Deck 25: Loss, Grief, Dying, and Death in Later Life

Question 1

The health care provider feels that an older female adult has about six weeks to live. After two months, the family remains at the bedside but, in the last few days, they have become increasingly impatient and irritable. This pattern is least indicative of which of the following statements?

A) The family is experiencing anticipatory grief for the older adult.
B) The family desires that the patient be relieved of her misery.
C) Anticipatory grieving can fail to attenuate acute grief upon death.
D) Grievers deal more easily with known losses at known times.

Answer 1

The family desires that the patient be relieved of her misery.

Question 2

Which of the following characteristics is associated with acute grief?

A) Waves of grief or distressing emotion
B) Prolonged inability to sleep after a loss
C) Exacerbations of grief on specific dates
D) Change in attitude toward the future loss

Answer 2

Waves of grief or distressing emotion

Question 3

Advance care planning is the process of planning for a time when older adults may not have the mental capacity to make decisions about their health care. Mrs. Jaworski, 75 years of age, has designated her daughter as her substitute decision maker if she is unable to speak for herself. Mrs. Jaworski is admitted to hospice care after a lengthy illness. What is the nurse's role in assisting this patient with advance care planning?

A) Require Mrs. Jaworski to complete an advance directive.
B) Provide legal information to Mrs. Jaworski and then help complete the advance directive.
C) Complete the advance directive and have Mrs. Jaworski sign the document before she loses consciousness.
D) Serve as a resource person ready to answer questions Mrs. Jaworski may have about end-of-life decision making.

Answer 3

Serve as a resource person ready to answer questions Mrs. Jaworski may have about end-of-life decision making.

Question 4

An older patient who has end-stage pulmonary disease decides to accept care from the palliative care nurse. This older adult is most likely to benefit from the palliative care nurse in terms of which following patient need of Weisman's six needs for the dying?

A) Closure
B) Control
C) Composure
D) Cohesiveness

Question 5

Mrs. Cantor, 70 years of age, has been admitted to hospital with chest pain. She has recently lost her husband because of a sudden myocardial infarction, and she blames herself for not recognizing his warning signs. What is the nurse's priority intervention with Mrs. Cantor?

A) Encourage Mrs. Cantor to complete her activities of daily living.
B) Encourage Mrs. Cantor to express feelings of guilt, fear, anger, or sadness.
C) Assess causes of Mrs. Cantor's disenfranchised grieving processes.
D) Identify Mrs. Cantor's feelings connected to anticipatory grief.

Question 6

Jean Smithers, 80 years of age, is grieving the loss of her husband, Adam, who died last month at the age of 82. They had been life partners for 60 years. She cries all the time and complains of feeling distracted and restless. She says that deciding what to wear seems too complex a task and she is "at loose ends." What type of grief is Jean Smithers experiencing?

A) Anticipatory grief
B) Persistent grief
C) Acute grief
D) Disenfranchised grief

Question 7

Which of the following statements about loss in older adulthood is true?

A) A person experiences each stage of grief once and then grieving is resolved.
B) Anti-anxiety agents are frequently recommended for reducing the pain of grief.
C) The Loss Response Model is concerned with the effect of loss on an individual.
D) Referring to the deceased in the past tense can acknowledge the death's reality.

Question 8

The son of an older adult couple ends his life suddenly and violently. The husband proceeds with living as usual. After one year, the wife remains in seclusion and is hospitalized for dehydration. Which step should the nurse implement to help improve the wife's mental health and wellness?

A) Encourage additional fluids and social activity.
B) Instruct the husband to display empathy for her.
C) Establish a trusting, caring relationship with her.
D) Ask social services for a survivors' support group.

Question 9

The actions of the family of an older adult who just died are chaotic, and the family members are unable to decide on a funeral home. The nurse observes "functional disruption." Which recommendation should the nurse implement?

A) Help them make a list of the problems.
B) Provide a list of preferred funeral homes.
C) Allow them privacy to work it out alone.
D) Suggest they call someone who can help.

Question 10

When an older female adult who is close to death asks the family to leave after short visits and acts withdrawn in their presence, the family becomes distraught. What does the nurse include in family teaching to explain the patient's behaviour?

A) The patient is preoccupied with her own death.
B) The patient must have unresolved family issues.
C) The patient can be experiencing anticipatory grief.
D) The patient's body prepares for death in this manner.

Question 11

Nurses have had strong opinions both for and against assisted passive euthanasia. Considerable confusion exists regarding terminology and interpretation of what effects the nurse's role may have in end-of-life care or palliative care. Which one of the following might constitute an example of active euthanasia?

A) Relieving patient suffering and improving the person's quality of living until death
B) Discontinuing tube feeds, but continuing with intravenous fluids
C) The physician providing the patient with sleeping pills and instructions about a lethal dose
D) A patient voluntarily requesting to be helped to die and receiving a lethal injection of pain-relieving medication

Question 12

Which of the following statements about loss, dying, and death for older adults is true?

A) Those at special risk for significantly adverse effects of grief are younger to middle-aged spouses because these partners are at the beginning of their life journey.
B) Visions, hallucinations, and an inability to communicate in a logical, sustained manner are not normal grief reactions for someone who has lost a spouse and should be regarded as signs of underlying health issues.
C) Pathological grief begins with normal grief responses whose evolution toward adjustment and the re-establishment of equilibrium is blocked by some obstacle.
D) Bereaved persons regain their normal capability about six months after loss, and regressive behaviour after that time should be examined by a therapist.

Question 13

Mrs. Palmer, 75 years of age, was admitted to hospital one week ago with end-stage cancer of the breast. This morning, when the nurse assesses Mrs. Palmer, a significant decline in all of her systems is apparent. Mr. Palmer, who is sitting beside her bed, looks at the nurse and states, "I miss her so much, how will I go on without her?" How should the nurse respond?

A) "Mr. Palmer, you look very tired. Why don't you go home and get some rest?"
B) "Mr. Palmer, would you like me to bring you some breakfast?"
C) "Mr. Palmer, I would really like to hear about your life together."
D) "Mr. Palmer, would you like me to call someone to be here with you?"

Question 14

The primary difference between the Loss Response Model (LRM) and the Worden model of grief is which of the following?

A) In the Worden model, those grieving pass through stages in order.
B) The LRM uses a systems approach that acts to uphold stability.
C) In the Worden model, the system helps to maintain the equilibrium.
D) In the LRM model, those grieving transition through several stages.

Question 15

After an older adult dies, his brother, who has a history of alcohol abuse, upsets the family by going on a drinking binge instead of attending the funeral. What is the best description of the brother's behaviour?

A) The brother has a personality disorder.
B) The brother is displaying a disrespectful attitude.
C) The brother is experiencing disenfranchised grief.
D) The brother is experiencing chronic grief.