Prep U's - Chapter 43 - Loss, Grief, and Dying (TF)
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? A. "All efforts will be taken to make sure your loved one is comfortable and out of pain." B. "If you change your mind after we remove the breathing tube, just tell us and it will be reinserted." C. "Once the endotracheal tube is removed, your loved one will no longer be able to breathe." D. "Your loved one will not feel or be aware of anything that is happening once the breathing tube is removed."
Answer: A Rationale: A common and valid concern of families during terminal weaning is to make sure the client is not suffering. As such, the nurse's role is to educate the family regarding comfort measures, such as pain medication and additional sedation. It is inaccurate to tell the family that the client will no longer be able to breathe once the tube is removed. The client may continue breathing for several hours to days. When a decision is made to terminate mechanical ventilation, it should be clear that reintubation is no longer an option and death is inevitable. The nurse must be honest with the family, as the client may be aware of loved ones in the room and talking to the client is encouraged.
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? A. "Have you gone through and donated your spouse's clothing?" B. "Do you cry on the anniversary of your spouse's death?" C. "Can you remember the good times together with your spouse?" D. "Do you keep photos of your spouse on your bedside table?"
Answer: A Rationale: Abnormal grief responses present beyond 3 years after a loss. The nurse can identify if a client suffers from abnormal grief through questions aimed at learning if the client has left the deceased's room and belongings intact, has reported physical symptoms similar to those the deceased had before death, and has talked about the deceased as if the individual were still alive. Remembering good times and keeping photos of loved ones are part of reminiscing and a healthy form of grieving. Crying on the anniversary of a loved one's death is part of the normal grieving response.
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? A. The client should be treated with antibiotics for pneumonia. B. The client should be resuscitated if he experiences respiratory arrest. C. The wishes of his family should be followed. D. Pharmacologic interventions should not be initiated.
Answer: A Rationale: The client has signed a document indicating a wish not to be resuscitated. Treating the pneumonia with antibiotics is not a resuscitation measure. The other options do not respect the client's right to choose.
A nurse is explaining the preparation of a death certificate to a student nurse. Which statements accurately describe this process? (Select all that apply.) A. A health care provider's signature is required on a death certificate. B. The nurse assumes responsibility for handling and filing the death certificate with the proper authorities. C. It is the nurse's responsibility to ensure that the health care provider has signed a death certificate. D. A death certificate is signed by the pathologist, the coroner, and others in special cases. E. Death certificates are sent to a national health department, which compiles many statistics from the information. F. U.S. law requires that a death certificate be prepared for each person who dies.
Answer: A, C, D, F Rationale: Death certificates are required in all deaths in the U.S., must be signed by a health care provider, and the pathologist or coroner. The nurse must ensure that death certificates are signed. Death certificates are sent to local health departments. The mortician handles and files death certificates.
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? A. school-aged child B. adult C. toddler D. infant
Answer: B Rationale: Adults tend to grieve more intensely and more continuously, but for a relatively shorter period of time than children. Having a good social network helps with this process, as well as having a stable lifestyle.
The nurse is caring for a client who has just expired. Which action will the nurse perform? A. Provide a complete bath. B. Allow the client's family to see the client's body before it is discharged. C. Have the nurse technician place identification tags on the outside of the shroud. D. Place the client in a semi-Fowler's position.
Answer: B Rationale: After the client has been pronounced dead, the nurse is responsible for preparing the body. Family members may need to see the client's body to accept the death fully; allow them to see the client's body before discharging to the mortician. The body is placed in normal anatomic position (flat) to avoid pooling of blood. In most cases it is unnecessary to wash the body, and some religions strictly forbid it. The nurse is legally responsible for placing identification tags on either the shroud or garment that the body is clothed in, and on the ankle to ensure that the body can be identified even if separated from its shroud.
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? A. A potential for complicated grieving related to loss of partner. B. Anxiety related to unknown reaction to stages of death. C. An inability for the client to care for self during the dying process. D. Impaired comfort related to the impending death.
