Chapter 18: Loss and End-of-Life Issues My Nursing Test Banks

Chapter 18: Loss and End-of-Life Issues

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. The nurse documents that a newly widowed older adult patient is likely experiencing physical grief responses when she:

a.

becomes hypotensive.

b.

has difficulty getting up from the chair.

c.

reports having tightness in the chest.

d.

develops a red rash over her upper chest and back.

ANS: C

Physical symptoms are commonly associated with acute grief responses. Tearfulness, crying, loss of appetite, feelings of hollowness in the stomach, decreased energy, fatigue, lethargy, and sleep difficulties are common symptoms of grief. Other physical sensations may include tension, weight loss or gain, sighing, feeling something stuck in ones throat, tightness in ones chest or throat, heart palpitations, restlessness, shortness of breath, and dry mouth.

DIF: Remembering (Knowledge) REF: Page 326 OBJ: 18-3

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

2. The nurse is confident that an older adult is successfully completing the tasks associated with mourning his wifes death when he:

a.

shares that, No amount of wishing will bring her back.

b.

openly cries in the presence of family and friends.

c.

takes cooking classes at the local community college.

d.

takes a female acquaintance to the movies.

ANS: D

The last task in the process of mourning is the withdrawal of emotional energy and the reinvestment in another relationship; this entails withdrawing emotional attachment to the lost person and continuing on with life.

DIF: Remembering (Knowledge) REF: Page 328 OBJ: 18-5

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

3. Although the family of a newly widowed older adult patient lives several hours away, they are interested in providing appropriate support. The nurse suggests it would be most helpful if they would:

a.

telephone daily and arrange for a neighbor to help with the shopping.

b.

assume responsibility for paying the bills and upkeep of the home.

c.

encourage the patient to move into a smaller home and learn to drive.

d.

include the patient in their yearly vacation plans

ANS: A

Loneliness and problems associated with the tasks of daily living are two of the most common and difficult adjustments for older bereaved spouses. Calling daily will help alleviate the loneliness. Taking over responsibilities may take away the only thing the patient has left. Learning to drive may be important, but the family should not encourage the patient to make a major life decision like moving now. Taking the patient on vacation is a nice idea, but this occurs yearly versus calling daily.

DIF: Applying (Application) REF: N/A OBJ: 18-3

TOP: Teaching-Learning MSC: Psychosocial Integrity

4. A man who recently lost his wife of 50 years shares with the nurse that hell never get over missing her. The nurse is most therapeutic when responding:

a.

We are here to help you anyway we can.

b.

Focus on the beautiful memories you have of her and your life together.

c.

Time will help you adjust to your loss.

d.

Youll never get over your loss but you can learn to live with it.

ANS: D

The third step in the process of mourning is the adjustment to an environment in which the deceased is missing. Older spouses have reported that they feel as though they will never get over their loss; instead, they have learned to live with it. It is nice to let the patient know you are here for him or her, but this does not give any useful information to help the patient. Telling the patient to focus on memories is dismissive. The nurse should not use clichs like time will help.

DIF: Applying (Application) REF: N/A OBJ: 18-5

TOP: Caring MSC: Psychosocial Integrity

5. The nurse documents that a patient is likely experiencing exaggerated grief when observing which behavior?

a.

Keeps telling family and friends that her spouse cant be dead.

b.

Re-reads her late spouses diaries nightly since the death 2 years ago.

c.

Develops severe abdominal pains on each anniversary of her spouses death.

d.

Becomes agitated whenever someone refers to the spouses death or moving on.

ANS: B

Exaggerated grief reactions occur when normal feelings of anxiety, depression, or hopelessness grow to unmanageable proportions. People with exaggerated grief may feel an overwhelming sense of being unable to live without the deceased person. They may lose the sense that the acute grief is transient and may continue in this intense despair for a long time. Re-reading diaries each night is the most specific example of this type of grief.

DIF: Applying (Application) REF: N/A OBJ: 18-4

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

6. The nurse is caring for an older adult who recently lost an adult child as a result of automobile accident. They shared a home and enjoyed a healthy parent-child relationship. The nurse is confident that the patient has progressed appropriately through the mourning process when the patient is observed doing which action?

a.

