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51 Cards in this Set
- Front
- Back
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Which of the following stages of grief according to Engle involve the rituals surrounding loss including funeral services?
a. Shock and Disbelief b. Developing awareness c. Restitution d. Resolving the loss |
c
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The husband of a patient who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. Which of the following types of grief would the husband be experiencing?
a. Anticipatory grief b. Inhibited grief c. Normal Grief d. Unresolved grief |
d
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A patient who was brought to the emergency room for gunshot wounds dies in intensive care 15hrs later. Which of the following statements concerning the need for an autopsy would apply to this patient?
a. The closest surviving family member should be consulted to determine whether an autopsy should be performed. b. The coroner must be notified to determine the need for an autopsy. c. The physician should be present to prepare the patient for an autopsy. d. An autopsy should not be performed because the nature of death has been established. |
b.
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Mr. Cooney, age 85, is in advanced stages of pneumonia with a no code order in his chart. Which of the following nursing care actions will help establish a trusting nurse patient relationship?
a. The nuse should not express his or her own fears about death in order to better concentrate on the patients needs. b. the nurse should reduce verbal and nonverbal contact with the patient and nonverbal contract with the patient to avoid confusing him. c. The nurse should encourage family members to assist in his nursing care. d. The nurse should arrange a visit from a spiritual advisor, regardless of the patients wishes to provide hope in the face of death. |
c
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A nurse informs a woman that there is nothing more that can be done medically for her premature infant who is expected to die. Which of the following types of grief might the mother be experiencing?
a. Anticipatory grief b. Inhibited grief c. Unresolved grief d. Dysfunctional grief |
a.
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According to Engle (1964) the exaggeration of the good qualities of the person or object lost, followed by acceptance of the loss is which of the following?
a. Restitution b. Awareness c. Outcome d. Idealization |
d
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Before the death of her husband Mrs. Sardi complained of frequent headaches and loss of appetite. No medical cause was found. Mrs. Sardi probably was experiencing which type of grief?
a. Abbreviated grief b. Anticipatory grief c. Unresolved grief d. Inhibited grief |
b
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Which of the following diagnoses specifically addresses human response to loss and impending death in the problem statement:
a. Dysfunctional Grieving related to loss of partner. b. Anxiety related to unknown reaction to stages of death c. Self care deficit related to weakness d. Altered Comfort related to complications of chemotherapy for end stage liver cancer. |
a.
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Which of the following are stages of grieving according to Engle? (select all that apply)
a. Shock and disbelief b. Developing awareness c. Anger and denial d. Resolving the loss e. Moralization f. Prioritizing |
a, b, d
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Which of the following are impending signs of death: (select all that apply)
a. Inability to swallow b. Increased gastrointestinal activity c. Pitting edema d. Decreased temperature e. Warm flushed skin f. Lowered blood pressure |
a, c, f
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Which of the following are suggested guidelines when breaking bad news to a patient? (select all that apply)
a. Explain the entire condition in detail regardless of what the patient may already know. b. Assume that the patient wants to know the entire truth about his or her condition. c. Give the information in small chunks and stop occasionally to see the information is being understood. d. Do not ally emotional reactions to distract information. e. Summarize the information and ask for questions. f. Respond to the patient with sincerity and empathy when appropriate. |
c, e, f
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Which of the following statements regarding end of life decision making are accurate? (select all that apply)
a. Living wills provide specific instructions provided or foregone in particular situations. b. In a living will a patient appoints an agent that he or she trusts to make decisions if he or she becomes incapacitated. c. The Patient Self Determination Act of 1990 requires all hospitals to inform their patients about advance directives. d. The status of advance directive varies from state to state. e. Nurses are legally responsible for arranging for a durable power of attorney for all terminal patients. f. Legally all attempts must e made by the healthcare team to resuscitate a terminal patient. |
a, c, d
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Which of the following statements accurately describe the process of the preparing a death certificate? (select all that apply)
a. US law requires that a death certificate be prepaed for each person who dies. b. Death certificates are sent to a national health department which compiles many statistics from the information. c. The nurse assumes responsibility for handling and filling the death certificate with the proper authorities. d. A physician's signature is required on a death certificate. e. It is the nurses responsibility to ensure that the physician has signed a death certificate. f. A death certificate is signed by the pathologist the coroner, and other in special cases. |
a,d,e,f
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Which of the following are actions performed by nurse when a patients dies? (select all that apply)
a. Washing the patients body b. Removing all tubes unless an autopsy is to be performed c. Placing identification on the shroud of garment and wrist. d. Placing identification tags on the patients dentures or other prostheses. e. Arranging for family members to view the body before it is discharged to the mortician f. Attending the funeral of a deceased patient and making following up visits to the family. |
b, d, e, f
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When an older man grieves for the loss of his youth, this type of loss is known as _____________ loss.
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Perceived
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____________ is the state of grieving during which a person experiences grief reaction.
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Bereavement
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According to Engel, ____________ is the final resolution of the grief process.
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Outcome
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Abnormal or distorted grief that may be unresolved or inhibited is known as _________________ grief.
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Dysfunctional
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According to the 1981 Presidents Commission for the study of Ethical Problems in Medicine and Biomedicaland behavioral Research death is defined as present when an individual has sustained either irreversible cessation of circulation and respiratory functions or _____________-
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Irreversible cessation of all functions of the entire including the brain stem.
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_____________ death the accepted criterion for death until the 1960's is the irreversible cessation of spontaneous respiration and circulation.
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Heart Lung
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_________ care involves taking care of the whole person body mind spirit heart and soul.
