Gerontological Nursing 3rd Edition By Tabloski – Test Bank

Chapter 11
Question 1
Type: MCMA
An older patient with terminal cancer is considering hospice care but is concerned that Medicare will stop payments if the care is provided for longer than 6 months. What can the nurse respond to this patient?
Standard Text: Select all that apply.
1. Medicare does not limit the hospice benefit.
2. Medicare regulations discourage a longer use of the benefit.
3. Hospice costs more than traditional hospital or long-term care.
4. Patient may enroll when the life expectancy is 6 months or less.
5. Hospice supports the family for 6 months after the patient’s death.
Correct Answer: 1,2,4
Rationale 1: Medicare law does not limit the hospice benefit.
Reference: Page 255
Rationale 2: Medicare regulations often discourage a patient from using hospice for longer than 6 months.
Reference: Page 255
Rationale 3: Hospice costs less than traditional hospital or long-term care.
Reference: Page 255
Rationale 4: Patients may enroll when their physician judges their life expectancy to be 6 months or less.
Reference: Page 255
Rationale 5: Hospice supports all family members during the illness and supports the family for 1 year after the death.
Reference: Page 255
Global Rationale:

Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 4. Discuss the diverse settings for end-of-life care and the role of the nurse in each setting.

Question 2
Type: MCMA
During an assessment the nurse determines that an older patient dying from a terminal illness is experiencing common fears. What fears did this nurse assess in the patient?
Standard Text: Select all that apply.
1. Dying alone
2. Loss of consciousness
3. Loss of bladder control
4. Leaving loved ones behind
5. Becoming a burden to others
Correct Answer: 1,2,3,5
Rationale 1: Common fears and concerns of the dying include dying alone.
Reference: Page 257
Rationale 2: Common fears and concerns of the dying include loss of consciousness.
Reference: Page 257
Rationale 3: Common fears and concerns of the dying include loss of bladder control.
Reference: Page 257
Rationale 4: Common fears and concerns of the dying do not include leaving loved ones behind.
Reference: Page 257
Rationale 5: Common fears and concerns of the dying include becoming a burden to others.
Reference: Page 257
Global Rationale:

Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 1. Describe the role of the nurse in providing quality end-of-life care for older adults and their families.

Question 3
Type: MCSA
An older patient dying of end-stage pulmonary disease and dementia receives narcotic medication for chronic pain. Currently the patient is restless and grimacing. How should the nurse interpret these assessment findings?
1. The patient is in pain.
2. The patient has an undiagnosed personality disorder.
3. The patient needs nonpharmacological pain management approaches.
4. The patient is not experiencing any difference in pain level and no adjustments are needed.
Correct Answer: 1
Rationale 1: When an older adult is unable to speak or self-report the level of pain, the nurse should carefully observe the patient for behavioral symptoms of pain that may include restlessness and grimacing.
Reference: Page 259
Rationale 2: Personality disorders with the presence of dementia are difficult to identify and to differentiate the source of the behavior.
Reference: Page 259
Rationale 3: Nonpharmacological pain management approaches can augment medication for pain; however, this patient is demonstrating signs of acute pain.
Reference: Page 259
Rationale 4: The patient is restless and grimacing, which are behavioral symptoms of pain that need to be addressed.
Reference: Page 259
Global Rationale:

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 5. Explore pharmacological and alternative methods of treating pain.

Question 4
Type: MCSA
An older patient dying from a terminal illness reports that the last dose of pain medication provided barely reduced the level of pain. What should the nurse do to help this patient?
1. Give the patient pain medication every hour.
2. Contact the physician for an adjustment in pain medication.
3. Provide the pain medication at the next scheduled dose time.
4. Give the patient another dose of the medication even though it is before the scheduled time.
Correct Answer: 2
Rationale 1: The nurse cannot prescribe the dose or frequency of pain medication and cannot give the patient pain medication every hour if it is not prescribed at this frequency.
Reference: Page 262
Rationale 2: Dying patients may need more pain medication than the normal range for the prescribed drug. Organic changes are occurring rapidly within the body and systems are shutting down, decreasing the absorption levels of drugs.
Reference: Page 262
Rationale 3: Delaying medication would cause unnecessary suffering for the patient.
Reference: Page 262
Rationale 4: Altering the administration schedule is outside of the scope of the professional practice role of nursing.
Reference: Page 262
Global Rationale:

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 5. Explore pharmacological and alternative methods of treating pain.

