Chapter 42: Loss, Grief, and Dying

The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the bargaining stage of grief is the one who states:

"I just want to see my son have a family of his own."

After the physician has discussed euthanasia with a terminal client and his family, the nurse assesses their understanding of the topic. Which of the following statements by the family indicates that learning has occurred?

"It is alright to stop dialysis."

A terminally ill client asks the nurse what assisted suicide is. Which response is best for the nurse to provide?

"It is when a lethal combination of drugs is made available to the client wishing to die."

Which of the following situations is most likely to warrant an autopsy?

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

Providing a comfortable, dignified death

A comfortable, dignified death for the client

Which of the following assessment findings would best support a nursing diagnosis of Dysfunctional Grieving?

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

A nurse caring for a client with a terminal illness understands which of the following to be true?

A nurse caring for a client with a terminal illness understands which of the following to be true?

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 nurse is explaining the preparation of a death certificate to a student nurse. Which statements accurately describe this process? (Select all that apply.)

A nurse is providing end-of-life care to a client at a health care facility. The client is anticipating death. The nurse understands that the client is in the acceptance stage of dying. Which of the following indicates that the client is in the acceptance stage of dying?

A nurse is providing end-of-life care to a client at a health care facility. The client is anticipating death. The nurse understands that the client is in the acceptance stage of dying. Which of the following indicates that the client is in the acceptance stage of dying?

A client has been asked to undergo a series of diagnostic tests following a routine blood test that indicates leukemia. The client refuses to believe the diagnosis and feels that there has been an error in the reports. Which stage of grief is the client going through?

Denial

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

The nurse is assessing a client who was diagnosed with metastatic prostate cancer. The nurse notes that the client is exhibiting signs of loss, grief, and intense sadness. Based upon this assessment data, the nurse will document that the client is in what stage of death and dying?

Depression

The nurse is assessing a patient who was diagnosed with metastatic prostate cancer. The nurse notes that the patient is exhibiting signs of loss, grief and intense sadness. Based upon this assessment data, the nurse will document that the patient is in what stage of death and dying?

Depression

The nurse enters a client's room and finds the client curled up in bed and crying. The nurse approaches the client and quietly asks why she is crying. The client replies, "Life was so good, and now I have cancer, and I don't understand why." The nurse recognizes the client as exhibiting signs of which stage of Engel's model of grief?

Developing awareness

A client's son is named to make decisions for his mother in the event she cannot speak for herself. This is an example of a(an) ...

Durable power of attorney

The family of a client with a severe traumatic brain injury is considering the withdrawal of his mechanical ventilation. What is the nurse's primary role in the preparation for terminal weaning?

Educating the family on what to reasonably expect after ventilation is discontinued

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

A client with a terminal illness is being cared for at home. When caring for a client who is in home care, the nurse discusses the importance of respite care. Which of the following interventions leads to respite care?

Encouraging the caregiver to identify surrogate caregivers

A client is being discharged from the hospital with terminal brain cancer and a life expectancy of 1 month. When planning this client's discharge, it is most important for the nurse to include a referral to which agency?

Hospice

The psychologist is teaching students about the factors that affect a person's reaction to grief. Which of the following statements by the students about developmental considerations is most accurate?

• "Death of a parent can delay a child's development." • "Sense of loss for a child is just as great as it is for an adult."

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. • U.S. law requires that a death certificate be prepared for each person who dies. • 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.

A male client with a diagnosis of lung cancer is seen in the clinic for follow-up care. Which nursing interventions are essential to include in this client's plan of care to address his grief? (Select all that apply.)

• Assist the client to form a support system • Help the client establish coping strategies • Promote good nutrition and sleep habits • Encourage participation in religious rituals

The emergency department (ED) nurse accepts an unconscious client brought in by ambulance. The client's family presents a durable power of attorney for health care for the client. Which of the following actions should the nurse take?

Obtain contact information for the person designated to make decisions for the client

When providing end-of-life care for clients, what will the nurse most often need to prioritize?

Pain control and emotional support

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

A client comes to the hospital because of complications related to newly diagnosed terminal cancer. The client is concerned about how his wife is coping with the diagnosis. Which information is important for the nurse to obtain to assess factors that may affect the family member's grief? (Select all that apply.)

• Financial concerns • Cultural practices • Religious beliefs • Social support

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

A nurse is conducting grief resolution for a patient who lost his wife in a motor vehicle accident in which he was the driver. Which interventions best accomplish this goal? (Select all that apply.)

