Potter and Perry, Fundamentals: Chapter 36 - The Experience of Loss, Death, and Grief

25. Which of the following statements, made by a nurse regarding the means by which older adults usually express and manage grief, reflects a need for further instruction and clarification? 1. "The greater the loss the greater the sense of grief." 2. "Managing depression will help the grieving adult cope." 3. "Having lived a long, happy life makes grieving easier to deal with." 4. "The longer you live, the more experience you have with grieving a death."

"Having lived a long, happy life makes grieving easier to deal with."

31. A terminal ill client's pain is being managed with opioid analgesics. When he reports experiencing constipation, the nurse's most therapeutic response is: 1. "It's a side effect of the pain medication you are taking." 2. "I'll discuss adding some additional bulk to your diet with your wife." 3. "Try drinking more liquids while you are awake to help soften your stool." 4. "I'll see about getting a prescription for a laxative in order to avoid the problem."

"I'll see about getting a prescription for a laxative in order to avoid the problem."

32. Which of the following statements shows the best understanding of Kübler-Ross's Five Stages of Dying? 1. "Crying is an expected behavior of the Depression Stage." 2. "There are tasks the client completes as they work toward acceptance." 3. "People grieve in the manner in which they are most culturally comfortable" 4. "Given enough time and support, most achieves acceptance of their own death."

"There are tasks the client completes as they work toward acceptance."

30. The nurse is caring for a terminal ill client in the final stages of the death process when the client's daughter asks, "Why are you putting drops in dad's eyes?" The nurse responds more accurately by telling the daughter that: 1. "His blinking reflex is gone and these drops lubricate his corneas." 2. "The drops will keep the corneas moist since you have donated them." 3. "They are artificial tears that will keep his eyes from becoming dry and painful." 4. "They were prescribed for him but I won't instill them if you prefer that I don't"

"They are artificial tears that will keep his eyes from becoming dry and painful."

16. The nurse finds a client who has been diagnosed with terminal lung cancer quietly crying. Which of the following nursing responses most reflects a need for additional guidance regarding therapeutic communication with a dying client? 1. "If there is anything I can do to help, just ask." 2. "Would you like some medication to help you sleep?" 3. "Do you want me to call your wife so you two can talk?" 4. "Try not to be sad; let's find something to be thankful for."

"Try not to be sad; let's find something to be thankful for."

29. The son of a client in the initial stage of the dying process is concerned that, "Mom just isn't eating much." The nurse responds most therapeutically by answering: 1. "Her body systems are beginning to shut down and she just doesn't need as much food." 2. "Her pain medication may be making her nauseated. Has she complained or been vomiting?" 3. "We can off her frequent, small portions of her favorite foods. Can you suggest some things she might enjoy?" 4. "Right now solid foods are not as important as drinking. Just be sure she continues to take in plenty of fluids."

"We can off her frequent, small portions of her favorite foods. Can you suggest some things she might enjoy?"

17. A terminally ill client shares with the nurse that he, "needs to tell someone what I want when the end comes." The nurse's most therapeutic response is: 1. "We can talk about that now if you want to. Let me close the door and pull up a chair." 2. "I imagine you would like to discuss matters with your primary care provider. I'll let him know you want to talk." 3. "Let me finish with my client care, I'll be back in 10 minutes, and we can talk as long as you need to." 4. "If you haven't discussed your feelings with your family yet, I'd suggest you do that when they visit this evening."

"We can talk about that now if you want to. Let me close the door and pull up a chair."

Regarding grief in older adults, which understanding helps guide your relationship with an elderly patient? A. Older adults have usually sustained many losses in life, which influence the current loss. B. Older adults with a poor memory experience grief less intensely. C. Older adults generally handle loss better because they have more experience with it. D. Social support is less important because an older adult's circle of friends has become smaller.

