Death & Loss

Which of the following statements, made by a nurse regarding the means by which older adults usually express and manage grief, reflects a need for further instruction and clarification? 1. The greater the loss the greater the sense of grief. 2. Managing depression will help the grieving adult cope. 3. Having lived a long, happy life makes grieving easier to deal with. 4.The longer you live, the more experience you have with grieving a death.

(3) There is little evidence that grief experiences differ due to age alone. Responses to loss are more likely related to the nature of the specific loss experience. Increased age increases the likelihood that older adults have faced multiple lossesloved ones, friends, valued objects, outliving a child, or declining health. Depression does make dealing with grief more difficult.

A family member of a dying patient talks casually with the nurse and expresses relief that she will not have to visit at the hospital anymore. Which theoretical description of grief best applies to this family member? a. Denial b. Anticipatory grief c. Yearning and Searching d. Dysfunctional grief

(b) Family members often grieve the impending loss of companionship, control, and sense of freedom and the mental and physical changes to be experienced by their loved one. Ultimately they grieve the impending death.

Enuresis is reported in a previously toilet trained toddler. While gathering a health history from the grandparent, the nurse asks about which factor as the most likely cause? a. Lack of outside playtime b. Having too many toys c. Dietary changes d. Recent parental death

A childs stage of development and chronological age will influence how he or she grieves. Toddlers can show grief through changes in their eating patterns, changes in their sleeping patterns, fussiness or irritability, and changes in their bowel and bladder habits. It is common for younger children to regress when under increased stress. Lack of outside playtime, dietary changes, and having too many toys are unlikely to cause enuresis.

A nurse encounters a family that experienced the death of their adult child last year. The parents are talking about the upcoming anniversary of their childs death. The nurse spends time with them discussing their childs life and death. The nurses action best demonstrates which nursing principle? a. Pain management technique b. Facilitating normal mourning c. Grief evaluation d. Palliative care

Anniversary reactions can reopen grief processes. A nurse should openly acknowledge the loss and talk about the common renewal of grief feeling around the anniversary of the individuals death. This facilitates normal mourning. The nurse is not attempting to alleviate a physical pain. The actions are of open communication, not evaluation. Palliative care refers to comfort measures for symptom relief.

A terminally ill client shares with the nurse that he, needs to tell someone what I want when the end comes. The nurses most therapeutic response is: 1. We can talk about that now if you want to. Let me close the door and pull up a chair. 2. I imagine you would like to discuss matters with your primary care provider. Ill let him know you want to talk. 3. Let me finish with my client care, Ill be back in 10 minutes, and we can talk as long as you need to. 4. If you havent discussed your feelings with your family yet, Id suggest you do that when they visit this evening.

Avoid communication barriers such as denying the clients grief, providing false reassurance, or avoiding discussion of sensitive issues. When you sense that a client wants to talk about something, make time right then, if at all possible.

The nurse has had three patients die during the past 2 days. Which approach is most appropriate to manage the nurses sadness? a. Telling the next patients why the nurse is sad b. Talking with a colleague or writing in a journal c. Exercising vigorously rather than sleeping d. Avoiding friends until the nurse feels better

Self-care strategies for nurses include talking with a close colleague and reflecting on feelings by writing in a journal. It is inappropriate for a nurse to talk with patients to resolve the nurses grief. Although exercise is important for self-care, sleep is also important. Shutting oneself away from friends is not self-care; the nurse should spend time with people who are nurturing.

A client who is Chinese American has just died on the unit. The nurse is prepared to provide after-death care to the client and anticipates the probable preferences of a family from this cultural background will include: 1. Pastoral care 2. Preparation for organ donation 3. Time for the family to bathe the client 4. Preparation for quick removal out of the hospital

Some families of Chinese Americans will prefer to bathe the client themselves. They often believe the body should remain intact; organ donation and autopsy are uncommon. Chinese Americans do not prefer pastoral care for after-death care of a family member. Organ donation is uncommon for Chinese Americans. Chinese Americans may desire time to bathe the client. Quick removal from the hospital is not preferred.

