NSG EXAM 4- ALL QUESTIONS WITH
VERIFIED ANSWERS
support for the family - ANSWER-- allow expression of feelings
- encourage the family to plan visits so that the patient has time to rest
- provide appropriate information when there are changes in the treatment plan
- assess family members' desire to perform patient care and provide education as
needed
- monitor caregiver fatigue
- provide privacy for the family to communicate and share feelings outside of the
patient's presence
- provide education about physical changes that occur as the patient approaches
death if desired
clinical signs of approaching death - ANSWER-- labored breathing
- collection of mucus in large airways
- decreased level of consciousness
- relaxation of facial muscles
- inability to swallow
- slow and weak pulse
- decreased blood pressure
- bowel and/or bladder incontinence
- decreased urine output
-cool, mottled (cyanotic) extremities
- perspiration
- diminished sensation of touch
- difficulty speaking
- nausea, abdominal distention, and/or flatus
- agitation or restlessness
- loss of movement and reflexes
euthanasia - ANSWER-means "good dying"
active euthanasia - ANSWER-taking measures or doing something to cause a
client's death
assisted suicide - ANSWER-- can be considered a type of active euthanasia
- legal in certain situations in the District of Colombia, California, Colorado, Oregon,
Vermont, Washington, Montana and New Mexico
passive euthanasia - ANSWER-- withdrawal of medical treatment (not doing
something) with the intention of allowing a client's death
- most societies have held the belief that this is legally and morally justified while
active euthanasia has been considered illegal and immoral, although this distinction
is being questioned today
Code of Ethics on End of Life Care - ANSWER-ANA Code of Ethics statement says
that the nurse "should provide interventions to relive pain and other symptoms in the
,dying patient consistent with palliative care practice standards and may not act with
the sole intent to end life"
Child-Life Services - ANSWER-if desired by the family of children experiencing loss,
these services may be able to speak with family and/or children about coping with
loss and grief, provide information about resources, and assist in memory-making
activities
therapeutic communication techniques for end of life - ANSWER-- silence
- offering self
- active listening
- asking questions
- asking open ended questions
- clarifying: may accomplish this through restating, reflecting, paraphrasing, or
exploring
- offering broad opening statements or general leads
- demonstrating recognition and acceptance
- focusing
- giving information
- summarizing
- touch
death - ANSWER-- the 1981 Uniform Determination of Death Act gives a legal
definition of death as either (1) irreversible cessation of all functions of circulatory
and respiratory functions or (2) irreversible cessation of all functions of the entire
brain, including the brainstem
- most protocols for the pronouncing of death require 2 distinct clinical examinations
- medical criteria for the certification of death include: cessation of breathing, flat
encephalogram (EEG), no response to stimuli that is deep and painful, and lack of
spontaneous movement and reflexes
end of life care orders - ANSWER-- DNR, DNI, Comfort Measures Only, terminal
weaning
- orders not to use certain other life-sustaining treatments may also be present
based on healthcare provider discussion with the client regarding their wishes, such
as ventilator support, dialysis, artificial hydration and nutrition, blood transfusions,
medications- such as antibiotics and/or surgery
terminal weaning - ANSWER-mechanical ventilation is gradually withdrawn from a
client with a terminal illness or condition that is not reversible and a poor prognosis
pain management at the end of life - ANSWER-- pain meds often opioids such as
morphine
- repositioning
- hygiene care
- relaxation techniques
- therapeutic touch
- comfortable clothing
- comforting possessions
,dyspnea management at end of life - ANSWER-- opioid pain meds such as morphine
- positioning the pt in semi-fowlers
- relaxation techniques
- supplemental oxygen therapy
excess oral secretion management at end of life - ANSWER-- semi-fowlers or semi
prone positioning
- anticholinergic medications
- suctioning
nausea/vomiting management at end of life - ANSWER-- administer anti-emetics
restlessness management at end of life - ANSWER-- pain medications
- anxiolytics
- relaxation techniques
- therapeutic touch
- promotion of decision-making
urinary incontinence management at end of life - ANSWER--nearby bedpan
- absorbant pads
- hygiene care
urinary retention management at end of life - ANSWER-- catheterization
diarrhea/bowel incontinence management at end of life - ANSWER-- nearby bedpan
- absorbant pads
- hygiene care
constipation management at end of life - ANSWER-- laxatives
- enemas
dehydration management at end of life - ANSWER-- sips of water and/or ice chips
end of life care - ANSWER-- prioritize management of sx causing the most
discomfort. Administer meds as ordered to manage sx
- perform ongoing assessments of sx to determine the effectiveness of tx and need
for changes in tx plan
- manage medication adverse effects
- reposition frequently to maintain comfort, airway patency, and skin and mucus
membrane integrity
- maintain an environment that promotes the patient's self esteem and dignity
- promote patient control by encouraging patient decision making in healthcare,
foods, and activities
- encourage and assist the patient to perform activities of daily living as they are able
and wish to do so
- encourage relaxation techniques if indicated
- use therapeutic touch as appropriate
- provide care and support to patient and family
