Question 1

A terminally ill patient tells the nurse that he needs help making his daughter understand that he is going to die since she is planning to take him home in a few days. Which of the following does this information provide to the nurse?

A) The patient does not think his daughter is capable of caring for him at home
B) The patient thinks he is sicker than he really is
C) The patient does not understand that he is going to be discharged in a few days
D) The patient and family member are not in the same stage of the grieving process

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Accepted Answer

Most caregivers report feeling safer having their loved one in the hospital rather than at home, in contrast with terminally ill individuals preferring home care to hospitalized care. The nurse should respond that the family might feel safer with her in the hospital. The nurse has no way of knowing if the family is too busy to provide for the patient or if the patient being at home would be disruptive to the family. The nurse also does not know if it would be hard for the family to care for the patient or if everyone is working.

Question 2

The 60-year-old daughter of an elderly patient tells the nurse that she is exhausted and regrets leaving her job to help her father at home. Which of the following can the nurse do to help this patient?

A) Tell the daughter that her father will not live forever and that she can get on with her life later
B) Remind the daughter that she is doing her duty
C) Suggest that the daughter find a job so that she can get away each day
D) Suggest the daughter take some time away from the parent and facilitate assistance for the patient while she is away

Accepted Answer

The daughter is 60 years old and might have health problems of her own to deal with. In addition, the daughter left her job to care for an aging parent. The nurse should suggest that the daughter take some time away and facilitate assistance for the patient while she is away. The nurse should not remind the daughter that she is doing her duty, or that she should find a job so she can get away each day. Telling the daughter that she can get on with her life later is an inappropriate response.

Question 3

The husband of a terminally ill patient is concerned that his 15-year-old daughter is angry with him that his wife is going to die. Which of the following should the nurse do to support the spouse?&#10;A) Tell him that the child will soon get over the death of the parent and things will be back to normal&#10;B) Encourage him to leave the child alone&#10;C) Remind him that children that age act unreasonably and getting upset will not help&#10;D) Explain that anger is a natural emotion at 15 and that the daughter needs to be reminded that one parent is still there to support and help her&#10;

Accepted Answer

The younger adolescent is becoming more autonomous and may express anger and/or fear at the death of a parent. This is a time when the adolescent thinks in terms of ideas rather than reality; the fact that she is still supported by the remaining parent may not be fully evident to her. The nurse should not encourage the husband to leave his daughter alone, tell him that children that age act unreasonably, or suggest that the child will soon get over the death and that things will return to normal.

Question 4

A terminally ill patient tells the nurse that he needs help making his daughter understand that he is going to die since she is planning to take him home in a few days. Which of the following does this information provide to the nurse?

A) The patient does not think his daughter is capable of caring for him at home
B) The patient thinks he is sicker than he really is
C) The patient does not understand that he is going to be discharged in a few days
D) The patient and family member are not in the same stage of the grieving process

Accepted Answer

Oftentimes, family members are not at the same stage of the grief process as the patient. The nurse should encourage the patient to talk openly with family members, and if necessary, should be present during the conversation. The request to help the patient's daughter understand his condition does not mean that the patient thinks he is sicker than he really is or does not understand that he is going to be discharged in a few days. The patient's request also does not mean that he thinks that the daughter is not capable of caring for him at home.

Question 5

The daughter of a terminally ill patient tells the nurse that she does not know what she is going to do with her life once her mother passes away since everything has revolved around her mother for years. Which of the following responses should the nurse give to this family member?

A) I am sure that you will be lonely but that will pass
B) It is important for you to take care of yourself and your responsibilities
C) Will you be able to return to work or take up a hobby to pass the time?
D) I am sure that your mother appreciated everything you have done to help her

Accepted Answer

The nurse needs to help the daughter understand that she has a life of her own and needs to take care of herself and her responsibilities. The nurse should not say that the daughter will be lonely or that the feeling will pass. Asking the daughter about employment or hobbies is not appropriate at this time. The nurse should also not say that the mother appreciated everything the daughter did to help her.

