NC1: CH. 36 Grief, loss, death, and the nursing process

Which physical change is observed in a patient who is in the last hours of life? Select all that apply. One, some, or all responses may be correct. Correct1 Sagging mouth 2 Light-colored urine 3 Absence of mottling Correct4 Relaxed jaw muscles Correct5 Increased pulmonary secretions

ANS: (1)Sagging mouth (4)Relaxed jaw muscles (5)Increased pulmonary secretions Physical changes observed in a patient who is in the last hours of life include a sagging mouth, relaxed jaw muscles, and increased pulmonary secretions. The patient will have dark-colored urine, not light-colored urine. The patient will have mottling, not an absence of mottling.

Which critical thinking model component will the nurse use to deliver empathetic, high-quality, supportive care while planning treatment for a patient experiencing grief and loss? Correct1 Attitudes 2 Standards 3 Experience 4 Knowledge

ANS: Attitudes are the critical thinking model component to deliver empathetic, high-quality, supportive care. The standards approach is used to provide privacy for the patient and family and apply ethical principles of autonomy in supporting the patient's choice regarding treatment; it is not the element to deliver empathetic, high-quality, supportive care. The experience approach uses previous patient responses to planned nursing interventions for pain and symptom management or loss of a significant other; it is not the component that focuses on delivering empathetic, high-quality, supportive care. The knowledge approach uses spirituality and other health professions as resources for dealing with loss; it is not the element that delivers empathetic, high-quality, supportive care.

Which statement about hospice care needs correction? 1 It is available in homes. 2 It provides care for terminally ill patients. 3 It gives priority to managing a patient's pain and other symptoms. Correct4 It accepts the patient into the program when the survival period is 10 months.

ANS: It accepts the patient into the program when the survival period is 10 months needs correction. Hospice services accept the patient into the program when the survival period is less than 6 months, not 10 months. The rest of the statements do not need correction because they give correct information. Hospice is available in home, hospital, extended care, and nursing home settings. This model of care provides care for terminally ill patients. It gives priority to managing a patient's pain and other symptoms.

How does the nurse demonstrate an understanding of the grieving process with a family dealing with the death of a loved one? 1 Explain that the grieving process will take them through each stage of grief in a specific order. 2 Offer insight on each stage of grief and what the family can expect to experience in each. 3 Suggest for the family to make an appointment with a family grief counselor to work through the grieving process. Correct4 Allow the family to express multiple emotions as they occur, offering support and availability.

ANS: Grief is a normal response to loss that is a cluster of emotions; it does not follow a predicable path and normally lasts about a year. The nurse should be available and listen to the patients throughout the process and not offer unsolicited advice or general comments regarding death. Grief is explained in a stepwise manner, but the stages can occur in any order and patients, and families can experience the stages multiple times. Offering insight is a valuable tool to help the family cope but is not the best manner in which to express an understanding of the grieving process. A grief counselor would be helpful if the family requires additional support.after the initial support provided by the nurse.

Arrange the stages of dying in the correct order beginning with the first stage. Correct1.Denial Correct2.Anger Correct3.Bargaining Correct4.Depression Correct5.Acceptance

ANS: Kübler-Ross describes five stages of dying in the following order: (1) denial, (2) anger, (3) bargaining, (4) depression, and (5) acceptance.

A patient's family member tells the nurse, "Our family is having a difficult time coping with our loved one's impending death. How can we be of help?" Which simple care activity does the nurse suggest? Select all that apply. One, some, or all responses may be correct. Correct1 Helping the patient fill out a menu Correct2 Offering food Correct3 Cooling the patient's face Correct4 Combing the patient's hair Correct5 Staying with the patient through the night if possible

ANS: Some family members who have a difficult time accepting a patient's impending death cope by making fewer visits. When family members do visit, inform them of the patient's status and share meaningful insights or encounters that you have had with the patient. The nurse should find simple and appropriate care activities for the family to perform, such as offering food, cooling the patient's face, combing hair, or filling out a menu. Nighttime can be particularly lonely for the patient. The nurse should suggest that a family member stay through the night if possible. Make exceptions to visiting policies by allowing family members to remain with patients who are dying at any time. Family members appreciate having open access or closeness to their loved one through their experiences at the end of life.

Which action would the nurse take for a patient newly diagnosed with a serious, life-changing illness whose conversations are abrupt, superficial, and unrelated to the illness? 1 Strongly suggest the patient talk about feelings. 2 Focus on the family to obtain the information needed. 3 Avoid discussing illness-related topics with quiet patients. Correct4 Remain alert for signals that the patient wants to talk.

ANS: The nurse would remain alert for signals that the patient wants to talk. The nurse would make no presumptions about this patient other than the fact that the patient is not yet ready to talk about the situation but would stay alert for a time when ready to talk. Strongly suggesting the patient talk is nontherapeutic as some people do not work through their problems by talking to others. The patient, not the family, is the focus even when that patient is reluctant to talk. The nurse does not avoid discussing illness-related topics as this is nontherapeutic; the nurse would talk about illness-related topics.

Which approach would the nurse use to begin a conversation about the goals of care for end of life? 1 Encourage family members to think more positively. 2 Avoid the discussion because it has to do with medical, not nursing, diagnoses. 3 Initiate a discussion about advance directives with the patient, family, and health care team. Correct4 Ask the patient to identify beliefs about the goals of care.

ANS: To begin a conversation, the nurse would ask the patient to identify beliefs about the goals of care. By first determining what the patient believes is best, the nurse can then discuss that option in more detail and give realistic ways of reaching the desired goal. Although encouraging family members is appropriate, encouraging them to think more positively is not. The nurse must support the family as they grieve. The nurse would not avoid the discussion because it is within the realm of nursing; it is not just medical. Initiating a discussion about advance directives with the patient, family, and health care team should first be done upon admission to the agency and should be with the patient first, then later with the family members and health care team.

Which statement made by a patient would support the nurse's conclusion that the depressed, female patient is experiencing chronic grief? 1 "My beloved pet died last week." 2 "I have been on chemotherapy for 6 months to treat cancer." 3 "My pregnancy was terminated when I was in an auto accident." Correct4 "I witnessed the sudden death of one of my close friends when we were children."

ANS: "I witnessed the sudden death of one of my close friends when we were children." The statement, "I witnessed the sudden death of one of my close friends when we were children" indicates chronic grief. A patient may experience normal grief after witnessing the sudden death of a close friend, but it may extend for a longer period of time, even decades, when it is sudden or unexpected. Therefore the patient may experience chronic grief. A patient who lost her beloved pet last week may experience normal grief, not chronic grief. A patient who is on chemotherapy for 6 months to treat cancer may experience anticipatory grief, not chronic grief. A patient may experience disenfranchised (not chronic) grief after a terminated pregnancy because of an accident.

Which possible cause of dyspnea would the nurse assess for in the terminally ill patient? Select all that apply. One, some, or all responses may be correct. Correct1 Fever Correct2 Anxiety Correct3 Anemia 4 Lack of fluid intake 5 Trigeminal nerve stimulation

ANS: (1) Fever (2) Anxiety (3) Anemia Dyspnea may occur because of fever, anxiety, or anemia. Fever increases metabolic demands and oxygen consumption. The body compensates for this increased demand by increasing the respiratory rate. Anxiety may cause hyperventilation and dyspnea. Anemia reduces tissue perfusion, and as a compensatory mechanism, the body increases the respiratory rate. Lack of fluid intake in the diet causes constipation or dehydration, not dyspnea. Stimulation of the trigeminal nerve does not cause dyspnea.

