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As death approaches, a patient diagnosed with acquired immunodeficiency syndrome (AIDS) says, 'I don't want to see a lot of visitors anymore. Just my parents and my sibling can come in for a while each day.' What action should the nurse take?
- A. Ask the patient to reconsider the decision because many interested and caring friends can be sources of support.
- B. Discuss the request with the parents and sibling. Suggest that they explain the patient's decision to friends.
- C. Suggest that the patient discuss these wishes with the health care provider.
- D. Place a 'no visitors' sign on the patient's door.
Correct Answer: B
Rationale: As many patient's approach death, they begin to withdraw. The correct response demonstrates the nurse's advocacy for the patient's preferences.
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A nurse counsels a person whose spouse recently died. The nurse uses cheer and humor to lift the person's spirits. At one point, the widowed person smiles briefly. What analysis of this scenario is correct?
- A. The nurse's technique was effective.
- B. Use of humor should be added to the plan of care.
- C. This approach may prove useful in other, similar situations.
- D. The nurse needs help developing therapeutic communication skills.
Correct Answer: D
Rationale: The nurse needs help to arrive at a more therapeutic approach. Attempts at cheering up a patient who is grieving serve only to emphasize the disparity between the patient's mood and that of others. Active listening should be the technique used by the nurse.
Psychotherapy for individuals at risk for complicated grief focuses on which goals? (Select all that apply.)
- A. Exploring emotional responses to a loss
- B. Identifying ways to break bonds with the deceased
- C. Solving problems related to moving forward in life
- D. Learning about the stages and symptoms of grieving
- E. Using antipsychotic medications for dysfunctional grief
Correct Answer: A,C,D
Rationale: Psychotherapy focuses on emotional responses, problem-solving for moving forward, and understanding grief stages. Antipsychotic medications are not typically used for grief.
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.
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.
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.