Ch. 40 - Death - Sherpath, Evolve, EOC
The nursing instructor is teaching student nurses about anticipatory grief. Which example does the nurse give for anticipatory grief? A woman who has lost her husband in a bomb blast A woman who had an abortion at her partner's insistence A patient who is expected to live only a few months due to cancer A father committing suicide because his only son was murdered
A patient who is expected to live only a few months due to cancer Anticipatory grief is grief experienced by an individual before the loss occurs. It can occur when an individual is diagnosed with any terminal disease; therefore a person who is expected to live only a few more months due to cancer experiences anticipatory grief. The death of a person in a bomb blast is not an expected event, and a woman who lost her husband in this manner may experience complicated grief. A woman who underwent an abortion under duress may not be able to share her grief because abortion is an uncomfortable subject; she may experience disenfranchised grief. A person being murdered is not an example of expected death, and a father committing suicide after losing his son in this manner is an example of exaggerated grief.
Which phrase describes grief? A person's emotional response to loss A person's outward social expression of loss The absence of something or someone Inner feelings and outer expressions of loss
A person's emotional response to loss Grief is defined as an emotional response to loss. The feelings of grief include anger, frustration, loneliness, sadness, guilt, regret, and peace. Mourning is the outward social expression of loss; it is expressed according to an individual's cultures, customs, rituals, traditions, and religious and spiritual beliefs. Loss is the absence of something or someone that a person is attached to. Bereavement is an individual's inner feelings and outward expressions that demonstrate the experience of loss.
A patient with terminal lung cancer becomes emotional and says, "Why did God let this happen to me?" Which stage of Kübler-Ross's theory does the nurse correlate with the patient's behavior? Anger Denial Bargaining Depression
Anger The five stages of grief as proposed by Kübler-Ross describe the emotional stages experienced by an individual during the grieving process. These stages are denial, anger, bargaining, depression, and acceptance. Anger is the second stage; it occurs when people truly recognize the circumstances of the loss. In this stage, people may become angry with themselves or seek to blame another entity such as God. Denial is the first stage, during which the person will not accept the reality of the situation. Bargaining is the third stage, in which the individual shows hope and does not think about the grief. Depression is the fourth stage, in which the person understands the certainty of death and sadness grows.
Which stages of dying are based on Kübler-Ross's classic behavioral theory? Select all that apply. Anger Denial Anxiety Yearning Depression
Anger Denial Depression Kübler-Ross describes her five stages of dying as denial, anger, bargaining, depression, and acceptance. In the anger stage, the person expresses resistance and intense anger toward God or other people for the loss. Denial is the stage wherein the person is not able to accept the loss. In the depression stage, the person realizes the full impact of the loss. Anxiety and yearning are not stages of dying in this theory.
Which nursing action best reflects sensitivity to cultural differences related to end-of-life care? Practice honesty with everyone, telling patients about their illness, even if the news is not good. Ask family members if they prefer to help with the care of the body after death. Provide postmortem care at the time of death to relieve family members of this difficult job. Value patient self-determination, understanding that each person makes his or her own decisions.
Ask family members if they prefer to help with the care of the body after death. The nurse should ask the family members if they wish to participate in postmortem care. Certain religions may require specialized procedures, religious rites, or ceremonies. Giving family members options in caregiving allows them to honor their cultural beliefs. Although western health care practices place a high value on honesty, people from some cultural backgrounds regard being told the "truth" as harmful. The nurse should allow the family as much time as they need to say their last goodbyes to their loved one. The family members may choose to be present and even take part in providing postmortem care. The nurse should value patient self-determination; however, the best nursing action that reflects sensitivity to cultural differences related to end-of-life care is allowing the family to help with postmortem care.
A patient diagnosed with terminal lung cancer asks the nurse, "How long can I live if I quit smoking and drinking?" The nurse identifies that the patient is in which stage of grief according to Kübler-Ross? Denial Acceptance Bargaining Depression
Bargaining In the five stages of grief, Kübler-Ross explains the sequence of emotions that a person experiences while grieving. The five stages in order are denial, anger, bargaining, depression, and acceptance. Bargaining is the third stage. In this stage, the individual demonstrates hope, refrains from thinking about grief, and may seek ways to live longer. Denial is the first stage; in this stage, the patient does not accept the situation. Acceptance is the fifth stage, during which the patient accepts the loss and realizes that he or she should lead the remainder of life. Depression is the fourth stage; the patient understands the certainty of death and becomes sad and cries.
A nurse is caring for a patient who is terminally ill. The nurse finds that the patient experiences chronic pain, deficient food intake, fatigue, and hopelessness. In this situation, which nursing diagnosis does the nurse identify as most important to address? Fatigue Chronic pain Hopelessness Deficient food intake
Chronic pain Chronic pain should be addressed first. Until the patient's pain is under control, it will not be possible for the patient to eat properly, to feel hopeful, or to feel energized. The issues of fatigue, hopelessness, and deficient food intake will need to be addressed at some point; however, they are not the most important issues at this time.
The nurse assesses that a patient is experiencing complicated grief. The patient states, "I am very busy with my normal daily routine since my husband died, and I don't have time to think about it." Which type of complicated grief does the nurse identify in this patient? Chronic Masked Delayed Exaggerated
Delayed Complicated grief occurs in a person who is unable to undergo the normal stages of grieving. It includes four types of grief: chronic grief, delayed grief, exaggerated grief, and masked grief. The patient in this question chooses to not think about her pain by keeping busy with household activities; this may indicate delayed grief. Grief reactions that last for at least 6 months after the loss indicate chronic grief. If the behavior of the grieving person interferes with normal functioning, it indicates masked grief. When a grieving person is unable to perform normal daily activities, it indicates exaggerated grief.
In which stage of dying does a patient realize the full impact of the loss? Anger Denial Depression Bargaining
Depression In the depression stage, the patient realizes the whole impact of the loss. At this stage, the patient feels hopeless and lonely. In the anger stage, the patient expresses resistance and intense anger at God, other people, or the situation itself. In the denial stage, the patient is psychologically not ready to accept the loss. In the bargaining stage, the patient postpones awareness of the loss and makes promises to self, God, or loved ones that he or she will live or believe differently if the loss is prevented from taking place. In the bargaining stage, the patient does not accept the truth.
2. The nurse is orienting new staff to a clinical unit that provides palliative care. A new employee asks what "grief" is exactly. Which statement indicates that the nurse has correctly defined grief? a. The emotional response to a loss b. The outward, social expression of a loss c. The depression felt after a loss d. The loss of a possession or loved one
a. The emotional response to a loss Grief is the emotional response to a loss that is an individualized and deeply personal feeling caused by a real or perceived loss. The outward, social expression of a loss is bereavement. Depression is not a normal response to loss, although there are many emotional feelings that occur due to a loss. The loss of a possession or a loved one is considered an actual loss.
7. Which of the following older adult patients is most appropriate for hospice care? a. A patient who is immobilized due to injuries and unable to afford specialized nursing care b. A patient who experienced a stroke and has been given 3 months to live c. A patient with cancer who is living with uncontrolled persistent pain d. A patient with HIV infection who is on Medicaid.
b. A patient who experienced a stroke and has been given 3 months to live Hospice care is provided to any patient who has a terminal diagnosis of 6 months or less to live and needs care to meet symptom control needs and quality-of-life concerns. Hospice is not for patients who are acutely ill and need specialized treatment, or for patients with chronic illnesses who are not in the terminal stage. Palliative care is provided to those patients who have a longer life expectancy and need assistance with symptom control measures and family support.
