Coping, grief, culture and end-of-life care

42 NCLEX-RN practice questions on Coping, grief, culture and end-of-life care, part of Psychosocial Integrity. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Hard · Select all that apply

   A daughter caring at home for her father with Alzheimer disease tells the nurse she sleeps 4 hours a night, has missed her own medical visits and says, 'I can't do this anymore.' Which interventions should the nurse include?

   1. AHelp her ask other relatives to share tasks
   2. BGive information about a caregiver support group
   3. CRefer her to respite care services
   4. DSuggest an adult day program for her father
   5. ETell her she must place her father in a nursing home now

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   Answer: A, B, C, D

   Generate solutions: caregiver role strain is eased by respite care, support groups, shared family care and adult day programs. The nurse also asks about the caregiver's own health and safety and explores, without imposing, longer-term care options.

   • E: The decision about placement is the family's, after exploring options.

2. Question 2 · Medium · Matrix

   The nurse reviews advance care planning with a client. For each statement, indicate whether it is accurate or inaccurate.

   For each row, choose: Accurate / Inaccurate

   1. A do-not-resuscitate order means the client receives no other treatment.
   2. A health care agent makes decisions only when the client can no longer decide.
   3. A living will takes effect as soon as the client is admitted.
   4. The client may change or revoke an advance directive at any time.
   5. A POLST form is a set of medical orders signed by a provider.

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   Answer:

   • A do-not-resuscitate order means the client receives no other treatment.: Inaccurate
   • A health care agent makes decisions only when the client can no longer decide.: Accurate
   • A living will takes effect as soon as the client is admitted.: Inaccurate
   • The client may change or revoke an advance directive at any time.: Accurate
   • A POLST form is a set of medical orders signed by a provider.: Accurate

   Generate solutions: advance directives (living will and durable power of attorney for health care) act only when the client lacks capacity and can be changed at any time. A DNR order concerns resuscitation alone, and a POLST is a portable medical order for seriously ill clients.

   • A do-not-resuscitate order means the client receives no other treatment.: DNR covers CPR only; all other indicated care continues.
   • A health care agent makes decisions only when the client can no longer decide.: The agent's authority begins when the client lacks capacity.
   • A living will takes effect as soon as the client is admitted.: It applies only when the client cannot speak for self and the stated conditions are met.
   • The client may change or revoke an advance directive at any time.: A competent client can revoke a directive at any time.
   • A POLST form is a set of medical orders signed by a provider.: POLST translates wishes into actionable orders.

3. Question 3 · Medium · Matrix

   A client with severe vision loss from macular degeneration is admitted to a medical unit. For each action, indicate whether it is indicated or contraindicated.

   For each row, choose: Indicated / Contraindicated

   1. Describe the meal tray using the hours of a clock
   2. Rearrange the furniture to make a wider path
   3. Pull the client by the wrist when walking together
   4. Keep the call light in the same place within reach
   5. Say your name as you enter the room

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   Answer:

   • Describe the meal tray using the hours of a clock: Indicated
   • Rearrange the furniture to make a wider path: Contraindicated
   • Pull the client by the wrist when walking together: Contraindicated
   • Keep the call light in the same place within reach: Indicated
   • Say your name as you enter the room: Indicated

   Take action: for clients with visual impairment, the nurse identifies self, explains actions, keeps the room layout constant, uses the clock method for meals and offers an elbow for guided walking. Unannounced changes in the environment are a major cause of falls.

   • Describe the meal tray using the hours of a clock: The clock method helps the client find food independently.
   • Rearrange the furniture to make a wider path: Moving objects without telling the client causes falls.
   • Pull the client by the wrist when walking together: The client holds the nurse's arm just above the elbow and walks half a step behind.
   • Keep the call light in the same place within reach: A consistent location lets the client find it safely.
   • Say your name as you enter the room: The client may not recognize who has come in.

4. Question 4 · Medium · Select all that apply

   A client is in the last days of life and is no longer swallowing safely. Which comfort measures should the nurse include?

   1. ATurn the client every 2 hours with pillow support
   2. BGive the scheduled opioid as prescribed
   3. CApply lip balm to dry lips
   4. DEncourage large sips of water to prevent dehydration
   5. EKeep the room brightly lit and the television on
   6. FMoisten the mouth often with swabs

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   Answer: A, B, C, F

   Generate solutions: comfort in the final days relies on mouth care, skin care and repositioning, regular pain relief and a calm environment. Forcing oral fluids when swallowing is unsafe adds the risk of aspiration without relieving thirst better than mouth care.

   • D: Fluids by mouth risk aspiration when swallowing is unsafe.
   • E: A calm, quiet setting is more comforting.

5. Question 5 · Hard · Matrix

   A client has expressive aphasia after a left-hemisphere stroke; his hearing and understanding are intact. For each action, indicate whether it is indicated or not indicated.

