NSG 501 Exam 4 With complete verified solutions 2025-2026

continuum of care

curative care, palliative care, hospice, death and bereavement care

preventative care

aims to improve and maintain health by ensuring people do not fall ill in the first place

(smoking cessation, healthy eating, weight loss, reducing alcohol use, etc)

curative care

treatment directed toward curing a patient's disease

palliative care

aims to improve the quality of life for clients and families coping with a life threatening and life limiting illness

hospice care

-must have a prognosis of 6 months or less

-cannot be receiving active medical treatment

-symptom management (especially pain), decision making about EOL issues, and support for client and family

advanced directives

a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.

role of nurse in end of life issues

-pain management

-communication with patient is equal to or supersedes clinical skill in EOL care

-awareness of cultural differences

-spiritual needs

-presence

actual loss

can no longer see, touch, hear, or have near person or something

perceived loss

uniquely defined by the person experiencing the loss and is less obvious to other people

maturational loss

a lifetime of normal development processes. ex kid goes to school and mom feels loss, kid may also feel loss. They spend less time together.

situational loss

unpredictable external events that brings loss

signs of approaching death

-loss of appetite

-sleeping or coma

-decreased UO

-disorientation, restlessness, agitation

-changing vital signs

-severe dyspnea

-cool skin and change in color

-hearing last sense to go

care of the body after death

-confirm death

-is autopsy requested or required?

-verify organ/tissue donation status

-patient identifiers

-provide care that is sensitive/culturally appropriate

-elevate HOB

-remove equipment as appropriate

-cleanse and cover body

-prepare environment (deodorizer, lower lights)

-allow families to view body

-provide privacy for grieving

-determine disposition of belongings

-after viewing - shroud and place

-complete documentation

-maintain privacy and dignity on transport

loss vs grief

Loss: the experience of separation from something of personal importance

Grief: deep emotional and mental anguish that is a response to the subjective experience of loss of something significant

Loss is the act of losing something, whereas grief is the emotional response to the loss****

types of loss: possessions or objects

what is the value of the object?

what is the sentiment attached to it? what was its usefulness?

types of loss: familiar environment

is the loss due to situational or maturational events? does the loss occur because of illness or injury? does loneliness, social isolation threaten self-esteem, belonging, or hopefulness?

types of loss: significant other or relationship

close friends, family members, divorce, pets. does loss threaten safety, love concept?

types of loss: aspect of self

illness, injury, valued aspect (fertility), identity

types of loss: life

grieving occurs in the dying and those left behind

factors that influence responses to loss and grief

-age and stage of development

-relationship to the lost object/person

-significance and meaning of the loss

-culture and ethnicity

-spiritual and religious beliefs

-gender

-socioeconomic status

-support system

-coping strategies

-cause of loss or death

-multiplicity of losses

Kubler-Ross' 5 stages of grief

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

theories of loss: attachment theory

-numbing: protects the person from the full impact of the loss

-yearning and searching: emotional outbursts, acute distress

-disorganization and despair: endless examination of why

-reorganization: accepts the change

theories of loss: grief tasks model

-accepts the reality of the loss

-experiences the pain of grief

-adjusts to a world without the loved one/thing

-emotionally relocates the decreased and moves on with life

theories of loss: Rando's R process model

-recognizing the loss

-reacting to the pain of separation

-reminiscing

-relinquishing old attachments

-readjusting to life after loss

-reminiscence

theories of loss: dual process model

-loss-oriented

-restoration-oriented

theories of loss: trajectories of bereavement

-common grief

-chronic grief

-chronic depression

-depression followed by improvement

-resilience

cultural differences of EOL care

-how are decisions made?

-who should information be directed to?

-what are views about suffering?

