Ch. 42
Which intervention does the nurse implement in the care plan for a patient who is grieving the loss of a loved one? Encourage the patient to include exercise. Instruct the patient to consume a healthy diet. Provide hope for the patient's remaining life. Limit the time for visitors to see the patient. Provide education about the stages of grief.
Ans: A,B,E Rationale A grieving patient may be unable to accept the truth about the loss of a loved one. The nurse encourages the grieving patient to include healthy behavior such as exercise because it will help to relieve stress. The nurse encourages the patient to consume a healthy diet to maintain normal metabolism. The nurse also provides education about the stages of grief, as it may help the grieving patient to accept the truth and prevent complicated grief. The nurse does not give the patient false assurances about his or her life because it may lead the patient to lose trust in the nurse. The nurse does not limit the time for visiting the patient because it may increase the grieving patient's anxiety.
A nurse is teaching student nurses about disenfranchised grief. What examples should the nurse include to better explain this type of grief? Select all that apply. Death of a pet Death of a same-sex romantic partner Loss of a child in an accident Loss of a husband due to heart attack Separation from a partner due to a prison sentence
Ans: A,B,E Rationale Disenfranchised grief, also known as marginal or unsupported grief, is due to the loss of a person with whom the relationship may not meet the societal norms or is otherwise trivialized. Examples that illustrate this type of grief include the loss of a pet or the loss of a same-sex partner in places where same-sex marriage is not recognized. Other examples of disenfranchised grief include the grief caused by the separation of a partner due to a prison sentence. The death of a child in an accident or death of a spouse due to heart attack are examples of normal grief, which are more fully recognized by society.
What are the types of complicated grief? Select all that apply. Chronic grief Delayed grief Masked grief Exaggerated grief Disenfranchised grief
Ans: A,B,C,D Rationale Four types of complicated grief have been identified: Chronic grief is characterized by grief reactions that do not diminish over time and continue for an indefinite or very long period of time. Delayed grief is characterized by suppression of the grief reaction while the grieving person consciously or unconsciously avoids the pain that has occurred with the loss. Exaggerated grief occurs when the survivor is overwhelmed by grief and cannot function in daily life. In such instances, the affected person may use self-destructive behaviors, such as drugs or alcohol, as a coping mechanism. The potential for suicide with exaggerated grief cannot be overlooked by the health care team. The final type of complicated grief is described as masked grief and occurs when the behaviors of the survivor interfere with normal functioning, but that person is not aware that these behaviors are concealing the actual grieving process. Disenfranchised grief is experienced by a person whose relationship with the deceased person is not supported socially or is of less significance.
A patient has been brought to the hospital gasping for breath. The patient dies despite receiving basic life support measures. What is the role of the nurse in providing care to the body? Select all that apply. Follow through with any organ donation arrangements. Clean any soiled areas of the body, and apply a clean gown. Elevate the feet to prevent facial discoloration. Accommodate the family's religious wishes, if possible. Remove tubes and indwelling lines if an autopsy is requested.
Ans: A,B,D Rationale Follow through with any organ donation arrangements. Ensure adherence to institutional and state policy and procedures. Clean any soiled areas on the body (a full bath is not necessary). Apply a clean gown. Accommodation of the family's religious wishes should be made if possible. To prevent facial discoloration, the head should be elevated. The tubes and indwelling lines should be retained if an autopsy is requested.
A patient with prostate cancer is in the terminal stage of the disease and wishes to have home care. How can the nurse help the family achieve optimal end-of-life care? Select all that apply. Advise the family members to apply for hospice care. Provide grief support measures. Motivate family members to consider euthanasia. Leave the patient alone at the time of death. Educate the family on the dying process.
Ans: A,B,E Rationale The nurse should help the family members obtain hospice care for the last days of the patient's life. Providing grief support measures to the family helps them to cope better with the anticipated loss. Educating the family members about the dying process helps them become mentally prepared for the loss. Euthanasia is not an ethically acceptable part of end-of-life care and is not legal in many countries. The nurse should make arrangements to provide privacy to the patient at the time of death, but should not leave the patient alone.
