(PrepU) Chapter 43: Loss, Grief, and Dying

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?

"No breathing and no pulse at 0840." The priority documentation is the assessment that indicates the client is dead. The other items can occur and will be documented after establishing that death has occurred.

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?" The client is expressing anger when displaying a "why me" attitude. The other statements are reflective of other stages of grief.

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?" 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.

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." 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.

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." An advance directive is a written statement identifying a competent person's preferences regarding which medical interventions to use in the event that the client can not make a decision for themselves concerning terminal care. The other responses are not correct.

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?

"Have you considered respite care so that you can rest for a few days?" Respite care (relief for the caregiver by a surrogate) is important because it gives the caregiver an opportunity to enjoy brief periods away from home. Short-term respite care can be arranged in an inpatient facility and would allow the caregiver time to rest. A residential home (long-term care facility) may not be warranted. Being critical of the caregiver is not helpful and while it is important to be empathetic, it is imperative to provide options that may be helpful, such as respite care. The focus of support may shift back and forth between the client and the caregiver.

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." 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 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?

"I would like to sit here with you and listen." 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.

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

"It must be very difficult for you." 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.

The hospice nurse is visiting a new client. Which assessment questions are appropriate for the nurse to ask a client who has a terminal illness? Select all that apply.

"Please describe what you have been told about your condition." "What community resources might be of help to you?" "How well do you think those around you are coping?" "Have you had any previous experiences with the death of someone you love?" Focused assessment for those experiencing loss, grief, and dying is directed toward determining the adequacy of the client's and family's knowledge, perceptions, coping strategies, and resources. Interview questions for these areas would include the following: adequacy of knowledge base ("describe your condition"), perceptions ("previous experience with death of someone you loved"), adequacy of resources ("community resources"), and adequacy of coping ("those around you coping"). Determining if a client has a will to distribute personal property is not a priority assessment for the nurse.

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." Kübler-Ross (1969) studied the responses to death and dying. Her findings are as follows: Sometimes a person returns to a previous stage; the stages of dying may overlap; the duration of any stage may range from as little as a few hours to as long as months; the process varies from person to person.

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." Palliative care involves taking care of the body, mind, spirit, heart, and soul. It views dying as something natural and personal. The goal of palliative care is to give clients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms. A do-not-resuscitate order means that no attempts are to be made to resuscitate a client whose breathing or heart stops. Gradual withdrawal of mechanical ventilation from a client with a terminal illness and poor prognosis is called terminal weaning. Clients do not have to be in an inpatient hospice unit to receive palliative care.

"My father has been dead for over a year and my mother still can't talk about him without crying. Is that normal?" What is the best response by the nurse?

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

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?

"This is common in older adults and doesn't necessarily indicate depression." Older adults may read obituaries and death notices in the newspaper daily in an effort to keep up with acquaintances. Although this activity may be viewed as potentially depressing, it may be an effective coping mechanism in helping to develop a peaceful and accepting attitude toward death. The other responses are not appropriate.

When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response?

"This must be very difficult for you." 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.

The nurse is providing care for a client that is terminally ill with cancer. The client states to the nurse, "Am I going to die?" What is the most therapeutic response by the nurse?

"What have you been told?" When a client asks a question that is surprising or unexpected, it is best to find out what the client has been told about the situation or how they feel about it. The nurse should not try to avoid responding to the question by leaving to go care for another client. Making a cliché statement such as "you will go when it is your time" or telling the client to not worry about it does not meet the client's need for an answer or for expressing their feelings.

Which situation is most likely to warrant an autopsy?

A client's death involves an allegation of a medical error. Allegations of incompetence or malpractice create a need for an autopsy. An unwitnessed death, an unsuccessful code, or a death by infectious disease may require an autopsy due to other situation-specific factors, but these situations themselves do not necessarily require an autopsy.

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. An inability to return to normal activities 18 months after a sibling's death is suggestive (though not definitive) of Dysfunctional Grieving. Crying and having difficulties sleeping are not unusual and will often accompany healthy grieving. A feeling of "not doing enough" is common during grief and would only be considered dysfunctional if this became a long-term and all-encompassing belief.

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 physician's signature is required on a death certificate. It is the nurse's responsibility to ensure that the physician has signed a death certificate. A death certificate is signed by the pathologist, the coroner, and others in special cases. U.S. law requires that a death certificate be prepared for each person who dies. Death certificates are required in all deaths in the U.S., must be signed by a physician, 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.

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

Administer sedation and analgesia. Terminal weaning is the gradual withdrawal of mechanical ventilation from a client with a terminal illness. Providing sedation and analgesia is the best way to reduce the client's discomfort during the process. The nurse participates in the process by educating the client and family about the burdens and benefits of continued ventilation and what to expect when terminal weaning is initiated. Supporting the family and having the family remain at the bedside are important roles of the nurse during terminal weaning, but do not directly affect discomfort as much as sedation and analgesia.

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 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.

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 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.