A

Regarding the request for organ and tissue donation at the time of death, the nurse needs to be aware that: A. Specially educated personnel make requests. B. Requests are usually made by the nurse caring for the patient at the time of death. C. Only patients who have given prior instruction regarding donation become donors. D. Professionals need to be very selective in whom they ask for organ and tissue donation.

A

Family members gather in the emergency department after learning that a family member was involved in a motor vehicle accident. After learning of the family member's unexpected death, the surviving family members begin to cry and scream in despair. The nurse recognizes this as the Bowlby Attachment Theory stage of a. Numbing. b. Disorganization and despair. c. Bargaining. d. Yearning and searching.

ANS: D Yearning and searching characterize the second bereavement phase in the Bowlby Attachment Theory. Emotional outbursts are common in this phase. During the numbing phase, the family may feel a sense of unreality. During disorganization and despair, the reason why the loss occurred is constantly questioned. Bargaining is part of the Kübler-Ross stages, not of the Bowlby Attachment Theory.

18. The wife of a client recently diagnosed with end-stage renal failure shares with the nurse that, "He just accepts this; I want a second opinion." The nurse recognizes that while the client has reached the acceptance stage of grieving, his wife is experiencing the: 1. Anger stage 2. Denial stage 3. Depression stage 4. Bargaining stage

Anger stage

27. The nurse most effectively addresses the protection of a terminally ill, incontinent client's skin from irritation and breakdown by: 1. Using adult diapers and changing them as soon as they become wet or otherwise soiled 2. Assessing the client's bed frequently for wetness and assuring clean, dry linens and clothing 3. Securing an order for an indwelling catheter and keeping the perineal area free of fecal matter 4. Offering the client frequent opportunities to toilet and responding promptly to requests to toilet

Assessing the client's bed frequently for wetness and assuring clean, dry linens and clothing

5. A client that was recently diagnosed with a terminal illness asks his nurse about organ donation. The nurse should: 1. Have the client first discuss the subject with the family 2. Suggest the client delay making a decision at this time 3. Assist the client to obtain the necessary information to make this decision 4. Contact the client's physician so consent can be obtained from the family

Assist the client to obtain the necessary information to make this decision

19. The mother of a child who was killed in an automobile accident is diagnosed with excessive grief. The nurse realizes that this diagnosis increases her risk of: 1. Attempting suicide 2. Developing anorexia nervosa 3. Becoming chronically depressed 4. Developing a psychiatric phobia

Attempting suicide

The nurse suggests that a patient receive a palliative care consultation for symptom management related to anxiety and increasing pain. A family member asks the nurse if this means that the patient is dying and is now "in hospice." What does the nurse tell the family member about palliative care? (Select all that apply.) A. Hospice and palliative care are the same thing. B. Palliative care is for any patient, any time, any disease, in any setting. C. Palliative care strategies are primarily designed to treat the patient's illness. D. Palliative care interventions relieve the symptoms of illness and treatment.

B, D

A self-care goal you set when caring for dying and grieving patients includes: A. Learning not to take losses so seriously. B. Limiting involvement with patients who are grieving. C. Maintaining life balance and reflecting on the meaning of your work. D. Admitting that you are not well suited to care for people who are grieving and asking the charge nurse not to assign you to care for these patients.

C

15. The nurse is using Bowlby's phases of mourning as a framework for assessing the client's response to the traumatic loss of her leg. During the "yearning and searching" phase, the nurse anticipates that the client may respond by: 1. Crying intermittently 2. Becoming angry at the nurse 3. Acting stunned by the eventual loss 4. Discussing the change in role that will occur

Crying intermittently

A family member asks a home care nurse what he should do if the patient's serious chronic illness worsens even with increased medical interventions. How does the nurse best begin a conversation about the goals of care at the end of life? A. Encourage the family member to think more positively about the patient's new therapy B. Avoid the discussion because it has to do with medical, not nursing, diagnoses C. Initiate a discussion about advance directives with the patient, family, and health care team D. Begin the discussion by asking the patient to identify his or her beliefs about the goals of care while the family member is present