- utilize therapeutic communication to develop and maintain communication among
the patient, family and healthcare team
, - assist with the understanding of information about progression of disease and
options for tx
- assist the patient in clarifying personal goals to assist in effective decision-making
- support the use of coping mechanisms the patient has had success with in the past
as appropriate
- support the pt in participation in religious practices that provide strength and
comfort as appropriate
- be aware of comments in the presence of unconscious clients as hearing is the last
sensation lost
death certificate - ANSWER-- legally required for each client who dies
- nurse's responsibility to ensure death certificate is signed by a clinician who is able
to sign depending on specific state lawas
- advance practice nurses but not registered nurses may sign death certificates after
completion of special training in the state of WV
Postmortem Care - ANSWER-- ask if the family wishes to spend time with the body
- determine whether the pt's personal belongings should be sent with a family
member or the body
- perform care with compassion and respect while attending to client and family
wishes per their religious, cultural, and social practices
- depending on facility policy, the nurse may be responsible for asking the family
which funeral home they wish to use
postmortem care: preparing the body - ANSWER-- provide privacy
- remove all lines and tubes, unless this is a coroner's (medical examiner's) case or
organs or tissues are to be donated
- cleanse the body as indicated
- align the body in the supine position with the head on a pillow, eyes closed,
dentures in place, and arms with palms down on top of the sheet and blanket
- change linens and gown
- comb the patient's hair and replace hairpieces if present
- tidy the room, removing unnecessary equipment, supplies and soiled linens
- provide a calm environment by reducing lighting and minimizing noise
postmortem care: after family viewing - ANSWER-- complete required
documentation
- apply identification tags according to facility policy
- transport or request transport for the patient as indicated by facility policy
autopsy - ANSWER-- examination of tissues and organs following death
- findings may help to advance medical science and pinpoint the cause of death
- consent is a legal requirement, and it is usually the responsibility of the health care
provider to obtain this consent
- if death occurs due to suicide, homicide, accident, illegal therapeutic practice, and
in some cases within 24 hours of hospital admission, the coroner must be notified
according to law. The coroner can then determine if autopsy is necessary and can
order one even if they patient/family have refused to consent
- most facility policies require that all tubes and lines remain in the patient
- forms must be completed per state and federal law
VERIFIED ANSWERS
support for the family - ANSWER-- allow expression of feelings
- encourage the family to plan visits so that the patient has time to rest
- provide appropriate information when there are changes in the treatment plan
- assess family members' desire to perform patient care and provide education as
needed
- monitor caregiver fatigue
- provide privacy for the family to communicate and share feelings outside of the
patient's presence
- provide education about physical changes that occur as the patient approaches
death if desired
clinical signs of approaching death - ANSWER-- labored breathing
- collection of mucus in large airways
- decreased level of consciousness
- relaxation of facial muscles
- inability to swallow
- slow and weak pulse
- decreased blood pressure
- bowel and/or bladder incontinence
- decreased urine output
-cool, mottled (cyanotic) extremities
- perspiration
- diminished sensation of touch
- difficulty speaking
- nausea, abdominal distention, and/or flatus
- agitation or restlessness
- loss of movement and reflexes
euthanasia - ANSWER-means "good dying"
active euthanasia - ANSWER-taking measures or doing something to cause a
client's death
assisted suicide - ANSWER-- can be considered a type of active euthanasia
- legal in certain situations in the District of Colombia, California, Colorado, Oregon,
Vermont, Washington, Montana and New Mexico
passive euthanasia - ANSWER-- withdrawal of medical treatment (not doing
something) with the intention of allowing a client's death
- most societies have held the belief that this is legally and morally justified while
active euthanasia has been considered illegal and immoral, although this distinction
is being questioned today
Code of Ethics on End of Life Care - ANSWER-ANA Code of Ethics statement says
that the nurse "should provide interventions to relive pain and other symptoms in the
,dying patient consistent with palliative care practice standards and may not act with
the sole intent to end life"
Child-Life Services - ANSWER-if desired by the family of children experiencing loss,
these services may be able to speak with family and/or children about coping with
loss and grief, provide information about resources, and assist in memory-making
activities
therapeutic communication techniques for end of life - ANSWER-- silence
- offering self
- active listening
- asking questions
- asking open ended questions
- clarifying: may accomplish this through restating, reflecting, paraphrasing, or
exploring
- offering broad opening statements or general leads
- demonstrating recognition and acceptance
- focusing
- giving information
- summarizing
- touch
death - ANSWER-- the 1981 Uniform Determination of Death Act gives a legal
definition of death as either (1) irreversible cessation of all functions of circulatory
and respiratory functions or (2) irreversible cessation of all functions of the entire
