Prep U questions - Chapter 43: Loss, Grief, and Dying

The wife of a client who has been diagnosed with terminal illness asks the nurse about the difference between palliative care and hospice care. Which info 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.

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 trying to help the client cope with the dying process. Which nursing statement is mostappropriate?

"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. Reference:

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." Kübler-Ross (1969) studied the responses to death and dying. Her 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.

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 patients 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.

When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response?

"This must be very difficult for you." The nurse should use statements with broad openings, such as "This must be difficult for you," to allow the client to continue expressing concerns and to acknowledge the client's feelings. This facilitates communication and allows the client to choose the topic or manner of response during this stage of the grieving process. Assuming the client is angry and sad or indicating that this is "a terrible diagnosis" is not an appropriate way to promote coping. The nurse should automatically assume a spiritual leader is desired.

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 has been on a ventilator for several days following a stroke. It is determined the client will not regain consciousness. The family has stated the client would not want to be maintained on a ventilator and has agreed to terminal weaning. The family has asked what will happen. What would the nurse state to the family? Select all that apply.

"Your relative may breathe on her own for hours to days." "No one can tell you if and when your loved one will die." "We will keep your relative comfortable throughout the dying process." During terminal weaning, it is expected that the client will not survive. However, death is never a certain outcome. It is not unusual for a client to initiate spontaneous respirations. The client could live for hours and even days. Thus, the nurse is correct in making statements such as, "Your relative may breathe on her own for hours to days" and "No one can tell you if and when your loved one will die." It is therapeutic and hopeful to tell the family their loved one will be kept comfortable during the dying process. The nurse would follow through on this promise. It would be incorrect for the nurse to say, "Your loved one will not breathe once the machine is turned off" and "Death will be instantaneous."

The nurse is receiving a change of shift report on a client who has a terminal illness and has exhibited a slow and progressive decline in the health status over the past several days. Which data supports the client's impending death? Select all that apply.

- Cyanotic nail beds in hands and feet bilaterally - Gurgling sounds emanating from the client's throat with each breath - Distended abdomen with last bowel movement documented 7 days ago

A nurse is assessing a dying client for realism of expectations and perception of condition. which interview questions address this concern? select all the apply - What have you been told about your condition? - How well do you think those around you are coping? - How do you see the next few weeks playing out? - What do you think may be happening in the midst of all of this? - Have you had any previous experience with this condition before? - How do you see the next few weeks playing out?

- Have you had any previous experience with this condition before? - How do you see the next few weeks playing out? - What do you think may be happening in the midst of all of this?

Which situation is most likely to warrant an autopsy?

A clients death involves an allegation of a medical error. Allegations of incompetence or malpractice create a need for an autopsy. An unwitnessed death, an unsuccessful code, or a death by infectious disease may require an autopsy due to other situation-specific factors, but these situations themselves do not necessarily require an autopsy.

which assessment finding would best support a nursing diagnosis of dysfunctional grieving?

A manis unable to return to work after his sisters death 18 months ago An inability to return to normal activities 18 months after a sibling's death is suggestive (though not definitive) of Dysfunctional 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 dysfunctional if this became a long-term and all-encompassing belief.

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 - treating illness 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 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

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. Anticipatory grieving comprises the intellectual and emotional responses and behaviors by which individuals, families, and communities work through the process of modifying self-concept based on the perception of loss.

which statement regarding perceptions of death by children is accurate?

At about age 9, the child perceives death as irreversible. At about 9 years of age, the Childs concept of death matures, and the child perceives death realistically as irreversible, universal, inevitable, and natural.

The client is a middle aged female who has been told she has cancer of the plasma. She states to the health care team, "just keep me alive until I can see my daughter graduate from high school." What stage of dying is the client exhibiting?

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

Depression The stages of Kuber-Ross are denial, anger, bargaining, depression, and acceptance.

A terminally ill client is bring cared for at home and receiving hospice care. The hospice nurse is helping the family cope with the clients deteriorating condition, educating them on the signs of approaching death. Which sign would the nurse include in this education plan?

