Deck 15: Loss, Grief, and End-of-Life Care

Question 1

A terminal patient in a skilled nursing home has stated that he does not want to get out of bed, because he is too tired and weak to sit in a chair. He sleeps on and off all day and night, his position is changed every 2 hours, and he is comfortable on his pain regimen. The next day the nurse will:

A) assess his strength and desire to get out of bed, but permit him to remain in bed if he chooses, because that is his position of comfort.
B) encourage him to sit in the chair for an hour, because it is important to change his activity or he will get weaker from inactivity.
C) leave him in bed if he wishes, but have him do active exercises of his legs and arms to prevent further muscle weakness.
D) get him out of bed for an hour in the morning and afternoon and for a short time (15 minutes) before bedtime so that he does not sleep all day and stay awake at night.

Answer 1

assess his strength and desire to get out of bed, but permit him to remain in bed if he chooses, because that is his position of comfort.

Question 2

The nurse can assess Cheyne-Stokes respiration by its characteristics of respirations that are:

A) harsh and rattling.
B) wheezing and labored.
C) shallow followed by periods of apnea.
D) long periods of apnea followed by a hiccoughing breath.

Answer 2

shallow followed by periods of apnea.

Question 3

A terminally ill patient is experiencing a great deal of dyspnea and noisy, "rattling," rapid respirations. The nurse administers morphine in a very small liquid or intramuscular dose. The purpose of this is to:

A) decrease pain caused by dyspnea.
B) hasten death by stopping respirations.
C) decrease respiratory rate and relieve dyspnea.
D) dry up secretions that are causing rattling.

Answer 3

decrease respiratory rate and relieve dyspnea.

Question 4

An oncologist has recommended that a hospice patient receives palliative radiation to reduce the pain of bony metastases. The patient reacts with anger, saying, "I don't want any more treatments that don't cure my cancer!" The hospice nurse tells the patient that the use of radiation:

A) may disqualify him from receiving hospice care.
B) may halt the metastatic process.
C) of this type is not curative and is part of hospice care.
D) will be used as a single treatment measure. Previous medications will be discontinued.

Question 5

A patient who is terminally ill has been unable to maintain good nutrition because of nausea and anorexia and has lost a great deal of weight. He is now unable to change his position in bed and needs frequent perineal care because of urinary incontinence. The nurse planning his care would include in the plan of care to:

A) coax him to eat high-calorie, high-fat food.
B) provide laxatives and stool softeners to prevent constipation.
C) contact the primary care provider for an order for tube feeding.
D) provide him with an air pressure mattress.

Question 6

A terminal patient asks the nurse if he could be given a deliberate overdose of medication that would "end this." According to the Code for Nurses, the nurse's most ethical response would be:

A) "Bringing on your death in this manner would be a subject you should discuss with your family and primary care provider."
B) "I can contact the primary care provider and request an order for a drug that could be used as you request."
C) "I cannot ethically give you a deliberate overdose."
D) "Let me have a while to consider your request."

Question 7

The loved ones of a young man, who is in the intensive care unit on life support after suffering irreversible brain damage resulting from a motorcycle accident, have been approached by the organ transplant team to consider organ donation. When they ask the nurse about this process, the nurse's best response would be:

A) "There is a small cost to the family for the donation, but it is for a good cause."
B) "Often families are comforted by the knowledge that some good came from this tragedy."
C) "Because your son has been on life support, the only organs they can use would be his kidneys."
D) "Organ donation will probably delay the funeral."

Question 8

The patient in hospice care says to the hospice nurse, "I want you to read my obituary that I just wrote." The nurse assesses that this patient is in the Satir Blevins (2008) stage of:

A) practice.
B) chaos.
C) integration.
D) acceptance.

Question 9

To help the family deal with the delirium of their dying relative, the nurse can suggest that they should:

A) stimulate the patient with music and visits from friends.
B) talk to the patient in quiet tones.
C) sit quietly in the room with the patient.
D) speak firmly to the patient to bring him back to reality.

