HESI CASE STUDY: LOSS, GRIEF, DEATH

Based on the assessment findings, what action should the nurse implement? A. Inform the family member that her mom's condition is worsening. B. Suggest that the daughter tell her father to rush back to the hospital immediately. C. Hold the family member's hand, but do not disclose the client's vital signs. D. Notify the family that the client will probably die today.

A. Inform the family member that her mom's condition is worsening.

Because the client has been losing weight and she has a decreased metabolic rate due to the dying process, the HCP prescribes 0.2 mg/kg oxycodone HCL of client's weight. She weighs 88 lbs. The medication is available as 20 mg/mL in a 30 mL bottle with a measured dropper. How many milliliters of medication will the nurse administer? (Enter numerical value only. If rounding is required, round to the nearest tenth.)

0.4

The client's spouse tells the nurse their faith in God has seen them through life's problems and they rely on that faith every day. What is the best response to support the client and her spouse spiritually? A. "Do you have any wishes I should convey to the staff?" B. "I wish my faith were as strong as yours." C. "Does your family share your faith?" D. "Would you like to visit the chapel on the first floor?"

A. "Do you have any wishes I should convey to the staff?"

Four days later, the client becomes more disoriented and she is unable to swallow thickened liquids or pureed foods without choking. Her weakness has progressed to the point at which she cannot bear her own weight or sit in a chair. The healthcare provider suggests inserting a nasogastric feeding tube to provide nutrition; however, the client's Living Will excludes tube feedings and intravenous nutrition. The client's spouse states they support the client's decision and this information was shared with their adult child. Which response demonstrates that the nurse understands the underlying premise of a Living Will? A. "We will honor the directives in her Living Will." B. "Are you sure that this is what you really want for the client?" C. "Your healthcare providers want to do all they can to preserve life." D. "Have you spoken to your faith leader about the client's wishes?"

A. "We will honor the directives in her Living Will."

Legal ConsiderationsThe Healthcare Provider (HCP) orders the client be admitted to the hospital. They also order a CMP, CBC, swallow evaluation, and saline lock. During the admission procedure, what is the nurse's responsibility regarding advance directives? A. Determine if the client has completed a Living Will and a durable power of attorney for healthcare (DPAHC). B. Explain that the Patient Self-Determination Act (PSDA) requires a living will. C. Instruct client's spouse to have the client sign a Living Will when she is no longer disoriented. D. Ask the client's spouse if they would like to make any changes.

A. Determine if the client has completed a Living Will and a durable power of attorney for healthcare (DPAHC). The Patient Self-Determination Act (1991) requires healthcare institutions to provide written information concerning the client's rights to refuse treatment and formulate advance directives. The nurse should ask the client's spouse if the client has completed a living will and a durable power of attorney for healthcare (DPAHC).

The nurse assessment reveals the client's diminished breath sounds with crackles in the right lung, her level of consciousness (LOC) has declined, and she has an oral temperature 102° F (38.9° C). After the client assessment is complete, what does the nurse determine is the BEST course of action? A. Report the assessment findings to the health care provider. B. Elevate the head of the clients bed to 45 degrees and instruct spouse to leave it elevated. C. Inform the spouse to give the client acetaminophen. D. Provide directions on how to properley feed a person with dysphagia to the spouse.

A. Report the assessment findings to the health care provider. Communicating with the health care provider is essential in order to advocate for the client's well-being.

State, Grief Process The client's adult child arrives to visit. Their last interaction was 3-months-ago, and is alarmed mother has lost weight, is weaker, is not eating, and not as responsive. They comment to the nurse mother talked about the Living Will but says angrily, "Don't you think you should do something? This is a hospital, isn't it?" What is the best response by the nurse? A. "Yes, this is the hospice unit of the hospital." B. "It must be difficult to see the changes in your mother." C. "Why are you angry at the nurses and other healthcare providers?" D. "You are in the stage of denial in the grief process."

