Loss, Grief, and Dying
When preparing for palliative care with the dying client, the nurse should provide the family with which explanation?
"The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms."
Which statement regarding perceptions of death by children is accurate?
At about age 9, the child perceives death as irreversible.
The husband of a patient who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. What type of grief is the husband experiencing?
Unresolved grief
The experience of parting with an object, person, belief, or relationship that one values is defined as:
loss.
Following surgery, the surgeon informed the client's spouse that invasive cancer was found during the procedure and the client may only have days to live. The client's spouse has told the physician and the nurse that they do not want the client to know the severity of the diagnosis. How will the nurse respond?
understanding that this directive would violate the client's rights
Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief?
Coping strategies
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." The most appropriate statement by the nurse is:
"Can you tell me about why you've made this decision?"
The caregiver of a client who is terminally ill is becoming short tempered with the client and states, "I just can't take this anymore." Which nursing response is most appropriate?
"Have you considered respite care so that you can rest for a few days?"
The cardiac nurse, who has been caring for a hospitalized, terminally ill client for 3 days, finds that the client has expired. The nurse manager knows that the nurse can legally care for these clients when the nurse states:
"Hospitals are mandated to notify transplant programs of potential donors."
A nurse completing admission paperwork asks the client about having an advanced directive. The client states, "I do not know, what is an advanced directive?" What is the nurse's best response?
"It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition."
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."
The psychiatrist is evaluating a client who has recently learned she has a terminal illness. Which statement indicates to the psychiatrist that the client is in the Kübler-Ross stage of bargaining?
"Just let me go on vacation with my wife; then I'll be satisfied."
The nurse is caring for a client who has just died after a long diagnosis of dementia. Which nursing assessment is the priority for documentation?
"No breathing and no pulse at 0840."
The nurse is caring for a client who recently found out he has a terminal illness. The nurse notes that the client is hostile and yelling. Which statement by the nurse shows that she has understanding of the Kübler-Ross emotional responses to impending death?
"Sometimes a person returns to a previous stage."
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."
A client is admitted to the hospital with a medical diagnosis of terminal lung cancer. Which question is most important for the nurse to ask first?
"What have you been told about your condition?"
The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the anger stage of grief is the one who states
"Why did this have to happen to me?"
The nurse is preparing a presentation on preparing children for death. What information should the nurse include?
- Encourage expression of feelings. - Provide for stability and safety. - Talk openly about death and the feelings associated with it.
A client has been diagnosed with a terminal illness and has periods of depression and periods of anger. The client's spouse is concerned, feeling as though their loved one is not moving forward in the stages of grief. What teaching is most appropriate for the nurse to include?
- Movement between stages can be progressive. - Movement back and forth between stages is expected.
A nurse is providing care to a terminally ill client. Which finding would alert the nurse to the fact that the client is dying?
- Pale, cool skin - Decreased urine output - Irregular heart rate
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?
- Social support - Religious beliefs - Financial concerns - Cultural practices
Which situation is most likely to warrant an autopsy?
A client's death involves an allegation of a medical error
An appropriate nursing diagnosis for the family of a client dying of cancer, whose members have expressed sorrow over the forthcoming loss, would be:
Anticipatory Grieving related to loss of family member, as evidenced by sorrow
A 40-year-old client has been declared brain dead following a fall from a roof. The client's advance directives state that he does not wish to have prolonged life measures, and that only his heart, kidneys, and liver should be donated. The client's wife wants to also donate the client's corneas. What is the appropriate nursing action?
Contact the organ procurement team to discuss organ donation with the wife
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?
Cleanse drainage from the skin.
When planning care for a 55-year-old male client with newly diagnosed terminal pancreatic cancer, which nursing diagnosis would be most appropriate?
Death anxiety
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
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?
Encourage discussion between the husband and wife regarding their intimacy needs
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.
The wife of a client who has been diagnosed with a terminal illness asks the nurse about the differences between palliative care and hospice care. Which information would the nurse most likely include in the response?
Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness.
A home hospice client who has Medicare is experiencing extreme pain at home and is refusing to receive inpatient care due to concerns over the cost of inpatient care. What teaching will the nurse include in the plan of care?
Inpatient pain management for hospice patients is covered by Medicare
A nurse caring for a client with a terminal illness understands which of the following to be true?
Recovery is not expected
The children of a male client with late-stage Alzheimer's 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 do which of the following?
Specify the treatment measures that the client wants and does not want.
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. Which of the following should happen in this case?
The client should be treated with antibiotics for pneumonia
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. Which of the following should happen in this case?
The client should be treated with antibiotics for pneumonia.
A pediatric nurse recognizes that preschoolers think of death as:
a long sleep
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.
Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal?
leaving the wife's room and belongings intact
The healthcare provider has notified the spouse of a client who died after a serious motor vehicle accident that all rescue efforts were unsuccessful, and that the client regrettably died. Several hours later, the nurse notes that the spouse is walking the hallways, asking people if they have seen her husband. Which condition does the nurse suspect?
shock
