Ch 44 Loss, Grief, and Dying PrepU
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? "Once you've started treatment, it's important to continue." "Have you discussed this with your health care provider?" "Can you tell me about why you've made this decision?" "Does your family agree with this decision?"
"Can you tell me about why you've made this decision?" Explanation: 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 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?" "Do you keep photos of your spouse on your bedside table?" "Can you remember the good times together with your spouse?" "Do you cry on the anniversary of your spouse's death?"
"Have you gone through and donated your spouse's clothing?" Explanation: 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 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? "I apologize for not responding more quickly and would be glad to help with whatever you need now." "I do not appreciate that you are speaking to me in that tone and would like you to lower your voice." "I was with another client that had pain which was a priority for me at that time." "You have not had the light on for long and I got here as quickly as I could."
"I apologize for not responding more quickly and would be glad to help with whatever you need now." Explanation: 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.
When reviewing a client's chart, the nurse notes that the client is in the disorganization stage of grief. Which assessment finding would support this conclusion? "A lot of the time I'm terrified that I'm going to die the same way." "I haven't let my children out of my sight. I am afraid something will happen to them." "I had a good time at my class reunion. It was nice to be out with other people again." "I feel like I have absolutely no idea what to do next."
"I feel like I have absolutely no idea what to do next." Explanation: 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.
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? "Unfortunately, we are unable to continue services past the 6 month period of time." "I will contact the health care provider to extend services since your family member meets the criteria." "We can discontinue the service for a period of time and then when your family member gets worse, readmit them." "We can admit your family member to the hospital for treatment and they can reinstate the hospice benefits."
"I will contact the health care provider to extend services since your family member meets the criteria." Explanation: Hospice care is generally provided to clients that have 6 months or less to live, although they are not automatically discharged when they reach 6 months after having been admitted to hospice care. The client may still receive care as long as the health care provider certifies that the client continues to meet the criteria for hospice services. The client should not be admitted to the hospital since the acceptance of palliative comfort care is required to qualify for hospice services. Based on the provided information, there is no need to admit the client to the hospital, and hospital admission may result in termination from the program due to the provision of non-palliative care.
A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education? "Palliative care provides relief from pain and other distressing symptoms." "Hospice care programs focus on quality rather than length of life." "In hospice care, nurses take on the responsibility of making care decisions for clients." "Palliative care affirms life and regards dying as a normal process."
"In hospice care, nurses take on the responsibility of making care decisions for clients." Explanation: 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. Focuses include pain control, quality of life and normalizing the dying process.
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." "There's no need for anger." "I can't imagine how awful this is for you." "You should try to make things right with your family."
"It must be very difficult for you." Explanation: 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 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." "This does not seem real to me." "It is all my fault! I did not see the signs." "What am I going to do now that my parent is gone?"
"Please go away; I just want to be left alone." Explanation: 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.
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? "Each stage of dying must be completed prior to moving to the next stage." "The process is the same from person to person." "Sometimes a person returns to a previous stage." "The duration of all stages is a few hours."
"Sometimes a person returns to a previous stage." Explanation: 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." "In palliative care, no attempts are to be made to resuscitate a client whose breathing or heart stops." "Palliative care is the gradual withdrawal of mechanical ventilation from a client with terminal illness and poor prognosis." "The client will have to go to an inpatient hospice unit in order to receive palliative care."
"The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms." Explanation: 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.
Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning? Administer sedation and analgesia. Provide an explanation of the process. Offer emotional support to the family. Have the client's family remain at the bedside.
Administer sedation and analgesia. Explanation: 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 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 Administering a morphine infusion Granting a client's request not to initiate enteral feeding when the client is unable to eat Neglecting to resuscitate a client with a "do not resuscitate" status
Administering a lethal dose of medication Explanation: 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? Denial Anger Bargaining Acceptance
Anger Explanation: 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.
Which statement regarding perceptions of death by children is accurate? Toddlers perceive death as irreversible and unnatural. Preschool-age children view death as a spiritual release. At about age 9, the child perceives death as irreversible. Adolescents tend to respond to death and grief better than adults
At about age 9, the child perceives death as irreversible. Explanation: 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. In the early school years (not toddler years), the child perceives death as unnatural, reversible, and avoidable. The concept of spiritual release is beyond most preschool-aged children. Adolescents generally have the capacity to mourn fully, but they are at greater risk for poorer outcomes than are adults because of the numerous other stressors and developmental changes they are experiencing during this stage of the life cycle.
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. Initiate a slow-code until the health care provider arrives. Respect the client's wishes and avoid calling a code.
Call a code and begin resuscitating the client. Explanation: 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? Avoid replacing dentures in the mouth. Place a rolled towel under the head. Cleanse drainage from the skin. Apply hairpins and clips.