B. "It must be difficult to see the changes in your mother."

Nutritional IssuesThe client is diagnosed with pnuemonia and is prescribed intravenous antibiotics for treatment. The client's swallow study determined that she should be on honey thick liquids and pureed foods. The spouse comes to visit the client and notices the "Swallow Precautions- thickened liquids" sign and asks the nurse what it means. The nurse explains since the client does not have adequate swallowing ability thin liquids may go into the trachea and then the lungs instead of the stomach and cause pneumonia. Suddenly, the spouse gets a shocked look on his face and says, "Oh, no! I did that. I gave her pneumonia?" What is the nurse's best response? A. "How was she positioned when you fed her?" B. "Saliva entering the lungs can also cause pneumonia. And you did not have a way of knowing she was aspirating." C. "You know you did the best you could." D. "We know it was not intentional on your part."

B. "Saliva entering the lungs can also cause pneumonia. And you did not have a way of knowing she was aspirating."

The client becomes difficult to arouse and does not follow commands. The daughter ask the nurse what they should tell their preschool child if she dies. Which phrase should the nurse recommend? A. "She went to sleep and didn't wake up." B. "She died and that makes us feel very sad." C. "God wanted her because she was so good." D. "We've lost her and will miss her very much."

B. "She died and that makes us feel very sad."

Growth and Development The client's spouse states they have been married for 52 years. The spouse sighs and wipes their eyes, softly remarking they won't know what to do when she is gone. What feedback from the nurse will encourage the spouse to elaborate more about feelings? A. Praise the couple for being able to stay married so long. B. Ask the spouse to share memories of the couple's time together. C. Remark they are role models for the faith community. D. Share the memories of own family.

B. Ask the spouse to share memories of the couple's time together.

Which assessment should the nurse complete immediately after hearing the client choked while eating? A. The caregiver's knowledge about feeding a person who is dysphagic. B. Auscultate the client's lungs for adventitious breath sounds. C. Assess the client's LOC with the mini-mental status exam. D. Determine the client's ability to swallow liquids.

B. Auscultate the client's lungs for adventitious breath sounds. RATIONALE: The client's lungs should be assessed immediately for adventitious breath sounds since she is at risk for aspiration pneumonia secondary to the choking incident.

The client's spouse has a copy of the client's Living Will and durable power of attorney for health care. The spouse states, "I do not want her to suffer." The nurse assures the spouse that the physicians and staff will make every effort to keep the client comfortable. After making sure the client and her spouse are settled and do not require anything further at this time, what action should the nurse take? A. Document that the client is aware of the Patient Self-Determination Act. B. Place a copy of the Living Will in the medical record and document its presence. C. Notify the HCP that the spouse desires euthanasia for the client. D. Report to the charge nurse the spouse seems to be in denial about the seriousness of the client's condition.

B. Place a copy of the Living Will in the medical record and document its presence. The nurse is responsible for placing a copy of the living will in the medical record and documenting its presence.

Postmortem Care The family members are at the bedside very early the next day when the client stops breathing. The healthcare provider arrives and pronounces the death. As the faith leader is being consulted regarding the preparation of the body, a group of individuals from the client's faith community arrive to assist with postmortem care. How should the nurse respond? A. Instruct the family and the religous leader to leave the room. B. Remain available to assist the women of the religous community as needed. C. Tell the religous leader that postmortem care must be done by the hospice staff regardless of religion. D. Remind the family that an autopsy must be performed before the burial. Submit Previous Section

B. Remain available to assist the women of the religous community as needed.

Spiritual Care The client rests more comfortably after the medication is initiated, and more alert. She is able to speak with her family when she is awake. She awakens while her faith leader is visiting and asks to pray. The nurse enters the room to obtain vital signs while the faith leader is praying. The client's spouse asks the nurse to remain with them for the prayer and then obtain the vital signs. Which action should the nurse choose to implement? A. Take the vital signs as prescribed. B. Stand quietly until the prayer is over. C. Express discomfort by leaving the room. D. Ask the faith leader to come back later to pray.

B. Stand quietly until the prayer is over.

What intervention should the nurse implement? A. Suction tracheal secretions. B. Suction oral secretions from mouth and throat. C. Encourage deep breathing every hour while awake. D. Teach the client how to use an incentive spirometer.

