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bedside about where the patient's funeral should be held. What should the nurse do first?
a. Ask the family members to leave the room if they are going to argue.
b. Take the family members aside and explain that the patient may be able to hear them.
c. Tell the family members that this decision is premature because the patient has not yet died.
d. Remind the family that this should be the patient's decision and to ask her if she regains consciousness.
6. A 20-yr-old patient with a massive head injury is on life support, including a ventilator to maintain respirations. What three criteria for brain death are necessary to discontinue life support?
a.
b.
c.
7. A patient with end-stage liver failure tells the nurse, “If I can just live to see my first grandchild who is expected in 5 months, then I can die happy.” The nurse recognizes that the patient is demonstrating which stage of grieving?
a. Prolonged grief disorder
b. Kübler-Ross's stage of bargaining c. Kübler-Ross's stage of depression
d. The new normal stage of the Grief Wheel
8. A terminally ill man tells the nurse, “I have never believed there is a God or an afterlife, but now it is too terrible to imagine that I will not exist. Why was I here in the first place?” What does this comment help the nurse recognize about the patient's needs?
a. He is experiencing spiritual distress.
b. This man most likely will not have a peaceful death.
c. He needs to be reassured that his feelings are normal.
d. This patient should be referred to a clergyman for a discussion of his beliefs.
9. In most states, directives to physicians, durable power of attorney for health care, and medical power of attorney are included in which legal documents?
a. Natural death acts b. Allow natural death c. Advance care planning d. Do not resuscitate order
10. A patient is receiving care to manage symptoms of a terminal illness when the disease no longer responds to treatment. What is this type of care known as?
a. Terminal care b. Palliative care c. Supportive care d. Maintenance care
11. Priority Decision: A patient in the last stages of life is experiencing shortness of breath and air hunger. Based on practice guidelines, what is the most appropriate action by the nurse?
a. Administer oxygen.
b. Administer bronchodilators.
c. Administer antianxiety agents.
d. Use any methods that make the patient more comfortable.
12. End-of-life palliative nursing care involves
a. constant assessment for changes in physiologic functioning.
b. administering large doses of analgesics to keep the patient sedated.
c. providing as little physical care as possible to prevent disturbing the patient.
d. encouraging the patient and family members to verbalize their feelings of sadness, loss, and forgiveness.
13. The dying patient and family have many interrelated psychosocial and physical care needs.
Which ones can the nurse manage with the patient and family (select all that apply)?
a. Anxiety b. Fear of pain c. The dying process d. Care being provided e. Anger toward the nurse f. Feeling powerless and hopeless
14. A deathly ill patient from a culture different than the nurse's is admitted. Which question is appropriate to help the nurse provide culturally competent care?
a. “If you die, will you want an autopsy?”
b. “Are you interested in learning about palliative or hospice care?”
c. “Do you have any preferences for what happens if you are dying?”
d. “Tell me about your expectations of care during this hospitalization.”
Case Study
End-of-Life Palliative Care
(©SylvieBouchard/iStock/Thinkstock)
Patient Profile
S.J., a 42-yr-old woman, had unsuccessful treatment for breast cancer 1 yr ago and now has metastasis to the lung and vertebrae. She lives at home with her husband, 15-yr-old daughter, and 12-yr-old son. She has been referred to hospice because of her deteriorating condition and
increasing pain. Her husband is an accountant and tries to do as much of his work at home as possible so that he can help care for his wife. Their children have become withdrawn, choosing to spend as much time as possible at their friends' homes and in outside activities.
Subjective Data
• S.J. reports that she stays in bed most of the time because it is too painful to stand and sit.
• She reports her pain as an 8 on a scale of 0 to 10 while taking oral MS Contin every 12 hours.
• She reports shortness of breath with almost any activity, such as getting up to go to the bathroom.
• S.J. says she knows she is dying, but her greatest suffering results from her children not caring about her.
• She and her husband have not talked with the children about her dying.
• Her husband reports that he does not know how to help his wife anymore and that he feels guilty sometimes when he just wishes it were all over.
Objective Data
• Height: 5 ft 2 in (157 cm)
• Weight: 97 lb (44 kg)
• Skin intact
• Vital signs: Temp 99° F (37.2° C), HR 92 bpm, RR 30, BP 102/60 Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What additional assessment data should the nurse obtain from S.J. and her husband before making any decisions about care of the family?
2. What types of grieving appear to be occurring in the family?
3. Priority Decision: What physical care should the nurse include in a plan for S.J. at this time?
4. Patient-Centered Care: What is the best way to facilitate healthy grieving in this family?
5. Teamwork and Collaboration: What resources of a hospice team are available to assist this patient and her family?
6. Priority Decision: Based on the assessment data provided, what are the priority nursing diagnoses?