The nurse can assess Cheyne-Stokes respiration by its characteristics of respirations that are:

harsh and rattling.

long periods of fast deep breaths.

shallow followed by periods of apnea.

Wheezing and labored.

Answer and Explanation

The Correct Answer is C

A. Harsh and rattling: Harsh and rattling respirations are indicative of other respiratory conditions, such as respiratory tract obstruction or excessive secretions in the airways, rather than Cheyne-Stokes respiration.

B. Long periods of fast deep breaths: This describes hyperventilation, where there are rapid and deep breaths without periods of apnea, which is not characteristic of Cheyne-Stokes respiration.

C. Shallow followed by periods of apnea: Cheyne-Stokes respiration is characterized by a pattern of gradually increasing and then decreasing depth of respirations, followed by periods of apnea (no breathing). This pattern repeats cyclically.

D. Wheezing and labored: Wheezing and labored respirations are associated with conditions such as asthma or chronic obstructive pulmonary disease (COPD), rather than Cheyne-Stokes respiration.

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Correct Answer is ["A","B","C","D"]

Explanation

A. Do not force the client to stay awake: Palliative care focuses on providing comfort and dignity to the patient, and forcing the client to stay awake would not align with this goal. Allowing the client to rest as needed is essential for maintaining comfort during the end-of-life process.

B. Administer pain medication by rectal or transdermal when client can no longer swallow: As the client approaches death, they may lose the ability to swallow oral medications. Administering pain medication rectally or via transdermal patches ensures that the client continues to receive adequate pain relief even when oral intake is no longer possible.

C. Position the client on her side: Positioning the client on her side helps prevent aspiration if there is vomiting and promotes comfort by reducing pressure on bony prominences. This position also facilitates effective airway management and can help alleviate respiratory distress.

D. Offer to turn and reposition client every 2 hours: Turning and repositioning can help prevent pressure ulcers and maintain skin integrity, during the terminal stage of illness. The frequency of turning and repositioning may be adjusted based on the client's comfort and clinical condition.

A. Anger B. Depression C. Acceptance D. Bargaining E. Denial

Correct Answer is E

Explanation

A. Anger: Anger involves feelings of frustration, resentment, or hostility towards the situation or others. The statement does not express anger but rather a refusal to accept the possibility of a serious illness.

B. Depression: Depression is characterized by feelings of sadness, hopelessness, and despair. While the statement may reflect concern, it does not indicate depressive symptoms.

C. Acceptance: Acceptance is characterized by coming to terms with one's impending death or loss. The statement does not indicate acceptance of the possibility of having cancer.

D. Bargaining: Bargaining involves attempting to negotiate or make deals to change the outcome of a situation. The statement does not suggest bargaining behavior.

E. Denial: Denial is the initial stage where individuals refuse to accept the reality of their situation. The statement "I've had stomach problems for years. I don't have cancer." suggests a refusal to accept the possibility of having cancer despite ongoing health issues. Therefore, it correlates with denial.

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The nurse can assess Cheyne-Stokes respiration by its characteristics of respirations that are:

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Naxlex Comprehensive Predictor Exams

A nurse is providing palliative care to a client who is receiving hospice care and is approaching death. Which of the following actions should the nurse take? (Select all that apply.)

Correct Answer is ["A","B","C","D"]

Explanation

Directions: Correlate the behavior with Kübler-Ross's stages of dying from the choices below. "I’ve had stomach problems for years. I don't have cancer."

Correct Answer is E

Explanation

An oncologist has recommended that a hospice patient receives palliative radiation to reduce the pain of bony metastases. The patient reacts with anger, saying, "l don't want any more treatments that don't cure my cancer!" The hospice nurse tells the patient that the use of radiation:

Directions: Correlate the behavior with Kübler-Ross's stages of dying from the choices below. "She's not that sick!"

Directions: Correlate the behavior with KübIer-Ross's stages of dying from the choices below. "Go away, I don't want company. "

A nurse is caring for a client who has a new diagnosis of chronic renal failure. The nurse should recognize which of the following client statements as an indication of anticipatory grief?

A terminally ill patient and his family have requested hospice care. The nurse clarifies hospice care philosophy as:

A nurse provides a back massage as palliative care to an unconscious client who is grimacing and restless. Which of the following indicates a therapeutic response? (Select all that apply.)

A nurse in an acute care facility is caring for a preschool-age child who is terminally ill and receiving palliative care. The parents tell the nurse that they have decided to take their child home. Which of the following responses should the nurse make?

After a patient death, the nurse is preparing to perform postmortem care. The body is placed supine with the head raised so that: