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A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important accomplishment available by attending a grief support group?
- A. Providing a framework for incorporating the old life into the new life
- B. Normalizing adaptation to a continuation of the old life
- C. Aiding in adjusting to using old, familiar social skills
- D. Normalization of feelings and experiences
Correct Answer: D
Rationale: Although many people complete the work of mourning with the informal support of families and friends, many find that talking with others who have had a similar experience, such as in formal support groups, normalizes the feelings and experiences and provides a framework for learning new skills to cope with the loss and create a new life. The other listed options are incorrect because they indicate the need to hold onto the old life and not move on.
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A patient has just been told that her illness is terminal. The patient tearfully states, I cant believe I am going to die. Why me? What is your best response?
- A. I know how you are feeling.
- B. You have lived a long life.
- C. This must be very difficult for you.
- D. Life can be so unfair.
Correct Answer: C
Rationale: The most important intervention the nurse can provide is listening empathetically. To communicate effectively, the nurse should ask open-ended questions and acknowledge the patients fears. Deflecting the statement or providing false sympathy must be avoided.
A medical nurse is providing palliative care to a patient with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurses care?
- A. To improve the patients and familys quality of life
- B. To support aggressive and innovative treatments for cure
- C. To provide physical support for the patient
- D. To help the patient develop a separate plan with each discipline of the health care team
Correct Answer: A
Rationale: The goal of palliative care is to improve the patients and the familys quality of life. The support should include the patients physical, emotional, and spiritual well-being. Each discipline should contribute to a single care plan that addresses the needs of the patient and family. The goal of palliative care is not aggressive support for curing the patient. Providing physical support for the patient is also not the goal of palliative care. Palliative care does not strive to achieve separate plans of care developed by the patient with each discipline of the health care team.
A hospice nurse is caring for a 22-year-old with a terminal diagnosis of leukemia. When updating this patients plan of nursing care, what should the nurse prioritize?
- A. Interventions aimed at maximizing quantity of life
- B. Providing financial advice to pay for care
- C. Providing realistic emotional preparation for death
- D. Making suggestions to maximize family social interactions after the patients death
Correct Answer: C
Rationale: Hospice care focuses on quality of life, but, by necessity, it usually includes realistic emotional, social, spiritual, and financial preparation for death. Financial advice and actions aimed at post-death interaction would not be appropriate priorities.
You are caring for a 50-year-old man diagnosed with multiple myeloma; he has just been told by the care team that his prognosis is poor. He is tearful and trying to express his feelings, but he is having difficulty. What should you do first?
- A. Ask if he would like you to sit with him while he collects his thoughts.
- B. Tell him that you will leave for now but will be back shortly.
- C. Offer to call pastoral care or a member of his chosen clergy.
- D. Reassure him that you can understand how he is feeling.
Correct Answer: A
Rationale: The most important intervention the nurse can provide is listening empathetically. Seriously ill patients and their families need time and support to cope with the changes brought about by serious illness and the prospect of impending death. The nurse who is able to listen without judging and without trying to solve the patients and familys problems provides an invaluable intervention. The patient needs to feel that people are concerned with his situation. Leaving him does not show acceptance of his feelings. Offering to call pastoral care may be helpful for some patients, but should be done after you have spent time with the patient. Telling the patient that you understand how he is feeling is inappropriate because it does not help him express his feelings.
The nurse is admitting a 52-year-old father of four into hospice care. The patient has a diagnosis of Parkinsons disease, which is progressing rapidly. The patient has made clear his preference to receive care at home. What interventions should the nurse prioritize in the plan of care?
- A. Aggressively continuing to fight the disease process
- B. Moving the patient to a long-term care facility when it becomes necessary
- C. Including the children in planning their fathers care
- D. Supporting the patients and familys values and choices
Correct Answer: D
Rationale: Nurses need to develop skill and comfort in assessing patients and families responses to serious illness and planning interventions that support their values and choices throughout the continuum of care. To be admitted to hospice care, the patient must have come to terms with the fact that he is dying. The scenario states that the patient wants to be cared for at home, not in a long-term setting. The children may be able to participate in their fathers care, but they should not be assigned responsibility for planning it.