1. Mr. Jones' young daughter died in a tragic car crash 1 year ago. Mr. Jones states that he still looks for his daughter when he drives by the playground of her former school and that he often misses work because of lack of sleep and intense feelings of grief. As a nurse, you understand that the type of grief Mr. Jones is experiencing is identified as: a. anticipatory grief. b. complicated grief. c. delayed grief. d. disenfranchised grief.
b. complicated grief. Complicated grief is characterized by distressing symptoms lasting at least 6 months following the death of a significant loved one and occurs with a sudden, unexpected death. Symptoms of complicated grief include intense longing for the deceased, denial of the death or sense of disbelief, imagining that the loss has not occurred, searching for the person in familiar places, extreme anger or bitterness over the loss, and avoiding things that remind them of the loss. Daily life routines are not able to be maintained, and a person's emotional as well as physical health becomes threatened. Anticipatory grief occurs prior to a loss, delayed grief occurs when the grief response is suppressed, and disenfranchised grief occurs when a loss is not recognized by society.
4. The mother of two children, 8 and 10 years of age, has just experienced the death of her mother, the children's grandmother. The mother is concerned about the emotional impact attending the funeral may have on her children. She asks the nurse what she should do in relation to her children attending the funeral. What is the nurse's best response? a. "Take them to the funeral—they need closure, and seeing their grandma in the casket will assist them in knowing that she has died and will not return. Many children attend funerals in today's society." b. "Do not take them to the funeral—they are too young to be exposed to the emotions that are demonstrated at funerals. Many children who attend funerals have adverse psychological reactions." c. "Talk to your children about how they feel about attending the funeral and encourage them to ask questions and talk about their concerns. If they want to go, they will need to be prepared for what will happen at the funeral." d. "Talk to your children about what your mother meant to you and how much she cared for them as her grandchildren, and then see if they really want to attend the funeral. If they want to go it is okay to take them."
c. "Talk to your children about how they feel about attending the funeral and encourage them to ask questions and talk about their concerns. If they want to go, they will need to be prepared for what will happen at the funeral." Caregivers should be encouraged to openly and honestly answer any questions the child may have as they are evaluating the child's responses to the loss while determining whether the child should attend the funeral of a family member. If young children are going to attend the funeral, they should be prepared for what they will see, who will be there, what they may feel, how they may see other people grieving, and what they will be doing during the time that they are at the funeral. It is essential to explain to the child what the body will look like, and the fact that the deceased will not talk, move, or breathe. Children should be allowed to attend funerals based on their own abilities to understand the loss, but they should not be forced to attend if they are fearful or have a strong negative reaction to the loss. The nurse should not give her opinion about the children attending or not attending without the mother's or nurse's first evaluating the children's level of understanding and their responses to the loss.
3. The nurse has been caring for a 65-year-old male patient who has just died. In planning for follow-up bereavement care, the nurse knows that which person is at risk for disenfranchised grief? a. A daughter who lives in a different state b. The son who was with the client when he died c. An estranged ex-wife of the patient who lives nearby d. The 16-year-old grandchild of the patient
c. An estranged ex-wife of the patient who lives nearby Disenfranchised grief, a term coined by Kenneth Doka, may occur with any loss that is not validated or recognized. This type of grief is encountered when a loss is experienced that cannot be openly acknowledged or publicly shared by the grieving person. An ex-wife who has been estranged from the deceased may not be able to openly express the grief that she may feel over the loss of someone who once played a significant part in her life. Other family members (such as a daughter who lives in another state, a son who has been active in the patient's care, or a grandchild) are able to openly express their grief and are viewed by society as having an acceptable grief response.
7. Which statement is true regarding advance directives? a. Advance directives apply only when the person has a chronic illness. b. Advance directives should be drawn up by family members of people who are incompetent. c. Discussion of advance directives is a nursing responsibility. d. Advance directives should be kept in a safety deposit box until the person dies.
c. Discussion of advance directives is a nursing responsibility. Advance directives go into effect when a person has a terminal illness and is unable or incapable of making decisions for themselves. Advance directives are completed by people who are competent and have decision-making capacity. Advance directives should be discussed by the nurse with family members, and the written documents should be given to family, health care providers, and those at institutions where health care is provided. It is the responsibility of the nurse to discuss advance directives with patients and their families; their benefits and limitations, how to complete an advance directive, and how advance directives can assist in decision making at the end of life.
8. A nurse is caring for a patient in the acute care setting who has a do-not-resuscitate order in place. The family approaches the nurse as he/she is walking down the hall and says, "I think my mother has died." To facilitate acceptance of the death by the family, an important nursing intervention is to: a. notify the physician that death has occurred while in the room with the family. b. ask another nurse to come into the room to confirm that death has occurred. c. assess the patient for pulse, respirations, or blood pressure with the family present. d. check that the cardiac monitor that was in place still has the appropriate leads attached.
c. assess the patient for pulse, respirations, or blood pressure with the family present. Experienced nurses will intuitively know when death has occurred, but the act of placing the stethoscope on a patient's chest and listening for heart sounds while assessing for any respiratory effort can act to confirm, thus facilitate the acceptance of death by family members who may have been present at the time of death.
5. The nurse has been caring for a patient who has just died. What is the preferred outcome in caring for the body after death? a. Make sure the body is sent to the morgue within an hour after death. b. Have the family members participate in the bathing and dressing of the deceased. c. Notify in person or by phone all family and team members immediately after the patient's death. d. Demonstrate respect for the body and provide a clean, peaceful impression of the deceased for the family.
d. Demonstrate respect for the body and provide a clean, peaceful impression of the deceased for the family. Demonstrating respect for the deceased maintains the dignity of that person and also can help the family in the grieving process. Proper positioning of the body and covering the body appropriately will promote a peaceful impression of the deceased for the family. Family often will request time with the deceased, and it is not necessary to place a time frame of 1 hour of the arrival of the body at the morgue. Family members may want to participate in bathing and dressing their loved one after death, but this should be their choice. It is not the responsibility of the nurse to notify all family members and team members of the death immediately, because the nurse will need to provide care to the family and determine what type of assistance they need in notifying family members.
END OF CHAPTER QUESTIONS
END OF CHAPTER QUESTIONS
EVOLVE - ONLINE ONLY - REVIEW QUESTIONS
EVOLVE - ONLINE ONLY - REVIEW QUESTIONS
The nursing instructor is teaching a group of student nurses about hospice care. Which statement made by a student nurse indicates a need for further teaching? "Hospice care is focused on controlling end-of-life symptoms." "Hospice care is limited to a period of no more than 6 months." "Hospice care is for patients who have given up on curative treatment." "Hospice care can be revoked by the patient to seek curative care."
"Hospice care is limited to a period of no more than 6 months." Hospice care is given to individuals with a life expectancy of 6 months. However, the condition of such patients may improve, and they may live longer than 6 months, so the duration of hospice care is not limited to 6 months. The main goal of hospice care is to improve quality of life by controlling end-of-life symptoms. Hospice care is provided to individuals who have decided to stop curative treatment. The condition of patients in hospice care may improve, and they can seek curative care.