Which physical change indicates that the patient will die soon, and that the nurse should notify the family? Select all that apply. One, some, or all responses may be correct. Correct1 Inability to swallow 2 Increased muscle tone 3 Increased urine output Correct4 Increased periods of sleeping Correct5 Coolness and cyanosis in extremities

ANS: (1) Inability to swallow (4)Increased periods of sleeping (5) coolness and cyanosis in extremities Physical changes include inability to swallow, increased periods of sleeping, and coolness and cyanosis in extremities. In the hours or days before death, the patient will have decreased intake of food or fluids and inability to swallow. Additionally, the patient will experience increased periods of sleeping and coolness and cyanosis in extremities such as the nose and fingers. Hours or days before death, muscle tone generally decreases (not increases). Another physical change is decreased urine output, not increased.

Which nursing intervention would the nurse include in the care plan for a terminally ill patient? Select all that apply. One, some, or all responses may be correct. Correct1 Maintain comfort. 2 Discuss options for euthanasia. Correct3 Preserve dignity and quality of life. Correct4 Provide social support to family members. 5 Offer economic support to family members.

ANS: (1) Maintain comfort. (3)Preserve dignity and quality of life. (4)Provide social support to family members. The nursing care plan should focus on maintaining comfort, preserving dignity and quality of life, and providing social support to family members. Terminally ill patients should be allowed to spend the rest of their days in as much comfort and peace as is possible given the patient's condition. The plan should also include providing social support to family members to prepare to grieve their loss. Euthanasia is a controversial issue, and nurses do not take part in that decision. The nurse would not provide economic support to family members.

Arrange the steps for postmortem care in the proper order.

ANS: (1) confirm that requests for organ/tissue donation or autopsy have been made. (2) elevate the head of the bed. (3) remove all tubes and indwelling lines. (4) bathe the body of the deceased. (5) position the body for family viewing. (6) apply name tags and shroud before transporting the body. The sequence is as follows: (1) confirm that requests for organ/tissue donation or autopsy have been made, (2) elevate the head of the bed, (3) remove all tubes and indwelling lines, (4) bathe the body of the deceased, (5) position the body for family viewing, and (6) apply name tags and shroud before transporting the body. Medical or legal issues (e.g., specimens, autopsy, tissue donation) should be considered before beginning, so the nurse does not have to disrupt care of the body once he or she has started. Positioning the head of the bed helps prevent pooling of blood in the face during all the other preparations. Once ready to work with the body, remove drains before bathing the body in the event that there is leakage or soiling of the bed on removal. Arrange the body for viewing and provide privacy to the family. Before transporting the body, apply identifying name tags and shroud according to agency policy.

Which statement made by a patient would exemplify the normal grief process? Select all that apply. One, some, or all responses may be correct. Correct1 "I can't believe I have colon cancer." 2 "I often forget my residential address." 3 "I witnessed the death of my married lover recently." Correct4 "I have lost interest in doing my regular work since I lost my beloved pet." Correct5 "I feel lonely since the death of my spouse, even though I have many friends."

ANS: (1)"I can't believe I have colon cancer." (4)"I have lost interest in doing my regular work since I lost my beloved pet." (5)"I feel lonely since the death of my spouse, even though I have many friends." Statements include "I can't believe I have colon cancer," "I have lost interest in doing my regular work since I lost my beloved pet," and "I feel lonely since the death of my spouse, even though I have many friends." In normal grief the patient may have feelings such as disbelief, yearning, anger, and depression. The patient may feel disbelief after a cancer diagnosis. The patient may also feel lonely, helpless, and lose interest in usual work because of depression. Therefore losing interest in work after the loss of a beloved pet and feeling lonely after the death of a spouse are signs of normal grief. Forgetting the residential address may indicate dementia and lead to anticipatory grief, not normal grief, and forgetting residential address is not a sign of normal grief. A patient who witnesses the death of a married lover may experience disenfranchised grief, not normal grief.

Which information about complicated grief is correct? Select all that apply. One, some, or all responses may be correct. Correct1 A delayed grief response is frequently triggered by a second loss. Correct2 In complicated grief, a person requires prolonged time to move forward after a loss. 3 Exaggerated grief is a normal grief response, except that it extends for a longer period of time. 4 Specific types of complicated grief include chronic, exaggerated, delayed, and anticipatory grief. Correct5 A loss because of homicide, suicide, or a sudden accident has the potential to become complicated grief.

ANS: (1)A delayed grief response is frequently triggered by a second loss. (2)In complicated grief, a person requires prolonged time to move forward after a loss. (5)A loss because of homicide, suicide, or a sudden accident has the potential to become complicated grief. Correct information includes a delayed grief response is frequently triggered by a second loss; in complicated grief, a person requires prolonged time to move forward after a loss; and a loss because of homicide, suicide, or a sudden accident has the potential to become complicated grief. Chronic (not exaggerated) grief is a normal grief response, except it extends for a longer period of time. Specific types of complicated grief include chronic, exaggerated, delayed, and masked grief, but not anticipatory grief.

Which action would the nurse take for a terminally ill patient? Select all that apply. One, some, or all responses may be correct. Correct1 Administering artificial tears to reduce corneal drying and irritation 2 Suggesting the patient lie on the right side to relieve constipation Correct3 Encouraging a patient taking opioid medication to increase fluid intake Correct4 Inserting an indwelling catheter in a patient with a decreased level of consciousness 5 Elevating the patient's head to inhibit lung expansion and postural drainage

ANS: (1)Administering artificial tears to reduce corneal drying and irritation (3)Encouraging a patient taking opioid medication to increase fluid intake (4)Inserting an indwelling catheter in a patient with a decreased level of consciousness The nurse would administer artificial tears to reduce corneal drying and irritation, encourage a patient taking opioid medication to increase fluid intake, and insert an indwelling catheter in a patient with a decreased level of consciousness. Administering artificial tears or optical lubricants reduces corneal drying and irritation. Encouraging patients who are on opioid medication to increase liquid intake helps reduce the risk of constipation caused by opioid drugs. Inserting an indwelling catheter in a patient with a decreased level of consciousness helps relieve urinary incontinence. Encouraging the patient to lie on the right side helps relieve nausea, not constipation; thus the nurse would not take this action. Elevating the patient's head does not inhibit lung expansion and postural drainage; therefore the nurse would not perform this intervention. Elevating the patient's head facilitates lung expansion and postural drainage.

Which physical change occurs a few days or hours prior to death in a patient? Select all that apply. One, some, or all responses may be correct. Correct1 Mottling of skin 2 Excessive responsiveness 3 Increased bowel movements Correct4 Cheyne-Stokes breathing pattern Correct5 Pallor of the skin

ANS: (1)Mottling of skin (4)Cheyne-Stokes breathing pattern (5)Pallor of the skin Physical changes include mottling skin, Cheyne-Stokes breathing pattern, and pallor of the skin. As peripheral circulation fails, there may be mottling of the skin. The breathing pattern may be altered in patients just prior to death. Cheyne-Stokes is a common breathing pattern seen in patients who are expected to die. As peripheral circulation fails, pallor in the skin may be found. Responsiveness will decrease, not become excessive. The bowel movements may decrease or cease completely or bowel incontinence may develop, but increased bowel movements do not occur.

