Chapter 43: Loss, Grief, and Dying

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 patients family should be asked to leave.

A)

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)

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)

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)

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)

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)

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)

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 nurses 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 physicians order for a slow code. D) If the patient is at home, call 911 and begin CPR.

B)

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)

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)

Although all of the following are factors that affect grief, which one is most likely to influence a persons expression of grief? A) socioeconomic factors B) cultural influences C) religious influences D) cause of death

B)

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 nurses 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 physicians responsibility.

B)

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)

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)

A patient asks a nurse to explain a living will. What is the nurses best answer? A) It specifies who will inherit the patients estate. B) It determines an individuals quality of life. C) It lists specific instructions for healthcare provisions. D) It identifies a trusted person to make healthcare decisions.

C)

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)

Kbler-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) Ive had a good life and I can die in peace.

C)

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)

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 wont be so afraid the patient will die. C) I believe the patient can hear me as long as she is alive. D) I dont know; the nurse in charge of the patient told me to.

C)

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)

A dying patient is crying. She states, I cant pray. I cant 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)

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)

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)

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) Im 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)

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)

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)

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)

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 dont worry. D) Let me tell you about your illness.

D)

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)