Chapter 15

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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:

―You have heard some very bad news today. Can you describe what you mean by burden?

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:

is uncomfortable with the term ―death‖ and is using a euphemism.

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:

―We certainly did, and I‘m going to miss her help—she was a real expert.

A terminally ill patient and his family have requested hospice care. The nurse clarifies hospice care philosophy as:

focusing on symptom management and comfort care.

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:

―Anger is a reaction that dying people experience. You may be feeling some anger yourselves.

A patient who was admitted to hospice for comfort care of end-stage respiratory disease is asked what his hope is for his remaining life. He says, ―I‘m hoping for a miracle—that I will wake up one of these mornings and be able to breathe like when I was 20. The nurse would best respond:

―Your miracle may be in the form of medication that will improve your comfort.

An oncologist has recommended that a hospice patient receives palliative radiation to reduce the pain of bony metastases. The patient reacts with anger, saying, ―I don‘t want any more treatments that don‘t cure my cancer! The hospice nurse tells the patient that the use of radiation:

of this type is not curative and is part of hospice care.

A patient admitted to the nursing home for terminal care is determined that he should not receive extraordinary measures such as resuscitation or the use of a ventilator if he stops breathing, or intravenous (IV) fluids or a feeding tube if he is unable to eat or drink. The nurse explains that these desires can best be honored by:

filing an advance directive with the health care facility.

The nurse is aware that in order to provide effective support to grieving patients and families, the nurse must:

solidify his or her own view of death.

The patient in hospice care says to the hospice nurse, ―I want you to read my obituary that I just wrote.‖ The nurse assesses that this patient is in the Satir Blevins (2008) stage of:

practice.

The nurse can assess Cheyne-Stokes respiration by its characteristics of respirations that are:

shallow followed by periods of apnea.

When a patient admitted for terminal care is asked by the admitting nurse, ―What has your doctor told you about your illness?‖ the patient states, ―She says that I have a terminal illness, but I know she‘s wrong.‖ The nurse recognizes that:

the patient is in denial and is unable to consciously admit what he has been told by the doctor.

A terminal patient asks the nurse if he could be given a deliberate overdose of medication that would ―end this.‖ According to the Code for Nurses, the nurse‘s most ethical response would be:

―I cannot ethically give you a deliberate overdose.

A patient who is terminally ill hasNbUeReSnINunGaTbBle.CtOoMmaintain good nutrition because of nausea and anorexia and has lost a great deal of weight. He is now unable to change his position in bed and needs frequent perineal care because of urinary incontinence. The nurse planning his care would include in the plan of care to:

provide him with an air pressure mattress.

A terminal patient in a skilled nursing home has stated that he does not want to get out of bed, because he is too tired and weak to sit in a chair. He sleeps on and off all day and night, his position is changed every 2 hours, and he is comfortable on his pain regimen. The next day the nurse will:

assess his strength and desire to get out of bed, but permit him to remain in bed if he chooses, because that is his position of comfort.

A hospice patient is unable to tolerate food or fluids and has advance directives that indicate that he does not want IV fluids or tube feedings if he is unable to take oral feedings. His family is concerned that he will be very uncomfortable without food or fluids. The nurse should tell them that:

IV fluids or tube feeding would likely make the patient more uncomfortable, and dehydration has been shown to decrease pain and discomfort.

To help the family deal with the delirium of their dying relative, the nurse can suggest that they should:

talk to the patient in quiet tones.

After a patient death, the nurse is preparing to perform postmortem care. The body is placed supine with the head raised so that:

blood will not pool in the face and cause discoloration.

The loved ones of a young man, who is in the intensive care unit on life support after suffering irreversible brain damage resulting from a motorcycle accident, have been approached by the organ transplant team to consider organ donation. When they ask the nurse about this process, the nurse‘s best response would be:

―Often families are comforted by the knowledge that some good came from this tragedy.

A terminally ill patient is experiencing a great deal of dyspnea and noisy, ―rattling, rapid respirations. The nurse administers morphine in a very small liquid or intramuscular dose. The purpose of this is to:

decrease respiratory rate and relieve dyspnea.

When the patient says, ―I can die happily if I can live long enough to see my first grandchild that will be born next month.‖ The nurse assesses that this patient is experiencing Kübler Ross‘s stage of:

bargaining.

When the nurse notes an increase in the level of daily function in the terminal patient, the nurse assesses that this patient has reached Kübler Ross‘s level of:

acceptance.

When the parents of a child who is on life support ask what indicates brain death, the nurse responds that brain death occurs when:

there is an absence of EEG waves.

The culturally sensitive nurse would delay a discussion relative to a patient‘s terminal illness if that patient were a:

35-year-old Mexican American farm laborer.

The nurse caring for a terminally ill patient with renal failure would question an order for pain control that prescribed:

meperidine.

During the dying process, patients may experience a bad taste in their mouth. Which of the following are appropriate nursing actions? (Select all that apply.)

Offer the patient hard candy., Assist the patient with frequent oral care., Offer the patient mouthwash.

A coroner is required to investigate death in which of the following situations? (Select all that apply.)

Deaths from injury, Suspected suicides, Deaths of persons not under the care of a primary care provider

The nurse discusses the grief theory of Maciejewski, which outlines the stages of grief as including: (Select all that apply.)

yearning., anger., denial., depression

When a patient chooses to die by refusing treatment that would prolong life, it is called _________ .

passive euthanasia

The five stages identified by Dr. Elisabeth Kübler Ross are ____________, _____________, ____________, ____________, and _________.

denial; acceptance; anger; bargaining; depression

Individuals move through the stages of grief at their own pace. When a person is ―stuck‖ in a stage and cannot move forward, this is called ___________.

dysfunctional grieving

The nurse who adopts the Maciejewski theory of grief assesses for the reduction of grief after a period of ________ months.

six

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