Chapter 43: Loss, Grief and Dying Prep U

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

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

A 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?" "Once you've started treatment, it's important to continue." "Have you discussed this with your health care provider?" "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 mostappropriate 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 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 would support this diagnosis? "I feel like I have absolutely no idea what to do next." "I haven't let my children out of my sight. I am afraid something will happen to them." "A lot of the time I'm terrified that I'm going to die the same way." "I had a good time at my class reunion. It was nice to be out with other people agai

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

A client with end-stage chronic obstructive pulmonary disease (COPD) has reached the end of the 6-month period for hospice services and the family caregiver states, "I don't know what we will do if they cut off our hospice services." What is the best response by the hospice nurse? "Unfortunately, we are unable to continue services past the 6 month period of time." "We can admit your family member to the hospital for treatment and they can reinstate the hospice benefits." "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."

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

The nurse is caring for a client who recently lost an older adult parent. Which client statement alerts the nurse that the stage of depression may have started within the grief process? "Please go away; I just want to be left alone." "This does not seem real to me." "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 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. "Children understand death on the same level as adults." "Children do not need to go through the same grief reactions 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." "Terminally ill children normally do not ask questions about death."

"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

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 duration of all stages is a few hours." "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 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 process is the same from person to person." "Each stage of dying must be completed prior to moving to the next stage." "The duration of all stages is a few hours."

"Sometimes a person returns to a previous stage."

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

"The client who is isolating himself from social contact after the death of his spouse is demonstrating a social expression of grief."

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

"The inability to talk about your dad 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? "Yes, this is a terrible diagnosis you've received." "This must be very difficult for you." "I'm sure you are angry and sad." "Have you talked with your spiritual leader about your fears?"

"This must be very difficult for you."

The nurse is providing care for a client that is terminally ill with cancer. The client states to the nurse, "Am I going to die?" What is the most therapeutic response by the nurse? "What have you been told?" "I have to go and assist another client right now." "You shouldn't worry about that right now." "You will go when it is your time."

"What have you been told?"

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 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?" "I just want to see my son have a family of his own."

"Why did this have to happen to me?"

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

"Why did this have to happen to me?"

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

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

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? providing counseling related to the stages of death and dying eliminating all forms of medical and nursing care aggressive management of symptoms treatment of the disease process

aggressive management of symptoms

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? treatment of the disease process eliminating all forms of medical and nursing care aggressive management of symptoms providing counseling related to the stages of death and dying

aggressive management of symptoms

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? Acceptance Bargaining Anger Denial

anger

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

anger

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 anger bargaining acceptance

bargaining

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

bargaining

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

bargaining

A widow develops cancer within 6 months of her husband's death. This may be a result of: alcohol intake. multiple losses. social isolation. bereavement.

bereavement.

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: symptoms of terminal illness should not be treated. care is premised on the fact that dying is a normal process. care is generally guided by nurses rather than health care providers. the client must be within 6 weeks of his expected death.

care is premised on the fact that dying is a normal process.

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

coping strategies

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

coping strategies

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 acceptance anger bargaining

denial

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? Denial Depression Bargaining Anger

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? acceptance bargaining denial and isolation depression

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 increased sensory stimulation decreased pain

difficulty swallowing

A client diagnosed with liver failure in hospice care died 10 hours ago. The client's spouse is having difficulty leaving the room and is crying uncontrollably. What situation does the nurse identify is happening with this client's spouse? bargaining grief pathologic grief anticipatory grief grief reaction

grief reaction

A client diagnosed with liver failure in hospice care died 10 hours ago. The client's spouse is having difficulty leaving the room and is crying uncontrollably. What situation does the nurse identify is happening with this client's spouse? pathologic grief anticipatory grief bargaining grief grief reaction

grief reaction

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

ineffective denial related to poor grief resolution

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

leaving the wife's room and belongings intact

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

loss

Which signs assessed in a dying client would the nurse recognize as signs of death? Select all that apply. Increased blood pressure Cheyne-Stokes respirations Increased body temperature Racing pulse Loss of movement, sensation, and reflexes Nausea, flatus, abdominal distention

nausea, flatus, abdominal distention cheyne-stokes repsirations loss of movement, sensation, and reflexes

In the Parkes model, a person uses denial as a psychological defense in the stage of: yearning. numbness. disorganization. reorganization.

numbness

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 Strong, bounding pulse Decreased urine output Irregular heart rate Pale, cool skin

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

people vary widely in their responses to loss stages occur at varying rates among people some people actually skip stages of grief all together

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. Some people actually skip some stages of grief altogether. Stages occur at varying rates among people. The stages of grief occur linearly and are static. 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.

