Chapter 44: Loss, Grief, and Dying PREPU review
The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the anger stage of grief is the one who states: A) "Why did this have to happen to me?" B) "I don't care about anything. I have no energy." C) "I do not believe I have this disease." D) "I just want to see my son have a family of his own."
A) "Why did this have to happen to me?" Explanation: The client is expressing anger when displaying a "why me" attitude. The other statements are reflective of other stages of grief.
The condition of a client with a traumatic brain injury continues to deteriorate despite medical efforts. The decision is made to terminally wean the client from mechanical ventilation. Which statement by the nurse is most significant in educating the family regarding terminal weaning? A) "All efforts will be taken to make sure your loved one is comfortable and out of pain." B) "If you change your mind after we remove the breathing tube, just tell us and it will be reinserted." C) "Your loved one will not feel or be aware of anything that is happening once the breathing tube is removed." D) "Once the endotracheal tube is removed, your loved one will no longer be able to breathe."
A) "All efforts will be taken to make sure your loved one is comfortable and out of pain." Explanation: A common and valid concern of families during terminal weaning is to make sure the client is not suffering. As such, the nurse's role is to educate the family regarding comfort measures, such as pain medication and additional sedation. It is inaccurate to tell the family that the client will no longer be able to breathe once the tube is removed. The client may continue breathing for several hours to days.
A client that is dying yells at the nurse, "I put my light on a long time ago and you do not even care enough to see what I need!" How should the nurse respond? A) "I apologize for not responding more quickly and would be glad to help with whatever you need now." B) "I do not appreciate that you are speaking to me in that tone and would like you to lower your voice." C) "I was with another client that had pain which was a priority for me at that time." D) "You have not had the light on for long and I got here as quickly as I could."
A) "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.
"My father has been dead for over a year and my mother still can't talk about him without crying. Is that normal?" What is the best response by the nurse? A) "The inability to talk about your dad without crying, even after a year, is still considered normal." B) "In fact, the more that someone cries about a loss, the better they're dealing with it." C) "It isn't considered normal. Has she considered seeing a therapist about her grief." D) "Did your mother cry a lot before your father died?"
A) "The inability to talk about your dad without crying, even after a year, is still considered normal." Explanation: 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.
When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response? A) "This must be very difficult for you." B) "I'm sure you are angry and sad." C) "Yes, this is a terrible diagnosis you've received." D) "Have you talked with your spiritual leader about your fears?"
A) "This must be very difficult for you." Explanation: 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.
Which assessment finding would best support a nursing concern of disordered grieving? A) A client is unable to return to work after their sibling's death 18 months ago. B) A client blames themself for not doing more to make their spouse's recent death more comfortable. C) A client cries frequently and loudly in the weeks following their child's death in an accident. D) A client has been experiencing chronic insomnia since their parent's death earlier this year.
A) A client is unable to return to work after their sibling's death 18 months ago. Explanation: An inability to return to normal activities 18 months after a sibling's death is suggestive (though not definitive) of disordered 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 disordered if this became a long-term and all-encompassing belief.
Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning? A) Administer sedation and analgesia. B) Offer emotional support to the family. C) Provide an explanation of the process. D) Have the client's family remain at the bedside.
A) 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.
The spouse of a recently deceased client states, "I just can't believe he left me. He swore he would never leave me and I feel betrayed!" Within the Kübler-Ross stages of grief, what stage does the nurse identify the client is experiencing? A) Anger B) Bargaining C) Denial and isolation D) Acceptance
A) Anger Explanation: The client is identified as being in the anger stage of the grieving process. The client has accepted the fact that the spouse is gone but is angry and betrayed at the departure from life. The client has yet to accept this death and may have some overlapping with depression as well. There is no evidence of bargaining or denial.
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? A) Inpatient pain management for hospice clients is covered by Medicare. B) Worry about payment should not be a concern for the client. C) Medicare does not cover costs that are not directly related to the diagnosis. D) Medicare does not cover pain control in the home; it must be in the inpatient care.
A) 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.
