Critical Care Nursing Practices and End-of-Life Care, Exams of Nursing

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MS 2 Exam 1 Sole Ch. 1-6 & Iggy 5,

Which of the following professional organizations best supports critical care nursing practice? a) AACN b) AHA c) ANA d) SCCM - A The American Association of Critical-Care Nurses is the specialty organization that supports and represents critical care nurses. A nurse has been working as a staff nurse in the surgical intensive care unit for 2 years and is interested in certification. Which credential would be most applicable for the nurse to seek? a) ACNPG-AG b) CNML c) CCRN d) PCCN - C The CCRN certification is appropriate for nurses in bedside practice who care for critically ill patients. The main purpose of certification is to

a) assure the consumer that you will not make a mistake b) prepare for graduate school c) promote magnet status for your facility d) validate knowledge of critical care nursing - D Certification assists in validating knowledge of the field, promotes excellence in the profession, and helps nurses to maintain their knowledge of critical care nursing. The synergy model of practice focuses on a) allowing unrestricted visiting for the patient 24 hours a day b) holistic and alternative therapies c) the needs of patients and their families, which drive nursing competency d) patients' needs for energy and support - C The synergy model of practice states that the needs of patients and families influence and drive competencies of nurses. The family of your critically ill patient tells you that they have not spoken with the physician in over 24 hours and that they have some questions they want clarified. During morning rounds, you convey this concern to the attending intensivist and arrange a meeting with the family at 4:00 PM. Which competency of critical care nursing does this represent? a) Advocacy and moral agency in solving ethical issues

b) Clinical judgment and clinical reasoning skills c) Collaboration with patients, families, and team members d) Facilitation of learning for patients, families, and team members - C Although one might consider that all of these competencies are being addressed, communication and collaboration with the family and physician best exemplify the competency of collaboration. The AACN Standards of Acute and Critical Care Nursing Practice use what framework to guide critical care nursing practice? a) Evidence-based practice b) Healthy work environment c) National Patient Safety Goals d) Nursing process - D The AACN Standards for Acute and Critical Care Nursing Practice delineate the nursing process as applied to critically ill patients: collect data, determine diagnoses, identify expected outcomes, develop a plan of care, implement interventions, and evaluate care. The charge nurse is responsible for making the patient assignments on the critical care unit. An experienced, certified nurse is assigned to care for the acutely ill patient with sepsis who also requires continuous renal replacement therapy and mechanical ventilation. The nurse with less than 1 year of experience is assigned to two patients who are more stable. This assignment reflects implementation of the a) crew resource model

b) National Patient Safety Goals c) QSEN model d) synergy model of practice - D This assignment demonstrates nursing care to meet the needs of the patient. The synergy model notes that the nurse competencies are matched to the patient characteristics. The vision of the American Association of Critical-Care Nurses is a health care system driven by a) a healthy work environment b) care for a multiprofessional team under the direction of a critical care physician c) the needs of critically ill patients and families d) respectful, healing, and humane environments - C The AACN vision is a health care system driven by the needs of critically ill patients and families where critical care nurses make their optimum contributions. The most important outcome of effective communication is to a) demonstrate caring practices to family members b) ensure that patient teaching is done c) meet the diversity needs of patients

d) reduce patient errors - D Many errors are directly attributed to faulty communication. Effective communication has been identified as an essential strategy to reduce patient errors and resolve issues related to patient care delivery. You are caring for a critically ill patient whose urine output has been low for 2 consecutive hours. After a thorough patient assessment, you call the intensivist with report. Which information do you convey regarding background? a) Urine output of 40 mL/2hr b) Current vital signs and history of aortic aneurysm repair 4 hours ago c) A statement that the patient is possibly hypovolemic d) A request for IV fluids - B The history and vital signs are part of the background. The family members of a critically ill patient bring a copy of the patient's living will to the hospital, which identifies the patient's wishes regarding health care. You discuss contents of the living will with the patient's physician. This is an example of implementation of which of the AACN Standards of Professional Performance? a) Acquires and maintains current knowledge of practice b) Acts ethically on the behalf of the patient and family c) Considers factors related to safe patient care

