end of life

Question 1

Which actions/interventions are necessary for a nurse to take following the death of a patient who will be autopsied?

Answer 1

Cover open wounds
After death, the nurse should cover any part of the body that may be upsetting for the family to see.
Correct

Document the death
Documentation of the time and date of death must be performed immediately after death.
Correct

Prepare the body for family viewing
Bathing and dressing the body demonstrates respect and can help family members in the grieving process.

Remove medical equipment from the room
All medical equipment should be removed from the room after death.

Question 2

Which interventions would the nurse employ for a patient experiencing end-of-life–related anxiety and restlessness?

Answer 2

Dimming the lights
Decreasing environmental stimuli often helps a patient who is agitated and restless.
Correct

Playing soft music
Soft music may promote peace and comfort to a patient who is agitated and restless.

Question 3

Which services are examples of hospice care?

Answer 3

Providing pain medication for a patient with terminal cancer
Hospice provides medications that are indicated for the patient’s condition and comfort, such as for pain relief.
Incorrect

Providing oxygen for home use to a patient with end-stage lung disease
Hospice provides medical equipment designed for home use, including oxygen.

Providing caregiver services to give caregivers of the patient a temporary break
Hospice provides respite care, which is caring for the patient while the caregivers and family receive a physical and emotional break.

Question 4

Which services are examples of palliative care?

Answer 4

Providing medication to ease the symptoms of chemotherapy
Palliative care is provided in combination with life-supporting therapy and may include medication to ease the symptoms of chemotherapy.
Incorrect

Offering support to the family of a patient who has just undergone bypass surgery
Palliative care includes support for the patient and family.

Question 5

A grieving husband asks the nurse the same questions over and over again regarding his wife’s body. Which intervention would the nurse take to help the husband integrate the information?

Answer 5

Answering any questions, even if they were answered already
The nurse should answer any questions, even if they were answered already. The family of a dying patient is tired and often cannot focus on information provided.

Question 6

Which nursing intervention includes a supportive environment to a patient during the end of life?

Answer 6

Encouraging the patient and family to display photographs and other comforting objects
The nurse should encourage the patient and family to bring some of their favorite belongings and photographs with them if the patient is not being cared for at home. This establishes a comforting and supportive environment for the dying patient.

Question 7

How would the nurse react to an actively dying patient reaching for unseen objects and talking to unseen people?

Answer 7

Asking the patient to explain what he or she is seeing
Listening is the most important job of the nurse during nearing-death awareness, and the nurse should ask the patient what he or she is seeing and how it makes him or her feel.

Question 8

Family members of a deceased patient begin telling stories about their loved one as the nurse cleans up and begins postmortem procedures. How would the nurse respond?

Answer 8

Allowing the family to continue until they feel comfortable leaving.
The nurse should respect the family’s right to remember the deceased and allow them the time to do so.

Question 9

The daughter of a patient for whom palliative care has been recommended asks the nurse how palliative care differs from hospice care. Which information would be included in the nurse’s response?

Answer 9

Palliative care offers symptom control in conjunction with life-prolonging treatment.
Palliative care is used in conjunction with life-prolonging therapies to offer symptom control and enhance quality of life.

Question 10

Which patient would qualify for hospice care?

Answer 10

A patient with end-stage liver failure

Hospice care is offered to terminally ill patients with end-stage disease.

Question 11

How can the nurse support the family of a dying patient as part of end-of-life care?

Answer 11

Explaining patient care
The nurse should explain measures used to control symptoms and maintain quality of life to decrease family stress.
Correct

Communicating the signs of death in a simple manner
The nurse should teach patients and families the signs and symptoms of the dying process in terms they can understand so they are prepared for the patient’s death.

Teaching the family how to provide basic care for the patient
The nurse should educate caregivers about how to provide physical care measures.
Correct

Assuring the family that members of the health care team are available to provide help as needed
The nurse should provide assurance that members of the health care team are available and ready to provide assistance and support.

Question 12

Which statements by the family members of a patient at end of life indicate successful teaching by the nurse?

Answer 12

“I understand that there are stages of grief that we are likely to go through after dad dies, and we all may not be in the same stage at the same time.”
This statement reflects a correct understanding about the stages of grieving and indicates successful teaching.
Correct

“Susie is really good at giving back rubs, and now we know it would be good for dad to relax and for us as well.”
This statement indicates successful teaching. Complementary therapy can be used for the patient’s symptom management and as a self-care method for family members.
Correct

“Now that I know that the local cancer center has such great resources, we’re going down there tomorrow to talk to someone.”
This statement indicates successful teaching as it demonstrates an understanding of resources that the family may utilize.

“Once dad is in his final days, we can help by bathing his face, turning him carefully, and making sure his mouth doesn’t get too dry.”
This statement indicates successful teaching. The family can be taught how to provide safe and comfortable care such as bathing, turning, and oral care.

Question 13

Which question would the nurse ask the family of a dying parent to assess anticipatory grief?

Answer 13

“How well are you able to make decisions?”

Anticipatory grief can cause decision-making to be difficult, so this question would provide assessment data related to anticipatory grief.

Question 14

Match each alteration in grieving to its specific cue.