Difficulty swallowing A sign of death is approaching is the clients difficulty in swallowing. People who are dying do not experience decreased pain. They may not be in a position to report pain; therefore, the caregiver should observe the client closely. Urinary output decreases when a person is approaching death due to system failure and limited intake. The client approaching death has decreased sensory stimulation.

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

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 clients fears?

Encourage discussion between the husband and wife regarding their intimacy needs. Partners of terminally ill clients may wish to be physically intimate with the dying person but are afraid of "hurting" him or her 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 that he cannot have relations based on the fatigue of the client's spouse is not appropriate. Reassuring the client that he 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.

when reviewing a clients chart, the nurse notes the 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 home hospice client who has medicare is experiencing extreme pain at home and is refusing to receive inpatient care due to concern 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. 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.

A hospice nurse is assessing a client with end-stage COPD. which assessment finding would suggest that the client is dying?

Jaundiced skin cheyne-stokes decreased urine output Physical signs that often occur when a client is dying include: skin is extremely pale, cyanotic, jaundiced, or mottled; the heartbeat is irregular and the pulse is weak, rapid, and irregular; respirations are changed, shallow, labored, faster or slower, or irregular (e.g., Cheyne-Stokes respirations); urine output is decreased due to worsening renal function and limited fluid intake; fecal retention or impaction occurs due to reduced gastrointestinal motility; incontinence occurs due to relaxation of the sphincter muscles; there is difficulty swallowing, generalized weakness, increased somnolence, and decreased responsiveness to external stimuli. Decreased pain does not occur with people who are dying.

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

Leaving the wife room 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.

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 priority documentation is the assessment that indicates the client is dead. The other items can occur and will be documented after establishing that death has occurred.

The nurse is performing postmortem care for a client who died after being brought to the emergency department after an alleged attack and rape in a grassy field. Which nursing action is appropriate?

Notify the coroner. The death of a client who died during or after suspicious circumstances will likely be investigated and the coroner should be notified. The body should not be washed, nor should nails be cleaned, nor the hair brushed, as these processes may remove evidence. All invasive tubes (intravenous, gastrointestinal, endotracheal) should be secured in place so as not to dislodge prior to the autopsy.

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 urine output Irregular heart rate 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.

The client is terminal and has unrelieved and intractable pain. The nurse is administering hydromorphone intravenously. The client states, "I want you to give me additional medication so I will die. I can't go on any longer." What action would the nurse take?

State, "This is not something I or any of the nurses can do." The American Nurses Association has issued a statement that assisting in suicide and participating in active euthanasia are in violation of the Code of Nurses. The best option is for the nurse to say, "This is not something I or any of the nurses can do." The nurse should then explore the meaning of the client's request, seek other measures to relieve the client's pain, and provide end-of-life counseling services. The nurse does not participate in active euthanasia, which includes contacting the health care provider to obtain a prescription for additional intravenous medication to honor the client's request, and obtaining additional medication from the automated medication system that would hasten the client's death. The nurse would be negligent in client care by limiting contact with the client due to this request.

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. he client has signed a document indicating a wish not to be resuscitated. Treating the pneumonia with antibiotics is not a resuscitation measure. The other options do not respect the client's right to choice.

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?

The client who is isolating himself from social contact after the death of his spouse is demonstrating a social expression of grief." Normal expressions of grief may be physical, emotional, social (feeling detached from others and isolating oneself from social contact), and spiritual. Grief is an internal emotional reaction to loss and occurs with loss caused by separation (e.g., divorce) or by death. Clients lamenting their loss of youth are demonstrating a type of perceived loss, which is intangible to others. Situational losses are experienced as a result of unpredictable events; a child going to college would be a maturational loss for the parent.

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.

The hospice nurse is assessing the wife of a client who dies 14 months ago. the nurse is concerned that the wife is still grieving the death of her husband. Which objective assessment finding would suggest that the wife is not still grieving?

The wife hair is clean and styled?

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).

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

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 and admission usually requires a 6-month life expectancy or less.

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 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.

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:

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.