Chapter 43 : Loss, Grief, and Dying
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: A) "Why did this have to happen to me?" B) "I do not believe I have this disease." C) "I just want to see my son have a family of his own." D) "I don't care about anything. I have no energy."
A) "Why did this have to happen to me?" Explanation: The client is expressing anger when displaying a "why me" attitude. The other statements are reflective of other stages of grief. Reference: Chapter 43: Loss, Grief, and Dying, p. 1689.
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. A) Pale, cool skin B) Regular deep respirations C) Decreased urine output D) Irregular heart rate E) Strong, bounding pulse
A) Pale, cool skin C) Decreased urine output D) Irregular heart rate Explanation: Signs of dying include extremely pale, cyanotic, jaundiced, mottled or cool skin; irregular heart rate; weak, rapid, irregular pulse; shallow, labored, faster, slower, or irregular respirations; and decreased urine output. Reference: Chapter 43: Loss, Grief, and Dying, p. 1689.
Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal? A) leaving the wife's room and belongings intact B) showing a photograph of the decedent C) talking about his wife's absent-mindedness D) telling the nurse how his life has changed
A) leaving the wife's room and belongings intact Explanation: Bereavement experts reported that they considered almost all bereavement manifestations to be normal during the early stages of grief, but considered most of the manifestations to be abnormal if they continue beyond 3 years. Reference: Chapter 43: Loss, Grief, and Dying, pp. 1688-1715.
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? A) Denial B) Anger C) Bargaining D) Acceptance
B) Anger Explanation: Anger is the second stage and is exhibited by statement similar to "Why me?" Denial occurs when the person refuses to believe certain information. Bargaining is an attempt to postpone death. During the acceptance stage, the dying clients accept their fate and make peace spiritually and with those to whom they are close. Reference: Chapter 43: Loss, Grief, and Dying, p. 1689.
Which are signs of a "good death"? Select all that apply. A) The person dies according to the wishes of the family. B) The person experiences moderate pain. C) The person has a sense of completion of life. D) The person is prepared for death. E) The person dies with dignity.
E) The person dies with dignity. D) The person is prepared for death. C) The person has a sense of completion of life. Explanation: A good death is one that allows a person to die on their own terms, relatively free of pain, and with dignity. It is free from avoidable distress and suffering for clients, families, and caregivers; in general accord with clients' families wishes; and reasonably consistent with clinical, cultural, and ethical standards (Institute of Medicine, 1997). The definition of a good death varies for each client, but there are factors important for a good death, including control of symptoms, preparation for death, opportunity to have a sense of completion of one's life, and a good relationship with health care professionals. Reference: Chapter 43: Loss, Grief, and Dying, p. 1688.
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? A) "Can you tell me about why you've made this decision?" B) "Have you discussed this with your health care provider?" C) "Does your family agree with this decision?" D) "Once you've started treatment, it's important to continue."
A) "Can you tell me about why you've made this decision?" Explanation: Having the client explain his decision-making process is open-ended and allows exploration of the client's feelings. A competent client is not required to continue with treatment that has been initiated. The other options are closed-ended and stop any further conversation. Reference: Chapter 43: Loss, Grief, and Dying, p. 1701.
The experience of parting with an object, person, belief, or relationship that one values is defined as: A) loss. B) bereavement. C) grief. D) death.
A) loss. Explanation: Loss is defined as the experience of parting with an object, person, belief, or relationship that one values; the loss requires a reorganization of one or more aspects of the person's life. Reference: Chapter 43: Loss, Grief, and Dying, p. 1685.
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: A) specify the treatment measures that the client wants and does not want. B) dictate how the client wants his estate handled after his death, and by whom. C) make legal provisions for active euthanasia. D) give permission for organ donation.
A) specify the treatment measures that the client wants and does not want. Explanation: Living wills provide instructions about the kinds of health care that should be used or rejected under specific circumstances. The management of an individual's estate is specified in a will, not a living will. It is not legal for a living will to make provisions for active euthanasia. A living will may or may not include reference to organ donation, but normally this is addressed in a separate, specific consent card or document. Reference: Chapter 43: Loss, Grief, and Dying, p. 1691.
The condition of a client with a traumatic brain injury continues to deteriorate despite medical efforts. The decision is made to terminally wean the client from mechanical ventilation. Which statement by the nurse is most significant in educating the family regarding terminal weaning? A) "Once the endotracheal tube is removed, your loved one will no longer be able to breathe." B) "All efforts will be taken to make sure your loved one is comfortable and out of pain." C) "If you change your mind after we remove the breathing tube, just tell us and it will be reinserted." D) "Your loved one will not feel or be aware of anything that is happening once the breathing tube is removed."
B) "All efforts will be taken to make sure your loved one is comfortable and out of pain." Explanation: A common and valid concern of families during terminal weaning is to make sure the client is not suffering. As such, the nurse's role is to educate the family regarding comfort measures, such as pain medication and additional sedation. It is inaccurate to tell the family that the client will no longer be able to breathe once the tube is removed. The client may continue breathing for several hours to days. When a decision is made to terminate mechanical ventilation, it should be clear that reintubation is no longer an option and death is inevitable. The nurse must be honest with the family, as the client may be aware of loved ones in the room and talking to the client is encouraged. Reference: Chapter 43: Loss, Grief, and Dying, Terminal Weaning, pp. 1694-1695.
A client with end-stage chronic obstructive pulmonary disease (COPD) has reached the end of the 6-month period for hospice services and the family caregiver states, "I don't know what we will do if they cut off our hospice services." What is the best response by the hospice nurse? A) "Unfortunately, we are unable to continue services past the 6 month period of time." B) "I will contact the health care provider to extend services since your family member meets the criteria." C) "We can discontinue the service for a period of time and then when your family member gets worse, readmit them." D) "We can admit your family member to the hospital for treatment and they can reinstate the hospice benefits."
