Nokea
A nurse manager notices that a staff member spends minimal time with a patient diagnosed with AIDS who is terminally ill. The patient says, 'I'm having intense emotional reactions to this illness. Sometimes I feel angry, but other times I feel afraid or abandoned.' The nurse manager can correctly hypothesize that the most likely reason for the staff member's avoidance is triggered by what?
- A. Fear of infection transmission.
- B. Feelings of inadequacy in dealing with complex emotional needs.
- C. Belief that the patient needs time alone with family and friends.
- D. Knowledge that the patient's former lifestyle included high-risk behaviors.
Correct Answer: B
Rationale: Many nurses tend to be more comfortable with meeting physical needs than in focusing on complex emotional needs.
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A woman whose husband is terminally ill says, 'I don't want to cry in front of him. I don't want him to know how soon death will occur or how sad I am.' Which response by the nurse would be most therapeutic?
- A. I'm glad you are protecting him at a time when he is so vulnerable.'
- B. He might be more comforted than disturbed by your tears.'
- C. It's important for you to know that time is running out.'
- D. You definitely need to be honest about your feelings.'
Correct Answer: B
Rationale: Emotional honesty is important to both the patient and the family. The patient may be comforted to know that the family is facing the inevitable.
Children of a widowed parent confer with the nurse; their surviving parent repeatedly relates the details of finding the deceased parent not breathing, performing cardiopulmonary resuscitation, going to the hospital by ambulance, and seeing the pronouncement of death. The family asks, 'What can we do?' How should the nurse best counsel the family?
- A. Encouraging them to share their own feelings with the surviving parent and ask for the retelling to stop
- B. Support the ideas that retelling the story should be limited to once daily to avoid unnecessary stimulation
- C. Share with them that retelling memories is to be expected as part of the aging process
- D. Reassure them that repeating the story is a helpful and a necessary part of grieving
Correct Answer: D
Rationale: Nurses are encouraged to tell bereaved patients that telling the personal story of loss as many times as needed is acceptable and healthy.
An adult who was widowed 18 months ago says, 'I can now remember good times we shared without getting upset. Sometimes I even think about the disappointments. I've become accustomed to sleeping in our bed alone.' How is the work of mourning best characterized?
- A. It is beginning.
- B. It is progressing abnormally.
- C. It is at or near completion.
- D. It has not yet begun.
Correct Answer: C
Rationale: The work of mourning has been successfully completed when the bereaved can remember both the positive and negative memories about the deceased and when the task of restructuring the relationship with the deceased is completed.
The partner of a patient in hospice care angrily tells the nurse, 'The care provided by the aide and other family members is inadequate, so I must do everything myself. Can't anyone do anything right?' How best should the palliative care nurse respond?
- A. Providing teaching about anticipatory grieving
- B. Assigning new personnel to the patient's care
- C. Arranging hospitalization for the patient
- D. Refer the partner for crisis counseling
Correct Answer: A
Rationale: The behaviors described in this scenario are consistent with anticipatory grieving. The spouse needs to be taught about the process of anticipatory grieving.
A nurse cared for a terminally ill patient for over a month and always looked forward to spending time with the patient. When the patient died, the nurse experienced sadness and felt mildly depressed. Eventually, the nurse explains these feelings to a mentor. What should be the mentor's focus when counseling the nurse?
- A. Implementing stress-reduction strategies
- B. Seeking therapy for dysfunctional grief
- C. Discussing the experience of disenfranchised grief
- D. Considering taking a leave of absence to pursue healing
Correct Answer: C
Rationale: The nurse is experiencing disenfranchised grief, which is not openly acknowledged or publicly mourned.