FN - Unit 4 - Chapter 44: Loss, Grief, and Dying

A nursing instructor has finished presenting information to a group of nursing students on the factors that influence the grieving process. Which statement by a student would indicate a need for further education? "The age of the grieving person can dramatically affect the grieving process." "A death that occurs as a result of natural causes is just as stressful as a death from homicide or suicide." "Some people find strength in dealing with loss through their religious beliefs, whereas others experience greater distress due to their beliefs." "Absence of social supports can create additional stressors for the grieving person."

"A death that occurs as a result of natural causes is just as stressful as a death from homicide or suicide." A loss that occurs under violent or frightening conditions is much more difficult to cope with than is a loss that occurs under more peaceful conditions. A death that occurs as a result of homicide or suicide is usually more stressful than is a death from natural causes. Some people find strength in dealing with loss through their faith, whereas others experience greater distress due to their beliefs. Sociocultural resources include the social support that is available from family, friends, coworkers, and formal institutions. Absence of these social supports creates additional stressors for the grieving person. The age at which a loss occurs has a major impact: The loss of a parent has different meanings to an infant, a child, and an adult.

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? "Once the endotracheal tube is removed, your loved one will no longer be able to breathe." "All efforts will be taken to make sure your loved one is comfortable and out of pain." "If you change your mind after we remove the breathing tube, just tell us and it will be reinserted." "Your loved one will not feel or be aware of anything that is happening once the breathing tube is removed."

"All efforts will be taken to make sure your loved one is comfortable and out of pain." A common and valid concern of families during terminal weaning is to make sure the client is not suffering. As such, the nurse's role is to educate the family regarding comfort measures, such as pain medication and additional sedation. It is inaccurate to tell the family that the client will no longer be able to breathe once the tube is removed. The client may continue breathing for several hours to days. When a decision is made to terminate mechanical ventilation, it should be clear that reintubation is no longer an option and death is inevitable. The nurse must be honest with the family, as the client may be aware of loved ones in the room and talking to the client is encouraged.

A 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?" 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.

The psychologist is teaching students about the factors that affect a person's reaction to grief. Which statements by the students about developmental considerations are accurate? Select all that apply. "Death of a parent can delay a child's development." "Terminally ill children normally do not ask questions about death." "Children do not need to go through the same grief reactions as adults." "Children understand death on the same level as adults." "Sense of loss for a child is just as great as it is for an adult."

"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." Children do not understand death on the same level as adults, but their sense of loss is just as great. Death of a parent or another significant person can delay a child's development. Both terminally ill children and their siblings are likely to talk and ask questions about death. Children need to go through the same grief reactions as adults.

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?" 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.

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 makes which statement? "I need to notify the coroner of all deaths." "The health care provider will give consent for the autopsy." "Hospitals are mandated to notify transplant programs of potential donors." "Organs are only retrieved from totally brain-dead clients."

"Hospitals are mandated to notify transplant programs of potential donors." The scarcity of organs has resulted in legislation mandating hospitals to notify transplantation programs of potential donors. Consent for autopsy is legally required, usually from the closest surviving family member. It is usually the health care provider's responsibility to obtain permission for an autopsy. If death is caused by accident, suicide, homicide, or illegal therapeutic practice, or if it occurs within 24 hours of admission to the hospital, the coroner must be notified. Organs can be obtained from brain-dead clients and non-heart-beating cadavers.

Which statement by the client indicates acceptance of dying? "I need to take out a life insurance policy right now." "I just want to live long enough to see my child get married." "Everyone dies; death is a part of life and I have to accept it." "I have finalized all my financial arrangements for my family."

"I have finalized all my financial arrangements for my family." 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.

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." 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.

The nurse is talking with the family after their loved one died. What words of support and comfort would be most therapeutic for the nurse to say after this event? "It's the lord's will." "I would like to sit here with you and listen." "Your loved one is in a better place." "You must accept the death and move on with your life."

"I would like to sit here with you and listen." Because comforting words are often difficult to find, the nurse should offer solace and support by being an attentive listener. The nurse should never assume that the client's spiritual and religious beliefs are the same as the family, making statements about the lord or being in a better place inappropriate. Informing newly grieving family members that they must move on is nontherapeutic and belittling.

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, the nurses make most of the care decisions for the clients." "Palliative care affirms life and regards dying as a normal process."

"In hospice care, the nurses make most of the care decisions for the clients." The philosophy of hospice is that clients and families are empowered to achieve as much control over their lives as possible. Hospice focuses on relieving symptoms and supporting clients with a life expectancy of 6 months or less, rather than years, and their families. However, palliative care may be given at any time during a client's illness, from diagnosis to end of life.

A nurse completing admission paperwork asks the client about having an advanced directive. The client states, "I do not know, what is an advanced directive?" What is the nurse's best response? "It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition." "It is an agreement that authorizes the hospital to make decisions on your behalf, if you become incapacitated." "I will contact the hospital social worker to come and discuss the development of an advance directive with you." "It is a document created by you and your attorney naming a beneficiary to handle your estate if you become terminally ill."

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

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? "The doctor will administer a lethal dose of barbiturates." "It is all right to stop dialysis." "Passive euthanasia is taking specific steps to cause a client's death." "Allowing the client to stop eating is a form of active euthanasia."

"It is all right to stop dialysis." 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.

The nursing student is learning how to care for clients whose death is expected within a limited period of time. Which statement makes the faculty member believe the student has mastered this topic? "Many clients know they have a terminal illness by picking up on nonverbal communication." "Competent clients do not have the right to refuse life-sustaining treatment." "Clients and their families should be told their diagnosis and prognosis without regard to cultural influences." "Health care personnel should not discuss the client's condition with the client's grieving family members."