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Palliative
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The period of acceptance of loss during which the person learns to deal with the loss.
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Mourning
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A type of loss in which a person displays loss and grief behaviors for a loss that has yet to take place.
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Anticipatory loss
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A type of loss that can be recognized by others as well as by the person sustaining the loss.
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Actual loss
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The state of grieving during which a person experiences grief reaction
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Bereavement
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A type of loss that is felt by the individual but is intangible to others such as loss of youth or financial independence.
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Perceived loss
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A type of loss that may be caused by an altered self image and inability to return to work
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Psychological loss
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A type of loss that is tangible such as the loss of a limb or organ
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Physical loss
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"I know I wont be having Sunday dinner with my mother anymore. Maybe my husband and I can eat out this Sunday."
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Resolving the loss
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"I cant believe my mother died of breast cancer! She was never seriously ill in her life."
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Shock and disbelief
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"My mother was the perfect parent. Wish I could be more like her with my kids."
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Idealization
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"Every time I think of my mother I cant help by cry."
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Developing awareness
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"I've been attending Mass every morning to pray for my mothers soul and to help me get over her death."
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Restitution
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"I miss my mother but at least now I can accept her death and try to get on with my life."
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Outcome
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A person experiencing _______ may have trouble expressing feelings of loss or may deny them.
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Unresolved Grief
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In the ________________ stage of dying the patient expresses range and hostility and adopts a "why me?" attitude.
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Anger
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In the case of a terminal illness the ___________ is usually responsible for deciding what and how much the patient should be told.
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Physician
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In a __________ the patient appoints an agent he or she trusts to make decisions if he or she becomes incapacitated.
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Durable power of attorney for healthcare
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The ________________ requires all hospitals to inform their patients of advance directives
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Patient Self Determination Act of 1990.
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A ___________ order may be written on the chart of a terminally ill patient if the patient or family has expressed a wish that there be no attempts to resuscitate the patient in the event of cardiopulmonary failure.
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No code or DNR
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____________ is the gradual withdrawal of mechanical ventilation from a patient with a terminal illness or an irreversible condition with a poor prognosis.
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Terminal weaning
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The ______________ assumes responsibility for handling and filing the death certificate with proper authorities.
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Mortician
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After the patient has been pronounced dead the __________ is responsible for preparing the body for discharge.
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nurse
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List tow nursing responsibilities that should be carried out after the death of a patient in each of the following areas.
a. Care of the body. b. Care of the family c. Discharging legal responsibilities. |
a. Care of the body: Place body in normal anatomic position; remove soiled dressings and tubes (unless an autopsy is being performed); place ID tags on shroud, ankle and prostheses.
b. Care of the family: Be an attentive listener; attend funeral (if family permits); make follow up call to asses family's well being. c. Discharging legal responsibilities: Ensure death certificate has been signed by physician; review organ donation arrangements. |
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Describe the following three definitions of dealth.
a. Heart and lung death b. Whole brain death c. Higher brain death |
a. Heart and lung death: The irreversible cessation of spontaneous respiration and circulation; the accepted criterion for death until the 1960's this definition emerged from the historical idea that the flow of the body fluids was essential for life.
b. Whole brain death: The irreversible cessation of all functions of the entire brain including the brain-stem, this definition emerged in the 1960's from the belief that neocortical functioning is the key to the definition of a human being. c. Higher brain death: the irreversible loss of all higher brain functions or cognitive function; this definition was suggested in the 1970's and emerged from the belief that the brain is more important than the spinal cord and that the critical functions are the individuals personality conscious life uniqueness, capacity for remembering judging reasoning acting enjoying and worrying. |
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Briefly describe the following stages of dying, according to Kubler - Ross.
a. Denial and isolation b. Anger. c. Bargaining d. Depression e. Acceptance |
a. Denial and isolation: The patient denies that he or she will die, may repress what is discussed and may isolate self from reality.
b. Anger: The patient expresses rage and hostility and adopts a "why me?" attitude. c. Bargaining: The Patient tries to barter for more time. d. Depression: The patient goes through a period of grief before death e. Acceptance: The patient feels tranquil; he or she has accepted death and is prepared to die. |
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Your patient is a 50yr old woman newly diagnosed with terminal uterine cancer. What information should be provided to her regarding her condition?
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As soon as possible the patient should be told her diagnosis and prognosis, how the disease is likely to progress and what this will mean for her.
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List the clinical signs of impending death.
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Inability to swallow; pitting edema; decreased gastrointestinal and urinary tract activity; bowel and bladder incontinence; loss of motion sensation and reflexes; elevated temperature; syanosis; lowered blood pressure; noisy or irregular respiration; and Cheynestokes respirations.
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Describe the role of the nurse in terminal weaning.
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Nursing's role is to participate in the decision making process by offering helpful information about the benefits and burdens of continued ventilation and description of what to expect if it is initiated. Supporting the patients family and managing sedation and analgesia are critical nursing responsibilities.
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List three goals for nurses who wish to become effective in caring for patients experiencing loss grief or dying and death
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a.Communicate openly with patients about their losses and invite discussion of adequacy of their coping mechanisms.
b. Respond genuinely to the concerns and feelings of dying patients and their families; do not be afraid to cry with patients and to allow feelings to show. c. Value time spent with patients and family members in which supportive presence is the primary interventions. |
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Your patients is a 62 yr old man dying of liver cancer at home with his family. List three patient goals or outcomes for this patient and his family.
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a. The patient shall make healthcare decisions reflecting his values and goals
b. The patient shall experience a comfortable and dignified death. c. The patient and family shall |
