Death and loss questions

The nurse recognizes which goal to be appropriate for the nursing diagnosis of Anxiety? a. The patient will attend a weekly support group. b. The patient will discuss possible coping strategies during weekly office visits. c. The patient will report increased ability to concentrate on care instructions before discharge. d. The patient's family will use respite care once a week for the next month.

c (rationale: Attending a weekly support group is an appropriate goal for Difficulty coping. An appropriate goal for Ineffective coping would be to discuss possible coping strategies during weekly visits. Using respite care once a week for the next month is an appropriate goal for Caregiver stress.)

The nurse is providing education to a patient around anger management strategies. Which statement indicates a need for further education by the patient? a. "Exercise can help me deal with the anger." b. "I can use humor." c. "I can punch things." d. "I can take a time-out."

c (rationale: Strategies should focus on nonviolent methods. Some anger management interventions include expressing feelings in a calm, non-confrontational manner; exercising; identifying potential solutions; taking a time-out; forgiving; diffusing the situation with humor; owning one's feelings; and breathing deeply.)

The nurse is assessing level of stress in a patient from another culture. Which question is the most appropriate in helping the nurse understand the impact of the patient's belief system? a. "Do you engage in prayer to help you during times of stress?" b. "Do you go to church or other form of organized worship?" c. "Do you have certain beliefs that are helpful during times of stress?" d. "Do you want spiritual counseling while you are here?"

c (rationale: The nurse needs to obtain a knowledge base of the patient's culture as well as identify health beliefs and cultural values from the patient's worldview. Asking the patient specific questions about prayer or church or spiritual counseling is inappropriate until the nurse first understands what the patient's own beliefs and practices are.)

Which interventions are considered helpful to assist nurses coping with the unexpected death of a patient for whom they cared for many weeks? (Select all that apply). a. Engaging in preferred personal spiritual practices b. Journaling personal reflections surrounding the death of the patient c. Scheduling work to a different shift than the one regularly worked d. Arranging a consultation with the unit manager to discuss a possible unit transfer e. Setting aside time for relaxation activities, such as painting, gardening, or exercising

a, b, e (rationale: Engaging in helpful personal spiritual practices, journaling personal reflections, and setting aside time for relaxation activities are all considered helpful strategies for nurses coping with loss and stress. Scheduling to work different shifts and discussing a possible unit transfer are both forms of avoidance that may result in increased stress and delayed grieving.)

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. Demonstrating care and supporting family participation c. Expecting the family to consistently perform the patients ADLs d. Refusing all assistance from the family to decrease family stress

b (rationale: 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.)

When the nurse measures the patient's blood glucose levels after an acute myocardial infarction (MI), the nurse knows this action is based on which rationale? a. Damaged muscle tissue releases glucose. b. Corticosteroids increase glucose. c. Myocardial infarctions are often seen in diabetics. d. All patients should have their blood glucose checked.

b (rationale: The endocrine system responds to stress on the body such as what happens during an acute MI. Corticosteroids are important in the stress response because they increase serum glucose levels and inhibit the inflammatory response. Although MIs can be seen in diabetics, there is nothing to indicate this patient is diabetic. All patients do not routinely have their blood glucose checked regularly.)

The nurse sees a young child in the clinic whose mother has only a few weeks to live. The child has been misbehaving at school recently and is suspended after picking fights with other students and defying teachers. The nurse identifies which stage of grieving that the patient is experiencing? a. Denial b. Anger c. Bargaining d. Depression

b (rationale: The patient is angry over the impending death of the mother and is acting out this anger at school by picking fights and defying his teachers. Denial is a temporary defense while processing the information. Bargaining is negotiation to change the predicted outcome. Depression includes crying and sadness.)

The nurse is caring for four patients. Which one should the nurse assess for spirituality needs as a priority? a. New mother, older child at home. b. Faces terminal diagnosis. c. needs to change medications d. pleasant but quiet

b (rationale: There are many cues to alert the nurse that a patient might have unmet spiritual needs, including facing a terminal illness. The nurse should conduct spiritual assessments on all patients, but this one is the priority.)

The nurse has been caring for a patient who just died. The patient's daughter is crying uncontrollably, saying, "She was my best friend. I thought she would make it! I don't know what I am going to do." What is the nurse's best response? a. Express sympathy and ask if she would like to talk with a chaplain. b. Give the daughter time to cry in her mother's room alone. c. Ask the daughter if her father is still living. d. Inquire if the daughter would like to pray.

a (rationale: At crisis times, spiritual advisers or chaplains are the best resource with the expertise to address family members' needs. Leaving the daughter alone or inquiring about her father would not provide the emotional support needed. The nurse should avoid making suggestions to the daughter but instead should seek to identify needs from the daughter's cues.)

The nurse is caring for a patient who has just died. Which assessment findings by the physician and nurse are used to confirm that death has occurred? (Select all that apply.) a. The patient was incontinent of bowel and bladder. b. The patient's pupils are fixed and dilated. c.The provider does not hear a heartbeat. d. the patients extremities are cool and mottled. e. the patient has no palpable peripheral pulses. f. the patients face is relaxed and the mouth is open

a, b, c, e (rationale: Assessment findings that confirm death has occurred include lack of pulse/heartbeat and fixed dilated pupils. Cool, mottled extremities, relaxed muscles, and incontinence of bowel and/or stool are common assessment findings in patients who are dying.)

The nurse manager of a busy oncology unit is concerned about compassion fatigue among the nursing staff. Which signs and symptoms would alert the nurse to this problem? (Select all that apply.) a. Nurses become very emotionally upset without an apparent cause. b. Nurses start to avoid caring for certain patients. c. Nurses start to call in sick more often. d. Nurses begin working more overtime. e. Nurses have difficulty showing empathy for patients.

a, b, c, e (rationale: Compassion fatigue occurs when deeply caring and empathetic nurses become overwhelmed by the constant needs of patients and families. Symptoms include mood swings, avoidance of working with some patients, frequent sick days, irritability, reduced memory, poor concentration, and a decreased ability to show empathy.)

The nurse recognizes which personality factors that have been shown to buffer the impact of stress? (Select all that apply.) a. Resilience b. Sense of coherence c. Gender d. Hardiness e. Coping style

a, b, d (rationale: Personality factors such as resilience, hardiness, and sense of coherence can buffer the impact of stress, reducing the negative consequences. Gender is not a personality factor. Coping style refers to a pattern of measures taken to relieve stress but is not a personality factor.)

Which statements by a patient would indicate the use of effective coping strategies? (Select all that apply.) a. "Each month, my wife and I attend a support group for parents of children with autism." b. "Talking with my spiritual adviser may challenge my thinking on how best to handle this situation." c. "I've invited my son to join me for drinks at the bar each night on his way home from work so that we can spend more time together." d. "We are looking into joining the new health club facility in our neighborhood." e. "After working all day, I eat dinner in front of the television while my family sits at the kitchen table."

a, b, d (rationale: Support groups, spiritual advisors, and health clubs all offer services that can enhance coping skills. The daily use of alcohol is not a healthy coping strategy, even if it involves spending time with family. Eating in front of the television promotes obesity and social isolation.)

The nurse is caring for a patient who died a few minutes ago. The patient's family is at the bedside and very demonstrative in their grief, weeping loudly and holding on to the patient's body. What is the most appropriate action of the nurse? a. Inform the family that the patient's body must be taken to the morgue shortly. b. Ask the family members to step outside while postmortem care is provided. c. Obtain required signatures for the body to be taken to the funeral home. d. provide privacy and allow the patients family to grieve over the body

d (rationale: The nurse should allow the patient's family to grieve in private over the loss of their loved one. Some cultures favor free expression of emotions after death, and the nurse should respect this. Signatures can be obtained, postmortem care can be provided, and the body brought to the morgue after an appropriate time of grieving has been provided to the family.)