A family member of a recently deceased patient talks casually with the nurse at the time of the patient's death and expresses relief that she will not have to visit at the hospital anymore. What theoretical description of grief best applies to this family member? Denial Anticipatory grief Dysfunctional grief Yearning and searching
Ans: B Rationale If a person has been anticipating a loss for some time, he or she may have already experienced many of the emotions (sadness, shock) commonly associated with death.
A patient lost a sibling in a car accident. On the same day, the patient lost his job. But the patient does not seem upset about the job loss. Which grief type is indicated by the patient's presentation? Delayed grief Masked grief Exaggerated grief Disenfranchised grief
Ans: A Rationale Delayed grief is characterized by suppression of the grief reaction while the grieving person consciously or unconsciously avoids the pain that has occurred with the loss. The loss of the job is less important than the loss of the sibling. So, the person shows a delayed response to the second loss. Masked grief is the grieving response wherein a person's normal functioning is disrupted, but the person does not realize that the disruption in functioning is due to the loss. In exaggerated grief, the person blames him- or herself for the loss. Disenfranchised grief is a loss that is not socially sanctioned, cannot be openly shared, or seems to be of lesser significance.
Which statement describes grief? A person's emotional response to loss A person's outward social expression of loss The absence of something or someone Inner feelings and outer expressions of loss
Ans: A Rationale Grief is defined as an emotional response to loss. The feelings of grief include anger, frustration, loneliness, sadness, guilt, regret, and peace. Mourning is the outward social expression of loss; it is expressed according to an individual's cultures, customs, rituals, traditions, and religious and spiritual beliefs. Loss is the absence of something or someone that a person is attached to. Bereavement is an individual's inner feelings and outward expressions that demonstrate the experience of loss.
The nurse is using Sheldon's stages of grief to assess a patient who lost both legs in a fatal accident. Which behavior does the nurse anticipate in this patient during the "pangs of grief" stage? Overwhelming sadness and anger Feelings of numbness and disbelief Loss of meaning and direction in life Development of new relationships
Ans: A Rationale Sheldon's stages of grief explain the emotional states of an individual during grief and loss. The four stages are initial shock, "pangs of grief," despair, and adjustment. The "pangs of grief" stage is the second stage, during which the patient may experience sadness, anger, guilt, vulnerability, anxiety, insomnia, social withdrawal, hallucinations, and restlessness. The first stage is the initial shock stage, during which the person becomes numb and does not believe the truth. Despair is the third stage, during which the person loses meaning and direction in life. In the adjustment phase, the patient develops new relationships and interests.
A patient with terminal lung cancer becomes emotional and says,"Why did God let this happen to me?" Which stage of Kubler-Ross's theory does the nurse correlate with the patient's behavior? Anger Denial Bargaining Depression
Ans: A Rationale The five stages of grief as proposed by Kubler-Ross describe the emotional stages experienced by an individual during the grieving process. These stages are denial, anger, bargaining, depression, and acceptance. Anger is the second stage; it occurs when people truly recognize the circumstances of the loss. In this stage, people may become angry with themselves or seek to blame another entity such as God. Denial is the first stage, during which the person will not accept the reality of the situation. Bargaining is the third stage, in which the individual shows hope and does not think about the grief. Depression is the fourth stage, in which the person understands the certainty of death and sadness grows.
Which cultural practices are commonly followed by Asian Americans during mourning? Select all that apply. Display a memorial of the deceased at home. Provide warm clothes for the deceased to wear. Prefer to have the person's remains cremated. Have music and singing at the wake and funeral. Share meals after the wake and after the funeral.
Ans: A,B Rationale In Asian-American culture, a memorial is displayed at the home in memory of the deceased person. They also show respect of the deceased person's body by providing warm clothes for the burial. Hindus prefer the cremation process. In African American culture, music and singing are commonly included during the mourning period to help people to handle grief and loss. After the funeral, they may share a meal to provide emotional support to the family.
