Nokea
The nurse has been caring for a terminally ill patient for the past 10 months. The nurse and the family are present when the patient dies and feels saddened and tearful as the family members begin to cry. Which of the following actions should the nurse take at this time?
- A. Contact a grief counsellor as soon as possible.
- B. Cry along with the patient's family members.
- C. Leave the home as quickly as possible to allow the family to grieve privately.
- D. Consider whether working in hospice is desirable since patient losses are common.
Correct Answer: B
Rationale: It is appropriate for the nurse to cry and express sadness in other ways when a patient dies, and the family is likely to feel that this is therapeutic. Contacting a grief counsellor, leaving the family to grieve privately, and considering whether hospice continues to be a satisfying place to work are all appropriate actions as well, but the nurse's initial action at this time should be to share the grieving process with the family.
You may also like to solve these questions
The nurse is providing hospice care to a patient who is manifesting a decrease in all body system functions except for a heart rate of 124 and a respiratory rate of 28. Which of the following is the basis for the nurses' response about these symptoms?
- A. They will continue to increase until death finally occurs.
- B. They are a normal response before these functions decrease.
- C. They indicate a reflex response to the slowing of other body systems.
- D. They may be associated with an improvement in the patient's condition.
Correct Answer: B
Rationale: An increase in heart and respiratory rate may occur before the slowing of these functions in the dying patient. Heart and respiratory rate typically slow as the patient progresses further toward death. In a dying patient, high respiratory and pulse rates do not indicate improvement, and it would be inappropriate for the nurse to indicate this to the family. The changes in pulse and respirations are not reflex responses.
The nurse is caring for a terminally ill patient who has 20-second periods of apnea followed by periods of deep and rapid breathing. Which of the following terms should the nurse use to document this finding?
- A. Agonal breathing
- B. Apneustic breathing
- C. Death rattle respirations
- D. Cheyne-Stokes respirations
Correct Answer: D
Rationale: Cheyne-Stokes respirations are characterized by periods of apnea alternating with deep and rapid breaths. The 'death rattle' is caused by accumulation of mucus in the airways, causing wet-sounding respirations. Agonal breathing has a very slow and irregular rate and rhythm. Apneustic respirations are irregular and gasping.
The family member of a patient who is dying tells the nurse, 'Mother doesn't really respond any more when I visit. I don't think she knows that I am here.' Which of the following responses by the nurse is most appropriate?
- A. You may need to cut back your visits for now to avoid overtiring your mother.
- B. Withdrawal may sometimes be a normal response when preparing to leave life.
- C. It will be important for you to stimulate your mother as she gets closer to dying.
- D. Many patients don't really know what is going on around them at the end of life.
Correct Answer: B
Rationale: Withdrawal is a normal psychosocial response to approaching death. Dying patients may maintain the ability to hear while not being able to respond. Stimulation will tire the patient and is not an appropriate response to withdrawal in this circumstance. Visitors are encouraged to be 'present' with the patient, talking softly and making physical contact in a way that does not demand a response from the patient.
Which of the following patients is most appropriate for the nurse to refer to hospice palliative care?
- A. A 60-year-old with lymphoma whose children are unable to discuss issues related to dying
- B. A 72-year-old with persistent severe pain as a result of spinal arthritis and vertebral collapse
- C. A 28-year-old with AIDS-related dementia who needs palliative care and pain management
- D. A 56-year-old with advanced liver failure whose family members can no longer care for him or her at home
Correct Answer: C
Rationale: Hospice is designed to provide palliative care such as symptom management and pain control for patients at the end of life. Patients who require more care than the family can provide, whose families are unable to discuss important issues related to dying, or who have severe pain are candidates for other nursing services but are not appropriate hospice patients.
The spouse of a patient with terminal lung cancer visits daily and cheerfully talks with the patient about vacation plans for the next year. When the nurse asks about any concerns, the spouse says, 'I'm busy at work, but otherwise things are fine.' Which of the following nursing diagnoses is appropriate?
- A. Ineffective denial related to threat of unpleasant reality
- B. Anxiety related to threat to current status
- C. Caregiver role strain related to inexperience with caregiving
- D. Hopelessness related to persistent stress
Correct Answer: A
Rationale: The spouse's behaviour and statements indicate the absence of anticipatory grieving, which may lead to impaired adjustment as the patient progresses toward death. The spouse does not appear to feel overwhelmed, hopeless, or anxious about the partner's impending death.