Ch. 44 -- Loss, Grief and Dying

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" ----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 the family. -----While this may be desired, the client should initiate it

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

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 their loss reaction?

"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 the client was not close to their parent, the impact might not be as great. On the other hand, if the parent was an important person in the client's life, the client's response might be greater. Other things to ask initially include whether the loss was expected and whether the client feels a sense of responsibility for the loss.

The cardiac nurse, who has been caring for a hospitalized client with a terminal illness for 3 days, finds that the client has died. The nurse manager knows that the nurse can legally care for these clients when the nurse makes which statement?

---->>> 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 clients who are brain-dead and cadavers without a heart beat.

The spouse of a recently deceased client states, "I just cannot believe the client left me. The client swore they would never leave me and I feel betrayed!" Within the Kübler-Ross stages of grief, what stage does the nurse identify the spouse is experiencing?

--- ANGER ---The spouse is identified as being in the anger stage of the grieving process. The spouse has accepted the fact that the client is gone but is angry and betrayed at the departure from life. The spouse has yet to accept this death and may have some overlapping with depression as well. There is no evidence of bargaining or denial.

"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?

---->> "The inability to talk about one's spouse 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.

A hospice nurse has developed a care plan for a client with liver cancer. The care plan focuses on providing palliative care for this client. The goal of palliative care is bestdescribed as providing clients with life-threatening illnesses a dignified quality of life through which means?

---->> Aggressive management of symptoms --- The goal of palliative care is to provide clients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms. There is no treatment goal for the life-threatening illness for palliative care. Aggressive management of symptoms includes medical and nursing care for the client. Providing counseling related to the stages of death and dying is pursued after aggressive management of symptoms.

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 attachments 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.

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 ---- 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 & admission usually requires a 6 MONTH life expectancy or less.

The children of a client with late-stage Alzheimer disease have informed the nurse on the unit that their parent 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 --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 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 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 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?" ----The client is expressing anger when displaying a "why me" attitude. ----The other statements are reflective of other stages of grief.

Which statement regarding perceptions of death by children is accurate ?

---->>> At about age 9, children perceive 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. In the early school years (not toddler years), the child perceives death as unnatural, reversible, and avoidable. ----The concept of spiritual release is beyond most preschool-aged children. ----Adolescents generally have the capacity to mourn fully, but they are at greater risk for poorer outcomes than are adults because of the numerous other stressors and developmental changes they are experiencing during this stage of the life cycle

The experience of parting with an object, person, belief or relationship that one values is defined as:

---->>> 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 nurse is providing postmortem care. Which of the following nursing actions is a legal responsibility?

---->>> 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.

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?

---->>>"Not everyone experiences grief in the same way and your loved one needs our support." ----Stages of grief include denial, anger, bargaining, depression, and acceptance. ----- The progression in which people move through stages varies from person to person. ----- Some people may not experience each stage. ----Sharing with the spouse that "Not everyone experiences grief in the same way and your loved one needs our support" is the most therapeutic response. ----Telling the spouse that something is wrong is incorrect as this is a normal response to grieving. -----There is no verifying data in the question stem indicating the client is suicidal and restraints are not used in a situation such as this. ----Telling the spouse that "most people go through all sorts of feelings" is not therapeutic; the nurse is minimizing the loved one's feelings.

The nurse is caring for a client whose spouse died 6 days ago. What assessment finding suggests that the client is in the first stage of Engel's model of grief?

---->>The client has difficulty believing the spouse is actually deceased. ---- In the initial shock and disbelief stage, the survivor either refuses to accept the loss or shows intellectual acceptance of the loss but denies the emotional impact. In the idealization stage, the deceased is seen in only positive terms. Estate planning and anger do not exemplify the initial shock and disbelief in early grief.

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?" ----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 nurse is caring for a client who recently found out they have a terminal illness. The nurse notes that the client is hostile and yelling. Which statement by the nurse shows understanding of the Kübler-Ross emotional responses to impending death?

--->> "Sometimes a person returns to a previous stage" --- Kübler-Ross (1969) studied the responses to death and dying. The 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.

A client has recently lost a parent. The client spent about 6 months deeply mourning the loss and is just now able to function at the pre-loss level. During this process, a strong social support network was able to assist the client. What developmental stage of life does the nurse identify the client is in?

--->> ADULT -- Adults tend to grieve more intensely and more continuously, but for a relatively shorter period of time than children. Having a good social network helps with this process, as well as having a stable lifestyle.

A 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 & 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 priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning?

--->> 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.

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 will the nurse take?

--->> Arrange for individuals 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.

Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief?

--->> Coping Strategies --- Dysfunctional grief can be unresolved or inhibited. In unresolved grief, a person may have trouble expressing feelings of loss or may deny them. ----Unresolved grief also describes a state of bereavement that extends over a lengthy period. -----With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms. -----Coping strategies are necessary in the grieving process and for resolution of grief. -----Many times individuals experiencing dysfunctional grief have difficulty with self-care activities; however, the individual should be encouraged to perform these activities independently. -----Pain management is usually not necessary in the management of dysfunctional grief. ---- The spiritual needs of the client are important as well and should be considered after coping strategies have been addressed

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?

