Deck 17: Loss, Grief, Dying

Question 1

Which nursing intervention should be included in the plan of care for a patient dying of cancer?
1)Have at least one family member remain at the bedside at all times.
2)Follow up weekly with other healthcare team members about family concerns.
3)Avoid discussing the dying process with the family to reduce sadness.
4)Encourage family members to participate in care of the patient, when possible.

Answer 1

4

Question 2

During a health history, a patient whose wife died unexpectedly 6 months ago in a motor vehicle accident admits to drinking at least six bourbon and waters every night before going to bed. Which type of grief does this best illustrate?
1)Delayed
2)Uncomplicated
3)Disenfranchised
4)Masked

Answer 2

4

Question 3

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?
1)Take the child to the funeral even if the child is frightened.
2)Notify the physician immediately if the child shows signs of regression.
3)Spend as much time as possible with the child.
4)Provide distraction whenever the child begins to express feelings of sadness.

Answer 3

3

Question 4

What is the American Nurses Association's (ANA) position on assisted suicide?
1)Since it is legal in some states, nurses can participate in assisted suicide.
2)Nurses must follow the policies of their employing agency.
3)Because it is legal in some states, the ANA refuses to take a position that may contradict a state law.
4)Participation by nurses in assisted suicide is prohibited.

Question 5

Which intervention takes priority for the patient receiving hospice care?
1)Turning and repositioning the patient every 2 hours
2)Assisting the patient out of bed into a chair twice a day
3)Administering pain medication to keep the patient comfortable
4)Providing the patient with small frequent, nutritious meals

Question 6

Throughout the course of the illness, a patient has denied its seriousness, even though the health professionals have explained prognosis of death very clearly. Physiological signs now indicate that the patient will probably die, 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?
1)"Your physical signs indicate that you will likely not live more than a few more hours."
2)"You seem very sure that you are not going to die. Please tell me more about what you are feeling."
3)"It seems to me you would be feeling some anger and wondering why all this is happening to you."
4)"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 7

Which sign would the nurse observe in a client who is days to hours before death?
1)Absence of heart activity
2)Yellowish pallor
3)Excessive urine output
4)Dry mucous membranes

Question 8

For the majority of grief theories and models, which response typically occurs in the initial stage/phase?
1)Awareness
2)Adjustment
3)Disbelief
4)Confrontation

Question 9

A male patient dying of heart failure has changed his choice about 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?
1)Deficient Knowledge
2)Spiritual Distress
3)Decisional Conflict
4)Complicated Grieving

Question 10

Which statement regarding palliative sedation is true?
1)Palliative sedation is a type of assisted suicide that is legal in a few states.
2)Involuntary euthanasia is a type of palliative sedation that is legal in several states.
3)The American Nurses Association enforces the legalities of palliative sedation for terminally ill patients.
4)The Hospice and Palliative Nurses Association promotes palliative sedation to manage unendurable and refractory symptoms.

Question 11

A patient previously lived with a sister for more than 20 years. Although it has been more than a year since the sister died, the patient tells the home health 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 even feel too tired to take a bath." The patient's clothing is not clean, and hair is not combed. The patient is apparently not eating adequately. What can the nurse conclude about this patient?
1)Is grieving longer than usual because of the closeness of the relationship with the sister
2)Is experiencing a depressive disorder rather than simply grieving the loss of the sister
3)Is feeling guilt and worthlessness because the sister died and the patient is still alive
4)Is interpreting the holiday as a trigger event, which is causing the patient to grieve

Question 12

A 73-year-old female 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?
1)Environmental loss
2)Internal loss
3)Perceived loss
4)Psychological loss

Question 13

The nurse has been explaining advance directives to a patient. Which response by the patient would indicate successful teaching?
1)"It specifies your healthcare instructions should you become unable to make self-directed decisions."
2)"It identifies the activities considered to be evidence of quality care."
3)"It verifies your understanding of the risks and benefits associated with a procedure."
4)"It allows you the autonomy to leave the hospital when you decide, even if it is against medical advice."