The health care provider shows a patient a chest radiograph and delivers a diagnosis of stage 2 lung cancer. Which statement made by the patient leads the nurse to conclude that the patient is in the first stage of grief according to the Kübler-Ross model? "I am going to die; it's all over." "Why did God let this happen to me?" "I will quit smoking; I want to live." "I don't think these results are mine."
"I don't think these results are mine." According to Kübler-Ross, there are five stages of grief, based on the emotional responses experienced by an individual during the process of grieving: denial, anger, bargaining, depression, and acceptance. Denial is the first stage; because the reality of death is hard to face, the person may not initially accept the situation. Depression is the fourth stage, during which the patient understands the certainty of death becomes sad, cries, and may state that it's all over and that he or she is going to die. Anger is the second stage, during which patients may become angry with themselves or with others. Bargaining is the third stage, during which the patient is ready to change his or her ways to improve his or her health condition.
A patient diagnosed with cancer is in the terminal stage. The patient tells the nurse, "I would do whatever you say. Please relieve me of this illness." Which stage of dying is the patient in? Anger Denial Depression Bargaining
Bargaining The patient expresses a willingness to do anything if the nurse helps relieve the patient from the illness. This indicates that the patient is in the bargaining stage. In this stage, the patient makes promises to self or significant others to behave differently in exchange for relief from the illness. In the anger stage, the patient expresses resistance and sometimes feels intense anger at another person or the situation. In the denial stage, the patient may not accept the truth. It provides psychological protection to the patient who cannot yet bear the loss. In the depression stage, the patient realizes the whole impact of the loss and may feel overwhelmingly sad, hopeless, and lonely.
A patient diagnosed with colorectal cancer underwent successful surgery. However, chemotherapy will be needed because the cancer has spread to other organs. The patient asks the nurse whether the spread of cancer will stop if she stops smoking and consuming alcohol. Which stage of grieving is the patient experiencing? Denial Anger Bargaining Resolution
Bargaining The patient is experiencing the bargaining stage of grief. In this stage, the patient offers to live a healthier life in exchange for better health. The stage of denial indicates that the patient is unable to accept illness or disability. In the stage of anger, patients tend to blame themselves and others for the condition. The anger is often directed toward the nurse and family members. In the stage of resolution, the patient starts accepting his or her illness and asks questions related to the illness and care.
How can the nurse actively communicate with a terminally ill patient? By asking closed-ended questions By sympathizing with the patient By discussing sensitive issues By asking open-ended questions
By asking open-ended questions The nurse can actively communicate with patients by asking open-ended questions. This helps patients expand their thoughts and tell their stories. The nurse can obtain more information from patients with open-ended questions. Asking a closed-ended question (one with a yes/no response) would not help the nurse understand the feelings and emotions of patients and thus should be avoided. Providing sympathy to patients would not necessarily allow them to express feelings; however, empathizing with patients would help them relate to the nurse and express their feelings in the process. Discussing sensitive issues can create barriers to communication; therefore sensitive issues should be avoided unless the patient brings them up.
A patient refuses to accept the death of a child. The patient no longer has a job, avoids communication with others, and remains aloof. Which grief type is indicated by the patient's presentation? Normal grief Complicated grief Anticipatory grief Disenfranchised grief
Complicated grief The patient is experiencing complicated grief. In complicated grief, a person has a difficult time moving forward after a loss. He or she experiences a chronic and disruptive yearning for the deceased; has trouble accepting the death and trusting others; and/or feels excessively bitter, emotionally numb, or anxious about the future. In normal grief, the person shows a common reaction characterized by complex emotional, cognitive, social, and spiritual responses to loss and death. In anticipatory grief, the grief extends over a long period of time, beginning before the actual loss occurs; the person absorbs the loss gradually and prepares for its inevitability. Disenfranchised grief occurs when the relationship of the person with the deceased is not socially sanctioned, cannot be openly shared, or seems to be of lesser significance.
A patient lost a sibling in a car accident and lost his job on the same day. The patient does not seem upset about the job loss. Which type of grief is indicated by the patient's presentation? Delayed grief Masked grief Exaggerated grief Disenfranchised grief
Delayed grief Delayed grief is characterized by suppression of the grief reaction while the grieving person consciously or unconsciously avoids the pain that has occurred with the loss. The loss of the job is less important than the loss of the sibling. Therefore the person shows a delayed response to the second loss. Masked grief is the grieving response wherein a person's normal functioning is disrupted, but the person does not realize that the disruption in functioning is due to the loss. In exaggerated grief, the person blames him- or herself for the loss. Disenfranchised grief is a loss that is not socially sanctioned, cannot be openly shared, or seems to be of lesser significance.
During a follow-up visit, a patient is crying and says, "I don't want any further treatment because I am going to die anyway." The nurse understands that the patient is in which stage of grief and loss? Denial Depression Bargaining Reorganization
Depression The patient is crying and does not have hope for life, which indicates that the patient is in the depression stage. In the denial stage, the patient is unwilling to accept the loss. In the bargaining stage, the patient has hope that he or she can change the circumstances. In the reorganization stage, the intensity of the patient's negative emotions related to the loss decreases, and the patient can enjoy his or her life.
Which stages of mourning are based on Bowlby's attachment theory? (Select all that apply.) Depression Bargaining Reorganization Searching and yearning Shock and numbness
Reorganization Searching and yearning Shock and numbness Bowlby's attachment theory describes the experience of mourning based on his studies of children separated from their parents during World War II. Bowlby's model of grief lists four stages of mourning: shock and numbness, searching and yearning, disorganization and despair, and reorganization. Depression and bargaining are stages of dying in Kübler-Ross's classic behavioral theory.
Which sign or symptom is characteristic of rigor mortis? The body appears pale. The body becomes cool. The skin color appears bluish. The joints of the body stiffen.
The joints of the body stiffen. Rigor mortis indicates stiffening of the joints. Pallor mortis indicates paleness of the body after death due to the lack of capillary circulation. After death, the body temperature drops and the body becomes cool, which is called algor mortis. Livor mortis is the bluish color of the body due to the loss of blood supply.
10. The nurse cares for dying patients and understands that "nearing death awareness" is a phenomenon evident by which patient statement(s)? (Select all that apply.) a. "Where are my shoes? I need to get ready for the trip." b. "Is my daughter from California going to come and visit before I die?" c. "When do you think that I am going to die?" d. "I was just talking to my daughter (deceased)." e. "How much longer can I live without food or water?"
a. "Where are my shoes? I need to get ready for the trip.? d. "I was just talking to my daughter (deceased)." Nearing death awareness has been described as a state manifested by a special communication of the dying that may occur in patients who are approaching death or are imminently dying. People experiencing this "nearing death awareness" may appear confused, but they may actually be making the transition from life to death. All of the other options are questions that dying people may ask, but they do not represent nearing death awareness.
