Exam 2 PrepU
The nurse is caring for a client whose spouse has just passed away. The nurse knows that according to the Kubler-Ross Model of Grief, there are five stages of grief that most grieving people progress through in order, although not everyone experiences all stages or in this order. Place the stages of grief in the order that is most commonly observed, and that the nurse would expect to see in this grieving client. 1) Anger 2) Depression 3) Acceptance 4) Bargaining 5) Denial
5; 1; 4; 2; 3
A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are ordered by the health care provider. Which intervention should the nurse complete first? A) Administer epinephrine (adrenaline). B) Complete a 12-lead ECG. C) Start a normal saline infusion. D) Administer diphenhydramine.
A) Administer epinephrine (adrenaline).
A school nurse is evaluating a 7-year-old child who is having an asthma attack. The child is cyanotic and unable to speak, with decreased breath sounds and shallow respirations. What is the nurse's next action? A) Prepare to ventilate the child. B) Monitor the child with a pulse oximeter in the office. C) Have the child lie down to conserve energy. D) Contact the child's parent or guardian.
A) Prepare to ventilate the child.
A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says: A) "I should sleep on my side all night long." B) "I should become involved in a weight loss program." C) "I should eat a high-protein diet." D) "I need to keep my inhaler at the bedside."
B) "I should become involved in a weight loss program."
When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response? A) "Yes, this is a terrible diagnosis you've received." B) "This must be very difficult for you." C) "I'm sure you are angry and sad." D) "Have you talked with your spiritual leader about your fears?"
B) "This must be very difficult for you."
Prolonged immobility is implicated in the development of which disorder? A) Bronchitis and bronchiectasis B) Atelectasis and pulmonary embolism C) Sarcoidosis and idiopathic pulmonary fibrosis D) Pulmonary hypertension and cor pulmonale
B) Atelectasis and pulmonary embolism
The family of a client who was receiving hospice care contacts the facility every week to talk with the nurse who was the client's primary caregiver. What action should be taken to support the family? A) Suggest the family engage in work and leisure activities. B) Contact the hospice agency to provide grief support for the family. C) Ask the family to come to the facility to meet with the primary nurse caregiver. D) Schedule time to visit the family at home.
B) Contact the hospice agency to provide grief support for the family.
Which experience could be the possible cause of grief due the loss of security and belonging for the client? A) Amputation B) Divorce C) Failure to achieve promotion at work D) Violence at workplace
B) Divorce
When developing the plan of care for a child with respiratory distress, what nursing intervention can the nurse provide that will facilitate respiratory movements and avoid airway compression? A) Administer antibiotics. B) Elevate the head of the bed. C) Administer intravenous fluids. D) Handle the child frequently to keep her stimulated to breathe.
B) Elevate the head of the bed.
A client who was prescribed CPAP several months ago reports non-adherence to treatment. What is the appropriate priority nursing intervention? A) Explain uses of BiPAP masks versus CPAP masks. B) Inquire about factors that contribute to non-adherence. C) Notify the healthcare provider of the client's current status. D) Document assessment and plan for intervention.
B) Inquire about factors that contribute to non-adherence.
The most common cause of cholinergic crisis includes which of the following? A) Undermedication B) Overmedication C) Compliance with medication D) Infection
B) Overmedication
A nurse is working with a dying client and the client's family. Which communication technique is most important to use? A) Offer the family different coping mechanisms. B) Use active listening and silence when communicating. C) Allow the family to initiate communication when they are ready. D) Avoid asking for more information from the client and family members.
B) Use active listening and silence when communicating.
The nurse is assessing a client's thorax and lungs. Which finding would indicate the need for further assessment? A) an anteroposterior to lateral ratio of 1:2 B) auscultation of short, high-pitched popping sounds during inspiration C) blowing, hollow sounds auscultated over the larynx D) palpation of muscle symmetry over the posterior thorax
B) auscultation of short, high-pitched popping sounds during inspiration
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? A) depression B) bargaining C) denial D) acceptance
B) bargaining
A client with uncontrolled hypertension experienced a stroke a week ago, leading to significant motor losses. A successful and normal adaptive response to these new limitations is evident if the client: A) changes the subject when the nurse addresses activities of daily living (ADLs). B) exhibits signs of grief. C) refuses to participate in physiotherapy. D) repeatedly states, "It is what it is."
B) exhibits signs of grief.
The nurse meets with a client who reports meeting with siblings yesterday to chose a coffin for the deceased mother. How can the nurse most accurately describe this process to the client? A) grieving B) mourning C) bereavement D) anticipatory grieving
B) mourning
A female client tells the nurse she has had low appetite and motivation since the recent breakup of a long-term relationship. The client states, "I just can't stand not having her around. I need her back." The client is experiencing which of Bowlby's phases of grieving? A) reorganization B) yearning C) disorganization and despair D) shock, numbness and protest
B) yearning
The nurse is caring for a client with a terminal illness who is awaiting transfer to hospice. The client states, "It is all out of my hands now." How should the nurse respond? A) "Are you feeling like you do not have control? Would you like to discuss the planned transfer to hospice?" B) "I hear you saying you do not feel in control. What coping technique do you usually use when feeling this way?" C) "I hear you saying things are out of your hands. Can you tell me more about what has you feeling this way?" D) "Change and transition can be challenging. We are here to support you. What can I do now to help?"
C) "I hear you saying things are out of your hands. Can you tell me more about what has you feeling this way?"
Which phrase can do much to instill hope in the dying client? A) "Everything will be fine, so don't worry." B) "This is a hopeless situation." C) "Let me tell you about your illness." D) "Nothing more can be done."
