End of LIfe
A terminally ill patient, in severe pain, asks a nurse to help her die. What must the nurse consider morally, ethically, and professionally before answering the patient? A) ANA Code for Nurses, ethical and professional standards B) own personal moral and ethical values and standards C) hospital or agency procedures and protocols D) Medical Code of Ethics, belief in active euthanasia
A) ANA Code for Nurses, ethical and professional standards
The nurse is aware that client care provided through a hospice is: A) Designed to meet the client's individual wishes, as much as possible B) Usually aimed at offering curative treatment for the client C) Involved in teaching families to provide postmortem care D) Offered primarily for hospitalized clients
A) Designed to meet the client's individual wishes, as much as possible The nurse's role in hospice is to meet the primary wishes of the dying client and to be open to individual desires of each client. The nurse supports a client's choice in maintaining comfort and dignity.
Which of the following statements is typical of the first stage of grieving described by Engel? A) No, not me. B) Why me? C) My husband was the best man in the world. D) The funeral service helped me survive.
A) No, not me.
A nurse assesses a terminally ill patient with a DNR order, with findings of decreased blood pressure, urinary and bowel incontinence, loss of reflexes, and Cheyne-Stokes respirations. Based on these findings, the nurse recognizes which of the following? A) These are signs of impending death. B) These signs do not indicate any abnormality. C) The patient requires immediate resuscitation. D) The patient's family should be asked to leave.
A) These are signs of impending death.
A woman has had a breast removed to treat cancer. What type of loss will she most likely experience? A) actual loss B) perceived loss C) maturational loss D) anticipatory loss
A) actual loss
Which of the following persons is responsible for handling and filing a death certificate with proper authorities? A) mortician B) physician C) nurse D) hospital administrator
A) mortician
A nurse is developing a plan of care for a dying patient. Which of the following physiologic basic human needs should be addressed? A) personal hygiene B) risk for infection C) family support D) spirituality
A) personal hygiene
The husband of a patient who died of breast cancer is still grieving for his wife 2 years later. What type of grief is he experiencing? A) unresolved B) situational C) inhibited D) maturational
A) unresolved
When planning care for the dying patient, which interventions promote the patient's dignity? (Select all that apply.) A. Providing respect B. Viewing patients as a whole C. Providing symptom management D. Showing interest E. Being present F. Using a preferred name
A, B, D, E, F A sense of dignity includes a person's positive self-regard, the ability to find meaning in life, feeling valued by others, and the way one is treated by caregivers.
Which factors influence a person's approach to death? (Select all that apply.) A. Culture B. Age C. Spirituality D. Personal beliefs E.Previous experiences with death F. Gender G.Level of education H.Degree of social support.
A, C, D, E, H Culture, spirituality, personal beliefs and values, previous experiences with death, and degree of social support influence how a person approaches death.
What are the physical changes that occur as death approaches? (Select all that apply.) A. Unresponsiveness B. Erythema C. Mottling D. Restlessness E. Increased urine output F. Weakness G. Incontinence
A, C, D, F, G. Patients experience physical changes that accompany the body shutting down.a response to loss, the process of coming to terms with a loss
A patient is hospitalized with severe depression after her divorce is finalized. Which type of loss is the patient experiencing? A. Actual B. Perceived C. Physical D. External
A. Actual he loss of a relationship is an actual loss. An actual loss is a reality that can be identified by others, not just by the person experiencing it. Perceived loss is internal; it can only be identified by the person experiencing the loss. Physical loss includes injuries, removal of an organ or body part, or loss of function. An external loss is an actual loss of an object.
9. Which of the following is true concerning hospice nursing care? A. It is designed to meet the client's individual wishes, as much as possible. B. It usually aims at offering curative treatment for the dying client. C. It involves learning how to provide postmortem care. D. It offers quality care to clients with good third party payment plans.
