prepU Chapter 42: Loss, Grief, and Dying

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?"

he 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."

When assessing a client, which statement indicates that the client is experiencing the anger stage of death and dying?

"I am a good person. Why did this happen to me?"

The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the bargaining stage of grief is the one who states:

"I just want to see my son have a family of his own."

Which client statement would cause the nurse to suspect that the stage of bargaining has been reached in the grief process?

"If I can just live long enough to see my daughter get married."

A terminally ill client asks the nurse what assisted suicide is. Which response is best for the nurse to provide?

"It is when a lethal combination of drugs is made available to the client wishing to die."

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 nursing student is learning how to care for clients whose death is expected within a limited period of time. Which of the following statements makes the faculty member believe the student has mastered this topic?

"Many clients know they have a terminal illness by picking up on nonverbal communication."

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 new hospice nurse is reviewing the concepts of loss and grief with her preceptor. Which of the following statements leads the preceptor to believe that the nurse has an understanding of grief and loss?

"The client who is isolating himself from social contact after the death of his spouse is demonstrating a social expression of grief."

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."

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."

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?"

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.

- Pale, cool skin - Decreased urine output - Irregular heart rate

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.

A nurse is preparing a presentation for a family support group for cancer. The nurse is planning to describe grieving and the various terms associated with this concept. Which term would the nurse use to describe the entire range of responses to the loss of a valued object, person, belief, or relationship?

Grief

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.

The wife of a man who is dying tells the nurse: "Harold was so good to me. He was like a saint with his patience. I will miss him terribly" Which stage of grief is this woman experiencing, according to Engel?

Idealization

The client is a young mother whose spouse died 3 months ago. The client is tearful and unkempt, eats a poor diet, and has lost 50 pounds since the death of the spouse. The client states, "I can't do this anymore." The nursing diagnosis best supported by these data is

Ineffective Coping related to failure of previously used coping mechanisms.

A nurse informs a woman that there is nothing more that can be done medically for her premature infant who is expected to die. The mother suppresses her grief and tells the nurse she is experiencing heart palpitations. What type of grief might the mother be experiencing?

Inhibited grief

Before the death of her husband, Mrs. Sardi complained of frequent headaches and loss of appetite. No medical cause was found. Mrs. Sardi probably was experiencing which type of grief?

Inhibited grief

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.

Which of the following describes lower-brain death?

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

The emergency department (ED) nurse accepts an unconscious client brought in by ambulance. The client's family presents a durable power of attorney for health care for the client. Which action should the nurse take?

Obtain contact information for the person designated to make decisions for the client.

A nurse is providing end-of-life care to a terminally ill client. Which actions should the nurse take to remove mucus and saliva from the client's mouth?

Perform suction in the client's mouth.

The nurse is taking care of Esther, a 24-year-old woman who was recently in a motor vehicle accident during which she lost her beloved golden retriever. She tells the nurse that when she thinks of him, her heart aches. She does not want to eat and can't sleep even though she is exhausted. Which stage of the grief cycle model is Esther experiencing?

Protest

What is the most important goal of care for the dying client who is receiving comfort care?

Providing a comfortable, dignified death

A nurse caring for a client with a terminal illness understands which of the following to be true?

Recovery is not expected

Which stage of the Parkes's model of grief lasts the longest?

Reorganization

With the help of the nurse, the parents of an infant who died shortly after birth arrange for a funeral service. Which stage of grief, according to Engel, involves the rituals surrounding loss, including funeral services?

Restitution

The nurse is caring for an older adult comatose client in his home. The client is dying, and the client's family is providing some care. The family asks, "What else can we do?" The nurse encourages the family members to do what?

Speak to the client.

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 nurse at the health care facility cares for several clients. Some of the clients may require end-of-life care. Which case may require the service of a coroner?

The client did not have any recent medical consultation.

A nurse is providing end-of-life care to a client at a health care facility. The client is anticipating death. The nurse understands that the client is in the acceptance stage of dying. What indicates that the client is in the acceptance stage of dying?

The client has settled all financial matters for surviving family members.

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.

Which does not coincide with Kübler-Ross's stages related to a dying client?

The dying client usually exhibits anger first.

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 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 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

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?

difficulty swallowing

The nurse is providing care to a group of terminally ill clients. The client who exhibits signs of impending death is the client who has:

distended abdomen, Cheyne-Stokes respirations.

The family of a client with a severe traumatic brain injury is considering the withdrawal of his mechanical ventilation. What is the nurse's primary role in the preparation for terminal weaning?

educating the family on what to reasonably expect after ventilation is discontinued

A client is being discharged from the hospital with terminal brain cancer and a life expectancy of 1 month. When planning this client's discharge, it is most important for the nurse to include a referral to which agency?

hospice

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 experience of parting with an object, person, belief, or relationship that one values is defined as:

loss

When providing end-of-life care for clients, what will the nurse most often need to prioritize?

pain control and emotional support

Which care environment would the nurse suggest to a client with no family near by who is diagnosed with end stage lung disease?

residential care

A nurse is assessing a client's grief response. Which concept would be most important for the nurse to keep in mind during the assessment to determine whether the client's response is normal or altered?

severity of the symptoms and the pattern of change over time

Which stage of grieving is exhibited by the husband of a victim of sudden death who refuses to accept that she is dead?

shock

The grieving process has several important functions. Which is not one of these functions?

to allow one to move on from their sadness

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

The hospice nurse is visiting a new client. Which assessment questions are appropriate for the nurse to ask a client that has a terminal illness? (Select all that apply.)

