Final exam death and dying

Question 1

“Loss

Answer 1

” when a valued person, object, or situation is changed or inaccessible so that its value is diminished or removed.

Question 2

“Actual loss

Answer 2

“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.

Question 3

Perceived loss

Answer 3

such as loss of youth, of financial independence, and of a valued environment, is experienced by the person but is intangible to others.

Question 4

Grief

Answer 4

And internal emotional reaction to Loss.

Question 4

“Anticipatory loss

Answer 4

“occurs when a person displays loss and grief behaviors for a loss that has yet to take place Anticipatory loss is often seen in the families of patients with serious and life-threatening illnesses and may lessen the effect of the actual loss of a family member.

Question 5

Mourning

Answer 5

Is the actions and expressions of that grief including the symbols and ceremonies such as: a funeral or final celebration of life, that make up the outward expression of grief

Question 6

Bereaved

Answer 6

In a state of grieving from loss of a loved one

Question 7

More important than the actual stages of any given grief reaction

Answer 7

Is the idea that grief is a process that varies from person to person

Question 8

Engel’s six stages of grief are.

Answer 8

1. Shock and disbelief
2. Developing awareness
3. Restitution
4. Resolving the loss
5. Idealization
6. Outcome

Question 9

Shock and disbelief

Answer 9

Defined as refusal to accept the fact of loss, followed by a stunned or numb response: “no not me”.

Question 10

Developing awareness

Answer 10

Characterized by physical and emotional responses such as anger, feeling empty and crying. “why me”

Question 11

Restitution

Answer 11

Involves the rituals surrounding loss - with death, it includes religious, cultural or social expressions

Question 12

Resolving the loss

Answer 12

Dealing with the void left by the loss.

Question 13

Idealization

Answer 13

Exaggerating the good qualities that a person or object had, followed by acceptance of the loss and a lessened need to focus on it.

Question 14

Outcome

Answer 14

Good resolution of the grief process, includes dealing with loss as a common life occurrence.

Question 15

Kubler-Ross five stages of reaction similar to Engel’s

Answer 15

1. Denial and isolation
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Question 16

Dysfunctional grief

Answer 16

Is abnormal or distorted. It may be either unresolved or inhibited.

Question 17

Unresolved grief

Answer 17

A state of bereavement that extends over a lengthy period.

Question 18

Inhibited grief

Answer 18

A person suppresses feelings of grief and may instead manifest somatic symptoms, such as abdominal pain or heart palpitations

Question 19

The uniform definition of death act 1981

Answer 19

Provides a legal definition of death as follows irreversible cessation of all functions of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brainstem, is dead

Question 20

The medical criteria used to certify a death are:

Answer 20

Cessation of breathing
No response to deep painful stimuli
Lack of reflexes (such as gag or corneal reflex) and spontaneous movement.

Question 21

The clinical signs of impending or approaching death include

Answer 21

Difficulty talking or swallowing
Nausea, flatus, abdominal distention
Urinary and or bowel incontinence or constipation
Loss of movement, sensation, and reflexes
Decreasing body temperature with cold or clammy skin
Weak, slow or irregular pulse
Decreased blood pressure
Noisy, irregular, or Cheyne-Stokes respirations
Restlessness and or agitation
Cooling, mottling, and cyanosis of the extremities and dependent areas

Question 22

Good death

Answer 22

Allows a person to die on his or her own terms, relatively free of pain with dignity.

Question 23

Kubler – Ross the five stages of dying with common reactions are

Answer 23

1. Denial– the patient denies the reality of death and may repress what is discussed. “They made a mistake.”
2. Anger the patient expresses rage and hostility and adopts a “why me?” attitude.
3. Bargaining the patient tries to barter for more time. “If I just can make it to my son’s graduation”.
4. Depression the patient goes through a period of grief before death. Characterized by crying and not speaking much.
5. Acceptance when the stage of acceptance is reach the patient feels tranquil. The patient is prepared to die.

Question 24

Terminal illness

Answer 24

An illness in which death is expected with in a limited space of time, the physician is usually responsible for deciding what, when, and how the patient should be told.

Question 25

Palliative care

Answer 25

Taking care of the whole person-body, mind, and spirit, heart and soul.

Question 26

Hospice care

Answer 26

Is care provide for people with limited life expectancy.

Question 27

Advance directives

Answer 27

Allowing individuals to state in advance what their choices would be for healthcare should certain circumstances develop.

Question 28

Living wills

Answer 28

Specific instructions about the kinds of healthcare that should be provided or not provided in particular situations.

Question 29

Durable power of attorney for healthcare

Answer 29

Appoints an agent the person trust to make decisions in the event of subsequent incapacity.

Question 30

Five wishes (Aging with Dignity2007) allows individuals to specify:

Answer 30

1. The person I want to make care decisions for me when I can’t.
2. The kind of medical treatment I want or don’t want.
3. How comfortable I want to be.
4. How I want people to treat me.
5. What I want my loved ones to know.

Question 31

Patient Self-determination Act of 1990

Answer 31

Requires all hospitals to inform patients about advance directives.

