Deck 17: Loss,grief, Dying

Question 1

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

Answer 1

Decisional Conflict

Question 2

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."

Answer 2

"You have the right to change your decision about treatment at any time."

Question 3

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.

Answer 3

Encourage family members to participate in care of the patient when possible.

Question 4

An older client recovering from a stroke in an acute care facility is transferred to a nursing home for ongoing care and the inability to provide self-care 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 5

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

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

Question 6

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

Question 7

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

A) Working through the pain and grief
B) Accepting the reality of the loss
C) Adjusting to the environment without the deceased
D) Investing emotional energy

Question 8

Which intervention is most appropriate when a client develops 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 9

The spouse of a dying client who wants to be present at the time of death desires to go home to shower but is afraid the client will die during that time.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 10

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

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

Question 11

The nurse reviews advance directives with a client.Which statement about an advance directive document indicates that teaching has been effective?

A) Specifies healthcare intentions if unable to make self-directed decisions
B) Identifies the activities considered to be evidence of quality care
C) Verifies understanding of the risks and benefits associated with a procedure
D) Allows the autonomy to leave the hospital even if it is against medical advice

Question 12

Which dysrhythmia confirms death?

A) Asystole
B) Pulseless electrical activity
C) Ventricular fibrillation
D) Ventricular tachycardia

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

An older client who became a widower a year ago reports beginning to adjust to life alone.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 15

The family notices that a terminally ill client is more focused and coherent and they ask whether the client is really going to die.When should the nurse recognize that a sudden surge of activity is most likely to 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

Which patient goal is most appropriate when managing the patient dying of cancer?

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 17

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 and 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 18

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 19

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.

Question 20

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) Prevent blood from settling in the head,neck,and shoulders.
B) Perform these actions more easily before rigor mortis develops.
C) Set the mouth in a natural position for viewing by the family.
D) Prevent discoloration caused by blood settling in the facial area.

Question 21

The nurse notes that a client whose spouse recently died is managing grief and planning for the future.Which factor is affecting the client's grief? Select all that apply.

A) Previous losses
B) Financial status
C) Support systems
D) Significance of the loss
E) Circumstances of the loss

Question 22

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.It is the patient's birthday.What should the nurse conclude about the patient?

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 birthday as a trigger event,which is causing her to hallucinate

Question 23

The nurse notes that the spouse of a terminally ill client stops visiting every day and talks about meeting with friends after work.Which type of grief is the spouse demonstrating?

A) Anticipatory
B) Complicated
C) Uncomplicated
D) Disenfranchised

Question 24

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 25

Throughout the course of an illness,a patient has denied its seriousness,even though health professionals have explained prognosis of death very clearly.Physiological signs now indicate that death will probably occur within a short period of time,but the patient 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 26

The spouse of a recently deceased client is having difficulty with grieving.What action should the nurse implement to help the spouse through the process? Select all that apply.

A) Ask questions about the deceased person's hobbies and activities.
B) Encourage the use of poems and stories about the deceased person.
C) Encourage questions and respond to them within a reasonable period of time.
D) Recommend removing the deceased person's clothing and personal items.
E) Go through photo albums and ask questions about the people in the pictures.

Question 27

For a patient to be eligible for insurance benefits that cover hospice care,a physician must certify which of the criteria as applying to the patient? Select 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.
E) An advance directive has been written.

Question 28

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

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

Question 29

The nurse reviews a medical record and notes that a terminally ill client has higher-brain death.What should the nurse expect when assessing this client?

A) Unconsciousness
B) Irregular heartbeat
C) Altered respiratory rate
D) Absent deep tendon reflexes

Question 30

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

A) Surgically inserting 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
E) Establishing an advance directive that addresses the next 6 months of care