Nokea
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.
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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.
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.
Which finding indicates the successful completion of an individual's grieving process?
- A. For 2 years, a person has kept the deceased spouse's belongings in their usual places.
- B. After 15 months, a widowed person realistically remembers both the pleasures and disappointments of the relationship with the spouse.
- C. 3 years after the death, a person talks about the spouse as if the spouse was still alive and weeps when others mention the spouse's name.
- D. 18 months after the spouse's death, a person says, 'I never cry or have feelings of loss even though we were always very close.'
Correct Answer: B
Rationale: The work of grieving is over when the bereaved can remember the individual realistically and acknowledge both the pleasure and disappointments associated with the loved one.
A family of a terminally ill patient asks the nurse, 'What can we say when our family member mentions death is coming soon?' Which response could the nurse suggest?
- A. We think you will be around for a long time.'
- B. We don't want you to give up trying to get well.'
- C. We don't think we're ready to talk about this yet.'
- D. We feel so sad when we think of life without you.'
Correct Answer: D
Rationale: This response is emotionally honest. It will allow the family opportunities to express emotions and further resolve issues in the relationship.