brain, including the brainstem
- most protocols for the pronouncing of death require 2 distinct clinical examinations
- medical criteria for the certification of death include: cessation of breathing, flat
encephalogram (EEG), no response to stimuli that is deep and painful, and lack of
spontaneous movement and reflexes
end of life care orders - ANSWER-- DNR, DNI, Comfort Measures Only, terminal
weaning
- orders not to use certain other life-sustaining treatments may also be present
based on healthcare provider discussion with the client regarding their wishes, such
as ventilator support, dialysis, artificial hydration and nutrition, blood transfusions,
medications- such as antibiotics and/or surgery
terminal weaning - ANSWER-mechanical ventilation is gradually withdrawn from a
client with a terminal illness or condition that is not reversible and a poor prognosis
pain management at the end of life - ANSWER-- pain meds often opioids such as
morphine
- repositioning
- hygiene care
- relaxation techniques
- therapeutic touch
- comfortable clothing
- comforting possessions
,dyspnea management at end of life - ANSWER-- opioid pain meds such as morphine
- positioning the pt in semi-fowlers
- relaxation techniques
- supplemental oxygen therapy
excess oral secretion management at end of life - ANSWER-- semi-fowlers or semi
prone positioning
- anticholinergic medications
- suctioning
nausea/vomiting management at end of life - ANSWER-- administer anti-emetics
restlessness management at end of life - ANSWER-- pain medications
- anxiolytics
- relaxation techniques
- therapeutic touch
- promotion of decision-making
urinary incontinence management at end of life - ANSWER--nearby bedpan
- absorbant pads
- hygiene care
urinary retention management at end of life - ANSWER-- catheterization
diarrhea/bowel incontinence management at end of life - ANSWER-- nearby bedpan
- absorbant pads
- hygiene care
constipation management at end of life - ANSWER-- laxatives
- enemas
dehydration management at end of life - ANSWER-- sips of water and/or ice chips
end of life care - ANSWER-- prioritize management of sx causing the most
discomfort. Administer meds as ordered to manage sx
- perform ongoing assessments of sx to determine the effectiveness of tx and need
for changes in tx plan
- manage medication adverse effects
- reposition frequently to maintain comfort, airway patency, and skin and mucus
membrane integrity
- maintain an environment that promotes the patient's self esteem and dignity
- promote patient control by encouraging patient decision making in healthcare,
foods, and activities
- encourage and assist the patient to perform activities of daily living as they are able
and wish to do so
- encourage relaxation techniques if indicated
- use therapeutic touch as appropriate
- provide care and support to patient and family
- utilize therapeutic communication to develop and maintain communication among
the patient, family and healthcare team
, - assist with the understanding of information about progression of disease and
options for tx
- assist the patient in clarifying personal goals to assist in effective decision-making
- support the use of coping mechanisms the patient has had success with in the past
as appropriate
- support the pt in participation in religious practices that provide strength and
comfort as appropriate
- be aware of comments in the presence of unconscious clients as hearing is the last
sensation lost
death certificate - ANSWER-- legally required for each client who dies
- nurse's responsibility to ensure death certificate is signed by a clinician who is able
to sign depending on specific state lawas
- advance practice nurses but not registered nurses may sign death certificates after
completion of special training in the state of WV
Postmortem Care - ANSWER-- ask if the family wishes to spend time with the body
- determine whether the pt's personal belongings should be sent with a family
member or the body
- perform care with compassion and respect while attending to client and family
wishes per their religious, cultural, and social practices
- depending on facility policy, the nurse may be responsible for asking the family
which funeral home they wish to use
postmortem care: preparing the body - ANSWER-- provide privacy
- remove all lines and tubes, unless this is a coroner's (medical examiner's) case or
organs or tissues are to be donated
- cleanse the body as indicated
- align the body in the supine position with the head on a pillow, eyes closed,
dentures in place, and arms with palms down on top of the sheet and blanket
- change linens and gown
- comb the patient's hair and replace hairpieces if present
- tidy the room, removing unnecessary equipment, supplies and soiled linens
- provide a calm environment by reducing lighting and minimizing noise
postmortem care: after family viewing - ANSWER-- complete required
documentation
- apply identification tags according to facility policy
- transport or request transport for the patient as indicated by facility policy
autopsy - ANSWER-- examination of tissues and organs following death
- findings may help to advance medical science and pinpoint the cause of death
- consent is a legal requirement, and it is usually the responsibility of the health care
provider to obtain this consent
- if death occurs due to suicide, homicide, accident, illegal therapeutic practice, and
in some cases within 24 hours of hospital admission, the coroner must be notified
according to law. The coroner can then determine if autopsy is necessary and can
order one even if they patient/family have refused to consent
- most facility policies require that all tubes and lines remain in the patient
- forms must be completed per state and federal law