Question 32

Because the status of advance directives varies from state to state, it is important for nurses to be familiar with federal and state laws concerning these directives.

Answer 32

.

Question 33

Do-Not-Resuscitate order

Answer 33

That no attempts are to be made to resuscitate a patient who stops breathing or whose heart stops beating.

Question 34

Comfort-measures-only order

Answer 34

The goal of treatment is a comfortable, dignified death and that further life-sustaining measures are no longer indicated.

Question 35

Terminal weaning

Answer 35

The gradual withdrawal of mechanical ventilation from a patient with a terminal illness or an irreversible condition with a poor prognosis.

Question 36

Euthanasia

Answer 36

Good dying

Question 37

2 types of euthanasia

Answer 37

Active and passive

Question 38

Active euthanasia

Answer 38

Taking steps to cause a patients death.

Question 39

Passive euthanasia

Answer 39

Withdrawing medical treatment with the intention of causing the patients death.

Question 40

Active euthanasia is DOING SOMETHING to end a patient’s life, whereas passive euthanasia is NOT DOING something to preserve a patient’s life.

Answer 40

In the US physician assisted suicide is legal in Oregon.

Question 41

A woman who is firmly committed to natural childbirth and who has attended each natural childbirth class in preparation for labor and delivery undergoes a cesarean delivery when her fetus displays signs of distress. Inconsolable, she cries and calls herself a failure as a mother. What type of loss is she experiencing? Select all that apply.

a. Actual
b. Perceived
c. Psychological
d. Anticipatory
e. Physical

Answer 41

a, b, and c. The loss experienced by the woman is

actual, perceived, and psychological.

Question 42

What term describes the period of acceptance of loss and grief during which the person learns to deal with loss through actions and expressions of grief?

a. Anticipatory grieving
b. Bereavement
c. Mourning
d. Stages of death and dying

Answer 42

c. Mourning is defined as the period of acceptance of loss and grief during which the person learns to deal with loss.

Question 43

A nurse interviews an 82-year-old resident of a nursing home who says that she has never gotten over the death of her son 20 years ago. She reports that her life fell apart after that and she never again felt like herself or was able to enjoy life. What type of grief is this woman experiencing?

a. Abbreviated
b. Anticipatory
c. Dysfunctional
d. Inhibited

Answer 43

c. Dysfunctional grief extends the mourning period for an abnormally long time, characterized by abnormal or distorted expressions of grief.

Question 44

A home health nurse has been visiting a patient with AIDS who says, “I’m no longer afraid of dying. I think I’ve made my peace with everyone, and I’m actually ready to move on.” This reflects his progress to which stage of death and dying?

a. Acceptance
b. Anger
c. Bargaining
d. Denial

Answer 44

a. The patient’s statement does reflect the acceptance stage of death and dying defined by Kübler-Ross.

Question 45

A nurse is visiting a patient with AIDS who is dying at home. During the visit, he breaks down and cries and tells the nurse that it is unfair that he should have to die now when he’s finally made peace with his family and wants to live. Which response by the nurse would be most appropriate?

a. “You can’t be feeling this way. You know you are going to die.”
b. “It does seem unfair. Tell me more about how you are feeling.”
c. “You’ll be all right; who knows how much time any of us has.”
d. “Tell me about your pain. Did it keep you awake last night?”

Answer 45

5. b. The nurse would want to validate that what the patient is saying has been heard and invite him to share more of his feelings, concerns, and fears.

Question 46

A nurse is caring for a terminally ill patient during the 11 PM to 7 AM shift. The patient says, “I just can’t sleep. I keep thinking about what my family will do when I am gone.” What response by the nurse would be most appropriate?

a. “Oh, don’t worry about that now. You need to sleep.”
b. “What seems to be concerning you the most?”
c. “I have talked to your wife and she told me she will be fine.”
d. “I have to go and give medicines now.”

Answer 46

b. Using an open-ended question allows the patient to continue talking.

Question 47

7. A patient tells a nurse that he has no one he trusts to make healthcare decisions for him should he become incapacitated. What should the nurse suggest he prepare?
   a. Combination advance medical directive
   b. Durable power of attorney for healthcare
   c. Living will
   d. Proxy for healthcare

Answer 47

c. The living will is a document whose precise purpose is to allow individuals to record specific instructions about the type of healthcare they would like to receive in particular end-of-life situations.

Question 48

Which of the following responses by a nurse would best reflect adherence to the position of the American Nurses Association?

a. A nurse promises a dying patient that he/she will do everything possible to keep the patient comfortable but that he/she cannot administer an injection or overdose to cause the patient’s death.
b. A nurse tells a dying patient who is on a ventilator that under no condition can he be removed from the ventilator because this is active euthanasia and is expressly forbidden by the Code for Nurses.
c. After exhausting every intervention to keep a dying patient comfortable, the nurse says, “I think you are now at a point where I’m prepared to do what you’ve been asking me. Let’s talk about when and how you want to die.”
d. In response to a patient who asks for assistance in committing suicide, a nurse replies, “I’m personally opposed to assisted suicide, but I’ll find you a colleague who can help you.”

