Chapter 30 Questions - Dying, Death, and Grieving

There is a conflict surrounding the dying experience in modern medicine, The medical model of treatment in the United States has traditionally been focused on the prolongation of life. What intrinsic factor plays into this medical model? Healthcare workers do not want their patients to die Medicare is a fee-for -service model Palliative care is expensive to administer Keeping people alive as long as possible is the ethical thing to do

Keeping people alive as long as possible is the ethical thing to do

Which ethical concept regarding client care poses the greatest concern for a nurse providing end-of-life care for a client considering euthanasia? Nonmaleficence Beneficence Autonomy Individual liberty

Nonmaleficence An ethical concept relevant to euthanasia is that of nonmaleficence, or doing no harm and considering whether helping to end life is an act of harm. None of the other ethical concepts is as directly related to the actions of nursing at the end of a client's life

Guadalupe is the matriarch of a large family. She is terminally ill and none of her family members know her end-of-life wishes. The best action for the nurse is to: Discuss durable power of attorney Organize a family meeting with Guadalupe's permission to discuss her goals and wishes Have a family meeting without Guadalupe so as not to upset her Ask the doctor to tell Guadalupe that she is dying

Organize a family meeting with Guadalupe's permission to discuss her goals and wishes

Which document allows an individual to appoint another person to make health care-related decisions for them if they become unable to do so for themself? Advance directive Living will Do not resuscitate request Power of attorney for health care

Power of attorney for health care A medical or healthcare power of attorney is a document that lets you appoint someone you trust to make decisions about your medical care if you are unable to do so. An advance directive may include a living will, that may include the request not to resuscitate, and/or a power of attorney for health care

Which factor will have the greatest impact on end-of-life nursing care in the coming decades? Technological advancements Decrease in federal funding for healthcare The aging of the Baby Boomers generation The decline in those entering the nursing profession

The aging of the Baby Boomers generation In 2014, the U.S. Census Bureau released a report projecting that the number of Americans over the age of 65 is expected to almost double from 43.1 million in 2012 to 83.7 million by 2050. Every day for the next 19 years, 10,000 baby boomers will be turning 65. This burgeoning sector of the population will place unprecedented strains on a health care system where health spending is growing faster than the overall economy. As this population experiences terminal illness, the need for end-of-life care will increase as well. While the other options are factors, the greatest impact will come from the existence of unprecedented numbers of terminal ill and dying clients

Which factor has the greatest influence on the hospice nurse's ability to provide respectful professional care? Acceptance that death is a natural part of life Possession of excellent care giving nursing skills The existence of a healthy, well-balanced personal life The desire to work with both the patient and the family

The existence of a healthy, well-balanced personal life

ATI CH 27 - 2. A charge nurse is reviewing Kubler-Ross: Five Stages of Grief with a group of newly licensed nurses. Which of the following stages should the charge nurse include in the teaching? select all that apply disequilibrium denial bargaining anger depression

denial bargaining anger depression

Considering the subject of medically assisted death, which statements identify the pros and cons of the argument associated with the issue of non-maleficence? select all that apply from the patient's perspective, there is no difference between ending life by providing a lethal prescription and by stopping treatment that prolongs life assisted death violates the oath to "do no harm" and destroys trust between patient and nurse there is equal protection under the laws that allows the right to refuse or withdraw treatment and to commit suicide every competent has the right to make decisions based on personal convictions human beings are the stewards but not the absolute masters of the gift of life

from the patient's perspective, there is no difference between ending life by providing a lethal prescription and by stopping treatment that prolongs life assisted death violates the oath to "do no harm" and destroys trust between patient and nurse

ATI CH 27 - 3. A nurse is working with a client who has recently lost his mother. The nurse recognizes that which of the following factors influence a client's grief and coping ability? select all that apply interpersonal relationships culture birth order religious beliefs prior experience with loss

interpersonal relationships culture religious beliefs prior experience with loss

ATI CH 27 - 1. A nurse is caring for a client following the loss of her partner due to a terminal illness. Identify the sequence o Engel's five stages of grief that the nurse should expect the client to experience. (select the stages of grief in order of occurrence. all steps must be used) developing awareness restitution shock and disbelief recovery resolution of the loss

shock and disbelief developing awareness restitution resolution recovery

Which statement made to the grieving patient demonstrates effective therapeutic communication? select all that apply your loved one was irreplacebly special it must be comforting to know they are with God now you can be very grateful for the time you had together I would like to take the flowers from the funeral home to your house your loss must be devastating. I can't imagine how you must be feeling right now

your loved one was irreplacebly special I would like to take the flowers from the funeral home to your house your loss must be devastating. I can't imagine how you must be feeling right now

Which question asked by the nurse demonstrates attention to the primary concern of palliative care? "Has your pain medication been effective at keeping you comfortable"? "Do you want to receive your palliative care at home or in an institutional setting?" "Do you have a spiritual provider you want me to be contacted?" "Who will be your acting as your primary care provider?"