An appropriate nursing diagnosis for the family of a client dying of cancer, whose members have expressed sorrow over the forthcoming loss, would be:

Anticipatory Grieving related to loss of family member, as evidenced by sorrow. Anticipatory grieving comprises the intellectual and emotional responses and behaviors by which individuals, families, and communities work through the process of modifying self-concept based on the perception of loss.

Which statement regarding perceptions of death by children is accurate?

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

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. If there is no DNR order to the contrary, the standard of care obligates professionals to attempt resuscitation if a client stops breathing or his or her heart stops. It is important for nurses to clarify a client's code status if the nurse has reason to believe a client would not want to be resuscitated. It is imperative that the client's wishes are documented in a formal document in the health record for all to view. Slow-codes are never good practice, and the nurse could be charged with negligence in the event of a slow-code and resultant client death. Calling the charge nurse or nurse manager is not appropriate because it can delay emergency care, which could result in negligence and client death.

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 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.

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 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 nurse is assessing the spouse of a client who has just died. Which subjective findings of grief would the nurse expect to assess? Select all that apply.

Detachment Bitterness Preoccupation with the loss Subjective symptoms of grief include detachment, bitterness, and preoccupation with the loss. Slowed motor function, unkempt appearance, and excessive weight gain are objective signs of grief.

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 In the disorganization stage of grief, the client may exhibit difficulty making decisions, aimlessness, 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, and wish to join the deceased. In the reorganization stage of grief, the client may exhibit a realistic memory of deceased, be comfortable when remembering the deceased, and return to previous level of ability.

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 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.

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. In preparing children for death, encourage expression of feelings, provide for stability and safety, talk openly about death, and encourage expression of feelings. Do not praise stoicism, nor encourage forgetting of the deceased, nor force the child to participate in mourning rituals.

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. Acceptance (an attitude of complacency) occurs after clients have dealt with their losses and completed unfinished business. After tying up all loose ends, dying clients feel prepared to die. Some even happily anticipate death, viewing it as a bridge to a better dimension. Nurses can help clients to pass from one stage to another by providing emotional support and by supporting the client's choices concerning terminal care. Facilitating the client's directives helps to maintain the client's personal dignity and locus of control. Accepting that death will occur and giving up are not the same thing and giving up is not expected.

A nurse is preparing a presentation for a family support group for cancer. The nurse is planning to describe grieving and the various terms associated with this concept. Which term would the nurse use to describe the entire range of responses to the loss of a valued object, person, belief, or relationship?

Grief Grief is person centered and encompasses the entire range of physical, psychological, cognitive, and behavioral responses to a loss of an object, person, belief, or relationship that one values. Bereavement is a state of desolation that occurs as the result of a loss, particularly the death of a significant other. Mourning encompasses the socially prescribed behaviors after the death of a significant other.

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 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.

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. Hospice programs, which, in effect, are a type of insurance benefit, focus on relieving symptoms and supporting clients with a life expectancy of 6 months or less, and their families. Palliative care, on the other hand, may be given at any time during a client's illness, from diagnosis to end of life. Hospice and palliative care programs provide care that focuses on quality rather than length of life. Both hospice and palliative care share a similar foundation. Hospice and palliative care provide physical, social, psychological, and spiritual support through a team of health care professionals and lay volunteers.

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 With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations. Anticipatory loss or grief occurs when a person displays loss and grief behaviors for a loss that has yet to take place. In unresolved grief, a person may have trouble expressing feelings of loss, may deny them, and the bereavement may extend over a lengthy period. Dysfunctional grief is abnormal or distorted; it may be either unresolved or inhibited.

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. Inpatient pain management is covered by Medicare as are any other Medicare-covered services needed to manage pain and other symptoms as recommended by the hospice team. Medicare will cover pain control in the home as well, but for extreme pain, hospitalization may be required. Telling a client not to worry about payment does not educate about what services are available.

When preparing for the death of a client, the nurse should provide the client's family with which interventions? Select all that apply.

Listen to concerns, fears, and worries. Encourage rest and proper nutrition. Explain the dying process and allow grieving. Utilize therapeutic communication techniques. The nurse can provide care for the family facing loss by listening to their concerns, fears, and worries. The nurse can do this by utilizing therapeutic communication techniques. The nurse should encourage the family to get adequate rest and nutrition. The reality of death may be less painful if the family is prepared ahead of time, which the nurse can facilitate by explaining the process and allowing the family to grieve. It is important for the family to get adequate rest, so it should not be suggested that the family never leave the bedside.

A client has been diagnosed with a terminal illness and has periods of depression and periods of anger. The client's spouse is concerned, feeling as though their loved one is not moving forward in the stages of grief. What teaching is most appropriate for the nurse to include? Select all that apply.

Movement between stages can be progressive. Movement back and forth between stages is expected. The Five Stages of Grief (the Kübler-Ross Model) are denial, anger, bargaining, depression, and acceptance. These stages, which represent a pattern of adjustment, may occur in a progressive fashion, or a person can move back and forth through the stages. There is no specific time period for the rate of progression, duration, or completion of the stages.

