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Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Palliative Care Nursing Quality Care to the End of Life 5th Edition Matzo

CHAPTER 1 Palliative Care Nursing Multiple Choice 1. The majority of hospice care is provided in which setting? A. Hospitals B. Private residences C. Jails D. PC clinics Answer: B Rationale: While hospice occurs in many different settings such as acute care hospital units, PC clinics or ambulatory settings, private practices, and prisons, most hospice care is provided in private residences such as nursing homes, homes, and residential facilities. 2. Which entity is the first professional organization for excellence in the practice of hospice nursing? A. National Board for Certification of Hospice and Palliative Nurses (NBCHPN) B. Hospice and Palliative Nurses Foundation (HPNF) C. Advancing Expert Care (AEC) D. Hospice and Palliative Care Nurses Association (HPNA) Answer: D Rationale: Incorporated in 1987, the Hospice Nurses Association (HNA) became the first professional nursing organization dedicated to promoting excellence in the practice of hospice nursing. NBCHN is the National Board for Certification of Hospice and Palliative Nurses. HPNF is the Hospice and Palliative Nurses Foundation. In 2014, the HPNA came together with the Hospice and Palliative Nurses Foundation (HPNF) and the Hospice and Palliative Credentialing Center (HPCC) to form a partnership with a synergized mission. The three distinct organizations form Advancing Expert Care (AEC). 3. In 1995, SUPPORT investigators came to which conclusion? A. Patients with end-of-life care felt they had adequate communication with their healthcare providers. B. Patients with end of life care were requesting less-aggressive medical treatments. C. Dying patients require an individual and collective commitment from healthcare providers. D. Dying patients were reporting moderate levels of pain and needed little increase in medication. Answer: C Rationale: The “Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment” (SUPPORT; SUPPORT Study Investigators, 1995) investigators believed that improving the end-of-life care for patients required an individual and collective commitment of healthcare providers and that the caregiving processes needed to be reshaped. SUPPORT Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

findings indicated a lack of communication between patients and their providers, particularly

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

related to EOL preferences, aggressiveness of medical treatments, and a high level of reported pain by seriously ill and dying patients. 4. Which type of disease is a leading cause of death today? A. Infectious B. Autoimmune C. Chronic D. Acute Answer: C Rationale: People today are living much longer than those of previous eras. The leading causes of death have changed from primarily infectious diseases to chronic illnesses. In 2014, the 10 leading causes of death were heart disease, cancer, chronic lower respiratory diseases, unintentional injuries, stroke, Alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease, and suicide. These 10 causes of death accounted for 74% of the 2.6 million deaths in 2014. 5.

What is the purpose of the eight domains of palliative care? A. To reflect national guidelines for quality palliative care B. To correlate palliative care with hospice parameters C. To determine nursing school palliative care learning objectives D. To educate physicians on the benefits of a palliative care

Answer: A Rationale: The domains of quality palliative care are designed to complement the process of improving PC quality. The qualifications of caregivers are determined by the organizations that grant professional credentials and programmatic accreditation. As a specialty organization, the Hospice and Palliative Care Nurses Association has identified the scope and standards of hospice and palliative care nursing and the competencies at all levels of nursing practice, specifically nursing assistants, licensed vocational nurses, professional registered nurses, and advanced practice nurses. 6. In addition to the nurse, which professionals are core members of the palliative care team? A. Dietician and physical therapist B. Physician and pharmacist C. Physician and nursing assistant D. Physician and social worker Answer: D Rationale: At the very minimum, the interprofessional team includes the physician, nurse, social worker, and clergy. While physical therapists, dieticians, and nursing assistants can play significant roles in the patient’s care, they are not considered part of the minimal team.

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

7. What is the last step in the advanced practice nurse’s standards for development and implementation of a plan of care? A. Planning B. Consultation C. Diagnosis D. Evaluation Answer: D Rationale: A specific notation of standards applies only to the advanced practice nurse, especially when creating a plan of care for the patient. The steps involved are assessment, diagnosis, outcome identification, planning, implementation, coordination of care, health teaching and health promotion, consultation, prescriptive authority and treatment, and evaluation. 8. Which situation shows a nurse demonstrating competency in collaboration when providing palliative care? A. Checking current research on effective pain management when determining the care plan for an end-of-life patient B. Consulting with a dietician when determining the meal plan for a patient with end-stage renal failure C. Providing a list of caregiver support groups to a patient's family members D. Reflecting on actions taken in a care situation and how they may be improved Answer: B Rationale: Interprofessional collaborative practice involves different types of health professionals working together with patients, families, and communities to deliver best practices and best patient outcomes. Practicing evidence-based nursing, being knowledgeable regarding resources to assist patients and families, and evaluating care are nursing competencies but does not reflect interprofessional collaboration. 9. What is the core principle of palliative care? A. Patient’s family involvement is approved by the healthcare provider. B. Patient’s care depends primarily on the disease involved. C. Patient and healthcare provider are the unit of care. D. Patient and family are the unit of care. Answer: D Rationale: A core principle of palliative care across the entire disease spectrum and in all settings is that the patient and family constitute the unit of care. The patient and family, rather than the disease, are the primary focus of care. Family-centered care forms the foundation of palliative care philosophy; it addresses the meaning of disease, suffering, life, and death within the context of each family unit. 10. Physical, psychological, spiritual, and social dimensions are part of which conceptual model? A. Whole-person suffering B. Calkin model of advanced nursing practice C. Systems approach Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

D. Clinical ethics

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Answer: A Rationale: Dame Cicely Saunder is the founder of St. Christopher’s Hospice in London. She developed a conceptual model of “whole-person” suffering that has four dimensions: physical, psychological, spiritual, and social. Suffering affects each domain of the bio–psycho–social– spiritual aspects of care. This forms the basis for the description of palliative care nursing practice. Short Answer 1. What is the difference between palliative care and hospice care? Model Answer: While there are similarities between palliative care and hospice care, palliative care involves identifying and preventing serious, chronic, or life-threatening illness, and is used along with measures to reverse the illness or prolong life. The focus is pain and symptom relief for the patient, comfort measures, and management of physical, psychological, or spiritual issues that the patient may experience during the illness trajectory. Palliative care was built on the foundation of Hospice care which is holistic, comprehensive care of the patient and family with serious, life-threatening, and progressive illness. The difference is that patients may be enrolled in Hospice, as a Medicare benefit, only during that last six months before death. Palliative and Hospice care exist on the same continuum of care with palliative care offered earlier in the illness experience. If a patient decides not to enroll in Hospice, Palliative care can also continue through the death of the patient and into the bereavement period of families. 2. Describe three factors that drew national attention to palliative care as it was first emerging as a care specialty. Model Answer: Billings and Block (1997) identified forces that increased national attention on palliative care. These included growing interest in death and dying; development of hospice programs; increasing integration of pain and symptom management into conventional care; concern about the high cost of dying; increased national focus on pain management; greater attention in medicine to caring rather than curing; national debates on physician-assisted suicide and euthanasia. All of these forces led to increased demand for expert, comprehensive palliative and hospice care. 3. What are at least four standards of nursing practice? Model Answer: The standards of nursing practice, which are the foundations of palliative care and hospice nursing, include providing age-appropriate and culturally, ethnically, and spiritually sensitive care and support; maintaining a safe environment; educating patients and families to identify appropriate settings and treatment options; assuring continuity of care and transitioning to the next appropriate setting; coordinating care across settings and among caregivers; managing information and protecting confidentiality; communicating promptly and effectively.

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

4. Discuss ways in which relief of suffering and quality of life can be enhanced for patients receiving palliative care and hospice. Model Answer: Relief of suffering and quality of life for individuals who are undergoing palliative care or hospice and their families are enhanced by providing effective pain and symptom management; addressing psychosocial and spiritual needs; incorporating cultural values and attitudes in the plan of care; creating a healing environment for a peaceful death; supporting those who are experiencing loss, grief, and bereavement; promoting ethical and legal decision making; advocating for personal wishes and preferences; using therapeutic communication skills in all interactions; facilitating collaborative practice; ensuring access to care and community resources through influencing and developing health and social policy; contributing to improved quality and cost-effective services; creating opportunities and implementing initiatives for palliative education for patients, families, colleagues, and community; and participating in the generation, testing, and evaluation of PC knowledge and practice. 5. Why is certification in hospice and palliative care valuable and important? Model Answer: Certification in hospice and palliative care means achieving tested and proven competency, increasing knowledge, committing to this specialty, being dedicated to professional development, committing to improved patient outcome, having compensation incentives, gaining recognition, and being an asset to an employer because certification is a recognized quality marker by patients, physicians, providers, quality organizations, insurers, and the federal government.

