N3270 Ch. 42: Loss, Grief, and Dying prep
It has been determined that a client who sustained a head injury following a motorcycle accident is brain dead. The client did not have an organ donation directive, however, the client did have records to indicate a wish not to have prolonged life support. What is the most appropriate action for the nurse? a) Contact the organ procurement team to discuss organ donation with the family. b) Wait until the family arrives from out of town to discuss organ donation. c) Explain to the family that organ donation is not an option as the client has refused life support. d) Prepare to remove the client from life support to align with life support records.
A
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? a) Unresolved b) Inhibited c) Situational d) Maturational
A
The nurse enters a client's room and finds the client curled up in bed and crying. The nurse approaches the client and quietly asks why she is crying. The client replies, "Life was so good, and now I have cancer, and I don't understand why." The nurse recognizes the client as exhibiting signs of which stage of Engel's model of grief? a) Developing awareness b) Shock and disbelief c) Idealization d) Restitution
A
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. a) The stages of grief occur linearly and are static. b) Some people actually skip some stages of grief altogether. c) People vary widely in their responses to loss. d) The stages are relatively discrete and identifiable. e) Stages occur at varying rates among people.
B, C, E
Which signs assessed in a dying client would the nurse recognize as signs of death? Select all that apply. a) Increased blood pressure b) Racing pulse c) Increased body temperature d) Cheyne-Stokes respirations e) Loss of movement, sensation, and reflexes f) Nausea, flatus, abdominal distention Submit your answer
D, E, F
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? a) Cleanse drainage from the skin. b) Avoid replacing dentures in the mouth. c) Place a rolled towel under the head. d) Apply hairpins and clips.
A
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? a) Inpatient pain management for hospice patients is covered by Medicare. b) Worry about payment should not be a concern for the client. c) Medicare does not cover costs that are not directly related to the diagnosis. d) Medicare does not cover pain control in the home, it must be in the inpatient care.
A
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? a) aggressive management of symptoms b) eliminating all forms of medical and nursing care c) treatment of the disease process d) providing counseling related to the stages of death and dying
A
A man is diagnosed with terminal kidney failure. His wife demonstrates loss and grief behaviors. What type of loss is the wife experiencing? a) Anticipatory loss b) Dysfunctional grieving c) Maturational loss d) Bereavement
A
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? a) refusal to accept death b) tightness in the throat c) behaving in a morbid manner d) difficulty breathing
A
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) Depression b) Anger c) Bargaining d) Denial
A
The nurse is caring for a client who has just expired. Which action will the nurse perform? a) Allow the client's family to see the client's body before it is discharged. b) Provide a complete bath. c) Place the client in a semi-Fowler's position. d) Have the nurse technician place identification tags on the outside of the shroud. Submit your answer
A
The nurse is giving palliative care to a client with a diagnosis of COPD. What is the goal of palliative care? a) to improve the client's and family's quality of life b) to support aggressive treatment for cure c) to provide physical support for the client d) The client may develop a separate plan with each discipline of the health care team.
A
The nurse is performing post mortem care on a client who died suddenly while in prison. Which nursing action is appropriate? a) taping the intravenous lines in place b) washing the body of blood c) removing the endotracheal tube d) releasing the body to mortuary personnel
A
The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate? a) "It must be very difficult for you." b) "You should try to make things right with your family." c) "There's no need for anger." d) "I can't imagine how awful this is for you."
A
The psychiatrist is evaluating a client who has recently learned she has a terminal illness. Which statement indicates to the psychiatrist that the client is in the Kübler-Ross stage of bargaining? a) "Just let me go on vacation with my wife; then I'll be satisfied." b) "Why is this happening to me—I quit smoking." c) "I know that my family will be taken care of. I am at peace." d) "I waited years to see my grandchildren and now I won't see them."
