G23: Diagnosis And Patient care! Trivia Quiz

1. State Death with Dignity Laws require that the terminally ill client be:

A. educated regarding treatment alternatives

B. over the age of 55

C. be supported in their decision by immediate family members

D. eligible for federal support services

ANS: A
The Death with Dignity Law legalizing a person’s right to end his or her life requires that persons must be informed of alternatives and counseling to insure that the person is fully informed regarding the risks of such actions. The remaining options are not criteria stated in the laws

Explanation

ANS: A
The Death with Dignity Law legalizing a person’s right to end his or her life requires that persons must be informed of alternatives and counseling to insure that the person is fully informed regarding the risks of such actions. The remaining options are not criteria stated in the laws

2. A 78-year-old patient who is dying of colon cancer with metastases to the liver is refusing to eat or drink. He is alert and oriented, and states that he has no desire to eat, which is causing the family great distress. In order to best address the client and family, the nurse:

A. Explain the family’s concern to the client

B. Educate the family that this is normal behavior in this situation

C. Contact the physician for an order for enteral feeding

D. Contact the dietitian for feeding supplements

ANS: B
The nurse should educate the family that this is a normal part of the dying process and should not pressure the client, contact the physician for enteral feeding, or contact the dietitian for feeding supplements. Because the patient is expressing a desire not to eat, his wishes should be honored. Essential to the facilitation of self-esteem is the premise that the values of the patient must figure significantly in the decisions that will affect the course of dying. Whenever possible, the nurse can have the person decide when to groom, eat, wake, sleep, and so on.

Explanation

ANS: B
The nurse should educate the family that this is a normal part of the dying process and should not pressure the client, contact the physician for enteral feeding, or contact the dietitian for feeding supplements. Because the patient is expressing a desire not to eat, his wishes should be honored. Essential to the facilitation of self-esteem is the premise that the values of the patient must figure significantly in the decisions that will affect the course of dying. Whenever possible, the nurse can have the person decide when to groom, eat, wake, sleep, and so on.

3. A woman is terminally ill. Although it has never been discussed in the family nor stated outright by her physician, she suspects that she will die because of her illness. Upon which concept will the nurse base therapeutic intervention on?

A. closed awareness

B. suspected awareness

C. mutual pretense.

D. open awareness.

ANS: B
In suspected awareness, the patient suspects that she is dying; however, it is never openly discussed. With closed awareness, the patient does not know that she is dying; it is kept secret. With mutual pretense, there is a “let’s pretend” atmosphere, where real feelings are kept hidden. Open awareness acknowledges the reality of the approaching death

Explanation

ANS: B
In suspected awareness, the patient suspects that she is dying; however, it is never openly discussed. With closed awareness, the patient does not know that she is dying; it is kept secret. With mutual pretense, there is a “let’s pretend” atmosphere, where real feelings are kept hidden. Open awareness acknowledges the reality of the approaching death

4. The nurse suspects that the spouse of a terminally ill client is experiencing anticipatory grief when they:

A. Dramatically reduce the time they spend attending to the client

B. Refuse to leave the client’s bedside regardless of the reason

C. Sob inconsolably whenever they visit

D. Spend hours recalling details of their life together

ANS: A
Anticipatory grief is the response to a real or perceived loss such as in anticipation of the death of a loved one. Behaviors that may signal anticipatory grief include a sudden change in attitude toward the thing or person to be lost. The other options are characteristics of normal grieving.

Explanation

ANS: A
Anticipatory grief is the response to a real or perceived loss such as in anticipation of the death of a loved one. Behaviors that may signal anticipatory grief include a sudden change in attitude toward the thing or person to be lost. The other options are characteristics of normal grieving.

5. Which truism will the nurse base spousal grief counseling upon?

A. Men are less likely to grieve the loss of a spouse

B. Women carry deeper attachments to their spouses than men do.

C. Women are generally more likely to outlive their spouses

D. The male response to grief has been thoroughly studied and documented

ANS: C
Three out of four women will be widowed at some point because women tend to live longer than men and frequently marry older men. There is no evidence that men grieve less than women; men and women grieve in different manners. It has not been found to be true that women carry attachments to their spouses that are less deep than men’s attachments. Male response to grief has not been studied as thoroughly as that of women; the abundance of literature on this topic deals with women.