Which physical change in the patient suggests that death is near? Select all that apply. One, some, or all responses may be correct. 1 Noisy respirations 2 Increased urine output 3 Decreased muscle tone 4 Decreased intake of food 5 Decreased periods of sleeping

ANS: (1)Noisy respirations (3)Decreased muscle tone (4)Decreased intake of food The physical changes include noisy respirations, decreased muscle tone, and decreased intake of food. As a patient nears death, body systems tend to slow down. Noisy respirations are caused by pooling of secretions in the airway. Muscle tone is reduced as the muscles become flaccid. Food intake is usually reduced because of the failure of the gastrointestinal system to function properly. Urine output is decreased (not increased) because fluid intake is reduced and the urinary system stops working. A dying patient has increased (not decreased) periods of sleeping. The patient tends to sleep most of the time because the brain and nervous system slow down their functions.

Which intervention would the nurse implement in caring for the family of a patient who has just died? Select all that apply. One, some, or all responses may be correct. Correct1 Offer family members the option to view the body. 2 Tell the family that the nurse knows how they feel. 3 Give the family advice on how to grieve. 4 Explain that their loved one is in a "better place." Correct5 Use periods of silence during the conversation.

ANS: (1)Offer family members the option to view the body. (5)Use periods of silence during the conversation. Interventions include offering family members the option to view the body and using periods of silence during the conversation. The nurse would offer family members the option to view the body and respect their decision to do so. The nurse would use periods of silence or quiet during the conversation to help the family members express their emotions. The nurse does not have to talk but can emotionally support the family simply by being present. The nurse would not tell the family that the nurse knows how they feel; that is untrue and belittling to the family. Giving the family advice on how to grieve is inappropriate; all must grieve in their own way. Explaining that their loved one is in a "better place" is inappropriate because it focuses on the nurse's belief, not the family's; instead use therapeutic techniques of listening and support.

Which statement is true regarding factors that influence grief and loss? Select all that apply. One, some, or all responses may be correct. Correct1 Religious practices help navigate the loss. Correct2 Increased irritability is a common expression of grief. 3 School-age children always understand the cause of loss. Correct4 Hope plays a vital role in a patient's adjustment to loss and death. 5 Socioeconomic status influences a person's grief process in a solely indirect way.

ANS: (1)Religious practices help navigate the loss. (2)Increased irritability is a common expression of grief. (4)Hope plays a vital role in a patient's adjustment to loss and death. Statements include religious practices help navigate the loss, increased irritability is a common expression of grief, and hope plays a vital role in a patient's adjustment to loss and death. School-age children do not always understand the cause of loss. Socioeconomic status influences a person's grief process in both direct and indirect ways, not just indirectly.

Which finding in the patient indicates a lack of hope caused by a terminal physical condition? Select all that apply. One, some, or all responses may be correct. Correct1 Sighs and has a negative view of the future Correct2 Turns away from the nurse 3 Wants to undergo more tests Correct4 Feels weak and has vague pain Correct5 Shows a lack of interest and communicates minimally

ANS: (1)Sighs and has a negative view of the future (2)Turns away from the nurse (4)Feels weak and has vague pain (5)Shows a lack of interest and communicates minimally Patient findings that indicate a lack of hope include sighs and has a negative view of the future, turning away from the nurse, feeling weak and vague pain, and showing a lack of interest and communicating minimally. A patient with hope would want to undergo more tests, whereas the patient who lacks hope does not want to undergo tests, feeling that it would be of no use.

Which nursing action to facilitate mourning would be performed for the family after the patient died? Select all that apply. One, some, or all responses may be correct. Correct1 Supporting the family's efforts to adjust to the loss 2 Keeping the family busy, not allowing too much time to dwell on grief 3 Offering the family wine to help them relax and overcome grief Correct4 Helping the family accept the reality of the loss 5 Instructing the family to resume normal life as soon as possible

ANS: (1)Supporting the family's efforts to adjust to the loss (4)Helping the family accept the reality of the loss Nursing actions include supporting the family's efforts to adjust to the loss and helping the family accept the reality of the loss. The nurse would provide support to the family to help them adjust to their loss and to accept the reality of the loss. The family should be allowed to grieve because it helps them come to terms with the loss; thus the nurse would not keep the family busy. Use of wine to get over the crisis is an ineffective way of coping and should be discouraged. The nurse would not try to hurry the family but should allow time for grieving and continuity of care; therefore the nurse would not instruct the family to resume normal life as soon as possible.

Which term refers to a specific type of complicated grief? Select all that apply. One, some, or all responses may be correct. 1 Anticipatory Correct2 Delayed Correct3 Masked Correct4 Exaggerated 5 Disenfranchised

ANS: (2) (3) (4) Terms for types of complicated grief include delayed, masked, and exaggerated. There are four types of complicated grief: delayed, masked, exaggerated, and chronic. Anticipatory grief and disenfranchised grief are not types of complicated grief. A commonality among all types of complicated grief is a prolonged or significantly difficult time moving forward after a loss. However, anticipatory grief focuses on grieving before an actual loss occurs, and disenfranchised grief focuses on grieving for socially unsanctioned relationships.

Which information would the nurse share with the family about hospice care? Select all that apply. One, some, or all responses may be correct. 1 Hospice is a place to care for terminally ill patients. Correct2 It is a philosophy for terminally ill patient care. Correct3 Hospice uses trained volunteers for visitation and respite care. 4 It meets the economic needs of terminally ill patients. Correct5 Hospice services are available at home as well as in extended care settings.

ANS: (2) It is a philosophy for terminally ill patient care. (3)Hospice uses trained volunteers for visitation and respite care. (5)Hospice services are available at home as well as in extended care settings. The nurse would share the following: it is a philosophy for terminally ill patient care, hospice uses trained volunteers for visitation and respite care, and hospice services are available at home as well as in extended care settings. Hospice is not always a specific place for terminally ill patients and does not provide economic support. Hospice focuses on physical, psychological, social, and spiritual needs.

Which nursing intervention is appropriate while caring for a body after death? Select all that apply. One, some, or all responses may be correct. 1 Removing the dentures from the mouth Correct2 Identifying the patient using two identifiers Correct3 Elevating the patient's head on one pillow Correct4 Combing the patient's hair or applying personal hairpieces 5 Instructing the family to stay away during the preparation of the body

ANS: (2)Identifying the patient using two identifiers (3)Elevating the patient's head on one pillow (4)Combing the patient's hair or applying personal hairpieces Interventions include identifying the patient using two identifiers, elevating the patient's head on one pillow, and combing the patient's hair or applying personal hairpieces. While caring for a body after death, the dentures are placed (not removed) in the mouth to maintain facial shape. The family members can participate, if desired, in preparing the body; the family should not be instructed to stay away.

When educating the family members about hospice care, which information would the nurse include? Select all that apply. One, some, or all responses may be correct. 1 The hospice care ends with the death of the patient. Correct2 It is a patient- and family-centered approach to care. Correct3 The hospice team promotes patient dignity and self-esteem. 4 It is a place to take care of terminally ill patients. Correct5 The hospice team gives preference to the patient's wishes.