A. It is designed to meet the client's individual wishes, as much as possible.
A year after her husband's death, a widow visits the unit on which he died. She talks about the anniversary and how much she misses him. Which type of grief is she experiencing? A. Normal B. Complicated C. Chronic D. Disenfranchised
A. Normal It is normal for anniversaries to prompt feelings of sadness and grief.
When caring for a dying client who is in pain, the nurse should provide: A. Pain medication on a regular schedule B. Frequent bathing and skin care. C. An environment that is quiet and limits visitors D. Backrubs and positioning every 2 hours
A. Pain medication on a regular schedule
To best assist a patient in the grieving process, which of the following is most helpful to determine? A. Previous experiences with grief and loss. B. Religious affiliation and denomination. C. Ethnic background and cultural practices D. Current financial status.
A. Previous experiences with grief and loss. Previous experiences with loss and grief help individuals develop coping skills and set a pattern of response to future episodes of loss and grief.
A grieving patient complains of confusion, inability to concentrate, and insomnia. What do these symptoms indicate? A. These are normal symptoms of grief. B. There is a need for pharmacological support for insomnia. C. The patient is experiencing complicated grief. D. These are common complaints of the admitted patient.
A. These are normal symptoms of grief. Symptoms of normal grief include a variety of feelings, thought patterns, physical sensations, and behaviors.
is a set of instructions to health care providers about what treatments are or are not to be administered when a person is terminally ill and unable to make informed decisions.
An Advance Directive
A client has been diagnosed with terminal cancer of the liver and is receiving chemotherapy on a medical unit. In an in-depth conversation with the nurse, the client states, "I wonder why this happened to me?" According to Kübler-Ross, the nurse identifies that this stage is associated with: A) Bargaining B) Denial C) Anger D) Depression
B) Denial According to Kübler-Ross, the client is in the denial stage of dying. The client may act as though nothing has happened, may refuse to believe or understand that a loss has occurred and may seem stunned, as though it is "unreal" or difficult to believe.
A dying patient and family have requested that no attempts be made to resuscitate the patient in the event of death. A doctor has written a DNR order. What is the nurse's responsibility if the patient dies? A) Follow his or her own conscience and perform CPR. B) Make no attempt to resuscitate the patient. C) Follow a verbal physician's order for a slow code. D) If the patient is at home, call 911 and begin CPR.
B) Make no attempt to resuscitate the patient.
The parents of a teenager who is being maintained on life support after a motorcycle crash tell the nurse, We would like to donate his organs if he dies. What is the nurse's role in organ donation? A) Realize that it is a legal responsibility to call the coroner. B) Review options and provide consent forms to the family. C) Make arrangements for protocols for retrieving the organs. D) None; organ donation is a physician's responsibility.
B) Review options and provide consent forms to the family.
A dying patient states in writing ahead of time what her choices would be for healthcare should certain circumstances develop. What is the term for this document? A) living will B) advance directives C) durable power of attorney D) comfort measures only
B) advance directives
A man is diagnosed with terminal kidney failure. His wife demonstrates loss and grief behaviors. What type of loss is the wife experiencing? A) maturational loss B) anticipatory loss C) dysfunctional grieving D) bereavement
B) anticipatory loss
Although all of the following are factors that affect grief, which one is most likely to influence a person's expression of grief? A) socioeconomic factors B) cultural influences C) religious influences D) cause of death
B) cultural influences
A patient is receiving palliative care for symptom management related to anxiety and pain. A family member asks if the patient is dying and now in "hospice." What does the nurse tell the family member about palliative care? (Select all that apply.) A. Palliative care and hospice are the same thing. B. Palliative care is for any patient, any time, any disease, in any setting. C. Palliative care strategies are primarily designed to treat the patient's illness. D. Palliative care relieves the symptoms of illness and treatment. E.Palliative care selects home health care services.
B, D Palliative care focuses on the prevention, relief, reduction, or soothing of symptoms of disease or disorders throughout the entire course of an illness. It can also include, but is not solely, care of the dying. The primary goal of palliative care is to help patients and families achieve the best possible quality of life.
The nurse is caring for a patient who is terminally ill with lung cancer. Recently, the patient's blood pressure has been decreasing and heart rate increasing. He is experiencing temperature fluctuations and perspires profusely with limited movement. Based on these findings, the patient will most likely die within which time period? A. 1 to 3 months B. 1 to 2 weeks C. Days to hours D. Moments
B. 1 to 2 weeks One to 2 weeks before death, patients typically exhibit decreased blood pressure, increased heart rate, increased perspiration, and temperature fluctuations; 1 to 3 months before death the patient withdraws from the world: sleep increases and appetite decreases. Days to hours before death, the patient may experience a surge in energy. Very near the time of death, the dying patient is typically not responsive to touch or sound.
