Foundations Chapter 42: PrepU
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.
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 three 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 client has been declared brain dead following a motor vehicle accident. What assessment data would the nurse anticipate? -sluggish pupillary response -no ocular movement -positive corneal response -breathing drive triggered only by respirator
-no ocular movement All brainstem reflexes would be absent (including pupillary response, corneal reflex, ocular movements). The respiratory drive would be absent.
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?"
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.
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.
Which assessment finding would best support a nursing diagnosis of Dysfunctional Grieving? -A man is unable to return to work after his sister's death 18 months ago. -A woman cries frequently and loudly in the weeks following her child's death in an accident. -A man blames himself for not doing more to make his wife's recent death more comfortable. -A woman has been experiencing chronic insomnia since her mother's death earlier this year.
-A man is unable to return to work after his sister's death 18 months ago. An inability to return to normal activities 18 months after a sibling's death is suggestive (though not definitive) of Dysfunctional Grieving. Crying and having difficulties sleeping are not unusual and will often accompany healthy grieving. A feeling of "not doing enough" is common during grief and would only be considered dysfunctional if this became a long-term and all-encompassing belief.
A nurse assesses a client who is grieving and notes that the client is in the numbness phase according to the Parkes grief model. Which defense would the nurse expect the client to most likely use? -Denial -Depression -Social withdrawal -Idealization
-Denial Parkes (1986) proposed four stages of grief: (a) numbness, (b) yearning, (c) disorganization, and (d) reorganization. In the numbness stage, which is usually brief, trauma so overwhelms the bereaved survivor that he must use denial as a psychological defense. The disorganization stage is characterized by severe depression, social withdrawal, and lack of interest in people and activities. Idealization involves repression of all negative feelings toward the deceased. This is a phase associated with Engel's model.
The nurse has noted that a dying client is increasingly withdrawn and is often teary at various times during the day. The nurse recognizes that the client may be experiencing which of Kübler-Ross's stages of grief? -Depression -Denial -Anger -Bargaining
-Depression Depression is a commonly accepted form of grief and it represents the emptiness when the client realizes the person or situation is gone or over. Signs and symptoms may be withdrawn, sadness, crying, and flat affect. Denial is the stage where client may disregard that the news of diagnosis or death is not true. Anger is the stage where the client may think "why me?" and "life's not fair!" Bargaining is the stage of false hope. The client might falsely make themselves believe that they can avoid the grief through a type of negotiation. The stages are denial, anger, bargaining, depression, and acceptance.
A client's son is named to make decisions for his mother in the event she cannot speak for herself. This is an example of a(an) ... -Exemplary representative -Significant power -Durable power of attorney -Advance estate director
-Durable power of attorney A durable power of attorney allows clients to designate another person to make decisions if they become incapacitated and cannot make decisions independently. Advanced estate planning typically involves estate tax reduction, Medicaid planning and/or special needs trust planning for a client with a large estate. Exemplary representative and significant power is not related to health care.
A home hospice client who has Medicare is experiencing extreme pain at home and is refusing to receive inpatient care due to concerns over the cost of inpatient care. What teaching will the nurse include in the plan of care? -Inpatient pain management for hospice patients is covered by Medicare. -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 patients is covered by Medicare.
A home hospice client who has Medicare is experiencing extreme pain at home and is refusing to receive inpatient care due to concerns over the cost of inpatient care. What teaching will the nurse include in the plan of care? -Inpatient pain management for hospice patients is covered by Medicare. -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 patients is covered by Medicare. Inpatient pain management is covered by Medicare as are any other Medicare-covered services needed to manage pain and other symptoms as recommended by the hospice team. Medicare will cover pain control in the home as well, but for extreme pain hospitalization may be required. Telling a client not to worry about payment does not educate about what services are available.
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.
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.