D

A woman experiences the loss of a very early-term pregnancy. Her friends do not mention the loss, and someone suggests to her that she can "always try again." The woman feels confusion over her sadness and stops talking about it with others. What type of grief response is she most likely experiencing? A. Delayed B. Anticipated C. Exaggerated D. Disenfranchised

D

A young man is diagnosed with a serious, life-changing illness. His conversations during his first 2 days of hospitalization are abrupt, superficial, and unrelated to his illness. What understanding about communication enhances your therapeutic communication with this patient? A. Younger patients are usually less talkative about their diagnosis. B. All patients benefit by talking about their feelings with another person. C. Avoid discussing illness-related topics with quiet patients. D. Remain alert for signals that the patient wants to discuss his illness.

D

10. To provide comfort for the client, while preparing to assist the client in the end stage of her life in response to anticipated symptom development, the nurse plans to: 1. Decrease the client's fluid intake 2. Limit the use of over-the-counter analgesics 3. Provide larger meals with more appealing seasoning 4. Determine valued activities and schedule rest periods

Determine valued activities and schedule rest periods

21. Experiencing normal grief over losses allows the adolescent to successfully: 1. Move past the loss 2. Regain a sense of security 3. Develop effectual coping skills 4. Deal with an actual loss later in life

Develop effectual coping skills

3. A newly graduated nurse is best prepared for the assignment of his first dying patient if he: 1. Completed a course dealing with death and dying 2. Is able to control his own personal emotions about death 3. Has previously experienced the death of a dear loved one 4. Has developed a personal understanding of his own feelings about death

Has developed a personal understanding of his own feelings about death

2. One of the benefits of anticipatory grieving to a client or family is that it can: 1. Be done in private 2. Be discussed with others 3. Promote separation of the ill client from the family 4. Help a person progress to a healthier emotional state

Help a person progress to a healthier emotional state

1. A client has a terminal illness and is discussing future treatments with the nurse. The nurse notes that he has not been eating and his response to the nurse's information is, "What does it matter?" The most appropriate nursing diagnosis for this client is: 1. Denial 2. Hopelessness 3. Social isolation 4. Spiritual distress

Hopelessness

11. To maintain the client's sense of self-worth during the end of life while working with a client in an inpatient hospice unit, the nurse should: 1. Leave the client alone to deal with final affairs 2. Call upon the client's spiritual advisor to manage care 3. Include regular visits throughout the day into the client's care plan 4. Facilitate the arrangements to have a grief counselor visit the client

Include regular visits throughout the day into the client's care plan

13. To promote comfort for the terminally ill client specific to nausea and vomiting, the nurse should: 1. Provide mouth care 2. Offer high-protein foods 3. Increase the fluid intake 4. Offer a high-residue diet

Offer high-protein foods

23. Which of the following nursing assessment data best reflects the successful achievement of the dying client's right to be pain free? 1. Introducing the client to effective alternative pain management techniques 2. Educating the client on the appropriate use of a patient-controlled analgesia device 3. Pain rated as a 3 out of 10 after the administration of the prescribed pain medication 4. Informed the primary care provider of the client's need for additional pain medication.

Pain rated as a 3 out of 10 after the administration of the prescribed pain medication

26. A terminally ill client is reporting a sense of anxiety and dyspnea. The nurse's initial intervention is to: 1. Assess the client's vital signs and administer the prescribed antianxiety medication 2. Determine the cause of the client's dyspnea and provide both emotional and physical support 3. Position the client in a semi-Fowler's position and provide supplemental oxygen via nasal cannula 4. Remain with the client and encourage him to express the concerns he is experiencing regarding his death

Position the client in a semi-Fowler's position and provide supplemental oxygen via nasal cannula

14. A nurse-initiated or independent activity for promotion of respiratory function in a terminally ill client is to: 1. Limit fluids 2. Position the client upright 3. Reduce narcotic analgesic use 4. Administer bronchodilators as needed

