Deck 32: Care for the Dying and for Those Who Grieve

Question 1

A nurse talks with a woman who recently learned that her husband died while jogging.Select the appropriate statement for the nurse.

A) "At least your husband did not suffer."
B) "It's better to go quickly as your husband did."
C) "Your husband's loss must be very painful for you."
D) "You will begin to feel better after you get over the shock."

Answer 1

"Your husband's loss must be very painful for you."

Question 2

A patient who was widowed 18 months ago says,"I can remember good times we had without getting upset.Sometimes I even think about the disappointments.I am still trying to become accustomed to sleeping in the bed all alone." The work of mourning:

A) is beginning.
B) has not begun.
C) is at or near completion.
D) is progressing abnormally.

Answer 2

is at or near completion.

Question 3

After the death of his wife,a man says,"I can't live without her…she was my whole life." Select the nurse's most therapeutic reply.

A) "Each day will get a little better."
B) "Her death is a terrible loss for you."
C) "It's important to recognize that she is no longer suffering."
D) "Your friends will help you cope with this change in your life."

Answer 3

"Her death is a terrible loss for you."

Question 4

A wife received news that her husband died of heart failure and called her family to come to the hospital.She angrily tells the nurse who cared for him,"He would still be alive if you had given him your undivided attention." Select the nurse's best response.

A) "I understand you are feeling upset.I will stay with you until your family comes."
B) "Your husband's heart was so severely damaged that it could no longer pump."
C) "I will call my supervisor to discuss this matter with you."
D) Hold the spouse's hand in silence until the family arrives.

Question 5

A child drowned while swimming in a local lake 2 years ago.Which behavior indicates the child's parents are mourning in an effective way? The parents who:

A) forbid their other children from going swimming.
B) keep a place set for the dead child at the family dinner table.
C) sealed their child's room exactly as the child left it 2 years ago.
D) throw flowers on the lake at each anniversary date of the accident.

Question 6

A patient with a new diagnosis of cancer says,"My father died of pancreatic cancer.I took care of him during his illness,so I know what is ahead for me." Which nursing diagnosis applies?

A) Anticipatory grieving
B) Ineffective coping
C) Ineffective denial
D) Spiritual distress

Question 7

An adult confides to a nurse,"The cancer in my neck spread in only 2 months.That is how my whole life has been.No matter what I do,I am sabotaged." As this patient faces the prospect of dying,which motif is evident?

A) Quest: seeking meaning in dying
B) Volatile: unresolved and unresigned
C) Endurance: triumph of inner strength
D) Incorporation: belief system accommodates death

Question 8

Nursing staff spend minimal time with a patient terminally ill with AIDS.The patient confides in the nurse leader,"I am having many confusing emotions.Sometimes I feel angry,sometimes afraid,sometimes abandoned." What is the most likely reason for the staff's avoidance of this patient?

A) The need to use extra infection control precautions
B) Disapproval of the patient's former high-risk lifestyle
C) Feelings of inadequacy in dealing with complex emotional needs
D) Wisdom that the patient needs time alone with significant others and for meditation

Question 9

A widower tells friends,"I am going to take my neighbor out for dinner.It's time for me to be more sociable again." Which phenomenon of bereavement is evident?

A) Anger
B) Preoccupation with the image of the deceased
C) Change in behavior;depression,disorganization,restlessness
D) Reorganization of behavior directed toward a new object or activity

Question 10

A husband whose wife is terminally ill says,"I don't want to cry in front of her.I need to be strong for her." Select the nurse's most therapeutic response.

A) "She might find comfort in your tears."
B) "You should be honest about your feelings."
C) "You need to consider the fact that time is running out."
D) "You are right to protect her at a time when she is so vulnerable."

Question 11

The grieving process is more difficult when a person:

A) has experienced many previous losses in life.
B) was emotionally independent of the deceased.
C) had few unresolved conflicts with the deceased.
D) recognizes the deceased was an elderly person,so it was time for death.

Question 12

After a spouse's death,a patient repeatedly says,"I should have recognized what was happening and been more helpful." This individual is experiencing:

A) preoccupation with the image of the deceased.
B) sensations of somatic distress.
C) anger.
D) guilt.

Question 13

A woman just received notification that her husband died.She approaches the nurse who cared for him during his last hours and says angrily,"If you had given him your undivided attention,he would still be alive." Which analysis applies?

