Nursing 109

N108: Transition to the Registered Professional Nurse Role Study Guide

Chapter 4

1. B As long as there is any unassisted respiratory effort, the physician will not declare a patient dead. If a patient is on a ventilator and being assisted to breathe, the physician will take the patient off the machine for some period of time to assess patient. 2. C A DNR, or do-not-resuscitate order, is one that is written by the physician that will indicate the patient does not want life-saving measures in the event of death. The last will and testament is a legal document describing what is to be done with the individual’s belongings at the time of death. A living will is a document in which the individual describes what steps should and should not be taken in certain circumstances if he is not able to voice his decisions. 3. B Typically, hospice care requires that a patient have a terminal diagnosis with a life expectancy of less than 6 months. The goal of hospice care is to keep the patient comfortable and enable a dignified death. Pain medications, food, and water are given if the patient wants them, but life-prolonging treatments are typically not done. 4. D Until the physician or medical examiner has determined that an autopsy will not be done, all tubes and catheters should be left in place. The body can be cleaned up and positioned in a normal position for family viewing. 5. C Actual loss is experiencedwhen a person,skill, or object is lost. Anticipatory loss occurs when an individual knows that a loss is imminent, but it has not occurred yet. Perceived loss is one that is felt by the individual but is not obvious to another person. Developmental loss is one that occurs as a result of the maturation process. 6. B Exaggerated grief is an intense reaction to a loss. Unresolved grief is grief lasts over an extended period of time and the sufferer has trouble returning to normal activities. Delayed grief is grief that is put off to be dealt with at a time in the future. Disenfranchised grief occurs when the individual cannot openly acknowledge the grief they’re feeling. 7. B The patient is angry about his loss and is misplacing the anger on the nurse. The nurse should understand that this anger is not directed at her and should attempt to talk to the patient about his loss and the anger he is feeling. 8. A Closed awareness is the state of awareness when the staff and family know the patient’s prognosis, but the patient does not. Mutual pretense describes the state of awareness in which everyone knows the prognosis but no one acknowledges or talks about it. Open awareness is the state of awareness in which everyone knows the prognosis and is comfortable talking about it. 9. D Her anxiety and fear may lead toineffective coping. All of these diagnoses may be appropriate for the patient; however, the patient is probably expressing her anxiety and fear related to her impending death. 10. B Often sitting and talking with a dying patient can alleviatemuch of her fear. Although it might be appropriate to encourage an aide or family member to sit with her, the patient’s need is now and the person to whom she has reached out to should immediately make time to sit with her.

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