C) "Let me tell you about your illness."
"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) "It is not normal. Your mother needs to see a therapist about her grief." C) "The inability to talk about your dad without crying, even after a year, is still considered normal." D) "In fact, the more that someone cries about a loss, the better they're dealing with it."
C) "The inability to talk about your dad without crying, even after a year, is still considered normal."
A client experiences burning muscle pain at the peak of high intensity physical training for an athletic competition. What is the best explanation for the cause of this occurrence? A) Fatty acids go through the beta-oxidation process to release energy. B) Acetyl-CoA begins the reactions in the citric acid cycle to release carbon dioxide. C) Anaerobic glycolysis creates pyruvate, which converts to lactic acid. D) Mitochondria cause oxidation of electrons to create a net increase of ATP.
C) Anaerobic glycolysis creates pyruvate, which converts to lactic acid.
An infant who was born prematurely and developed respiratory distress syndrome was placed on mechanical ventilation for several weeks. What condition should the nurse monitor the infant for related to the long-term ventilatory support? A) Spasmodic croup B) Bacterial tracheitis C) Bronchopulmonary dysplasia D) Blastomycosis
C) Bronchopulmonary dysplasia
According to Mardi Horowitz (2001), life begins to feel "normal" again in which stage? A) Outcry B) Denial and intrusion C) Completion D) Working through
C) Completion
A client has been diagnosed with Guillain-Barré syndrome and is being treated in the intensive care unit. The client is experiencing rapidly ascending paralysis. What is the nurse's priorityintervention when caring for this client? A) Inserting a Foley catheter B) Assessing distal peripheral pulses C) Maintenance of the client's airway D) Restarting the IV when it infiltrates
C) Maintenance of the client's airway
A nurse is volunteering at a day camp. A child is stung by a bee and develops wheezing in the upper airways. The child is experiencing: A) bronchiolitis. B) bronchiectasis. C) a bronchospasm. D) bronchitis.
C) a bronchospasm.
A middle-aged man walks into the emergency department reporting chest pain radiating to the neck, shortness of breath, and nausea. His heart rate is 120 and BP is 94/60. The ED physician recognizes the client is having an acute MI with decreased cardiac output. The nurse identifies the nausea to be in response to: A) fear of having to make major lifestyle changes. B) the client hasn't digested his meal completely. C) hypoxia exerting a direct effect on the chemoreceptor trigger zone. D) the client doesn't have a very high pain tolerance.
C) hypoxia exerting a direct effect on the chemoreceptor trigger zone.
Which statement by the nurse would be considered inappropriate when comforting a family who has experienced a stillborn infant? A) "I will make handprints and footprints of the baby for you to keep." B) "Many mothers who have lost an infant want pictures of the baby. Can I make some for you?" C) "Have you named your baby yet? I would like to know your baby's name." D) "I know you are hurting, but you can have another baby in the future."
D) "I know you are hurting, but you can have another baby in the future."
Which statement describes emphysema? A) Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years B) Chronic dilatation of a bronchus or bronchi C) A disease that results in reversible airflow obstruction, a common clinical outcome D) A disease of the airways characterized by destruction of the walls of overdistended alveoli
D) A disease of the airways characterized by destruction of the walls of overdistended alveoli
Which assessment findings can most accurately be described as complicated grieving? A) A person has been experiencing chronic insomnia since the person's mother's death earlier this year B) A person cries frequently and loudly in the weeks following a child's death in an accident C) A person blames oneself for not doing more to make a spouse's recent death more comfortable D) A person is unable to return to work after a sister's death 18 months ago
D) A person is unable to return to work after a sister's death 18 months ago
Which is an age-related change in the respiratory system? A) Loss of muscle strength and size B) Increased blood pressure C) Difficulty swallowing D) Decreased gas exchange
D) Decreased gas exchange
Which of the following is a term that refers to individual, family, group, and cultural expressions of grief and associated behaviors? A) Bereavement B) Grief C) Spirituality D) Mourning
D) Mourning
During which phase of Bowlby's grief process does the bereaved person begin to reestablish a sense of personal identity, direction, and purpose for living? A) Phase of disorganization and despair B) Phase of yearning and searching C) Phase of numbing D) Phase of recognition
D) Phase of recognition
A public health nurse is participating in a health fair that is being held at a local community center. The nurse should encourage adult participants to completely eliminate which of the following from their diet and lifestyle? A) Cholesterol B) Alcohol C) Salt D) Smoking
D) Smoking
The nurse develops outcome criteria for a patient with chronic obstructive pulmonary disease. Which outcome criteria are appropriate for this patient? A) The nurse will obtain a pulse oximetry reading twice a day. B) The patient will perform passive range-of-motion exercises once daily. C) The patient will not experience an alteration in skin integrity. D) The patient will have the ability to climb a flight of stairs without experiencing difficulty in breathing.
D) The patient will have the ability to climb a flight of stairs without experiencing difficulty in breathing.
Which comfort technique does a nurse teach to a client with pleurisy to assist with splinting the chest wall? A) Use a prescribed analgesic B) Use a heat application C) Elevate the head of the bed D) Turn onto the affected side
D) Turn onto the affected side
A client is returning from the operating room after inguinal hernia repair. The nurse notes that the client has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure? A) right upper quadrant pain B) dependent edema C) jugular vein distention D) bibasilar crackles
D) bibasilar crackles
A client has inhaled, drawing air into the oropharynx. From this location, air will: A) undergo gas exchange, beginning in the bronchi. B) start to diffuse into the type I alveoli lining the trachea. C) proceed from type I alveolar cells to type II alveolar cells and into circulation. D) proceed through the trachea, bronchi, and then bronchioles.
