Deck 9: Psychosocial Considerations

Question 1

The 10-year-old brother of a terminally ill teenager tells the patient that he can't wait for him to come home because then the parents will pay some attention to him. The nurse realizes that the brother is experiencing:

A) Excitement
B) Fatigue from having to visit his brother in the hospital
C) Isolation and feeling unimportant
D) Depression

Answer 1

Isolation and feeling unimportant

Question 2

A 6-year-old terminally ill patient tells the nurse that he is being punished for not wanting his new baby sister. The nurse realizes which of the following?

A) The parents will be busy with the new child which will help with the grieving process
B) The new baby will replace the child who is terminally ill
C) The new baby will most likely have the same illness as the terminally ill child
D) The child believes that the illness is a punishment for evil thoughts or deeds

Answer 2

The child believes that the illness is a punishment for evil thoughts or deeds

Question 3

A terminally ill 30-year-old male patient tells the nurse that he regrets that he will not be around to help his wife raise their two children. Which of the following is this patient demonstrating?

A) Loss of intimacy with his spouse
B) Inability to perform responsibilities as a parent
C) Loss of valued career
D) Being a financial burden to his family

Answer 3

Inability to perform responsibilities as a parent

Question 4

The family of a dying patient is talking with the patient while the nurse provides physical care. The nurse participates in the conversation and relates an event that occurred a few days prior that brought smiles and laughter from those present in the room. Which of the following is occurring with the nurse and family?

A) Being present and self-aware when providing end-of-life care
B) Distracting the family from the dire situation
C) Hiding grief
D) Denying the patient's terminal condition

Question 5

A terminally ill patient is being visited by his first wife and children. The second wife arrives with her children. The room is crowded and the patient is visibly conflicted with the situation. The wives do not acknowledge each other and the children are making faces across the room. Which of the following should the nurse do?

A) Ask that both families leave since the patient is unable to tolerate any visitors
B) Nothing, since this is between the family members
C) Suggest that the wives visit and then the children visit
D) Ask that both families meet in a conference room to discuss visitation so that the patient does not continue to be upset

Question 6

The primary nurse of a recently deceased hospice patient realizes that the widow will be celebrating her birthday in a week. Which of the following should the nurse do?

A) Send a "thinking about you" card to the widow
B) Say a prayer for the widow
C) Nothing, because the widow was not the nurse's patient
D) Light a candle for the deceased patient at a religious service

Question 7

The wife of a chronically ill patient has stopped going to the hairdresser and tells the nurse that all she does is care for her husband. Which of the following should the nurse do to support the wife?

A) Suggest that someone else, perhaps another family member, assist with the patient's care so that the wife can have time for her needs
B) Remind the wife that it is her responsibility to care for the patient
C) Offer to have the patient admitted to a skilled nursing facility so that she can just visit and not have to provide care at home
D) Remind the wife that this will not go on forever and that the patient will eventually die

Question 8

The wife of a terminally ill patient tells the nurse that, no matter what she does, the patient complains and it drags down her mood. Which of the following can the nurse do to help this situation?

A) Listen to the wife
B) Suggest the wife accept that the patient is not happy
C) Suggest the wife engage the patient by responding with "what will make you happy?"
D) Ask the wife if there is any hobby or activity she can do to lift her spirits

Question 9

The nurse is preparing the body of a deceased patient to be seen by the family in the hospital. Which of the following should the nurse do?

A) Keep all equipment used for care in the room and change the top sheet of the bed
B) Place the patient flat in bed, remove the pillow, remove the gown, and cover with a light sheet
C) Elevate the head of the bed with a pillow, close eyes, insert dentures, and ensure the bed linens and gown are clean
D) Keep all equipment used for care in place, turn on the overhead lights, and remove chairs from the room

Question 10

A patient tells the nurse that though her husband passed away two years ago, she has yet to return to living a normal life. Which of the following is this patient describing?

