The patient has a terminal diagnosis and is very near death. When the nurse assesses the patient and finds no pulse or blood pressure, the family begins sobbing and hugging each other. Some family members hold the patient’s hand. The nurse is overwhelmed by the presence of grief and leaves the room. What is the nurse demonstrating?

Choice A reason: Depression in Kübler-Ross’s stages involves sadness and withdrawal due to loss. Marital discord suggests conflict, not introspective grief. The patient’s relational tension with her terminally ill spouse aligns with anger, not depression, which would manifest as despair or hopelessness rather than active discord.

Choice B reason: Denial involves refusing to accept the reality of death, often early in the dying process. Marital discord indicates engagement with the situation, not avoidance. The patient’s conflict suggests emotional reaction, aligning with anger, not denial, making this an incorrect stage for her behavior.

Choice C reason: Bargaining involves seeking to delay death through promises or deals, often privately. Marital discord reflects externalized emotion, not negotiation. The patient’s conflict with her spouse points to anger, not bargaining, which is less likely to manifest as relational tension, making this incorrect.

Choice D reason: Anger, per Kübler-Ross, involves frustration and resentment, often directed at loved ones, as the patient grapples with mortality. New marital discord with her terminally ill spouse suggests the patient is expressing anger, a common reaction to the unfairness of death, making this the correct stage.

Choice A reason: Short naps (15-20 minutes) are recommended for narcolepsy to manage excessive daytime sleepiness without disrupting nighttime sleep. This aligns with evidence-based management, improving alertness. No intervention is needed, as this practice supports symptom control, enhancing daily function and reducing sleep attacks in narcolepsy patients.

Choice B reason: Taking antidepressants, like SSRIs or SNRIs, is standard for narcolepsy to manage cataplexy or sleep disturbances. This is appropriate and requires no intervention unless misuse occurs. The nurse would ensure proper dosing, as antidepressants support symptom control, improving quality of life without disrupting narcolepsy management strategies.

Choice C reason: Chewing gum regularly is benign and unrelated to narcolepsy management. It may help with alertness but doesn’t warrant intervention. Unlike environmental factors like room temperature, gum has no significant impact on sleep quality or narcolepsy symptoms, making it an irrelevant focus for nursing education or correction.

Choice D reason: Sleeping in a hot, stuffy room disrupts sleep quality, exacerbating narcolepsy symptoms like fragmented sleep or daytime sleepiness. The nurse intervenes to promote a cool, well-ventilated sleep environment, critical for optimizing rest. Poor sleep hygiene worsens narcolepsy, reducing treatment efficacy and increasing risks of sleep attacks or fatigue.