Funds TEST BANK Ch10 - FA Davis practice PDF

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FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

Chapter 10: Loss, Grief, and Dying Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1. The nurse provides care to a terminal patient who states, “I don’t need anything from you. Leave me alone!” Based on this information, the nurse documents that the patient is likely experiencing which stage of grief? 1. Anger 2. Denial 3. Bargaining 4. Acceptance

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2. The nurse witnesses a terminally ill patient telling the health-care provider, “I don’t want my life prolonged, as stated in my living will.” Which action does the nurse anticipate from the health-care provider based on the patient’s statement? 1. The provider will ignore the patient’s request. 2. The provider will write a do-not-resuscitate (DNR) prescription. 3. The provider will explain to the patient the importance of positive thinking. 4. The provider will speak to the patient’s family before writing a DNR prescription.

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3. The nurse provides care to a patient who is dying of colon cancer who states, “I know I can beat this cancer if I just change the things that I eat.” Based on Kübler-Ross’ stages of grief, which stage does the nurse document in the medical record that the patient is experiencing? 1. Anger 2. Denial 3. Bargaining 4. Acceptance

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4. The nurse provides care to a patient who is prescribed palliative care. The patient asks, “What is the difference between hospice care and palliative care?” Which does the nurse include in the response to the patient regarding palliative care? 1. It is aggressive but administered to cure the disease. 2. It is geared toward the patient, family, and their wishes. 3. It indicates the patient has fewer than six months to live. 4. It may be aggressive and is directed at eliminating discomfort.

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5. The nurse provides care to a terminally ill patient. Which patient response indicates to the nurse a readiness to talk about dying? 1. “What do you think death feels like?” 2. “I’m feeling a little stronger each day.” 3. “I’ve decided to begin taking chemotherapy again.” 4. “Do you think you could just sit with me for a while?”

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6. The nurse provides care for a patient who is actively dying. The patient’s spouse tells the nurse, “I am worried that my husband is not getting enough fluids.” Which response by the nurse is appropriate? 1. “Your husband will drink when he gets thirsty. Don’t worry about him.” 2. “Your husband signed a living will indicating he doesn’t want to be given food and water.” 3. “I will let the doctor know about your concern. Your husband may need an IV to keep him hydrated.” 4. “It is natural to become dehydrated before death. It will actually make him more Copyright © 2019 F. A. Davis Company

FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

comfortable.” ____

7. The nurse provides care to a patient who has died. Which action does the nurse implement when preforming postmortem care? 1. Document the time when the patient stopped breathing and the heart ceased. 2. Insist that the family bathe the patient so they can begin the grieving process. 3. Bathe the patient’s body and remove all tubes, unless an autopsy is prescribed. 4. Notifying the health-care provider so that the patient will be legally pronounced dead.

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8. The nurse provides care to a patient who is actively dying. The patient’s spouse is upset about her husband’s respirations. Which response by the nurse is appropriate when providing education to the spouse about Cheyne-Stokes respirations? 1. “As your husband approaches end of life, breathing becomes slow and deep.” 2. “As your husband approaches end of life, breathing becomes slow and shallow.” 3. “As your husband approaches end of life, breathing causes cyanosis of the hands and feet.” 4. “As your husband approaches end of life, breathing will be a cycle of shallow and deep respirations.”

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9. The nurse provides care to a terminally ill patient. The patient’s family asks the nurse what should be expected during the dying process. Which response by the nurse is accurate and appropriate? 1. “Everybody is different, so it is difficult to say.” 2. “Your loved one’s heart will stop, and then breathing stops a few minutes later.” 3. “Respirations and heart rate first become very irregular and then stop altogether.” 4. “Breathing will stop, and then the heart will cease beating within a few minutes.”

____ 10. The nurse provides care to a patient who is terminally ill. Which nursing action is the priority when providing care to this patient at the end of life? 1. Touching the patient to show caring 2. Giving the patient prescribed pain medication 3. Encouraging the patient to reminisce about life 4. Encouraging visits from a member of the clergy ____ 11. The nurse provides care to a patient who is actively dying. When planning care for this patient and the family, the nurse prioritizes interventions to address which physical change associated with the dying process to ease the family’s anxiety? 1. Pallor and circumoral cyanosis 2. Restlessness and difficulty in sleeping 3. Accumulation of secretions in the trachea 4. Conjunctival dryness that causes tearing of the eyes ____ 12. The nurse provides care to a patient who has a written document containing medical decisions should the patient be unable to make them as the illness progresses. Which end-of-life documentation does the patient have based on the current information? 1. Living will 2. Terminal illness 3. Durable power of attorney (DPR) 4. Do-not-resuscitate (DNR) prescription ____ 13. The nurse reinforces education to a terminally ill patient and family regarding the senses. Which statement by a family member indicates correct understanding of the information presented? 1. “My loved one will retain the ability to see until the very end.” 2. “My loved one’s taste will not be affected by the dying process.” Copyright © 2019 F. A. Davis Company

FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

3. “My loved one’s ability to hear is the last sense to go at end of life.” 4. “My loved one will not be able to smell once the dying process begins.” ____ 14. When providing care to a patient diagnosed with a terminal illness, which traditional first stage of grief does the nurse not anticipate the patient will exhibit? 1. Bargaining 2. Anger 3. Denial 4. Depression ____ 15. The nurse provides care to a terminally ill patient. Upon entering the patient’s room, the nurse notes the patient is not breathing. The patient does not have a do-not-resuscitate (DNR) prescription. Which action does the nurse implement based on the current data? 1. Ask another nurse to write a DNR prescription. 2. Notify the selected funeral home that the patient has expired. 3. Call the health-care provider to get a verbal DNR prescription. 4. Begin cardiopulmonary resuscitation (CPR) because a DNR prescription is not written. ____ 16. A terminally ill patient refuses to take adequate pain medication. The patient expresses worry that the use of pain medication may result in addiction. Which response by the nurse is appropriate? 1. Express admiration for the patient’s strength. 2. Place the medication in an IV drip. 3. Explain to the patient that morphine does not cause addiction. 4. Teach the patient that addiction is not a concern during the terminal stages of illness. ____ 17. A patient’s daughter approaches a nurse to explain that upon the death of a male, female nurses should not touch the body. The family also asks that the body remain completely covered with the feet turned toward Mecca. Based on the family’s request, the nurse concludes that the family identifies with which faith? 1. Jewish 2. Muslim 3. Buddhist 4. Orthodox ____ 18. The spouse of a dying patient states to the nurse, “I believe remorse for the dead leads to more suffering of the soul and will increase the soul’s difficulty in leaving the earthly plane. I prefer to think only happy thoughts to facilitate the journey.” Which culture does the nurse identify for the couple based on the spouse’s statement? 1. Jewish 2. Hindu 3. Amish 4. Hispanic American ____ 19. The nurse provides care to a patient who experiences dyspnea. The patient states, “I don’t want to take any more medication.” Which nonpharmacological intervention does the nurse implement for this patient? 1. Implementing music therapy 2. Giving the patient small sips of warm water 3. Putting a fan near the bed to circulate the air 4. Providing additional movement and range-of-motion exercises ____ 20. The nurse reinforces education for the family of a terminally ill patient. When discussing respite care with the family, which statement by a family member indicates correct understanding of the information? 1. “Respite care means you will treat my family member for pain.” 2. “Respite care means my family member will be given a medication to assist with death.” 3. “Respite care means that when my spouse stops breathing no resuscitation will be Copyright © 2019 F. A. Davis Company

FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

implemented.” 4. “Respite care means that I will be given an opportunity to have time away from my spouse without worrying about his care.” ____ 21. The nurse prepares to perform postmortem care on a patient who passed away. Which step does the nurse implement for safety during this procedure? 1. Donning gloves 2. Respecting cultural beliefs 3. Closing the door to the room 4. Determining if family members want to participate ____ 22. An older adult patient becomes progressively more confused. The patient begins talking to long-gone loved ones about places and events that do not make any sense to the family. Which is the priority nursing action based on the current information? 1. Hydrate the patient. 2. Attempt to reorient the patient. 3. Verify the patient’s level of consciousness. 4. Protect the patient from injury by bed rails or equipment. ____ 23. The nurse provides care to a terminally ill patient who has barely eaten anything for several days. Which nursing action is appropriate for this patient? 1. Place the patient on IV nutrition. 2. Ask the health-care provider to insert a feeding tube for the patient. 3. Insist that the patient eat something at least three to four times a day. 4. Encourage the patient to eat whatever foods he or she thinks sound and look appealing. Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 24. The nurse provides care to a terminal patient who is approaching end of life. Which information does the nurse reinforce with the family members as indicating death is very near? Select all that apply. 1. Nonresponsiveness 2. Slow and thready pulse 3. Mottling of feet and legs 4. Edema of lower extremity 5. Agitation and withdrawal ____ 25. When asked by family members of a terminally ill patient what benefit their loved one would experience as a result of dehydration, a nurse explains that which of the following is true? Select all that apply. 1. Gastric fluid excretions increase so as to lessen nausea. 2. Dehydration will contribute to less edema and discomfort from ascites. 3. Urinary output decreases, which results in less discomfort from toileting. 4. Mucous secretions increase and provide comfort to the mouth and throat. 5. Dehydration increases endorphin production and decreases perception of pain.

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FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

Chapter 10: Loss, Grief, and Dying Answer Section MULTIPLE CHOICE 1. ANS: 1 Chapter: Chapter 10, Loss, Grief, and Dying Objective: 6. Explain the traditional five stages of grief. Page: 172 Heading: Facing Loss > Five Traditional Stages of Grief Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Grief and Loss Difficulty: Moderate

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Feedback This is correct. The patient who states, “I don’t need anything from you. Leave me alone!” suggests that the patient is experiencing the anger stage of grief. This is incorrect. Denial involves disbelief that one has a terminal illness. This is incorrect. Bargaining is the stage in which a terminally ill patient offers something in exchange for death. This is incorrect. Acceptance indicates resolution of conflicting feelings toward death.

PTS: 1 CON: Grief and Loss 2. ANS: 4 Chapter: Chapter 10, Loss, Grief, and Dying Objective: 4. Discuss durable power of attorney and living wills. Page: 167 Heading: Dealing With the Terminal Patient > End-of-Life Documentation Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Grief and Loss Difficulty: Moderate Feedback 1 This is incorrect. It is unethical for the provider to ignore the patient’s request. 2 This is incorrect. The provider will wait to write a DNR prescription until speaking to the family. 3 This is incorrect. While positive thinking is important, this does not address the patient’s wishes. 4 This is correct. In response to a patient’s request, the provider will speak to the family and probably write a DNR prescription. PTS: 1 CON: Grief and Loss 3. ANS: 3 Chapter: Chapter 10, Loss, Grief, and Dying Objective: 6. Explain the traditional five stages of grief. Page: 172 Copyright © 2019 F. A. Davis Company

FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

Heading: Facing Loss > Five Traditional Stages of Grief Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Cellular Regulation | Grief and Loss Difficulty: Difficult

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Feedback This is incorrect. The anger stage is characterized by statements that describe frustration and are emotionally charged. This is incorrect. When in denial, the patient is attempting to avoid death. In this example, the patient is attempting to bargain. This is correct. A patient stating a willingness to change eating habits to beat colon cancer is an example of bargaining or bartering. This is incorrect. Most likely, a patient’s acceptance of death would be demonstrated by finalizing a will, telling family everything will be fine, and so forth.