d) Uses clinical inquiry and integrates research findings in practice - B Discussing end-of-life issues is an example of a nurse acting ethically on behalf of the patient and family. Which of the following assists the critical care nurse in ensuring that care is appropriate and based on research? a) Clinical practice guidelines b) Computerized physician order entry c) Consulting with advanced practice nurses d) Implementing Joint Commission National Patient Safety Goals - A Clinical practice guidelines are being implemented to ensure that care is appropriate and based on research. Comparing the patient's current (home) medications with those ordered during hospitalization and communicating a complete list of medications to the next provider when the patient is transferred within an organization or to another setting are strategies to: a) improve accuracy of patient identification b) prevent errors related to look-alike and sound-alike medications c) reconcile medications across the continuum of care d) reduce harms associated with the administration of anticoagulants -

C

These are steps recommended in the National Patient Safety Goals to reconcile medications across the continuum of care. As part of nursing management of a critically ill patient, orders are written to keep the head of the bed elevated at 30 degrees, awaken the patient from sedation each morning to assess readiness to wean from mechanical ventilation, and implement oral care protocols every 4 hours. These interventions are done as a group to reduce the risk of ventilator- associated pneumonia. This group of evidence-based interventions is often called a a) bundle of care b) clinical practice guideline c) patient safety goal d) quality improvement initiative - A A group of evidence-based interventions done as a whole to improve outcomes is termed a bundle of care. This is an example of the ventilator bundle. You work in an intermediate care unit and have asked to be involved in developing new guidelines to prevent pressure ulcers in your patient population. The nurse manager tells you that you do not yet have enough experience to be on the prevention task force and that your ideas will be rejected by others. This situation is an example of a) a barrier to handoff communication b) a work environment that is unhealthy c) ineffective decision making

d) nursing practice that is not evidence-based - B These are examples of an unhealthy work environment. A healthy work environment values communication, collaboration, and effective decision making Which of the following statements describes the core concept of the synergy model of practice? a) All nurses must be certified in order to have the synergy model implemented b) Family members must be included in daily interdisciplinary rounds c) Nurses and physicians must work collaboratively and synergistically to influence care d) Unique needs of patients and their families influence nursing competencies - D The synergy model of practice is care based on the unique needs and characteristics of the patient and family members A nurse who plans care based on the patient's gender, ethnicity, spirituality, and lifestyle is said to a) be a moral advocate b) facilitate learning c) respond to diversity d) use clinical judgment - C Response to diversity considers all of these aspects when planning and implementing care.

Which of the following is a National Patient Safety Goal? Select all that apply. a) Accurately identify patients b) Eliminate the use of patient restraints c) Reconcile medications across the continuum of care d) Reduce risks of healthcare-acquired infection e) Reduce costs associated with hospitalization - A, C, D All except for eliminating the use of restraints and reducing costs are current National Patient Safety Goals. Which of the following is (are) official journal(s) of the American Association of Critical-Care Nurses? Select all that apply. a) American Journal of Critical Care b) Critical Care Clinics of North America c) Critical Care Nurse d) Critical Care Nursing Quarterly e) Critical Care Nursing Management - A, C American Journal of Critical Care and Critical Care Nurse are two official AACN publications.

The first critical care units were (Select all that apply) a) burn units b) coronary care units c) recovery rooms d) neonatal intensive care units e) high-risk OB units - B, C Recovery rooms and coronary care units were the first units designated to care for critically ill patients. Which of the following nursing activities demonstrates implementation of the AACN Standards of Professional Performance? (Select all that apply.) a) Attending a meeting of the local chapter of the American Association of Critical-Care Nurses in which a continuing education program on sepsis is being taught b) Collaborating with a pastoral services colleague to assist in meeting spiritual needs of the patient and family c) Participating on the unit's nurse practice council d) Posting an article from Critical Care Nurse on the management of VTE for your colleagues to read e) Using evidence-based strategies to prevent VAP - A, B, C, D, E

