Ch 37. Loss and Grief and the Nursing Process EAQ
Which critical thinking skill will the student nurse use to deliver high-quality, supportive care while planning treatment for a patient with grief and loss? 1 Attitudes 2 Standards 3 Experience 4 Knowledge
1 Critical thinking model for loss, death, and grief planning helps the nurse to plan the care for the patients. The attitudes approach in the critical thinking model helps the nurse to deliver high-quality supportive care. The standards approach is used to provide privacy for the patient and family and apply ethical principles of autonomy in supporting the patient's choice regarding treatment. The experience approach uses previous patient responses to planned nursing interventions for pain and symptom management or loss of a significant other. The knowledge approach uses spirituality as a resource for dealing with loss.
Regarding the request for organ and tissue donation at the time of death, what should the nurse keep in mind? 1 Specially educated personnel make requests. 2 Requests are usually made by the nurse caring for the patient at the time of death. 3 Only patients who have given prior instruction regarding donation become donors. 4 Professionals need to be very selective in whom they ask for organ and tissue donation.
1 Individuals specially trained in requesting organ donations facilitate the process. They are skilled in talking compassionately to people who have suffered a tragic, sudden loss and have answers to many questions that people have regarding the donation process. Nurses do not request organ donations, although they do provide support and reinforce or clarify explanations to the deceased person's family during the request process. If the deceased person has not left behind instructions concerning organ and tissue donation, the family gives or denies consent at the time of death. Organ tissue donations are requested at every death.
A terminally ill patient is bedridden. On examination, the nurse finds that the patient has dyspnea. Which possible causes of dyspnea should the nurse evaluate in the patient? Select all that apply. 1 Fever 2 Anxiety 3 Anemia 4 Lack of fluid intake 5 Trigeminal nerve stimulation
1, 2, 3 Dyspnea may occur due to fever, anxiety, or anemia. Fever increases metabolic demands and oxygen consumption. The body compensates for this increased demand by increasing the respiratory rate. Anxiety may cause hyperventilation and dyspnea. Anemia reduces tissue perfusion, and as a compensatory mechanism, the body increases the respiratory rate. Lack of fluid intake in the diet causes constipation. Stimulation of the trigeminal nerve does not cause dyspnea. Stimulation of the trigeminal nerve in the cheek decreases dyspneic sensation.
An older adult has chronic body aches due to muscular dystrophy. The associated pain has put the patient in a state of hopelessness. Which nursing interventions would be helpful to this patient? Select all that apply. 1 Treating the chronic pain 2 Setting appropriate goals 3 Identifying sources of social support 4 Motivating the patient to get a job 5 Suggesting the use of heating pads
1, 2, 3 Treating the pain helps the patient gain hope. Setting up appropriate goals helps in prioritizing the problems, so matters of lesser importance will not receive much attention. An older adult with a debilitating disease will definitely require social support. Advising the patient to get a job may not be appropriate due to the patient's age, disease, and the associated pain. Heating pads can sometimes relieve pain but are a temporary measure.
A patient has been brought to the hospital in a gasping state. The patient dies despite receiving basic life support measures. What fit within the role of the nurse in obtaining an autopsy? Select all that apply. 1 Respecting the family's wishes and final decisions 2 Informing the family that all the organs will be replaced 3 Answering questions and supporting the family's choices 4 Obtaining autopsy permission from the family members 5 Signing the request for autopsy
1, 2, 3, 4 The nurse should respect the family's wishes and decisions. In autopsy, all organs are assessed for the cause of death and will be replaced. The nurse should answer all the family's questions related to the autopsy and support their choices. The nurse should also take the permission for autopsy from the family members. Physicians or coroners sign some medical forms such as requests for autopsy, but the registered nurse gathers and records much of the remaining information surrounding a death. Nurses also usually witness or delegate the signing of forms (e.g., release of body or personal belongings forms).
