Chapter 24: Loss, Death, and End-of-Life Care Nursing School Test Banks

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
ANS: B
The body should be placed in the supine position, with the arms at the sides or with the hands across the abdomen.

DIF: Cognitive Level: Knowledge REF: p. 377-378 OBJ: 1
TOP: Positioning after Death KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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
ANS: D
Strauss and Glaser have identified three states of awareness: closed awareness, mutual pretense, and open awareness.

DIF: Cognitive Level: Knowledge REF: p. 378 OBJ: 2
TOP: Awareness of Terminal Illness KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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.
ANS: B
Pain control must be consistent to provide constant relief rather than waiting until the pain is unbearable and then trying to relieve it. Addiction to narcotics is of little concern.

DIF: Cognitive Level: Application REF: p. 372-373 OBJ: 5
TOP: Pain Control KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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
ANS: A
The simple presence of someone provides support and comfort. Neither words nor actions are necessary unless the patient requires something. Holding hands, touching, and listening are quality nursing responses.

DIF: Cognitive Level: Application REF: p. 373 OBJ: 5
TOP: Fear of Loneliness KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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 patients respirations?
a. Deep, clear breath sounds
b. Noisy, wet-sounding respirations
c. Even, unlabored respirations
d. Shallow, clear breath sounds
ANS: B
Breathing may sound wet and noisy. Noisy, wet-sounding respirations, termed the death rattle, are a response based on mouth breathing and accumulation of mucus in the upper airways.

DIF: Cognitive Level: Comprehension REF: p. 373 OBJ: 2
TOP: Respiratory Changes KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. What is believed to be the last sense to remain intact during the death process?
a. Touch
b. Sight
c. Smell
d. Hearing
ANS: D
Hearing is commonly believed to be the last sense to remain intact during the death process.

DIF: Cognitive Level: Knowledge REF: p. 373 OBJ: 4
TOP: Sensory Changes KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. A patients 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.
ANS: B
The body gradually relaxes until all functions end. The respirations cease first, and then the heart stops beating within a few minutes.

DIF: Cognitive Level: Comprehension REF: p. 373 OBJ: 2
TOP: Death Process KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. While a nurse bathes a patient, he says, Why are you giving me a bath? Im going to die no matter what. What should be the nurses most appropriate response?
a. A bath will make you feel better.
b. Would you like to talk about how you are feeling?
c. Dont you want your bath today?
d. I can give you some medicine to make you feel better.
ANS: B
Anger is a common and normal response to grief. Therapeutic communication should focus on the patients feelings.

DIF: Cognitive Level: Comprehension REF: p. 370-371 | p. 376
OBJ: 2 TOP: Anger KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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 Martocchios clusters of grief?
a. Shock and disbelief
b. Yearning and protest
c. Anguish, disorganization, and despair
d. Identification in bereavement
ANS: B
Martocchios clusters of grief identify yearning and protest as anger directed toward God, health care providers, and survivors, as well as toward even the deceased for dying.

DIF: Cognitive Level: Knowledge REF: p. 371 OBJ: 2
TOP: Martocchios Clusters of Grief KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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 Kbler-Ross?
a. Denial
b. Anger
c. Bargaining
d. Depression
ANS: A
Kbler-Ross identifies denial as the person refusing to acknowledge the impending loss.

DIF: Cognitive Level: Knowledge REF: p. 370-371 OBJ: 2
TOP: Kbler-Ross Stages of Grief KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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 patients record to see whether the physician has written an order for the patient to have organs donated.
d. Notify the physician of the familys wishes.
ANS: D
The physician should be notified immediately because some tissues must be harvested within hours after death. The decision to donate organs may be made by the patient or immediate family.

DIF: Cognitive Level: Application REF: p. 378 OBJ: 7
TOP: Organ Donation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

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 persons 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.
ANS: B
Written information concerning a patients rights to accept or refuse treatment must be provided to the patient. Advance directives are written statements of a persons wishes regarding medical care.

DIF: Cognitive Level: Application REF: p. 378 OBJ: 7
TOP: Cardiopulmonary Resuscitation KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

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.
ANS: A
A chemical code involves the use of medications for resuscitation without the use of CPR.

DIF: Cognitive Level: Knowledge REF: p. 378 OBJ: 7
TOP: Chemical Code KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

14. A nurse is caring for a patient who is terminally ill whose religion is Orthodox Jew. This patients physicians 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.
ANS: A
Only designated Orthodox Jewish persons or a Jewish burial service may care for the body. The dying person is not left alone. The body is not left alone between death and burial, which must occur within 24 hours. The body is not to be touched for up to 30 minutes after death.

DIF: Cognitive Level: Comprehension REF: p. 377 OBJ: 1
TOP: Cultural Considerations KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

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
ANS: C
Uncomplicated grief assists the person in accepting the reality of death.

