Exam (elaborations)
Gerontological Nursing, 4e (Tabloski) Chapter 11 Care at the End of Life
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Gerontological Nursing, 4e (Tabloski) Chapter 11 Care at the End of Life
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Gerontological Nursing, 4e (Tabloski)Chapter 11 Care at the End of Life
1) AnrolderrpatientrwithrterminalrcancerrisrconsideringrhospicercarerbutrisrconcernedrthatrMedicarer
willrstoprpaymentsrifrthercarerisrprovidedrforrlongerrthanr6rmonths.rWhatrcanrthernurserrespondrtorthisr
patient?rSelectrallrthatrapply.
1. Medicarerdoesrnotrlimitrtherhospicerbenefit.
2. Medicarerregulationsrdiscouragerarlongerruserofrtherbenefit.
3. Hospicercostsrmorerthanrtraditionalrhospitalrorrlong-termrcare.
4. Patientrmayrenrollrwhenrtherliferexpectancyrisr6rmonthsrorrless.
5. Hospicersupportsrtherfamilyrforr6rmonthsrafterrtherpatient'srdeath.rA
nswer:r 1,r2,r4
Explanation:r 1.rMedicarerlawrdoesrnotrlimitrtherhospicerbenefit.
2. Medicarerregulationsroftenrdiscouragerarpatientrfromrusingrhospicerforrlongerrthanr6rmonths.
3. Hospicercostsrlessrthanrtraditionalrhospitalrorrlong-termrcare.
4. Patientsrmayrenrollrwhenrtheirrphysicianrjudgesrtheirrliferexpectancyrtorber6rmonthsrorrless.
5. Hospicersupportsrallrfamilyrmembersrduringrtherillnessrandrsupportsrtherfamilyrforr1ryearrafterrther
death.
PagerRef:r255
CognitiverLevel:r Applying
ClientrNeed:r PsychosocialrIntegrity
Nurs/IntegrConc.:r NursingrProcess:rImplementation
LearningrOutcome:r4.rDiscussrtherdiversersettingsrforrend-of-
lifercarerandrtherrolerofrthernurserinreachrsetting.
2) Thernurserisrcaringrforranrolderrpatientrwhorisrterminallyrillrandrinrtherendrstagesrofrlife.rWhi
chractionsrbyrtherpatientrwouldrthernurseranticipate?rSelectrallrthatrapply.
1. Askingranrestrangedrbrotherrtormakerarhospitalrvisit.
2. Assigningrarfamilyrmemberrasrexecutorrofrtheirrestate.
3. Discussingrpainrmanagementrwithrtheirrphysician.
4. Voicingrconcernsrofrleavingrbehindrlovedronesrafterrdeath.
5. Increasingrtherhoursrforrprivaterdutyraidrtorassistrwithrpersonalrcarerneeds.rAn
swer:r 1,r2,r3,r5
Explanation:r 1.rCommonrfearsrandrconcernsrofrtherdyingrincludernotrwantingrtordieralone.
2. Financialrandrestaterplanningrconcernsrarercommonrwithrthoserterminallyrill.
3. Commonrfearsrandrconcernsrofrtherdyingrincluderhopingrforrarpeacefulrdeath.
4. Commonrfearsrofrtherdyingrdornotrincluderleavingrlovedronesrbehind.
5. Commonrfearsrandrconcernsrincluderbecomingrarburdenrtorothersrduringrendrofrlife.rPa
gerRef:r248-249
CognitiverLevel:r Analyzing
ClientrNeed:r PsychosocialrIntegrity
Nurs/IntegrConc.:r NursingrProcess:rAssessment
LearningrOutcome:r1.rDescribertherrolerofrthernurserinrprovidingrqualityrend-of-
lifercarerforrolderradultsrandrtheirrfamilies.
1
Copyrightr©r2019rPearsonrEducation,rInc.
,3) Thernurseradministersrarnarcoticrforrpainrtorarterminalrpatientrwithrend-
stagerpulmonaryrdiseaserandrdementia.rAfterronerhour,rtherpatientrexhibitsrfacialrgrimacingrandrrestl
essness.rHowrshouldrthernurserinterpretrtheserassessmentrfindings?
1. Therpatientrhasrcontinuingrpain.
2. Therpatientrisrexperiencingrarsleeprdisorder.
3. Therpatientrrequiresrcomfortrmeasures.
4. Therpatientrassessmentrisrisrwithinrnormalrlimits.rA
nswer:r 1
Explanation:r 1.rWhenranrolderradultrisrunablertorspeakrorrself-
reportrtherlevelrofrpain,rthernursershouldrcarefullyrobservertherpatientrforrbehavioralrsymptomsrofrpa
inrthatrmayrincluderrestlessnessrandrgrimacing.
