Deck 10: Loss, Grief, and Dying

Question 1

A patient's daughter approaches a nurse to explain that upon his death, female nurses should not touch him. The family also asks that the body remain completely covered with his feet turned toward Mecca. The nurse identifies that the family is

A) Buddhist.
B) Jewish.
C) Muslim.
D) Orthodox.

Answer 1

Muslim.

Question 2

A nurse understands that perhaps the most important care that can be provided for the terminally ill patient is

A) Caring and touching.
B) Encouraging reminiscing.
C) Giving pain medication.
D) Encouraging visits from a member of the clergy.

Answer 2

Caring and touching.

Question 3

A patient with a terminal illness does not have a do-not-resuscitate (DNR) order, and upon entering the room, a nurse finds that the patient is not breathing. The first action that the nurse will take is to

A) Ask another nurse to write the order for a DNR.
B) Call the physician to get an order for a DNR.
C) Begin cardiopulmonary resuscitation (CPR) because an order for a DNR is not written.
D) Notify the selected funeral home that the patient has expired.

Answer 3

Begin cardiopulmonary resuscitation (CPR) because an order for a DNR is not written.

Question 4

A nurse has just witnessed a terminally ill patient telling the physician that he does not wish to have his life prolonged as stated in his living will. The nurse expects that the physician will

A) Explain to the patient why he should be more hopeful.
B) Write a do-not-resuscitate (DNR) order.
C) Speak to the patient's family before writing a DNR order.
D) Ignore the patient's request.

Question 5

A nurse understands that the physical change associated with the dying process that typically creates the most anxiety for the family is

A) Restlessness and difficulty in sleeping.
B) Pallor and circumoral cyanosis.
C) Accumulation of secretions in the trachea.
D) Conjunctival dryness that causes tearing of the eyes.

Question 6

A nurse explains to a family that research supports that the last sense to leave a dying patient is

A) Sight.
B) Hearing.
C) Taste.
D) Vision.

Question 7

The family of a terminally ill patient asks the nurse what they should expect when she dies. The nurse tells the family:

A) "Her heart will stop, and she will stop breathing a few minutes later."
B) "Respirations and heart rate first become very irregular and then stop altogether."
C) "Everybody is different, so it is difficult to say."
D) "Her breathing will stop, and her heart will cease beating within a few minutes."

Question 8

A wife is extremely upset about her husband's respirations. A nurse explains that this type of breathing is a symptom of end-stage disease. The breathing is called Cheyne-Stokes and is characterized by

A) Slow, shallow respirations.
B) Slow, deep respirations.
C) A cycle of shallow and deep respirations.
D) Cyanosis of the hands and feet.

Question 9

The husband of a dying woman expresses that he believes remorse for the dead leads to more suffering of the soul and will increase the soul's difficulty in leaving the earthly plane. He prefers to think only happy thoughts to facilitate her journey. A nurse identifies that the couple must be

A) Jewish.
B) Hindu.
C) Hispanic American.
D) Amish.

Question 10

A terminally ill patient asks a nurse to promise him that all of his symptoms and discomfort will be effectively managed until his death. The nurse promises the patient with confidence that

A) Pain can be relieved.
B) Nausea can be managed.
C) Respiratory distress can be eliminated.
D) All of the above.

Question 11

When questioned by a patient about the difference between palliative care and the services provided by hospice, a nurse explains that palliative treatment

A) Is aggressive, but administered to cure the disease.
B) Is geared toward the patient, family, and their wishes.
C) May be aggressive and is directed at eliminating discomfort.
D) Indicates the patient has fewer than 6 months to live.

Question 12

A terminally ill patient is refusing to take adequate pain medication. The patient expresses worry that the use of pain medication may result in addiction. A nurse should

A) Express admiration for the patient's strength.
B) Explain to the patient that morphine does not cause addiction.
C) Place the medication in an intravenous (IV) drip.
D) Teach the patient that addiction is not a concern during the terminal stages of illness.

Question 13

A patient suffering from dyspnea tells a nurse that she does not wish to take any additional drugs to help relieve her condition. The nurse suggests a nonpharmacological intervention such as

A) Putting a fan near the bed to circulate the air
B) Giving the patient small sips of warm water
C) Providing additional movement and range-of-motion exercises
D) Music therapy

Question 14

While caring for a patient who has just been diagnosed with a terminal illness, a nurse expects to see the patient exhibit the traditional first stage of grief, which is called

A) Bargaining.
B) Anger.
C) Denial.
D) Depression.