"Many clients know they have a terminal illness by picking up on nonverbal communication." A terminal illness is an illness in which death is expected within a limited period of time. The nurse and other health care professionals are involved in discussions with these clients and their families. Many clients realize without being told that they have a terminal illness, picking up this knowledge from nonverbal communication by their families and health care professionals. Competent clients have the right to consent and/or refuse any and all medical treatments—even life-sustaining treatment. Cultural influences may dictate how much information is desired and which family members are to be informed. Health care personnel should be available to discuss the client's condition with family members and should offer support and care as the family begins the grieving process.

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? "My parent is suffering with cancer and death will be a relief of the pain." "There is no way I can stay in the hospital because my parent is sick." "I do not think my parent really has cancer. I think my parent needs to get a third opinion." "It is fine if my parent dies. We have not been close for years."

"My parent is suffering with cancer and death will be a relief of the pain." Anticipatory grief is the characteristic pattern of psychological and physiologic responses a person makes to the impending loss of a significant person. The client's statement, "My parent is suffering with cancer and death will be a relief of the pain," is an example of anticipatory grief and is intended to facilitate coping when death occurs. The client's statement, "There is no way I can stay in the hospital because my parent is sick" demonstrates empathy for the parent and denial of a personal need for treatment. Denial is apparent when the client suggests the parent's diagnosis is incorrect. Denial is also apparent when the client relates it is "fine" if the mother expires because they were not close.

The hospice nurse is visiting a new client. Which assessment questions are appropriate for the nurse to ask a client who has a terminal illness? Select all that apply. "Please describe what you have been told about your condition." "What community resources might be of help to you?" "How well do you think those around you are coping?" "Have you had any previous experiences with the death of someone you love?" "Do you have a will?"

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

The nurse is caring for a client who recently 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." 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." 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 new hospice nurse is reviewing the concepts of loss and grief with the preceptor. Which statement leads the preceptor to believe that the nurse has an understanding of grief and loss? "People only experience grief when someone dies." "Older adult clients who are lamenting their loss of youth are demonstrating actual loss." "The client who is isolating himself from social contact after the death of his spouse is demonstrating a social expression of grief." "Clients can experience a sense of loss when their child leaves for college. This is a type of situational loss."

"The client who is isolating himself from social contact after the death of his spouse is demonstrating a social expression of grief." Normal expressions of grief may be physical, emotional, social (feeling detached from others and isolating oneself from social contact), and spiritual. Grief is an internal emotional reaction to loss and occurs with loss caused by separation (e.g., divorce) or by death. Clients lamenting their loss of youth are demonstrating a type of perceived loss, which is intangible to others. Situational losses are experienced as a result of unpredictable events; a child going to college would be a maturational loss for the parent.

"My father has been dead for over a year and my mother still can't talk about him without crying. Is that normal?" What is the best response by the nurse? "The inability to talk about your dad without crying, even after a year, is still considered normal." "It is not normal. Your mother needs to see a therapist about her grief." "In fact, the more that someone cries about a loss, the better they're dealing with it." "Did your mother cry a lot before your father died?"

"The inability to talk about your dad without crying, even after a year, is still considered normal." Normal responses to bereavement after 1 year include the inability to speak of the deceased without intense emotion, clinical signs of depression, and feelings of meaninglessness. Increased crying does not necessarily signal increased coping, however.

When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response? "This must be very difficult for you." "I'm sure you are angry and sad." "Yes, this is a terrible diagnosis you've received." "Have you talked with your spiritual leader about your fears?"

"This must be very difficult for you." The nurse should use statements with broad openings, such as "This must be difficult for you," to allow the client to continue expressing concerns and to acknowledge the client's feelings. This facilitates communication and allows the client to choose the topic or manner of response during this stage of the grieving process. Assuming the client is angry and sad or indicating that this is "a terrible diagnosis" is not an appropriate way to promote coping. The nurse should automatically assume a spiritual leader is desired.

When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response? "This must be very difficult for you." "I'm sure you are angry and sad." "Yes, this is a terrible diagnosis you've received." "Have you talked with your spiritual leader about your fears?"

"This must be very difficult for you." The nurse should use statements with broad openings, such as "This must be difficult for you," to allow the client to continue expressing concerns and to acknowledge the client's feelings. This facilitates communication and allows the client to choose the topic or manner of response during this stage of the grieving process. Assuming the client is angry and sad or indicating that this is "a terrible diagnosis" is not an appropriate way to promote coping. The nurse should automatically assume a spiritual leader is desired.

A client is admitted to the hospital with a medical diagnosis of terminal lung cancer. Which question is most important for the nurse to ask first? "What have you been told about your condition?" "Do you have any questions for your doctor?" "Are you experiencing any pain right now?" "Do you understand what an advance directive is?

"What have you been told about your condition?" Focused assessment for those experiencing loss, grief, and dying is directed toward determining the adequacy of the client's and family's knowledge, perceptions, coping strategies, and resources. The priority is to assess what the client has been told about the condition in order to identify whether the client's and family's knowledge will allow them to make informed decisions that will serve their best interests. Pain and advance directives are important to ask, but not the first priority at this time. Asking if there are questions for the doctor is not the priority of a focused assessment. Also, the nurse should use open-ended questions when possible.

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? "You shouldn't worry about that right now." "I have to go and assist another client right now." "What have you been told?" "You will go when it is your time."