All answers are correct. Attending a program to learn about sepsis—Acquires and maintains current knowledge and competency in patient care. Collaborating with pastoral services—Collaborates with the health care team to provide care in a healing, humane, and caring environment. Posting information for others—Contributes to the professional development of peers and other health care providers. Nurse practice council—Provides leadership in the practice setting. Evidence-based practices—Uses clinical inquiry in practice. Which scenarios contribute to effective handoff communication at change of shift? (Select all that apply.) a) The nephrology consultant physician is making rounds and asks you for an update on the patient's status and to assist in placing a central line for hemodialysis. b) The noise level is high because twice as many staff members are present and everyone is giving report in the nurses' station. c) The unit has decided to use a standardized checklist/tool for change-of-shift reports and patient transfers. d) You and the oncoming nurse conduct a standardized report at the patient's bedside and review key assessment findings. e) The off-going nurse is giving the patient medications at the same time as giving handoff report to the oncoming nurse. - C, D A reporting tool and bedside report improve handoff communication by ensuring standardized communication and review of assessment findings. Conducting report at the bedside also reduces noise that commonly occurs at the nurses' station during a change of shift. Which strategy is important in addressing issues associated with the aging workforce? (Select all that apply.) a) Allowing nurses to work flexible shift durations

b) Encouraging older nurses to transfer to an outpatient setting that is less stressful c) Hiring nurse technicians who are available to assist with patient care, such as turning the patient d) Remodeling patient care rooms to include devices to assist in patient lifting e) Developing a staffing model that accurately reflects the unit's needs - A, C, D Modifying the work environment to reduce physical demands is one strategy to assist the aging workforce. Examples include overhead lifts to prevent back injuries. Twelve-hour shifts can be quite demanding; therefore, allowing nurses flexibility in choosing shifts of shorter duration is a good option as well. Adequate staffing, including both registered nurses and nonlicensed assistive personnel to help with nursing and nonnursing tasks, is helpful. Which of the following strategies will assist in creating a healthy work environment for the critical care nurse? (Select all that apply.) a) Celebrating improved outcomes from a nurse-driven protocol with a pizza party b) Implementing a medication safety program designed by pharmacists c) Modifying the staffing pattern to ensure a 1:1 nurse/patient ratio d) Offering quarterly joint nurse-physician workshops to discuss unit issues e) Using the SBAR technique for handoff communication - A, D, E Meaningful recognition, true collaboration, and skilled communication are elements of a healthy work environment. what are the risk factors for hip fractures? -

falls females calcium or vit D deficiency inactivity smoking medical conditions (dizziness/arthritis) meds leading to bone loss

1. A student asks the nurse what is the best way to assess a clients pain. Which response by the nurse is best? a. Numeric pain scale b. Behavioral assessment c. Objective observation d. Clients self-report - d. Clients self-report
2. A new nurse reports to the precepting nurse that a client requested pain medication, and when the nurse brought it, the client was sound asleep. The nurse states the client cannot possibly sleep with the severe pain the client described. What response by the experienced nurse is best? a. Being able to sleep doesnt mean pain doesnt exist. b. Have you ever experienced any type of pain? c. The client should be assessed for drug addiction. d. Youre right; I would put the medication back. - a. Being able to sleep doesnt mean pain doesnt exist.
3. The nurse in the surgery clinic is discussing an upcoming surgical procedure with a client. What information provided by the nurse is most appropriate for the clients long-term outcome? a. At least you know that the pain after surgery will diminish quickly. b. Discuss acceptable pain control after your operation with the surgeon. c. Opioids often cause nausea but you wont have to take them for long. d. The nursing staff will give you pain medication when you ask them for it. - b. Discuss acceptable pain control after your operation with the surgeon.
4. A nurse is assessing pain on a confused older client who has difficulty with verbal expression. What pain assessment tool would the nurse choose for this assessment?

a. Numeric rating scale b. Verbal Descriptor Scale c. FACES Pain Scale-Revised d. Wong-Baker FACES Pain Scale - c. FACES Pain Scale-Revised

5. The nurse is assessing a clients pain and has elicited information on the location, quality, intensity, effect on functioning, aggravating and relieving factors, and onset and duration. What question by the nurse would be best to ask the client for completing a comprehensive pain assessment? a. Are you worried about addiction to pain pills? b. Do you attach any spiritual meaning to pain? c. How high would you say your pain tolerance is? d. What pain rating would be acceptable to you? - d. What pain rating would be acceptable to you?
6. A nurse is assessing pain in an older adult. What action by the nurse is best? a. Ask only yes-or-no questions so the client doesnt get too tired. b. Give the client a picture of the pain scale and come back later. c. Question the client about new pain only, not normal pain from aging. d. Sit down, ask one question at a time, and allow the client to answer. - d. Sit down, ask one question at a time, and allow the client to answer.
7. The nurse receives a hand-off report. One client is described as a drug seeker who is obsessed with even tiny changes in physical condition and is on the light constantly asking for more pain medication. When assessing this clients pain, what statement or question by the nurse is most appropriate? a. Help me understand how pain is affecting you right now. b. I wish I could do more; is there anything I can get for you? c. You cannot have more pain medication for 3 hours. d. Why do you think the medication is not helping your pain? - a. Help me understand how pain is affecting you right now.
8. A nurse on the medical-surgical unit has received a hand-off report. Which client should the nurse see first?

