Chapter 43

actual loss

can be recognized by others

The nurse is assessing a client recently diagnosed with terminal lung cancer who states, "This can't be happening to me. Maybe the doctor made a mistake." Which stage of death and dying is the client exhibiting?

denial

A widow develops cancer within 6 months of her husband's death. This may be a result of:

bereavement

A client with a terminal illness is overheard by the nurse saying, "If I promise never to smoke another cigarette in my life, please let me recover from this lung cancer." How will the nurse document this stage of grief according to the Kübler-Ross model?

bargaining

The nurse is taking care of a client recently involved in a motor vehicle accident during which a pet was thrown from the vehicle and died. The client states, "My heart aches and I can't eat or sleep." According to Kübler-Ross, what stage of grief is the client experiencing?

depression

anticipatory loss

loss has not yet taken place

In the Parkes model, a person uses denial as a psychological defense in the stage of:

numbness.

The nurse has noted that a dying client is increasingly withdrawn and is often teary at various times during the day. The nurse recognizes that the client may be experiencing which of Kübler-Ross's stages of grief?

Depression

A client comes to the hospital because of complications related to newly diagnosed terminal cancer. The client is concerned about how his wife is coping with the diagnosis. Which information is important for the nurse to obtain to assess factors that may affect the family member's grief? Select all that apply.

Financial concerns Cultural practices Religious beliefs Social support

The client is a young mother whose spouse died 3 months ago. The client is tearful and unkempt, eats a poor diet, and has lost 50 lb (22.6 kg) since the death of the spouse. The client states, "I can't do this anymore." The nursing diagnosis best supported by these data is:

Ineffective coping related to failure of previously used coping mechanisms

The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate?

"It must be very difficult for you."

A client has been receiving dialysis for years and now states, "I have been thinking about this for a long time. I no longer wish to continue dialysis. I just want to die." What is the most appropriate statement by the nurse?

"Can you tell me about why you've made this decision?"

Which nursing interventions would be anticipated with hospice care? Select all that apply.

Administer prescribed morphine for pain control. Ease respiratory function by providing oxygen via nasal cannula. Administer prescribed antiemetics to control nausea. Insert a Foley catheter to prevent incontinence.

The nurse is caring for a client who has just expired. Which action will the nurse perform?

Allow the client's family to see the client's body before it is discharged.

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage, according to Kübler-Ross?

Anger

Which statement regarding perceptions of death by children is accurate?

At about age 9, the child perceives death as irreversible.

The nurse enters a client's room and finds the client curled up in bed and crying. The client states, "My life is so good, and now I have cancer. Why me? I have tried to be a good person." The nurse recognizes the client as exhibiting signs of which stage of Engel's model of grief?

Developing awareness

The wife of a client who has been diagnosed with a terminal illness asks the nurse about the differences between palliative care and hospice care. Which information would the nurse most likely include in the response?

Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness.

A home hospice client who has Medicare is experiencing extreme pain at home and is refusing to receive inpatient care due to concerns over the cost of inpatient care. What teaching will the nurse include in the plan of care?

Inpatient pain management for hospice patients is covered by Medicare.

The nurse is caring for a client who has terminal lung cancer and is unconscious. What assessment would indicate to the nurse that the client's death is imminent?

Mottling of the lower limbs

Which signs assessed in a dying client would the nurse recognize as signs of death? Select all that apply.

Nausea, flatus, abdominal distention Cheyne-Stokes respirations Loss of movement, sensation, and reflexes

Which are signs of a "good death"? Select all that apply.

The person has a sense of completion of life. The person is prepared for death. The person dies with dignity.

The husband of a client who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. What type of grief is the husband experiencing?

Unresolved grief

What is Kübler-Ross's third stage of grief?

bargaining

physical loss versus psychological loss

example: someone who has lost their limbs and also feels like shameful of their body

The nurse is talking with the son of a client with end-stage renal failure and late-stage dementia. The client can no longer live at home, and the son states, "I live 500 miles away. I don't know what to do." Which type of living arrangement will the nurse teach the son about?

residential care

Which care environment would the nurse suggest to a client with no family nearby who is diagnosed with end-stage lung disease?

residential care

Which stage of grieving is exhibited by the husband of a victim of sudden death who refuses to accept that she is dead?

shock

The children of a male client with late-stage Alzheimer disease have informed the nurse on the unit that their father possesses a living will. The nurse should recognize that this document is most likely to:

specify the treatment measures that the client wants and does not want.