The charge nurse overhears a new nurse telling a patient that he should no longer follow his vegetarian diet because his protein needs are so high and because "God made animals for us to eat." What action by the charge nurse is best? a. No action is necessary for the charge nurse to take. b. Reinforce the nurse's teaching on proper diet. c. Offer to call the dietitian to work with the patient. d. Privately speak to the nurse about this conversation.

d (rationale: The nurse should not share opinions or religious edicts with patients when those beliefs contradict the patient's. The charge nurse should counsel the new nurse about this practice. The patient may hold deep convictions about being a vegetarian and may feel disapproval from the nurse, which will impact the nurse-patient relationship. The other options are not appropriate, although the charge nurse could suggest the new nurse collaborate with the dietitian and patient to determine high-protein foods the patient finds acceptable.)

A patient is scheduled to have an MRI and has a metal religious icon pinned to his gown, which can't go in the scanner. What action by the nurse is best? a. Take the icon off the patient's gown until she returns. b. Give the icon to the patient's family for safekeeping. c. Pin the icon to the patient's pillow so it can go to radiology. d. Explain the restriction and ask the patient's preference.

d (rationale: The religious icon has profound significance for the patient and should not be removed by the nurse. Since the icon cannot go into the MRI scanner itself, the nurse should explain the situation to the patient and get the patient's opinion of various options. All other options are possibilities, but it should be the patient's determination.)

How can the nurse best address the religious needs of patients who are Jewish? a. By documenting the need for a kosher diet b. By allowing time for prayer before each meal c. By inquiring about Sabbath religious practices d. By asking about religious practices that might affect care

d (rationale: There are a variety of levels of observance within the Jewish community. It is best to ask patients about what practices will affect their care. Do not assume that all persons of faith are equally observant of religious traditions.)

A patient in the hospital is an adherent Muslim. Which of the five pillars of Islam can the nurse assist the patient in meeting? a. Praying five times a day b. Having privacy c. Personal cleanliness d. Giving alms e. Maintaining modesty

a (rationale: The five pillars of Islam are: believe in one God, pray five times a day facing Mecca, giving alms to the less fortunate, fasting during Ramadan, and making a pilgrimage to Mecca. The nurse is best able to help the patient maintain the practice of praying five times a day while hospitalized.)

The nurse is caring for a patient who is having difficulty coping after being in a motor vehicle crash in which her brother was killed. The patient was driving the car and blames herself for the accident. What is the priority nursing intervention of the nurse? a. Check to make sure that the patient does not want to hurt or kill herself. b. Educate the patient about available support systems for grief resolution. c. Enhance the patient's coping skills to alleviate depression and anxiety. d. Encourage the patient to meet with a spiritual leader for guidance.

a (rationale: The highest priority for the nurse is to ensure the safety of the patient, so assessment of potential suicidal tendencies is paramount. The other interventions can take place once the nurse is confident that the patient will not try to hurt or kill herself.)

1While caring for a 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 have 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 (rationale: 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.)

Which statement by the patient indicates to the nurse that it may be an appropriate time to consider hospice care rather than further aggressive measures to treat his terminal illness? a. "I am praying every day that this last round of chemotherapy will work." b. "I want to spend what time I have left at home with my grandchildren." c. "I need to meet with my financial planner to make sure my life insurance is all set." d. "I am concerned that my wife won't be able to live on her own after my death."

b (rationale: Hospice care is provided to patients who are terminally ill and wish to have no further aggressive treatment in attempt to cure the disease. The patient's statement that she just wants to be home with her grandchildren indicates a readiness for hospice care.)

In the immediate postoperative period after open-heart surgery, a patient who is not a diabetic has elevated blood glucose levels. What physiologic stress response would the nurse recognize as being directly responsible for the patient's increased blood sugar? a. Release of epinephrine b. Circulation of endorphins c. Increase in corticosteroids d. Secretion of corticotropin-releasing hormone (CRH)

c (rationale: Corticosteroids increase serum glucose levels and inhibit the inflammatory response. Patients who have experienced extreme physiologic stress will often require short-term insulin therapy until their corticosteroid and blood glucose levels return to normal. Epinephrine, CRH, and endorphins all respond to stress; however, corticosteroids are directly responsible for the increase in this patient's blood sugar.)

The nurse knows which goal to be appropriate for the nursing diagnosis of Caregiver stress? a. The patient will report an ability to focus on discharge instructions. b. The caregiver will attend a coping skills class on a weekly basis. c. Caregiver will use respite care for the family loved one once a week for the next month. d. The patient will discuss strategies for coping with relationship violence within 24 hours.

c (rationale: The patient will discuss possible coping strategies during weekly office visits is an appropriate goal for Difficulty coping. The patient will report an ability to focus on discharge instructions is an appropriate goal for Anxiety. Relationship violence is not related.)

The nurse is caring for a terminally ill patient who will probably die within the next 2 weeks. What is the priority nursing intervention? a. Encouraging the patient to limit fluid intake to minimize congestion b. Limiting the use of pain medications so that the patient can visit with family c. Helping the patient to identify and complete desired tasks and activities d. Completing funeral arrangements with the patient's next of kin

c (rationale: The priority intervention for the nurse currently is to help the patient identify and complete desired tasks and activities while the patient is still able to do so. Pain management is a high priority at this time, so analgesics should never be limited unless requested by the patient. The patient can drink as much or as little fluid as desired.)

The nurse is performing a physical assessment of patient who is undergoing a bone marrow biopsy. What finding by the nurse indicates the patient is experiencing stress? a. blood pressure of 120/84 b. temperature of 99.5F c. heart rate of 110 beats/minute d. respiratory rate of 10 breaths/min

c (rationale: The release of hormones increases the heart rate, resulting in increased cardiac output and elevated blood pressure. A reading of 120/84 is a normal blood pressure, and temperature is elevated is indicative of an infection. The respiratory rate increases in stress not decreases.)

The nurse is educating the patient on the use of relaxation therapy. Which statement by the patient indicates a need for further education? a. "I should relax my muscles from head to toe." b. "I visual the relaxed muscle." c. "I should do this three times a week." d. "I focus on muscles that are tense."

c (rationale: This technique should be done daily. Typically, relaxation progresses from head to toe. With practice, the patient visualizes an image of the relaxed muscles and will be able to relax muscles from the mental image. progressive relaxation is implemented by having patients focus on muscles that are tensed adn then intentionally relax those muscle groups)

The nurse is caring for a patient on a medical-surgical inpatient unit when the patient tells the nurse he is very sad and is considering suicide. What is the first thing the nurse should do? a. Notify the health care provider. b. Make a referral to psychiatric services. c. Implement one-on-one observations. d. Document in the electronic medical record.

c (rationale: Verbalization of suicidal ideation or a suicide plan must be taken seriously. In the case of a hospitalized patient, one-on-one observation should be implemented to ensure patient safety. Once the patient is under observation, the health care provider is notified to put in the referral; nurses generally do not put in the referral. Documentation is always done after the patient's safety is ensured.)

The nurse is caring for a patient with a new diagnosis of diabetes type 2. Which statement indicates a negative coping response? a. "I will look up information on the internet about diabetes" b. "I will join a support group" c. "I will only focus on learning to manage my medication first." d. "I will make changes slowly so I can adapt to each change."

c (rationale: When the patient puts limits on learning by stating he/she will only learn about medication, he/she is using avoidance strategies to alleviate stress. Using strategies such as information gathering (seeking information about diabetes) is positive. Joining support groups and making changes slowly to adapt is also taking direct action by moving forward.)

