Chapter 17. Loss, Grief, & Dying
The nurse is caring for a patient in a persistent vegetative state (PVS). Which finding is inconsistent with this diagnosis? a)Aware of family, but can't respond to them b)Opened her eyes in response to external stimuli c)Has occasional grimaces and tears d)Has periods of eyes opening and closing
A A patient in a coma has a prolonged, deep state of unconsciousness and cannot be aroused. A patient in a persistent vegetative state (PVS) has only lost the higher cerebral functions and may have a sleep-wake cycle with eyes opening and closing; some spontaneous movement; may occasionally grimace, cry, or laugh; and may react to loud noises. The patient is not cognitively aware of the environment.
The nurse has been explaining advance directives to a patient. Which response by the patient would indicate that he has correctly understood the information? "An advance directive is a document that: a)Specifies your healthcare instructions should you become unable to make self-directed decisions" b)Identifies the activities considered to be evidence of quality care" c)Verifies your understanding of the risks and benefits associated with a procedure" d)Allows you the autonomy to leave the hospital when you decide, even if it is against medical advice"
A An advance directive is a group of instructions stating the patient's healthcare wishes should he become unable to make decisions. The Patient Care Partnership is a document that helps to ensure that patients receive quality care. An informed consent form verifies the patient's understanding of risks and benefits associated with a procedure. An "against medical advice" form allows the patient to leave the hospital against medical advice and releases the hospital from responsibility for the patient.
Which dysrhythmia confirms death? a)Asystole (absence of heart activity) b)Pulseless electrical activity c)Ventricular fibrillation d)Ventricular tachycardia
A Asystole is a dysrhythmia that commonly serves as a confirmation of death. Pulseless electrical activity, ventricular fibrillation, and ventricular tachycardia are potentially lethal dysrhythmias that may respond to treatment.
The nurse had been caring for a patient in a hospice facility for 1 month. When the patient dies, the family invites the nurse to attend the calling hours and funeral. What is the most appropriate action for the nurse to take? a)Attend the services, if she wishes to do so, as this can help to diffuse the nurse's feelings of loss and can be meaningful to the family. b)Ask another nurse for her opinion on this matter, because her own judgment may not be reliable at this time. c)Do not attend the service, because nurses cannot become attached or overly involved with family members after the death of their patients. d)Attend the service but stay for only a short period of time, as these occasions are reserved for close friends and family.
A If the nurse wishes to do so, it is appropriate to attend calling hours or attend funeral services. This often helps a nurse to diffuse some of her own feelings associated with the loss and is very meaningful to family members. It acknowledges that a nurse took her time to remember them and their loved one. One can ask another nurse for an opinion; however, this is not necessary as it is perfectly acceptable for a nurse to attend services. There is no recommended "time frame" for how long a nurse should be in attendance at a service. This is at the discretion of the nurse.
A 73-year-old patient who suffered a stroke is being transferred from the acute care hospital to a nursing home for ongoing care because she is unable to care for herself at home. Which type of loss is this patient most likely experiencing? a)Environmental loss b)Internal loss c)Perceived loss d)Psychological loss
A This patient is most likely experiencing an environmental loss because she is unable to return to her familiar home setting. Instead, she is being transferred to the new environment of a nursing home. Internal, perceived, and psychological losses are internal and can be identified only by the person experiencing them.
The nurse is caring for a patient who has cancer and is terminally ill. What are the most appropriate action(s) by the nurse in providing end-of-life care that will address the patient's cultural and spiritual needs? Select all that apply. a)Be an empathetic listener for the patient. b)Allow the patient to participate in his spiritual rituals. c)Recognize that this is an emotional time and prepare for intense crying. d)Contact pastoral care or the patient's clergyperson.
