N102 Final Exam Review: Grief Stages and End-of-Life Care Insights
END OF LIFE CARE
Which of the following responses is an indication the client is in the phase of the grief process?
Between diagnosis and death the pt may exhibit the 5 stages of grief:
1. Denial - Deny that they are sick and dying. May insist that the doctor is wrong and ask to see another
doctor. May even refuse medical tx.
2. Anger - Realizes that death is going to happen. Anger may be taken out on the healthcare team or
family. If personal habits (ex: smoking) contributed to the disease there may be anger directed at self.
3. Bargaining - Dying person tries to make a deal with someone perceived as having control over their
fate, like an HCP or god. Ex: Pray to live long enough to witness an event (wedding, birth of a
grandchild)
4. Depression - Realizes fully that their diagnosis is certain to end in death and this knowledge makes the
person sad. Might not want to talk, even to family members. The person may cry easily or frequently.
5. Acceptance - Accepts that death is coming and is at peace with this knowledge. The person
demonstrates acceptance by taking care of unfinished business (writing a will, making amends with
friends or family)
Question:
The nurse is caring for a patient who has been recently diagnosed with late stage pancreatic cancer. The
patient refuses to accept the diagnosis and refuses to adhere to treatment. What is the most likely psychosocial
purpose of this patients strategy?
a. The pt may be trying to protect loved ones from the emotional effects of the illness.
b. The pt is being noncompliant in order to assert power over caregivers
c. The pt may be skeptical of the benefits of the Western biomedical model of health
d. The pt thinks that tx does not provide him comfort
Answer: A. Pts who are characterized as being in denial may be using this strategy to preserve important
interpersonal relationships, to protect others from the emotional effects of their illness, and to protect themselves
bc fears of abandonment. Each of the other options is plausible, but less likely.
Contrast/compare non-complicated (normal) grieving with complicated (maladaptive) grieving behavior.
1. Complicated Grief and Mourning
a. Characterized by prolonged feelings of sadness and feelings of general worthlessness or
hopelessness that persist long after the death, prolonged symptoms that interfere with activities
of daily living (anorexia, insomnia, fatigue, panic), or self destructive behaviors such as alcohol
N102 Final Exam Review: Grief Stages and End-of-Life Care Insights
,N102 Final Exam Review: Grief Stages and End-of-Life Care Insights
or substance abuse and suicidal ideation or attempts. Complicated grief and mourning require
professional assessment and can be treated with psychological interventions and, in some
cases, with medications.
Explain the psychosocial benefits of the stages of grief.
1. Grief = transition/growth
2. Shock = protection
3. Anger = protection/change
4. Fear = caution/protection
5. Love = giving/joy/delight
Which are assessment findings when death is near?
1. Less interest in eating and drinking. Urinary output decreases.
2. As the body weakens, the pt will sleep more and begin to detach from the environment
3. Mental confusion may become apparent
4. Vision and hearing may become somewhat impaired, and speech may be difficult to understand
5. Secretions may collect in the back of the throat and rattle or gurgle as the pt breathes through the
mouth
6. Breathing may become irregular with periods of no breathing (apnea).
7. As oxygen supply to the brain decreases, the pt may become restless
8. The pt may feel hot one moment and cold the next as the body loses it ability to thermoregulate.
9. Loss of bladder and bowel control may occur around the time of death.
10. As people approach death, many times they report seeing gardens, libraries, or family or friends who
have died.
11. Skin color changes or mottling (blotchy, red-purplish marbling of the skin)
Question: The nurse is caring for a pt who has terminal lung cancer and is unconscious. Which assessment
finding would most clearly indicate to the nurse that the pts death is imminent?
a. Mottling of the lower limbs
b. Slow, steady pulse
c. Bowel incontinence
d. Increased swallowing
Answer: a. Rationale: The time of death is generally preceded by a period of gradual diminishment of bodily
functions in which increasing intervals between respirations, weakened and irregular pulse, and skin color
changes or mottling may be observed. The pt will not be able to swallow secretions, so suctioning, frequent
and gentle mouth care, and, possibly, the administration of a transdermal anticholinergic drug. Bowel
incontinence may or may not occur.
Hospice programs emphasize?
The principles underlying hospice are as follows:
N102 Final Exam Review: Grief Stages and End-of-Life Care Insights
, N102 Final Exam Review: Grief Stages and End-of-Life Care Insights
1. Death must be accepted
2. The pts total care is best managed by an interdisciplinary team whose members communicate regularly
with one another.