A patient, who is an adherent Muslim, is in a burn unit with severe burns. The patient has high caloric requirements but is refusing to eat during Ramadan. What action by the nurse is best? a. Insert a feeding tube and provide enteral feedings. b. Ask the provider about Total Peripheral Nutrition. c. Call the patient's religious leader for advice. d. Tell the patient he has to eat to get better.

c (rationale: With permission, the nurse should consult with the patient's religious leader on this situation. There may be exceptions to the rule to fast during Ramadan for medical conditions. The other options ignore the patient's religious preferences, and both the tube feeding and parenteral nutrition have potential serious side effects.)

The nurse is caring for a 45-year-old woman who is a breast cancer survivor. What activity associated with her cancer experience will promote this patient's spiritual well-being? a. Attending church every week b. Making sure that she follows her medication regimen c. Arranging for the genetic testing on family members d. Speaking about her cancer experience to increase breast cancer awareness

d (rationale: Speaking about her experience helps promote meaning and purpose in life. Church attendance does not guarantee time of spiritual reflection related to her breast cancer experience. Treatment and genetic testing assist in physical treatment and risk identification but do not necessarily relate to finding meaning and purpose.)

A 25-year-old female patient demands that her mother or father be present during all blood testing. Which defense mechanism could the nurse document as being used by this patient? a. Sublimation b. Repression c. Projection d. Regression

d (rationale: This young adult patient is reverting back to behavior consistent with an earlier stage of development, which is the defense mechanism of regression. Sublimation is channeling unacceptable emotions into acceptable actions. Repression involves blocking unacceptable thoughts from consciousness, and projection attributes one person's desires or traits to another person.)

The hospice nurse is caring for a terminally ill patient. The patient's son is distraught because the patient will probably die within the next few days and there is nothing he can do about it. What is the most appropriate nursing diagnosis for the patient's son currently? a. Chronic grief related to impending death of mother b. Death anxiety related to feeling powerless over situation c. Powerlessness related to progression of mother's terminal illness d. Complicated grieving related to desired avoidance of mourning

b (rationale: The patient's son is experiencing death anxiety because he is unable to change the outcome of his mother's imminent death. The son makes no mention of religious beliefs, so impaired religiosity is not appropriate. Complicated grieving is applicable to individuals who have recently experienced a loss. Chronic grief is grief that continues for a long period of time.)

The hospice nurse is caring for a several adult children shortly after the death of a parent. They have various reactions as they deal with their loss. The nurse recognizes which reactions to be in the cognitive domain? a. They let the house get filthy because they can't be bothered to clean it. b. They are tossing and turning all night and are unable to get a good night's sleep. c. They are easily distracted and often lose train of thought during conversation. d. They have lost their appetites and have no desire to eat anything.

c (rationale: Cognitive deficits include the inability to concentrate and follow a conversation. Letting the house get filthy is a sign of apathy, which is in the behavioral domain. Insomnia falls within the behavioral and physical domains. Loss of appetite is within the physical domain.)

Which intervention would be most appropriate for the nurse to include in the care plan for a patient who is experiencing constipation and increased heart and respiratory rates? a. Time management b. Decreased grain intake c. Relaxation therapy d. Regimented exercise

c (rationale: Relaxation therapy typically lowers the person's heart and respiratory rates while increasing gastric motility. Not enough information is provided to indicate the need for time management. Both decreased grain intake and regimented exercise may exacerbate the patient's problems.)

The nurse is assessing the patient's use of coping skills in response to stressful situations. The nurse identifies which question to be the most useful? a. "Have you been evaluated for stress?" b. "Do you have someone you can go to for help when you are stressed?" c. "How have you managed stressful situations in the past?" d. "Does stress cause you to experience muscle tension or headaches?"

c (rationale: The use of open-ended questions assists in obtaining accurate information regarding the patient's stressors and coping skills. Questions that elicit yes/no answers will not allow the patient to provide as much information. Asking the patient about headaches and tension is asking about physical symptoms, not coping skills.)

A patient is finding conflict when trying to maintain personal beliefs while making health care decisions. What Nursing diagnosis is a priority as the nurse plans care? a. Spiritual distress b. Impaired religiosity c. Moral distress d. Decisional conflict

d (rationale: Decisional conflict is unclear personal beliefs, questioning of personal beliefs while making decisions, delayed decision making. The other diagnoses may exist as well, but they are not manifested by this conflict.)

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, d (rationale: 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.)

The nurse identifies which factors that center on the childhood stress related to school experiences? (Select all that apply.) a. Goal achievement b. Family dissolution c. Life changes d. Test anxiety e. Competition

a, d, e (rationale: Childhood stress related to the school experience centers on competition, goal achievement, and test anxiety. Family dissolution and life changes are not related to the school experience.)

The student nurse learns that spirituality consists of practices that lead to connection to which items? (Select all that apply.) a. Other people b. Nature c. Religious institutions d. Oneself e. Higher power

a, d, e (rationale: Spiritual practices generally promote three categories of activity: connection with oneself, with others, and with a higher power.)

The nurse is providing discharge instructions for a patient with multiple sclerosis. Which discharge instruction is aimed at preventing a future exacerbation? a. Engage in some form of exercise as tolerated. b. Avoid highly stressful situations. c. Check your skin regularly for pressure sores. d. Eat a diet with lots of fiber.

b (rationale: High stress levels are known to exacerbate multiple sclerosis and other autoimmune diseases. Exercise helps keep muscles loose and helps with balance. Assessing skin for pressure sores and eating a diet with high fiber prevents complications from multiple sclerosis.)

The nurse knows the one theory explaining the variation in response to stress among individuals is identified by which term? a. Stress appraisal b. Sense of coherence c. Allostasis d. Homeostasis

b (rationale: Sense of coherence (SOC) is a characteristic of personality that references one's perception of the world as comprehensible, meaningful, and manageable. Stress appraisal is the automatic, often unconscious assessment of a demand or stressor. Allostasis is an alternative term for the stress response. Homeostasis is the tendency of the body to seek and maintain a condition of balance or equilibrium.)

A patient is hesitating to accept a blood transfusion as a course of treatment. What Nursing diagnosis is most appropriate for this patient? a. Spiritual distress b. Anxiety c. Moral distress d. Decisional conflict

c (rationale: Moral distress is cultural conflict between medical treatment and religious beliefs, expressions of concern about rejection by religious community, hesitation in accepting blood transfusion. The other diagnoses are not related.)

A nurse is concerned about not consistently meeting the spiritual needs of patients. What action by the nurse is best? a. Care for own spiritual needs. b. Begin a meditation practice. c. Consult the chaplain. d. Read books on the subject.

a (rationale: To avoid burnout and a decreased ability to attend to the spiritual needs of patients, nurses must take care of their own spiritual needs first. This may include meditation, consultations, and reading, but other activities can guide the nurse into a reflective practice that will allow better spiritual care.)

The nurse is caring for a female patient who died a few minutes previously. The patient's family comes in to the room and immediately starts to wash the body in preparation for burial. What is the most appropriate action of the nurse currently? a. Inform the patient's family that the body must be transported to the morgue. b. Instruct the patient's family that hospital staff will provide postmortem care. c. Obtain needed signatures for organ donation and autopsy. d. Offer to provide any needed supplies and provide privacy for the family.

d (rationale: The most appropriate action of the nurse currently is to allow the family to wash the patient's body in accordance with their wishes and cultural values. The family may wish to participate in this procedure or may complete this procedure in private. Health care personnel should abide by their wishes as much as possible. Signatures may be obtained from the next of kin when washing is complete. The patient's body may be transported to the morgue or funeral home after washing is completed.)

