Loss and Grieving Chapter 40

The nurse is talking with the family after their loved one died. What words of support and comfort would be most therapeutic for the nurse to say after this event? "It's the lords will" "I would like to sit here with you and listen." "Your loved one is in a better place." "You must accept the death and move on with your life."

"I would like to sit here with you and listen."

The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate? "It must be very difficult for you." "There's no need for anger." "I can't imagine how awful this is for you." "You should try to make things right with your family."

"It must be very difficult for you."

A nurse is conducting grief resolution for a client who lost his wife in a motor vehicle accident in which he was the driver. Which interventions best accomplish this goal? Select all that apply. Encourage the client's desire to keep silent about the event. Avoid making empathetic statements about the client's grief. Avoid identification of fears regarding the loss. Listen to expressions of grief. Include significant others in discussions and decisions as appropriate. Communicate acceptance of discussing the loss.

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

A group of nursing students is reviewing information about children and their perceptions about death. The students demonstrate understanding of the information when they state that a child's concept about death matures at about which age? 7 years 8 years 9 years 10 years

9 years

Which assessment finding would best support a nursing diagnosis of Dysfunctional Grieving? A man is unable to return to work after his sister's death 18 months ago. A woman cries frequently and loudly in the weeks following her child's death in an accident. A man blames himself for not doing more to make his wife's recent death more comfortable. A woman has been experiencing chronic insomnia since her mother's death earlier this year.

A man is unable to return to work after his sister's death 18 months ago.

A nursing instructor is describing the stages of grief as identified by Kübler-Ross. The instructor asks the students to place the stages in their usual sequence from first to last. The students demonstrate understanding when they place the stages in which order? Depression Anger Denial Acceptance Bargaining

Denial Anger Bargaining Depression Acceptance

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

Depression

The nurse is assessing a client who was diagnosed with metastatic prostate cancer. The nurse notes that the client is exhibiting signs of loss, grief, and intense sadness. Based upon this assessment data, the nurse will document that the client is in which stage of death and dying, according to Kübler-Ross? Depression Denial Anger Acceptance

Depression

The nurse is providing care to the spouse of a client who has died. The spouse is in the protest phase of grief. Which intervention would be most appropriate? Select all that apply. Help the spouse mobilize a support system. Encourage the client to express diverse feelings. Refer the spouse to a self-help group. Provide anticipatory guidance about the normal grief process. Protect the spouse from physical harm.

Encourage the client to express diverse feelings. Provide anticipatory guidance about the normal grief process.

A terminally ill client told her family, "I am ready to die." Her family is very upset that she has given up and wants the nurse to intervene. Which nursing intervention is most appropriate? Explain to the family that acceptance is part of the grieving process. Explain to the family that giving up is expected with terminal illness. Explain to the client that she cannot give up because her family needs her. Encourage the client to think about living instead of dying.

Explain to the family that acceptance is part of the grieving process.

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

Financial concerns Cultural practices Religious beliefs Social support

The wife of a client who has been diagnosed with a terminal illness asks the nurse about the differences between palliative care and hospice care. Which information would the nurse most likely include in the response? Hospice care differs from palliative care in its foundational philosophy. Hospice care focuses on quality of life while palliative care focuses on length of life. Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness. Hospice provides physical and psychological support; palliative care provides social and spiritual support.

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

Which signs assessed in a dying client would the nurse recognize as signs of death? Select all that apply. Increased body temperature Nausea, flatus, abdominal distention Racing pulse Cheyne-Stokes respirations Loss of movement, sensation, and reflexes Increased blood pressure

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

A home care nurse observes that the client denies the fact that she has lost her husband. The nurse interprets this denial as a psychological defense. Using the Parkes model, the nurse identifies that the client is in which stage? Numbness Yearning Disorganization Reorganization

Numbness

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. *Decreased Urine Output *Irregular Heart Rate *Pale, Cool Skin *Strong, bounding pulse *Regular deep respirations

Pale, cool skin Decreased urine output Irregular heart rate

Mr. Cooney, age 85, is in advanced stages of pneumonia with a no-code order in his chart. Which nursing care action will help establish a trusting nurse-client relationship? The nurse discusses the client's fears and doubts openly and serves as a nonjudgmental listener. The nurse reduces verbal and nonverbal contact with the client to avoid confusing him. The nurse avoids providing counseling and death education because it is not within the scope of professional nursing practice. The nurse arranges a visit from a spiritual advisor for dying clients, regardless of the client's wishes, to provide hope in the face of death.

