Question 1

Mrs.Jakobs' son has just died.He was living with HIV and most recently AIDS.What can the nurse do at this time to provide comfort for Mrs.Jakobs?

Accepted Answer

Being present with Mrs.Jakobs in silence can provide her with comfort without imposing any clichéd phrases or ideas. It allows her to process her grief in her own way and feel supported without pressure to put on a façade of strength.

Question 2

A client with terminal lung cancer complains of being short of breath.He has bilateral crackles and wheezes,despite oxygen at 4 Lpm via nasal cannula and diuretic therapy.What nursing interventions are appropriate for this client? (Select all that apply.)

Accepted Answer

Placing a fan in the room can help improve airflow and comfort. Elevating the head of the bed to Fowler's position can aid in breathing. Morphine sulfate can help alleviate dyspnea by reducing the sensation of breathlessness.

Question 3

In which of the following age ranges is it characteristic to accept one's own mortality?

Accepted Answer

According to Erikson's theory of psychosocial development, individuals in the age range of 45 to 65 years enter the stage of generativity vs. stagnation, where they begin to accept their own mortality and come to terms with the fact that they have limited time left to create a meaningful legacy or contribute to their community. Therefore, option D is the correct choice.

Question 4

The nurse is caring for a client whose family does not want to tell him that he is dying.What is the nurse's best action according to these wishes?

Accepted Answer

The nurse's best action is to talk to the family about their concerns and the importance of honesty and open communication with the patient. It is important to respect the family's wishes, but also to advocate for the patient's right to know the truth about their condition. The nurse can offer resources and support to the family to help them navigate this difficult situation. Changing the subject or arranging an encounter to tell the patient the truth without the family's consent would not be ethical or respectful of the family's wishes.

Question 5

Ms.Cruikshank is a student nurse who is experiencing her first day on a palliative care unit.She is interested in the physiological and sensory changes that occur before death.How does the RN respond when Ms.Cruikshank asks about which sense is the last lost before death?

Accepted Answer

Hearing is typically the last sense to be lost before death. This phenomenon is known as terminal lucidity where the individual may suddenly become alert and conversant before passing away. However, it's important to note that this is not always the case and varies from person to person.

Question 6

The nurse is counselling a family in which a member is terminally ill.The family has children of varying ages.What should the nurse teach the family about the reactions of children to death?

Accepted Answer

Children around age 9 begin to understand that death is final and inevitable, as their cognitive development allows them to grasp the concept of permanence.

Question 7

Mrs.Donaldson has her extended family over to her house the day before her father's funeral.With the exception of her youngest son,Daniel,everyone is helping to put a picture story board together before the service.Daniel is outside on the swing in the back yard.In regards to supporting Daniel and his grief,what should Mrs.Donaldson do?

Accepted Answer

Mrs.Donaldson should talk to Daniel to see how he is feeling and offer support. It is important to acknowledge and address grief in children, and providing a safe and supportive environment can help them better cope with their emotions. Bringing him inside or having the other children join him may not address his individual needs and feelings. While having him write a story about his grandfather for the picture board may be a good idea, it should not be the only course of action taken to support him.

Question 8

Which of the following is a clinical sign of imminent death?

Accepted Answer

The answer of Which of the following is a clinical...

Question 9

Mr.Van Buskirk's wife just died 30 minutes ago on the medical unit.What actions by the nurse supports Mr.Van Buskirk's grieving? (Select all that apply.)

Accepted Answer

Being present, comfortable with silence, and respecting cultural and religious values are all important actions to support someone in their grieving process. Suggesting resources such as grief support groups is also helpful. However, it may not be appropriate for the nurse to assist with funeral arrangements as this is typically the responsibility of the family or a designated person. Speaking in terms of what he needs and not his current pain is not a helpful response as it may minimize or invalidate his feelings of grief.

Question 10

Mr.Raffin is caring for his terminally ill wife at home.He has children that live close by and are in daily contact with him.Mr.Raffin asks the nurse how he will know when death is close so that he can make sure his children are with him.Which of the following are signs of imminent death? (Select all that apply.)

Accepted Answer

Signs of imminent death include relaxation of the facial muscles, indicating a decrease in the body's ability to maintain muscle tone; abdominal distention, which can occur as the body's systems slow down and gases build up; and complaints of blurred vision, which can result from decreased blood flow to the eyes and changes in brain function as the body prepares for death. Flushed skin of extremities and deep rhythmic breathing are not typically signs of imminent death.