Position the client upright

8. The nurse is providing care to a dying client. Which of the following is the primary concern? The nurse should: 1. Promote optimism in the client and be a source of encouragement 2. Promote dignity and self-esteem in as many interventions as is appropriate 3. Allow the client to be alone and expect isolation on the part of the dying person 4. Intervene in the client's activities and promote as near normal functions as possible

Promote dignity and self-esteem in as many interventions as is appropriate

28. In order to most effectively address the discomfort of limited oral fluid intake for a client in the latter stages of the dying process, the nurse should: 1. Provide mouth care at least every 2 hours 2. Offer ice chips each time the client is visited 3. Provide the client frequent sips of a favorite beverage 4. Moisten the client's lips with an appropriate water based lubricant

Provide mouth care at least every 2 hours

24. Which of the following interventions best reflects the nurse's attempt to honor the terminally ill client's cultural values? 1. Interviewing both the client and the family to identify preferred end-of-life care 2. Talking openly and without biases about the client's end-of-life care preferences 3. Providing the family with the opportunity to realize the client's end-of-life wishes 4. Becoming familiar with the death rituals most common among the nurse's client population

Providing the family with the opportunity to realize the client's end-of-life wishes

4. The family of a client with a terminal illness will be able to help provide some psychological support to their family member. To assist the family to meet this outcome, the nurse plans to include in the teaching plan: 1. Demonstration of bathing techniques 2. Application of oxygen delivery devices 3. Recognition of the client's needs and fears 4. Information on when to contact the hospice nurse

Recognition of the client's needs and fears

12. A nursing intervention to assist the client with a nursing diagnosis of sleep pattern disturbance related to the loss of spouse and fear of nightmares should be to: 1. Administer sleeping medication per order 2. Refer the client to a psychologist or psychotherapist 3. Have the client complete a detailed sleep pattern assessment 4. Sit with the client while encouraging verbalization of feelings

Sit with the client while encouraging verbalization of feelings

7. A client who is Chinese American has just died on the unit. The nurse is prepared to provide after-death care to the client and anticipates the probable preferences of a family from this cultural background will include: 1. Pastoral care 2. Preparation for organ donation 3. Time for the family to bathe the client 4. Preparation for quick removal out of the hospital

Time for the family to bathe the client

20. The nurse recognizes that which of the following clients is at greatest risk for complicated (dysfunctional) grief? 1. A 26-year-old who is diagnosed with rheumatoid arthritis 2. The 58-year-old only child whose mother recently died of cancer 3. A teenage parent whose child died of sudden infant death syndrome (SIDS) 4. A 50-year-old diabetic client who has experienced an above-the-knee amputation

A teenage parent whose child died of sudden infant death syndrome (SIDS)

The mother of a recently murdered child keeps the child's room intact. Family members are encouraging her to redecorate and move forward in life. The visiting nurse recognizes this behavior as _____ grief. a. Normal b. End-of-life c. Abnormal d. Complicated

ANS: A Family members will grieve differently. One sign of normal grief is keeping the deceased individual's room intact as a way to keep that person alive in the minds of survivors. This is happening after the family member is deceased, so it is not end-of-life grief. It is not abnormal or complicated grief; the child died recently.

A correctional facility nurse is called to the scene of a deceased inmate. The correction officer wants to quickly move the body to the funeral home because he is not comfortable with death. The inmate's body will need to be transported where? a. Coroner's office for an autopsy b. Police department for an investigation c. Directly to the inmate's family d. Warden for inspection

ANS: A Law often requires that an autopsy be performed if death occurred during incarceration; as the result of foul play, homicide, or suicide; or as an accidental death, as occurs in car accidents. The nurse must understand the policies that are applied in cases of foul play death and must ensure that the decedent's body is properly cared for after death, despite the emotional feelings of individuals in close contact with the decedent.

After the anticipated demise of a chronically ill patient, the unit nurse is found crying in the staff lounge. The best response to her crying colleague would be a. "It is normal to feel this way. Give yourself some time to mourn." b. "Your other patients still need you, so hurry back to them." c. "You're being a bad role model to the unit's nursing students." d. "Why don't you take a sedative to cope?"