The nurse discusses the client's fears and doubts openly and serves as a nonjudgmental listener.

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? decreased pain difficulty swallowing increased urinary output increased sensory stimulation

difficulty swallowing

The nurse is giving palliative care to a client with a diagnosis of COPD. What is the goal of palliative care? to improve the client's and family's quality of life to support aggressive treatment for cure to provide physical support for the client The client may develop a separate plan with each discipline of the health care team.

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

Palliative care is a structured system for care delivery. What is its aim? to give traditional medical care to prevent and relieve suffering to bridge between curative care and hospice care to provide care while there is still hope

to prevent and relieve suffering

A man is diagnosed with terminal kidney failure. His wife demonstrates loss and grief behaviors. What type of loss is the wife experiencing? Maturational loss Anticipatory loss Dysfunctional grieving Bereavement

Anticipatory loss

A nurse is caring for a client with HIV-related pneumonia. The client is unable to come to terms with the fact that she is dying and feels that life has been unfair to her. How can the nurse promote acceptance in this client? Tell the client that the illness can be overcome. Ask the client if she wants to meet and thank her loved ones. Inform the client that the reports show improvement. Ask relatives not to discuss death in front of the client.

Ask the client if she wants to meet and thank her loved ones.

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 was able to assist the client. What developmental stage of life does the nurse identify the client is in? adult. infant. toddler. school-aged child.

adult.

A hospice nurse has developed a care plan for a client with liver cancer. The care plan focuses on providing palliative care for this client. The goal of palliative care is best described as providing clients with life-threatening illnesses a dignified quality of life through which means? aggressive management of symptoms treatment of the disease process eliminating all forms of medical and nursing care providing counseling related to the stages of death and dying

aggressive management of symptoms

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? "Once you've started treatment, it's important to continue." "Have you discussed this with your health care provider?" "Can you tell me about why you've made this decision?" "Does your family agree with this decision?"

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

Which phrase can do much to instill hope in the dying client? "This is a hopeless situation." "Nothing more can be done." "Everything will be fine, so don't worry." "Let me tell you about your illness."

"Let me tell you about your illness."

Which phrase can do much to instill hope in the dying client? "This is a hopeless situation." "Nothing more can be done." "Everything will be fine, so don't worry." "Let me tell you about your illness."

"Let me tell you about your illness."

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? "Each stage of dying must be completed prior to moving to the next stage." "The process is the same from person to person." "Sometimes a person returns to a previous stage." "The duration of all stages is a few hours."

"Sometimes a person returns to a previous stage."

The daughter of an older client is concerned that her mother is depressed because she is reading the obituaries every day. What is the most appropriate nursing response? "This is common in older adults and doesn't necessarily indicate depression." "This indicates that your mother is entering into the bargaining stage of grief." "This is a clear indicator that your mother is depressed." "This is a sign of impending death and we need to notify the provider."

"This is common older adults and doesn't necessarily indicate depression."

When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response? "This must be very difficult for you." "I'm sure you are angry and sad." "Yes, this is a terrible diagnosis you've received." "Have you talked with your spiritual leader about your fears?"

"This must be very difficult for you."

A woman has had a breast removed to treat cancer. What type of loss will she most likely experience? Actual loss Perceived loss Maturational loss Anticipatory loss

Actual loss

The nurse is caring for a client who has just expired. Which action will the nurse perform? Provide a complete bath. Place the client in a semi-Fowler's position. Allow the client's family to see the client's body before it is discharged. Have the nurse technician place identification tags on the outside of the shroud.

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

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

An older client grieves for the loss of his independence.

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? Denial Anger Bargaining Acceptance

Anger

What is Kübler-Ross's third stage of grief? Depression Bargaining Denial Anger

Bargaining

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? Avoid replacing dentures in the mouth. Place a rolled towel under the head. Cleanse drainage from the skin. Apply hairpins and clips.

Cleanse drainage from the skin.

A client severely injured in a motor vehicle accident is rushed to the health care facility with severe head injuries and profuse loss of blood. Which sign indicates approaching death? The frequency of urination decreases. The arms and legs are warm to touch. The client is calm and peaceful. Client's breathing becomes noisy.

Client's breathing becomes noisy.

