Which behavior suggests that an older adult who has lost his life partner is successfully managing the exploration stage of the adjustment process?

1. He smiles when reminiscing about the trips they took together over the years.
2. He explains that he can’t make a decision about moving “just yet.”
3. He agrees to eat some of his “favorite soup” that his daughter has made.
4. He is heard saying, “I’ll never get over the loss, but my life has a purpose.”

A

Which activity would a couple in the reorientation phase of their retirement engage in?

1. Establishing a new budget that will allow them to travel to see the grandchildren
2. Reading magazines devoted to making decisions about retirement plans
3. Looking for ways to “fill up the days”
4. Volunteering at the local animal shelter

A

Which nursing intervention best addresses the need for social support demonstrated by an older adult couple who will be assuming responsibility for the raising of two grandchildren?

1. Facilitating a support group for children being raised by grandparents
2. Helping the grandparents express their feeling regarding this unexpected role change
3. Offering a monthly parenting class for this cohort of grandparents
4. Suggesting couple’s therapy to assist in managing any new stress on their marriage

C

Which statements made by a couple who have recently retired support the nurse’s evaluation that the transition to retirement has been a successful one? (Select all that apply.)

1. “I’m afraid we can’t make it that weekend; we’ll be visiting the grandchildren.”
2. “I’m not accustomed to sharing my kitchen with anyone else.”
3. “One week I was working 50 hours and the next I didn’t have to get up until noon.”
4. “I often wonder if my buddies from the plant miss me.”
5. “We have found a few painless ways to reduce our monthly expenses.”

A,E

Which intervention demonstrates effective care for an individual who has expressed a wish to “retire sometime soon”? (Select all that apply.)

1. Asking about when she plans to retire
2. Assessing her ability to handle the stresses of retirement
3. Engaging her in a conversation about her interests
4. Inquiring about the existence of any chronic illnesses
5. Scheduling a full physical examination

A,B,C,D,E

An older woman is preparing to move in with her daughter following the death of her spouse of 55 years. The daughter asks a nurse, “I know we are doing the right thing for mom, but I am a bit nervous about this. Do you have any suggestions about things that we should do in preparation?” The nurse responds: (Select all that apply.)

1. “Have you chosen an area of the house for your mom to live in?”
2. “Have you considered scheduling regular visits for your mom with your sister who lives out of state?”
3. “You have every right to be nervous; multigenerational households are usually not successful.”
4. “Have you investigated what activities are available at the senior center near your home?”
5. “Since your mom is so computer literate she can stay in touch with her friends

when she moves.”

A,B,D,E

Which behavior is characteristic of grief by a disenfranchised adult child in response to a parent’s death following a lengthy, painful illness?

1. Crying out loudly while invoking “God’s help” to go on with life
2. Announcing to family members, “I’ve already grieved the loss.”
3. Having difficulty even deciding what to wear to the funeral
4. Going on a drinking binge instead of attending the funeral

D

When working with a bereaved individual the goal of nursing interventions is to:

A.assist the individual to go through the stages of grief work in optimal order.

B. assists the individual to attain a healthy adjustment to loss experience.

C. encourage the individual to talk about his or her feelings about the deceased individual.

D.offer support and advice about how to successfully achieve grief work.

B

Which truism will the nurse base spousal grief counseling upon?

1. Men are less likely to grieve the loss of a spouse.
2. Women carry deeper attachments to their spouses than men do.
3. Women are generally more likely to outlive their spouses.
4. The male response to grief has been thoroughly studied and documented.

C

A woman is terminally ill. Although it has never been discussed in the family or stated outright by her physician, she is growing to believe that she will die because of her illness. Upon which concept will the nurse base therapeutic intervention on?

1. Closed awareness
2. Suspected awareness
3. Mutual pretense
4. Open awareness

B

The nurse suspects that the spouse of a terminally ill client is experiencing anticipatory grief when he :

1. dramatically reduces the time he spends attending to the client.
2. refuses to leave the client’s bedside regardless of the reason.
3. sobs inconsolably whenever he visits.
4. spends hours recalling details of their life together.

A

The nurse sits at the bedside of a comatose, terminally ill older client reading the wishes expressed in the numerous cards the client has received. Which concept of grief work is the nurse addressing with this intervention?

1. Everyone needs social interaction.
2. The nurse needs to “attend to the patient.”
3. Hearing is believed to be the last sense to be lost
4. The individual is living until he or she is dead.

