Revision 14

20. The nurse is taking care of a dying child. The nurse is trying to locate the child's listed religion to make sure whether mandatory baptism must be performed. Based on this information, which religions have mandatory baptism? 1. Roman Catholic 2. Russian Orthodox 3. Greek Orthodox 4. Quakers A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4

Ans: A Feedback: Roman Catholics, Greek Orthodox, and Russian Orthodox have mandatory baptism. Quakers have no belief in afterlife and do not have mandatory baptism.

23. A nurse is taking care of a client in the depression stage of dying. Based on this information, what suggestion for helping the individual cope does the nurse need to make sure is present in the nursing care plan? A) Allow the person to rest. B) Encourage family support. C) Try to assist in client's wishes. D) Provide physical care.

Ans: A Feedback: A good suggestion to help a person cope in the depression stage of dying is allowing the client to rest. Encouraging family support and trying to assist in client's wishes are appropriate suggestions for helping the person cope in the bargaining stage of dying. Providing physical care is an appropriate suggestion for the acceptance stage of dying.

19. The nurse and primary care provider have to ask the family of a young victim of a motor vehicle accident about obtaining an autopsy. The nurse is a recent graduate and remembers reviewing culture, ethnicity, and religious beliefs and practice related to death. Based on this information, which client's family would the nurse anticipate that the autopsy cannot be performed? A) Christian Science B) Episcopal C) Greek Orthodox D) Hindu

Ans: A Feedback: An autopsy is forbidden for the Christian Science religion. Episcopal, Greek Orthodox, and Hindu religion do not forbid an autopsy.

17. A nurse is working with a dying client. The nurse best demonstrates support of dying with dignity when completing which nursing action? A) Allows the client to make as many decisions as possible about care B) Tells the client own views about the afterlife C) Does not talk about the impending death and only focuses on current care needed D) Completes most of physical care for the client

Ans: A Feedback: Assisting the client to die with dignity involves the client participating and choosing the remainder of life and supporting the acceptance stage of dying. Sharing the nurse's own views about life after death does not support the client's own influence of culture, ethnicity, or religious beliefs. Only when a client requests assistance should the nurse provide it, because otherwise the nurse is not supporting the client's acceptance of the final stage of growth and development.

18. The family of a client that just died tells the nurse that they will take care of the body and that the funeral will be held at home. Based on this information about traditional religious beliefs and practices related to death, what most likely will the nurse find listed in the electronic medical record as the client's religion? A) Amish B) Baptist C) Buddhist D) Christian Science

Ans: A Feedback: The Amish and Mennonite religion's practices include that the family cares for the body and the funeral is often at the home. Baptists practice prayer and communion. Buddhists have a priest perform last rites and chanting rituals. The Christian Science has a reader called with no last rites.

5. A client dying of terminal illness is in the acceptance stage of dying. The family is worried that the client is devoid of all feelings and has given up everything associated with life. How can the nurse explain the client's behavior to the family? A) The client is resolving emotional conflicts about death. B) The client is not willing to communicate with family. C) The client is trying to escape the reality of death. D) The client is concentrating on past losses.

Ans: A Feedback: The nurse explains to the family that the client is resolving emotional conflicts about death and accepting impending death. It would not be correct to say that the client is unwilling to communicate with the family because he or she is not in the anger and rage stage of dying. The client is not trying to escape reality of death because he or she is not in the stage of preparatory depression. The client is not concentrating on past losses because he or she is not in the reactive depression stage of dying.

25. A nurse is taking care of a client who is beginning to recognize that this was the last summer he will be able to play golf because he has this feeling that the bladder cancer is getting worse rapidly. Based on the data that the nurse collected during the visit to the primary care provider, which stage of dying is this client most likely experiencing? A) Anger B) Bargaining C) Depression D) Acceptance

Ans: B Feedback: During the bargaining—not anger, depression, or acceptance—stage of dying the client feels guilty and is developing an awareness of the diagnosis.

24. A nurse is taking care of a client in the denial stage of dying. The student nurse is preparing a short postclinical report about the stages of dying and wants to include a brief description of the stages of death. The student nurse has to be able to describe each stage in one word. Which word by the student nurse would best describe the denial stage of dying? A) Rage B) Shock C) Guilt D) Grief

Ans: B Feedback: During the denial stage of dealing with death, the individual experiences shock. Rage occurs in the anger stage; guilt occurs in the bargaining stage and grief is present in the depression stage.

1. The nurse caring for a client with terminal illness observes that the client is unresponsive and in the final detachment stage of dying. Basic human needs are a priority for the dying person. What is the highest priority for nursing care at this time? A) Emotional needs B) Physical needs C) Spiritual needs D) Social needs

Ans: B Feedback: Nursing care should be primarily directed toward the physical needs. Because the client is unresponsive and gradually separating from the world, the client does not have any emotional, spiritual, or social needs.

3. The nurse is caring for an aged client who is dying. The client has accepted death and interacts with the nurse. Which is the most likely statement by the client to the nurse at this time? A) "No, not me!" B) "I am at peace with the diagnosis." C) "Yes me, but why did this happen to me?" D) "If I could just live just two more weeks, I can see my daughter get married."