Cleanse drainage from the skin. Explanation: 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 client has been declared brain dead following a fall from a roof. The client's advance directives state they do not wish to have prolonged life measures, and that only the heart, kidneys, and liver should be donated. The client's spouse wants to also donate the client's corneas. What is the appropriate nursing action? Discontinue life support in keeping with the client's wishes. Contact the organ procurement team to discuss organ donation with the spouse. Prepare for harvesting of the client's heart, kidneys, liver, and corneas. Explain that organ harvesting requires that the client donate all organs or none.
Contact the organ procurement team to discuss organ donation with the spouse. Explanation: The organ procurement team should be contacted as soon as possible to talk with the client's spouse. This discussion cannot wait, as the fragility of organs increases as time passes. While it is important to honor a client's wishes, life support cannot be withdrawn until the potential for organ donation is determined. The organ procurement team is specially trained to have these kinds of conversations.
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 Denial Anger Bargaining
Depression Explanation: 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.
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 Denial Anger Bargaining
Depression Explanation: 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.
The partner of a client with terminal cancer is afraid of hurting the client during sexual intercourse. Which action by the nurse is likely to be most helpful in reducing this client's fears? Encourage discussion between the client and their partner regarding their intimacy needs Reassure the client's partner that they cannot hurt the client during sexual intercourse Inform the client's partner that the client cannot have sexual intercourse due to fatigue Suggest other ways the couple can spend time together, such as watching television together
Encourage discussion between the client and their partner regarding their intimacy needs Explanation: Partners of terminally ill clients may wish to be physically intimate with the dying person but are afraid of "hurting" them, 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's partner that they cannot have relations based on the fatigue of the client is not appropriate. Reassuring the client's partner that they will not cause pain is incorrect.
The nurse is preparing a presentation on preparing children for the death of a family member or friend. What information should the nurse include? Select all that apply. Encourage the child's distraction as much as possible Encourage expression of feelings Provide for stability and safety Praise stoicism Talk openly about death and the feelings associated with it
Encourage expression of feelings Provide for stability and safety Talk openly about death and the feelings associated with it Explanation: 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.
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 A regular apical pulse of 90 beats/minute Systolic blood pressure which rose from 100 to 110 mm Hg Cyanotic nail beds in hands and feet bilaterally
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 Explanation: 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 oncology nurse is learning to care for dying clients. Which ideals should guide the nurse in facilitating a good death for these clients? Select all that apply. The care of the dying client should be guided by the values and preferences of the nurse. Care for dying clients should focus on pharmacologic relief of pain. Independence and dignity are central issues for many dying clients. A good death is one that allows a person to die on his family's terms. The characteristics of a good death vary for each client.
Independence and dignity are central issues for many dying clients. The characteristics of a good death vary for each client. Explanation: A good death is one that allows a person to die on his own terms. Independence and dignity are central issues for many dying clients. The characteristics of a good death vary for each client. The care of a dying client should be guided by the values and preferences of the individual. Care for dying clients should focus on the relief of symptoms, not limited to pain, and should use both pharmacologic and nonpharmacologic means.
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 clients is covered by Medicare. Medicare does not cover costs that are not directly related to the diagnosis. Medicare does not cover pain control in the home; it must be in the inpatient care. Worry about payment should not be a concern for the client.
Inpatient pain management for hospice clients is covered by Medicare. Explanation: 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 assessing a person who is grieving using the grief cycle model, which concept would be most important for the nurse to keep in mind? Select all that apply. People vary widely in their responses to loss. Stages occur at varying rates among people. The stages of grief occur linearly and are static. Some people actually skip some stages of grief altogether. The stages are relatively discrete and identifiable.
People vary widely in their responses to loss. Stages occur at varying rates among people. Some people actually skip some stages of grief altogether. Explanation: 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 developed cancer within eight months of their spouse's death. The nurse will consider the possibility of what cause? Unsafe living conditions Increased alcohol intake Physical effects of bereavement Self-harm
Physical effects of bereavement Explanation: 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. Alcohol use is a risk factor for cancer but this would be unlikely to manifest in only a few months. Grieving individuals are at a risk for self-harm but this does not result in cancer. There are aspects of unsafe living conditions that increase risk for cancer but this would not likely affect the client in such a short amount of time.
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 was diagnosed with acute kidney failure. The client was being administered oxygen therapy. The client did not have any recent medical consultation. The client is an older adult with a history of hypertension.
The client did not have any recent medical consultation. Explanation: 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 kidney injury, 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 resuscitated if he experiences respiratory arrest. The client should be treated with antibiotics for pneumonia. The wishes of his family should be followed. Pharmacologic interventions should not be initiated.
The client should be treated with antibiotics for pneumonia. Explanation: 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 frequency of urination decreases. The arms and legs are warm to touch. The client is calm and peaceful. The client's breathing becomes noisy.
The client's breathing becomes noisy. Explanation: 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.