a. Client being discharged later on a complicated analgesia regimen b. Client with new-onset abdominal pain, rated as an 8 on a 0-to-10 scale c. Postoperative client who received oral opioid analgesia 45 minutes ago d. Client who has returned from physical therapy and is resting in the recliner - b. Client with new-onset abdominal pain, rated as an 8 on a 0-to-10 scale

9. A nurse uses the Checklist of Nonverbal Pain Indicators to assess pain in a nonverbal client with advanced dementia. The client scores a zero. What action by the nurse is best? a. Assess physiologic indicators and vital signs. b. Do not give pain medication as no pain is indicated. c. Document the findings and continue to monitor. d. Try a small dose of analgesic medication for pain. - a. Assess physiologic indicators and vital signs.
10. A student nurse asks why several clients are getting more than one type of pain medication instead of very high doses of one medication. What response by the registered nurse is best? a. A multimodal approach is the preferred method of control. b. Doctors are much more liberal with pain medications now. c. Pain is so complex it takes different approaches to control it. d. Clients are consumers and they demand lots of pain medicine. - c. Pain is so complex it takes different approaches to control it.
11. A client who had surgery has extreme postoperative pain that is worsened when trying to participate in physical therapy. What intervention for pain management does the nurse include in the clients care plan? a. As-needed pain medication after therapy b. Client-controlled analgesia with a basal rate c. Pain medications prior to therapy only d. Round-the-clock analgesia with PRN analgesics - d. Round-the-clock analgesia with PRN analgesics
12. A nurse on the postoperative inpatient unit receives a hand-off report on four clients using patient- controlled analgesia (PCA) pumps. Which client should the nurse see first?

a. Client who appears to be sleeping soundly b. Client with no bolus request in 6 hours c. Client who is pressing the button every 10 minutes d. Client with a respiratory rate of 8 breaths/min - d. Client with a respiratory rate of 8 breaths/min

13. A registered nurse (RN) and nursing student are caring for a client who is receiving pain medication via patient-controlled analgesia (PCA). What action by the student requires the RN to intervene? a. Assesses the clients pain level per agency policy b. Monitors the clients respiratory rate and sedation c. Presses the button when the client cannot reach it d. Reinforces client teaching about using the PCA pump - c. Presses the button when the client cannot reach it
14. A client is put on twice-daily acetaminophen (Tylenol) for osteoarthritis. What finding in the clients health history would lead the nurse to consult with the provider over the choice of medication? a. 25pack-year smoking history b. Drinking 3 to 5 beers a day c. Previous peptic ulcer d. Taking warfarin (Coumadin) - b. Drinking 3 to 5 beers a day
15. A nurse is preparing to give a client ketorolac (Toradol) intravenously for pain. Which assessment findings would lead the nurse to consult with the provider? a. Bilateral lung crackles b. Hypoactive bowel sounds c. Self-reported pain of 3/ d. Urine output of 20 mL/2 hr - d. Urine output of 20 mL/2 hr
16. A hospitalized client uses a transdermal fentanyl (Duragesic) patch for chronic pain. What action by the nurse is most important for client safety?

a. Assess and record the clients pain every 4 hours. b. Ensure the client is eating a high-fiber diet. c. Monitor the clients bowel function every shift. d. Remove the old patch when applying the new one. - d. Remove the old patch when applying the new one.