Answer: B Rationale: Anxiety related to unknown reaction to stages of death relates directly to an impending death. Complicated grieving refers to a grieving process that is not normal. Self-care deficit refers to personal care issues, not response to impending death. Impaired comfort is a physiologic problem associated with dying.
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? A. anticipatory grief B. grief reaction C. bargaining grief D. pathological grief
Answer: B Rationale: The client's spouse is demonstrating behaviors related to a grief reaction. The anticipatory grief occurs prior to the death. The client's spouse has not had enough of a length of time to determine if the grief is pathologic. The spouse is experiencing the denial stage of grief and not the bargaining stage.
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. Depression D. Denial
Answer: C Rationale: Depression is a commonly accepted form of grief and it represents the emptiness when the client realizes the person or situation is gone or over. Signs and symptoms may be withdrawn, sadness, crying, and flat affect. Denial is the stage where client may disregard that the news of diagnosis or death is not true. Anger is the stage where the client may think "why me?" and "life's not fair!" Bargaining is the stage of false hope. The client might falsely make themselves believe that they can avoid the grief through a type of negotiation. The stages are denial, anger, bargaining, depression, and acceptance.
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: A. symptoms of terminal illness should not be treated. B. care is generally guided by nurses rather than health care providers. C. care is premised on the fact that dying is a normal process. D. the client must be within 6 weeks of his expected death.
Answer: C Rationale: Hospice care is premised on the fact that dying is a normal process. Symptoms are treated aggressively in order to preserve comfort. Care is interdisciplinary and admission usually requires a 6-month life expectancy or less.
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. Restitution B. Outcome C. Idealization D. Awareness
Answer: C Rationale: Idealization is the exaggeration of the good qualities that the person had, followed by acceptance of the loss and a lessened need to focus on it. Restitution involves the rituals surrounding loss—with death, it includes religious, cultural, or social expressions of mourning, such as funeral services. Developing awareness is characterized by physical and emotional responses such as anger, feeling empty, and crying. Outcome, the final resolution of the grief process, includes dealing with loss as a common life occurrence.
Which stage of grieving is exhibited by the husband of a victim of sudden death who refuses to accept that she is dead? A. protest B. doubt C. shock D. depression
Answer: C Rationale: In the shock and disbelief stage, the survivor either refuses to accept the loss or shows intellectual acceptance of the loss but denies the emotional impact.
The experience of parting with an object, person, belief, or relationship that one values is defined as: A. bereavement. B. death. C. loss. D. grief.
Answer: C Rationale: Loss is defined as the experience of parting with an object, person, belief, or relationship that one values; the loss requires a reorganization of one or more aspects of the person's life.
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 are relatively discrete and identifiable. B. The stages of grief occur linearly and are static. C. Stages occur at varying rates among people. D. Some people actually skip some stages of grief altogether. E. People vary widely in their responses to loss.
Answer: C, D, E Rationale: In reality, the stages of the grief cycle model are not as discrete as the model indicates. However, it is helpful to use the model as a general guide, while keeping in mind that people may vary greatly in their responses to loss and still fall within the normal response range. Grieving persons may go through the stages at varying rates, go back and forth between stages, or skip stages.
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? A. "Once you've started treatment, it's important to continue." B. "Does your family agree with this decision?" C. "Have you discussed this with your health care provider?" D. "Can you tell me about why you've made this decision?"
Answer: D Rationale: Having the client explain his decision-making process is open-ended and allows exploration of the client's feelings. A competent client is not required to continue with treatment that has been initiated. The other options are closed-ended and stop any further conversation.
What is Kübler-Ross's third stage of grief? A. denial B. depression C. anger D. bargaining
Answer: D Rationale: Her proposed stages of grief are denial, anger, bargaining, depression, and acceptance.