An older adult has chronic body aches due to muscular dystrophy. The associated pain has caused the patient to feel hopeless. On a home visit, the nurse finds that the patient eats less and has lost significant weight. Which nursing interventions would promote nutritional status in the patient? Select all that apply. 1 Encouraging consumption of food that the patient prefers 2 Arranging for home delivery of food 3 Emphasizing parenteral nutrition 4 Planning for social activities that involve eating 5 Encouraging more foods at each meal with a reduction in the number of meals
1, 2, 4 Providing preferred foods might help the patient eat more. Arranging for the food to be delivered at home reduces discomfort for the patient. Social activities with friends that involve eating help the patient to have food with others. Parenteral nutrition should be given only to those patients who cannot take food orally. Patients should be encouraged to take small, frequent meals to improve food intake and nutritional status.
A patient is diagnosed with terminal stage cancer. Which findings in the patient indicate lack of hope due to deteriorating physical condition? Select all that apply. 1 The patient sighs and has a negative view of the future. 2 The patient displays sad facial and voice expressions. 3 The patient wants to undergo more tests. 4 The patient feels weak, lacks energy, and has vague pains. 5 The patient shows a lack of interest and communicates minimally.
1, 2, 4, 5 The patient who lacks hope due to deteriorating physical condition may sigh often and have a negative view of life. The patient usually has sad facial and voice expressions. The patient lacks energy and complains of vague pains. Interest is lacking, and communication is minimal. The patient does not want to undergo tests, feeling that it would be of no use.
A 50-year-old patient discusses the recent loss of his spouse with the nurse during a routine checkup. Which findings in the patient would indicate grief? Select all that apply. 1 Lack of energy 2 Lack of interest 3 Desire to move around 4 Increased communication 5 Insomnia
1, 2, 5
Which physical changes are observed in a patient who is in his or her last hours of life? Select all that apply. 1 Sagging mouth 2 Light-colored urine 3 Increased urination 4 Relaxed jaw muscles 5 Increased pulmonary secretions
1, 4 Physical changes observed in a patient who is in his or her last hours of life include a sagging mouth and relaxed jaw muscles. Dark-colored urine, decreased urination, and decreased pulmonary secretions are physical changes observed in a patient who is in his or her last hours of life.
A patient passed away after a massive heart attack 5 days following hospitalization. Which nursing actions should be performed for the family to facilitate mourning? Select all that apply. 1 Supporting the family's efforts to adjust to the loss 2 Keeping the family busy, not allowing too much time to dwell in grief 3 Offering the family alcohol to help them relax and overcome grief. 4 Helping the family to accept the reality of the loss. 5 Instructing the family to resume normal life as soon as possible.
1, 4 The nurse should provide support to the family to help them adjust to their loss and to accept the reality of the loss. The family should be allowed to grieve, because it helps to come to terms with the loss. Use of alcohol to get over the crisis is an ineffective way of coping and should be discouraged. The nurse should not try to hurry the family but should allow time for grieving and continuity of care.
Which physical changes occur a few days prior to death in a patient? Select all that apply. 1 Mottling of skin 2 Very high peripheral pulses 3 Increased bowel movements 4 Cheyne-Stokes breathing pattern 5 Patches of varying colors of pallor on the skin
1, 4, 5 As peripheral circulation fails, there may be mottling of the skin. The breath pattern may be altered in patients just prior to death. Cheyne-Stokes is a common breathing pattern seen in patients who are expected to die. As peripheral circulation fails, patches of varying colors of pallor in the skin may be found. The peripheral circulation will continue to fail as the death nears. The bowel movements may decrease or cease completely.
The nurse is closely monitoring a patient who is critically ill with a chronic disease. Which physical changes indicate that the patient will die soon, and the nurse should inform the family? Select all that apply. 1 Inability to swallow 2 Increased muscle tone 3 Increased urine output 4 Increased periods of sleeping 5 Coolness and cyanosis in extremities
1, 4, 5 In the hours or days before death, the patient will have decreased intake of food or fluids and inability to swallow. Additionally, just prior to death, the patient will experience increased periods of sleeping and coolness and cyanosis in extremities such as the nose and fingers. Hours or days before death muscle tone generally decreases, jaw muscles relax, and sagging of mouth is seen. Decreased urine output, dark-colored urine, and bladder incontinence are observed in the patients hours or days before death.
A patient is diagnosed with breast cancer. The patient is sad and disappointed. Which assessment activities are appropriate when planning care for this patient? Select all that apply. 1 Observe her nonverbal behavior. 2 Observe the relatives who visit the patient. 3 Assess her economical background. 4 Assess her response to care options. 5 Observe her interactions with others.