• Listen to expressions of grief. • Include significant others in discussions and decisions as appropriate. • Communicate acceptance of discussing loss.

The nurse is discussing end-of-life decisions with a patient who has terminal cancer. Which statements describe the patient's options? (Select all that apply.)

• Living wills provide specific instructions about the kinds of health care that should be provided or foregone in particular situations. • The Patient Self-Determination Act of 1990 requires all hospitals to inform their patients about advance directives. • The status of advance directives varies from state to state.

A nurse is explaining the preparation of a death certificate to a student nurse. Which statements accurately describe this process? (Select all that apply.)

• U.S. law requires that a death certificate be prepared for each person who dies. • 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

A nurse is explaining the preparation of a death certificate to a student nurse. Which statements accurately describe this process? (Select all that apply.)

• U.S. law requires that a death certificate be prepared for each person who dies. • 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.

With the help of the nurse, the parents of an infant who died shortly after birth arrange for a funeral service. What stage of grief, according to Engel, involves the rituals surrounding loss, including funeral services?

Restitution

Mr. Cooney, age 85, is in advanced stages of pneumonia with a no-code order in his chart. Which of the following nursing care actions will help establish a trusting nurse-patient relationship?

The nurse discusses the patient's fears and doubts openly and serves as a nonjudgmental listener.

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

The nurse is providing care to a group of terminally ill clients. The client who exhibits signs of impending death is the client who has

distended abdomen, Cheyne-Stokes respirations.

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

leaving the wife's room and belongings intact

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

loss.

Which diagnosis specifically addresses human response to loss and impending death in the problem statement?

Anxiety related to unknown reaction to stages of death

The nurse is aware that there is a potential for errors in the certification of death when ...

the client had a condition that has the potential to temporarily suspend life process.

Upon interviewing the client, the nurse finds that the client is providing care for her mother who is terminally ill. The client is depressed and already mourning the loss. Which nursing diagnosis would be most appropriate for the client?

Anticipatory grieving

The cardiac nurse, who has been caring for a hospitalized terminally ill client for 3 days, finds that the client has expired. The nurse manager knows that the nurse can legally care for these clients when the nurse states which of the following?

"Hospitals are mandated to notify transplant programs of potential donors."

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

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

The psychiatrist is evaluating a client who has recently learned she has a terminal illness. Which of the following statements indicates to the psychiatrist that the client is in the Kübler-Ross stage of bargaining?

"Just let me go on vacation with my wife; then I'll be satisfied."

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 of the following statements by the nurse shows that she has understanding of the Kübler-Ross emotional responses to impending death?

"Sometimes a person returns to a previous stage."

The nurse 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 new hospice nurse is reviewing the concepts of loss and grief with her preceptor. Which of the following statements leads the preceptor to believe that the nurse has an understanding of grief and loss?

"The client who is isolating himself from social contact after the death of his spouse is demonstrating a social expression of grief."

When preparing for palliative care with the dying client, the nurse should provide the family with which explanation?

"The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms."

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

Administer 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 of the following would be an example of assisted suicide?

Administering a lethal dose of medication

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 the best quality of life through which means?

Aggressive management of symptoms.

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

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

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 of the following signs indicates approaching death?

Breathing becomes noisy

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.

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

Coping strategies

When planning care for a 55-year-old male client with newly diagnosed terminal pancreatic cancer, which nursing diagnosis would be most appropriate?

Death anxiety

A nurse is conducting grief resolution for a patient who lost his wife in a motor vehicle accident in which he was the driver. Which interventions best accomplish this goal? (Select all that apply.)

Maturational loss

A nurse is providing end-of-life care to a terminally ill client. Which of the following actions should the nurse take to remove mucus and saliva from the client's mouth?

Perform suction in the client's mouth.

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

Providing a comfortable, dignified death

A nurse caring for a client with a terminal illness understands which of the following to be true?

Recovery is not expected

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 do what?

Speak to the client.

The children of a male client with late-stage Alzheimer's 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 do which of the following?

Specify the treatment measures that the client wants and does not want.

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. Which of the following should happen in this case?

The client should be treated with antibiotics for pneumonia.

Which of the following does not coincide with Kübler-Ross's stages related to a dying client?

The dying client usually exhibits anger first.

The husband of a patient who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. What type of grief is the husband experiencing?

Unresolved grief

The client has a new diagnosis that requires high-risk treatment. The client is indecisive about treatment and states, "I don't know what to do." The nurse determines the most appropriate outcome is that the client will

report feelings of peace about the decision regarding treatment.