End-of-life Care and Palliative Care > Fundamentals
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Understanding End-of-Life Care and Palliative Care
Total Questions : 5
Showing 5 questions, Sign in for moreA nurse is caring for a client who has terminal cancer and is receiving palliative care at home. The client's spouse asks the nurse what palliative care means. Which of the following responses should the nurse make?
A) "Palliative care is a type of care that focuses on relieving your loved one's pain and symptoms, as well as providing emotional and spiritual support for both of you."
B) "Palliative care is a type of care that helps your loved one prepare for death by withdrawing any life-sustaining treatments and medications."
C) "Palliative care is a type of care that aims to cure your loved one's cancer by using aggressive treatments and interventions."
D) "Palliative care is a type of care that involves hospice services and requires your loved one to have a life expectancy of six months or less."
Explanation
Palliative care is a holistic approach to care that focuses on improving the quality of life for clients with serious illnesses and their families. It addresses physical, emotional, social, and spiritual needs, and can be provided at any stage of illness, along with curative treatments.
Option B is incorrect because palliative care does not necessarily involve withdrawing treatments or medications, unless they are causing more harm than benefit.
Option C is incorrect because palliative care does not aim to cure the disease, but rather to manage the symptoms and enhance comfort.
Option D is incorrect because palliative care is not the same as hospice care, which is a specific type of palliative care for clients who have a life expectancy of six months or less and have decided to forego curative treatments.
A client who has advanced heart failure is admitted to the hospital for symptom management. The client tells the nurse that he does not want any resuscitation measures if his heart stops. Which of the following actions should the nurse take?
A) Respect the client's wishes and document them in the medical record.
B) Inform the client that he needs to have a written advance directive to refuse resuscitation.
C) Encourage the client to reconsider his decision and discuss the benefits of resuscitation.
D) Notify the health care provider and request a referral to a palliative care team.
Explanation
The nurse should notify the health care provider and request a referral to a palliative care team, which can help the client and his family explore his goals of care, preferences, values, and beliefs regarding end-of-life care. The palliative care team can also assist with completing an advance directive, which is a legal document that specifies the client's wishes for medical treatment in case he becomes unable to communicate them.
Option A is incorrect because respecting the client's wishes is not enough; the nurse should also ensure that they are communicated to the health care team and documented in an advance directive.
Option B is incorrect because although an advance directive is recommended, it is not required; the client can verbally express his wishes to his health care provider, who can then write a do-not-resuscitate (DNR) order.
Option C is incorrect because it is not appropriate for the nurse to impose her own values or opinions on the client; rather, she should respect his autonomy and support his decision.
A nurse is providing education to a group of nursing students about end-of-life care. Which of the following statements by a nursing student indicates an understanding of the teaching?
Explanation
End-of-life care is based on the ethical principles of beneficence (doing good) and nonmaleficence (doing no harm), which guide the health care team in providing compassionate and respectful care that alleviates suffering and promotes dignity for dying clients.
Option A is incorrect because end-of-life care can be provided in various settings, such as hospitals, nursing homes, or home health agencies, depending on the client's needs and preferences.
Option C is incorrect because informed consent is not required for end-of-life care; however, it may be needed for specific treatments or procedures that are part of end-of-life care, such as pain medication, blood transfusions, or organ donation.
Option D is incorrect because end-of-life care does not necessarily include interventions such as artificial nutrition and hydration, which may be considered futile or burdensome for some clients; rather, the decision to use or withhold these interventions should be based on the client's wishes, values, and goals of care.
A client who has a terminal illness and is receiving hospice care at home has a prescription for morphine sulfate 10 mg PO every 4 hr PRN for pain. The client's family member tells the nurse that the client is experiencing increased pain and asks if he can give him more morphine.
Which of the following responses should the nurse make?
Explanation
The nurse should instruct the family member to call the hospice nurse first to get an order for a higher dose of morphine, if needed. The hospice nurse can assess the client's pain level, vital signs, and response to the medication, and adjust the dose accordingly.
Option A is incorrect because although respiratory rate is one of the factors to monitor when administering opioids, it is not the only one; other factors include level of consciousness, oxygen saturation, and presence of adverse effects. Moreover, the family member should not increase the dose of morphine without consulting the hospice nurse.
Option B is incorrect because although respiratory depression is a potential side effect of opioids, it is not a common cause of death in clients receiving palliative care; rather, opioids are considered safe and effective for managing pain and dyspnea in dying clients, as long as they are prescribed and administered appropriately.
Option D is incorrect because tolerance and dependence are not major concerns in clients receiving palliative care; rather, the goal is to provide adequate pain relief and comfort for the client.
A client who has a do-not-resuscitate (DNR) order is admitted to the hospital for pneumonia. The client's condition deteriorates and he becomes unresponsive. The nurse notices that his heart rate is dropping and his blood pressure is low.
Which of the following actions should the nurse take?
Explanation
The nurse should continue to provide comfort measures and emotional support to the client, as well as respect his DNR order, which means that no resuscitation measures should be attempted if he experiences cardiac or respiratory arrest.
Option A is incorrect because initiating CPR and calling a code blue would violate the client's DNR order and his right to refuse treatment.
Option B is incorrect because administering oxygen via nasal cannula may be considered a form of resuscitation, depending on the client's wishes and goals of care; moreover, monitoring his vital signs may not be necessary or beneficial at this stage of his illness. Option C is incorrect because notifying the health care provider and the client's family of his status may not be a priority at this time; rather, the nurse should focus on providing compassionate care to the client until he dies.
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