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(Purdue) NU475 Providing
Transition Care- Chronic,
Palliative, Hospice Care
Midterm Exam G, Exams of
Nursing Assured A+|Perfect
Pass
Which one of the following statements is most accurate when differentiating hospice from palliative care? A) Both palliative care and hospice focus on cure; however, hospice focuses on terminal illnesses, and palliative care focuses on diseases that are more chronic in nature. B) Palliative care consists of comfort and symptom management and is often a part of hospice care. C) Hospice is more of a specific place than a concept of care, whereas palliative care is more of a concept of care. D) Hospice is intended for people who have a projected life expectancy of 6 months or more, and palliative care is intended
for people who are actively dying. - ANSWERS -B
Feedback: Palliative care consists of comfort and symptom management and is often part of hospice care. Neither palliative care nor hospice focuses on cure. Hospice does focus on care of people who are known to be at end of life, and palliative care can be provided to people who have chronic ongoing health conditions even when death is not imminent. Hospice is more of a concept of care than a specific place. Palliative care should be a major focus of care throughout the aging process, regardless of whether death is imminent within 6 months. When describing the philosophy of hospice care to a group of students, which of the following would the instructor include? A) The right to die and euthanasia B) Working with people in their last year of life C) Holistic and family-centered care to terminally ill clients D) Weaving hospice concepts around curative treatment -
ANSWERS -C
Feedback:
A client will receive hospice care under the Medicare Hospice Benefit. The nurse understands that which of the following is true? A) The client denies terminal prognosis. B) The client has a prognosis of at least 6 months of life. C) The client chooses life-extending care. D) The hospice acts as clinical and financial case manager. -
ANSWERS -D
Feedback: The Medicare Hospice Benefit requires that a client, who has a prognosis of 6 months or less, must sign up for the comfort- focused hospice benefit and waive the regular hospice benefit. This mandates that the client acknowledge a terminal prognosis and choose comforting care instead of life-extending care. When this choice is made, the hospice coordinates care in all settings, functioning both as clinical and financial case manager. When describing the role of hospice nurses to a group of students, a hospice nurse identifies which of the following as most important? A)
Speaking the truth B) Sustaining oneself C) Encouraging choice D)
Strengthening the family - ANSWERS -B
Feedback: Although speaking the truth, encouraging choice and strengthening the family are key interventions of a hospice nurse, sustaining oneself is the priority. Effective hospice nurses understand that to care for others, they must care for themselves because without a healthy nurse, the client cannot thrive. Which of the following Medicare definitions prevent people who could benefit from home care services from receiving those services, even when it would be most cost effective for the client to receive home care rather than more expensive emergent and inpatient interventions? Select all that apply. A) Home-bound status B) Medical necessity C)
Refusing to pay for homemaking and personal care that might
keep a person at home as long as possible - ANSWERS -B
Feedback: The Medicare requirement that patients receiving hospice benefits must have discontinued treatment in order to receive hospice service. It is not appropriate for there to be controlled cost at the expense of assuring quality of life and comfort. Education and support for clients and family caregivers is important, and homemaking and personal care might keep a person at home as long as possible that would reflect a cost savings in the long run. When providing palliative care to a client receiving hospice care, which of the following would be important? Select all that apply. A) Assume nothing about what is wrong B) Use the most complex interventions first C) Believe what the client is reporting D) Be persistent in trying different strategies E)
Wait until the symptoms recur to relieve them - ANSWERS -A, C,
D
Feedback: When providing palliative care, the nurse should make no assumptions about what is wrong; believe the client's report of symptoms; anticipate the symptoms and relieve them before they recur; choose the least complex and most manageable interventions that clients and families can manage themselves at home; and never give up, but persist in trying different palliative strategies. The family of a hospice client is holding a vigil at the client's bedside. During a visit, a hospice nurse participates in this vigil and encourages each of the family members to say their good- byes. The nurse is demonstrating which of the following? A) Palliative care B) Guided letting go C) Connecting D)
Responsive use of self - ANSWERS -B
Feedback: Guiding letting go is a truly unique nursing practice that involves helping the client to let go of former activities and hopes,
Home health care emphasizes rehabilitation and stabilization of the client whereas hospice emphasizes the quality of life and comfort. Focusing on the whole family, expert use of opioids for suffering and management of symptoms are features associated with hospice care. In contrast, home health care focuses on the health of the client; opioids are used hesitantly to reduce suffering; and symptom management may require hospitalization if unmanageable. A home health care nurse is assigned to visit a client's home. The nurse identifies the area as a problem neighborhood. Which of the following would be most appropriate for the nurse to do? A) Perform the visit via telephone B) Have another nurse buddy along C) Reschedule the visit for another time D)
Leave the cell phone at home - ANSWERS -B
Feedback: If there is a question of safety, the nurse should have another nurse accompany him or her on the visit. It would be inappropriate to perform the visit over the telephone. The nurse needs to physically see the client to perform the assessment. The agency typically has policies about how soon after a referral the
client must be seen. So, rescheduling the visit may not be an option. In addition, rescheduling the visit does nothing to address the safety issues. The nurse should carry his or her cell phone but leave any valuables, such as cash, wallet, or purse locked in the care. A home health care nurse is invited as a guest speaker to talk to a group of students about challenges of working in the home. As part of the discussion, the nurse describes medication safety. Which of the following would the nurse include as a measure to address this issue? A) Asking the client what he or she takes the drug for B) Throwing out any medications over 1 month old C) Reconciling drugs in the home with those on the discharge sheet D) Setting up medication boxes to organize the medications -
ANSWERS -C
Feedback: It is important for the home health care nurse to reconcile the medications in the client's home with those on the discharge sheet. If there are any discrepancies, then the nurse should contact the client's primary care physician to clarify any differences and confirm the orders. Asking the client what he