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

The nurse is caring for a client with terminal illness who is refusing food and fluids. The family is concerned and suggests that a feeding tube be used. Which is the best response by the nurse? "Stop feeding the client by mouth! You will make him choke!" "When clients are in this stage, food and fluid are unnecessary." "Do you feel that if you force your loved one to eat, he will get better?" "I will get some liquids and pureed foods for you to feed your loved one."

"When clients are in this stage, food and fluid are unnecessary." The most therapeutic response the nurse can give to the family is honesty in the dying process. The nurse could respond, "When clients are in this stage, food and fluid are unnecessary." As the client is dying, it is common to stop eating and drinking. Although it is possible to result in choking, yelling at the family to stop the feeding because of the risk of choking would damage the nurse-client relationship and not provide needed instructions for the family. Assuming that the family thinks feeding will prolong the client's life is inappropriate, as they may think feeding would provide comfort. The nurse needs to assess the understanding of dying with the family. Providing pureed foods and water could result in choking and should be avoided.

The nurse is caring for a client who recently experienced the death of the spouse. The client states, "I am so frustrated with myself because I feel like I should be back to my normal self by now but I am not." How should the nurse respond? Select all that apply. "You have come a long way in your process. Let's look at all of the progress you have had already." "Most people do move on with their lives at this point. You may be experiencing pathological grief." "It would be helpful to discuss what supports you have in your life right now. Please share this information with me." "It is really beneficial to talk about how you are feeling. Tell me more about how you are feeling frustrated." "There are many resources in the community that can be beneficial during this time. I can share these with you."

"You have come a long way in your process. Let's look at all of the progress you have had already." "It would be helpful to discuss what supports you have in your life right now. Please share this information with me." "It is really beneficial to talk about how you are feeling. Tell me more about how you are feeling frustrated." "There are many resources in the community that can be beneficial during this time. I can share these with you." People can feel that there is a specific time frame in which they should be done with the grieving process. In such a case, they are seeking information, not advice. It is important for the nurse to ensure that the client is not made to feel abnormal or bad about the grief experience. Instead, communication interventions that employ exploring, clarifying, and education can be beneficial to the grieving individual. An appropriate response by the nurse includes elements that remind the client of strengths and the progress made in the grief process. In addition, the nurse should assess for supports and resources that already exist to help the client in the grief process. Encouraging the client to share feelings through self-expression can be therapeutic and have a positive influence on the nurse-client relationship. Mourning takes longer for some than for others; there is no standard length of time for "normal" grieving. It would be inappropriate for the nurse to tell the client that his or her grief is pathological. This is not helpful to the client and may serve to further alienate and frustrate the client without purpose.

Which assessment finding would best support a nursing concern of disordered grieving? A client is unable to return to work after their sibling's death 18 months ago. A client cries frequently and loudly in the weeks following their child's death in an accident. A client blames themself for not doing more to make their spouses's recent death more comfortable. A client has been experiencing chronic insomnia since their parent's death earlier this year.

A client is unable to return to work after their sibling's death 18 months ago. An inability to return to normal activities 18 months after a sibling's death is suggestive (though not definitive) of 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 situation is most likely to warrant an autopsy? A client's death involves an allegation of a medical error. A palliative client dies unwitnessed during the night. A client dies after unsuccessful cardiopulmonary resuscitation. A client's death is attributed to an infectious disease.

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

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? Address the client's diagnosis and prognosis at a later time or date. Enlist the assistance of another nurse to help the client face the reality of the situation. Supplement conversations with the client by using written material about the diagnosis. Restate the client's situation in more specific and detailed terms.

Address the client's diagnosis and prognosis at a later time or date. 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. It is disrespectful, and likely counterproductive, to have others reiterate the message, to provide written material, or to increase the amount of detail if the client is not ready to engage at this time.

Which nursing interventions would be anticipated with hospice care? Select all that apply. Administer prescribed morphine for pain control. Ease respiratory function by providing oxygen via nasal cannula. Administer prescribed chemotherapy to treat invasive liver cancer. Administer prescribed antiemetics to control nausea. Insert a Foley catheter to prevent incontinence.

Administer prescribed morphine for pain control. Ease respiratory function by providing oxygen via nasal cannula. Administer prescribed antiemetics to control nausea. Insert a Foley catheter to prevent incontinence. While receiving hospice care, the client must accept palliative comfort care instead of care to cure the terminal illness. Chemotherapy is a curative measure and would not be routine hospice therapy. All other measures are specific to increasing client comfort, which is the purpose of 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. 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 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.

The nurse is caring for a client who has just expired. Which action will the nurse perform? Provide a complete bath. Place the client in a semi-Fowler's position. Allow the client's family to see the client's body before it is discharged. Have the nurse technician place identification tags on the outside of the shroud.

Allow the client's family to see the client's body before it is discharged. After the client has been pronounced dead, the nurse is responsible for preparing the body. Family members may need to see the client's body to accept the death fully; allow them to see the client's body before discharging to the mortician. The body is placed in normal anatomic position (flat) to avoid pooling of blood. In most cases it is unnecessary to wash the body, and some religions strictly forbid it. The nurse is legally responsible for placing identification tags on either the shroud or garment that the body is clothed in, and on the ankle to ensure that the body can be identified even if separated from its shroud.

A client 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 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.

A client is dying and the nurse has developed a strong rapport with the client and spouse. The spouse states to the nurse, "I just don't know how I am going to deal with the process. It makes me nervous to think I can't deal with it." What is the priority concern with the spouse of the client? A potential for complicated grieving related to loss of partner Anxiety related to unknown reaction to stages of death An inability for the client to care for self during the dying process Impaired comfort related to the impending death

Anxiety related to unknown reaction to stages of death Anxiety related to unknown reaction to stages of death relates directly to an impending death. Complicated grieving refers to a grieving process that is not normal. Self-care deficit refers to personal care issues, not response to impending death. Impaired comfort is a physiologic problem associated with dying.