D

A 78-year-old patient who is dying of colon cancer with metastases to the liver is refusing to eat or drink. He is alert and oriented, and states that he has no desire to eat, which is causing the family great distress. In order to best address the client and family, the nurse should:

1. explain the family’s concern to the client.
2. educate the family that this is normal behavior in this situation.
3. contact the physician for an order for enteral feeding.
4. contact the dietitian for feeding supplements.

B

Which principle regarding grief crisis intervention is the basis for intervention planning?

1. The acute phase is the most intense period of the grieving process.
2. The intensity of the grief is in proportion to the expected death trajectory.
3. Grief work is most effective when addressed during the acute phase of grief.
4. Anticipatory grief is an expected barrier to grief work.

C

. Which intervention is an example of countercoping for a client who has recently received a terminal diagnosis of cancer? (Select all that apply.)

1. Answering the client’s questions regarding the trajectory of his or her illness
2. Offering to pray with the client and family
3. Scheduling a meeting with the client and family to identify alternative end-of-life plans
4. Assessing the client frequently for depression and risk of self-harm
5. Being available to just listen to the client talk about dying

A,C,D,E

A nurse is caring for a patient in Portland, Oregon, who has a terminal illness. The patient tells the nurse that she has made a decision “to end it all,” that she has suffered enough and is considering asking her physician to prescribe medications to help her die. The nurse knows that the regulations for physician-assisted suicide include which of the following? (Select all that apply.)

A.A nurse or physician must be the one to administer the medications.

B.The patient must have a prognosis of 6 months or less to live.

C.The patient must be informed of all treatments and alternatives.

D.The family of the patient must agree in writing to the patient’s decision.

E.The patient must have received counseling to ensure that she is fully informed of the risks.

B,C

The daughter of a patient who has a chronic illness that has reached the terminal phase talks about the palliative care referral that the primary care provider made for her mother. Which of the following statements indicate that the daughter needs additional education about palliative care? (Select all that apply.)

1. “I know that palliative care is only available to people who have 6 months or less to live. That is really hard to cope with.”
2. “My mom still can be actively treated while receiving palliative care.”
3. “I understand that the palliative care team is made up of health care professionals of all different disciplines, not just doctors and nurses.”
4. “The goal of palliative care is to prevent or to minimize suffering”
5. “My mom will have to be transferred to a special unit in the hospital in order toreceive palliative care.”

A,E

A patient tells a nurse that she has prepared a living will (LW). The nurse understands that a living will: (Select all that apply.)

1. is an advanced directive that is used in the situation of a person who is unable to speak for herself or himself.
2. is a legally binding document in all states and territories of the United States.
3. appoints a proxy to uphold the patient’s wishes.
4. includes the provision that the patient’s next of kin have more authority than the appointed proxy.
5. can be revoked by the patient at any time in either writing or verbally.

A,C,E

Which of the following statements is true about loss in older adulthood?
a.
A person experiences each stage of grief once, and then grieving is resolved.
b.
Antianxiety agents are frequently recommended for reducing the pain of grief.
c.
The loss response model is concerned with the effect of loss on an individual.
d.
Referring to the deceased in the past tense can acknowledge the death's reality.

D

Which of the following interventions is recommended for an older adult in the final stages of dying?
a.
Apply an electric blanket to keep the patient warm.
b.
Lower the head of the bed, and turn the head to the side.
c.
Decrease the number of visitors.
d.
Support the preservation of energy.

D

Which of the following statements is true about end-of-life care?
a.
The physician is the ultimate authority in the decision to use or not to use life-sustaining medical treatment.
b.
The proxy appointed in a living will cannot speak for the testator in health care matters other than terminal illness.
c.
A patient with dementia cannot be capable of making personal wishes known about life-sustaining treatment.
d.
The American Nurses Association encourages nurses to participate in assisted suicide.

B

Which of the following is a true statement about loss, dying, and death for older adults?
a.
Men and women tend to respond similarly to the loss of a spouse.
b.
Visions on the part of a person who has lost a spouse are not normal grief reactions and should be regarded as signs of underlying defects.
c.
The grieving process is not rigidly structured.
d.
Bereaved persons regain their normal capability approximately 6 months after loss, and regressive behavior after that time should be discouraged.

C

Which of the following indicate a person is effectively coping? (Select all that apply.)
a.
Avoids avoidance
c.
Focuses on solutions
b.
Confronts realities
d.
Redefines problems

B,C,D

A family member asks the nurse to explain the purpose of hospice care. Which of the following is the best response? Hospice care:
1) Is appropriate when the patient desires to intentionally end his life
2) Focuses on minimizing the disease process as rapidly as possible
3) Focuses on symptom management for patients not responding to treatment
4) Is holistic care for patients dying or debilitated and not expected to improve

D