ANS: A Nurses often witness suffering on a daily basis. Nurses, as humans, also experience grief and loss when they have been intensely involved in the patient's suffering and death. Offer comfort and understanding to colleagues, and maintain a stable patient care environment. It is inappropriate to create guilt by telling a grieving nurse to hurry back to her patients or by indicating that she is a bad role model. Suggesting that a colleague take sedative during a shift is dangerous for the safety of patients in her care.

"I know it seems strange, but I feel guilty being pregnant after the death of my son last year," said a woman during her routine obstetrical examination. The nurse spends extra time with this woman, helping her to better bond with her unborn child. This demonstrates which nursing technique? a. Facilitating mourning b. Providing curative therapy c. Promoting spirituality d. Eradicating grief

ANS: A The nurse facilitates mourning in family members who are still surviving. By acknowledging the pregnant woman's emotions, the nurse helps the mother bond with her fetus and recognize the emotions that still exist for the deceased child. The nurse is not attempting to help the patient eradicate grief, which would be unrealistic. Curative therapy and spiritual promotion are not addressed by the nurse's statement.

A dying patient with liver and renal failure requires pain medication. The nurse anticipates that the medication dose will be a. Given at appropriate milligrams per kilogram medication levels. b. A decreased dose from milligrams per kilogram levels. c. An increased dose from milligrams per kilogram levels. d. Given at midrange for dosing at recommended levels.

ANS: B A dying individual will likely have a decline in renal and liver functioning. Because of reduced organ functioning, a decreased dose would be in order, so the individual does not develop toxic levels of the medications.

A nurse encounters a family that experienced the death of their adult child last year. The parents are talking about the upcoming anniversary of their child's death. The nurse spends time with them discussing their child's life and death. The nurse's action best demonstrates which nursing principle? a. Pain management technique b. Facilitating normal mourning c. Grief evaluation d. Palliative care

ANS: B Anniversary reactions can reopen grief processes. A nurse should openly acknowledge the loss and talk about the common renewal of grief feeling around the anniversary of the individual's death. This facilitates normal mourning. The nurse is not attempting to alleviate a physical pain. The actions are of open communication, not evaluation. Palliative care refers to comfort measures for symptom relief.

A woman is called into her supervisor's office regarding her deteriorating work performance since the loss of her husband 2 years ago. The woman begins sobbing and saying that she is "falling apart" at home as well. The woman is escorted to the nurse's office, where the nurse recognizes the woman's symptoms as which of the following? a. Normal grief b. Complicated grief c. Disenfranchised grief d. Perceived grief

ANS: B Complicated or dysfunctional grief occurs when an individual has a complicated grieving process that interferes with common routines of life for excessively long periods of time. Normal grief is the most common reaction to death; it involves a complex range of normal coping strategies. Disenfranchised grief involves a relationship that is not socially sanctioned. Perceived grief is not a type of grief; perceived loss is a loss that is not obvious to other people.

An Orthodox Jewish Rabbi has been pronounced dead. The nursing assistant respectfully asks family members to leave the room and go home as postmortem care is provided. Which of the following statements from the supervising nurse reflects correct knowledge of Jewish culture? a. "I wish they would go home because we have work to do here." b. "Family members stay with the body until burial the next day." c. "I should have called a male colleague to handle the body." d. "I thought they would quietly leave after praying and touching the Rabbi's head."

ANS: B Jewish culture calls for family members or religious officials to stay with the decedent's body until the time of burial. A male provider is unnecessary. Requesting or expecting the family to go home is not providing culturally sensitive care.

A man is hospitalized after surgery that amputated both lower extremities owing to injuries sustained during military service. The nurse should recognize his need to grieve for what type of loss? a. Maturational loss b. Situational loss c. Perceived loss d. Uncomplicated loss

ANS: B Loss of a body part from injury is a situational loss. Maturational losses occur as part of normal life transitions. Perceived loss is not obvious to other people. Uncomplicated is not a type of loss; it is a description of normal grief.