A, B When a person is terminally ill his spiritual and cultural concerns may or not be of great importance. The nurse must take the lead from the person and ask what these concerns and needs are. Only then can the nurse take action to provide end-of-life care that will address these concerns. Some ways to address these concerns are providing empathetic listening, allowing the person to participate in spiritual and cultural rituals, contacting pastoral care or clergy, if the person asks for them, and providing comfort and good communication. Nurses cannot assume that all persons will engage in intense crying or wailing. Some cultures may emphasize keeping emotions more subdued and limiting expressions of grief to private settings, whereas others gauge the value of the deceased by the amount of wailing and crying.
For a patient to be eligible for insurance benefits covering hospice care, a physician must certify which of the following? Select all that apply. a)Life expectancy is not more than 6 months. b)Life expectancy is not more than 12 months. c)The condition is expected to improve slightly. d)The condition is not expected to improve.
A, D For a patient to be eligible for hospice care insurance benefits, a physician must certify that the patient is not expected to improve or will most likely die within 6 months.
A 16-year-old boy recently lost his father in a tragic motorcycle accident. In assessing how well this teenager is managing and coping with the death of his father, the nurse should be most alert for: a)Engaging in excessive crying b)Engaging in health risk behaviors c)Not doing his homework d)Distancing himself from friends
B All behaviors listed in this item are ways in which a teenager may deal with loss and death. Research however, shows that bereaved youths who have lost a parent have a high frequency of engaging in health risk behaviors. The nurse must be alert to these behaviors and make appropriate interventions as these are of the highest priority.
Which patient is at most risk for experiencing difficult grieving? a)The middle-aged woman whose grandmother died of advanced Parkinson's disease b)A young adult with three small children whose wife died suddenly in an accident c)The middle-aged person whose spouse suffered chronic, painful death d)The older adult whose spouse died of complications of chronic renal disease
B Although it is impossible to predict with certainty and the grieving process is highly individual and personal, those who suffer a sudden loss typically have more difficult grieving than those who have had the time to prepare for the death. Family and friends of persons with chronic illnesses or cancer have usually had time to prepare emotionally for the death, initiate the funeral and burial arrangements, and begin the grieving process before the death occurs.
Which intervention by the nurse is most appropriate when she notices that her dying patient has developed a "death rattle"? a)Perform nasotracheal suctioning of secretions. b)Turn the patient on his side and raise the head of the bed. c)Insert a nasopharyngeal airway as needed. d)Administer morphine sulfate intravenously.
B If a "death rattle" occurs, turn the patient on his side, and elevate the head of the bed. Nasotracheal suctioning and inserting a nasopharyngeal airway are ineffective against a "death rattle" and may cause the patient unnecessary discomfort. The patient may require IV morphine sulfate to treat pain, but it does not help stop a "death rattle." This narcotic analgesic can also reduce the respiratory drive, leading to hypoventilation and respiratory depression or arrest.
Throughout the course of his illness, a patient has denied its seriousness, even though his health professionals have explained prognosis of death very clearly. Physiological signs now indicate that he will probably die within a short period of time, but he is still firmly in a state of emotional denial. The patient says to the nurse, "Tell my wife to stop hovering and go home. I'm going to be fine." How should the nurse respond? a)"Your physical signs indicate that you will likely not live more than a few more days." b)"You seem very sure that you are not going to die. Please tell me more about what you are feeling." c)"It seems to me you would be feeling some anger and wondering why all this is happening to you." d)"It would be best for your family if you were able to work through this and come to accept the reality of your situation."
