Eliopoulos - Gerontological Nursing :
End of Life Care Exam
The 45-year-old son of a dying woman is profoundly uncomfortable with discussions of
her expected time of death, funeral preparations, and the signs and symptoms that may
signal that death is imminent. Which of the following historical phenomena may have
contributed to the son's reluctance to acknowledge the reality of death?
A) In the past, death was viewed positively as a welcome transition, while it is now often
seen as an undesirable evil.
B) The declining death rate means that individuals live longer and survive to experience
more unsettling symptoms and discomfort
than in past generations.
C) Many people now die in institutional settings, limiting the amount of previous
exposure to death that many individuals have.
D) Modern medical technology and increasing vigilance of treatment has brought about
a mistrust of the natural dying process. - Answers -Ans: C
Because many people now die in hospitals and care facilities rather than homes, many
individuals have minimal exposure to the reality of death, exacerbating their fear and
discomfort about the process. Death was not necessarily viewed positively in the past
and
pain and discomfort have always been realities. Fear of the dying process is not
necessarily a result of advances in medical
technology.
A 79-year-old woman with a longstanding diagnosis of chronic leukemia experienced a
blast crisis one week ago and died overnight. Place the stages of the coping
mechanisms that the woman's family will go through in the most likely chronological
order. Use all the options.
A) Anger
B) Denial
C) Acceptance
D) Bargaining
, E) Depression - Answers -Ans: B, A, D, E, C
Kübler-Ross' conceptual framework of the coping mechanisms surrounding death
progress through stages of denial, anger,
bargaining, depression and acceptance.
The daughter of a 79-year-old man with a diagnosis of small-cell lung cancer has
learned that her father has been found to have bone metastases. The daughter has
approached the oncologist who is caring for him with information that she has found on
the Internet that promises to cause remission of cancer through intensive antioxidant
therapy. She is adamant that the physician facilitate the treatment and liaise with the
providers who are located overseas. Which of the stages of Kübler-Ross' conceptual
framework is the daughter most likely experiencing?
A) Depression
B) Anger
C) Denial
D) Bargaining - Answers -Ans: C
The quest for a more positive outcome from unlikely sources is associated with the
stage of denial.
Faced with the crushing reality of her imminent death, a 72-year-old female patient with
advanced pancreatic cancer has become withdrawn and quiet, with her family stating
that they believe she is depressed. Which of the following interventions should the
nurse prioritize?
A) Create a physical environment with more natural light and privacy
B) Emphasize the patient's need for a sustained serotonin reuptake inhibitor (SSRI) to
her care team.
C) Provide gentle encouragement and assure the patient that the care team will
prioritize her pain control.
D) Focus on being truly with the patient and using therapeutic touch appropriately. -
Answers -Ans: D
Given the gravity of the dying patient's circumstances, encouragement, modifications to
the physical environment or
antidepressants are unlikely to be as therapeutic as simple touch and presence.
The children and wife of a man dying of renal failure are eager to interact with him as
much as possible in the days before his death. Consequently, the daughter has
questioned the nurse's decision to administer the man's scheduled hydromorphone,
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