Deck 48: Loss,grieving,and Death

Question 1

Mrs.Jakobs' son has just died.He was living with HIV and most recently AIDS.What can the nurse do at this time to provide comfort for Mrs.Jakobs?

A)Be present in silence with Mrs.Jakobs
B)Tell her that her son is at peace now
C)Let her know that time will heal her wounds
D)Ask her whether funeral arrangements have been made

Answer 1

Be present in silence with Mrs.Jakobs

Question 2

A client with terminal lung cancer complains of being short of breath.He has bilateral crackles and wheezes,despite oxygen at 4 Lpm via nasal cannula and diuretic therapy.What nursing interventions are appropriate for this client? (Select all that apply.)

A) Move the client to a room closer to the nurse's desk for closer observation
B) Help the client assume a position lying on the right side
C) Place a fan in the room to move air around the client
D) Change the client's oxygen therapy to a non-rebreathing mask
E) Elevate the head of the client's bed to a Fowler's position
F) Consider use of a prn morphine sulfate order

Answer 2

Place a fan in the room to move air around the client
Elevate the head of the client's bed to a Fowler's position
Consider use of a prn morphine sulfate order

Question 3

In which of the following age ranges is it characteristic to accept one's own mortality?

A)9 to 12 years
B)12 to 18 years
C)18 to 45 years
D)45 to 65 years

Answer 3

45 to 65 years

Question 4

The nurse is caring for a client whose family does not want to tell him that he is dying.What is the nurse's best action according to these wishes?

A)Arrange an encounter with the client and tell him the truth
B)Change the subject when the client asks about his impending death
C)Tell the family that the patient has the right to know that he is dying
D)Talk to the family about the situation and their concerns

Question 5

Ms.Cruikshank is a student nurse who is experiencing her first day on a palliative care unit.She is interested in the physiological and sensory changes that occur before death.How does the RN respond when Ms.Cruikshank asks about which sense is the last lost before death?

A)Sight
B)Smell
C)Hearing
D)Touch

Question 6

The nurse is counselling a family in which a member is terminally ill.The family has children of varying ages.What should the nurse teach the family about the reactions of children to death?

A)Toddlers perceive death as irreversible.
B)Preschool children view death as a spiritual release.
C)At about age 9,children begin to understand death is inevitable.
D)Adolescents' views are influenced by cultural beliefs.

Question 7

Mrs.Donaldson has her extended family over to her house the day before her father's funeral.With the exception of her youngest son,Daniel,everyone is helping to put a picture story board together before the service.Daniel is outside on the swing in the back yard.In regards to supporting Daniel and his grief,what should Mrs.Donaldson do?

A)Talk to Daniel to see how he is feeling
B)Bring Daniel inside to join the other family
C)Have the other children go out and join Daniel
D)Have Daniel write a story about his grandfather for the picture board

Question 8

Which of the following is a clinical sign of imminent death?

A)Flat encephalogram
B)Sensory impairment
C)Muscle rigidity
D)Unconsciousness

Question 9

Mr.Van Buskirk's wife just died 30 minutes ago on the medical unit.What actions by the nurse supports Mr.Van Buskirk's grieving? (Select all that apply.)

A) Be present,but comfortable with silence
B) Assists him with the arrangements for the funeral home
C) Suggest resources such as grief support groups
D) Speak in terms of what he needs and not his current pain
E) Respect his cultural and religious values related to his loss

Question 10

Mr.Raffin is caring for his terminally ill wife at home.He has children that live close by and are in daily contact with him.Mr.Raffin asks the nurse how he will know when death is close so that he can make sure his children are with him.Which of the following are signs of imminent death? (Select all that apply.)

A) Relaxation of the facial muscles
B) Flushed skin of extremities
C) Abdominal distention
D) Deep rhythmic breathing
E) Complaints of blurred vision

Question 11

Which of the following is feared most by an older adult facing death?

A)Nausea
B)Loss of control
C)The cost of terminal care
D)The unknown

Question 12

Mrs.Donaldson's father has just died.She says to the nurse,"How will I help my young son cope with this loss?" What information can the nurse provide to Mrs.Donaldson?

A)Give the child permission to be sad
B)Pray with him for his grandfather's soul
C)Tell the child that his grandfather went to sleep and will not wake up
D)Deal with your own grief privately first

Question 13

The nurse is providing postmortem care for a client whose family would like to view the body before it is transported to the morgue.Which of the following interventions are necessary for this preparation? (Select all that apply.)

