NU140- Chapter 43 Loss, Grief, and Dying

The family of a patient who has just died asks to be alone with the body and asks for supplies to wash the body. The nurse providing care knows that the mortician usually washes the body. Which response would be most appropriate? a. Inform the family that there is no need for them to wash the body since the mortician typically does this. b. Explain that hospital policy forbids their being alone with the deceased patient and that hospital supplies are to be used only by hospital personnel. c. Give the supplies to the family but maintain a watchful eye to make sure that nothing unusual happens. d. Provide the requested supplies, checking if this request is linked to their religious or cultural customs and asking if there is anything else you can do to help.

d. Provide the requested supplies, checking if this request is linked to their religious or cultural customs and asking if there is anything else you can do to help.

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

hospice care; taking care of the whole person—body, mind, spirit, heart, and soul—with the goal of giving patients with life-threatening illnesses the best quality of life they can have through the aggressive management of symptoms

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.

Terminal illness

illness from which there is no reasonable expectation of recovery or cure

Loss

inaccessibility or change in a valued person, object, or situation. Actual loss: loss tangible to both the person sustaining the loss and to others. Perceived loss: loss tangible only to the person sustaining it. Physical loss: loss of life, limb, an object, person, pet, or job. Psychological loss: loss that affects a person's self-image. Anticipatory loss: loss behaviors displayed before the actual loss occurs.

Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal?

leaving the wife's room and belongings intact

Palliative sedation

the lowering of patient consciousness with medication for the express purpose of limiting the patient's awareness of suffering that is intractable and intolerable

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

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?"

Death

(1) irreversible cessation of all functions of circulatory and respiratory functions; (2) irreversible cessation of all functions of the entire brain, including the brainstem; (3) termination of life

Active euthanasia

someone other than the patient commits an action with the intent to end the patient's life, for example, injecting the patient with a lethal dose of a drug

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.

MOLST form

stands for Medical Order for Life-Sustaining Treatment, a medical order indicating a patient's wishes regarding treatments commonly used in a medical crisis

POLST form

stands for Physician Order for Life-Sustaining Treatment, a medical order indicating a patient's wishes regarding treatments commonly used in a medical crisis; must be completed and signed by a health care professional, not the patient

Bereavement

state of grieving or going through the grief process

Terminal weaning

withdrawal of life-sustaining therapy with the understanding that death may result, generally after a decision is made that the therapy in question is medically futile or disproportionately burdensome

Advance directive

written directive that allows people to state in advance what their choices for health care would be if certain circumstances should develop

A nurse caring for a client with a terminal illness understands which statement to be true?

Recovery is not expected.

The home health nurse is visiting a client who has been living alone for the past 5 years following the death of the spouse. Which behavior suggests the client may be experiencing abnormal grief?

The client talks as if the loss just happened.

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

to prevent and relieve suffering

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 physician 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

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." What is the most appropriate statement by the nurse?

"Can you tell me about why you've made this decision?"

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?"

When assessing a client, which statement indicates that the client is experiencing the anger stage of death and dying?

"I am a good person. Why did this happen to me?"

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?

"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, the nurses make most of the care decisions for the 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 is informed of the diagnosis of leukemia based on recent testing results. The client states, "I do not have leukemia." Which additional statement indicates the client is experiencing denial?

"Mistakes are made with laboratory tests all the time."

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 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 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."

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 visits a client in the home who is at the end stage of life from stage IV colon cancer and observes that the client is in obvious pain. The nurse asks the spouse when the client last had medication for pain and the spouse reports withholding the pain medication, fearing the client will become addicted. How should the nurse respond to the spouse?

"The fear of addiction should not prevent the client from obtaining adequate pain relief so let us discuss the schedule of medication."

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."

Which situation is most likely to warrant an autopsy?

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

Which assessment finding would best support a nursing diagnosis of Dysfunctional Grieving?

A man is unable to return to work after his sister's death 18 months ago.

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.

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?

Administering a lethal dose of medication

A nurse is conducting an in-service program for a group of hospice nurses. When describing the grief response in adults and older adults as compared to children, which would the nurse most likely include? Select all that apply.

Adults and older adults grieve more continuously. Children need to go through the same grief reactions as adults do Adults and older adults do not seek an immediate replacement for the lost loved one.

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 nurse is assessing a client who was diagnosed with metastatic prostate cancer. Which information from the client's medical record indicates the client is experiencing depression?

Appears sullen, shakes head "yes" or "no," refuses visitors

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.

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?

Disorganization

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?

Depression

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

Encourage discussion between the husband and wife regarding their intimacy needs

The nurse is preparing a presentation on preparing children for death. What information should the nurse include? Select all that apply.

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

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 family that acceptance is part of the grieving process.

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.

A nurse informs a woman that there is nothing more that can be done medically for her premature infant who is expected to die. The mother suppresses her grief and tells the nurse she is experiencing heart palpitations. What type of grief might the mother be experiencing?

Inhibited grief

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 patients is covered by Medicare.

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

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.