"Has your pain medication been effective at keeping you comfortable"? Excellent symptom management is a hallmark of palliative nursing. Assessing pain management would reflect such a concern. While the other options present appropriate assessment questions, they do not address the primary issue of palliative care

Which statements identify a client's progress through the stages of grief? Select all that apply. "He didn't die; I'm sure he will be found and be just fine." "I will never accept he's gone; I will never give up looking for him." "If they find him, I'll never doubt miracles again." "I'll never understand why he risked his life by hitchhiking at night." "Knowing he's gone makes me so sad."

"He didn't die; I'm sure he will be found and be just fine." "If they find him, I'll never doubt miracles again." "I'll never understand why he risked his life by hitchhiking at night." "Knowing he's gone makes me so sad." The five stages of grief identified by Kübler-Ross include denial, anger, bargaining, depression, and acceptance. The statement concerning never giving up demonstrates the inability to accept the individual's death

Which statement made by a widow demonstrates that her grief work has been effective? select all that apply "I can remember how much my deceased husband loved chocolate chip ice cream" "Painting is my new passion, and I really enjoy learning the various strokes" "Jim could be very stubborn when he though he was right" "I don't know why he had to die" "I just can't believe he's gone"

"I can remember how much my deceased husband loved chocolate chip ice cream" "Painting is my new passion, and I really enjoy learning the various strokes" "Jim could be very stubborn when he though he was right"

ATI CH 27 - 4. A nurse is discussing normal grief with a client who recently lost a child. Which of the following statements made by the client indicates understanding:? select all that apply "I may experience feelings of resentment" "I will probably withdraw from others" "I can expect to experience changes in sleep" "It is possible that I will experience suicidal thoughts" "It is expected that I will have a loss of self-esteem"

"I may experience feelings of resentment" "I will probably withdraw from others" "I can expect to experience changes in sleep"

Which statement made by a patient demonstrates acceptance of criteria required of hospice care? "I want my family to be with me" "There is no cure for my illness. I've accepted that" "It's important to me that I die in my own home" "I don't want my family to bear the burden of caring for me"

"There is no cure for my illness. I've accepted that"

Which assessment question best demonstrates the nurse's understanding of a dying client's needs? "What are your hopes for your final days?" "Have you completed a Living Will?" "Are you aware of the pain control options available?" "Do you have any concerns about paying for your end-of-life care?"

"What are your hopes for your final days?" Care of the dying is a nursing responsibility. The focus of this care needs to shift toward the question, "What do you hope for at the end of your life?" rather than managing the cost of medical care. Pain management and advance directives are only individual aspects of end of life care

ATI CH 27 - 5. A nurse is caring for a client who lost his mother to cancer last month. The client states, "I'd still have my mother if the doctor would have diagnosed her sooner." Which of the following responses should the nurse make? "You sound angry. Anger is a normal feeling associated with loss" "I think you would feel better if you talked about your feelings with a support group" "I understand just how you feel. I felt the same when my mother died" "Do other members of your family also feel this way?"

"You sound angry. Anger is a normal feeling associated with loss"

A client who has recently received a terminal cancer diagnosis has expressed the desire to, "stay out of the hospital and die at home." Which nursing intervention will best help the client achieve this end-of-life goal? Involving the client and his/her family in treatment decisions Encouraging adherence to the medical treatment plan Discussing available pain control measures Assistance with advance care planning

Assistance with advance care planning Advance care planning has helped patients and their families achieve end-of-life goals, avoid hospitalization, and increase hospice and palliative care use. While the other options are appropriate interventions, none are as focused on assuring the client's end-of-life goals that are documented supporting their achievement

Which intervention demonstrates the fulfillment of a moral duty a nurse has to a dying patient? Treating the client respectfully Advocating for the client's right to privacy Assuring the client has the information needed for informed consent Assisting the client in determining their preferences and goals for care

Assisting the client in determining their preferences and goals for care According to the American Nurses Association's Code of Ethics nurses have a moral duty to help patients determine these preferences and goals at the end of life. The remaining options relate to compliance with client rights