1, 4, 5 Nonverbal behavior such as sad expressions and closed eyes may indicate grief. Observing the patient's responses to care options can give an idea about her feelings and hopelessness. Her interactions with others may reveal a lack of interest and unwillingness to meet others. Observing the patient's relatives may not contribute in planning care for the patient. Assessment of the economic background may not be relevant to the grief response.
The hospice nurse is caring for the family of a patient who has just died. Which interventions should the nurse implement in caring for the family? Select all that apply. 1 Offer family members the option to view the body. 2 Tell the family that the nurse knows how they feel. 3 Give the family advice on how to grieve. 4 Explain that their loved one is in a "better place." 5 Use periods of silence during the conversation.
1, 5 The nurse should offer family members the option to view the body and respect their decision to do so. The nurse should use periods of silence during the conversation to help the family members express their emotions. The nurse does not have to talk but can emotionally support the family simply by being present.
The nurse is providing postmortem care. Which action is the priority? 1 Locating the patient's clothing 2 Providing culturally and religiously sensitive care in body preparation 3 Transporting the body to the morgue as soon as possible to prevent body decomposition 4 Providing all postmortem care to protect the family of the deceased from having to see the body
2 At the end of life, religious and cultural expectations are important for the lasting memories held by the family about the way their loved one's death occurred. Sensitive care contributes to feelings of closure, appropriateness of the death rituals, and fulfilled family obligations. A body should be placed in the morgue soon after death, but it is more important to provide sensitive and dignified care to the deceased.
A patient who has a serious, life-limiting chronic illness wants to continue to engage in self-care and live as normally as possible. Which nursing responses reflect a helpful understanding of patient self-care at the end of life? 1 "Learning to accept that you can't perform some activities anymore will bring you more acceptance and peace." 2 "Which activities are most important to you, and how can you continue to do them?" 3 "People in your life want to help you with things; allow them to do what they want for you." 4 "Spending more of your time resting or reading will conserve your energy."
2 Even seriously ill people want to carry on with life, doing what they can to maintain their identity and purpose. They know best how to regulate their energy and wishes for how to spend their time. The nurse should not encourage the patient to scale back on their most valued activities or suggest that the patient needs others to help them with things.
A nurse is evaluating outcomes for a critically ill patient, and wants to validate the achievement of goals and expectations. Which question asked by the nurse indicates a need for correction? 1 "Are you receiving high-quality care?" 2 "Are you comfortable talking about your grief?" 3 "Do you have a specific request that I have not met?" 4 "Are your needs being addressed in a timely manner?"
2 While evaluating patient outcomes, the nurse should ask the patient a few questions to validate achievement of goals and expectations. Asking the patient about his or her comfort level talking about grief is an assessment question and would not help the nurse to validate the patient outcomes. Asking the patient if the standard of care is being met helps to evaluate the patient outcomes. Asking the patient about specific needs helps validate the achievement of goals and expectations. Asking the patient if needs are addressed in a timely manner helps to validate expected outcomes.
The registered nurse delegates the task of caring for a body after death to nursing assistive personnel (NAP). Which nursing interventions are appropriate while caring for a body after death? Select all that apply. 1 Removing the dentures from the mouth 2 Identifying the patient using two identifiers 3 Elevating the patient's head on one pillow 4 Combing patient's hair or applying personal hairpieces 5 Instructing the family to stay away from the preparation of the body
2, 3, 4 The task of caring of the body after death can be assigned to nursing assistive personnel (NAP). The NAP should identify the patient using two identifiers. The NAP should elevate the patient's head on one pillow to prevent discoloration of the face. The NAP should comb patient's hair or apply personal hairpieces. While caring for a body after death, the NAP should leave the dentures in the mouth to maintain facial shape. The NAP should ask the family members whether they wish to participate in preparation of the body.
An older adult has chronic body aches due to muscular dystrophy. The associated pain has put made the patient feel hopeless. The nurse suggests hospice care. When educating the family members about hospice care, which information should the nurse include? Select all that apply. 1 The hospice care ends with death of the patient. 2 It is a patient- and family-centered approach to care. 3 The hospice team promotes patient dignity and self-esteem. 4 It is a place to take care of terminally ill patients. 5 The hospice team gives preference to the patient's wishes.