Question 14

Which patient is at most risk for experiencing difficult grieving?
1)The middle-aged woman whose grandmother died of advanced Parkinson's disease
2)A young adult with three small children whose wife died suddenly in an accident
3)The middle-aged person whose spouse suffered a chronic, painful death
4)An older adult whose spouse died of complications of chronic renal disease

Question 15

Which intervention by the nurse is most appropriate when a patient who is dying develops a "death rattle"?
1)Turn the patient to the prone position.
2)Raise the head of the bed.
3)Provide intravenous (IV) fluids.
4)Administer pain medication intravenously.

Question 16

Which patient goal is most appropriate when managing the patient dying of cancer? The patient will:
1)Request pain medication when needed
2)Report or demonstrate satisfactory pain control
3)Use only nonpharmacological measures to control pain
4)Verbalize understanding that it may not be possible to control the pain

Question 17

The nurse is caring for a patient in a persistent vegetative state (PVS). Which finding would the nurse expect to observe?
1)Is aware of family, but can't respond to them
2)Obeys the nurse's commands
3)Has occasional grimaces and tears
4)Speaks intermittently

Question 18

A patient's wife has told nurses 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?
1)"Certainly, go ahead; your husband will most likely hold on until you return."
2)"Your husband could live for days or a few hours; you can do whatever you are comfortable with."
3)"I'll stay continuously at his bedside while you are gone."
4)"Don't worry. Your husband is in good hands; I'll look out for him."

Question 19

How should the nurse respond to a family immediately after a patient dies?
1)Ask the family to leave the patient's room so postmortem care can be performed.
2)Leave tubes and IV lines in place until the family has the opportunity to view the body.
3)Express sympathy to the family by saying, "I am sorry for your loss."
4)Tell the family that they will have limited time with their loved one.

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?
1)To prevent blood from settling in the head, neck, and shoulders
2)To perform these actions more easily before rigor mortis develops
3)To set the mouth in a natural position for viewing by the family
4)To avoid discoloration caused by blood settling in the facial area

Question 21

The nurse is caring for an unresponsive, near-death patient in the intensive care unit, and it is unclear whether or not this patient is an organ donor. The family states, "I think he put 'organ donor' on his license but we don't want to donate his organs." What is the nurse's priority action at this time?
1)Review the driver's license and prepare for donation.
2)Honor the family's wishes, as the patient is unable to make a decision.
3)Maintain the viability of organs until a resolution is made.
4)Contact the primary care provider.

Question 22

The nurse is caring for a patient who has cancer and is terminally ill. What are the most appropriate actions by the nurse in providing end-of-life care that will address the patient's spiritual needs? Select all that apply.
1)Be an empathetic listener for the patient.
2)Allow the patient to participate in spiritual rituals.
3)Recognize that this is an emotional time and prepare for intense crying.
4)Contact pastoral care or the patient's clergyperson before the patient asks.
5)Provide time for meditation, if requested.

Question 23

A nursing student attending a conference on grief says to one of the presenters, "The patient I cared for last week in clinical told me she cried for 4 months after she lost her cat. Isn't that an excessive amount of time to cry over a cat?" What is the most appropriate response by the presenter?
1)"Yes, 4 months is an excessive amount of time. Encourage her to obtain counseling."
2)"No, when I lost my dog, I cried for 4 months. It was a difficult experience for me"
3)"As long as the patient is able to get to other things in her life, then it is okay."
4)"No, all people grieve differently depending on how meaningful the loss was in their life."

Question 24

Which statements describe legal responsibilities after the death of a patient? Select all that apply.
1)Next of kin must sign a consent before any autopsy can be performed.
2)If the patient is donating organs, necessary arrangements must be made.
3)The person who pronounces death must sign the death certificate.
4)Family members are not allowed to participate in postmortem care.
5)Special preparations must be followed when the patient dies from a communicable disease.

Question 25

Which warning signs would indicate that a child needs professional help after the death of a loved one? Select all that apply.
1)Interested in usual activities
2)Extended regression
3)Withdrawal from friends
4)Inability to sleep
5)Intermittent sadness

Question 26

A patient in a cancer clinic says to the nurse, "I'm just so angry. I feel like God is punishing me. I know this is a bad way to think, but I don't deserve to die of cancer." What is the most appropriate response by the nurse?
1)"Death is part of life. With the passing of more time, you will learn to accept this."
2)"It sounds like you are losing your faith in God. God does not punish people."
3)"It is normal for you to feel this way. I'm interested in hearing more about how you feel."
4)"Anger is not good for you at this time. We can talk about some more helpful, positive feelings."