A woman has had a breast removed to treat cancer. What type of loss will she most likely experience? A) actual loss B) perceived loss C) maturational loss D) anticipatory loss

a

A family is grieving after learning of a family members accidental death. The transplant coordinator requests to talk with the family about possible organ and tissue donation. The nurse recognizes that a. All religions allow for organ donation. b. Life support must be removed before organ and tissue retrieval occurs. c. The best time for organ and tissue donation is immediately after the autopsy. d. The transplant coordinator is working in accordance with federal law.

It is a federal law to require facilities to develop policies about organ donation. The transplant coordinator has additional education on providing answers about organ donation. Not all religions allow for organ donation. A patient may be on life support during organ removal to preserve organ tissues. Autopsy compromises organ integrity; removal should occur prior.

During a follow-up visit, a woman is describing new onset of marital discord with her terminally ill spouse. Using the Kbler-Ross behavioral theory, the nurse recognizes that the spouse is in which stage of dying? a. Denial b. Bargaining c. Anger d. Depression

Kbler-Ross traditional theory involves five stages of dying. The anger stage of adjustment to an impending death can involve resistance, anger at God, anger at people, and anger at the situation. Denial would involve failure to accept a death. Bargaining is an action to delay acceptance of death by bartering. Depression would present as withdrawal from others.

Validation of a dying persons life would be demonstrated by which nursing action? a. Taking pictures of visitors b. Calling the organ donation coordinator c. Listening to family stories about the person d. Providing quiet visiting time

Listening to family members stories validates the importance of the dying individuals life and reinforces the dignity of the persons life. Taking pictures of visitors does not address the value of a persons life. Calling organ donation and providing private visiting time are components of the dying process, but they do not validate a dying persons life.

The nurse recognizes that which of the following clients is at greatest risk for complicated (dysfunctional) grief? 1. A 26-year-old who is diagnosed with rheumatoid arthritis 2. The 58-year-old only child whose mother recently died of cancer 3. A teenage parent whose child died of sudden infant death syndrome (SIDS) 4. A 50-year-old diabetic client who has experienced an above-the-knee amputation

Loss associated with homicide, suicide, sudden accidents, or the loss of a child has the potential to become complicated.

A man is hospitalized after surgery that amputated both lower extremities owing to injuries sustained during military service. The nurse should recognize his need to grieve for what type of loss? a. Maturational loss b. Situational loss c. Perceived loss d. Uncomplicated loss

Loss of a body part from injury is a situational loss. Maturational losses occur as part of normal life transitions. Perceived loss is not obvious to other people. Uncomplicated is not a type of loss; it is a description of normal grief.

Experiencing normal grief over losses allows the adolescent to successfully: 1. Move past the loss 2. Regain a sense of security 3. Develop effectual coping skills 4. Deal with an actual loss later in life

Normal grief experiences often help persons to mature and develop coping methods for dealing with other losses in the future. The remaining options are facets of successfully coping with loss.

Which comment to a patient by a new nurse regarding palliative care needs to be corrected? 1. "Even though you're continuing treatment, palliative care is something we might want to talk about." 2. "Palliative care is appropriate for people with any diagnosis." 3. "Only people who are dying can receive palliative care." 4. "Children are able to receive palliative care."

Palliative care is available to all patients regardless of age, diagnosis, and prognosis.

The nurse is caring for a terminal ill client in the final stages of the death process when the clients daughter asks, Why are you putting drops in dads eyes? The nurse responds more accurately by telling the daughter that: 1. His blinking reflex is gone and these drops lubricate his corneas. 2. The drops will keep the corneas moist since you have donated them. 3. They are artificial tears that will keep his eyes from becoming dry and painful. 4. They were prescribed for him but I wont instill them if you prefer that I dont

(3) Blinking reflexes diminish near death, causing drying of the cornea. Optical lubricants or artificial tears reduce corneal drying. While the other options are accurate, they do not address the daughters question as thoroughly as the identification of and reasoning for the drops.