17. A hospitalized client has a history of depression for which sertraline (Zoloft) is prescribed. The client also has a morphine allergy and a history of alcoholism. After surgery, several opioid analgesics are prescribed. Which one would the nurse choose? a. Hydrocodone and acetaminophen (Lorcet) b. Hydromorphone (Dilaudid) c. Meperidine (Demerol) d. Tramadol (Ultram) - b. Hydromorphone (Dilaudid)
18. A client has received an opioid analgesic for pain. The nurse assesses that the client has a Pasero Scale score of 3 and a respiratory rate of 7 shallow breaths/min. The clients oxygen saturation is 87%. What action should the nurse perform first? a. Apply oxygen at 4 L/min. b. Attempt to arouse the client. c. Give naloxone (Narcan). d. Notify the Rapid Response Team. - b. Attempt to arouse the client.
19. An older adult has diabetic neuropathy and often reports unbearable foot pain. About which medication would the nurse plan to educate the client? a. Desipramine (Norpramin) b. Duloxetine (Cymbalta) c. Morphine sulfate d. Nortriptyline (Pamelor) - b. Duloxetine (Cymbalta)

20. An emergency department (ED) manager wishes to start offering clients nonpharmacologic pain control methodologies as an adjunct to medication. Which strategy would be most successful with this client population? a. Listening to music on a headset b. Participating in biofeedback c. Playing video games d. Using guided imagery - a. Listening to music on a headset
21. An older client who lives alone is being discharged on opioid analgesics. What action by the nurse is most important? a. Discuss the need for home health care. b. Give the client follow-up information. c. Provide written discharge instructions. d. Request a home safety assessment. - d. Request a home safety assessment.
22. A nurse is caring for four clients receiving pain medication. After the hand-off report, which client should the nurse see first? a. Client who is crying and agitated b. Client with a heart rate of 104 beats/min c. Client with a Pasero Scale score of 4 d. Client with a verbal pain report of 9 - c. Client with a Pasero Scale score of 4
23. A nurse is caring for a client on an epidural patient-controlled analgesia (PCA) pump. What action by the nurse is most important to ensure client safety? a. Assess and record vital signs every 2 hours. b. Have another nurse double-check the pump settings. c. Instruct the client to report any unrelieved pain. d. Monitor for numbness and tingling in the legs. - b. Have another nurse double-check the pump settings.

24. A postoperative client is reluctant to participate in physical therapy. What action by the nurse is best? a. Ask the client about pain goals and if they are being met. b. Ask the client why he or she is being uncooperative with therapy. c. Increase the dose of analgesia given prior to therapy sessions. d. Tell the client that physical therapy is required to regain function. - a. Ask the client about pain goals and if they are being met.
25. A client is being discharged from the hospital after surgery on hydrocodone and acetaminophen (Lorcet). What discharge instruction is most important for this client? a. Call the doctor if the Lorcet does not relieve your pain. b. Check any over-the-counter medications for acetaminophen. c. Eat more fiber and drink more water to prevent constipation. d. Keep your follow-up appointment with the surgeon as scheduled. - b. Check any over-the-counter medications for acetaminophen.
26. A faculty member explains to students the process by which pain is perceived by the client. Which processes does the faculty member include in the discussion? (Select all that apply.) a. Induction b. Modulation c. Sensory perception d. Transduction e. Transmission - b. Modulation c. Sensory perception d. Transduction e. Transmission
27. A faculty member explains the concepts of addiction, tolerance, and dependence to students. Which information is accurate? (Select all that apply.) a. Addiction is a chronic physiologic disease process. b. Physical dependence and addiction are the same thing.

c. Pseudoaddiction can result in withdrawal symptoms. d. Tolerance is a normal response to regular opioid use. e. Tolerance is said to occur when opioid effects decrease. - a. Addiction is a chronic physiologic disease process. d. Tolerance is a normal response to regular opioid use. e. Tolerance is said to occur when opioid effects decrease.

