Chapter 42: Death and Loss

Question 1

1. The hospice nurse is caring for a terminally ill patient. The patient’s son is distraught because the patient will probably die within the next few days and there is nothing he can do about it. What is the most appropriate nursing diagnosis for the patient’s son at this time?
   a.
   Chronic sorrow r/t impending death of mother
   b.
   Impaired religiosity r/t difficulty adhering to religious beliefs
   c.
   Powerlessness r/t progression of mother’s terminal illness
   d.
   Complicated grieving r/t desired avoidance of mourning

Answer 1

ANS: C

Question 2

2.	The nurse is caring for a terminally ill patient whose children have come home to be with their mother during her last few days. They spend time looking through picture albums, watching old home movies, and remembering fun times spent together. Which term best describes the activity of the patient’s children?
a.
Anticipatory grieving
b.
Bereavement
c.
Caregiver role strain
d.
Death anxiety

Answer 2

ANS: A

Question 3

3. The nurse is caring for a female patient who died a few minutes previously. The patient’s family comes in to the room and immediately starts to wash the body in preparation for burial. What is the most appropriate action of the nurse at this time?
   a.
   Inform the patient’s family that the body must be transported to the morgue.
   b.
   Instruct the patient’s family that hospital staff will provide post-mortem care.
   c.
   Obtain needed signatures for organ donation and autopsy.
   d.
   Offer to provide any needed supplies and provide privacy for the family.

Answer 3

ANS: D

Question 4

4.	The nurse is caring for an emergency room patient who died as a result of a mishap with a loaded gun. The patient’s body will be transported to the coroner’s office for an autopsy. Which items will the nursing staff remove from the body before it leaves the hospital?
a.
Endotracheal tube
b.
Foley catheter and IV line
c.
Dentures
d.
Necklace and watch

Answer 4

ANS: D

Question 5

5.	The nurse is caring for a patient who suffered a miscarriage at 24 weeks of pregnancy. The patient is devastated by the loss but her husband minimizes her grief by stating, “Quit crying. It’s not like you lost a real baby.” What term best describes the anguish felt by the patient?
a.
Disenfranchised grief
b.
Ineffective denial
c.
Moral distress
d.
Interrupted family processes

Answer 5

ANS: A

Question 6

6. The hospice nurse is caring for a father and his children following the death of their mother. The father is having difficulty taking on the responsibilities and duties that were previously done by his wife, especially relating to and communicating with his teenage daughters. Which nursing diagnosis best describes the family’s situation at this time?
   a.
   Impaired parenting r/t inappropriate child care arrangements
   b.
   Ineffective denial r/t new and unpleasant reality of single parenting
   c.
   Interrupted family processes r/t father’s caregiving role changes
   d.
   Disturbed thought processes r/t father’s feelings of grief over loss of wife

Answer 6

ANS: C

Question 7

7. The nurse is caring for a terminally ill patient who appears to be calmly having a conversation with someone even though there is nobody else in the room. The patient reaches out and appears to take something out of thin air and hold it close. Which is the appropriate action of the nurse?
   a.
   Reorient the patient and reassure that nobody else is in the room.
   b.
   Be present but quiet and let the patient continue the conversation.
   c.
   Carefully assess the patient’s mental status and level of attention.
   d.
   Obtain a set of vital signs and check the patient’s pulse oximetry.

Answer 7

ANS: B

Question 8

8. The nurse is caring for a patient who died a few minutes ago. The patient’s family is at the bedside and very demonstrative in their grief, weeping loudly and holding on to the patient’s body. What is the most appropriate action of the nurse?
   a.
   Inform the family that the patient’s body must be taken to the morgue shortly.
   b.
   Ask the family members to step outside while postmortem care is provided.
   c.
   Obtain required signatures for the body to be taken to the funeral home.
   d.
   Provide privacy and allow the patient’s family to grieve over the body.

Answer 8

ANS: D

Question 9

9. The nurse is caring for a patient who lost her husband 1 year ago. The patient and her husband had been married for 55 years. The patient no longer takes care of herself or cooks and rarely eats, stating she has no appetite. The nurse determines that the nursing diagnosis of Complicated grieving applies to the patient. Which is the priority goal for the patient at this time?
   a.
   The patient will shower every other day and eat at least two meals a day.
   b.
   The patient will identify personal strengths that will increase coping ability.
   c.
   The patient will discuss the meaning of her loss with a family member or close friend.
   d.
   The patient will be provided with phone numbers for local community resources.