A nurse has the responsibility of managing a deceased patient's postmortem care. Which of the following is the proper order for postmortem care? 1. Bathe the body of the deceased. 2. Collect any needed specimens. 3. Remove all tubes and indwelling lines. 4. Position the body for family viewing. 5. Speak to the family members about their possible participation. 6. Ensure that the request for organ/tissue donation and/or autopsy was completed. 7. Notify support person (e.g., spiritual care provider, bereavement specialist) for the family. 8. Accurately tag the body, including the identity of the deceased and safety issues regarding infection control. 9. Elevate the head of the bed. A. 9, 1, 2, 4, 3, 5, 7, 8, 6 B. 6, 9, 2, 5, 7, 3, 1, 4, 8 C. 8, 4, 1, 3, 5, 2, 6, 7, 9 D. 2, 1, 5, 3, 7, 9, 4, 8, 6
B. 6, 9, 2, 5, 7, 3, 1, 4, 8 This is the proper order for postmortem care.
Which of the following is the best intervention to help a hospitalized patient maintain some autonomy? A. Use therapeutic techniques when communicating with the patient. B. Allow the patient to determine timing and scheduling of interventions. C. Encourage family to only visit for short periods of time. D. Provide the patient with a private room close to the nurse's station.
B. Allow the patient to determine timing and scheduling of interventions. Providing the opportunity for patients to have control of decisions concerning care allows them to maintain autonomy and dignity
A family member of a dying patient talks casually with the nurse and expresses relief that she will not have to visit at the hospital anymore. Which theoretical description of grief best applies to this family member? A. Denial B. Anticipatory grief. C. Yearning and searching D. Dysfunctional grief
B. Anticipatory grief. Family members often grieve the impending loss of companionship, control, and sense of freedom and the mental and physical changes to be experienced by their loved one. Ultimately they grieve the impending death.
6. A client has been diagnosed with terminal cancer of the liver and is receiving chemotherapy on a medical unit. In an in-depth conversation with the nurse, the client states, "I wonder why this happened to me?" Which stage is this associated with? A. Anxiety B. Denial C. Confrontation D. Depression
B. Denial
According to Engel, three phases are involved in the grieving process. By experiencing these steps, a person is believed to: A. Die with dignity B. Develop self-awareness C. Accept the inevitable D. Help family members
B. Develop self-awareness
When providing postmortem care, which action is a priority for the nurse? A. Locating the patient's clothing B. Providing culturally and religiously sensitive care in body preparation C. Transporting the body to the morgue as soon as possible D. Providing postmortem care to protect the family of the deceased from having to view the body
B. Providing culturally and religiously sensitive care in body preparation Various cultures and religions have specific postmortem care practices. Honoring these practices is important for the family as they prepare to mourn their loved one.
the state of having experienced a loss.
Bereavement
Cessation of breathing No response to painful stimuli Lack of reflexes (gag/corneal) & spontaneous movement
Brain Death (Harvard Criteria, 1968)
Which of the following is an example of a perceived loss? A) A patient mourns the loss of his amputated leg. B) A patient grieves for the loss of his wife to cancer. C) An older patient grieves for the loss of his independence. D) A patient grieves for the loss of his job.
C) An older patient grieves for the loss of his independence.
The nurse is assigned to a client who was recently diagnosed with a terminal illness. During morning care, the client asks about organ donation. The nurse should: A) Have the client first discuss the subject with the family B) Suggest the client delay making a decision at this time C) Assist the client to obtain the necessary information to make this decision D) Contact the physician so consent can be obtained from the family
C) Assist the client to obtain the necessary information to make this decision No topic that a dying client wishes to discuss should be avoided. The nurse should respond to questions openly and honestly. As client advocate, the nurse should assist the client to obtain the necessary information to make this decision.
