Human Growth & Development
When working with a client who has spontaneously aborted a pregnancy, it is important for the nurse to first deal with his or her own feelings regarding abortion, death, and loss to be able to do what? Maintain control of the situation Share personal grief with the client Allow the client to express her grief Teach the client how to cope effectively
Allow the client to express her grief Rationale The nurse can be more sensitive to the needs of the client by addressing personal emotions first. Control is not, and should not be, the goal of the nurse. The client's feelings, not the nurse's, should be the focus. A time of crisis is not the time to teach; the client is not ready to learn.
What are the priority nursing interventions for a grieving client? Select all that apply. Recording client details Allowing the client to express feelings Monitoring the psychologic behavior of the client Counseling the family members about diet modifications Respecting the feelings of the client and creating a comfortable environment
Allowing the client to express feelings Respecting the feelings of the client and creating a comfortable environment Rationale The priority nursing interventions for a client in grief includes providing an environment that allows the client to express his or her feelings, such as anger, fear, and guilt. Respecting the client's privacy and need or desire to talk (or not) is important and helps create a comfortable environment. Recording client details is possible only when the client is stabilized. Monitoring the psychologic behavior of the client is a moderate priority. Counseling the client's family members about lifestyle modifications is the last priority because this is of low importance.
A parent whose daughter is killed in a school bus accident tearfully tells the nurse, "My daughter was just getting over the chickenpox and didn't want to go to school, but I insisted that she go. It's my fault that she's dead." How should the nurse anticipate that perceiving a death as preventable will likely influence the grieving process? The loss may be easier to understand and accept. The mourner may experience pathological grief. Bereavement may be of greater intensity and duration. The grieving process may progress to a psychiatric illness
Bereavement may be of greater intensity and duration Rationale Deaths that are perceived as preventable cause greater guilt for mourners and therefore increase the intensity and duration of the grieving process. Loss is usually difficult to understand and accept. Seeing the death as preventable may prolong and intensify the mourning process but will not necessarily result in a pathological reaction or a psychiatric illness.
A nurse is evaluating the appropriateness of a family member's initial response to grief. What is the most important factor for the nurse to consider? Personality traits Educational level Cultural background Past experiences with death
Cultural background Rationale In the initial stage of grief the degree of anguish experienced is influenced by cultural background. Although personality traits factor into the grief process, they are not as important as culture. Educational level is not related directly to a grief response. While past experience is important, it is not as significant as culture.
A client with cancer is told by a health care provider that cancer has metastasized to other organs and is untreatable. The client tells the nurse, "I think they made a mistake. I don't think I have cancer. I feel too good to be dying." Which stage of grief does the nurse conclude that the client is experiencing? Anger Denial Bargaining Acceptance
Denial Rationale The client has difficulty accepting the inevitability of death and attempts to deny the reality of it. In the anger stage the client strikes out with statements such as "Why me?" and "How could God do this to me?" The client is angry at life and is still angrier to be removed from it by death. In the bargaining stage the client attempts to bargain for more time; the reality of death is no longer denied, but the client tries to manipulate and extend the remaining time. In the acceptance stage the client accepts the inevitability of death and quietly awaits it.
Which member of a primary hospice team is responsible for rendering personal care and assisting with the bathing of clients? Hospice aide Primary nurse Volunteer coordinator Bereavement coordinator
Hospice Aide Rationale A hospice aide is responsible for providing personal care to the client and assisting with bathing. A primary nurse serves as a liaison among the client, health care provider, and interdisciplinary team; evaluates the client's response to treatment; and educates the client and family on disease process and care. A volunteer coordinator assesses the needs of the client and caregiver for volunteer services. A bereavement coordinator assesses and supports the bereaved survivor and facilitates support groups.
The significant other of a client who is dying of acquired immunodeficiency syndrome (AIDS) tells the nurse, "Life is not worth living without my partner." What should the nurse plan to do to help the significant other cope with the impending death? Involve the significant other's support system Explore the significant other's psychotic thoughts Suggest a bereavement group to the significant other Reinforce the current self-image of the significant other
Involve the significant other's support system Rationale Involving the support system will decrease the person's feelings of isolation. Anticipatory grieving does not involve psychotic thoughts. Suggesting a bereavement group to the significant other is premature. The concern is about loss and loneliness, not self-image.