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

CHAPTER 2: Palliative Care: Responsive to the Need for Healthcare Reform in the United States Multiple Choice 1. Which statement describes palliative care for a patient recently diagnosed with pancreatic cancer? A. Patients with a rapidly progressing cancer benefit little from palliative care. B. Palliative care is offered in the last 6 months of life. C. Palliative care focuses primarily on disease management D. Palliative care can be provided along with curative treatments. Answer: D Rationale: Palliative care can be provided in the context of curative treatments, concurrently with symptom alleviation of the disease or its treatment, as well as offering psychological and spiritual support during the illness experience. Palliative care begins at the time of the patient’s diagnosis and continues until the patient’s death, and into the bereavement period for families. 2. The rising cost of healthcare has caused which of the following effects? A. Palliative care is becoming a structured system of care within mainstream healthcare. B. The number of patient consultations to palliative care is decreasing. C. Palliative care is increasing medical expenses. D. The need to limit the numT beErSoT fB treAaN tmKeS ntEoLpL tioEnRs.oC ffeOrM ed. Answer: A Rationale: Palliative care is moving into the mainstream of healthcare as a highly structured and organized system of care. Because of the increase in the number of people age 65 and older, more patients are seeking palliative care. Palliative care promotes quality health outcomes, providing added value while lowering health care costs. Palliative care which is comfort and supportive care can be offered along with curative therapies. 3. A patient has just received a diagnosis of rheumatoid arthritis. If the patient receives a palliative care consultation, which outcome is most likely? A. Care will be shifted from home to hospital. B. Comprehensive, coordinated care will occur C. Quality of life for family will be unchanged. D. Laboratory and pharmaceutical costs will increase. Answer: B Rationale: Palliative care results in fewer hospital days, fewer emergency department or physician office visits, and fewer days in a skilled nursing facility. As more patients wish to remain at home during an illness and to die at home, palliative care allows the shift of care from hospital to home, while providing comprehensive coordinated care across settings. Palliative care increases the quality of life for patients and their families, and reduces the total costs of ICU admissions, lowers the cost per day, lowers the direct costs per admission, and also reduces Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

laboratory costs.

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

4. Which patient is most likely to have access to quality hospice or palliative care? A. Jason, who receives outpatient services in rural Tennessee B. Carmine, who has been admitted to a small community hospital in Arizona C. Nancy, who has been admitted to an academic medical center in Massachusetts D. Adele, who receives outpatient services at the VA hospital in Georgia Answer: C Rationale: There is state-to-state and region-to-region variability in accessibility and availability of palliative care. Issues may be due to a shortage of trained professionals in PC, particularly in public and community provider hospitals, which serve Americans who are without healthcare insurance or those who live in geographically isolated areas. PC has grown rapidly in the U.S. healthcare system, with 90% of large hospitals with 300 or more beds now having a PC team. The number of palliative care programs is highest in the New England (88% of hospitals), Pacific (77% of hospitals), and mid-Atlantic (77% of hospitals) areas and lowest in the west south central (43%) and east south central (42%) states. In contrast, only 26% of for-profit hospitals, 37% of community hospitals, and 54% of public hospitals offer PC. Most veterans receive hospice care (71%), while 52% received palliative care. 5. In which way does voluntary certification in palliative care support healthcare reform? A. Increases the number of palliative care programs supervised by physicians B. Links palliative care with hospice care in the minds of patients C. Insures that palliative care programs meet the criteria for quality palliative care D. Maintains current reimbursement standards for palliative care Answer: C Rationale: The current voluntary certification in PC, as recommended by the Joint Commission, as well as the expectation for hospitals to achieve Magnet status, supports the mandate for healthcare reform in America and the provision of PC for patients and families. Certification insures that a palliative care program meets the criteria for quality palliative care as identified in the National Quality Forum Consensus Guidelines for Quality Palliative Care. 6. The family of a patient with Alzheimerʼs disease requests an appointment with a palliative care specialist. Which of the four “As” of Maryland’s Blueprint for Success does this demonstrate? A. Awareness B. Acknowledgment C. Action D. Access Answer: D Rationale: Access is the right, privilege, or ability to make use of resources and information related to palliative and hospice care.

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

7. Which statement describes palliative care on a global level? A. Most countries are starting to consider palliative care to be a human right. B. Palliative care has been well integrated into the healthcare systems of most countries. C. Funding for palliative care is highly reimbursed in most countries. D. Palliative care occurs primarily in the home across most countries. Answer: A Rationale: In many countries, access to PC is being considered a human right, as it ensures the relief of pain and suffering from cruel, inhumane, and degrading treatment. The integration of palliative care into global health care settings is moving forward in many countries but not all countries. The reimbursement of palliative care remains a challenge. 8. Which action by the nurse most empowers the patient? A. Consulting with the attending physician B. Explaining risks and benefits of treatments C. Discussing the prognosis with family members D. Choosing a plan of care based on research evidence Answer: B Rationale: Explaining risks and benefits of treatments most empowers the patient because the patient is informed of and can make decisions about his or her healthcare accordingly. 9. What role in the nursing profession develops new palliative care knowledge? A. Nurse researchers B. Nurse educators C. Doctors of Nursing Practice D. Clinical Nurse Leaders Answer: A Rationale: Nurse researchers have the skill to conduct nursing studies and add to the development of knowledge related to palliative care. Doctors of Nursing Practice translate knowledge into practice. Nurse educators and Clinical Nurse Leaders educate nurses and promote the advancement of quality palliative care. 10. Which action by nurses will best integrate palliative care into mainstream healthcare? A. Establish networks of palliative care providers B. Increase public knowledge of palliative care C. Ensure the funding of palliative care D. Participate in social and political activism for palliative care Answer: B Rationale: Modification of public perceptions of palliative care is central to improving knowledge of, and access to, services, empowering individuals and involving communities in end-of-life care. Nurses, as educators, must focus on achieving a comprehensive knowledge of the public regarding palliative care. Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Short Answer 1. Describe the 3-year palliative care/hospice demonstration project implemented by the Centers for Medicare & Medicaid Services under the requirements of the Affordable Care Act of 2010. Model Answer: This project is designed to allow patients to receive aggressive treatment and palliative/hospice care concurrently. It requires an evaluation of the current hospice eligibility criteria, with the expectation that the current prognosis of 6 months or less to live for patients with advanced illness will be relaxed. Additional project outcomes measured are the cost saving of palliative home healthcare programs and an evaluation of patients’ and families’ quality of life. The project hypothesizes that, compared to usual care, there will be improved survival rates when palliative care is performed along with life-sustaining treatments. 2. What are four positive health outcomes of palliative care? Model Answer: Studies conclude that palliative care reduces the overuse of marginally effective, ineffective, and unnecessary treatments, and results in fewer hospital readmissions, allowing greater continuity of care and the development of safe transition plans upon initial discharge. Other positive health outcomes of palliative care include better management of pain and other symptoms; emotional, spiritual, and social support of patients and families; better quality of life for patients and families; increased patient/family satisfaction; efficient TiElyS/pTaBtiA ELmLeE handling of time-intensive fam enNt/K teS am etR in. gsC; O beMtter coordination of care; increased specialty-level assistance to attending physicians; support for discharge planning staff; and nurse and physician satisfaction. 3. What roles do healthcare professionals have in promoting healthcare reform, especially in palliative care? Model Answer: According to Maryland’s Action Plan, healthcare professionals play major roles in the education of patients, families, and communities regarding palliative and hospice care, including advanced care planning. They should develop and implement educational programs (formal and informal) related to palliative and hospice care, and communicate these programs to patients through conversations, healthcare publications, and media/marketing. In addition, healthcare professionals must be educated to ensure adequate staffing of PC programs, particularly given the increase in the number of programs. Medical, nursing, and social work schools are not only integrating PC into their curriculum, but are also creating graduate programs with a focus on PC. In addition, several interprofessional fellowship programs in PC are offered across the country, which reinforce the importance of interprofessional collaboration and teamwork. Healthcare professionals should also actively participate in palliative education and palliative care initiatives by attending national conferences, increase certification and credentialing rates, and make referrals to palliative care services and hospice care. Lastly, healthcare professionals should incorporate the National Quality Forum Preferred Practices of Palliative Care as a standard of care within the institution. Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

4. What are the most optimal and efficient methods for implementing palliative care on an international level? Model Answer: To direct the international future of PC, a meeting of clinicians, health economists, researchers, policy makers, and advocates was convened with the identification of seven recommendations. These include sharing definitions of PC; recognizing the strengths and weaknesses of different payment systems; identifying country-specific and international research priorities; determining appropriate economic evaluation methods; evaluating PC costs; supporting interprofessional PC education and training programs; and developing national standards to regulate and determine PC planning and development. 5. What responsibilities do advanced practice nurses have in implementing a palliative care program? Model Answer: Advanced practice nurses make the case to hospital administration to implement a palliative program and develop the business plan that includes interprofessional resources, feasibility and accessibility, cost control, revenue generation, integration and leveraging of existing services, and decisions regarding the structure and model of the programs. They design the operational plan for the implementation of PC programs, such as space needs, staffing roles and requirements, basic policies and procedures, and projections of patient volumes and program capacity, as well as consideration of financial and strategic planning issues. The hospital’s financial viability, including the value of the program regarding the length of stay at the hospital, daily census, hospital billing revenues, estimated cost savings, and potential coT ntE riS buTtiBoA nsNbKySpE hiL laL ntEhR ro.pC y,OaM re outlined. Given their advanced clinical knowledge and expertise related to healthcare systems, advanced practice nurses provide the perspective as to how PC can meet the expectations of quality care within the context of cost effectiveness and reform.