A) Provide a total bed bath
B) Place absorbent pads beneath the body
C) Remove dentures
D) Dress the client in street clothes
E) Place a pillow under the head
F) Tape the eyelids closed

Question 14

The nurse is discussing end of life care with Mrs.Masters,a 61-year-old mother of two grown daughters.She has terminal uterine cancer.Mrs.Masters is very clear about the care she wishes to receive,and does not want to leave any difficult decisions to her daughters.Which of the following best describes the appropriate legal document to provide health providers with direction for future care for Mrs.Masters?

A)Living will
B)Advance directive
C)Proxy directive
D)Power of attorney

Question 15

A client who has just been diagnosed with a slowly progressive terminal illness asks the nurse about the availability of hospice services.What information should the nurse share with this client?

A)When clients are designated as terminally ill,they are automatically assigned to hospice care.
B)Hospice services are generally reserved for those who have a life expectancy of 6 months or less.
C)Hospice care is based on seeking cure of the underlying illness.
D)Provision of hospice services is reserved only for those who refuse other palliative treatments.

Question 16

The nurse is providing support for a bereaved client.What does the nurse need to know about the experience of grief?

A)Experienced differently by different people
B)Best carried out in solitude
C)Expressions of grief for longer than 6 months are socially unacceptable
D)Detrimental to emotional well-being

Question 17

The terminally ill client states to the nurse,"I'm just not ready to go." Which of the following is the most appropriate response by the nurse?

A)"Tell me more about what you mean when you say that you're not ready."
B)"You're not ready to go where?"
C)"Don't be afraid,dying is a natural process."
D)"I can understand that.Most people don't want to die."

Question 18

What should the nurse understand when applying models of grief to terminally ill clients?

A)The Kubler-Ross model is primarily used to describe anticipatory grief.
B)No clear timetables exist,nor are there clear-cut stages of grief.
C)The models serve as clear and definitive predictors of grief behaviours.
D)There is strong research proving that these models are not useful for many dying clients.

Question 19

Palliative care competencies include listening,engaging in difficult conversations,and the ability to be present with clients.

Question 20

Which of the following is a useful nursing intervention in treatment of anxiety associated with receiving a terminal diagnosis?

A)Explore the client's history with other stressful life events and how they coped at that time
B)Speak with the family about how best to help the client cope
C)Provide information about the client's terminal illness only on a need to know basis
D)Encourage early pharmaceutical intervention with anti-anxiety and sedative medications

Question 21

The nurse in a palliative care unit is caring for Mrs.Redmond,an 81-year-old terminally ill client.While completing Mrs.Redmond's assessment,she complains of feeling short of breath.Her vital signs are as follows: T-36.9,Pulse 52 and thready,and Respirations 18 and regular.What should the nurse do next?

A)Consult the physician for possible chest X-ray (CXR)
B)Provide prn bronchodilator
C)Contact physician to report heart rate
D)Change her position

Question 22

The husband of a client with a terminal illness states that he will miss evening walks with his wife.This comment best indicates which type of loss?

A)Actual loss
B)Perceived loss
C)Anticipatory loss
D)Anticipatory perceived loss

Question 23

After a biopsy,the client tells his physician that if the mass is malignant,he wants to know,but he does not want any further treatment or his family to know.What would be a major nursing responsibility in caring for the client?

A)Convince him to tell his family
B)Suggest he consider treatment options
C)Support his decisions regarding care
D)Contact his family so they can help him

Question 24

What is the earliest age at which most persons accept death as being irreversible?

A)3 years old
B)5 years old
C)9 years old
D)12 years old

Question 25

A nurse is caring for terminally ill clients on a palliative care unit.What considerations does the nurse need to make to provide supportive care to these clients?

A)Evaluate her own ability to interact supportively in this area
B)Enhance the client's body image
C)Provide accurate information and education
D)Assist the client to identify spiritual concerns

Question 26

Which of the following describes the legal document that specifies who will make care decisions for a client when they are unable?

A)Self-determination act
B)Proxy directive
C)Living will
D)Advance directives

Question 27

Ms.Clarence is a student nurse caring for a terminally ill client on the palliative care floor.When discussing her plan of care for the day with the RN,she discusses pain control.What statement by Ms.Clarence indicates that a knowledge gap exists in relation to pain control of the palliative client?

A)Analgesics are most effective if given prn.
B)Opioids generally are the drugs of choice.
C)Massage can be used as an adjunct treatment.
D)Fear of precipitating a delirious episode may result in undertreatment.

Question 28

Which of the following interventions would best help to maintain a dying client's dignity and sense of self-worth?

A)Allow the client to make choices and set timetables for scheduled activities
B)Suggest that the client die quietly at home in a familiar environment
C)Have other terminally ill individuals visit the client
D)Schedule uninterrupted quiet time for the client to reflect on her past