death and dying
A dying patient wants to talk to the nurse. The patient states, "I know I'm dying, aren't I?" What would an appropriate nursing response be? "This must be very difficult for you." "Tell me more about what's on your mind." "I'm so sorry. I know how you must feel." "You know you're dying?"
"This must be very difficult for you."
When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response? "This must be very difficult for you." "I'm sure you are angry and sad." "Yes, this is a terrible diagnosis you've received." "Have you talked with your spiritual leader about your fears?"
"This must be very difficult for you."
A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education? "Palliative care provides relief from pain and other distressing symptoms." "Hospice care programs focus on quality rather than length of life." "In hospice care, the nurses make most of the care decisions for the clients." "Palliative care affirms life and regards dying as a normal process."
"In hospice care, the nurses make most of the care decisions for the clients."
The nurse is caring for a client with terminal illness who is refusing food and fluids. The family is concerned and suggests that a feeding tube. Which is the best response by the nurse? "Stop feeding the patient by mouth! You will make him choke!" "When clients are in this stage, food and fluid are unnecessary." "Do you feel that if you force your loved one to eat, he will get better?" "I will get some liquids and pureed foods for you to feed your loved one."
"When clients are in this stage, food and fluid are unnecessary."
special orders
-allow natural death, do-not-resuscitate, or no-code orders -terminal weaning -voluntary cessation of eating and drinking -active and passive euthanasia -palliative sedation
true or false the goal of palliative care is to give patients with life-threatening illnesses the best quality of life they can have by the aggressive treatment of symptoms
A.True the goal of palliative care is to give patients with life-threatening illnesses the best quality of life they can have by the aggressive treatment of symptoms
Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning? Administer sedation and analgesia. Provide an explanation of the process. Offer emotional support to the family. Have the client's family remain at the bedside.
Administer sedation and analgesia.
Immediately on cessation of vital functions, the body begins to change. The nurse would expect which physical change to occur following death? Dusky appearance Increased body temperature Flushed appearance Absence of incontinence
Dusky appearance
true or false more important than the actual stages of any given grief reaction is the idea that grief is a process that is the same from person to person
B.false more important than the actual stages of any given grief reaction is the idea that grief is a process that varies from person to person
true or false a living will appoints an agent, trusted by the person who is ill, to make decisions in the event of subsequent incapacity
B.false rationale: a durable power of attorney appoints an agent, trusted by the person who is ill, to make decisions, in the even of subsequent incapacity
a person who exaggerates the good qualities of his recently deceased father is experiencing what stage of Engel's grief? A.shock and disbelief B.restitution C.idealization D.outcome
C. Idealization idealization is the exaggeration of the good qualities the person of object had, followed by acceptance of the loss. Shock and disbelief are defined as refusal to accept the loss, followed by a stunned response. restitution involves the rituals surrounding the loss. outcome involves dealing with the loss as a common life occurrence
what is known as actions and expressions of grief, including the symbols and ceremonies that make up outward expression of grief A. grief B .bereavement C. mourning
C. mourning
A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using? Medical directive by proxy Living will declaration Durable power of attorney for health care End-of-life treatment directive
Durable power of attorney for health care
an elderly person who is placed in a nursing home by his family is remorseful about the loss of his financial independence. What is the term for the type of loss he is experiencing A.physical loss B.psychological loss C. actual loss D. percieved loss
D. perceived loss perceived loss is felt by the person, but intangible to others, as is the case with loss of financial independence. Physical loss and actual loss can be recognized by others as well as the person sustaining the loss. Psychological loss may be caused by an altered self-image
The family members of a dying patient are finding it difficult to verbalize feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations? Encourage the family members to express their feelings and listen to them in their frank communication. Encourage conversations on the impending death of the patient. Be a silent observer and allow the patient to communicate with the family members. Encourage the patient's family members to spend time with the patient.
Encourage the family members to express their feelings and listen to them in their frank communication.