An older adult client experiences the death of a spouse. Which behavior by the client exemplifies the grief stage of reorganization? Shares pictures of the spouse and talks about the spouse continuously Appears sad and reaches out to adult children for support Voices disbelief regarding the death of the spouse Adopts frequent phrases and mannerisms of the deceased

Appears sad and reaches out to adult children for support Appearing sad and reaching out to loved ones for support indicates the client is in the grief stage of reorganization. Sadness may not be gone during reorganization; however, acceptance of the death and looking to others for support are steps forward in reestablishing a sense of normalcy. Sharing pictures and incessant talking about the deceased are behaviors portrayed in the yearning stage of grief. Voicing disbelief regarding the death is part of the denial stage. Repeating frequent phrases and mannerisms of the deceased occurs in the yearning stage of grief.

The nurse makes a home visit for a client whose 12-year-old child died 4 years ago. The nurse finds the child's room with all belongings still intact. The client also speaks as if the child is still alive. Which action would the nurse take in this situation? Recommend the client to participate in mourning rituals. Encourage the expression of feelings of sadness or resentment. Arrange for individual counseling for the client. Refer the client to a peer-led Internet-based support group for bereaved parents.

Arrange for individual counseling for the client. Keeping the child's room intact and talking as if the child is still alive more than 3 years after the child's death are symptoms of dysfunctional grief. The nurse would refer clients experiencing dysfunctional or prolonged grief to individual counseling, psychotherapy, or to professionally led support groups. Participation in mourning rituals would have been helpful when the death occurred, not 4 years later. The client is stuck in feelings of sadness and resentment and needs professional help to work through these feelings. Peer-led Internet-based support groups fall into the self-help genre; a client with dysfunctional grieving 4 years after a death needs professional help.

A 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 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. Urge the client to continue a usual routine.

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. Nursing interventions used to help clients move through grief include helping the client mobilize a support system. The nurse can also help the client establish coping behaviors used in the past. Other interventions to include when helping clients move through grief are promoting good nutrition and sleep habits. The nurse should encourage the client to participate in religious rituals that are important to him. The nurse should not urge the client to continue his usual routine because it may not include healthy behaviors. For example, the nurse should not encourage use of alcohol, drugs, and caffeine during the grief process.

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 better than adults with death.

At about age 9, the child perceives death as irreversible. At about 9 years of age, the child's concept of death matures, and the child perceives death realistically as irreversible, universal, inevitable, and natural.

A graduate nurse enters a client's room and finds the client unresponsive, not breathing, and without a carotid pulse. The graduate nurse is aware that the client has mentioned that he does not wish to be resuscitated, but there is no DNR order on the client's chart. What is the nurse's best action? Call a code and begin resuscitating the client. Initiate a slow-code until the health care provider arrives. Consult with the charge nurse or nurse manager before calling the code. Respect the client's wishes and avoid calling a code.

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

A client at a health care facility has died after a prolonged illness. A nurse is assigned to perform postmortem care for the client. Which intervention should the nurse perform when providing postmortem care? 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. 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.

It has been determined that a client who sustained a head injury following a motorcycle accident is brain dead. The client did not have an organ donation directive. However, the client did have records to indicate a wish not to have prolonged life support. What is the most appropriate action for the nurse? Contact the organ procurement team to discuss organ donation with the family. Explain to the family that organ donation is not an option, as the client has refused life support. Wait until the family arrives from out of town to discuss organ donation. Prepare to remove the client from life support to align with life support records.

Contact the organ procurement team to discuss organ donation with the family. The organ procurement team should be contacted as soon as possible to discuss transplantation with the family. 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, even if doing so contradicts a person's advance directive because life support that has the potential to save lives overrides the desire to withdraw life support.

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. 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.

A nurse is assessing the spouse of a client who has just died. Which subjective findings of grief would the nurse expect to assess? Select all that apply. Detachment Bitterness Preoccupation with the loss Slowed motor function Unkempt appearance Excessive weight gain

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

The 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? Living will form Durable power of attorney form Advance directive form Health care provider's progress notes

Durable power of attorney form The nurse would review the durable power of attorney (DPA) for health care form identifying the client's chosen proxy for health care decision-making. The DPA for health care is a person legally designated by the client to make health care decisions if the client becomes physically or mentally unable to do so. A living will is a legal document detailing the client's wishes for end-of-life care and usually includes specifics such as resuscitation in the event of cardiopulmonary arrest and wishes regarding feeding tubes. An advance directive is a legal form filled out by the client or client's DPA for health care that identifies wishes regarding lifesaving treatment. The health care provider's progress notes are drafted by the health care provider regarding the client's current status and medical treatment plan.

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 Reassure the client's husband that he cannot hurt the client during sexual intercourse Inform the client's husband 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 husband and wife regarding their intimacy needs Partners of terminally ill clients may wish to be physically intimate with the dying person but are afraid of "hurting" him or her and may also be afraid that an open expression of sexuality is somehow "inappropriate" when someone is dying. Encourage discussion and suggest ways to be physically intimate that will meet the needs of both partners, such as a foot massage or embrace, and not just watching TV. Telling the client that he cannot have relations based on the fatigue of the client's spouse is not appropriate. Reassuring the client that he will not cause pain is incorrect.