The nurse is caring for a client that is at the end of life. After the client is pronounced dead, what actions by the nurse are essential components of care? Select all that apply.

Removing all tubes according to agency policy, unless an autopsy is to be performed Placing identification tags on the client's dentures or other prostheses Arranging for family members to view the body before it is discharged to the mortician

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.

The nurse is assisting a client and family with the death and dying process. Which is the first thing the nurse does to prepare to provide culturally competent care?

Understand the client's beliefs.

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

Hospice care

a type of end-of-life care for persons who are terminally ill, characterized by the following: (1) patients are kept as free of pain as possible so that they may die comfortably and with dignity; (2) patients receive continuity of care, are not abandoned, and do not lose personal identity; (3) patients retain as much control as possible over decisions regarding their care and are allowed to refuse further life-prolonging technologic interventions; and (4) patients are viewed as individuals with personal fears, thoughts, feelings, values, and hopes

A home health care nurse has been visiting a patient with AIDS who says, "I'm no longer afraid of dying. I think I've made my peace with everyone, and I'm actually ready to move on." This reflects the patient's progress to which stage of death and dying? a. Acceptance b. Anger c. Bargaining d. Denial

a. Acceptance

A nurse midwife is assisting a patient who is firmly committed to natural childbirth to deliver a full-term baby. A cesarean delivery becomes necessary when the fetus displays signs of distress. Inconsolable, the patient cries and calls herself a failure as a mother. The nurse notes that the patient is experiencing what type of loss? Select all that apply. a. Actual b. Perceived c. Psychological d. Anticipatory e. Physical f. Maturational

a. Actual b. Perceived c. Psychological

A patient diagnosed with breast cancer who is in the end stages of her illness has been in the medical intensive care unit for 3 weeks. Her husband tells the nurse that he and his wife often talked about the end of her life and that she was very clear about not wanting aggressive treatment that would merely prolong her dying. The nurse could suggest that the husband speak to his wife's health care provider about which type of order? a. Comfort Measures Only b. Do Not Hospitalize c. Do Not Resuscitate d. Slow Code Only

a. Comfort Measures Only

A nurse is preparing a family for a terminal weaning of a loved one. Which nursing actions would facilitate this process? Select all that apply. a. Participate in the decision-making process by offering the family information about the advantages and disadvantages of continued ventilatory support. b. Explain to the family what will happen at each phase of the weaning and offer support. c. Check the orders for sedation and analgesia, making sure that the anticipated death is comfortable and dignified. d. Tell the family that death will occur almost immediately after the patient is removed from the ventilator. e. Tell the family that the decision for terminal weaning of a patient must be made by the primary care provider. f. Set up mandatory counseling sessions for the patient and family to assist them in making this end-of-life decision.

a. Participate in the decision-making process by offering the family information about the advantages and disadvantages of continued ventilatory support. b. Explain to the family what will happen at each phase of the weaning and offer support. c. Check the orders for sedation and analgesia, making sure that the anticipated death is comfortable and dignified.

A nurse who cared for a dying patient and his family documents that the family is experiencing a period of mourning. Which behaviors would the nurse expect to see at this stage? Select all that apply. a. The family arranges for a funeral for their loved one. b. The family arranges for a memorial scholarship for their loved one. c. The coroner pronounces the patient's death. d. The family arranges for hospice for their loved one. e. The patient is diagnosed with terminal cancer. f. The patient's daughter writes a poem expressing her sorrow.

a. The family arranges for a funeral for their loved one. b. The family arranges for a memorial scholarship for their loved one. f. The patient's daughter writes a poem expressing her sorrow.

A nurse is providing postmortem care. Which nursing action violates the standards of caring for the body after a patient has been pronounced dead and is not scheduled for an autopsy? a. The nurse leaves the patient in a sitting position while the family visits. b. The nurse places identification tags on both the shroud and the ankle. c. The nurse removes soiled dressings and tubes. d. The nurse makes sure a death certificate is issued and signed.

a. The nurse leaves the patient in a sitting position while the family visits.

A hospice nurse is caring for a patient who is terminally ill and who is on a ventilator. After a restless night, the patient hands the nurse a note with the request: "Please help me end my suffering." Which response by a nurse would best reflect adherence to the position of the American Nurses Association (ANA) regarding assisted suicide? a. The nurse promises the patient that he or she will do everything possible to keep the patient comfortable but cannot administer an injection or overdose to cause the patient's death. b. The nurse tells the patient that under no condition can he be removed from the ventilator because this is active euthanasia and is expressly forbidden by the Code for Nurses. c. After exhausting every intervention to keep a dying patient comfortable, the nurse says, "I think you are now at a point where I'm prepared to do what you've been asking me. Let's talk about when and how you want to die." d. The nurse responds: "I'm personally opposed to assisted suicide, but I'll find you a colleague who can help you."

a. The nurse promises the patient that he or she will do everything possible to keep the patient comfortable but cannot administer an injection or overdose to cause the patient's death.

