craven chapter 40

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

an older client grieves for the loss of his independence

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? -Denial - Anger - Bargaining -Acceptance

anger

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. -non-heart-beating cadavers are not potential organ donors. -clients must have an organ donor card to donate organs. -nursing focus should be directed at organ donation once it is decided to withdraw life support.

hospitals are mandated to notify transplantation

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)"Palliative care provides pain relief and other distressing symptoms." B)"Hospice care programs focus on quality rather than length of life." C)"In hospice care, the nurses make most of the care decisions for the patients." D)"Hospice focuses on treatments and care aimed only at relieving symptoms in the last few months of life" E)"Palliative care affirms life and regards dying as a normal process."

in hospice care, the nurses make most of the care decisions for the patients

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

inpatient pain management for hospice patients is covered by medicare

Which statement accurately describes the process known as grief reaction? - Reactions to grief and dying are different. -Reactions to grief are similar for all people. -Reactions to grief follow all stages of the grieving process. -Reactions to grief may differ from client to family.

reactions to grief may differ from client to family

A nurse is caring for a client with a terminal illness. Which statement is true of a terminal illness? -Recovery is very slow. - Recovery is beyond reasonable expectation. - Recovery is dependent on the client's treatment options. -Recovery takes a minimum of 3 months.

recovery is beyond reasonable expectation

An older adult client at a health care facility dies after a prolonged illness. Which is a psychological reaction associated with the different stages of grief? -refusal to accept death - behaving in a morbid manner -tightness in the throat -difficulty breathing

refusal to accept death

A nurse is providing care to a client in the protest stage of grief. Which interventions would be most appropriate? Select all that apply. -Encourage expression of diverse feelings. - Help identify new support systems. - Refer the client to self-help groups. - Refer the client for career counseling. - Teach client about the normal grief process.

Encourage expression of diverse feelings. Help identify new support systems. Teach client about the normal grief process.

To adequately assist a patient and family from a different culture with the death and dying process, the nurse must A)Understand the patient's cultural beliefs B)Progress through the stages of grief C)Experience death in his own life D)Have felt distress and anger

understand the patients cultural beliefs

The husband of a client who died of breast cancer is still grieving for his wife 2 years later. What type of grief is he experiencing? - situational - inhibited -unresolved -maturational

unresolved

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? -decreased pain -difficulty swallowing -increased urinary output - increased sensory stimulation

difficulty swallowing

The hospice nurse is assessing the wife of a patient who died 14 months ago. The nurse is concerned that the wife is still grieving the death of her husband. Which of the following objective assessment findings would suggest that the wife is NOT still grieving? A)Stating, "I think about him all of the time." B)Weight loss of 40 pounds in the last 14 months C)Stating, "I can't go on living like this." D)Hair is clean and styled.

hair is clean and styled

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 differs from palliative care in its foundational philosophy. -Hospice care focuses on quality of life while palliative care focuses on length of life. - Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness. -Hospice provides physical and psychological support; palliative care provides social and spiritual support.

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

When reviewing a patient's chart, the nurse notes that the patient is in the disorganization stage of grief. Which assessment finding would support this diagnosis? A)"It doesn't matter what I look like." B)"I haven't let my children out of my sight. I am afraid something will happen to them." C)"I had a good time at my class reunion. It was nice to be out with other people again." D)"I'm sick all of the time. I just can't get rid of this cold."

im sick all of the time. I just cant get rid of this cold

The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate? -"There's no need for anger." - "I can't imagine how awful this is for you." - "You should try to make things right with your family." -"It must be very difficult for you."

it must be very difficult for you

Which of the following describes lower-brain death? -It results in the inability to maintain circulation and respiration and is ventilator dependent. - It results in a vegetative state in which the client has no consciousness, speech, or feelings but is able to breathe independently. - It results in an irreversible cessation of heart-lung function. - It results in a coma state.

