Chapter 24: Loss, Death, and End–of-Life Care
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. How should a nurse position the body after the death of a patient?
a.
Prone
b.
Supine
c.
On the side
d.
In Fowler position
2. According to Strauss and Glaser, three states of awareness of terminal illness have been
identified. What do these states include?
a.
Denial, anger, and depression
b.
Shock, yearning, and anguish
c.
Avoidance, confrontation, and accommodation
d.
Closed awareness, mutual pretense, and open awareness
3. When planning the care of a patient who is terminally ill, a nurse should include the
prevention of pain and relief from discomfort. What should the nurse implement when
administering pain medication?
a.
Narcotics have the potential for addiction.
b.
Pain medication must be given before the pain becomes unbearable.
c.
Pain medication should be given no more often than every 6 hours.
d.
Narcotics must be given as needed only.
4. What is one of the most important interventions for a nurse to implement when caring for a
patient who is terminally ill?
a.
Touching and listening to the patient
b.
Encouraging the patient to express any regrets
c.
Assessing for signs and symptoms of impending death
d.
Talking to the patient about how other patients have handled the dying process
5. A nurse is assessing a patient who is terminally ill for clinical signs of impending death. What
should the nurse expect when assessing the patient’s respirations?
a.
Deep, clear breath sounds
b.
Noisy, wet-sounding respirations
c.
Even, unlabored respirations
d.
Shallow, clear breath sounds
6. What is believed to be the last sense to remain intact during the death process?
a.
Touch
b.
Sight
c.
Smell
d.
Hearing
7. A patient’s family asks a nurse what to expect when the patient dies. What is the most
accurate response by the nurse?
a.
His heart will stop, and then later he will quit breathing.
b.
His respirations will cease first, and then the heart stops beating within a few
minutes.
c.
His heartbeat and breathing will just stop suddenly without warning.
d.
He will quit breathing first, and then it could be several hours before his heart
stops.
8. While a nurse bathes a patient, he says, “Why are you giving me a bath? I’m going to die no
matter what.” What should be the nurse’s most appropriate response?
a.
“A bath will make you feel better.”
b.
“Would you like to talk about how you are feeling?”
c.
“Don’t you want your bath today?”
d.
“I can give you some medicine to make you feel better.”
9. The wife of a patient who has just died states, “I hate all of you nurses and doctors for letting
my husband die.” What should the nurse recognize this reaction as according to Martocchio’s
clusters of grief?
a.
Shock and disbelief
b.
Yearning and protest
c.
Anguish, disorganization, and despair
d.
Identification in bereavement
10. A patient recently diagnosed with inoperable lung cancer tells a nurse, “I am looking forward
to seeing my daughter graduate from college in 2 years.” What stage of grief should the nurse
recognize this as according to Elizabeth Kübler-Ross?
a.
Denial
b.
Anger
c.
Bargaining
d.
Depression
11. The family of a patient who is showing signs of impending death tells a nurse that they would
like for any organs that can be used to be donated. What action should the nurse implement?
a.
Wait until the patient has died before discussing organ donation with the family.
b.
Tell the family that the patient has not signed a consent, so the organs cannot be
donated.
c.
Check the patient’s record to see whether the physician has written an order for the
patient to have organs donated.
d.
Notify the physician of the family’s wishes.
12. A patient who is terminally ill has asked a nurse if he can request that cardiopulmonary
resuscitation (CPR) not be used in the event he has respiratory or cardiac arrest. What is the
best response by the nurse?
a.
“The physician is the only one that can make that decision.”
b.
“I will be glad to get you some information on advance directives, which are
written statements of a person’s wishes regarding medical care.”
c.
“Yes, you can make that decision; I will tell all the nurses.”
d.
“Your family will have to make the decision.”
13. What is the responsibility of a physician if a patient suffers respiratory or cardiac arrest and
legal requests specify “chemical code only”?
a.
Use medications for resuscitation without CPR.
b.
Use medications and CPR.
c.
Use CPR only.
d.
Use no means of resuscitation.
14. A nurse is caring for a patient who is terminally ill whose religion is Orthodox Jew. This
patient’s physician’s orders specify “do not resuscitate” (DNR). The patient is alone and is
having signs of impending death. What action should the nurse implement?
a.
Notify the family.
b.
Wait until the patient dies and then notify the family.
c.
Transfer the body to the mortuary or the morgue immediately after death.
d.
Stay with the patient until death occurs, prepare the body, and then call the family.
15. In caring for a dying patient who is grieving, a nurse bases patient care on the theory that grief
is helpful and assists the person in accepting the reality of death. What is this type of grief is
called?
a.
Dysfunctional
b.
Unresolved
c.
Uncomplicated
d.