A 70-year-old patient who has had a number of strokes refuses further life-sustaining interventions, including artificial nutrition and hydration. She is competent, understands the consequences of her actions, is not depressed, and persists in refusing treatment. Her health care provider is adamant that she cannot be allowed to die this way, and her daughter agrees. An ethics consult has been initiated. Who would be the appropriate decision maker? a. The patient b. The patient's daughter c. The patient's health care provider d. The ethics consult team

a. The patient

Dysfunctional grief

abnormal or distorted grief that may be either unresolved or inhibited

Do Not Resuscitate (DNR) order

an order specifying that there be no attempt to resuscitate a patient in the event of cardiopulmonary arrest

Allow Natural Death (AND) order

an order that no attempts are to be made to resuscitate a patient who stops breathing or whose heart stops beating

Comfort Measures Only order

an order written to indicate that the goal of treatment is a comfortable, dignified death and that further life-sustaining measures are no longer indicated

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. She is constantly yelling at me." The nurse understands that the client is in which stage of grief according to Kübler-Ross?

anger

A nurse is visiting a patient with pancreatic cancer who is dying at home. During the visit, he breaks down and cries, and tells the nurse that it is unfair that he should have to die now when he's finally made peace with his family. Which response by the nurse would be most appropriate? a. "You can't be feeling this way. You know you are going to die." b. "It does seem unfair. Tell me more about how you are feeling." c. "You'll be all right; who knows how much time any of us has." d. "Tell me about your pain. Did it keep you awake last night?"

b. "It does seem unfair. Tell me more about how you are feeling."

A nurse is caring for a terminally ill patient during the 11 PM to 7 AM shift. The patient says, "I just can't sleep. I keep thinking about what my family will do when I am gone." What response by the nurse would be most appropriate? a. "Oh, don't worry about that now. You need to sleep." b. "What seems to be concerning you the most?" c. "I have talked to your wife and she told me she will be fine." d. "I'm not qualified to advise you, I suggest you discuss this with your wife."

b. "What seems to be concerning you the most?"

A patient tells a nurse that he would like to appoint his daughter to make decisions for him should he become incapacitated. What should the nurse suggest he prepare? a. POLST form b. Durable power of attorney for health care c. Living will d. Allow Natural Death (AND) form

b. Durable power of attorney for health care

A nurse is caring for terminally ill patients in a hospital setting. Which nursing action describes appropriate end-of-life care? a. To eliminate confusion, the nurse takes care not to speak too much when caring for a comatose patient. b. The nurse sits on the side of the bed of a dying patient, holding the patient's hand, and crying with the patient. c. The nurse refers to a counselor the daughter of a dying patient who is complaining about the care associated with artificially feeding her father. d. The nurse tells a dying patient to sit back and relax and performs patient hygiene for the patient because it is easier than having the patient help.

b. The nurse sits on the side of the bed of a dying patient, holding the patient's hand, and crying with the patient.

A client diagnosed with terminal cancer is making plans to take a trip to visit an estranged sibling. What stage of death and dying, according to Kübler-Ross, is best illustrated in this description?

bargaining

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

bargaining

A premature infant with serious respiratory problems has been in the neonatal intensive care unit for the last 3 months. The infant's parents also have a 22-month-old son at home. The nurse's assessment data for the parents include chronic fatigue and decreased energy, guilt about neglecting the son at home, shortness of temper with one another, and apprehension about their continued ability to go on this way. What human response would be appropriate for the nurse to document? a. Grieving b. Ineffective Coping c. Caregiver Role Strain d. Powerlessness

c. Caregiver Role Strain

A nurse interviews an 82-year-old resident of a long-term care facility who says that she has never gotten over the death of her son 20 years ago. She reports that her life fell apart after that and she never again felt like herself or was able to enjoy life. What type of grief is this woman experiencing? a. Somatic grief b. Anticipatory grief c. Unresolved grief d. Inhibited grief

c. Unresolved grief

Anticipatory loss

condition in which a person displays loss and grief behaviors for a loss that has yet to take place

The nurse is assessing a client recently diagnosed with terminal lung cancer who states, "This can't be happening to me. Maybe the doctor made a mistake." Which stage of death and dying is the client exhibiting?

denial

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 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.

Grief

emotional response to loss. Dysfunctional grief: distorted or abnormal grief response, including inhibited grief (suppression of grief reaction) and unresolved grief (lengthy or denied grief reaction). Abbreviated grief: short but genuine grief reaction. Anticipatory grief: grief reaction before actual loss.

Perceived loss

loss of youth, of financial independence, and of a valued environment experienced by a person, but intangible to others

Actual loss

loss that can be recognized by others as well as by the person sustaining the loss, such as loss of a limb or a spouse

The experience of parting with an object, person, belief, or relationship that one values is defined as:

loss.

Euthanasia

mercy killing; the deliberate termination of the life of a person

Mourning

period during which a person learns to accept grief

Advance care planning (ACP)

process of planning for future care in the event a person becomes unable to make his or her own decisions

What is the most important goal of care for the dying client who is receiving comfort care?

providing a comfortable, dignified death

Which care environment would the nurse suggest to a client with no family nearby who is diagnosed with end-stage lung disease?

residential care