A patient's breast biopsy results return as positive for cancer. The patient says that there is some mistake and that she cannot have breast cancer. What actions should the nurse take to provide further information to this patient? Select all that apply. Explain the situation to her relative or significant other. Carefully explain the significance and need for prompt tumor removal. Discuss chemotherapy treatment. Inform the patient about breast implants. Talk to the patient in a firm voice.
Ans: A,B Rationale When the patient is in the denial stage secondary to a new diagnosis, the nurse should try to explain the situation to a relative or significant other, as the patient is not willing to accept the new condition or any other information about it. The nurse should carefully and empathetically inform the patient about surgical treatment and its significance. During the denial stage, discussion of other detailed and future information such as chemotherapy and the possible necessity for breast implants should be avoided. The nurse should not use a firm voice while dealing with a patient in the denial stage of grieving.
Which are stages of grief and loss according to Sheldon's theory? Select all that apply. Shock Despair Bargaining "Pangs of grief" Reorganization
Ans: A,B,D Rationale According to Sheldon' theory, grief and loss takes place in four stages: initial shock, "pangs of grief," despair, and adjustment. At first, the grieving patient will experience shock due to the loss of a loved one. After experiencing the pain of grief, the person may fall into despair trying to adjust to the new life. During the "pangs of grief" stage, the patient may experience the pain of grief. Bargaining is a stage of grief as described by Kubler-Ross. Reorganization is the last stage of the Bowlby model of grief. STUDY TIP: Sheldon's stages of grief can be abbreviated "IPDA" or IsPgDA". Make up a sentence or question to help you recall the order, such as " IsPa ge Doing Anything for Sheldon?" Because you are studying more than one theory about stages of grief, you may wish to include the name of the theorist in your sentence.
What are common emotions and experiences during Sheldon's "pangs of grief" stage? Select all that apply. Sadness Insomnia Numbness Social withdrawal Loss of direction in life
Ans: A,B,D Rationale According to Sheldon's theory, grief and loss include four stages: initial shock, "pangs of grief," despair, and adjustment. During the "pangs of grief" stage, an individual experiences the pain of loss, which may result in sadness, insomnia, and social withdrawal. Numbness occurs in the initial stage of grief. After experiencing the pain of loss, the patient may try to adjust to the environment, which is the fifth stage. In the stage of despair, the patient may feel a loss of direction in life.
The nurse is caring for a patient whose spouse died of cancer 1 year ago. The nurse diagnoses exaggerated grief. Which finding led the nurse to conclusion? Select all that apply. The patient drinks heavily and has become addicted to narcotics. The patient attempted suicide by jumping from a building. The patient cries often and remains in a depressed state. The patient is unable to concentrate on job-related tasks. The patient made changes to the house to forget the deceased spouse.
Ans: A,B,D Rationale Patients with exaggerated grief show intense reactions of grief, which include the use of drugs or alcohol and thoughts of suicide, and cannot lead a normal life. A patient with exaggerated grief may attempt suicide and may not be able to concentrate on work. Crying and depression for a prolonged period of time may indicate chronic grief but are not necessarily indicative of complicated grief. A patient with delayed grief consciously or unconsciously avoids things that remind him or her of the loss; therefore, a patient who changes his or her house to avoid memories of a person may experience delayed grief.
An older adult has chronic body aches due to muscular dystrophy. The associated pain has put the patient in a state of hopelessness. On a home visit, a nurse finds that the patient eats less and has lost significant weight. What nursing interventions would promote nutritional status in the patient? Select all that apply. Encourage consumption of food that the patient prefers. Arrange for home delivery of food. Emphasize parenteral nutrition. Plan for social activities that involve eating. Encourage more foods in each meal with a reduction in the number of meals.
Ans: A,B,D Rationale 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 eat 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 nurse is caring for a terminally ill patient. Which behavior shows that the patient is in a stage of dying? Select all that apply. Denial Depression Anticipation Acceptance Preparation
Ans: A,B,D Rationale The five stages of dying as defined by Kübler-Ross are denial, anger, bargaining, depression, and acceptance. Anticipation and preparation are not part of the stages of dying so these would not be relevant to the nurse's observation and diagnosis.