Question 6

A terminally ill patient tells his family that he has "had a good life" and wants everyone to enjoy theirs as well. The family members are quietly weeping and ask him if there is anything he would like or anyone he would like to see one last time. The nurse realizes this family is functioning as which of the following?

A) A confused family
B) A dysfunctional family
C) A healthy family
D) A relieved family

Accepted Answer

Although the family members are weeping, they are functioning in a healthy way by asking the patient if there is anything he would like or anyone he would like to see one last time. The members of this family respect each other and are able to discuss difficult topics with honesty and openness. There is no evidence to suggest that the family is dysfunctional, confused, or relieved.

Question 7

The parents of a dying child are having difficulty deciding when to discontinue life support. Which of the following can be done to assist these parents?&#10;A) Help the parents identify what would be in their child's best interest&#10;B) Ask the parents what they want&#10;C) Suggest that the decision be made soon so that they can resume their normal lives as soon as possible&#10;D) Encourage them to allow the dying process to occur naturally&#10;

Accepted Answer

The Best Interest standard mandates that the decision-makers truly examine what is in the child's best interest. Asking the parents what they want would be an example of the paternalistic decision-making model, a model has its basis solely in the parents' desires, which may not be in the best interest of the child. The nurse should not suggest that the decision be made soon so that they can resume their normal lives as soon as possible. Encouraging the parents to allow the dying process to occur naturally may or may not be a choice for the child.

Question 8

The mother of a dying child is seen sitting in the lounge, quietly crying and saying "I don't know what I am going to do without her." The nurse realizes that which of the following is occurring with the mother?

A) Inappropriate drama
B) Effective coping
C) Exaggerated response
D) Anticipatory grieving

Accepted Answer

Allowing and helping parents to express their grief in an anticipatory rather than reactive manner assists them in accepting the death and shortens the bereavement time following it. Means of assisting parents with anticipatory grieving include allowing them to openly express their feelings, fears, and concerns. The mother is not demonstrating effective coping, an exaggerated response, or inappropriate drama.

Question 9

A patient with a terminal illness is receiving a blood transfusion and physical therapy in preparation for discharge to his home. The nurse realizes that these treatments will provide which of the following for the patient?

A) Speed the patient's discharge
B) Delay the dying process
C) Help the patient deny that he is dying
D) Enhance the patient's quality of life

Accepted Answer

Continuing to provide some aggressive therapies throughout the illness can enhance the patient's quality of life. The provision of aggressive therapies will not delay the dying process nor help the patient deny that he is dying. These treatments may or may not speed the patient's discharge.

Question 10

A 10-year-old child with terminal cancer tells the nurse that he wants to flush his own port in preparation for the chemotherapy treatment. The nurse realizes the patient is functioning within which of Erickson's stages of development?

A) Autonomy versus Shame
B) Trust versus Mistrust
C) Industry versus Inferiority
D) Integrity versus Despair

Accepted Answer

The school-age child is at the Industry versus Inferiority stage of Erickson's stages of development. Basic strengths of this stage are methodicalness and competence. Trust versus Mistrust is the stage from infancy to 18 months of age. Autonomy versus Shame is seen in early childhood, while Integrity versus Despair is seen in late adulthood.

Question 11

The son of a terminally ill patient tells the nurse that he is "afraid" to leave his mother's side since he does not want her to die while he is gone. Which of the following responses should the nurse give to this family member?

A) She most likely will not die while you are gone, so please go and return as soon as possible
B) It is important for you to balance your responsibilities with the needs of your mother
C) It is probably best that you not leave her at this time
D) She might we waiting for you to give her permission to die and you will do this if you go

Accepted Answer

The answer of The son of a terminally ill patient...

Question 12

A terminally ill patient has many care needs. The patient's wife asks the nurse if there is something she can do to feel part of her husband's care. Which of the following would fulfill the patient's and wife's needs?