ANS: (2)It is a patient- and family-centered approach to care. (3)The hospice team promotes patient dignity and self-esteem. (5)The hospice team gives preference to the patient's wishes. The nurse would share the following information: It is a patient- and family-centered approach to care; the hospice team promotes patient dignity and self-esteem; and the hospice team gives preference to the patient's wishes. Hospice provides therapeutic care, psychosocial care, and symptom management. It also promotes patients' dignity and self-esteem. In situations involving differences of opinion between the patient and the family members, the hospice team favors the patient's wishes. Hospice care does not end with the death of the patient; hospice may make frequent visits after the death of the patient to help the family in the grieving process. Hospice is not a place, but a philosophy of care for the terminally ill.

Which information would the nurse share with a family member who is confused about hospice and palliative care? Select all that apply. One, some, or all responses may be correct. 1 Palliative care and hospice are the same thing. Correct2 Palliative care is for any patient, any time, any disease, in any setting. 3 Palliative care strategies are primarily designed to treat the patient's illness. Correct4 Palliative care interventions relieve the symptoms of illness and treatment. 5 Palliative care is provided only at the end of life, but unlike hospice care, it is focused strictly on the comfort of the patient.

ANS: (2)Palliative care is for any patient, any time, any disease, in any setting. (4)Palliative care interventions relieve the symptoms of illness and treatment. The nurse would share the following: palliative care is for any patient, any time, any disease, in any setting; and palliative care interventions relieve the symptoms of illness and treatment. Palliative care and hospice are not the same thing; thus the nurse would not share this information. Palliative care interventions focus on the prevention, relief, reduction, or soothing of symptoms of disease or disorders throughout the entire course of an illness; the focus of palliative care is not to cure (treat) a patient's illness. Palliative care is not reserved for people who are at the end of life. The goal of palliative care is to help relieve the symptoms of any illness and associated treatments at any time along the continuum of that illness.

Which term is associated with Erikson's theory of psychosocial development? Select all that apply. One, some, or all responses may be correct.

ANS: (2)Trust (5)Autonomy (6)Generativity According to Erikson's theory of psychosocial development, individuals need to accomplish a particular task before successfully mastering the stage and progressing to the next one. Each task is framed with opposing conflicts, and tasks, once mastered, are challenged and tested again during new situations or at times of conflict. Tasks include trust versus mistrust, autonomy versus isolation, and generativity vsersus self-absorption and stagnation. Freud had a strong influence on his psychoanalytical followers, including Erik Erikson (1902-1994), who constructed a theory of development that differed from Freud's in one main aspect: Erikson's stages emphasize a person's relationship to family and culture rather than sexual urges. Freud's theory of psychosexual development included oral, anal, phallic, latent, and genital stages.

Which general approach would the nurse use to prioritize three nursing diagnoses for a patient who is having anxiety and hopelessness as a result of a loss? Select all that apply. One, some, or all responses may be correct. 1 Use family members and health care provider's orders as primary resources for prioritizing actions. 2 Address the nursing diagnosis that most affects the medical diagnosis. Correct3 Ask the patient to identify the most distressing symptom and address that diagnosis first. Correct4 Use nursing knowledge to address the problem that is the underlying cause of other diagnoses. 5 Select the nursing diagnosis that is easiest to fix based upon the disease process.

ANS: (3)Ask the patient to identify the most distressing symptom and address that diagnosis first. (4)Use nursing knowledge to address the problem that is the underlying cause of other diagnoses. The nurse would ask the patient to identify the most distressing symptom and address that diagnosis first and use nursing knowledge to address the problem that is the underlying cause of other diagnoses. When prioritizing nursing diagnoses, the nurse would first get the patient's sense of the most important issue. Some patients do not fully understand the physiology or relationship among diagnoses. For example, one patient may not understand that pain contributes to a decreased appetite or depression. The nurse's knowledge, along with the patient's perceptions, helps determine the diagnosis with the highest priority. Planning care should be patient centered, not based on family members and health care provider's orders. Although all nursing diagnoses affect the medical diagnosis, that is not the appropriate method to prioritizing nursing diagnoses. Selecting the nursing diagnosis that is easiest to fix is not the appropriate way to prioritize nursing diagnoses.

Which activity would the nurse identify as an aspect of Worden's grief tasks model? Select all that apply. One, some, or all responses may be correct. 1 Block the pain of grief 2 Deny the reality of the loss Correct3 Experience the pain of grief Correct4 Adjust to a world in which the deceased is missing Correct5 Emotionally relocate the deceased and move on with life

ANS: (3)Experience the pain of grief (4)Adjust to a world in which the deceased is missing (5)Emotionally relocate the deceased and move on with life Activities include experiencing the pain of grief, adjusting to a world in which the deceased is missing, and emotionally relocating the deceased and moving on with life. Once a person accepts the reality of loss, the person may experience the pain of grief. Grief is manifested by loneliness, sadness, or despair. This stage is followed by adjustments to a world in which the deceased is missing. The final stage is to emotionally relocate the deceased and move on with life. Blocking the pain and denying the loss do not help one move on, and they are not activities of the grief tasks model.

Which stage is included in Bowlby's attachment theory? Select all that apply. One, some, or all responses may be correct. 1 Depression 2 Bargaining Correct3 Reorganization Correct4 Yearning and searching Correct5 Disorganization and despair

ANS: (3)Reorganization (4)Yearning and searching (5)Disorganization and despair Stages include reorganization, yearning and searching, and disorganization and despair. There are four stages of mourning: numbing, yearning and searching, disorganization and despair, and reorganization. In the reorganization stage, the last stage of mourning, a person accepts the loss and starts living with it. Yearning and searching are in the second stage of bereavement in which a person is in acute distress. This stage is characterized by emotional outbursts such as crying. In the stage of disorganization and despair, a person endlessly tries to find out how and why the loss occurred. Depression and bargaining are stages of dying in Kübler-Ross's classic theory, not Bowlby's.

Which right according to the Dying Person's Bill of Rights would the nurse be aware of when treating terminally ill patients? Select all that apply. One, some, or all responses may be correct. 1 To die alone 2 To be judged 3 To be free from pain 4 To retain individuality 5 To make decisions about care

ANS: (3)To be free from pain (4)To retain individuality (5)To make decisions about care The rights include to be free from pain, to retain individuality, and to make decisions about care. According to the Dying Person's Bill of Rights, the person has the right not to die alone; thus the patient should not be left to die alone. According to the Dying Person's Bill of Rights, the patient has the right to not be judged; therefore to be judged is unacceptable.

Which stage of dying, according to the Kübler-Ross theory, is reflected in the patient's statement, "I miss my partner. I will never get my partner back?" 1 Anger 2 Denial 3 Bargaining Correct4 Acceptance

ANS: Acceptance The patient is exhibiting the acceptance stage. The Kübler-Ross theory consists of five stages of dying. When the patient accepts the death of the partner, it indicates acceptance. When the patient says that the partner will be missed and he or she will never get the partner back, it does not indicate anger, denial, or bargaining. When the patient expresses anger or resistance toward God or others, it indicates anger. When the patient cannot accept the loss, it indicates denial. When the patient postpones awareness of the loss by trying to prevent it from happening, it indicates bargaining.

Which type of loss is illustrated when a young adult loses a limb from diabetes and is very upset about it? Correct1 Actual 2 Perceived 3 Necessary 4 Maturational

ANS: Actual The young adult has suffered an actual loss because the patient can no longer feel, see, or know the lost limb. A perceived loss is experienced by the person alone and is less obvious to other people; losing a limb is obvious, not less obvious, to others. Necessary losses are natural and positive; they occur because of normal life changes. Losing a limb is not natural. A maturational loss is a form of loss after expected, normal life changes across the life span; losing a limb is not an expected, normal life change.

