Prep U Chapter 42 -- Grief, Loss and Dying

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

Coping strategies

The psychiatrist is evaluating a client who has recently learned she has a terminal illness. Which statement indicates to the psychiatrist that the client is in the Kübler-Ross stage of bargaining?

"Just let me go on vacation with my wife; then I'll be satisfied."

Which client statement alerts the nurse that the stage of depression may have started within the grief process?

"I can't seem to stop crying about the diagnosis."

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."

A nurse completing admission paperwork asks the client about having an advanced directive. The client states, "I do not know, what is an advanced directive?" What is the nurse's best response?

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

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."

The nurse is caring for a client who has just died after a long diagnosis of dementia. Which nursing assessment is the priority for documentation?

"No breathing and no pulse at 0840."

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

"Sometimes a person returns to a previous stage."

The daughter of an older client is concerned that her mother is depressed because she is reading the obituaries every day. What is the most appropriate nursing response?

"This is common in older adults and doesn't necessarily indicate depression."

A client is admitted to the hospital with a medical diagnosis of terminal lung cancer. Which question is most important for the nurse to ask first?

"What have you been told about your condition?"

Which assessment finding would best support a nursing diagnosis of Dysfunctional Grieving?

A man is unable to return to work after his sister's death 18 months ago.

A 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

A woman has responded to her recent diagnosis of lung cancer by making extensive plans for overseas travel with her children, despite the fact that her oncologist has informed her of her extremely poor prognosis. The client is adamant that she does not want to discuss her cancer and the nurse consequently recognizes that the client is likely in the denial stage of grief. How can the nurse best facilitate the client's healthy grieving?

Address the client's diagnosis and prognosis at a later time or date.

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

Administer sedation and analgesia

An appropriate nursing diagnosis for the family of a client dying of cancer, whose members have expressed sorrow over the forthcoming loss, would be:

Anticipatory Grieving related to loss of family member, as evidenced by sorrow

Which statement regarding perceptions of death by children is accurate?

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

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

Bargaining

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

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.

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?

Client's breathing becomes noisy.

The nurse has noted that a dying client is increasingly withdrawn and is often teary at various times during the day. The nurse recognizes that the client may be experiencing which of Kübler-Ross's stages of grief?

Depression

A terminally ill client told her family, "I am ready to die." Her family is very upset that she has given up and wants the nurse to intervene. Which nursing intervention is most appropriate?

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

A nurse is preparing a presentation for a family support group for cancer. The nurse is planning to describe grieving and the various terms associated with this concept. Which term would the nurse use to describe the entire range of responses to the loss of a valued object, person, belief, or relationship?

Grief

A nurse is taking care of a client who is obviously going through the shock phase of grieving. Which nursing intervention is best for this client?

Help the client mobilize support systems.

The wife of a client who has been diagnosed with a terminal illness asks the nurse about the differences between palliative care and hospice care. Which information would the nurse most likely include in the response?

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

A 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 patients is covered by Medicare.

A client has been diagnosed with a terminal illness and has periods of depression and periods of anger, alternating with periods of acceptance. What teaching is most appropriate for the nurse to include when the client's spouse says that the client seems emotionally unstable?

Movement between stages of grief is normal.

The wife of recently deceased client states that she can't think of anything other than her husband. She wakes up at night and goes to look for him before realizing that he is dead. The nurse understands that the wife is which stage of Demi's model of grief?

Protest

The nurse is taking care of Esther, a 24-year-old woman who was recently in a motor vehicle accident during which she lost her beloved golden retriever. She tells the nurse that when she thinks of him, her heart aches. She does not want to eat and can't sleep even though she is exhausted. Which stage of the grief cycle model is Esther experiencing?

Protest - Grief Cycle Model

The children of a male client with late-stage Alzheimer's 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 do which of the following?

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

A patient 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 patient?

