Deck 5: Nursing Care of Patients Experiencing Loss, Grief, and Death

Question 1

A terminally ill patient is demonstrating signs of spiritual distress. Which should the nurse do first to assist this patient?

A) Use the FICA assessment.
B) Help the patient with guided imagery.
C) Offer to pray with the patient.
D) Leave the patient alone with her thoughts.

Answer 1

Use the FICA assessment.

Question 2

At the time of admission, a patient with a terminal illness tells the nurse that her daughter will be allowed to make health-related decisions if she becomes incapacitated. What should the nurse realize this patient is specifically describing?

A) healthcare surrogate
B) living will
C) durable power of attorney
D) advance directive

Answer 2

healthcare surrogate

Question 3

A terminally ill patient is receiving palliative care. What does the nurse understand the purpose of this type of care to be?

A) alleviating suffering and enhancing quality of life
B) reducing pain and preventing medical complications
C) controlling side effects of illness while postponing death
D) withdrawing all medical care to allow natural death

Answer 3

alleviating suffering and enhancing quality of life

Question 4

A 30-year-old terminally ill patient is concerned about how her 7-year-old child will perceive her death. What advice from the nurse would be most beneficial?

A) Children this age recognize that death is permanent.
B) Children this age emotionally distance themselves from the death.
C) Because the child fears separation the patient can prepare the child by explaining that death is permanent.
D) Children this age think death is sleeping.

Question 5

A competent older adult patient has a living will stating that resuscitation and heroic life support measures are to be avoided. The family members are not supportive of this directive. Which action by the nurse is the most appropriate?

A) Place the document on the chart.
B) Contact the Social Services department.
C) Notify the hospital attorney.
D) Explain to the patient that the conflict could invalidate the document.

Question 6

A patient tells the nurse that her husband passed away a year ago and she is now beginning to realize that he is truly gone. The patient is planning to begin a new job and possibly move to a new community. The nurse realizes that this patient is in which stage of Bowlby's theory of attachment?

A) detachment
B) protest
C) despair
D) anger

Question 7

After an unsuccessful resuscitation attempt, a patient dies. What should the nurse do first?

A) Document the time of death.
B) Notify the funeral home.
C) Contact the physician.
D) Contact the orderly for transport to the morgue.

Question 8

A patient of Native American descent is expected to die. The family arrives at the hospital and wants to observe their religious and cultural traditions. Which intervention by the nursing staff would be most appropriate?

A) Offer the family a private room to sit together.
B) Discourage the family from sitting with their loved one prior to death.
C) Discuss the possibility of transferring the patient home for the death.
D) Encourage the family to consider a DNR order.

Question 9

A patient with a chronic illness asks the nurse if the new medication is going to cure the disease. Which is the nurse's best response?

A) "It will help you be more comfortable. I don't think it's going to cure the disease."
B) "Of course it's going to cure the disease."
C) "If you believe it will cure the disease, then it will."
D) "I don't think it's going to help or hurt at this time."

Question 10

A terminally ill patient is experiencing secretions pooling in the back of the throat. What can the nurse do to help this patient feel more comfortable?

A) Raise the head of the bed.
B) Gently massage the patient.
C) Provide frequent small sips of fluids.
D) Provide oral care.

Question 11

While preparing for the discharge of a terminally ill older adult patient, the family asks for information concerning the most appropriate time to become involved with a hospice agency. Which action by the nurse is most correct?

A) Assist the family with making contact with a hospice agency at this time.
B) Determine the patient's life expectancy to gauge when the contact should be made.
C) Encourage the family to "hold off" making the contact until death is very close.
D) Determine what expectations the family has of the hospice agency.

Question 12

A patient asks the nurse what it means to have hospice care at home. What should the nurse respond to this patient?

A) "Hospice makes sure that you are comfortable at home."
B) "Hospice care helps cure your illness."
C) "Hospice care is for patients who will be sick for longer than a year."
D) "Hospice care means your physical needs will be met."

Question 13

A terminally ill patient is experiencing dyspnea and tells the nurse that he feels like he is suffocating. What can the nurse do to assist this patient?

A) Keep the room cool with a slight breeze.
B) Increase the heat in the room.
C) Provide additional intravenous fluids.
D) Assist the patient to a sitting position out of bed.