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. A) Irregular heart rate B) Regular deep respirations C) Pale, cool skin D) Decreased urine output E) Strong, bounding pulse
A) Irregular heart rate C) Pale, cool skin D) 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. A) Some people actually skip some stages of grief altogether. B) The stages of grief occur linearly and are static. C) The stages are relatively discrete and identifiable. D) Stages occur at varying rates among people. E) People vary widely in their responses to loss.
A) Some people actually skip some stages of grief altogether. D) Stages occur at varying rates among people. E) People vary widely in their responses to loss.
A client in a long-term care facility has signed a form stating that he does not want to be resuscitated. He develops an upper respiratory infection that progresses to pneumonia. His health rapidly deteriorates, and he is no longer competent. The client's family states that they want everything possible done for the client. What should happen in this case? A) The client should be treated with antibiotics for pneumonia. B) The client should be resuscitated if he experiences respiratory arrest. C) Pharmacologic interventions should not be initiated. D) The wishes of his family should be followed.
A) 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.
Which does not coincide with Kübler-Ross's stages related to a dying client? A) The dying client usually exhibits anger first. B) Clients don't always follow the stages in order. C) The client may be in several stages at once. D) Some client regress, then move forward again.
A) The dying client usually exhibits anger first. Explanation: The dying client does not usually exhibit anger first. The client may be in several stages at once, clients don't always follow the stages in order, and some regress and then move forward.
Which are signs of a "good death"? Select all that apply. A) The person is prepared for death. B) The person dies with dignity. C) The person experiences moderate pain. D) The person has a sense of completion of life. E) The person dies according to the wishes of the family.
A) The person is prepared for death. B) The person dies with dignity. D) The person has a sense of completion of life.
A client has a diagnosis of bladder cancer with metastasis. The client asks the nurse about the characteristics of hospice care. The nurse should explain that: A) care is premised on the fact that dying is a normal process. B) symptoms of terminal illness should not be treated. C) care is generally guided by nurses rather than health care providers. D) the client must be within 6 weeks of his expected death.
A) care is premised on the fact that dying is a normal process. Explanation: 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? A) coping strategies B) spiritual distress C) self-care activities D) pain management
A) 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.
When preparing the care plan for a dying client, it is important for the nurse to include a goal that addresses which needs? Select all that apply. A) management of pain B) nutritional therapy C) expression of feelings D) use of coping strategies E) urinary elimination
A) management of pain C) expression of feelings D) use of coping strategies
When preparing the care plan for a dying client, it is important for the nurse to include a goal that addresses which needs? Select all that apply. A) management of pain B) urinary elimination C) expression of feelings D) use of coping strategies E) nutritional therapy
A) management of pain C) expression of feelings D) use of coping strategies
The children of a male client with late-stage Alzheimer disease have informed the nurse on the unit that their father possesses a living will. The nurse should recognize that this document is most likely to: A) specify the treatment measures that the client wants and does not want. B) dictate how the client wants his estate handled after his death, and by whom. C) make legal provisions for active euthanasia. D) give permission for organ donation.
A) 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.
The nurse is giving palliative care to a client with a diagnosis of COPD. What is the goal of palliative care? A) to improve the client's and family's quality of life B) to support aggressive treatment for cure C) to provide physical support for the client D) The client may develop a separate plan with each discipline of the health care team.
A) 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.
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 rationale: Assisted suicide refers to providing another person the means to end his or her own life, such as administering a lethal dose of a medication. This is not to be confused with the ethically and legally supported practices of withholding or withdrawing medical treatment in accordance with the wishes of the terminally ill individual. Administering a morphine infusion may be used to assist with a client's pain near the end of life.
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 Acceptance Anger Bargaining
Anger rationale: Anger is the second stage and is exhibited by statement similar to "Why me?"
Family members of a dying client are in the room with their loved one. As the client nears death, what should the nurse tell the family? A) "Please leave the room now. It is time to let go." B) "Please stay with your loved one and talk to him." C) "Only one family member at a time can stay in the room." D) "I will have to get an order for you to stay now."