A terminally ill client told her family, "I am ready to die." Her family is very upset that she has given up and wants the nurse to intervene. Which nursing intervention is most appropriate? Explain to the family that acceptance is part of the grieving process. Explain to the family that giving up is expected with terminal illness. Explain to the client that she cannot give up because her family needs her. Encourage the client to think about living instead of dying.

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

A 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 Previous relationships

Financial concerns Cultural practices Religious beliefs Social support Many factors, including socioeconomic position, cultural and religious influences, and social support affect a person's reaction to, and expression of, grief. The socioeconomic position is the financial elements and how it affects treatment. Cultural and religious influences may impact the client and client's wife ability to belong to a larger entity and have empathy with others. Social support also provides empathy for the client and client's wife. Like the stages of grief reaction, these factors vary from person to person. Previous relationships may be a part of healing and working through the stages of grief but it is not important for the assessment.

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 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 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 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.

A nurse is assessing a dying client for realism of expectations and perception of condition. Which interview questions address this concern? Select all that apply. Have you had any previous experience with this condition before? Do you know how to contact your doctor and get answers to your questions? How do you see the next few weeks playing out? What have you been told about your condition? How well do you think those around you are coping? What do you think may be happening in the midst of all of this?

Have you had any previous experience with this condition before? How do you see the next few weeks playing out? What do you think may be happening in the midst of all of this? A focused assessment regarding realism of expectations and perception of condition includes the following questions: Have you had any previous experiences with this condition or with the death of someone you love? What are your expectations in this case? How do you see the next few weeks (days) playing out? What are your fears, hopes, concerns, worries? What good do you think might be happening in the midst of all this? The objective is to discover whether the client and family have unrealistic expectations or misperceptions about the diagnosis, prognosis, and care options that could interfere with their decision making and coping. Asking the client if he knows how to contact his doctor, what he has been told about his condition, and how well others around him are coping don't address these objectives.

The wife of a client who has been diagnosed with a terminal illness asks the nurse about the differences between palliative care and hospice care. Which information would the nurse most likely include in the response? Hospice care differs from palliative care in its foundational philosophy. Hospice care focuses on quality of life while palliative care focuses on length of life. Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness. Hospice provides physical and psychological support; palliative care provides social and spiritual support.

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

The wife of a man who is dying tells the nurse: "Harold was so good to me. He was like a saint with his patience. I will miss him terribly" Which stage of grief is this woman experiencing, according to Engel? Restitution Awareness Outcome Idealization

Idealization Idealization is the exaggeration of the good qualities that the person had, followed by acceptance of the loss and a lessened need to focus on it. Restitution involves the rituals surrounding loss—with death, it includes religious, cultural, or social expressions of mourning, such as funeral services. Developing awareness is characterized by physical and emotional responses such as anger, feeling empty, and crying. Outcome, the final resolution of the grief process, includes dealing with loss as a common life occurrence.

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. 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.

After the death of a terminally ill spouse, a client reports frequent headaches and loss of appetite. The client states, "How am I going to live without him?" What type of grief is the client experiencing? Abbreviated grief Anticipatory grief Unresolved grief Inhibited grief

Inhibited grief With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations. Abbreviated grief is not a common classification of grief. 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.

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. 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.

The hospice nurse is educating a client's family on the physical signs of approaching death. The nurse identifies that the education has been effective when the family says they will know that death is imminent when they see which related symptoms? Select all that apply. Irregular respiratory rate Restlessness Increased body temperature Bowel incontinence Cyanosis of dependent areas

Irregular respiratory rate Restlessness Bowel incontinence Cyanosis of dependent areas Clinical signs of impending or approaching death include bowel incontinence or constipation, decreasing body temperature, irregular or Cheyne-Stokes respirations, slow or irregular heart rate, restlessness and/or agitation; and cooling, mottling, and cyanosis of the extremities and dependent areas.

A nurse is providing care to a 9 1/2-year old child who is terminally ill. When talking with the child, the nurse would need to understand that the child most likely views death as which type of event? Select all that apply. Irreversible Avoidable Unnatural Universal Inevitable

Irreversible Universal Inevitable At around 9 years of age, children perceive death realistically as irreversible, universal, inevitable, and natural. During the early school years, a child perceives death as unnatural, reversible, and avoidable.

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. Suggest that the family doesn't leave the bedside. Utilize therapeutic communication techniques.

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

A 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. Encourage the client's desire to keep silent about the event. Avoid making empathetic statements about the client's grief. Avoid identification of fears regarding the loss. Listen to expressions of grief. Include significant others in discussions and decisions as appropriate. Communicate acceptance of discussing the loss.

Listen to expressions of grief. Include significant others in discussions and decisions as appropriate. Communicate acceptance of discussing the loss. Grief resolution involves dealing with the loss. Listening to the client's expressions of grief, including significant others in discussions, and communicating acceptance helps the client deal effectively with the loss. Encouraging the client to keep silent about the event, not being empathetic, and avoiding identification of fears does not help the client in dealing with the loss.

The nurse is discussing end-of-life decisions with a client who has terminal cancer. Which statements describe the client'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. In a living will, a client appoints an agent that he or she trusts to make decisions if he or she becomes incapacitated. The Patient Self-Determination Act of 1990 requires all hospitals to inform their clients about advance directives. The status of advance directives varies from state to state. Nurses are legally responsible for arranging for a durable power of attorney for all terminal clients. Legally, all attempts must be made by the health care team to resuscitate a terminal client.

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 clients about advance directives. The status of advance directives varies from state to state. Advance directives, including living wills, helps the client to make decisions concerning their end-of-life care. Appointing an agent for care involves identifying a durable power of attorney for healthcare, which is the responsibility of the client, family, or significant others. If a client has advance directives, resuscitation is not warranted.