3. A postoperative client has an epidural infusion of morphine and bupivacaine (Marcaine). What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Ask the client to point out any areas of numbness or tingling. b. Determine how many people are needed to ambulate the client. c. Perform a bladder scan if the client is unable to void after 4 hours. d. Remind the client to use the incentive spirometer every hour. e. Take and record the clients vital signs per agency protocol. - c. Perform a bladder scan if the client is unable to void after 4 hours. d. Remind the client to use the incentive spirometer every hour. e. Take and record the clients vital signs per agency protocol.
4. A client with a broken arm has had ice placed on it for 20 minutes. A short time after the ice was removed, the client reports that the effect has worn off and requests pain medication, which cannot be given yet. What actions by the nurse are most appropriate? (Select all that apply.) a. Ask for a physical therapy consult. b. Educate the client on cold therapy. c. Offer to provide a heating pad. d. Repeat the ice application. e. Teach the client relaxation techniques. - b. Educate the client on cold therapy. d. Repeat the ice application. e. Teach the client relaxation techniques.
5. A student nurse learns that there are physical consequences to unrelieved pain. Which factors are included in this problem? (Select all that apply.)

a. Decreased immune response b. Development of chronic pain c. Increased gastrointestinal (GI) motility d. Possible immobility e. Slower healing - a. Decreased immune response b. Development of chronic pain d. Possible immobility e. Slower healing

6. A nursing student is studying pain sources. Which statements accurately describe different types of pain? (Select all that apply.) a. Neuropathic pain sometimes accompanies amputation. b. Nociceptive pain originates from abnormal pain processing. c. Deep somatic pain is pain arising from bone and connective tissues. d. Somatic pain originates from skin and subcutaneous tissues. e. Visceral pain is often diffuse and poorly localized. - a. Neuropathic pain sometimes accompanies amputation. c. Deep somatic pain is pain arising from bone and connective tissues. d. Somatic pain originates from skin and subcutaneous tissues. e. Visceral pain is often diffuse and poorly localized.
7. A nurse on the postoperative unit administers many opioid analgesics. What actions by the nurse are best to prevent unwanted sedation as a complication of these medications? (Select all that apply.) a. Avoid using other medications that cause sedation. b. Delay giving medication if the client is sleeping. c. Give the lowest dose that produces good control. d. Identify clients at high risk for unwanted sedation. e. Use an oximeter to monitor clients receiving analgesia. - a. Avoid using other medications that cause sedation. c. Give the lowest dose that produces good control.

d. Identify clients at high risk for unwanted sedation. e. Use an oximeter to monitor clients receiving analgesia.

8. A client reports a great deal of pain following a fairly minor operation. The surgeon leaves a prescription for the nurse to administer a placebo instead of pain medication. What actions by the nurse are most appropriate? (Select all that apply.) a. Consult with the prescriber and voice objections. b. Delegate administration of the placebo to another nurse. c. Give the placebo and reassess the clients pain. d. Notify the nurse manager of the physicians request. e. Tell the client what the prescriber ordered. - a. Consult with the prescriber and voice objections. d. Notify the nurse manager of the physicians request.
9. A client is to receive 4 mg morphine sulfate IV push. The pharmacy delivers 5 mg in a 2-mL vial. How much should the nurse administer for one dose? (Record your answer using a decimal rounded to the nearest tenth.) ____ mL - 1.6mL
10. A nurse is preparing to give an infusion of acetaminophen (Ofirmev). The pharmacy delivers a bag containing 50 mL of normal saline and the Ofirmev. At what rate does the nurse set the IV pump to deliver this dose? (Record your answer using a whole number.) ____ mL/hr - 200mL/hr A nurse cares for a dying client. Which manifestation of dying should the nurse treat first? a. Anorexia b. Pain c. Nausea d. Hair loss - B Rationale: Only symptoms that cause distress for a dying client should be treated. Such symptoms include pain, nausea and vomiting, dyspnea, and agitation. These problems interfere with the client's

comfort. Even when symptoms, such as anorexia or hair loss, disturb the family, they should be treated only if the client is distressed by their presence. The nurse should treat the client's pain first. A nurse plans care for a client who is nearing end of life. Which question should the nurse ask when developing this client's plan of care? a. "Is your advance directive up to date and notarized?" b. "Do you want to be at home at the end of your life?" c. "Would you like a physical therapist to assist you with range-of-motion activities?" d. "Have your children discussed resuscitation with your health care provider?" - B Rationale: When developing a plan of care for a dying client, consideration should be given for where the client wants to die. Advance directives do not need to be notarized. A physical therapist would not be involved in end-of-life care. The client should discuss resuscitation with the health care provider and children; do-not-resuscitate status should be the client's decision, not the family's decision. A nurse is caring for a client who has lung cancer and is dying. Which prescription should the nurse question? a. Morphine 10 mg sublingual every 6 hours PRN for pain level greater than 5 b. Albuterol (Proventil) metered dose inhaler every 4 hours PRN for wheezes c. Atropine solution 1% sublingual every 4 hours PRN for excessive oral secretions d. Sodium biphosphate (Fleet) enema once a day PRN for impacted stool - A Rationale: Pain medications should be scheduled around the clock to maintain comfort and prevent reoccurrence of pain. The other medications are appropriate for this client. A client tells the nurse that, even though it has been 4 months since her sister's death, she frequently finds herself crying uncontrollably. How should the nurse respond? a. "Most people move on within a few months. You should see a grief counselor." b. "Whenever you start to cry, distract yourself from thoughts of your sister." c. "You should try not to cry. I'm sure your sister is in a better place now." d. "Your feelings are completely normal and may continue for a long time." -