B. Suction oral secretions from mouth and throat.

The client now lies quietly with her eyes closed. She no longer responds verbally, but she smiles when her family speaks to her. To assist the client and family in life review, what is the best intervention by the nurse? A. Encourage visitors to talk quietly so the client is not disturbed. B. Suggest to the family that they bring photo albums to show the client. C. Encourage the client and family to talk about their experiences. D. Encourage visitors to use touch when communicating with the client.

C. Encourage the client and family to talk about their experiences.

The family tells the nurse they feel helpless and don't know what to do to make the client more comfortable. Family asks the nurse if it would be all right to have a massage therapist come in and gently massage her mother's back and limbs. How should the nurse respond to the family's request? A. Ask the family what purpose she thinks massage will serve. B. Inform family must produce the therapist's credentials first. C. Inform the family massage therapists are welcome in the hospice unit. D. Share with the family the nurse uses alternative therapies themselves.

C. Inform the family massage therapists are welcome in the hospice unit.

End-of-Life CareThe client's spouse decides to go home to sleep in their own bed. Another of the client's family spends the night at the bedside. Early the next morning, the client's vital signs are pulse 50 beats/min and thready, respirations 10 breaths/min and shallow, BP 70/30 mmHg, Glasgow Coma Scale 3. Which other physical symptom should the nurse anticipate? A. Hyperreflexia in legs and arms. B. Increased urinary output. C. Mottling of hands and feet. D. Head turned away from light.

C. Mottling of hands and feet.

Children and Death The nurse explains the stages of grief and ways the family can support other family memers as the client moves back and forth among the stages.The client's family began reading age-appropriate books and talking to the younger children about death as soon as they received the news a family member was hospitalized. They are concerned because their school-aged child repeatedly asks questions about what happens to the physical body after death and wants specific information about what the funeral home will do to the body. Family asks the nurse what they should tell their school-aged child. What is the best response by the nurse? A. Tell the family to take the child to a grief counselor immediately. B. Call the family's faith leader to get information that is culturally appropriate. C. Recommend their child's questions be answered honestly in simple terms. D. Ask to speak to the child to assess what is really bothering him.

C. Recommend their child's questions be answered honestly in simple terms.

Managing Discomfort The client begins to sleep more, and she has less alert time. Over the last few days, she has become more restless, has increased grimacing, and periodically clenches her fists. The nurse notes an increase in heart rate, respiration, and blood pressure during these episodes. The HCP is contacted, and oxycodone HCL immediate-release concentrate solution is prescribed to be administered via the oral transmucosal route every 4 hours as needed for pain. The client's spouse is informed of the order and asks the nurse why oxycodone was prescribed in this manner. What information regarding the medication order should the nurse provide to the client's spouse? (Select all that apply. One, some, or all options may be correct.) Select all that apply A. This route is least likely to produce drug addiction. B. There is no other route by which to give this medication. C. The medication is rapidly absorbed and acts quickly. D. This route decreases the chance of aspiration. E. Risk for respiratory depression is lessened using this route.

C. The medication is rapidly absorbed and acts quickly. D. This route decreases the chance of aspiration.

The client has frequent episodes of coughing and choking with decreased oxygen saturation and is transferred to the hospice unit. The nurse identifies the client's nursing diagnosis of "Ineffective airway clearance." Which nursing intervention should be implemented to care for the client's mouth? A. Give her sips of water through a straw. B. Offer her an ounce of ice chips every hour. C. Provide mouth care daily with her bath. D. Clean her mouth frequently with oral swabs.

D. Clean her mouth frequently with oral swabs. The client's nurse is correct to ensure that frequent mouth care is given with oral swabs.

The client's adolescent family member enters the room, kisses the client, and remarks, "I think she can get better if we just give her more time. Just because she was moved to this hospice doesn't mean she will die." The nurse recognizes the adolescent has already begun to grieve the loss of a family member. According to the Kubler-Ross Model, how should the nurse categorize this stage of grief being exemplified by the adolescent's statements? A. Acceptance. B. Depression. C. Bargaining. D. Denial.

D. Denial.