D) proceed through the trachea, bronchi, and then bronchioles.
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: A) "Why did this have to happen to me?" B) "I don't care about anything. I have no energy." C) "I do not believe I have this disease." D) "I just want to see my son have a family of his own."
A) "Why did this have to happen to me?"
The nurse is providing individual support to a female client who attends a group for people who have experienced loss of a family member to suicide. The client's son committed suicide one month ago. The client was not aware that her son experienced depression. Which risk factors for complicated grief are most likely for this client? (Select all that apply.) A) low self-esteem B) death of a child C) low trust in others D) death by suicide E) sudden, unexpected death
B) death of a child D) death by suicide E) sudden, unexpected death
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 had a good time at my class reunion. It was nice to be out with other people again." B) "I haven't let my children out of my sight. I am afraid something will happen to them." C) "I feel like I have absolutely no idea what to do next." D) "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."
A nurse is assessing a client who is depressed but unwilling to discuss the client's feelings. After speaking with the client's caregiver, the nurse learns that the client's pet died recently. Which is the most likely reason the client has hesitated to express the client's feelings? A) The client feels that the feelings related to the pet's death are insignificant. B) The client feels that the nurse would not be able to make the client feel better. C) The client feels that the nurse would not consider the grief as significant. D) The client does not want to remember the memories of the pet.
C) The clients feels that the nurse would not consider the grief as significant.
An obstetric ultrasound reveals that the client's fetus has spina bifida. The mother is concerned about raising a child with a congenital abnormality and starts to cry. Which response by the nurse is best? A) "I'll refer you to a support group of other spina bifida mothers who can help you." B) "Can you tell me the reasons why you might not be able to care for a special needs child?" C) "Here are some tissues. We can talk about your decisions when you're not so upset." D) "I know this must be overwhelming. I'm here to sit with you and support you."
D) "I know this must be overwhelming. I'm here to sit with you and support you."
The nurse is caring for an infant girl in an outpatient setting. The infant has just been diagnosed with developmental dysplasia of the hip (DDH). The mother is very upset about the diagnosis and blames herself for her daughter's condition. Which response best addresses the mother's concerns? A) "Don't worry; this is a relatively common diagnosis." B) "There are simple noninvasive treatment options." C) "Your daughter will likely wear a Pavlik harness." D) "This is not your fault and we will help you with her care and treatment."
D) "This is not your fault and we will help you with her care and treatment."
A client who has been in recovery from alcohol abuse for over one year tells the nurse he is drinking 5 to 6 beers per night since the client's mother's death. Which is the nurse's mostaccurate explanation for the client's grief response? A) behavioral B) physiologic C) spiritual D) emotional
A) behavioral
A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation? A) Sympathy B) Empathy C) Pity D) Indifference
B) Empathy
What is Kübler-Ross's third stage of grief? A) depression B) bargaining C) anger D) denial
B) bargaining
The nurse is providing discharge instructions for a client who has received a prescription for lorazepam after the death of a loved one. Which phase of psychopharmacologic treatment does this describe? A) maintenance B) diagnosis C) stabilization D) initiation
C) stabilization
The nurse is caring for a client who has recently lost a sibling due to suicide. Which type of grief does the nurse anticipate the client is experiencing? A) chronic grief B) uncomplicated grief C) traumatic grief D) complicated grief
C) traumatic grief
The experience of parting with an object, person, belief, or relationship that one values is defined as: A) death. B) bereavement. C) grief. D) loss.
D) loss.
The parents of a school-age child with a brain tumor have elected to have only comfort measures instituted for their dying child. The child has been experiencing significant discomfort and has been receiving pain medication. A nurse knows that the pain-management principle most effective in controlling the child's pain is: A) alternating stronger opioid pain medications with nonopioid agents. B) administering pain medication promptly when the child requests it. C) using an age-appropriate tool for effectively assessing pain. D) striving to prevent pain by routine administration of pain medication.
D) striving to prevent pain by routine administration of pain medication.
A group of nursing students is reviewing information about grief and bereavement. The students demonstrate understanding of the information when they state: A) Bereavement is the process of mourning and grief is the emotional reaction. B) Bereavement is influenced by culture, but grief is not. C) Grief and bereavement are used interchangeably as responses to loss. D) Grief involves confronting the stressor, but bereavement helps to avoid the stressor.
A) Bereavement is the process of mourning and grief is the emotional reaction.
Which is the initial stage of grief, according to Kübler-Ross? A) Denial B) Anger C) Depression D) Bargaining
A) Denial
A client who experienced shock is now nonresponsive and having cardiac dysrhythmias. The client is being mechanically ventilated, receiving medications to maintain renal perfusion, and is not responding to treatment. In this stage, it is most important for the nurse to A) Encourage the family to touch and talk to the client. B) Inform the family that everything is being done to assist with the client's survival. C) Open up discussion among the family members about nursing home placement. D) Contact a spiritual advisor to provide comfort to the family.
A) Encourage the family to touch and talk to the client.
Which type of grief occurs when a person is stuck in a state of chronic grieving? A) complicated grief B) traumatic grief C) uncomplicated grief D) bereavement
A) complicated grief
The nurse is providing care to the following clients. The nurse assesses the client exhibiting maladaptive behavior as the client who is: A) experiencing a terminal illness and states, "If I pray to God and go to church each week, I will live." B) overweight, consumes 1,600 calories/day, and exercises 30 minutes a day 5 times each week. C) 84 years old with multiple health problems and requesting to see an end-of-life care specialist. D) participating in a smoking cessation program after her father was diagnosed with lung cancer.
