Chapter 36: End-of-Life Care

Question 1

Suicide committed with the help of another individual

Answer 1

Assisted suicide

Question 2

A medical order advising providers not to initiate cardiopulmonary resuscitation in the event of cardiac or respiratory arrest

Answer 2

Do not resuscitate (DNR)

Question 3

Period when recovery from illness is not expected, death is anticipated, and focus is on comfort

Answer 3

End of life

Question 4

A program that delivers palliative care to dying individual and support to dying person and that person’s family and caregivers

Answer 4

Hospice care

Question 5

Care that relieves suffering and provides comfort when cure is not possible

Answer 5

Palliative care

Question 6

Decision by competent terminally ill person to end his or her life

Answer 6

Rational suicide

Question 7

___ is an inevitable, unequivocal, and universal experience, common to all.

Answer 7

Death

Question 8

The cessation of life is often dealt with in terms of __ and __.

Answer 8

fury and fear

Question 9

Gerontological nurses commonly face the reality of death because more than __% of deaths occur in old age

Answer 9

80%

Question 10

The final termination of life, the cessation of all vital functions, or the act or fact of dying

Answer 10

definitions of death

Question 11

Avoiding discussions about death and not making a will or other plans related to one’s own death are clues to the lack of ___

Answer 11

internalization of one’s mortality.

Question 12

__ one’s own mortality can be therapeutic to the nurse personally, as well as helpful in the care of dying patients.

Answer 12

Understanding

Question 13

T/F: Nurses were discouraged from showing emotion when a patient died

Answer 13

True

Question 14

the study of death and dying

Answer 14

thanatology

Question 15

Not only was open discussion of an individual’s impending death rare but also it was typical for the dying person to be moved to a separate and often ___

Answer 15

isolated location during the last few hours of life.

Question 16

If the family was present, they were frequently left alone with the dying person, with or without benefit of a professional’s support?

Answer 16

without

Question 17

When death did occur, the body was removed from the unit in secrecy so that ___

Answer 17

other patients would be unaware of the event.

Question 18

Only through this ___ can the most therapeutic and individualized support be given to the dying person.

Answer 18

assessment

Question 19

__, __, __, and __ are all characteristics of an aging client with altered thought processes.

Answer 19

Depression, anxiety, fear, and isolation

Question 20

__ __ is not typically associated with altered thought processes or fear.

Answer 20

Deficient knowledge

Question 21

Patients’ reactions to __ are influenced by previous experiences with death, age, health status, philosophy of life, and religious, spiritual, and cultural beliefs.

Answer 21

dying

Question 22

Elisabeth Kübler-Ross developed a conceptual framework outlining the coping mechanisms of dying in terms of ___ stages

Answer 22

five

Question 23

The 5 stages are:

Answer 23

• denial
• anger
• bargaining
• depression
• acceptance

Question 24

Perhaps the most important nursing action during this stage is to accept the dying individual’s reactions and to provide an open door for honest dialogue.

Answer 24

denial stage

Question 25

During this time, the family may feel guilt, embarrassment, grief, or anger in response to the dying person’s anger. May believe nothing is right, they have unfilled desires and unfinished business.

Answer 25

Anger

Question 26

What stage: They may agree to be a better Christian if God lets them live through one more Christmas; they may promise to take better care of themselves if the physician initiates aggressive therapy to prolong life; they may promise anything in return for an extension of life.

Answer 26

Bargaining

Question 27

An interest in prayer and a desire for visits from clergy are commonly seen during this stage. Reality of the dying process is emphasized.

Answer 27

Depression

Question 28

What stage: For many dying persons, a time comes when the struggling ends and relief ensues. It is as though a final rest is being taken to gain the strength for a long journey. Maybe they’ll have their final conversations with their family members during this stage

Answer 28

Acceptance

Question 29

Significantly, __ commonly permeates all stages of the dying process

Answer 29

hope

Question 30

Concern regarding the degree of ___ that will be experienced and its management may be a considerable source of distress for dying individuals; nurses can reduce distress for patients by supplying them with realistic information regarding __. (same word for both blanks)

Answer 30

pain

Question 31

Complaints of pain or discomfort, nausea, irritability, restlessness, and anxiety are common indicators of __

Answer 31

pain

Question 32

In some circumstances, __ can be associated with pain.

Answer 32

confusion

Question 33

For the dying patient, the goal of pain management is to

Answer 33

prevent pain from occurring

Question 34

__ or __ is used for mild pain

Answer 34

aspirin or acetaminophen

Question 35

__ or ___ is used for moderate pain

Answer 35

codeine or oxycodone

Question 36

__ or __ is used for severe pain.

Answer 36

morphine or hydromorphone

Question 37

__ and ___ are contraindicated for pain control in older adults because of their high incidence of adverse effects, particularly psychosis, at relatively low dosages.

Answer 37

Meperidine and pentazocine

Question 38

__ __ is a common problem in dying patients

Answer 38

Respiratory distress

Question 39

Psychological distress can be associated with the __, __, and __ that results from the thought of suffocating

Answer 39

fear, anxiety, and helplessness

Question 40

The causes of respiratory distress can range from __ to __.

Answer 40

pleural effusion to deteriorating blood gas levels

Question 41

Atropine or furosemide may be administered to reduce __ __

Answer 41

bronchial secretions

Question 42

What can cause constipation in the dying patients?

