Death
According to the Uniform Definition of Death Act, which criteria must be met to declare a person legally dead? Select all that apply.
A. Irreversible cessation of all brain function, including the brainstem
B. Absence of pulse and heartbeat for 10 minutes
C. Irreversible cessation of circulatory and respiratory functions
D. Lack of reflexes and flat encephalogram
A, C, and D
A woman experiences sadness and grief after her child leaves for college. What type of loss is she experiencing?
A. Actual loss
B. Situational loss
C. Maturational loss
D. Anticipatory loss
C. Maturational loss
Rationale: Maturational loss occurs as part of normal life transitions, such as children growing up and moving out.
A nurse is caring for a terminally ill patient who has a Physician Order for Life-Sustaining Treatment (POLST) form. Which intervention should the nurse prioritize?
A. Follow the patient’s POLST orders regarding life-sustaining treatment.
B. Initiate CPR if the patient’s heart rate slows.
C. Disregard the POLST if the family requests full resuscitation.
D. Encourage the patient to create an advance directive instead.
A. Follow the patient’s POLST orders regarding life-sustaining treatment.
Rationale: A POLST form outlines specific medical interventions the patient wishes to receive or avoid. The nurse must follow the POLST directives, even if the family requests otherwise, as the document reflects the patient’s wishes.
A nurse is educating a group of nursing students on the definitions of grief-related terms. Which statement by a student indicates a need for further teaching?
A. "Grief is an internal emotional reaction to loss."
B. "Bereavement is the outward expression of grief through rituals and ceremonies."
C. "Mourning refers to the actions and expressions of grief."
D. "Dysfunctional grief is an abnormal or distorted grieving process."
B. "Bereavement is the outward expression of grief through rituals and ceremonies."
Rationale: Bereavement refers to the state of grieving after losing a loved one, while mourning includes the outward expressions of grief, such as rituals and ceremonies.
A nurse is assessing a patient in the final stages of life. Which signs and symptoms indicate that death is imminent?
A. Cold, mottled extremities
B. Increased appetite and thirst
C. Cheyne-Stokes respirations
D. Urinary incontinence
E. Increased blood pressure
A, C, and D
Rationale: Signs of impending death include cold, mottled extremities, Cheyne-Stokes respirations, urinary and bowel incontinence, and decreasing blood pressure.
Which situation is an example of anticipatory loss?
A. A patient grieving the loss of a spouse who recently passed away
B. A patient with a terminal illness who is aware of their approaching death
C. A family experiencing shock after an unexpected death
D. A patient who loses a limb in an accident
B. A patient with a terminal illness who is aware of their approaching death
Rationale: Anticipatory loss occurs when a person or family begins to grieve before the loss actually happens, such as in a terminal illness.
A physician orders terminal weaning for a patient who is on mechanical ventilation. Which action by the nurse is appropriate?
A. Administering sedatives and analgesics as needed
B. Removing the ventilator without notifying the family
C. Initiating CPR if the patient stops breathing
D. Increasing ventilator support to ease breathing
A. Administering sedatives and analgesics as needed
Rationale: Terminal weaning is the gradual withdrawal of mechanical ventilation in a patient with a poor prognosis, no brain activity. Comfort measures, including sedatives and analgesics, are provided to ease distress. CPR should not be initiated unless requested by an advance directive.
A nurse is educating a family about palliative care for their loved one with terminal cancer. Which statement by a family member indicates a need for further teaching?
A. "Palliative care focuses on relieving symptoms and improving comfort."
B. "Palliative care includes emotional and spiritual support for both the patient and family."
C. "Palliative care is only for patients who are actively dying."
D. "Palliative care can be provided alongside curative treatments."
C. "Palliative care is only for patients who are actively dying."
Rationale: Palliative care is designed to provide symptom relief and improve quality of life at any stage of a serious illness, not just for those actively dying. It can be provided alongside curative treatments.
Which nursing intervention addresses the physiological needs of a dying patient?
A. Providing spiritual counseling
B. Managing pain and ensuring comfort
C. Encouraging the patient to express feelings
D. Offering psychological support to the family
B. Managing pain and ensuring comfort
Rationale: The physiological needs of a dying patient include pain management, hygiene, comfort, and symptom relief. Spiritual and psychological needs are also important but fall under different categories.
A nurse is providing comfort measures only for a terminally ill patient. Which interventions are appropriate? Select all that apply.
A. Providing pain relief
B. Administering oxygen to reduce dyspnea
C. Performing frequent vital signs and laboratory testing
D. Allowing family to be present and involved in care
A, B, and D
Rationale: Comfort measures focus on relief of symptoms, pain management, and emotional support. Frequent monitoring and aggressive treatments are not part of comfort-focused care.
A nurse is explaining advance directives to a patient. Which statement by the patient indicates correct understanding?
A. "A living will allows my family to make all medical decisions for me."
B. "An advance directive only goes into effect after I pass away."
C. "A durable power of attorney appoints someone to make decisions for me if I cannot."
D. "A living will is a verbal agreement with my healthcare provider about my wishes."
C. "A durable power of attorney appoints someone to make decisions for me if I cannot."
Rationale: Advance directives include a living will, which outlines medical treatment preferences, and a durable power of attorney, which designates someone to make decisions on behalf of the patient.