A) experiencing a terminal illness and states, "If I pray to God and go to church each week, I will live."
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) Administering a morphine infusion B) Administering a lethal dose of medication C) Neglecting to resuscitate a client with a "do not resuscitate" status D) Granting a client's request not to initiate enteral feeding when the client is unable to eat
B) Administering a lethal dose of medication
The nurse is caring for a client who has been placed in palliative care. The nurse observes the client constantly looking at photographs from youth. According to the tasks of grieving by Rando, which task is being accomplished here? A) React B) Recollect C) Recognize D) Relinquish
B) Recollect
The family of a client receiving hospice care takes a dinner break only to learn that the client died while they were absent from the bedside. What should the nurse do to console the family at this time? A) Discuss how the client is no longer in pain and is now at rest. B) Stay with the family while they view the body. C) Explain that the time of death could not be predicted. D) Allow the family to feel guilty for leaving the client to die alone.
B) Stay with the family while they view the body.
A client diagnosed with advanced lung cancer has a nursing diagnosis of Ineffective Coping. What assessment data would provide evidence to the nurse for this diagnosis? A) The client makes funeral plans. B) The client states, "I am sure the doctors have misdiagnosed me." C) The client asks about hospice services. D) The client states, "I hope that I am able to attend my daughter's wedding."
B) The client states, "I am sure the doctors have misdiagnosed me."
The nurse observes that a client is very sad and dejected after a myocardial infarction. What is the best response to the statement, "Life will never be the same"? A) "I don't understand. You have survived this heart attack. Why do you think life will never be the same?" B) "Hope has important healing powers. You need to be a little more hopeful of your recovery from this heart attack." C) "You're very concerned when you think about how this will change your life." D) "This heart attack really saddens you."
C) "You're very concerned when you think about how this will change your life."
The roommate of a recently deceased client is observed sitting in the client lounge crying. What should the nurse do to support this person? A) Change the roommate's assigned room. B) Permit the roommate to cry alone. C) Console the roommate as grieving begins. D) Ask the facility chaplain to talk with the roommate.
C) Console the roommate as grieving begins.
When the nurse is assisting the parents in the grieving process after the death of their neonate, what is the nurse's most important action? A) Removing the infant quickly. B) Leaving the parents alone. C) Keeping the communication lines open. D) Contacting a grief counselor.
C) Keeping the communication lines open.
Which is the most frequent and persistent bereavement-associated symptom? A) Headaches B) Indigestion C) Sleep disturbances D) Impaired appetite
C) Sleep distubances
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.
C) bereavement
The nurse is assessing a client who is grieving the loss of a spouse. According to Kubler-Ross's stages of grieving, which statement indicates that the client is in the depression stage? A) "Please send my spouse back to me dear God. I would never ever fight again." B) "My spouse was laughing and happy yesterday. My spouse cannot be dead." C) "Oh God. Why did you take my spouse away from me? What wrong did I do?" D) "My spouse is gone. I am having a really hard time finding a reason to keep going."
D) "My spouse is gone. I am having a really hard time finding a reason to keep going."
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? A) Anger B) Bargaining C) Denial D) Depression
D) Depression
The client expresses grief about not being able to fulfill the wish to pursue doctoral studies. Which type of loss does this indicate? A) Loss of safety B) Loss of security and a sense of belonging C) Loss of self-esteem D) Loss related to self-actualization
D) Loss related to self-actualization
A client gives birth to a neonate prematurely at 28 weeks' gestation. The neonate is placed in the neonatal intensive care unit (NICU). Three days later, the client's partner seems withdrawn and barely speaks to the staff when visiting the child in the NICU. Which interpretation of this behavior is most appropriate? A) The client's partner is exhibiting displaced anger at the nursing staff. B) The client's partner needs antidepressants. C) The client's partner has depression because of grieving. D) The client's partner denies the seriousness of the child's condition.
C) The client's partner has depression because of grieving.
Which nursing diagnosis is most likely for a client who has just undergone a total laryngectomy? A) deficient knowledge B) risk for infection C) impaired verbal communication D) risk for chronic low self-esteem
C) impaired verbal communication
The nurse is caring for a client who recently lost an infant to sudden infant death syndrome (SIDS). The client talks about how going back to work last week and that the couple want to become pregnant again soon to have another baby. The client reports feeling sad sometimes, but also feeling happy sometimes. What stage of grief does this client demonstrate? A) Bargaining B) Denial C) Delusion D) Acceptance
D) Acceptance
Which factor is likely to have the greatest impact on how a client responds to grief? A) Cause of death B) Religious influences C) Socioeconomic factors D) Cultural influences
D) Cultural influences
A home health nurse is visiting a family after the recent death of their matriarch. The nurse observes that the family is dressed in black, all of the mirrors are covered, and that the immediate family is sitting on square wooden boxes instead of chairs. The nurse asks what is happening, and is told, "We are Jewish, and the family is 'Sitting Shiva'." This family is fulfilling which family function? A) economical function B) socialization function C) physical function D) affective and coping functions
D) affective and coping functions
The healthcare provider has indicated that a client has a poor prognosis for recovery, and the family is very concerned. How would the nurse best support the family? A) Reassure the family that it is normal to feel concerned after hearing such a prognosis. B) Accommodate their grieving, explain what is happening, and encourage involvement in the care. C) Encourage realistic expectations of recovery and reinforce the reality of the prognosis. D) Encourage the family to stay positive and focus on the possibilities for the future.