2. Restlessnessrmayrindicaterarsleeprdifficultyrbutrgrimacingroccursrwithrpain,rnotrinsomnia.
3. Comfortrmeasuresrcanraugmentrmedicationrforrpain;rhowever,rthisrpatientrisrdemonstratingrsig
nsrofracuterpain.
4. Therpatientrisrrestlessrandrgrimacing,rwhichrarerbehavioralrsymptomsrofrpainrthatrisrnotrnor
malrandrneedsrtorberaddressed.
PagerRef:r250
CognitiverLevel:r Analyzing
ClientrNeed:r PhysiologicalrIntegrity
ClientrNeedrSub:r PharmacologicalrandrParenteralrTherapiesrN
urs/IntegrConc.:rrNursingrProcess:rAssessment
LearningrOutcome:r 5.rExplorerpharmacologicalrandralternativermethodsrofrtreatingrpain.
4) Anrolderrpatientrdyingrfromrarterminalrillnessrreportsrthatrtherlastrdoserofrpainrmedicationrpro
videdrbarelyrreducedrtherlevelrofrpain.rWhatrshouldrthernurserdortorhelprthisrpatient?
1. Givertherpatientrpainrmedicationreveryrhour.
2. Contactrtherphysicianrforranradjustmentrinrpainrmedication.
3. Providertherpainrmedicationratrthernextrscheduledrdosertime.
4. Givertherpatientranotherrdoserofrthermedicationrevenrthoughritrisrbeforertherscheduledrtime.rAns
wer:r 2
Explanation:r 1.rThernursercannotrprescribertherdoserorrfrequencyrofrpainrmedicationrandrcannotrgiv
ertherpatientrpainrmedicationreveryrhourrifritrisrnotrprescribedratrthisrfrequency.
2. Dyingrpatientsrmayrneedrmorerpainrmedicationrthanrthernormalrrangerforrtherprescribedrdrug.rOrg
anicrchangesrareroccurringrrapidlyrwithinrtherbodyrandrsystemsrarershuttingrdown,rdecreasingrthera
bsorptionrlevelsrofrdrugs.
3. Delayingrmedicationrwouldrcauserunnecessaryrsufferingrforrtherpatient.
4. Alteringrtheradministrationrschedulerisroutsiderofrtherscoperofrtherprofessionalrpracticerrolerofrnur
sing.
PagerRef:r262
CognitiverLevel:r Applying
ClientrNeed:r PhysiologicalrIntegrity
ClientrNeedrSub:r PharmacologicalrandrParenteralrTherapiesrN
urs/IntegrConc.:r NursingrProcess:rImplementation
LearningrOutcome:r 5.rExplorerpharmacologicalrandralternativermethodsrofrtreatingrpain.
2
Copyrightr©r2019rPearsonrEducation,rInc.
, 5) Thernurserisrplanningroralrhygienerforranrolderrpatientrwithrarterminalrillnessrwhorhasranrintactr
swallowingrreflex.rWhichrinterventionsrwouldrberappropriaterforrthisrpatient?rSelectrallrthatrappl
y.
1. Offerricerchipsrfrequently.
2. Providercarerwithrsoftrswabs.
3. Applyrpetroleumrjellyrtortherlips.
4. Brushrtherteethrthreertimesrarday.
5. Avoidrusingralcohol-
basedrsolutions.rAnswer:r 1,r2,r3,r5
Explanation:r 1.rIcerchipsrtorrelievertherfeelingrofrdrynessrmayrberofferedrasrlongrasrtherswal
lowingrreflexrisrpresent.
2. Oralrcarerwithrsoftrswabsrshouldrberprovidedrseveralrtimesrardayrandrwheneverrthermouthrhasrarfo
ulrodorrorrappearsruncomfortablerforrtherpatient.
3. Soothingrointmentsrorrpetroleumrjellyrmayrberappliedrtortherlipsrtorpreventrpainfulrcrackingrorrdryi
ng.
4. Therpatient'sroralrhygienershouldrberprovidedrwithrsoftroralrswabsrorrmoistenedrcloths.rArtoot
hbrushrwouldrbertoorharshrforrtherpatient'srdelicateroralrtissues.
5. Alcohol-
basedrproductsrcanrberirritatingrandrdryingrandrtheirruserisrdiscouraged.rPagerRef:r262
CognitiverLevel:r Applying
ClientrNeed:r PhysiologicalrIntegrityrClient
rNeedrSub:r BasicrCarerandrComfort
Nurs/IntegrConc.:r NursingrProcess:rPlanning
LearningrOutcome:r 7.rImplementrappropriaternursingrinterventionsrwhenrcaringrforrtherdyingrpat
ient.
3
Copyrightr©r2019rPearsonrEducation,rInc.
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