The client is a young parent whose spouse died 3 months ago. The client is tearful and unkempt, eats a poor diet, and has lost 50 lb (22.6 kg) since the death of the spouse. The client states, "I cannot do this anymore." Which nursing concern is best supported by these data? A. ineffective denial related to poor grief resolution. B. death anxiety related to death of spouse. C. decisional conflict related to inability to progress following spouse's death. D. ineffective coping related to failure of previously used coping mechanisms.
Answer: D Rationale: The nursing concern best supported by these data is Ineffective coping. Defining characteristics include poor coping skills with activities of daily living as evidenced by unkempt appearance, eating poorly and losing weight, and client statement. Death anxiety refers to an impending death or thoughts of death. Ineffective denial refers to denying the reality of the situation. Decisional conflict refers to inability to make decisions.
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. Anger B. Bargaining C. Denial D. Acceptance
Answer: A Rationale: Anger is the second stage and is exhibited by statement similar to "Why me?" Denial occurs when the person refuses to believe certain information. Bargaining is an attempt to postpone death. During the acceptance stage, the dying clients accept their fate and make peace spiritually and with those to whom they are close.
Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief? A. coping strategies B. pain management C. spiritual distress D. self-care activities
Answer: A Rationale: Dysfunctional grief can be unresolved or inhibited. In unresolved grief, a person may have trouble expressing feelings of loss or may deny them. Unresolved grief also describes a state of bereavement that extends over a lengthy period. With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms. Coping strategies are necessary in the grieving process and for resolution of grief. Many times individuals experiencing dysfunctional grief have difficulty with self-care activities; however, the individual should be encouraged to perform these activities independently. Pain management is usually not necessary in the management of dysfunctional grief. The spiritual needs of the client are important as well and should be considered after coping strategies have been addressed.
The hospice nurse is caring for a group of clients with terminal illness. Which is the highest care priority for a client in the process of dying? A. Pain management B. Hydration C. Hygiene D. Skin care
Answer: A Rationale: End-of-life care requires comprehensive blended nursing skills and is unique to each client's circumstances. Common priorities, however, include the need to provide pain control and emotional support. Hydration and hygiene are not priorities at the end of life. As the client is dying, skin care is not the priority.
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. progress through the stages of grief. C. have felt distress and anger. D. experience death in his or her own life.
Answer: A Rationale: Nurses should be aware of the specific cultural and religious beliefs of the clients they are serving and help their clients deal with loss in a manner that is congruent with their cultural and religious beliefs and practices. It is important for a nurse to know the stages of grief to facilitate a plan of care for a client experiencing death. It is not important for a nurse to have experience with death prior to assisting a client with a different culture about death. A nurse should not feel distress or anger with helping a client deal with death. The feelings of a nurse should be supportive of cultural implications as well as empathy and sympathy.
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 just want to see my son have a family of his own." C. "I don't care about anything. I have no energy." D. "I do not believe I have this disease."
Answer: A Rationale: The client is expressing anger when displaying a "why me" attitude. The other statements are reflective of other stages of grief.
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!" Using Kübler-Ross stages of grief, what stage does the nurse identify the client is experiencing? A. anger B. denial and isolation C. acceptance D. bargaining
Answer: A Rationale: The client is identified as being in the anger stage of the grieving process. The client has accepted the fact that the spouse is gone but is angry and betrayed at the departure from life. The client has yet to accept this death and may have some overlapping with depression as well.
Which does not coincide with Kübler-Ross's stages related to a dying client? A. The dying client usually exhibits anger first. B. Some client regress, then move forward again. C. The client may be in several stages at once. D. Clients don't always follow the stages in order.
Answer: A Rationale: The dying client does not usually exhibit anger first. The client may be in several stages at once, clients don't always follow the stages in order, and some regress and then move forward.
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.