3. Pain and other symptoms of terminal illness must be managed
4. The patient and the family should be viewed as a single unit of care.
5. Home care of the dying is necessary
6. Bereavement (period during which mourning for a loss takes place) and education should be ongoing.
Palliative programs emphasize?
1. Palliative care
a. Focuses on caring interventions and symptom management rather than cure for diseases or
conditions that no longer respond to treatment.
b. Pain and symptoms are controlled; the dying clients should be as pain-free and as comfortable
as possible.
c. Hospice care provides support and care for clients in the last phases of incurable diseases so
that they might live as fully and as comfortably as possible; client and family needs are the focus
of any intervention.
Question: A nurse who works in the specialty of palliative care frequently encounters issues and situations that
constitute ethical dilemmas. What issue has most often presented challenging ethical issues, especially in the
context of palliative care?
a. The increase in cultural diversity in the U.S.
b. Staffing shortages in health care and questions concerning quality care
c. Increased costs of health care coupled with inequalities in access
d. Ability of technology to prolong life beyond meaningful quality of life
Answer: D. The application of technology to prolong life has raised several ethical issues. The major question
is, bc we can prolong life through increasingly sophisticated technology, does it necessarily follow that we must
do so? The increase in cultural diversity has not raised ethical issues in healthcare. Similarly, costs and staffing
issues are relevant, but not central to the most common ethical issues surrounding palliative care.
What is the ANA ethical position on assisted suicide?
In its position statement on Euthanasia, Assisted Suicide and Aid in Dying, the ANA clearly prohibits nurses’
participation in assisted suicide and euthanasia:
Because the acts are in direct violation of (the code of ethics), the ethical traditions and goals of the profession,
and its covenant with society. Nurses have an obligation to provide humane, comprehensive, and
compassionate care that respects the rights of pts but upholds the standards of the profession in the presence
of chronic, debilitating illness and at end-of-life (ANA, 2013, p. 1)
End of life care: Best responses and interventions to a client laments about being terminally ill.
End of life care: Hope fostering strategies for terminally ill.
N102 Final Exam Review: Grief Stages and End-of-Life Care Insights
END OF LIFE CARE
Which of the following responses is an indication the client is in the phase of the grief process?
Between diagnosis and death the pt may exhibit the 5 stages of grief:
1. Denial - Deny that they are sick and dying. May insist that the doctor is wrong and ask to see another
doctor. May even refuse medical tx.
2. Anger - Realizes that death is going to happen. Anger may be taken out on the healthcare team or
family. If personal habits (ex: smoking) contributed to the disease there may be anger directed at self.
3. Bargaining - Dying person tries to make a deal with someone perceived as having control over their
fate, like an HCP or god. Ex: Pray to live long enough to witness an event (wedding, birth of a
grandchild)
4. Depression - Realizes fully that their diagnosis is certain to end in death and this knowledge makes the
person sad. Might not want to talk, even to family members. The person may cry easily or frequently.
5. Acceptance - Accepts that death is coming and is at peace with this knowledge. The person
demonstrates acceptance by taking care of unfinished business (writing a will, making amends with
friends or family)
Question:
The nurse is caring for a patient who has been recently diagnosed with late stage pancreatic cancer. The
patient refuses to accept the diagnosis and refuses to adhere to treatment. What is the most likely psychosocial
purpose of this patients strategy?
a. The pt may be trying to protect loved ones from the emotional effects of the illness.
b. The pt is being noncompliant in order to assert power over caregivers
c. The pt may be skeptical of the benefits of the Western biomedical model of health
d. The pt thinks that tx does not provide him comfort
Answer: A. Pts who are characterized as being in denial may be using this strategy to preserve important
interpersonal relationships, to protect others from the emotional effects of their illness, and to protect themselves
bc fears of abandonment. Each of the other options is plausible, but less likely.
Contrast/compare non-complicated (normal) grieving with complicated (maladaptive) grieving behavior.
1. Complicated Grief and Mourning
a. Characterized by prolonged feelings of sadness and feelings of general worthlessness or
hopelessness that persist long after the death, prolonged symptoms that interfere with activities
of daily living (anorexia, insomnia, fatigue, panic), or self destructive behaviors such as alcohol
N102 Final Exam Review: Grief Stages and End-of-Life Care Insights
,N102 Final Exam Review: Grief Stages and End-of-Life Care Insights
or substance abuse and suicidal ideation or attempts. Complicated grief and mourning require
professional assessment and can be treated with psychological interventions and, in some
cases, with medications.