Question 11

Which of the following is feared most by an older adult facing death?

Accepted Answer

Loss of control is often cited as a significant fear among older adults facing death, as it encompasses concerns about dependency, inability to manage pain or symptoms, and loss of dignity.

Question 12

Mrs.Donaldson's father has just died.She says to the nurse,"How will I help my young son cope with this loss?" What information can the nurse provide to Mrs.Donaldson?

Accepted Answer

Giving the child permission to be sad and expressing their feelings is important in coping with loss. It is important for the child to feel supported and not rushed through their grieving process. It is also important to provide age-appropriate explanations and avoid euphemisms such as "went to sleep" to prevent confusion or fear. Dealing with one's own grief privately is also important, but it does not directly address the question of how to help the child cope. Praying with the child may be appropriate for families that value religious or spiritual practices, but it is not universally applicable.

Question 13

The nurse is providing postmortem care for a client whose family would like to view the body before it is transported to the morgue.Which of the following interventions are necessary for this preparation? (Select all that apply.)

Accepted Answer

Placing absorbent pads beneath the body helps manage any bodily fluids, and placing a pillow under the head gives a more natural appearance.

Question 14

The nurse is discussing end of life care with Mrs.Masters,a 61-year-old mother of two grown daughters.She has terminal uterine cancer.Mrs.Masters is very clear about the care she wishes to receive,and does not want to leave any difficult decisions to her daughters.Which of the following best describes the appropriate legal document to provide health providers with direction for future care for Mrs.Masters?

Accepted Answer

A living will is a legal document that allows a person to state their wishes about end-of-life care. It can be used to specify the types of medical treatment that a person wants or does not want to receive if they become unable to make decisions for themselves.

Question 15

A client who has just been diagnosed with a slowly progressive terminal illness asks the nurse about the availability of hospice services.What information should the nurse share with this client?

Accepted Answer

Hospice services are generally reserved for those who have a life expectancy of 6 months or less. Hospice care emphasizes quality of life through pain and symptom management and emotional and spiritual support, rather than seeking a cure for the underlying illness. Hospice care may be provided alongside curative treatments if the client desires it. It is also important to note that clients do not get automatically assigned to hospice care when designated as terminally ill. Hospice services are available for anyone who meets the eligibility criteria, regardless of whether or not they have refused other palliative treatments.

Question 16

The nurse is providing support for a bereaved client.What does the nurse need to know about the experience of grief?

Accepted Answer

The experience of grief is highly individualistic and can vary widely from one person to the next. It is important for the nurse to be aware that grieving individuals may express their grief in a number of different ways depending on their personality, culture, and other factors. Thus, the nurse must approach each individual with sensitivity and understanding, recognizing that grief is a complex and deeply personal experience.

Question 17

The terminally ill client states to the nurse,"I'm just not ready to go." Which of the following is the most appropriate response by the nurse?

Accepted Answer

This response shows the nurse is actively listening and encourages the client to express their feelings and concerns further. It allows for a deeper understanding of the client's thoughts and emotions surrounding death.

Question 18

What should the nurse understand when applying models of grief to terminally ill clients?

Accepted Answer

No clear timetables exist, nor are there clear-cut stages of grief when applying models of grief to terminally ill clients. The Kubler-Ross model is primarily used to describe stages of grief experienced by people who have lost loved ones, not necessarily those who are facing their own terminal illness. The models cannot serve as clear and definitive predictors of grief behaviors since each person's response to grief is unique. Although the usefulness of models of grief for dying clients may vary, there is no strong research proving that they are not useful.

Question 19

Palliative care competencies include listening,engaging in difficult conversations,and the ability to be present with clients.

Accepted Answer

Palliative care competencies do include the ability to listen actively, engage in difficult conversations, and provide a comforting presence to clients.

Question 20

Which of the following is a useful nursing intervention in treatment of anxiety associated with receiving a terminal diagnosis?

Accepted Answer

Exploring the client's history with other stressful life events and how they coped at that time can help the nurse understand the client's coping mechanisms and provide more individualized care. Encouraging early pharmaceutical intervention should not be the first choice and providing information about the terminal illness only on a need to know basis may increase anxiety and mistrust. While speaking with the family about how best to help the client cope is important, it is not the most useful single intervention listed.

Quiz 48: Loss,grieving,and Death