C. CH 42 Palliative, end of life

Question 1

The nurse is caring for a patient who is dying. She overhears the patient saying, God, if you will only let me live to see my daughter get married, I promise I will start going to church again. The nurse understands that the patient is in which stage of grief according to Kubler-Ross?
A) Denial
B) Bargaining
C) Depression
D) Anger
E) Acceptance

Answer 1

B) Bargaining

Question 2

2. The nurse is preparing a presentation on preparing children for death. What information should the nurse include? Select all that apply.
   A) Encourage forgetting of the deceased
   B) Encourage expression of feelings
   C) Provide for stability and safety
   D) Praise stoicism
   E) Talk openly about death and the feelings associated with it

Answer 2

B) Encourage expression of feelings
C) Provide for stability and safety
E) Talk openly about death and the feelings associated with it

Question 3

My father has been dead for over a year and my mother still cant talk about him without crying. Is that normal? What is the best response by the nurse?

a) The inability to talk about your dad without crying, even after a year, is still considered normal.
b) It is not normal. Your mother needs to see a therapist about her grief.
c) Everyone deals with loss differently. You just need to be patient with your mother.
d) Did your mother cry a lot before your father died?

Answer 3

a) The inability to talk about your dad without crying, even after a year, is still considered normal

Question 3

3. A nurse is caring for a patient whose husband died over four years ago. The nurse suspects that the patient has abnormal grief. Which of the assessment findings would support this?
   A) Talking about her husband as if he were still alive
   B) Keeping photos of her husband on her bedside table
   C) Talking and laughing about the time when he forgot their anniversary
   D) Crying on the anniversary of his death

Answer 3

A) Talking about her husband as if he were still alive

Question 4

5. When reviewing a patients chart, the nurse notes that the patient is in the disorganization stage of grief. Which assessment finding would support this diagnosis?
   A) It doesnt matter what I look like.
   B) I havent let my children out of my sight. I am afraid something will happen to them.
   C) I had a good time at my class reunion. It was nice to be out with other people again.
   D) Im sick all of the time. I just cant get rid of this cold

Answer 4

D) Im sick all of the time. I just cant get rid of this cold

Question 5

6. The hospice nurse is visiting the wife of a patient who died 10 months ago. The wife states, My life is meaningless since my husband died. The nurse recognizes that the patient is in which stage of grief?
A) Shock
B) Protest
C) Disorganization
D) Reorganization

Answer 5

C) Disorganization

Question 6

7. The wife of a recently deceased patient states that she cant think of anything other than her husband. She wakes up at night and goes to look for him before realizing that he is dead. The nurse understands that the wife is in which stage of grief?
A) Shock
B) Protest
C) Disorganization 
D) Reorganization

Answer 6

B) Protest

Question 7

8) The nurse is preparing the body of a patient who was killed in a car accident for the family to view. Which of the following steps would be contraindicated ?
a. Removal of all IVs and other medical tubing.
b. Clean, position, and cover the patient with a sheet, exposing only the head and a hand.
c. Inform the family that they can have as much time alone with the patient as they wish.
d. Respect all religious and cultural practices of the family.

Answer 7

a. Removal of all IVs and other medical tubing.

Question 8

9. A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education?
   A) Palliative care provides pain relief and other distressing symptoms.
   B) Hospice care programs focus on quality rather than length of life.
   C) In hospice care, the nurses make most of the care decisions for the patients.
   D) Hospice focuses on treatments and care aimed only at relieving symptoms in the last few months of life
   E) Palliative care affirms life and regards dying as a normal process.

Answer 8

C) In hospice care, the nurses make most of the care decisions for the patients.

Question 9

10. The nurse is preparing a care plan for a patient with the nursing diagnosis of Dysfunctional Grieving. Which of the following nursing interventions should the nurse include? Select all that apply.
    A) Provide the patient with information regarding a grief support group.
    B) Encourage the patient to have regular check-ups with their healthcare provider.
    C) Avoid talking about the loss if it upsets the patient.
    D) Refer the patient to a grief specialist.
    E) Encourage the patient to talk about only the positives of the deceased person.

Answer 9

A) Provide the patient with information regarding a grief support group.
B) Encourage the patient to have regular check-ups with their healthcare provider.
D) Refer the patient to a grief specialist.

Question 10

11. The hospice nurse is assessing the wife of a patient who died 14 months ago. The nurse is concerned that the wife is still grieving the death of her husband. Which of the following objective assessment findings would suggest that the wife is NOT still grieving?
    a. Stating, I think about him all of the time.
    b. Weight loss of 40 pounds in the last 14 months
    c. Stating, I cant go on living like this.
    d. Hair is clean and styled.

Answer 10

d. Hair is clean and styled.