While caring for a patient near end of life, a student talks to her. Another student asks why she is talking to someone who is dying. Which response would be accurate? A) It makes me feel better to talk to my patients. B) I do this so I won't be so afraid the patient will die. C) I believe the patient can hear me as long as she is alive. D) I don't know; the nurse in charge of the patient told me to.
C) I believe the patient can hear me as long as she is alive.
A patient asks a nurse to explain a living will. What is the nurse's best answer? A) It specifies who will inherit the patient's estate. B) It determines an individual's quality of life. C) It lists specific instructions for healthcare provisions. D) It identifies a trusted person to make healthcare decisions.
C) It lists specific instructions for healthcare provisions.
Kübler-Ross defines five stages of psychosocial responses to dying and death. Which of the following statements is characteristic of the bargaining stage? A) The doctors must have made a mistake. B) Why did this happen to me? I always exercised. C) Just let me live to see my grandson born. D) I've had a good life and I can die in peace.
C) Just let me live to see my grandson born.
The nurse is working with a client on an inpatient hospice unit. To maintain the client's sense of self-worth during the end of life, the nurse should: A) Leave the client alone to deal with final affairs B) Call on the client's spiritual advisor to take over care C) Plan regular visits throughout the day D) Have a grief counselor visit
C) Plan regular visits throughout the day Spending time to let clients share their life experiences, particularly what has been meaningful, enables the nurse to know clients better. Knowing clients facilitates choice of therapies that promote client decision-making and autonomy. Planning regular visits also helps the client maintain a sense of self-worth, because it demonstrates that he or she is worthy of the nurse's time and attention.
Family members of a dying patient are in the room with the patient. As the patient nears death, what should the nurse tell the family? A) Please leave the room now. It is time to let go. B) Only one family member at a time can stay in the room. C) Please stay with your loved one and talk to him. D) I will have to get an order for you to stay now.
C) Please stay with your loved one and talk to him.
An identified outcome for the family of the client with a terminal illness is that they will be able to provide psychological support to the dying client. To assist the family to meet this outcome, the nurse plans to include in the teaching plan: A) Demonstration of bathing techniques B) Application of oxygen devices. C) Recognition of client needs and fears. D) Information on when to contact the hospice nurse
C) Recognition of client needs and fears. A dying client's family is better prepared to provide psychological support if the nurse discusses with them ways to support the dying person and listen to needs and fears.
A hospice nurse is providing emotional care and support for a family who lost a son. The care will be provided based on what knowledge? A) All members of the family will react to loss in the same way. B) Grief is an abnormal physical reaction to a loss. C) Stages of grief reactions may overlap and are individualized. D) Bereavement is a normal process, requiring little intervention.
C) Stages of grief reactions may overlap and are individualized.
A nurse providing palliative care for a dying man and his family knows that the goal of palliative care is: A) to aggressively treat the disease. B) to provide care for the dying in the home. C) to aggressively treat the symptoms of the disease. D) to support the family of the dying patient.
C) to aggressively treat the symptoms of the disease.
Which of the following are signs of a good death. Select all that apply. A) minimal or moderate pain experienced B) The person dies according to the wishes of the family. C) The person dies with dignity. D) The person is prepared for death. E) The person has a sense of completion of life. F) The person has a good relationship with healthcare providers.
C, D, E, F
Which comment to a patient by a new nurse regarding palliative care needs to be corrected? A. Even though you're continuing treatment, palliative care is something we might want to talk about." B. "Palliative care is appropriate for people with any diagnosis." C. "Only people who are dying can receive palliative care." D. "Children are able to receive palliative care." Incorrect
C. "Only people who are dying can receive palliative care." Palliative care is available to all patients regardless of age, diagnosis, and prognosis.
5. The nurse is assigned to a client who was recently diagnosed with a terminal illness. During morning care, the client asks about organ donation. You should: A. Have the client first discuss the subject with his family B. Suggest that the client delay making a decision at this time C. Assist the client to obtain the information necessary to make this decision D. Contact the client's physician in order to obtain consent from the family
C. Assist the client to obtain the information necessary to make this decision
What is the palliative care team's primary obligation for the patient with severe pain? A. Providing postmortem care. B. Teaching about grief stages. C. Enhancing the patient's quality of life. D. Supporting the family after the death.