The nurse has had three patients die during the past 2 days. Which approach is most appropriate to manage the nurse's sadness? a. Telling the next patients why the nurse is sad b. Talking with a colleague or writing in a journal c. Exercising vigorously rather than sleeping d. Avoiding friends until the nurse feels better

ANS: B Self-care strategies for nurses include talking with a close colleague and reflecting on feelings by writing in a journal. It is inappropriate for a nurse to talk with patients to resolve the nurse's grief. Although exercise is important for self-care, sleep is also important. Shutting oneself away from friends is not self-care; the nurse should spend time with people who are nurturing.

A patient cancels a scheduled appointment because she will be attending a Shiva for a family member. Recognizing the importance of this cultural ritual, the nurse's best comment would be which of the following? a. "Congratulations, what's the baby's name?" b. "I'm so sorry for your loss." c. "Missionary church outreach is so important." d. "Can I buy a ticket to this fundraiser?"

ANS: B The Jewish mourning ritual of Shiva incorporates the community's helping behaviors toward those experiencing death, sets expectations for behaviors of the survivor, and provides the community with sustaining traditions and rituals. An understanding of the religious and cultural significance of Shiva allows the nurse to know how to appropriately respond.

A severely depressed patient cannot state any positive attributes to his or her life. The nurse patiently sits with this patient and assists the patient to identify several activities the patient is actually looking forward to in life. The nurse is helping the patient to demonstrate which spiritual concept? a. Time management b. Hope c. Charity d. Faith

ANS: B The concept of hope is vital to nursing; it enables a person to anticipate positive experiences. Being patient and friendly and creating positive relationships are key concepts in all areas of nursing, but especially with depressed patients. The nurse's actions do not address time management, charity, or faith.

A couple is informed that their fetus' condition is incompatible with life after birth. Nurses can best help the couple with their end-of-life decision making by offering them which of the following? a. An advance directive to complete b. Brief discussion and funeral guidance c. Time and careful explanations d. Instructions on how to proceed

ANS: C Families can have limited knowledge when asked to make important ethical decisions. Nurses have the time, patience, and knowledge base to assist the family to understand their ethical situation and to help them make their own educated decision. Advance directives are completed by the person who is dying. Funeral guidance is best provided by a chaplain or a caretaker.

During a follow-up visit, a woman is describing new onset of marital discord with her terminally ill spouse. Using the Kübler-Ross behavioral theory, the nurse recognizes that the spouse is in which stage of dying? a. Denial b. Bargaining c. Anger d. Depression

ANS: C Kübler-Ross' traditional theory involves five stages of dying. The anger stage of adjustment to an impending death can involve resistance, anger at God, anger at people, and anger at the situation. Denial would involve failure to accept a death. Bargaining is an action to delay acceptance of death by bartering. Depression would present as withdrawal from others.

Validation of a dying person's life would be demonstrated by which nursing action? a. Taking pictures of visitors b. Calling the organ donation coordinator c. Listening to family stories about the person d. Providing quiet visiting time

ANS: C Listening to family members' stories validates the importance of the dying individual's life and reinforces the dignity of the person's life. Taking pictures of visitors does not address the value of a person's life. Calling organ donation and providing private visiting time are components of the dying process, but they do not validate a dying person's life.

The father has recently begun to attend his children's school functions since the death of his wife. This would best be described as which task in the Worden Grief Tasks Model? a. Task I b. Task II c. Task III d. Task IV

ANS: C The Worden Grief Tasks Model consists of four tasks. Task III is seen when the surviving family member begins to adjust to life without the deceased. Task I is accepting the reality of the loss, Task II is working through the pain of grief, and Task IV is emotionally relocating the deceased and moving on with life.

