Question 1

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?

Accepted Answer

The nurse should advise the family to spend as much time as possible with the child.If the child is frightened about attending the funeral,he should not be forced to attend.Signs of regression are a normal reaction to the loss of a loved one,especially a parent.The child should be encouraged to express his feelings and fears.

Question 2

According to the Uniform Determination of Death Act,which bodily function must be lost to declare death?

Accepted Answer

According to the Uniform Determination of Death Act,death can be declared when there is a loss of brain stem function.Higher-brain death occurs when there is a loss of consciousness,cephalic reflexes,and spontaneous respirations.

Question 3

According to William Worden,which task in the grieving process takes longest to achieve?

Accepted Answer

Worden described the tasks a grieving person must achieve.They progress from an initial numbness or denial through experiencing and working through pain and grief and eventually moving on with life.Shock with disbelief is not a Worden task.

Question 4

What emotional response is typical during the Rando's confrontation phase of the grieving process?

Accepted Answer

During the confrontation phase,the person faces the loss and experiences emotional upset.In the avoidance phase,the person experiences shock,disbelief,denial,anger,and bargaining.During the accommodation phase,the person begins to live with the loss,feel better,and resume routine activities.

Question 5

A patient dying of heart failure has changed his choice about his 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?

Accepted Answer

This patient is experiencing Decisional Conflict related to his end-of-life treatment measures.Deficient Knowledge,Spiritual Distress,or Death Anxiety may be the etiology of his changing decisions,but his indecision about his treatment option clearly identifies his Decisional Conflict.

Question 6

A 73-year-old 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?

Accepted Answer

This patient is most likely experiencing an environmental loss because she is unable to return to her familiar home setting.Instead,she is being transferred to the new environment of a nursing home.Internal,perceived,and psychological losses are internal and can only be identified by the person experiencing them.

Question 7

Which dysrhythmia confirms death?

Accepted Answer

Asystole is a dysrhythmia that commonly serves as a confirmation of death.Pulseless electrical activity,ventricular fibrillation,and ventricular tachycardia are potentially lethal dysrhythmias that may respond to treatment.

Question 8

Which patient is at most risk for experiencing difficult grieving?

Accepted Answer

Although it is impossible to predict with certainty and the grieving process is highly individual and personal,in general those who suffer a sudden loss typically have more difficult grieving than those who have had the time to prepare for the death.Family and friends of persons with chronic illnesses (e.g.,cancer)have usually had time to emotionally prepare for the death,initiate the funeral and burial arrangements,and begin the grieving process before the death occurs.

Question 9

Which of the following patient goals is most appropriate when managing the patient dying of cancer? The patient will

Accepted Answer

The most important goal is that the patient will report or demonstrate satisfactory pain control.The nurse should administer pain medication on a regular schedule to ensure satisfactory pain control; pain may not be controlled if medication is administered on an "as needed" basis.Nonpharmacologic measures can be a helpful adjunct in controlling pain,but they are not likely to be adequate for pain associated with cancer.Effective pain-control medications are available and can be administered by several routes; it should be possible to control the pain.

Question 10

A patient with a history of chronic obstructive pulmonary disease has a living will that states he does not want endotracheal intubation and mechanical ventilation as a means of respiratory resuscitation.As the patient's condition deteriorates,the patient asks whether he can change his decision.Which response by the nurse is best?

Accepted Answer

The nurse should inform the patient that he has the right to change his decision about treatment at any time.Next,the nurse should notify the physician of the patient's decision so that the physician can speak to the patient and revise the treatment plan as needed.Questioning the patient's decision is judgmental.The patient has the right to change his living will at any time.The medical team should not follow the living will if the patient changes his decision about what is in it.

Question 11

Which intervention takes priority for the patient receiving hospice care?

Accepted Answer

A priority intervention for the hospice team is administering pain medications to keep the patient comfortable.Turning the patient to prevent skin breakdown and promote comfort is also important,but it does not take priority over administering pain medications.The patient may not be able to eat meals or get out of bed into the chair and may tolerate only small amounts at a meal.During the dying process,bowel activity reduces and digestion is minimal,which often results in nausea or food intolerance.Additionally,the body's need for nutrition and hydration is reduced as the body begins the desiccation process.

Question 12

A patient's wife tells the nurse 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?