The nurse assessing a patient using the SPIRIT framework would ask which questions? (Select all that apply.) a. "Do you follow a particular religion?" b. "How involved in your church are you?" c. "Are there any practices I can help you with?" d. "How will your religion affect your care?" e. "What gives you hope in bad situations?"

a, b, c, d (rationale: SPIRIT stands for Spiritual belief system, personal spirituality, integration and involvement in a spiritual community, ritualized practices and restrictions, implications for medical care, and terminal events planning. Hope is a good thing to assess but is more related to the HOPE framework.)

When does the nurse assess patients' spirituality? (Select all that apply.) a. Upon admission b. New diagnosis c. Life-changing diagnosis d. When the chaplain makes rounds e. When facing treatment decisions

a, b, c, e (rationale: There are many times at which a spiritual assessment is necessary. All patients should have their spirituality assessed upon admission at a minimum. Other assessments should be conducted at times when the patient is at risk for spiritual distress. Assessment should be done based on patient need, not when the chaplain is available.)

The nurse who incorporates the HOPE framework assesses a Native American patient for which of the following? (Select all that apply.) a. Desire for shaman to be present b. Personal use of herbs and prayers c. Desire to create a living will d. Power of storytelling for healing e. Involvement in church activities

a, b, d (rationale: Native Americans often use shamans; prayers, songs, and dances; storytelling; and herbs in health care. The HOPE framework assesses sources of hope, meaning comfort, strength, peace, love, and connection; organized religion; personal spirituality and practice; and effects on medical care and end-of-life issues. The nurse who knows about both topics will assess this patient for the desire for a shaman to be present, the personal use of herbs and prayers, and storytelling. A living will is more accurately assessed with the SPIRIT framework. Involvement in church activities can be best assessed using either the SPIRIT or FICA framework.)

The student using the FICA Spiritual Health Assessment will consider which factors? (Select all that apply.) a. Faith and belief b. Focused practices c. Importance of faith d. Faith community involvement e. Address spirituality in care

a, c, d, e (rationale: FICA stands for faith and belief, importance of faith, faith community involvement, and address spirituality in care.)

Which actions by a nurse constitute spiritual care? (Select all that apply.) a. Baptizing a critically ill child per the parent's request b. Leaving the room, giving the patient and family privacy for prayer c. Considering developmental stage when planning care d. Notifying the hospital chaplain of a patient's request e. Praying with patients and families when requested

a, c, d, e (rationale: Many activities fall into the realm of spiritual nursing care, including baptizing an infant in an emergency, notifying the chaplain or other religious leader of patient requests for service, and praying with the patient and family. The nurse always considers the patient's developmental level when planning or providing any type of care. The patient and/or family may or may not want privacy for prayer; the nurse should assess the situation and not just leave.)

The nurse knows that when patients are experiencing stress, which physiologic changes can be seen in their signs and symptoms? (Select all that apply.) a. Increase in heart rate b. Flaccid muscles c. Pupil dilation d. Decrease in blood pressure e. Increase in respiratory rate

a, c, e (rationale: The physiologic response to stress, whether physical or psychological, is activation of the autonomic nervous system, resulting in an increase in heart rate, blood pressure, and respirations along with pupil dilation and muscle tension and decreased blood flow to the skin.)

The nurse concerned about a patient's spiritual needs can best address this by which action? a. Leaving a note on the chart for other professionals b. Calling the chaplain to come see the patient c. Collaborating during interdisciplinary rounds d. Informing the provider of the patient's needs

c (rationale: Spiritual care must be multidisciplinary to be most effective. The nurse best addresses patients' spiritual needs by discussing them during interdisciplinary rounds.)

The nurse is caring for a terminally ill patient who is actively dying and refuses to eat anything other than a few bites of ice cream. The patient's family member approaches the nurse and requests that a feeding tube be inserted so that her loved one will not starve to death. what is the best response by the nurse? a. "Loss of appetite is a natural part of the dying process. Tube feedings would be uncomfortable and cause nausea." b. "I will contact the provider to obtain an order to insert the tube and start tube feedings." c. "Intravenous fluids would be more comfortable for the patient than a tube feeding. I will call the doctor to get the order." d. "I will listen to the patient's abdomen to make sure that bowel sounds are present and try encouraging oral fluids."

a (rationale: Common physical symptoms at the end of life include anorexia and cachexia. Tube feedings will cause discomfort as the tube is inserted and nausea as the GI tract is given food that it cannot handle. Encouraging oral intake will lead to increased secretions and congestion as well as possible aspiration of fluids. Intravenous fluids will increase congestion and edema. The nurse would educate the family on this part of the dying process.)

A home health care nurse has been working with a patient who has the Nursing diagnosis Spiritual Distress. After a few weeks of implementing the care plan, what method is best for the nurse to determine if goals have been met? a. Ask the patient to what extent he/she feels goals have been met. b. Ask the patient to rate the distress on a scale of 1 to 10. c. Assess for objective data to support goal attainment. d. Determine if the patient thinks the interventions are helpful.

a (rationale: For a diagnosis with a large subjective component, getting the patient's feedback on goal attainment is best. There may be no objective data the nurse can use to rate goal attainment. Using a scale can be a part of the evaluation, but the patient's determination is best.)

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 (rationale: 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.)

Which short-term goal would be most appropriate for a patient with the nursing diagnosis Anxiety with supporting data, including upcoming diagnostic tests, expressions of concern, and pacing around the room? a. Patient will discuss specific aspects of concern. b. Nurse will administer prescribed antianxiety medication. c. Patient will understand diagnostic test procedures. d. Nurse will describe test procedures in detail to allay concerns.

a (rationale: Having the patient discuss specific aspects of concern allows the nurse the opportunity to assess the patient's level of anxiety and what interventions might be most appropriate to help allay the stated concerns. Goals must be patient centered, measurable, and realistic. None of the other three goals meet these criteria. Two of the goals are nurse focused. The action "understand" is not measurable.)

A patient who claims to be very involved in church is near death. What action by the nurse is best? a. Get permission to contact the religious leader. b. Allow the family to stay at the patient's bedside. c. Call the hospital chaplain to come to the bedside. d. Ask if the patient and family want to pray.

a (rationale: Organized religions use rituals to mark important life events such as birth, marriage, and death. This patient would most likely want end-of-life rituals as practiced in his/her church. The nurse's best action is to contact the religious leader (with permission) of that church or institution. Allowing the family to remain at the bedside is important but not the best option to care for the patient's spirituality needs. The hospital chaplain is a valuable resource, but the patient's own religious leader would be better. Praying with the family is always acceptable, but it is best to let the family take the lead in prayer.)

A patient has the Nursing diagnosis Spiritual Distress. What assessment by the patient best indicates that an important goal has been met? a. Observed praying quietly. b. Indecisive about treatment. c. Asks nurse if God exists. d. Executes living will.

a (rationale: Patients may have spiritual distress when facing situations that threaten their meaning and purpose in life, such as in the face of a terminal diagnosis. Patients often express anger, frustration, neediness, or crying. The patient who has worked through this situation and is able to pray has best shown goal attainment. Indecision and questioning do not indicate the resolution of this diagnosis. Executing a living will may be an indication of pragmatism.)

