Deck 0 Chapter 36

Question 1

A nurse encounters a family that experienced the death of their adult child last year. The parents are talking about the upcoming anniversary of their child’s death. The nurse spends time with them discussing their child’s life and death. The nurse’s action best demonstrates which nursing principle?

1. Pain management technique
2. Facilitating normal mourning
3. Grief evaluation
4. Palliative care

Answer 1

2. Facilitating normal mourning

Rationale:

Anniversary reactions can reopen grief processes. A nurse should openly acknowledge the loss and talk about the common renewal of grief feeling around the anniversary of the individual’s death. This facilitates normal mourning. The nurse is not attempting to alleviate a physical pain. The actions are of open communication, not evaluation. Palliative care refers to comfort measures for symptom relief.

Question 2

A cancer patient asks the nurse what the criteria are for hospice care. What should the nurse answer?

1. Having a terminal illness, such as cancer
2. Needing assistance with pain management
3. Expected to live less than 6 to 12 more months
4. Completion of an advance directive

Answer 2

3. Expected to live less than 6 to 12 more months

Rationale:

The criterion for hospice care is being expected to live less than 6 to 12 more months. Patients with a terminal illness are not eligible until that point. Palliative care provides assistance with pain management when a patient is not eligible for hospice care. An advance directive can be completed by any person, even those who are healthy.

Question 3

A terminally ill patient is experiencing constipation secondary to pain medication. What is the best way for the nurse to improve the patient’s constipation problem?

1. Massage the patient’s abdomen.
2. Contact the provider to discontinue pain medication.
3. Administer enemas twice daily for 7 days.
4. Use a stimulant laxative and increase fluid intake.

Answer 3

4. Use a stimulant laxative and increase fluid intake.

Rationale:

Opioid medication is known to slow gastrointestinal transit time, which places the patient at high risk for constipation. Stimulant laxatives are indicated for opioid-induced constipation. Added water to the diet will allow water to be pulled into the GI tract, softening up stool. Massaging the patient’s abdomen may cause further discomfort. Discontinuing pain medication is inappropriate for a terminally ill patient. Enema administration is not the first step in the treatment of opioid-induced constipation.

Question 4

A severely depressed patient cannot state any positive attributes to his or her life. The nurse patiently sits with this patient and assists the patient to identify several activities the patient is actually looking forward to in life. The nurse is helping the patient to demonstrate which spiritual concept?

1. Time management
2. Hope
3. Charity
4. Faith

Answer 4

2. Hope

Rationale:

The concept of hope is vital to nursing; it enables a person to anticipate positive experiences. Being patient and friendly and creating positive relationships are key concepts in all areas of nursing, but especially with depressed patients. The nurse’s actions do not address time management, charity, or faith.

Question 5

In preparation for the eventual death of a female hospice patient of the Muslim faith, the nurse organizes a meeting of all hospice caregivers. A plan of care to be followed when this patient dies is prepared. This plan of care would include

1. Male health care workers care for the body after death has occurred.
2. Body preparation for autopsy.
3. Body preparation for cremation.
4. Female health care workers care for the body after death has occurred.

Answer 5

4. Female health care workers care for the body after death has occurred.

Rationale:

Islamic culture calls for modesty and same-sex caregivers whenever possible. Muslim faith discourages cremation and autopsy to preserve the sanctity of the soul of the deceased.

Question 6

Family members gather in the emergency department after learning that a family member was involved in a motor vehicle accident. After learning of the family member’s unexpected death, the surviving family members begin to cry and scream in despair. The nurse recognizes this as the Bowlby Attachment Theory stage of

1. Numbing.
2. Disorganization and despair.
3. Bargaining.
4. Yearning and searching.

Answer 6

4. Yearning and searching.

Rationale:

Yearning and searching characterize the second bereavement phase in the Bowlby Attachment Theory. Emotional outbursts are common in this phase. During the numbing phase, the family may feel a sense of unreality. During disorganization and despair, the reason why the loss occurred is constantly questioned. Bargaining is part of the Kübler-Ross stages, not of the Bowlby Attachment Theory.