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

CHAPTER 3: Interprofessional Collaboration Multiple Choice 1. Which patient would benefit most from an interprofessional palliative care team? A. Janice, who has Crohnʼs disease, is an active member of her synagogue, and lives near her two adult children B. Troy, who has a torn meniscus, is running back for his high school football team, and lives with his parents and three sisters C. Carl, who has hypertension controlled by medication, works long hours as a custodian, and lives by himself D. Ann, who has lupus, has retired from being a research assistant, and is recently widowed and lives by herself Answer: D Rationale: While all patients can benefit from an interprofessional palliative care team, some patients have more resources than others. Of the four patients listed, Ann would benefit the most. She has a chronic disease that requires pain management and occasional hospitalization. Since she is retired, she may not have supportive friends from work, and since she is recently widowed, she has undergone a great loss. 2. Which example demonstrates interprofessional team care? A. A patient addicted to alcoT hoElSwThB oA atN teK mSpE tsLsuLiE ciR de., C t hOenMreceives a visit from a social worker after going home from the hospital B. A mother on the obstetrical unit whose premature infant is in the NICU receives a visit from the hospital clergy C. An overweight patient, with heart disease who undergoes bypass surgery, receives a referral for a dietician upon discharge to help him lose weight D. An indigent patient with cancer who undergoes chemotherapy and is then referred to a radiologist. Answer: B Rationale: Quality, comprehensive, whole-person care depends on the integration of curative and palliative care. The mother of a premature infant in the NICU who then receives a visit from the hospital clergy is an example of interprofessional team care. Her spiritual needs are being addressed at the same time that her baby is receiving medical care. All the other examples involve healthcare and healthcare professionals brought in later when they should have been brought in concurrently with the medical care. 3. Which process demonstrates interprofessional practice? A. Curative methods are used first, then palliative methods. B. Communication is primarily through the patient’s chart. C. Integrated plan of care is formulated by many professionals. D. Family needs are addressed after the plan of care is enacted. Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Answer: C Rationale: An interprofessional team approach integrates separate disciplines into a single consultation, discussing the patient history, assessment, diagnosis, intervention, and short- and long-term care management. The goals of care are established by the team, together with the patient and the family, who are involved in making healthcare decisions. 4. Which interprofessional team member usually assesses patient and family physical, emotional, and spiritual needs? A. Registered nurse B. Chaplain C. Palliative care physician D. Social worker Answer: A Rationale: A registered nurse conducts a comprehensive assessment of patients’ and families’ physical, emotional, and spiritual needs and intervenes through therapeutic presence and communication, use of nursing interventions, and administration of medical treatments to improve the quality of life. 5. Which of the following is an example of good interprofessional communication? A. Confirming a registered nurse was aware that a patient was being given two prescriptions B. Ensuring physicians communicate with one another and the palliative care nurse about what to prescribe for a patient TuBnA C. Asking the pharmacist to T coEmSm icN atK eS wE itL hL thE eR re.giCstOerMed nurse about what prescriptions a patient should receive D. Having the palliative care nurse inform physicians which prescriptions would be best for a patient Answer: B Rationale: Certain levels of decision making may be made by individual members of the interprofessional team, whereas other levels will require input from the entire team as a whole. Poor, fragmented decision making results from the failure to include appropriate team members in the decision-making process. Physicians should communicate with one another and the palliative care nurse about what to prescribe for a patient. The registered nurse is not responsible for writing prescriptions. Asking the pharmacist to communicate with the registered nurse about what prescriptions a patient should receive is inappropriate, as is having the palliative care nurse inform physicians what prescriptions they should write. 6. If the interprofessional team leader asks other team members for their expert opinions but develops the plan of care on his or her own and expects the other team members to follow it, what will the result most likely be? A. Fragmented decision making B. Lack of input C. Lack of innovated problem solving D. Miscommunication of information Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Answer: C Rationale: The interprofessional team leader is displaying lack of respect for the knowledge and skills of other team members. This may stifle the creativity and innovative solutions if team members consistently think they are not being listened to. There is no lack of input because the team leader has asked for expert opinions. 7. Which healthcare professional is demonstrating interprofessional competence? A. A physician who makes sure the nurse sees to the family’s needs while he or she focuses on curative methods B. An advanced care nurse who wants a clergy member on every patient’s team C. A physician who uses the same team model at a new hospital that was used at a previous hospital for continuity D. A registered nurse who asks patients and families regarding their needs and preferences and involves support of the community Answer: D Rationale: Interprofessional competence means following the principles of interprofessional healthcare, which are patient centered and community/population focused rather than profession centered. A registered nurse who wants to restructure her work schedule to do community outreach is community/population focused rather than profession centered. A physician who makes sure the nurse sees to the family’s needs while he or she focuses on curative methods is not looking at the patient holistically, which is a basic tenet of the interprofessional care. An advanced care nurse who wants a clergy member on every patient’s team is not being patient EL centered if the patient does not wT anEt S aT clB erAgN yK mS em beLr.EARp.hCyO siM cian who uses the same team model at a new hospital that was used at a previous hospital for continuity is not being sensitive to the fact that different practice settings may require different team models. 8. What is the key to healthcare reform for providing compassionate, cost-effective, evidencebased healthcare that is individualized for each patient? A. Interprofessional education B. New laws concerning medical treatments C. Surveys requesting input from patients D. Interprofessional marketing Answer: A Rationale: Interprofessional education is key to developing a workforce of the future that will provide comprehensive, compassionate, cost-effective, continuous, evidence-based healthcare for varying patient populations, families, and communities. Interprofessional marketing can bring awareness about the interprofessional team approach but does not necessarily lead to healthcare reform. 9. Which statement describes the use of an interprofessional team care? A. It is effective only in large hospitals with many team members. B. Patients become confused with so many different team members. C. Team members develop their own discipline specific plan of care. D. Team members can share leadership for the patient’s best interest. Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Answer: D Rationale: Sharing or rotating group leadership is of value in equalizing power and responsibility and acknowledging and appreciating the expertise of all members of the interprofessional group. This provides new insights; the best thinking of colleagues is valued since there is a sense of shared responsibility in insuring the best patient and family healthcare outcomes. 10. Which statement regarding an interprofessional team is incorrect? A. Leadership of the team is shared depending on the patient issue. B. Health professional competencies are unique to their discipline, as well as shared. C. The plan of care is developed by the champion of the team. D. Collaboration, coordinated decision making, and conflict avoidance are essential. Answer: B Rationale: The Center for Advancement of Interprofessional Education (IPE) emphasizes the unique and shared competencies of health professionals, as well as the importance of having a champion of interprofessional collaboration, who may assume a leadership role, but engages all team members. The champion of interprofessional collaboration may be the leader of the interprofessional team, or another healthcare professional may assume that role. Leadership may also change, depending on the patient’s case. An interprofessional team approach integrates separate disciplines into a single consultation, discussing the patient history, assessment, diagnosis, intervention, and short- and long-term care management. A dynamic and outcomeoriented interprofessional team requires collaboration, leadership, coordinated decision making, and conflict resolution. Short Answer 1. What are the driving forces behind an interprofessional approach to palliative care? Model Answer: Palliative care requires a comprehensive and holistic approach that cannot be addressed by just one healthcare professional. There is a need to reduce morbidity and mortality rates, improve care coordination, provide patient-centered care, reduce healthcare costs, and enhance group accountability for the quality of healthcare. Healthcare professionals need to work together as a team. This will involve redesigning healthcare education, retraining health professionals already in the workforce, and reforming the overall healthcare system. Research suggests that interprofessional learning is essential for patientcentered, cost-effective, efficient, safer, timelier, and more equitable healthcare. For patients and family members, interprofessional practice can decrease total patient complications, decrease the length of hospital stay, reduce outpatient visits, and reduce mortality rates, including suicide rates. 2. Kacie is 32, married, and the mother of two small children. She was admitted to the hospital with weakness and pain that seemed to come out of the blue. After extensive tests, she has been diagnosed with multiple sclerosis. What would be the advantages of an interprofessional model of care for her? Model Answer: Based on an interprofessional model of care, leadership, communication, Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

and decision-making means leadership is shared and based on patient and family needs and