The nurse is caring for a patient who has just died in a motor vehicle accident. What is the priority action of the nurse before the patient's family arrives to see the patient's body? a. Gently wash the body and provide perineal care. b. Remove the patient's dentures and jewelry. c. Ensure that the death certificate has been signed. d. Determine which funeral home will pick up the body.

a (rationale: Release of bowel and bladder contents often occur at the time of death, and the perineal care is a priority before the family arrives. The body should be gently cleaned to remove blood and debris from the accident. The patient's dentures and jewelry should not be removed from the body. The death certificate does not need to be signed before the family arrives. The family can decide which funeral home will be used and notify the nurse after their arrival.)

A male patient is told that he may have colon cancer. Which response by the patient best indicates that his initial appraisal of the situation is that it is primarily a challenge to be met? a. Requesting information on various treatment options b. Demanding to see another physician immediately c. Storming out of the gastroenterologist's office d. Yelling at the nurse who is scheduling his colonoscopy

a (rationale: Requesting further information regarding treatment indicates that the patient is viewing the situation primarily as a challenge to be faced. Primary and secondary appraisals determine whether the stressful situation or transaction is a threat or a challenge. A threat invokes the possibility of harm or loss, whereas a challenge holds the possibility of benefit. Demanding, angry behavior indicates that the patient feels threatened rather than challenged.)

The nurse is caring for a patient who lost her husband 1 year ago after 55 years of marriage. The patient no longer takes care of herself or cooks and rarely eats, stating she has no appetite. The nurse determines that the Nursing diagnosis of complicated grieving applies to the patient. Which is the priority goal for the patient? a. The patient will shower every other day and eat at least two meals a day. b. The patient will identify personal strengths that will increase coping ability. c. The patient will discuss the meaning of her loss with a family member or friend. d. The patient will be provided with phone numbers for local community resources.

a (rationale: The highest priority goal of this patient is self-care including showering and eating in order to protect her health and safety. The other goals are lower priority after the patient's necessary activities of daily living are addressed. Goals should also reflect what the patient accomplishes; so the goal of being provided with phone numbers is actually something for the nurse to do.)

The nurse is caring for a terminally ill patient whose children have come home to be with their mother during her last few days. They spend time looking through picture albums, watching old home movies, and remembering fun times spent together. the nurse identifies which term that best describes the activity of the patients children? a. anticipatory grieving b. bereavement c. caregiver role strain d. death anxiety

a (rationale: The patient and her children are experiencing anticipatory grief as they prepare for the expected death of the patient. Reminiscence and life review are used to assist those experiencing anticipatory grief with the realization that death is approaching.)

The nurse is caring for a patient who suffered a miscarriage at 24 weeks of pregnancy. The patient is devastated by the loss but her husband minimizes her grief by stating, "Quit crying. It's not like you lost a real baby." What term best describes the anguish felt by the patient? a. Disenfranchised grief b. Delayed grief c. Moral distress d. Masked grief

a (rationale: The patient is experiencing disenfranchised grief because she cannot share the pain of her loss with her husband. The husband is not willing to support his wife as she mourns the loss of her pregnancy or recognize the grief that she is going through. Delayed grief is suppression of the grief process. Moral distress occurs when people cannot act according to their moral values. Masked grief occurs when a person's bereavement behaviors interfere with his or her life, but the person does not notice this.)

The hospice nurse is caring for a terminally ill patient who will probably die within the next hour or two. The patient's daughter is keeping a vigil by the bedside and asks what she can do to help her father at this time. What is the appropriate response of the nurse? a. "Just let him know you are here, talk to him, and let him know that you love him." b. "You can try to feed him a few bites of ice cream to keep his mouth from getting dry" c. "You can take this time to ensure that arrangements are set with the funeral home." d. "You should let me know when your father's breathing pattern changes."

a (rationale: The patient's daughter should be encouraged to spend the last moments of her father's life with him, reassuring him with her presence. The daughter should be encouraged to continue talking with him because the patient may still hear her even if his eyes are closed and he does not speak. The nurse is responsible for monitoring the patient for breathing changes. Oral intake will lead to nausea and/or aspiration. This is not the time to make arrangements with the funeral home.)

The nurse is caring for a patient who is terminally ill with metastatic bone cancer. The patient tells the nurse that he is not afraid of death but does not want to be in pain and suffer before he dies. Which intervention by the nurse will be most appropriate to meet this patient's wishes? a. Establish around-the-clock dosing for pain medications with additional doses for breakthrough pain. b. Assist the patient to reminisce and review his life, spending as much time as possible with loved ones. c. Use therapeutic touch, guided imagery, and soft music to put the patient at ease and relieve anxiety. d. Encourage the patient to participate in prayer and meditation along with preferred religious practices.

a (rationale: The patient's primary wish is to die without pain, and the best intervention to meet this goal is administration of pain medication around the clock with extra doses for breakthrough pain. The other interventions may make the patient more comfortable but will not address his primary desire for adequate pain management.)

Two adult siblings are caring for their ill mother, who requires 24-hour care. She needs assistance with feeding, bathing, and toileting. One of the siblings takes time to exercise after work, whereas the other goes directly to the mother's home before and after work each day. The nurse recognizes that people may react differently to the same stressors depending on which factors? (Select all that apply.) a. Individual coping skills b. Type of identified stressor c. Amount of perceived stress d. Personal appraisal of the stressor e. Hair color, gender, and skin type

a, b, c, d (rationale: The person's coping skills have an impact on how that person perceives and responds to stress. The type and amount of stress as well as the appraisal of stress also affect how the person reacts. Hair color, gender, and skin type are not recognized as factors related to stress reactions.)

The nurse manager of the unit is implementing a program to assist the nursing staff in managing compassion fatigue. Which interventions will be the most successful? (Select all that apply.) a. Support group that nurses can participate in that meets on the unit b. Exercise competitions to encourage nurse to exercise and log their time c. Organized break times so nurses can get off the unit for breaks and lunches d. Quiet area on the unit where the nurses can go during break e. Promotion of work-life balance

a, b, c, d, e (rationale: To care most effectively for others, nurses must first take time to care for themselves. Many of the stress reduction interventions incorporated into patient care plans can be effective in addressing the stressors faced by nurses. Exercise, balanced nutrition, and mindfulness therapy have been shown to help health care professionals in coping with the demands of patient care. Interventions designed specifically to prevent nurse burnout and address compassion fatigue include mentoring programs, quiet areas on a nursing unit for relaxation, availability of pastoral care, the sharing of feelings with trusted colleagues, and promotion of work-life balance.)

The nurse is caring for a patient who just died after a lengthy illness. Which portions of postmortem care may be delegated by the nurse to the nursing assistant? (Select all that apply.) a. Gently washing the body and closing the patient's eyes b. Offering support and empathy to the patient's family members c. Documenting the patient's time of death in the medical record d. Notifying all of the patient's consulting providers of the patient's death e. f. Removing the patient's hospital ID band, IV lines, and urinary catheter Gathering the patient's belongings so they may be taken home by the family

a, b, f (rationale: The nurse assistant can gently wash the patient's body, close the patient's eyes, and gather the patient's belongings. Offering support and empathy to the patient's family members would be done by all of the involved members of the nursing staff. Documenting the time of death in the chart and notifying all of the patient's providers is performed by the nurse. The nurse assistant can remove the patient's IV lines and urinary catheter if allowed by policy, but the hospital ID band would be left in place.)

