Chapter 43 Flashcards
A terminally ill client states to the nurse, “My situation is hopeless; I have no control over anything.” The nurse
implements which of the following interventions to enable hope for the client?
A) State to the client, “We have explored all treatment options.”
B) Encourage the client to discuss his feelings.
C) Sit in a chair next to the client.
D) Hold the client’s hand.
E) Withhold information about disease progression
B) Encourage the client to discuss his feelings.
C) Sit in a chair next to the client.
D) Hold the client’s hand.
Measures to establish rapport with the client (e.g., providing time and physical contact by sitting in a chair next to the client; holding the client’s hand) should be utilized. The client should be encouraged to express his feelings. The nurse avoids language that would extinguish hope as in the statement, “We have explored all treatment options.” The nurse should provide information about the progress of the disease.
Which one of the following statements accurately describes the process known as grief reaction?
A) Reactions to grief and dying are different.
B) Reactions to grief are similar for all people.
C) Reactions to grief follow all stages of the grieving process.
D) Reactions to grief may differ from client to family
D) Reactions to grief may differ from client to family
Reactions to grief and dying are similar. The stages of these reactions overlap and vary among individuals. One person may skip a reaction stage, whereas another may repeat an earlier stage. Each person is different, and clients and family members may be at different reaction stages. More important than the actual stages of any given grief reaction is the idea that grief is a process that varies from person to person.
A dying client is crying. She states, Why me, Lord?” and “I can’t pray.” What would be an appropriate nursing diagnosis based on this data? A) Psycho-spiritual distress B) Low self esteem C) Ineffective coping D) Knowledge deficit related to praying
A) Psycho-spiritual distress
Spiritual needs must be included in the plan of care for the dying client. Verbal cues to psycho-spiritual distress include
inability to pray and lack of inability to forgive one’s self.
A woman has had a breast removed to treat cancer. What type of loss will she most likely experience? A) Actual loss B) Perceived loss C) Maturational loss D) Anticipatory loss
A) Actual loss
Loss occurs when a valued person, object, or situation is changed or made inaccessible so that its value is diminished or
removed. Actual loss can be recognized by others as well as by the person sustaining the loss.
According to the Harvard University Medical School committee, what function must be irreversibly lost to define death? A) Respiratory functions B) Reflexes C) Consciousness D) Brain function
D) Brain function
A Harvard University Medical School committee added that the nonreversible loss of brain function, accompanied by the more traditional signs, should be the definitive definition of death.
A nurse is developing a plan of care for a dying client. Which of the following physiologic basic human needs should be addressed? A) Personal hygiene B) Rsk for infection C) Family support D) Spirituality
A) Personal hygiene
Physiologic care of the dying client involves meeting physical needs such as personal hygiene, pain control, nutritional
and fluid needs, movement, elimination, and respiratory care.
Although all of the following are factors that affect grief, which one is most likely to influence a person’s expression of grief? A) Socioeconomic factors B) Cultural influences C) Religious influences D) Cause of death
B) Cultural influences
Both the physical and emotional manifestations of grief may be culturally influenced. Culture also influences a person’s
expression of grief.
A nurse is caring for a young client who is dying of renal failure. What should the nurse do when caring for the dying client’s family members?
A) Inform the family that the client may soon be out of danger
B) Request the family members not to talk about death to the client
C) Inform the family members that it is time to bid farewell to the client
D) Provide respite care to the client’s family members
C) Inform the family members that it is time to bid farewell to the client
The nurse should ask the family members to meet the client so that they can have a chance to say a final goodbye. The nurse should not provide any false hope to the client’s family by telling them that the client may soon be out of danger.
The nurse should not ask the client’s family members to avoid talking about death, because the client would want to know that he or she is loved and will be missed by the family. Respite care is usually provided when the client is resting or out of danger
An appropriate nursing diagnosis for the family of a client dying of cancer, whose members have expressed sorrow over
the forthcoming loss, would be …
A) Anticipatory grieving related to 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 loss of family member and sorrow
D) Dysfunctional grieving related to future loss of family member, manifested by family’s developmental regression
A) Anticipatory grieving related to loss of family member, as evidenced by sorrow
Anticipatory grieving comprises the intellectual and emotional responses and behaviors by which individuals, families,
and communities work through the process of modifying self-concept based on the perception of loss.