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

goals. Many different healthcare professionals will be brought together to formulate her plan of care. Team members will directly interact with Kacie and her family, share information, provide consultation, and work interdependently together to provide comprehensive, continuous care. The team will likely consist of her physician, palliative care nurse, as well as a physical therapist, an occupational therapist, and pharmacist. 3. What roles does the interprofessional team nurse have in the therapeutic relationship with the patient and other team members? Model Answer: As a coordinator of care and a core member of the interprofessional team, the nurse has the responsibility of developing therapeutic relationships with the patient and family and among all pertinent members of the team. The goal is to ensure effective and supportive communication and quality patient outcomes. The nurse continually reassesses the goals of the patient and family, and their treatment preferences, and offers support. Often, the physician has had a long-term relationship with the patient and family, and as the needs for traditional medical model of curative care lessen, the physician may feel a sense of loss. The collaborative relationship with the physician may also be a source of support for the physician both personally and professionally. The nurse is also a primary conduit for information, critical assessments, and evaluation of the patient and family goals within the interprofessional team. A critical aspect of palliative care involves the identification and subsequent resolution of often differing goals of the patient, family, or the healthcare team. The nurse is instrumental in coordinating and implementing a comprehensive family-focused plan of care. 4. An advanced care nurse in a 300-bed hospital located in a mid-sized city has taken note of high dissatisfaction rates from patients regarding their hospital stays. The nurse knows that budget cuts have had much to do with this, and is concerned that this may be a continuing trend. While researching other hospitals that are similar in size that are facing the same issues, the nurse reads about interprofessional team healthcare. The nurse is concerned about how well it could be implemented, given the diverse personalities of the hospital healthcare professionals. What steps could the nurse take as an experiment for interprofessional collaboration? Model Answer: The nurse could try an interprofessional case study modeled after the one used by a group of eight interprofessional colleagues in the College of Nursing and Health Sciences. This was a reflective process by the group leader that led to the identification of eight steps of the group collaborative process. These include the discussion of the leadership of the group going forward, depending on clinical issue to be addressed; the group process promoting commitment and accountability, such as establishing the best day and time to meet or the use of technology in conducting meetings, as well as strategies for communication through email; shared group responsibility in reviewing the health sciences literature regarding the care of the specific patient population, with each member contributing their findings during a group discussion from their disciplinary perspective; outlining the components of the comprehensive health history and physical examination from an interprofessional perspective and developing case-specific details; reviewing the case findings with identification and prioritization of clinical diagnoses; developing holistic Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

interventions, including discipline-specific and complementary interventions from an

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

interprofessional perspective to address diagnoses/clinical problems; and involving all team members in the evaluation of health outcomes. This method involved all members contributing equally from their area of expertise instead of using traditional hospital hierarchy. 5. What is necessary to keep the momentum going for healthcare reform through the implementation of interprofessional healthcare teams? Model Answer: Transformative change in education and clinical practice is needed. It will involve interprofessional networking of colleagues within, across, and beyond the university environment and those within healthcare systems and agencies. Further research on the structure, processes, and outcomes related to interprofessional collaboration is needed as it relates to patients and their families, healthcare providers, and institutional outcomes.

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

CHAPTER 4: Ethical Aspects of Palliative Care Multiple Choice 1. If a nurse is wondering if removing a terminal patient’s feeding tube was the right action to do, what is the nurse engaged in? A. Ethics consultation B. Ethical inquiry C. Value clarification D. Moral uncertainty Answer: B Rationale: Ethical inquiry seeks to interpret acts, and to answer such questions as “What is the right thing to do?” includes an evaluation of the moral agent and his or her character, the motive for the act itself, and the effect of the action on others. 2. Which situation is an example of an ethic of caring? A. A nurse who avoids telling terminal patients to prepare for the end of life so they will remain calm. B. A nurse who spends an extra few minutes with each patient to find out how he or she is feeling. C. A nurse who recommends that patients receive palliative care only in the hospital for the best outcome. D. A nurse who urges patients to request opioids for pain relief since they provide the most analgesia. Answer: B Rationale: Caring, within the context of an ethics of care, refers to care for, emotional commitment to, and willingness to act on behalf of persons with whom one has a significant relationship. An example of this is a nurse who spends an extra few minutes with each patient to find out how he or she is feeling because the nurse is forming a relationship with these patients. 3. The custodial parent of a terminally ill child in a hospital has requested that the noncustodial parent be prevented from visiting the child. The concern is that the child will become upset. However, the child has been asking to see the noncustodial parent. The healthcare professionals are trying to decide how to handle the situation. Which concept is involved? A. Moral analysis B. Value clarification C. Ethics of doing D. Ethics of being Answer: C Rationale: Ethical theories that focus primarily on actions and decisions are considered ethics of doing. Moral analysis is employed to discern all the parameters involved in a decision. Ethical theories that focus on an individual’s character attributes and virtues are considered ethics of Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

being. Values clarification is a process of self-reflection that helps individuals identify, consider, and articulate the belief, purposes, and attitudes they prize and that drive their actions. 4.

Which situation describes a nurse breaking the fundamental principle of respect for persons? A. Allowing family to stay in the room with the patient after hospital visiting hours are over B. Questioning whether a patient’s DNR order has been properly documented C. Forgetting to note a dietary allergy in the patient’s chart, which causes an anaphylactic event D. Administering pain medications last to patients on the floor who are on government assistance

Answer: D Rationale: The most fundamental ethical principle within nursing practice is the principle of respect for persons. The first provision in the Code of Ethics for Nurses calls for nurses to “respect the dignity and rights of all human beings regardless of the factors contributing to the person’s health status. The worth of a person is not affected by illness, ability, socioeconomic status, functional status, or proximity to death.” Administering pain medications last to patients on the floor who are on government assistance shows lack of respect for these persons. 5. Melanie has just been diagnosed with early-onset Alzheimerʼs disease. She is terrified about her future and is unsure what do to about her healthcare. Which surrogate decision-making option is the most optimal for Melanie? A. Writing an advance directive that outlines her wishes B. Depending on a family mT EbSeT em r’B sA suN bsKtiStuEteLdLjuEdRg. mC enOtM C. Relying on healthcare professionals to make decisions in her best interest D. Trusting that she will make her own best decisions when she is lucid Answer: A Rationale: There are three standards for surrogate decision making: written advance directives (e.g., living wills), substituted judgment, and best interest. These three standards are ordered so that advance directives have priority over the other two, and substituted judgment has priority over the best-interest standard. The best of all situations is a thoughtfully drafted advance directive applied by a surrogate decision maker who knows the patient’s values and wishes. 6. Jeremy has been living with an aggressive form of leukemia for some time and is currently undergoing chemotherapy. Recently, a nurse making a home healthcare visit said that Jeremy might consider experimental treatments. The survival rate with the experimental treatments is lower than that for chemotherapy, but the side effects are milder. What issue does this present? A. Duty-based ethics B. Principle of double effect C. Nonmaleficence D. Morality Answer: B Rationale: Any discussion that includes attempts to distinguish between harming and benefiting Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

patients often includes the principle of double effect. The traditional formulation of this principle

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

stipulates that four conditions be met before an act with both good and bad consequences may be morally justified: The action itself must be good or at least morally indifferent; the individual must sincerely intend only the good effect and not the evil; the evil effect cannot be the means to the good effect; there must be a proportionately valid reason for permitting the evil effect; that is, there must be a favorable balance between the good and the evil effects of the action. Nurses may appeal to this principle in morally difficult situations where it is not possible to benefit a patient by an action without at the same time causing harm. 7. If a nurse is confronted with an ethical dilemma, which approach would be most useful in resolving it? A. Organize a committee, identify authority figures who can make decisions, notify legal entities B. Consider past actions, present relevant information to patient, have patient make choices C. Gather relevant facts, identify parties involved, identify choices and consequences D. Identify conflicts of ethical principles, give information to authority figures, step away from the situation Answer: C Rationale: Steps that can help resolve an ethical dilemma include reviewing the situation; gathering all relevant facts; identifying the parties or stakeholders involved; identifying relevant legal data; identifying specific conflicts of ethical principles or values; identifying possible choices, their purpose, and their probable consequences to the welfare of the patient; identifying and making use of interprofessional and institutional resources; identifying practical constraints .aCkO to decision making; taking actionTifEySoT uBarAeNthKeSdE ecLisLioEnRm erMor supporting the authorized decision maker; reviewing and evaluating the situation after action is taken. 8. Which consideration demonstrates the primary moral concern for nurses? A. Whether parents are choosing the correct course of chemotherapy for their child B. Whether parents understand if a medication’s benefit outweighs side effects for their child C. Whether family members understand the end of life is near for their loved one D. Whether family members are initiating life-sustaining treatments too late Answer: B Rationale: Optional or nonburdensome treatments include all medications, treatments, and operations that offer a reasonable hope of benefit and can be obtained and used without excessive expense, pain, or other inconvenience from the patient’s perspective. Extraordinary (or burdensome) treatments are those that are very costly, unusual, difficult or dangerous, or do not offer a reasonable hope of benefit to the patient. What should be of moral concern for nurses is not what the intervention is, but whether the benefits of its continued use outweigh its associated burdens, as determined by the patient or surrogate decision maker. 9. Which concern plays a central role in the debate surrounding assistance in dying? A. If prescriptions for lethal amounts of medication is the same as withholding food and water B. That increasing numbers of terminal patients will end their lives rather than receive Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

palliative care

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

C. Negative attitudes that have been directed toward those who choose to end their lives D. A possible cultural shift leading to vulnerable patients perishing too soon Answer: D Rationale: While some individuals benefit from access to lethal prescriptions to control the timing of their death, others are harmed by lack of access, leading to concerns about unintended negative consequences of legalizing and sanctioning this practice. The concern is that allowing healthcare providers to support patients who choose to end their life through legally and professionally sanctioned access to lethal prescription will accelerate a cultural shift that will lead some of the most vulnerable members of society to die too soon. 10. Which statement accurately describes pediatric medical considerations? A. Minors need to be included in decisions about their care B. Parents have the final say about their infant’s care C. Parents can always choose what type of care their children receive D. Minors cannot override parents’ decisions about what care they receive Answer: A Rationale: Minors have rights to be included in end-of-life decision making, depending on their decision-making capacity and maturity. Short Answer