The nursing student learns which facts about religion and spirituality? (Select all that apply.) a. Spirituality focuses on the meaning of life to people. b. Religion and spirituality are mutually exclusive. c. Religion implies an organized way of worship. d. Religion provides the structure by which to understand spirituality. e. Spirituality is an individual practice that does not include others.

a, c, d (rationale: Spirituality focuses on the meanings of life, death, and existence. Religion is an organized and structured method of practicing or expressing one's spirituality, so they are interconnected and not mutually exclusive. Religion provides the structure for expressing spirituality. Spirituality can be expressed through relationships with others.)

The nurse assigned to the neonatal intensive care unit (NICU) has spent most of the day working with a critically ill infant, with the mother standing by. The infant experiences a cardiac arrest and does not survive. The mother spends an hour crying and holding the baby, saying good-bye. Which spiritual care interventions are most appropriate for the nurse to implement? (Select all that apply.) a. If desired, briefly hold the baby to say good-bye after the mother leaves. b. Follow procedures to prepare the body for transport to the morgue. c. Visit the mother the next day to see how she is doing. d. Call the family's spiritual adviser or the chaplain. e. Ask the mother if you could call a family member or friend to be with her.

a, d, e (rationale: It is important for nurses to take time to say "good-bye" to patients with whom they have developed a relationship. In this case, it would be appropriate for the nurse to hold the infant briefly, if desired, after the family has left before preparing the body for the morgue. With consent, the mother needs to be surrounded by appropriate persons to provide spiritual support, including a chaplain, family members, and friends. Although it is critical that the nurse follow procedures in preparing bodies for the morgue, it is not considered spiritual care. Visiting the mother after her loss could be viewed as a violation of professional boundaries, especially for a nurse who worked with the family for only a day.)

The nurse is caring for an Islamic patient who has just died. The family is traveling from overseas. Which action is the priority for the nurse to take right after the patient dies? a. Arranging for embalming to preserve the body until burial b. Rearrange the furniture so the bed can face Mecca c. Arranging for transportation of the body to the crematorium d. Bringing in fruit for the patient's journey to the other world

b (rationale: After death, a patient's body can be turned to face Mecca which is the holy site for Muslims. The nurse would need to find out which direction that is. The family will work with the funeral home to determine when and where burial will take place. Buddhists often bring fruit when someone dies.)

The nurse is educating the patient about alternative therapies. Which statement by the patient indicates a need for more information? a. Alternative therapies can include relaxation techniques. b. Alternative therapies are used in conjunction with medical therapies. c. Alternative therapies can be used when patients are experiencing stress. d. Some alternative therapists require certification.

b (rationale: Alternative therapies are used in place of medical treatment. These types of interventions are useful when patients are experiencing physiologic and psychological responses to stress. Some complementary and alternative therapies such as therapeutic touch, Reiki, biofeedback, and massage therapy require additional certification and training, whereas muscle relaxation and guided imagery do not.)

A patient has recently been given a terminal diagnosis. When family members offer to help, the patient snaps and yells at them, but then angrily accuses them of not helping. The patient's spouse is frustrated and asks the hospice nurse what to do about this situation. What response by the nurse is best? a. "Don't worry. Your spouse will get over this phase soon." b. "Anger is an expected part of the grieving process." c. "Would your spouse be open to professional counseling?" d. "This diagnosis is difficult to handle; just be patient."

b (rationale: Anger is one of the stages of grief as identified by Elizabeth Kubler-Ross. The nurse would first explain this to the spouse. Telling the spouse the patient will get over the phase soon or that the diagnosis is difficult to handle is false reassurance and dismissive of the concerns. It is too early to consider counseling although the patient may need it later. This is also a yes/no question which is not therapeutic.)

A nurse works in a pediatric oncology unit and is feeling depressed and discouraged. What initial action by the nurse is best? a. Apply for a job transfer to another unit. b. Consult with the hospital chaplain. c. Make an appointment with Employee Assistance. d. ask other nurses how they deal with the stress

b (rationale: Hospital chaplains are great resources for nurses experiencing burnout, moral distress, or spiritual distress. The nurse can take all options, but a consultation with the chaplain is the best place to start to see if the issue can be resolved. The chaplain has a wider range of perceptions and tools than do the other staff nurses.)

The nurse knows that when coordination between multiple health care disciplines is needed, which role should be utilized? a. Pastoral care b. Case manager c. Social worker d. Dietitian

b (rationale: If coordination of care between multiple health care disciplines is needed, a case manager is used. Pastoral care plays a significant role in addressing stress anxiety issues when the patient has a preferred religion or strong faith background. A social worker identifies appropriate services and resources. A dietitian can provide education regarding dietary needs and food choices.)

The nurse is caring for a terminally ill patient whose family is insistent that additional chemotherapy be administered even though the patient will most likely die within the next few days. What is the best response of the nurse? a. "The insurance company will not pay for chemotherapy at this stage." b. "The focus right now needs to be on keeping your loved one comfortable." c. "I will call the provider and relay your wishes." d. "the patient needs to get stronger first before chemotherapy can be administered."

b (rationale: Nurses advocate for patients to ensure that they are aware of their options for care that include interventions, treatments, anticipated outcomes, as well as risk and benefits of any decision made concerning medical care. The nurse must function as the patient's advocate and encourage what is in the best interest of the patient. Chemotherapy will not extend the patient's life when death is expected within the next few days and will only make the patient suffer needlessly when it is administered. The patient will not get stronger over the next few days, and this criterion for chemotherapy will never be met.)

In which scenario is palliative care provided? a. Only in the homes of the terminally ill b. For any chronic 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 (rationale: Palliative care is provided in a variety of settings, including home care, freestanding inpatient units, hospitals, long-term care facilities, and prisons. It is also administered to the homeless and to patients with any disease or illness that has been determined to be chronic and in need of symptom control. Any patient who is experiencing symptoms—physical, psychological, or spiritual—benefits from palliative care. Once a patient is terminal or has less than 6 months to live, the patient can choose to seek hospice care.)

The nurse is caring for a terminally ill patient who appears to be calmly having a conversation with someone even though there is nobody else in the room. The patient reaches out and appears to take something out of thin air and hold it close. Which is the appropriate action of the nurse? a. Reorient the patient and reassure that nobody else is in the room. b. Be present but quiet and let the patient continue the conversation. c. Carefully assess the patient's mental status and level of attention. d. obtain a set of vital signs and check the patients pulse oximetry

b (rationale: Patients who are near death sometimes have a special communication with loved ones who have already died. It is important to recognize that these experiences can be comforting to the dying patient, and nurses would not contradict or argue with the person. It is imperative to simply be present with the person, listen, and be open to any attempts to communicate. It is acceptable to ask gentle questions such as "What are you seeing?" or "How does that make you feel?" Having an open discussion with the family while describing what is occurring may provide further insight to the nurse as the health care provider, as well as promoting a sense of understanding and acceptance for the family. As long as the patient is calm and content, the best action of the nurse is to be present but let the patient continue the conversation undisturbed.)

The nurse has been assigned the same patients for the past 4 days. Two of the patients demand a great deal of attention, and the nurse feels anxious and angry about being given this assignment again. What action would demonstrate the most effective way for the nurse to cope with the patient care assignment? a. Share complaints about the assignment with the nurse manager. b. Prioritize the patients' needs and identify a specific time period to care for each patient. c. Talk with the patients and explain that they cannot expect so much personal attention. d. Trade assignments with another nurse who is unaware of the concerns regarding the patient assignment.

b (rationale: Prioritizing care and setting aside time to spend with specific patients constitute the most effective coping strategy for the nurse to use. Sharing concerns with the nurse manager does not demonstrate strong problem-solving skills; it merely shows a desire to complain. Trading assignments diminishes the continuity of care during which patient trust and nurse-patient relationships are developed. Patients are always the focus of nursing care and should not be given the impression that the nurse does not have time to care or listen to their concerns.)