Following surgery, the surgeon informed the client's spouse that invasive cancer was found during the procedure and the client may only have days to live. The client's spouse has told the physician and the nurse that they do not want the client to know the severity of the diagnosis. How will the nurse respond? -not disclosing any information to the client -understanding that learning about impending death will create unnecessary worry -understanding that this directive would violate the client's rights -understanding that the client's spouse has the right to direct care for the dying client
-understanding that this directive would violate the client's rights The dying client's bill of rights includes the right to not be deceived and to receive truthful answers regarding prognosis and care. The nurse will be honest with the client. Impending worry will likely occur, but the client has a right to know their prognosis and the client's spouse does not have the right to direct care.
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 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 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
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.
A nurse is providing care to pediatric clients on an oncology floor. The nurse would expect which age group as perceiving death as reversible, avoidable and occurring in degrees? -Infants -Toddlers -Preschoolers -School-age children
-Preschoolers Preschoolers perceive death as reversible, avoidable, and occurring in degrees. Infants have no concept of life and death. Toddlers experience a fear of abandonment. Early school-age children perceive death as unnatural, reversible and avoidable, and may also personify death.
A 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 siituation 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 pathological. 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.
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 benificiary 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.
The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate? -"It must be very difficult for you." -"There's no need for anger." -"I can't imagine how awful this is for you." -"You should try to make things right with your family."
-"It must be very difficult for you."
The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate? -"It must be very difficult for you." -"There's no need for anger." -"I can't imagine how awful this is for you." -"You should try to make things right with your family."
-"It must be very difficult for you." Use statements with broad openings such as "It must be difficult for you" and "Do you want to talk about it?" Such language encourages communication and allows the client to choose the topic or manner of response. Accept the client's behavior. Anger is part of the grieving process. Indicating that this is "awful" is not an appropriate way to promote coping. It is not the nurse's role to tell the client to make things right with family. While this may be desired, the client should initiate it.
The psychiatrist is evaluating a client who has recently learned she has a terminal illness. Which statement indicates to the psychiatrist that the client is in the Kübler-Ross stage of bargaining? -"I know that my family will be taken care of. I am at peace." -"Why is this happening to me—I quit smoking." -"I waited years to see my grandchildren and now I won't see them." -"Just let me go on vacation with my wife; then I'll be satisfied."
-"Just let me go on vacation with my wife; then I'll be satisfied." According to Kübler-Ross, the five stages of dying, with common reactions are: denial, anger ("why me" questions), bargaining (the client tries to barter for more time ("just let me go on vacation..."), depression ("I waited years to see my grandchildren and now I won't"), and acceptance ("I am at peace.").
The nurse is caring for a client who has just died after a long diagnosis of dementia. Which nursing assessment is the priority for documentation? -"No breathing and no pulse at 0840." -"Post mortem care completed." -"Body transported to morgue." -"Notified the patient's daughter."
-"No breathing and no pulse at 0840." The priority documentation is the assessment that indicates the client is dead. The other items can occur and will be documented after establishing that death has occurred.
The nurse is 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.
When preparing for palliative care with the dying client, the nurse should provide the family with which explanation? -"The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms." -"In palliative care, no attempts are to be made to resuscitate a client whose breathing or heart stops." -"Palliative care is the gradual withdrawal of mechanical ventilation from a client with terminal illness and poor prognosis." -"The client will have to go to an inpatient hospice unit in order to receive palliative care."
-"The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms." Palliative care involves taking care of the body, mind, spirit, heart, and soul. It views dying as something natural and personal. The goal of palliative care is to give patients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms. A do-not-resuscitate order means that no attempts are to be made to resuscitate a client whose breathing or heart stops. Gradual withdrawal of mechanical ventilation from a client with a terminal illness and poor prognosis is called terminal weaning. Clients do not have to be in an inpatient hospice unit to receive palliative care.
The daughter of an older client is concerned that her mother is depressed because she is reading the obituaries every day. What is the most appropriate nursing response? -"This is common in older adults and doesn't necessarily indicate depression." -"This indicates that your mother is entering into the bargaining stage of grief." -"This is a clear indicator that your mother is depressed." -"This is a sign of impending death and we need to notify the provider."
