Deck 21: Communication Approaches in Palliative Care

Question 1

An 89-year-old patient who recently lost a life-partner of 69 years to cancer, shares with the nurse that "I had the strangest thing happen to me last night. I woke up and saw my partner sitting next to my bed." What is the nurse's best initial response?

A) "How long have you been hallucinating?"
B) "Hallucinations are often caused by disturbance in brain chemicals."
C) "Hallucinations can be a normal response to extreme stress."
D) "I recommend you speak to your doctor to discuss this hallucination."

Answer 1

"Hallucinations can be a normal response to extreme stress."

Question 2

Which individual is most likely experiencing a delayed grief reaction?

A) A 22-year-old army pilot on leave from the Iraq war who talks about the death of his crew member.
B) A 93-year-old women, whose husband of 73 years died 1 year ago, who reminisces about their life together.
C) A 54-year-old man who just completed a 28-day inpatient rehabilitation who is talking about the death of his wife 3 years ago.
D) A child whose parents were divorced 3 months ago and is acting out at school.

Answer 2

A 54-year-old man who just completed a 28-day inpatient rehabilitation who is talking about the death of his wife 3 years ago.

Question 3

A patient insistence on being transferred to a new facility at another hospital. The patient is demanding a second opinion stating, "They must have made a mistake." The nurse recognizes that the best communication technique to use with this patient is to do what?

A) Clarify the patient's response.
B) Reflect the patient's behavior.
C) Summarize the patient's behavior.
D) Acknowledge the patient's feelings.

Answer 3

Reflect the patient's behavior.

Question 4

The nurse is caring for an 8-year-old child in the school nurse's office because the child received a bloody nose in a scuffle with another child during recess. The nurse discovers that the child's parents have recently divorced. The nurse recognizes that the child's behavior is a demonstration of what?

A) Normal testing of social boundaries
B) Denial of the emotional trauma being experienced
C) An urgent need for grief counseling.
D) A common response children adopt when grieving.

Question 5

The nurse is caring for a patient who has been given 6 months to live after being diagnosed with stage 4 cancer of the lung. Evidence that the patient is in the bargaining stage of death and dying is demonstrated by which of the following statements?

A) "Not me"
B) "Why me?"
C) "Yes, me"
D) "Let me"

Question 6

Stoicism and denial of grief are examples of how a family coping with death is affected by factor?

A) Kübler-Ross stages of grief
B) Cultural influences
C) Existing developmental level
D) Prior life experience

Question 7

A terminally ill patient states, "I can't go on anymore, help me!" Which stage of dying is the patient experiencing?

A) Why Me?
B) No, not me
C) Let me
D) Yes, Me

Question 8

Which of the following is defined as a normal grief response associated with an ongoing living loss that is permanent, progressive, recurring, and cyclic in nature?

A) Somatization disorder
B) Chronic sorrow
C) Chronic grief
D) Absent grief

Question 9

Which is the best definition of end-of-life (EOL) decision making?

A) Decisions should be transparent, meaning that all parties involved in the decision should fully understand the implications of their decision.
B) Families and patients must consider existing legal issues as patients approach the end of life.
C) To provide the patient with full information about risks and benefits of prolonging life.
D) The process that health care providers, patients and patients' families go through when considering what treatments will or will not be used to treat a terminal illness.

Question 10

The nurse is caring for a patient who has just experienced the death of a parent. How can the nurse best demonstrate support for the patient during this period of grief?

A) Sitting quietly with the patient and not discussing the loss.
B) Gently reminding the patient that the parent lived a long life.
C) I'll have the institution's chaplain spot in to visit with you
D) Asking the patient how they can best be supported.

Question 11

Which of the following best describes anticipatory grief?

A) It occurs after the actual death.
B) It occurs when death was sudden and unexpected.
C) Only the family of the dying patient experiences it.
D) It can be colored by ambivalent feelings.

Question 12

A 21-year-old patient informs the nurse that, "I'm not sleeping since my life partner was killed in a car accident 1 month ago". Which statement would be of most concern to the nurse?

A) "I am moving on and plan to start dating again."
B) "It's my fault. I should have insisted we both stay home."
C) "I wish I had been more attentive and loving."
D) "I cannot sleep because I keep reliving the car accident."

Question 13

The nurse is caring for a patient who has just received biopsy reports that indicate recurrence of metastatic stage IV breast cancer. Which patient's statement best indicates the acceptance stage of death and dying?

A) "The test results are incredible."
B) "The test results are positive."
C) "The test results are negative."
D) "The test results will be repeated next week."

Question 14

Which of the following statements is true about grief?

A) Grief always occurs immediately after a loss.
B) Support for a grieving patient includes closed communication.
C) Recurring, wavelike feelings of sadness and loss are common feelings in a patient who is grieving.
D) It is normal for grief to be exaggerated.

Question 15

The nurse is caring for a terminally ill 15-year-old patient. The patient tells the nurse, "I know I am not going home again. I think it is harder for my parents than me. Will you talk to them for me?" Which is the best response by the nurse?

A) "It is true that you will be dying soon, but you must be honest with your parents."
B) "That's not true, but I will talk to your parents."
C) "You are having a bad day, so I will be back later to see if you need anything else."
D) "Yes but you need to talk to them also. I will help you with that."

Question 16

A patient's adult children call the nurse hourly with concerns about their mother's death and end-of-life care. What is the nurse's best response to the family's needs?

A) Provide detailed, scientific information for their questions
B) Discuss the physiology behind the patient's physical symptoms.
C) Withhold most information to avoid unnecessary fears.
D) Continue to provide frequent updates.

Question 17

Which is an inappropriate intervention for communicating with terminally ill patients?

A) Allowing the patient to lead discussions about the future
B) Offering automatic responses and trite reassurances
C) Respecting the individual's pattern of communication
D) Maintaining a sense of calm

Question 18

When evaluating care of dying patients, the nurse recognizes that interventions have been unsuccessful if the patient demonstrating what behavior?

A) States, I'm hopeful there will be a cure any day now."
B) The decision is made to die at home.
C) The patient expresses the need to discuss pain medication options.
D) The nurse and patient talk about the patient's family vacations at the beach