2, 3, 5 Hospice is a patient- and family-centered approach to care. It provides therapeutic care, psychosocial care, and symptom management; it also promotes patients' dignity and self-esteem. In situations involving differences of opinion between the patient and the family members, the hospice team favors the patient's wishes. Hospice care does not end with death of the patient; there are frequent visits following the death of the patient to help the family members in the grieving process. Hospice is not a place, but a philosophy of care for the terminally ill.
The nurse is explaining about hospice care to the family members of a patient who has had a massive stroke. Which information should the nurse provide to the family members? Select all that apply. 1 Hospice is a place to care for terminally ill patients. 2 Hospice is a philosophy for terminally ill patients. 3 Hospice manages the patient's pain and provides comfort. 4 Hospice meets the economic needs of terminally ill patients. 5 Hospice services are available at home as well as in hospital settings.
2, 3, 5 Hospice is a philosophy and a model for terminally ill patients. It tries to provide comfort and manages the patient's pain and suffering. The services are available at home as well as in a hospital setting. Hospice is not always a specific place for terminally ill patients and does not provide economic support.
The nurse suggests that a patient receive a palliative care consultation for symptom management related to anxiety and increasing pain. A family member asks the nurse if this means that the patient is dying and is now "in hospice." What should the nurse tell the family member about palliative care? Select all that apply. 1 Hospice and palliative care are the same thing. 2 Palliative care is for any patient, any time, any disease, in any setting. 3 Palliative care strategies are primarily designed to treat the patient's illness. 4 Palliative care interventions relieve the symptoms of illness and treatment. 5 Palliative care is provided only at the end of life, but unlike hospice care, it is focused strictly on comfort of the patient.
2, 4 Palliative care is not reserved for people who are at the end of life. The goal of palliative care is to help relieve the symptoms of any illness and associated treatments at any time along the continuum of that illness.
A terminally ill patient reports nausea. Which interventions should the nurse include in the nursing care plan to relieve nausea? Select all that apply. 1 Avoid clear liquids. 2 Administer antiemetic agents if prescribed. 3 Offer liquids that increase stomach acidity. 4 Provide oral care at least every 2 to 4 hours. 5 Discontinue medications or foods that cause nausea.
2, 4, 5 Nausea in a terminally ill patient may be due to pain, medication, or decreased blood flow to the gastrointestinal (GI) tract due to the illness. Antiemetic agents may help to prevent nausea. Oral care helps to prevent halitosis, keeps the mouth moist and free of infection, and relieves nausea, and should be provided every 2 to 4 hours. Foods and medications that may cause nausea should be avoided. Administering them would increase the patient's discomfort by aggravating nausea. The nurse should offer the patient clear liquids to prevent dehydration. Liquids that increase stomach acidity should be avoided, because they can worsen the nausea.
The nursing student is caring for a patient who is terminally ill. Which actions performed by the nursing student under the supervision of the registered nurse indicate a need for correction? Select all that apply. 1 Administering artificial tears to reduce corneal drying and irritation 2 Encouraging the patient to lie on the right side to relieve constipation 3 Encouraging a patient taking opioid medication to increase fluid intake 4 Placing an indwelling catheter in a patient with decreased level of consciousness 5 Elevating the patient's head to facilitate postural drainage and relieve nausea
2, 5 Encouraging the patient to lie on the right side helps to relieve nausea, not constipation. Regular periods of ambulation may help to relieve constipation. Elevating the head of a patient to facilitate postural drainage helps to relieve noisy breathing or death rattle in terminally ill patients. Administering artificial tears or optical lubricants reduces corneal drying and irritation. Placing an indwelling catheter in the patients with decreased level of consciousness helps to relieve urinary incontinence. Encouraging patients who are on opioid medication to increase liquid intake helps reduce the risk of constipation due to opioid drugs.
The nurse is caring for a patient who is nearing death. Which is the best nursing action that focuses on the patient? 1 Tell the patient, "You'll be going home soon." 2 Encourage the patient to interact with family members. 3 Hold the patient's hand and state, "You're not alone." 4 Discuss what to expect with the family members at the bedside.