Question 15

The wife of a patient who is nearing the end of his life tells a nurse that she is worried because her husband is not getting enough fluids. The nurse responds by saying:

A) "He will drink when he gets thirsty. Don't worry about him."
B) "It is natural to become dehydrated before death. It will actually make him more comfortable."
C) "I will let his physician know about it. He may want to start an IV to keep him hydrated."
D) "Your husband has signed a living will indicating he doesn't want to be given food and water."

Question 16

A patient dying of colon cancer tells a nurse that he is sure that he can beat the cancer if he changes his eating habits. The nurse understands that the patient is likely in the stage defined by Kübler-Ross as

A) Acceptance.
B) Anger.
C) Denial.
D) Bargaining.

Question 17

A patient has a written document containing medical decisions should the patient be unable to make them as the illness progresses. The nurse understands that the patient has a

A) Durable power of attorney (DPR).
B) Do-not-resuscitate (DNR) order.
C) Living will.
D) Terminal illness.

Question 18

Immediately after a patient's death, a nurse performs postmortem care. Correct care would include

A) Insisting that the family bathe the patient so they can begin the grieving process.
B) Documenting the time when the patient stopped breathing and the heart ceased.
C) Notifying the physician so that the patient will be legally pronounced dead.
D) Bathing the body and removing all tubes, unless an autopsy might be ordered.

Question 19

A nurse understands that when a terminal patient states, "No, I don't need anything. What would you get me anyway?" he or she is most likely in the stage of grief called

A) Denial.
B) Acceptance.
C) Anger.
D) Bargaining.

Question 20

A nurse realizes that a terminally ill patient is ready to talk about dying when he or she states:

A) "I'm feeling a little stronger each day."
B) "Do you think you could just sit with me for a while?"
C) "I've decided to begin taking chemotherapy again."
D) "What do you think death feels like?"

Question 21

A nurse explains to a terminally ill patient's family members that they should expect their loved one to experience five stages of grief. Place the five stages in the typical order in which grief is experienced (1-5). (Enter the number of each step in the proper sequence, do not use commas).
1. Anger
2. Acceptance
3. Denial
4. Depression
5. Bargaining

Question 22

When asked by the family of an 86-year-old terminally ill patient about treatment options, a nurse states, "Treatment options are more difficult with the elderly, as the choices are dependent on the patient's dependence on others, the terminal illness itself, and ____________________."

Question 23

A nurse explains to family members that they can anticipate that death is very near for their loved one when they see which of the following?

A) Mottling of feet and legs
B) Edema of lower extremity
C) Slow and thready pulse
D) Agitation and withdrawal
E) Nonresponsiveness

Question 24

A hospice nurse notices that the family of a terminally ill patient has not left the patient's room for several days. The nurse knows that providing ____________________ for a period even as brief as 3 to 4 hours can provide some temporary relief for the family members.

Question 25

A terminally ill patient has barely eaten anything for several days. A nurse should

A) Place the patient on intravenous (IV) nutrition.
B) Ask the doctor to insert a feeding tube.
C) Insist that the patient eat something at least three times a day.
D) Encourage the patient to eat whatever foods he or she thinks sound and look appealing.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 26

When asked by family members of a terminally ill patient what benefit their loved one would experience as a result of dehydration, a nurse explains that which of the following is true?

A) Mucous secretions increase and provide comfort to the mouth and throat.
B) Dehydration will contribute to less edema and discomfort from ascites.
C) Gastric fluid excretions increase so as to lessen nausea.
D) Urinary output decreases, which results in less discomfort from toileting.
E) Dehydration increases endorphin production and decreases perception of pain.

Question 27

An elderly female patient is becoming progressively more confused. She begins talking to long-gone loved ones about places and events that do not make any sense to her family. A nurse should

A) Verify the patient's level of consciousness.
B) Attempt to reorient the patient.
C) Protect the patient from injury by bed rails or equipment.
D) Hydrate the patient.

Question 28

A terminally ill patient's respirations have become cyclic in nature, beginning with periods of shallow, slow breaths before becoming progressively deeper. A nurse expects that the respirations will become progressively shallower again, ending the cycle with 15- to 50-second periods of ____________________.

Question 29

A bedridden patient in hospice care is suffering from nausea, vomiting, confusion, constipation, lethargy, decreased deep tendon reflexes, polyuria, and extreme thirst. A nurse identifies these symptoms as

A) Dyspnea.
B) Hypercalcemia.
C) Cyanosis.
D) Cheyne-Stokes respirations.

Question 30

As a terminally ill patient gets closer to death, a nurse notices that the patient has become flush and very pale around the mouth. The nurse recognizes this condition as circumoral ____________________.