A nurse is educating the family of a terminally ill patient on how to assist with care at home. Which statement by the family indicates a need for further teaching?
A. "We should help reposition them every two hours to prevent discomfort."
B. "We should allow them to be completely independent, even if they struggle."
C. "We can help with hygiene and offer comfort measures as needed."
D. "We should provide emotional support and encourage them to express feelings."
B. "We should allow them to be completely independent, even if they struggle."
Rationale: Family members should assist as needed to ensure the patient's comfort and dignity while maintaining as much independence as possible. However, if a patient is struggling, assistance should be offered.
A terminally ill patient tells the nurse, "I am afraid of what will happen after I die." Which nursing action best addresses the patient’s psychological needs?
A. Provide pain relief and reposition the patient
B. Encourage the patient to express fears and concerns
C. Administer sedatives to reduce anxiety
D. Explain postmortem care procedures
B. Encourage the patient to express fears and concerns
Rationale: Psychological needs include fear of the unknown, separation from loved ones, loss of control, and unfinished business. Encouraging open discussion helps patients cope with their emotions.
A nurse is providing postmortem care for a patient who has just passed away. Which action is most appropriate when supporting the family?
A. Avoid discussing the patient’s death to prevent distress
B. Offer a private space for the family to grieve
C. Encourage the family to leave immediately so care can proceed
D. Ask the family to assist in removing medical devices
B. Offer a private space for the family to grieve
Rationale: Supporting grieving families includes providing privacy, listening to their emotions, and allowing them time to say goodbye.
A nurse is educating a patient about a living will. Which statement by the patient indicates correct understanding?
A. "A living will allows my doctor to make medical decisions for me."
B. "A living will outlines the medical treatments I do or do not want if I become unable to communicate."
C. "A living will appoints someone to make decisions for me when I pass away."
D. "A living will is only valid if my family agrees with my decisions."
B. "A living will outlines the medical treatments I do or do not want if I become unable to communicate."
Rationale: A living will is a type of advance directive that specifies a patient’s wishes regarding medical treatment in the event they become incapacitated. It does not appoint a decision-maker (that is the role of a durable power of attorney for healthcare).
Which nursing interventions are included in postmortem care? Select all that apply.
A. Placing the body in an anatomical position
B. Removing tubes and dressings unless an autopsy is scheduled
C. Placing identification tags on the body
D. Initiating CPR if the family requests resuscitation
E. Following local laws if the patient died of a communicable disease
A, B, C, and E
Rationale: Postmortem care includes positioning the body, removing tubes and dressings unless an autopsy is scheduled, and placing identification tags. If a patient has died, CPR should not be initiated regardless of family requests. Local laws must be followed for communicable diseases.
A nurse is caring for a dying patient who states, "I feel like I need to make amends before I go." How should the nurse respond?
A. "You need to conserve your energy right now."
B. "Would you like me to contact a spiritual advisor or clergy member for you?"
C. "There is nothing more you need to do; just focus on resting."
D. "Let’s discuss adjusting your pain medication to make you feel better."
B. "Would you like me to contact a spiritual advisor or clergy member for you?"
Rationale: Spiritual needs of dying patients include finding meaning, seeking forgiveness, and making amends. Offering to contact a spiritual advisor or clergy supports the patient’s spiritual well-being.
A patient diagnosed with a terminal illness tells the nurse, "This can't be true. The doctors must have made a mistake." According to Kübler-Ross’s stages of grief, which stage is the patient experiencing?
A. Anger
B. Bargaining
C. Denial
D. Acceptance
A patient diagnosed with a terminal illness tells the nurse, "This can't be true. The doctors must have made a mistake." According to Kübler-Ross’s stages of grief, which stage is the patient experiencing?
A. Anger
B. Bargaining
C. Denial
D. Acceptance
A nurse is caring for a patient on mechanical ventilation whose condition has worsened significantly. The healthcare team is discussing terminal weaning. Who is responsible for making the final decision regarding terminal weaning?
A. The attending physician
B. The healthcare team collectively
C. The patient or their designated healthcare proxy
D. The patient’s primary nurse
C. The patient or their designated healthcare proxy
Rationale: The decision for terminal weaning is ultimately made by the patient if they are capable or by their designated healthcare proxy (as outlined in an advance directive or durable power of attorney for healthcare). While the physician and healthcare team provide recommendations, the patient’s autonomy and wishes guide the final decision.
A terminally ill patient expresses fear about leaving their loved ones behind. What is the most appropriate nursing intervention?
A. Offer pain medication to help reduce stress
B. Provide an opportunity for the patient to talk about their fears
C. Change the subject to distract them from their concerns
D. Tell them not to worry and that their family will be fine
B. Provide an opportunity for the patient to talk about their fears
Rationale: Addressing psychological needs includes allowing the patient to express their emotions, fears, and concerns about dying.