A) Denial
B) Reorganization
C) Disorganization
D) Complicated grief reaction

Question 11

The family of a terminally ill patient tells the nurse that they are tired of being on "death watch" and want to know if they can take turns away from the patient but still be on hand when the end is near. Which of the following responses can the nurse give to this family?

A) Suggest the family not leave since there is no way of knowing when the end will come
B) Explain the patient's current status, with a realistic expectation of when the end is near
C) Encourage the family to go about their normal activities without concern for the patient
D) Explain that the family must stay and breaks should be limited to 15 minute increments

Question 12

The significant other of a patient dying with AIDS has been asked by the family to leave the patient's room. Which of the following should the nurse do to assist in this situation?

A) Suggest that the significant other stay outside the room to avoid upsetting the family
B) Nothing, since it is the family's right to make the decision
C) Ask the patient what he wants and assist the family in understanding that the patient's needs must come first
D) Tell the significant other to phone the patient instead of visiting

Question 13

The immediate family members of a dying patient are sitting in the patient's room, taking turns talking about an important event that they had shared with him. The patient is observed smiling and thanking each family member in turn. The nurse realizes that which of the following is occurring?

A) The family is engaged in storytelling
B) The family is giving the patient hope to live
C) The family is showing the patient that they are not going to grieve when he is gone
D) The family is just trying to pass the time

Question 14

A terminally ill patient is asking questions about death and what it will be like. The nurse is not comfortable with the conversation but wants to support the patient. Which of the following should the nurse do?

A) Remind the patient that death is the great unknown and that no one can answer his questions
B) Tell the patient that no one knows what death is like
C) Ask the patient if it would be alright to invite a clergy member to discuss his questions with him
D) Suggest that the patient focus on living instead of dying

Question 15

A patient tells the nurse that since her husband died 6 months ago, she does not go out of the house much and spends most days in darkness and alone. The nurse realizes this patient is experiencing which phase of the mourning process?

A) Disorganization
B) Disbelief
C) Desperate longing
D) Reorganization

Question 16

The family of a terminally ill patient is asking questions that the nurse has minimal experience responding to. Which of the following should the nurse do?

A) Tell the family that their questions are not appropriate to be asking a nurse
B) Answer the questions anyway
C) Suggest the family talk with their clergy
D) Explain that she has limited knowledge and refer the family to another healthcare provider more experienced with these questions

Question 17

The primary nurse of a terminally ill patient who has died is in the room when the family arrives to view the patient. Which of the following should the nurse do?

A) Apologize for being in the room and leave
B) Quietly step away from the patient, stand off to the side, and offer to be present to offer support and grieve with the family
C) Ask if anyone needs anything and leave the room
D) Stay at the head of the bed of the patient and answer questions

Question 18

A nurse who experienced the death of her own husband is caring for a patient who is near death. She provides physical care to the patient and leaves the room. The wife is sitting at the bedside, holding the patient's hand. Which of the following is occurring with the nurse in this situation?

A) Not wanting to cause the patient unnecessary pain at this time
B) Providing the patient and wife with time alone
C) Having difficulty with the situation since it is similar to the one she experienced
D) Realizing that death is near and the wife is to be the one who shares it with the patient

Question 19

The wife of a patient who has just passed away tells the nurse that even though her husband has been ill for a long time, she just feels numb. The nurse realizes that the patient is experiencing which of the following stages of the mourning process?

A) Desperate longing
B) Disbelief
C) Disorganization
D) Reorganization

Question 20

The son of a terminally ill patient is asking his father where the deeds for the house and cars are located. The patient responds with "your sister knows." The son is visibly upset and continues to prod his father for the answer. Which of the following should the nurse do?

A) Ask to speak with the son outside the patient's room, and suggest that he talk with his sister regarding his request
B) Do nothing, since this is a conversation between family members
C) Call Security to have the son escorted from the patient's room
D) Call the physician to intervene