.oCrOalMuncertainty, and a situation in 1. Describe a situation in which Ta EnS u rTseBiA sN exKpS erEieLncLi E n gRm which the nurse is experiencing an ethical dilemma. Explain how these situations are similar, and how they are different. Model Answer: Moral uncertainty occurs when nurses are uncertain if a moral problem exists, are unsure about its nature, and are unclear which values conflict and which principles might facilitate clarification. An ethical dilemma occurs less frequently and is understood as a situation in which two or more clear ethical principles apply that support mutually inconsistent courses of action. Each alternative course of action can be justified by an ethical rule or principle, but one can choose or satisfy only one course of action at the expense of not satisfying the other. A situation involving moral uncertainly could be a patient who is alcoholic and continues to drink even though the alcohol interferes with potentially lifesaving medication. The moral uncertainty could be in how to address the patient’s drinking and discussing the ramifications, especially if the nurse has values against drinking excessively. A situation involving an ethical dilemma is a nurse who is with a patient who has just been sexually assaulted by a man. The attending physician is male, and the patient is terrified to be touched by him. The patient needs care but refuses to be seen by the physician. Both situations require the nurse to do self-inquiry, to come up with the best course of action, and to ensure the client’s care and safety. The first situation, however, requires the nurse to examine his or her own morals. The second situation requires the nurse to discern the most ethical solution.

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

2. Myron is 23 years old and is addicted to heroin. He has been in and out of treatment for his addiction since he was 15 and cannot seem to stay clean. He has lucid moments but is high more often than not. He has just been brought to the emergency room by his parents when they discovered him passed out in his room. As he is being treated for the overdose, the physician notes an orange tint to his skin, mucous membranes, and sclera of his eyes. A liver panel is ordered, and he is tested for hepatitis infection. The physician would like to do further liver testing. What are the steps needed to determine whether Myron is decisionally capable for his own healthcare? Model Answer: A decisionally capable person is able to understand a proposed intervention (or its termination), deliberate regarding major risks and benefits, make a decision in light of that deliberation, and communicate the choice to others (whether verbally or nonverbally). If Myron is decisionally capable, he should understand the condition for which the intervention is recommended (hepatitis infection and/or cirrhosis of the liver), the nature of the recommended intervention (further liver testing), and the risks and benefits of the recommended intervention and of alternative interventions, including no intervention or treatment. The physician should determine that Myron acknowledges that treatment is recommended, he understands how the proposed treatment or lack of treatment can affect his quality of life, and his decision is not substantially based on a delusional belief. 3. What factors are involved in ensuring that justice is done within cost containment measures for healthcare? Model Answer: This is a com TpEleSxTisBsA ueN. K InStE heLcLuE rrR en.t C erO aM of cost containment and social injustice, those who are already marginalized and disadvantaged by poverty, chronic or terminal illness, old age, cultural and racial status, or gender may not think they are entitled to life-sustaining procedures. Additionally, in certain political and societal realms, these people may be seen as a drain on resources and entitled to only minimal care. This is a conflict with the basic tenet of nursing, which is respect for all persons, and nurses may feel a great deal of ethical and moral conflict. However, many who advocate for U.S. healthcare reform agree that cost must be considered in the allocation of healthcare resources. There are increasing numbers of people with chronic critical illnesses in the United States. Fairly weighing such costs and associated burdens against benefits requires interprofessional understanding and cooperative effort among all affected parties within society. Caregivers face challenges in reaching ethical decisions that are fair to individual patients while using available resources responsibly and treating comparable cases alike. 4. Jackie is 14 years old and was hit by a car while riding her bicycle. She has been in a persistent vegetative state for over a year. Her parents are trying to come to terms with letting her go and have started talking about letting her die with dignity. Jackie’s nurses and physicians are recommending withdrawing artificial nutrition and hydration. What are ethical considerations of this? Model Answer: Often the most difficult decisions about withholding treatments are those that involve caring and nurturing interventions, such as providing food and fluids. “Artificial” or technologically provided nutrition and hydration (ANH) is not the same as Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

oral provision of food and water. Food and water are continued to be offered orally as long as

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

patients desire them. However, a moral and legal consensus is that ANH is a medical treatment that may be refused or withdrawn on the same grounds as any other medical intervention—whether it is a benefit or a burden. Jackie’s parents and healthcare providers may have ethical difficulties if they are unclear whether continued provision of nutrition is more beneficial or harmful to Jackie. On one hand, continuing to provide ANH is unlikely to achieve the clinical outcome for which it is most often used, namely, to enhance comfort, prolong life, and improve the quality of life. On the other hand, Jackie is still alive, and the basic tenet of humanity and medicine is “do no harm.” Additionally, nurses should know whether their state’s legislative policy restricts or limits parental rights to decide about the administration of ANH, as that will play a role in the decision as well. 5. What resources are available for nurses to assist them in ethical decision making and to help prevent burnout? Model Answer: Nurses may experience conflict between their own moral values and the values of the profession, and they have the right to remain true to their own conscientious moral and religious beliefs. Although prohibited from compromising legitimate patient choices or imposing their values on others, nurses who are ethically opposed to certain patient interventions will find support for their position in the Code of Ethics for Nurses. They have the right to withdraw from providing interventions that run counter to their core beliefs, assuming that arrangements can be made for the patient’s safe transfer to the care of another. Conflict inevitably arises between nurses’ roles as caregivers and patient advocates, institutional employees, and clinicians expected to implement physicians’ orders. The nurse LoErR ethicist helps nurses identify T anEdSbT etB teA rN mK anSaE geLm al.dC isO trM ess in the workplace. Ethics consultation help staff identify and understand the specific ethical issues the case raises; improve communication between the patient, family, and healthcare team; provide emotional support to the health team members involved in a difficult case; offer ethically justifiable recommendations for how to resolve an ethical question or dilemma; and improve patient care by preventing patient care decisions that run counter to ethical guidelines and standards. Multidisciplinary and nursing ethics committees should be available to nurses for case consultation regarding ethical conflicts. Activities such as “Schwartz rounds” and nurse resilience programs proactively address factors that can lead to moral distress and burnout. Interprofessional ethics rounds also present an opportunity for individuals working in different patient care disciplines to discuss regularly troubling cases that may not require an immediate decision. Such meetings allow for analysis, exploration, and sharing of different points of view. Thus, when ethical problems do occur, a foundation exists to provide guidance about the most effective way to respond.