B) "I will contact the health care provider to extend services since your family member meets the criteria." Explanation: Hospice care is generally provided to clients that have 6 months or less to live, although they are not automatically discharged when they reach 6 months after having been admitted to hospice care. The client may still receive care as long as the health care provider certifies that the client continues to meet the criteria for hospice services. The client should not be admitted to the hospital since the acceptance of palliative comfort care is required to qualify for hospice services. Based on the provided information, there is no need to admit the client to the hospital, and hospital admission may result in termination from the program due to the provision of non-palliative care. Reference: Chapter 43: Loss, Grief, and Dying, Palliative Care and Hospice, pp. 1690-1691.
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? A) decreased pain B) difficulty swallowing C) increased urinary output D) increased sensory stimulation
B) difficulty swallowing Explanation: A sign that death is approaching is the client's difficulty in swallowing. People who are dying do not experience decreased pain. They may not be in a position to report pain; therefore, the caregiver should observe the client closely. Urinary output decreases when a person is approaching death due to system failure and limited intake. The client approaching death has decreased sensory stimulation. Reference: Chapter 43: Loss, Grief, and Dying, p. 1688.
Palliative care is a structured system for care delivery. What is its aim? A) to give traditional medical care B) to prevent and relieve suffering C) to bridge between curative care and hospice care D) to provide care while there is still hope
B) to prevent and relieve suffering Explanation: Palliative care, which is conceptually broader than hospice care, is both an approach to care and a structured system for care delivery that aims to "...prevent and relieve suffering and to support the best possible quality of life for clients and their families, regardless of the stage of the disease or the need for other therapies." Palliative care goes beyond giving traditional medical care. Palliative care is considered a "bridge" not exclusively limited to hospice care. "Hope" is something clients and families have even while the client is actively dying. Reference: Chapter 43: Loss, Grief, and Dying, p. 1690.
When planning care for a 55-year-old client with newly diagnosed terminal pancreatic cancer, which nursing concern is most appropriate for the care plan? A) failure to thrive B) altered comfort C) death anxiety D) unproductive coping
C) death anxiety Explanation: The data the nurse collects about how a client or the client's caregivers are responding to an actual or impending loss or to impending death may support several different nursing concerns. Death anxiety is common when the medical diagnosis is new. It is related to the inability to predict how the last stage of illness will play out. Coping mechanisms are important in the dying process, and they will need to be assessed to determine their adequacy. Failure to thrive is not appropriate for this client, based on the medical diagnosis. Altered comfort may be appropriate, but it is not as important as the client's death anxiety at this time due to the newness of the client's medical diagnosis. Reference: Chapter 43: Loss, Grief, and Dying, p. 1701.
A client's son is named to make decisions for his mother in the event she cannot speak for herself. This is an example of a(an): A) exemplary representative. B) significant power. C) durable power of attorney. D) advance estate director.
C) durable power of attorney. Explanation: A durable power of attorney allows clients to designate another person to make decisions if they become incapacitated and cannot make decisions independently. Advanced estate planning typically involves estate tax reduction, Medicaid planning and/or special needs trust planning is for a client with a large estate. Exemplary representative and significant power are not related to health care. Reference: Chapter 43: Loss, Grief, and Dying, pp. 1691-1715.
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. A) use of coping strategies B) urinary elimination C) expression of feelings D) management of pain E) nutritional therapy
C) expression of feelings D) management of pain A) use of coping strategies Explanation: Nursing care for the dying client should be directed toward the achievement of several goals, including demonstration of the ability to express feelings, fears, and concerns. The client's pain should be managed effectively to allow the client to interact meaningfully with family. The client should also be able to identify and utilize effective coping strategies such as deep breathing, talking with family members, and rest periods. Nutritional therapy and urinary elimination are not specific to the dying client, and more assessment would be needed to determine if these are viable needs for the client. Reference: Chapter 43: Loss, Grief, and Dying, p. 1701.
Which does not coincide with Kübler-Ross's stages related to a dying client? A) The client may be in several stages at once. B) Some client regress, then move forward again. C) Clients don't always follow the stages in order. D) The dying client usually exhibits anger first.
D) The dying client usually exhibits anger first. Explanation: The dying client does not usually exhibit anger first. The client may be in several stages at once, clients don't always follow the stages in order, and some regress and then move forward. Reference: Chapter 43: Loss, Grief, and Dying, p. 1689.
During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving? A) "It is fine if my parent dies. We have not been close for years." B) "There is no way I can stay in the hospital because my parent is sick." C) "I do not think my parent really has cancer. I think my parent needs to get a third opinion." D) "My parent is suffering with cancer and death will be a relief of the pain."
D) "My parent is suffering with cancer and death will be a relief of the pain." Explanation: Anticipatory grief is the characteristic pattern of psychological and physiologic responses a person makes to the impending loss of a significant person. The client's statement, "My parent is suffering with cancer and death will be a relief of the pain," is an example of anticipatory grief and is intended to facilitate coping when death occurs. The client's statement, "There is no way I can stay in the hospital because my parent is sick" demonstrates empathy for the parent and denial of a personal need for treatment. Denial is apparent when the client suggests the parent's diagnosis is incorrect. Denial is also apparent when the client relates it is "fine" if the mother expires because they were not close. Reference: Chapter 43: Loss, Grief, and Dying, Concepts of Loss and Grief, p. 1685.
A nurse is caring for a client whose spouse died more than 4 years ago. What assessment question will the nurse ask to determine if the client is experiencing abnormal grief? A) "Have you gone through and donated your spouse's clothing?" B) "Do you keep photos of your spouse on your bedside table?" C) "Can you remember the good times together with your spouse?" D) "Do you cry on the anniversary of your spouse's death?"
A) "Have you gone through and donated your spouse's clothing?" Explanation: Abnormal grief responses present beyond 3 years after a loss. The nurse can identify if a client suffers from abnormal grief through questions aimed at learning if the client has left the deceased's room and belongings intact, has reported physical symptoms similar to those the deceased had before death, and has talked about the deceased as if the individual were still alive. Remembering good times and keeping photos of loved ones are part of reminiscing and a healthy form of grieving. Crying on the anniversary of a loved one's death is part of the normal grieving response. Reference: Chapter 43: Loss, Grief, and Dying, Dying and Death, p. 1688.