Ans: B Feedback: The most likely statement by the client would be, "I am at peace with the diagnosis" because the client has already accepted death. The client would not say, "No, not me!", because the client is not denying death. The client would not say, "Yes me, but why did this happen to me?" or "If I could just live just two more weeks, I can see my daughter get married." because the client is not bargaining for time and is not developing an awareness of death.

13. A nurse is caring for a dying male client who belongs to an organized religious group. How can the nurse best help the client to draw strength from his religious faith? A) Limit visitors to immediate family during prayer sessions. B) Arrange for individuals from the client's religious group to pray with the client. C) Have the hospital chaplain visit with the client each day. D) Find out what religious materials would be of help to the client.

Ans: B Feedback: The nurse can best help the client by arranging for people from the client's religious group to visit and pray with the client so that he is able to draw strength from God and prayer. Limiting prayer to family members who may or may not have the client's same beliefs limits the opportunities for support of others for the client. The hospital chaplain can assist with prayer, but may not know the client well or hold the same religious beliefs as the client. Religious materials can be helpful, but they do not provide the social support of others.

9. A male client with terminal pancreatic cancer is aware that he's dying. The family members are unable to confront the situation. Based on this information, which suggestion should the nurse offer the family? A) Appear cheerful before the client. B) Talk honesty and clearly about death. C) Provide hope and encouragement. D) Discuss future plans for the client.

Ans: B Feedback: The nurse should advise the family to talk to the client honestly and clearly about death. It would not be right for the family to appear cheerful before the client because it may confuse him. If the family provides hope and encouragement or discusses future plans; the client would be misled into believing of recovering soon.

15. A client's family tells the nurse that their cultural and ethnic beliefs will not allow their father's body to be left alone at any time before burial. The mortuary is unable to pick up the body until morning because of a terrible storm that prohibits proper transportation. The policy of the hospital is that all bodies must be stored in the hospital morgue until pickup of the body is possible. Based on the influence of culture and ethnic beliefs of the family, what is the best way for the nurse to resolve this situation? A) Explain the policy of the hospital to the family members and arrange to have the body moved to the morgue. B) Contact the nursing supervisor to find out if there is some other way to resolve the issue. C) Contact the client's primary care provider to talk to the family about the situation. D) Locate an unoccupied room and move the deceased client to the room with someone to stay with the body.

Ans: B Feedback: When possible, a modification of agency policy that demonstrates respect for individual culture and ethnic beliefs is important to explore. The primary care provider is unable to modify the implementation of stated agency policies. Utilizing an empty room with an employee to sit with the deceased is not an appropriate option.

4. The nurse is caring for an aged client who is dying. The client has not accepted death and is acting out in interactions with the nurse. Which is the most likely statement by the client to the nurse at this time? A) "No, not me!" B) "I am at peace with the diagnosis." C) "Yes me, but why did this happen to me?" D) "If I could just live just two more weeks, I can see my daughter get married."

Ans: C Feedback: The most likely statement by the client would be, "Yes me, but why did this happen to me?" The client would not say "I am at peace with the diagnosis" because the client has not already accepted death. The client would not say, "No, not me!", because the client is not denying death. or "If I could just live just two more weeks, I can see my daughter get married" because the client is not bargaining for time and is not developing an awareness of death.

2. The nurse is caring for a young client who was in a motor vehicle accident. The client is dying and the family is inconsolable. The nurse understands that the client and the family are not rooted in any organized religion. What is the best kind of spiritual support that the nurse can provide to the client and the family? A) Suggest spiritual readings B) Encourage religious rituals C) Provide compassionate care D) Ask client's family to join a religious group

Ans: C Feedback: The nurse can provide the best kind of spiritual support to the client and the family by providing compassionate care. Asking the client's family to join a religious group, encouraging religious rituals, or discourses by a spiritual person are not appropriate interventions, because the client and the family are not rooted in any organized religion.

14. A nurse is caring for a dying client who belongs to an organized religious group. Why is spirituality important for individuals faced with death? A) Family and friends are unable to support an individual's organized religious beliefs. B) Spirituality helps individuals to find answers to their queries regarding the meaning of death. C) Religion can support spirituality and the existence of the soul. D) Organized religion can ensure what will occur before the afterlife.

Ans: C Feedback: People who are dying need the support of family and friends and, most of all, a spiritual foundation on which they can. Spirituality helps them to find answers to their queries regarding the meaning of life, the existence of the soul, and the possibility of an afterlife.

10. An older adult client is dying and tells the nurse of hoping to live to see his daughter receive her promotion to full professor. The nurse understands the client's frame of mind. Based on this information, what information should the nurse put on in sign-off report about which stage of dying is the client going through? A) Denial B) Anger C) Bargaining D) Depression

Ans: C Feedback: The client is going through the bargaining stage of dying, because the client is trying to make a deal in the hope of postponing death. The client is not undergoing depression, because the client is not concentrating on past losses. The client is not in the denial stage of dying, because the client is not ignoring reality. The client is not denying the diagnosis of terminal illness and, thus, is not going through a denial stage.