A client asks a nurse to explain a living will. What is the nurse’s best answer?
A) It specifies who will inherit the client’s estate.
B) It determines an individual’s quality of life.
C) It lists specific instructions for health care provisions.
D) It identifies a trusted person to make health care decisions.
C) It lists specific instructions for health care provisions.
A living will is a type of written advance directive that provides specific instructions about the kinds of health care that should be provided or foregone in particular situations.
The husband of a client who died of breast cancer is still grieving for his wife two years later. What type of grief is he experiencing? A) Unresolved B) Situational C) Inhibited D) Maturational
A) Unresolved
Unresolved grief is abnormal or distorted; it may be either unresolved or inhibited. In unresolved grief, a person may have trouble expressing feelings of loss or may deny them; unresolved grief also describes a state of bereavement that extends over a lengthy period. With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations.
The nurse is giving palliative care to a client with a diagnosis of COPD. What is the goal of palliative care?
A) Improve the client’s and family’s quality of life.
B) Support aggressive treatment for cure.
C) Provide physical support for the client.
D) The client may develop a separate plan with each discipline of the health care team
A) Improve the client’s and family’s quality of life.
The goal of palliative care is to improve the client’s and the family’s quality of life. The support should include the
patient’s physical, emotional, and spiritual well-being. Each discipline should contribute to a single care plan that
addresses the needs of the client and family. Options B, C and D are incorrect; the goal of palliative care is not
aggressive support for curing the client. Providing physical support for the client is also not the goal of palliative care.
Separate plans of care developed by the client with each discipline of the health care team are not the goal of palliative
care.
A terminally ill client, in severe pain, asks a nurse to help her die. What must the nurse consider morally, ethically, and
professionally before answering the client?
A) ANA Code for Nurses, ethical and professional standards
B) Own personal moral and ethical values and standards
C) Hospital or agency procedures and protocols
D) Medical Code of Ethics, belief in active euthanasia
A) ANA Code for Nurses, ethical and professional standards
The ANA Code of Ethics, the ethical traditions and goals of the nursing profession, and nursing’s covenant with society, all affirm that it is a violation for nurses to participate in assisting in a suicide and active euthanasia (assisting a client to die).
A man is diagnosed with terminal kidney failure. His wife demonstrates loss and grief behaviors. What type of loss is the wife experiencing? A) Maturational loss B) Anticipatory loss C) Dysfunctional grieving D) Bereavement
B) Anticipatory loss
Anticipatory loss occurs when a person displays loss and grief behaviors for a loss that has yet to take place. It is often seen in the families of clients with serious or life-threatening illnesses, and serves to lessen the effect of the actual loss of
a family member.
A dying client is undergoing terminal weaning. What is the purpose of this intervention?
A) To manage the symptoms of the illness
B) To prepare for resuscitation of the client
C) To initiate life-sustaining measures for the client
D) To gradually withdraw mechanical ventilation
D) To gradually withdraw mechanical ventilation
Terminal weaning is the gradual withdrawal of mechanical ventilation from a client with a terminal illness or an irreversible condition with a poor prognosis
Which of the following is an example of a perceived loss?
A) A client mourns the loss of his amputated leg.
B) A client grieves for the loss of his wife to cancer.
C) An older client grieves for the loss of his independence.
D) A client grieves for the loss of his job.
C) An older client grieves for the loss of his independence.
Perceived loss, such asloss of youth, of financial independence, and of a valued environment, is experienced by the
person but is intangible to others. Answers A, B, and D are actual loss and can be recognized by others as well as by the
person sustaining the loss; for example, loss of a limb, of a child, of a valued object such as money, and of a job.
Kübler-Ross defines five stages of psychosocial responses to dying and death. Which of the following statements is
characteristic of the bargaining stage?
A) “The doctors must have made a mistake.”
B) “Why did this happen to me? I always exercised.”
C) “Just let me live to see my grandson born.”
D) “I’ve had a good life and I can die in peace.”
C) “Just let me live to see my grandson born.”