A
Which care environment would the nurse suggest to a client with no family near by who is diagnosed with end stage lung disease? a) residential care b) respite care c) home care d) acute care
A
The hospice nurse is educating a client's family on the physical signs of approaching death. The nurse knows that the education has been effective when the family says they will know that death is imminent when they see which of the following? Select all that apply. a) Restlessness b) Cyanosis of dependent areas c) Increased body temperature d) Bowel incontinence e) Irregular respiratory rate
A, B, D, E
A nurse is providing care to a client in the protest stage of grief. Which interventions would be most appropriate? Select all that apply. a) Encourage expression of diverse feelings. b) Help identify new support systems. c) Refer the client for career counseling. d) Refer the client to self-help groups. e) Teach client about the normal grief process.
A, B, E
A terminally ill client states to the nurse, "My situation is hopeless; I have no control over anything." The nurse implements which interventions to enable hope for the client? Select all that apply. a) Encourage the client to discuss his feelings. b) Hold the client's hand. c) Withhold information about disease progression. d) State to the client, "We have explored all treatment options." e) Sit in a chair next to the client.
A, B, E
A nurse is assessing a dying client for realism of expectations and perception of condition. Which interview questions address this concern? Select all that apply. a) How do you see the next few weeks playing out? b) What have you been told about your condition? c) How well do you think those around you are coping? d) Have you had any previous experience with this condition before? e) What do you think may be happening in the midst of all of this? f) Do you know how to contact your doctor and get answers to your questions?
A, D, E
The emergency department (ED) nurse accepts an unconscious client brought in by ambulance. The client's family presents a durable power of attorney for health care for the client. Which action should the nurse take? a) Communicate to other ED staff that there should be no attempts to resuscitate the client. b) Obtain contact information for the person designated to make decisions for the client. c) Initiate active euthanasia. d) Initiate a slow code in the case of cardiopulmonary or respiratory arrest.
B
A client diagnosed with terminal cancer is making plans to take a trip to visit her daughter, from whom she has been estranged for many years. What stage of death and dying, according to Kübler-Ross, is best illustrated in this description? a) Anger b) Bargaining c) Acceptance d) Depression
B
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? a) The arms and legs are warm to touch. b) Client's breathing becomes noisy. c) The client is calm and peaceful. d) The frequency of urination decreases.
B
A client who has died an unexplained death has numerous catheters and drainage tubes in place and is being prepared for an autopsy. In providing care to the body after the client has been pronounced dead, how shall the nurse manage the tubes prior to the autopsy? a) The nurse will remove all tubes and discard in isolation trash receptacles. b) The nurse will not remove any tubes from the body. c) The nurse will remove all catheters in blood vessels and leave drains and urinary catheters in place. d) The nurse will remove all tubes and send the tubes to the autopsy procedure with the body.
B
A group of nursing students is reviewing information about children and their perceptions about death. The students demonstrate understanding of the information when they state that a child's concept about death matures at about which age? a) 8 years b) 9 years c) 10 years d) 7 years
B
A nurse is caring for a client with a terminal illness. Which statement is true of a terminal illness? a) Recovery is very slow. b) Recovery is beyond reasonable expectation. c) Recovery takes a minimum of 3 months. d) Recovery is dependent on the client's treatment options.
B
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? a) decreased pain b) difficulty swallowing c) increased urinary output d) increased sensory stimulation
B
A young client died following a cardiac arrest. The nurse caring for the client and the family notes that some members of the family refuse to accept that the client has died. What stage of grief is the family experiencing? a) Idealization b) Shock and disbelief c) Developing awareness d) Restitution period
B
Palliative care is a structured system for care delivery. What is its aim? a) to give traditional medical care b) to prevent and relieve suffering c) to bridge between curative care and hospice care d) to provide care while there is still hope
B
The caregiver of a client who is terminally ill is becoming short tempered with the client and states, "I just can't take this anymore." Which nursing response is most appropriate? a) "It is hard to care for someone who is ill." b) "Have you considered respite care so that you can rest for a few days?" c) "It won't help for you to be intolerant of the client." d) "Have you considered residential care so you don't have to care for your loved one?"
B
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) "Sometimes a person returns to a previous stage." c) "Each stage of dying must be completed prior to moving to the next stage." d) "The duration of all stages is a few hours."