Answer 48

a. The American Nurses Association position statement states that nurse-assisted suicide and participation in active euthanasia violate the Code for Nurses and the ethical traditions of the profession.

Question 49

A patient diagnosed with breast cancer who is not in the end stages of her illness has been in the medical intensive care unit for 3 weeks. Her husband tells the nurse caring for the patient that he and his wife often talked about the end of her life and that she was very clear about not wanting aggressive treatment that would merely prolong her dying. The nurse and hus- band both agree that this seems to be all that therapy is now doing for her. The nurse would suggest that the husband speak to his wife’s physician about which type of order?

a. Comfort-measures-only
b. Do-not-hospitalize
c. Do-not-resuscitate
d. Slow-code-only

Answer 49

a. Comfort-measures-only order. The wife would want all aggressive treatment to be stopped at this point and all care to be directed to a comfortable, dignified death.

Question 50

Which of the following would be least appropriate for a nurse to do when involved in the terminal weaning of a patient?

a. Participate in the decision-making process by offering the family information about the advantages and disadvantages of continued ventilatory support
b. Explain to the family what will happen at each phase of the weaning and offer support
c. Check the orders for sedation and analgesia, making sure that the anticipated death is comfortable and dignified
d. Tell the family that death will occur almost immediately after the patient is removed from the ventilator

Answer 50

d. Because there are no guarantees how any patient will respond once removed from a ventilator, and because it is possible for the patient to breathe on his or her own and live for hours, days, and, rarely, even weeks, the family should definitely not be told that death will occur immediately.

Question 51

All of the following diagnoses may apply to a young couple who gave birth to a premature infant with seri- ous respiratory problems who has been in the neonatal intensive care unit for the last 3 months. The couple has a 22-month-old son at home. Which diagnosis would be most appropriate based on the following assessment data: report of chronic fatigue and decreased energy, guilt about neglecting son at home, shortness of temper with one another, and apprehension about continued ability to go on this way?

a. Grieving
b. Ineffective Coping
c. Caregiver Role Strain
d. Powerlessness

Answer 51

c. The defining characteristics for the NANDA diagnosis Caregiver Role Strain fit the set of assessment data provided.

Question 52

Which of the nursing actions would a nurse correct if he saw a nursing assistant doing it?

a. Talking to a comatose patient, explaining what is happening at each step along the way when providing his care.
b. Sitting on the side of the bed of a dying patient holding her hand and crying with her
c. Listening to the daughter of a dying patient about the demands of care associated with artificially feeding her father.
d. Telling a dying patient to sit back and relax and that he will wash him because it’s easier that way

Answer 52

d. Because it is good to encourage dying patients to be as active as possible for as long as possible, it is generally not good practice to perform basic self-care measures the patient can perform simply because it is “easier” to do it this way.

Question 53

A nurse is providing postmortem care. Which of the following nursing actions violates the standards of caring for the body after a patient has been pronounced dead and is not scheduled for an autopsy?

a. Maintaining the patient in a comfortable sitting position until the family has arrived to say good-bye
b. Placing identification tags on both the shroud and the ankle
c. Removing soiled dressings and tubes
d. Preparing to transfer the body to the morgue

Answer 53

a. Because the body should be placed in normal anatomic position to avoid pooling of blood, leaving the body in a sitting position is contraindicated.

Question 54

The family of a patient who has just died asks to be alone with the body and asks for supplies to wash the body. The nurse providing care knows that the mortician usually washes the body. Which response would be most appropriate?

a. Inform the family that there is no need for them to wash the body since the mortician typically does this.
b. Explain that hospital policy forbids their being alone with the deceased patient and that hospital supplies are to be used only by hospital personnel
c. Give the supplies to the family but maintain a watchful eye to make sure that nothing unusual happens
d. Provide the requested supplies, checking if this request is linked to their religious or cultural customs and asking if there is anything else you can do to help

Answer 54

d. The family may want to wash the body for personal, religious, or cultural reasons and should be allowed to do so.

Question 55

A 70-year-old woman who has had a number of strokes refuses further life-sustaining interventions, including artificial nutrition and hydration. She is competent, understands the consequences of her actions, is not depressed, and persists in refusing treatment. Her doctor is adamant that she cannot be allowed to die this way, and her daughter agrees. An ethics consult has been initiated. Who would be the appropriate decision maker?

a. Patient
b. Daughter
c. Doctor
d. Ethics consult team

Answer 55

a. Because this patient is competent, she has the right to refuse therapy that she finds to be disproportionately burdensome, even if this hastens her death. Neither her daughter nor her doctor has the authority to assume her decision-making responsibilities unless she asks them to do this. The ethics consult team is not a decision- making body; it can make recommendations but has no authority to order anything.

Question 56

Four major task of grieving process

Answer 56

1. Acceptance of the loss
2. Acknowledgment of the intensity of the pain of loss
3. Adaption to life after loss
4. Cultivation of new relationships and activities.

Question 57

Grieving process two basic goals

Answer 57

Healing the self

Recovering from the loss