To maintain the clients sense of self-worth during the end of life while working with a client in an inpatient hospice unit, the nurse should: 1. Leave the client alone to deal with final affairs 2. Call upon the clients spiritual advisor to manage care 3. Include regular visits throughout the day into the clients care plan 4. Facilitate the arrangements to have a grief counselor visit the client

(3) Spending time to let clients share their life experiences, particularly what has been meaningful, enables the nurse to know clients better. Knowing clients then facilitates choice of therapies that promote client decision-making and autonomy. Planning regular visits also helps the client maintain a sense of self-worth, because it demonstrates that he or she is worthy of the nurses time and attention. The client should not be left alone to feel abandoned or isolated. Nurses can help clients meet spiritual needs by facilitating connections to a spiritual practice or community and supporting the expression of culturally held beliefs. A clients spiritual advisor may also be called upon but is not the only source of spiritual support. The nurse who turns care over to the spiritual advisor is not promoting the clients sense of self-worth, as it may imply the client is not worthy of the nurses time or attention. A grief counselor may be requested to visit if the client is experiencing complicated grief. Having a grief counselor visit is not an intervention that will help maintain a clients sense of self-worth.

Mrs. Harrisons father died a week ago. Mr. Harrison is experiencing headaches and fatigue, and keeps shouting at his wife to turn down the television, although he has not done so in the past. Mrs. Harrison is having trouble sleeping, has no appetite, and says she feels like she is choking all the time. How should the nurse interpret these assessment findings as the basis for a follow-up assessment? a. Mrs. Harrison is grieving and Mr. Harrison is angry. b. Mrs. Harrison is ill and Mr. Harrison is grieving. c. Both Mr. and Mrs. Harrison likely are in denial. d. Both Mr. and Mr. Harrison likely are grieving.

(d) Symptoms of normal grief include headache, fatigue, oversensitivity to noise, insomnia, appetite disturbance, and choking sensation. Different people manifest different symptoms. Denial is assessed when the person indicates that he is not accepting that the loss happened.

A newly graduated nurse is assigned to his first dying patient. The nurse is best prepared to care for this client if he: a. Completed a course dealing with death and dying b. Is able to control his own emotions about death c. Experiences the death of a loved one d. Has developed a personal understanding of his own feelings about death

*d.* When caring for clients experiencing grief, its important for the nurse to assess his own emotional well-being & to understand his own feelings about death. The nurse who is aware of his own feelings will be less likely to place personal situations & values before those of the client. *a.* Although course work on death & dying may add to the nurses knowledge base, it does not best prepare the nurse for caring for a dying client. The nurse needs to have an awareness of his own feelings about death first, as death can raise many emotions. *b.* Being able to control ones own emotions is important; however, it is unlikely that the nurse would be able to do so if he has not first developed a personal understanding of his own feelings about death. *c.* Experiencing the death of a loved one is not prerequisite to caring for a dying client. Experiencing death may help an individual mature in dealing with loss, or it may bring up many negative emotions if complicated grief is present. The nurse is best prepared by first developing an understanding of his own feelings about death.

What are the physical changes that occur as death approaches? 1. Unresponsiveness 2. erythema 3. mottling 4. restlessness 5. increased urine output 6. weakness 7. incontinence

1, 3, 4, 6, 7

Which factors influence a person's approach to death?

1. Culture 2. Spirituality, 3. Personal beliefs and values, 4. Previous experiences with death 5. Previous degree of social support

The nurse finds a client who has been diagnosed with terminal lung cancer quietly crying. Which of the following nursing responses most reflects a need for additional guidance regarding therapeutic communication with a dying client? 1. If there is anything I can do to help, just ask. 2. Would you like some medication to help you sleep? 3. Do you want me to call your wife so you two can talk? 4. Try not to be sad; lets find something to be thankful for.

