Loss, grief, and dying

The nurse is caring for a client who recently lost an older adult parent. Which client statement alerts the nurse that the stage of depression may have started within the grief process?

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

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 trying to help the client cope with the dying process. Which nursing statement is mostappropriate?

"It must be very difficult for you."

During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving?

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

The condition of a client with a traumatic brain injury continues to deteriorate despite medical efforts. The decision is made to terminally wean the client from mechanical ventilation. Which statement by the nurse is most significant in educating the family regarding terminal weaning?

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

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 conclusion?

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

Which statement by the client indicates acceptance of dying?

"I have finalized all my financial arrangements for my family."

A client with end-stage chronic obstructive pulmonary disease (COPD) has reached the end of the 6-month period for hospice services and the family caregiver states, "I don't know what we will do if they cut off our hospice services." What is the best response by the hospice nurse?

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

After the health care provider has discussed euthanasia with a terminal client and family, the nurse assesses their understanding of the topic. Which statement by the family indicates that learning has occurred?

"It is all right to stop dialysis."

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."

A client diagnosed with a terminal illness is displaying periods of depression and anger alternating with acceptance. The client's spouse is concerned about the client's labile mood. When talking with the client's spouse, which statement made by the nurse best addresses principles of loss and grieving?

"Not everyone experiences grief in the same way and your loved one needs our support."

When preparing for palliative care with the dying client, the nurse should provide the family with which explanation?

"The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms."

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?"

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?"

A client has responded to a recent diagnosis of lung cancer by making extensive plans for overseas travel with family, despite the extremely poor prognosis. The client is adamant about not discussing cancer and is identified by the nurse as experiencing the denial stage of grief. How can the nurse best facilitate the client's healthy grieving?

Address the client's diagnosis and prognosis at a later time or date.

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.

A client is dying and the nurse has developed a strong rapport with the client and spouse. The spouse states to the nurse, "I just don't know how I am going to deal with the process. It makes me nervous to think I can't deal with it." What is the priority concern with the spouse of the client?

Anxiety related to unknown reaction to stages of death

Which statement regarding perceptions of death by children is accurate?

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

A graduate nurse enters a client's room and finds the client unresponsive, not breathing, and without a carotid pulse. The graduate nurse is aware that the client has mentioned that he does not wish to be resuscitated, but there is no DNR order on the client's chart. What is the nurse's best action?

Call a code and begin resuscitating the client.

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.

A client has been declared brain dead following a fall from a roof. The client's advance directives state they do not wish to have prolonged life measures, and that only the heart, kidneys, and liver should be donated. The client's spouse wants to also donate the client's corneas. What is the appropriate nursing action?

Contact the organ procurement team to discuss organ donation with the spouse.

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.

The wife of a man who is dying tells the nurse: "Harold was so good to me. He was like a saint with his patience. I will miss him terribly" Which stage of grief is this woman experiencing, according to Engel?

Idealization

After the death of a terminally ill spouse, a client reports frequent headaches and loss of appetite. The client states, "How am I going to live without him?" What type of grief is the client experiencing?

Inhibited grief a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations.

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 clients is covered by Medicare.

The emergency department nurse is consoling the adult child of a client who died upon arrival to the hospital. Which grief behavior is common in the shock phase of grief?

Intellectual acceptance and flat affect

The nurse is working with a client's whose wife died four years ago. Which assessment finding will prompt the nurse to prioritize assessment for dysfunctional grief?

Leaving his wife's clothes and belongings intact

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 Jaundinced Cyanotic

With the help of the nurse, the parents of an infant who died shortly after birth arrange for a funeral service. Which stage of grief, according to Engel, involves the rituals surrounding loss, including funeral services?

Restitution

The nurse is caring for a client whose spouse died 6 days ago. What assessment finding would suggest that the client is in the first stage of Engel's model of grief?

The client has difficulty believing the spouse is actually deceased

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 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.

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

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

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.

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

coping strategies

When planning care for a 55-year-old client with newly diagnosed terminal pancreatic cancer, which nursing concern is most appropriate for the care plan?

death anxiety

Stages of greiving

denial, anger, bargaining, depression, acceptance

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 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 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.

When a patient passes, the nurse puts them in a

supine position to prevent blood pooling

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