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? Mottling of the lower limbs Slow, steady pulse Pursed lip breathing Increased swallowing

Mottling of the lower limbs 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. The client will not be able to swallow secretions, so suctioning, frequent and gentle mouth care, and possibly the administration of a transdermal anticholinergic drug may be required.

A client has been diagnosed with a terminal illness and has periods of depression and periods of anger. The client's spouse is concerned, feeling as though their loved one is not moving forward in the stages of grief. What teaching is most appropriate for the nurse to include? Select all that apply. Anger follows depression in the stages of grief. Movement between stages can be progressive. Movement back and forth between stages is expected. Depression is not a stage in the grief process. Bargaining should occur between depression and anger.

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

The hospice nurse is caring for a group of clients with terminal illness. Which is the highest care priority for a client in the process of dying? Hydration Hygiene Skin care Pain management

Pain management End-of-life care requires comprehensive blended nursing skills and is unique to each client's circumstances. Common priorities, however, include the need to provide pain control and emotional support. Hydration and hygiene are not priorities at the end of life. As the client is dying, skin care is not the priority.

A nurse is providing care to a terminally ill client. Which finding would alert the nurse to the fact that the client is dying? Select all that apply. Pale, cool skin Regular deep respirations Decreased urine output Irregular heart rate Strong, bounding pulse

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

When assessing a person who is grieving using the grief cycle model, which concept would be most important for the nurse to keep in mind? Select all that apply. People vary widely in their responses to loss. Stages occur at varying rates among people. 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. 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.

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. 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.

The nurse is caring for a client that is at the end of life. After the client is pronounced dead, what actions by the nurse are essential components of care? Select all that apply. Washing the client's body Removing all tubes according to agency policy, unless an autopsy is to be performed Placing identification on the wrist Placing identification tags on the client's dentures or other prostheses Arranging for family members to view the body before it is discharged to the mortician

Removing all tubes according to agency policy, unless an autopsy is to be performed Placing identification tags on the client's dentures or other prostheses Arranging for family members to view the body before it is discharged to the mortician If acceptable to facility policy, the nurse can remove all tubes for a more natural appearance during viewing of the body by the family immediately after death has occurred, unless an autopsy is expected. The nurse should place identification tags on dentures and other prostheses, in case they become separated from the deceased. It is not necessary for the nurse to wash the client's body; only cleaning soiled areas is required in most facilities. Identification tags are necessary to place on the body to ensure the body is correctly identified, in case a shroud or garment is separated from the client.

With the help of the nurse, the parents of an infant who died shortly after birth arrange for a funeral service. Which stage of grief, according to Engel, involves the rituals surrounding loss, including funeral services? Shock and disbelief Developing awareness Restitution Resolving the loss

Restitution Restitution is the stage of grief that involves the rituals surrounding loss; with death, it includes religious, cultural, or social expressions of mourning, such as funeral services. Shock and disbelief involve the person being in denial or having a numbed response to the death. Developing awareness is characterized by physical and emotional responses such as anger, emptiness, and crying. Resolving the loss involves dealing with the void left by the loss.

Applying Engel's models of grief, place the phases below in the order in which they would occur from first to last.

Shock and disbelief Developing awareness Restitution Resolving the loss Idealization Outcome Engel (1964), one of the first to study grief, proposed six phases of grief: (a) shock and disbelief, (b) developing awareness, (c) restitution, (d) resolving the loss, (e) idealization, and (f) outcome.

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. 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.

The nurse is making sure that all factors are in place for a client's death certificate. What potential error that may occur does the nurse identify? The client had a condition that has the potential to temporarily suspend life process. The client lived with numerous comorbidities prior to death. The client was in good health prior to an accident or medical incident that caused death. The client was younger than 12 years of age or older than 75.

The client had a condition that has the potential to temporarily suspend life process. Errors in certification of death have the potential to occur in conditions that might not permanently suspend life processes, such as from hypothermia, drug or metabolic intoxication, or circulatory shock. There is also a risk of error in children under 5 years of age. Previous good health or multiple comorbidities do not present a greatly increased risk of error when determining death.

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. 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. 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 who was brought to the emergency room for gunshot wounds dies in intensive care 15 hours later. Which statement concerning the need for an autopsy would apply to this client? The closest surviving family member should be consulted to determine whether an autopsy should be performed. The coroner must be notified to determine the need for an autopsy. The health care provider should be present to prepare the client for an autopsy. An autopsy should not be performed because the nature of death has been established.

The coroner must be notified to determine the need for an autopsy. If death is caused by accident, suicide, homicide, or illegal therapeutic practice, the coroner must be notified, according to law. The coroner may decide that an autopsy is advisable, and does not need the permission of the family for the autopsy to be performed. The health care provider does not need to be present during the autopsy, only the designated person performing the autopsy (medical examiner or pathologist).

Which does not coincide with Kübler-Ross's stages related to a dying client? Clients don't always follow the stages in order. Some client regress, then move forward again. The dying client usually exhibits anger first. The client may be in several stages at once.

The dying client usually exhibits anger first. The dying client does not usually exhibit anger first. The client may be in several stages at once, clients don't always follow the stages in order, and some regress and then move forward.

The nurse is teaching a client with terminal cancer who is interested in hospice care. Which home hospice benefits will the nurse explain? Select all that apply. The nurse and health care provider are on call 24 hours, every day of the week. Medications to treat cancer are provided. Counseling services are available. Pain will be managed with medication, if needed. Homemaker services can be included.