Tells family members that her child is in a better place.

b.

Arranges for personal grief counseling.

c.

Cries softly during the familys first year memorial service.

d.

Plans a summer vacation with friends from work.

ANS: D

Mourning is often used to refer to the ritualistic behaviors in which people engage during bereavement. More recently, mourning is the term used for processes related to learning how to live with ones loss and grief. The last task of mourning is emotionally relocating the deceased person and moving on with life. Going on a vacation with friends is a good example of this. The other actions do not show this resolution.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 18-5

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

7. The nurse evaluates how an older adult patient will react to the death of a spouse based on how the patient:

a.

expresses concern for his spouse during a prolonged illness.

b.

reacts when their beloved dog was sent to live with an adult child.

c.

demonstrates his or her philosophy of health and happiness.

d.

expresses how his spouses illness has impacted their life together.

ANS: B

Ones responses to loss and death are characterized by ones natural reaction to all kinds of losses, not just death. Peoples responses depend on their perception of the events and the meaning of the loss within the context of their lives and their physical, psychosocial, and spiritual life patterns. This behavior will likely be similar for all major losses, including the relocation of a pet. The other options do not demonstrate a grief reaction.

DIF: Applying (Application) REF: N/A OBJ: 18-4

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

8. A novice hospice nurse shows the best understanding of the nursing role related to an older adult patients mourning over the loss of an adult child when stating:

a.

I see mourning as a very individualized process.

b.

The patients coping skills need to be assessed regularly.

c.

The patient needs all the help I can give to get better.

d.

Hopefully the patient will be in a healthy mental state soon.

ANS: A

The goal of nursing care for older persons who are grieving and mourning is not to make them feel better quickly, although nurses are often tempted to try to do so. Nurses should assist and support bereaved persons through the grieving process, recognizing that pain is a normal and healthy response to loss and allowing bereaved persons to accomplish the tasks of mourning in their own ways.

DIF: Application (Applying) REF: N/A OBJ: 18-3

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

9. An older adult man has been the primary caregiver for his chronically ill wife for the past 10 years. When his wife dies, the nurse prepares the family for the likely possibility that their father will express:

a.

guilt that he is alive while she is dead.

b.

deep despair for his loss.

c.

personal relief that she has died.

d.

concern that he could have cared for her better.

ANS: C

For some older persons, the grief experience may include feelings of relief and emancipation, especially after prolonged suffering or a difficult relationship. Because this may occur, the nurse should let the family know of its possibility. The other options are possible too; however, the relief response is a more universal experience.

DIF: Understanding (Comprehension) REF: Page 326 OBJ: 18-3

TOP: Teaching-Learning MSC: Psychosocial Integrity

10. A hospice nurse shows the best understanding of the personal commitment to the dying patient by:

a.

providing the patient with sufficient, effective pain management therapies.

b.

addressing the patients need to feel valued by those attending to his or her death.

c.

being available emotionally and physically throughout the dying process.

d.

empathizing with the patient and his or her family and friends during the process.

ANS: C

Once a nurse becomes committed to working with a patient and family throughout the dying process, it is important to follow through on this commitment as much as possible. The other options are narrower in scope.

DIF: Applying (Application) REF: N/A OBJ: 18-9

TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

11. The nurse shows an understanding of the primary factor that facilitates the adjustment to the loss of a spouse when asking:

a.

Are you planning to continue to run your flower shop?

b.

How long were you and your spouse married?

c.

Does your son and his family live nearby?

d.

Do you consider yourself a religious person?

ANS: A

For those who have strong social support and established patterns of independent interaction outside the lost relationship, the adjustment process toward creating new social roles and interactions may occur more quickly.

DIF: Applying (Application) REF: N/A OBJ: 18-5

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

12. The nurse determines that the daughter of a widowed older adult patient has a poor understanding of the grieving process when she reports that:

a.

Mom is going to be okay; she is a strong, independent woman.

b.

Its been 16 months since Dad died, but Mom still hasnt moved on with her life.

c.

My mother has agreed to come and live with me for at least a little while.

d.

My mom cries when she looks at pictures of Dad, but I think she needs to cry.

