LeMone & Burke's Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)

Chapter 5 Palliative and End-of-Life Care

1) The family member of a terminally ill patient wants to donate a million dollars to the hospital if the patient can be cured. In which stage of Kübler-Ross's stages of loss is the family member demonstrating?

1. Bargaining

2. Denial

3. Anger

4. Acceptance

Page Ref: 110

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.C.7. Recognize personally held values and beliefs about the management of pain or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

2) A patient whose spouse died a year ago is starting a new job and plans to move to a new community. In which stage of Bowlby's theory of attachment is this patient demonstrating?

1. Detachment

2. Protest

3. Despair

4. Anger

Page Ref: 109

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

3) A patient has decided to join a support group for surviving spouses of victims of violent crime. According to Engel's theory of grief and loss, in which stage is this patient?

1. Restitution

2. Acute grief

3. Shock and disbelief

4. Denial

Page Ref: 109

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

4) A 30-year-old terminally ill patient is concerned about how her 7-year-old child will perceive her death. What advice from the nurse would be most beneficial?

1. Children of this age recognize that death is permanent.

2. Children of this age emotionally distance themselves from the death.

3. Because the child fears separation, the patient can prepare the child by explaining that death is permanent.

4. Children of this age think death is sleeping.

Page Ref: 110

Cognitive Level: Applying

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

5) A patient says that her estranged spouse died a little over a year ago and states, "I am not sure why this is so difficult. I really couldn't stand him near the end." Which response by the nurse is most appropriate?

1. "Sometimes a rocky relationship with someone at the time of their death can affect your ability to grieve."

2. "You seem angry."

3. "You should contact a therapist."

4. "You are just entering the grief process. Things will get better."

Page Ref: 111

Cognitive Level: Applying

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

6) A terminally ill patient is demonstrating signs of spiritual distress. Which should the nurse do first to assist this patient?

1. Use the FICA assessment.

2. Help the patient with guided imagery.

3. Offer to pray with the patient.

4. Leave the patient alone.

Page Ref: 112

Cognitive Level: Applying

Client Need & Sub: Psychosocial Integrity: Religious and Spiritual Influences on Health

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

7) After an unsuccessful resuscitation attempt, a patient dies. What should the nurse do first?

1. Document the time of death.

2. Notify the funeral home.

3. Contact the physician.

4. Contact the orderly for transport to the morgue.

Page Ref: 118

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 4. Recognize the legal and ethical considerations involved in providing palliative care and care at end-of-life.

8) A terminally ill patient is experiencing secretions pooling in the back of the throat. What can the nurse do to help this patient feel more comfortable?

1. Raise the head of the bed.

2. Gently massage the patient.

3. Provide frequent small sips of fluids.

4. Provide oral care.

Page Ref: 117

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Quality & Safety; Knowledge; Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

9) A terminally ill patient experiencing dyspnea reports a feeling of suffocation. What can the nurse do to assist this patient?

1. Keep the room cool with a slight breeze.

2. Increase the heat in the room.

3. Provide additional intravenous fluids.

4. Assist the patient to a sitting position out of bed.

Page Ref: 117

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Quality & Safety; Knowledge; Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

10) A terminally ill patient nearing end of life is dehydrated and complains of being thirsty. What can the nurse do to make the patient more comfortable?

1. Provide oral care every 2 hours.

2. Increase intravenous fluids.

3. Raise the head of the bed.

4. Begin enteral feedings.

Page Ref: 118

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Quality & Safety; Knowledge; Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

11) A competent older adult patient has a living will stating that resuscitation and heroic life support measures are to be avoided even though family members are not supportive of this directive. Which action by the nurse is the most appropriate?

1. Place the document on the chart.

2. Contact the Social Services department.

3. Notify the hospital attorney.

4. Explain to the patient that the conflict could invalidate the document.

Page Ref: 116

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 4. Recognize the legal and ethical considerations involved in providing palliative care and care at end-of-life.

12) At the time of admission, a patient with a terminal illness appoints an adult daughter to make health-related decisions if the patient becomes incapacitated. What should the nurse realize this patient is specifically describing?

1. Healthcare surrogate

2. Living will

3. Durable power of attorney

4. Advance directive

Page Ref: 116

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 4. Recognize the legal and ethical considerations involved in providing palliative care and care at end-of-life.

13) A terminally ill patient and the family agree that the physician will write a do-not-resuscitate order for the patient. What should the nurse implement when following this order?