9. While working with patients in a hospice setting, the nurse is aware that certain symptoms are particularly common among patients near the end of life. Which of the following health problems should the nurse anticipate among dying patients? a. Peripheral edema b. Dyspnea c. Anemia d. Peripheral neuropathy
b. Dyspnea The most common symptoms at the end of life include pain and shortness of breath. While edema, anemia, and peripheral neuropathy are symptoms that may need to be addressed during care provided at the end of life, dyspnea is most commonly found in the last several weeks of life as physiologic changes occur that cause shortness of breath.
5. Rather than simply providing physical care to patients, hospice was designed to: a. reduce hospital bills for families. b. provide better psychosocial care. c. improve a patient's quality of life. d. allow families control over the decision making for alert elders.
c. improve a patient's quality of life. The goal of hospice care is to provide comfort and support to terminally ill patients and their families. Control of symptoms and quality of life issues are a priority when providing care.
4. What are advanced directives? a. Provide relief from pain and other distressing symptoms, affirm life and regard dying as a normal process, and intend to neither hasten nor postpone death. b. Authorize someone to make decisions about property after the person is deceased. c. Are programs that provide comfort and supportive care for terminally ill patients and their families. d. Are legal documents that allow people to communicate their wishes about what type of medical care they would like to receive at the end of life.
d. Are legal documents that allow people to communicate their wishes about what type of medical care they would like to receive at the end of life. Advance directives are legal documents that allow people to communicate their wishes about what type of medical care they would like to receive at the end of life. It is a nursing responsibility to be aware of types of advance directives available and to discuss the options with patients and families. A copy of the patient's advance directives should be part of the medical records. Hospice is a program that provides comfort and supportive care for terminally ill patients. A will authorizes someone to make decisions about property after a person is deceased. Palliative care is a program that provides comfort and supportive care for terminally ill patients and their families.
3. As a nurse, you evaluate how an individual is progressing through the process of grief, loss, and mourning and understand that a grieving individual is functioning effectively if he/she is: a. using distraction as a coping mechanism while avoiding contact with former friends who have not experienced a loss. b. dealing with conflict by avoiding those family members who appear to be coping effectively. c. able to express his/her feelings of loss and grief to close friends only when in social situations. d. able to accept assistance and support of friends and family as needed during the time of loss and grief.
d. able to accept assistance and support of friends and family as needed during the time of loss and grief. Outcomes identified for the process of loss and grief include: talking about the loss and the meaning of the loss, expressing feelings appropriate to the loss, identifying factors that may affect the grieving process, which include healthy coping strategies and support systems, and accepting assistance from friends, family, and significant others during the process of grief and bereavement.
A patient in hospice care tells the nurse, "I can see my grandparents, who died when I was 10 years old." Which response by the nurse is best? "Don't worry, I'll call the psychiatrist for medication." "How does it make you feel to see your grandparents?" "Relax, there is no one in this room besides you and me." "I'll ask your spouse to come tomorrow to talk with you."
"How does it make you feel to see your grandparents?" Nearing death awareness is a special communication of dying; it occurs when people are approaching death. People close to death may say that they have spoken to or seen people who have already died, so the nurse understands that the person is close to death. In this situation, the nurse stays with the patient, listens, and communicates with the patient by asking about his or her feelings. If the nurse states that he or she will be calling a psychiatrist, the patient may feel that he or she has some other complications. The nurse does not contradict the dying person by saying that there is no one in the room. The nurse calmly listens to the patient's words and does not deflect this responsibility on to the spouse.
The nurse is using Kübler-Ross's five stages of grief to assess a patient whose son was murdered. Which response might the patient give during the anger stage? "I will have to lead the rest of my life without him." "I talked with my son this morning." "I lost my only son; is there any reason to live?" "I will fight for justice. My son's murderer will pay!"
"I will fight for justice. My son's murderer will pay!" Kübler-Ross's five stages of grief stage explain the emotional stages experienced by an individual during the process of grieving. The five stages are denial, anger, bargaining, depression, and acceptance. Anger is the second stage, during which the patient truly recognizes the circumstances of the loss. Patients may become angry with themselves or others and declare that they will punish the person responsible. Acceptance is the fifth stage, during which the person comes to the reality of loss and understands that he or she should lead the remaining part of life without the person who has died. Denial is the first stage. In this case, the reality of the son's death is hard to face, so the patient may refuse to accept the situation. Depression is the fourth stage, during which the person comes to terms with the death of the son, becomes sad, cries, and may declare that there is no reason to live.
A patient says to the nurse, "I lost my wife a few days ago in an accident. Since then, I've been feeling lonely, unable to sleep, and cannot concentrate on anything. I'm also feeling tightness in my chest, and I think I'm going crazy." Which response by the nurse is best? "You need to move forward and then concentrate on your future." "I think you have a mental illness; it's best to contact a psychiatrist." "I think you have underlying health problems; I'll notify the health care provider." "These are all normal reactions; let's discuss some ways to handle it."
"These are all normal reactions; let's discuss some ways to handle it." Grief is an emotional response to a loss. Feelings of loneliness, sleeplessness, inability to concentrate, and feelings of tightness in the chest are normal feelings of grief. The nurse provides emotional support by ensuring the patient that these are all normal reactions of grief and suggests measures for coping. The nurse also respects the patient's feelings and talks with him or her politely to explain ways to move on. The nurse understands the reactions of an individual during the grieving process and does not create unwarranted fear in the individual regarding his or her health and mental status by telling the patient to meet with a psychiatrist or a health care provider.
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 nursing response reflects a helpful understanding of patient self-care at the end of life? "Learning to accept that you can't perform some activities anymore will bring you more acceptance and peace." "Which activities are most important to you, and how can you continue to do them?" "People in your life want to help you with things; allow them to do what they want for you." "Spending more of your time resting or reading will conserve your energy."
"Which activities are most important to you, and how can you continue to do them?" Even seriously ill people want to carry on with life, doing what they can to maintain their identity and purpose. They know best how to regulate their energy and wishes for how to spend their time. Accepting their illness is key to healing; however, the patient should continue to do what they can for themselves. Allowing people to do what they want is not conducive to patient satisfaction and independence. The patient should be in control of what others can do for them. Resting and reading may not be how the patient wishes to spend the rest of his or her life.
Which patient is most likely to experience disenfranchised grief? 30-year-old with a diagnosis of inoperable lung cancer 45-year-old with diabetes who has had a leg amputation 50-year-old whose parent just died of a brain tumor 29-year-old who has undergone an abortion
29-year-old who has undergone an abortion Disenfranchised grief is a loss that is not accepted by society or that of a grieving individual who cannot publicly share his or her grief. People at risk of disenfranchised grief include mothers who have terminated a pregnancy, ex-spouses, ex-partners, friends, lovers, mistresses, and co-workers. A patient who had an abortion may not be able to share the grief because abortions are uncomfortable to discuss. A patient with a diagnosis of inoperable lung cancer, a patient with diabetes who has undergone a leg amputation, and a patient whose mother has died from a brain tumor would likely be able to share their grief publicly; therefore these are not examples of disenfranchised grief.
Which nursing action best reflects sensitivity to cultural differences related to end-of-life care? Practice honesty with everyone, telling patients about their illness, even if the news is not good. Ask family members if they prefer to help with the care of the body after death. Provide postmortem care at the time of death to relieve family members of this difficult job. Value patient self-determination, understanding that each person makes his or her own decisions.