Answer: A Rationale: The goal of palliative care is to improve the client's and the family's quality of life. The support should include the client's physical, emotional, and spiritual well-being. Each discipline should contribute to a single care plan that addresses the needs of the client and family. The goal of palliative care is not aggressive support for curing the client. Providing physical support for the client is also not the goal of palliative care. A separate plan of care developed by the client with each discipline of the health care team is not the goal of palliative care.
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. treatment of the disease process. C. providing counseling related to the stages of death and dying. D. eliminating all forms of medical and nursing care.
Answer: A Rationale: The goal of palliative care is to provide clients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms. There is no treatment goal for the life-threatening illness for palliative care. Aggressive management of symptoms includes medical and nursing care for the client. Providing counseling related to the stages of death and dying is pursued after aggressive management of symptoms.
The nurse is providing care for a confused client who no longer is able to make health care decisions. Which document will the nurse review on the client's medical record to determine the designated person to make decisions on the client's behalf? A. Durable power of attorney form. B. Health care provider's progress notes. C. Advance directive form. D. Living will form.
Answer: A Rationale: The nurse would review the durable power of attorney (DPA) for health care form identifying the client's chosen proxy for health care decision-making. The DPA for health care is a person legally designated by the client to make health care decisions if the client becomes physically or mentally unable to do so. A living will is a legal document detailing the client's wishes for end-of-life care and usually includes specifics such as resuscitation in the event of cardiopulmonary arrest and wishes regarding feeding tubes. An advance directive is a legal form filled out by the client or client's DPA for health care that identifies wishes regarding lifesaving treatment. The health care provider's progress notes are drafted by the health care provider regarding the client's current status and medical treatment plan.
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? A. "It is fine if my parent dies. We have not been close for years." B. "My parent is suffering with cancer and death will be a relief of the pain." C. "I do not think my parent really has cancer. I think my parent needs to get a third opinion." D. "There is no way I can stay in the hospital because my parent is sick."
Answer: B Rationale: Anticipatory grief is the characteristic pattern of psychological and physiologic responses a person makes to the impending loss of a significant person. The client's statement, "My parent is suffering with cancer and death will be a relief of the pain," is an example of anticipatory grief and is intended to facilitate coping when death occurs. The client's statement, "There is no way I can stay in the hospital because my parent is sick" demonstrates empathy for the parent and denial of a personal need for treatment. Denial is apparent when the client suggests the parent's diagnosis is incorrect. Denial is also apparent when the client relates it is "fine" if the mother expires because they were not close.
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? A. Administering a morphine infusion. B. Administering a lethal dose of medication. C. Granting a client's request not to initiate enteral feeding when the client is unable to eat. D. Neglecting to resuscitate a client with a "do not resuscitate" status.
Answer: B Rationale: Assisted suicide refers to providing another person the means to end his or her own life, such as administering a lethal dose of a medication. This is not to be confused with the ethically and legally supported practices of withholding or withdrawing medical treatment in accordance with the wishes of the terminally ill individual. Administering a morphine infusion may be used to assist with a client's pain near the end of life. Granting a client's request not to initiate enteral feeding when the client is unable to eat is an example of wishes of a terminally ill client, and the agreed-upon measures near the end of life. Neglecting to resuscitate a client with a "do not resuscitate" status is following the prescribed, mutually agreed-upon decisions about care.
Which statement regarding perceptions of death by children is accurate? A. Adolescents tend to respond better than adults with death. B. At about age 9, the child perceives death as irreversible. C. Toddlers perceive death as irreversible and unnatural. D. Preschool-age children view death as a spiritual release.
Answer: B Rationale: At about 9 years of age, the child's concept of death matures, and the child perceives death realistically as irreversible, universal, inevitable, and natural.
The nurse is talking with the family after their loved one died. What words of support and comfort would be most therapeutic for the nurse to say after this event? A. "You must accept the death and move on with your life." B. "I would like to sit here with you and listen." C. "Your loved one is in a better place." D. "It's the lord's will."