B
The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the bargaining stage of grief is the one who states: a) "I don't care about anything. I have no energy." b) "I just want to see my son have a family of his own." c) "Why did this have to happen to me?" d) "I do not believe I have this disease."
B
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? a) Awareness b) Idealization c) Outcome d) Restitution
B
Upon interviewing the client, the nurse finds that the client is providing care for her mother who is terminally ill. The client is depressed and already mourning the loss. Which nursing diagnosis would be most appropriate for the client? a) Dysfunctional grieving b) Anticipatory grieving c) Prolonged grieving d) Normal grieving
B
Which of the following describes lower-brain death? a) It results in a vegetative state in which the client has no consciousness, speech, or feelings but is able to breathe independently. b) It results in the inability to maintain circulation and respiration and is ventilator dependent. c) It results in an irreversible cessation of heart-lung function. d) It results in a coma state.
B
Which of the following is an example of a perceived loss? a) A client grieves for the loss of his wife to cancer. b) An older client grieves for the loss of his independence. c) A client mourns the loss of his amputated leg. d) A client grieves for the loss of his job.
B
Which phrase can do much to instill hope in the dying client? a) "This is a hopeless situation." b) "Let me tell you about your illness." c) "Nothing more can be done." d) "Everything will be fine, so don't worry."
B
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. a) Strong, bounding pulse b) Pale, cool skin c) Irregular heart rate d) Decreased urine output e) Regular deep respirations
B, C, D
A client comes to the hospital because of complications related to newly diagnosed terminal cancer. The client is concerned about how his wife is coping with the diagnosis. Which information is important for the nurse to obtain to assess factors that may affect the family member's grief? Select all that apply. a) Previous relationships b) Cultural practices c) Social support d) Financial concerns e) Religious beliefs
B, C, D, E
A male 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 his grief? Select all that apply. a) Urge the client to continue his usual routine. b) Help the client establish coping strategies. c) Promote good nutrition and sleep habits. d) Assist the client to form a support system. e) Encourage participation in religious rituals.
B, C, D, E
A client has been declared brain dead following a motor vehicle accident. What assessment data would the nurse anticipate? a) sluggish pupillary response b) breathing drive triggered only by respirator c) no ocular movement d) positive corneal response
C
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? a) Denial b) Bargaining c) Anger d) Acceptance
C
The daughter of an older client is concerned that her mother is depressed because she is reading the obituaries every day. What is the most appropriate nursing response? a) "This is a clear indicator that your mother is depressed." b) "This is a sign of impending death and we need to notify the provider." c) "This is common in older adults and doesn't necessarily indicate depression." d) "This indicates that your mother is entering into the bargaining stage of grief."
C
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? a) Slow, steady pulse b) Pursed lip breathing c) Mottling of the lower limbs d) Increased swallowing
C
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
The nurse is providing care to a group of terminally ill clients. The client who exhibits signs of impending death is the client who has: a) eyes closed, temperature 98.4°F. b) warm, pale skin and frequent urination. c) distended abdomen, Cheyne-Stokes respirations. d) a blood pressure of 100/64 mm Hg, regular pulse of 64 beats/minute.
C
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? a) Hospice provides physical and psychological support; palliative care provides social and spiritual support. b) Hospice care differs from palliative care in its foundational philosophy. c) Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness. d) Hospice care focuses on quality of life while palliative care focuses on length of life.
C
What is Kübler-Ross's third stage of grief? a) Denial b) Depression c) Bargaining d) Anger
C
Which assessment finding would best support a nursing diagnosis of Dysfunctional Grieving? a) A woman cries frequently and loudly in the weeks following her child's death in an accident. b) A woman has been experiencing chronic insomnia since her mother's death earlier this year. c) A man is unable to return to work after his sister's death 18 months ago. d) A man blames himself for not doing more to make his wife's recent death more comfortable.
