Deck 17: Loss,Grief, Dying

Question 1

The mother of a preschool child dies suddenly of a ruptured cerebral aneurysm.What recommendation should the nurse make to the family regarding how to most therapeutically care for the child?

A) Take the child to the funeral even if he is frightened.
B) Notify the physician immediately if the child shows signs of regression.
C) Spend as much time as possible with the child.
D) Provide distraction whenever the child begins to express feelings of sadness.

Answer 1

Spend as much time as possible with the child.

Question 2

According to the Uniform Determination of Death Act,which bodily function must be lost to declare death?

A) Consciousness
B) Brain stem function
C) Cephalic reflexes
D) Spontaneous respirations

Answer 2

Brain stem function

Question 3

According to William Worden,which task in the grieving process takes longest to achieve?

A) Accepting that the loved one is gone
B) Experiencing the pain from the loss
C) Adjusting to the environment without the deceased
D) Investing emotional energy

Answer 3

Accepting that the loved one is gone

Question 4

What emotional response is typical during the Rando's confrontation phase of the grieving process?

A) Anger and bargaining
B) Shock with disbelief
C) Denial
D) Emotional upset

Question 5

A patient dying of heart failure has changed his choice about his end-of-life treatment measures several times.He says,"I just can't make up my mind about it." Which nursing diagnosis is most appropriate for this patient?

A) Deficient Knowledge
B) Spiritual Distress
C) Decisional Conflict
D) Death Anxiety

Question 6

A 73-year-old patient who suffered a stroke is being transferred from the acute care hospital to a nursing home for ongoing care because she is unable to care for herself at home.Which type of loss is this patient most likely experiencing?

A) Environmental loss
B) Internal loss
C) Perceived loss
D) Psychological loss

Question 7

Which dysrhythmia confirms death?

A) Asystole (absence of heart activity)
B) Pulseless electrical activity
C) Ventricular fibrillation
D) Ventricular tachycardia

Question 8

Which patient is at most risk for experiencing difficult grieving?

A) The middle-aged woman whose grandmother died of advanced Parkinson's disease
B) The young adult with three small children whose wife died suddenly in an accident
C) The middle-aged person whose spouse suffered a slow, painful death
D) The older adult whose spouse died of complications of chronic renal disease

Question 9

Which of the following patient goals is most appropriate when managing the patient dying of cancer? The patient will

A) Request pain medication when needed
B) Report or demonstrate satisfactory pain control
C) Use only nonpharmacological measures to control pain
D) Verbalize understanding that it may not be possible to control his pain

Question 10

A patient with a history of chronic obstructive pulmonary disease has a living will that states he does not want endotracheal intubation and mechanical ventilation as a means of respiratory resuscitation.As the patient's condition deteriorates,the patient asks whether he can change his decision.Which response by the nurse is best?

A) "I'll call your physician right away so he can discuss this with you."
B) "You have the right to change your decision about treatment at any time."
C) "Are you sure you want to change your decision?"
D) "We must follow whatever is written in your living will."

Question 11

Which intervention takes priority for the patient receiving hospice care?

A) Turning and repositioning the patient every 2 hours
B) Assisting the patient out of bed into a chair twice a day
C) Administering pain medication to keep the patient comfortable
D) Providing the patient with small frequent, nutritious meals

Question 12

A patient's wife tells the nurse that she wants to be with her husband when he dies.The patient's respirations are irregular,and he is congested.The wife tells the nurse that she would like to go home to shower but that she is afraid her husband might die before she returns.Which response by the nurse is best?

A) "Certainly, go ahead; your husband will most likely hold on until you return."
B) "Your husband could live for days or a few hours; you should do whatever you are comfortable with."
C) "You need to take care of yourself; go home and shower, and I'll stay at his bedside while you are gone."
D) "Don't worry. Your husband is in good hands; I'll look out for him."

Question 13

How should the nurse respond to a family immediately after a patient dies?

A) Ask the family to leave the patient's room so postmortem care can be performed.
B) Leave tubes and IV lines in place until the family has the opportunity to view the body.
C) Express sympathy to the family (e.g., "I am sorry for your loss").
D) Tell the family that they will have limited time with their loved one.

Question 14

When providing postmortem care,the nurse places dentures in the mouth and closes the eyes and mouth of the patient within 2 to 4 hours after death.Why is the timing of the action so important?