Question 5
Type: MCMA
The nurse is planning oral hygiene for an older patient with a terminal illness who has an intact swallowing reflex. Which interventions would be appropriate for this patient?
Standard Text: Select all that apply.
1. Offer ice chips frequently.
2. Provide care with soft swabs.
3. Apply petroleum jelly to the lips.
4. Brush the teeth three times a day.
5. Avoid using alcohol-based solutions.
Correct Answer: 1,2,3,5
Rationale 1: Ice chips to relieve the feeling of dryness may be offered as long as the swallowing reflex is present.
Reference: Page 262
Rationale 2: Oral care with soft swabs should be provided several times a day and whenever the mouth has a foul odor or appears uncomfortable for the patient.
Reference: Page 262
Rationale 3: Soothing ointments or petroleum jelly may be applied to the lips to prevent painful cracking or drying.
Reference: Page 262
Rationale 4: The patient’s oral hygiene should be provided with soft oral swabs or moistened cloths. A toothbrush would be too harsh for the patient’s delicate oral tissues.
Reference: Page 262
Rationale 5: Alcohol-based products can be irritating and drying and their use is discouraged.
Reference: Page 262
Global Rationale:

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Basic Care and Comfort
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: 7. Implement appropriate nursing interventions when caring for the dying patient.

Question 6
Type: MCSA
The family of an older patient dying of liver cancer is concerned that the patient will not eat or drink. The patient is alert and oriented, and expresses no desire to eat. What action would the nurse take?
1. Force fluids.
2. Consult the dietician for feeding supplements.
3. Contact the physician for an order for tube feedings.
4. Comply with the patient’s wishes despite the family’s concern.
Correct Answer: 4
Rationale 1: The patient’s wishes should be respected. The nurse should educate the family and reassure them that anorexia may result in ketosis that can lead to a peaceful state of mind and decreased pain.
Reference: Page 263
Rationale 2: The patient’s wishes should be respected. The nurse should educate the family and reassure them that anorexia may result in ketosis that can lead to a peaceful state of mind and decreased pain.
Reference: Page 263
Rationale 3: The patient’s wishes should be respected. The nurse should educate the family and reassure them that anorexia may result in ketosis that can lead to a peaceful state of mind and decreased pain.
Reference: Page 263
Rationale 4: Anorexia and dehydration are common and normal with the patient with a terminal illness. The patient’s wishes should be respected. The nurse should educate the family and reassure them that anorexia may result in ketosis that can lead to a peaceful state of mind and decreased pain.
Reference: Page 263
Global Rationale:

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Basic Care and Comfort
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 7. Implement appropriate nursing interventions when caring for the dying patient.

Question 7
Type: MCSA
An older patient with end-stage renal and heart failure is experiencing odd dreams and is talking with people who are not present in the room. What does this finding indicate to the nurse?
1. Pending death
2. Ineffective pain medication
3. Overdose of narcotic medication
4. Normal visual and auditory hallucinations at the end of life
Correct Answer: 4
Rationale 1: Respiratory, neurological, and cardiac changes are more likely to indicate impending death.
Reference: Page 263
Rationale 2: Odd dreams and hallucinations in the terminally ill patient do not indicate ineffective pain medication. Grimacing and complaining of pain would indicate ineffective pain medication management.
Reference: Page 263
Rationale 3: Odd dreams and hallucinations in the terminally ill patient do not occur because of an overdose of narcotic medication. A change in respiratory status would indicate an overdose of narcotic medication.
Reference: Page 263
Rationale 4: Terminal delirium presents as confusion, restlessness, and/or agitation, with or without day–night reversal. Visual, auditory, and olfactory hallucinations may occur during this time. It is important for the nurse to understand that this condition is often irreversible, and that the patient’s experience of the delirium may be very different from what is witnessed by caregivers.
Reference: Page 263
Global Rationale:

Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 6. Identify the signs of approaching death.