Which statement made by a client with terminal illness indicates acceptance of the diagnosis? A) "I have made my will and made arrangements for my daughter to live with her grandparents." B) "Please, let me make it through the night and I will be a better person." C) "I cannot bear the thought of not being there when my grandchildren are born." D) "After all I have done for the church, I end up getting cancer!"
A) "I have made my will and made arrangements for my daughter to live with her grandparents." Explanation: Acceptance is conveyed when the client has accepted the reality of death and feel tranquil. This is expressed by stating the will is made and family arrangements are in place. Bargaining is seen when the client attempts to negotiate with a higher power to live through the night. Anger is apparent when the client states, "After all I have done for the church, I end up getting cancer!" Depressing is apparent when the client states not being able bear the thought of family continuing without one. Reference: Chapter 43: Loss, Grief, and Dying, Responses to Dying and Death, p. 1689.
A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education? A) "In hospice care, the nurses make most of the care decisions for the clients." B) "Hospice care programs focus on quality rather than length of life." C) "Palliative care affirms life and regards dying as a normal process." D) "Palliative care provides relief from pain and other distressing symptoms."
A) "In hospice care, the nurses make most of the care decisions for the clients." Explanation: The philosophy of hospice is that clients and families are empowered to achieve as much control over their lives as possible. Hospice focuses on relieving symptoms and supporting clients with a life expectancy of 6 months or less, rather than years, and their families. However, palliative care may be given at any time during a client's illness, from diagnosis to end of life. Reference: Chapter 43: Loss, Grief, and Dying, pp. 1690-1691.
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? A) "It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition." B) "It is an agreement that authorizes the hospital to make decisions on your behalf, if you become incapacitated." C) "I will contact the hospital social worker to come and discuss the development of an advance directive with you." D) "It is a document created by you and your attorney naming a beneficiary to handle your estate if you become terminally ill."
A) "It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition." Explanation: An advance directive is a written statement identifying a competent person's preferences regarding which medical interventions to use in the event that the client can not make a decision for themselves concerning terminal care. The other responses are not correct. Reference: Chapter 43: Loss, Grief, and Dying, p. 1697.
A terminally ill client asks the nurse what assisted suicide is. Which response is best for the nurse to provide? A) "It is when a lethal combination of drugs is made available to the client wishing to die." B) "It is when the clinician administers a lethal dose of medication to cause the client's death." C) "It is withdrawing medical treatment with the intention of causing a client's death." D) "It is best if you talk to your doctor about that since assisted suicide is illegal in all states."
A) "It is when a lethal combination of drugs is made available to the client wishing to die." Explanation: Assisted suicide is when the clinician provides the client with the means to cause his or her own death (provides a prescription for a lethal dose of barbiturates). Passive euthanasia is the withdrawal of medical treatment with the intention of causing the client's death. In active euthanasia, the clinician acts directly to cause the death of the client (administers a lethal dose of medication). The nurse should answer the question rather than defer to the health care provider and the legality of assisted suicide. Reference: Chapter 43: Loss, Grief, and Dying, p. 1695.
The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate? A) "It must be very difficult for you." B) "There's no need for anger." C) "I can't imagine how awful this is for you." D) "You should try to make things right with your family."
A) "It must be very difficult for you." Explanation: Use statements with broad openings such as "It must be difficult for you" and "Do you want to talk about it?" Such language encourages communication and allows the client to choose the topic or manner of response. Accept the client's behavior. Anger is part of the grieving process. Indicating that this is "awful" is not an appropriate way to promote coping. It is not the nurse's role to tell the client to make things right with the family. While this may be desired, the client should initiate it. Reference: Chapter 43: Loss, Grief, and Dying, p. 1703.
The nurse is caring for a client who recently lost an older adult parent. Which client statement alerts the nurse that the stage of depression may have started within the grief process? A) "Please go away; I just want to be left alone." B) "It is all my fault! I did not see the signs." C) "This does not seem real to me." D) "What am I going to do now that my parent is gone?"
A) "Please go away; I just want to be left alone." Explanation: The clinical definition of depression is anxiety and hostility turned inward. The statement asking the nurse to go away and a desire to be "left alone" indicates withdrawal, which is a characteristic of depression. "This does not seem real to me" indicates the client is in denial. Blaming oneself for the loss is an expression of guilt that may occur in the anger phase of grieving. Feeling uncertain about the future may occur as the grieving person accepts that the loved one is deceased and life will be different. Reference: Chapter 43: Loss, Grief, and Dying, Responses to Dying and Death, p. 1689.
"My father has been dead for over a year and my mother still can't talk about him without crying. Is that normal?" What is the best response by the nurse? A) "The inability to talk about your dad without crying, even after a year, is still considered normal." B) "It is not normal. Your mother needs to see a therapist about her grief." C) "Did your mother cry a lot before your father died?" D) "In fact, the more that someone cries about a loss, the better they're dealing with it."
A) "The inability to talk about your dad without crying, even after a year, is still considered normal." Explanation: Normal responses to bereavement after 1 year include the inability to speak of the deceased without intense emotion, clinical signs of depression, and feelings of meaninglessness. Increased crying does not necessarily signal increased coping, however. Reference: Chapter 43: Loss, Grief, and Dying, p. 1688.
When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response? A) "This must be very difficult for you." B) "I'm sure you are angry and sad." C) "Yes, this is a terrible diagnosis you've received." D) "Have you talked with your spiritual leader about your fears?"
A) "This must be very difficult for you." Explanation: The nurse should use statements with broad openings, such as "This must be difficult for you," to allow the client to continue expressing concerns and to acknowledge the client's feelings. This facilitates communication and allows the client to choose the topic or manner of response during this stage of the grieving process. Assuming the client is angry and sad or indicating that this is "a terrible diagnosis" is not an appropriate way to promote coping. The nurse should automatically assume a spiritual leader is desired. Reference: Chapter 43: Loss, Grief, and Dying, p. 1703.
Which assessment finding would best support a nursing concern of disordered grieving? A) A client is unable to return to work after their sibling's death 18 months ago. B) A client cries frequently and loudly in the weeks following their child's death in an accident. C) A client blames themself for not doing more to make their spouses's recent death more comfortable. D) A client has been experiencing chronic insomnia since their parent's death earlier this year.