A) To prevent blood from settling in the head, neck, and shoulders
B) To perform these actions more easily before rigor mortis develops
C) To set the mouth in a natural position for viewing by the family
D) To prevent discoloration caused by blood settling in the facial area

Question 15

Mr.Jackson is terminally ill with metastatic cancer of the colon.His family notices that he is suddenly more focused and coherent.They are questioning whether he is really going to die.The nurse recognizes that a sudden surge of activity may occur

A) Moments before death
B) Days to hours before death
C) 1 to 2 weeks before death
D) 1 to 3 months before death

Question 16

During a health history,a patient whose wife died unexpectedly 6 months ago in a motor vehicle accident admits that he drinks at least six bourbon and waters every night before going to bed.Which type of grief does this best illustrate?

A) Delayed
B) Chronic
C) Disenfranchised
D) Masked

Question 17

Which nursing intervention should be included in the plan of care for a patient dying of cancer?

A) Encourage at least one family member to remain at the bedside at all times.
B) Follow-up with other healthcare team members during weekly meetings.
C) Avoid discussing the dying process with family (to reduce sadness).
D) Encourage family members to participate in care of the patient when possible.

Question 18

Which intervention by the nurse is most appropriate when she notices that her dying patient has developed a "death rattle"?

A) Perform nasotracheal suctioning of secretions.
B) Turn the patient on his side and raise the head of the bed.
C) Insert a nasopharyngeal airway as needed.
D) Administer morphine sulfate intravenously.

Question 19

An elderly man lost his wife a year ago to cardiovascular disease.During a healthcare visit,he tells the nurse he has begun adjusting to life without his wife.According to John Bowlby,which stage of grief does this comment most likely indicate?

A) Shock and numbness
B) Yearning and searching
C) Disorganization and despair
D) Reorganization

Question 20

The nurse has been explaining advance directives to a patient.Which response by the patient would indicate that he has correctly understood the information? "An advance directive is a document

A) Specifying your healthcare intentions should you become unable to make self-directed decisions"
B) Identifying the activities considered to be evidence of quality care"
C) Verifying your understanding of the risks and benefits associated with a procedure"
D) Allowing you the autonomy to leave the hospital when you decide, even if it is against medical advice"

Question 21

Throughout the course of his illness,a patient has denied its seriousness,even though his health professionals have explained prognosis of death very clearly.Physiologic signs now indicate that he will probably die within a short period of time,but he is still firmly in a state of emotional denial.The patient says to the nurse,"Tell my wife to stop hovering and go home.I'm going to be fine." How should the nurse respond?

A) "Your physical signs indicate that you will likely not live more than a few more days."
B) "You seem very sure that you are not going to die. Please tell me more about what you are feeling."
C) "It seems to me you would be feeling some anger and wondering why all this is happening to you."
D) "It would be best for your family if you were able to work through this and come to accept the reality of your situation."

Question 22

Which intervention should be included in the plan of care for a patient in the end-stage death process?

A) Encourage the patient to accept as much help as possible.
B) Avoid administering laxatives.
C) Wet the lips and mouth frequently.
D) Administer pain medication on an as-needed basis.

Question 23

To be eligible for insurance benefits covering hospice care,a physician must certify that which of the following apply to the patient? Choose all that apply.

A) Life expectancy is not more than 6 months.
B) Life expectancy is not more than 12 months.
C) Condition is expected to improve slightly.
D) Condition is not expected to improve.

Question 24

Which of the following might be a warning sign that a child needs professional help after the death of a loved one? Choose all that apply.

A) Interest in his usual activities
B) Extended regression
C) Withdrawal from friends
D) Inability to sleep
E) Intermittent sadness

Question 25

A home health patient previously lived with her sister for more than 20 years.Although it has been over a year since her sister died,the patient tells the nurse,"It's no worse now,but I never feel any relief from this overwhelming sadness.I still can't sleep a full night.The house is a mess; I feel too tired,even to take a bath.But,sometimes at night,she comes to me and I can see her plain as can be." The patient's clothing is not clean and her hair is not combed.She is apparently not eating adequately.What can the nurse conclude? The patient is probably

A) Grieving longer than usual because of the closeness of the relationship with her sister
B) Experiencing a depressive disorder rather than simply grieving the loss of her sister
C) Feeling guilt and worthlessness because her sister died and she is still alive
D) Interpreting the holiday as a trigger event, which is causing her to hallucinate

Question 26

Which intervention is appropriate for a client receiving palliative care? Choose all that apply.

A) Surgical insertion of a device to decrease the workload of the heart in a patient awaiting heart transplantation
B) Administering IV dopamine to raise blood pressure of a patient with end-stage lung cancer
C) Providing moisturizing eye drops to an unconscious patient whose eyes are dry
D) Administering a medication to relieve the nausea of a patient with end-stage leukemia