A home hospice client who has Medicare is experiencing extreme pain at home and is refusing to receive inpatient care due to concerns over the cost of inpatient care. What teaching will the nurse include in the plan of care? Inpatient pain management for hospice patients is covered by Medicare. Medicare does not cover costs that are not directly related to the diagnosis. Medicare does not cover pain control in the home, it must be in the inpatient care. Worry about payment should not be a concern for the client.

Inpatient pain management for hospice patients is covered by Medicare.

Which of the following describes lower-brain death? It results in the inability to maintain circulation and respiration and is ventilator dependent. It results in a vegetative state in which the client has no consciousness, speech, or feelings but is able to breathe independently. It results in an irreversible cessation of heart-lung function. It results in a coma state.

It results in the inability to maintain circulation and respiration and is ventilator dependent.

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. People vary widely in their responses to loss. Stages occur at varying rates among people. The stages of grief occur linearly and are static. Some people actually skip some stages of grief altogether. The stages are relatively discrete and identifiable.

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

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. * People vary widely in their responses to loss. * Stages occur at varying rates among people. * The stages of grief occur linearly and are static. * Some people actually skip some stages of grief altogether. * The stages are relatively discrete and identifiable.

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

Which statement accurately describes the process known as grief reaction? Reactions to grief and dying are different. Reactions to grief are similar for all people. Reactions to grief follow all stages of the grieving process. Reactions to grief may differ from client to family.

Reactions to grief may differ from client to family.

A nurse is caring for a client with a terminal illness. Which statement is true of a terminal illness? Recovery is very slow. Recovery is beyond reasonable expectation. Recovery is dependent on the client's treatment options. Recovery takes a minimum of 3 months.

Recovery is beyond reasonable expectation.

A group of nursing students is reviewing the various models of grieving. The students demonstrate understanding of the information when they identify the stages of the grief cycle model listed. Place them in the proper sequence from first to last that would demonstrate the student's accurate understanding. 1.Reorganization 2.Shock 3.Disorganization 4.Protest

Shock Protest Disorganization Reorganization

A young client died following a cardiac arrest. The nurse caring for the client and the family notes that some members of the family refuse to accept that the client has died. What stage of grief is the family experiencing? Shock and disbelief Developing awareness Restitution period Idealization

Shock and disbelief

A client visits the health care facility for a regular check-up. The nurse is aware that the client lost his wife two months earlier. What would lead the nurse to suspect dysfunctional grief? The client thinks briefly about suicide. The client has resumed normal life. The client begins abusing alcohol. The client expresses a wish to die.

The client begins abusing alcohol.

Which does not coincide with Kübler-Ross's stages related to a dying client? Clients don't always follow the stages in order. Some client regress, then move forward again. The dying client usually exhibits anger first. The client may be in several stages at once.

The dying client usually exhibits anger first.

What is a proper action to take when preparing a child for death? The nurse should know her own feelings and beliefs. Praise stoicism. Encourage remembrance of deceased. Compare the child to the deceased. Expect the child to alternate between grieving and normal functioning.

The nurse should know her own feelings and beliefs. Encourage remembrance of deceased. Expect the child to alternate between grieving and normal functioning.

A client who has died an unexplained death has numerous catheters and drainage tubes in place and is being prepared for an autopsy. In providing care to the body after the client has been pronounced dead, how shall the nurse manage the tubes prior to the autopsy? The nurse will not remove any tubes from the body. The nurse will remove all catheters in blood vessels and leave drains and urinary catheters in place. The nurse will remove all tubes and discard in isolation trash receptacles. The nurse will remove all tubes and send the tubes to the autopsy procedure with the body.

The nurse will not remove any tubes from the body.

The husband of a client who died of breast cancer is still grieving for his wife 2 years later. What type of grief is he experiencing? Unresolved Situational Inhibited Maturational

Unresolved

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

bargaining

A client has a diagnosis of bladder cancer with metastasis. The client asks the nurse about the characteristics of hospice care. The nurse should explain that: care is premised on the fact that dying is a normal process. symptoms of terminal illness should not be treated. care is generally guided by nurses rather than physicians. the client must be within 6 weeks of his expected death.

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

An older adult client at a health care facility dies after a prolonged illness. Which is a psychological reaction associated with the different stages of grief? refusal to accept death behaving in a morbid manner tightness in the throat difficulty breathing

refusal to accept death