Question 7

After the anticipated demise of a chronically ill patient, the unit nurse is found crying in the staff lounge. The best response to her crying colleague would be

1. “It is normal to feel this way. Give yourself some time to mourn.”
2. “Your other patients still need you, so hurry back to them.”
3. “You’re being a bad role model to the unit’s nursing students.”
4. “Why don’t you take a sedative to cope?”

Answer 7

1. “It is normal to feel this way. Give yourself some time to mourn.”

Rationale:

Nurses often witness suffering on a daily basis. Nurses, as humans, also experience grief and loss when they have been intensely involved in the patient’s suffering and death. Offer comfort and understanding to colleagues, and maintain a stable patient care environment. It is inappropriate to create guilt by telling a grieving nurse to hurry back to her patients or by indicating that she is a bad role model. Suggesting that a colleague take sedative during a shift is dangerous for the safety of patients in her care.

Question 8

A family is grieving after learning of a family member’s accidental death. The transplant coordinator requests to talk with the family about possible organ and tissue donation. The nurse recognizes that

1. All religions allow for organ donation.
2. Life support must be removed before organ and tissue retrieval occurs.
3. The best time for organ and tissue donation is immediately after the autopsy.
4. The transplant coordinator is working in accordance with federal law.

Answer 8

4. The transplant coordinator is working in accordance with federal law.

Rationale:

It is a federal law to require facilities to develop policies about organ donation. The transplant coordinator has additional education on providing answers about organ donation. Not all religions allow for organ donation. A patient may be on life support during organ removal to preserve organ tissues. Autopsy compromises organ integrity; removal should occur prior.

Question 9

An Orthodox Jewish Rabbi has been pronounced dead. The nursing assistant respectfully asks family members to leave the room and go home as postmortem care is provided. Which of the following statements from the supervising nurse reflects correct knowledge of Jewish culture?

1. “I wish they would go home because we have work to do here.”
2. “Family members stay with the body until burial the next day.”
3. “I should have called a male colleague to handle the body.”
4. “I thought they would quietly leave after praying and touching the Rabbi’s head.”

Answer 9

2. “Family members stay with the body until burial the next day.”

Rationale:

Jewish culture calls for family members or religious officials to stay with the decedent’s body until the time of burial. A male provider is unnecessary. Requesting or expecting the family to go home is not providing culturally sensitive care.

Question 10

The palliative team’s primary obligation to a patient in severe pain includes which of the following?

1. Supporting the patient’s nurse in her grief
2. Providing postmortem care for the patient
3. Teaching the patient the stages of grief
4. Enhancing the patient’s quality of life

Answer 10

4. Enhancing the patient’s quality of life

Rationale:

The primary goal of palliative care is to help patients and families achieve the best quality of life. Providing support for the patient’s nurse is not the primary obligation when the patient is experiencing severe pain. Not all collaborative team members would be able to provide postmortem care, as is the case for nutritionists, social workers, and pharmacists. Teaching about stages of grief should not be the focus when severe pain is present.

Question 11

A man is hospitalized after surgery that amputated both lower extremities owing to injuries sustained during military service. The nurse should recognize his need to grieve for what type of loss?

1. Maturational loss
2. Situational loss
3. Perceived loss
4. Uncomplicated loss

Answer 11

2. Situational loss

Rationale:

Loss of a body part from injury is a situational loss. Maturational losses occur as part of normal life transitions. Perceived loss is not obvious to other people. Uncomplicated is not a type of loss; it is a description of normal grief.

Question 12

“I know it seems strange, but I feel guilty being pregnant after the death of my son last year,” said a woman during her routine obstetrical examination. The nurse spends extra time with this woman, helping her to better bond with her unborn child. This demonstrates which nursing technique?

1. Facilitating mourning
2. Providing curative therapy
3. Promoting spirituality
4. Eradicating grief

Answer 12

1. Facilitating mourning

Rationale:

The nurse facilitates mourning in family members who are still surviving. By acknowledging the pregnant woman’s emotions, the nurse helps the mother bond with her fetus and recognize the emotions that still exist for the deceased child. The nurse is not attempting to help the patient eradicate grief, which would be unrealistic. Curative therapy and spiritual promotion are not addressed by the nurse’s statement.

