Chapter 43: loss, grief, and dying

For which persons are death certificates necessary? Select all that apply. A) Death from an infectious disease B) Death in an institutional setting C) Unexpected death D) Murder victims E) Death before age 65 years

A) Death from an infectious disease B) Death in an institutional setting C) Unexpected death D) Murder victims E) Death before age 65 years

As decisions related to health care become increasingly complex, nurses need to be familiar with concepts related to 1. advance directives. Which statement regarding advance directives is correct? A) Hospitals are legally required to inform clients about advance directives. B) The status of advance directives remains consistent from state to state. C) Advance directives should be developed with the assistance of a physician or nurse. D) Nurses can be appointed a surrogate decision maker by the client.

A) Hospitals are legally required to inform clients about advance directives.

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

A) Improve the client's and family's quality of life.

Which of the following persons is responsible for handling and filing a death certificate with proper authorities? A) Mortician B) Physician C) Nurse D) Hospital administrator

A) Mortician

A nurse is developing a plan of care for a dying client. Which of the following physiologic basic human needs should be 20. addressed? A) Personal hygiene B) Risk for infection C) Family support D) Spirituality

A) Personal hygiene

A dying client is crying. She states, Why me, Lord?" and "I can't pray." What would be an appropriate nursing 35. diagnosis based on this data? A) Psycho-spiritual distress B) Low self esteem C) Ineffective coping D) Knowledge deficit related to praying

A) Psycho-spiritual distress

A young client died following a cardiac arrest. The nurse caring for the client and the family notes that some members of 25. the family refuse to accept that the client has died. What stage of grief is the family experiencing? A) Shock and disbelief B) Developing awareness C) Restitution period D) Idealization

A) Shock and disbelief

A nurse assesses a terminally ill patient with a DNR order, with findings of decreased blood pressure, urinary and bowel incontinence, loss of reflexes, and Cheyne-Stokes respirations. Based on these findings, the nurse recognizes which of 9. the following? A) These are signs of impending death. B) These signs do not indicate any abnormality. C) The client requires immediate resuscitation. D) The client's family should be asked to leave.

A) These are signs of impending death.

The husband of a client who died of breast cancer is still grieving for his wife two years later. What type of grief is he 7. experiencing? A) Unresolved B) Situational C) Inhibited D) Maturational

A) Unresolved

The client is newly diagnosed as having a terminal disease and asks, "I'm going to die soon, aren't I?" What are the 31. most appropriate statements by the nurse? Select all that apply. A) "You should ask your health care provider that question." B) "What have you been told by your health care provider?" C) "How do you feel about that?" D) "This is something I am not comfortable discussing." E) "No, you are not actively dying."

B) "What have you been told by your health care provider?" C) "How do you feel about that?"

A dying client states in writing ahead of time what her choices would be for health care should certain circumstances 14. develop. What is the term for this document? A) Living will B) Advance directives C) Durable power of attorney D) Comfort measures only

B) Advance directives

A middle-age woman is mentally preparing for the death of her mother. What is the term for this mental preparation? A) Grieving B) Anticipatory grieving C) Bereavement D) Loss

B) Anticipatory grieving

A man is diagnosed with terminal kidney failure. His wife demonstrates loss and grief behaviors. What type of loss is 4. the wife experiencing? A) Maturational loss B) Anticipatory loss C) Dysfunctional grieving D) Bereavement

B) Anticipatory loss

Although all of the following are factors that affect grief, which one is most likely to influence a person's expression of 18. grief? A) Socioeconomic factors B) Cultural influences C) Religious influences D) Cause of death

B) Cultural influences

A terminally ill client states to the nurse, "My situation is hopeless; I have no control over anything." The nurse 32. implements which of the following interventions to enable hope for the client? A) State to the client, "We have explored all treatment options." B) Encourage the client to discuss his feelings. C) Sit in a chair next to the client. D) Hold the client's hand. E) Withhold information about disease progression.

B) Encourage the client to discuss his feelings. C) Sit in a chair next to the client. D) Hold the client's hand.

A dying client and family have requested that no attempts be made to resuscitate the client in the event of death. A 15. doctor has written a DNR order. What is the nurse's responsibility if the client dies? A) Follow his or her own conscience and perform CPR. B) Make no attempt to resuscitate the client. C) Follow a verbal physician order for a slow code. D) If the client is at home, call 911 and begin CPR.

B) Make no attempt to resuscitate the client.

Palliative care is a structured system for care delivery that has what as its aim? A) To give traditional medical care B) To prevent and relieve suffering C) To bridge between curative care and hospice care D) To provide care while there is still hope

B) To prevent and relieve suffering

While caring for a client near end of life, a student talks to her. Another student asks why she is talking to someone who 21. is dying. Which response would be accurate? A) "It makes me feel better to talk to my clients." B) "I do this so I won't be so afraid the client will die." C) "I believe the client can hear me as long as she is alive." D) "I don't know; the nurse in charge of the client told me to."