ANS: B

It used to be believed that after the first anniversary of the death, grief should be resolved. This has been shown to be inaccurate; many factors influence the time for adjustment. Older persons who have experienced multiple losses may need more time. For some, the losses may never be resolved; a person may simply learn to live with the feelings of grief. In any case, the time needed for grieving is individualized.

DIF: Applying (Application) REF: N/A OBJ: 18-3

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

13. When a 66-year-old patient dies as a result of surgical complications, the nurse begins to facilitate the familys acceptance of their loss by:

a.

preparing each family member sufficiently prior to viewing the body of their loved one.

b.

presenting the body of their loved one in an appropriate, respectful manner.

c.

assuring them that the patient received the best possible care postsurgery.

d.

providing them with an effective explanation of the problems that caused the patients death.

ANS: D

Having information about the death and the events preceding and following the death is important in helping to actualize the loss. The nurse should prepare the family members on what to expect when viewing the body and prepare the body in a respectful way as this shows respect and caring. Assurances that the patient received the best care possible may sound hollow.

DIF: Applying (Application) REF: N/A OBJ: 18-9

TOP: Communication and Documentation MSC: Psychosocial Integrity

14. A hospice nurse is caring for a patient and notes the patients spouse engaged in anticipatory grieving. What action by the spouse best demonstrates this reaction?

a.

Spending time learning about the business owned by the patient

b.

Receiving many visitors from church and social organizations

c.

Delegating household tasks so the spouse can stay with the patient

d.

Taking long walks outside then napping for extended periods

ANS: A

Anticipatory grieving includes the processes of mourning, coping, and planning that are initiated when the impending loss of a loved one becomes apparent. It serves to reduce shock, confusion, and depression. The spouse learning about a business he or she will likely have to take over shows future planning. The other actions do not.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 18-4

TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity

15. The nurse knows a family whose adult child killed several people before taking his own life. The funerals of all involved were held on the same 2 days. The nurse notes the family seems embarrassed, uncomfortable with expressions of sorrow, and wants a very quiet funeral. What type of grief does the nurse suspect the family has?

a.

Anticipatory

b.

Disenfranchised

c.

Masked

d.

Complicated

ANS: B

Disenfranchised grief occurs when the loss cannot be openly acknowledged and causes complications because there is lack of social support for the survivors. In this situation where the adult child died under such terrible circumstances, the family may feel they have no right to grieve when their child caused so many others grief. Anticipatory grief occurs when a death is impending. Masked grief is a self-protective mechanism for those who cannot bear the process of mourning. Complicated grief includes masked grief.

DIF: Remembering (Knowledge) REF: Page 327 OBJ: 18-4

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

16. A patient has been grieving the loss of a spouse and seems to be doing surprisingly well when a beloved pet dies. The patient demonstrates extreme signs of sadness and despair, saying, I cannot possibly go on without Kitty. When working with the family, what does the nurse suggest?

a.

Get the patient another cat.

b.

Suggest the patient see the physician.

c.

Refer the patient to a grief therapist.

d.

Suggest they take the patient on a trip.

ANS: C

This patient is demonstrating a delayed or postponed grief reaction. Doing surprisingly well may indicate a lack of grief response at the original loss, then an exaggerated reaction to a smaller, subsequent loss. The most appropriate action is to refer the patient and family to a grief counselor who can help the patient work through both losses. Getting another cat dismisses the importance of the first one. A physician visit may be needed, but a grief counselor is more appropriate. Taking the patient on a trip will not help resolve the situation.

DIF: Applying (Application) REF: N/A OBJ: 18-4

TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

17. The nurse in the emergency department cared for a patient who had a fatal heart attack. The nurse goes to meet the family in the private waiting room. The nurse is acting most appropriately when responding:

a.

What do you know about what happened today?

b.

Im so sorry but your loved one has died.

c.

We did all we could, but unfortunately it was not enough.

d.

Is there someone I can call for you?

ANS: A

Asking the family to recount what they know of the events helps them actualize the death, the first step in accepting the event. This allows the family to tell their story, at which point the nurse picks up with what happened in the emergency department. This also gives the family some time to prepare for the news of the death. Immediately stating the patient has died offers no preparation and will come as a great shock. Stating that what was done was not enough may imply that more could have been done. Asking to call for support may be confusing, as the family does not yet know the patient has died.

