Chapter 15: Loss, Grief, the Dying Patient, and Palliative Care My Nursing Test Banks

Chapter 15: Loss, Grief, the Dying Patient, and Palliative Care

Test Bank

MULTIPLE CHOICE

1. 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.

ANS: B

A persons reaction to a loss is influenced by the importance of what that person perceives the loss entails. To help the patient validate what the loss means is therapeutic.

DIF: Cognitive Level: Application REF: p. 191 OBJ: Clinical Practice #2

TOP: Value and Loss KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

2. 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 wifes death.

c.

is uncomfortable with the term death and is using a euphemism.

d.

is no longer grieving the death of his wife.

ANS: C

In many societies there is avoidance of using words such as died or death, and euphemisms are commonly used.

DIF: Cognitive Level: Analysis REF: p. 190 OBJ: Theory #1

TOP: Societal Views of Death KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

3. A neighbor who was widowed 2 months ago gives the nurse his wife Helens 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 Im going to miss her helpshe was a real expert.

b.

Helen wouldnt want to see you cryingshe 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 isnt suffering anymore.

ANS: A

Sharing the feeling of loss is appropriate and supportive and recognizes the loss of the grieving husband.

DIF: Cognitive Level: Application REF: p. 191 OBJ: Clinical Practice #2

TOP: Therapeutic Communication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

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

a.

helping the patient die 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 patients wish.

ANS: B

The philosophy of hospice care focuses on comfort care and the acceptance of death as part of life. Hospice is opposed to assisted suicide and provides relief of symptoms that are associated with terminal illness. Hospice care can be provided in a hospital, home, or extended care facility.

DIF: Cognitive Level: Comprehension REF: p. 198 OBJ: Theory #2

TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

5. 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 isnt receiving the care he needs. The nurses most informative response would be:

a.

Dont let him get away with this abuse. He doesnt need to yell at you.

b.

This may be how he feels best in dealing with this illness. Youll just have to ignore it.

c.

Im 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.

ANS: D

Anger is one of the stages terminally ill patients and their caregivers may experience. It may be prolonged, or it may be a passing stage or one that is returned to in the course of the final illness. Reacting with anger or just passively ignoring it does not assist the patient in dealing with his feelings.

DIF: Cognitive Level: Analysis REF: p. 195, Table 15-1

OBJ: Theory #1 TOP: Anger Phase KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

6. 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, Im hoping for a miraclethat I will wake up one of these mornings and be able to breathe like when I was 20. The nurse would best respond:

a.

Thats 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.

ANS: D

Instilling hope that the struggle for respiratory relief will be available is a comfort measure.

DIF: Cognitive Level: Application REF: p. 194 OBJ: Clinical Practice #1

TOP: Hope KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: basic care and comfort

7. An oncologist has recommended that a hospice patient receive palliative radiation to reduce the pain of bony metastases. The patient reacts with anger, saying, I dont want any more treatments that dont 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.

ANS: C

Palliative radiation is performed to relieve symptoms but does not direct its therapy toward cure, and thus is comfort care or hospice-appropriate treatment. Other medications for comfort will still be used in the hospice care.

DIF: Cognitive Level: Analysis REF: p. 197 OBJ: Theory #2

TOP: Palliative Radiation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

8. 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 (DNR) request.

b.

including these desires in his will.

c.

filing an advance directive with the health care facility.

d.

informing his physician of his desires.

ANS: C

An advance directive sets out the patients desires relative to end-of-life issues. A DNR only prevents the initiation of cardiopulmonary resuscitation (CPR). The naming of a durable power of attorney for health care or a health care proxy appoints a person to carry out the advance directive.

DIF: Cognitive Level: Application REF: p. 200 OBJ: Clinical Practice #4

TOP: Advance Directive KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

9. 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.

ANS: C

Nurses must understand and solidify their own view of death before they can offer effective support to dying patients and their significant others. Constant optimism and positive attitudes are not always appropriate.