Question 10

A patient who was admitted to hospice for comfort care of end-stage respiratory disease is asked what his hope is for his remaining life. He says, "I'm hoping for a miracle-that I will wake up one of these mornings and be able to breathe like when I was 20." The nurse would best respond:

A) "That's not likely to happen. Is there something more realistic you are hoping for?"
B) "Your lungs are too damaged for you ever to breathe like you did when you were 20."
C) "It must be very tiring to have to struggle for every breath you take."
D) "Your miracle may be in the form of medication that will improve your comfort."

Question 11

The nurse is aware that in order to provide effective support to grieving patients and families, the nurse must:

A) keep a professional distance from the situation.
B) understand all the theories of grief.
C) solidify his or her own view of death.
D) stay positive and optimistic at all times.

Question 12

After a patient death, the nurse is preparing to perform postmortem care. The body is placed supine with the head raised so that:

A) the deceased will appear to be sleeping.
B) blood will not pool in the face and cause discoloration.
C) movement of the deceased will be more convenient.
D) feces and urine will drain onto the bed pads.

Question 13

A neighbor who was widowed 2 months ago gives the nurse his wife Helen's gardening books "because the two of you loved flowers." He tries to hold back tears, but begins to cry. To decrease his discomfort, the nurse should say:

A) "We certainly did, and I'm going to miss her help-she was a real expert."
B) "Helen wouldn't want to see you crying-she would rather you smile and remember the good times," and give him a hug.
C) "Things will get easier with time. Time has a way of healing even the most painful losses."
D) "Helen is in a better place; you should be glad she isn't suffering anymore."

Question 14

A 33-year-old patient has been told that her disease is terminal. The patient is crying and states, "I will just be a dependent drain on my family. I hate being a burden to them." The nurse can best respond:

A) "Is there any reason to tell your family about this now? You still have some time in which you can enjoy life."
B) "You have heard some very bad news today. Can you describe what you mean by burden?"
C) "I doubt that your loving family will view your terminal care as a burden."
D) "I know. I would feel terrible if I had been told I was dying."

Question 15

A terminally ill patient and his family have requested hospice care. The nurse clarifies hospice care philosophy as:

A) helping the patient dies easily and quickly at home.
B) focusing on symptom management and comfort care.
C) excluding hospital care.
D) supporting assisted suicide if that is the patient's wish.

Question 16

A patient admitted to the nursing home for terminal care is determined that he should not receive extraordinary measures such as resuscitation or the use of a ventilator if he stops breathing, or intravenous (IV) fluids or a feeding tube if he is unable to eat or drink. The nurse explains that these desires can best be honored by:

A) signing a do-not-resuscitate/do-not-intubate (DNR/DNI) request.
B) including these desires in his will.
C) filing an advance directive with the health care facility.
D) informing his primary care provider of his desires.

Question 17

A patient tells the nurse during an admission interview that his wife "went on to her reward." The nurse assesses that this statement is an indication that the patient:

A) has a strong religious belief system.
B) has dysfunctional grieving and is unable to address his wife's death.
C) is uncomfortable with the term "death" and is using a euphemism.
D) is no longer grieving the death of his wife.

Question 18

When a patient admitted for terminal care is asked by the admitting nurse, "What has your doctor told you about your illness?" the patient states, "She says that I have a terminal illness, but I know she's wrong." The nurse recognizes that:

A) the patient has a doctor who does not tell patients when they have a terminal illness.
B) the patient is in denial and is unable to consciously admit what he has been told by the doctor.
C) the patient needs to be told that he doesn't have long to live so that he can make his final arrangements.
D) she will have to avoid all conversation that refers to his disease or symptoms so as not to increase his anxiety.