A) A client is unable to return to work after their sibling's death 18 months ago. Explanation: An inability to return to normal activities 18 months after a sibling's death is suggestive (though not definitive) of disordered grieving. Crying and having difficulties sleeping are not unusual and will often accompany healthy grieving. A feeling of "not doing enough" is common during grief and would only be considered disordered if this became a long-term and all-encompassing belief. Reference: Chapter 43: Loss, Grief, and Dying, p. 1687.
Which situation is most likely to warrant an autopsy? A) A client's death involves an allegation of a medical error. B) A palliative client dies unwitnessed during the night. C) A client dies after unsuccessful cardiopulmonary resuscitation. D) A client's death is attributed to an infectious disease.
A) A client's death involves an allegation of a medical error. Explanation: Allegations of incompetence or malpractice create a need for an autopsy. An unwitnessed death, an unsuccessful code, or a death by infectious disease may require an autopsy due to other situation-specific factors, but these situations themselves do not necessarily require an autopsy. Reference: Chapter 43: Loss, Grief, and Dying, p. 1697.
Assisted suicide is expressly prohibited under statutory or common law in the overwhelming majority of states. Yet public support for assisted suicide has resulted in a number of state ballot initiatives. The issue of assisted suicide is opposed by nursing and medical organizations as a violation of the ethical traditions of nursing and medicine. Which scenario would be an example of assisted suicide? A) Administering a lethal dose of medication B) Neglecting to resuscitate a client with a "do not resuscitate" status C) Granting a client's request not to initiate enteral feeding when the client is unable to eat D) Administering a morphine infusion
A) Administering a lethal dose of medication Explanation: Assisted suicide refers to providing another person the means to end his or her own life, such as administering a lethal dose of a medication. This is not to be confused with the ethically and legally supported practices of withholding or withdrawing medical treatment in accordance with the wishes of the terminally ill individual. Administering a morphine infusion may be used to assist with a client's pain near the end of life. Granting a client's request not to initiate enteral feeding when the client is unable to eat is an example of wishes of a terminally ill client, and the agreed-upon measures near the end of life. Neglecting to resuscitate a client with a "do not resuscitate" status is following the prescribed, mutually agreed-upon decisions about care. Reference: Chapter 43: Loss, Grief, and Dying, pp. 1691-1695.
The hospice nurse is caring for a client with allow natural death (AND) orders. The nurse assesses that the client has a slow, irregular heart rate, has cooling of the extremities, and is agitated. Which interventions can the nurse implement? Select all that apply. A) Allow the client to stop drinking fluids. B) Do not perform cardiopulmonary resuscitation. C) Implement a slow code in the case of cardiopulmonary or respiratory arrest. D) Administer a lethal dose of barbiturates. E) Use medication to lower client consciousness to limit awareness of suffering.
A) Allow the client to stop drinking fluids. B) Do not perform cardiopulmonary resuscitation. E) Use medication to lower client consciousness to limit awareness of suffering. Explanation: A client with signs of a slow, irregular heart rate, cooling of the extremities, and restlessness is showing signs of impending death. The health care provider has written AND orders for this client, so cardiopulmonary resuscitation should not be implemented, including a slow code. When clients who are imminently dying have pain and suffering, palliative sedation (using medication to lower client consciousness) may be utilized to limit awareness of suffering. Allowing the client to stop drinking fluids would be a type of passive euthanasia. Administering a lethal dose of barbiturates, or active euthanasia, is immoral and illegal. Reference: Chapter 43: Loss, Grief, and Dying, p. 1694.
The nurse is providing care for a confused client who no longer is able to make health care decisions. Which document will the nurse review on the client's medical record to determine the designated person to make decisions on the client's behalf? A) Durable power of attorney form B) Advance directive form C) Living will form D) Health care provider's progress notes
A) Durable power of attorney form Explanation: The nurse would review the durable power of attorney (DPA) for health care form identifying the client's chosen proxy for health care decision-making. The DPA for health care is a person legally designated by the client to make health care decisions if the client becomes physically or mentally unable to do so. A living will is a legal document detailing the client's wishes for end-of-life care and usually includes specifics such as resuscitation in the event of cardiopulmonary arrest and wishes regarding feeding tubes. An advance directive is a legal form filled out by the client or client's DPA for health care that identifies wishes regarding lifesaving treatment. The health care provider's progress notes are drafted by the health care provider regarding the client's current status and medical treatment plan. Reference: Chapter 43: Loss, Grief, and Dying, Advance Care Planning, p. 1691.
The husband of a client with terminal cancer is afraid of hurting his wife during sexual intercourse. Which action by the nurse is likely to be most helpful in reducing this client's fears? A) Encourage discussion between the husband and wife regarding their intimacy needs B) Reassure the client's husband that he cannot hurt the client during sexual intercourse C) Inform the client's husband that the client cannot have sexual intercourse due to fatigue D) Suggest other ways the couple can spend time together, such as watching television together
A) Encourage discussion between the husband and wife regarding their intimacy needs Explanation: Partners of terminally ill clients may wish to be physically intimate with the dying person but are afraid of "hurting" him or her and may also be afraid that an open expression of sexuality is somehow "inappropriate" when someone is dying. Encourage discussion and suggest ways to be physically intimate that will meet the needs of both partners, such as a foot massage or embrace, and not just watching TV. Telling the client that he cannot have relations based on the fatigue of the client's spouse is not appropriate. Reassuring the client that he will not cause pain is incorrect. Reference: Chapter 43: Loss, Grief, and Dying, p. 1708.
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? A) Inpatient pain management for hospice clients is covered by Medicare. B) Medicare does not cover costs that are not directly related to the diagnosis. C) Medicare does not cover pain control in the home; it must be in the inpatient care. D) Worry about payment should not be a concern for the client.
A) Inpatient pain management for hospice clients is covered by Medicare. Explanation: Inpatient pain management is covered by Medicare as are any other Medicare-covered services needed to manage pain and other symptoms as recommended by the hospice team. Medicare will cover pain control in the home as well, but for extreme pain, hospitalization may be required. Telling a client not to worry about payment does not educate about what services are available. Reference: Chapter 43: Loss, Grief, and Dying, p. 1691.