In the bargaining stage of the psychosocial responses to dying and death, the client tries to bargain for more time to live. It is important to meet wishes for putting personal affairs in order and fulfilling last wishes during this time, if possible, because bargaining helps clients move into later stages of dying.
A dying client states in writing ahead of time what her choices would be for health care should certain circumstances
develop. What is the term for this document?
A) Living will
B) Advance directives
C) Durable power of attorney
D) Comfort measures only
B) Advance directives
Two kinds of written advance directives can minimize difficulties by allowing individuals to state in advance what their
choices would be for health care, should certain circumstances develop. Living wills provide specific instructions about
the kinds of health care that should be provided or foregone in particular situations. A durable power of attorney for health care appoints an agent the person trusts to make decisions in the event of subsequent incapacity. Comfort measures only indicate that the goal of treatment is a comfortable, dignified death, and that further life-sustaining
measures are no longer indicated
While caring for a client near end of life, a student talks to her. Another student asks why she is talking to someone who is dying. Which response would be accurate?
A) “It makes me feel better to talk to my clients.”
B) “I do this so I won’t be so afraid the client will die.”
C) “I believe the client can hear me as long as she is alive.”
D) “I don’t know; the nurse in charge of the client told me to.”
C) “I believe the client can hear me as long as she is alive.”
The sense of hearing is believed to be the last sense to leave the body, with many clients able to hear almost to the moment of death. The nurse should explain to the client the nursing care being given and the noises in the unit.
Which of the following statements is typical of the first stage of grieving described by Engel?
A) “No, not me.”
B) “Why me?”
C) “My husband was the best man in the world.”
D) “The funeral service helped me survive.”
A) “No, not me.”
According to Engel, the first stage of grief is shock and disbelief. In this initial stage, the surviving family members
often refuse to accept the fact of the loss, followed by a stunned or numb response of “No, not me.”
A nurse providing palliative care for a dying man and his family knows that the goal of palliative care is what?
A) To aggressively treat the disease.
B) To provide care for the dying in the home.
C) To aggressively treat the symptoms of the disease.
D) To support the family of the dying client.
C) To aggressively treat the symptoms of the disease.
Palliative care means taking care of the whole person—body, mind, and spirit, heart and soul. It views dying as
something natural and personal. The goal of palliative care is to give clients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms. Hospice care is care provided for people with
limited life expectancy, often in the home. While hospice care focuses on the needs of the dying, palliative care is
appropriate across the spectrum of disease and illness.
Palliative care is a structured system for care delivery that has what as its aim?
A) To give traditional medical care
B) To prevent and relieve suffering
C) To bridge between curative care and hospice care
D) To provide care while there is still hope
B) To prevent and relieve suffering
Palliative care, which is conceptually broader than hospice care, is both an approach to care and a structured system for
care delivery that aims to…prevent and relieve suffering and to support the best possible quality of life for clients and their families, regardless of the stage of the disease or the need for other therapies. Palliative care goes beyond giving traditional medical care, which makes option A incorrect. Palliative care is considered a bridge not exclusively limited to
hospice care, which makes option C incorrect. Option D is incorrect; hope is something clients and families have even
while the client is actively dying
Family members of a dying client are in the room with their loved one. As the client nears death, what should the nurse
tell the family?
A) “Please leave the room now. It is time to let go.”
B) “Only one family member at a time can stay in the room.”
C) “Please stay with your loved one and talk to him.”
D) “I will have to get an order for you to stay now.”
C) “Please stay with your loved one and talk to him.”
A fear of having to face death alone is a primary concern of dying patients. The presence of family members in the room
should be encouraged and reminiscences should be shared.
A nurse is providing postmortem care. Which of the following nursing actions is a legal responsibility?
A) Placing the body in normal anatomic position
B) Removing tubes and soiled dressings
C) Washing the body to remove blood and excretions
D) Placing ID tags on the shroud and ankle
D) Placing ID tags on the shroud and ankle
Although the nurse may place the body in a normal anatomic position and remove tubes and soiled dressings, the only
legal action is placing ID tags on the shroud and ankle. The body is not usually washed by the nurse, as different cultures
and religions have specific guidelines concerning cleansing the body.
