1.
Which behavior is characteristic of grief by a disenfranchised adult child in response to a parent’s death following a lengthy, painful illness?
Correct Answer
D. D. Going on a drinking binge instead of attending the funeral.
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.
2.
When working with a bereaved individual, the goal of nursing interventions is to:
Correct Answer
B. B. assist the individual to attain a healthy adjustment to the loss experience
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.
3.
Which truism will the nurse base spousal grief counseling upon?
Correct Answer
C. C. Women are generally more likely to outlive their spouses
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.
4.
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?
Correct Answer
B. B. suspected awareness
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
5.
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:
Correct Answer
D. D. who is the client’s durable power of attorney for health care (DPAHC).
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.
6.
State Death with Dignity Laws require that the terminally ill client be:
Correct Answer
A. A. educated regarding treatment alternatives
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
7.
What research finding is the basis for care planning of the client receiving palliative care?
Correct Answer
B. B. Pain management is inadequately addressed among the terminally ill population.
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.
8.
The nurse suspects that the spouse of a terminally ill client is experiencing anticipatory grief when they:
Correct Answer
A. A. Dramatically reduce the time they spend attending to the client
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.
9.
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?
Correct Answer
D. D. The individual is living until they are dead
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
10.
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:
Correct Answer
B. B. Educate the family that this is normal behavior in this situation
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.
11.
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?
Correct Answer
A. I cry for a client when I’m alone but never when I’m with them.”
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.
12.
Which principle regarding grief crisis intervention is the basis for intervention planning?
Correct Answer
C. C. Grief work is most effective when addressed during the acute phase of grief
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.
13.
Which intervention is an example of countercoping for a client who has recently received a terminal diagnosis of cancer? Select all that apply.
Correct Answer(s)
A. A. Answering the client’s questions regarding the trajectory of their illness
C. C. Scheduling a meeting with the client and family to identify alternative end of life plans
D. D. Assessing the client frequently for depression and risk of self harm
E. E. Being available to just listen to the client talk about dying
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.