A nurse is conducting a spiritual assessment of a terminally ill client using the four step FICA process and asks the question, "What gives your life meaning?" The nurse is assessing which of the following? Importance and influence Community Address in care Faith and belief
Faith and belief
A client has been declared to have a terminal illness. What intervention will a nurse perform regarding the final decision of a dying client? Respect the client's and family members' choices Share emotional pain Abide by the dying client's wishes Ask the family members about spiritual care
Respect the client's and family members' choices
The nurse is receiving a change of shift report on a client who has a terminal illness and has exhibited a slow and progressive decline in the health status over the past several days. Which data supports the client's impending death? Select all that apply. Gurgling sounds emanating from the client's throat with each breath Distended abdomen with last bowel movement documented 7 days ago A regular apical pulse of 90 beats/minute Systolic blood pressure which rose from 100 to 110 mm Hg Cyanotic nail beds in hands and feet bilaterally
Gurgling sounds emanating from the client's throat with each breath Distended abdomen with last bowel movement documented 7 days ago Cyanotic nail beds in hands and feet bilaterally
A 36-year-old mother of three was recently diagnosed with a chronic illness. The nurse prepared information for the patient on how to manage her illness. To help her cope with the shock and resentment that she was experiencing, the nurse gave her facts about her illness with honesty and empathy. Which of the following are the best comments that the nurse can include when talking to the patient about chronic illness? Select all that apply. It is characterized by a progressive decline in normal physiologic function It can be associated with exacerbations and remissions. It is defined as long-term with the possibility of a cure if intervention is rapid and timely. It can require short-term management (<3 months). It results in residual disability due to non-reversible pathology.
It is characterized by a progressive decline in normal physiologic function It can be associated with exacerbations and remissions. It results in residual disability due to non-reversible pathology.
A nurse is caring for a client with end-stage testicular cancer who has been referred to hospice care. Which criterion indicates that the client requires more teaching about hospice care? The client doesn't want to discuss death around his girlfriend. The client entered a clinical trial through the National Cancer Institute. The physician orders weekly blood transfusions to be given at home. The client explains that he isn't ready to complete his will.
The client entered a clinical trial through the National Cancer Institute.
The nurse is caring for a client who just learned of his terminal diagnosis. After the physician leaves, the nurse remains to answer further questions so that the client can make an informed decision about further treatment. By providing all available information, the nurse is promoting which ethical principle? The principle of justice The principle of nonmaleficence The principle of fidelity The principle of autonomy
The principle of autonomy
can be recognized by others
actual loss
A hospice nurse has developed a care plan for a client with liver cancer. The care plan focuses on providing palliative care for this client. The goal of palliative care is best described as providing clients with life-threatening illnesses a dignified quality of life through which means? aggressive management of symptoms treatment of the disease process eliminating all forms of medical and nursing care providing counseling related to the stages of death and dying
aggressive management of symptoms
A client diagnosed with terminal cancer is making plans to take a trip to visit an estranged sibling. What stage of death and dying, according to Kübler-Ross, is best illustrated in this description? bargaining anger depression acceptance
bargaining
what is known a state of grieving from loss of a loved one A.mourning B.bereavement C.grief
bereavement
The spouse of a terminally ill client is confused by the new terminology being used during discussions regarding the client's treatment. The nurse should explain that palliative care is: care that will reduce the client's physical discomfort and manage clinical symptoms. care that is provided at the very end of an illness to ease the dying process. an alternative therapy that uses massage and progressive relaxation for pain relief. offered to terminally ill clients who wish to remain in their homes in lieu of hospice care.
care that will reduce the client's physical discomfort and manage clinical symptoms.
what is known as an internal emotional reaction to loss A.bereavement B.mourning C.grief
grief
spiritual needs of dying patients
patient needs meaning and purpose ,love and relatedness, forgiveness and hope
needs of intimacy of dying patients
patient needs ways to be physically intimate that meets needs of both partners
is felt by person but intangible to others
perceived loss
physiologic needs of dying patients
physicals needs such as hygiene pain control nutritional needs
what would you do for a family in the case of a sudden death?
provide a private place for family to begin grieving
The children of a male client with late-stage Alzheimer disease have informed the nurse on the unit that their father possesses a living will. The nurse should recognize that this document is most likely to: specify the treatment measures that the client wants and does not want. dictate how the client wants his estate handled after his death, and by whom. make legal provisions for active euthanasia. give permission for organ donation.
specify the treatment measures that the client wants and does not want.
