Question 1

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?

Accepted Answer

Hospice care is provided to patients who are terminally ill and wish to have no further aggressive treatment in attempt to cure the disease. The patient's statement that she just wants to be home with her grandchildren indicates a readiness for hospice care.

Question 2

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?

Accepted Answer

Patients who are near death sometimes have a special communication with loved ones who have already died. As long as the patient is calm and content, the best action of the nurse is to be present but let the patient continue the conversation undisturbed.

Question 3

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?

Accepted Answer

The patient's daughter should be encouraged to spend the last moments of her father's life with him, reassuring him with her presence. The daughter should be encouraged to continue talking with him because the patient may still hear her even if his eyes are closed and he does not speak. The nurse is responsible for monitoring the patient for breathing changes. Oral intake will lead to nausea and/or aspiration. This is not the time to make arrangements with the funeral home.

Question 4

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?

Accepted Answer

The nurse should allow the patient's family to grieve in private over the loss of their loved one. Some cultures favor free expression of emotions after death, and the nurse should respect this. Signatures can be obtained, postmortem care can be provided, and the body brought to the morgue after an appropriate time of grieving has been provided to the family.

Question 5

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?

Accepted Answer

The best diagnosis for this family is Interrupted family processes r/t father's caregiving role changes, as evidenced by the father's difficulties in taking over the responsibilities and duties previously done by his wife. This situation exemplifies the diagnosis in the change of family functioning that has occurred as a result of the death of the children's mother.

Question 6

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?

Accepted Answer

The patient's primary wish is to die without pain, and the best intervention to meet this goal is administration of pain medication around the clock with extra doses for breakthrough pain. The other interventions may make the patient more comfortable but will not address his primary desire for adequate pain management.

Question 7

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?

Accepted Answer

The patient is experiencing disenfranchised grief because she cannot share the pain of her loss with her husband. The husband is not willing to support his wife as she mourns the loss of her pregnancy or recognize the grief that she is going through.

Question 8

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?

Accepted Answer

The primary goal of the caregiver role strain nursing diagnosis is that the patient's wife will be able to maintain her own health while caring for her husband. Getting sufficient sleep is an important step toward keeping her health intact, and the patient's wife feels supported sufficiently by the hospice aide in order to sleep through the night.

Question 9

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?

Accepted Answer

Medical devices and tubes are not removed from the body if an autopsy is to be performed. The patient's necklace and watch may be removed and given to the patient's family members before the body is transported to the coroner's office for autopsy. Dentures should be left in the patient's mouth.

Question 10

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?

Accepted Answer

The nurse must function as the patient's advocate and encourage what is in the best interest of the patient. Chemotherapy will not extend the patient's life when death is expected within the next few days and will only make the patient suffer needlessly when it is administered. The patient will not get stronger over the next few days, and this criterion for chemotherapy will never be met.

Question 11

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?

Accepted Answer

The patient is angry over the impending death of his mother and is acting out this anger at school by picking fights and defying his teachers.

Question 12

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?

Accepted Answer

The highest priority goal of this patient is self-care including showering and eating in order to protect her health and safety. The other goals are lower priority after the patient's necessary activities of daily living are addressed.

Question 13

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?

Accepted Answer

As the patient's advocate, the nurse should help provide the necessary information for the patient to set up a scholarship if that is his decision. The patient does not need to discuss the subject with his family first, and assessment of the patient's mental status is not needed. The patient may not have the time to wait a few days before contacting the university.

Question 14

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?

Accepted Answer

The patient and her children are experiencing anticipatory grief as they prepare for the expected death of the patient. The patient and her children are preparing themselves for what is to come.

Question 15

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?

Accepted Answer

The most appropriate action of the nurse at this time is to allow the family to wash the patient's body in accordance with their wishes and cultural values. Signatures may be obtained from the next of kin when washing is complete. The patient's body may be transported to the morgue or funeral home after washing is completed.

Question 16

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?

Accepted Answer

The patient's son is experiencing powerlessness because he is unable to change the outcome of his mother's imminent death. The son makes no mention of religious beliefs, so impaired religiosity is not appropriate. Complicated grieving is applicable to individuals who have recently experienced a loss.

Question 17

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?

Accepted Answer

Cognitive deficits include the inability to concentrate and follow a conversation. Letting the house get filthy is a sign of apathy, which is in the behavioral domain. Insomnia falls within the behavioral and physical domains. Loss of appetite is within the physical domain.

Question 18

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?

Accepted Answer

According to the Islamic religion, washing of the body should be performed by a person of the same gender. Burial should be done as soon as possible after death, so cremation and embalming will not be needed. The rosary is prayed by Christians usually of Hispanic/Latino American descent.

Question 19

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?

Accepted Answer

Goals are met by the patient rather than nursing or medical staff. The patient's use of effective coping strategies without drinking alcohol is an appropriate goal. Referring the patient for counseling and encouraging the patient to verbalize stressors are interventions rather than goals.

Question 20

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?

Accepted Answer

Release of bowel and bladder contents often occur at the time of death, and the perineal care is a priority before the family arrives. The body should be gently cleaned to remove blood and debris from the accident. The patient's dentures and jewelry should not be removed from the body. The death certificate does not need to be signed before the family arrives. The family can decide which funeral home will be used and notify the nurse after their arrival.

Quiz 42: Death and Loss