3 Holding the hand of a dying patient and stating "You're not alone" communicates concern and caring even if the patient is unable to respond. An actively dying person may not be able to interact, and telling the patient that death will occur soon may increase the patient's sense of anxiety. Discussing the process with family members does not focus on the patient.
The registered nurse is teaching a nursing student about nonpharmacological interventions that decrease nausea for terminally ill patients. Which statement made by the nursing student nurse indicates effective learning? 1 "I will provide cool air in the room." 2 "I will provide massage therapy to the patient." 3 "I will encourage the patient to lie on the right side." 4 "I will provide background music of patient's choice."
3 The patient is encouraged to lie on right side when he or she complains of nausea. The nurse should provide cool air in the room if the patient is suspected to have an ineffective breathing pattern. The nurse should massage the body of the patient at the site of pain. The nurse should provide background music of the patient's choice so that patient may divert his or her mind from pain by providing a soothing environment.
While caring for a patient in the last of hours of life, the nurse anticipates death. Which action of the nurse indicates a need for correction? 1 Lowering side rails of the bed 2 Placing a chair close to the bed 3 Covering the hands of the patient 4 Encouraging the family to touch the patient
3 When the nurse anticipates death in a patient, the nurse should expose the hands of the patient. The nurse should lower the side rails of the bed. The nurse should place a chair close to the bedside. The nurse should encourage the family to continue touching the patient.
The nurse has identified three nursing diagnoses for a patient who is having anxiety and hopelessness as a result of a loss. Which general approach should the nurse take to prioritize the nursing diagnoses? Select all that apply. 1 Use family members and physician orders as primary resources for prioritizing actions. 2 Address the nursing diagnosis that most affects the medical diagnosis. 3 Ask the patient to identify the most distressing symptom and address that diagnosis first. 4 Use nursing knowledge to address the problem that is the underlying cause of other diagnoses.
3, 4 When prioritizing nursing diagnoses, the nurse should first get the patient's sense of the most important issue. Some patients do not fully understand the physiology or relationship among diagnoses. For example, one patient may not understand that pain contributes to a decreased appetite or depression. The nurse's knowledge, along with the patient's perceptions, helps to determine the diagnosis with the highest priority. Planning care should be patient centered. All nursing diagnoses affect the medical diagnosis, but the patient's perception of the most distressing symptom is most important.
The nurse works in a terminal-care facility. Which rights of a dying person should the nurse be aware of when treating patients in this setting? Select all that apply. 1 The right to die alone 2 The right to be deceived 3 The right to be free from pain 4 The right to peace and dignity 5 The right to make decisions about care
3, 4, 5 A dying person's rights include the right to be free from pain, the right to peace and dignity, and the right to make decisions about care. The patient should not be left to die alone and should not be deceived.
A patient in a rehabilitation clinic is recovering from the loss of a limb in a motor-vehicle accident. In addition to providing wound care and physical therapy, which factors should the nurse assess to help the patient recover? Select all that apply. 1 Religion 2 Culture 3 Family support 4 Behaviors indicating a grief response 5 The patient's point of view of the loss
3, 4, 5 Assessing family support helps the nurse understand whether the patient will be able to cope with the loss. The patient may exhibit behaviors indicating a grief response. The nurse should be watchful of a negative response. It is important to understand the loss from the patient's point of view to know the significance of the loss. The patient's religion and culture also affect the patient's coping. However, assessment of religion and culture is less important when coping with the loss of a body part and more important during death.
A patient admitted with a diagnosis of stroke died after 7 days of hospitalization. Which information should the nurse document when a patient dies? Select all that apply. 1 Height of deceased 2 Race of the deceased 3 Time and date of death 4 Medical devices left in the body 5 Name of health care provider certifying death
3, 4, 5 Documentation is important in cases related to patient deaths because it carries legal implication. The information that must be documented includes the time and date of death, the medical devices left in the body, and the name of the health care provider certifying the death. The height and race of the deceased need not be documented.
