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Shortly after a man's wife dies, the man approaches the nurse who cared for his wife during her final hours of life and says angrily, 'If you had given your undivided attention, she would still be alive.' Which analysis applies?
- A. The husband will pursue legal action regarding the nurse's negligence.
- B. Anger is a phenomenon experienced during grieving.
- C. The husband had ambivalent feelings about his wife.
- D. In some cultures, grief is expressed exclusively by anger.
Correct Answer: B
Rationale: Anger may protect the bereaved from facing the devastating reality of the loss. Anger expressed during mourning is not directed toward the nurse personally.
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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.
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.
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.
A grieving patient tells a nurse, 'It's been 8 months since my spouse died. I thought I would feel better by now, but lately I feel worse. I have no energy. I am lonely, but I don't want to be around people. What should I do?' What is the nurse's best counsel?
- A. Seek psychotherapy.
- B. Become active in a church.
- C. Go to the spouse's grave every day.
- D. Understand this is a normal response.
Correct Answer: D
Rationale: The patient needs understanding and support that the feelings are normal. Loneliness and aimlessness are most pronounced 6 to 9 months after the death.
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.