A cancer patient asks the nurse what the criteria are for hospice care. What should the nurse answer? a. Having a terminal illness, such as cancer b. Needing assistance with pain management c. Expected to live less than 6 to 12 more months d. Completion of an advance directive

ANS: C The criterion for hospice care is being expected to live less than 6 to 12 more months. Patients with a terminal illness are not eligible until that point. Palliative care provides assistance with pain management when a patient is not eligible for hospice care. An advance directive can be completed by any person, even those who are healthy.

Enuresis is reported in a previously toilet trained toddler. While gathering a health history from the grandparent, the nurse asks about which factor as the most likely cause? a. Lack of outside playtime b. Having too many toys c. Dietary changes d. Recent parental death

ANS: D A child's stage of development and chronological age will influence how he or she grieves. Toddlers can show grief through changes in their eating patterns, changes in their sleeping patterns, fussiness or irritability, and changes in their bowel and bladder habits. It is common for younger children to regress when under increased stress. Lack of outside playtime, dietary changes, and having too many toys are unlikely to cause enuresis.

In preparation for the eventual death of a female hospice patient of the Muslim faith, the nurse organizes a meeting of all hospice caregivers. A plan of care to be followed when this patient dies is prepared. This plan of care would include a. Male health care workers care for the body after death has occurred. b. Body preparation for autopsy. c. Body preparation for cremation. d. Female health care workers care for the body after death has occurred.

ANS: D Islamic culture calls for modesty and same-sex caregivers whenever possible. Muslim faith discourages cremation and autopsy to preserve the sanctity of the soul of the deceased.

A family is grieving after learning of a family member's accidental death. The transplant coordinator requests to talk with the family about possible organ and tissue donation. The nurse recognizes that a. All religions allow for organ donation. b. Life support must be removed before organ and tissue retrieval occurs. c. The best time for organ and tissue donation is immediately after the autopsy. d. The transplant coordinator is working in accordance with federal law.

ANS: D It is a federal law to require facilities to develop policies about organ donation. The transplant coordinator has additional education on providing answers about organ donation. Not all religions allow for organ donation. A patient may be on life support during organ removal to preserve organ tissues. Autopsy compromises organ integrity; removal should occur prior.

A terminally ill patient is experiencing constipation secondary to pain medication. What is the best way for the nurse to improve the patient's constipation problem? a. Massage the patient's abdomen. b. Contact the provider to discontinue pain medication. c. Administer enemas twice daily for 7 days. d. Use a stimulant laxative and increase fluid intake.

ANS: D Opioid medication is known to slow gastrointestinal transit time, which places the patient at high risk for constipation. Stimulant laxatives are indicated for opioid-induced constipation. Added water to the diet will allow water to be pulled into the GI tract, softening up stool. Massaging the patient's abdomen may cause further discomfort. Discontinuing pain medication is inappropriate for a terminally ill patient. Enema administration is not the first step in the treatment of opioid-induced constipation.

Mrs. Harrison's father died a week ago. Mr. Harrison is experiencing headaches and fatigue, and keeps shouting at his wife to turn down the television, although he has not done so in the past. Mrs. Harrison is having trouble sleeping, has no appetite, and says she feels like she is choking all the time. How should the nurse interpret these assessment findings as the basis for a follow-up assessment? a. Mrs. Harrison is grieving and Mr. Harrison is angry. b. Mrs. Harrison is ill and Mr. Harrison is grieving. c. Both Mr. and Mrs. Harrison likely are in denial. d. Both Mr. and Mr. Harrison likely are grieving.

ANS: D Symptoms of normal grief include headache, fatigue, oversensitivity to noise, insomnia, appetite disturbance, and choking sensation. Different people manifest different symptoms. Denial is assessed when the person indicates that he is not accepting that the loss happened.

