Chp 43 PrepU Loss, Grief, and Dying

A couple has sent their youngest child to college in another state and both are experiencing "empty nest syndrome." This is an example of:

maturational loss.

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:

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

The nurse is giving palliative care to a client with a diagnosis of COPD. What is the goal of palliative care?

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 prevent and relieve suffering

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?

"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?

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

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."

A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education?

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

A nurse completing admission paperwork asks the client about having an advanced directive. The client states, "I do not know, what is an advanced directive?" What is the nurse's best response?

"It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition."

The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate?

"It must be very difficult for you."

The 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?

"What have you been told?"

When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response?

"This must be very difficult for you."

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?"

Which nursing interventions would be anticipated with hospice care? Select all that apply.

Administer prescribed morphine for pain control. Ease respiratory function by providing oxygen via nasal cannula. Administer prescribed antiemetics to control nausea. Insert a Foley catheter to prevent incontinence.

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

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?

Administering a lethal dose of medication

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.

Which statement regarding perceptions of death by children is accurate?

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

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 hospice nurse is visiting the wife of a client who died 10 months ago. The wife states, "My life is meaningless since my husband died." The nurse recognizes that the client is in which stage of grief?

Disorganization

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

Irregular respiratory rate Restlessness Bowel incontinence Cyanosis of dependent areas

A client comes to the hospital because of complications related to newly diagnosed terminal cancer. The client is concerned about how his wife is coping with the diagnosis. Which information is important for the nurse to obtain to assess factors that may affect the family member's grief? Select all that apply.

Financial concerns Cultural practices Religious beliefs Social support

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.

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

The wife of a client who has been diagnosed with a terminal illness asks the nurse about the differences between palliative care and hospice care. Which information would the nurse most likely include in the response?

Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness

A nurse is providing care to a 9 1/2-year old child who is terminally ill. When talking with the child, the nurse would need to understand that the child most likely views death as which type of event? Select all that apply.

Irreversible Universal Inevitable

A home hospice client who has Medicare is experiencing extreme pain at home and is refusing to receive inpatient care due to concerns over the cost of inpatient care. What teaching will the nurse include in the plan of care?

Inpatient pain management for hospice patients is covered by Medicare.

A nurse 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.

The nurse is discussing end-of-life decisions with a patient who has terminal cancer. Which statements describe the patient's options? (Select all that apply.)

Living wills provide specific instructions about the kinds of health care that should be provided or foregone in particular situations. The Patient Self-Determination Act of 1990 requires all hospitals to inform their patients about advance directives. The status of advance directives varies from state to state.

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

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 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

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.

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.

The nurse is making sure that all factors are in place for a client's death certificate. What potential error that may occur does the nurse identify?

The client had a condition that has the potential to temporarily suspend life process.

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. What should happen in this case?

The client should be treated with antibiotics for pneumonia.

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?

The client's breathing becomes noisy.

A client who was brought to the emergency room for gunshot wounds dies in intensive care 15 hours later. Which statement concerning the need for an autopsy would apply to this client?

The coroner must be notified to determine the need for an autopsy

Which are signs of a "good death"? Select all that apply.

The person dies with dignity. The person is prepared for death. The person has a sense of completion of life.

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?

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 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 Kübler-Ross Model?

acceptance

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

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

The spouse of a recently deceased client states, "I just can't believe he left me. He swore he would never leave me and I feel betrayed!" Using Kübler-Ross stages of grief, what stage does the nurse identify the client is experiencing?

anger

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

A client with a terminal illness is overheard by the nurse saying, "If I promise never to smoke another cigarette in my life, please let me recover from this lung cancer." How will the nurse document this stage of grief according to the Kübler-Ross model?

bargaining

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

bargaining

A widow develops cancer within 6 months of her husband's death. This may be a result of:

bereavement.

A client has a diagnosis of bladder cancer with metastasis. The client asks the nurse about the characteristics of hospice care. The nurse should explain that:

care is premised on the fact that dying is a normal process.

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.

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

coping strategies

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

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

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

A critical care nurse is aware of the legislation that surrounds organ donation. When caring for a potential organ donor, the nurse is aware that:

hospitals are mandated to notify transplantation programs of potential donors.

A nurse is providing postmortem care. Which of the following nursing actions is a legal responsibility?

placing ID tags on the shroud and ankle

The nurse is talking with the son of a client with end-stage renal failure and late-stage dementia. The client can no longer live at home, and the son states, "I live 500 miles away. I don't know what to do." Which type of living arrangement will the nurse teach the son about?

residential care

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

residential care

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.