B) "Please stay with your loved one and talk to him." Explanation: A fear of having to face death alone is a primary concern of dying clients. The presence of family members in the room should be encouraged and reminiscences should be shared. Most health care organizations allow additional family members to stay in a dying client's room. Forcing the family member to leave is not empathic to the dying client.
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. A) "Do you have a will?" B) "How well do you think those around you are coping?" C) "What community resources might be of help to you?" D) "Have you had any previous experiences with the death of someone you love?" E) "Please describe what you have been told about your condition."
B) "How well do you think those around you are coping?" C) "What community resources might be of help to you?" D) "Have you had any previous experiences with the death of someone you love?" E) "Please describe what you have been told about your condition."
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? A) "Each stage of dying must be completed prior to moving to the next stage." B) "Sometimes a person returns to a previous stage." C) "The duration of all stages is a few hours." D) "The process is the same from person to person."
B) "Sometimes a person returns to a previous stage." rationale: 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.
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? A) "I have to go and assist another client right now." B) "What have you been told?" C) "You shouldn't worry about that right now." D) "You will go when it is your time."
B) "What have you been told?" Explanation: 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) A client's death is attributed to an infectious disease. B) A client's death involves an allegation of a medical error. C) A client dies after unsuccessful cardiopulmonary resuscitation. D) A palliative client dies unwitnessed during the night.
B) A client's death involves an allegation of a medical error. Explanation: 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.
A client has responded to a recent diagnosis of lung cancer by making extensive plans for overseas travel with family, despite the extremely poor prognosis. The client is adamant about not discussing cancer and is identified by the nurse as experiencing the denial stage of grief. How can the nurse best facilitate the client's healthy grieving? A) Enlist the assistance of another nurse to help the client face the reality of the situation. B) Address the client's diagnosis and prognosis at a later time or date. C) Restate the client's situation in more specific and detailed terms. D) Supplement conversations with the client by using written material about the diagnosis.
B) Address the client's diagnosis and prognosis at a later time or date. Explanation: In the absence of the client's readiness to become more aware of the situation, the nurse should respect the client's current position and revisit the matter when the client is more ready.
The nurse is caring for a client who has just expired. Which action will the nurse perform? A) Have the nurse technician place identification tags on the outside of the shroud. B) Allow the client's family to see the client's body before it is discharged. C) Provide a complete bath. D) Place the client in a semi-Fowler's position.
B) Allow the client's family to see the client's body before it is discharged. Explanation: After the client has been pronounced dead, the nurse is responsible for preparing the body. Family members may need to see the client's body to accept the death fully; allow them to see the client's body before discharging to the mortician.
The nurse has noted that a dying client is increasingly withdrawn and is often teary at various times during the day. The nurse recognizes that the client may be experiencing which of Kübler-Ross's stages of grief? A) Anger B) Depression C) Bargaining D) Denial
B) 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 is providing care for a confused client who no longer is able to make health care decisions. Which document will the nurse review on the client's medical record to determine the designated person to make decisions on the client's behalf? A) Advance directive form B) Durable power of attorney form C) Living will form D) Health care provider's progress notes
B) Durable power of attorney form Explanation: The nurse would review the durable power of attorney (DPA) for health care form identifying the client's chosen proxy for health care decision-making. The DPA for health care is a person legally designated by the client to make health care decisions if the client becomes physically or mentally unable to do so.
The nurse is working with a client's whose wife died four years ago. Which assessment finding will prompt the nurse to prioritize assessment for dysfunctional grief? A) Talking humorously about his wife's absent-mindedness B) Leaving his wife's clothes and belongings intact C) Displaying multiple photographs of his wife D) Explaining to the nurse the ways in which his life has changed
B) Leaving his wife's clothes and belongings intact Explanation: Bereavement experts reported that they considered almost all bereavement manifestations to be normal during the early stages of grief, but considered most of the manifestations to be abnormal if they continue beyond 3 years. Leaving the deceased's room and belongings intact is among these concerning behaviors.
A nurse is conducting grief resolution for a client 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. A) Encourage the client's desire to keep silent about the event. B) Listen to expressions of grief. C) Include significant others in discussions and decisions as appropriate. D) Communicate acceptance of discussing the loss. E) Avoid making empathetic statements about the client's grief. F) Avoid identification of fears regarding the loss.
