Chapter 43: Grief and Loss PREP U and questions

The condition of a client with a traumatic brain injury continues to deteriorate despite medical efforts. The decision is made to terminally wean the client from mechanical ventilation. Which statement by the nurse is most significant in educating the family regarding terminal weaning? A. "If you change your mind after we remove the breathing tube, just tell us and it will be reinserted." B. "Once the endotracheal tube is removed, your loved one will no longer be able to breathe." C. "Your loved one will not feel or be aware of anything that is happening once the breathing tube is removed." D. "All efforts will be taken to make sure your loved one is comfortable and out of pain."

"All efforts will be taken to make sure your loved one is comfortable and out of pain."

A client has been receiving dialysis for years and now states, "I have been thinking about this for a long time. I no longer wish to continue dialysis. I just want to die." What is the most appropriate statement by the nurse? "Once you've started treatment, it's important to continue." "Have you discussed this with your health care provider?" "Can you tell me about why you've made this decision?" "Does your family agree with this decision?"

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

When reviewing a client's chart, the nurse notes that the client is in the disorganization stage of grief. Which assessment finding would support this diagnosis? A. "I haven't let my children out of my sight. I am afraid something will happen to them." B. "A lot of the time I'm terrified that I'm going to die the same way." C. "I feel like I have absolutely no idea what to do next." D. "I had a good time at my class reunion. It was nice to be out with other people again."

"I feel like I have absolutely no idea what to do next."

A client with end-stage chronic obstructive pulmonary disease (COPD) has reached the end of the 6-month period for hospice services and the family caregiver states, "I don't know what we will do if they cut off our hospice services." What is the best response by the hospice nurse? A. "We can discontinue the service for a period of time and then when your family member gets worse, readmit them." B. "We can admit your family member to the hospital for treatment and they can reinstate the hospice benefits." C. "I will contact the health care provider to extend services since your family member meets the criteria." D. "Unfortunately, we are unable to continue services past the 6 month period of time."

"I will contact the health care provider to extend services since your family member meets the criteria."

A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education? A. "Hospice care programs focus on quality rather than length of life." B. "In hospice care, the nurses make most of the care decisions for the clients." C. "Palliative care provides relief from pain and other distressing symptoms." D. "Palliative care affirms life and regards dying as a normal process."

"In hospice care, the nurses make most of the care decisions for the clients."

A nurse is visiting a patient with pancreatic cancer who is dying at home. During the visit, he breaks down and cries, and tells the nurse that it is unfair that he should have to die now when he's finally made peace with his family. Which response by the nurse would be most appropriate? "You can't be feeling this way. You know you are going to die." "It does seem unfair. Tell me more about how you are feeling." "You'll be all right; who knows how much time any of us has." "Tell me about your pain. Did it keep you awake last night?"

"It does seem unfair. Tell me more about how you are feeling."

After the physician has discussed euthanasia with a terminal client and family, the nurse assesses their understanding of the topic. Which statement by the family indicates that learning has occurred? A. "Passive euthanasia is taking specific steps to cause a client's death." B. "It is all right to stop dialysis." C. "The doctor will administer a lethal dose of barbiturates." D. "Allowing the client to stop eating is a form of active euthanasia."

"It is all right to stop dialysis."

During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving? A. "There is no way I can stay in the hospital because my parent is sick." B. "I do not think my parent really has cancer. I think my parent needs to get a third opinion." C. "It is fine if my parent dies. We have not been close for years." D. "My parent is suffering with cancer and death will be a relief of the pain."

"My parent is suffering with cancer and death will be a relief of the pain."

During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving? A. "There is no way I can stay in the hospital because my parent is sick." B. "My parent is suffering with cancer and death will be a relief of the pain." C. "It is fine if my parent dies. We have not been close for years." D. "I do not think my parent really has cancer. I think my parent needs to get a third opinion."

"My parent is suffering with cancer and death will be a relief of the pain."

The nurse is caring for a client who recently lost an older adult parent. Which client statement alerts the nurse that the stage of depression may have started within the grief process? "This does not seem real to me." "Please go away; I just want to be left alone." "What am I going to do now that my parent is gone?" "It is all my fault! I did not see the signs."

"Please go away; I just want to be left alone."

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

"Sometimes a person returns to a previous stage."

