Chapter 36: The Experience of Loss, Death, and Grief Practice Test Flashcards
Regarding the request for organ and tissue donation at the time of death, the nurse needs to be aware that:
- Specially educated personnel make requests.
- Requests are usually made by the nurse caring for the patient at the time of death.
- Only patients who have given prior instruction regarding donation become donors.
- Professionals need to be very selective in whom they ask for organ and tissue donation.
Answer: 1.
Individuals specially trained in requesting organ donations facilitate the process. They are skilled in talking compassionately to people who have suffered a tragic, sudden loss and have answers to many questions that people have regarding the donation process.
The nurse notes that a woman who recently began cancer treatment appears quiet and withdrawn, states that she does not believe the treatments will make any difference, does not ask about her progress, and missed two chemotherapy sessions. Based on the above assessment data, the nurse gathers more information to consider making which of the following nursing diagnoses?
- Anxiety
- Hopelessness
- Spiritual distress
- Complicated grieving
Answer: 2.
The patient exhibits signs and symptoms of hopelessness. Manifestations of hopelessness include withdrawing, not following through with recommended treatment, and losing confidence that anything she does will be of help.
A family member asks a home care nurse what he should do if the patient’s serious chronic illness worsens even with increased medical interventions. How does the nurse best begin a conversation about the goals of care at the end of life?
- Encourage the family member to think more positively about the patient’s new therapy
- Avoid the discussion because it has to do with medical, not nursing, diagnoses
- Initiate a discussion about advance directives with the patient, family, and health care team
- Begin the discussion by asking the patient to identify his or her beliefs about the goals of care while the family member is present
Answer: 4.
If you ask the patient first what he or she believes is best, you know how to discuss that option in more detail and give realistic ways of reaching that desired goal. Discussing other possible options after the patient’s preference helps family members know and understand the patient’s wishes.
Which of the following nursing actions best reflects sensitivity to cultural differences related to end-of-life care?
- Practice honesty with everyone, telling patients about their illness, even if the news is not good.
- Ask family members if they prefer to help with the care of the body after death.
- Provide postmortem care at the time of death to relieve family members of this difficult job.
- Value patient self-determination, understanding that each person makes his or her own decisions.
Answer: 2.
Giving people options in caregiving allows them to honor their cultural beliefs. Although western health care practices place a high value on honesty, people from some cultural backgrounds regard being told the “truth” as harmful.
A young man is diagnosed with a serious, life-changing illness. His conversations during his first 2 days of hospitalization are abrupt, superficial, and unrelated to his illness. What under- standing about communication enhances your therapeutic communication with this patient?
- Younger patients are usually less talkative about their diagnosis.
- All patients benefit by talking about their feelings with another person.
- Avoid discussing illness-related topics with quiet patients.
- Remain alert for signals that the patient wants to discuss his illness.
Answer: 4.
Make no presumptions about this patient other than the fact that he is not yet ready to talk about his situation. However, stay alert for a time when he might want to talk to you. Some people do not work through their problems by talking to others.
A woman experiences the loss of a very early–term pregnancy. Her friends do not mention the loss, and someone suggests to her that she can “always try again.” The woman feels confusion over her sadness and stops talking about it with others. What type of grief response is she most likely experiencing?
- Delayed
- Anticipated
- Exaggerated
- Disenfranchised
Answer: 4.
This woman’s friends are not fully acknowledging the value of her pregnancy because of the short length of time the woman was pregnant or because, by comparison, the loss seems less than losing a child after birth. The loss does not seem “legitimate.” Thus the woman does not experience sympathy from others and feels disenfranchised.
A nurse has the responsibility of managing a deceased patient’s post-mortem care. Arrange the steps for post-mortem care in the proper order.
- Bathe the body of the deceased.
- Collect any needed specimens.
- Remove all tubes and indwelling lines.
- Position the body for family visit/viewing.
- Speak to the family members about their possible participation.
- Confirm that request for organ/tissue donation and/or autopsy has been made.
- Notify a support person (e.g., spiritual care provider, bereavement specialist) for the family.
- Accurately tag the body, indicating the identity of the deceased and safety issues regarding infection control.
- Elevate the head of the bed.
Answer: 6, 9, 2, 5, 7, 3, 1, 4, 8.
Positioning the head of the bed first helps prevent pooling of blood in the face during all of the other preparations. Find out if there are medical or legal considerations (specimens, autopsy, or tissue donation) before beginning so you do not have to disrupt your care of the person once you have started. Notify a support person for the family while you make other preparations. Invite the family early so you do not violate any cultural or spiritual rituals by beginning your care too early. Once ready to work with the body, remove drains before bathing the body in the event that there is leakage or soiling of the bed on removal. Arrange the person for viewing and transport to the morgue as the last step
- A family member of a recently deceased patient talks casually with the nurse at the time of the patient’s death and expresses relief that she will not have to visit at the hospital anymore. What theoretical description of grief best applies to this family member?