B) Listen to expressions of grief. C) Include significant others in discussions and decisions as appropriate. D) Communicate acceptance of discussing the loss.
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. A) Slowed motor function B) Preoccupation with the loss C) Excessive weight gain D) Detachment E) Bitterness F) Unkempt appearance
B) Preoccupation with the loss D) Detachment E) Bitterness Explanation: 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 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. A) Talk openly about death and the feelings associated with it B) Provide for stability and safety C) Praise stoicism D) Encourage expression of feelings E) Encourage the child's distraction as much as possible
B) Provide for stability and safety C) Praise stoicism E) Encourage the child's distraction as much as possible
The hospice nurse is caring for a client who is dying. Which intervention(s) should be included in the plan of care? Select all that apply. A) Obtain the blood pressure frequently. B) Routinely administer pain medications. C) Provide cool foods and fluids. D) Offer normal amounts of food and fluids. E) Gently massage the arms and legs. F) Cluster nursing activities. G) Place in a supine position when drooling occurs.
B) Routinely administer pain medications. C) Provide cool foods and fluids. E) Gently massage the arms and legs. F) Cluster nursing activities.
When assessing a person who is grieving using the grief cycle model, which concept would be most important for the nurse to keep in mind? Select all that apply. A) The stages of grief occur linearly and are static. B) Stages occur at varying rates among people. C) People vary widely in their responses to loss. D) The stages are relatively discrete and identifiable. E) Some people actually skip some stages of grief altogether.
B) Stages occur at varying rates among people. C) People vary widely in their responses to loss. E) Some people actually skip some stages of grief altogether.
The nurse is caring for a client whose spouse died 6 days ago. What assessment finding would suggest that the client is in the first stage of Engel's model of grief? A) The client expresses anger at God B) The client has difficulty believing the spouse is actually deceased C) The client speaks of the spouse in exclusively positive terms D) The client is focused on estate planning
B) The client has difficulty believing the spouse is actually deceased Explanation: In the initial 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 husband of a client who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. What type of grief is the husband experiencing? A) Normal grief B) Unresolved grief C) Inhibited grief D) Anticipatory grief
B) 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.
A client has recently lost a parent. The client spent about 6 months deeply mourning the loss and is just now able to function at the pre-loss level. During this process, a strong social support network was able to assist the client. What developmental stage of life does the nurse identify the client is in? A) toddler B) adult C) school-aged child D) infant
B) adult Explanation: Adults tend to grieve more intensely and more continuously, but for a relatively shorter period of time than children. Having a good social network helps with this process, as well as having a stable lifestyle.
A hospice nurse has developed a care plan for a client with liver cancer. The care plan focuses on providing palliative care for this client. The goal of palliative care is best described as providing clients with life-threatening illnesses a dignified quality of life through which means? A) treatment of the disease process B) aggressive management of symptoms C) eliminating all forms of medical and nursing care D) providing counseling related to the stages of death and dying
B) aggressive management of symptoms Explanation: The goal of palliative care is to provide clients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms. There is no treatment goal for the life-threatening illness for palliative care. Aggressive management of symptoms includes medical and nursing care for the client. Providing counseling related to the stages of death and dying is pursued after aggressive management of symptoms.
Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief? A) self-care activities B) coping strategies C) spiritual distress D) pain management
B) coping strategies
Palliative care is a structured system for care delivery. What is its aim? A) to give traditional medical care B) to prevent and relieve suffering C) to bridge between curative care and hospice care D) to provide care while there is still hope
B) 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.
During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving? A) "I do not think my parent really has cancer. I think my parent needs to get a third opinion." B) "It is fine if my parent dies. We have not been close for years." C) "My parent is suffering with cancer and death will be a relief of the pain." D) "There is no way I can stay in the hospital because my parent is sick."
C) "My parent is suffering with cancer and death will be a relief of the pain." Explanation: Anticipatory grief is the characteristic pattern of psychological and physiologic responses a person makes to the impending loss of a significant person. The client's statement, "My parent is suffering with cancer and death will be a relief of the pain," is an example of anticipatory grief and is intended to facilitate coping when death occurs.
