Question 1

The 10-year-old brother of a terminally ill teenager tells the patient that he can't wait for him to come home because then the parents will pay some attention to him. The nurse realizes that the brother is experiencing:

Accepted Answer

Siblings of terminally ill children may feel isolated and unimportant because of the focus on the dying child. There is no way of knowing if the 10-year-old brother is fatigued or depressed. The brother is not feeling excitement.

Question 2

A 6-year-old terminally ill patient tells the nurse that he is being punished for not wanting his new baby sister. The nurse realizes which of the following?

Accepted Answer

Children who are facing death may believe that the illness is a punishment for evil deeds. The patient said that he is being punished for not wanting his new baby sister. The new baby cannot replace the ill child. There is no way of knowing if the new baby will have the same illness. The parents will grieve the loss of their child regardless of having to care for a new baby or not.

Question 3

A terminally ill 30-year-old male patient tells the nurse that he regrets that he will not be around to help his wife raise their two children. Which of the following is this patient demonstrating?

Accepted Answer

The patient is a young adult with a young family. He is expressing regret that he will not be alive to help raise his children, demonstrating awareness of the inability to perform responsibilities as a parent. The patient is not demonstrating the loss of intimacy with his spouse or the loss of a valued career. There is no way of knowing if the patient is a financial burden to his family.

Question 4

The family of a dying patient is talking with the patient while the nurse provides physical care. The nurse participates in the conversation and relates an event that occurred a few days prior that brought smiles and laughter from those present in the room. Which of the following is occurring with the nurse and family?

Accepted Answer

Being present for the patients and families, listening to their stories, and offering stories of their own, will help nurses to process their feelings about the end-of-life experience. This increased self-awareness enables them to better provide the nursing care needed as patient and family face an end-of-life situation. The nurse is being present and self-aware in this situation. She is not distracting the family from the dire situation, hiding grief, or denying the patient's terminal condition.

Question 5

A terminally ill patient is being visited by his first wife and children. The second wife arrives with her children. The room is crowded and the patient is visibly conflicted with the situation. The wives do not acknowledge each other and the children are making faces across the room. Which of the following should the nurse do?

Accepted Answer

The patient has two different families, both of which are visiting him at the same time. The families do not get along and the wives aren't speaking. The patient is unable to do anything. The nurse should intervene-- a doing nothing is not an option. She nurse should not suggest that the wives visit the patient together. The families should visit with the patient so asking them to leave is also not an option.

Question 6

The primary nurse of a recently deceased hospice patient realizes that the widow will be celebrating her birthday in a week. Which of the following should the nurse do?

Accepted Answer

Cards sent on special days may be especially meaningful. The nurse should send the widow a "thinking about you" card. Doing nothing would not be appropriate. Saying a prayer for the widow or lighting a candle for the deceased patient at a religious service might be appropriate but do not overtly support the widow.

Question 7

The wife of a chronically ill patient has stopped going to the hairdresser and tells the nurse that all she does is care for her husband. Which of the following should the nurse do to support the wife?

Accepted Answer

Many family members who have been caring for dying loved ones at home are dealing with increasingly complex physical and psychological issues. As the patient's condition worsens, family caregivers often tend to resist offers of help for themselves. Their own needs are ignored as they focus on the needs of the dying family member, increasing their risk of developing physical or psychological disorders. The nurse should not remind the wife that it is her responsibility to care for the patient or that the situation will not go on forever since the patient will eventually die. There is not enough information to support the patient being admitted to a skilled nursing facility for care.

Question 8

The wife of a terminally ill patient tells the nurse that, no matter what she does, the patient complains and it drags down her mood. Which of the following can the nurse do to help this situation?

Accepted Answer

The nurse assists individuals in identifying their negative coping mechanisms and encouraging the positive ones. Family members may be assisted to cope through attending support groups, becoming involved in an exercise program, or making use of artistic abilities. Suggesting that the wife accept the patient's behavior will not help her Suggesting that she confront the patient is inappropriate. Listening to her is important; however, it may not help lift her mood.

Question 9

The nurse is preparing the body of a deceased patient to be seen by the family in the hospital. Which of the following should the nurse do?

Accepted Answer

In preparation for the family's time with the body, the room should be straightened as much as possible, reducing unnecessary clutter around the patient. The patient's gown and bed linens should be clean, and equipment such as oxygen tubing and intravenous lines should be removed, though hospital policy may require that invasive lines remain in place if an autopsy is scheduled. The need for any equipment left in place should be explained to the family. The patient's head should be elevated on a pillow, and positioning should allow for the mouth and eyes to be closed. Dentures should be placed in the mouth, if possible. If the patient normally wears glasses, they may be put on as well. Boxes of tissue should be placed beside the bed. The head of the bed should not be flat, the patient should be wearing a gown, the overhead lights do not need to be turned on, and chairs should be available in the room.

Question 10

A patient tells the nurse that though her husband passed away two years ago, she has yet to return to living a normal life. Which of the following is this patient describing?

Accepted Answer

There are four stages in the mourning process. The final stage, reorganization, occurs approximately 12 months after the death. If this stage does not occur by this time, the person is experiencing a complicated grief reaction and should be referred for counseling. Reorganization is integrating the loss into normal life and activities. Disorganization is the third phase of the mourning process and is characterized by depression or isolation. This patient is not describing denial.

