HESI Case Study- Hospice

Scenario: Jill Green is a 42-year-old mother of two who has been married for 17 years. She was diagnosed with ovarian cancer 2 years ago. After the initial diagnosis Jill had a total hysterectomy with salpingo-oophorectomy. For the last 2 years she has undergone intensive chemotherapy and radiation. Despite treatment, the ovarian cancer progressed to the late stage and metastasized to the lungs and bones. After collaborating with her healthcare providers, Jill has decided to pursue palliative care.
Which statement by Jill indicates an understanding of palliative care?
C. Treatments and medications will be utilized to control my pain and increase my comfort.

Rationale: Interventions will be used to control pain and increase comfort and quality of life for the client.

Which problem should the nurse address first?
B. The problem that the client identifies as first priority, the problem that most concerns the client.

Rationale: Highest priority should be focused on what the client identifies as first priority.

Client is concerned about falling while showering.
Which action should the nurse take first?
B. Determine if safety equipment is needed.

Rationale: Safety is the first priority to reduce injury.

A shower chair is deemed necessary. Which information about Jill’s care should the RN convey to the UAP?
D. Place hygienic supplies within the client’s reach from the shower chair.

Rationale: This will promote independence and reduce risk for falls.

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When talking with the Green family, which information should the RN include about hospice care? SELECT ALL THAT APPLY.
A. The care is client and family focused.

Rationale: The care is client and family focused.

C. Bereavement follow-up is provided after the client’s death.

Rationale: Bereavement care is a component of hospice care.

D. Interdisciplinary care focuses on symptom management.

Rationale: Interdisciplinary care primarily focuses on symptom management..

The client’s 11-year-old seems irritable and angry when she is with the client and has recently been disruptive in school.
How should the nurse respond to the client?
A. Continue to offer opportunities for your daughter to talk about her feelings.

Rationale: Family members should be encouraged to talk about their feelings.

Which nursing diagnosis should the RN add to the plan of care?
D. Anticipatory grieving related to the potential loss of wife and mother.

Rationale: Grieving for the client’s death is still anticipatory at this time.

What are the five stages of grief according to Dr. Elizabeth Kubler-Ross?
Denial, Anger, Bargaining, Depression, Acceptance.
The client talks openly to the RN about death. The client thinks that she is vacillating between depression and bargaining stages.
What technique should the RN use when communicating with the client about the terminal illness?
D. Respect clients pattern of communication, and ways of dealing with stress.

Rationale: The nurse should respect the client’s readiness to talk about and deal with the illness while offering support when needed.

The client states that she feels she was stamped with an “expiration date” when her physician told her she only had 4-6 months to live. The client explains that she feels overwhelmed because there is still so much she still wants to teach her children.
What intervention should the nurse implement?
C. Ask the client is she is interested in having a volunteer help her record her thoughts.

Rationale: This is a service offered by trained hospice volunteers that helps clients pass along information to their family and friends.

Over the next few months the clients condition deteriorates. The husband states the client wakes at night in pain but is afraid to give the client pain medicine. He is afraid that is he does provide pain medicine the client will not wake the next morning.
How should the nurse respond to the husband’s concern?
B. We can collaborate with the health care provider to try to find a dose of pain medicine that works for the client.

Rationale: It is important to collaborate to find a pain regimen that will keep the client’s pain under control even in the middle of the night.

HCP prescribes a duragesic Fentynal pain patch.
Which medication does the nurse expect to give to prevent a common side effect of a duragesic pain patch?
C. Docusate sodium (Colace)

Rationale: Constipation is a common side effect.

Which information is most important the RN should teach the husband?
B. Remove the old patch before placing a new patch.

Rationale: To prevent overdose.

The morphine sulfate (Roxanol) elixir is supplied 10mg per ml. What is the maximum volume in ml that the client can receive per day?
The client states to the RN that the pain regimen is working much better. The client now complains of burning, “electric-like” pain.
Which medication would the RN expect the HCP to prescribe to treat the type of pain the client described?
B. Gabapentin (Neurontin)

Rationale: Used to treat neuropathic pain.

Which nursing intervention describes the use of guided imagery to control pain?
C. Visualize a pain free mental scenario while achieving a deep state of relaxation.
The husband asks the nurse if aromatherapy would help the client.
Which is the best response to the husband by the nurse?
B. Aromatherapy may be used with caution to preven nausea.
The RN collaborates with the client’s family to maintain care. The RN notices the husband has lost weight and has only be getting about 2 hours of sleep per night. The husband states, “I don’t know what I’ll do if I don’t get a break from all this.”
What action should the nurse take?
A. Talk to the family and client about the possibility of hospitalization respite care.

Rationale: Respite care can be used to allow family time to regain strength and good mental health.

Upon assessment the nurse finds that the client’s hands, arms, and feet are cool to touch.
What intervention should the nurse implement?
A. Place socks on client’s feet and a light blanket.

Rationale: Increase comfort to the client.

The client is awake and conscious but becomes restless and picks at the bed linen.
Which interventions for restlessness should the RN encourage the client’s family to try? SELECT ALL THAT APPLY.
A. Keeps the lights dim.
Rationale: This is therapeutic.
B. Read a poem of passage aloud.
Rationale: This provides comfort.
D. Gently rub back or stroke arms.
Rationale: This provides soothing comfort.
E. Play soothing music.
Rationale: This is a distraction.
The client’s conditions continues to decline. Mucus starts to collect in the client’s airway.
Which intervention should the nurse implement?
D. Administer prescribed atropine drops sublingually.

Rationale: this will dry up secretions and quiet the death rattle.

Despite having Cheyne-Stokes respirations for 2 hours the client regains consciousness.
What explanation should the nurse offer to the family for this change in status?
B. An unexpected alertness sometimes occurs when a client is near death and it is called a “rally”.

Rationale: This is not uncommon. Nurses should prepare families for this rally but note that this does not mean a change in their health condition.

The client’s respirations deteriorate and pupils become fixed and dilated. The husband begins to panic and says he wants everything done to save the client.
which response by the nurse is therapeutic?
B. Tell me the conversations you had with the client about this moment?

Rationale: This reminds the family of the time the client expressed their feelings and wishes about dying.

Which intervention by the nurse will facilitate the anticipatory grieving process?
C. Encourage the client’s husband to verbally to the client that it is okay to die.

Rationale: Giving this information is therapeutic.

Which nursing intervention is therapeutic for the family immediately after the client passes?
B. Allow the family as much time with the client as they wish.

Rationale: This gives the family time to say their goodbyes and helps with the grieving process.

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