11. A female client is angry and unable to comprehend dying. How can the nurse caring for the client best ensure that the client reaches a stage of acceptance and peace? A) Convince the client that she is dying B) Ask the client to seek comfort in prayer C) Allow the client to take her own time D) Explain that all people eventually die

Ans: C Feedback: The nurse should allow the client to take her own time in moving through the dying process, rather than hastening her through it, because this will not help the client. The nurse should not try to convince the client that she is dying or explain to the client that all people eventually die, because the client is aware of these facts, but is not willing to accept them at the moment. It would not be appropriate for the nurse to ask the client to seek comfort in prayer, because she needs to accept the situation first.

6. A young male client is diagnosed with terminal cancer. The client is violent when the nurse approaches and is experiencing anger and rage as a result of the impending death. Based on the data collected, how does the nurse best explain the client's reaction? A) Client is angry with the nurse. B) Client is upset with the family. C) Client is rebelling against helplessness. D) Client is denying the diagnosis.

Ans: C Feedback: The nurse understands that the client is rebelling against helplessness. The client is going through anger and rage because of the difficulty of the situation. The client is not angry with the nurse, because the nurse is not responsible for the illness. The client is not upset with the family, because they also are helpless. The client is not denying the diagnosis, because the client has accepted that he is dying and that is why he is experiencing helplessness.

21. A client with terminal cardiovascular disease shouts at everyone who comes into the room. The visitors express to the nurse that they are hurt and upset. What is the best advice to the visitors by the nurse? A) Do not argue with the client. B) Answer the client's questions honestly. C) Listen to what the client is saying. D) Try to assist with the client's wishes despite the anger.

Ans: C Feedback: This client is in the anger stage of dealing with death. The best suggestion for helping the person cope is to listen to what the client is saying. No arguing and answering the client's questions honestly are good ways to help the person who is the denial stage of dealing with death. Trying to assist in client's wishes is an appropriate way to help the person in the bargaining stage of the diagnosis of death.

12. The Kübler-Ross stages of grief and loss typically occur in individuals who are close to the person who has died or is expected to die. These stages have also been identified and used for a multiplicity of life's situations. The stages are in random order. What is the correct sequence for these stages? 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance 6. Detachment A) 6, 1, 2, 3, 4, 5 B) 4, 3, 5, 2, 1, 6 C) 2, 1, 3, 4, 5, 6 D) 1, 2, 3, 4, 5, 6

Ans: D Feedback: The correct sequences of stages are denial, anger, bargaining, depression, acceptance, and detachment.

8. A terminally ill client realizes that death is near and dwells on past losses. Based on this information, which stage of dying should the nurse identify in the electronic medical record that this client going through? A) Denial B) Anger C) Bargaining D) Depression

Ans: D Feedback: A client concentrating on past losses is passing through the depression stage of dying. The client is not undergoing denial, because the client has no doubts regarding the diagnosis. The client is not lashing out at family members or the healthcare personnel, so the client is not going through anger. The client is not trying to daydream or escape reality by bargaining.

7. A female client with terminal illness tells the nurse that she is so sad and has no hope for recovery. The client sleeps a great deal as if trying to escape from reality. Which is the highest priority way for the nurse to help the client? A) Encouragement B) Reassurance C) Casual talk D) Gentle touch

Ans: D Feedback: A gentle touch of the hand indicating the presence of someone close is very helpful for clients experiencing preparatory depression. Encouragement or reassurance does not help, because the client has already resigned to the impending death. The client tries to evade reality by sleeping a great deal. In such a situation, the client is not willing to participate in casual talk. Thus, encouraging casual talk with the client is not an appropriate intervention, because it could cause her discomfort.

16. A nursing care plan includes the desired outcome of "quality of life" for a client with cancer who is likely to die within a few years. Which is the best example that would indicate that the outcome has been met for the client? A) The client believes that there is adequate financial resources to pay for own healthcare and healthcare for the surviving spouse. B) The client spends the majority of time in spiritual reflection. C) The client has no signs or symptoms of preventive complication of the cancer at this time. D) The client verbalizes satisfaction regarding relationships with family members.

Ans: D Feedback: Although financial stability is present, spiritual peace evident, and no current physical complications to be considered, the most important thing in meeting the desired outcome is that the client expresses satisfaction regarding relationships with family members. Quality of life is demonstrated when the client expresses satisfaction with a variety of aspects of life.

22. A client is dying and tells the nurse that she hopes to stay alive until her son returns from overseas in the military in one month. The client wants to see the son's captain insignia on his uniform. What is the best suggestion for helping the client to cope by the nurse? A) Answer questions honestly about the request. B) Allow the individual to talk to the primary care provider about the realities of the wish. C) Do not argue with the client about whether the wish is appropriate. D) Try to assist the client with making the wish a reality.

Ans: D Feedback: The client is in the bargaining stage of dying. Trying to assist in the client's wishes is the best way to help the person cope at this time. Answering questions honestly, allowing the individual to talk to the primary care provider, and not arguing are appropriate ways to deal with a client in the denial stage of dying.