Question 13

The nurse has had three patients die during the past 2 days. Which approach is most appropriate to manage the nurse’s sadness?

1. Telling the next patients why the nurse is sad
2. Talking with a colleague or writing in a journal
3. Exercising vigorously rather than sleeping
4. Avoiding friends until the nurse feels better

Answer 13

2. Talking with a colleague or writing in a journal

Rationale:

Self-care strategies for nurses include talking with a close colleague and reflecting on feelings by writing in a journal. It is inappropriate for a nurse to talk with patients to resolve the nurse’s grief. Although exercise is important for self-care, sleep is also important. Shutting oneself away from friends is not self-care; the nurse should spend time with people who are nurturing.

Question 14

A woman is called into her supervisor’s office regarding her deteriorating work performance since the loss of her husband 2 years ago. The woman begins sobbing and saying that she is “falling apart” at home as well. The woman is escorted to the nurse’s office, where the nurse recognizes the woman’s symptoms as which of the following?

1. Normal grief
2. Complicated grief
3. Disenfranchised grief
4. Perceived grief

Answer 14

2. Complicated grief

Rationale:

Complicated or dysfunctional grief occurs when an individual has a complicated grieving process that interferes with common routines of life for excessively long periods of time. Normal grief is the most common reaction to death; it involves a complex range of normal coping strategies. Disenfranchised grief involves a relationship that is not socially sanctioned. Perceived grief is not a type of grief; perceived loss is a loss that is not obvious to other people.

Question 15

The father has recently begun to attend his children’s school functions since the death of his wife. This would best be described as which task in the Worden Grief Tasks Model?

1. Task I
2. Task II
3. Task III
4. Task IV

Answer 15

3. Task III

Rationale:

The Worden Grief Tasks Model consists of four tasks. Task III is seen when the surviving family member begins to adjust to life without the deceased. Task I is accepting the reality of the loss, Task II is working through the pain of grief, and Task IV is emotionally relocating the deceased and moving on with life.

Question 16

The mother of a recently murdered child keeps the child’s room intact. Family members are encouraging her to redecorate and move forward in life. The visiting nurse recognizes this behavior as _____ grief.

1. Normal
2. End-of-life
3. Abnormal
4. Complicated

Answer 16

1. Normal

Rationale:

Family members will grieve differently. One sign of normal grief is keeping the deceased individual’s room intact as a way to keep that person alive in the minds of survivors. This is happening after the family member is deceased, so it is not end-of-life grief. It is not abnormal or complicated grief; the child died recently.

Question 17

Validation of a dying person’s life would be demonstrated by which nursing action?

1. Taking pictures of visitors
2. Calling the organ donation coordinator
3. Listening to family stories about the person
4. Providing quiet visiting time

Answer 17

3. Listening to family stories about the person

Rationale:

Listening to family members’ stories validates the importance of the dying individual’s life and reinforces the dignity of the person’s life. Taking pictures of visitors does not address the value of a person’s life. Calling organ donation and providing private visiting time are components of the dying process, but they do not validate a dying person’s life.

Question 18

A couple is informed that their fetus’ condition is incompatible with life after birth. Nurses can best help the couple with their end-of-life decision making by offering them which of the following?

1. An advance directive to complete
2. Brief discussion and funeral guidance
3. Time and careful explanations
4. Instructions on how to proceed

Answer 18

3. Time and careful explanations

Rationale:

Families can have limited knowledge when asked to make important ethical decisions. Nurses have the time, patience, and knowledge base to assist the family to understand their ethical situation and to help them make their own educated decision. Advance directives are completed by the person who is dying. Funeral guidance is best provided by a chaplain or a caretaker.

Question 19

A correctional facility nurse is called to the scene of a deceased inmate. The correction officer wants to quickly move the body to the funeral home because he is not comfortable with death. The inmate’s body will need to be transported where?