DIF: Cognitive Level: Comprehension REF: p. 190 OBJ: Clinical Practice #1

TOP: Attitude Toward Death KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

10. 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.

ANS: A

According to the Satir-Blevins theory of loss (2008), this patient is in the phase of practice. The patient is practicing with the writing of the obituary the fact that life is coming to an end.

DIF: Cognitive Level: Analysis REF: p. 190 OBJ: Theory #1

TOP: Satir/Blevins theory of Change & Loss

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

11. 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.

ANS: C

Cheyne-Stokes respirations become more and more shallow followed by periods of apnea, and then respirations resume.

DIF: Cognitive Level: Comprehension REF: p. 191 OBJ: Theory #5

TOP: The Dying Process KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: basic care and comfort

12. 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 shes 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 doesnt 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.

ANS: B

The patients statement indicates Kbler-Rosss stage of denial in which patients will not accept information and buffer themselves from information that may be painful.

DIF: Cognitive Level: Analysis REF: p. 195, Table 15-1

OBJ: Theory #1 TOP: Denial Phase

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

13. 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 nurses most ethical response would be:

a.

Bringing on your death in this manner would be a subject you should discuss with your family and physician.

b.

I can contact the physician 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.

ANS: C

The position of the American Nurses Association (ANA) expressly states that active euthanasia and assisted suicide are considered a violation of the ANAs Code for Nurses.

DIF: Cognitive Level: Application REF: p. 200 OBJ: Theory #7

TOP: Assisted Suicide KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

14. 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 physician for an order for tube feeding.

d.

provide him with an air pressure mattress.

ANS: D

Provision of an air pressure mattress will help preserve the patients skin integrity that the weight loss, inactivity, poor nutritional intake, and incontinence have caused.

DIF: Cognitive Level: Application REF: p. 198 OBJ: Clinical Practice #3

TOP: Skin Integrity KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: reduction of risk

15. 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.

ANS: A

Comfort care recognizes that the patient is the best judge of his energy; if he does not wish to get out of bed, then frequent turning and positioning and use of appropriate pressure- and pain-relief measures are a better choice.

DIF: Cognitive Level: Application REF: p. 198 OBJ: Clinical Practice #3

TOP: Comfort KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: basic care and comfort

16. 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.

ANS: D

Dehydration in the terminally ill patient has been shown in research to decrease pain and to be a more comfortable condition than when tube feeding is introduced into the intestine or when IV fluids are used to reverse dehydration.

DIF: Cognitive Level: Application REF: p. 198 OBJ: Clinical Practice #5

TOP: Comfort KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: basic care and comfort

17. 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.

ANS: B

Talking with the patient is comforting to the patient. Even when unresponsive, patients can hear. Stimulation is not helpful and may confuse the patient further.

DIF: Cognitive Level: Application REF: p. 198 OBJ: Theory #5

TOP: Delirium KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

18. 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.

ANS: B

After death, the head of the deceased is raised to prevent discoloration by the pooling of blood in the face.

DIF: Cognitive Level: Comprehension REF: p. 202 OBJ: Clinical Practice #6

TOP: Postmortem Care KEY: Nursing Process Step: Implementation

MSC: NCLEX: N/A

19. The family members 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 nurses 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.

ANS: B

There are many more persons needing organs than there are donors. Nurses are in a position to educate the public about organ donation.

DIF: Cognitive Level: Application REF: p. 201 OBJ: Clinical Practice #2

TOP: Organ Donation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

20. 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.

ANS: C

Morphine is used to ease terminal dyspnea by reducing the rate and increasing the depth of respirations.

DIF: Cognitive Level: Comprehension REF: p. 198 OBJ: Clinical Practice #3

TOP: Use of Morphine KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

21. 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 Kbler-Rosss stage of:

a.

denial.

b.

bargaining.

c.

anger.

d.

depression.

ANS: B

Kbler-Rosss stages of coping with death include the bargaining stage in which the person seeks the reward of extended life.