Answer 9

ANS: A

Question 10

10. The hospice nurse is caring for a several adult children shortly after the death of their mother. They have various reactions as they deal with their loss. Which reactions are considered to be in the cognitive domain?
    a.
    They let the house get filthy because they can’t be bothered to clean it.
    b.
    They are tossing and turning all night and are unable to get a good night’s sleep.
    c.
    They are easily distracted and often lose train of thought during conversation.
    d.
    They have lost their appetites and have no desire to eat anything.

Answer 10

ANS: C

Question 11

11. The hospice nurse is caring for a patient who is terminally ill. The patient’s wife is the primary caregiver, providing constant care and spending all of her time meeting his needs. The nurse applies the diagnosis of caregiver role strain to the patient’s situation. After implementing appropriate interventions, which assessment finding by the nurse indicates that the primary goal for this diagnosis has been met?
    a.
    The patient’s wife was encouraged to talk about her feelings and fears with the hospice nurse.
    b.
    A hospice aide stays with the patient through the night and his wife is able to get adequate sleep.
    c.
    The patient’s wife verbalized understanding of techniques for management of nausea, pain, and constipation.
    d.
    Information about caregivers’ support group meetings was provided to the patient’s wife.

Answer 11

ANS: B

Question 12

12. The nurse is caring for a patient who has just died in a motor vehicle accident. What is the priority action of the nurse before the patient’s family arrives to see the patient’s body?
    a.
    Gently wash the body and provide perineal care.
    b.
    Remove the patient’s dentures and jewelry.
    c.
    Ensure that the death certificate has been signed.
    d.
    Determine which funeral home will pick up the body.

Answer 12

ANS: A

Question 13

13. The nurse is caring for a patient who is terminally ill with metastatic bone cancer. The patient tells the nurse that he is not afraid of death but does not want to be in pain and suffer before he dies. Which intervention will be most appropriate to meet this patient’s wishes?
    a.
    Establish around-the-clock dosing for pain medications with additional doses for breakthrough pain.
    b.
    Assist the patient to reminisce and review his life, spending as much time as possible with loved ones.
    c.
    Use therapeutic touch, guided imagery, and soft music to put the patient at ease and relieve anxiety.
    d.
    Encourage the patient to participate in prayer and meditation along with preferred religious practices.

Answer 13

ANS: A

Question 14

14. The home care nurse is caring for a terminally ill patient who states that he wants to set up a scholarship in his name at the local university before he dies. What is the best action of the nurse?
    a.
    Suggest that the patient think it over and wait a few days before contacting the school.
    b.
    Direct the patient to ask his family about the possibility of starting a scholarship.
    c.
    Assess the patient’s mental status to ensure that he is competent to make the decision.
    d.
    Assist the patient to find the necessary information about endowed scholarships.

Answer 14

ANS: D

Question 15

15. Which statement by the patient indicates that it may be an appropriate time to consider hospice care rather than further aggressive measures to treat his terminal illness?
    a.
    “I am praying every day that this last round of chemotherapy will work.”
    b.
    “I want to spend what time I have left at home with my grandchildren.”
    c.
    “I need to meet with my financial planner to make sure my life insurance is all set.”
    d.
    “I am concerned that my wife won’t be able to live on her own after my death.”

Answer 15

ANS: B

Question 16

16. The hospice nurse is caring for a terminally ill patient who will probably die within the next hour or two. The patient’s daughter is keeping a vigil by the bedside and asks what she can do to help her father at this time. What is the appropriate response of the nurse?
    a.
    “Just let him know you are here, talk to him, and let him know that you love him.”
    b.
    “You can try to feed him a few bites of ice cream to keep his mouth from getting dry.”
    c.
    “You can take this time to ensure that arrangements are set with the funeral home.”
    d.
    “You should let me know when your father’s breathing pattern changes.”