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

CHAPTER 5: Legal Aspect of Palliative Care and Advance Care Planning Multiple Choice 1. Which legality makes sure that Cho completely understands all the aspects of the hysterectomy her physician recommends before agreeing to the surgery? A. Life-sustaining treatment order B. Advance directive C. Informed consent D. Durable power of attorney for healthcare Answer: C Rationale: The fundamental goals of informed consent are patient autonomy and selfdetermination, empowering them to exercise these rights rationally and intelligently. Informed consent means all the benefits and risks of medical procedures have been explained to the patient before the patient makes a decision whether to receive the treatment or not. 2. Which statement describes informed consent regarding children? A. Children have little sense of autonomy, so parents make healthcare decisions for them. B. Children younger than adolescents can understand treatment options and the potential end of their lives. C. School-age children are uT suEalSlyTaBllAoN wK edStE oL haLvE eR th.eCfiO naMl say on whether they will receive treatments. D. Adolescent children have full autonomy and can make their own healthcare decisions. Answer: B Rationale: A study by Hinds et al. found that children as young as 10 years dying from brain tumors could understand the potential treatment options and recognize that their death could be the consequence of their decision. 3. Delphina is 67 years old, with a history of strokes, and is on Medicare. She does not want to receive painful or invasive procedures that prolong her life but decrease her quality of life and concerned that her children would override her wishes should she have a medical emergency. According to the Patient Self-Determination Act (PSDA), what is her hospital required to provide her that will help her? A. An in-person meeting about individual rights concerning advance directives B. Verbal information about rights under state law to have an advance directive C. Written documents about hospital policies regarding advance directives D. Online sites to research how to write an advance directive Answer: C Rationale: The PSDA requires that facilities participating in the Medicare and Medicaid program provide written information to individuals about hospital policies regarding advance directives and about their right to participate in medical decision making and formulate advance directives. Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Information about rights under state law to have an advance directive and policies regarding advance directive need to be given in writing, not verbally or as a verbal consultation. 4. Which document causes concern for healthcare providers because it may not allow for advances in medical treatment? A. Durable power of attorney B. Do-not-resuscitate directive C. Living will D. Medical directive Answer: D Rationale: Healthcare providers voice concern with the accuracy of medical directives because they do not allow for advances in medical treatment or for the patient to change his or her mind about one of the interventions or situations without changing or destroying the directive. 5. In which case do laws allow physicians to prescribe large doses of opioids? A. Chronic pain B. Intractable pain C. Patient request for the end of life D. Family request for patientʼs end of life Answer: B Rationale: Several states have enacted intractable pain statutes to encourage those who treat patients who are terminally ill a n T dE haSvT eB inA trN acKtaSbE leLpL aiE nRto.m CaOnMage the pain without the threat of legal liability if the treatment results in the patient’s death. Chronic pain, patient request for the end of life, and family request for patientʼs end of life are not legally supported reasons for prescription of large doses of opioids. 6. A patient has been left unconscious from a car accident and had never formulated an advance directive. Which entity has the primary legal right to make decisions on the patient’s behalf? A. Court system B. Healthcare institution C. Family member D. Family lawyer Answer: C Rationale: In 1982, the President’s Commission concluded that family decision making had gained and should be accorded legal acceptance. Motivated by concern over the formal legal status of family decision making in the 1980s, state legislatures recognized and began to regulate it by statute. Since the patient does not have an advance directive, the family lawyer has not been given authority to act on his or her behalf. The healthcare institution and the court system would step in only if no one else is able to act on the patient’s behalf. 7. Which question may be the most beneficial in initiating a discussion with the patient about the end-of-life preparation? A. “Do you have an advance directive for your future medical care?” Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

B. “Is it okay to talk with you about your health and future medical care?”

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

C. “Can we talk about procedures for your future medical care?” D. “Are you okay with talking about legal aspects of your future medical care? Answer: B Rationale: The provider asking for permission to discuss the patient’s current condition and possible future medical care displays caring and sensitivity, and is inviting the patient into a discussion about this difficult topic. Asking about an advance directive, procedures, and legal aspects of future medical care may feel abrupt and insensitive to the patient. These types of questions are more utilitarian in approach and can be off-putting. 8. Which is an accurate statement about advance directives? A. People may think they cause treatment to be withheld unnecessarily. B. Most patients have them and have given them to their physicians. C. Emergency admission is the best time to receive information about them. D. Physicians adhere to them even in conflict with family preferences. Answer: A Rationale: People may be concerned that once an advance directive is completed and it contains a statement to withhold treatment, providers will devote less attention to their care and may withhold more treatment than was desired. The public has not embraced the use of advance directives, and most Americans do not have one even though surveys demonstrate strong support for them. t eE nS anTaBdA vaNnK ceSdEiL reL ctE ivR e. wC itO h M a DNR order and presented it to 9. A patient had previously w r i t T her family and physician. The patient slips into a coma from diabetic complications and her family members are unable to accept the DNR order, forbidding the physician from using it. What is the most appropriate first step for the physician? A. Try to resolve the issue with the family members B. Refer the issue to the courts and have it resolved there C. Bring the issue to an ethics committee for discussion D. Think carefully and critically through the ethical issues Answer: D Rationale: Physicians need to think carefully and critically through the ethical issues themselves before they try to resolve disagreements with the patient or family. It is important that this reflection be done first before other actions so that the physician is clear about all the factors involved in the situation. 10. Which resource would best help nurses in enhancing their knowledge of professional moral obligations? A. American Nurses Association Center for Ethics and Human Rights B. Supreme Court of the United States C. Black’s Law Dictionary D. Joint Commission on Accreditation of Healthcare Organizations Answer: A Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Rationale: Ethics rounds, grand rounds, ethics colloquia, courses in basic nursing education, continuing education offerings, and conferences all provide forums for nurses, students, faculty, and clinicians to enhance their ethical and legal awareness. The American Nurses Association Center for Ethics and Human Rights is one rich resource for nurses who seek consultation and ethics information. Short Answer 1. What are the purposes of natural death acts? Model Answer: Natural death acts sprang from the belief that medical technology had made possible the artificial prolongation of patients’ lives beyond their natural limits. Another underlying assumption of the acts was that adults in the United States have the right to control decisions about how they live their lives as well as how they die. Natural death acts allow patients to refuse excessive medical care at the end of life. In addition, some natural death acts specifically state that “physicians and nurses should not withhold or unreasonably diminish pain medication for patients in a terminal condition where the primary intent of providing such medication is to alleviate pain and maintain or increase the patient’s comfort.” Most states also include in their natural death act a provision that a person’s right to control his or her healthcare may be exercised by an authorized representative who validly holds the person’s durable power of attorney for healthcare. 2. A young and active couple has not discussed how to handle medical issues, thinking it would be something to worry about T inElaStT erByA eaNrsK. SOEn eL oLfEt hRe.mCeOx M p e r i en c e s a traumatic and significant brain injury, and the physicians tell the patient’s partner that recovery is unlikely and asks about the patient’s preferred treatment. What factors will the partner need to consider? Why is it likely the partner will have trouble making decisions about the treatment? Model Answer: In this situation, there is no clear and convincing evidence of what the patient would have wanted, so the partner is being called on to make decisions. The factors that should be taken into account when deciding what is in the patient’s best interest are the level of cognitive functioning, quality of life, treatment options, current level of pain and suffering, likelihood of pain and suffering if treatment is continued versus withdrawn, and benefits and burdens from treatment. Although these factors seem objective, the partner is likely to find the factors difficult to consider, and intense emotions may make it difficult to deliberate carefully. Shapiro (2015) notes that even the most diligent and responsible surrogates experienced a lack of clarity and were unsure about how to weigh the risks and benefits to the patients. It was difficult for the surrogates to extrapolate from incomplete information and to appreciate the uncertainty of a prognosis. Shapiro states that “many surrogates know the right outcome, it is the process that haunts and paralyzes them.” 3. A 74-year-old patient with cancer has been transported to the hospital to be stabilized in the ICU. The patient has an advance directive refusing life-sustaining treatments. The patient’s children arrive to find they cannot talk with him because of his intubation. The physician explains that life-sustaining treatments may be used for the patient, but they are painful and invasive, and it may be time to prepare for the patient’s end of life. The family becomes Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

upset and comes into conflict over further treatment decisions. What could have been done to help prevent or resolve the emotional anguish of this situation? Model Answer: Decision about end-of-life care needs to be made in a family context. Discussion with patients about end-of-life care helps a patient and their family prepare for death. The patient should have made his physician aware of his advance directive, and thoughtful discussions among the patient, his physician, and his children about his choices would have been helpful. The attending physician now has an ethical dilemma about whether to follow the advance directive or to follow the wishes of the patient’s children. Even if the patient had discussed his advance directive with his children, it is still possible they would not be prepared for his end of life and would want life-sustaining treatments performed. Conflicts among the physician, the patient’s wishes, and his family about his end-of-life care may need to be resolved by the development of consensus about goals for care through listening, thoughtful discussion, multidisciplinary rounds, and ethics consultation. 4. Describe physician orders for life-sustaining treatment (POLST). Model Answer: Physician orders for life-sustaining treatment (POLST) are not an advance directive. They are a set of medical orders for a patient with a serious, life-threatening condition. The physician discusses predictable future events for a patient with a lifethreatening condition (such as cardiac arrest with severe heart failure) and determines in conjunction with the patient or surrogate how the patient should be treated if/when the events arise. A document is created that specifies the treatment the physician has prescribed. The document is usually brightly T coEloSreTdBsA oN thKatSiE t iL sL eaEsR y .t oCi dOeMn t i f y , and it accompanies the patient across healthcare settings, ensuring continuity of care. It is designed to provide quick, clear guidance to healthcare providers about the care that the patient desires and the primary healthcare provider has prescribed. The categories for choices on POLST forms vary from state to state. Physicians, after consultation with their patients or surrogates, prescribe either “attempt resuscitation” or DNAR at the start of the document. Other categories on the documents used in most states provide places for the physician to prescribe or to withhold a range of medical interventions from comfort measures only to full treatment, the use of antibiotics, and the administration of artificially administered nutrition. 5. Explain how the nurse is an advocate for a patient’s end-of-life preferences. Model Answer: As the ANA has stated in its position statement, it is the responsibility of nurses to facilitate informed decision making for patients at the end of life. This responsibility begins when the nurse has a patient consider what would be important to him or her at the end of life, continues with the nurse educating the person about end-of-life care options, and is completed when the nurse advocates for and delivers the type of care the patient desires at the end of her or his life. However, this process of communication about EOL care is not solely the responsibility of the patient and the nurse; it is an interprofessional process that includes at least the physician and family in addition to the patient and nurse. On admission to a healthcare institution, the nurse should ask the patient and family if the patient has an advance directive and, if a directive exists, whether they can produce a copy of the directive. The nurse or another healthcare provider needs to inquire if the patient still wants Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

the directive to take effect. The nurse may use the directive to help families to understand and follow the choices laid out in the directive for a family member who has become gravely ill and is incapacitated. Often, however, no advance directive exists. When the patient is gravely ill, it is often the nurse who first notices that death is approaching. Clear communication to the family and physician is essential at this time because the family frequently has not considered death as an alternative. If death appears imminent and there has been no decision about end-of-life expectations, nurses may introduce the discussion of withholding or withdrawing life-sustaining interventions, such as CPR, intubation, and ventilation. Most patients and families want to discuss end-of-life care with their nurse, but they need to hear the same message from the patient’s physician. The nurse must be in communication with the physician about the patient’s prognosis and the patient and family’s preferences about end-of-life care. In situations in which death is not imminent, the nurse can assist a surrogate or family member to understand her or his role in the multidisciplinary team and to help make the decision about the patient’s end-of-life care. The nurse must educate the person about what the role of the surrogate entails as well as how important it is.

