PrepU Chapter 42: Loss and Grieving

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?

"All efforts will be taken to make sure your loved one is comfortable and out of pain."

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?

"Can you tell me about why you've made this decision?"

The nurse is conducting a support group for clients who have recently lost a child. Which statement by one of the attendees indicates the protest phase of grief?

"I feel like my child is here with me all the time."

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."

Which phrase can do much to instill hope in the dying client?

"Let me tell you about your illness."

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."

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?

"Sometimes a person returns to a previous stage."

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."

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 nursing instructor is describing the stages of grief as identified by Kübler-Ross. The instructor asks the students to place the stages in their usual sequence from first to last. The students demonstrate understanding when they place the stages in which order?

Denial Anger Bargaining Depression Acceptance

A terminally ill client states to the nurse, "My situation is hopeless; I have no control over anything." The nurse implements which interventions to enable hope for the client? Select all that apply.

Encourage the client to discuss feelings. Sit in a chair next to the client. Hold the client's hand.

A nurse is caring for a young client who is diagnosed with chronic renal failure. Which is an effective strategy to help the client cope with the diagnosis?

Encourage the client to join a local support group of young people with renal disease.

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 Cyanotic nail beds in hands and feet bilaterally

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 Universal Inevitable

The client is terminal and has unrelieved and intractable pain. The nurse is administering hydromorphone intravenously. The client states, "I want you to give me additional medication so I will die. I can't go on any longer." What action would the nurse take?

State, "This is not something I or any of the nurses can do."

The nurse is caring for a client with terminal illness. Which should the nurse teach the family about physiological signs of imminent death?

There will be changes in vital signs, skin color, and responsiveness.

A woman has had a breast removed to treat cancer. What type of loss will she most likely experience?

actual loss

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage, according to Kübler-Ross?

anger

What is Kübler-Ross's third stage of grief?

bargaining

The nurse is caring for a young adult who experienced the death of a spouse 10 months ago. Which behavior is consistent with effective coping?

crying while reminiscing about the spouse

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

The nurse is taking care of a client recently involved in a motor vehicle accident during which a pet was thrown from the vehicle and died. The client states, "My heart aches and I can't eat or sleep." According to Kübler-Ross, what stage of grief is the client experiencing?

depression

The emergency department nurse is consoling the adult child of a client who died upon arrival to the hospital. Which grief behavior is common in the shock phase of grief?

intellectual acceptance and flat affect

A nurse is providing end-of-life care for a client. Which symptom indicates brain failure? Select all that apply.

stupor disorientation hyporeflexia

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

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 Decreased urine output Irregular heart rate

Palliative care is a structured system for care delivery. What is its aim?

to prevent and relieve suffering

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?

"I will contact the health care provider to extend services since your family member meets the criteria."

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."

A client with a terminal diagnosis states, "I am so glad I had a good life. I am ready to die." How will the nurse assist the client to communicate this acceptance of death to the family?

Ask the client how the nurse can best support the discussion with family

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 is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness.

A nurse is providing end-of-life care to a client who spends most of the time praying and talking about a "spiritual connection." The nurse interprets this as indicating which stage of grief?

acceptance

A nurse is caring for a client with a terminal illness. Which statement is true of a terminal illness?

recovery is beyond reasonable expectation

An older adult client at a health care facility dies after a prolonged illness. Which is a psychological reaction associated with the different stages of grief?

refusal to accept death

The home health nurse is visiting a client who has been living alone for the past 5 years following the death of the spouse. Which behavior suggests the client may be experiencing abnormal grief?

the client talks as if the loss just happened

A man is diagnosed with terminal kidney failure. His wife demonstrates loss and grief behaviors. What type of loss is the wife experiencing?

anticipatory loss

A client is informed about the results of a biopsy, which indicate a malignant tumor that has spread. The client states, "Well once you remove the tumor, I will be just fine." What stage of the grief process does the nurse identify the client is experiencing?

denial

A terminally ill client is being cared for at home and receiving hospice care. The hospice nurse is helping the family cope with the client's deteriorating condition, educating them on the signs of approaching death. Which sign would the nurse include in this education plan?

difficulty swallowing

A home care nurse is providing care to an older adult client who is dying. The client's son asks the nurse how, when the time comes, he should tell his own children about their grandfather's death. Which suggestion by the nurse would be most appropriate? Select all that apply.

Include the children in any rituals. Encourage the children to remember their grandfather. Help make the children feel loved and safe.

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?

bargaining

The client is a middle-aged female who has been told she has cancer of the plasma. She states to the health care team, "Just keep me alive until I can see my daughter graduate from high school." What stage of dying is this client exhibiting?

bargaining

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?

cleanse drainage from the skin