B Not all patients go through all the traditional stages of grieving. It is not the nurse's responsibility to move patients sequentially through each stage of the dying and grieving process with the goal that everyone ends life accepting death. It is a nursing responsibility to accept and support people "where they are" and help them to express their feelings. Nurses need to understand patients, not change them. In this situation, denial may be very important to this patient, as an emotional defense and coping strategy. "You seem very sure. . . . Please tell me . . . what you are feeling" restates what the patient has said (indicating understanding) and encourages expression of feelings—both are supportive. Even though moving him through stages is not the goal in this situation, support does facilitate that. Telling the patient that his physical signs indicate that death is imminent is presenting truth and reality; however, the exact time of death is not always predictable. Forecasting the hour of death can have negative impact on the family as they anticipate the event with emotion and exhaustion. Presenting reality is appropriate in certain circumstances earlier in the dying process, but not in this situation because it has already been tried with no change in the patient. Presenting reality does not support the patient's needs at this time. Saying "It seems to me you would be feeling some anger . . ." is directed toward moving the patient from denial and suggesting he should feel something he has not yet expressed. This is not therapeutic. Saying "It would be best for your family . . ." presumes that the nurse knows more about what is "best" for the patient's family more than the patient himself. This statement is also judgmental.
When providing postmortem care, the nurse places dentures in the mouth and closes the eyes and mouth of the patient within 2 to 4 hours after death. Why is the timing of the action so important? a)To prevent blood from settling in the head, neck, and shoulders b)To perform these actions more easily before rigor mortis develops c)To set the mouth in a natural position for viewing by the family d)To prevent discoloration caused by blood settling in the facial area
B Rigor mortis develops 2 to 4 hours after death; therefore, the nurse should place dentures in the mouth and close the patient's eyes and mouth before that time. The nurse should place a pillow under the head and shoulders to prevent blood from settling there and causing discoloration. Closing the patient's mouth and tying a strip of soft gauze under the chin and around the head keeps the mouth set in a natural position for a viewing later. Closing the eyes after death creates a peaceful resting appearance when the body is later viewed but has nothing to do with setting the mouth. Placing dentures in the mouth and closing the eyes and mouth do not prevent discoloration in the facial area.
Which of the following patient goals is most appropriate when managing the patient dying of cancer? The patient will: a)Request pain medication when needed b)Report or demonstrate satisfactory pain control c)Use only nonpharmacological measures to control pain d)Verbalize understanding that it may not be possible to control his pain
B The most important goal is that the patient will report or demonstrate satisfactory pain control. The nurse should administer pain medication on a regular schedule to ensure satisfactory pain control; pain may not be controlled if medication is administered on an "as needed" basis. Nonpharmacological measures can be a helpful adjunct in controlling pain, but they are not likely to be adequate for pain associated with cancer. Effective pain-control medications are available and can be administered by several routes; it should be possible to control the pain.
A patient's wife has told nurses that she wants to be with her husband when he dies. The patient's respirations are irregular, and he is congested. The wife tells the nurse that she would like to go home to shower but that she is afraid her husband might die before she returns. Which response by the nurse is best? a)"Certainly, go ahead; your husband will most likely hold on until you return." b)"Your husband could live for days or a few hours; you should do whatever you are comfortable with." c)"You need to take care of yourself; go home and shower, and I'll stay at his bedside while you are gone." d)"Don't worry. Your husband is in good hands; I'll look out for him."
B The patient is exhibiting signs that typically occur days to a few hours before death. The nurse should provide information to the wife so she can make an informed decision about whether to leave her husband's bedside. The nurse should not offer false reassurance by stating that the patient will most likely be fine until the wife's return. The nurse should not offer her opinion by telling the wife that she needs to take care of herself. It is also unrealistic for the nurse to stay with the patient until his wife returns. The nurse would be minimizing the wife's concern by telling her not to worry because her husband is in good hands. The issue for the family member is not trust in the competency of the healthcare provider but rather wanting to be present with her spouse at the time of death.