PTS: 1 CON: Cellular Regulation | Grief and Loss 4. ANS: 4 Chapter: Chapter 10, Loss, Grief, and Dying Objective: 3. Explain the differences among curative care, palliative care, and hospice care. | 13. Discuss information found in the Connection features in this chapter. Page: 165, 166 Heading: Dealing With the Terminal Patient > Palliative Care and Hospice Care Integrated Processes: Teaching and Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate

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Feedback This is incorrect. Curing a disease is curative, not palliative, care. This is incorrect. Hospice, not palliative care, is geared toward the patient and family. This is incorrect. Patients placed on palliative care generally have more than 6 months to live. This is correct. Palliative care may be aggressive toward comfort, but not toward curing the illness.

PTS: 1 CON: Grief and Loss 5. ANS: 1 Chapter: Chapter 10, Loss, Grief, and Dying Objective: 12. Identify comments the patient might make indicating that he or she desires to discuss his or her terminal condition. Page: 179 Heading: Observation and Provision of Comfort > Just Be There Integrated Processes: Communication and Documentation Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Grief and Loss Difficulty: Difficult Copyright © 2019 F. A. Davis Company

FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

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Feedback This is correct. When a nurse is questioned by a patient about death, the nurse would correctly identify that the patient is ready to discuss it. This is incorrect. This statement does not acknowledge death. This is incorrect. The decision made to continue treatment might not indicate a need to talk about dying. This is incorrect. Usually a nurse’s presence is comforting to someone dying or dealing with a difficult situation, but the request does not indicate a need to talk.

PTS: 1 CON: Grief and Loss 6. ANS: 4 Chapter: Chapter 10, Loss, Grief, and Dying Objective: 11. Describe at least four beneficial effects of dehydration at the end of life. Page: 176 Heading: Nursing Care > Teaching Integrated Processes: Teaching and Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Grief and Loss Difficulty: Difficult

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Feedback This is incorrect. Not drinking is a symptom of dying, so telling the patient’s spouse that he will drink when he gets thirsty is incorrect and inappropriate. This is incorrect. Although a living will may be signed, it is more therapeutic for the nurse to explain the effects of dehydration at end-of-life. This is incorrect. Although in some cases IV hydration may be prescribed, this is mostly due to requests by family. This ultimately increases the patient’s discomfort and should be avoided. This is correct. Prior to death a patient will dehydrate. This increases comfort due to decreased urination, less gastric acids, and so forth.

PTS: 1 CON: Grief and Loss 7. ANS: 3 Chapter: Chapter 10, Loss, Grief, and Dying Objective: 15. Answer questions about the skill in this chapter. Page: 180 Heading: Postmortem Care Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Grief and Loss Difficulty: Moderate

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Feedback This is incorrect. It is correct to first document the time breathing and the heart ceased, but this action is not part of postmortem care. This is incorrect. It is correct to offer to let the family assist with bathing. However,

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FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

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insisting on participation is not appropriate. This is correct. The patient will be bathed and tubes removed during postmortem care unless an autopsy is anticipated. This is incorrect. Notifying the provider is a task that the nurse will perform, but it is not postmortem care.

PTS: 1 CON: Grief and Loss 8. ANS: 4 Chapter: Chapter 10, Loss, Grief, and Dying Objective: 8. List at least seven signs and symptoms frequently present in end-stage disease. Page: 175 Heading: The Dying Process > Physical Changes Integrated Processes: Teaching and Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Oxygenation | Grief and Loss | Nursing Roles Difficulty: Moderate

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Feedback This is incorrect. Some of the respirations will be deep, but Cheyne-Stoke respirations are cyclic. This is incorrect. Respirations may be shallow, but Cheyne-Stoke respirations are cyclic in nature. This is incorrect. Cyanosis of the hands and feet occurs as the patient nears death, but it is not the result of Cheyne-Stokes respirations. This is correct. Cheyne-Stoke respirations are cyclic and may consist of shallow and then deep respirations.

PTS: 1 CON: Oxygenation | Grief and Loss | Nursing Roles 9. ANS: 4 Chapter: Chapter 10, Loss, Grief, and Dying Objective: 9. Contrast the psychological, physical, and emotional changes commonly noted in patients preparing for death. Page: 180 Heading: Postmortem Care Integrated Processes: Teaching and Learning Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Grief and Loss Difficulty: Difficult

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