A client with a terminal disease is admitted to hospice care. The nurse coordinator assigns a primary team. Which member of the hospice team evaluates the client's response to treatment and provides emotional support to the client and his caregiver? Hospice aide Primary nurse Hospice pharmacist Bereavement coordinator
Primary Nurse Rationale The primary nurse, a licensed nurse, would evaluate the client's response to treatment and provide emotional support to the client and his caregiver. The hospice aide, certified as a home health aide, is tasked with administering personal care and providing assistance with bathing. The hospice pharmacist, a licensed registered pharmacist, would provide drug consultation. The bereavement coordinator, a professional with grief experience, provides emotional support but does so for the bereaved survivor while facilitating support groups.
What is the role of a hospice volunteer on a primary hospice team? Administering personal care Assisting the client with bathing Assessing the bereaved survivor Providing companionship to clients and caregivers
Providing companionship to clients and caregivers Rationale A hospice volunteer provides companionship to clients and caregivers. A hospice aide helps with personal care and assists the client with bathing. A bereavement coordinator assesses bereaved survivors.
A client in the terminal stage of cancer is being admitted to the hospice care unit. One member of the interdisciplinary team assists the client and family in filling out insurance papers. Which team member would be assisting? Social worker Primary nurse Spiritual coordinator Volunteer coordinator
Social worker Rationale A social worker would assist in filling out insurance papers and supporting the client and caregiver with grief issues. A primary nurse serves as a liaison among the client and caregiver, health care providers, and the interdisciplinary team. A spiritual coordinator serves as a liaison between the client and the spiritual community. A volunteer coordinator recruits and trains volunteers.
A nurse facilitating a support group of widows and widowers recalls that research indicates that the probability of a spouse having a pathological or morbid grief response will be greater in what case? The couple had an ambivalent relationship. The cause of the spouse's death was suicide. The relationship between the spouses was satisfying. There was a long preparatory grief period before a spouse's death.
The cause of the spouse's death was suicide Rationale The survivors of a suicide feel more guilt and bitterness and go through a longer grieving process, and therefore the chances of a pathological grief response are increased. An ambivalent relationship between the spouses may result in a difficult grief response because of guilty feelings but should not cause a morbid grief response. Research documents that the more satisfying the relationship, the more likely that the mourner will establish a new relationship. With a preparatory grief period a person may have the opportunity to work through a part of the grief process before the death and have a shorter mourning period after the death.
Which member of the hospice care team is responsible for providing respite care to the client's caregiver? Nurse coordinator Spiritual coordinator Volunteer coordinator Bereavement coordinator
Volunteer coordinator Rationale A volunteer coordinator of a hospice care team is responsible for providing respite care to the caregiver of the client. A nurse coordinator manages the client's care, explains the services, and assigns a primary team. A spiritual coordinator serves as a liaison between the client and the spiritual community and coordinates spiritual support. A bereavement coordinator assesses and supports the bereaved survivor and facilitates support groups.
A nurse cares for a client with terminal pancreatic cancer. The client tells the nurse, "I have some spiritual questions and would like to talk with someone." Which member of the core interdisciplinary hospice team should be contacted? Social worker Hospice volunteer Spiritual coordinator Bereavement coordinator
Spiritual Coordinator Rationale A spiritual coordinator coordinates spiritual support for the client. A social worker evaluates and provides any necessary counseling in situations of grief. A primary spiritual leader supports clients in coping with their fears and uncertainty about spiritual issues. A bereavement coordinator assesses and supports bereaved survivors and facilitates access to support groups for them.
A licensed practical nurse discusses hospice care with a nursing student. Which statements made by the nursing student indicates a need for further discussion? Select all that apply. "A client's spouse is considered a primary caregiver." "The hospice Medicare benefit covers all expenses for palliative treatments." "A hospice provides dying older adults with a higher level of control and dignity in death." "The hospice Medicare benefit for bereavement care is not provided after the death of the client." "Hospice care can be provided to all older adults requiring hospitalization for the treatment of an illness."
"The hospice Medicare benefit for bereavement care is not provided after the death of the client." "Hospice care can be provided to all older adults requiring hospitalization for the treatment of an illness." Rationale Hospice Medicare pays benefits for bereavement for up to 1 year after a client's death. Hospice care is provided only to clients with terminal illnesses who requiring palliative care. The client's spouse would indeed be considered a primary caregiver. The Medicare benefit for hospice care covers all palliative treatment expenses. Dying adults often achieve a higher level of control and dignity within a hospice than with other types of health care.