What are the different stages of dying based on the Kubler-Ross theory? Anger Denial Anxiety Yearning Depression
Ans: A,B,E Rationale Kübler-Ross describes five stages of dying, including anger, denial, and depression. In the anger stage, the person expresses resistance and intense anger towards God or other people for the loss. Denial is the stage wherein the person is not able to accept the loss. In the depression stage, the person realizes the full impact of the loss. Anxiety and yearning are not stages of dying in this theory. STUDY TIP: Use the mnemonic "DABDA" to recall Kübler-Ross's stages of dying: Denial, Anger, Bargaining, Depression, and Acceptance. To help you distinguish between the two Ds and two As, consider that it seems logical that denial would be the first response, and that several stages are likely needed before acceptance is possible.
A nurse is caring for a terminally ill patient. Which physical changes in the patient suggest that death is near? Select all that apply. Noisy respirations Increased urine output Decreased blood pressure Decreased oral intake Decreased periods of sleeping
Ans: A,C,D Rationale Physical symptoms at the end of life include weakness and fatigue, increased drowsiness, and sleeping more and responding less. Decreases in oral intake and the swallowing reflex may occur. Universal manifestations of imminent death include a decrease in urine output; cold and mottled extremities; and changes in vital signs, in that the blood pressure decreases and heart rate often increases but can decrease. Changes in breathing patterns with periods of apnea that increase as the body shuts down and apparent respiratory congestion or the "death rattle" from the inability to swallow secretions also are common manifestations of impending death.
After assessment, the nurse finds that a patient is near death. Which findings led the nurse to this conclusion? Select all that apply. Hearing the death rattle Pale and bluish skin Decreased urine output Decreased blood pressure Involuntary release of urine
Ans: A,C,D Rationale As the patient approaches death, he or she may lose the ability to swallow and may have an increased production of bronchial secretions. This results in the accumulation of secretions in the throat and chest. It produces a sound that is called a death rattle. In this stage, metabolic changes occur in the body and urine output decreases. In addition, inadequate pumping of blood occurs, which results in decreased blood pressure. The skin becomes pale and bluish due to blood settling after death occurs. An involuntary release of urine occurs due to loss of control over the muscles and also occurs after death.
Which symptoms does the nurse observe in a patient at the end of life? Select all that apply. Fatigue Cool body Weakness Drowsiness Bluish skin color
Ans: A,C,D Rationale The patient may have drastic metabolic changes in the body during the end-of-life stage. Because of inadequate nutrition or metabolic problems, the patient will have fatigue and feel weak. The patient may also feel drowsy because of metabolic changes. Disturbance in the body's thermoregulation function causes the body to cool, which is a sign of death. A bluish skin color indicates blood settling in the body and occurs after the patient dies.
A nurse understands that grief can come in many forms. Exaggerated grief is a type of complicated grief. Which statements are true about exaggerated grief? Select all that apply. Suicide is a risk for these patients. The patient's grief is usually delayed. The patient exhibits maladaptive behavior. Exaggerated grief is triggered by a second loss. The patient exhibits self-destructive behavior.
Ans: A,C,E Rationale Suicide is a risk for people who experience exaggerated grief in which self-destructive or maladaptive behaviors are present. Exaggerated grief is not usually delayed. If a person's grief response is delayed, it is called delayed grief and it is often triggered by a second loss.
A patient has passed away after a massive heart attack 5 days following hospitalization. What nursing actions are performed for the family to facilitate mourning? Select all that apply. Support the family's efforts to adjust to the loss. Keep the family busy, not allowing too much time to dwell on grief. Offer the family alcohol to help them relax and overcome grief. Help the family to accept the reality of the loss. Instruct the family to resume normal life as soon as possible.
Ans: A,D Rationale The nurse should provide support to the family to help them adjust to the loss of their family member by helping them to accept the reality of loss. The family should be allowed to grieve, as it helps them to come to terms with the loss. Use of alcohol for getting over the crisis is an ineffective way of coping and should be discouraged. The nurse should not try to rush the family through the grief process; allow time for grieving and continuity of care.