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

CHAPTER 6: Culture and Spirituality as Domains of Quality Palliative Care Multiple Choice 1. When a patient has a terminal illness, which aspect informs the nurse the most about how the patient will approach death? A. Level of education B. Cultural background C. Views of family members D. Type of support system Answer: B Rationale: Cultural background relates to the degree of fatalism or activism in accepting or controlling death, and maintaining hope, as well as to the views of the patient and family about death. Level of education, views of family members, and type of support may play roles in how the patient approaches death, but the core factor is the patient’s cultural background. 2. Qiu is a Chinese American and the patriarch of his family. Qiu is now 84 years old and in end-stage renal failure. What can the nurse expect when approaching him about the end-oflife care? A. Request for hospice services prEoS gnToB siA s NKSELLER.COM B. Reluctance to discuss the T C. Belief in fighting to the end D. A sense of fatalism Answer: B Rationale: Generally, members of Chinese culture are reluctant to discuss prognosis and diagnosis as they believe discussing end-of-life issues is like wishing death upon the patient, or may lead to hopelessness, especially as terminal illness is not socially accepted. There is also the belief a person’s final days should be characterized by calm and that the patient should not be involved in decision making. 3. If a nurse refrains from casually touching and making direct eye contact with a patient because these actions are considered disrespectful, which principle is being observed? A. Cultural diversity B. Cultural awareness C. Cultural sensitivity D. Cultural knowledge Answer: C Rationale: Cultural sensitivity requires the recognition of individual attitudes and beliefs and a refinement of communication skills related to active listening, use of silence and touch, conversational distance, language patterns, and the effective use of translators. Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

4. Which action demonstrates cultural awareness on the part of the nurse? A. Consider the role of family members in making decisions regarding patient care. B. Asking a family member to translate medical treatment procedures to the patient C. Being honest with the patient about his or her chances of survival D. Avoiding asking about the patient’s spiritual beliefs because these are private Answer: A Rationale: Consideration should be given to the issue of family involvement in decision making. Disagreement and conflict between family and healthcare professionals may occur when the family insists on making decisions for patients who have decisional capacity. As healthcare professionals, it is important to identify the key members of the family and involve them in the discussions as desired by the patient. 5. What is the purpose of the nurse asking patients about their degree of ethnic identity, family structure, and beliefs about health and illness? A. Assess cultural diversity B. Create cultural competencies C. Determine cultural sensitivity D. Conduct cultural assessments Answer: D Rationale: In conducting cultural assessments, there are many areas to be addressed, including asking patients about their Degree of ethnic identity, family structure, and beliefs about health and illness. 6. Jaime explains to her physician that she feels calm in the face of her end of life because she believes she will be transitioning to another plane of existence in the universe. What is Jaime describing? A. Her religiosity B. Her spirituality C. Her culture D. Her reverence Answer: B Rationale: Throughout a person’s lifetime, and particularly as people age, religion and spirituality assist them to confront their finitude and vulnerability; to uncover meaning, value, and dignity in illness and death; to establish connection with others and a higher life force; and to find hope, love, and forgiveness in the midst of fear and despair. As such, spirituality engenders serenity and transcendence, thereby buffering stress. Religiosity is one means of expressing spirituality. Religiosity refers to beliefs and practices of different faiths and an acceptance of their traditions, such as Catholicism, Eastern perspectives, Islam, Judaism, and Protestantism. 7. What relationship do spirituality and religiosity have with end-of-life care? A. Patients may use them to assert an indirect form of control B. They are a small part of the patient’s plan of care C. Patients should never substitute them for medical treatment Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

D. They have a slight effect on the despair and isolation patients may feel

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Answer: A Rationale: Religiosity or spirituality also facilitates coping with chronic pain, disability, and serious illness by providing an indirect form of control that helps to interrupt the cycle of anxiety and depression. For some individuals, prayer provides a form of control by believing that through prayer they can influence their medical outcome; in contrast, others deliberately turn over to God their health situation. It is essential that the patient’s spirituality and/or religiosity be integrated into the patient’s plan of care because they can be a source of comfort and anxiety relief. 8. How can nurses best help alleviate a patient’s suffering? A. Assure the patient that family members are unaffected B. Tell the patient that physical pain is the predominate form C. Disclose to the patient personally painful events in a show of empathy D. listen to the feelings and experiences of a patient’s losses and how they found meaning. Answer: D Rationale: Genuinely listening to the patient navigate through losses to find meaning can help alleviate a patient’s suffering. This builds trust; the patient will not feel alone, can express thoughts of despair, and search for hope. 9. What is the nurse engaged in by asking the patient questions about their faith, their religious community, and whether faith is helping them cope? A. Spiritual assessment B. Spiritual caregiving C. Spiritual distress D. Spiritual intervention Answer: A Rationale: The nurse is engaged in spiritual assessment to determine what spiritual or religious needs the patient may have. 10. How can hospice and palliative care nurses prevent or alleviate burnout? A. Research spiritual aspects of other cultures B. Align patientʼs spiritual needs with their own C. Take care of their own spiritual needs D. Keep their spiritual side separate from their work Answer: C Rationale: In caring for people with life-threatening and progressive illness, nurses must remain in tune with their own spiritual needs, healing themselves as well as others. Short Answer 1. What are the seven themes representing core principles relevant to Native American healthcare identified by Lowe and Struthers (2001)? Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Model Answer: The themes include caring, which embodies characteristics of health, relationships, holism, and knowledge, and is characterized as a “partnership in healing”; traditions, which refers to valuing and connection with heritage; respect, which includes characteristics of honor, identity, and strength and refers to the components of presence and compassion; connection, which honors all people, the past, present, and future, harmony with nature, and explores differences and similarities; holism, which includes balance and culture; trust, which is characterized through relationship, presence, and respect; and spirituality, which includes unity, honor, balance, and healing and includes components of touching, learning, and utilizing traditions to recognize oneness and unity. 2. Olivia is a recent graduate of nursing school. In her first week of work at the hospital, Bharat is admitted. Bharat is from India and is now living in the United States with her adult son. She has had a persistent productive cough, and her respiration has become labored. Olivia comes in one day to discover that Bharat died during the evening. She is horrified to see someone from Bharat’s family tending to her body, and to hear that Bharat will be cremated. Olivia is confused and thinks that someone should explain how things are done in America. Which principles of culturally sensitive care would Olivia benefit from? Model Answer: The first principle is to be knowledgeable about cultural values and attitudes. Healthcare professionals should attend to a patient’s needs in a sensitive, understanding, and nonjudgmental way, and respond with flexibility as much as possible. Olivia should understand that cultures different from hers have different rituals surrounding death. For Asian Indians, after death, family members should be the only ones to touch the body, and ideally a family meTmEbS erToBf A thNeKsaSmEeLsL exEsRh. ouCldOM clean the body. After the body is cleansed, a cloth is tied under the chin and over the top of the head, and the body is wrapped in red cloth. Embalming and organ donation are prohibited, and there is a preference for cremation. The tenth principle is for health professionals to conduct a self-assessment of their own beliefs about illness and death. For Olivia, this would include how her beliefs influence her attitudes; how culture and religion influence her personal attitudes toward death; what kind of death does she prefer for herself; what efforts does she believe should be made to keep a seriously ill person alive; how their bodies should be disposed of; as well as what rituals they have participated in to honor the dead. 3. Malachi grew up without spiritual or religious instruction and identifies as an agnostic. He is a nurse in a small community hospital. The community has a strong religious presence, with churches of several denominations, a synagogue, and a mosque with a small congregation. Malachi has been the nurse for several patients as they faced end of life. Each has requested that he pray for him or her, and once a family clasped hands in a prayer circle around their loved one’s hospital bed and asked Malachi to join them. These situations have made Malachi acutely uncomfortable and unsure of what to say. He wants to be respectful but is at a loss for words. What recommendations could be made to Malachi? Model Answer: Since the spiritual needs of the patient are important, Malachi could talk with his supervisor about the best approaches. He could do a self-evaluation about what he is comfortable doing and saying. Patients at end-of-life care just need to feel their caregivers are present and genuine, and sometimes a touch on the shoulder and a smile are enough. His Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

kindness will show through. He may not need to say anything and just respectfully listen to

