PrepU Chapter 44: Loss, Grief, and Dying

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? acceptance bargaining depression denial

bargaining

Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief? coping strategies self-care activities spiritual distress pain management

coping strategies

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? "Your loved one will not feel or be aware of anything that is happening once the breathing tube is removed." "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."

"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? "Have you discussed this with your health care provider?" "Does your family agree with this decision?" "Once you've started treatment, it's important to continue." "Can you tell me about why you've made this decision?"

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

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?"

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? "Do you keep photos of your spouse on your bedside table?" "Do you cry on the anniversary of your spouse's death?" "Have you gone through and donated your spouse's clothing?" "Can you remember the good times together with your spouse?"

"Have you gone through and donated your spouse's clothing?"

When reviewing a client's chart, the nurse notes that the client is in the disorganization stage of grief. Which assessment finding supports this conclusion? "I feel like I have absolutely no idea what to do next." "I have not let my children out of my sight. I am afraid something will happen to them." "A lot of the time I am terrified that I am going to die the same way." "I had a good time at my class reunion. It was nice to be out with other people again."

"I feel like I have absolutely no idea what to do next."

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." "I have finalized all my financial arrangements for my family." "Everyone dies; death is a part of life and I have to accept it."

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

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? "We can admit your family member to the hospital for treatment and they can reinstate the hospice benefits." "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."

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

The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate? "There's no need for anger." "It must be very difficult for you." "You should try to make things right with your family." "I can't imagine how awful this is for you."

"It must be very difficult for you."

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? "I would like to sit here with you and listen." "Your loved one is in a better place." "It's the Lord's will." "You must accept the death and move on with your life."

"I would like to sit here with you and listen."

A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education? "Hospice care programs focus on quality rather than length of life." "In hospice care, nurses take on the responsibility of making care decisions for clients." "Palliative care affirms life and regards dying as a normal process." "Palliative care provides relief from pain and other distressing symptoms."

"In hospice care, nurses take on the responsibility of making care decisions for clients."

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." "It is a document created by you and your attorney naming a beneficiary to handle your estate if you become terminally ill." "I will contact the hospital social worker to come and discuss the development of an advance directive with you."

"It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition."

The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate? "You should try to make things right with your family." "It must be very difficult for you." "I can't imagine how awful this is for you." "There's no need for anger."

"It must be very difficult for you."

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

"My parent is suffering with cancer and death will be a relief of the pain."

A client diagnosed with a terminal illness is displaying periods of depression and anger alternating with acceptance. The client's spouse is concerned about the client's labile mood. When talking with the client's spouse, which statement made by the nurse best addresses principles of loss and grieving? "Sometimes people become suicidal and we will place your loved one in restraints." "I think you are correct. Something is wrong with your loved one." "Most people go through all sorts of feelings and your loved one is no different." "Not everyone experiences grief in the same way and your loved one needs our support."

"Not everyone experiences grief in the same way and your loved one needs our support."

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? "This does not seem real to me." "Please go away; I just want to be left alone." "What am I going to do now that my parent is gone?" "It is all my fault! I did not see the signs."

"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."

When preparing for palliative care with the dying client, the nurse should provide the family with which explanation? "Palliative care is the gradual withdrawal of mechanical ventilation from a client with terminal illness and poor prognosis." "The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms." "The client will have to go to an inpatient hospice unit in order to receive palliative care." "In palliative care, no attempts are to be made to resuscitate a client whose breathing or heart stops."

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

"My father has been dead for over a year and my mother still cannot talk about them without crying. Is that normal?" How should the nurse respond? "Did your mother cry a lot before your father died?" "The inability to talk about your father without crying, even after a year, is still considered normal." "It is not considered normal. Has your mother considered seeing a therapist about their grief." "In fact, the more that someone cries about a loss, the better they are dealing with it."

"The inability to talk about your father without crying, even after a year, is still considered normal."

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

"This must be very difficult for you."

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: "I just want to see my son have a family of his own." "Why did this have to happen to me?" "I don't care about anything. I have no energy." "I do not believe I have this disease."

"Why did this have to happen to me?"

The nurse is preparing a presentation on preparing children for the death of a family member or friend. What information should the nurse include? Select all that apply. Provide for stability and safety. Talk openly about death and the feelings associated with it. Praise stoicism. Encourage expression of feelings. Distract the child as much as possible.

- Encourage expression of feelings. - Provide for stability and safety. - Talk openly about death and the feelings associated with it.

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. A regular apical pulse of 90 beats/minute Gurgling sounds emanating from the client's throat with each breath Systolic blood pressure which rose from 100 to 110 mm Hg Distended abdomen with last bowel movement documented 7 days ago 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

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. Regular deep respirations Irregular heart rate Pale, cool skin Decreased urine output Strong, bounding pulse

- Pale, cool skin - Decreased urine output - Irregular heart rate

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. The stages are relatively discrete and identifiable. People vary widely in their responses to loss. The stages of grief occur linearly and are static. Stages occur at varying rates among people. Some people actually skip some stages of grief altogether.

- People vary widely in their responses to loss. - Stages occur at varying rates among people. - Some people actually skip some stages of grief altogether.