DIF: Cognitive Level: Comprehension REF: p. 195, Table 15-1

OBJ: Theory #1 TOP: Stages of Coping with Death

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

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 Kbler-Rosss level of:

a.

yearning.

b.

bargaining.

c.

depression.

d.

acceptance.

ANS: D

Kbler-Rosss stages of coping with death include the acceptance stage in which the struggle is over, the pain is gone, and the patient has found peace. The patient frequently demonstrates a heightened level of activity in his or her daily function during this stage.

DIF: Cognitive Level: Comprehension REF: p. 191 OBJ: Theory #1

TOP: Acceptance Stage KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

23. 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.

ANS: C

Brain death is the absence of brain waves on an EEG; this has been the definition of death since the 1970s.

DIF: Cognitive Level: Knowledge REF: p. 191 OBJ: Theory #1

TOP: Brain Death KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

24. The culturally sensitive nurse would delay a discussion relative to a patients 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.

ANS: B

Persons with Hispanic and Korean backgrounds are less likely to want to know about their terminal disease, feeling that the family should make the decisions about life-sustaining treatments.

DIF: Cognitive Level: Comprehension REF: p. 192 OBJ: Theory #3

TOP: Cultural Considerations KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

25. 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.

ANS: C

Patients in renal failure cannot adequately clear meperidine (Demerol) from their system and will become oversedated.

DIF: Cognitive Level: Application REF: p. 197, Table 1-2

OBJ: Theory #4 TOP: Meperidine KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: pharmacological therapies

COMPLETION

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

ANS:

passive euthanasia

Passive euthanasia is when the patient is choosing to refuse treatment for himself or herself, which will result in death.

DIF: Cognitive Level: Comprehension REF: p. 200 OBJ: Theory #6

TOP: End-of-Life Issues KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

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

ANS:

denial; anger; bargaining; depression; acceptance

Each dying patient and family member may experience any of these stages during the dying process. Understanding the stages assists in early identification and appropriate interventions to help the patient and family cope.

DIF: Cognitive Level: Knowledge REF: p. 195, Table 15-1

OBJ: Theory #1 TOP: The Dying Process KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

28. 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 _______________.

ANS:

dysfunctional grieving

Dysfunctional grieving is visible grief over a prolonged period of time. Some theorists say grief after 6 months is dysfunctional; others say up to 2 years.

DIF: Cognitive Level: Analysis REF: p. 191 OBJ: Theory #1

TOP: Grieving KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

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

ANS:

6

six

According to the theory of Maciejewski the indicators of grief should peak and begin to diminish after a period of 6 months.

DIF: Cognitive Level: Application REF: p. 191 OBJ: Theory #1

TOP: Maciejewski Theory KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

MULTIPLE RESPONSE

30. 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.

ANS: A, B, E

Hard candy, mouthwash, and oral care help stimulate saliva production and relieve the dryness and any bad taste in the patients mouth related to the dryness.

DIF: Cognitive Level: Application REF: p. 198 OBJ: Clinical Practice #3

TOP: Nursing Process and the Dying Patient

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

31. 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 physician

ANS: A, C, E

The coroner investigates death when there may be a question of cause.

DIF: Cognitive Level: Analysis REF: p. 201 OBJ: Clinical Practice #6

TOP: Postmortem Issues KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

32. 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.

ANS: A, C, D, E

The grief theory of Maciejewski states that the loss is accepted, but followed by denial, yearning, anger, depression, and acceptance.

DIF: Cognitive Level: Comprehension REF: p. 191 OBJ: Theory #1

TOP: Maciejewski Theory KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

OTHER

33. Place the steps of postmortem care in their proper sequence. (Separate letters with 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.

ANS:

C, E, B, A, D

Postmortem care should be performed with dignity and reference for the deceased. The body should be positioned with the head raised, dentures should be replaced, the body should be cleansed of all body fluids and soiled dressings, all tubing and equipment should be removed from the room, and the deceased should be dressed in a gown and covered up to the chest.

DIF: Cognitive Level: Analysis REF: p. 202, Skill 15-1

OBJ: Clinical Practice #6 TOP: Postmortem Care

KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

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