Which type of grief occurs when a patient diagnosed with end-stage cancer is worried about dying and is rushing to complete tasks? 1 Normal Correct2 Anticipatory 3 Complicated 4 Disenfranchised

ANS: Anticipatory This is anticipatory grief. Anticipatory grief is a forewarning or cushion that gives people time to prepare or complete the tasks related to their impending death. Normal grief is a common and universal reaction to loss or death that may be unexpected or traumatic and occurs after the loss, not before. In complicated grief, a person has a prolonged or significantly difficult time moving forward after a loss; it does not occur before a loss as in this scenario. People experience disenfranchised grief when their relationship to the deceased person is not socially sanctioned, cannot be shared openly, or seems of lesser significance; cancer is significant and does not cause disenfranchised grief in the person who has cancer.

Which type of grief is exemplified when the parents feel severe grief and loss after seeing their child suffering with cancer? 1 Normal Correct2 Anticipatory 3 Complicated 4 Disenfranchised

ANS: Anticipatory When experiencing anticipatory grief, family members grieve the impending loss of companionship, control, sense of freedom, and the mental and physical changes their loved one will experience. Normal grief is a common and universal reaction to loss or death that may be unexpected or traumatic; normal grief does not occur until after the loss. In this scenario, grieving is occurring before the loss. In complicated grief, a patient has a prolonged or significantly difficult time moving forward after a loss, not before the actual loss, as in this situation. Disenfranchised grief is experienced by a patient when the relationship to the deceased person is not socially sanctioned, cannot be shared openly, or seems of lesser significance; the bond of parents and their children is a socially sanctioned relationship and would not be considered disenfranchised grief.

Which theoretical description of grief is exemplified when a female family member of a recently deceased patient talks casually with the nurse at the time of the patient's death and expresses relief that she will not have to visit the hospital anymore? 1 Denial Correct2 Anticipatory grief 3 Dysfunctional grief 4 Yearning and searching

ANS: Anticipatory grief The theoretical description is anticipatory grief. A person who has been anticipating a loss (anticipatory grief) for some time may have already experienced many of the emotions (e.g., sadness, shock) commonly associated with death. Denial is a stage of dying that a patient would experience; the female family member was not dying. Everyone experiences and expresses grief differently; therefore dysfunctional grief is inappropriate in this situation. Yearning and searching are aspects of Bowlby's attachment theory and does not explain this woman's actions.

Which action would the nurse take for a dying patient with chronic dull pain who does not have a support person to provide home care? 1 Hospitalize the patient in the intensive care unit. 2 Arrange for inpatient hospice care. 3 Provide acute care to the patient. 4 Seclude the patient in a separate room.

ANS: Arrange for inpatient hospice care. The nurse would arrange for inpatient hospice care. The patient is terminally ill and has chronic dull pain. The patient also does not have a support person to provide care in the home. Based on this, the patient needs inpatient hospice care to improve the quality of life during the last days of life. The patient does not need hospitalization in the intensive care unit because the condition cannot be cured. Acute care refers to the short-term treatment for an episode of illness or severe injury. In this situation, the patient has an irreversible terminal illness that cannot be managed by acute care. Seclusion would make the patient depressed and is inappropriate.

Which nursing action reflects sensitivity to cultural differences related to end-of-life care? 1 Realize that not showing emotions means the family was not close. Correct2 Ask family members if they prefer to help with care of the body after death. 3 Provide postmortem care at the time of death to relieve family members of this difficult job. 4 Value patient self-determination, understanding that each person makes his or her own decisions.

ANS: Ask family members if they prefer to help with care of the body after death. The nurse would ask family members if they prefer to help with care of the body after death. Giving people options in caregiving after death allows them to honor their cultural beliefs. In some cultures, holding back public displays of emotions is the accepted behavior after death while in others, public display of wailing is acceptable; therefore the nurse cannot assume the family was not close. In some cultures, preparing the body is accepted and desired; thus the nurse would not assume and provide postmortem care. In some cultures, self-determination may not be a given right for every person. Remember that every culture and person is different.

Which technique would the nurse use to communicate actively with a terminally ill patient? 1 Asking closed-ended questions 2 Sympathizing with the patient 3 Avoiding sensitive issues 4 Asking open-ended questions

ANS: Asking open-ended questions The nurse can actively communicate with patients by asking open-ended questions. This helps patients expand their thoughts and tell their stories. The nurse would avoid using closed-ended questions, such as ones with a "yes" or "no" response, because they will not help the nurse understand the feelings and emotions of the patients, and closed-ended questions are not active communication. Being sympathetic will not necessarily allow patients to express feelings and will not allow active communication. The nurse would not avoid sensitive issue as this would not facilitate active communication. Do not avoid talking about a topic; nurses must use therapeutic techniques to discuss sensitive issues.

After the death of a patient, the nurse helps with care of the body and asks if any family members want to be included. This intervention is useful for which purpose? 1 Moving them past denial of death 2 Assessing for signs of complicated grief Correct3 Beginning to provide bereavement care 4 Inquiring about organ donation in a timely manner

ANS: Beginning to provide bereavement care Nurses provide bereavement care soon after a patient's death, and involving the family in caring for the body helps with bereavement and mourning. Denial can be a useful stage of grief, and family must grieve in their own timeline. It is not up to the nurse to move them more quickly than they are able; signs of complicated grief are not usually apparent until grieving goes on past a year; inquiring about organ donation is not the purpose of asking the family to help with the aftercare of the body.

Which type of grief describes a patient who lost a sibling in a motor vehicle accident and 2 weeks later loses a job, but the patient seems more upset about the job loss? Correct1 Delayed 2 Masked 3 Exaggerated 4 Disenfranchised

ANS: Delayed The patient is experiencing delayed grief. In delayed grief a person's grief response is unusually delayed or postponed because the loss is so overwhelming that the person must avoid the full realization of the loss. A delayed grief response is frequently triggered by a second loss, sometimes seemingly not as significant as the first loss—for example the patient lost a sibling but the full realization of the loss comes after the loss of a job. Masked grief is the grieving response wherein a person's normal functioning is disrupted, but the person does not realize that the disruption in functioning is because of the loss; this is not the case in this situation. In exaggerated grief, the person often exhibits self-destructive behavior or obsessions; this is not the case in this situation. Disenfranchised grief is a loss that is not socially sanctioned, cannot be openly shared, or seems to be of lesser significance to others; loss of a sibling and job are socially sanctioned and significant, making this situation unrelated to disenfranchised grief.

Which stage of the Kübler-Ross theory is reflected in the patient's statement, "I will seek a second opinion and have the tests done again at another hospital?" 1 Anger Correct2 Denial 3 Bargaining 4 Depression

ANS: Denial Saying "I will seek a second opinion and have the tests done again at another hospital" indicates denial. The Kübler-Ross theory (1969) consists of five stages. When the patient is unable to accept the fact that he or she is dying, it indicates denial. As a result, the patient wants to perform the tests again at another hospital. Anger is the expression of resistance or anger toward God or other people, not seeking a second opinion. Bargaining is characterized by postponing awareness of the loss by trying to prevent it from happening, not by seeking a second opinion. Depression is characterized by the individual realizing the full impact of the loss. The patient is not realizing the full impact; in fact, the patient in this situation is in denial wanting a second opinion as a form of psychological protection.