Accepted Answer

The patient is exhibiting signs that typically occur days to a few hours before death.The nurse should provide information to the wife so she can make an informed decision about whether to leave her husband's bedside.The nurse should not offer false reassurance by stating that the patient will most likely be fine until the wife's return.The nurse should not offer her opinion by telling the wife that she needs to take care of herself.It is also unrealistic for the nurse to stay with the patient until his wife returns.The nurse would be minimizing the wife's concern by telling her not to worry because her husband is in good hands.The issue for the family member is not trust in the competency of the healthcare provider but rather wanting to be present with her spouse at the time of death.

Question 13

How should the nurse respond to a family immediately after a patient dies?

Accepted Answer

The nurse should express sympathy to the family immediately after the patient's death.She should give the family as much time as they need with their loved one and take care to present the body in a restful pose.If family members are not present at the time of death,remove tubes and IV lines before they see the body,unless an autopsy is planned or the death is being investigated by the coroner.The body should not be removed from the patient care area until the family is ready.

Question 14

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?

Accepted Answer

Rigor mortis develops 2 to 4 hours after death; therefore,the nurse should place dentures in the mouth and close the patient's eyes and mouth before that time.The nurse should place a pillow under the head and shoulders to prevent blood from settling there and causing discoloration.Closing the patient's mouth and tying a strip of soft gauze under the chin and around the head keeps the mouth set in a natural position for a viewing later.Closing the eyes after death creates a peaceful resting appearance when the body is later viewed but has nothing to do with setting the mouth.Placing dentures in the mouth and closing the eyes and mouth do not prevent discoloration in the facial area.

Question 15

Mr.Jackson is terminally ill with metastatic cancer of the colon.His family notices that he is suddenly more focused and coherent.They are questioning whether he is really going to die.The nurse recognizes that a sudden surge of activity may occur

Accepted Answer

Days to hours before death,patients commonly experience a surge of energy that brings mental clarity and a desire to speak with family.One to 3 months before death,the dying person begins to withdraw from the world by sleeping more and eating less.One to 2 weeks before death,the body loses its ability to maintain itself,and body systems begin to deteriorate.Near the time of death,the dying person does not respond to touch or sound and cannot be awakened.

Question 16

During a health history,a patient whose wife died unexpectedly 6 months ago in a motor vehicle accident admits that he drinks at least six bourbon and waters every night before going to bed.Which type of grief does this best illustrate?

Accepted Answer

Masked grief occurs when the person is grieving,but it may look as though something else is occurring; in this case,the person is abusing alcohol.Delayed grief occurs when grief is put off until a later time.Chronic grief begins as normal grief but continues long term with little resolution of feelings or ability to rejoin normal life.Disenfranchised grief is experienced when a loss is not socially supported.

Question 17

Which nursing intervention should be included in the plan of care for a patient dying of cancer?

Accepted Answer

The plan of care should include encouraging family members to help with the patient's care when they are able.Family members should also be encouraged to take care of themselves.They often need to be encouraged to take breaks to eat and rest.Provide them with anticipatory guidance about the stages of death so they know what to expect.Follow up promptly (not weekly)with other healthcare team members to address family concerns.

Question 18

Which intervention by the nurse is most appropriate when she notices that her dying patient has developed a "death rattle"?

Accepted Answer

If a "death rattle" occurs,turn the patient on his side,and elevate the head of the bed.Nasotracheal suctioning and inserting a nasopharyngeal airway are ineffective against a "death rattle" and may cause the patient unnecessary discomfort.The patient may require IV morphine sulfate to treat pain,but it does not help stop a "death rattle." This narcotic analgesic can also reduce the respiratory drive,leading to hypoventilation and respiratory depression or arrest.

Question 19

An elderly man lost his wife a year ago to cardiovascular disease.During a healthcare visit,he tells the nurse he has begun adjusting to life without his wife.According to John Bowlby,which stage of grief does this comment most likely indicate?

Accepted Answer

According to Bowlby,a person adjusts to life without the deceased during the reorganization phase.During the shock and numbness phase,the person experiences disorientation and a feeling of helplessness.The person wants to be reconnected with the deceased during the yearning and searching phase.The person feels pain and the emotions of grief during the disorganization and despair phase.

Question 20

The nurse has been explaining advance directives to a patient.Which response by the patient would indicate that he has correctly understood the information? "An advance directive is a document

Accepted Answer

An advance directive is a group of instructions stating the patient's healthcare wishes should he become unable to make decisions.The Patient Care Partnership is a document that helps to ensure that patients receive quality care.An informed consent form verifies the patient's understanding of risks and benefits associated with a procedure.An "against medical advice" form allows the patient to leave the hospital against medical advice and releases the hospital of responsibility for the patient.

Quiz 17: Loss,Grief, Dying