C. Enhancing the patient's quality of life. Palliative care focuses on enhancing the patient's quality of life.
A newly graduated nurse is assigned to his first dying patient. The nurse is best prepared to care for this client if he: A. Has completed a course dealing with death and dying B. Is able to control his own emotions about death C. Has developed a personal understanding of his own feelings about death D. Has experienced the death of a loved one
C. Has developed a personal understanding of his own feelings about death
A young mother is dying of breast cancer with bone metastasis and tells the nurse, "My body hurts so much. I can hardly move. Why is God making me suffer when I have done nothing bad in my life? I feel like giving up. How can I care for my children when I can't even care for myself?" What is the most appropriate nursing diagnosis for this patient? A. Spiritual Distress related to questioning God B. Hopelessness related to terminal diagnosis. C. Pain related to disease process. D. Anticipatory Grief related to impending death
C. Pain related to disease process Pain control is always the priority.
A nurse is caring for a dying patient who is non-responsive. Which of the following is it important for the nurse to do? A. Be alert to the patient's nonverbal cues. B. Direct explanations about care to family members. C. Tell the patient when the nurse is about to leave the room. D. Sit by the head of the bed when speaking to the patient.
C. Tell the patient when the nurse is about to leave the room. The nurse should continue to communicate with dying patients even if they are non-responsive. Research indicates that patients continue to hear even though the level of consciousness is low, sometimes up to the moment of death. Nonverbal actions would not communicate meaning for a patient who is non-responsive; nor would the patient be aware that the nurse is sitting instead of standing when speaking. The nurse should direct explanations of care to the patient, as always; nurses should not talk about the patient to others in the patient's presence, even when the patient is comatose.
A client is dying from an unexplained condition of the bone marrow. Which of the following is true for the client's family in this situation? A. Family members should be told to be emotionally controlled and to be a source of support for the client. B. Children should not be told how serious the client's condition is until the client has stabilized his/her own emotions. C. The client's spouse should be given information that explains how he/she may go through stages of grief in a different manner from the client. D. The spouse should be expected to react in the same manner as in other crises that have occurred in the past.
C. The client's spouse should be given information that explains how he/she may go through stages of grief in a different manner from the client.
The nurse is preparing to assist the client in the end stage of her life. To provide comfort for the client in response to anticipated symptom development, the nurse plans to: A) Decrease the client's fluid intake B) Limit the use of analgesics C) Provide larger meals with more seasoning D) Determine valued activities and schedule rest periods
D) Determine valued activities and schedule rest periods To promote comfort in the terminally ill client, the nurse should help the client to identify values or desired tasks and then help the client to conserve energy for those tasks.
A newly graduated nurse is assigned to his/her first dying patient. The nurse is best prepared to care for this client if s/he: A) Completed a course dealing with death and dying. B) Is able to control his/her own emotions about death. C) Experiences the death of a loved one. D) Has developed a personal understanding of his/her own feelings about death
D) Has developed a personal understanding of his/her own feelings about death When caring for clients experiencing grief, it is important for the nurse to assess his/her own emotional well-being and to understand his/her own feelings about death. The nurse who is aware of his/her own feelings will be less likely to place personal situations and values before those of the client.
The nurse recognizes that anticipatory grieving can be most beneficial to a client or family because it can: A) Be done in private B) Be discussed with others C) Promote separation of the ill client from the family D) Help a person progress to a healthier emotional state
D) Help a person progress to a healthier emotional state The benefit of anticipatory grief is that it allows time for the process of grief (i.e., to say good-bye and complete life affairs). Anticipatory grief allows time to grieve in private, to discuss the anticipated loss with others, and to "let go" of the loved one. Anticipatory grief can help a person progress to a healthier emotional state of acceptance and dealing with loss.
The nurse is discussing future treatments with a client who has a terminal illness. The nurse notes that the client has not been eating and responds to the nurse's information by saying, "What does it matter?" The most appropriate nursing diagnosis for this client is: A) Social isolation B) Spiritual distress C) Denial D) Hopelessness
D) Hopelessness A defining characteristic for the nursing diagnosis of hopelessness may include the client stating, "What does it matter?" when offered choices or information concerning him or her. The client's behavior of not eating also is an indicator of hopelessness.