A patient is newly diagnosed with diabetes and requires insulin injections. He requests information about classes offered by the diabetes educator. Which type of coping technique is this patient using? a. Emotion-focused b. Problem-focused c. Avoidance d. Denial

b (rationale: Problem-focused coping techniques are aimed at altering or removing a stressor. If this patient gains the skills to administer his own injections from the diabetes educator, he will remove a major stressor associated with a new diabetes diagnosis. Emotion-focused coping techniques, avoidance, and denial are all psychological techniques, rather than a psychomotor-based activity, which is required in this situation.)

A patient died suddenly in the emergency department. Which action by the nurse best provides the family connection with others? a. Offering the family written information on grief support groups. b. Asking the family if there is someone the nurse can call for them. c. Having the hospital social worker or chaplain sit with the family. d. Offering to stay with the family during this difficult time.

b (rationale: Promoting connectedness means recognizing that family and friends are providing at least some of the patient's spiritual care. The nurse best assists when offering to call someone for the patient or family. The other options may be appropriate but are not directly related to connectedness.)

The student nurse asks why spirituality is important in health care. What response by the registered nurse is best? a. "All people have a spiritual aspect to their beings." b. "Spirituality affects behavior, which also affects health." c. "Knowledge of it is needed to understand a patient holistically." d. "People who are less spiritual have worse outcomes."

b (rationale: Spirituality affects behavior, which has a direct impact on health. Spirituality is a universal concept, but all people may not recognize it in themselves. Holistic knowledge is indeed based in part on spirituality, but that does not give the student information on a concrete link. Less spiritual people may or may not have worse outcomes.)

The nurse is teaching a patient about the difference between mild anxiety and moderate anxiety. Which statement by the patient indicates a need for further education? a. "Mild anxiety can help me remember things." b. "Moderate anxiety will narrow my focus." c. "Mild anxiety will help me be creative." d. "Moderate anxiety will increase my perception."

d (rationale: Moderate anxiety narrows a person's focus, dulls perception, and may challenge a person to pay attention or use appropriate problem-solving skills. Mild anxiety can be motivational, foster creativity, and increase a person's ability to think clearly.)

The nurse knows when the body responds to the release of hormones during "fight or flight," that response includes which physiological signs? (Select all that apply.) a. Decreased respiratory rate b. Slowing of the digestive process c. Glucose being mobilized from the liver d. Pupils dilating e. Smooth muscles in the bronchi constricting

b, c, d (rationale: The release of hormones increases the heart rate, resulting in increased cardiac output, and elevated blood pressure. The flow of blood to muscles at the expense of the digestive and other systems not immediately needed in the fight-or-flight response. Smooth muscles in the bronchi relax and dilate the bronchi and smaller airways, and the respiratory rate increases, allowing for an enhanced flow of well-oxygenated blood to muscles and other organs. The motility of the digestive tract is decreased, slowing digestive processes, but glucose and fatty acids are mobilized from the liver and other stores to support increased mental activities (alertness) and skeletal muscle function. Pupillary dilation produces a larger visual field.)

The nurse who is aware of spirituality practices of major religions knows that which religions view health and illness as a process of balance or imbalance? (Select all that apply.) a. Catholicism b. Native American c. Hinduism d. Greek Orthodox e. Buddhism

b, c, e (rationale: Native American, Hindu, and Buddhist practitioners believe that health and illness are a matter of balance or imbalance in the body.)

The nurse working with older adults wants to support healthy coping strategies. What actions by the nurse are most appropriate? (Select all that apply.) a. Installing boxing equipment in the recreation room b. Provide reminiscing sessions for the adults to share personal stories c. Arrange for gentle yoga to be provided at the senior center d. Create activities designed to distract them from their losses e. Encourage the adults to eat frequent, healthy snacks

b, c, e (rationale: To promote health coping in older adults, the nurse would provide reminiscing sessions, yoga, and would encourage small healthy snacks as this population frequently loses their appetite when stressed. Boxing equipment might cause the adults to focus on anger. Distraction can be a negative or positive coping mechanism.)

A patient asks the nurse to pray with him. The nurse is an atheist and uncomfortable with this request. What action by the nurse is best? a. Deny the request because of atheistic beliefs. b. Offer to call the chaplain instead. c. Agree to sit with the patient while he prays. d. Ask the patient if he will meditate instead.

c (rationale: Although the nurse is uncomfortable with the request, the patient's needs (not the nurse's) come first. The nurse should attempt to honor the request while not imposing his/her ideas of religion and spirituality on the patient. The best option is to agree to sit with the patient while he prays himself. This is consistent with caring behaviors and fulfilling the patient's needs. Denying the request does nothing to address the patient's needs. The nurse can offer to call the chaplain in addition to sitting with the patient. Asking the patient to change his practices is unethical.)

The student nurse asks why he needs to assess a patient's spirituality when he can call the chaplain. What response by the nurse is best? a. "This way you learn what is involved in a spiritual assessment." b. "Students need to perform all aspects of patient care." c. "Regulatory organizations list this as a required BSN competence." d. "All patients should have a spirituality assessment."

c (rationale: Although there is some truth to all options, several regulatory groups list conducting a spiritual assessment as a vital skill for nurses, including the American Association of Colleges of Nursing, The Joint Commission, and the American Nurses Association.)

The nurse identifies which goal to be appropriate for the nursing diagnosis of Difficulty coping? a. The patient will report an ability to remember discharge instructions. b. The patient's family will understand how to access respite care services. c. The patient will discuss possible coping strategies during weekly counseling sessions. d. the patient will attend an online support group weekly

c (rationale: An appropriate goal for Difficulty coping would be to discuss coping strategies. Remembering discharge instructions is an appropriate goal for Anxiety. Understanding how to access respite care services is an appropriate goal for Caregiver stress. Attending a support group is an appropriate goal for Difficulty coping.)

The grandmother of two children, 8 and 10 years of age, has died. Their mother asks the nurse what she should do about her children attending the funeral. What is the nurse's best response? a. "Take them to the funeral—they need closure. 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." c. "Talk to your children about how they feel about attending the funeral and encourage them to ask questions and talk about their concerns." d. "Talk to your children about what your mother meant to you and how much she cared for them, and then see if they really want to attend the funeral."

c (rationale: 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 the funeral but can encourage the mother to evaluate each child's feelings about the loss. The parents should make the decision about the children attending the funeral, not the children or the nurse.)

What is the most important action to implement when providing spiritual care in nursing practice? a. Contacting the health care facility chaplain b. Completing the FICA spiritual assessment and referring the patient, as needed c. Recognizing situations and patient behaviors indicating a spiritual need d. Spending some time in self-reflection

c (rationale: Changes in spiritual needs happen in the moment, and it is critical for nurses to recognize when a spiritual need arises. The FICA tool is not sensitive to daily changes in spiritual needs. Calling a chaplain may be an appropriate intervention when the need arises. Nurses should integrate self-reflection in their own spiritual practices to find meaning in their life experiences, but that is not the most important aspect of providing spiritual care.)

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 patient when he died c. An estranged ex-wife of the patient who lives nearby d. The 16-year-old grandchild of the patient

c (rationale: 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.)