A nurse completing admission paperwork asks the client about having an advanced directive. The client states, "I do not know, what is an advanced directive?" What is the nurse's best response?

"It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition."

A graduate nurse enters a client's room and finds the client unresponsive, not breathing, and without a carotid pulse. The graduate nurse is aware that the client has mentioned that he does not wish to be resuscitated, but there is no DNR order on the client's chart. What is the nurse's best action?

Call a code and begin resuscitating the client.

The nurse is receiving a change of shift report on a client who has a terminal illness and has exhibited a slow and progressive decline in the health status over the past several days. Which data supports the client's impending death? Select all that apply.

Gurgling sounds emanating from the client's throat with each breath Distended abdomen with last bowel movement documented 7 days ago Cyanotic nail beds in hands and feet bilaterally

When assessing a person who is grieving using the grief cycle model, which concept would be most important for the nurse to keep in mind? Select all that apply.

Stages occur at varying rates among people. People vary widely in their responses to loss. Some people actually skip some stages of grief altogether.

A nurse is providing care to a terminally ill client. Which finding would alert the nurse to the fact that the client is dying? Select all that apply.

Pale, cool skin Irregular heart rate Decreased urine output

Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal?

leaving the wife's room and belongings intact

The health care provider has notified the spouse of a client who died after a serious motor vehicle accident that all rescue efforts were unsuccessful, and that the client regrettably died. Several hours later, the nurse notes that the spouse is walking the hallways, asking people if they have seen her husband. Which condition does the nurse suspect?

shock

With the help of the nurse, the parents of an infant who died shortly after birth arrange for a funeral service. Which stage of grief, according to Engel, involves the rituals surrounding loss, including funeral services?

Restitution

A nurse at the health care facility cares for several clients. Some of the clients may require end-of-life care. Which case may require the service of a coroner?

The client did not have any recent medical consultation.

A client severely injured in a motor vehicle accident is rushed to the health care facility with severe head injuries and profuse loss of blood. Which sign indicates approaching death?

The client's breathing becomes noisy.

A client who was brought to the emergency room for gunshot wounds dies in intensive care 15 hours later. Which statement concerning the need for an autopsy would apply to this client?

The coroner must be notified to determine the need for an autopsy.

Which does not coincide with Kübler-Ross's stages related to a dying client?

The dying client usually exhibits anger first.

A client has recently lost a parent. The client spent about 6 months deeply mourning the loss and is just now able to function at the pre-loss level. During this process, a strong social support network was able to assist the client. What developmental stage of life does the nurse identify the client is in?

adult

A hospice nurse has developed a care plan for a client with liver cancer. The care plan focuses on providing palliative care for this client. The goal of palliative care is best described as providing clients with life-threatening illnesses a dignified quality of life through which means?

aggressive management of symptoms

Kubler-Ross stages of dying

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

palliative care

Care designed not to treat an illness but to provide physical and emotional comfort to the patient and support and guidance to his or her family.

The hospice nurse is visiting the wife of a client who died 10 months ago. The wife states, "My life is meaningless since my husband died." The nurse recognizes that the client is in which stage of grief?

Disorganization

A nurse is assessing a dying client for realism of expectations and perception of condition. Which interview questions address this concern? Select all that apply.

Have you had any previous experience with this condition before? How do you see the next few weeks playing out? What do you think may be happening in the midst of all of this?

The wife of a man who is dying tells the nurse: "Harold was so good to me. He was like a saint with his patience. I will miss him terribly" Which stage of grief is this woman experiencing, according to Engel?

Idealization

After the death of a terminally ill spouse, a client reports frequent headaches and loss of appetite. The client states, "How am I going to live without him?" What type of grief is the client experiencing?