A nurse is talking to a patient who has been told he has a terminal illness and is responding in an angry manner. What statement by the nurse would best facilitate better patient outcomes? A) Why are you so angry? The doctor told you why you will not live. B) I'm sorry you are in pain right now, but we have to talk about this. C) When you feel like talking about how you feel, let me know. D) How much do you know and what do you want to know?
D) How much do you know and what do you want to know?
Which of the following phrases can do much to instill hope in the dying patient? A) This is a hopeless situation. B) Nothing more can be done. C) Everything will be fine, so don't worry. D) Let me tell you about your illness.
D) Let me tell you about your illness.
Which of the following is the primary concern of the nurse for providing care to a dying client? The nurse should: A) Promote optimism in the client and be a source of encouragement B) Intervene in the client's activities of daily living and promote as near normal functions as possible C) Allow the client to be alone and expect isolation on the part of the dying person D) Promote dignity and self-esteem in as many interventions as possible
D) Promote dignity and self-esteem in as many interventions as possible The focus in planning nursing care is to support the client physically, emotionally, developmentally, and spiritually in the expression of grief. When caring for the dying client, it is important to devise a plan that helps a client to die with dignity and offers family members the assurance that their loved one is cared for with care and compassion.
Which one of the following statements accurately describes the process known as grief reaction? A) Reactions to grief and dying are different. B) Reactions to grief are similar for all people. C) Reactions to grief follow all stages of the grieving process. D) Reactions to grief may differ from patient to family.
D) Reactions to grief may differ from patient to family.
A nurse who provides bereavement counseling is working with the family of a child who recently died from cancer. Which of the following statements may be a common expression of grief and guilt by a family member? A) 65-year-old grandparent: It helped me prepare for my death. B) Parents: We did everything we could and we are at peace. C) Uncle: It was for the best. D) Sister: It is all my fault; I wanted him to die.
D) Sister: It is all my fault; I wanted him to die.
A dying patient is crying. She states, I can't pray. I can't forgive myself. What would be an appropriate nursing diagnosis based on this data? A) Noncompliance B) Knowledge Deficit C) Low Self-Esteem D) Spiritual Distress
D) Spiritual Distress
7. According to the Harvard University Medical School committee, what function must be irreversibly lost to define death? A) respiratory functions B) reflexes C) consciousness D) brain function
D) brain function
A patient is diagnosed with a terminal illness. Who is usually responsible for deciding what, when, and how the patient should be told? A) family B) clergy C) nurse D) physician
D) physician
A nurse is providing postmortem care. Which of the following nursing actions is a legal responsibility? A) placing the body in normal anatomic position B) removing tubes and soiled dressings C) washing the body to remove blood and excretions D) placing ID tags on the shroud and ankle
D) placing ID tags on the shroud and ankle
A dying patient is undergoing terminal weaning. What is the purpose of this intervention? A) to manage the symptoms of the illness B) to prepare for resuscitation of the patient C) to initiate life-sustaining measures for the patient D) to gradually withdraw mechanical ventilation
D) to gradually withdraw mechanical ventilation
10. An 11-year-old is seeing a counselor to help her deal with the death of a maternal grandmother. The counselor should expect this child to make which of the following statements? A. "I wonder if Grandma will ever come back?" B. "I think I'll start going to church with Mom now. " C. "I'm not ever going to die-it makes everyone too sad. " D. "I wonder if I'll die of a heart attack, too?"
D. "I wonder if I'll die of a heart attack, too?"
A patient has been in the dying process for about 10 days. His wife has left his side only for very short periods during that time, and she looks pale and exhausted. The nurse, realizing the wife has not eaten much, suggests that she take a break to eat and rest. The woman refuses, saying, "I don't want to leave him. I won't have him much longer, and I don't want him to go when I'm gone." What should the nurse do? A. Explain that she will be of more help to her husband if she is rested and well. B. Tell the wife that it is safe to leave her husband for an hour or two because he won't die that soon. C. Call the primary care provider to come and try to persuade her to take physical care of herself. D. Arrange for a cot for her at the bedside and arrange to have food brought to her.