The nurse is caring for a patient who is undergoing a major cardiac procedure. When the patient complains of a racing heart and nausea, the nurse recognizes these complaints as part of what hormone response? a. Sense of coherence b. Stress appraisal c. Fight or flight d. Sympathoadrenal response

c (rationale: In the "fight or flight" response, the corticotropin-releasing hormone (CRH) released by the hypothalamus stimulates the pituitary to release adrenocorticotropic hormone (ACTH). These hormones increase the heart rate, resulting in increased cardiac output, and the motility of the digestive tract is decreased, slowing digestive processes that could result in abdominal distress. Sense of coherence (SOC) is a characteristic of personality that references one's perception of the world as comprehensible, meaningful, and manageable. Stress appraisal is the automatic, often unconscious, assessment of a demand, or stressor. The sympathoadrenal response is a consequence of hypothalamic activation in sympathetic stimulation, which triggers epinephrine and norepinephrine release from the adrenal medulla.)

Which statement is true regarding advance care planning and advance directives? a. Advance care planning applies only when the person is dying. b. Advance care planning should be done by family members of people who are incompetent. c. Discussion of advance care planning is a nursing responsibility. d. Advance directives should be kept in a safety deposit box until the person dies.

c (rationale: It is the responsibility of the nurse to discuss advance care planning and 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. Advance directives go into effect when a person has a terminal illness and is unable or incapable of making decisions for oneself. 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.)

The nurse is caring for a religious patient who is going to surgery the next day. The patient states that she is afraid and asks the nurse to pray with her, although the nurse is not religious. What is the most appropriate response by the nurse? a. "I am not confident praying, but I will think about you tomorrow." b. "I need to take care of other patients right now, but I will be back." c. "I am uncomfortable praying. May I call the chaplain for you?" d. "I don't do that. Nurses are not allowed to do that at our hospital."

c (rationale: Offering to call the chaplain because the nurse is uncomfortable praying is the best option. Avoiding the subject or focusing on the nurse's feelings or needs is not appropriate and will not provide for the patient's stated spiritual need.)

The hospice nurse is caring for a patient who is terminally ill. The patient's spouse is the primary caregiver, providing constant care and spending all his or her time meeting the patient's needs. The spouse says to the nurse "After my spouse dies, I will finally get that colonoscopy my provider has been bugging me about." What does the nurse understand about this statement? a. The spouse is looking forward to being freed from the caretaker role. b. The spouse has neglected his or her own physical needs for too long. c. The spouse is making some realistic plans for life after the death. d. The spouse is in denial that the patient is dying and the important role of caregiver will end.

c (rationale: Often caregivers neglect their own needs while in the caregiver role. The spouse understands the patient will die soon and is being realistic in understanding his or her own physical needs have been neglected. This shows healthy coping.)

The nurse is seeing a patient during a follow-up visit after discharge in which the patient had a nursing diagnosis of Difficulty coping. Which statement by the patient would be a cause for concern? a. "I am sleeping better most nights." b. "I feel less anxious." c. "I do not need to do the relaxation exercises anymore." d. "I am continuing my exercises every day."

c (rationale: Patients need to continue using the stress-reduction techniques to maintain a feeling of well-being. Once stress decreases, patients typically report feeling better, sleeping more soundly, and feeling less anxious. Continuing their positive activities such as exercising is good.)

Which statement by a patient best illustrates reflection on a spiritual need? a. "My husband told me what to do about this situation, and I'm sure he's right." b. "There is little I can do now to change my circumstances. I just need to adapt." c. "I need to think a little more about how I feel about undergoing this treatment." d. "Whatever the physician wants to do is fine. I don't have much of an option."

c (rationale: Reflection requires intentional thought about a situation to determine how it affects or is affected by the person's beliefs and values. Simply having someone tell the person what to do is not reflection. Adopting a fatalistic attitude or accepting the decision of a physician without inquiry is not reflection either.)

How do people who participate in organized religion differ from nonreligious people? a. Religious people are healthier than spiritual people. b. Religious people are more spiritual than nonreligious people. c. Religious people express their spirituality through faith traditions. d. Religious people have spiritual practices, whereas nonreligious people do not have spiritual practices.

c (rationale: Religious people express their beliefs through faith traditions. Research has not indicated that religious people are healthier or more spiritual than those who do not participate in organized religion. Nonreligious people may practice various spiritual disciplines.)

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, e (rationale: 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 and emotions common to each stage. This facilitates nursing interventions that can be focused on the stage the patient is experiencing or the task the person is attempting to complete related to the process of grief.)

When using a stress assessment tool with a patient from another culture, what factors must the nurse take into consideration? (Select all that apply.) a. Specific methods of managing stress are revealed in using stress assessment tools. b. Stress assessment tools should be used only for persons living in North America. c. Stress assessment tools may not be appropriate for all people of all ages. d. Resistance resources become evident when stress assessment tools are analyzed. e. Adaptations may need to be made to the assessment tool based on circumstances.

c, e (rationale: It is not possible to use stress assessment tools in some situations. Stress assessment tools must be adapted to specific age groups, cultures, and circumstances to be most effective in gathering pertinent data. Stress assessment tools identify only stressors that the person is experiencing and not methods of managing stress or the person's resistance resources.)

The home care nurse is caring for a terminally ill patient who states that he wants to set up a scholarship in his name at the local university before he dies. What is the best action by the nurse? a. Suggest that the patient think it over and wait a few days before contacting the school. b. Direct the patient to ask his family about the possibility of starting a scholarship. c. Assess the patient's mental status to ensure that he is competent to make the decision. d. Assist the patient to find the necessary information about endowed scholarships.

d (rationale: As the patient's advocate, the nurse should help provide the necessary information for the patient to set up a scholarship if that is his decision. The patient does not need to discuss the subject with his family first, and assessment of the patient's mental status is not needed. The patient may not have the time to wait a few days before contacting the university.)

The nurse is caring for a 16-year-old boy receiving chemotherapy for testicular cancer. He says that his parents are religious and left a cross next to his bed for "good luck." What is the most appropriate response by the nurse? a. "Would you like to talk with a chaplain?" b. "Sounds like you are not very religious." c. "How well do you get along with your parents?" d. "What helps you get through tough times?"

d (rationale: Asking an open-ended question is the best response that the nurse can make to this patient's comment. It will encourage the patient to share what he thinks would be most supportive at this time. Asking the patient if he would like to talk with a chaplain is incongruent with his comment about having a cross for good luck. Sharing that he does not sound religious is judgmental and asking about his relationship with his parents is changing the subject.)

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 that 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 (rationale: 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 for 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.)

The nurse is caring for a patient whose mother recently passed away. The patient states that she has not been able to concentrate or sleep since the funeral and is consuming increasing amounts of alcohol to get through each day. The nurse knows which goal to be most appropriate for this patient? a. The patient will be referred to medical social services for evaluation and counseling. b. The patient will be encouraged to describe previous stressors and coping mechanisms. c. Nursing staff support patient's coping attempts and encourage verbalization of feelings. d. The patient will use effective coping strategies with no alcohol consumption.

d (rationale: Goals are met by the patient rather than nursing or medical staff. The patient's use of effective coping strategies without drinking alcohol is an appropriate goal. Referring the patient for counseling and encouraging the patient to verbalize stressors are interventions rather than goals.)

The nurse is caring for an emergency room patient who died because of a mishap with a loaded gun. The patient's body will be transported to the coroner's office for an autopsy. Which items will the nursing staff remove from the body before it leaves the hospital? a. Endotracheal tube b. Foley catheter and IV line c. Dentures d. Necklace and watch

d (rationale: Medical devices and tubes are not removed from the body if an autopsy is to be performed. The patient's necklace and watch may be removed and given to the patient's family members before the body is transported to the coroner's office for autopsy. Dentures should be left in the patient's mouth.)