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. Removing all tubes according to agency policy, unless an autopsy is to be performed Arranging for family members to view the body before it is discharged to the mortician Placing identification tags on the client's dentures or other prostheses Washing the client's body Placing identification on the wrist

- 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

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. 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. Medications to treat cancer are provided.

- 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.

Which are signs of a "good death"? Select all that apply. The person dies according to the wishes of the family. The person experiences moderate pain. 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.

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. Allow the client to stop drinking fluids. Use medication to lower client consciousness to limit awareness of suffering. Implement a slow code in the case of cardiopulmonary or respiratory arrest. Administer a lethal dose of barbiturates. Do not perform cardiopulmonary resuscitation.

- Use medication to lower client consciousness to limit awareness of suffering. - Allow the client to stop drinking fluids. - Do not perform cardiopulmonary resuscitation.

Which assessment finding would best support a nursing concern of disordered grieving? 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.

A client is unable to return to work after their sibling's death 18 months ago.

Which situation is most likely to warrant an autopsy? A client's death is attributed to an infectious disease. A client dies after unsuccessful cardiopulmonary resuscitation. A palliative client dies unwitnessed during the night. A client's death involves an allegation of a medical error.

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

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? Neglecting to resuscitate a client with a "do not resuscitate" status Granting a client's request not to initiate enteral feeding when the client is unable to eat Administering a morphine infusion Administering a lethal dose of medication

Administering a lethal dose of medication

The nurse is caring for a client who has just expired. Which action will the nurse perform? Provide a complete bath. 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. Place the client in a semi-Fowler's position.

Allow the client's family to see the client's body before it is discharged.

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

Anger

Which statement regarding perceptions of death by children is accurate? Preschool-age children view death as a spiritual release. Adolescents tend to respond to death and grief better than adults. Toddlers perceive death as irreversible and unnatural. At about age 9, children perceive death as irreversible.

At about age 9, children perceive death as irreversible.

Palliative care is a structured system for care delivery. What is its aim? A) to give traditional medical care B) to prevent and relieve suffering C) to bridge between curative care and hospice care D) to provide care while there is still hope

B) to prevent and relieve suffering

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? Consult with the charge nurse or nurse manager before calling the code. Call a code and begin resuscitating the client. Initiate a slow-code until the health care provider arrives. Respect the client's wishes and avoid calling a code.

Call a code and begin resuscitating the client.

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? Apply hairpins and clips. Avoid replacing dentures in the mouth. Cleanse drainage from the skin. Place a rolled towel under the head.

Cleanse drainage from the skin.

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

Durable power of attorney form

The partner of a client with terminal cancer is afraid of hurting the client during sexual intercourse. Which action by the nurse is likely to be most helpful in reducing this client's fears? Reassure the client's partner that they cannot hurt the client during sexual intercourse Encourage discussion between the client and their partner regarding their intimacy needs Inform the client's partner 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 client and their partner regarding their intimacy needs

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 giving up is expected with terminal illness. Encourage the client to think about living instead of dying. Explain to the client that she cannot give up because her family needs her. Explain to the family that acceptance is part of the grieving process.

Explain to the family that acceptance is part of the grieving process.

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 provides physical and psychological support; palliative care provides social and spiritual support. Hospice care differs from palliative care in its foundational philosophy. Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness. 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.

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.

A nurse caring for a client with a terminal illness understands which statement to be true? Recovery is not expected. Recovery will be longer than 3 months. Recovery will be slow. Recovery is dependent on selected treatment.

Recovery is not expected.

The nurse is assisting a client and family with the death and dying process. In an effort to provide culturally competent care, what action will the nurse perform first? Create a referral to spiritual care. Seek to understand the client's beliefs. Explain the stages of grief. Ensure the family has sufficient privacy to grieve.

Seek to understand the client's beliefs.

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 did not have any recent medical consultation. The client was being administered oxygen therapy. The client is an older adult with a history of hypertension. The client was diagnosed with acute kidney failure.

The client did not have any recent medical consultation.

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 treated with antibiotics for pneumonia.

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 client's breathing becomes noisy.

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? Unresolved grief Anticipatory grief Inhibited grief Normal 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? Unresolved grief Inhibited grief Normal grief Anticipatory grief

Unresolved grief

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? depression bargaining anger acceptance

bargaining

When planning care for a 55-year-old client with newly diagnosed terminal pancreatic cancer, which nursing concern is most appropriate for the care plan? failure to thrive unproductive coping altered comfort death anxiety

death anxiety

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? anger acceptance bargaining denial

denial

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? bargaining acceptance anger denial

denial

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 acceptance bargaining denial and isolation

depression

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 increased urinary output decreased pain increased sensory stimulation

difficulty swallowing

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): significant power. advance estate director. exemplary representative. durable power of attorney.

durable power of attorney.

The nurse is working with a client's whose spouse died 4 years ago. Which assessment finding will prompt the nurse to perform assessment for dysfunctional grief?

leaving the spouse's clothes and belongings intact

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

loss.

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: give permission for organ donation. make legal provisions for active euthanasia. 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.

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

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

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 health care provider 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 this directive would violate the client's rights understanding that learning about impending death will create unnecessary worry 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