- Denial
- Anticipatory grief
- Dysfunctional grief
- Yearning and searching
Answer: 2.
If a person has been anticipating a loss for some time, he or she may have already experienced many of the emotions (sadness, shock) commonly associated with death.
A self-care goal you set when caring for dying and grieving patients includes:
- Learning not to take losses so seriously.
- Limiting involvement with patients who are grieving.
- Maintaining life balance and reflecting on the meaning of your work.
- Admitting that you are not well suited to care for people who are grieving and asking the charge nurse not to assign you to care for these patients.
Answer: 3.
Maintaining life balance is very important for emotional, spiritual, and physical well-being. Withdrawing or not seeing one’s work with grieving people as serious does not help maintain balance but rather may contribute to numbing feelings.
A nurse is providing postmortem care. Which action is the priority?
- Locating the patient’s clothing
- Providing culturally and religiously sensitive care in body preparation
- Transporting the body to the morgue as soon as possible to prevent body decomposition
- Providing all postmortem care to protect the family of the deceased from having to see the body
Answer: 2.
At the end of life religious and cultural expectations are important for the lasting memories held by the family about the way their loved one’s death occurred. Sensitive care contributes to feelings of closure, appropriateness of the death rituals, and fulfilled family obligations.
Which approach to helping grieving people is most consistent with postmodern grief theories?
- Help the patient identify the tasks to be accomplished during his or her grief.
- Encourage people to recognize stages of grieving in anticipation of what is to come.
- Listen carefully to a person’s story of how his or her grief experience is unfolding.
- Offer general grief timelines to help the person know when a phase will pass.
Answer: 3.
Postmodern grief interventions focus on the uniqueness of the patient’s story that unfolds and “writes” itself as the person lives through the experience of loss.
A patient who has a serious, life-limiting chronic illness wants to continue to engage in self-care and live as normally as possible. Which of the following nursing responses reflect a helpful understanding of patient self-care at the end of life?
- “Learning to accept that you can’t perform some activities anymore will bring you more acceptance and peace.”
- “Which activities are most important to you, and how can you continue to do them?”
- “People in your life want to help you with things; allow them to do what they want for you.”
- “Spending more of your time resting or reading will con- serve your energy.”
Answer: 2.
Even seriously ill people want to carry on with life, doing what they can to maintain their identity and purpose. They know best how to regulate their energy and wishes for how to spend their time.
The nurse suggests that a patient receive a palliative care consultation for symptom management related to anxiety and increasing pain. A family member asks the nurse if this means that the patient is dying and is now “in hospice.” What does the nurse tell the family member about palliative care? (Select all that apply.)
- Hospice and palliative care are the same thing.
- Palliative care is for any patient, any time, any disease, in any setting
- Palliative care strategies are primarily designed to treat the patient’s illness.
- Palliative care interventions relieve the symptoms of illness and treatment.
Answer: 2, 4.
Palliative care is not reserved for people who are at the end of life. The goal of palliative care is to help relieve the burdens of illness at any time along the continuum of that illness.
You have identified three nursing diagnoses for a patient who is having anxiety and hopelessness as a result of a loss. Which general approach do you take to prioritize the nursing diagnoses? (Select all that apply.)
- Use family members and physician orders as primary resources for prioritizing your actions.
- Address the nursing diagnosis that most affects the medical diagnosis.
- Ask the patient to identify the most distressing symptom and first address that diagnosis.
- Use nursing knowledge to address the problem that is the underlying cause of other diagnoses.
Answer: 3, 4.
When you are prioritizing nursing diagnoses, first get the patient’s sense of the most important issue. Some patients do not fully understand the physiology or relationship among diagnoses. For example, one patient does not understand that pain contributes to a decreased appetite or depression. Your nursing knowledge along with the patient’s perceptions help you determine the diagnosis with the highest priority
Regarding grief in older adults, which understanding helps guide your relationship with an elderly patient?
- Older adults have usually sustained many losses in life, which influence the current loss.
- Older adults with a poor memory experience grief less intensely.
- Older adults generally handle loss better because they have more experience with it.
- Social support is less important because an older adult’s circle of friends has become smaller
. Answer: 1.
Older adults have usually sustained more losses because they have lived longer. For people at any age, each loss influences the way one responds to subsequent losses. The loss of a social network makes it more important to find resources and sources of social support for grieving older adults. Sometimes many losses overpower a person’s coping resources instead of making him or her stronger.