A primary healthcare provider tells a client about the diagnosis of inoperable cancer and that the client does not have long to live. After the primary healthcare provider leaves, the client says to the nurse, "I feel fine. I probably only have the flu." The nurse determines that the client is in the denial stage of grief. What should the nurse do to help meet the client's emotional needs? Reassure the client that everything will be alright. Leave the client alone to confront feelings of impending loss. Encourage the denial until the client is able to accept reality. Allow the denial and be available to discuss the situation with the client.
Allow the denial and be available to discuss the situation with the client. Rationale Allowing the denial and being available to discuss the situation with the client does not remove the client's only way of coping, and it permits future movement through the grieving process when the client is ready. Reassuring the client that everything will be alright is false reassurance. The client must not be abandoned; the nurse's presence is a form of emotional support. The client's denial should be neither encouraged nor removed; encouraging denial is a form of false reassurance.
What is a function of a bereavement support group? Filing of insurance papers Providing drug consultation Assisting in solving any problems between a caregiver and client Providing families who have lost loved ones a chance to communicate and share their feelings
Providing families who have lost loved ones a chance to communicate and share their feelings Rationale A bereavement group provides families who have lost loved ones the chance to communicate and share their feelings. Filing insurance papers is administrative and therefore not a function of bereavement groups. Drug consultation is done by pharmacists, not bereavement groups. Social workers, not bereavement groups, help resolve any problems between a caregiver and client.
The nurse is providing care for parents who have experienced a stillbirth. What is the most appropriate intervention at this time? Giving a detailed explanation of what may have caused the stillbirth Providing the parents the opportunity to say goodbye to their newborn Explaining that autopsy is not recommended in the setting of a stillbirth Waiting to provide any information about follow-up care until the parents have had an opportunity to adjust to the grief
Providing the parents the opportunity to say goodbye to their newborn Rationale Parents should be given the opportunity to say goodbye to a stillborn baby. Because the parents may not think to ask to see the baby, the nurse should provide this opportunity. Giving a detailed explanation of possible causes of the stillbirth is nontherapeutic. An autopsy may be performed when there is a stillbirth. The decision is left to the parents. The procedure can be very important in answering the question "Why?" if there is a chance that the cause of death can be determined. Before the parents leave the hospital, arrangements for follow-up care should be made. This information should be provided immediately, because it can help the parents begin the grieving process. Many hospitals have a team consisting of a social worker, chaplain, and nurse that is called when a stillbirth occurs.
A nurse understands the stages of parental adjustment that follow the birth of an at-risk infant who is in the neonatal intensive care unit. To better plan nursing care, the nurse bases observations and assessments on what recognition? The parents should be encouraged to visit their newborn within a day of birth The mother should not see the infant until she has completed the necessary grief work The mother should be reunited with her infant as soon as possible to enhance adjustment The nurse should wait until the parents ask to see their newborn before suggesting a visit
The mother should be reunited with her infant as soon as possible to enhance adjustment Rationale The mother should be reunited with her newborn at the first opportunity after she is emotionally prepared. There is no magic about the first 24 hours; some mothers are too ill, or both parents may be too frightened, to see their baby that soon. Grief work will go on for an extended period and has no relationship to when the infant is seen. Some parents may be too frightened to ask to see their baby; the nurse can prepare the parents and then suggest a visit.
Which member of a hospice team coordinates assignments among volunteers? Hospice aide Hospice volunteer Volunteer coordinator Bereavement coordinator
Volunteer coordinator Rationale A volunteer coordinator trains volunteers and coordinates assignments among them. A hospice aide helps with personal care and bathing. A hospice volunteer provides companionship to clients and caregivers. A bereavement coordinator assesses the bereaved survivors.
Which team members are members of a primary hospice team? Select all that apply. Social worker Medical director Spiritual coordinator Volunteer coordinator Bereavement coordinator
Volunteer coordinator Bereavement coordinator Rationale A volunteer coordinator and a bereavement coordinator are members of a primary hospice team. A social worker, a medical director, and a spiritual coordinator would be members of a core interdisciplinary hospice team.