In which stage of dying does a patient realize the full impact of the loss? 1 Anger 2 Denial Correct3 Depression 4 Bargaining

ANS: Depression In the depression stage, the patient realizes the full impact of the loss. At this stage, the patient feels hopeless and lonely. In the anger stage, the patient expresses resistance and intense anger at God, other people, or the situation itself, and does not experience the full impact of the loss. In the denial stage, the patient is psychologically not ready to accept the loss; thus the patient is not ready to realize the full impact of the loss when in denial. In the bargaining stage, the patient postpones awareness of the loss by preventing it from happening; realizing the full impact of the loss does not occur in bargaining.

Which type of grief is exemplified when a patient states, "I have been depressed since the death of my ex-husband?" 1 Normal 2 Anticipatory 3 Complicated Correct4 Disenfranchised

ANS: Disenfranchised In disenfranchised grief, the patient may be depressed because of the death of an ex-spouse or extramarital partner. Normal grief is a common and universal reaction, and the patient may have feelings such as disbelief, yearning, anger, and depression; but being depressed after the death of an ex-husband is not a type of normal grief. The patient may experience anticipatory grief before the actual loss or death occurs; in this situation an actual loss has occurred so is not anticipatory. In complicated grief, a person has a prolonged or significantly difficult time moving forward after a loss; this situation is grief after the loss of an ex-husband, indicating disenfranchised grief.

Which type of grief response describes a woman who experiences the loss of a very early term pregnancy and her friend suggests to her that she can "always try again?" 1 Delayed 2 Anticipatory 3 Exaggerated Correct4 Disenfranchised

ANS: Disenfranchised This is disenfranchised grief. This woman's friend is not fully acknowledging the value of her pregnancy because of the short length of time the woman was pregnant or because, by comparison, the loss seems less than losing a child after birth. The loss does not seem "legitimate." Thus the woman does not experience sympathy from others and feels disenfranchised. Delayed grief is a type of complicated grief in which the person's response is unusually delayed or postponed because the loss is so overwhelming; the woman in this scenario did not wait to grieve. Anticipatory grief occurs before the actual loss or death occurs; the woman in this situation did not experience grief until she lost the baby. Exaggerated grief is also a type of complicated grief in which the person often exhibits self-destructive or maladaptive behaviors; the woman did not experience maladaptive behaviors in this situation.

Which action would the nurse take for a dying patient who is breathing loudly? 1 Administer narcotics. Correct2 Elevate the head of the bed. 3 Apply lip balm to the patient's lips. 4 Position patient on the right side.

ANS: Elevate the head of the bed The nurse would elevate the head of the bed. Noisy breathing may be caused by the movement of secretions in the airway during inspiratory and expiratory phases. Elevating the patient's head facilitates postural drainage and comforts the patient. Administering narcotics is appropriate if the patient has tachypnea, not loud breathing. Applying lip balm to the patient's lips is for mucous membrane discomfort, not for loud breathing. Positioning the patient on the right side helps treat nausea, not loud breathing.

Which strategy would the nurse use to assist the patient newly diagnosed with colon cancer who is withdrawn? 1 Obtain a prescription for a psychiatric evaluation. 2 Encourage the patient to identify fears and verbalize feelings. 3 Allow the patient to remain withdrawn to avoid drawing attention to this behavior. 4 Explain to the patient that newer treatments permit many people to survive colon cancer.

ANS: Encourage the patient to identify fears and verbalize feelings. The nurse encourages the patient to identify fears and verbalize feelings. The nurse recognizes that the patient could be expressing feelings of grief, and allowing the patient to verbalize feelings will help the patient move through the phases of the grief process. The patient does not need a psychiatric evaluation, as this is a normal grief process to the diagnosis of colon cancer; it is not a psychiatric disorder. The patient should not be left alone, because the patient needs support to cope with the illness. Explaining newer treatment options at this time is too early; the patient needs to process the information first.

Which action would the nurse take to decrease nausea for a terminally ill patient? 1 Provide cool air in the patient's room. 2 Encourage massage therapy for the patient. Correct3 Encourage the patient to lie on the right side. 4 Provide background music of patient's choice.

ANS: Encourage the patient to lie on the right side. The patient is encouraged to lie on the right side when nausea is present. The nurse would provide cool air in the room if the patient is suspected to have an ineffective breathing pattern, not for nausea. The nurse would use massage therapy and background music of the patient's choice for pain, not for nausea.

According to attachment theory, which action represents disorganization and despair? 1 Feeling lethargic and loss of appetite 2 Emotional outbursts of tearful sobbing 3 Separating oneself from the lost relationship Correct4 Endless examination of how and why the loss has occurred

ANS: Endless examination of how and why the loss has occurred According to attachment theory, endless examination of how and why the loss has occurred represents disorganization and despair. Feeling lethargic, loss of appetite, and emotional outbursts of tearful sobbing represent yearning and searching, not disorganization and despair. In the stage of reorganization (not disorganization and despair), the person separates him- or herself from the lost relationship.

Which type of grief is exemplified when the survivor of a motor vehicle accident attempts suicide because of feeling responsible for the friend's death? 1 Delayed 2 Masked Correct3 Exaggerated 4 Ambiguous

ANS: Exaggerated The patient is experiencing exaggerated grief. The person with exaggerated grief is at a high risk of suicide. In certain situations, a loss is so overwhelming that the person takes time to realize and react to it, which is referred to as delayed grief. In this situation the response was not delayed. In masked grief, the person shows disruptive behavior but is unaware that the disruptive behavior is a result of the loss; that did not occur in this situation. Ambiguous loss occurs when the person who is lost is physically present but not psychologically available, as in severe dementia or brain injury; in this situation the survivor physically lost a friend.

Which action would the nurse take when caring for a patient who is nearing death? 1 Tell the patient, "You'll be going home soon." 2 Encourage the patient to interact with family members. Correct3 Hold the patient's hand and state, "You're not alone." 4 Discuss what to expect with the family members at the bedside.

ANS: Hold the patient's hand and state, "You're not alone." Holding the hand of a dying patient and stating "You're not alone" communicates concern and caring even if the patient is unable to respond and is the action to take. Telling a dying patient "You'll be going home soon" is inappropriate; home may mean something totally different to the patient as compared to the nurse. Encouraging the patient to interact with family members is inappropriate at this time; the nurse needs to encourage the family to continue to talk to the patient, not vice versa. Discussing the process with family members does not focus on the patient, and the patient can still hear even though he or she may be unable to respond, which could increase anxiety.

When explaining hospice care to a patient and family, the nurse differentiates hospice and palliative care in which way? 1 Palliative care takes place in a health care facility. Correct2 Hospice care is for patients with a life-limiting illness. 3 Hospice encourages an autopsy after patient death for family closure. 4 Palliative services continue for approximately 6 months after patient death.

ANS: Hospice care is for patients with a life-limiting illness. Hospice care is provided for patients with a life-limiting illness, usually with a prognosis of 6 months or fewer to live. Palliative care can be provided in a home, a skilled nursing facility, or an acute care facility. Hospice leaves the question of autopsy to the family and does not encourage it as a method of closure. Palliative services are patient focused, and they will end when the patient no longer is alive or no longer is in need of them.