Answer: B Rationale: Because comforting words are often difficult to find, the nurse should offer solace and support by being an attentive listener. The nurse should never assume that the client's spiritual and religious beliefs are the same as the family, making statements about the lord or being in a better place inappropriate. Informing newly grieving family members that they must move on is nontherapeutic and belittling.
Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal? A. showing a photograph of the decedent. B. leaving the wife's room and belongings intact. C. telling the nurse how his life has changed. D. talking about his wife's absent-mindedness.
Answer: B Rationale: Bereavement experts reported that they considered almost all bereavement manifestations to be normal during the early stages of grief, but considered most of the manifestations to be abnormal if they continue beyond 3 years.
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? A. Family at bedside talking about grandchild's success in college. B. Appears sullen, shakes head "yes" or "no," refuses visitors. C. Confused as to time and place, oriented to person. D. Threw water pitcher on the floor stating, "That is not cold enough!".
Answer: B Rationale: Loss, grief, and sadness indicate depression. As such, "Appears sullen, shakes head "yes" or "no," and refuses visitors are signs of depression. The client is expressing anger when throwing the water pitcher on the floor. The family at the bedside talking about a grandchild's success in college is a normal interaction and may indicate acceptance of the current situation. If confusion is acute and sudden, it may indicate the beginning of the client's physical decline.
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 client is calm and peaceful. B. The client's breathing becomes noisy. C. The frequency of urination decreases. D. The arms and legs are warm to touch.
Answer: B Rationale: Noisy breathing, or death rattle, is common during the final stages of dying because of the accumulation of secretions in the lungs. Reduced urination is not seen during the final stages of dying. Instead, the client develops loss of control over bladder and bowels due to loss of neurological control. The peripheral parts of the client's body such as the arms and the legs are cold to touch (not warm) because the circulation is directed away from the periphery and toward the core of the body. Clients in the last stages of dying are usually not calm and peaceful; they occasionally exhibit sudden restlessness due to hunger for oxygen.
"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. "The inability to talk about your dad without crying, even after a year, is still considered normal." C. "In fact, the more that someone cries about a loss, the better they're dealing with it." D. "It is not normal. Your mother needs to see a therapist about her grief."
Answer: B Rationale: Normal responses to bereavement after 1 year include the inability to speak of the deceased without intense emotion, clinical signs of depression, and feelings of meaninglessness. Increased crying does not necessarily signal increased coping, however.
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.
Answer: B Rationale: Palliative care, which is conceptually broader than hospice care, is both an approach to care and a structured system for care delivery that aims to "...prevent and relieve suffering and to support the best possible quality of life for clients and their families, regardless of the stage of the disease or the need for other therapies." Palliative care goes beyond giving traditional medical care. Palliative care is considered a "bridge" not exclusively limited to hospice care. "Hope" is something clients and families have even while the client is actively dying.
A widow develops cancer within 6 months of her husband's death. This may be a result of: A. alcohol intake. B. bereavement. C. social isolation. D. multiple losses.
Answer: B Rationale: Physical health and psychosocial adjustment are intricately intertwined. The bereaved are known to be at greater risk for mortality and morbidity than are comparable non-bereaved people.
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? A. "I think you are correct. Something is wrong with your loved one." B. "Not everyone experiences grief in the same way and your loved one needs our support." C. "Sometimes people become suicidal, and we will place your loved one in restraints." D. "Most people go through all sorts of feelings and your loved one is no different."
Answer: B Rationale: Stages of grief include denial, anger, bargaining, depression, and acceptance. The progression in which people move through stages varies from person to person. Some people may not experience each stage. Sharing with the spouse that "Not everyone experiences grief in the same way and your loved one needs our support" is the most therapeutic response. Telling the spouse that something is wrong is incorrect as this is a normal response to grieving. There is no verifying data in the question stem indicating the client is suicidal and restraints are not used in a situation such as this. Telling the spouse that "most people go through all sorts of feelings" is not therapeutic; the nurse is minimizing the loved one's feelings.
