CHAPTER 11 Care at the End of Life

Chapter 11 Care at the End of Life

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

11.1•The nurse is discussing hospice care with the family of a 68-year-old man dying of cancer. The wife of the client states that she is worried that Medicare will stop payments if the client lives longer than 6 months. The nurse can support the wife by explaining

1. Medicare does not limit the hospice benefit.
2. the doctor can best explain the role of hospice.
3. the finance office could answer that question.
4. we do not know if the client will live past 6 months.

Answer: 1

Rationale: Medicare law does not limit the hospice benefit, but Medicare regulation often discourages long lengths of stay in hospitals. Telling the client to contact the physician or finance department does not provide answers that the client’s wife is seeking. The nurse should take responsibility to seek out the information for the client and his wife in this time of stress and need. It is true the client may not live 6 months, but expressing this to the wife does not provide support for the concern expressed.

Intervention

Psychosocial Integrity

Application

11.2•A 75-year-old client who is dying from liver disease tells the nurse that he is concerned about going home and living on his own. He is independent in his care at present and does not want to see this end. He expresses his fear of dying alone and losing control of his body functions. The nurse determines that this client’s concerns are

1. common fears and concerns of the dying patient.
2. signs of depression.
3. unrealistic fears because the client shows no symptoms at present.
4. appropriate to get an order for hospice care.

Answer: 1

Rationale: Common fears of the dying patient include death itself; thoughts of a long or painful death; facing death alone; loss of body control, such as bowel and bladder incontinence; loss of consciousness; and so on. Withdrawing and not expressing may be more of a sign of depression than talking about them. They are realistic concerns because they are expressed by the patient and at this stage, the client is not ready for hospice care because a time frame of 6 months has not been identified and the client is still independent.

Assessment

Psychosocial Integrity

Analysis

11.3•The nurse is completing a home care visit of an 86-year-old client who is dying of end-stage pulmonary disease and dementia. The client has been taking narcotic medication for the treatment of chronic arthritic pain. During your visit, the family tells you that the client seems more restless, grimacing and crying. The nurse interprets this report by the family as

1. the client being uncooperative because of a personality disorder.
2. not an unusual finding and the family should continue to administer the medication as needed.
3. a sign that the client may be in pain and adjustment to the pain medication or administration schedule is needed.
4. a need for the client to try alternative methods for pain relief instead of pain medication.

Answer: 3

Rationale: Clients with dementia may not be able to accurately express their pain. Other behavior changes, such as agitation, restlessness, and grimacing, often indicate ineffective management of pain. Therefore, adjustments to the pain medication or schedule are warranted. Personality disorders with the presence of dementia are difficult to identify and to differentiate the source of the behavior. Although alternative measures augment pain relief, medications and their administration should be examined as a priority of the assessment.

Assessment

Physiological Integrity

Analysis

11.4•An 82-year-old client is dying of lung cancer. On review of the client’s medication, the nurse notes that the client is being given pain control and that the client requires increasingly higher doses of medication. The physician prescribed morphine 6 to 10 mg every 4 hours. The previous dose of 10 mg was given 2 hours ago, and the client reports that the medication barely affected his pain. What intervention would the nurse perform to address the client’s pain?

1. wait 2 more hours and give the client 10 mg
2. give the client 10 mg of morphine even though it is before the scheduled time
3. contact the physician for an adjustment in pain medication
4. give the patient 5 mg of morphine every hour instead of 10 mg every 2 hours

Answer: 3

Rationale: Dying patients may need more pain medication than the normal range for the prescribed drug. Organic changes occur rapidly and systems are closing down, thus absorption levels of drugs are diminishing also. Therefore, consulting with the physician for adjustment of pain medication is warranted. Delaying medication would cause unnecessary suffering for the client and altering the administration schedule is outside of the scope of the professional practice role of nursing.

Implementation

Physiological Integrity

Analysis