Which factor is likely responsible for a 2-year-old child eating very little food and having sleep disturbances since losing his or her parent? 1 Coping strategies 2 Nature of the loss Correct3 Human development 4 Personal relationship

ANS: Human development Human development is the factor likely responsible for a toddler not eating much and having sleep disturbances. In this case the toddler cannot understand loss or death but often feels anxiety over the loss of objects and separation from parents, which leads to changes in eating and sleeping patterns. In coping strategies, the person uses life experiences to deal with the stress of the loss; a toddler is too young to have developed coping strategies. In this situation the child is too young to understand the loss; thus the nature of the loss is not the factor affecting the child's behavior, health, and well-being. Similarly, the child is too young to understand the quality and meaning of the lost personal relationship. Thus this factor is also not affecting the response.

Which action would the nurse take to educate a patient who has a dying parent about anticipatory grief and its management? 1 Emphasize high-dose sedation. 2 Tell the patient to avoid meeting with the parent. 3 Explain to the patient that grief may aggravate the situation. Correct4 Instruct the patient who will eventually get mentally prepared for the loss.

ANS: Instruct the patient who will eventually get mentally prepared for the loss. The nurse would instruct the patient who will eventually get mentally prepared for the loss. Because the parent is dying, the patient will eventually prepare for the inevitability that the parent will die. High-dose sedation is not recommended for anticipatory grief. Avoiding the parent is not a justifiable way of escaping anticipatory grief. Explaining that grief will aggravate the situation is inappropriate; grief is a process, and the nurse would support the patient through the process.

Which critical thinking skill does the nurse use when considering how the patient's cultural perspectives affect the meaning of loss or death? 1 Attitudes 2 Standards 3 Experience 4 Knowledge

ANS: Knowledge The nurse uses knowledge as the critical thinking skill to understand the patient's cultural perspectives on the meaning of loss or death. Attitudes is the critical thinking skill that involves taking risks if necessary to develop a close relationship with the patient to understand loss; it does not focus on cultural perspectives affecting the meaning of loss/death in a patient. Standards is the critical thinking approach used for applying principles outlined in professional and clinical standards, not considering how cultural perspectives affect the meaning of loss/death. Experience is the critical thinking approach used to care for a patient who experienced a physical or emotional loss or death and personal experience with loss/death, not the effect of culture on loss/death.

Which patient may experience intangible loss? 1 Lost a hand 2 Lost both parents Correct3 Lacks confidence 4 Has transient paralysis

ANS: Lacks confidence A patient lacking confidence is experiencing intangible loss. Losses of self-esteem, confidence, or dreams are considered intangible loss. Losses of body parts or body function, relationships, or possessions are considered tangible things. Therefore a patient who lost a body part such as a hand, a patient who lost the parent-child relationship because of death of parents, and a patient who lost use of a body part (transient paralysis) is experiencing tangible loss, not intangible.

Which approach to helping grieving people is most consistent with high-quality care? 1 Helping the patient identify tasks to be accomplished during grief 2 Encouraging people to recognize stages of grieving in anticipation of what is to come Correct3 Listening carefully to a person's story of how the grief experience is unfolding 4 Offering general grief timelines to help the person know when a phase will pass

ANS: Listening carefully to a person's story of how the grief experience is unfolding Listening carefully to a person's story of how the grief experience is unfolding is most consistent with high-quality care. Although helping the patient identify tasks, encouraging people to recognize stages, and offering general grief timelines are helpful, the nurse needs to focus on the patient's journey, not theories nor the nurse's directing.

Regarding grief in older adults, which understanding helps guide the nurse's relationship with an elderly patient? Correct1 Older adults have usually sustained many losses in life, which influence the current loss. 2 The changes in memory from aging allow older adults to experience grief less intensely. 3 Older adults generally handle loss better because they have more experience with it. 4 Social support is less important because an older adult's circle of friends has become smaller.

ANS: Older adults have usually sustained many losses in life, which influence the current loss. The nurse would remember older adults have usually sustained many losses in life, which influence the current loss. For people at any age, each loss influences the way one responds to subsequent losses. There is little evidence grief experiences differ because of age alone; therefore it is inappropriate to think that older adults experience grief less intensely. Sometimes many losses overpower an older person's coping resources instead of making the person stronger. The loss of a social network makes it more (not less) important to find resources and sources of social support for grieving older adults.

Which patient is at risk of developing suicidal tendency based on the given data? 1 Patient A 2 Patient B Correct3 Patient C 4 Patient D

ANS: Patient C: deep depression Patients experiencing exaggerated grief, such as Patient C, may have psychiatric disorders; these individuals are often at risk of suicide. Patients experiencing chronic grief, such as Patient A, show a normal grief response, but it can last for an extended period of time. These individuals would not typically be at risk of suicide. A delayed grief response, as seen with Patient B, is frequently triggered by a second loss. These individuals are not typically at risk of suicide. In masked grief, the patient is unaware that the disruptive behavior is a result of the loss and ineffective grief resolution. These individuals are not typically at risk of suicide. Therefore Patient D experiencing chronic grief would not likely be at risk of developing suicidal tendency.

A parent of an adolescent tells the nurse, "Shortly after we moved to a new neighborhood, my son lost interest in school and friends." Which type of loss does the nurse suspect? 1 Actual Correct2 Perceived 3 Situational 4 Maturational

ANS: Perceived A perceived loss is often experienced internally and is not always obvious. It can be a loss of confidence or change in a social group, such as when the son moved to a new place. An actual loss occurs when a person who has died can no longer be seen or heard. A situational loss occurs with a sudden, external event such as an accident. A maturational loss is a normal life change loss.

Which type of loss occurs when a person loses confidence because of rejection by a friend? 1 Actual Correct2 Perceived 3 Situational 4 Maturational

ANS: Perceived This is a perceived loss. Perceived loss is defined as a person experiencing loss that is less obvious to other people. A person who lost confidence because of rejection by a friend may experience perceived loss. Actual loss occurs when a person can no longer see, feel, or hear a person or object. It occurs when there is a loss of body part or job, not a loss of confidence because of rejection. A person who meets unexpected external events such as sustaining an injury with physical changes in an automobile accident experiences situational loss; situational loss is not when a person loses confidence because of rejection. Maturational loss is a form of necessary loss that includes all expected normal life changes across the life span; rejection from a friend is not considered a normal life change.

Which person is experiencing anticipatory grief? 1 Person whose former spouse is dead. Correct2 Person who is caring for a family member with severe dementia. 3 Person who has a conflicted relationship with the deceased. 4 Person whose husband's body is not found after a terrorist attack.

ANS: Person who is caring for a family member with severe dementia. A person who is caring for a family member with severe dementia experiences anticipatory grief. In this grief people predict loss and begin to prepare for it. A person whose former spouse is dead experiences disenfranchised grief, not anticipatory grief. A person who has a conflicted relationship with the deceased experiences complicated grief, not anticipatory grief. A person whose husband's body is not found after a terrorist attack may experience disenfranchised or complicated grief, but not anticipatory grief.

Which intervention would the nurse perform for a patient who is experiencing severe pain during end-of-life care and tells the nurse, "I do not want medication for pain, and I want to be awake when my family visits me"? 1 Distract the patient and administer the medication. 2 Administer the medication when the family visits the patient. Correct3 Provide alternative pain management therapies such as heat or cold. 4 Firmly instruct the patient that medicines are necessary for treatment.