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. Place a rolled towel under the head. B. Cleanse drainage from the skin. C. Apply hairpins and clips. D. Avoid replacing dentures in the mouth.
Answer: B Rationale: The nurse should cleanse secretions and drainage from the skin to ensure delivery of a hygienic body. The dentures should be replaced in the mouth, as they maintain the natural contour of the face. A small rolled towel is placed beneath the chin of the client to close the mouth; it is not placed under the head. The nurse should remove all hairpins or clips to prevent accidental trauma to the client's face.
A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education? A. "Hospice care programs focus on quality rather than length of life." B. "In hospice care, the nurses make most of the care decisions for the clients." C. "Palliative care affirms life and regards dying as a normal process." D. "Palliative care provides relief from pain and other distressing symptoms."
Answer: B Rationale: The philosophy of hospice is that clients and families are empowered to achieve as much control over their lives as possible. Hospice focuses on relieving symptoms and supporting clients with a life expectancy of 6 months or less, rather than years, and their families. However, palliative care may be given at any time during a client's illness, from diagnosis to end of life.
The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate? A. "There's no need for anger." B. "It must be very difficult for you." C. "You should try to make things right with your family." D. "I can't imagine how awful this is for you."
Answer: B Rationale: Use statements with broad openings such as "It must be difficult for you" and "Do you want to talk about it?" Such language encourages communication and allows the client to choose the topic or manner of response. Accept the client's behavior. Anger is part of the grieving process. Indicating that this is "awful" is not an appropriate way to promote coping. It is not the nurse's role to tell the client to make things right with the family. While this may be desired, the client should initiate it.
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. urinary elimination B. management of pain C. use of coping strategies D. expression of feelings E. nutritional therapy
Answer: B, C, D Rationale: Nursing care for the dying client should be directed toward the achievement of several goals, including demonstration of the ability to express feelings, fears, and concerns. The client's pain should be managed effectively to allow the client to interact meaningfully with family. The client should also be able to identify and utilize effective coping strategies such as deep breathing, talking with family members, and rest periods. Nutritional therapy and urinary elimination are not specific to the dying client, and more assessment would be needed to determine if these are viable needs for the client.
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. A. Systolic blood pressure which rose from 100 to 110 mm Hg. B. Cyanotic nail beds in hands and feet bilaterally. C. Gurgling sounds emanating from the client's throat with each breath. D. Distended abdomen with last bowel movement documented 7 days ago. E. A regular apical pulse of 90 beats/minute.
Answer: B, C, D Rationale: Signs of an impending death include noisy respirations, abdominal distention, constipation, and cyanosis of the extremities. The pulse may be slow and/or irregular. The systolic blood pressure would be decreasing, not increasing.
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. "A lot of the time I'm terrified that I'm going to die the same way." B. "I had a good time at my class reunion. It was nice to be out with other people again." C. "I haven't let my children out of my sight. I am afraid something will happen to them." D. "I feel like I have absolutely no idea what to do next."
Answer: D Rationale: In the disorganization stage of grief, the client may exhibit difficulty making decisions, aimlessness, decreased resistance to illness, and loss of interest in people, work, and usual activities. In the protest stage of grief, the client may exhibit preoccupation with thoughts of the deceased, searching for the deceased, dreams/nightmares, hallucinations, and concerns about others' health and safety. In the shock stage, the client may exhibit slowed and disorganized thinking, blocking of thoughts, neglect of appearance, and wish to join the deceased. In the reorganization stage of grief, the client may exhibit a realistic memory of the deceased, be comfortable when remembering the deceased, and return to previous level of ability.