Question 14

A terminally ill patient who does not have an advance directive or do-not-resuscitate order in place stops breathing. What should the nurse do to assist this patient?

A) Call a code.
B) Initiate a slow code.
C) Contact the physician to assess the patient for death.
D) Contact the nursing supervisor.

Question 15

A patient has decided to join a support group for surviving spouses of victims of violent crime. According to Engel's theory of grief and loss, the nurse identifies that this patient is in which stage?

A) restitution
B) acute grief
C) shock and disbelief
D) denial

Question 16

A terminally ill patient and the family agree that the physician will write a do-not-resuscitate order for the patient. The nurse understands that what should be implemented when following this order?

A) Do not call a code if the patient stops breathing or the heart stops beating.
B) Call a code only if the patient stops breathing.
C) Call a code only if the patient's heart stops beating.
D) Withhold food and fluids but provide pain medication.

Question 17

The brother of a terminally ill patient states, "I'll donate a million dollars to the hospital if they cure my brother." The nurse realizes this statement indicates which phase of Kübler-Ross's stages of loss?

A) bargaining
B) denial
C) anger
D) acceptance

Question 18

A patient tells the nurse that her estranged husband died a little over a year ago and states, "I am not sure why this is so difficult. I really couldn't stand him near the end." Which response by the nurse is most appropriate?

A) "Sometimes a rocky relationship with someone at the time of their death can affect your ability to grieve."
B) "You seem angry."
C) "You should contact a therapist."
D) "You are just entering the grief process. Things will get better."

Question 19

A terminally ill patient nearing end of life is dehydrated and complains of being thirsty. What can the nurse do to make the patient more comfortable?

A) Provide oral care every 2 hours.
B) Increase intravenous fluids.
C) Raise the head of the bed.
D) Begin enteral feedings.

Question 20

A patient tells the nurse that since his wife died he has not been able to sleep and sees no reason to continue living. According to Freud's theory on grief and loss, what should the nurse realize this patient is experiencing?

A) depression
B) grieving
C) emancipation
D) denial

Question 21

A patient who had a below-the-knee amputation 2 months ago is seen walking with a new limb prosthesis and returning to work. What does the nurse realize about this patient?

A) The patient has completed the work of mourning the loss of the leg.
B) The patient is having difficulty with grief.
C) The patient is in denial.
D) The patient is forgetting about the disease that caused the loss of the limb.

Question 22

A patient who has just lost her spouse asks the nurse how long it will be until she feels like living again. The nurse realizes this patient has to work through which phases of the grieving process according to Bowlby?

A) denial
B) despair
C) detachment
D) protest
E) restitution

Question 23

The nurse, reviewing data for a patient receiving hospice, believes death is imminent. Which manifestations of impending death did the nurse observe on the patient's medical record? (Review the information provided from the patient's medical record.)

A) vital signs and skin appearance
B) vital signs and output
C) vital signs and intake
D) vital signs and lung sounds

Question 24

The nurse is assessing a dying patient's spiritual beliefs about death. Which acronym represents topics the nurse can use to help with this assessment process?

A) ABC
B) FICA
C) DABDA
D) RACE

Question 25

A patient diagnosed with pancreatic cancer is prescribed strict intake and output. During the last shift, the patient received 1 liter of 0.9% normal saline; two 50-milliliter doses of morphine sulfate in 0.9% normal saline; 3 ounces water. What should the nurse calculate this patient's total intake for the previous shift to be?

Question 26

The sibling of a patient who is nearing death has insisted on intravenous fluids because "My brother wants to live." Which findings should the nurse expect when assessing this patient?

A) The nurse notes the presence of inspiratory and expiratory crackles in all lung fields.
B) The nurse notes that there is increasing edema in the patient's ankles and feet bilaterally.
C) The patient has developed ascites.
D) The patient has lost 6 pounds from last week.
E) The nurse learns during shift report that the patient vomited three times during the night shift.

Question 27

The nurse suspects a patient is in the final stages of the dying process. What manifestations did the nurse assess in this patient?

A) change in level of consciousness
B) sudden increase in taste and smell
C) urinary incontinence
D) increased blood pressure
E) irregular heart rate

Question 28

A patient being treated for terminal cancer is prescribed morphine sulfate through a continuous intravenous infusion. The pharmacy is requesting the patient's current weight in kilograms. During the last measurement, the patient's weight was documented as 128 lbs. What should the nurse calculate this patient's weight in kg to be?