Ask family members if they prefer to help with the care of the body after death. The nurse should ask the family members if they wish to participate in postmortem care. Certain religions may require specialized procedures, religious rites, or ceremonies. Giving family members options in caregiving allows them to honor their cultural beliefs. Although western health care practices place a high value on honesty, people from some cultural backgrounds regard being told the "truth" as harmful. The nurse should allow the family as much time as they need to say their last goodbyes to their loved one. The family members may choose to be present and even take part in providing postmortem care. The nurse should value patient self-determination; however, the best nursing action that reflects sensitivity to cultural differences related to end-of-life care is allowing the family to help with postmortem care.
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 should the nurse best begin a conversation about the goals of care at the end of life? Encourage the family member to think more positively about the patient's new therapy. Avoid the discussion because it has to do with medical, not nursing, diagnoses. Initiate a discussion about advance directives with the patient, family, and health care team. Begin the discussion by asking the patient to identify his or her beliefs about the goals of care while the family member is present.
Begin the discussion by asking the patient to identify his or her beliefs about the goals of care while the family member is present. If the nurse asks the patient first what he or she believes is best, the nurse knows how to discuss that option in more detail and give realistic ways of reaching that desired goal. Discussing other possible options after the patient's preference helps family members know and understand the patient's wishes.
A 1-year-old child lost his mother in a car accident. The child refuses to eat and has sleep disturbance. Which factor is most likely responsible for this response? Coping strategies Nature of the loss Developmental stage Personal relationship
Developmental stage Children experience the grieving process in ways that vary according to their age and developmental stage of life. In this case, the child does not understand the loss. The child is aware that the mother is not present. Changes in eating and sleep habits are due to this awareness. In coping strategies, the person uses life experiences to deal with the stress of the loss, which is not possible for a 1-year-old child. In this situation, the child is too young to understand the loss; thus the nature of the loss is not the reason affecting his behavior, health, and well-being. Similarly the child is too young to understand the quality and meaning of the lost personal relationship; thus this factor is not affecting the response.
The nurse notes that a patient refuses to share feelings and does not express grief. After communicating with the patient, the nurse discovers that the patient's former spouse recently died. Which type of grief does this patient behavior reflect? Delayed Chronic Exaggerated Disenfranchised
Disenfranchised Disenfranchised grief is a type of grief that is not validated openly or acknowledged by society. The patient has lost a former spouse, but cannot grieve openly because the loss may not be recognized by society. In delayed grief, the patient suppresses the grief reaction and avoids the pain from the loss. In chronic grief, the patient has grief reactions for a long time. In exaggerated grief, the patient shows self-destructive behaviors.
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. Which type of grief response is this patient most likely experiencing? Delayed Anticipated Exaggerated Disenfranchised
Disenfranchised This woman's friends are not fully acknowledging the value of her pregnancy because of the short length of time the woman was pregnant or because, by comparison, the loss seems less than losing a child after birth. The loss does not seem "legitimate." Thus the woman does not experience sympathy from others and feels disenfranchised. Delayed grief is characterized by suppression of the grief reaction while the grieving person consciously or unconsciously avoids the pain that has occurred with the loss. Anticipated grief is defined as the cognitive, affective, cultural, and social reactions to an expected death. Exaggerated death occurs when the survivor is overwhelmed by grief and cannot function in daily life.
An older adult with muscular dystrophy has chronic body aches and is in a state of hopelessness. On a home visit, a nurse finds that the patient eats less and has lost significant weight. Which nursing interventions would promote nutritional status in the patient? Select all that apply. Encourage consumption of food that the patient prefers Arrange for home delivery of food Emphasize parenteral nutrition Plan for social activities that involve eating Encourage more foods in each meal with a reduction in the number of meals
Encourage consumption of food that the patient prefers Arrange for home delivery of food Plan for social activities that involve eating Providing preferred foods might help the patient eat more. Arranging for the food to be delivered at home reduces discomfort for the patient because the patient does not have to prepare the food for consumption. Social activities with friends that involve eating may improve food intake. Parenteral nutrition should be given to those patients who cannot consume food orally. Patients should be encouraged to eat small, frequent meals to improve food intake and nutritional status.
A patient, newly diagnosed with colon cancer, has become withdrawn from family members. Which strategy should a nurse use to assist the patient at this time? Obtain a prescription for a psychiatric evaluation. Encourage the patient to identify fears and verbalize feelings. Allow the patient to remain withdrawn to avoid drawing attention to this behavior. Explain to the patient that newer treatments permit many people to survive colon cancer.
Encourage the patient to identify fears and verbalize feelings. The nurse recognizes that the patient could be expressing feelings of grief. The nurse should encourage the patient to verbalize feelings and identify fears. This would help the patient move through the phases of the grief process. The patient does not need a psychiatric evaluation, as it is a normal grief process and not a psychiatric disorder. The patient should not be left alone, because the patient needs support to cope with the illness. Explaining to the patient about newer treatment options may not affect the grief process.
The nurse is assessing a patient who is emotionally overwhelmed because of the death of the patient's father. The nurse learns that the patient is taking illicit drugs. Which type of grief does the nurse infer from the patient's behavior? Denial stage Bargaining stage Exaggerated grief Disenfranchised grief
Exaggerated grief The consumption of drugs indicates self-destructive behavior, which is characteristic of exaggerated grief. In the denial stage, the patient denies the truth, but does not show self-destructive behavior. In the bargaining stage, a terminally ill patient may seek ways to change his or her situation or outcome. In cases of disenfranchised grief, the patient does not express grief openly, because society may not accept the expression of grief for an ex-spouse, ex-partner, or ex-lover.
A patient is being evaluated in the emergency room with a complaint of gasping for breath. Despite receiving basic life support measures, the patient expires. Which actions does the nurse take in providing postmortem care? Select all that apply. Follow through with any organ donation arrangements Clean any soiled areas of the body and apply a clean gown Elevate the feet to prevent facial discoloration Accommodate the family's religious wishes, if possible Remove tubes and indwelling lines if an autopsy is requested
Follow through with any organ donation arrangements Clean any soiled areas of the body and apply a clean gown Accommodate the family's religious wishes, if possible The nurse should follow through with any organ donation arrangements and ensure adherence to institutional and state policy and procedures. The nurse should also clean any soiled areas on the body (a full bath is not necessary) and then apply a clean gown. Accommodation of the family's religious wishes should be made, if possible. To prevent facial discoloration, the head should be elevated, not the feet. The tubes and indwelling lines should be retained if an autopsy is requested.
Which cultural practices are commonly followed by African Americans when mourning? (Select all that apply.) Preference to cremate their deceased loved ones Having music and singing at the wake and funeral Offering the dying patient the sacrament of the sick Including a meal for friends after the wake and funeral Respecting the body by having warm clothes for the burial
Having music and singing at the wake and funeral Including a meal for friends after the wake and funeral In African American culture, music and singing are often included at the wake and funeral as part of the mourning process. After the wake and funeral, a meal is shared to provide emotional support to the family. Hindus prefer the cremation process. Christians often offer the sacrament of the sick. Asian Americans commonly show respect for the body by providing warm clothes for the burial.
Which nursing action is best when caring for a patient who is nearing death? Tell the patient, "You'll be going home soon." Encourage the patient to interact with family members. Hold the patient's hand and state, "You're not alone." Discuss what to expect with the family members at the bedside.