A) The comment warns of a malpractice suit.
B) Anger is a phenomenon experienced during grieving.
C) The patient had ambivalent feelings about her husband.
D) In some cultures,grief is expressed solely through anger.

Question 14

Which finding indicates successful completion of an individual's grieving process?

A) For 2 years after her husband's death,a widow has kept her husband's belongings in their usual places.
B) After 15 months,a widower realistically remembers both the pleasures and disappointments of his relationship with his wife.
C) Three years after her husband's death,a widow talks about her husband as if he is alive and weeps when others mention his name.
D) Eighteen months after a spouse's death,a person says,"I have never cried or had feelings of loss,even though we were very close."

Question 15

Family members ask the nurse,"What can we say when our loved one says,'Death is coming soon?'" To promote communication,which response could the nurse suggest for family members?

A) "We feel sad when we think about life without you."
B) "We have not given up on getting you well."
C) "We think you will be around for a long time yet."
D) "Let's talk about the good memories we have."

Question 16

A terminally ill patient says,"I know I will never get well,but... ," and the patient's voice trails off.Select the most therapeutic response by the nurse.

A) "What do you hope for?"
B) "Do you have questions about what is happening?"
C) "You are not going to get well.It is healthy that you accept that."
D) "When you have questions,it is best to talk to the health care provider."

Question 17

Four teenagers died in an automobile accident.One week later,which behavior by parents indicates adaptive mourning? The parents who:

A) isolate themselves at home.
B) return immediately to employment.
C) forbid other teens in the household to drive a car.
D) create a scholarship fund at their child's high school.

Question 18

As death approaches,a patient with AIDS says,"I do not have enough energy for many visitors anymore,and I am embarrassed about how I look.I only want to see my parents and sister." What action should the nurse take?

A) Support the patient to share the request with the parents and sister.Suggest that they inform the patient's friends of the request.
B) Encourage the patient to reconsider this decision.Interested and caring friends can be sources of support.
C) Suggest that the patient discuss these wishes with the health care provider.
D) Place a "No Visitors" sign on the patient's door.

Question 19

A recently widowed patient tells the nurse,"I am having epigastric discomfort.I think I have developed an ulcer." Diagnostic tests are negative.Which phenomenon of bereavement is evident?

A) Preoccupation with the image of the deceased
B) Disorganization,depression,and restlessness
C) Sensations of somatic distress
D) Reorganization of behavior

Question 20

A patient with pancreatic cancer says,"I know I am dying,but I am still alive.I want to be in control as long as I can." Which reply by the nurse shows active listening?

A) "Our staff will do their best to manage your pain."
B) "Your mind and spirit are healthy,although your body is frail."
C) "Most people do not know how to help.Try not to be hard on them."
D) "Are you saying you want people to stop focusing on your diagnosis?"

Question 21

A woman was awakened one morning by a police officer after her husband died while jogging.For the next 3 days,the widow stoically went through the funeral ritual in a state of numbness.Friends tried to get her to vent her feelings by crying.Which statements offer likely explanations regarding the widow's inability to cry? Select all that apply.

A) Psychologically unhealthy individuals are likely to have atypical grief reactions.
B) The acute stage of grief involves shock and disbelief that may last for several days.
C) Culture influences grief responses.Some groups view emotional displays negatively.
D) The widow had anticipated her husband's death long before it occurred and completed her mourning.
E) The unconscious use of denial is normal for several days after a loss.It protects the individual from the intolerable pain of loss.

Question 22

Which patients meet criteria for hospice services? Select all that apply.

A) A 92-year-old with pneumonia and late-stage Alzheimer's disease
B) A 74-year-old with advanced COPD and life expectancy of 2 years
C) A 54-year-old with glioblastoma and life expectancy of 8 to 10 weeks
D) A 16-year-old with type 1 diabetes,multiple infections,and substance abuse
E) A 36-year-old with multiple sclerosis complicated by depression and pain associated with muscle spasms

Question 23

Which statements by a terminally ill patient provide information to the nurse relevant to spiritual assessment? Select all that apply.

A) "I feel an inner peace with my decision to use hospice services."
B) "I prepared advance directives to spare my children the need to make difficult decisions."
C) "Listening to hymns helps deepen my relaxation and the relief I get from my pain medication."
D) "I plan to use these last weeks to experience the process of dying as fully as I experienced the richness of living."
E) "I can trust the health care provider to prescribe enough medication to keep me comfortable in the days to come."