"My father has been dead for over a year and my mother still can't talk about him without crying. Is that normal?" What is the best response by the nurse? A. "Did your mother cry a lot before your father died?" B. "The inability to talk about your dad without crying, even after a year, is still considered normal." C. "In fact, the more that someone cries about a loss, the better they're dealing with it." D. "It is not normal. Your mother needs to see a therapist about her grief."

"The inability to talk about your dad without crying, even after a year, is still considered normal."

"My father has been dead for over a year and my mother still can't talk about him without crying. Is that normal?" What is the best response by the nurse? A. "In fact, the more that someone cries about a loss, the better they're dealing with it." B. "Did your mother cry a lot before your father died?" C. "It is not normal. Your mother needs to see a therapist about her grief." D. "The inability to talk about your dad without crying, even after a year, is still considered normal."

"The inability to talk about your dad without crying, even after a year, is still considered normal."

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

"This must be very difficult for you."

The nurse is providing care for a client that is terminally ill with cancer. The client states to the nurse, "Am I going to die?" What is the most therapeutic response by the nurse? "You shouldn't worry about that right now." "You will go when it is your time." "I have to go and assist another client right now." "What have you been told?"

"What have you been told?"

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: "I do not believe I have this disease." "I don't care about anything. I have no energy." "Why did this have to happen to me?" "I just want to see my son have a family of his own."

"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 anger stage of grief is the one who states: "Why did this have to happen to me?" "I don't care about anything. I have no energy." "I just want to see my son have a family of his own." "I do not believe I have this disease."

"Why did this have to happen to me?"

The nurse is caring for several clients in the home care setting. Which client, when found deceased, will the nurse report as a case for the medical examiner? A. a client found with an empty bottle for a newly-prescribed opioid by the bedside B. a client treated for end-stage kidney failure who is on home hemodialysis C. a client who was recently discharged from the hospital after a myocardial infarction D. a client with lung cancer who refused hospice and is living with a spouse

A client found with an empty bottle for a newly-prescribed opioid by the bedside.

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

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

A home health care nurse has been visiting a patient with AIDS who says, "I'm no longer afraid of dying. I think I've made my peace with everyone, and I'm actually ready to move on." This reflects the patient's progress to which stage of death and dying? Acceptance Anger Bargaining Denial

A. Acceptance

A nurse midwife is assisting a patient who is firmly committed to natural childbirth to deliver a full-term baby. A cesarean delivery becomes necessary when the fetus displays signs of distress. Inconsolable, the patient cries and calls herself a failure as a mother. The nurse notes that the patient is experiencing what type of loss? Select all that apply. A. Actual B. Perceived C. Psychological D. Anticipatory E. Physical F. Maturational

A. Actual B. Perceived C. Psychological

A nurse is preparing a family for a terminal weaning of a loved one. Which nursing actions would facilitate this process? Select all that apply. A. Participate in the decision-making process by offering the family information about the advantages and disadvantages of continued ventilatory support. B. Explain to the family what will happen at each phase of the weaning and offer support. C. Check the orders for sedation and analgesia, making sure that the anticipated death is comfortable and dignified. D. Tell the family that death will occur almost immediately after the patient is removed from the ventilator. E. Tell the family that the decision for terminal weaning of a patient must be made by the primary care provider. F. Set up mandatory counseling sessions for the patient and family to assist them in making this end-of-life decision.

A. Participate in the decision-making process by offering the family information about the advantages and disadvantages of continued ventilatory support. B. Explain to the family what will happen at each phase of the weaning and offer support. C. Check the orders for sedation and analgesia, making sure that the anticipated death is comfortable and dignified.

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

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

A nurse who cared for a dying patient and his family documents that the family is experiencing a period of mourning. Which behaviors would the nurse expect to see at this stage? Select all that apply. A. The family arranges for a funeral for their loved one. B. The family arranges for a memorial scholarship for their loved one. C. The coroner pronounces the patient's death. D. The family arranges for hospice for their loved one. E. The patient is diagnosed with terminal cancer. F. The patient's daughter writes a poem expressing her sorrow.

A. The family arranges for a funeral for their loved one. B. The family arranges for a memorial scholarship for their loved one. F. The patient's daughter writes a poem expressing her sorrow.

Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning? Provide an explanation of the process. Administer sedation and analgesia. Offer emotional support to the family. Have the client's family remain at the bedside.