Explanation

ANS: C
Three out of four women will be widowed at some point because women tend to live longer than men and frequently marry older men. There is no evidence that men grieve less than women; men and women grieve in different manners. It has not been found to be true that women carry attachments to their spouses that are less deep than men’s attachments. Male response to grief has not been studied as thoroughly as that of women; the abundance of literature on this topic deals with women.

6. What research finding is the basis for care planning of the client receiving palliative care?

A. Palliative care is most useful when implement in the last 6 months of life

B. Pain management is inadequately addressed among the terminally ill population.

C. Palliative care is only offered to patients whose deaths are imminent.

D. Resuscitation in the case of a cardiac or respiratory arrest is not implemented

ANS: B
Research has indicated that advance care planning and terminal pain management are inadequate and support of the grieving family may be nonexistent. No research supports that palliative care is most effective in any particular period of the death trajectory. There are no time limits placed on palliative care. A DNR is required in order to eliminate resuscitation efforts.

Explanation

ANS: B
Research has indicated that advance care planning and terminal pain management are inadequate and support of the grieving family may be nonexistent. No research supports that palliative care is most effective in any particular period of the death trajectory. There are no time limits placed on palliative care. A DNR is required in order to eliminate resuscitation efforts.

7. An important trait seen in a nurse who is effective in caring for the terminally ill is emotional maturity. Which statement by a nurse shows this maturity?

I cry for a client when I’m alone but never when I’m with them.”

My job is to create a ‘good death’ for my clients.”

C. “This is a stressful job and it isn’t something just any nurse can do.”

D. “My clients are the best part of this emotionally draining job.”

ANS: A
Emotional maturity requires that a nurse must be comfortable with their own lives or at least be able to set aside their own sadness and grief while working with that of others. The responsibility of a good death is not the nurse’s alone. Being able to effectively and compassionately care for a dying client and a grieving family while managing one’s own grief is vital.

Explanation

ANS: A
Emotional maturity requires that a nurse must be comfortable with their own lives or at least be able to set aside their own sadness and grief while working with that of others. The responsibility of a good death is not the nurse’s alone. Being able to effectively and compassionately care for a dying client and a grieving family while managing one’s own grief is vital.

8. When working with a bereaved individual, the goal of nursing interventions is to:

A. assist the individual to go through the stages of grief work in the optimal order

B. assist the individual to attain a healthy adjustment to the loss experience

C. encourage the individual to talk about his or her feelings about the deceased individual.

D. offer support and advice about how to successfully achieve grief work.

ANS: B
The goal of nursing interventions when working with bereaved individuals is to help them adjust in a healthy manner. There is no optimal order in which to experience grief. Not all individuals are able to talk about their feelings, nor is it helpful for everyone. The role of nursing is to offer support, but not advice.

Explanation

ANS: B
The goal of nursing interventions when working with bereaved individuals is to help them adjust in a healthy manner. There is no optimal order in which to experience grief. Not all individuals are able to talk about their feelings, nor is it helpful for everyone. The role of nursing is to offer support, but not advice.

9. Which behavior is characteristic of grief by a disenfranchised adult child in response to a parent's death following a lengthy, painful illness?

A. Crying out loudly while invoking “God’s help in going on with life.”

B. Announcing to family members that, “I’ve already grieved the loss.”

C. Having difficulty even deciding what to wear to the funeral

D. Going on a drinking binge instead of attending the funeral.

ANS: D
The individual is exhibiting disenfranchised grief since situations have distanced them from the family, making grieving openly impossible. Pathological grief begins with a normal grieving process, but obstacles interfere with a normal evolution toward adjustment causing reactions to be exaggerated. Anticipatory grief is a response to a real or perceived loss before the loss occurs. Acute grief is a crisis; it is a syndrome of physical and psychological symptoms of distress, often accompanied by functional disruption.