B) Accommodate their grieving, explain what is happening, and encourage involvement in the care.
The spouse of a client who died of breast cancer is still grieving 2 years later. What type of grief is the spouse experiencing? A) Maturational B) Complicated C) Situational D) Inhibited
B) Complicated
The nurse is caring for a client who has just been diagnosed with cancer. The client states that the client will "never be able to cope with this situation." What is the nurse aware that coping is? A) Coping is a physiologic measure used to deal with change, and the client will physically adapt. B) Coping is the physiologic and psychological processes that people use to adapt to change. C) Coping is the human need for faith and hope, which create change. D) Coping is a social measure used to deal with change and loss.
B) Coping is the physiologic and psychological processes that people use to adapt to change.
A client undergoing chemotherapy for breast cancer has lost all hair. The client states, "I cannot stand to see myself without hair. I am disgusting." What would be the most appropriate nursing diagnosis for the nurse to use to address this client's problem? A) Disturbed Body Image as evidenced by client's negative comments B) Disturbed Body Image related to loss of hair C) Disturbed Body Image as evidenced by client's refusal to look at self D) Disturbed Body Image related to breast cancer
B) Disturbed Body Image related to loss of hair
An older adult client shares with the nurse having never gotten over the grief of losing a parent 22 years ago. The client states that the parent completed suicide and the client found the parent and called for emergency assistance. The nurse assesses that the client is experiencing which type of grief? A) Disenfranchised B) Dysfunctional C) Uncomplicated D) Anticipatory
B) Dysfunctional
A 10-year-old girl with bone cancer is near death. Which action should best minimize her 8-year-old sister's anxiety? A) Discouraging the child's questions about death B) Explaining how the morphine drip works C) Telling her that her sister won't need food any more D) Correcting her when she says her sister won't die
B) Explaining how the morphine drip works
Which explanation would be the nurse's best response when asked about the denial stage of grief? A) It provides an opportunity to adjust to the realization that death will occur B) It provides the individual with a temporary escape from the reality of dying C) It affords the individual a chance to prepare for the death experience D) It gives all involved a chance to hope that there has been a mistake made
B) It provides the individual with a temporary escape from the reality of dying
A community mental health nurse has come to know that the mother of a long-term client has passed away. What are ways for the nurse to determine if the client will be at risk for complicated grief? Select all that apply. A) The client has attempted suicide in the past. B) The client has a history of cardiac diseases. C) The client has a large family. D) The client has low self-esteem. E) The client is unable to trust others.
A) The client has attempted suicide in the past. D) The client has low self-esteem. E) The client is unable to trust others.
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? A) Disorganization B) Protest C) Reorganization D) Shock
A) Disorganization
An older adult client has received a terminal lung cancer diagnosis. The client's adult children are tearful and afraid to leave their parent's bedside. What type of grieving is this family most likely experiencing? A) Anticipatory B) Uncomplicated C) Disenfranchised D) Dysfunctional
A) Anticipatory
What question should nurses ask themselves to determine if the care they provide to the grieving client has been both therapeutic and client focused? A) "Do I have the strength to be present and to facilitate the client who is grieving?" B) "Do I still get personal satisfaction from my work with the grieving client?" C) "How do I personally react when I am working through the grieving process?" D) "How long can I continue working with grieving clients?"
A) "Do I have the strength to be present and to facilitate the client who is grieving?"
Which statement is typical of the first stage of grieving described by Engel? A) "My husband was the best man in the world." B) "Why me?" C) "No, not me." D) "The funeral service helped me survive."
C) "No, not me."
A nurse has been present for the hospital death of a Muslim client who was surrounded by family members when the client passed. The nurse demonstrates appropriate cultural considerations when stating: A) "Shall I ask the pastor to attend for support?" B) "How would you like to complete the five steps of the burial process?" C) "You probably won't cremate the body, will you?" D) "Are there any rituals you will observe here for your loved one?"
D) "Are there any rituals you will observe here for your loved one?"
A nurse is assessing a terminally ill female client. Which client statement indicates that the client is in the bargaining stage of dying? A) "Why is this happening to me. I've led a good life. Why is God punishing me?" B) "I just want to see my daughter graduate from college. That's all." C) "I don't know how my husband is going to manage things when I'm gone." D) "I can't believe this. I'm going to get a second opinion."
B) "I just want to see my daughter graduate from college. That's all."
A client whose child has died is withdrawn, has flat affect, makes minimal eye contact, and states, "I can't live without my child." What is the most appropriate response by the nurse? A) "I would like to sit with you and talk about your child." B) "Would you like me to call your spouse?" C) "This is a normal response to the loss of a loved one." D) "Could I call the health care provider for you?"
A) "I would like to sit with you and talk about your child."
A nurse is providing care to the family of a client who was brought to the emergency department and suddenly died. Which of the following would be appropriate for the nurse to do? Select all that apply. A) Ask the family if they would like to view the body. B) Talk with the family about the client having "passed on." C) Provide a private place for the family to be together. D) Provide sedation to family members as needed. E) Allow the family to express their emotions freely.
A) Ask the family if they would like to view the body. C) Provide a private place for the family to be together. E) Allow the family to express their emotions freely.