Administer sedation and analgesia

Assisted suicide is expressly prohibited under statutory or common law in the overwhelming majority of states. Yet public support for physician-assisted suicide has resulted in a number of state ballot initiatives. The issue of assisted suicide is opposed by nursing and medical organizations as a violation of the ethical traditions of nursing and medicine. Which scenario would be an example of assisted suicide? A. Granting a client's request not to initiate enteral feeding when the client is unable to eat B. Neglecting to resuscitate a client with a "do not resuscitate" status C. Administering a morphine infusion D. Administering a lethal dose of medication

Administering a lethal dose of medication

A client has recently lost a parent. The client spent about 6 months deeply mourning the loss and is just now able to function at the pre-loss level. During this process, a strong social support network was able to assist the client. What developmental stage of life does the nurse identify the client is in? adult toddler infant school-aged child

Adult

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 Bargaining Acceptance Denial

Anger

Which statement regarding perceptions of death by children is accurate? Toddlers perceive death as irreversible and unnatural. At about age 9, the child perceives death as irreversible. Preschool-age children view death as a spiritual release. Adolescents tend to respond better than adults with death.

At about age 9, the child perceives death as irreversible.

A nurse is caring for a terminally ill patient during the 11 PM to 7 AM shift. The patient says, "I just can't sleep. I keep thinking about what my family will do when I am gone." What response by the nurse would be most appropriate? A. "Oh, don't worry about that now. You need to sleep." B. "What seems to be concerning you the most?" C. "I have talked to your wife and she told me she will be fine." D. "I'm not qualified to advise you, I suggest you discuss this with your wife."

B. "What seems to be concerning you the most?"

The nurse is receiving a change of shift report on a client who has a terminal illness and has exhibited a slow and progressive decline in the health status over the past several days. Which data supports the client's impending death? Select all that apply. A. A regular apical pulse of 90 beats/minute B. Distended abdomen with last bowel movement documented 7 days ago C. Gurgling sounds emanating from the client's throat with each breath D. Cyanotic nail beds in hands and feet bilaterally E. Systolic blood pressure which rose from 100 to 110 mm Hg

B. Distended abdomen with last bowel movement documented 7 days ago C. Gurgling sounds emanating from the client's throat with each breath D. Cyanotic nail beds in hands and feet bilaterally

What is Kübler-Ross's third stage of grief? denial depression bargaining anger

Bargaining

A premature infant with serious respiratory problems has been in the neonatal intensive care unit for the last 3 months. The infant's parents also have a 22-month-old son at home. The nurse's assessment data for the parents include chronic fatigue and decreased energy, guilt about neglecting the son at home, shortness of temper with one another, and apprehension about their continued ability to go on this way. What human response would be appropriate for the nurse to document? Grieving Ineffective Coping Caregiver Role Strain Powerlessness

Caregiver Role Strain

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

Cleanse drainage from the skin

A patient diagnosed with breast cancer who is in the end stages of her illness has been in the medical intensive care unit for 3 weeks. Her husband tells the nurse that he and his wife often talked about the end of her life and that she was very clear about not wanting aggressive treatment that would merely prolong her dying. The nurse could suggest that the husband speak to his wife's health care provider about which type of order? Comfort Measures Only Do Not Hospitalize Do Not Resuscitate Slow Code Only

Comfort Measures Only

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? increased urinary output decreased pain difficulty swallowing increased sensory stimulation

Difficulty swallowing

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): advance estate director. significant power. durable power of attorney. exemplary representative.

Durable power of attorney

Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief? spiritual distress self-care activities pain management coping strategies

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? Anger Depression Denial Bargaining

Depression

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? Denial Bargaining Anger Depression

Depression

A patient tells a nurse that he would like to appoint his daughter to make decisions for him should he become incapacitated. What should the nurse suggest he prepare? POLST form Durable power of attorney for health care Living will Allow Natural Death (AND) form

Durable power of attorney for health care

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? A. Reassure the client's husband that he cannot hurt the client during sexual intercourse B. Suggest other ways the couple can spend time together, such as watching television together C. Encourage discussion between the husband and wife regarding their intimacy needs D. Inform the client's husband that the client cannot have sexual intercourse due to fatigue

Encourage discussion between the husband and wife regarding their intimacy needs.