Maladaptive
16. A nurse is on duty in the emergency department when a patient is brought in who has died
almost immediately after admission. The family states that the patient has had no history of
medical problems and that no apparent reason for death is known. What should occur in this
situation?
a.
The police must be notified.
b.
The family may choose to have an autopsy performed.
c.
An autopsy is required by law, and the coroner or medical examiner must be
notified.
d.
The body must be held at the hospital for 24 hours.
17. A nurse is preparing a patient’s body after death and discovers that the patient’s dentures were
not in his mouth before death. What action should the nurse implement?
a.
Insert them gently into the mouth.
b.
Give them to the family.
c.
Throw them away.
d.
Send them to waste management to be disposed of properly.
18. A patient who is terminally ill asks a nurse what is meant by a medical power of attorney.
What is the nurse’s best explanation of this written document?
a.
“It allows another person to manage your financial affairs.”
b.
“It allows the physician to make any medical decisions that need to be made for
you.”
c.
“It says you have given up all rights to make medical decisions for yourself.”
d.
“It allows you to select someone to make health care decisions for you only if you
are unable to do so for yourself.”
19. What right does the Omnibus Reconciliation Act of 1990 require institutions to provide
written information to patients concerning?
a.
Donation of organs
b.
Accepting or refusing treatment
c.
Autopsy
d.
Physician-assisted suicide
20. What important need should a nurse caring for a dying patient understand?
a.
Frequent, thorough physical assessments
b.
Not imposing repeated and unnecessary assessments
c.
Current, updated health history from the patient
d.
Limiting the amount of visitors allowed
21. Nurses who have been caring for patients who are terminally ill frequently begin to feel
helpless and frustrated. What is best for the nurse to implement when caring for the terminally
ill patient?
a.
Find another job.
b.
Express feelings to a friend or coworker.
c.
Ignore these feelings because they will soon be gone.
d.
Ask to care for different patients.
22. What should be the primary nursing goal when caring for a patient who is experiencing
dysfunctional grieving?
a.
Enhancement of self-esteem
b.
Resolution of grief
c.
Provision of safety measures
d.
Prevention of complications
23. A patient who has been diagnosed with a terminal illness is crying when a nurse enters the
room. The patient states, “I promised God that I would be a better person if He will just let me
get over this disease.” What stage of grieving according to Kübler-Ross should the nurse
recognize this as?
a.
Denial
b.
Anger
c.
Bargaining
d.
Depression
24. According to Rando’s phases of grief responses, what phase is a patient in who is beginning
emotional healing and learning to deal with his or her loss?
a.
Avoidance
b.
Confrontation
c.
Accommodation
d.
Depression
25. A dying 10-year-old boy tells a nurse, “I am going to leave and live with my grandpa in
heaven.” How should the nurse interpret this child is feeling?
a.
Fearful of death
b.
Accepting his own death based on adult attitudes
c.
Experiencing death anxiety
d.
Expressing anger
26. A 16-year-old boy who is positive for the human immunodeficiency virus (HIV) confesses to
the school nurse that he sneaks out of his home at night and rides his motorcycle at high rates
of speed. How should the nurse interpret this behavior?
a.
An attempt at manipulation
b.
Striving for identity
c.
Defiance of impending death
d.
A normal teenage prank
MULTIPLE RESPONSE
27. What is the focus of the provision of palliative care? (Select all that apply.)
a.
Care and not cure
b.
Service only in the hospital
c.
Environment for a pain-free death
d.
Psychologic support to the patient
e.
Psychologic support to the family
28. A nurse assesses a Protestant ethic is in place with a family of a dying patient. Taking this into
consideration what feelings should the nurse be sure to respect? (Select all that apply.)
a.
Independence
b.
Privacy
c.
Open expressions of grief
d.
Repression of feelings
e.
Toughing it out
29. A nurse counsels the family of a 6-year-old child experiencing the death of his grandfather not
to shield the child from the grandfather’s death. What feelings might this child develop if
protected from the pain of bereavement? (Select all that apply.)
a.
Fear
b.
Anger
c.
Abandonment
d.
Blame
e.
Inability to express feelings
30. How is death frequently viewed in American society? (Select all that apply.)
a.
Integral part of life
b.
Natural
c.
Negative
d.
Spiritually positive
e.
Unacceptable
31. What preferences does the document “Five Wishes” help a dying person communicate to the
family? (Select all that apply.)
a.
Who should make decisions
b.
What medical treatment will be acceptable
c.
How to distribute assets such as real estate
d.
Degree of comfort desired
e.
How they wish to be treated
COMPLETION
32. When the family of a dying person does not discuss the issue of death openly and avoids the
subject of dying altogether, the nurse recognizes this behavior representative of the _____
stage described by Straus and Glaser.