Question 11

The family of a terminally ill patient tells the nurse that they are tired of being on "death watch" and want to know if they can take turns away from the patient but still be on hand when the end is near. Which of the following responses can the nurse give to this family?

Accepted Answer

Keeping patients and families informed about the current situation may assist in building coping power. Sharing information with the patient and family will also increase opportunities for communication, as well as realistic planning for end-of-life care. The nurse should support the family's needs and not suggest that they stay at the patient's bedside. Nor should she encourage the family to go about their normal activities without concern for the patient. Limiting the family to 15 minute breaks might not be sufficient and should not be suggested.

Question 12

The significant other of a patient dying with AIDS has been asked by the family to leave the patient's room. Which of the following should the nurse do to assist in this situation?

Accepted Answer

The family may ask that the significant other not be allowed to visit and the nurse may need to serve as an advocate. Attempting to bring family members and significant others to an understanding may be difficult, but will be in the best interest of the patient. Emphasizing the importance of focusing on the patient may help bring harmony to the situation. It would be inappropriate for the nurse to do nothing, suggest that the significant other stay out of the room, or tell the significant other to phone the patient instead of visiting.

Question 13

The immediate family members of a dying patient are sitting in the patient's room, taking turns talking about an important event that they had shared with him. The patient is observed smiling and thanking each family member in turn. The nurse realizes that which of the following is occurring?

Accepted Answer

Families in the process of losing a loved one will often use storytelling as another means of coping. The family is not giving the patient hope to live, showing the patient that they are not going to grieve when he is gone, or talking just to pass the time. The storytelling is intentional.

Question 14

A terminally ill patient is asking questions about death and what it will be like. The nurse is not comfortable with the conversation but wants to support the patient. Which of the following should the nurse do?

Accepted Answer

The nurse believes that the situation requires advice from someone more experienced in a particular area and explains it to the patient. Then, with the patient's permission, the appropriate inquiries and referrals should be made. The nurse should not tell the patient that no one knows what death is like, or remind him that death is the great unknown, or Suggesting that the patient focus on living instead of dying is minimizing his need to have questions answered and should not be done.

Question 15

A patient tells the nurse that since her husband died 6 months ago, she does not go out of the house much and spends most days in darkness and alone. The nurse realizes this patient is experiencing which phase of the mourning process?

Accepted Answer

Disorganization is the third phase of the mourning process and is characterized by feelings of isolation and depression. Disbelief is characterized by numbness. Desperate longing is characterized by the desire to be with the deceased person. Reorganization is characterized by returning to some degree of normal life without the person who passed away.

Question 16

The family of a terminally ill patient is asking questions that the nurse has minimal experience responding to. Which of the following should the nurse do?

Accepted Answer

If the nurse believes that the situation requires referral to a professional counselor, or there is a need to seek advice from someone more experienced in a particular area, this should be explained to the patient. Then, with the patient's permission, the appropriate inquiries and referrals should be made. The nurse should not answer the questions anyway, suggest that the family talk with their clergy, or tell them that their questions are inappropriate.

Question 17

The primary nurse of a terminally ill patient who has died is in the room when the family arrives to view the patient. Which of the following should the nurse do?

Accepted Answer

If it is agreeable to family, the nurse who has been caring for the patient should also remain in the room, respectfully maintaining a presence. There may be family members who are overcome with grief and will require nursing assistance. The nurse should not be ashamed to shed tears with the family at the bedside. She should not apologize and leave the room, ask if anyone needs anything or stay at the head of the bed and answer questions. This is the family's time.

Question 18

A nurse who experienced the death of her own husband is caring for a patient who is near death. She provides physical care to the patient and leaves the room. The wife is sitting at the bedside, holding the patient's hand. Which of the following is occurring with the nurse in this situation?

Accepted Answer

Nurses may become overwhelmed by the experience of death that patients and families are facing as well. There may be situations, for example, where the patient is the same age as the nurse or as the nurse's child, causing the nurse deep psychological or emotional pain Nurses may use defense mechanisms to allay their personal discomfort, including focusing only on the physical care needs of patients, rather than caring for the whole person. The nurse is not providing the patient and wife with time alone, nor demonstrating concern with the patient's pain. The nurse has no way of knowing if death is near.

Question 19

The wife of a patient who has just passed away tells the nurse that even though her husband has been ill for a long time, she just feels numb. The nurse realizes that the patient is experiencing which of the following stages of the mourning process?

Accepted Answer

There are four stages of the mourning process. The first is disbelief, or a feeling of numbness. This is what the spouse is describing. The second phase is a desperate longing to be with the deceased. The third involves a sense of disorganization and despair. The fourth is reorganization, when the person begins to again find meaning in life, integrating the loss of the loved one into a renewed sense of normalcy.

Question 20

The son of a terminally ill patient is asking his father where the deeds for the house and cars are located. The patient responds with "your sister knows." The son is visibly upset and continues to prod his father for the answer. Which of the following should the nurse do?

Accepted Answer

There may be times when family members do not have the best interests of the patient at heart. Family decisions may be made that are inconsiderate or self-serving. This is a situation where the son is asking the terminally ill patient for information. The patient says that the daughter knows the answer and says nothing further. The son is prodding the patient and becoming upset. The nurse needs to intervene, away from the patient, and suggest that he talk with the sister. The son does not need to be escorted by Security out of the patient's room. The physician does not need to be contacted to intervene.

Quiz 9: Psychosocial Considerations