The death of which terminal ill client, who self-administered a lethal dose of medication, resulted in the state of California adopting a Right to Die law? Terri Schiavo Jack Kevorkian Karen Anne Quinlan Brittany Maynard

Brittany Maynard Brittany Maynard was diagnosed with inoperable brain cancer in January of 2014. She and her husband moved from their home state of California to Oregon so that she could participate in Oregon's Death with Dignity Act. On November 1, 2014, Brittany self-administered a lethal dose of medication obtained under Oregon law. After Brittany's death, California Governor Jerry Brown signed a right to die bill into law. While all the other options identify individuals that played a role in the campaign to legalize physician-assisted suicide, none of their deaths resulted in California's adoption of a right to die law

Which assessment findings are associated with approaching death? Select all that apply. Increased drowsiness Increased blood pressure Progressive weakness Decreased heart rate Loss of appetite

Increased drowsiness Progressive weakness Loss of appetite The process of dying varies based upon the underlying cause. Some general signs of approaching death include growing weakness, loss of appetite, and increased drowsiness, an increase in heart rate, and a decrease in blood pressure.

Holly is a 53-year-old female with terminal breast cancer. Holly's nurse in the hospital brings up the subject of hospice care. Holly becomes upset and states, "I am not ready to give up and die" You respond that hospice is: A model of healthcare that emphasizes quality of life for you and your family the end of curative treatments and pain management A multidisciplinary team providing curative and therapeutic treatment An aggressive medical plan to end suffering and hasten death

A model of healthcare that emphasizes quality of life for you and your family

Which issue should the nurse discuss when planning end-of-life care for a terminal ill client? Select all that apply. Advance directive planning Hospice admission Cost of needed services Symptom management Curative therapies

Advance directive planning Hospice admission Symptom management Patients often turn to their nurse for assistance in understanding how to make end-of-life decisions. Appropriate topics include advance directive planning, hospice admission, and symptom management including pain medication. The discussion of financial issues should be referred to social services or a personal finance advisor. Curative therapies are not considered when the client has been identified as having a terminal diagnosis

Which form of grief involves concerns for the future? Disenfranchised Dysfunctional Anticipatory Maladaptive

Anticipatory Anticipatory grief or anticipatory mourning is when a future loss is being mourned in advance. None of the other options are associated with premature mourning for a loss that is likely to occur in the future

The dying patient with a neurocognitive disorder such as Alzheimer's disease is especially challenging to provide care for. They may have symptoms or pain that they are unable to adequately describe or define. Reversible conditions that respond to treatment that may affect level of consciousness, anxiety, or agitation include: Inability to communicate Distended bladder, constipation, or nausea Reduced urinary output Weakness due to the dying process

Distended bladder, constipation, or nausea

A terminally ill client expresses to the nurse the desire to discuss end-of-life issues. What is likely to be the greatest barrier to that discussion? The health provider's hesitancy to prescribe palliative care The client's lack of knowledge regarding the various issues The family's unwillingness to acknowledge the inevitable The nurse's reluctance to discuss death-related issues

The nurse's reluctance to discuss death-related issues Despite being trained to nonjudgmentally discuss difficult and sensitive issues with patients and families, nurses are often afraid to talk about death. Talking about death is difficult because of the emotions that are involved. While the other options may be factors, the nurse's attitude and willingness to engage in such a conversation initially have the greatest impact

A bereavement group run by a local hospice includes a woman who is distraught over her supervisor's death. The woman appears severely distressed. SHe has trouble functioning with activities of daily living and making the simplest of decisions. The group facilitator recognizes that this woman is suffering from disenfranchised grief after learning: The woman was in love with her married supervisor She has not taken enough time off work to grieve properly The supervisor died over a year ago Her family is not involved enough to support her

The woman was in love with her married supervisor

A dying client's family is concerned that the opioid pain medication being prescribed will hasten the client's death. Why? The Rule of Double Effect (RDE) prevents the use of opioids to facilitate a client's death. There is little research evidence to support that appropriate opioid management will result in an earlier death. Pain management for the terminally ill is the primary concern of the health care team. Addition to the opioid is a greater risk than is the possibility of a premature death.

There is little research evidence to support that appropriate opioid management will result in an earlier death. Pain is sometimes undertreated because the patient and/or family is concerned about sedation, addiction, and/or hastening the demise of their loved one. The RDE is a bioethical principle that allows a physician or APRN to make a decision, such as prescribing adequate pain medication, even though the pain medication might cause the patient to die sooner. There is little evidence, however, to support the concern that appropriate use of opioids will hasten death