DIF: Applying (Application) REF: N/A OBJ: 18-9

TOP: Caring MSC: Psychosocial Integrity

18. A nurse is assisting a patient with a life review. What action by the nurse is best?

a.

Ask the patient what his or her job was.

b.

Ask about memories the patient is proud of.

c.

Ask the patient about special holiday foods.

d.

Ask the patient to name children and grandchildren.

ANS: B

During the life review, if patients can see that their lives were meaningful and worth living, then a sense of ego integrity emerges. The nurse can best assist this by asking the patient to relate memories that evoke pride in accomplishments. The other topics can be used to guide a life review but are too narrow in focus to be the best answer.

DIF: Applying (Application) REF: N/A OBJ: 18-9

TOP: Caring MSC: Psychosocial Integrity

19. An older patient is near the end of life and the family is concerned that the patient has a pressure ulcer because, in their view, this denotes poor care. What explanation by the nurse is best?

a.

Youre right; we will try harder to care for her.

b.

Im so sorry this is upsetting for you to see.

c.

We are doing the best we can to care for your loved one.

d.

Age-related changes can make it impossible to prevent ulcers.

ANS: D

Age-related changes plus changes associated with the end of life can make preventing pressure ulcers nearly impossible, even with the best care. The nurse gently explains this to the family. The other statements do not give the family factual information.

DIF: Understanding (Comprehension) REF: Page 334 OBJ: 18-9

TOP: Teaching-Learning MSC: Physiologic Integrity

20. The family members of a dying patient are distressed at the patients restlessness and lack of sleep. They ask the nurse to just give her something. What response by the nurse is best?

a.

Administer a sedative or hypnotic.

b.

Tell the family shell soon be sleeping enough.

c.

Try nonpharmacologic comfort measures.

d.

Explain that medications are not used in this case.

ANS: C

Nonpharmacologic comfort measures should be implemented first because of the erratic pharmacokinetics seen at the end of life. Drug responses and side effects vary widely and are difficult to control. If nonpharmacologic measures do not work, medications can be tried but must be monitored continuously.

DIF: Applying (Application) REF: N/A OBJ: 18-9

TOP: Nursing process: Implementation MSC: Physiologic Integrity

21. A dying older patient has dyspnea, which causes anxiety. What action by the nurse is best?

a.

Provide oxygen for a saturation less than 90%.

b.

Provide a cool fan to blow on the patient.

c.

Administer prescribed morphine sulfate.

d.

Administer a prescribed bronchodilator.

ANS: C

Morphine sulfate is often used for dyspnea and has the added benefit of slight sedation, which will help this patients anxiety. Providing oxygen based on saturations does nothing for the patients distress; the patient may feel short of breath, even with an oxygen saturation of 100%. A cool fan may help. There is no indication that the patient needs a bronchodilator. IF the patient has wheezing, this would be appropriate.

DIF: Applying (Application) REF: N/A OBJ: 18-9

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

22. A dying patient is being cared for at home. The family relates to the hospice nurse that they are distressed that the patient no longer wants favorite food items. What response by the nurse is best?

a.

Dying people dont usually want to eat.

b.

Your loved one wont starve to death.

c.

Why do you insist of trying to feed her?

d.

Is there another way you can show caring?

ANS: D

Dying patients often have anorexia, and research shows that eating and drinking can actually increase distressing symptoms. However, the provision of food is universally seen as an act of caring and people place great emphasis on eating. The nurse can best help the family by helping them identify other ways to show caring. The other options do not give any useful information and could be seen as a cold response.

DIF: Applying (Application) REF: N/A OBJ: 18-9

TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

MULTIPLE RESPONSE

1. A nurse working with a dying patient would expect to add interventions to the care plan to address which needs? (Select all that apply.)

a.

Pain

b.

Dyspnea

c.

Delirium

d.

Dementia

e.

Restlessness

ANS: A, B, C, E

Pain, dyspnea, delirium, and restlessness are common symptoms experienced by patients at the end of life. Dementia may be an issue for some, but it is not considered a commonly experienced symptom.

DIF: Remembering (Knowledge) REF: Page 335 OBJ: 18-9

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

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