Hold the patient's hand and state, "You're not alone." Holding the hand of a dying patient and stating "You're not alone" communicates concern and caring, even if the patient is unable to respond. An actively dying person may not be able to interact, and telling the patient that he or she is going to die soon may increase his or her sense of anxiety. Discussing the process with family members does not focus on the patient.
A patient discusses the recent loss of his spouse with the nurse during a routine checkup. Which findings in the patient would indicate reactions to loss? Select all that apply. Lack of energy Lack of interest Desire to move around Increased communication Insomnia
Lack of energy Lack of interest Insomnia Reactions to loss include a lack of energy, lack of interest, and insomnia. Desire to move around and increased communication are not associated with grief reaction, as these are related to reorganization.
Which action by the nurse is appropriate when the family of a dying patient is highly emotional and critical of the nursing care? Listen to concerns and provide reassurance. Explain all interventions in technical terms. Request that the nursing supervisor talk to the family. Avoid the patient's family as much as possible to reduce confrontations.
Listen to concerns and provide reassurance. The family of a dying patient often responds emotionally due to stress and frustration. Active listening and reassurance can help reduce this. Explaining interventions in highly technical terms may increase their sense of stress as they try to understand the process. Asking for a nursing supervisor to talk to the family or avoiding them may actually increase their sense of frustration.
According to Sheldon's theory of grief, which emotional experiences are seen in an individual during the despair stage? Belief and disbelief Sadness, anger, and guilt Development of new relationships Loss of meaning and direction in life
Loss of meaning and direction in life According to Sheldon, an individual experiences four different stages during the grieving process. This includes the initial shock, grief, despair, and adjustment. Despair is the third stage; common emotions and experiences in this stage include loss of meaning and direction in life. Initial shock is the first stage, during which common emotions and experiences include numbness, disbelief, and relief. Grief is the second stage; common emotions and experiences in this stage include sadness, anger, guilt, feelings of vulnerability and anxiety, regret, insomnia, social withdrawal, hallucinations of the dead person, restlessness, and searching behavior. Adjustment refers to the final stage, during which an individual develops new relationships or interests.
Which self-care goal would the nurse include when caring for dying and grieving patients? Learning not to take losses so seriously Limiting involvement with patients who are grieving Maintaining life balance and reflecting on the meaning of his or her work Admitting that he or she is not well suited to care for people who are grieving and asking the charge nurse not to assign care for these patients
Maintaining life balance and reflecting on the meaning of his or her work Maintaining life balance is very important for emotional, spiritual, and physical well-being. Withdrawing or not seeing one's work with grieving people as serious does not help maintain balance, but rather may contribute to numbing feelings. Losing a patient on a continual basis can take its toll on a nurse. A nurse should take every patient loss seriously and should perform a self-evaluation to determine if there was anything he or she could have done differently. The nurse should not limit his or her involvement with patients who are grieving. In some instances, the nurse may be the patient's only source of support. The nurse must conduct a self-reflection, as death and dying is a natural part of life. If a nurse is not physically or mentally able to care for the dying patient, then he or she may need to reevaluate this career choice.
A patient tells the nurse, "I feel really low these days, and I'm having trouble sleeping. I don't know what's happened to me." After a brief talk, the nurse learns that the patient's beloved pet has died recently. Which type of grief does the patient's behavior indicate? Delayed Masked Anticipatory Disenfranchised
Masked Depression and an inability to sleep are two signs of grief. In masked grief, the survivor is unaware that the behaviors interfering with normal functioning stem from a loss and associated grief. In delayed grief, the person consciously or unconsciously avoids the pain that occurs with loss. The patient in this question is not displaying any attempts to prevent the grief. Anticipatory grief is the grief experienced by an individual before loss occurs. The patient in this question is showing grief symptoms after the death of the pet; therefore the patient is not experiencing anticipatory grief. Disenfranchised grief is a loss that is not acceptable to society or a loss for which the grieving individual cannot publicly share the grief. The patient in this question can publicly share the grief caused by the death of a pet; therefore the patient is likely not experiencing disenfranchised grief.
Regarding grief in older adults, which understanding helps guide the nurse's relationship with an older adult patient? Older adults have usually sustained many losses in life, which influences the current loss. Older adults with a poor memory experience grief less intensely. Older adults generally handle loss better because they have more experience with it. Social support is less important because an older adult's circle of friends has become smaller.
Older adults have usually sustained many losses in life, which influences the current loss. Older adults have usually sustained more losses because they have lived longer. For people at any age, each loss influences the response to subsequent losses. The loss of a social network makes it more important to find resources and sources of social support for grieving older adults. Sometimes many losses overpower a person's coping resources instead of making him or her stronger.
The nurse is using Sheldon's stages of grief to assess a patient who lost both legs in an accident. Which behavior does the nurse anticipate from this patient during the "pangs of grief" stage? Overwhelming sadness and anger Feelings of numbness and disbelief Loss of meaning and direction in life Development of new relationships
Overwhelming sadness and anger Sheldon's stages of grief explain the emotional states of an individual during grief and loss. The four stages are initial shock, "pangs of grief," despair, and adjustment. The "pangs of grief" stage is the second stage, during which the patient may experience sadness, anger, guilt, vulnerability, anxiety, insomnia, social withdrawal, hallucinations, and restlessness. The first stage is the initial shock stage, during which the person becomes numb and does not believe the truth. Despair is the third stage, during which the person loses meaning and direction in life. In the adjustment phase, the patient develops new relationships and interests.
An adult woman is recovering from a mastectomy for breast cancer and is frequently tearful when left alone. The nurse's approach should be based on an understanding of which concept? Patients need support in dealing with the loss of a body part. The patient's family should take the lead role in providing support. The nurse should explain that breast tissue is not essential to life. The patient should focus on the cure of the cancer rather than loss of the breast.
Patients need support in dealing with the loss of a body part. The nurse should encourage the patient to talk about the threats to body image, including the meaning of the loss, the reactions of others, and the ways in which the patient is grieving. The patient's family will play a role in providing support; however, the patient must work her way through the stages of grief. This will require the patient to assume the lead role in her grieving process. Telling the patient that her breast is not essential to life is not therapeutic and will not offer support. The patient may understand that her main focus should be on treating the cancer; however, at the moment, she must attend to the loss of her body part and work her way through the grieving process.
Which nursing interventions should the nurse implement to provide comfort to a patient who is actively dying? (Select all that apply.) Reposition the patient hourly. Play comforting music in the room. Suction the patient every 2 hours. Give the patient a gentle bath. Use a moistening agent on the patient's lips.
Play comforting music in the room. Give the patient a gentle bath. Use a moistening agent on the patient's lips. Playing comforting music provides peace and relaxation. A gentle bath helps maintain cleanliness and provides comfort. Moistening agents prevent lip dryness and provide comfort. Repositioning the patient hourly may help prevent skin breakdown but may also cause a dying patient discomfort. Suctioning removes secretions that may block the airway but does not provide comfort.