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? A)The client did not have any recent medical consultation. B) The client is an older adult with a history of hypertension. C) The client was being administered oxygen therapy. D) The client was diagnosed with acute kidney failure.
A) The client did not have any recent medical consultation. Explanation: The services of a coroner may be needed in a case where the client did not have any recent medical consultation. A coroner is a person legally designated to investigate deaths that may not be the result of natural causes. Death following a diagnosis of acute kidney injury, administration of oxygen therapy, or a history of hypertension does not call for the services of a coroner. Reference: Chapter 43: Loss, Grief, and Dying, pp. 1696-1697.
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? A) The client's breathing becomes noisy. B) The frequency of urination decreases. C) The arms and legs are warm to touch. D) The client is calm and peaceful.
A) The client's breathing becomes noisy. Explanation: Noisy breathing, or death rattle, is common during the final stages of dying because of the accumulation of secretions in the lungs. Reduced urination is not seen during the final stages of dying. Instead, the client develops loss of control over bladder and bowels due to loss of neurological control. The peripheral parts of the client's body such as the arms and the legs are cold to touch (not warm) because the circulation is directed away from the periphery and toward the core of the body. Clients in the last stages of dying are usually not calm and peaceful; they occasionally exhibit sudden restlessness due to hunger for oxygen. Reference: Chapter 43: Loss, Grief, and Dying, p. 1688.
What is Kübler-Ross's third stage of grief? A) bargaining B) denial C) depression D) anger
A) bargaining Explanation: Her proposed stages of grief are denial, anger, bargaining, depression, and acceptance. Reference: Chapter 43: Loss, Grief, and Dying, p. 1687.
Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief? A) coping strategies B) self-care activities C) pain management D) spiritual distress
A) coping strategies Explanation: Dysfunctional grief can be unresolved or inhibited. In unresolved grief, a person may have trouble expressing feelings of loss or may deny them. Unresolved grief also describes a state of bereavement that extends over a lengthy period. With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms. Coping strategies are necessary in the grieving process and for resolution of grief. Many times individuals experiencing dysfunctional grief have difficulty with self-care activities; however, the individual should be encouraged to perform these activities independently. Pain management is usually not necessary in the management of dysfunctional grief. The spiritual needs of the client are important as well and should be considered after coping strategies have been addressed. Reference: Chapter 43: Loss, Grief, and Dying, p. 1699.
Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal? A) leaving the wife's room and belongings intact B) telling the nurse how his life has changed C) talking about his wife's absent-mindedness D) showing a photograph of the decedent
A) leaving the wife's room and belongings intact Explanation: Bereavement experts reported that they considered almost all bereavement manifestations to be normal during the early stages of grief, but considered most of the manifestations to be abnormal if they continue beyond 3 years. Reference: Chapter 43: Loss, Grief, and Dying, pp. 1688-1715.
The nurse is giving palliative care to a client with a diagnosis of COPD. What is the goal of palliative care? A) to improve the client's and family's quality of life B) to support aggressive treatment for cure C) to provide physical support for the client D) The client may develop a separate plan with each discipline of the health care team.
A) to improve the client's and family's quality of life Explanation: The goal of palliative care is to improve the client's and the family's quality of life. The support should include the client's physical, emotional, and spiritual well-being. Each discipline should contribute to a single care plan that addresses the needs of the client and family. The goal of palliative care is not aggressive support for curing the client. Providing physical support for the client is also not the goal of palliative care. A separate plan of care developed by the client with each discipline of the health care team is not the goal of palliative care. Reference: Chapter 43: Loss, Grief, and Dying, p. 1690.
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? A) "The process is the same from person to person." B) "Sometimes a person returns to a previous stage." C) "Each stage of dying must be completed prior to moving to the next stage." D) "The duration of all stages is a few hours."
B) "Sometimes a person returns to a previous stage." Explanation: Kübler-Ross (1969) studied the responses to death and dying. Her findings are as follows: Sometimes a person returns to a previous stage; the stages of dying may overlap; the duration of any stage may range from as little as a few hours to as long as months; the process varies from person to person. Reference: Chapter 43: Loss, Grief, and Dying, pp. 1687-1688.
When preparing for the death of a client, the nurse should provide the client's family with which interventions? Select all that apply. A) Suggest that the family doesn't leave the bedside. B) Listen to concerns, fears, and worries. C) Utilize therapeutic communication techniques. D) Encourage rest and proper nutrition. E) Explain the dying process and allow grieving.
B) Listen to concerns, fears, and worries. D) Encourage rest and proper nutrition. E) Explain the dying process and allow grieving. C) Utilize therapeutic communication techniques. Explanation: The nurse can provide care for the family facing loss by listening to their concerns, fears, and worries. The nurse can do this by utilizing therapeutic communication techniques. The nurse should encourage the family to get adequate rest and nutrition. The reality of death may be less painful if the family is prepared ahead of time, which the nurse can facilitate by explaining the process and allowing the family to grieve. It is important for the family to get adequate rest, so it should not be suggested that the family never leave the bedside. Reference: Chapter 43: Loss, Grief, and Dying, p. 1708.
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. A) Stages occur at varying rates among people. B) People vary widely in their responses to loss. C) Some people actually skip some stages of grief altogether. D) The stages are relatively discrete and identifiable. E) The stages of grief occur linearly and are static.
B) People vary widely in their responses to loss. A) Stages occur at varying rates among people. C) Some people actually skip some stages of grief altogether. Explanation: In reality, the stages of the grief cycle model are not as discrete as the model indicates. However, it is helpful to use the model as a general guide, while keeping in mind that people may vary greatly in their responses to loss and still fall within the normal response range. Grieving persons may go through the stages at varying rates, go back and forth between stages, or skip stages. Reference: Chapter 43: Loss, Grief, and Dying, p. 1687.