Inhibited grief

When preparing for the death of a client, the nurse should provide the client's family with which interventions? Select all that apply.

Listen to concerns, fears, and worries. Encourage rest and proper nutrition. Explain the dying process and allow grieving. Utilize therapeutic communication techniques.

A nurse is conducting grief resolution for a client who lost his wife in a motor vehicle accident in which he was the driver. Which interventions best accomplish this goal? Select all that apply.

Listen to expressions of grief. Include significant others in discussions and decisions as appropriate. Communicate acceptance of discussing the loss.

A client has been diagnosed with a terminal illness and has periods of depression and periods of anger, alternating with periods of acceptance. What teaching is most appropriate for the nurse to include when the client's spouse says that the client seems emotionally unstable?

Movement between stages of grief is normal.

A client in a long-term care facility has signed a form stating that he does not want to be resuscitated. He develops an upper respiratory infection that progresses to pneumonia. His health rapidly deteriorates, and he is no longer competent. The client's family states that they want everything possible done for the client. What should happen in this case?

The client should be treated with antibiotics for pneumonia.

A terminally ill client is being cared for at home and receiving hospice care. The hospice nurse is helping the family cope with the client's deteriorating condition, educating them on the signs of approaching death. Which sign would the nurse include in this education plan?

difficulty swallowing

situational loss

experienced as a result of an unpredictable event

maturational loss

experienced as a result of natural developmental process

perceived loss

is felt by person but intangible to others

A couple has sent their youngest child to college in another state and both are experiencing "empty nest syndrome." This is an example of:

maturational loss.

When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response?

"This must be very difficult for you."

The nurse is providing care for a client that is terminally ill with cancer. The client states to the nurse, "Am I going to die?" What is the most therapeutic response by the nurse?

"What have you been told?"

The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the anger stage of grief is the one who states:

"Why did this have to happen to me?"

When reviewing a client's chart, the nurse notes that the client is in the disorganization stage of grief. Which assessment finding would support this diagnosis?

"I feel like I have absolutely no idea what to do next."

A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education?

"In hospice care, the nurses make most of the care decisions for the clients."

The psychiatrist is evaluating a client who has recently learned she has a terminal illness. Which statement indicates to the psychiatrist that the client is in the Kübler-Ross stage of bargaining?

"Just let me go on vacation with my wife; then I'll be satisfied."

The nurse is caring for a client who recently found out he has a terminal illness. The nurse notes that the client is hostile and yelling. Which statement by the nurse shows that she has understanding of the Kübler-Ross emotional responses to impending death?

"Sometimes a person returns to a previous stage."

A client at a health care facility has died after a prolonged illness. A nurse is assigned to perform postmortem care for the client. Which intervention should the nurse perform when providing postmortem care?Q

Cleanse drainage from the skin.

A nurse is assessing the spouse of a client who has just died. Which subjective findings of grief would the nurse expect to assess? Select all that apply.

Detachment Bitterness Preoccupation with the loss

A client has a diagnosis of bladder cancer with metastasis. The client asks the nurse about the characteristics of hospice care. The nurse should explain that:

care is premised on the fact that dying is a normal process.

Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief?

coping startegies

When preparing the care plan for a dying client, it is important for the nurse to include a goal that addresses which needs? Select all that apply.

expression of feelings management of pain use of coping strategies

A client is being discharged from the hospital with terminal brain cancer and a life expectancy of 1 month. When planning this client's discharge, it is most important for the nurse to include a referral to which agency?

hospice

A critical care nurse is aware of the legislation that surrounds organ donation. When caring for a potential organ donor, the nurse is aware that:

hospitals are mandated to notify transplantation programs of potential donors.

The nurse is giving palliative care to a client with a diagnosis of COPD. What is the goal of palliative care?

to improve the client's and family's quality of life

Palliative care is a structured system for care delivery. What is its aim?

to prevent and relieve suffering

Following surgery, the surgeon informed the client's spouse that invasive cancer was found during the procedure and the client may only have days to live. The client's spouse has told the physician and the nurse that they do not want the client to know the severity of the diagnosis. How will the nurse respond?

understanding that this directive would violate the client's rights