   For each row, choose: Indicated / Not indicated

   1. Talk about him with his wife as though he is not present
   2. Ask questions that can be answered with yes or no
   3. Provide a picture or word board
   4. Give him time to answer without finishing his sentences
   5. Speak loudly and slowly in single words

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   Answer:

   • Talk about him with his wife as though he is not present: Not indicated
   • Ask questions that can be answered with yes or no: Indicated
   • Provide a picture or word board: Indicated
   • Give him time to answer without finishing his sentences: Indicated
   • Speak loudly and slowly in single words: Not indicated

   Take action: in expressive (Broca) aphasia, understanding is preserved but speech output is limited. The nurse uses yes/no questions, communication boards and patience, and speaks to the client as a capable adult in a normal voice.

   • Talk about him with his wife as though he is not present: This is disrespectful; he understands everything that is said.
   • Ask questions that can be answered with yes or no: This lets him answer without forming sentences.
   • Provide a picture or word board: Pointing gives him another way to express needs.
   • Give him time to answer without finishing his sentences: Patience reduces frustration and supports speech recovery.
   • Speak loudly and slowly in single words: His hearing and understanding are intact, so this is unnecessary and belittling.

6. Question 6 · Easy · Matrix

   A client has just learned that his cancer has spread. For each statement, indicate the stage of grief it best reflects.

   For each row, choose: Denial / Anger / Bargaining

   1. The lab must have mixed my scan up with someone else's.
   2. I feel fine, so there is no reason to start any treatment.
   3. If I can just get to my daughter's wedding in June, I will accept what happens.
   4. Do not touch me. None of you nurses know what you are doing.
   5. Why did my doctor not find this a year ago? He is useless.

   Answer and explanation in LearnFree account

7. Question 7 · Medium · Select all that apply

   A client has just died on a medical unit. Which nursing actions show culturally and spiritually respectful care?

   1. ARemove religious objects from the body before transfer
   2. BAssume the family follows every practice of their stated religion
   3. CCall the chaplain or the family's own faith leader on request
   4. DAsk the family which rituals or prayers they wish to perform
   5. EAllow family members to stay with the body if they wish

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8. Question 8 · Hard · Select all that apply

   A client has just given birth to a stillborn son at 36 weeks. Which nursing actions support the parents' grieving?

   1. AOffer a room away from the sounds of other newborns
   2. BRemind them that they can have another baby
   3. CUse the baby's name when the parents have chosen one
   4. DCreate keepsakes such as footprints and a lock of hair with their consent
   5. EOffer the parents the chance to see and hold their baby
   6. FEncourage the parents not to look at the baby to avoid distress

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9. Question 9 · Medium · Select all that apply

   A client whose spouse died in a car crash 3 days ago comes to the clinic saying she cannot think or make any decisions. Which actions fit crisis intervention?

   1. AExplore unresolved conflicts from her childhood
   2. BMake all of her decisions for her until the crisis ends
   3. CHelp her name relatives or friends who can stay with her
   4. DAsk whether she has thoughts of harming herself
   5. EFocus on the problems she must solve this week
   6. FAsk how she has coped with past difficult events

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10. Question 10 · Easy · Select all that apply

    The nurse prepares the family of a client on a hospice unit for the changes that come in the last hours of life. Which signs should the nurse describe?

    1. APauses in breathing that alternate with deep breaths
    2. BLess urine that becomes dark
    3. CA strong, bounding pulse
    4. DMottled, bluish skin on the knees and feet
    5. EA sudden increase in appetite
    6. FCool hands and feet

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11. Question 11 · Medium · Matrix

    A hospice bereavement nurse telephones relatives of clients who died on the unit. For each finding the relatives describe, indicate whether it is an expected grief response or requires follow-up.

    For each row, choose: Expected grief response / Requires follow-up

    1. A father says he feels worthless and has a plan to end his life
    2. A man sleeps poorly during the first weeks after his brother's death
    3. A woman still cannot work 18 months after her son died, yearns for him all day and avoids every reminder
    4. A widow cries when she hears her husband's favorite song 2 months after his death
    5. A man briefly hears his dead wife's voice calling his name at home

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12. Question 12 · Hard · Matrix

    A pediatric nurse talks with three grieving children whose grandfather has died. For each statement, indicate the developmental stage it best fits.

    For each row, choose: Preschool (3 to 5 years) / School-age (6 to 12 years) / Adolescent

    1. Grandpa is only sleeping in that box.
    2. What happens to a body after it is buried?
    3. Does it hurt when your heart stops?
    4. When will Grandpa wake up and come home?
    5. What is the point of anything if everyone just dies?

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13. Question 13 · Medium · Select all that apply

    A client whose husband died 2 weeks ago starts to cry while talking with the nurse. Which nurse responses are therapeutic?

    1. ATell me about him.
    2. BThis must be very hard for you.
    3. CYou should keep busy so you do not dwell on it.
    4. DI know exactly how you feel.
    5. EI will sit here with you for a while.
    6. FAt least he is not suffering anymore.