Avoid communication barriers such as denying the clients grief, providing false reassurance, or avoiding discussion of sensitive issues. Remember that a clients emotions are not something you can fix. Instead, view emotional expression as a necessary part of the clients adjustment to significant life changes and development of effective coping skills.

A woman is called into her supervisors office regarding her deteriorating work performance since the loss of her husband 2 years ago. The woman begins sobbing and saying that she is falling apart at home as well. The woman is escorted to the nurses office, where the nurse recognizes the woman's symptoms as which of the following? a. Normal grief b. Complicated grief c. Disenfranchised grief d. Perceived grief

Complicated or dysfunctional grief occurs when an individual has a complicated grieving process that interferes with common routines of life for excessively long periods of time. Normal grief is the most common reaction to death; it involves a complex range of normal coping strategies. Disenfranchised grief involves a relationship that is not socially sanctioned. Perceived grief is not a type of grief; perceived loss is a loss that is not obvious to other people.

The mother of a recently murdered child keeps the childs room intact. Family members are encouraging her to redecorate and move forward in life. The visiting nurse recognizes this behavior as _____ grief. a. Normal b. End-of-life c. Abnormal d. Complicated

Family members will grieve differently. One sign of normal grief is keeping the deceased individuals room intact as a way to keep that person alive in the minds of survivors. This is happening after the family member is deceased, so it is not end-of-life grief. It is not abnormal or complicated grief; the child died recently.

The wife of a client recently diagnosed with end-stage renal failure shares with the nurse that, He just accepts this; I want a second opinion. The nurse recognizes that while the client has reached the acceptance stage of grieving, his wife is experiencing the: 1. Anger stage 2. Denial stage 3. Depression stage 4. Bargaining stage

In the denial stage, a person acts as though nothing has happened and refuses to accept the fact of the loss. The person shows no understanding of what has occurred. When experiencing the anger stage of adjustment to loss, a person expresses resistance and sometimes feels intense anger at God, other people, or the situation. Bargaining cushions and postpones awareness of the loss by trying to prevent it from happening. Grieving or dying people make promises to self, God, or loved ones that they will live or believe differently if they can be spared the dreaded outcome. When a person realizes the full impact of the loss, depression occurs. Some individuals feel overwhelmingly sad, hopeless, and lonely. Resigned to the bad outcome, they sometimes withdraw from relationships and life. In acceptance, the person incorporates the loss into life and finds ways to move forward.

A client who recently experienced an amputation of the left thumb has a perceived loss of physical attractiveness. The nurse recognizes that such a loss is: 1. More easily assessed than actual losses 2. Much less personal than an actual loss 3. Universally experienced by all amputees 4. Capable of producing grief similar to an actual loss

Perceived losses are easy to overlook because they are so internally and individually experienced, although they are grieved in the same way as an actual loss. The express of grief over a loss, perceived or real, is a very individualized, personal response.

A severely depressed patient cannot state any positive attributes to his or her life. The nurse patiently sits with this patient and assists the patient to identify several activities the patient is actually looking forward to in life. The nurse is helping the patient to demonstrate which spiritual concept? a. Time management b. Hope c. Charity d. Faith

The concept of hope is vital to nursing; it enables a person to anticipate positive experiences. Being patient and friendly and creating positive relationships are key concepts in all areas of nursing, but especially with depressed patients. The nurses actions do not address time management, charity, or faith.

A cancer patient asks the nurse what the criteria are for hospice care. What should the nurse answer? a. Having a terminal illness, such as cancer b. Needing assistance with pain management c. Expected to live less than 6 to 12 more months d. Completion of an advance directive

The criterion for hospice care is being expected to live less than *6 to 12 more months.* Patients with a terminal illness are not eligible until that point. Palliative care provides assistance with pain management when a patient is not eligible for hospice care. An advance directive can be completed by any person, even those who are healthy.