1. Coroner’s office for an autopsy
2. Police department for an investigation
3. Directly to the inmate’s family
4. Warden for inspection

Answer 19

1. Coroner’s office for an autopsy

Rationale:

Law often requires that an autopsy be performed if death occurred during incarceration; as the result of foul play, homicide, or suicide; or as an accidental death, as occurs in car accidents. The nurse must understand the policies that are applied in cases of foul play death and must ensure that the decedent’s body is properly cared for after death, despite the emotional feelings of individuals in close contact with the decedent.

Question 20

A dying patient with liver and renal failure requires pain medication. The nurse anticipates that the medication dose will be

1. Given at appropriate milligrams per kilogram medication levels.
2. A decreased dose from milligrams per kilogram levels.
3. An increased dose from milligrams per kilogram levels.
4. Given at midrange for dosing at recommended levels.

Answer 20

2. A decreased dose from milligrams per kilogram levels.

Rationale:

A dying individual will likely have a decline in renal and liver functioning. Because of reduced organ functioning, a decreased dose would be in order, so the individual does not develop toxic levels of the medications.

Question 21

A patient cancels a scheduled appointment because she will be attending a Shiva for a family member. Recognizing the importance of this cultural ritual, the nurse’s best comment would be which of the following?

1. “Congratulations, what’s the baby’s name?”
2. “I’m so sorry for your loss.”
3. “Missionary church outreach is so important.”
4. “Can I buy a ticket to this fundraiser?”

Answer 21

2. “I’m so sorry for your loss.”

Rationale:

The Jewish mourning ritual of Shiva incorporates the community’s helping behaviors toward those experiencing death, sets expectations for behaviors of the survivor, and provides the community with sustaining traditions and rituals. An understanding of the religious and cultural significance of Shiva allows the nurse to know how to appropriately respond.

Question 22

During a follow-up visit, a woman is describing new onset of marital discord with her terminally ill spouse. Using the Kübler-Ross behavioral theory, the nurse recognizes that the spouse is in which stage of dying?

1. Denial
2. Bargaining
3. Anger
4. Depression

Answer 22

3. Anger

Rationale:

Kübler-Ross’ traditional theory involves five stages of dying. The anger stage of adjustment to an impending death can involve resistance, anger at God, anger at people, and anger at the situation. Denial would involve failure to accept a death. Bargaining is an action to delay acceptance of death by bartering. Depression would present as withdrawal from others.

Question 23

Enuresis is reported in a previously toilet trained toddler. While gathering a health history from the grandparent, the nurse asks about which factor as the most likely cause?

1. Lack of outside playtime
2. Having too many toys
3. Dietary changes
4. Recent parental death

Answer 23

4. Recent parental death

Rationale:

A child’s stage of development and chronological age will influence how he or she grieves. Toddlers can show grief through changes in their eating patterns, changes in their sleeping patterns, fussiness or irritability, and changes in their bowel and bladder habits. It is common for younger children to regress when under increased stress. Lack of outside playtime, dietary changes, and having too many toys are unlikely to cause enuresis.

Question 24

Mrs. Harrison’s father died a week ago. Mr. Harrison is experiencing headaches and fatigue, and keeps shouting at his wife to turn down the television, although he has not done so in the past. Mrs. Harrison is having trouble sleeping, has no appetite, and says she feels like she is choking all the time. How should the nurse interpret these assessment findings as the basis for a follow-up assessment?

1. Mrs. Harrison is grieving and Mr. Harrison is angry.
2. Mrs. Harrison is ill and Mr. Harrison is grieving.
3. Both Mr. and Mrs. Harrison likely are in denial.
4. Both Mr. and Mr. Harrison likely are grieving.

Answer 24

4. Both Mr. and Mr. Harrison likely are grieving.

Rationale:

Symptoms of normal grief include headache, fatigue, oversensitivity to noise, insomnia, appetite disturbance, and choking sensation. Different people manifest different symptoms. Denial is assessed when the person indicates that he is not accepting that the loss happened..