ANS: Provide alternative pain management therapies such as heat or cold. The nurse would provide alternative pain management therapies such as heat or cold. When the patient is not willing to take medication to spend time with family, the nurse would respect the patient's decision. Nonpharmacological therapies such as heat or cold and a soothing environment will provide relief to the patient. The nurse would not distract the patient and administer medication because this will create mistrust between the patient and the nurse and legally would be battery. The nurse would not violate the patient's directives and administer the medication when the family visits. The nurse would respect the patient's wishes on whether to take medication or not and would not firmly instruct the patient to take pain medications. Nurses do not coerce patients.

Which action is the priority in providing postmortem care? 1 Dressing the patient in the patient's own clothing Correct2 Providing culturally and religiously sensitive care in body preparation 3 Transporting the body to the morgue as soon as possible to prevent body decomposition 4 Performing postmortem care to protect the family of the deceased from having to see the body

ANS: Providing culturally and religiously sensitive care in body preparation The priority is providing culturally religiously sensitive care in body preparation. At the end of life, religious and cultural expectations are important for respecting and providing dignity to the deceased and for the lasting memories held by the family about the way their loved one's death occurred. Sensitive care contributes to feelings of closure, appropriateness of the death rituals, and fulfilled family obligations. Dressing the patient in the patient's own clothing is not the priority. The patient's wishes or family's wishes would be honored for clothing. A body should be placed in the morgue soon after death, but it is more important to provide sensitive and dignified care to the deceased. Performing postmortem care to protect the family is not the priority; in fact, some families may want to participate in the preparation of the body.

Which condition is the nurse managing when applying topical moisturizer to a dying patient's dry, scaly dermis? 1 Infection Correct2 Skin irritation 3 Corneal drying 4 Buccal discomfort

ANS: Skin irritation The nurse is managing skin irritation. Skin irritation leads to skin/dermal dryness and scaling. Topical moisturizers help reduce such irritation. Anti-infective medications (not topical moisturizer) would be beneficial in reducing infections. Artificial tears and optical lubricants (not topical moisturizer) are beneficial for reducing corneal drying. Buccal discomfort occurs in the mouth, not the dermis/skin.

Which guideline would the nurse keep in mind regarding the request for organ and tissue donation at the time of death? Correct1 Specially educated personnel make requests. 2 Requests are usually made by the nurse caring for the patient at the time of death. 3 Only patients who have given prior instruction regarding donation become donors. 4 Nurses need to be very selective in whom they ask for organ and tissue donation.

ANS: Specially educated personnel make requests. The guideline to remember is specially educated personnel make requests. Individuals specially trained in requesting organ donations facilitate the process. They are skilled in talking compassionately to people who have suffered a tragic, sudden loss and have answers to many questions that people have regarding the donation process. Nurses caring for the patient at the time of death do not request organ donations, although they do provide support and reinforce or clarify explanations to the deceased person's family during the request process. If the deceased person has not left behind instructions concerning organ and tissue donation, the family gives or denies consent at the time of death. Specially trained professionals, not nurses, know the requirements for organ/tissue donations.

Which theory includes denial and acceptance? Correct1 Stages of dying 2 Attachment theory 3 Rando's "R" process model 4 Grief tasks model

ANS: Stage of dying Stages of dying by Kübler-Ross explains denial, anger, bargaining, depression, and acceptance. Attachment theory by Bowlby explains numbing, yearning, and searching; it does not include denial and acceptance. Rando's "R" process model includes recognize, react, recollect and re-experience, relinquish, readjust, and reinvest; it does not include denial and acceptance. The grief tasks model by Worden accepts the reality of the loss, experiences the pain of grief, adjusts to a world in which the deceased is missing, and emotionally relocates the deceased and moves on with life; it does not include denial and acceptance.

Which action is appropriate for the dying, peaceful, hospice patient who develops anorexia and the family members become very anxious because of the reduced food intake? 1 Encourage the patient to eat. Correct2 Support the grieving family. 3 Promote spiritual comfort and hope to the patient. 4 Refer the patient for a dietary consult.

ANS: Support the grieving family. The appropriate action is to support the grieving family. The nurse would support the grieving family members and provide them emotional support, as they are very anxious. The patient should not be encouraged to eat. Patients in the last days of life often develop anorexia, and forcing food or fluids stresses the patient's compromised gastrointestinal and cardiovascular systems, potentially creating increased discomfort. The patient is at peace and does not need spiritual comfort and hope. The patient is dying and anorexia is a normal process of dying; therefore a dietary consult is inappropriate at this time.

Which patient's condition can be categorized as delayed grief? 1 Exhibiting psychosis because of grief 2 Having depression because of death of a child Correct3 Trying to avoid the full realization of the loss 4 Being unaware that grief is causing disruptive behavior

ANS: Trying to avoid the full realization of the loss Trying to avoid the full realization of the loss is delayed grief. In delayed grief, the person may postpone the grief response because the loss is so overwhelming the person must avoid the full realization of the loss. A patient who is exhibiting psychosis may be experiencing exaggerated grief, not delayed grief. A patient who is depressed because of the death of a child may be experiencing normal grief, not delayed grief. A patient who is unaware of behaving disruptively as a result of grief may be experiencing masked grief, not delayed grief.

Which stage of Bowlby's attachment theory is occurring when the patient who recently lost parents in a road accident has shortness of breath, a feeling of lethargy, and loss of appetite? 1 Numbing 2 Reorganization Correct3 Yearning and searching 4 Disorganization and despair

ANS: Yearning and searching The patient is in yearning and searching. Bowlby's attachment theory describes four stages of mourning: numbing, yearning and searching, disorganization and despair, and reorganization. Yearning and searching are in the second stage of bereavement characterized by shortness of breath, a feeling of lethargy, and loss of appetite with emotional outbursts. Numbing is the first stage of mourning characterized by stunned and unreal feelings; this stage does not have shortness of breath, a feeling of lethargy, and loss of appetite. Reorganization is the last stage of mourning, which is characterized by accepting the change, assuming unfamiliar roles, and acquiring new skills to build new relationships; this stage does not have shortness of breath, a feeling of lethargy, and loss of appetite. Disorganization and despair are in the third stage of mourning, which is characterized by repeating the accident stories many times; it does not have shortness of breath, a feeling of lethargy, and loss of appetite.

Which stage of the attachment theory of grief and mourning is characterized by emotional outbursts of tearful sobbing? 1 Numbing 2 Reorganization Correct3 Yearning and searching 4 Disorganization and despair

ANS: Yearning and searching The yearning and searching stage of the attachment theory is characterized by emotional outbursts of tearful sobbing. Numbing involves protecting the person from the full impact of the loss, but it does not involve emotional outbursts of tearful sobbing. Reorganization involves accepting the change and assuming unfamiliar roles, but it does not involve emotional outbursts of tearful sobbing. Disorganization and despair are characterized by endless examinations of how and why the loss occurred, but they do not involve emotional outbursts of tearful sobbing.

Which information would the nurse document when a patient dies after being hospitalized for 7 days? Select all that apply. One, some, or all responses may be correct. 1 Height of deceased 2 Race of deceased Correct3 Time and date of death Correct4 Medical devices left in the body Correct5 Name of health care provider certifying death

ANS:(3)Time and date of death (4)Medical devices left in the body (5)Name of health care provider certifying death The nurse would document time and date of death, medical devices left in the body, and name of health care provider certifying death. Documentation is important in cases related to patient deaths because it carries legal implications. The height and race of the deceased need not be documented.