Question 11

12) A nursing instructor has finished presenting information to a group of nursing students on the factors that influence the grieving process. Which statement by a student would indicate a need for further education?
A) The age of the person who died can dramatically affect the grieving process.
B) A death that occurs as a result of homicide or suicide is just as stressful as a death from natural causes.
C) Some people find strength in dealing with loss through their religious beliefs, whereas others experience greater distress due to their beliefs.
D) Absence of social supports can create additional stressors for the grieving person.

Answer 11

B) A death that occurs as a result of homicide or suicide is just as stressful as a death from natural causes.

Question 12

13. The hospice nurse is caring for a patient with lung cancer. The patients daughter states, My mom isnt happy with anything I do for her. She is constantly yelling at me. The nurse understands that the patient is in which stage of grief according to Kbler-Ross?
A) Depression
B) Anger
C) Acceptance
D) Bargaining
E) Denial

Answer 12

B) Anger

Question 13

14. An appropriate nursing diagnosis for the family of a patient dying of cancer whose members have expressed sorrow over the forthcoming loss would be
    A) Anticipatory grieving related to the loss of family member as evidenced by sorrow
    B) Dysfunctional grieving related to the loss of family member as manifested by behaviors indicating anxiety
    C) Potential for grieving related to the loss of family member and sorrow
    D) Dysfunctional grieving related to the future loss of family member manifested by the familys developmental regression

Answer 13

A) Anticipatory grieving related to the loss of family member as evidenced by sorrow

Question 14

15) A widow develops cancer within 6 months of her husbands death. This may be a result of
a. Social isolation
b. Alcohol intake
c. Bereavement
d. Multiple losses

Answer 14

c. Bereavement

Question 15

16. Which of the following manifestations of grief by the patient who lost his wife 3 years earlier is considered abnormal?
    a) Showing a photograph of the decedent
    b) Talking about his wifes absent-mindedness
    c) Telling the nurse how his life has changed
    d) Leaving the wifes room and belongings intact

Answer 15

d) Leaving the wifes room and belongings intact

Question 16

To adequately assist a patient and family from a different culture with the death and dying process, the nurse must

a) Understand the patients cultural beliefs
b) Progress through the stages of grief
c) Experience death in his own life
d) Have felt distress and anger

Answer 16

a) Understand the patients cultural beliefs

Question 17

18. Which of the following statements about grief should the nurse include in the teaching plan developed to address a group of young adults?
    A) Individuals from lower socioeconomic classes tend to have a better outcome about loss.
    B) Nutrition and wellness have little effect on the outcome of grief.
    C) A familys developmental state does not affect the grief process.
    D) Multiple losses may strain the individuals ability to cope effectively.

Answer 17

D) Multiple losses may strain the individuals ability to cope effectively.

Question 18

19. Which of the following statements regarding perceptions of death by children is accurate?
    A) Toddlers perceive death as irreversible and unnatural.
    B) Preschool-age children view death as a spiritual release.
    c) At age 9, the child perceives death as irreversible.
    d) Adolescents tend to respond better than adults with death.

Answer 18

c) At age 9, the child perceives death as irreversible.

Question 19

A pediatric nurse recognizes that preschoolers think of death as

a) A long sleep
b) Irreversible
c) Inevitable
d) Natural

Answer 19

a) A long sleep

Question 20

21) A widower who continues to improve his level of functioning higher than before the loss is best described at which stage of the Grief Cycle Model?
a) Shock
b) Protest
c) Disorganization
d) Reorganization

Answer 20

d) Reorganization

Question 21

22) Which of the following stages of grieving is displayed by a woman who appears depressed and withdrawn?
a) Shock
b) Protest
c) Disorganization
d) Reorganization

Answer 21

c) Disorganization

Question 22

23. In the Parkes Model, a person uses denial as a psychological defense in the stage of
A) Numbness
B) Yearning
C) Disorganization
D) Reorganization

Answer 22

A) Numbness

Question 23

24. A widow has just returned home from the funeral of her husband. She feels alone in her home. Her family has left to go back to their home in another area of the country. What stage of Engels model does this represent?
A) Shock and disbelief
b) Developing awareness
c) Restitution
d) Resolving the grief

Answer 23

b) Developing awareness

Question 24

Which of the following stages of grieving is exhibited by the husband of a victim of sudden death who refuses to accept that she is dead?

a) Shock
b) Protest
c) Depression
d) Doubt

Answer 24

a) Shock

Question 25

26) The term bereavement is best defined as a
a) Psychological response to a loss
b) Socially conventional behavior after a loss
c) Period of time after a loss of a loved one
d) State of desolation that occurs after a loss

Answer 25

d) State of desolation that occurs after a loss

Question 26

27) A middle-age woman is mentally preparing for the death of her mother. This is termed
a. Grieving
b. Anticipatory grieving
c. Bereavement
D) Loss

Answer 26

b. Anticipatory grieving

Question 27

28. The experience of parting with an object, person, belief, or relationship that one values is
A) Loss
B) Bereavement
C) Grief
D) Death

Answer 27

A) Loss