C
The oncology nurse is learning to care for dying clients. Which ideals should guide the nurse in facilitating a good death for these clients? Select all that apply. a) A good death is one that allows a person to die on his family's terms. b) The care of the dying client should be guided by the values and preferences of the nurse. c) The characteristics of a good death vary for each client. d) Care for dying clients should focus on pharmacologic relief of pain. e) Independence and dignity are central issues for many dying clients.
C, E
A client diagnosed with liver failure in hospice care died 10 hours ago. The client's spouse won't leave the client's room and is angry that the room is being cleaned. What does the nurse suspect? a) anticipatory grief b) grief response c) bargaining grief d) pathologic grief
D
A client has been receiving dialysis for years and now states, "I have been thinking about this for a long time. I no longer wish to continue dialysis. I just want to die." The most appropriate statement by the nurse is: a) "Once you've started treatment, it's important to continue." b) "Have you discussed this with your health care provider?" c) "Does your family agree with this decision?" d) "Can you tell me about why you've made this decision?"
D
A nurse is caring for a client with HIV-related pneumonia. The client is unable to come to terms with the fact that she is dying and feels that life has been unfair to her. How can the nurse promote acceptance in this client? a) Tell the client that the illness can be overcome. b) Inform the client that the reports show improvement. c) Ask relatives not to discuss death in front of the client. d) Ask the client if she wants to meet and thank her loved ones.
D
A woman has had a breast removed to treat cancer. What type of loss will she most likely experience? a) Perceived loss b) Maturational loss c) Anticipatory loss d) Actual loss
D
Kübler-Ross defines five stages of psychosocial responses to dying and death. Which statement is characteristic of the bargaining stage? a) "Why did this happen to me? I always exercised." b) "The doctors must have made a mistake." c) "I've had a good life and I can die in peace." d) "Just let me live to see my grandson born."
D
The family of a client with a severe traumatic brain injury is considering the withdrawal of his mechanical ventilation. What is the nurse's primary role in the preparation for terminal weaning? a) assisting with pulmonary resuscitation if the client is unable to breathe independently b) assisting with chest physiotherapy before and after ventilation ceases c) preparing the bedside for postmortem care d) educating the family on what to reasonably expect after ventilation is discontinued
D
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? a) "Body transported to morgue." b) "Notified the patient's daughter." c) "Post mortem care completed." d) "No breathing and no pulse at 0840."
D
The nurse is taking care of a client who was hospitalized for an ulcerative colitis flare. Her father recently died of colon cancer. Which question would be essential to ask this client at the start of the assessment of her loss reaction? a) What did your father do for a living? b) Did your father also have ulcerative colitis? c) How old was your father? d) How close were you to your father? Submit your answer
D
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? a) Hospice provides physical and psychological support; palliative care provides social and spiritual support. b) Hospice care differs from palliative care in its foundational philosophy. c) Hospice care focuses on quality of life while palliative care focuses on length of life. d) Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness.
D
Which display is an example of dysfunctional grieving? a) Weeping b) Outbursts of anger c) Emotional blunting d) All choices e) None of the choices Submit your answer
E
Question: A group of nursing students is reviewing the various models of grieving. 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. Protest Reorganization Shock Disorganization
SHOCK, PROTEST, DISORGANIZATION, REORGANIZATION
The experience of parting with an object, person, belief, or relationship that one values is defined as: a)loss. b)bereavement. c)grief. d)death.
a
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? a)"It is an agreement that authorizes the hospital to make decisions on your behalf, if you become incapacitated." b)"It is a document created by you and your attorney naming a beneficiary to handle your estate if you become terminally ill." c)"It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition." d)"I will contact the hospital social worker to come and discuss the development of an advance directive with you."
c
When preparing for palliative care with the dying client, the nurse should provide the family with which explanation? a)"The client will have to go to an inpatient hospice unit in order to receive palliative care." b)"In palliative care, no attempts are to be made to resuscitate a client whose breathing or heart stops." c)"The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms." d)"Palliative care is the gradual withdrawal of mechanical ventilation from a client with terminal illness and poor prognosis."
c