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? support group outpatient rehab home health hospice

Hospice

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? A. Inpatient pain management for hospice clients is covered by Medicare. B. Medicare does not cover pain control in the home; it must be in the inpatient care. C. Worry about payment should not be a concern for the client. D. Medicare does not cover costs that are not directly related to the diagnosis.

Inpatient pain management for hospice client's is covered by Medicare.

The family of a patient who has just died asks to be alone with the body and asks for supplies to wash the body. The nurse providing care knows that the mortician usually washes the body. Which response would be most appropriate? A. Inform the family that there is no need for them to wash the body since the mortician typically does this. B. Explain that hospital policy forbids their being alone with the deceased patient and that hospital supplies are to be used only by hospital personnel. C. Give the supplies to the family but maintain a watchful eye to make sure that nothing unusual happens. D. Provide the requested supplies, checking if this request is linked to their religious or cultural customs and asking if there is anything else you can do to help.

Provide the requested supplies, checking if this request is linked to their religious or cultural customs and asking if there is anything else you can do to help.

A nurse is providing postmortem care. Which nursing action violates the standards of caring for the body after a patient has been pronounced dead and is not scheduled for an autopsy? A. The nurse leaves the patient in a sitting position while the family visits. B. The nurse places identification tags on both the shroud and the ankle. C. The nurse removes soiled dressings and tubes. D. The nurse makes sure a death certificate is issued and signed.

The nurse leaves the patient in a sitting position while the family visits.

A hospice nurse is caring for a patient who is terminally ill and who is on a ventilator. After a restless night, the patient hands the nurse a note with the request: "Please help me end my suffering." Which response by a nurse would best reflect adherence to the position of the American Nurses Association (ANA) regarding assisted suicide? A. The nurse promises the patient that he or she will do everything possible to keep the patient comfortable but cannot administer an injection or overdose to cause the patient's death. B. The nurse tells the patient that under no condition can he be removed from the ventilator because this is active euthanasia and is expressly forbidden by the Code for Nurses. C. After exhausting every intervention to keep a dying patient comfortable, the nurse says, "I think you are now at a point where I'm prepared to do what you've been asking me. Let's talk about when and how you want to die." D. The nurse responds: "I'm personally opposed to assisted suicide, but I'll find you a colleague who can help you."

The nurse promises the patient that he or she will do everything possible to keep the patient comfortable but cannot administer an injection or overdose to cause the patient's death.

A nurse is caring for terminally ill patients in a hospital setting. Which nursing action describes appropriate end-of-life care? A. To eliminate confusion, the nurse takes care not to speak too much when caring for a comatose patient. B. The nurse sits on the side of the bed of a dying patient, holding the patient's hand, and crying with the patient. C. The nurse refers to a counselor the daughter of a dying patient who is complaining about the care associated with artificially feeding her father. D. The nurse tells a dying patient to sit back and relax and performs patient hygiene for the patient because it is easier than having the patient help.

The nurse sits on the side of the bed of a dying patient, holding the patient's hand, and crying with the patient.

A 70-year-old patient who has had a number of strokes refuses further life-sustaining interventions, including artificial nutrition and hydration. She is competent, understands the consequences of her actions, is not depressed, and persists in refusing treatment. Her health care provider is adamant that she cannot be allowed to die this way, and her daughter agrees. An ethics consult has been initiated. Who would be the appropriate decision maker? The patient The patient's daughter The patient's health care provider The ethics consult team

The patient

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

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

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

To prevent and relieve suffering

A nurse interviews an 82-year-old resident of a long-term care facility who says that she has never gotten over the death of her son 20 years ago. She reports that her life fell apart after that and she never again felt like herself or was able to enjoy life. What type of grief is this woman experiencing? Somatic grief Anticipatory grief Unresolved grief Inhibited grief

Unresolved grief

The husband of a client 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? Normal grief Inhibited grief Unresolved grief Anticipatory grief

Unresolved grief

The children of a male client with late-stage Alzheimer 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: A. dictate how the client wants his estate handled after his death, and by whom. B. make legal provisions for active euthanasia. C. give permission for organ donation. D. specify the treatment measures that the client wants and does not want.

specify the treatment measures that the client wants and does not want.

The children of a male client with late-stage Alzheimer 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: A. give permission for organ donation. B. specify the treatment measures that the client wants and does not want. C. make legal provisions for active euthanasia. D. dictate how the client wants his estate handled after his death, and by whom.

specify the treatment measures that the client wants and does not want.