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

The husband of a patient 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

When preparing for the death of a client, the nurse should provide the client's family with which interventions? Select all that apply. a.) Encourage rest and proper nutrition. b.) Suggest that the family doesn't leave the bedside. c.) Explain the dying process and allow grieving. d.) Utilize therapeutic communication techniques. e.) Listen to concerns, fears, and worries.

a.) Encourage rest and proper nutrition. c.) Explain the dying process and allow grieving. d.) Utilize therapeutic communication techniques. e.) Listen to concerns, fears, and worries.

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 best described as providing clients with life-threatening illnesses a dignified quality of life through which means?

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. a.) preparing the client for the loss without warning b.) allowing the person to avoid the experience of the loss more fully c.) allowing the outer reality of loss to become internally accepted d.) altering the emotional attachment to that which was lost

c.) allowing the outer reality of loss to become internally accepted d.) altering the emotional attachment to that which was lost

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

Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal?

leaving the wife's room and belongings intact

The health care provider has notified the spouse of a client who died after a serious motor vehicle accident that all rescue efforts were unsuccessful, and that the client regrettably died. Several hours later, the nurse notes that the spouse is walking the hallways, asking people if they have seen her husband. Which condition does the nurse suspect?

shock

The nurse is performing post mortem care on a client who died suddenly while in prison. Which nursing action is appropriate?

taping the intravenous lines in place

The nurse is aware that there is a potential for errors in the certification of death when ...

the client had a condition that has the potential to temporarily suspend life process

Following surgery, the surgeon informed the client's spouse that invasive cancer was found during the procedure and the client may only have days to live. The client's spouse has told the physician and the nurse that they do not want the client to know the severity of the diagnosis. How will the nurse respond?

understanding that this directive would violate the client's rights

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 children of a male client with late-stage Alzheimer's 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 do which of the following? a.) Make legal provisions for active euthanasia. b.) Dictate how the client wants his estate handled after his death, and by whom. c.) Specify the treatment measures that the client wants and does not want. d.) Give permission for organ donation.

D: Specify the treatment measures that the patient wants and does not want. Rationale: Living wills provide intructions about the kinds of healthcare that should be used or rejected under specific circumstances. The management of individual's estate is specified in a will, not a living will, and it is not leagal 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 sperate, specific consent card or document.

The hospice nurse is visiting the wife of a client who died 10 months ago. The wife states, "My life is meaningless since my husband died." The nurse recognizes that the client is in which stage of grief?

Disorganization

A client's son is named to make decisions for his mother in the event she cannot speak for herself. This is an example of a(an) ...

Durable power of attorney

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?

Encourage discussion between the husband and wife regarding their intimacy needs

The nurse is preparing a presentation on preparing children for death. What information should the nurse include? Select all that apply.

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

A client with a terminal illness is being cared for at home. When caring for a client who is in home care, the nurse discusses the importance of respite care. Which of the following interventions leads to respite care?

Encouraging the caregiver to identify surrogate caregivers

A client has been diagnosed with a terminal illness and has periods of depression and periods of anger. The client's spouse is concerned, feeling as though their loved one is not moving forward in the stages of grief. What teaching is most appropriate for the nurse to include?

Movement between stages can be progressive. Movement back and forth between stages is expected.

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. Which of the following should happen in this case?

The client should be treated with antibiotics for pneumonia.

Which actions are performed by the nurse when a client dies? Select all that apply. a.) placing identification tags on the client's dentures or other prostheses b.) arranging for family members to view the body before it is discharged to the mortician c.) washing the client's body d.) removing all tubes according to agency policy, unless an autopsy is to be performed e.) placing identification on the shroud or garment and wrist f.) attending the funeral of a deceased client and making follow-up visits to the family

a.) placing identification tags on the client's dentures or other prostheses b.) arranging for family members to view the body before it is discharged to the mortician d.) removing all tubes according to agency policy, unless an autopsy is to be performed f.) attending the funeral of a deceased client and making follow-up visits to the family