Question 24

A child drowned while swimming in a local lake 2 years ago.Which behaviors show the child's parents are mourning in an effective way? The parents who: (Select all that apply. )

A) Maintain a place setting for the dead child at the family dinner table.
B) Throw flowers on the lake at each anniversary date of the accident.
C) Keep their child's room exactly as the child left it 2 years ago.
D) Purchase life vests for children at a local group home.
E) Enroll their other children in swimming lessons.

Question 25

A father and son have a long history of hostility and conflict.As the father dies,he finally expresses his love,but the son is unable to respond verbally.Which gift of resolving relationships is most important to address with the son?

A) Guilt
B) Anger
C) Gratitude
D) Forgiveness

Question 26

A woman grieving her husband's sudden death tells the nurse,"Yesterday,I saw my husband walk through the door,smile at me,but then he just faded away." Select the nurse's most appropriate action.

A) Assess for substance use and abuse.
B) Assess the patient's psychiatric history.
C) Refer the patient to the mental health center.
D) Counsel that visualizations are a normal part of grieving.

Question 27

A bystander was killed during a robbery 2 weeks ago.His widow,who has schizoaffective disorder,cries spontaneously when talking about his death.Select the nurse's most therapeutic response.

A) "Are you hearing voices at night?"
B) "I am worried about how much you are crying.Your grief over your husband's death has gone on too long."
C) "This loss is harder to accept because of your mental illness.I will refer you to a partial hospitalization program."
D) "The unexpected death of your husband must be very painful.I am glad you are able to talk to me about your feelings."

Question 28

Which event is most likely to precipitate grief across a community?

A) A local bank is robbed twice in a single month
B) An adolescent shoots the principal of a local high school
C) The elderly pastor of the town's largest church dies of heart failure
D) Concrete pilings crumble in a bridge important to movement of local traffic

Question 29

Children of a widow confer with the nurse because their mother repeatedly tells details of finding her husband not breathing,performing CPR,the trip to the hospital,and seeing him pronounced dead.Family members are concerned that this is traumatic to others hearing the story and ask,"What can we do?" The nurse should counsel the family that:

A) they should express their feelings to their mother and ask her not to retell the story.
B) the retelling should be limited to once daily to avoid unnecessary stimulation.
C) repeating the story and her feelings is a helpful and necessary part of grieving.
D) retelling of memories is expected as part of the aging process.

Question 30

A hospice patient tells the nurse,"Life has been good.I am proud of being self-educated.I overcame adversity and always gave my best.I intend to die as I lived: optimistic." The nurse planning care for this patient would recognize the importance of:

A) providing aggressive pain and symptom management.
B) helping the patient reassess and explore existing conflicts.
C) assisting the patient to focus on the meaning in life and death.
D) supporting the patient's use of own resources to meet challenges.

Question 31

Which actions by a nurse are most appropriate when caring for a hospice patient? Select all that apply.

A) Giving choices
B) Fostering personal control
C) Explaining curative options
D) Supporting the patient's spirituality
E) Offering interventions that convey respect

Question 32

A nurse asks a hospice nurse,"Who should be referred for hospice care?" Select the correct reply.

A) "Hospice is for terminally ill patients with cancer."
B) "Patients in the end stage of any disease are eligible."
C) "We are best equipped to care for patients with end-stage renal disease."
D) "Patients with degenerative neurological disease are eligible after respiration is affected."

Question 33

A nurse cared for a terminally ill patient over a month and looked forward to spending time with this patient.After the patient died,the nurse began to sleep poorly,lacked energy,and felt depressed.Eventually the nurse explained these feelings to a mentor.The mentor should counsel the nurse:

A) about stress-reduction strategies.
B) to seek therapy for dysfunctional grief.
C) about the experience of disenfranchised grief.
D) to consider taking a leave of absence to pursue healing.

Question 34

The spouse of a patient being cared for at home by hospice angrily tells the nurse,"Care provided by the aide is inadequate,so I must do everything myself.Why is this happening? Can't someone help?" The hospice nurse should:

A) provide teaching about anticipatory grieving.
B) assign new hospice personnel to the case.
C) refer the spouse for crisis intervention.
D) arrange hospitalization for the patient.