Question 29

A patient in the final stages of colon cancer is demonstrating Cheyne-Stokes respirations. To assess these respirations, the nurse should auscultate breath sounds over which area of the thorax? (Click the cursor over the location where the stethoscope should be placed.)

Question 30

A young adult male patient diagnosed with terminal pancreatic cancer tells the nurse that if he lets his hair grow, God will cure him. What should the nurse realize this patient is demonstrating?

A) The patient is having delusions and is using religious beliefs to block his loss.
B) The patient is bargaining and is postponing his loss.
C) The patient is in denial, and his religious beliefs block his loss.
D) The patient is normal; bargaining with God for physical healing reflects a stage of grieving.
E) The patient is feeling anger and is using his religious beliefs to project his loss.

Question 31

The nurse is instructing others on the use of hospice care. Which statements would indicate to the nurse that the teaching session has been effective?

A) "Hospice care is designed for individuals with a terminal prognosis who cannot stay at the hospital."
B) "Hospice care is designed for individuals with a terminal prognosis who decide to spend their final days at home with their families."
C) "Hospice care is designed for individuals with a terminal prognosis who decide to stay in the hospital for symptom management."
D) "Hospice care is designed for individuals with a terminal prognosis who have to go into a hospice center for proper symptom management."
E) "Hospice care is designed for individuals with a terminal prognosis who decide to receive treatment for their symptoms at home, the hospital, or the hospice center."

Question 32

A patient tells the nurse, "I dread going on after the divorce is final. I have no idea how I am going to manage financially or emotionally." The nurse realizes this patient is demonstrating which aspect of Caplan's stress and loss theory?

A) living without the assets and guidance
B) psychic pain
C) reduced problem-solving ability
D) emotional turmoil

Question 33

A patient diagnosed with testicular cancer tells the nurse that he does not believe he has cancer. The nurse realizes that the patient may be progressing through the stages of grief. Place in order the stages of grief.

A) depression
B) acceptance
C) anger
D) denial
E) bargaining
F) non of the above.

Question 34

The nurse is caring for a patient who is nearing death from a terminal illness. The patient is experiencing secretions in the back of the throat and dyspnea. Which medications should the nurse provide to assist this patient?

A) Oxygen
B) Morphine
C) Atropine
D) Scopolamine
E) Demerol

Question 35

A patient is explaining her experiences after the sudden death of her daughter a few years ago. If Elizabeth Kübler-Ross's sequence is applied, in which order did the patient experience the stages of death and dying? Rank the patient's statements in the order they would have been made.

A) "I have to admit I tried to make a deal with God to bring her back to me."
B) "I'm going to try to use my experience with her illness to help other parents."
C) "I cannot get my mind around it. I still keep waiting for her to come home from school."
D) "I can hardly get out of bed because I just want to sleep."
E) "I just feel so mad at her for leaving me!"
F) non of the above.

Question 36

The spouse of a former patient tells the nurse that he has joined a support group to help with the loss of his wife. The nurse realizes this patient is in which phase of Engel's grief process?

A) acute
B) restitution
C) long-term
D) resolution

Question 37

A patient who is a recent widow states, "I wanted to ask him for a divorce and then he died." What should the nurse realize this patient is at risk for developing?

A) an accelerated grief reaction
B) a dysfunctional grief reaction
C) a typical grief reaction process
D) psychosomatic disorders

Question 38

A patient of Mexican American descent is dying. Which statements by the patient's only son are expected?

A) "We have already notified our priest about Dad's condition."
B) "When the time of death gets closer, we would like him transferred to the inpatient hospice unit at the hospital."
C) "My sister is pregnant, so she really can't help with his care."
D) "My family members will be here at the house a lot right now."
E) "We don't want to worry him, so if there is any change in his condition, please talk to me about it."

Question 39

A patient tells the nurse, "My husband left me to be with God." What should the nurse realize this patient is demonstrating?

A) coping
B) denial
C) a regional difference in the way death is expressed
D) a cultural rite related to death

Question 40

A patient diagnosed with terminal cancer tells the nurse that she knows everything about a living will. Upon assessment, the nurse realizes the patient needs additional instruction on this type of advance directive when the patient makes which statements?