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

the patient and the patient’s family. He could also say something like, “You are in my thoughts and I am here for you.” What he should not do is offer his personal beliefs of agnosticism. 4. How can healthcare professionals help patients discover hope during a serious illness and end-of-life care? Model Answer: Despite the stage of illness and a situation of poor prognosis, healthcare professionals can provide hope and a positive outlook by discussing goals of care, offering symptom control, providing supportive resources, and promising the patient that they will not abandon her or him. At times, the most important way to provide hope is by listening attentively and being physically present, which convey a sense of value and affirmation of worth. Hope is then gained that the patient will not be abandoned and isolated. Health professionals can help dying patients co-create meaning day by day while emphasizing the importance of bearing witness to the struggles, joys, and hope of the dying person. 5. Describe ways health professionals can be spiritual caregivers for their patients. Model Answer: During hospitalizations, health professionals may ask if the person would like to speak with the clergy or chaplain or have the opportunity to attend a hospital worship service. Patients may also be asked if they would like someone to pray with or for them or have spiritual reading materials. If a person is not religious or does not want a health professional to address religious issues, spiritual conversations around hope, love, courage, and forgiveness can occur in T thE eS prToB viA deNr–KpSatEieLnL t rEeR la. tioCnO shMip. Humor also has an effect on the spiritual aspect of healing, as many patients find humor “spiritually uplifting.” Health professionals can also encourage patients to socialize with friends, family, and children, as well as encouraging them to help others, even if only by active listening. Adults can also pass on their legacy to others by recording personal histories, telling stories, and reminiscing about the past. If the person is isolated, the health practitioner can suggest his or her watching spiritual or religious television programs or provide an opportunity to enjoy his or her favorite sacred or secular music, or other forms of art. Healthcare professionals may encourage opportunities for patients to experience nature in whatever ways they can, such as a walk or wheelchair ride in the garden or courtyard, or as they sit outside feeling the air and warmth of the sun. Spiritual uplifting in the present moment can also occur as the practitioner attempts to create meaning and a source of pleasure in the present moment.

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

CHAPTER 7: Intimacy and Sexual Health Multiple Choice 1. Which statement describes sexual health? A. Ability of sexual structures to orgasm B. Optimally functioning sexual organs C. Ability to communicate sexual needs and desires D. Physical, emotional, and social aspects of being sexual Answer: D Rationale: One definition of sexual health is the integration of somatic, intellectual, and social aspects of being sexual. The ability of sexual structures to orgasm and optimally functioning sexual organs are only part of sexual health—the somatic aspect. The ability to communicate sexual needs and desires is also only part of sexual health—the intellectual aspect. 2. A patient has been treated for breast cancer and is seeing her physician for a follow-up examination. She has been wondering if it is okay to resume sexual relations with her husband, but instead avoids eye contact with her physician and answers in monosyllables. What issue is most likely preventing the patient from talking with her physician about sex? A. She is embarrassed. B. She would like more privacy. sE toS oTbB usAyN . KSELLER.COM C. She thinks her physician iT D. She is unsure if her physician is knowledgeable. Answer: A Rationale: Sexuality assessment is frequently overlooked by palliative care providers when healthcare needs are being assessed. Healthcare professionals may avoid discussion of sexuality because of embarrassment, assuming that the sex life is over due to the disease, lack of knowledge, and lack of time. Patient-reported barriers can include embarrassment, privacy, and environmental factors. The patient’s behavior indicates that she is embarrassed. 3. Which statement most describes conversations between healthcare professionals and their patients about the patients’ sexual issues? A. Healthcare professionals usually initiate the dialogue. B. Healthcare professionals may be too embarrassed to discuss these issues. C. Healthcare professionals are eager to offer their knowledge. D. Healthcare professionals are willing to set aside time for these issues. Answer: B Rationale: Healthcare professionals’ barriers to discussing sexuality include embarrassment, misinformed beliefs and assumptions, lack of knowledge, inadequate communication skills, and time constraints. Sexual health is not routinely assessed due to the belief that the patient will bring up the topic if it is a concern; the perception that people are “too sick” to be sexual; lack of their own comfort with the topic; preconceived ideas, attitudes, and values regarding sexuality; Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

perceived lack of time for this conversation; and the feeling that there are “more important” issues to be addressed. 4. When should the initial assessment of the patient’s sexual needs be made? A. After healing is complete B. Before the diagnosis C. At the time of diagnosis D. During the course of treatment Answer: C Rationale: The most effective communication addresses the needs of the patient at each stage of his or her illness. The initial assessment should begin when the diagnosis is made and continue throughout the disease process. Communication with cancer patients is delicate in that the disease is both life threatening and potentially treatable or curable, which creates much uncertainty and stress on the patient. 5. Women most likely to report sexual issues are those diagnosed with which type of cancer? A. Colorectal B. Breast C. Gynecological D. Lung Answer: B Rationale: Hughes et al. (2017) stTuE diS edTsBeA xuNaK l hSeEalLt hLoEf Rw.o C mOe nMd i a g n o s e d with breast cancer versus non-breast-cancer patients, noting that issues of sexual dysfunction are primarily documented in colorectal or gynecological cancer. However, their study found that regardless of demographic variables, women diagnosed with breast cancer were statistically more likely to report sexual problems. Women living with breast cancer typically experience body image issues, permanent menopause resulting from cancer treatments, and aromatase inhibitors that negatively affect sexual expression. Other types of cancer can result in sexual issues, but breast cancer causes the most reporting of sexual issues. 6. What change in sexual health is usually focused on for men? A. Prostate function B. Sperm production C. Testosterone levels D. Erectile function Answer: D Rationale: Alterations in sexual health for men primarily focus on erectile function. Cancer treatments can interfere with erection by damaging a man’s pelvic nerves, pelvic blood vessels, or hormone balance. Prostate, bladder, and colon cancer are often treated with radiation to the pelvis. The higher the total dose of radiation and the wider the section of the pelvis irradiated, the greater the chance of an erection problem later. Erectile dysfunction (ED) is a common complication of diabetes (secondary to autonomic neuropathy, vascular insufficiency, or psychological factors) in at least half of men over age 50. ED can also occur as a result of cardiovascular disease, Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

hypertension, hypercholesterolemia, smoking, and the abuse of drugs including alcohol. Prostate

Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman

function, sperm production, and testosterone levels can also be of concern, but the primary concern is erectile function. 7. A patient is being prepped for laser surgery for cervical cancer. Her respirations increase, and she begins sweating. As the treatment begins, she starts trembling and crying, then yells for the physician to stop while pulling herself away from the physician. What is the patient most likely experiencing? A. Posttraumatic stress symptoms B. Fear about the prognosis C. Sexual health anxiety D. Pain from the procedure Answer: A Rationale: Posttraumatic stress symptoms (PTSS) can be exemplified by re-experiencing the trauma, avoidance of trauma-related stimuli, and negative alterations of cognition, mood, arousal, and reactivity following exposure to a stressor. It is possible that the patient could be experiencing fear about the prognosis, sexual health anxiety, and pain from the procedure, but her extreme reactions point to PTSS. 8. What characterizes sexuality in those with severe illness? A. Sexual health concerns vary widely B. Positional modifications are too cumbersome C. Masturbation is used only minimally for sexual gratification D. Patients feel encouraged tT oE enSgTagBeAiN nK paSrtEnL erL edEsRe. xuCaO l aMctivity Answer: A Rationale: Sexual health concerns in those with severe illness vary widely. Some patients are comfortable talking with their healthcare professionals about issues, some are not. There are psychological, physical, and emotional aspects of sexuality that can be traumatized by severe illness, and it is difficult to determine what these will be at the onset of disease. 9. A patient is being treated for testicular cancer and would like to discuss sexual issues with his healthcare professional. Which question should his healthcare professional ask first? A. Can you describe your issues with erectile dysfunction? B. What are your concerns about being able to father children? C. How has your illness affected your emotional intimacy with your partner? D. What are your worries about your attractiveness to your partner? Answer: C Rationale: While patients indicate that emotional connections take precedence over physical concerns, healthcare professionals may focus more on whether a patient is capable of having sex and on the impact of illness on menopause, erectile, or fertility status. This perspective offers a medicalized approach to sexuality, which may be different than the patient’s goals. Asking the patient’s concerns for emotional intimacy with his or her partner is a good way to initiate dialog and what is likely foremost in his or her mind. Test Bank for Palliative Care Nursing Quality Care to the End of Life 5th Edition by Marianne Matzo, Deborah Sherman