1. Do not call a code if the patient stops breathing or the heart stops beating.

2. Call a code only if the patient stops breathing.

3. Call a code only if the patient's heart stops beating.

4. Withhold food and fluids but provide pain medication.

Page Ref: 116

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 4. Recognize the legal and ethical considerations involved in providing palliative care and care at end-of-life.

14) A terminally ill patient who does not have an advance directive or do-not-resuscitate order in place stops breathing. What should the nurse do to assist this patient?

1. Call a code.

2. Initiate a slow code.

3. Contact the physician to assess the patient for death.

4. Contact the nursing supervisor.

Page Ref: 116

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 4. Recognize the legal and ethical considerations involved in providing palliative care and care at end-of-life.

15) A terminally ill patient is receiving palliative care. What type of care should the nurse anticipate this patient will receive?

1. Alleviating suffering and enhancing quality of life.

2. Reducing pain and preventing medical complications.

3. Controlling side effects of illness while postponing death.

4. Withdrawing all medical care to allow natural death.

Page Ref: 113

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.2 Explain the concept of palliative care and the nurse's role in care of the patient and family.

MNL Learning Outcome: 2. Integrate collaborative interventions to manage and improve outcomes for the patient in palliative care and care at end-of-life.

16) A patient asks the nurse what it means to have hospice care at home. What should the nurse respond to this patient?

1. "Hospice makes sure that you are comfortable at home."

2. "Hospice care helps cure your illness."

3. "Hospice care is for patients who will be sick for longer than a year."

4. "Hospice care means your physical needs will be met."

Page Ref: 115

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

17) A patient receiving palliative care for a chronic illness asks the nurse if the new medication is going to cure the disease. Which is the nurse's best response?

1. "It will help you be more comfortable. I don't think it's going to cure the disease."

2. "Of course it's going to cure the disease."

3. "If you believe it will cure the disease, then it will."

4. "I don't think it's going to help or hurt at this time."

Page Ref: 113

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.2 Explain the concept of palliative care and the nurse's role in care of the patient and family.

MNL Learning Outcome: 2. Integrate collaborative interventions to manage and improve outcomes for the patient in palliative care and care at end-of-life.

18) A patient is explaining experiences after the sudden death of a family member a few years ago. If Elizabeth Kübler-Ross's sequence is applied, in which order did the patient experience the stages of death and dying? Rank the patient's statements in the order they would have been made. Place in order the steps of the process.

Choice 1. "I have to admit I tried to make a deal with God."

Choice 2. "I'm going to try to use my experience to help other people."

Choice 3. "I cannot get my mind around it. I still keep waiting for them to come home."

Choice 4. "I can hardly get out of bed because I just want to sleep."

Choice 5. "I just feel so angry that I was left."

Page Ref: 110

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.C.7. Recognize personally held values and beliefs about the management of pain or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

19) A patient who is nearing death from a terminal illness is experiencing secretions in the back of the throat and dyspnea. Which medication should the nurse provide to assist this patient? Select all that apply.

1. Oxygen

2. Morphine

3. Atropine

4. Scopolamine

5. Demerol

Page Ref: 122

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

20) The family of a patient who is nearing death has insisted on intravenous fluids. Which finding should the nurse expect when assessing this patient? Select all that apply.

1. Inspiratory and expiratory crackles in all lung fields.

2. Increasing edema in the patient's ankles and feet bilaterally.

3. Ascites.

4. Weight loss of 6 pounds from last week.

5. Vomited three times during the previous shift.

Page Ref: 118

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

21) A patient of Mexican American descent is dying. Which statements by the patient's only son are expected? Select all that apply.

1. "We have already notified our priest about Dad's condition."

2. "When the time of death gets closer, we would like him transferred to the inpatient hospice unit at the hospital."

3. "My sister is pregnant, so she really can't help with his care."

4. "My family members will be here at the house a lot right now."

5. "We don't want to worry him, so if there is any change in his condition, please talk to me about it."

Page Ref: 113

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Cultural Awareness/Cultural Influences on Health

Standards: QSEN Competencies: I.C.6. Willingly support patient-centered care for individuals and groups whose values differ from own | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

22) A patient diagnosed with testicular cancer does not believe he has cancer. The nurse realizes that the patient may be progressing through the stages of grief. Place in order the stages of grief.

Choice 1. Depression

Choice 2. Acceptance

Choice 3. Anger

Choice 4. Denial

Choice 5. Bargaining

Page Ref: 110

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.C.7. Recognize personally held values and beliefs about the management of pain or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

23) The nurse suspects a patient is in the final stages of the dying process. What manifestation did the nurse assess in this patient? Select all that apply.