Explanation

ANS: D
The individual is exhibiting disenfranchised grief since situations have distanced them from the family, making grieving openly impossible. Pathological grief begins with a normal grieving process, but obstacles interfere with a normal evolution toward adjustment causing reactions to be exaggerated. Anticipatory grief is a response to a real or perceived loss before the loss occurs. Acute grief is a crisis; it is a syndrome of physical and psychological symptoms of distress, often accompanied by functional disruption.

10. When a chronically ill 80-year-old client is admitted to your acute care facility in an unconscious state, the nurse's priority is to determine:

A. the client’s wishes concerning a ‘good death’

B. where the client’s living will can be found

C. if the client has expressed a wish to be a “do not resuscitate” (DNR).

D. who is the client’s durable power of attorney for health care (DPAHC).

ANS: D
A DPAHC is an individual appointed by the patient, a surrogate, to speak for the patient in all matters related to health care. Identifying such an individual has priority in this scenario. The client’s wishes concerning end life care is important but considered premature at this time. A living will is restricted to represent a person’s wishes specific to a particular condition of a terminal illness and applies only to that case. A DNR is premature in this situation as well.

Explanation

ANS: D
A DPAHC is an individual appointed by the patient, a surrogate, to speak for the patient in all matters related to health care. Identifying such an individual has priority in this scenario. The client’s wishes concerning end life care is important but considered premature at this time. A living will is restricted to represent a person’s wishes specific to a particular condition of a terminal illness and applies only to that case. A DNR is premature in this situation as well.

11. Which principle regarding grief crisis intervention is the basis for intervention planning?

A. The acute phase is the most intense period of the grieving process

B. The intensity of the grief is in proportion to the expected death trajectory

C. Grief work is most effective when addressed during the acute phase of grief

D. Anticipatory grief is an expected barrier to grief work

ANS: C
The acute phase is usually the peak time of stress and anxiety as the life and future of the individual and the family is thrown into disequilibrium. Crisis intervention is most effective here because the individual, family, and caregivers are struggling to come to terms with the knowledge. While the other options are true, they are not as directly related to intervention planning.

Explanation

ANS: C
The acute phase is usually the peak time of stress and anxiety as the life and future of the individual and the family is thrown into disequilibrium. Crisis intervention is most effective here because the individual, family, and caregivers are struggling to come to terms with the knowledge. While the other options are true, they are not as directly related to intervention planning.

12. The nurse sits at the bedside of a comatose, terminally ill older client reading the wishes expressed in the numerous cards the client has received. Which concept of grief work is the nurse addressing with this intervention?

A. Everyone needs social interaction

B. The nurse needs to ‘attend to the patient’

C. Hearing is believed to be the last sense to be lost

D. The individual is living until they are dead

ANS: D
An individual is living until he or she has died; the nurse works with the elder and significant others to maintain as high a quality of life as possible before, during and after the loss or death. While the other options are true they are not directly involved in grief work

Explanation

ANS: D
An individual is living until he or she has died; the nurse works with the elder and significant others to maintain as high a quality of life as possible before, during and after the loss or death. While the other options are true they are not directly involved in grief work

13. Which intervention is an example of countercoping for a client who has recently received a terminal diagnosis of cancer? Select all that apply.

A. Answering the client’s questions regarding the trajectory of their illness

B. Offering to pray with the client and family

C. Scheduling a meeting with the client and family to identify alternative end of life plans

D. Assessing the client frequently for depression and risk of self harm

E. Being available to just listen to the client talk about dying

ANS: A, C, D, E
One of the strategies of countercoping includes clarification and control. The nurse helps cope with loss and dying by helping individuals confront the loss by getting or receiving information, considering alternatives, and finding a way to make the grief manageable. The nurse helps persons resume control by encouraging them to avoid acting on impulse. It is not an acceptable practice to initiate such an intervention as asking the client to pray.

Explanation

ANS: A, C, D, E
One of the strategies of countercoping includes clarification and control. The nurse helps cope with loss and dying by helping individuals confront the loss by getting or receiving information, considering alternatives, and finding a way to make the grief manageable. The nurse helps persons resume control by encouraging them to avoid acting on impulse. It is not an acceptable practice to initiate such an intervention as asking the client to pray.

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