A home health patient previously lived with her sister for more than 20 years. Although it has been more than a year since her sister died, the patient tells the nurse, "It's no worse now, but I never feel any relief from this overwhelming sadness. I still can't sleep a full night. The house is a mess; I feel too tired even to take a bath. But, sometimes at night, she comes to me and I can see her plain as can be." The patient's clothing is not clean and her hair is not combed. She is apparently not eating adequately. What can the nurse conclude? The patient is probably a)Grieving longer than usual because of the closeness of the relationship with her sister b)Experiencing a depressive disorder rather than simply grieving the loss of her sister c)Feeling guilt and worthlessness because her sister died and she is still alive d)Interpreting the holiday as a trigger event, which is causing her to hallucinate
B The patient is likely experiencing a depressive disorder. Her symptoms include unrelieved, overwhelming sadness; insomnia; difficulty carrying out ADLs; fatigue; and visual hallucinations. Note that her sadness is pervasive, not created by a trigger event (holiday). Of those symptoms, insomnia is common to both grief and depression, but the other symptoms are signs of depressive disorder. There is, of course, no "correct" time line for what constitutes "longer than usual" grieving; however, the patient's symptoms are typical of depression, not grief. She has not said she feels guilty or worthless, and there is nothing from which the nurse could infer that. She has specifically said the holiday has not made her feel any worse—that is, it has not been a trigger event.
Which of the following statements describes legal responsibilities after the death of a person? Select all that apply. a)Next of kin must sign a consent before any autopsy can be performed. b)If the patient is donating organs, necessary arrangements must be made. c)The person who pronounces death must sign the death certificate. d)Family members are not allowed to participate in postmortem care.
B, C Legal responsibilities when a death has occurred include notifying the primary care provider of the death; making certain the person who pronounces death signs the death certificate; reviewing and making any necessary arrangements for organ donation, if applicable; following state laws if a person has died of a communicable disease; and recognizing conditions and circumstances for obtaining an autopsy. An autopsy requires signed permission from the next of kin, except in cases in which an autopsy is required by law (e.g., a suspicious or unwitnessed death). Additionally, each state possesses laws for other conditions of autopsy. For example, in some states, if a patient has died within 24 hours of a hospital admission an autopsy is automatically performed. Postmortem care is usually provided by the nurse; however, this is often per agency policy. There is no law about family members' participation in postmortem care and, in fact, family members are encouraged if they choose to participate in postmortem care.
Nurses frequently encounter death of patients in many healthcare settings. What are some strategies nurses can use to better care for themselves when dealing with death and the dying? Select all that apply. a)Recognize that you must remain detached and unemotional when working with dying patients. b)Talk with colleagues about your feelings related to death and dying. c)Take time for yourself through relaxation and focusing on peaceful thoughts. d)Have a good understanding of your own feelings about death and dying.
B, C, D Take care of yourself! As a nurse, this is a very important piece in working with grieving, death, and dying. This can be very rewarding work; however, it can also be emotionally draining. Some strategies that are useful to nurses in working with this stressful type of work include understanding your own attitudes, beliefs, and feelings concerning death; talking to colleagues about your feelings; being able to confront and accept grief as a normal process; attending services for patients whom you have lost; joining a support group; and taking time for relaxing and a little "pampering" (e.g., a bubble bath or a massage).
Which of the following might be a warning sign that a child needs professional help after the death of a loved one? Select all that apply. a)Interested in his usual activities b)Extended regression c)Withdrawal from friends d)Inability to sleep e)Intermittent sadness
B, C, D The warning signs that may indicate the need for professional help include inability to sleep, extended regression, loss of interest in daily activities, and withdrawal from friends. Remaining interested in usual activities is a sign of coping; intermittent expressions of sadness and anger are to be expected, even over a long period of time, so would not indicate a need for professional help.
Dr. Elisabeth Kübler-Ross has written extensively on the psychological stages of death and dying. Which statement(s) listed below are most consistent with her theory? Select all that apply. a)A patient must pass through each of the five stages of death and dying. b)Her theory has expanded and can now be applied to losses other than death. c)The nurse's role is to help patients move from one stage to the next, and finally to acceptance. d)Patients may experience two or three stages at the same time.