D

Rationale: Frequent crying is not an abnormal response. The nurse should let the client know that this is normal and okay. Although the client may benefit from talking with a grief counselor, it is not unusual for her to still be grieving after a few months. The other responses are not as therapeutic because they justify or minimize the client's response. After teaching a client about advance directives, a nurse assesses the client's understanding. Which statement indicates the client correctly understands the teaching? a. "An advance directive will keep my children from selling my home when I'm old." b. "An advance directive will be completed as soon as I'm incapacitated and can't think for myself." c. "An advance directive will specify what I want done when I can no longer make decisions about health care." d. "An advance directive will allow me to keep my money out of the reach of my family." - C Rationale: An advance directive is a written document prepared by a competent individual that specifies what, if any, extraordinary actions a person would want taken when he or she can no longer make decisions about personal health care. It does not address issues such as the client's residence or financial matters. A nurse teaches a client who is considering being admitted to hospice. Which statement should the nurse include in this client's teaching? a. "Hospice admission has specific criteria. You may not be a viable candidate, so we will look at alternative plans for your discharge." b. "Hospice care focuses on a holistic approach to health care. It is designed not to hasten death, but rather to relieve symptoms." c. "Hospice care will not help with your symptoms of depression. I will refer you to the facility's counseling services instead." d. "You seem to be experiencing some difficulty with this stage of the grieving process. Let's talk about your feelings." - B Rationale: As both a philosophy and a system of care, hospice care uses an interdisciplinary approach to assess and address the holistic needs of clients and families to facilitate quality of life and a peaceful death. This holistic approach neither hastens nor postpones death but provides relief of symptoms experienced by the dying client.

A nurse is caring for a dying client. The client's spouse states, "I think he is choking to death." How should the nurse respond? a. "Do not worry. The choking sound is normal during the dying process." b. "I will administer more morphine to keep your husband comfortable." c. "I can ask the respiratory therapist to suction secretions out through his nose." d. "I will have another nurse assist me to turn your husband on his side." - D Rationale: The choking sound or "death rattle" is common in dying clients. The nurse should acknowledge the spouse's concerns and provide interventions that will reduce the choking sounds. Repositioning the client onto one side with a towel under the mouth to collect secretions is the best intervention. The nurse should not minimize the spouse's concerns. Morphine will assist with comfort but will not decrease the choking sounds. Nasotracheal suctioning is not appropriate in a dying client. The nurse is teaching a family member about various types of complementary therapies that might be effective for relieving the dying client's anxiety and restlessness. Which statement made by the family member indicates understanding of the nurse's teaching? a. "Maybe we should just hire an around-the-clock sitter to stay with Grandmother." b. "I have some of her favorite hymns on a CD that I could bring for music therapy." c. "I don't think that she'll need pain medication along with her herbal treatments." d. "I will burn therapeutic incense in the room so we can stop the anxiety pills." - B Rationale: Music therapy is a complementary therapy that may produce relaxation by quieting the mind and removing a client's inner restlessness. Hiring an around-the-clock sitter does not demonstrate that the client's family understands complementary therapies. Complementary therapies are used in conjunction with traditional therapy. Complementary therapy would not replace pain or anxiety medication but may help decrease the need for these medications. A nurse is caring for a terminally ill client who has just died in a hospital setting with family members at the bedside. Which action should the nurse take first? a. Call for emergency assistance so that resuscitation procedures can begin. b. Ask family members if they would like to spend time alone with the client. c. Ensure that a death certificate has been completed by the physician.