--->> Durable power of attorney form ---- NOT ADVANCE DIRECTIVE 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 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?

--->> Encourage discussion between the client and their partner regarding their intimacy needs. ---- Partners of terminally ill clients may wish to be physically intimate with the dying person but are afraid of "hurting" them, 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's partner that they cannot have relations based on the fatigue of the client is not appropriate. ---Reassuring the client's partner that they will not cause pain is incorrect

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. ----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.

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?

--->> 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. ---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 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 & flat affect ----Engel's model of grief proposed shock and disbelief as the first reaction to a loss. During this time, the family member may deny the loss or accept it and become emotionally flat. As such, intellectual acceptance and flat affect are consistent with the shock stage. Focusing energy on funeral arrangements and rituals is consistent with the restitution phase of grieving. Crying, anger, and intense psychological pain indicate the family member is entering the stage of awareness. Adopting character traits of the deceased occurs in the idealization phase.

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 ---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 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 --- 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.

Which signs assessed in a dying client would the nurse recognize as signs of death? Select all that apply.

--->> Nausea, flatus, abdominal distention --->> Cheyne- Stokes respirations --->> Loss of movement, sensation, & reflexes ----Signs of impending death include nausea, flatus, abdominal distention, Cheyne-Stokes respirations, and loss of movement, sensation, and reflexes. The body temperature decreases, pulse decreases, and blood pressure decreases.

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 UO --->> Irregular HR -- 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.

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

--->> TO PREVENT & 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.

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. ---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.

Which are signs of a "good death"? Select all that apply.

--->> The person's 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.

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

--->> To prevent & 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

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 ---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).

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 --->> 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 client has developed cancer within 8 months of their spouse's death. The nurse will consider the possibility of what cause ?

--->> physical effects of bereavement ----Physical health and psychosocial adjustment are intricately intertwined. People experiencing bereavement are known to be at greater risk for mortality and morbidity than are comparable people not experiencing bereavement. Alcohol use is a risk factor for cancer, but this would be unlikely to manifest in only a few months. Grieving individuals are at a risk for self-harm, but this does not result in cancer. There are aspects of unsafe living conditions that increase risk for cancer, but this would not likely affect the client in such a short amount of time.

A client's adult child is named to make decisions for the client in the event the client cannot speak for themselves. This is an example of a(an)

--->>> 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 is for a client with a large estate. ----Exemplary representative and significant power are not related to health care.

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 ?" ---- 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.

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." -----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.

A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education?

--->>> '' In hospice care, nurses takes on the responsibility of making care decisions for 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. Focuses include pain control, quality of life and normalizing the dying process.

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. ---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.

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 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.

Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning?

--->>> 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.

The nurse is caring for a client who has just expired. Which action will the nurse perform?

--->>> Allow 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

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

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

Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief?

--->>> COPING STRATEGIES ---- Dysfunctional grief can be unresolved or inhibited. In unresolved grief, a person may have trouble expressing feelings of loss or may deny them. --- Unresolved grief also describes a state of bereavement that extends over a lengthy period. With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms. -----Coping strategies are necessary in the grieving process and for resolution of grief. Many times individuals experiencing dysfunctional grief have difficulty with self-care activities; however, the individual should be encouraged to perform these activities independently. -----Pain management is usually not necessary in the management of dysfunctional grief. The spiritual needs of the client are important as well and should be considered after coping strategies have been addressed.

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. ----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.

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?

--->>> 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 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 ---Bereavement experts reported that they considered almost all bereavement manifestations to be normal during the early stages of grief, but considered most of the manifestations to be abnormal if they continue beyond 3 years. Leaving the deceased's room and belongings intact is among these concerning behaviors. None of the other listed actions suggest dysfunctional grief.

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

--->>> Shock & 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 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.

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 --- the client signed a document indicating to NOT BE RESUSCITATED. Treating th pneumonia with antibiotics is not part of the resuscitation method.

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 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)

The nurse is giving palliative care to a client with a diagnosis of COPD. What is the goal of palliative care?

--->>> To improve the clieint'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 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 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.

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." ---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 parent dies 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?" ----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 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. ---->> Placing identification tags on the client's dentures or other prostheses. ---->> Arranging for family members to view thee 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.

Family members of a dying client are in the room with their loved one. As the client nears death, what should the nurse tell the family?

-->>" Please stay with your loved one and talk to him" ----A fear of having to face death alone is a primary concern of dying clients. The presence of family members in the room should be encouraged and reminiscences should be shared. Most health care organizations allow additional family members to stay in a dying client's room. Forcing the family member to leave is not empathic to the dying client.

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". ---Palliative care involves taking care of the body, mind, spirit, heart, and soul. It views dying as something natural and personal. The goal of palliative care is to give clients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms. A do-not-resuscitate order means that no attempts are to be made to resuscitate a client whose breathing or heart stops. Gradual withdrawal of mechanical ventilation from a client with a terminal illness and poor prognosis is called terminal weaning. Clients do not have to be in an inpatient hospice unit to receive palliative care