-what are views about death, EOL care, "pulling the plug"?

organ donation

Donating or giving one's organs and/or tissues after death; one may designate specific organs or may donate any needed organs

cardiac death

death in which the heart has stopped functioning

brain death

a diagnosis of death based on the cessation of all signs of brain activity, as measured by electrical brain waves

nurse's role in organ donation

-contact Organ Procurement Organization (OPO) before discussion with family

-OPO initiates conversation with patient

-no cost to a family for the gift of organ and tissue donation

-all major religions in the US support donation as an unselfish act of charity to save or improve someone's life

-if you are sick or injured and admitted to a hospital, the #1 priority is to save your life

-when matching donor organs to recipients, the computerized matching system considers issues such as severity of illness, blood type, time spent waiting, other important medical information, and geographic location. Recipient's financial or celebrity status or race does not figure in

loss and grief: assessment

-be present

-use active listening, silence, therapeutic touch

-use open, honest communication

-ask open-ended questions

loss and grief: nursing diagnosis

-death anxiety

-risk for aspiration

-risk for imbalanced body temperature

-bowel incontinence

-decreased cardiac output

loss and grief: planning

-goals and outcomes based on nursing diagnosis

-setting priorities (encourage patient to share their priorities for care, give priority to a patient's most urgent physical or psychological needs), maintain an ongoing assessment to revise the plan of care according to patient needs and preferences)

-teamwork and collaboration

loss and grief: implementation

-health promotion (focus on coping and optimizing health)

-palliative care

-hospice care

-use therapeutic communication

-provide psychological care

-manage symptoms

-promote dignity and self-esteem

-maintain a comfortable and peaceful environment

-promote spiritual comfort and hope

-protect against abandonment and isolation

-support the grieving family

-assist with EOL decision making

-facilitate mourning

-care after death

loss and grief: evaluation

-patient outcomes (ask evaluations, short- and long-term achievements)

what are the stages of the sleep cycle?

NREM-1, NREM-2, NREM-3, REM

NREM-1

light sleep

NREM-2

onset of sleep, body is becoming disengaged from surroundings, body temp starts dropping

NREM-3

deepest and most restorative

-decrease BP, RR

-decrease muscle tone, increase blood supply

-tissue growth and repair

-hormones

REM

-rapid eye movement

-active brain, muscle atonia

-brain restoration

factors that affect sleep

age, environment, light, blue light device use, temperature, noise, alcohol, caffeine, pain, mood (anxiety/worry), patterns of elimination, exercise, shift work, lifestyle, medications

insomnia

recurring problems in falling or staying asleep

narcolepsy

uncontrollable sleep attacks

sleep apnea

a sleep disorder characterized by temporary cessations of breathing during sleep and repeated momentary awakenings

circadian rhythm disorders

disturbances of the sleep-wake cycle such as jet lag and shift work

restless leg syndrome

uncomfortable sensations in legs causing movement and loss of sleep

parasomnias/night terrors

Seven arousals in which the person, often a child, is physically active. Often hallucinatory, and expresses a strong emotions such as terror.

- unlike nightmares, occurs during stage III NREM sleep.

hospital-acquired sleep alterations

-alarms, buzzers, call lights

-pain

-unfamiliar environment

-lines/drains

-bright lights

-unnecessary interventions

-unmonitored noise levels (hallway conversations, squeaky wheels)

-depression

-anxiety

-poor sleep hygiene

sleep promotion: role of the nurse

-assessment (questions, sleep diary, STQ)

-potential diagnosis (readiness for enhanced sleep, sleep deprivation, disturbed sleep pattern)

-outcomes (manageable steps, pt will report being able to fall asleep within 30 minutes of going to bed)

-interventions (depends on underlying cause - pain control, noise reduction, lighting, bundle/clustering care, bathing, music therapy, ear plugs)

-evaluation

sleep hygiene

The practice of following good sleep habits to sleep soundly and be alert during the day

consequences of sleep deprivation

accidental death, impaired brain activity, yawning, cognitive dysfunction, memory problems, moodiness, hallucinations, depression, micro sleep, accident prone, weakened immune response, cold/flue, weight gain, type 2 diabetes, high blood pressure, heart disease

sex assigned at birth

sex organs someone was born with

gender

the socially constructed roles and characteristics by which a culture defines male and female

gender identity

our sense of being male or female

cisgender

term used when gender identity and/or expression aligns with the sex assigned at birth

transgender

an umbrella term describing people whose gender identity or expression differs from that associated with their birth sex

TGNC

transgender or gender nonconforming

transgender woman (MTF)

a woman who was assigned male at birth

transgender man (FTM)

a man who was assigned female at birth

non-binary

gender identities that are not exclusively masculine or feminine

gender role behavior

the behavior a person conveys about being male or female, which may or may not be the same as biologic gender or gender identity

gender noncomformity

individuals expressing behavior and attitudes consistently characteristic of the opposite sex

sexuality

desire, sexual preference, and sexual identity and behavior

sexual health

a state of physical, emotional, mental, and social well-being in relation to sexuality

sexual identity/orientation

our sense of self as it relates to the type of sexual attraction we have for others

sexual behavior

the kind(s) of sex someone is having, who and what

sexuality through the lifespan: infancy

0-1

assigned gender role of male or female

sexuality through the lifespan: toddler/early childhood

1-3

-gender identity develops - "I am a boy" or "I am a girl"

-body exploration and genital fondling

sexuality through the lifespan: preschool/late childhood

3-6

-aware of their body and other's body - "I'll show you mine"

-media influences understanding about male/female and gender role learning of how to behave like a boy or girl

sexuality through the lifespan: school age/early adolescent

6-12

-enter into puberty (growth of genitals, breast development)

-closeness of same gendered friends

sexuality through the lifespan: adolescent

12-18

-development of secondary sex characteristics with changes in physical and emotions

-menstruation and sperm production

-greater awareness of sexual identity and gender identity

-strong need for independence

-possibility of sexual activity and pregnancy

sexual health: assessment

assess all adolescent patients aged 11 and older about

1. puberty and sex

2. gender identity

3. sexual attraction/orientation

4. sexual activity

sexuality through the lifespan: adult

18-40

-decision-making about partnerships, marriage, family, careers

-sexual activity, pregnancy

sexuality through the lifespan: middle adult

40-60

-sexual activity

-bodily changes (erections, vaginal dryness, libido)

-menopause

sexuality through the lifespan: older adult

60+

sexual activity

role of the nurse: sexuality awareness

self-examination of bias

role of the nurse: sexuality skill and knowledge

-assessing the sexual health of your patient; know the right questions to ask and potential health risks that exist

-applying the nursing process (ADPIE)

inter professional collaborative practice

When multiple health workers from different professional backgrounds work together with patients, families, [careers], and communities to deliver the highest quality of care

benefits of inter professional teams

Organization

-reduced hospitalization time and costs

team

Team

-efficient use of healthcare resources

Patients

-improved outcomes and quality of care; reduced errors

Individuals

-enhanced job satisfaction

-enhanced wellbeing

Team STEPPS

Team Strategies and Tools to Enhance Performance and Patient Safety

-team structure

-communication

-leadership

-situation monitoring

-mutual support

Communication: SBAR

S: situation, what is going on with the patient

B: background, what is the clinical background or context

A: assessment, what do I think the problem is

R: recommendation, what would I recommend

Communication: Call-out

-strategy used to communicate important or critical information

-informs all team members simultaneously during emergent situations

"air status" ... "airway clear"

Communication: Check back

using closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended

"give 25mg Benadryl IV push"... "25mg Benadryl IVP"

Communication: CUS

I am concerned

I am uncomfortable

This is a safety issue

Communication: Hand off

I pass the baton

Team STEPPS: leadership

-maximizes activities of the team

-articulates goals

Team STEPPS: situation monitoring

ongoing awareness

Team STEPPS: mutual support

providing feedback

statutory law

legislative acts declaring, commanding, or prohibiting something

Nurse Practice Act

defines the legal boundaries of nursing practice in each state

administrative law

The body of law created by administrative agencies in order to carry out their duties and responsibilities.

State Board of Nursing

requires hospitals to report nurses who are incompetent

common law

(civil law) a law established by following earlier judicial decisions

Darling v Charleston Community Memorial Hospital

corporate liability

broken leg resulted in amputation;

rules hospital didn't have enough staff to review doctors' and nurses' work

Standards of Care for nurses

-legal guidelines for nursing practice and provide the minimum acceptable nursing care

-what a reasonably prudent nurse would do in the same or similar circumstances

who sets the Standards of Care for nurses?

-ANA (American Nurses Association)

-Nurse Practice Act(s)

-Specialty nursing organizations (ONC, CMSRN, AORN, ACNM)

-Policies and procedures of the institution (RUMC, P&Ps)

Tort law

Law that deals with harm to a person or a person's property.

Intentional torts

assault and battery

assault vs battery

Assault = placing a person in fear or immediate bodily harm

Battery = unlawfully touching a person