B, D Perhaps the best-known author on the psychology of dying is Dr. Elisabeth Kübler-Ross. She believed that if people understood what dying patients are experiencing, they would be more competent in caring for them. Her theory, centering on five stages of death and dying, has become a classic for professional and lay readers. Some of the main points of her theory are the following: A person may not go through every stage, a person may not go through the stages in a linear fashion, a person does not necessarily complete one stage and move on to the next, and a person may experience two or three stages simultaneously. She does not address the nurse's specific role; however, it should be noted that as nurses, it is not our responsibility to move people to the next stage so that the dying patient accepts death. It is the nurse's responsibility to accept and support people "where they are" and help them to verbalize their feelings.
The nurse is caring for an unresponsive, near-death patient in the intensive care unit and it is unclear whether or not this patient is an organ donor. The family states, "I think he put 'organ donor' on his license but we don't want to donate his organs." What is the nurse's priority action at this time? a)Review the driver's license and prepare for donation. b)Honor the family's wishes, as the patient is unable to make a decision. c)Maintain the viability of organs until a resolution is made. d)Contact the primary care provider.
C A conflict between a potential organ donor's wishes, advance directive, and measures to ensure viability of the organs must be resolved as soon as possible by checking with the donor (if possible), the surrogate decision maker, or another person as authorized under state law. Until a resolution is made maintaining the viability of the organs has the highest priority. Contacting the primary care provider is not helpful, as the patient has the first right to the decision and family is second.
Which intervention takes priority for the patient receiving hospice care? a)Turning and repositioning the patient every 2 hours b)Assisting the patient out of bed into a chair twice a day c)Administering pain medication to keep the patient comfortable d)Providing the patient with small frequent, nutritious meals
C A priority intervention for the hospice team is administering pain medications to keep the patient comfortable. Turning the patient to prevent skin breakdown and promote comfort is also important, but it does not take priority over administering pain medications. The patient may not be able to eat meals or get out of bed into the chair, and may tolerate only small amounts at a meal. During the dying process, bowel activity reduces and digestion is minimal, which often results in nausea or food intolerance. Additionally, the body's need for nutrition and hydration is reduced as the body begins the desiccation process.
A patient in a cancer clinic says to the nurse, "I'm just so angry. I feel like God is punishing me. I know this is a bad way to think, but I don't deserve to die of cancer." What is the most appropriate response by the nurse? a)"Death is part of life. With the passing of more time you will learn to accept this." b)"It sounds like you are losing your faith in God. God does not punish people." c)"It is normal for you to feel this way. I'm interested in hearing more about how you feel." d)"Anger is not good for you at this time. We can talk about some more helpful, positive feelings."
C Reassure the patient that it is not wrong or bad to feel anger, guilt, relief, or other feelings he may believe are unacceptable. Patients need to feel that their feelings are not wrong and that they are going through a difficult time and a normal process. It is further helpful to ask more questions of the patient so the nurse can obtain a better assessment of other feelings the patient may be experiencing.
The student informs her preceptor that the acronym "AND" is being recommended to replace "DNR" for patients who do not want to be resuscitated. What does the acronym "AND" stand for? a)Attempt no dietary measures b)Adjust nursing directives c)Allow natural death d)Alternative nursing care desired
C The acronym "AND" stands for allow natural death and is being recommended to replace the term do not resuscitate (DNR) because the former contains the word death, so the intent of the provider's order is clear.
The mother of a preschool child dies suddenly of a ruptured cerebral aneurysm. What recommendation should the nurse make to the family regarding how to most therapeutically care for the child? a)Take the child to the funeral even if he is frightened. b)Notify the physician immediately if the child shows signs of regression. c)Spend as much time as possible with the child. d)Provide distraction whenever the child begins to express feelings of sadness.
C The nurse should advise the family to spend as much time as possible with the child. If the child is frightened about attending the funeral, he should not be forced to attend. Signs of regression are a normal reaction to the loss of a loved one, especially a parent. The child should be encouraged to express his feelings and fears.
How should the nurse respond to a family immediately after a patient dies? a)Ask the family to leave the patient's room so postmortem care can be performed. b)Leave tubes and IV lines in place until the family has the opportunity to view the body. c)Express sympathy to the family (e.g., "I am sorry for your loss"). d)Tell the family that they will have limited time with their loved one.