A 40-year-old patient with prostate cancer has undergone prostatectomy and is on chemotherapy. Which questions should the nurse ask when assessing the psychosocial health of the patient? Select all that apply. "How do you feel about the cancer?" "Have you experienced any sexual changes?" "Are you experiencing increased fatigue because of the cancer?" "On a scale of 0-10, how do you rate your distress?" "What do you feel about your family handling and managing your cancer?"
Ans: A,D,E Rationale Cancer and its treatment affect the patient on all spheres: physical, mental, and emotional. Asking the patient how he feels about his cancer is a good example of an open-ended question. It gives the patient an opportunity to explore his emotional sphere completely. By asking the patient to rate his distress, the nurse can assess its severity. Asking about how the family is coping helps the nurse evaluate the coping skills of the family and the patient. Asking if the patient is experiencing any sexual changes is part of the sexual assessment of the patient, not the psychosocial assessment. Similarly, asking if the patient is experiencing increased fatigue is a part of the physical assessment, not the psychosocial assessment.
A patient is diagnosed with breast cancer. The patient is sad and disappointed. What are the appropriate assessment activities when planning care for this patient? Select all that apply. Observe her nonverbal behavior. Observe the relatives who visit her. Assess her economic background. Assess her response to care options. Observe her interactions with others.
Ans: A,D,E Rationale Nonverbal behavior like sadness and closed eyes may indicate grief. Observing her responses to care options can give an idea about her feelings and hopelessness. Her interactions with others may reveal her lack of interest and unwillingness to meet others. Observing the patient's relatives may not contribute to planning care for the patient. Assessment of the patient's economic background may not indicate grief response.
A patient is diagnosed with advanced leukemia. The patient is hopeless about the treatment. What nursing interventions would help the patient to overcome hopelessness? Select all that apply. Treat chronic pain. Advise dietary modification. Provide economic support. Identify sources of social support. Provide opportunities to express positive life events.
Ans: A,D,E Rationale Treatment of pain can make the patient more comfortable and help in building a positive outlook. The family members, friends, and support groups can be approached for help. Providing opportunities to express positive life events helps the patient to focus on positivity rather than negativity related to the disease. Dietary modification and economic support do not relieve hopelessness.
A 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. Offer family members the option to view the body. Tell the family that the nurse knows how they feel. Give the family advice on how to grieve. Explain that their loved one is in a "better place." Be present.
Ans: A,E Rationale The nurse should offer the family members the option to view the body, and respect their decision to do so. The nurse does not have to talk, but can emotionally support the family simply by being present.
A nurse is caring for a patient who is terminally ill. The nurse finds that the patient experiences chronic pain, imbalanced nutrition, fatigue, and hopelessness. In this situation, which nursing diagnosis does the nurse identify as most important to address? Fatigue Chronic pain Hopelessness Imbalanced nutrition
Ans: B Rationale Chronic pain should be treated first. Until the patient's pain is under control, it will not be possible for the patient to eat properly, to feel hopeful, or to feel energized. Treatment of fatigue, hopelessness, and imbalanced nutrition would have lower priority.
A 69-year-old patient is diagnosed with myocardial infarction. The patient underwent coronary artery bypass graft surgery and has been discharged. Two days after the discharge, the patient comes back to the hospital reporting pus in the sternal incision site. The nurse tells the patient that this indicates infection and some tests will be performed. The patient shouts at the nurse and the surgeon, and blames them for the complication. What would be the appropriate nursing action? The nurse should explain that they are not responsible for this condition. The nurse should remain silent and let the patient express his anger. The nurse should ignore the patient and attend to other patients. The nurse should tell the patient that the surgery had been unsuccessful.
Ans: B Rationale Anger is one of the early stages in the psychosocial adaptation to grief. The patient is not ready to accept the problem and needs the opportunity to express feelings. Telling the patient that the nurse and surgeon are not responsible for this condition should not be the immediate response. The patient should be allowed to express all of his feelings first. The nurse should treat every patient with respect and dignity; ignoring the patient is an inappropriate behavior. Pus from the sternal site does not indicate that the surgery has been unsuccessful; it is a complication of the surgery and can be caused by multiple factors.