D. Arrange for a cot for her at the bedside and arrange to have food brought to her. The nurse was correct to suggest that the woman needs to eat and rest. However, this is primarily for the woman's well-being, not because she needs to be of more help to her husband. The nurse should not assure her that her husband will not die in an hour or two, because she does not know exactly when he will die. It would be inappropriate to ask anyone else to try to persuade her to change her mind; the nurse should support the wife's decisions in a therapeutic manner and not try to change them. The nurse should not rely on the physician to encourage basic care and comfort for the family. She should make the wife as comfortable as possible if she does not wish to leave the room. This would include arranging for her to rest in the patient's room and having food and drink brought to the room.D
Anticipatory grieving can be beneficial to a client or family because it can: A. Be done in private B. Draw a family closer to help care for each other more C. Be discussed with others. D. Help a person progress to a healthier emotional state
D. Help a person progress to a healthier emotional state
A family member asks the nurse to explain the purpose of hospice care. Which of the following is the best response? Hospice care: A. Is appropriate when the patient desires to intentionally end his life B. Focuses on minimizing the disease process as rapidly as possible C. Focuses on symptom management for patients not responding to treatment D. Is holistic care for patients dying or debilitated and not expected to improve
D. Is holistic care for patients dying or debilitated and not expected to improve Hospice care focuses on holistic care of patients actively dying or not expected to improve. It helps patients face death with dignity and comfort. Euthanasia refers to the deliberate ending of a life. Palliative care is aggressively planned care that manages symptoms of patients whose disease process no longer responds to treatment. Aggressive medical treatment is aimed at stopping the disease process.
8. Which of the following is the primary concern of the nurse for providing care to a dying client? The nurse should: A. Attempt to assess hope in the client and to be a source of encouragement to the client B. Intervene in the client's activities of daily living and promote as near normal functions as possible C. Allow the client to be alone and expect isolation on the part of the dying person D. Promote dignity and self-esteem in as many interventions as possible
D. Promote dignity and self-esteem in as many interventions as possible
On entering a room the nurse sees the patient crying softly. What is the most therapeutic response? A. Using silence B. Asking, "Why are you crying today?" C. Using therapeutic touch D. Stating, "I see that you're crying."
D. Stating, "I see that you're crying." Stating an observation encourages patients to share without putting the patient on the defensive.
a response to loss, the process of coming to terms with a loss
Grief
In this type of care: May be inpatient, or in the home Provided by a multidisciplinary team: physicians, nurses, social work, clergy, therapists, etc. Doctor must certify that the patient has a terminal condition, less than 6 months to live Covered by Medicare, and most Medicaid and private insurance
Hospice care.
the social and cultural expressions of grief: customs, rituals and traditions
Mourning
In this type of care: Similar to hospice care, but does not require certification of terminal status Focus on holistic care Death is natural and personal Goal: best quality of life with use of aggressive management of symptoms
Palliative Care
Individual who has sustained: Irreversible cessation of all functions of circulatory & respiratory functions OR Irreversible cessation of all functions of entire brain, including brain stem.
Uniform Definition of Death Act (1981)
After a patient dies of ovarian cancer, her daughter says to the nurse, "You'll probably think I'm terrible, but I'm glad she can finally rest peacefully." Which response by the nurse is best? A. "Your feelings are a normal response to watching your loved one suffer." B. "It's unusual for family members to be grateful that a loved one has died." C. "Your mother's death has been very hard on you; you should seek counseling." D. "I don't understand what you mean by this comment."
Your feelings are a normal response to watching your loved one suffer." The nurse should reassure the patient's daughter that her feelings are normal; there is no need for the daughter to seek counseling based on the information provided in this situation. Keep in mind that people can grieve in a dysfunctional manner for which they would benefit from counseling or other mental health support services. By responding, "It's unusual for family members to be grateful that a loved one has died," the nurse is being judgmental. The nurse who states she doesn't understand the family member's comment should at least seek clarification and prompt further exploration of the person's feelings. A comment of this nature can be a discussion starter for the daughter to release feelings and begin the grieving process.
the 5 stages of death are...
denial anger bargaining depression acceptance.
Non-responsiveness, no signs of respiration of heartbeat Fixed, dilated pupils, rigor mortis.
traditional definition of death.