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

The nurse is caring for a client who has terminal lung cancer and is unconscious. What assessment would indicate to the nurse that the client's death is imminent? -Slow, steady pulse - Pursed lip breathing -Mottling of the lower limbs -Increased swallowing

mottling of the lower limbs

Which of the following statements about grief should the nurse include in the teaching plan developed to address a group of young adults? A)Individuals from lower socioeconomic classes tend to have a better outcome about loss. B)Nutrition and wellness have little effect on the outcome of grief. C)A family's developmental state does not affect the grief process. D)Multiple losses may strain the individual's ability to cope effectively.

multiple losses may strain the individuals ability to cope effectively

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." - "Postmortem care completed." - "Body transported to morgue." - "Notified the patient's daughter."

no breathing and no pulse at 0840

A home care nurse observes that the client denies the fact that she has lost her husband. The nurse interprets this denial as a psychological defense. Using the Parkes model, the nurse identifies that the client is in which stage? - Yearning - Disorganization -Numbness -Reorganization

numbness

"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)"The inability to talk about your dad without crying, even after a year, is still considered normal." B)"It is not normal. Your mother needs to see a therapist about her grief." C)"Everyone deals with loss differently. You just need to be patient with your mother." D)"Did your mother cry a lot before your father died?"

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

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 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 -infant - toddler - school-aged child

adult

Which signs assessed in a dying client would the nurse recognize as signs of death? Select all that apply. -Increased body temperature -Nausea, flatus, abdominal distention -Racing pulse -Cheyne-Stokes respirations -Loss of movement, sensation, and reflexes -Increased blood pressure

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

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 - Regular deep respirations - Decreased urine output -Irregular heart rate -Strong, bounding pulse

Pale, cool skin Decreased urine output Irregular heart rate

The nurse is caring for a client who has just expired. Which action will the nurse perform? -Provide a complete bath. -Place the client in a semi-Fowler's position. -Allow the client's family to see the client's body before it is discharged. -Have the nurse technician place identification tags on the outside of the shroud.

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

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

Anticipatory grieving related to the loss of family member as evidenced by sorrow

A 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 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. -Urge the client to continue a usual routine.

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.

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 - A regular apical pulse of 90 beats/minute -Systolic blood pressure which rose from 100 to 110 mm Hg -Cyanotic nail beds in hands and feet bilaterally

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

A home care nurse is providing care to an older adult client who is dying. The client's son asks the nurse how, when the time comes, he should tell his own children about their grandfather's death. Which suggestion by the nurse would be most appropriate? Select all that apply. -Tell your children to be stoic. -Include the children in any rituals. -Encourage the children to remember their grandfather. -Compare the children to their grandfather. - Help make the children feel loved and safe.

Include the children in any rituals. Encourage the children to remember their grandfather. Help make the children feel loved and safe.

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. -Encourage the client's desire to keep silent about the event. -Avoid making empathetic statements about the client's grief. - Avoid identification of fears regarding the loss. -Listen to expressions of grief. - Include significant others in discussions and decisions as appropriate. -Communicate acceptance of discussing the loss.

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

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. - The stages of grief occur linearly and are static. -Some people actually skip some stages of grief altogether. -The stages are relatively discrete and identifiable.

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

The nurse is caring for a client that is at the end of life. After the client is pronounced dead, what actions by the nurse are essential components of care? Select all that apply. -Washing the client's body - Removing all tubes according to agency policy, unless an autopsy is to be performed - Placing identification on the wrist -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

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

The students demonstrate understanding of the information when they identify the stages of the grief cycle model listed. Place them in the proper sequence from first to last that would demonstrate the student's accurate understanding.

Shock Protest Disorganization Reorganization

Applying Engel's models of grief, place the phases below in the order in which they would occur from first to last.