C) "I believe the client can hear me as long as she is alive."

Kübler-Ross defines five stages of psychosocial responses to dying and death. Which of the following statements is 10. characteristic of the bargaining stage? A) "The doctors must have made a mistake." B) "Why did this happen to me? I always exercised." C) "Just let me live to see my grandson born." D) "I've had a good life and I can die in peace."

C) "Just let me live to see my grandson born."

Family members of a dying client are in the room with their loved one. As the client nears death, what should the nurse 23. tell the family? A) "Please leave the room now. It is time to let go." B) "Only one family member at a time can stay in the room." C) "Please stay with your loved one and talk to him." D) "I will have to get an order for you to stay now."

C) "Please stay with your loved one and talk to him."

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

C) An older client grieves for the loss of his independence.

A nurse is caring for a young client who is dying of renal failure. What should the nurse do when caring for the dying 26. client's family members? A) Inform the family that the client may soon be out of danger B) Request the family members not to talk about death to the client C) Inform the family members that it is time to bid farewell to the client D) Provide respite care to the client's family members

C) Inform the family members that it is time to bid farewell to the client

A client asks a nurse to explain a living will. What is the nurse's best answer? A) It specifies who will inherit the client's estate. B) It determines an individual's quality of life. C) It lists specific instructions for health care provisions. D) It identifies a trusted person to make health care decisions.

C) It lists specific instructions for health care provisions.

A hospice nurse is providing emotional care and support for a family who lost a son. The care will be provided based on 22. what knowledge? A) All members of the family will react to loss in the same way. B) Grief is an abnormal physical reaction to a loss. C) Stages of grief reactions may overlap and are individualized. D) Bereavement is a normal process, requiring little intervention.

C) Stages of grief reactions may overlap and are individualized.

A nurse providing palliative care for a dying man and his family knows that the goal of palliative care is what? A) To aggressively treat the disease. B) To provide care for the dying in the home. C) To aggressively treat the symptoms of the disease. D) To support the family of the dying client.

C) To aggressively treat the symptoms of the disease.

According to the Harvard University Medical School committee, what function must be irreversibly lost to define death? A) Respiratory functions B) Reflexes C) Consciousness D) Brain function

D) Brain function

A client is diagnosed with a terminal illness. Who is usually responsible for deciding what, when, and how the client 11. should be told? A) Family B) Clergy C) Nurse D) Physician

D) Physician

A nurse is providing postmortem care. Which of the following nursing actions is a legal responsibility? A) Placing the body in normal anatomic position B) Removing tubes and soiled dressings C) Washing the body to remove blood and excretions D) Placing ID tags on the shroud and ankle

D) Placing ID tags on the shroud and ankle

A nurse is caring for a young client with acute renal failure who is dying. What care should the nurse take when helping 27. dying clients to cope? A) Avoid discussing death with the client. B) Ask the client's family not to disturb the client. C) Avoid informing the client of his or her actual health status. D) Provide opportunities for the client to express his or her feelings freely.

D) Provide opportunities for the client to express his or her feelings freely.

Which one of the following statements accurately describes the process known as grief reaction? A) Reactions to grief and dying are different. B) Reactions to grief are similar for all people. C) Reactions to grief follow all stages of the grieving process. D) Reactions to grief may differ from client to family.

D) Reactions to grief may differ from client to family.

A dying client is undergoing terminal weaning. What is the purpose of this intervention? A) To manage the symptoms of the illness B) To prepare for resuscitation of the client C) To initiate life-sustaining measures for the client D) To gradually withdraw mechanical ventilation

D) To gradually withdraw mechanical ventilation

Which of the following statements is typical of the first stage of grieving described by Engel? A) "No, not me." B) "Why me?" C) "My husband was the best man in the world." D) "The funeral service helped me survive."

A) "No, not me."

A terminally ill client, in severe pain, asks a nurse to help her die. What must the nurse consider morally, ethically, and 16. professionally before answering the client? A) ANA Code for Nurses, ethical and professional standards B) Own personal moral and ethical values and standards C) Hospital or agency procedures and protocols D) Medical Code of Ethics, belief in active euthanasia

A) ANA Code for Nurses, ethical and professional standards

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

A) Actual loss

An appropriate nursing diagnosis for the family of a client dying of cancer, whose members have expressed sorrow over 29. the forthcoming loss, would be ... A) Anticipatory grieving related to loss of family member, as evidenced by sorrow B) Dysfunctional grieving related to the loss of family member, as manifested by behaviors indicating anxiety C) Potential for grieving related to loss of family member and sorrow D) Dysfunctional grieving related to future loss of family member, manifested by family's developmental regression

A) Anticipatory grieving related to loss of family member, as evidenced by sorrow