Question 27

Which statement best describes the difference between a "DNAR" and an "AND" order?
1)There is no difference in the two terms. Both are used synonymously.
2)A DNAR is an order not to resuscitate; an AND is an order to attempt to resuscitate.
3)AND contains the word death, so the intent of the order by the provider is clear.
4)A DNAR order provides specific instructions for hydration and feeding. An AND does not.

Question 28

The American Nurses Association (ANA) lists recommendations concerning DNARs and ANDs. Which statements indicate the nurse has a correct understanding of the ANA recommendations? Select all that apply.
1)A DNAR means that the nurse can discontinue care including removal of a feeding tube.
2)If there is no DNAR or AND written, the nurse can participate in a "slow code" until a written order is obtained.
3)Nurses should take an active role in developing policies related to DNARs and ANDs.
4)If there is any conflict or confusion regarding a DNAR or AND, the competent patient's choices will always have the highest priority.
5)Nurses should advocate for a patient's end-of-life preference to be honored over the family's.

Question 29

Which statements indicate the nurse has a good understanding of Dr. Elisabeth Kübler-Ross's theory? Select all that apply.
1)Patients must pass through each of the five stages of death and dying.
2)Kübler-Ross's theory includes psychological responses from the terminal diagnosis to the actual death.
3)The nurse's role is to help patients move from one stage to the next, and finally to acceptance.
4)Patients may experience two or three stages at the same time.
5)Kübler-Ross's theory includes completing one stage and moving on to the next in sequence.

Question 30

Which component is contained within the definition of the Uniform Determination of Death Act?
1)Cessation of blood flow to vital organs
2)Cessation of spontaneous respirations
3)Irreversible cessation of higher-brain functions
4)Irreversible cessation of brain and brainstem function

Question 31

Which interventions are appropriate for a client receiving palliative care? Select all that apply.
1)Surgically inserting a device to decrease the workload of the heart in a client awaiting heart transplantation
2)Infusing intravenous dopamine to raise the blood pressure of a client with end-stage lung cancer
3)Providing moisturizing eye drops to an unconscious client whose eyes are dry
4)Administering a medication to relieve the nausea of a client with end-stage leukemia
5)Withholding pain medication from a terminally ill client with bone cancer

Question 32

A 16-year-old boy recently lost his father in a tragic motorcycle accident. In assessing how well this teenager is managing and coping with the death of his father, the nurse should be most alert for which high-priority behavior?
1)Exhibiting excessive crying
2)Engaging in health risk behaviors
3)Not doing his homework
4)Distancing himself from friends

Question 33

For a patient to be eligible for insurance benefits covering hospice care, a physician must certify which conditions? Select all that apply.
1)Life expectancy is not more than 6 months.
2)Life expectancy is not more than 12 months.
3)The condition is expected to improve slightly.
4)The condition is not expected to improve.
5)The condition is severe and long-term.

Question 34

Nurses frequently encounter death of patients in many healthcare settings. What are some strategies nurses can use to better care for themselves when dealing with death and the dying? Select all that apply.
1)Remain detached and unemotional when working with dying patients.
2)Talk with colleagues about feelings related to death and dying.
3)Use relaxation and focus on peaceful thoughts.
4)Understand own feelings about death and dying.
5)Suppress grieving when patients die.

Question 35

The nurse had been caring for a patient in a hospice facility for 1 month. When the patient dies, the family invites the nurse to attend the calling hours and funeral. What is the most appropriate action for the nurse to take?
1)Attend the services, if the nurse wishes to do so, as this can help to diffuse the nurse's feelings of loss and can be meaningful to the family.
2)Ask another nurse for an opinion on this matter, because the nurse's own judgment may not be reliable at this time.
3)Do not attend the service, because nurses cannot become attached or overly involved with family members after the death of their patients.
4)Be present at the service but stay for only a short period of time, as these occasions are reserved for close friends and family.