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 Irregular heart rate Decreased urine output Signs of dying include extremely pale, cyanotic, jaundiced, mottled or cool skin; irregular heart rate; weak, rapid, irregular pulse; shallow, labored, faster, slower, or irregular respirations; and decreased urine output.

When assessing a person who is grieving using the grief cycle model, which concept would be most important for the nurse to keep in mind? Select all that apply.

People vary widely in their responses to loss. Stages occur at varying rates among people. Some people actually skip some stages of grief altogether. 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 nurse is providing care to pediatric clients on an oncology floor. The nurse would expect which age group as perceiving death as reversible, avoidable and occurring in degrees?

Preschoolers Preschoolers perceive death as reversible, avoidable, and occurring in degrees. Infants have no concept of life and death. Toddlers experience a fear of abandonment. Early school-age children perceive death as unnatural, reversible and avoidable, and may also personify death.

A nurse at the health care facility cares for several clients. Some of the clients may require end-of-life care. Which case may require the service of a coroner?

The client did not have any recent medical consultation. The services of a coroner may be needed in a case where the client did not have any recent medical consultation. A coroner is a person legally designated to investigate deaths that may not be the result of natural causes. Death following a diagnosis of acute renal failure, administration of oxygen therapy, or a history of hypertension does not call for the services of a coroner.

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 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 choice.

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

The client's breathing becomes noisy. 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.

The hospice nurse is assessing the wife of a client who died 14 months ago. The nurse is concerned that the wife is still grieving the death of her husband. Which objective assessment finding would suggest that the wife is not still grieving?

The wife's hair is clean and styled. Many of the subjective manifestations of grief have concomitant objective manifestations: dejected physical appearance, slowed motor function, weeping, outbursts of anger, emotional blunting, unkempt appearance, sleep, appetite disturbance (excessive weight loss or gain). Direct quotes are subjective data.

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 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 nurse should explain to the client's family member that a comfort-measures-only order is being implemented to obtain which expected outcome?

a comfortable, dignified death for the client A comfort-measures-only order indicates that the goal of treatment is a comfortable, dignified death and that further life-sustaining measures are no longer indicated. It does not have any bearing on organ donation. Comfort measures provide clear guidelines as the nursing care to be provided, which eliminates additional life-sustaining measures that the family has agreed upon.

A client with a terminal illness is overheard by the nurse saying, "If I promise never to smoke another cigarette in my life, please let me recover from this lung cancer." How will the nurse document this stage of grief according to the Kübler-Ross model?

bargaining Bargaining is a psychological mechanism for delaying the inevitable, usually by negotiating with a higher power. All other choices are incorrect.

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

bargaining Her proposed stages of grief are denial, anger, bargaining, depression, and acceptance.

A widow develops cancer within 6 months of her husband's death. This may be a result of:

bereavement 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 has a diagnosis of bladder cancer with metastasis. The client asks the nurse about the characteristics of hospice care. The nurse should explain that:

care is premised on the fact that dying is a normal process. 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.

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

coping strategies 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 nurse is taking care of a client recently involved in a motor vehicle accident during which a pet was thrown from the vehicle and died. The client states, "My heart aches and I can't eat or sleep." According to Kübler-Ross, what stage of grief is the client experiencing?

depression According to Kübler-Ross (1969), the client would be in the depression stage, as evidenced by the loss of sleep and appetite. The other stages do not apply to this client according to the statements made.

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 sign that death is approaching is the client's difficulty in swallowing. People who are dying do not experience decreased pain. They may not be in a position to report pain; therefore, the caregiver should observe the client closely. Urinary output decreases when a person is approaching death due to system failure and limited intake. The client approaching death has decreased sensory stimulation.

When preparing the care plan for a dying client, it is important for the nurse to include a goal that addresses which needs? Select all that apply.

expression of feelings management of pain use of coping strategies 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 experience of parting with an object, person, belief, or relationship that one values is defined as:

loss 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.

A nurse is assessing a client's grief response. Which concept would be most important for the nurse to keep in mind during the assessment to determine whether the client's response is normal or altered?

severity of the symptoms and the pattern of change over time Although depressive symptoms, possible self-harm, shock, disbelief, nightmares, and hallucinations may be part of the grief response, the nurse must assess the severity of the symptoms and the pattern of change over time to distinguish between normal and altered grief reactions. Observation and assessment of a grieving person at a single point in time is not a good way to assess the normality of the grief response.

Which stage of grieving is exhibited by the husband of a victim of sudden death who refuses to accept that she is dead?

shock 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 nurse is caring for an older adult comatose client in his home. The client is dying, and the client's family is providing some care. The family asks, "What else can we do?" The nurse encourages the family members to:

speak to the client. Dying clients may retain the sense of hearing until death ensues. The nurse should tell the client's family to communicate to the dying family member. Ice chips may be given to clients who are still able to swallow. This client cannot cooperate in swallowing. Position the comatose client in a semi-prone position to allow drainage of saliva. The client may need to be bathed frequently, not daily.

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. 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.