A client that has been shot in the chest is now deceased, and the nurse is delegated to provide postmortem care. In which situation should the delegating charge nurse intervene while the nurse is providing postmortem care? The nurse is preparing to remove the IV lines from the deceased. The nurse tapes the endotracheal tube to prevent accidental removal. The nurse uses the provided tags for identification of the deceased. The nurse provides privacy and maintains dignity while performing postmortem care.
The nurse is preparing to remove the IV lines from the deceased. Explanation: Because the client is deceased due to an unnatural or suspicious cause, an autopsy will be performed. All IV needles and lines, endotracheal, gastrointestinal tubes, drains, and airways must remain with the body. They should be firmly taped or secured so that they will not be inadvertently removed or leak. The body is not washed, even if it is soiled, to avoid removing evidence. The deceased should always be treated with dignity by providing privacy and treating the body with respect. Tags should always be used to identify the body.
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? Anticipatory grief Inhibited grief Normal grief Unresolved grief
Unresolved grief Explanation: 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 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 treated for end-stage kidney failure who is on home hemodialysis a client with lung cancer who refused hospice and is living with a spouse a client found with an empty bottle for a newly-prescribed opioid by the bedside a client who was recently discharged from the hospital after a myocardial infarction
a client found with an empty bottle for a newly-prescribed opioid by the bedside Explanation: A death that is reportable to the medical examiner would include one that is suspicious for suicide (in this instance, as demonstrated by an empty prescription bottle for an opioid). The deaths of the other clients described are not suspicious. The client with end-stage kidney disease is under the regular care of a health care provider since receiving dialysis at home. A client with cancer is not suspicious. Even with the refusal of hospice care, the client has been diagnosed with an end-stage disease, thus not qualifying for a medical examiner case. A client who was recently discharged after a myocardial infarction who had also been receiving care from a primary care provider is not considered suspicious. Other indications for reporting to a medical examiner include a death that occurs when a client is otherwise in good health and not under the care of a provider, a client who was involved in a violent crime such as a homicide, a client who dies while in police custody or in prison, a client who has had a criminal abortion, or if the deceased poses a potential threat to public health (such as a client who had an infectious disease).
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? depression acceptance bargaining denial
bargaining Explanation: Bargaining is a psychological mechanism for delaying the inevitable, usually by negotiating with a higher power. All other choices are incorrect.
To adequately assist a client and family from a different culture with the death and dying process, the nurse should: be aware of the client's cultural beliefs. progress through the stages of grief. experience death in his or her own life. have felt distress and anger.
be aware of the client's cultural beliefs. Explanation: 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.
Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief? coping strategies self-care activities pain management spiritual distress
coping strategies Explanation: 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 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 bargaining anger depression
denial Explanation: In the denial stage, the client denies the reality of death and may repress what is discussed. The client may think the doctor made a mistake in the diagnosis or that his or her records were mixed up with another client's records. In the anger stage, the client demonstrates rage and hostility. In the bargaining stage, the client tries to barter for more time. In the depression stage, the client demonstrates a period of grief before death characterized by crying and not speaking much.
A hospice nurse is assessing a client with end-stage chronic obstructive pulmonary disease (COPD). Which assessment findings would suggest that the client is dying? Select all that apply. jaundiced skin regular but slow heart rate Cheyne-Stokes respirations decreased urine output decreased pain
jaundice, cheyne-stoes, decreased urine output Explanation: Physical signs that often occur when a client is dying include: skin is extremely pale, cyanotic, jaundiced, or mottled; the heartbeat is irregular and the pulse is weak, rapid, and irregular; respirations are changed, shallow, labored, faster or slower, or irregular (e.g., Cheyne-Stokes respirations); urine output is decreased due to worsening renal function and limited fluid intake; fecal retention or impaction occurs due to reduced gastrointestinal motility; incontinence occurs due to relaxation of the sphincter muscles; there is difficulty swallowing, generalized weakness, increased somnolence, and decreased responsiveness to external stimuli. Decreased pain does not occur with people who are dying.
The experience of parting with an object, person, belief, or relationship that one values is defined as: loss. bereavement. grief. death.
loss. Explanation: 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.
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. dictate how the client wants his estate handled after his death, and by whom. make legal provisions for active euthanasia. give permission for organ donation.
specify the treatment measures that the client wants and does not want. Explanation: 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 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. dictate how the client wants his estate handled after his death, and by whom. make legal provisions for active euthanasia. give permission for organ donation.
specify the treatment measures that the client wants and does not want. Explanation: 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 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 to support aggressive treatment for cure to provide physical support for the client The client may develop a separate plan with each discipline of the health care team.
to improve the client's and family's quality of life Explanation: 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.
Palliative care is a structured system for care delivery. What is its aim? to give traditional medical care to prevent and relieve suffering to bridge between curative care and hospice care to provide care while there is still hope
to prevent and relieve suffering Explanation: 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.