Answer 16

ANS: A

Question 17

17. The nurse is caring for a male Islamic patient who has just died. Which action is the priority for the nurse to take when postmortem care is provided?
    a.
    Arranging for embalming to preserve the body until burial
    b.
    Arranging for male staff to gently wash the patient’s body
    c.
    Arranging for transportation of the body to the crematorium
    d.
    Preparing the room so that the family can say the rosary at the bedside

Answer 17

ANS: B

Question 18

18. The nurse is caring for a patient whose mother recently passed away. The patient states that she has not been able to concentrate or sleep since the funeral and is consuming increasing amounts of alcohol to get through each day. Which goal is most appropriate for this patient?
    a.
    The patient will be referred to medical social services for evaluation and counseling.
    b.
    The patient will be encouraged to describe previous stressors and coping mechanisms.
    c.
    Nursing staff support patient’s coping attempts and encourage verbalization of feelings.
    d.
    The patient will use effective coping strategies with no alcohol consumption.

Answer 18

ANS: D

Question 19

19.	The nurse is caring for a young patient whose mother has only a few weeks to live. The patient has been misbehaving at school recently and is suspended after picking fights with other students and defying teachers. Which stage of grieving is the patient experiencing?
a.
Denial
b.
Anger
c.
Bargaining
d.
Depression

Answer 19

ANS: B

Question 20

20. The nurse is caring for a terminally ill patient whose family is insistent that additional chemotherapy be administered even though the patient will most likely die within the next few days. What is the best response of the nurse?
    a.
    “The insurance company will not pay for chemotherapy at this stage.”
    b.
    “The focus right now needs to be on keeping your loved one comfortable.”
    c.
    “I will call the physician and let him know that you would like to restart chemotherapy.”
    d.
    “The patient needs to get stronger first before chemotherapy can be administered.”

Answer 20

ANS: B

Question 21

21. The nurse is caring for a patient who is having difficulty coping after being in a motor vehicle accident in which her brother was killed. The patient was driving the car and blames herself for the accident. What is the priority nursing intervention of the nurse?
    a.
    Check to make sure that the patient does not want to hurt or kill herself.
    b.
    Educate the patient about available support systems for grief resolution.
    c.
    Enhance the patient’s coping skills to alleviate depression and anxiety.
    d.
    Encourage the patient to meet with a spiritual leader for guidance.

Answer 21

ANS: A

Question 22

22. The nurse is caring for a terminally ill patient who will probably die within the next 2 weeks. What is the priority nursing intervention?
    a.
    Encouraging the patient to limit fluid intake to minimize congestion
    b.
    Limiting the use of pain medications so that the patient can visit with family
    c.
    Helping the patient to identify and complete desired tasks and activities
    d.
    Completing funeral arrangements with the patient’s next of kin

Answer 22

ANS: C

Question 23

23. The nurse is caring for a terminally ill patient who is actively dying and refuses to eat anything other than a few bites of ice cream. The patient’s family member approaches the nurse and requests that a feeding tube be inserted so that her loved one will not starve to death. What is the best response of the nurse?
    a.
    “Loss of appetite is a natural part of the dying process. Tube feedings would be uncomfortable and cause nausea.”
    b.
    “I will contact the physician to obtain an order to insert the tube and start tube feedings.”
    c.
    “Intravenous fluids would be more comfortable for the patient than a tube feeding. I will call the doctor to get the order.”
    d.
    “I will listen to the patient’s abdomen to make sure that bowel sounds are present and try encouraging oral fluids.”

Answer 23

ANS: A

Question 24

1. The nurse is caring for a patient who just died after a lengthy illness. Which portions of postmortem care may be delegated to the nursing assistant? (Select all that apply.)
   a.
   Gently washing the body and closing the patient’s eyes
   b.
   Offering support and empathy to the patient’s family members
   c.
   Documenting the patient’s time of death in the medical record
   d.
   Notifying all of the patient’s consulting physicians of the patient’s death
   e.
   Removing the patient’s hospital ID band, IV lines, and urinary catheter
   f.
   Gathering the patient’s belongings so they may be taken home by the family

Answer 24

ANS: A, F

Question 25

2. The nurse is caring for a patient who has just died. Which assessment findings by the physician and nurse are used to confirm that death has occurred? (Select all that apply.)
   a.
   The patient was incontinent of bowel and bladder.
   b.
   The patient’s pupils are fixed and dilated.
   c.
   The physician does not hear a heartbeat.
   d.
   The patient’s extremities are cool and mottled.
   e.
   The patient has no palpable peripheral pulses.
   f.
   The patient’s face is relaxed and the mouth is open.

Answer 25

ANS: B, C, E