Chapter 15 Loss, Grief, and End-of-Life Care

Chapter 15  Loss, Grief, and End-of-Life Care

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. A 33-year-old patient has been told that her disease is terminal. The patient is crying and states, “I will just be a dependent drain on my family. I hate being a burden to them.” The nurse can best respond:
a.
“Is there any reason to tell your family about this now? You still have some time in which you can enjoy life.”
b.
“You have heard some very bad news today. Can you describe what you mean by burden?”
c.
“I doubt that your loving family will view your terminal care as a burden.”
d.
“I know. I would feel terrible if I had been told I was dying.”

ANS: B
A person’s reaction to a loss is influenced by the importance of what that person perceives the loss entails. To help the patient validate what the loss means is therapeutic.

DIF: Cognitive Level: Application REF: p. 200 OBJ: Clinical Practice #2
TOP: Value and Loss KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

2. A patient tells the nurse during an admission interview that his wife “went on to her reward.” The nurse assesses that this statement is an indication that the patient:
a.
has a strong religious belief system.
b.
has dysfunctional grieving and is unable to address his wife’s death.
c.
is uncomfortable with the term “death” and is using a euphemism.
d.
is no longer grieving the death of his wife.

ANS: C
In many societies there is avoidance of using words such as “died” or “death,” and euphemisms are commonly used.

DIF: Cognitive Level: Analysis REF: p. 199 OBJ: Theory #1
TOP: Societal Views of Death KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

3. A neighbor who was widowed 2 months ago gives the nurse his wife Helen’s gardening books “because the two of you loved flowers.” He tries to hold back tears, but begins to cry. To decrease his discomfort, the nurse should say:
a.
“We certainly did, and I’m going to miss her help—she was a real expert.”
b.
“Helen wouldn’t want to see you crying—she would rather you smile and remember the good times,” and give him a hug.
c.
“Things will get easier with time. Time has a way of healing even the most painful losses.”
d.
“Helen is in a better place; you should be glad she isn’t suffering anymore.”

ANS: A
Sharing the feeling of loss is appropriate and supportive and recognizes the loss of the grieving husband.

DIF: Cognitive Level: Application REF: p. 200 OBJ: Clinical Practice #2
TOP: Therapeutic Communication KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

4. A terminally ill patient and his family have requested hospice care. The nurse clarifies hospice care philosophy as:
a.
helping the patient dies easily and quickly at home.
b.
focusing on symptom management and comfort care.
c.
excluding hospital care.
d.
supporting assisted suicide if that is the patient’s wish.

ANS: B
The primary goal of hospice and palliative care is to improve quality of life, alleviate suffering, and improve end-of-life experience for the patients and their loved ones.

DIF: Cognitive Level: Comprehension REF: p. 201 OBJ: Theory #2
TOP: Hospice KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

5. A terminally ill patient is angry and belligerent. He yells at the nurses and his family for not coming quickly enough when he calls, and he states that he isn’t receiving the care he needs. The nurse’s most informative response would be:
a.
“Don’t let him get away with this abuse. He doesn’t need to yell at you.”
b.
“This may be how he feels best in dealing with this illness. You’ll just have to ignore it.”
c.
“I’m afraid he is having a bad day and feels neglected.”
d.
“Anger is a reaction that dying people experience. You may be feeling some anger yourselves.”

ANS: D
Anger is one of the stages terminally ill patients and their caregivers may experience. It may be prolonged, or it may be a passing stage or one that is returned to in the course of the final illness. Reacting with anger or just passively ignoring it does not assist the patient in dealing with his feelings.

DIF: Cognitive Level: Analysis REF: p. 201|Table 15-1
OBJ: Theory #1 TOP: Anger Phase KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation