ADN 420 Exam 2

A nurse is caring for a client who is grieving the loss of a loved one. Which factor would the nurse identify as contributing to the possibility of complicated bereavement? A. The client has experienced a number of previous losses. B. The client has a good support system C. The client has unresolved conflicts with the deceased D. The client was independent of the the deceased.

A. The following factors have negative effects on the mourning process: high dependency on the deceased, ambivalence toward the deceased, a poor or absent support system, a high number of past losses or other recent losses, poor physical or mental health, and young age of the deceased. The other options do not support difficult bereavement.

A public health nurse is developing a plan to implement strategies to assist in lowering of maternal and infant mortality rates for black women in the United States. Which factors should not be included in the plan? A.There remains a bias among health care providers toward black women. B.Black women have limited access to quality of care. C.The socioeconomic status of the black women is a consideration. D.Black women have adequate obstetrical insurance coverage.

D. The maternal mortality and morbidity rates for black women in the Unites States have been three to four times higher than for white women. This difference in the pregnancy-related mortality ratio is the largest disparity in the area of maternal and child health. Researchers do not entirely understand what accounts for this disparity, but some suspected causes of the higher maternal mortality rates for minority women include low socioeconomic status, limited or no insurance coverage, bias among health care providers, and quality of care available in the community.

The hospice nurse is educating a client's family on the physical signs of approaching death. The nurse identifies that the education has been effective when the family says they will know that death is imminent when they see which related symptoms? Select all that apply. 1. Bowel incontinence 2. Irregular respiratory rate 3. Restlessness 4. Cyanosis of dependent areas 5. Increased body temp

1,2,3,4 Clinical signs of impending or approaching death include bowel incontinence or constipation, decreasing body temperature, irregular or Cheyne-Stokes respirations, slow or irregular heart rate, restlessness and/or agitation; and cooling, mottling, and cyanosis of the extremities and dependent areas.

When assessing a patient who is grieving, the nurse identifies several emotional indicators. Which of the following would be consistent with the nurse's findings? Select all that apply. 1. Purposeless Activity 2. Self Blame 3. Apathy 4. Lack of interest 5. Social withdrawal 6. Crying

2,3,5 Emotional indicators of grieving include social withdrawal, apathy, and self-blame. Crying, purposeless activity, and lack of interest would be categorized as behavioral indicators.

Which statement, made by the nurse, focuses on the purposeful assessment of a client coping with a terminal diagnosis? A. "Who do you want to share information about your prognosis with?" B. "Getting such news has to be upsetting, can we talk about your feelings?" C."Social services will help make the arrangements for your hospice care." D. "How can I help you right now?"

A. Purposeful assessment of support systems provides the grieving client with an awareness of those who can meet his or her emotional and spiritual needs for security and love. The nurse can help the client to identify his or her support systems and reach out and accept what they can offer. The remaining options provide attempts at support that the client may not be ready or able to accept at this time.

The nurse is caring for a client who is dying. The nurse overhears the client saying, "God, if you will only let me live to see my daughter get married, I promise I will start going to church again." The nurse understands that the client is in which stage of grief according to Kübler-Ross? A. Depression B. Bargaining C. Anger D. Denial

B

The nurse most effectively explains to a terminally ill client's spouse that the frustration and anger the client is exhibiting is associated with what aspect of dying? A. A symptom of poor acceptance of the clients inevitable death B. An unconscious means of facilitating separation with loved ones C. An expression of a universally held need of the dying D. a sign of the anger stage of grieving

C.

In assessing a postmastectomy client, the nurse determines that the client is in denial. The nurse can best respond by A.Interpreting the denial B.Supporting the denial C. Accepting the denial D. Confronting the denial

C. When a client is faced with body image alterations and, possibly, terminal illness and death, the nurse should allow the client to express their feelings. By accepting the initial denial, the nurse acknowledges the role that denial plays in the coping process. Interpreting the client's denial and then confronting the client with it will increase their anxiety, hinder the development of a trusting relationship, and delay the client's acceptance of their condition. Accepting the client's denial doesn't imply that the nurse supports it.

The nurse is assisting parents who have just experienced the death of their twin infants. What would be the most appropriate action for the nurse? A. Call the hospital clergy to initiate prayer with the parents B.. encourage the parents to avoid exposure to their infants medical care C. Encourage the father to support his wife by allowing her to cry and grieve D. Allow the parents to be present at medical rounds and the resuscitation

D In times of impending death and loss initiate spiritual comfort by calling the hospital clergy only if appropriate; offer to pray with the family only if appropriate. Have the parents participate in early and repeated care conferencing to reduce family stress. Allow the family to be present at both medical rounds and resuscitation; provide explanations of all procedures. Encourage the father to cry and grieve with his partner.

A nurse is assessing a client with a terminal illness and finds that the client has cachexia. The nurse interprets this as indicating which of the following? A. Extreme anorexia B. severe asthenia C. Starvation D. Profound protein loss

D. Cachexia is associated with anabolic and catabolic changes in metabolism that relate to activity of neurohormones and proinflammatory cytokines, resulting in profound protein loss. Although anorexia may exacerbate cachexia, it is not a primary cause. Starvation refers to simple food deprivation and is not cachexia. Anorexia-cachexia syndrome, characterized by disturbances in carbohydrate, protein, and fat metabolism, endocrine dysfunction, and anemia results in severe asthenia (loss of energy).

Nursing students are reviewing information about grieving and its assessment findings. The students demonstrate an understanding of the information when they identify which of the following as a behavioral indicator? A. Sadness b. Longing for what was lost C. Questioning of beliefs D. Forgetfulness

D. Forgetfulness is considered a behavioral indicator of grieving. Sadness, longing for what was lost, and a questioning of beliefs reflect emotional indicators.

The nurse is caring for a client in a hospice facility and uses healing touch. A family member asks the nurse, "What good is touching going to do with cancer?" What is the best response by the nurse? Select all that apply. 1.To stimulate wound healing 2.To decrease pain 3.To increase anxiety 4.To promote health 5.To support end-of-life

1,2,4,5 Healing touch can be used by nurses to stimulate wound healing, decrease pain, promote health, and support end-of-life. Healing touch decreases anxiety; it does not increase anxiety.

A nurse who provides care on an acute medical unit has observed that physicians are frequently reluctant to refer clients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply. 1.Financial pressures on health care providers 2.Client reluctance to accept this type of care 3.Ease of making a terminal diagnosis 4.Advances in "curative" treatment in late-stage illness 5.Strong association of hospice care with prolonging death

1,2,4 Physicians are reluctant to refer clients to hospice, and clients are reluctant to accept this form of care. Reasons include the difficulties in making a terminal prognosis (especially for those clients with noncancer diagnoses), the strong association of hospice with death, advances in "curative" treatment options in late-stage illness, and financial pressures on health care providers that may cause them to retain rather than refer hospice-eligible clients.

Which of the following would lead the nurse to identify that a client is experiencing a physiologic response to grief? A. Crying B. Choking Sensation C. Slow movements D. Sadness

B A choking sensation would be considered a physiologic indicator of grieving. Sadness would be an emotional indicator. Slow movements and crying would be considered behavioral indicators.

A nurse is caring for a client who is scheduled to have a below the knee amputation. The client is visibly upset and angry and shouts at the nurse. Which of the following responses would be most appropriate? A. its okay to be angry and upset. is there anything i can do for you? B. The doctor has ordered you a sedative let me get it now C. You can yell at me all you want i still need to take your vitals D. Be quiet you might upset other clients

A. Clients vary in their reactions to the impending loss of a limb. The amount of grief is thought to be proportional to the symbolic significance of the part and the resultant degree of disability and deformity. Anger and depression are common emotions. The nurse acknowledges the client's feelings and remains objective and nonjudgmental as the client expresses negative emotional responses. Telling the client that it is okay to be angry and upset and then to offer help acknowledges the client's feelings and provides support. Reassuring the client that his or her reaction is normal may provide comfort. The nurse should not shame, criticize, or trivialize the client's behavior. Telling the client that he can yell all he wants or to be quiet demeans the client and does not address his feelings. Sedating the client ignores the client's feelings.

The nurse is assessing a client who reports feeling hopeless since a divorce. Which would be an appropriate question for the nurse to ask in order to determine mental health status for this client? A. Do you ever use drugs to help feel less emotional pain B. is there a history of mental illness in your immediate family C. would you consider marrying again D. Do you feel that someone else could ever love you

A. Negative circumstances such as poverty, poor physical health, unemployment, divorce, abuse, neglect, and unresolved childhood loss generally precipitate feelings of hopelessness, helplessness, or worthlessness. These negative responses place a person at risk for depression, substance abuse, or other mental health disorders. History of mental illness, marrying again, and the client's thoughts on whether another person would love the client again are appropriate general assessment questions but not as directly focused on the client's mental health status as substance use.

A client reports a new onset of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. The health care provider orders a diagnostic workup, which reveals end-stage gallbladder cancer. What nursing intervention should be used to facilitate adaptive coping? A. Refer client to professional counseling B. Encourage ventilation of negative feelings C. Proved written education for prescribed treatments D. Assist with ADLs

A. Referring the client for professional counseling will facilitate adaptive coping. Encouraging ventilation of negative feelings will allow for emotional expression, but may not facilitate coping. Physical well-being will increase self-esteem, but won't necessarily help the patient cope with the diagnosis. Providing written education is for client teaching, not to facilitate coping.

A nurse is conducting a spiritual assessment of a terminally ill client using the four step FICA process and asks the question, "What gives your life meaning?" The nurse is assessing which of the following? A. Faith and belief B. Importance and influence C. Address in care D. Community

A. The question about what gives life meaning provides information about the client's faith and belief. Importance and influence are addressed by questions focusing on the role faith plays in the client's life and how his or her beliefs affect the way the client cares for self and illness. Community is addressed by questions focusing on the client's participation in a spiritual or religious community and the support obtained from it. Address in care focuses on how the nurse would integrate the issues involving spirituality in the client's care.

A hospice nurse performs a follow-up telephone call to the spouse of a client who died about 1 year ago. The spouse tells the nurse, "I'm always feeling so sad. Life just doesn't feel worth living." Further conversation reveals that the spouse is having trouble sleeping and eating since her husband's death and that the spouse is "drinking more since he died." The nurse identifies which nursing diagnosis as the priority? A. Complicated Grieving B. Stress overload C. Grieving D. Ineffective coping

A. Complicated grieving is characterized by prolonged feelings of sadness and feelings of general worthlessness or hopelessness that persist long after the death, prolonged symptoms that interfere with activities, or self-destructive behaviors such as alcohol or substance abuse and suicidal ideation or attempts. Thus, the nursing diagnosis of complicated grieving would be the priority and most appropriate. Although the client may be having trouble coping or experiencing stress, complicated grieving is more applicable. Although there is no time table to denote grieving, the nursing diagnosis of grieving would be more appropriate in the period surrounding the husband's death, rather than 1 year later.

After the physician has discussed euthanasia with a terminal client and family, the nurse assesses their understanding of the topic. Which statement by the family indicates that learning has occurred? A. Passive euthanasia is taking specific steps to cause a clients death B. It is all right to stop dialysis C. Allowing the client to stop eating D. The doctor will administer a lethal dose of barbiturates

B. Active euthanasia is taking specific steps to cause a client's death (lethal dose of barbiturates) and has been deemed both immoral and illegal in most states. Passive euthanasia is defined as withdrawing medical treatment (dialysis) with the intention of causing the client's death and is morally and legally justified. Allowing the client to stop eating would be a form of passive euthanasia.

A client has responded to the recent diagnosis of lung cancer by making extensive plans for overseas travel with the client's children, despite the fact that the oncologist has informed the client of the extremely poor prognosis. The nurse consequently recognizes that the client is likely in the denial stage of grief. How can the nurse best facilitate adaptive grieving for this client? A.Supplement conversations with the client by using written material about the diagnosis B. Address the client's diagnosis and prognosis at a later time or date C. Enlist the assistance of another nurse to help client face reality of the situation. D. Restate the clients situation in more specific detailed terms.

B. In the absence of the client's readiness to become more aware of the situation, the nurse should respect the client's current position and revisit the matter when the client is more ready. It is disrespectful, and likely counterproductive, to have others reiterate the message, to provide written material, or to increase the amount of detail if the client is not ready to engage at this time.

Friends of two teenagers recently killed in a car accident are discussing their sense of loss. Which comment best indicates that the friends are trying to make sense of the loss cognitively? A. If only we had stayed longer they wouldn't have been on that road B. Why did they have to die so young C. They shouldn't have been driving so recklessly D. It took the ambulance too long to get there

B. One of the cognitive responses to grief involves the grieving person making sense of the loss. Asking a "why" question suggests that the individual is trying to make sense of a seemingly senseless event. Blaming the individual, one's own actions, or external circumstances suggests that the person has identified explanatory factors and is not at a loss to explain the event.

A client has just died following urosepsis that progressed to septic shock. The client's spouse says, "I knew this was coming, but I feel so numb and hollow inside." The nurse should know that these statements are characteristic of what? A.Depression stage of dying B.Uncomplicated grief and mourning C. Acceptance stage of dying D. Complicated Grief and mourning

B. Uncomplicated grief and mourning are characterized by emotional feelings of sadness, anger, guilt, and numbness; physical sensations, such as hollowness in the stomach and tightness in the chest, weakness, and lack of energy; cognitions that include preoccupation with the loss and a sense of the deceased as still present; and behaviors such as crying, visiting places that are reminders of the deceased, social withdrawal, and restless overactivity. Complicated grief and mourning occur at a prolonged time after the death. The spouse's statement does not clearly suggest depression or acceptance.

During a home care visit to a client in hospice, the client's spouse reveals to the nurse an understanding that the client's death is inevitable. Recognizing the spouse is exemplifying the Kübler-Ross stage of acceptance, which statement by the nurse is most appropriate? A. Have you thought about what you will do when you find your spouse after he has died? B. Make sure you have made previous arrangements with the funeral home for burial arrangements C. Tell me how you plan to react when you first realize that your spouse is breathless and has no pulse

C. Anticipating and planning interventions is a cornerstone of end-of-life care. The nurse encourages communication and anticipatory grieving by using open-ended statements such as "Tell me. . . ." Effective communication techniques include the avoidance of closed-ended statements and giving advice.

A hospice nurse is visiting the home of a client who was recently diagnosed with a terminal illness. The nurse is developing the client's plan of care and is assessing beliefs and preferences about end-of-life care. The nurse would expect to complete this assessment at which time? A. On initial visit B. As the client's condition begins to deteriorate C. When the client exhibits signs of immediate death D. Over the course of several visits.

D. Information about end-of-life care beliefs, preferences, and practices should be gathered in short segments over a period of time, such as over several visits. Trying to elicit the information in one visit would be overwhelming. Waiting until the client's condition begins to deteriorate or when signs of imminent death appear would be too late. The nurse needs to integrate the client's beliefs, preferences, and practices into the plan of care.