C The nurse should express sympathy to the family immediately after the patient's death. She should give the family as much time as they need with their loved one and take care to present the body in a restful pose. If family members are not present at the time of death, remove tubes and IV lines before they see the body, unless an autopsy is planned or the death is being investigated by the coroner. The body should not be removed from the patient care area until the family is ready.
Which statement below best describes the difference between a "DNAR" and an "AND" order? a)There is no difference in the two terms. Both are used synonymously. b)A DNR is an order not to resuscitate; an AND is an order not to attempt to resuscitate. c)AND contains the word death, so the intent of the order by the provider is clear. d)A DNR order provides specific instructions for hydration and feeding. An AND does not.
C There is a difference between a DNAR and an AND. The acronym "AND" stands for allow natural death and is being recommended to replace the term do not resuscitate (DNR) and do not attempt to resuscitate (DNAR) because "AND" contains the word death, so the intent of the provider's order is clear. Usually a DNR, DNAR, and an AND order do not provide explicit instructions for hydration and feeding, as this is usually written as part of an advance directive/living will.
A patient dying of heart failure has changed his choice about his end-of-life treatment measures several times. He says, "I just can't make up my mind about it." Which nursing diagnosis is most appropriate for this patient? a)Deficient Knowledge b)Spiritual Distress c)Decisional Conflict d)Death Anxiety
C This patient is experiencing Decisional Conflict related to his end-of-life treatment measures. Deficient Knowledge, Spiritual Distress, or Death Anxiety may be the etiology of his changing decisions, but his indecision about his treatment option clearly identifies his Decisional Conflict.
Which intervention is appropriate for a client receiving palliative care? Select all that apply. a)Surgically inserting a device to decrease the workload of the heart in a patient awaiting heart transplantation b)Administering intravenous dopamine to raise the blood pressure of a patient with end-stage lung cancer c)Providing moisturizing eyedrops to an unconscious patient whose eyes are dry d)Administering a medication to relieve the nausea of a patient with end-stage leukemia
C, D Palliative care focuses on relieving symptoms for patients whose disease process no longer responds to treatment. Providing moisturizing eyedrops and administering antinausea medication in a patient with end-stage leukemia are examples of palliative care. Surgically inserting a device to decrease heart workload and administering dopamine are aggressive treatment measures.
The American Nurses Association (ANA) lists recommendations concerning DNARs and ANDs. Which of the following statements are consistent with the ANA recommendations? Select all that apply. a)A DNAR means that the nurse can discontinue care including removal of a feeding tube. b)If there is no DNAR or AND written, the nurse can participate in a "slow code" until a written order is obtained. c)Nurses should take an active role in developing policies related to DNARs and ANDs. d)If there is any conflict or confusion regarding a DNAR or AND, the competent patient's choices will always have the highest priority.
C, D The American Nurses Association (ANA) has written recommendations pertaining to DNAR and AND. They are as follows: The competent patient's choices have highest priority when there is conflict. If the patient is not competent, highest priority is given to the advance directive or surrogate decision makers. A DNAR must be documented, reviewed, and updated. A DNAR does not mean to discontinue care or provide substandard care. There is nothing written by the ANA to address removal of a feeding tube when a DNAR is written. Finally, the ANA recommends that nurses have a responsibility to avoid participation in "slow codes" or "partial codes."