The nurse is providing care to a dying client. Which of the following is the primary concern? The nurse should: 1. Promote optimism in the client and be a source of encouragement 2. Promote dignity and self-esteem in as many interventions as is appropriate 3. Allow the client to be alone and expect isolation on the part of the dying person 4. Intervene in the clients activities and promote as near normal functions as possible

The focus in planning nursing care is to support the client physically, emotionally, developmentally, &spiritually in the expression of grief. When caring for the dying client, it is important to devise a plan that helps a client to die with dignity & offers family members the assurance their loved one is cared for w/ care & compassion. Optimism should not be the primary focus when caring for the dying client. The nurse should promote the clients self-esteem & allow the client to die with dignity. The client does not need to be left alone. The nurses or familys presence may be comforting to the client by showing that he or she is being cared for and is worthy of attention. The client should be allowed to make choices and perform as many activities of daily living independently as possible. This allows the client to maintain self-esteem and dignity.

A client, who is receiving chemotherapy on a medical unit due to a recent diagnosis of terminal cancer of the liver, has an in-depth conversation with the nurse. The client says, This cannot be happening to me. The nurse identifies that this stage is associated with, according to Kbler-Ross: a. Anxiety b. Denial c. Confrontation d. Depression

b. According to Kbler-Ross, the client is in the denial stage of dying. The client may act as though nothing has happened, may refuse to believe or understand that a loss has occurred and may seem stunned, as though it is unreal or difficult to believe. d. During depression, the individual may feel overwhelmingly lonely and withdraw from interpersonal interaction

There is a different focus for the client with hospice nursing care. The nurse is aware that client care provided through a hospice is: 1. Designed to meet the clients individual wishes, as much as possible 2. Aimed at offering curative treatment plans intended for client recovery 3. Involved in teaching families and/or caregivers to provide postmortem care 4. Offered primarily for hospitalized clients for whom at-home care is not possible

The nurses role in hospice is to meet the primary wishes of the dying client and to be open to individual desires of each client. The nurse supports a clients choice in maintaining comfort and dignity. Hospice care is for the terminally ill. It is not aimed at offering curative treatment, but rather the emphasis is on palliative care. Hospice care may provide bereavement follow-up for the family after a clients death, but hospice nurses typically do not teach the family postmortem care. Hospice care is primarily for home care, but a client in a hospice may become hospitalized.

The palliative teams primary obligation to a patient in severe pain includes which of the following? a. Supporting the patients nurse in her grief b. Providing postmortem care for the patient c. Teaching the patient the stages of grief d. Enhancing the patients quality of life

The primary goal of palliative care is to help patients and families achieve the best quality of life. Providing support for the patients nurse is not the primary obligation when the patient is experiencing severe pain. Not all collaborative team members would be able to provide postmortem care, as is the case for nutritionists, social workers, and pharmacists. Teaching about stages of grief should not be the focus when severe pain is present

To provide comfort for the client, while preparing to assist the client in the end stage of her life in response to anticipated symptom development, the nurse plans to: 1. Decrease the clients fluid intake 2. Limit the use of over-the-counter analgesics 3. Provide larger meals with more appealing seasoning 4. Determine valued activities and schedule rest periods

To promote comfort in the terminally ill client, the nurse should help the client to identify values or desired tasks; then help the client to conserve energy for those tasks. Decreasing the clients fluid intake may make the terminally ill client more prone to dehydration and constipation. The nurse should take measures to help maintain oral intake, such as administering antiemetics, applying topical analgesics to oral lesions, and offering ice chips. The use of analgesics should not be limited. Controlling the terminally ill clients level of pain is a primary concern in promoting comfort. Nausea and vomiting and anorexia may increase the terminally ill clients likelihood of inadequate nutrition. The nurse should serve smaller portions and bland foods, which may be more palatable.