A) Teaching her how to flush the indwelling urinary catheter
B) Instructing the wife on how to administer intravenous medication
C) Instructing the wife on how to safely provide food and fluids while preventing aspiration
D) Teaching her how to change the patient's abdominal wound dressing

Accepted Answer

The answer of A terminally ill patient has many care...

Question 13

A terminally ill patient tells his son that the family has to realize that he is dying and begin to talk about it rather than pretending that it is not going to happen. The son responds by telling his father to stop talking about death and leaves the room. Which of the following does this conversation provide to the nurse?

A) The patient was attempting to help the family understand that he is going to die, which might be a different expectation than that of the son
B) The son is uncomfortable with death
C) The patient and son have a difficult relationship
D) The son does not have a good relationship with the other family members

Accepted Answer

The answer of A terminally ill patient tells his son...

Question 14

The mother of a 10-month-old baby, grieving the death of a close friend, is having difficulty addressing the baby's needs. Which of the following should the nurse do to assist the mother and child?&#10;A) Contact Children and Youth Services and see if the child can be temporarily placed with another family&#10;B) Find out if other adult family members can step in and help with the infant's care needs&#10;C) Discuss the issue with the mother and suggest that she realize that life goes on&#10;D) Remind the mother that she has responsibilities that cannot be ignored&#10;

Accepted Answer

The answer of The mother of a 10-month-old baby, grieving...

Question 15

A dying patient tells the nurse that she fears her children will forget her when she is gone. Which of the following can the nurse do to help this patient?&#10;A) Ask her what she would like done to ensure the children do not forget her&#10;B) Reassure her that the remaining family members will not permit that to occur&#10;C) Suggest the children visit with the patient as much as possible since the end is near&#10;D) Ask the patient if she wants her children to remember her as dying&#10;

Accepted Answer

The answer of A dying patient tells the nurse that...

Question 16

The nurse is caring for a patient who is experiencing the third trajectory of life. Which of the following should be included in this patient's plan of care?&#10;A) Assistance with home activities of daily living&#10;B) Palliative care&#10;C) Hospice care&#10;D) Treatment of sudden exacerbations of the illness&#10;

Accepted Answer

The answer of The nurse is caring for a patient...

Question 17

A 20-year-old patient tells the nurse that he does not believe he has cancer and that the lab made a mistake with his blood-test results. The nurse realizes this patient is demonstrating which of the following?

A) Acceptance
B) Denial
C) Anger
D) Confusion

Accepted Answer

The answer of A 20-year-old patient tells the nurse that...

Question 18

A dying patient tells the nurse he is sorry that he will not be able to see his daughter graduate from high school. Which of the following can the nurse suggest to this patient?&#10;A) Encourage the patient to not dwell on what he will be missing&#10;B) Write a letter to his daughter to be given to her on her graduation day&#10;C) Remind the patient that his energies should be focused on living each day as well as possible&#10;D) Remind the patient that children are resilient and what is important to a parent is not as important to a child&#10;

Accepted Answer

The answer of A dying patient tells the nurse he...

Question 19

A dying child tells the nurse that once she &#34;gets over this disease,&#34; she plans to go to Disney World and have a long, well-deserved vacation. The nurse realizes the patient is demonstrating:&#10;A) One final wish before death&#10;B) Delirium&#10;C) Confusion&#10;D) A focus on cure and continuing life&#10;

Accepted Answer

The answer of A dying child tells the nurse that...

Question 20

The father of a child dying after being hit by a moving vehicle is concerned that his wife is not going to take the child's prognosis very well. Which of the following responses should the nurse give the father?

A) I will let you tell her the child's prognosis
B) What are the cues that signal the amount of information she will be able to handle at this time?
C) Someone needs to tell her that the child is not going to survive
D) The physician can talk with her

Accepted Answer

The answer of The father of a child dying after...

Deck 7: Caring for End-Of-Life Patients Across the Life Span