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? A) Shock and disbelief B) Restitution C) Resolving the loss D) Developing awareness
B) Restitution Explanation: Restitution is the stage of grief that involves the rituals surrounding loss; with death, it includes religious, cultural, or social expressions of mourning, such as funeral services. Shock and disbelief involve the person being in denial or having a numbed response to the death. Developing awareness is characterized by physical and emotional responses such as anger, emptiness, and crying. Resolving the loss involves dealing with the void left by the loss. Reference: Chapter 43: Loss, Grief, and Dying, p. 1687.
The home health nurse is visiting a client who has been living alone for the past 5 years following the death of the spouse. Which behavior suggests the client may be experiencing abnormal grief? A) The client becomes teary when talking about the deceased spouse. B) The client talks as if the loss just happened. C) The client's living environment is extremely clean and neat. D) The client reports attending church on a weekly basis.
B) The client talks as if the loss just happened. Explanation: Altered or dysfunctional grieving is grief that falls outside the normal response range and may be manifested as exaggerated grief, prolonged grief, or absence of grief. As such, the client talking as if the death of the spouse just happened, when in reality it occurred 5 years earlier, is demonstrating abnormal grieving. Becoming teary when speaking of the spouse may occur because of missing the person and is normal grieving. The client's extremely neat and clean living environment may not be associated with grief, as the client is maintaining a suitable living environment. Attending church on a weekly basis may also be seen as a normal behavior. Reference: Chapter 43: Loss, Grief, and Dying, Dysfunctional Grief, pp. 1687-1688.
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? A) Anticipatory grief B) Unresolved grief C) Inhibited grief D) Normal grief
B) Unresolved grief Explanation: In unresolved grief, a person may have trouble expressing feelings of loss, may deny them, and the bereavement may extend over a lengthy period. Anticipatory loss or grief occurs when a person displays loss and grief behaviors for a loss that has yet to take place. Inhibited grief occurs when a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations. Normal expressions of grief may be physical (crying, headaches, difficulty sleeping, fatigue), emotional (feelings of sadness and yearning), social (feeling detached from others and isolating oneself from social contact), and spiritual (questioning the reason for the loss, the purpose of pain and suffering, the purpose of life, and the meaning of death). Reference: Chapter 43: Loss, Grief, and Dying, p. 1687.
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? A) infant B) adult C) school-aged child D) toddler
B) adult Explanation: Adults tend to grieve more intensely and more continuously, but for a relatively shorter period of time than children. Having a good social network helps with this process, as well as having a stable lifestyle. Reference: Chapter 43: Loss, Grief, and Dying, p. 1697.
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? A) anger B) denial C) depression D) bargaining
B) denial Explanation: In the denial stage, the client denies the reality of death and may repress what is discussed. The client may think the doctor made a mistake in the diagnosis or that his or her records were mixed up with another client's records. In the anger stage, the client demonstrates rage and hostility. In the bargaining stage, the client tries to barter for more time. In the depression stage, the client demonstrates a period of grief before death characterized by crying and not speaking much. Reference: Chapter 43: Loss, Grief, and Dying, p. 1689.
During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving? A) "I do not think my parent really has cancer. I think my parent needs to get a third opinion." B) "It is fine if my parent dies. We have not been close for years." C) "My parent is suffering with cancer and death will be a relief of the pain." D) "There is no way I can stay in the hospital because my parent is sick."
C) "My parent is suffering with cancer and death will be a relief of the pain." Explanation: Anticipatory grief is the characteristic pattern of psychological and physiologic responses a person makes to the impending loss of a significant person. The client's statement, "My parent is suffering with cancer and death will be a relief of the pain," is an example of anticipatory grief and is intended to facilitate coping when death occurs. The client's statement, "There is no way I can stay in the hospital because my parent is sick" demonstrates empathy for the parent and denial of a personal need for treatment. Denial is apparent when the client suggests the parent's diagnosis is incorrect. Denial is also apparent when the client relates it is "fine" if the mother expires because they were not close. Reference: Chapter 43: Loss, Grief, and Dying, Concepts of Loss and Grief, p. 1685.
The nurse is caring for a client who has just expired. Which action will the nurse perform? A) Place the client in a semi-Fowler's position. B) Have the nurse technician place identification tags on the outside of the shroud. C) Allow the client's family to see the client's body before it is discharged. D) Provide a complete bath.
C) Allow the client's family to see the client's body before it is discharged. Explanation: After the client has been pronounced dead, the nurse is responsible for preparing the body. Family members may need to see the client's body to accept the death fully; allow them to see the client's body before discharging to the mortician. The body is placed in normal anatomic position (flat) to avoid pooling of blood. In most cases it is unnecessary to wash the body, and some religions strictly forbid it. The nurse is legally responsible for placing identification tags on either the shroud or garment that the body is clothed in, and on the ankle to ensure that the body can be identified even if separated from its shroud. Reference: Chapter 43: Loss, Grief, and Dying, p. 1708.
Which statement regarding perceptions of death by children is accurate? A) Toddlers perceive death as irreversible and unnatural. B) Preschool-age children view death as a spiritual release. C) At about age 9, the child perceives death as irreversible. D) Adolescents tend to respond better than adults with death.
C) At about age 9, the child perceives death as irreversible. Explanation: At about 9 years of age, the child's concept of death matures, and the child perceives death realistically as irreversible, universal, inevitable, and natural. Reference: Chapter 43: Loss, Grief, and Dying, p. 1687.
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. A) Cyanotic nail beds in hands and feet bilaterally B) Distended abdomen with last bowel movement documented 7 days ago C) Gurgling sounds emanating from the client's throat with each breath D) A regular apical pulse of 90 beats/minute E) Systolic blood pressure which rose from 100 to 110 mm Hg
C) Gurgling sounds emanating from the client's throat with each breath B) Distended abdomen with last bowel movement documented 7 days ago A) Cyanotic nail beds in hands and feet bilaterally Explanation: Signs of an impending death include noisy respirations, abdominal distention, constipation, and cyanosis of the extremities. The pulse may be slow and/or irregular. The systolic blood pressure would be decreasing, not increasing. Reference: Chapter 43: Loss, Grief, and Dying, p. 1688.