1. Change in level of consciousness

2. Sudden increase in taste and smell

3. Urinary incontinence

4. Increased blood pressure

5. Irregular heart rate

Page Ref: 117

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Quality & Safety; Knowledge; Current Best Practices | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

24) A patient diagnosed with terminal cancer learns about a living will. Which patient statement indicates that additional teaching is required? Select all that apply.

1. "A living will is a document in which I designate someone to make healthcare-related decisions for me in the event I become unconscious."

2. "A living will is a document in which I designate someone to make healthcare and legal decisions for me in the event I become unconscious."

3. "A living will is a document in which I designate my personal wishes and which directions to follow in the event I become unconscious."

4. "A living will is a document in which I designate which directions to follow in the event I become unconscious, but the directions can be modified by my family."

5. "A living will is a document in which my family designates someone to make decisions for me in the event I become unconscious."

Page Ref: 116

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 4. Recognize the legal and ethical considerations involved in providing palliative care and care at end-of-life.

25) The nurse is instructing others on the use of hospice care. Which statements would indicate to the nurse that the teaching session has been effective? Select all that apply.

1. "Hospice care is designed for individuals with a terminal prognosis who cannot stay at the hospital."

2. "Hospice care is designed for individuals with a terminal prognosis who decide to spend their final days at home with their families."

3. "Hospice care is designed for individuals with a terminal prognosis who decide to stay in the hospital for symptom management."

4. "Hospice care is designed for individuals with a terminal prognosis who have to go into a hospice center for proper symptom management."

5. "Hospice care is designed for individuals with a terminal prognosis who decide to receive treatment for their symptoms at home, the hospital, or the hospice center."

Page Ref: 115

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Quality & Safety; Knowledge; Current Best Practices | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

26) A young adult male patient diagnosed with terminal pancreatic cancer believes that if his hair grows, God will cure him. What should the nurse realize this patient is demonstrating? Select all that apply.

1. The patient is having delusions and is using religious beliefs to block his loss.

2. The patient is bargaining and is postponing his loss.

3. The patient is in denial, and his religious beliefs block his loss.

4. The patient is normal; bargaining with God for physical healing reflects a stage of grieving.

5. The patient is feeling anger and is using his religious beliefs to project his loss.

Page Ref: 110

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.C.7. Recognize personally held values and beliefs about the management of pain or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

27) A patient who had a below-the-knee amputation 2 months ago is seen walking with a new limb prosthesis and returning to work. What does the nurse realize about this patient?

1. The patient has completed the work of mourning the loss of the leg.

2. The patient is having difficulty with grief.

3. The patient is in denial.

4. The patient is forgetting about the disease that caused the loss of the limb.

Page Ref: 109

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

28) A patient whose spouse has died asks how long it will take to feel like living again. Which stages of Bowlby's grieving process does this patient have to work through? Select all that apply.

1. Denial

2. Despair

3. Detachment

4. Protest

5. Restitution

Page Ref: 109

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

29) The spouse of a former patient reports joining a support group to help with the loss of the patient. Which phase of Engel's grief process is the spouse demonstrating?

1. Acute

2. Restitution

3. Long-term

4. Resolution

Page Ref: 109

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

30) A patient getting a divorce is concerned about managing financially and emotionally. Which aspect of Caplan's stress and loss theory is this patient demonstrating?

1. Living without the assets and guidance

2. Psychic pain

3. Reduced problem-solving ability

4. Emotional turmoil

Page Ref: 109

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

31) A patient tells the nurse, "My husband left me to be with God." What should the nurse realize this patient is demonstrating?

1. Coping

2. Denial

3. A regional difference in the way death is expressed

4. A cultural rite related to death

Page Ref: 111

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Religious and Spiritual Influences on Health

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

32) The nurse is assessing a dying patient's spiritual beliefs about death. Which acronym represents topics the nurse can use to help with this assessment process?

1. ABC

2. FICA

3. DABDA

4. RACE

Page Ref: 112

Cognitive Level: Applying

Client Need & Sub: Psychosocial Integrity: Religious and Spiritual Influences on Health

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

33) A patient states, "My husband is the person you should talk with if I am not able to make decisions about my care." What should the nurse realize the spouse has been designated to be?