A) "A living will is a document in which I designate someone to make healthcare-related decisions for me in the event I become unconscious."
B) "A living will is a document in which I designate someone to make healthcare and legal decisions for me in the event I become unconscious."
C) "A living will is a document in which I designate my personal wishes and which directions to follow in the event I become unconscious."
D) "A living will is a document in which I designate which directions to follow in the event I become unconscious, but the directions can be modified by my family."
E) "A living will is a document in which my family designates someone to make decisions for me in the event I become unconscious."

Question 41

A preoperative patient says to the nurse, "I hope I wake up after surgery. I don't know what my family would do if I didn't." The nurse realizes this patient is demonstrating which potential problem?

A) coping
B) chronic sorrow
C) anticipatory grieving
D) death anxiety

Question 42

The family of a dying patient wants to help relieve the patient's progressive dyspnea. What should the nurse instruct the family to do for the patient?

A) Lower the head of the bed.
B) Raise the head of the bed.
C) Suction the patient as much as possible.
D) Perform chest physiotherapy.

Question 43

A patient whose spouse passed away 5 years ago becomes severely depressed on holidays, anniversaries, and birthdays. What should the nurse do to help this patient?

A) Encourage the patient to talk with family or spiritual support systems.
B) Explain that these feelings are a sign of chronic depression.
C) Help the patient talk about the loss and hopes for the future.
D) Explain that these feelings will last as long as the patient is alive.
E) Role-play ways for the patient to get through the days when depression is the worst.

Question 44

During a home visit the nurse determines that a patient whose spouse died 10 months ago is demonstrating signs of grief resolution. What did the nurse assess to come to this conclusion?

A) Not living in the past
B) Breaking ties with the lost person
C) Asking for help to end the pain of the loss
D) Experiencing waves of sadness when looking at a picture
E) Wishing that death had occurred at the same time the spouse died

Question 45

The family of a dying patient states, "She has to be in pain, because all she does is moan." What should the nurse realize this family is doing?

A) overreacting
B) asking for more pain medication for the patient
C) not understanding that moaning can be agitation in the patient
D) considering moaning to be a sign the patient is recovering

Question 46

A patient who nearing the end of life is irritable and uncomfortable in bed. Which actions should the nurse take to make the patient more comfortable?

A) Raise the head of the bed.
B) Apply bed pads over the linens.
C) Gently massage the extremities.
D) Reduce the amount of pain medication.
E) Use a draw sheet to turn the patient.

Question 47

The nurse who provided care to a terminally ill patient does not want to spend any time with the grieving family and begins to provide care to another patient. What is this nurse demonstrating?

A) empathy
B) apathy
C) overemotionality
D) blunting

Question 48

A patient with a terminal illness says that when the pain becomes too unbearable he plans to take an overdose of pain medication and end it all. How should the nurse respond to this patient's plan?

A) "Do you have a living will?"
B) "Have you assigned durable power of attorney to anyone?"
C) "Have you considered a healthcare surrogate?"
D) "Have you researched methods for self-euthanasia?"
E) "Have you talked with your healthcare provider about orders for life-sustaining treatment?"

Question 49

A patient who has recently loss his spouse states, "I just can't cry." What should the nurse realize this patient is at risk for developing?

A) psychological issues
B) depression
C) overemotionality
D) somatic symptoms

Question 50

A patient with a terminal illness is experiencing severe nausea and vomiting. Which medications should the nurse consider appropriate for the patient at this time?

A) Furosemide (Lasix)
B) Ondansetron (Zofran)
C) Meperidine (Demerol)
D) Morphine sulfate (Morphine)
E) Prochlorperazine (Compazine)

Question 51

The patient states, "My husband is the person you should talk with if I am not able to make decisions about my care." What should the nurse realize the spouse has been designated to be?

A) the person who has the patient's living will
B) the healthcare surrogate
C) the person with the durable power of attorney
D) nothing more than the spouse

Question 52

A dying patient tells the nurse, "Don't let my family leave me." What should the nurse realize this patient is demonstrating?

A) fear of dying alone
B) the anticipation of improving in health
C) the need for the family to see the patient improve
D) the desire to prolong life