A patient in the terminal stages of acquired immunodeficiency syndrome reports chronic dull pain. On assessment, the nurse learns that the patient does not have a family support system to care for her. Which action by the nurse would be the most appropriate? Hospitalize the patient in the intensive care unit Provide hospice care to the patient Provide acute care to the patient Seclude the patient in separate room
Provide hospice care to the patient The patient is terminally ill and has chronic dull pain; therefore the patient needs hospice care to improve the quality of life during her last days. The patient does not need hospitalization, as the condition cannot be cured. Acute care refers to the short-term treatment for an episode of illness or severe injury. In this situation, the patient has an irreversible terminal illness that cannot be managed by acute care. Seclusion may lead to depression and therefore should be avoided.
Which interventions should the nurse implement to provide a supportive environment for a dying patient? (Select all that apply.) Instruct the family to not bring any pets in to visit. Provide privacy while the family is with the patient. Allow the patient to have photographs in his or her room. Allow the family to visit only during the visiting hours. Provide an environment with input from the patient.
Provide privacy while the family is with the patient. Allow the patient to have photographs in his or her room Provide an environment with input from the patient. The nurse provides privacy to the patient and the family because they may feel uncomfortable sharing their feelings. Photographs provide comfort and give the nurse insight about family dynamics. Maintaining the environment according to the choices and needs of the patient gives the patient comfort. Allowing pets during the visit also provides comfort and companionship. The family should be allowed unrestricted visiting hours to comfort the patient.
A nurse is providing postmortem care. Which action is priority? Locating the patient's clothing Providing culturally and religiously sensitive care in body preparation Transporting the body to the morgue as soon as possible to prevent body decomposition Providing all postmortem care to protect the family of the deceased from having to see the body
Providing culturally and religiously sensitive care in body preparation At the end of life, religious and cultural expectations are important for the lasting memories held by the family about the way their loved one's death occurred. Sensitive care contributes to feelings of closure, appropriateness of the death rituals, and fulfilled family obligations. Locating the patient's clothing, transporting the body to the morgue, and protecting the family from seeing the body are not priority actions the nurse should take.
A patient who underwent coronary artery bypass graft surgery has developed pus in the sternal incision site. After assessing the surgical site, the nurse tells the patient that some tests will need to be done to rule out an infection. The patient begins to shout at the nurse and blames her and the surgeon for the complication. Which action by the nurse would be appropriate? Explain that they are not responsible for this condition. Remain silent and let the patient express his anger. Ignore the patient and attend to other patients. Tell the patient that the surgery had been unsuccessful.
Remain silent and let the patient express his anger. Anger is one of the early stages in the psychosocial adaptation to grief. The patient is not ready to accept the problem and needs the opportunity to express feelings. Telling the patient that the nurse and surgeon are not responsible for this condition should not be the immediate response. The patient should be allowed to express all of his feelings first. The nurse should treat every patient with respect and dignity; ignoring the patient is an inappropriate behavior. Pus from the sternal site does not indicate that the surgery has been unsuccessful; it is a complication of the surgery and can be caused by multiple factors.
The registered nurse is evaluating a student nurse who is preparing a body for autopsy in the morgue. Which nursing action implemented by the student nurse indicates the need for further teaching? Bathing and dressing the patient's body Placing the body into the supine position Placing absorbent pads under the buttocks Removing the nasogastric tube from the body
Removing the nasogastric tube from the body The nurse should not detach medical equipment such as intravenous lines, nasogastric tubes, chest tubes, or endotracheal tubes from the patient because this body will undergo an autopsy, which allows the medical examiner to determine the cause of death. The body is placed in the supine position with head and shoulders elevated on one pillow. This body position prevents abnormal pooling of the blood and keeps the patient's face from being discolored. The nurse bathes and dresses the body to show respect and maintain the dead person's dignity. The nurse may also place absorbent pads under the buttocks so that when the muscles relax they will provide a barrier for the expulsion of urine and feces.
In which stage of mourning described by Bowlby's model of grief does a person accept change, acquire new skills, and build new relationships? Numbing Reorganization Yearning and searching Disorganization and despair
Reorganization In the reorganization stage of mourning, the person accepts change, acquires new skills, and builds new relationships. In this stage, the person is trying to create separation from a lost relationship. In the numbing stage, the person feels numb. In the yearning and searching stage, the person experiences an inner and intense yearning for the lost person. In this stage, the person also shows some physical symptoms. In the disorganization and despair stage, the patient extends blame and expresses anger toward anyone who might be responsible for the loss.
A patient who is in a hospice care facility develops anorexia. The patient is comfortable and at peace; however, the patient's family members are very anxious due to the patient's reduced food intake. Which nursing action would be appropriate in this situation? Encourage the patient to eat. Support the grieving family. Promote spiritual comfort and hope to the patient. Maintain a comfortable and peaceful environment.
Support the grieving family. The nurse should support the grieving family members and provide them emotional support because they are very anxious. The patient should not be encouraged to eat. Patients in the last days of life often develop anorexia, and forcing food or fluids stresses the patient's compromised gastrointestinal and cardiovascular systems, potentially creating increased discomfort. The patient is at peace and does not need immediate spiritual comfort. Usually hospice care facilities have a comfortable and peaceful environment, and the patient is already peaceful.
The nurse is providing bereavement support to a 7-year-old child whose mother died in an accident. How would the nurse respond when the child says, "Mama, what happened to you? Please get up and eat something"? Distract the child by telling stories and showing them toys. Request that the relatives take the child away. Tell the truth that the child's mother died and will not return. Tell the child that she is sleeping and will wake up after some time.
Tell the truth that the child's mother died and will not return. When children lose their loved ones, they may become emotional, and, depending on their age, they may not know what is happening. The nurse tells the truth that the deceased person will not talk, move, eat, or breathe anymore. Distracting the child by telling stories and showing toys may help the child forget the tragedy at that moment, but will not help the child process or come to terms with the loss. If the child is removed without knowing what happened, he or she may feel more anxious, and this may affect the child's mental status. Consoling the child by lying will confuse the child and may have a negative effect on his or her mental status.
The nurse is caring for a patient whose spouse died of cancer 1 year ago. The nurse diagnoses exaggerated grief. Which finding led the nurse to this conclusion? Select all that apply. The patient drinks heavily and has become addicted to narcotics. The patient attempted suicide by jumping from a building. The patient cries often and remains in a depressed state. The patient is unable to concentrate on job-related tasks. The patient made changes to the house to forget the deceased spouse.
The patient drinks heavily and has become addicted to narcotics. The patient attempted suicide by jumping from a building. The patient is unable to concentrate on job-related tasks. Patients with exaggerated grief show intense reactions of grief, which include the use of drugs or alcohol and thoughts of suicide, and cannot function in daily life. A patient with exaggerated grief may attempt suicide and may not be able to concentrate on work. Crying and depression for a prolonged period of time may indicate chronic grief but are not necessarily indicative of complicated grief. A patient with delayed grief consciously or unconsciously avoids things that remind him or her of the loss; therefore a patient who changes his or her house to avoid memories of a person may experience delayed grief.
The nurse is providing hospice care to a terminally ill patient who is describing bright lights and spiritual entities. Which conclusion does the nurse make regarding the patient's condition? The patient is showing signs of a mental illness. The patient is approaching the end of life. The patient is confused and is fearful of death. The patient is having an adverse medication reaction.
