Med-Surg Chapter: 44

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."

The nurse is caring for a client with terminal illness who is refusing food and fluids. The family is concerned and suggests that a feeding tube be used. Which is the best response by the nurse?

"When clients are in this stage, food and fluid are unnecessary."

"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?

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

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."

The nurse is caring for a woman with terminal breast cancer. Which statement made by the client reflects the bargaining stage of grief?

"Please, let me live long enough to see my grandchild."

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."

T/F: Living wills provide specific instructions regarding the distribution of personal property and wealth after a person dies

False

T/F: Perceived loss is felt by the person and can be recognized by others

False

Following surgery, the surgeon informed the client's spouse that invasive cancer was found during the procedure and the client may only have days to live. The client's spouse has told the health care provider and the nurse that they do not want the client to know the severity of the diagnosis. How will the nurse respond?

understanding that this directive would violate the client's rights

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

"It must be very difficult for you."

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."

A nurse has finished presenting information on the factors that influence the grieving process. Which statement by a participant would indicate a need for further education?

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

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."

A nurse is caring for a client whose spouse died more than 4 years ago. What assessment question will the nurse ask to determine if the client is experiencing abnormal grief?

"Have you gone through and donated your spouse's clothing?"

"It is a document created by you and your attorney naming a beneficiary to handle your estate if you become terminally ill."

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

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."

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

"In hospice care, nurses take on the responsibility of making care decisions for clients."

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

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

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."

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?

"Sometimes a person returns to a previous stage."

The nurse is preparing a presentation on preparing children for the death of a family member or friend. What information should the nurse include? Select all that apply. -Encourage the child's distraction as much as possible -Encourage expression of feelings -Provide for stability and safety -Praise stoicism -Talk openly about death and the feelings associated with it

-Encourage expression of feelings -Provide for stability and safety -Talk openly about death and the feelings associated with it

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

A nurse is conducting a program for a local community support group about grieving. The nurse would describe grief as fulfilling which function? Select all that apply. -allowing the outer reality of loss to become internally accepted -altering the emotional attachment to that which was lost -permitting the bereaved person to become unattached to -others -preparing the client for the loss without warning -allowing the person to avoid the experience of the loss more fully

-allowing the outer reality of loss to become internally accepted -altering the emotional attachment to that which was lost

When preparing the care plan for a dying client, it is important for the nurse to include a goal that addresses which needs? Select all that apply. -expression of feelings -management of pain -use of coping strategies -nutritional therapy -urinary elimination

-expression of feelings -management of pain -use of coping strategies

Which situation is most likely to warrant an autopsy?

A client's death involves an allegation of a medical error

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

Administer sedation and analgesia

Assisted suicide is expressly prohibited under statutory or common law in the overwhelming majority of states. Yet public support for assisted suicide has resulted in a number of state ballot initiatives. The issue of assisted suicide is opposed by nursing and medical organizations as a violation of the ethical traditions of nursing and medicine. Which scenario would be an example of assisted suicide?

Administering a lethal dose of medication

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage, according to Kübler-Ross?

Anger

The hospice nurse is caring for a client with lung cancer. The client's daughter states, "My mom isn't happy with anything I do for her. It's not like her to be so hypercritical." The nurse understands that the client is likely in which stage of grief according to Kübler-Ross?

Anger

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

Anger

When a person displays loss and grief behaviors for a loss that has yet to take place, this is referred to as:

Anticipatory loss

Which statement regarding perceptions of death by children is accurate?

At about age 9, the child perceives death as irreversible

During which of the following stages, according to Kübler Ross, will a dying patient put their personal affairs in order?

Bargaining

In which of the following states is it legal under certain circumstances to assist in committing suicide?

California

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 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.

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

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

Coping strategies

The partner of a client with terminal cancer is afraid of hurting the client during sexual intercourse. Which action by the nurse is likely to be most helpful in reducing this client's fears?

Encourage discussion between the client and their partner regarding their intimacy needs

A terminally ill client told her family, "I am ready to die." Her family is very upset that she has given up and wants the nurse to intervene. Which nursing intervention is most appropriate?

Explain to the client that acceptance is part of the grieving process

T/F: Legal options to prevent the improper use of cardiopulmonary resuscitation includes the Do Not Resuscitate (DNR) order, the Allow Natural Death (AND) order, and the slow code

False

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 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 inact

A nurse is providing end-of-life care to a terminally ill client. Which action should the nurse take to remove mucus and saliva from the client's mouth?

Perform suction in the client's mouth

A client has developed cancer within eight months of their spouse's death. The nurse will consider the possibility of what cause?

Physical effects of bereavement

Which of the following refers to a medical order indicating a patient's wishes regarding treatments commonly used in a medical crisis?

Physician order for life-sustaining treatment

Which of the following actions would be contraindicated when preparing a body that will be sent for autopsy?

Removal of tube and IV's

The nurse is assisting a client and family with the death and dying process. In an effort to provide culturally competent care, what action will the nurse perform first?

Seek to understand the client's beliefs

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

A client in a long-term care facility has signed a form stating that he does not want to be resuscitated. He develops an upper respiratory infection that progresses to pneumonia. His health rapidly deteriorates, and he is no longer competent. The client's family states that they want everything possible done for the client. What should happen in this case?

The client should be treated with antibiotics for pneumonia

A client severely injured in a motor vehicle accident is rushed to the health care facility with severe head injuries and profuse loss of blood. Which sign indicates approaching death?

The client's breathing becomes noisy

Which does not coincide with Kübler-Ross's stages related to a dying client?

The dying client usually exhibits anger first

T/F: Hearing is believed to be the last sense to leave the body before death

True

T/F: Terminal weaning is the gradual withdrawal of mechanical ventilation from a patient with a terminal illness or an irreversible condition with a poor prognosis

True

The husband of a client who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. What type of grief is the husband experiencing?

Unresolved grief

The nurse is taking care of a client who was hospitalized for an ulcerative colitis exacerbation. Recently, the client's parent died from colon cancer. Which question would be essential to ask this client at the start of the assessment of her loss reaction?

What type of relationship did you have with your parent?

The nurse is caring for several clients in the home care setting. Which client, when found deceased, will the nurse report as a case for the medical examiner?

a client found with an empty bottle for a newly-prescribed opioid by the bedside

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

The nurse is caring for a client who is dying. The nurse overhears the client saying, "God, if you will only let me live to see my daughter get married, I promise I will start going to church again." The nurse understands that the client is in which stage of grief according to Kübler-Ross?

bargaining

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

bargaining

A client is informed about the results of a biopsy, which indicate a malignant tumor that has spread. The client states, "Well once you remove the tumor, I will be just fine." What stage of the grief process does the nurse identify the client is experiencing?

denial

A client's son is named to make decisions for his mother in the event she cannot speak for herself. This is an example of a(an):

durable power of attorney

A client diagnosed with liver failure in hospice care died 10 hours ago. The client's spouse is having difficulty leaving the room and is crying uncontrollably. What situation does the nurse identify is happening with this client's spouse?

grief reaction

A client is being discharged from the hospital with terminal brain cancer and a life expectancy of 1 month. When planning this client's discharge, it is most important for the nurse to include a referral to which agency?

hospice

Palliative care is a structured system for care delivery. What is its aim?

to prevent and relieve suffering