• "Please describe what you have been told about your condition." • "What community resources might be of help to you?" • "How well do you think those around you are coping?" • "Have you had any previous experiences with the death of someone you love?"

A nurse is conducting an in-service program for a group of hospice nurses. When describing the grief response in adults and older adults as compared to children, which would the nurse most likely include? Select all that apply.

• Adults and older adults grieve more continuously. • Adults and older adults do not seek an immediate replacement for the lost loved one.

A male client with a diagnosis of lung cancer is seen in the clinic for follow-up care. Which nursing interventions are essential to include in this client's plan of care to address his grief? Select all that apply.

• Assist the client to form a support system. • Help the client establish coping strategies. • Promote good nutrition and sleep habits. • Encourage participation in religious rituals.

When preparing the care plan for a dying client, it is important for the nurse to include a goal that addresses which needs? (Select all that apply.)

• Expression of feelings • Management of pain • Use of coping strategies

The hospice nurse is educating a client's family on the physical signs of approaching death. The nurse knows that the education has been effective when the family says they will know that death is imminent when they see which of the following? Select all that apply.

• Irregular respiratory rate • Restlessness • Bowel incontinence • Cyanosis of dependent areas

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.

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

Which signs assessed in a dying client would the nurse recognize as signs of death? Select all that apply.

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

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. • Some people actually skip some stages of grief altogether.

What is a proper action to take when preparing a child for death?

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

A nurse is explaining the preparation of a death certificate to a student nurse. Which statements accurately describe this process? (Select all that apply.)

• U.S. law requires that a death certificate be prepared for each person who dies. • A physician's signature is required on a death certificate. • It is the nurse's responsibility to ensure that the physician has signed a death certificate. • A death certificate is signed by the pathologist, the coroner, and others in special cases.

Which actions are performed by the nurse when a client dies? Select all that apply.

• removing all tubes according to agency policy, unless an autopsy is to be performed • placing identification tags on the client's dentures or other prostheses • arranging for family members to view the body before it is discharged to the mortician • attending the funeral of a deceased client and making follow-up visits to the family

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 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?

Anger

A woman has responded to her recent diagnosis of lung cancer by making extensive plans for overseas travel with her children, despite the fact that her oncologist has informed her of her extremely poor prognosis. The client is adamant that she does not want to discuss her cancer and the nurse consequently recognizes that the client is likely in the denial stage of grief. How can the nurse best facilitate the client's healthy grieving?

Address the client's diagnosis and prognosis at a later time or date.

Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning?

Administer sedation and analgesia

The nurse is caring for a client who has just expired. Which action will the nurse perform?

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

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 client with a terminal illness is being cared for at home. When caring for a client who is in home care, the nurse discusses the importance of respite care. Which of the following interventions leads to respite care?

Encouraging the caregiver to identify surrogate caregivers

Upon interviewing the client, the nurse finds that the client is providing care for her mother who is terminally ill. The client is depressed and already mourning the loss. Which nursing diagnosis would be most appropriate for the client?

Anticipatory grieving

What is Kübler-Ross's third stage of grief?

Bargaining

A nurse assesses a client who is grieving and notes that the client is in the numbness phase according to the Parkes grief model. Which defense would the nurse expect the client to most likely use?

Denial

The nurse is assessing a client recently diagnosed with terminal lung cancer who states, "This can't be happening to me. Maybe the doctor made a mistake." Which stage of death and dying is the client exhibiting?

Denial

A graduate nurse enters a client's room and finds the client unresponsive, not breathing, and without a carotid pulse. The graduate nurse is aware that the client has mentioned that he does not wish to be resuscitated, but there is no DNR order on the client's chart. What is the nurse's best action?

Call a code and begin resuscitating the client.

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.

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?

Client's breathing becomes noisy.

Upon admission, the nurse should give the highest priority to addressing which need of a client who is displaying symptoms of dysfunctional grief?

Coping strategies

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 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 what stage of death and dying?

Depression

A client's son is named to make decisions for his mother in the event she cannot speak for herself. This is an example of a(an) ...

Durable power of attorney

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

A client has been asked to undergo a series of diagnostic tests following a routine blood test that indicates leukemia. The client refuses to believe the diagnosis and feels that there has been an error in the reports. Which stage of grief is the client going through?

Denial

A client has been diagnosed with a terminal illness and has made an appointment with an attorney to complete a will. How will the nurse document this stage of grief according the Kubler-Moss Model?

acceptance

A terminally ill client states, "I am ready to die". What stage of grief does the nurse suspect?

acceptance

A client has recently lost his father. The client spent about 6 months deeply mourning his loss and is just now able to function at his pre-loss level. He was helped in this process by his strong social support. This client is most likely a(an):

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