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? A) Hospice care differs from palliative care in its foundational philosophy. B) Hospice care focuses on quality of life while palliative care focuses on length of life. C) Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness. D) Hospice provides physical and psychological support; palliative care provides social and spiritual support.
C) Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness. Explanation: Hospice programs, which, in effect, are a type of insurance benefit, focus on relieving symptoms and supporting clients with a life expectancy of 6 months or less, and their families. Palliative care, on the other hand, may be given at any time during a client's illness, from diagnosis to end of life. Hospice and palliative care programs provide care that focuses on quality rather than length of life. Both hospice and palliative care share a similar foundation. Hospice and palliative care provide physical, social, psychological, and spiritual support through a team of health care professionals and lay volunteers. Reference: Chapter 43: Loss, Grief, and Dying, p. 1690.
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? A) The client should be resuscitated if he experiences respiratory arrest. B) Pharmacologic interventions should not be initiated. C) The client should be treated with antibiotics for pneumonia. D) The wishes of his family should be followed.
C) The client should be treated with antibiotics for pneumonia. Explanation: The client has signed a document indicating a wish not to be resuscitated. Treating the pneumonia with antibiotics is not a resuscitation measure. The other options do not respect the client's right to choice. Reference: Chapter 43: Loss, Grief, and Dying, p. 1694.
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? A) acceptance B) denial and isolation C) depression D) bargaining
C) depression Explanation: According to Kübler-Ross (1969), the client would be in the depression stage, as evidenced by the loss of sleep and appetite. The other stages do not apply to this client according to the statements made. Reference: Chapter 43: Loss, Grief, and Dying, pp. 1687-1689.
A nurse is providing postmortem care. Which of the following nursing actions is a legal responsibility? A) removing tubes and soiled dressings B) washing the body to remove blood and excretions C) placing ID tags on the shroud and ankle D) placing the body in normal anatomic position
C) placing ID tags on the shroud and ankle Explanation: Although the nurse may place the body in a normal anatomic position and remove tubes and soiled dressings, the only legal action is placing ID tags on the shroud and ankle. The body is not usually washed by the nurse, as different cultures and religions have specific guidelines concerning cleansing the body. Reference: Chapter 43: Loss, Grief, and Dying, p. 1708.
A client diagnosed with a terminal illness is displaying periods of depression and anger alternating with acceptance. The client's spouse is concerned about the client's labile mood. When talking with the client's spouse, which statement made by the nurse best addresses principles of loss and grieving? A) "Most people go through all sorts of feelings and your loved one is no different." B) "Sometimes people become suicidal and we will place your loved one in restraints." C) "I think you are correct. Something is wrong with your loved one." D) "Not everyone experiences grief in the same way and your loved one needs our support."
D) "Not everyone experiences grief in the same way and your loved one needs our support." Explanation: Stages of grief include denial, anger, bargaining, depression, and acceptance. The progression in which people move through stages varies from person to person. Some people may not experience each stage. Sharing with the spouse that "Not everyone experiences grief in the same way and your loved one needs our support" is the most therapeutic response. Telling the spouse that something is wrong is incorrect as this is a normal response to grieving. There is no verifying data in the question stem indicating the client is suicidal and restraints are not used in a situation such as this. Telling the spouse that "most people go through all sorts of feelings" is not therapeutic; the nurse is minimizing the loved one's feelings. Reference: Chapter 43: Loss, Grief, and Dying, Responses to Dying and Death, p. 1689.
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? A) "You will go when it is your time." B) "You shouldn't worry about that right now." C) "I have to go and assist another client right now." D) "What have you been told?"
D) "What have you been told?" Explanation: When a client asks a question that is surprising or unexpected, it is best to find out what the client has been told about the situation or how they feel about it. The nurse should not try to avoid responding to the question by leaving to go care for another client. Making a cliché statement such as "you will go when it is your time" or telling the client to not worry about it does not meet the client's need for an answer or for expressing their feelings. Reference: Chapter 43: Loss, Grief, and Dying, p. 1700.
Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning? A) Offer emotional support to the family. B) Provide an explanation of the process. C) Have the client's family remain at the bedside. D) Administer sedation and analgesia.
D) Administer sedation and analgesia. Explanation: Terminal weaning is the gradual withdrawal of mechanical ventilation from a client with a terminal illness. Providing sedation and analgesia is the best way to reduce the client's discomfort during the process. The nurse participates in the process by educating the client and family about the burdens and benefits of continued ventilation and what to expect when terminal weaning is initiated. Supporting the family and having the family remain at the bedside are important roles of the nurse during terminal weaning, but do not directly affect discomfort as much as sedation and analgesia. Reference: Chapter 43: Loss, Grief, and Dying, p. 1694.
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? A) treatment of the disease process B) providing counseling related to the stages of death and dying C) eliminating all forms of medical and nursing care D) aggressive management of symptoms
D) aggressive management of symptoms Explanation: The goal of palliative care is to provide clients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms. There is no treatment goal for the life-threatening illness for palliative care. Aggressive management of symptoms includes medical and nursing care for the client. Providing counseling related to the stages of death and dying is pursued after aggressive management of symptoms. Reference: Chapter 43: Loss, Grief, and Dying, p. 1690.
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? A) Initiate a slow-code until the health care provider arrives. B) Respect the client's wishes and avoid calling a code. C) Consult with the charge nurse or nurse manager before calling the code. D) Call a code and begin resuscitating the client.
D) Call a code and begin resuscitating the client. Explanation: If there is no DNR order to the contrary, the standard of care obligates professionals to attempt resuscitation if a client stops breathing or his or her heart stops. It is important for nurses to clarify a client's code status if the nurse has reason to believe a client would not want to be resuscitated. It is imperative that the client's wishes are documented in a formal document in the health record for all to view. Slow-codes are never good practice, and the nurse could be charged with negligence in the event of a slow-code and resultant client death. Calling the charge nurse or nurse manager is not appropriate because it can delay emergency care, which could result in negligence and client death. Reference: Chapter 43: Loss, Grief, and Dying, p. 1694.
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? A) Place a rolled towel under the head. B) Apply hairpins and clips. C) Avoid replacing dentures in the mouth. D) Cleanse drainage from the skin.