The registered nurse is coordinating patient and family care during and after the death of a patient. Which actions performed by the nurse pertain to cultural and religious rituals of the patient? Select all that apply. 1 Providing safe and appropriate postmortem care 2 Gathering and recording much of the remaining information surrounding a death 3 Allowing the family members to place the body on the floor with the head facing north 4 Allowing the members of an extended family to stay with the deceased for up to 8 hours after death 5 Explaining to family members that an autopsy does not deform the body and that all organs are replaced in the body
3, 4, 5 The care provided by the nurse after death changes with the cultural background of the patient. Allowing the family members to place the body on the floor with the head facing north is associated with cultural and religious rituals of the Hindu religion. Allowing the members of an extended family to stay with the deceased for up to 8 hours after death is associated with cultural and religious rituals of the Chinese. Explaining to family members that an autopsy does not deform the body and that all organs are replaced in the body is part of the care provided after death for people who believe that all of the body parts must remain with the person to enter into heaven. Providing safe and appropriate postmortem care is general care after the death of a patient of any cultural or religious background. Gathering and recording much of the remaining information surrounding a death is an action performed by the nurse as a part of general care provided after death.
Which nursing intervention would relieve tachypnea in a terminally ill patient? 1 Turning the patient to one side 2 Providing oral care to the patient 3 Placing the patient in supine position 4 Administering narcotic agents to the patient
4 Administering narcotic agents to a terminally ill patient would help relieve tachypnea. Turning the patient to a side would help reduce noisy breathing that may occur due to pooling of secretions. Providing oral care would also help reduce noisy breathing. The patient should be placed in fowler's position by elevating the head of the bed to reduce ineffective breathing patterns such as tachypnea.
A family member asks the home care nurse what to do if the patient's serious chronic illness worsens even with increased medical interventions. How should the nurse best begin a conversation about the goals of care at the end of life? 1 Encourage the family member to think more positively about the patient's new therapy. 2 Avoid the discussion because it has to do with medical, not nursing, diagnoses. 3 Initiate a discussion about advance directives with the patient, family, and health care team. 4 Ask the patient to identify beliefs about the goals of care while the family member is present.
4 By first determining what the patient believes is best, the nurse can then discuss that option in more detail and give realistic ways of reaching the desired goal. Discussing other possible options after identifying the patient's preferences helps family members know and understand the patient's wishes.
The registered nurse is caring for a patient who is terminally ill. Which observations made by the nurse when evaluating the patient's outcomes indicate the use of experience as a critical thinking skill? 1 Clinical symptoms of an improved level of comfort 2 Perseverance in seeking successful comfort measures 3 Characteristics of the resolution of grief in the patient 4 Previous responses to planned nursing interventions for symptom management
4 Experience is the critical thinking skill a nurse will use to evaluate the previous patient responses to planned nursing interventions for symptom management or loss of a significant other. A clinical symptom of an improved level of comfort is evaluated by using the critical thinking skill of knowledge. Perseverance in seeking successful comfort measures is evaluated using attitudes as a critical thinking skill. Characteristics of the resolution of grief in the patient are evaluated by using knowledge as a critical thinking skill.
While caring for the body of a deceased patient, the nurse attaches an eagle feather to the patient. Which culture is reflected in the nurse's action? 1 Chinese 2 Hispanic 3 Buddhist 4 Native American
4 Native Americans are diverse tribal groups with different practices, traditions, and ceremonies. According to their culture, after cleaning the body, an eagle feather is attached to symbolize a return home. Chinese cultural rituals involve bathing the body by the eldest son or daughter under the direction of priest or elder relative. Hispanic cultural rituals involve amulets or rosary beads, healing practices (folk medicine), and prayer. Buddhist cultural rituals involve not touching the body after death.
The nurse is caring for a terminally ill patient. How can the nurse actively communicate with the patient? 1 By asking close-ended questions 2 By sympathizing with the patient 3 By discussing sensitive issues 4 By asking open-ended questions
4 The nurse can actively communicate with patients by asking open-ended questions. This helps patients to expand their thoughts and tell their stories. The nurse can obtain more information from patients with open-ended questions. The nurse should avoid asking close-ended questions, such as ones with a Yes/No response, because they will not help the nurse to understand the feelings and emotions of the patients. Being sympathetic will not necessarily allow patients to express feelings. Empathizing with patients will help them to relate with the nurse and express their feelings in the process. Discussing sensitive issues can create barriers to communication. Therefore, such issues should be avoided unless the patient brings them up.