-"This is common in older adults and doesn't necessarily indicate depression." Older adults may read obituaries and death notices in the newspaper daily in an effort to keep up with acquaintances. Although this activity may be viewed as potentially depressing, it may be an effective coping mechanism in helping to develop a peaceful and accepting attitude toward death. The other responses are not appropriate.
The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the anger stage of grief is the one who states -"Why did this have to happen to me?" -"I do not believe I have this disease." -"I just want to see my son have a family of his own." -"I don't care about anything. I have no energy."
-"Why did this have to happen to me?" The client is expressing anger when displaying a "why me" attitude. The other statements are reflective of other stages of grief.
Assisted suicide is expressly prohibited under statutory or common law in the overwhelming majority of states. Yet public support for physician-assisted suicide has resulted in a number of state ballot initiatives. The issue of assisted suicide is opposed by nursing and medical organizations as a violation of the ethical traditions of nursing and medicine. Which scenario would be an example of assisted suicide? -Administering a lethal dose of medication -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.
An appropriate nursing diagnosis for the family of a client dying of cancer, whose members have expressed sorrow over the forthcoming loss, would be: -Anticipatory Grieving related to loss of family member, as evidenced by sorrow -Dysfunctional Grieving related to the loss of family member, as manifested by behaviors indicating anxiety -Potential for Grieving related to loss of family member and sorrow -Dysfunctional Grieving related to future loss of family member, manifested by family's developmental regression
-Anticipatory Grieving related to loss of family member, as evidenced by sorrow Anticipatory grieving comprises the intellectual and emotional responses and behaviors by which individuals, families, and communities work through the process of modifying self-concept based on the perception of loss.
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 physician 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.
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. -Client's breathing becomes noisy.
-Client's breathing becomes noisy.
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.
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 socioecnomic 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.
A client is being discharged from the hospital with terminal brain cancer and a life expectancy of 1 month. When planning this client's discharge, it is most important for the nurse to include a referral to which agency? -Hospice -Support group -Home health -Outpatient rehab
-Hospice Hospice is care provided for people with limited life expectancy, often in the home. A support group would be appropriate, but not as high in priority as hospice. Home health and outpatient rehab would not be appropriate for this client as both of these facilities promote care toward independence.
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.
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 nurse is providing end-of-life care to a client at a health care facility. The client is anticipating death. The nurse understands that the client is in the acceptance stage of dying. What indicates that the client is in the acceptance stage of dying? -The client hopes to live long enough to see the client's daughter settled in life. -The client gets into arguments with the health care personnel. -The client wants to get a second opinion on the diagnostic reports. -The client has settled all financial matters for surviving family members.
-The client has settled all financial matters for surviving family members. The client is in the acceptance stage of dying, because the client has settled all financial matters for the surviving family members. The client who hopes to live long enough to see the client's daughter settled in life is in the bargaining stage of dying, trying to bargain for more time. A client in the second stage of dying, which is anger, gets into arguments with the health care personnel; it is an emotional response to feeling victimized. A client who wants to get a second opinion on the diagnostic reports is in the denial stage of dying.
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.
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
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).
A client has been declared brain dead following a suicide attempt. What assessment data would the nurse anticipate? Select all that apply. -absence of breathing drive when disconnected from ventilator -sluggish papillary responses -mild facial muscle movements in response to noxious stimuli -absence of pharyngeal and tracheal flexes -no ocular movement
-absence of breathing drive when disconnected from ventilator -absence of pharyngeal and tracheal flexes -no ocular movement All brainstem reflexes are absent (including pupillary response, corneal reflex, ocular movements, facial movement in response to noxious stimuli), and the breathing drive is absent when disconnected from a ventilator, in a client who has been declared brain dead.
A client with a terminal illness is overherard 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 the Kübler-Ross model? -depression -acceptance -bargaining -denial
-bargaining
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 physicians. -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.
A widow has just returned home from the funeral of her husband. She feels alone in her home. Her family has left to go back to their home in another area of the country. What stage of Engel's model does this represent? -shock and disbelief -developing awareness -restitution -resolving the grief
-developing awareness Developing awareness occurs as the reality and meaning of the loss penetrate the person's consciousness.
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 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.