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? A. Normal grief B. Anticipatory grief C. Inhibited grief. D. Unresolved grief
Answer: D Rationale: In unresolved grief, a person may have trouble expressing feelings of loss, may deny them, and the bereavement may extend over a lengthy period. Anticipatory loss or grief occurs when a person displays loss and grief behaviors for a loss that has yet to take place. Inhibited grief occurs when a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations. Normal expressions of grief may be physical (crying, headaches, difficulty sleeping, fatigue), emotional (feelings of sadness and yearning), social (feeling detached from others and isolating oneself from social contact), and spiritual (questioning the reason for the loss, the purpose of pain and suffering, the purpose of life, and the meaning of death).
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: A. give permission for organ donation. B. dictate how the client wants his estate handled after his death, and by whom. C. make legal provisions for active euthanasia. D. specify the treatment measures that the client wants and does not want.
Answer: D Rationale: Living wills provide instructions about the kinds of health care that should be used or rejected under specific circumstances. The management of an individual's estate is specified in a will, not a living will. It is not legal for a living will to make provisions for active euthanasia. A living will may or may not include reference to organ donation, but normally this is addressed in a separate, specific consent card or document.
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? A. Reassure the client's husband that he cannot hurt the client during sexual intercourse. B. Suggest other ways the couple can spend time together, such as watching television together. C. Inform the client's husband that the client cannot have sexual intercourse due to fatigue. D. Encourage discussion between the husband and wife regarding their intimacy needs.
Answer: D Rationale: Partners of terminally ill clients may wish to be physically intimate with the dying person but are afraid of "hurting" him or her and may also be afraid that an open expression of sexuality is somehow "inappropriate" when someone is dying. Encourage discussion and suggest ways to be physically intimate that will meet the needs of both partners, such as a foot massage or embrace, and not just watching TV. Telling the client that he cannot have relations based on the fatigue of the client's spouse is not appropriate. Reassuring the client that he will not cause pain is incorrect.
A client that is dying yells at the nurse, "I put my light on a long time ago and you do not even care enough to see what I need!" How should the nurse respond? A. "I do not appreciate that you are speaking to me in that tone and would like you to lower your voice." B. "You have not had the light on for long and I got here as quickly as I could." C. "I was with another client that had pain which was a priority for me at that time." D. "I apologize for not responding more quickly and would be glad to help with whatever you need now."
Answer: D Rationale: The client who is dying may be experiencing a myriad of emotions such as anger at the situation, pain, fear of dying, and fear of being alone. The nurse should be accepting of the client's behavior, whatever it is, and adapt to it. By giving an apology and acknowledging the client's feelings, the nurse is demonstrating empathy and acceptance. Admonishing the client to speak more quietly makes the issue personal and about the nurse's feelings and emotions. The client is not interested in the nurse's activity with another client, and the activity of administering medication should not be discussed with the client. Insinuating that the client is being untruthful about the time spent waiting is argumentative and accusatory, which is non-therapeutic.
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? A. "This does not seem real to me." B. "What am I going to do now that my parent is gone?" C. "It is all my fault! I did not see the signs." D. "Please go away; I just want to be left alone."
Answer: D Rationale: The clinical definition of depression is anxiety and hostility turned inward. The statement asking the nurse to go away and a desire to be "left alone" indicates withdrawal, which is a characteristic of depression. "This does not seem real to me" indicates the client is in denial. Blaming oneself for the loss is an expression of guilt that may occur in the anger phase of grieving. Feeling uncertain about the future may occur as the grieving person accepts that the loved one is deceased, and life will be different.
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. "Have you talked with your spiritual leader about your fears?" C. "I'm sure you are angry and sad." D. "This must be very difficult for you."
Answer: D Rationale: The nurse should use statements with broad openings, such as "This must be difficult for you," to allow the client to continue expressing concerns and to acknowledge the client's feelings. This facilitates communication and allows the client to choose the topic or manner of response during this stage of the grieving process. Assuming the client is angry and sad or indicating that this is "a terrible diagnosis" is not an appropriate way to promote coping. The nurse should automatically assume a spiritual leader is desired.