A nurse identifies a nursing diagnosis of spiritual distress for a patient based on assessment of which of the following? Select all that apply. A) Despair B) Acceptance C) Anger D) Peacefulness E) Ambivalence
A) Despair C) Anger E) Ambivalence
A client with poorly controlled type 1 diabetes has just been informed that an amputation of the lower leg is required. The nurse can anticipate that the client will experience a reaction to the loss of which human need according to Maslow's hierarchy? A) physiologic B) self-actualization C) safety D) security and belonging
A) physiologic
A client with end-stage pancreatic cancer has decided to terminate medical intervention. What should a nurse anticipate when consulting with palliative care? A) referral for bereavement counseling B) decreased need for nutritional supplementation C) decreased need for pain medications D) decreased need for antidepressant medication
A) referral for bereavement counseling
Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal? A) telling the nurse how his life has changed B) leaving the wife's room and belongings intact C) talking about his wife's absent-mindedness D) showing a photograph of the decedent
B) leaving the wife's room and belongings intact
A nurse is assisting a grieving client and spouse to deal with the loss of their 24-week-old infant. Which of the following actions would be most appropriate from the nurse? Select all that apply. A) Offer to stay with the grieving parents. B) Answer the parents' questions accurately. C) Remind the parents that there must have been something wrong with the baby. D) Provide an early opportunity for the couple to see the child if desired. E) The nurse should control emotions so as to not upset the parents.
A) Offer to stay with the grieving parents. B) Answer the parents' questions accurately. D) Provide an early opportunity for the couple to see the child if desired.
The nurse has been providing care to a client during a divorce. The client is now divorced from the spouse, effective 2 weeks ago. The nurse identified a nursing diagnosis of "Readiness for Enhanced Coping." What statement by the client would support this nursing diagnosis? A) The client states, "I feel like I can finally get along with my life now that the divorce is final." B) The client states, "I am afraid that I have been drinking too much just to fill my time." C) The client states, "Now that I am divorced, I will have to work two jobs just to pay my bills." D) The client states, "I can't believe that he divorced me after 20 years of marriage."
A) The client states, "I feel like I can finally get along with my life now that the divorce is final."
A client in the final stages of terminal cancer tells the nurse: "I wish I could just be allowed to die. I'm tired of fighting this illness. I have lived a good life. I continue my chemotherapy and radiation treatments only because my family wants me to." What is the nurse's best response? A) "Would you like to talk with your minister about the significance of death?" B) "Would you like to talk with a psychologist about your thoughts and feelings?" C) "Would you like to meet with your family and your healthcare provider about this matter?" D) "I'll contact the healthcare provider to cancel your treatments."
C) "Would you like to meet with your family and your healthcare provider about this matter?"
The nurse is caring for a client who is receiving a combination of antineoplastic agents. The client has been told that alopecia is likely to occur, and the client is tearful and distraught about this. What is the nurse's best response? A) Reassure the client that other people who are treated with cancer also experience this. B) Reassure the client that the hair loss will be temporary rather than permanent. C) Encourage the client to view the hair loss as something that indicates cancer is being eradicated. D) Validate the client's sense of impending loss and offer guidance for getting a wig.
D) Validate the client's sense of impending loss and offer guidance for getting a wig.
A client is admitted with severe depression after the loss of a child. The nurse documents what findings as supporting the diagnosis of depression? A) argumentative conversation with loud voice B) rapid, erratic movements when mobilizing C) exaggerated fearful responses to new environment D) slow physical movements and slow speech
D) slow physical movements and slow speech
The hospice nurse is assessing the wife of a client who died 14 months ago. The nurse is concerned that the wife is still grieving the death of her husband. Which objective assessment finding would suggest that the wife is not still grieving? A) The wife states, "I can't go on living like this." B) The wife states, "I think about him all of the time." C) The wife has a weight loss of 40 pounds in the last 14 months. D) The wife's hair is clean and styled.
D) The wife's hair is clean and styled.
A client is diagnosed with terminal kidney failure. The client's spouse demonstrates loss and grief behaviors. Which term accurately describes the spouse's experience? A) Anticipatory grief B) Maturational loss C) Bereavement D) Dysfunctional grieving
A) Anticipatory grief
A client describes himself as being "devastated" after hearing that his HIV test has come back positive. Which response by the nurse is most appropriate? A) "This is certainly scary news, but the care team is going to make sure that you get all the information you need." B) "It's entirely normal to feel that way. We are going to try our best to help you get all the support you need." C) "I understand how difficult this must be for you, but it's nothing that you should be ashamed of." D) "I've provided care for many clients living with HIV and AIDS, so I understand how you feel."
B) "It's entirely normal to feel that way. We are going to try our best to help you get all the support you need."
A client has recently been diagnosed with cancer. The client says, "What did I do wrong to get such a disease?" Which nonverbal processes, along with the client's statement, would convey a congruent message? Select all that apply. A) A cheerful expression B) A fearful tone of voice C) A sad facial expression D) A sarcastic tone of voice E) An erect, confident posture
B) A fearful tone of voice C) A sad facial expression
The home health nurse attends to a terminally ill client whose older adult spouse is the primary caregiver. The spouse states, "I am so ashamed to admit that sometimes I wish it would all just end. I am so tired." How should the nurse respond? A) "I hear you saying you are wishing it to end. Would you like to explore hospice settings?" B) "It is absolutely normal and understandable that you wish your spouse's suffering could be over." C) "It sounds like you are overwhelmed. How can we better support you through this process?" D) "This is a difficult time for you and your reaction is understandable. You should not be ashamed."
C) "It sounds like you are overwhelmed. How can we better support you through this process?"
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) "The process is the same from person to person." B) "Each stage of dying must be completed prior to moving to the next stage." C) "Sometimes a person returns to a previous stage." D) "The duration of all stages is a few hours."
C) "Sometimes a person returns to a previous stage."