The nurse is caring for a client who recently lost an older adult parent. Which client statement alerts the nurse that the stage of depression may have started within the grief process? A) "It is all my fault! I did not see the signs." B) "This does not seem real to me." C) "Please go away; I just want to be left alone." D) "What am I going to do now that my parent is gone?"
C) "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.
When preparing for palliative care with the dying client, the nurse should provide the family with which explanation? A) "Palliative care is the gradual withdrawal of mechanical ventilation from a client with terminal illness and poor prognosis." B) "In palliative care, no attempts are to be made to resuscitate a client whose breathing or heart stops." C) "The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms." D) "The client will have to go to an inpatient hospice unit in order to receive palliative care."
C) "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 statement regarding perceptions of death by children is accurate? A) Adolescents tend to respond to death and grief better than adults B) Toddlers perceive death as irreversible and unnatural. C) At about age 9, the child perceives death as irreversible. D) Preschool-age children view death as a spiritual release.
C) 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.
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? A) Hospice care focuses on quality of life while palliative care focuses on length of life. B) Hospice care differs from palliative care in its foundational philosophy. C) Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness. D) Hospice provides physical and psychological support; palliative care provides social and spiritual support.
C) Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness. Explanation: 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.
The nurse is caring for a client who has terminal lung cancer and is unconscious. What assessment would indicate to the nurse that the client's death is imminent? A) Increased swallowing B) Pursed lip breathing C) Mottling of the lower limbs D) Slow, steady pulse
C) Mottling of the lower limbs Explanation: The time of death is generally preceded by a period of gradual diminishing of bodily functions. During this time, the nurse may observe increased intervals between respirations, weakened and irregular pulse, and skin color may change or become mottled.
A client has developed cancer within eight months of their spouse's death. The nurse will consider the possibility of what cause? A) Unsafe living conditions B) Increased alcohol intake C) Physical effects of bereavement D) Self-harm
C) 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? A) The client is an older adult with a history of hypertension. B) The client was diagnosed with acute kidney failure. C) The client did not have any recent medical consultation. D) The client was being administered oxygen therapy.
C) 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 severely injured in a motor vehicle accident is rushed to the health care facility with severe head injuries and profuse loss of blood. Which sign indicates approaching death? A) The arms and legs are warm to touch. B) The frequency of urination decreases. C) The client's breathing becomes noisy. D) The client is calm and peaceful.
C) 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 is informed about the results of a biopsy, which indicate a malignant tumor that has spread. The client states, "Well once you remove the tumor, I will be just fine." What stage of the grief process does the nurse identify the client is experiencing? A) bargaining B) acceptance C) denial D) anger
C) denial Explanation: By making this statement, the client denies the seriousness of the malignant tumor diagnosis. Denial is often the first emotion the client will experience, as initially it helps in coping with the reality of impending death. There is nothing in the client's statement to indicate anger or acceptance. Bargaining would be indicated by the client negotiating with a higher power to extend life or delay the inevitable.
A client diagnosed with liver failure in hospice care died 10 hours ago. The client's spouse is having difficulty leaving the room and is crying uncontrollably. What situation does the nurse identify is happening with this client's spouse? A) pathologic grief B) bargaining grief C) grief reaction D) anticipatory grief
C) grief reaction Explanation: The client's spouse is demonstrating behaviors related to a grief reaction. The anticipatory grief occurs prior to the death. The client's spouse has not had enough of a length of time to determine if the grief is pathologic.
A nurse is caring for a client whose spouse died more than 4 years ago. What assessment question will the nurse ask to determine if the client is experiencing abnormal grief? A) "Do you cry on the anniversary of your spouse's death?" B) "Do you keep photos of your spouse on your bedside table?" C) "Can you remember the good times together with your spouse?" D) "Have you gone through and donated your spouse's clothing?"
D) "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.
Which statement by the client indicates acceptance of dying? A) "I need to take out a life insurance policy right now." B) "Everyone dies; death is a part of life and I have to accept it." C) "I just want to live long enough to see my child get married." D) "I have finalized all my financial arrangements for my family."