Shock and disbelief Developing awareness Restitution Resolving the loss Idealization Outcome

Which are signs of a "good death"? Select all that apply. -The person experiences moderate pain. -The person dies according to the wishes of the family. -The person dies with dignity. -The person is prepared for death. - The person has a sense of completion of life.

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

A nursing instructor has finished presenting information to a group of nursing students on the factors that influence the grieving process. Which statement by a student would indicate a need for further education? A)"The age of the person who died can dramatically affect the grieving process." B)"A death that occurs as a result of homicide or suicide is just as stressful as a death from natural causes." C)"Some people find strength in dealing with loss through their religious beliefs, whereas others experience greater distress due to their beliefs." D)"Absence of social supports can create additional stressors for the grieving person."

a death that occurs as a result of homicide or suicide is just as stressful as a death from natural causes

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

a man is unable to return to work after his sisters death 18 months ago

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

actual loss

A widow develops cancer within 6 months of her husband's death. This may be a result of A)Social isolation B)Alcohol intake C)Bereavement D)Multiple losses

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: -symptoms of terminal illness should not be treated. -care is generally guided by nurses rather than physicians. -care is premised on the fact that dying is a normal process. -the client must be within 6 weeks of his expected death.

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

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

cleanse drainage from the skin

Although all of the following are factors that affect grief, which one is most likely to influence a person's expression of grief? -socioeconomic factors - cultural influences -religious influences -cause of death

cultural influences

A nursing instructor is describing the stages of grief as identified by Kübler-Ross.

denial anger Bargaining Depression Acceptance

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 -Anger -Depression -Bargaining

depression

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 - treatment of the disease process -eliminating all forms of medical and nursing care -providing counseling related to the stages of death and dying

aggressive management of symptoms

A middle-age woman is mentally preparing for the death of her mother. This is termed A)Grieving B)Anticipatory grieving C)Bereavement D)Loss

anticipatory grieving

Which of the following stages of grieving is exhibited by the husband of a victim of sudden death who refuses to accept that she is dead? A)Doubt B)Protest C)Depression D)Shock

shock

The term bereavement is best defined as a A)Psychological response to a loss B)Socially conventional behavior after a loss C)Period of time after a loss of a loved one D)State of desolation that occurs after a loss

state of desolation that occurs after a loss

A client visits the health care facility for a regular check-up. The nurse is aware that the client lost his wife 2 months earlier. What would lead the nurse to suspect dysfunctional grief? -The client thinks briefly about suicide. - The client has resumed normal life. - The client begins abusing alcohol. - The client expresses a wish to die.

the client begins abusing alcohol

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 frequency of urination decreases. -The arms and legs are warm to touch. - The client is calm and peaceful. - The client's breathing becomes noisy.

the clients breathing becomes noisy

Which does not coincide with Kübler-Ross's stages related to a dying client? -Clients don't always follow the stages in order. -Some client regress, then move forward again. - The dying client usually exhibits anger first. - The client may be in several stages at once.

the dying client usually exhibits anger first

A widow has just returned home from the funeral of her husband. She feels alone in her home. Her family has left to go back to their home in another area of the country. What stage of Engel's model does this represent? A)Shock and disbelief B)Developing awareness C)Restitution D)Resolving the grief

developing awareness

A nurse is providing care to pediatric clients on an oncology floor. The nurse would expect which age group as perceiving death as reversible, avoidable and occurring in degrees? -Infants - Toddlers - Preschoolers - School-age children

preschoolers

The nurse is preparing a care plan for a patient with the nursing diagnosis of Dysfunctional Grieving. Which of the following nursing interventions should the nurse include? Select all that apply. A)Provide the patient with information regarding a grief support group. B)Encourage the patient to have regular check-ups with their healthcare provider. C)Avoid talking about the loss if it upsets the patient. D)Refer the patient to a grief specialist. E)Encourage the patient to talk about only the positives of the deceased person.

provide the patient with information regarding a grief support group encourage the patient to have regular check ups with their healthcare provider refer the patient to a grief specialist