1. The person who has the patient's living will

2. The healthcare surrogate

3. The person with the durable power of attorney

4. Nothing more than the spouse

Page Ref: 116

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 4. Recognize the legal and ethical considerations involved in providing palliative care and care at end-of-life.

34) The family of a dying patient wants to help relieve the patient's progressive dyspnea. What should the nurse instruct the family to do for the patient?

1. Lower the head of the bed.

2. Raise the head of the bed.

3. Suction the patient as much as possible.

4. Perform chest physiotherapy.

Page Ref: 117

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Quality & Safety; Knowledge; Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

35) The family thinks a dying patient is in pain because of constant moaning. What should the nurse realize this family is doing?

1. Overreacting.

2. Asking for more pain medication for the patient.

3. Not understanding that moaning can be agitation in the patient.

4. Considering moaning to be a sign the patient is recovering.

Page Ref: 118

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Quality & Safety; Knowledge; Current best practices | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

36) A dying patient does not want family members to leave. What should the nurse realize this patient is demonstrating?

1. Fear of dying alone.

2. The anticipation of improving in health.

3. The need for the family to see the patient improve.

4. The desire to prolong life.

Page Ref: 118

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: End of Life Care

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

37) The nurse who provided care to a terminally ill patient does not want to spend any time with the grieving family and begins to provide care to another patient. What is this nurse demonstrating?

1. Empathy

2. Apathy

3. Over-emotionality

4. Blunting

Page Ref: 119

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Coping Mechanisms

Standards: QSEN Competencies: I.C.7. Recognize personally held values and beliefs about the management of pain or suffering | AACN Essentials Competencies: VIII.7. Identify personal, professional and environmental risks that impact personal and professional choices and behaviors | NLN Competencies: Context and Environment; Ethical Comportment; Examine personal beliefs, values, and biases with regard to respect for persons, human dignity, equality, and justice; explore ideas of nurse caring and compassion. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

38) A patient who has recently lost a spouse is unable to cry. What should the nurse realize this patient is at risk for developing?

1. Psychological issues

2. Depression

3. Over-emotionality

4. Somatic symptoms

Page Ref: 120

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

39) A preoperative patient says, "I hope I wake up after surgery. I don't know what my family would do if I didn't." Which potential issue is this patient demonstrating?

1. Coping

2. Chronic sorrow

3. Anticipatory grieving

4. Death anxiety

Page Ref: 109

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 5.1 Differentiate theories of loss and grief and outline factors affecting responses to loss.

MNL Learning Outcome: 1. Consider theories and factors related to loss and grief.

40) A patient with a terminal illness plans to take an overdose of pain medication and end it all. How should the nurse respond to this patient's plan? Select all that apply.

1. "Do you have a living will?"

2. "Have you assigned durable power of attorney to anyone?"

3. "Have you considered a healthcare surrogate?"

4. "Have you researched methods for self-euthanasia?"

5. "Have you talked with your healthcare provider about orders for life-sustaining treatment?"

Page Ref: 116

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 4. Recognize the legal and ethical considerations involved in providing palliative care and care at end-of-life.

41) A patient who is nearing the end of life is irritable and uncomfortable in bed. Which action should the nurse take to make the patient more comfortable? Select all that apply.

1. Raise the head of the bed.

2. Apply bed pads over the linens.

3. Gently massage the extremities.

4. Reduce the amount of pain medication.

5. Use a draw sheet to turn the patient.

Page Ref: 117

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Quality & Safety; Knowledge; Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

42) A patient with a terminal illness is experiencing severe nausea and vomiting. Which medication should the nurse consider appropriate for the patient at this time? Select all that apply.

1. Furosemide (Lasix)

2. Ondansetron (Zofran)

3. Meperidine (Demerol)

4. Morphine sulfate (Morphine)

5. Prochlorperazine (Compazine)

Page Ref: 118

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: QSEN Competencies: I.B.6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Quality & Safety; Knowledge; Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.

43) During a home visit, the nurse determines that a patient whose spouse died 10 months ago is demonstrating signs of grief resolution. What did the nurse assess to come to this conclusion? Select all that apply.

1. Not living in the past

2. Breaking ties with the lost person

3. Asking for help to end the pain of the loss

4. Experiencing waves of sadness when looking at a picture

5. Wishing that death had occurred at the same time the spouse died

Page Ref: 123

Cognitive Level: Analyzing

Client Need & Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.3 Outline the legal, ethical, and physiologic issues encountered when caring for the dying patient.

MNL Learning Outcome: 3. Utilize the nursing process in the care of the patient receiving palliative care and care at the end-of-life.