Question 19

A terminally ill patient is angry and belligerent. He yells at the nurses and his family for not coming quickly enough when he calls, and he states that he isn't receiving the care he needs. The nurse's most informative response would be:

A) "Don't let him get away with this abuse. He doesn't need to yell at you."
B) "This may be how he feels best in dealing with this illness. You'll just have to ignore it."
C) "I'm afraid he is having a bad day and feels neglected."
D) "Anger is a reaction that dying people experience. You may be feeling some anger yourselves."

Question 20

A hospice patient is unable to tolerate food or fluids and has advance directives that indicate that he does not want IV fluids or tube feedings if he is unable to take oral feedings. His family is concerned that he will be very uncomfortable without food or fluids. The nurse should tell them that:

A) once the patient is unconscious, his health care proxy can order IV fluids or tube feedings to prevent dehydration.
B) dehydration is painful, and medication can be given to overcome any pain.
C) IV fluids or a tube feeding would make the patient much more comfortable, and they should try to talk him into accepting them.
D) IV fluids or tube feeding would likely make the patient more uncomfortable, and dehydration has been shown to decrease pain and discomfort.

Question 21

The nurse discusses the grief theory of Maciejewski, which outlines the stages of grief as including: (Select all that apply.)

A) yearning.
B) bargaining.
C) anger.
D) denial.
E) depression.

Question 22

When the nurse notes an increase in the level of daily function in the terminal patient, the nurse assesses that this patient has reached Kübler Ross's level of:

A) yearning.
B) bargaining.
C) depression.
D) acceptance.

Question 23

Individuals move through the stages of grief at their own pace. When a person is "stuck" in a stage and cannot move forward, this is called ___________.

Question 24

The five stages identified by Dr. Elisabeth Kübler Ross are __________, _________, ___________, ____________, and _____________.

Question 25

A coroner is required to investigate death in which of the following situations? (Select all that apply.)

A) Deaths from injury
B) All deaths that occur at home
C) Suspected suicides
D) Any death in the hospital
E) Deaths of persons not under the care of a primary care provider

Question 26

When a patient chooses to die by refusing treatment that would prolong life, it is called ___________.

Question 27

Place the steps of postmortem care in their proper sequence. (Separate letters by a comma and space as follows: A, B, C, D, E.)

A) Remove all tubing and equipment from the room.
B) Cleanse the body of all body fluids.
C) Position the body with the head of the bed raised 15 degrees.
D) Dress the deceased in a hospital gown and cover the deceased up to the chest.
E) Replace dentures.

Question 28

During the dying process, patients may experience a bad taste in their mouth. Which of the following are appropriate nursing actions? (Select all that apply.)

A) Offer the patient hard candy.
B) Assist the patient with frequent oral care.
C) Offer the patient large amounts of water or juice.
D) Explain to the patient that this is a normal part of dying and nothing can be done.
E) Offer the patient mouthwash.
F) Offer the patient frequent meals.

Question 29

The culturally sensitive nurse would delay a discussion relative to a patient's terminal illness if that patient were a:

A) 28-year-old Caucasian auto mechanic.
B) 35-year-old Mexican American farm laborer.
C) 40-year-old Chinese businessman.
D) 50-year-old American Indian policeman.

Question 30

The nurse who adopts the Maciejewski theory of grief assesses for the reduction of grief after a period of ________ months.

Question 31

The nurse caring for a terminally ill patient with renal failure would question an order for pain control that prescribed:

A) methadone.
B) oxycodone.
C) meperidine.
D) morphine.

Question 32

When the patient says, "I can die happily if I can live long enough to see my first grandchild that will be born next month." The nurse assesses that this patient is experiencing Kübler Ross's stage of:

A) denial.
B) bargaining.
C) anger.
D) depression.

Question 33

When the parents of a child who is on life support ask what indicates brain death, the nurse responds that brain death occurs when:

A) there have not been signals on the EKG.
B) no deep tendon reflexes can be stimulated.
C) there is an absence of EEG waves.
D) there have been no voluntary respirations for 5 minutes.