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

placing ID tags on the shroud and ankle

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

providing a comfortable, dignified death

Which care environment would the nurse suggest to a client with no family nearby who is diagnosed with end-stage lung disease? residential care home care respite care acute care

residential care

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

shock

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. dictate how the client wants his estate handled after his death, and by whom. make legal provisions for active euthanasia. specify the treatment measures that the client wants and does not want.

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

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. specify the treatment measures that the client wants and does not want. make legal provisions for active euthanasia. 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.

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 diagnosed with acute kidney failure. The client is an older adult with a history of hypertension. The client was being administered oxygen therapy.

the client did not have any recent medical consultation.

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

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

to prevent and relieve suffering

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

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? "Your loved one is in a better place." "I would like to sit here with you and listen." "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? "In hospice care, the nurses make most of the care decisions for the clients." "Palliative care provides relief from pain and other distressing symptoms." "Palliative care affirms life and regards dying as a normal process." "Hospice care programs focus on quality rather than length of life."

"In hospice care, the nurses make most of the care decisions for the clients."

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 bestresponse? "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." "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."

"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? "There's no need for anger." "It must be very difficult for you." "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 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?" "Do you have a will?" "How well do you think those around you are coping?" "Have you had any previous experiences with the death of someone you love?"

"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?"

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? "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." "Sometimes people become suicidal and we will place your loved one in restraints."

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

Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning? Offer emotional support to the family. Provide an explanation of the process. Administer sedation and analgesia. Have the client's family remain at the bedside.

Administer sedation and analgesia.

Assisted suicide is expressly prohibited under statutory or common law in the overwhelming majority of states. Yet public support for assisted suicide has resulted in a number of state ballot initiatives. The issue of assisted suicide is opposed by nursing and medical organizations as a violation of the ethical traditions of nursing and medicine. Which scenario would be an example of assisted suicide? Neglecting to resuscitate a client with a "do not resuscitate" status Administering a morphine infusion Granting a client's request not to initiate enteral feeding when the client is unable to eat 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? Allow the client's family to see the client's body before it is discharged. Place the client in a semi-Fowler's position. Have the nurse technician place identification tags on the outside of the shroud. Provide a complete bath.

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? Anger Acceptance Bargaining Denial

Anger

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

At about age 9, the child perceives death as irreversible.

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

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. Place a rolled towel under the head. Cleanse drainage from the skin.

Cleanse drainage from the skin.

The hospice nurse is caring for a client who is dying. Which intervention(s) should be included in the plan of care? Select all that apply. Cluster nursing activities. Offer normal amounts of food and fluids. Obtain the blood pressure frequently. Gently massage the arms and legs. Place in a supine position when drooling occurs. Provide cool foods and fluids. Routinely administer pain medications.

Cluster nursing activities. Gently massage the arms and legs. Provide cool foods and fluids. Routinely administer pain medications.

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? Bargaining Depression Denial Anger

Depression

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? Inform the client's husband that the client cannot have sexual intercourse due to fatigue Encourage discussion between the husband and wife regarding their intimacy needs Suggest other ways the couple can spend time together, such as watching television together Reassure the client's husband that he cannot hurt the client during sexual intercourse

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

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

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? Medicare does not cover pain control in the home; it must be in the inpatient care. Worry about payment should not be a concern for the client. Inpatient pain management for hospice clients is covered by Medicare. Medicare does not cover costs that are not directly related to the diagnosis.

Inpatient pain management for hospice clients is covered by Medicare.

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." "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." "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."

During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving? "My parent is suffering with cancer and death will be a relief of the pain." "There is no way I can stay in the hospital because my parent is sick." "I do not think my parent really has cancer. I think my parent needs to get a third opinion." "It is fine if my parent dies. We have not been close for years."

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

Which signs assessed in a dying client would the nurse recognize as signs of death? Select all that apply. Increased blood pressure Increased body temperature Cheyne-Stokes respirations Nausea, flatus, abdominal distention Loss of movement, sensation, and reflexes Racing pulse

Nausea, flatus, abdominal Cheyne-Stokes respirations Loss of movement, sensation, and reflexes

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? An autopsy should not be performed because the nature of death has been established. The closest surviving family member should be consulted to determine whether an autopsy should be performed. The health care provider should be present to prepare the client for an autopsy. The coroner must be notified to determine the need for an autopsy.

The coroner must be notified to determine the need for an autopsy.

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 Anticipatory grief Normal grief

Unresolved grief

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 wishes of his family should be followed. The client should be treated with antibiotics for pneumonia. The client should be resuscitated if he experiences respiratory arrest. Pharmacologic interventions should not be initiated.

The client should be treated with antibiotics for pneumonia.

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 becomes teary when talking about the deceased spouse. The client's living environment is extremely clean and neat. The client talks as if the loss just happened. The client reports attending church on a weekly basis.

The client talks as if the loss just happened.

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 arms and legs are warm to touch. The frequency of urination decreases. The client is calm and peaceful.

The client's breathing becomes noisy.