hours orally with a suppository when the pain is not controlled.
Correct Answer: B
Rationale: Sustained-release morphine with breakthrough doses is standard for cancer pain, per WHO pain ladder. NSAIDs, Tylenol, or Demerol regimens are less effective or outdated.