Answer 42

Reduced food and fluid intake, inactivity, and the effects of medications

Question 43

It must be remembered that what may appear to be diarrhea may actually be ___

Answer 43

seepage of liquid wastes around a fecal impaction

Question 44

Many dying patients experience anorexia, nausea, and vomiting that can prevent the ___

Answer 44

ingestion of even the most basic nutrients

Question 45

Nausea and vomiting can be controlled with the use of __

Answer 45

antiemetics and antihistamines; and ginger

Question 46

Assessment should explore not only their religious affiliation but also their __ __ __.

Answer 46

individual religious practices.

Question 47

When death is near, bodily functions will slow and certain signs and symptoms will occur, including:

Answer 47

- Erratic breathing (slow) to aganol breathing (not effective) - cool extremities - pallor and modeled skin - decreased L.O.C - decline in blood pressure - rapid, weak pulse - dyspnea and periods of apnea - slower or no pupil response to light - profuse perspiration - bladder and bowel incontinence - loss of hearing and vision

Question 48

If a patient is unresponsive, should he or she still be spoken to and touched?

Answer 48

Yes

Question 49

A patient can express desires regarding terminal care and life-sustaining measures through the legal document of an __ __

Answer 49

advance directive

Question 50

All health care facilities and agencies that receive Medicare and Medicaid funding must provide information to patients about the__

Answer 50

Patient Self-Determination Act

Question 51

The __ gives individuals the right to express their choice regarding medical and surgical care and to have those preferences honored at a later time if they are unable to communicate it

Answer 51

Patient Self-Determination Act

Question 52

What time is when the most intense grief occurs?

Answer 52

After the agitation of the funeral has diminished and fewer visitors are calling to pay their respects.

Question 53

Medical evaluation of the ___ is crucial

Answer 53

survivors

Question 54

Nursing staff may feel powerless as they realize that their best efforts can do little to overcome the reality of __ __

Answer 54

impending death

Question 55

Nursing staff should be encouraged to express their own feelings about __ __

Answer 55

patients’ deaths

Question 56

In recent years, there has been growing acceptance of ___ suicide

Answer 56

rational

Question 57

A patient’s decision to put an end to his or her life demands __ and __

Answer 57

exploration and assessment.

Question 58

People are ___ to accept mortality.

Answer 58

reluctant

Question 59

Gerontological nurses often face death and must learn to ___.

Answer 59

deal with the entire dying process

Question 60

___ Death: determined by EEG

Answer 60

Brain

Question 61

__ death: determined by the absence of cardiac and pulmonary functions

Answer 61

Somatic

Question 62

___ death: determined by cessation of cellular function

Answer 62

Molecular

Question 63

In the past there were __ mortality rates.

Answer 63

higher

Question 64

In the past, death in the home was viewed as a ____ process.

Answer 64

natural

Question 65

In the present, people have __ experience with death.

Answer 65

limited

Question 66

Most people have ___ direct involvement with dying individuals.

Answer 66

minimal

Question 67

Death has become a more ___ and ___ event due to the hospital environment.

Answer 67

impersonal | unusual

Question 68

Factors that can influence a family on how they feel about the death:

Answer 68

- previous experiences with death - religious, spiritual, cultural beliefs - philosophy of life - age - health status

Question 69

The nurse needs to understand which interventions are __ __ during each stage of Kubler-Ross's framework.

Answer 69

most appropriate

Question 70

T/F: All dying persons progress through the stages in an orderly sequence and experience all of the stages.

Answer 70

FALSE

Question 71

Nurses were prepared to deal with care of a dead body, but now they need to be ___

Answer 71

more involved in the dying process

Question 72

What stage: Initial awareness of impending death Deny the reality of the situation Serves several useful purposes May occur at various times throughout an illness; fluctuation

Answer 72

Denial

Question 73

What stage: It may be useful for nurses to discuss their feelings about the patient’s anger with an objective colleague who can serve as a sounding board so that the nurse–patient relationship continues to be therapeutic.

Answer 73

Anger

Question 74

What stage: The nurse may need to help the family understand this depression, explaining that their efforts to cheer the dying person can hinder rather than enhance the patient’s emotional preparation. The nurse may emphasize that this type of depression is necessary for the individual to be able to approach death in a stage of acceptance and peace.

Answer 74

depression

Question 75

What stage: Touching, comforting, and being near the person are valuable nursing actions.

Answer 75

Acceptance

Question 76

Hope is used as a temporary ____

Answer 76

form of denial

Question 77

A realistic confrontation of impending death does not negate the presence of ___.

Answer 77

hope

Question 78

Constipation and respiratory distress are indications of ___.

Answer 78

pain

Question 79

Common problem in dying patients is ___ ___, which is due to fear of dying.

Answer 79

respiratory distress.

Question 80

Signs of imminent death:

Answer 80

Bodily functions slow down

Question 81

___ & ___ may also pass through the stages of the dying process before they accept the impending death of a loved one.

Answer 81

Family & friends

Question 82

Postventive work of Edwin Schneidman:

Answer 82

- Total care of a dying person needs to include contact and rapport with the survivors-to-be. - It is best to begin as soon as possible after the tragedy, within the first 72 hours if possible. - Remarkably little resistance is met from survivor-victims (most will talk) - The role of negative emotions toward the deceased needs to be explored, but not at the beginning. - The professional plays the important role of reality tester - Medical evaluation of the survivors is crucial.

Question 83

Death can be viewed as a __ __ by staff.

Answer 83

dissatisfying failure

Question 84

Many individuals are reluctant to accept ___

Answer 84

mortality

Question 85

United Nations Vital Statistics Division uses ___ for death.

Answer 85

statistics