DIF: Cognitive Level: Knowledge REF: p. 369 OBJ: 2
TOP: Grief KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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.
ANS: C
Under law, in most states, an autopsy is required if a person expires by suicide, homicide, within 24 hours of admission to a health care facility, or from unknown causes.

DIF: Cognitive Level: Comprehension REF: p. 377 OBJ: 7
TOP: Autopsy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

17. A nurse is preparing a patients body after death and discovers that the patients 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.
ANS: A
Dentures may be inserted gently to maintain the normal facial appearance. If the dentures cannot be inserted easily, do not force them.

DIF: Cognitive Level: Application REF: p. 377 OBJ: 7
TOP: Body Preparation KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

18. A patient who is terminally ill asks a nurse what is meant by a medical power of attorney. What is the nurses 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.
ANS: D
A medical power of attorney allows someone other than the patient to make medical decisions for the patient only if the person is incapable of making decisions as certified by the physician.

DIF: Cognitive Level: Knowledge REF: p. 380 OBJ: 7
TOP: Medical Power of Attorney KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

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
ANS: B
The Omnibus Reconciliation Act requires that all institutions that participate with Medicare must provide written information to patients concerning their rights to accept or refuse treatment.

DIF: Cognitive Level: Knowledge REF: p. 378 OBJ: 7
TOP: Omnibus Reconciliation Act KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

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
ANS: B
Being sensitive and not imposing repeated and unnecessary assessments on the dying patient are important.

DIF: Cognitive Level: Comprehension REF: p. 375 OBJ: 5
TOP: Assessment of the Dying Patient KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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.
ANS: B
The basic recognition of the nurses feelings allows openness with the patient and the family.

DIF: Cognitive Level: Application REF: p. 377-378 OBJ: 6
TOP: Caregiver Response KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A

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
ANS: B
Dysfunctional grief is disruptive to a persons typical lifestyle and must be resolved.

DIF: Cognitive Level: Comprehension REF: p. 370 OBJ: 4
TOP: Dysfunctional Grief KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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 Kbler-Ross should the nurse recognize this as?
a. Denial
b. Anger
c. Bargaining
d. Depression
ANS: C
In the bargaining stage, the person wishes for more time to avoid the loss. The patient may express feelings that the loss is occurring as a punishment for past actions and may try to bargain with a higher power to gain time.

DIF: Cognitive Level: Knowledge REF: p. 371 OBJ: 2
TOP: Kbler-Ross Stages of Grief KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

24. According to Randos 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
ANS: C
In the accommodation phase, emotional healing is beginning, the intensity of grief is gradually subsiding, and the person is learning to deal with the loss.

DIF: Cognitive Level: Comprehension REF: p. 371 OBJ: 2
TOP: Randos Grief Responses KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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
ANS: B
A 10- to 12-year-old child accepts death based on adult attitudes.

DIF: Cognitive Level: Analysis REF: p. 370 OBJ: 2
TOP: Childs View of Death KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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
ANS: C
Teenagers between the ages of 13 and 18 years may act out with dangerous or risky behavior in defiance of death.

DIF: Cognitive Level: Analysis REF: p. 371 OBJ: 2
TOP: Defiant Behavior KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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
ANS: A, C, D, E
The concept of palliative care is to provide a painless death and psychologic support to the patient and family. Care outside of the hospital is provided by nurses from a hospice service that come into the home.

DIF: Cognitive Level: Comprehension REF: p. 368 OBJ: 4
TOP: Palliative Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

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
ANS: A, B, D, E
The Protestant ethic dictates that the persons be strong, private, and show a stoic front. Privacy of the event and their feelings are important.

DIF: Cognitive Level: Knowledge REF: p. 370 OBJ: 1
TOP: Protestant Grief Ethic KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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 grandfathers 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
ANS: A, C, E
Small children who are protected from the grief of the death of a loved one frequently develop feelings of fear and abandonment. They frequently regress to a younger level of developmental behavior and feel an inability to express their feelings.

DIF: Cognitive Level: Knowledge REF: p. 370 OBJ: 2
TOP: Childs Bereavement KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

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
ANS: C, E
Americans essentially view death and impending death as an event that is negative and unacceptable to their values of preservation of health and prolonging life.

DIF: Cognitive Level: Knowledge REF: p. 369 OBJ: 1
TOP: American Concept of Death KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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
ANS: A, B, D, E
The document Five Wishes does not act in the place of a will, but it is recognized as a patients advance directives.

DIF: Cognitive Level: Knowledge REF: p. 382 OBJ: 2
TOP: Five Wishes KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

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.

ANS:
mutual pretense
The process of mutual pretense occurs with the family and the dying patient denying the approaching death and avoids any discussion about it.

DIF: Cognitive Level: Comprehension REF: p. 372 OBJ: 2
TOP: Strauss and Glasers Phases KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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