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14. Question 14 · Hard · Select all that apply

    A client with advanced lung disease has stopped attending his weekly prayer group and refuses visits from his pastor. Which client statements suggest spiritual distress?

    1. AI cannot pray anymore. It feels empty.
    2. BI would like my daughter here when the doctor comes.
    3. CMy life was a waste. None of it mattered.
    4. DCould you bring me my rosary from my bag?
    5. EWhy would God let this happen to me?

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15. Question 15 · Hard · Select all that apply

    A client who speaks only Vietnamese is about to hear that her biopsy shows cancer. Her 15-year-old grandson, who is fluent in English, offers to translate. Which actions should the nurse take?

    1. ALet the grandson translate because he is family
    2. BSpeak directly to the client, not to the interpreter
    3. CArrange a qualified medical interpreter
    4. DUse gestures and simple English to save time
    5. EAsk the client how much information she wants and who should hear it

    Answer and explanation in LearnFree account

16. Question 16 · Medium · Select all that apply

    An 82-year-old client is admitted with pneumonia and is at risk for delirium. Which actions should the nurse include in the plan of care?

    1. AEncourage family visits and familiar objects from home
    2. BApply wrist restraints at night to prevent wandering
    3. CMake sure the client wears glasses and hearing aids
    4. DKeep lights on during the day and dimmed at night
    5. EPlace a clock and calendar where the client can see them

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17. Question 17 · Hard · Matrix

    During admission assessments on a medical unit, clients describe practices from their culture or faith. For each practice, indicate whether the nurse can accommodate it as it is or must follow it up with the client and provider.

    For each row, choose: Accommodate as it is / Requires follow-up

    1. Plans to fast from dawn to sunset during Ramadan while taking insulin
    2. Asks for warm drinks and soups instead of iced water after surgery
    3. Drinks a bitter herbal tea twice a day but cannot name its contents
    4. Wears a small religious amulet on a cord around the wrist
    5. Has round, faded bruise-like marks on the back from cupping done last week

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18. Question 18 · Medium · Select all that apply

    The nurse explains palliative care to a client with newly diagnosed heart failure. Which statements about palliative care are accurate?

    1. AIt is limited to clients expected to live 6 months or less
    2. BIt can start at the time of diagnosis
    3. CIt can be given along with treatment aimed at cure
    4. DIt focuses on symptom relief and quality of life
    5. EIt requires the client to sign a do-not-resuscitate order

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19. Question 19 · Medium

    A dying client has loud, gurgling breathing from secretions in the throat. The daughter is upset by the sound. Which action is most appropriate?

    1. AIncrease the IV fluid rate to thin the secretions
    2. BTurn the client onto her side and explain the cause
    3. CPerform deep nasotracheal suctioning every hour
    4. DRaise the head of the bed and give oral fluids

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20. Question 20 · Easy

    A nurse explains crisis theory to a student. A crisis is usually resolved, for better or worse, within about:

    1. A2 to 3 years
    2. B6 to 12 months
    3. C4 to 6 weeks
    4. D24 to 48 hours

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21. Question 21 · Medium

    A client comes to the clinic two days after her house burned down. She says she cannot think straight and does not know where her family will sleep. Which nurse action fits crisis intervention best?

    1. AGive her a list of long-term counseling services only
    2. BHelp her name the most urgent need and who she can call
    3. CExplore how her childhood shapes the way she copes now
    4. DAdvise her to wait a few weeks until she feels calmer

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22. Question 22 · Hard

    A client with terminal cancer has a do-not-resuscitate order and a signed POLST form choosing comfort measures only. While the nurse is in the room, the client stops breathing and has no pulse. A visiting nephew shouts, "Do something, start CPR!" What should the nurse do?

    1. AStart CPR until the provider arrives to confirm the order
    2. BCall a code because a family member has requested it
    3. CAsk the nephew to sign a form overriding the DNR order
    4. DNot start CPR, stay with the family and notify the provider

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23. Question 23 · Medium

    A nurse is giving discharge instructions to an older client with presbycusis who does not wear hearing aids. The most effective technique is to:

    1. AFace the client and speak slowly in a low-pitched voice
    2. BShout the instructions close to the client's better ear
    3. CTalk quickly so the client does not get tired of listening
    4. DSpeak from behind so the client can concentrate on sound

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24. Question 24 · Medium

    A client with a new diagnosis of a terminal illness says, "God must be punishing me for something." Which response by the nurse is most appropriate?

    1. AGod does not punish people with illness
    2. BYou should not think that way about God
    3. CMany people feel that way, so do not worry
    4. DTell me more about what you are feeling

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25. Question 25 · Hard

    A competent 70-year-old client has just had tests that show advanced cancer. Her adult children ask the nurse not to tell her, saying that in their culture the family receives bad news and protects the elder. What is the most appropriate nursing action?

    1. ATell the children that US law forbids any family involvement
    2. BTell the client the full diagnosis immediately against their wishes
    3. CAsk the client privately how much she wants to know and who should be told
    4. DAgree with the children and keep the diagnosis from the client

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