Which factor does not influence the grieving person's return to homeostasis? A) Adequate coping B) Adequate support systems C) Adequate self-awareness on the part of the nurse D) Adequate perception of the situation
C) Adequate self-awareness on the part of the nurse
A nurse is providing care to a couple who have experienced intrauterine fetal demise. Which action would be least effective in assisting a couple at this time? A) Assist the family in making arrangements for their stillborn infant. B) Give the parents a lock of the infant's hair. C) Avoid any discussion of the situation with the couple. D) Allow the couple to spend as much time as they want with their stillborn infant.
C) Avoid any discussion of the situation with the couple.
The client has been recently diagnosed with cancer. When the nurse tells the client about the diagnosis, the client says, "I have been eating healthy food and working out regularly." According to the Kubler-Ross's stages of grieving, which stage of grief is the client in? A) Anger B) Depression C) Denial D) Bargaining
C) Denial
An appropriate nursing diagnosis for the family of a client dying of cancer, whose members have expressed sorrow over the forthcoming loss, would be: A) Dysfunctional Grieving related to the loss of family member, as manifested by behaviors indicating anxiety. B) Potential for Grieving related to loss of family member and sorrow. C) Dysfunctional Grieving related to future loss of family member, manifested by family's developmental regression. D) Anticipatory Grieving related to loss of family member, as evidenced by sorrow.
D) Anticipatory Grieving related to loss of family member, as evidenced by sorrow.
When describing the term "grief" to a group of students, which of the following would the instructor include? A) A feeling of connectedness with one's self and others B) A part of the life cycle in the form of change, growth, and transition C) Feelings of apprehension or worry in response to a situation D) The response experienced by anyone who has suffered a loss
D) The response experienced by anyone who has suffered a loss
Caregivers of a 9-year-old client in the terminal phase of a fatal illness ask the nurse for guidance in discussing death with the client. Which response is appropriate? A) "Children of that age typically fantasize about what dying will be like, which is much better than knowing the truth." B) "At this developmental stage, children are afraid of death, so it's best not to discuss it with them." C) "Children of that age view death as temporary and reversible, which makes it hard to explain." D) "At this developmental stage, most children have an adult concept of death and should be encouraged to discuss it."
D) "At this developmental stage, most children have an adult concept of death and should be encouraged to discuss it."
A 9-year-old has suffered a severe anaphylactic reaction and dies. The nurse is providing support for the grieving parents. Which comment would best help them cope? A) "Would you like to see the chaplain?" B) "You would be more comfortable here in the lounge." C) "Can I get you something to eat?" D) "How can I help you get through this?"
D) "How can I help you get through this?"
Which statement by a client would alert the nurse that the client is experiencing complicated grief? A) "It's been a week, but it still seems unreal that my mother has B) died." B) "I blame myself for my brother having committed suicide." C) "I keep imagining the scene of my spouse's accident that caused death." D) "I am still so angry about my grandmother's death even after a year."
D) "I am still so angry about my grandmother's death even after a year."
A nurse is assessing a client who has recently lost her husband. During the interview the nurse realizes that the client is unable to cope with the loss. The client finds it difficult to organize daily tasks or solve problems effectively. Which suggestion would be most appropriate for the nurse to suggest as a crisis intervention? A) tense and relax muscle groups systematically B) keep the home environment noise free C) perform meditation to relax D) seek assistance from family and friends
D) seek assistance from family and friends
The nurse is working with a client who is grieving over the death of a parent. Which concept is the nurse demonstrating when stating to the client, "I know how sad I was when I lost my parent"? A) object relations B) operant behavior C) empathy D) transference
C) empathy
A mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement best communicates a spirit of hopefulness to this client? A) "I know another client with the same diagnosis who has been in remission for 10 years." B) "I believe that you will fight hard to beat this and see your babies grow up." C) "You should seek a second medical opinion about your diagnosis." D) "Let's take this one day at a time; remember you have your daughter's dance recital next month."
D) "Let's take this one day at a time; remember you have your daughter's dance recital next month."
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. A) expression of feelings B) management of pain C) use of coping strategies D) nutritional therapy E) urinary elimination
A) expression of feelings B) management of pain C) use of coping strategies
A client is arranging a funeral ceremony for the client's child. According to the Worden's tasks of grieving, which task is being accomplished? A) Acceptance of the reality of the loss B) Emotional relocation of that which has been lost and moving on with life C) Adjustment to the environment that has changed due to the loss D) Working through the pain of grief
A) Acceptance of the reality of the loss
A client has been diagnosed with colon cancer with metastasis to the lymph nodes. When the nurse enters the room, the client says life is "not worth living." What is the nurse's best therapeutic response? A) Approach the client and ask if there are questions about the condition. B) Ask the client if calling the family would be helpful. C) Assure the client that everything will work out fine. D) Explain that the condition is complicated and ask a physician to come speak with the client.
A) Approach the client and ask if there are questions about the condition.
The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which intervention should a nurse perform in such a situation? A) Encourage the family members to express their feelings and listen to them in their frank communication B) Encourage the client's family members to spend time with the client C) Be a silent observer and allow the client to communicate with the family members D) Encourage conversations about the impending death of the client
A) Encourage the family members to express their feelings and listen to them in their frank communication
A nurse is caring for a 5-year-old child who's in the terminal stages of cancer. Which statements are true? Select all that apply. A) The parents may be at different stages in dealing with the child's death. B) The death of a child may have long-term disruptive effects on the family. C) The child does not fully understand the concept of death. D) Whispering in the child's room will help the child to cope. E) The dying child may become clingy and act like a toddler. F) The child is thinking about the future and knows he may not be able to participate.