Answer 14

Symptoms of drug or alcohol abuse
 Exaggerated 
Signs of grief over an extended period 
Chronic 
Physical symptoms such as heartburn or rapid heart rate  
Masked
No outward signs of grief displayed  
Delayed

Question 15

Which question related to socioeconomic status would the nurse ask the caregiver of a terminally ill patient?

Answer 15

“How well are you able to pay for the patient’s medications?”

Asking if the caregiver is able to afford the patient’s medications relates to socioeconomic status and provides information that is essential to the comprehensive care of a terminally ill patient.

Question 16

Which physical assessment findings are physical signs of death?

Answer 16

Absence of heartbeat
The heartbeat stops at the time of death.
Correct

Opening of the mouth
The jaw loosens and the mouth can remain open at the time of death because of a lack of muscle control.
Correct

Involuntary release of urine or stool
Urine and stool are involuntarily released at the time of death because of a lack of nervous system control.

Question 17

Which assessment question would provide information related to caregiver strain on the daughter of a terminally ill patient?

Answer 17

“How much sleep are you getting each night?”

Sleeping too much or too little would provide the nurse with information related to the strain on a caregiver.

Question 18

Which tool would the nurse use to identify the needs of a patient at home suffering from a terminal illness?

Answer 18

Toolkit of Instruments to Measure End-of-Life Care (TIME)

The TIME tool assesses the needs of a patient at home suffering from a terminal illness.

Question 19

Which nursing assessment cue indicates that a patient is approaching the end of life?

Answer 19

The patient has stopped eating and drinking.
Refusal of food and fluids, usually as a result of the inability to swallow, are good indications that a patient is likely close to death.

Question 20

Which physical assessment finding is a sign of death known as rigor mortis?

Answer 20

Stiffening of the joints in the body

Rigor mortis describes the stiffening of the joints in the body and is a sign of death.

Question 21

Which cue is relevant for a patient with complicated grief?

Answer 21

The patient avoids going into the bedroom of the deceased.
Avoidance of reminders of the loss such as not entering the bedroom of the deceased is an unexpected finding and a relevant cue about the patient’s complicated grief.

Question 22

Which patient cue requires immediate intervention?

Answer 22

“I have nothing to live for. The pain will never stop unless I do something.”

Statements of having nothing to live for and stopping the pain are indicators of suicidal thoughts and require immediate intervention.

Question 23

Match the hypotheses to their cues.

Answer 23

“It’s been a couple of months, and my sleep cycle is still mixed up.”
Grief
“I can’t watch baseball; my dying father loves it, so it makes me cry.”
Anticipatory Grief
“All I can think about is how I should’ve been able to prevent his death.”
Dysfunctional Grief
“Since my wife died, I feel so isolated and alone.” Risk for Loneliness

Question 24

Which SMART outcomes related to grief and death are appropriate?

Answer 24

Patient will outline final wishes within 24 hours.
Outlining final wishes is a measurable and timely outcome related to death.

Patient will admit that her sorrow is leading to feelings of hopelessness within 2 weeks.
Acknowledging the impact of sorrow is an appropriate, timely, and measurable outcome related to grief and death.

Patient will acknowledge that the grieving process is dysfunctional within 1 week.
Acknowledging that the grieving process is dysfunctional is a measurable and timely outcome related to grief.
Correct

Family will participate each week in a support group for relatives of those who commit suicide.
Weekly family participation in a support group for relatives of persons who commit suicide is a measurable outcome.

Question 25

Match the nursing hypothesis with an appropriate outcome.

Answer 25

patient will demonstrate normal grief work within 6 months.
Grief
Patient will accept assistance from family within 2 weeks of diagnosis.
Anticipatory Grief
Patient will participate in own care and set goals within 1 month.
Hopelessness

Question 26

Which interpretation would the nurse make about a patient who says, “I have cried every day since my husband died”?

Answer 26

This may be an expected or unexpected finding.
This is the only interpretation the nurse can make about the patient at this time. The grief response is varied, so the nurse must determine how much time has passed before making a judgment on whether it is an expected or unexpected finding

Question 27

The nurse would develop a hypothesis of Anticipatory Grief for which patient?

Answer 27

Intense sadness at the approaching loss of a grandmother
A patient with intense sadness at the approaching loss of a grandmother is displaying cues for the hypothesis of Anticipatory Grief.

Question 28

Which hypothesis is associated with the patient outcome “Patient will participate in ongoing positive social activities within the next 2 weeks”?

Answer 28

Risk for Loneliness

Participating in ongoing positive social activities is an outcome for the hypothesis Risk for Loneliness.

Question 29

Which multidisciplinary team members would the nurse likely collaborate/consult with when caring for a patient who was diagnosed with inoperable cancer and has less than 6 months to live?

Answer 29

Social worker
The nurse may collaborate with a social worker to help identify financial and insurance resources for end-of-life care.

Hospice nurse
The nurse collaborates with the hospice nurse to meet the patient’s end-of-life needs, specifically regarding the diagnosis of less than 6 months to live, which makes the patient eligible for hospice care.

Spiritual care provider
The nurse may need to collaborate with the spiritual care provider based on the patient’s wishes to meet the patient’s spiritual needs.
Correct

Primary health care provider
The nurse would collaborate with the primary health care provider for medication prescriptions, prescriptions for hospice care, and other comfort prescriptions.