D) Cleanse drainage from the skin. Explanation: The nurse should cleanse secretions and drainage from the skin to ensure delivery of a hygienic body. The dentures should be replaced in the mouth, as they maintain the natural contour of the face. A small rolled towel is placed beneath the chin of the client to close the mouth; it is not placed under the head. The nurse should remove all hairpins or clips to prevent accidental trauma to the client's face. Reference: Chapter 43: Loss, Grief, and Dying, p. 1708.
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? A) Anger B) Denial C) Bargaining D) Depression
D) Depression Explanation: Depression is a commonly accepted form of grief and it represents the emptiness when the client realizes the person or situation is gone or over. Signs and symptoms may be withdrawn, sadness, crying, and flat affect. Denial is the stage where client may disregard that the news of diagnosis or death is not true. Anger is the stage where the client may think "why me?" and "life's not fair!" Bargaining is the stage of false hope. The client might falsely make themselves believe that they can avoid the grief through a type of negotiation. The stages are denial, anger, bargaining, depression, and acceptance. Reference: Chapter 43: Loss, Grief, and Dying, p. 1689.
The hospice nurse is caring for a group of clients with terminal illness. Which is the highest care priority for a client in the process of dying? A) Hydration B) Hygiene C) Skin care D) Pain management
D) Pain management Explanation: End-of-life care requires comprehensive blended nursing skills and is unique to each client's circumstances. Common priorities, however, include the need to provide pain control and emotional support. Hydration and hygiene are not priorities at the end of life. As the client is dying, skin care is not the priority. Reference: Chapter 43: Loss, Grief, and Dying, Terminal Illness, p. 1689.
The nurse is taking care of a client who was hospitalized for an ulcerative colitis exacerbation. Recently, the client's parent died from colon cancer. Which question would be essential to ask this client at the start of the assessment of her loss reaction? A) Did your parent seek early treatment for the colon cancer? B) What did your parent do for a living? C) How old was your parent? D) What type of relationship did you have with your parent?
D) What type of relationship did you have with your parent? Explanation: When assessing a client for a reaction, both physically and psychologically, to loss, it is important to get a sense of what part the deceased person played in the client's life. If she was not close to her father, the impact might not be so great. On the other hand, if he was an important person in her life, her response might be greater. Other things to initially ask about include whether the loss was expected and whether or not the client feels a sense of responsibility for the loss. Reference: Chapter 43: Loss, Grief, and Dying, pp. 1697-1698.
The nurse is caring for several clients in the home care setting. Which client, when found deceased, will the nurse report as a case for the medical examiner? A) a client who was recently discharged from the hospital after a myocardial infarction B) a client treated for end-stage kidney failure who is on home hemodialysis C) a client with lung cancer who refused hospice and is living with a spouse D) a client found with an empty bottle for a newly-prescribed opioid by the bedside
D) a client found with an empty bottle for a newly-prescribed opioid by the bedside Explanation: A death that is reportable to the medical examiner would include one that is suspicious for suicide (in this instance, as demonstrated by an empty prescription bottle for an opioid). The deaths of the other clients described are not suspicious. The client with end-stage kidney disease is under the regular care of a health care provider since receiving dialysis at home. A client with cancer is not suspicious. Even with the refusal of hospice care, the client has been diagnosed with an end-stage disease, thus not qualifying for a medical examiner case. A client who was recently discharged after a myocardial infarction who had also been receiving care from a primary care provider is not considered suspicious. Other indications for reporting to a medical examiner include a death that occurs when a client is otherwise in good health and not under the care of a provider, a client who was involved in a violent crime such as a homicide, a client who dies while in police custody or in prison, a client who has had a criminal abortion, or if the deceased poses a potential threat to public health (such as a client who had an infectious disease). Reference: Chapter 43: Loss, Grief, and Dying, Cause of Death, p. 1698.
The spouse of a recently deceased client states, "I just can't believe he left me. He swore he would never leave me and I feel betrayed!" Using Kübler-Ross stages of grief, what stage does the nurse identify the client is experiencing? A) acceptance B) denial and isolation C) bargaining D) anger
D) anger Explanation: The client is identified as being in the anger stage of the grieving process. The client has accepted the fact that the spouse is gone but is angry and betrayed at the departure from life. The client has yet to accept this death and may have some overlapping with depression as well. Reference: Chapter 43: Loss, Grief, and Dying, pp. 1687-1689.
A widow develops cancer within 6 months of her husband's death. This may be a result of: A) multiple losses. B) social isolation. C) alcohol intake. D) bereavement.
D) bereavement. Explanation: Physical health and psychosocial adjustment are intricately intertwined. The bereaved are known to be at greater risk for mortality and morbidity than are comparable non-bereaved people. Reference: Chapter 43: Loss, Grief, and Dying, p. 1688.
A client diagnosed with liver failure in hospice care died 10 hours ago. The client's spouse is having difficulty leaving the room and is crying uncontrollably. What situation does the nurse identify is happening with this client's spouse? A) bargaining grief B) anticipatory grief C) pathologic grief D) grief reaction
D) grief reaction Explanation: The client's spouse is demonstrating behaviors related to a grief reaction. The anticipatory grief occurs prior to the death. The client's spouse has not had enough of a length of time to determine if the grief is pathologic. The spouse is experiencing the denial stage of grief and not the bargaining stage. Reference: Chapter 43: Loss, Grief, and Dying, p. 1687.
In the Parkes model, a person uses denial as a psychological defense in the stage of: A) reorganization. B) yearning. C) disorganization. D) numbness.
D) numbness. Explanation: In the numbness stage, which is usually brief, trauma so overwhelms the bereaved survivor that he or she must use denial as a psychological defense. Reference: Chapter 43: Loss, Grief, and Dying, p. 1689.
Which stage of grieving is exhibited by the husband of a victim of sudden death who refuses to accept that she is dead? A) protest B) depression C) doubt D) shock
D) shock Explanation: In the shock and disbelief stage, the survivor either refuses to accept the loss or shows intellectual acceptance of the loss but denies the emotional impact. Reference: Chapter 43: Loss, Grief, and Dying, p. 1687.