The nurse and health care provider are on call 24 hours, every day of the week. Counseling services are available. Pain will be managed with medication, if needed. Homemaker services can be included. Among the many available services, hospice services include on-call nurses and health care providers (24 hours per day, 7 days per week), counselors, pain management techniques, and homemaker services. Clients receiving hospice care are not actively being treated for cancer, but rather are receiving palliative care.

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. 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.

What is a proper action to take when preparing a child for death? Select all that apply. The nurse should know her own feelings and beliefs. Praise stoicism. Encourage remembrance of deceased. Compare the child to the deceased. Expect the child to alternate between grieving and normal functioning.

The nurse should know her own feelings and beliefs. Encourage remembrance of deceased. Expect the child to alternate between grieving and normal functioning. When preparing a child for death, it is important for the nurse to know her own feelings and beliefs; to be honest; begin at the child's level; include the child in family rituals related to death and mourning; encourage expression of feelings; provide security and stability; encourage remembrance of the deceased; recognize that children grieve differently than adults; expect the child to alternate between grieving and normal functioning; talk openly about death and the feelings it generates; and introduce death concepts into conversations naturally.

Which are signs of a "good death"? Select all that apply. The person experiences moderate pain. The person dies according to the wishes of the family. The person dies with dignity. The person is prepared for death. The person has a sense of completion of life.

The person dies with dignity. The person is prepared for death. The person has a sense of completion of life. A good death is one that allows a person to die on their own terms, relatively free of pain, and with dignity. It is free from avoidable distress and suffering for clients, families, and caregivers; in general accord with clients' families wishes; and reasonably consistent with clinical, cultural, and ethical standards (Institute of Medicine, 1997). The definition of a good death varies for each client, but there are factors important for a good death, including control of symptoms, preparation for death, opportunity to have a sense of completion of one's life, and a good relationship with health care professionals.

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 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 hospice nurse is caring for a client with allow natural death (AND) orders. The nurse assesses that the client has a slow, irregular heart rate, has cooling of the extremities, and is agitated. Which interventions can the nurse implement? Select all that apply. Use medication to lower client consciousness to limit awareness of suffering. Administer a lethal dose of barbiturates. Allow the client to stop drinking fluids. Do not perform cardiopulmonary resuscitation. Implement a slow code in the case of cardiopulmonary or respiratory arrest.

Use medication to lower client consciousness to limit awareness of suffering. Allow the client to stop drinking fluids. Do not perform cardiopulmonary resuscitation. A client with signs of a slow, irregular heart rate, cooling of the extremities, and restlessness is showing signs of impending death. The health care provider has written AND orders for this client, so cardiopulmonary resuscitation should not be implemented, including a slow code. When clients who are imminently dying have pain and suffering, palliative sedation (using medication to lower client consciousness) may be utilized to limit awareness of suffering. Allowing the client to stop drinking fluids would be a type of passive euthanasia. Administering a lethal dose of barbiturates, or active euthanasia, is immoral and illegal.

The nurse is taking care of a client who was hospitalized for an ulcerative colitis exacerbation. Recently, the client's parent died from colon cancer. Which question would be essential to ask this client at the start of the assessment of her loss reaction? What did your parent do for a living? What type of relationship did you have with your parent? Did your parent seek early treatment for the colon cancer? How old was your parent?

What type of relationship did you have with your parent? When assessing a client for a reaction, both physically and psychologically, to loss, it is important to get a sense of what part the deceased person played in the client's life. If she was not close to her father, the impact might not be so great. On the other hand, if he was an important person in her life, her response might be greater. Other things to initially ask about include whether the loss was expected and whether or not the client feels a sense of responsibility for the loss.

A nurse is conducting a program for a local community support group about grieving. The nurse would describe grief as fulfilling which function? Select all that apply. allowing the outer reality of loss to become internally accepted altering the emotional attachment to that which was lost permitting the bereaved person to become unattached to others preparing the client for the loss without warning allowing the person to avoid the experience of the loss more fully

allowing the outer reality of loss to become internally accepted altering the emotional attachment to that which was lost Grief has several important functions: to make the outer reality of the loss into an internally accepted reality; to alter the emotional attachment to the lost person or object; and to make it possible for the bereaved person to become attached to other people or objects. Grief does not prepare the client for the loss nor does it allow the person to avoid the experience the loss more fully. Grief is a necessary and normal reaction to loss.

The spouse of a recently deceased client states, "I just can't believe he left me. He swore he would never leave me and I feel betrayed!" Using Kübler-Ross stages of grief, what stage does the nurse identify the client is experiencing? denial and isolation anger acceptance bargaining

anger 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.

A client diagnosed with terminal cancer is making plans to take a trip to visit an estranged sibling. What stage of death and dying, according to Kübler-Ross, is best illustrated in this description? bargaining anger depression acceptance

bargaining This example demonstrates characteristics of bargaining, such as a desire to fulfill wishes, make a will, visit relatives, and put affairs in order. This stage is unlike the acceptance stage, during which the client feels tranquil and is prepared to die with all arrangements in order. During the anger stage, the client expresses rage and hostility. In the depression stage, the client goes through a period of grief before death.

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

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

What is Kübler-Ross's third stage of grief? depression bargaining denial anger

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

What is Kübler-Ross's third stage of grief? depression bargaining denial anger

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

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. 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.

A client has a diagnosis of bladder cancer with metastasis. The client asks the nurse about the characteristics of hospice care. The nurse should explain that: care is premised on the fact that dying is a normal process. symptoms of terminal illness should not be treated. care is generally guided by nurses rather than health care providers. the client must be within 6 weeks of his expected death.

care is premised on the fact that dying is a normal process. Hospice care is premised on the fact that dying is a normal process. Symptoms are treated aggressively in order to preserve comfort. Care is interdisciplinary and admission usually requires a 6-month life expectancy or less.