A) The parents may be at different stages in dealing with the child's death. B) The death of a child may have long-term disruptive effects on the family. C) The child does not fully understand the concept of death. E) The dying child may become clingy and act like a toddler.
Which action, displayed by a grieving partner over a dying spouse, should cause the nurse to suggest counseling? A) The partner blames his spouse's family for the client's current health problems. B) The partner shows their wedding pictures to everyone who enters his spouse's room. C) The partner makes plans for the spouse's funeral. D) The partner considers giving away the spouse's treasured items as the spouse requested.
A) The partner blames his spouse's family for the client's current health problems.
To adequately assist a client and family from a different culture with the death and dying process, the nurse should: A) be aware of the client's cultural beliefs. B) experience death in his or her own life. C) progress through the stages of grief. D) have felt distress and anger.
A) be aware of the client's cultural beliefs.
Which nursing activity supports the principles of palliative care for a dying infant and the infant's family? A) creating a therapeutic, homelike environment for the infant and the infant's family B) minimizing noise and disruption to decrease stress for the infant C) clustering care activities to provide as much rest as possible for the infant D) maintaining routines and structure for the infant and the infant's family
A) creating a therapeutic, homelike environment for the infant and the infant's family
A client who is in the process of divorce tells the nurse the client will require some time off from work due to the inability to concentrate. According to Bowlby's phases of grieving, which phase best reflects this client's current experience? A) disorganization and despair B) yearning C) reorganization D) shock, numbness, and protest
A) disorganization and despair
A client who has recently lost his same-sex partner in a motor vehicle accident tells the nurse, "My family doesn't speak to me because of my lifestyle. I feel like I have no one to talk to about my loss." The client is experiencing: A) insecure attachment. B) ambivalent attachment. C) disenfranchised grief. D) complicated grieving.
C) disenfranchised grief.
A community care nurse is visiting a client at home. The client was discharged from the hospital one week ago after having a mastectomy. After the nurse completes the physical examination, the nurse asks, "How are you feeling about your body changes?" The client tells the nurse she is not interested in talking right now and would prefer that the nurse leave. Which is the nurse's most effective use of communication skills? A) "I just want you to know that I am available to talk when you are feeling up to it." B) "Have I said something to offend you?" C) "I can sit with you here so that you don't feel alone." D) "It would be beneficial for you to connect with other people who have had this surgery."
A) "I just want you to know that I am available to talk when you are feeling up to it."
A client undergoing a mastectomy says, "I've been a basket case just thinking of what implications this has for my family." How should the nurse respond? A) "This is a very difficult adjustment period for you and your family." B) "Sounds like you are still in denial about the diagnosis." C) "You need to talk to someone who has gone through this same experience." D) "Let's discuss this problem with your ex-husband and daughter."
A) "This is a very difficult adjustment period for you and your family."
During the interview at a crisis center, a newly widowed client reveals the wish "to join my spouse in heaven." The nurse determines that the client does not plan self-harm. What is the best response by the nurse? A) "What feelings have you been experiencing?" B) "What was the cause of your spouse's death?" C) "Are you feeling depressed?" D) "What family lives near by?"
A) "What feelings have you been experiencing?"
Which assessment finding would best support a nursing diagnosis of Dysfunctional Grieving? A) A man is unable to return to work after his sister's death 18 months ago. B) A man blames himself for not doing more to make his wife's recent death more comfortable. C) A woman has been experiencing chronic insomnia since her mother's death earlier this year. D) A woman cries frequently and loudly in the weeks following her child's death in an accident.
A) A man is unable to return to work after his sister's death 18 months ago.
The psychologist is teaching students about the factors that affect a person's reaction to grief. Which statements by the students about developmental considerations are accurate? Select all that apply. A) "Terminally ill children normally do not ask questions about death." B) "Sense of loss for a child is just as great as it is for an adult." C) "Death of a parent can delay a child's development." D) "Children understand death on the same level as adults." E) "Children do not need to go through the same grief reactions as adults."
B) "Sense of loss for a child is just as great as it is for an adult." C) "Death of a parent can delay a child's development."
The client states, "No one cares about me anymore. All the people I loved are dead." Which response by the nurse is most therapeutic? A) "You must be feeling lonely at this time. Would you like to talk about your loss?" B) "I understand you are feeling lonely. Would you like me to arrange for a volunteer visitor?" C) "I am sorry for your loss. Would you like to share some stories about your loved ones?" D) "You sound very lonely. Is there a friend or relative I could call for you?"
A) "You must be feeling lonely at this time. Would you like to talk about your loss?"
Which of the following patients would the nurse identify as LEAST likely to be experiencing loss? A) Patient with diabetes who had his foot amputated B) Patient who is abusing substances C) Patient whose spouse just recently died from a chronic illness D) Patient who was just told that he has lung cancer
B) Patient who is abusing substances
A nurse is caring for a 5-year-old child with end-stage acquired immunodeficiency syndrome (AIDS). The child confides that the child is ready to go to heaven and see Grandpa. The nurse knows that the child's parents aren't comfortable with the idea of discontinuing treatment. What should the nurse do? A) Listen to the child but recognize that the child too young to make these decisions. B) Talk with the parents about the dying process and make the parents aware of what the child has confided. C) Tell the child that the nurse will talk with the parents and change the parents minds. D) Tell the physician that the family would like to discontinue treatment.
B) Talk with the parents about the dying process and make the parents aware of what the child has confided
A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client? A) Chronic low self-esteem B) Anticipatory grieving C) Disturbed body image D) Impaired swallowing
B) Anticipatory grieving