The palliative team's primary obligation to a patient in severe pain includes which of the following? a. Supporting the patient's nurse in her grief b. Providing postmortem care for the patient c. Teaching the patient the stages of grief d. Enhancing the patient's quality of life

ANS: D The primary goal of palliative care is to help patients and families achieve the best quality of life. Providing support for the patient's nurse is not the primary obligation when the patient is experiencing severe pain. Not all collaborative team members would be able to provide postmortem care, as is the case for nutritionists, social workers, and pharmacists. Teaching about stages of grief should not be the focus when severe pain is present.

A family member of a recently deceased patient talks casually with the nurse at the time of the patient ' s death and expresses relief that she will not have to visit at the hospital anymore. What theoretical description of grief best applies to this family member? A. Denial B. Anticipatory grief C. Dysfunctional grief D. Yearning and searching

B

A nurse is providing postmortem care. Which action is the priority? A. Locating the patient's clothing B. Providing culturally and religiously sensitive care in body preparation C. Transporting the body to the morgue as soon as possible to prevent body decomposition D. Providing all postmortem care to protect the family of the deceased from having to see the body

B

A patient who has a serious, life-limiting chronic illness wants to continue to engage in self-care and live as normally as possible. Which of the following nursing responses reflect a helpful understanding of patient self-care at the end of life? A. "Learning to accept that you can't perform some activities anymore will bring you more acceptance and peace." B. "Which activities are most important to you, and how can you continue to do them?" C. "People in your life want to help you with things; allow them to do what they want for you." D. "Spending more of your time resting or reading will conserve your energy."

B

The nurse notes that a woman who recently began cancer treatment appears quiet and withdrawn, states that she does not believe the treatments will make any difference, does not ask about her progress, and missed two chemotherapy sessions. Based on the above assessment data, the nurse gathers more information to consider making which of the following nursing diagnoses? A. Anxiety B. Hopelessness C. Spiritual distress D. Complicated grieving

B

Which of the following nursing actions best reflects sensitivity to cultural differences related to end-of-life care? A. Practice honesty with everyone, telling patients about their illness, even if the news is not good. B. Ask family members if they prefer to help with the care of the body after death. C. Provide postmortem care at the time of death to relieve family members of this difficult job. D. Value patient self-determination, understanding that each person makes his or her own decisions.

B

Which approach to helping grieving people is most consistent with postmodern grief theories? A. Help the patient identify the tasks to be accomplished during his or her grief. B. Encourage people to recognize stages of grieving in anticipation of what is to come. C. Listen carefully to a person's story of how his or her grief experience is unfolding. D. Offer general grief timelines to help the person know when a phase will pass.

C

You have identified three nursing diagnoses for a patient who is having anxiety and hopelessness as a result of a loss. Which general approach do you take to prioritize the nursing diagnoses? (Select all that apply.) A. Use family members and physician orders as primary resources for prioritizing your actions. B. Address the nursing diagnosis that most affects the medical diagnosis. C. Ask the patient to identify the most distressing symptom and first address that diagnosis. D. Use nursing knowledge to address the problem that is the underlying cause of other diagnoses

C, D

22. A client who recently experienced an amputation of the left thumb has a perceived loss of physical attractiveness. The nurse recognizes that such a loss is: 1. More easily assessed than actual losses 2. Much less personal than an actual loss 3. Universally experienced by all amputees 4. Capable of producing grief similar to an actual loss

Capable of producing grief similar to an actual loss

6. A client, who is receiving chemotherapy on a medical unit due to a recent diagnosis of terminal cancer of the liver, has an in-depth conversation with the nurse. The client says, "This cannot be happening to me." The nurse identifies that this stage is associated with, according to Kübler-Ross: 1. Anxiety 2. Denial 3. Confrontation 4. Depression

Denial

9. There is a different focus for the client with hospice nursing care. The nurse is aware that client care provided through a hospice is: 1. Designed to meet the client's individual wishes, as much as possible 2. Aimed at offering curative treatment plans intended for client recovery 3. Involved in teaching families and/or caregivers to provide postmortem care 4. Offered primarily for hospitalized clients for whom at-home care is not possible

Designed to meet the client's individual wishes, as much as possible