Explain the psychosocial benefits of the stages of grief.
1. Grief = transition/growth
2. Shock = protection
3. Anger = protection/change
4. Fear = caution/protection
5. Love = giving/joy/delight
Which are assessment findings when death is near?
1. Less interest in eating and drinking. Urinary output decreases.
2. As the body weakens, the pt will sleep more and begin to detach from the environment
3. Mental confusion may become apparent
4. Vision and hearing may become somewhat impaired, and speech may be difficult to understand
5. Secretions may collect in the back of the throat and rattle or gurgle as the pt breathes through the
mouth
6. Breathing may become irregular with periods of no breathing (apnea).
7. As oxygen supply to the brain decreases, the pt may become restless
8. The pt may feel hot one moment and cold the next as the body loses it ability to thermoregulate.
9. Loss of bladder and bowel control may occur around the time of death.
10. As people approach death, many times they report seeing gardens, libraries, or family or friends who
have died.
11. Skin color changes or mottling (blotchy, red-purplish marbling of the skin)
Question: The nurse is caring for a pt who has terminal lung cancer and is unconscious. Which assessment
finding would most clearly indicate to the nurse that the pts death is imminent?
a. Mottling of the lower limbs
b. Slow, steady pulse
c. Bowel incontinence
d. Increased swallowing
Answer: a. Rationale: The time of death is generally preceded by a period of gradual diminishment of bodily
functions in which increasing intervals between respirations, weakened and irregular pulse, and skin color
changes or mottling may be observed. The pt will not be able to swallow secretions, so suctioning, frequent
and gentle mouth care, and, possibly, the administration of a transdermal anticholinergic drug. Bowel
incontinence may or may not occur.
Hospice programs emphasize?
The principles underlying hospice are as follows:
N102 Final Exam Review: Grief Stages and End-of-Life Care Insights
, N102 Final Exam Review: Grief Stages and End-of-Life Care Insights
1. Death must be accepted
2. The pts total care is best managed by an interdisciplinary team whose members communicate regularly
with one another.
3. Pain and other symptoms of terminal illness must be managed
4. The patient and the family should be viewed as a single unit of care.
5. Home care of the dying is necessary
6. Bereavement (period during which mourning for a loss takes place) and education should be ongoing.
Palliative programs emphasize?
1. Palliative care
a. Focuses on caring interventions and symptom management rather than cure for diseases or
conditions that no longer respond to treatment.
b. Pain and symptoms are controlled; the dying clients should be as pain-free and as comfortable
as possible.
c. Hospice care provides support and care for clients in the last phases of incurable diseases so
that they might live as fully and as comfortably as possible; client and family needs are the focus
of any intervention.
Question: A nurse who works in the specialty of palliative care frequently encounters issues and situations that
constitute ethical dilemmas. What issue has most often presented challenging ethical issues, especially in the
context of palliative care?
a. The increase in cultural diversity in the U.S.
b. Staffing shortages in health care and questions concerning quality care
c. Increased costs of health care coupled with inequalities in access
d. Ability of technology to prolong life beyond meaningful quality of life
Answer: D. The application of technology to prolong life has raised several ethical issues. The major question
is, bc we can prolong life through increasingly sophisticated technology, does it necessarily follow that we must
do so? The increase in cultural diversity has not raised ethical issues in healthcare. Similarly, costs and staffing
issues are relevant, but not central to the most common ethical issues surrounding palliative care.
What is the ANA ethical position on assisted suicide?
In its position statement on Euthanasia, Assisted Suicide and Aid in Dying, the ANA clearly prohibits nurses’
participation in assisted suicide and euthanasia:
Because the acts are in direct violation of (the code of ethics), the ethical traditions and goals of the profession,
and its covenant with society. Nurses have an obligation to provide humane, comprehensive, and
compassionate care that respects the rights of pts but upholds the standards of the profession in the presence
of chronic, debilitating illness and at end-of-life (ANA, 2013, p. 1)
End of life care: Best responses and interventions to a client laments about being terminally ill.
End of life care: Hope fostering strategies for terminally ill.
N102 Final Exam Review: Grief Stages and End-of-Life Care Insights