Which of the following is an example of a perceived loss? A) A patient mourns the loss of his amputated leg. B) A patient grieves for the loss of his wife to cancer. C) An older patient grieves for the loss of his independence. D) A patient grieves for the loss of his job.

c

The family of a client with a terminal illness will be able to help provide some psychological support to their family member. To assist the family to meet this outcome, the nurse plans to include in the teaching plan: 1. Demonstration of bathing techniques 2. Application of oxygen delivery devices 3. Recognition of the clients needs and fears 4. Information on when to contact the hospice nurse

c. A dying clients family is better prepared to provide psychological support if the nurse discusses with them ways to support the dying person and listen to needs and fears. a. Demonstration of bathing techniques may help the family meet the dying clients physical needs, not to providing psychological support. b. Application of oxygen devices may help the family provide physical needs for the client, not to provide psychological support for the client. d. Information on when to contact the hospice nurse is important knowledge for the family to have and may help them feel they are being supported in caring for the dying client. However, contact information does not help the family provide psychological support to the dying client.

The nurse is assigned to a client who was recently diagnosed with a terminal illness. During morning care, the client asks about organ donation. The nurse should: a. Have the client first discuss the subject with the family b. Suggest the client delay making a decision at this time c. Assist the client to obtain the necessary information to make this decision d. Contact the physician so consent can be obtained from the family

c. No topic that a dying client wishes to discuss should be avoided. The nurse should respond to questions openly and honestly. As client advocate, the nurse should assist the client to obtain the necessary information to make this decision. a. The nurse should provide the client with information with which to make such a decision. Although the nurse may suggest that the client discuss this option after having obtained information, it is up to the client to discuss the subject with the family. b. The nurse should respect the client and provide the necessary information for him or her to make a decision, rather than dismissing the clients question. d. It is not necessary to contact the physician or the family for consent for organ donation if the client is capable of making this decision.

The nurse is discussing future treatments with a client who has a terminal illness. The nurse notes that the client has not been eating and responds to the nurses information by saying, What does it matter? The most appropriate nursing diagnosis for this client is: a. Social isolation b. Spiritual distress c. Denial d. Hopelessness

d. A defining characteristic for the nursing diagnosis of hopelessness may include the client stating, 'What does it matter?' when offered choices or info concerning him. The clients behavior of not eating also is an indicator of hopelessness. a. This is not an example of social isolation. The client is not avoiding or restricted from seeing others. b. Spiritual distress is not the most appropriate nursing diagnosis for this client. The focus should be on the clients lack of hope. c. The clients behavior and verbalization does not indicate denial.

The nurse recognizes that anticipatory grieving can be most beneficial to a client or family because it can: a. Be done in private b. Be discussed with others c. Promote separation of the ill client from the family d. Help a person progress to a healthier emotional state

d. The benefit of anticipatory grief: it allows time for the process of grief (i.e. to say good-bye & complete life affairs). it allows time to grieve in private, to discuss the anticipated loss w/ others, & to let go of the loved one. It can help a person progress to a healthier emotional state of acceptance & dealing w/ loss. a. Its not most beneficial for grieving to take place only in private. It is important for grief to be acknowledged by others, & to be able to receive the support of others in the grieving process. b. Anticipatory grieving can be discussed w/ others in most circumstances. However, at times, anticip. grief may be *disenfranchised* grief as well, meaning it cannot be openly acknowledged, socially sanctioned, or publicly shared, such as a partner dying of AIDS. The benefit of anticip. grieving is not so much that it can be discussed in most circumstances, as this discussion also can occur w/ normal grief when the actual loss has occurred. c. Anticip. grief is the process of disengaging or letting go that occurs before an actual loss or death has occurred. The benefit is not the separation of the ill client from the family as much as it is the process of being able to say good-bye, to put life affairs in order, and as a result, it can help a client or family to progress to a higher emotional state.