true or false it is appropriate for the nurse to attend the funeral and make a follow-up visit to the family
true
what are engels six stages of grief
-shock and disbelief -developing awareness -restitution -resolving the loss -idealization -outcome
needs for patient that will be an organ donor
-these patients will need to be one a ventilator until the transplant team comes to retrieve the body -the donor body needs to be oxygenated to preserve function of the transplantable organ -this process is facilitated through a transplant team and the gift of life organization and UNOS the united network for organ sharing (it is a private company under contact by the federal government)
During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving? "My parent is suffering with cancer and death will be a relief of the pain." "There is no way I can stay in the hospital because my parent is sick." "I do not think my parent really has cancer. I think my parent needs to get a third opinion." "It is fine if my parent dies. We have not been close for years."
"My parent is suffering with cancer and death will be a relief of the pain."
"My father has been dead for over a year and my mother still can't talk about him without crying. Is that normal?" What is the best response by the nurse? "The inability to talk about your dad without crying, even after a year, is still considered normal." "It is not normal. Your mother needs to see a therapist about her grief." "In fact, the more that someone cries about a loss, the better they're dealing with it." "Did your mother cry a lot before your father died?"
"The inability to talk about your dad without crying, even after a year, is still considered normal."
providing postmortem care
-care of the body -care of the family -discharging legal responsibilities -death certificate issued and signed -labeling body -reviewing organ donation arrangements, if any -care of other patients
what are the four components of a good death
-control of symptoms -preparation for death -opportunity to have a sense of completion of one's life -good relationship with health care professionals
A graduate nurse enters a client's room and finds the client unresponsive, not breathing, and without a carotid pulse. The graduate nurse is aware that the client has mentioned that he does not wish to be resuscitated, but there is no DNR order on the client's chart. What is the nurse's best action? Call a code and begin resuscitating the client. Initiate a slow-code until the physician arrives. Consult with the charge nurse or nurse manager before calling the code. Respect the client's wishes and avoid calling a code.
Call a code and begin resuscitating the client.
A terminally ill patient is admitted to the hospital. The patient grabs the nurse's hand and asks, "Am I dying?" What response would be best for the nurse to give? "Why do you think that?" "Did someone tell you that you are dying?" "Tell me more about what's on your mind." "I am not at liberty to disclose that information."
"Tell me more about what's on your mind."
what are kubler ross's five stages of grief
-denial and isolation -anger -bargaining -depression -acceptance
factors affecting grief and dying
-developmental consideration -family -socioeconomic factors -cultural ,gender, and religious influences -cause of death
clinical signs of impending death
-difficulty talking or swallowing -nausea, flatus, abdominal distention -urinary and/or bowel incontinence or constipation -loss of movement, sensation, and reflexes -decreasing body temperature, with cold or clammy skin -weak ,slow, or irregular pulse -decreasing blood pressure -noisy, irregular, or cheyne-stokes respirations -restlessness or agitation -cooling, mottling, and cyanosis of the extremities and dependent areas
Developing a Trusting Nurse-Patient Relationship
-explain the patient's condition and treatment -teach self-care and promoting self-esteem -teach family members to assist in care -meet the needs of the dying patient -meet family need
A client at a health care facility has died after a prolonged illness. A nurse is assigned to perform postmortem care for the client. Which intervention should the nurse perform when providing postmortem care? Avoid replacing dentures in the mouth. Place a rolled towel under the head. Cleanse drainage from the skin. Apply hairpins and clips.
Cleanse drainage from the skin.
advanced directives
-indicate who will make decisions for the patients in case the patient is unable -indicate the kind of medical treatment the patient wants or doesn't want -indicate how comfortable the patient wants to be -indicate how the patients want to be treated by others -indicate what the patients wants loved ones to know
post mortem care of the family
-listen to family's expressions of grief loss, and helplessness -offer solace and support by being an attentive listener -arrange for family members to view the body
psychological needs of a dying patient
-patient needs control over fear of the unknown, pain separation, leaving loved ones, loss of dignity. loss of control, unfinished business, isolation
postmortem care of the body
-prepare the body for discharge -place the body in anatomic position, replace dressings, and remove tubes (unless there is an autopsy scheduled) -place identification tags on the body -follow local law if patient died of communicable disease
