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A patient newly diagnosed with pancreatic cancer says, 'My father also died of pancreatic cancer. I took care of him during his illness. I can't go through that.' Select the highest priority nursing diagnosis.
- A. Anticipatory grieving
- B. Ineffective coping
- C. Ineffective denial
- D. Risk for suicide
Correct Answer: D
Rationale: The patient's statement has a subtle message of suicide. Suicide is a risk for people with major losses, including terminal disease.
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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.
A widow grieving her husband's sudden and unexpected death tells the nurse, 'I'm not feeling well. Yesterday, I saw my husband walk through the door, stop, and smile at me. Then he just faded away.' Which is the nurse's most appropriate action?
- A. Assess for recent substance abuse.
- B. Suggest a referral to the mental health clinic.
- C. Arrange for an evaluation for antidepressant medication.
- D. Counsel the widow that visualizations are a normal part of grieving.
Correct Answer: D
Rationale: Grieving patients often dream about, visualize, think about, or search for the lost loved one. This is considered a normal phenomenon.
Which actions by a nurse contribute to protecting the rights of patients who are terminally ill? (Select all that apply.)
- A. Maintain hope for a positive prognosis.
- B. Hug the patient when sadness is expressed.
- C. Offer choices that promote personal control.
- D. Provide interventions that convey respect.
- E. Support the patient's quest for spiritual growth.
Correct Answer: C,D,E
Rationale: The answers support the rights of the individual who is dying. Offering choices, providing respectful interventions, and supporting spiritual growth respect the patient's autonomy and dignity.
A patient diagnosed with metastatic brain cancer says, 'I'm dying, but I'm still living. I want to be in control as long as I can.' Which reply shows the nurse was actively listening?
- A. Our staff will do their best to help you feel comfortable.'
- B. Most people do not know how to help and are afraid of death.'
- C. Although your body is frail, your mind and spirit are healthy.'
- D. You want people to stop focusing on your weaknesses.'
Correct Answer: C
Rationale: The patient is asking for acknowledgment that he or she is not totally sick; even in the terminal state, strengths and capabilities are present.
A terminally ill patient tells the nurse, 'Life has been good. I am proud of my education. I overcame adversity with willpower. I always gave my best and expected things to turn out well. I intend to die as I lived: optimistically.' The nurse planning care for this patient recognizes a critical need to focus on maintaining the patient's state of mind?
- A. Providing aggressive pain and symptom management
- B. Helping the patient reassess and explore existing conflicts
- C. Assisting the patient to focus on the meaning in life and death
- D. Supporting the patient's use of personal resources to meet challenges
Correct Answer: D
Rationale: The patient whose intrinsic strength and endurance have been a hallmark often wishes to approach dying by staying optimistic and in control.