FREE Certified Hospice and Palliative Nurse Questions and Answers
Jenny's pleural effusion is being intermittently drained using an indwelling pleural catheter. The nurse is on hand to instruct patients on how to use the catheter at home. Which aspect must the nurse emphasize to Jenny in order for her to avoid vasovagal symptoms?
Draw the fluid off gradually, removing no more than one to 1.5 liters at a time, in order to prevent vasovagal symptoms (tachycardia, hypotension, and fainting). If the pleural space is more than 1.5 liters, fully draining it could cause discomfort, vasovagal reactions, and coughing. It is preferable to train a caregiver on how to access the catheter safely in a palliative context. Drainage should never last longer than eight hours since continued catheter access can cause infection or emboli.
A person suffering from persistent obstructive pulmonary patient with COPD is given a portable nebulizer. Upon administration of albuterol, the patient reports elevated mental alertness, a fast heartbeat, and the nurse is aware that the drug has caused sleeplessness. encouraged the:
Mental disorders are caused by sympathetic nervous system stimulation, consciousness, elevated heart rate, and elevated cardiac reduced digestion, bronch odilation, contractility, and localized vasodilation.
The most prevalent lung disease at its end stage observed in hospice environments is:
COPD is the most frequent respiratory condition observed in hospice settings, after lung cancer.
What other medications must to be taken along with any opioid regimen?
Any patient using an opioid should also be prescribed a prophylactic bowel regimen to avoid or treat constipation, as it is one of the major side effects of opioid therapy. Senna is a laxative stimulant that increases bowel movement by chemically stimulating the gut. Diphenhydramine is an antihistamine used to treat opioid-induced pruritus, ondansetron HCl is a 5-HT3 receptor antagonist used to prevent nausea and vomiting, and pamidronate is a bisphosphonate used as an adjuvant to opioids for bone pain.
Draco uses a short-acting prn opioid for breakthrough pain in addition to taking continuous-release morphine every 12 hours for pain management. At 9–10 hours, he is having end-of-dose failure. What would be the best course of action to treat Draco's discomfort?
End-of-dose failure in Draco means that the blood levels of the medication are dropping in the final hours of the dosage cycle before the body absorbs the next dose as planned. Breakthrough pain, which is defined by an episode of agony despite control of ongoing baseline pain, is not the same as this. Jordan will have more consistent drug blood levels thanks to a shorter round-the-close drug interval. A short-acting bolus immediately before the next dosing cycle would only be produced by increasing the prn dose, and this could result in drowsiness and other adverse effects. It is not required to transition to another opioid because this is often done because of a negative side effect. In the last hours of the dosing cycle, a corticosteroid would not produce the desired pain control outcome.
After receiving a PEG tube, 69-year-old Eric, who has end-stage esophageal cancer, recently left the hospital and went back home. Margaret, his wife, who will be taking care of him, says she trained to give him his tube feedings while he was in the hospital. How should Margaret be evaluated to see how well she can complete this task?
The best way to see that she is competent is to have her demonstrate the ability for you. The following actions should, at the very least, be taken after teaching patients or caregivers how to perform a particular skill or task: First, Ask for a statement of understanding; Second, Watch a follow-up demonstration, if applicable; and Third, Record the answer. These are crucial components in guaranteeing patient safety and adult education.
Which patient is most likely to not receive adequate care for their pain symptoms?
Contrary to popular belief, under-treatment of pain is more likely to occur in older people, people of color, and women than in younger individuals with fewer co-morbidities. The 86-year-old possesses two of the three risk variables for each of the four case studies.
Which of the following could point to a bad prognosis for a hospice patient with an end-stage cardiac condition?
Indicators of a poor prognosis in this patient population include unexplained syncope, prior cardiac arrest with resuscitation, and an embolic stroke originating from the cardiac system.
A 57-year-old individual with advanced liver Hepatic encephalopathy is being treated for the condition. 30 milliliters of lactulose BID. The patient is conscious and focused and mentions having multiple episodes of watery diarrhea, one of which led to this morning's incontinence. The caregiver ought to?
Diarrhea is a severe adverse effect of lactulose that frequently if left untreated, leads to noncompliance. Since the question stem is alert, it is safe to give the patient instructions to reserve the lactulose dose for later. The medicine's dosage will need to be modified in order for the patient to receive the medicine with no unpleasant side effects.
Which of the following is a crucial component of supporting the patient's care needs when a hospice patient is dealing with growing weakness, exhaustion, and decreasing mobility?
Supporting the hospice patient who is progressively weaker and more exhausted requires prioritizing energy consumption. Giving the patient the tools to prioritize their physical, emotional, and spiritual needs will enable them to focus their limited resources on the areas that are most important to them.
Due to advanced ovarian cancer, Vangie has an incomplete bowel blockage. She is throwing up feces and complaining of severe abdominal pain. Only non-pharmacologic therapies are desired by her and her family. Which intervention is most likely to be successful?
The most suitable technique at this stage of obstruction is the insertion of a nasogastric tube for decompression venting and emptying of stomach contents. Although intestinal rest is essential, it won't clear the stomach's contents and, ideally, prevent vomiting. The obstruction cannot be resolved with a Foley catheter, and introducing food while the obstruction is still present will make matters worse.