A nurse is providing postmortem care. Which action is the priority? Locating the patient's clothing Providing culturally and religiously sensitive care in body preparation Transporting the body to the morgue as soon as possible to prevent body decomposition Providing all postmortem care to protect the family of the deceased from having to see the body
Ans: B Rationale 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. Locating the patient's clothing, transporting the body to the morgue, and protecting the family from seeing the body are not priority actions the nurse should take.
A patient tells the nurse, "I feel really low these days and I'm having trouble sleeping. I don't know what's happened to me." After a brief talk, the nurse comes to know that the patient's beloved pet has died recently. What type of grief does the patient's behavior indicate? Delayed grief Masked grief Anticipatory grief Disenfranchised grief
Ans: B Rationale Depression and an inability to sleep are two signs of grief. In masked grief, the survivor is unaware that the behaviors interfering with normal functioning stem from a loss and associated grief. In delayed grief, the person consciously or unconsciously avoids the pain that occurs with loss. The patient in this question is not displaying any attempts to prevent the grief. Anticipatory grief is the grief experienced by an individual before loss occurs. The patient in this question is showing grief symptoms after the death of the pet, therefore the patient is not experiencing anticipatory grief. Disenfranchised grief is a loss that is not acceptable by the society or the grieving individual cannot publicly share the grief. The patient in this question can publicly share the grief caused by the death of a pet; therefore, the patient is likely not experiencing disenfranchised grief.
The nursing instructor is teaching a group of student nurses about hospice care. Which statement made by a student nurse indicates a need for further teaching? "Hospice care is focused on controlling end-of-life symptoms." "Hospice care is limited to a period of no more than 6 months." "Hospice care is for patients who have given up on curative treatment." "Hospice care can be revoked by the patient to seek curative care."
Ans: B Rationale Hospice care is given to individuals with a life expectancy of 6 months. However, the condition of such patients may improve and they may live longer than 6 months, so the duration of hospice care is not limited to 6 months. The main goal of hospice care is to improve quality of life by controlling end-of-life symptoms. Hospice care is provided to individuals who have decided to stop curative treatment. The condition of patients in hospice care may improve, and they can seek curative care.
A patient's caregiver wants to know if there are support services that would give him some time off from caregiving. Which services can the nurse suggest? Hospice Respite care Nursing clinics Assisted living
Ans: B Rationale Respite care is a service that gives time off to patients' caregivers. This service can be received at home or in a day care center. Professionals take care of the patient while the caregiver completes his chores or handles other responsibilities. Hospice is a service in which terminally ill patients receive palliative care in their homes or in special facilities. Nursing clinics diagnose and treat medical conditions. Assisted living is associated with long-term care facilities, where patients live with other individuals in a homelike surrounding.
A patient who is in a hospice care facility develops anorexia. The patient reports feeling uncomfortable after eating but is otherwise peaceful. The patient's family members become very anxious due to the patient's reduced food intake. What is the appropriate nursing action in this situation? Encourage the patient to eat. Support the grieving family. Promote spiritual comfort and hope to the patient. Maintain a comfortable and peaceful environment.
Ans: B Rationale The nurse should support the grieving family members and provide them emotional support because they are very anxious. The patient should not be encouraged to eat. Patients in the last days of life often develop anorexia, and forcing food or fluids stresses the patient's compromised gastrointestinal and cardiovascular systems, potentially creating increased discomfort. The patient is at peace and does not need immediate spiritual comfort. Usually hospice care facilities have a comfortable and peaceful environment, and the patient is already peaceful.
During a follow-up visit, the nurse notices that a patient is crying and says, "I don't want any further treatment because I am going to die anyway." What does the nurse understand from the assessment? The patient is in the denial stage. The patient is in the depression stage. The patient is in the bargaining stage. The patient is in the reorganization stage
Ans: B Rationale The patient is crying and does not have hope for life, which indicates that the patient is in the depression stage. In the denial stage, the patient is unwilling to accept the loss. In the bargaining stage, the patient has hope that he or she can change the circumstances. In the reorganization stage, the intensity of the patient's negative emotions related to the loss decrease and the patient can enjoy his or her life.