The patient is approaching the end of life. Nearing death awareness is a special communication that occurs when people are approaching death. People near death may say that they see a bright light or spiritual beings; therefore the nurse can conclude that the person is near death. The nurse does not assume that this is a sign of mental illness, confusion, or a reaction to medication.
The nurse observes noisy breathing when caring for a terminally ill patient. Which condition in the patient would be evaluated to determine the cause? Anemia Increased oxygen demand Anticholinergic medications Thick secretions in the airway
Thick secretions in the airway Noisy breathing, also known as a death rattle, is caused by thick secretions in the airway and decreased muscle tone, swallow, and cough. Noisy breathing refers to the sound of secretions moving in the airway during inspiratory and expiratory phases. It indicates the last stage of life. It does not occur due to an anemic condition, increased oxygen demand, or anticholinergic medications. Anemic conditions and increased oxygen demand cause dyspnea or shortness of breath. Anticholinergic medications are helpful to relieve noisy breathing by decreasing the secretions.
A patient is diagnosed with advanced leukemia and is hopeless about the treatment. Which nursing interventions would help the patient overcome hopelessness? (Select all that apply.) Treat chronic pain. Advise dietary modification. Provide economic support. Identify sources of social support. Provide opportunities to express positive life events.
Treat chronic pain. Identify sources of social support. Provide opportunities to express positive life events. Treatment of pain can make the patient more comfortable and help in building a positive outlook. The family members, friends, and support groups can be approached for help. Providing opportunities to express positive life events helps the patient focus on positivity rather than negativity related to the disease. Dietary modification and economic support do not relieve hopelessness.
2. Mr. S. has recently lost his wife of 56 years after she had been diagnosed with terminal pancreatic cancer. Which of the following focused assessment questions is appropriate to ask when you suspect that Mr. S. may be experiencing dysfunctional grief? a. "How would you describe your feelings about the loss of your wife?" b. "Do you feel that your sense of loss has gotten worse over the last year?" c. "Do you have any religious or spiritual beliefs that have helped you during this time of loss?" d. "What types of support do you have during this time?"
b. "Do you feel that your sense of loss has gotten worse over the last year?" Dysfunctional grieving includes more focused questions that help the nurse to identify potential patterns of coping that are not healthy for the individual experiencing grief and include: worsening grief, dysfunctional or unhealthy coping strategies, and an inability to function in activities of daily living. General nursing assessment parameters pertinent to nursing for a grieving individual include: current coping strategies, available support systems, health status (physical as well as emotional), and religious or spiritual beliefs.
1. While caring for a female patient with advanced multiple sclerosis, the nurse is discussing the difference between hospice and palliative care. Which statement by the patient indicates understanding of the difference between hospice care and palliative care? a. "I will need to get hospice care if I want my symptoms controlled." b. "I can get palliative care right now—even though I am not going to die anytime soon." c. "My doctor has to make the decision if I have hospice care." d. "I can't get any other treatments, even if they are experimental if I choose palliative care."
b. "I can get palliative care right now—even though I am not going to die anytime soon." Hospice care and palliative care are focused on the management of symptoms. Hospice care is provided to those who have a prognosis of less than 6 months to live. Palliative care is provided to any person who needs assistance with management of symptoms. Physicians delineate the prognosis, but the patient and family ultimately make the decision if they want care provided by hospice.
9. In caring for a dying patient, what is an appropriate nursing action to increase family involvement? a. Insisting that all bedside care be performed by the family b. Asking family members what they would like to do for their loved one and allowing them to participate c. Expecting the family to be able to perform the patient's daily needs and to meet them consistently d. Refusing all assistance from the family, to decrease family stress
b. Asking family members what they would like to do for their loved one and allowing them to participate Many family members would like to be involved in the care of their loved one while the person is dying. It is the responsibility of the nurse to assess the level of involvement in which the family would like to participate related to patient care. Teaching about care measures is a nursing intervention that can be implemented to assist family members during the process of anticipatory grief. Family members should not be expected to meet all of the patient's needs but should not be excluded from caring for their loved one.
8. In which scenario is hospice care provided? a. Only in the homes of the terminally ill b. For any terminal illness that requires symptom control c. For cancer patients only in their last weeks of life d. Only in hospital settings based on the seriousness of the illness
b. For any terminal illness that requires symptom control Hospice care is provided in a variety of settings, including home care, freestanding inpatient units, hospitals, long-term care facilities, and prisons, as well as to the homeless, for patients with any disease or illness that has been determined to be life-limiting (prognosis of 6-month survival). Any patient who is experiencing symptoms—physical, psychological, or spiritual—benefits from hospice support and symptom control at the end of life.
6. Several theorists have identified stages of the grieving process. The nurse understands these stages and knows that people progress through them in an individualized manner. Which statements are true regarding the steps of the grieving process? (Select all that apply.) a. There is a definite "timetable" or period of time specific to each stage of the grieving process. b. Nursing interventions are generalized across all stages of the grieving process. c. Tasks to be achieved at each stage have been identified by each theorist. d. There is a common stepwise progression through each stage of the grieving process. e. Not all individuals will experience all stages of grief.
c. Tasks to be achieved at each stage have been identified by each theorist. e. Not all individuals will experience all stages of grief. Each stage of the grieving process has associated tasks that allow successful grieving to occur on an individualized basis. Theories that describe the grieving process are simply guides to understanding the process of grief, and there is no specific timeline regarding when people "should be" in a certain stage, "should" move from one stage to the next, or follow a stepwise progression. Not all people will experience all stages of grief. Essentially there is no timetable for the process of grief and bereavement. Nurses need to understand these stages, and the feelings as well as emotions that are common in each stage, so that nursing interventions can then be focused on the individual stage that a person is experiencing, or the task that the person is attempting to complete related to the process of grief.
10. The best way for a new nurse to cope with his/her own feelings related to death, loss, and grief while caring for patients is to: a. emotionally distance him/herself from dying patients and their families immediately after death has occurred. b. provide ongoing bereavement support to families of patients who have died. c. develop a beginning awareness of his/her own fears, feelings, responses, and reactions to death and dying. d. discuss feelings of loss with family members and friends as a way to cope with loss in the workplace.
c. develop a beginning awareness of his/her own fears, feelings, responses, and reactions to death and dying. To effectively care for the dying, nurses need to explore their personal feelings regarding death. Self-exploration and reflection through personal death awareness exercises and discussion of beliefs and life and death with friends, peers, coworkers, and pastoral care workers may promote an understanding and acceptance of death as a part of life. Emotional distancing from patients and families is not an effective way for nurses to learn about themselves and their response to death and loss. Nurses also do not provide ongoing bereavement support to families, although they may provide information about ongoing bereavement services in the community. It is important to discuss feelings of loss with others, but it should be done with peers, coworkers, pastoral care workers, or other members of the health care team who have also experienced loss related to death in the work setting.
6. A nurse's role when communicating with a provider caring for a dying patient is: a. to make him/her see the situation correctly. b. to carry out his/her orders. c. to advocate for the patient's wishes. d. to suggest an appropriate course of action.
c. to advocate for the patient's wishes. A major role of the nurse, in any setting, especially when a patient is dying is to advocate for his/her wishes related to end-of-life care. It is not the role of the nurse to diagnose or treat medical conditions, but it is the role of the nurse to advocate for the patient and implement appropriately identified independent nursing interventions.