D) "I have finalized all my financial arrangements for my family." Explanation: Acceptance of dying is expressed by the statement, "I have finalized all my financial arrangements for my family." The statement, "I need to take out a life insurance policy right now" may represent the client in the anger phase of death and dying, as anxiety is expressed. The client is in the bargaining stage when indicating, "I just want to live long enough to see my child get married." The client could be in the anger stage when stating, "Everyone dies; death is a part of life and I have to accept it," as the client is expressing frustration with the situation.
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) a client treated for end-stage kidney failure who is on home hemodialysis B) a client with lung cancer who refused hospice and is living with a spouse C) a client who was recently discharged from the hospital after a myocardial infarction D) a client found with an empty bottle for a newly-prescribed opioid by the bedside
D) 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).
A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education? A) "Palliative care affirms life and regards dying as a normal process." B) "Hospice care programs focus on quality rather than length of life." C) "Palliative care provides relief from pain and other distressing symptoms." D) "In hospice care, nurses take on the responsibility of making care decisions for clients."
D) "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.
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? A) "It is a document created by you and your attorney naming a beneficiary to handle your estate if you become terminally ill." B) "I will contact the hospital social worker to come and discuss the development of an advance directive with you." C) "It is an agreement that authorizes the hospital to make decisions on your behalf, if you become incapacitated." D) "It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition."
D) "It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition." Explanation: 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.
After the health care provider has discussed euthanasia with a terminal client and family, the nurse assesses their understanding of the topic. Which statement by the family indicates that learning has occurred? A) "Passive euthanasia is taking specific steps to cause a client's death." B) "The doctor will administer a lethal dose of barbiturates." C) "Allowing the client to stop eating is a form of active euthanasia." D) "It is all right to stop dialysis."
D) "It is all right to stop dialysis." Explanation: Active euthanasia is taking specific steps to cause a client's death (lethal dose of barbiturates) and has been deemed both immoral and illegal in most states. Passive euthanasia is defined as withdrawing medical treatment (dialysis) with the intention of causing the client's death and is morally and legally justified. Allowing the client to stop eating would be a form of passive euthanasia.
During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving? A) "It is fine if my parent dies. We have not been close for years." B) "I do not think my parent really has cancer. I think my parent needs to get a third opinion." C) "There is no way I can stay in the hospital because my parent is sick." D) "My parent is suffering with cancer and death will be a relief of the pain."
D) "My parent is suffering with cancer and death will be a relief of the pain." Explanation: Anticipatory grief is the characteristic pattern of psychological and physiologic responses a person makes to the impending loss of a significant person. The client's statement, "My parent is suffering with cancer and death will be a relief of the pain," is an example of anticipatory grief and is intended to facilitate coping when death occurs.
A client diagnosed with a terminal illness is displaying periods of depression and anger alternating with acceptance. The client's spouse is concerned about the client's labile mood. When talking with the client's spouse, which statement made by the nurse best addresses principles of loss and grieving? A) "I think you are correct. Something is wrong with your loved one." B) "Most people go through all sorts of feelings and your loved one is no different." C) "Sometimes people become suicidal and we will place your loved one in restraints." D) "Not everyone experiences grief in the same way and your loved one needs our support."
D) "Not everyone experiences grief in the same way and your loved one needs our support."
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? A) Respect the client's wishes and avoid calling a code. B) Initiate a slow-code until the health care provider arrives. C) Consult with the charge nurse or nurse manager before calling the code. D) Call a code and begin resuscitating the client.
D) Call a code and begin resuscitating the client.
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? A) Respect the client's wishes and avoid calling a code. B) Initiate a slow-code until the health care provider arrives. C) Consult with the charge nurse or nurse manager before calling the code. D) Call a code and begin resuscitating the client.
D) 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.
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? A) Unresolved grief B) Dysfunctional grief C) Anticipatory grief D) Inhibited grief
D) Inhibited grief Explanation: 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 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? A) decreased pain B) increased sensory stimulation C) increased urinary output D) difficulty swallowing
D) difficulty swallowing Explanation: 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.