Which of the following best reflects the definition of the Uniform Determination of Death Act? a)Cessation of blood flow to vital organs b)Cessation of spontaneous respirations c)Irreversible cessation of higher-brain functions d)Irreversible cessation of brain and brainstem function
D Historically, death has been defined as the cessation of the flow of vital bodily fluids. This definition evolved over time to other definitions including heart-lung death, whole-brain death, and higher-brain death. Each of these definitions rendered it possible to keep a person "alive" indefinitely with the means of mechanical ventilation. In 1981, the Uniform Determination of Death Act was proposed specifically to address this issue and provide a highly reliable means of declaring death for the ventilator-maintained body. The definition for determination of death cites two conditions for determining death. The first is the irreversible cessation of circulatory and respiratory functions and the second is the irreversible cessation of all functions of the entire brain, including the brainstem. Each of these definitions includes the word irreversible, as cessation of circulatory and respiratory function can be resumed through cardiopulmonary resuscitation (CPR).
A nursing student attending a conference on grief says to one of the presenters, "The patient I cared for last week in clinical told me she cried for 4 months after she lost her cat. Isn't that an excessive amount of time to cry over a cat?" What is the most appropriate response by the presenter? a)"Yes, 4 months is an excessive amount of time. Encourage her to obtain counseling." b)"No, when I lost my dog, I cried for 4 months. It was a difficult experience for me" c)"As long as the patient is able to get to other things in her life, then it is okay." d)"No, all people grieve differently depending on how meaningful the loss was in their life."
D It is almost impossible to determine the appropriate amount of time needed for grieving and mourning a loss. Much is determined by the meaning of the loss and how significant the loss is to one's life. The best answer is to acknowledge that all people will grieve differently depending on the meaning of that loss. One cannot say the patient needs counseling, as there is no evidence of dysfunctional grieving. Acknowledging a personal experience to make a point is helpful and sometimes useful; however, this is not the best answer and will not help the student learn the significance and meaningfulness of loss. Stating that as long as the patient is getting to other things in her life may be correct; however, this does not explicitly answer the student's question.
During a health history, a patient whose wife died unexpectedly 6 months ago in a motor vehicle accident admits that he drinks at least six bourbon and waters every night before going to bed. Which type of grief does this best illustrate? a)Delayed b)Chronic c)Disenfranchised d)Masked
D Masked grief occurs when the person is grieving, but it may look as though something else is occurring; in this case, the person is abusing alcohol. Delayed grief occurs when grief is put off until a later time. Chronic grief begins as normal grief but continues long term with little resolution of feelings or ability to rejoin normal life. Disenfranchised grief is experienced when a loss is not socially supported.
Which of the following statements regarding palliative sedation is true? a)Palliative sedation is a type of assisted suicide that is legal in a few states. b)Involuntary euthanasia is a type of palliative sedation that is legal in several states. c)The American Nurses Association opposes the use of palliative sedation because it is a form of voluntary euthanasia. d)The Hospice and Palliative Nurses Association promotes palliative sedation to manage unendurable and refractory symptoms.
D Palliative sedation—the use of controlled and monitored non-opioid medications to lower the patient's level of consciousness to the extent necessary, for relief of awareness of refractory and unendurable symptoms—is advocated by the Hospice and Palliative Nurses Association.
What is the American Nurses Association's (ANA) position on assisted suicide? a)Because it is legal in some states, nurses can participate in assisted suicide. b)Nurses must follow the policies of their employing agency. c)Because it is legal in some states, the ANA refuses to take a position that may contradict a state law. d)The ANA prohibits nurses from participating in assisted suicide.
D The American Nurses Association recognizes that assisted suicide is legal in a few states, but is opposed to the practice. Nurses are prohibited from participation in assisted suicide because it is a direct violation of the Code of Ethics.
Which nursing intervention should be included in the plan of care for a patient dying of cancer? a)Encourage at least one family member to remain at the bedside at all times. b)Follow up with other healthcare team members during weekly meetings. c)Avoid discussing the dying process with family (to reduce sadness). d)Encourage family members to participate in care of the patient when possible.
D The plan of care should include encouraging family members to help with the patient's care when they are able. Family members should also be encouraged to take care of themselves. They often need to be encouraged to take breaks to eat or rest. Provide them with anticipatory guidance about the stages of death so they know what to expect. Follow up promptly (not weekly) with other healthcare team members to address family concerns.