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 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 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? decreased pain difficulty swallowing increased urinary output increased sensory stimulation

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

When preparing the care plan for a dying client, it is important for the nurse to include a goal that addresses which needs? Select all that apply. expression of feelings management of pain use of coping strategies nutritional therapy urinary elimination

expression of feelings management of pain use of coping strategies Nursing care for the dying client should be directed toward the achievement of several goals, including demonstration of the ability to express feelings, fears, and concerns. The client's pain should be managed effectively to allow the client to interact meaningfully with family. The client should also be able to identify and utilize effective coping strategies such as deep breathing, talking with family members, and rest periods. Nutritional therapy and urinary elimination are not specific to the dying client, and more assessment would be needed to determine if these are viable needs for the client.

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? anticipatory grief pathologic grief grief reaction bargaining grief

grief reaction The client's spouse is demonstrating behaviors related to a grief reaction. The anticipatory grief occurs prior to the death. The client's spouse has not had enough of a length of time to determine if the grief is pathologic. The spouse is experiencing the denial stage of grief and not the bargaining stage.

A critical care nurse is aware of the legislation that surrounds organ donation. When caring for a potential organ donor, the nurse is aware that: hospitals are mandated to notify transplantation programs of potential donors. non-heart-beating cadavers are not potential organ donors. clients must have an organ donor card to donate organs. nursing focus should be directed at organ donation once it is decided to withdraw life support.

hospitals are mandated to notify transplantation programs of potential donors. The scarcity of organs has resulted in legislation mandating hospitals and other health care agencies to notify transplantation programs of potential donors. New protocols allow the retrieval of organs from non-heart-beating cadavers. The family of a deceased client may decide to donate the organs, and a donor card is not necessary in this circumstance. Attention to optimal client and family care at the time of life-sustaining therapy withdrawal should remain the nurse's priority in care.

The nurse anticipates a dying client to exhibit which signs of impending death? Select all that apply. incontinence restlessness loss of sensation flushed extremities increased body temperature Cheyne-Stokes respirations

incontinence restlessness loss of sensation Cheyne-Stokes respirations Signs of impending death include incontinence, restlessness, loss of sensation, cyanotic extremities, decreased body temperature, and Cheyne-Stokes respirations. Increased body temperature occurs in infection. Flushed extremities occurs in anaphylaxis.

The client is a young parent whose spouse died 3 months ago. The client is tearful and unkempt, eats a poor diet, and has lost 50 lb (22.6 kg) since the death of the spouse. The client states, "I cannot do this anymore." Which nursing concern is best supported by these data? death anxiety related to death of spouse ineffective coping related to failure of previously used coping mechanisms ineffective denial related to poor grief resolution decisional conflict related to inability to progress following spouse's death

ineffective coping related to failure of previously used coping mechanisms The nursing concern best supported by these data is Ineffective coping. Defining characteristics include poor coping skills with activities of daily living as evidenced by unkempt appearance, eating poorly and losing weight, and client statement. Death anxiety refers to an impending death or thoughts of death. Ineffective denial refers to denying the reality of the situation. Decisional conflict refers to inability to make decisions.

A 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

jaundiced skin Cheyne-Stokes respirations decreased urine output 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.

Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal? showing a photograph of the decedent talking about his wife's absent-mindedness telling the nurse how his life has changed leaving the wife's room and belongings intact

leaving the wife's room and belongings intact Bereavement experts reported that they considered almost all bereavement manifestations to be normal during the early stages of grief, but considered most of the manifestations to be abnormal if they continue beyond 3 years.

The experience of parting with an object, person, belief, or relationship that one values is defined as: loss. bereavement. grief. death.

loss. Loss is defined as the experience of parting with an object, person, belief, or relationship that one values; the loss requires a reorganization of one or more aspects of the person's life.

A couple has sent their youngest child to college in another state and both are experiencing "empty nest syndrome." This is an example of: maturational loss. situational loss. physical loss. anticipatory loss.

maturational loss. Maturational loss is experienced as a result of natural developmental processes, such as sending children off to kindergarten or away to college. A situational loss occurs as a result of an unpredictable event. Physical loss is a loss such as a body part (amputation). Anticipatory loss involves a display of loss, and grief behaviors for a loss that has yet to take place.

A nurse is providing postmortem care. Which of the following nursing actions is a legal responsibility? placing the body in normal anatomic position removing tubes and soiled dressings washing the body to remove blood and excretions placing ID tags on the shroud and ankle

placing ID tags on the shroud and ankle Although the nurse may place the body in a normal anatomic position and remove tubes and soiled dressings, the only legal action is placing ID tags on the shroud and ankle. The body is not usually washed by the nurse, as different cultures and religions have specific guidelines concerning cleansing the body.

What is the most important goal of care for the dying client who is receiving comfort care? providing a comfortable, dignified death using a feeding tube to provide nutrition identifying appropriate coping mechanisms ensuring family members are present at the bedside

providing a comfortable, dignified death Clients or their surrogates may request a comfort-measures-only order, which indicates that the goal of treatment is a comfortable, dignified death and that further life-sustaining measures are no longer indicated. Using a feeding tube and identifying appropriate coping mechanisms are not characteristics of comfort care. The presence of family members at the bedside is important for any dying client and is not specific to comfort care.

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

shock In the shock and disbelief stage, the survivor either refuses to accept the loss or shows intellectual acceptance of the loss but denies the emotional impact.

The 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. 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 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.

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 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 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.