Question 8
Type: MCSA
While providing postmortem care to a patient who has died the patient elicits a respiratory sound when turned. What should the nurse do?
1. Check for a pulse.
2. Reposition the airway.
3. Continue with the postmortem care.
4. Report to the physician the patient is still breathing.
Correct Answer: 3
Rationale 1: Checking for a pulse is not necessary in a deceased patient.
Reference: Page 266
Rationale 2: Repositioning the airway is not necessary in a deceased patient.
Reference: Page 266
Rationale 3: When the body is moved or the extremities repositioned, the body may produce respiratory-type sounds or the chest may appear to rise and fall. This can be alarming, but is only the sound of air leaving the lungs.
Reference: Page 266
Rationale 4: Contacting the physician is not necessary because the sound is a normal finding.
Reference: Page 266
Global Rationale:

Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 8. Describe postmortem care.

Question 9
Type: MCSA
An older patient is not breathing well and has cold, mottled skin. The patient has a living will and requests comfort measures only. What should the nurse do to care for this patient?
1. Ask the family what they want to be done for the patient.
2. Contact the physician for orders to control the patient’s breathing.
3. Provide personal hygiene and skin care as outlined in the care plan.
4. Withhold pain medication, hygiene, and nutrition until the patient dies.
Correct Answer: 3
Rationale 1: Asking the family what they want to be done for the patient will go against the patient’s written wishes and is inappropriate.
Reference: Page 267
Rationale 2: Contacting the physician to intervene to control respiration is considered adding extraordinary measures and is inappropriate, as is going against the patient’s written wishes when a living will is present and in force.
Reference: Page 267
Rationale 3: Comfort measures only indicate that the patient does not want extraordinary measures to sustain life. This does not mean that nursing care ceases but that nursing care to provide patient comfort is intensified and maintained through the end stages of the patient’s life.
Reference: Page 267
Rationale 4: Comfort measures only indicate that the patient does not want extraordinary measures to sustain life. This does not mean that nursing care ceases but that nursing care to provide patient comfort is intensified and maintained through the end stages of the patient’s life.
Reference: Page 267
Global Rationale:

Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub: Basic Care and Comfort
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 7. Implement appropriate nursing interventions when caring for the dying patient.

Question 10
Type: MCSA
The family of an older patient with a terminal illness has been aware of the patient’s pending death and is present when the patient dies. The family’s reaction to the patient’s death was very emotional and demonstrated a state of disbelief. How should the nurse interpret this family’s behavior?
1. Irrational behavior
2. Expression of anger
3. Maladaptive coping of the family
4. Normal shock when experiencing the loss of a loved one
Correct Answer: 4
Rationale 1: Even if the family is expecting the death, the actual notification may be shocking to the family and needs to be handled gently and with empathy. This is not irrational behavior.
Reference: Page 265
Rationale 2: Even if the family is expecting the death, the actual notification may be shocking to the family and needs to be handled gently and with empathy. This is not an expression of anger.
Reference: Page 265
Rationale 3: Even if the family is expecting the death, the actual notification may be shocking to the family and needs to be handled gently and with empathy. This is not maladaptive coping of the family.
Reference: Page 265
Rationale 4: Even if the family is expecting the death, the actual notification may be shocking to the family and needs to be handled gently and with empathy. There is disbelief that death has occurred and may be marked by shock, emotional dullness, and restless behavior that may include stupor and withdrawal. It may include physical characteristics such as nausea or insomnia.
Reference: Page 265
Global Rationale:

Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 9. Discuss family support during the grief and bereavement period.