A patient refuses to accept the death of a child. The patient no longer has a job, avoids communication with others, and remains aloof. Which grief type is indicated by the patient's presentation? Normal grief Complicated grief Anticipatory grief Disenfranchised grief
Ans: B Rationale The patient is experiencing complicated grief. In complicated grief, a person has a difficult time moving forward after a loss. He or she experiences a chronic and disruptive yearning for the deceased; has trouble accepting the death and trusting others; and/or feels excessively bitter, emotionally numb, or anxious about the future. In normal grief, the person shows a common reaction characterized by complex emotional, cognitive, social, and spiritual responses to loss and death. In anticipatory grief, the grief extends over a long period of time, beginning before the actual loss occurs; the person absorbs the loss gradually and prepares for its inevitability. Disenfranchised grief occurs when the relationship of the person with the deceased is not socially sanctioned, cannot be openly shared, or seems to be of lesser significance.
Which behaviors does the nurse avoid when addressing his or her own feelings of loss and fear of mortality in order to provide effective care to a patient who is dying? Select all that apply. Verbalizing his or her feelings. Using defense mechanisms. Avoiding the expression of emotions. Focusing only on the patient's physical needs. Making time for relaxation or a vacation.
Ans: B,C,D Rationale Working with dying patients may create a personal sense of loss and fear about the nurse's own mortality. However, resorting to defense mechanisms only provides temporary relief for the nurse to cope with the difficult emotions surrounding death. Focusing only on the patient's physical needs provides a distraction from any uncomfortable feelings, but cause the nurse to emotionally withdraw from dying patients and their families when they most need emotional support. Expression of emotions with friends helps the nurse to accept that death is a part of life. The nurse verbalizes his or her own feelings, which helps in processing his or her own reactions to the grieving process. Making time for relaxation and vacations is an important aspect of a nurse's self care and will help the nurse to provide effective care to patients.
An older adult has chronic body aches due to muscular dystrophy. The associated pain has put the patient in a state of hopelessness. A nurse suggests hospice care. How should the nurse educate the family members about hospice care? Select all that apply. The hospice care ends with death of the patient. It is a patient- and family-centered approach to care. The hospice team promotes patient dignity and self-esteem. It is a place to take care of terminally ill patients. The hospice team gives preference to the patient's wishes.
Ans: B,C,E Rationale Hospice is a patient- and family-centered approach to care. It provides therapeutic care, psychosocial care, symptom management, and promotes patients' dignity and self-esteem. In situations of difference 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.
A nurse is explaining about hospice care to the family members of a patient who has had a massive stroke. What information should the nurse provide to the family members? Select all that apply. Hospice is a place to care for terminally ill patients. Hospice is a program that provides care for terminally ill patients. Hospice manages the patient's pain and provides comfort. Hospice meets the economic needs of terminally ill patients. Hospice services are available at home as well as hospital settings.
Ans: B,C,E Rationale Hospice is a program and model for terminally ill patients. It seeks to provide comfort and manages the patient's pain. The services are available at home as well as in a hospital setting. Hospice is not a specific place for terminally ill patients, and does not provide economic support.
Which cultural practices are commonly followed by African Americans when mourning? Select all that apply. Preference to cremate their deceased loved ones Having music and singing at the wake and funeral Offering the dying patient the sacrament of the sick Including a meal for friends after the wake and funeral Respecting the body by having warm clothes for the burial
Ans: B,D Rationale In African-American culture, music and singing are often included at the wake and funeral as part of the mourning process. After the wake and funeral, a meal is shared to provide emotional support to the family. Hindus prefer the cremation process. Christians often offer the sacrament of the sick. Asian Americans commonly show respect for the body by providing warm clothes for the burial.
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 does the nurse tell the family member about palliative care? Select all that apply. Hospice and palliative care are the same thing. Palliative care is for any patient, any time, any disease, in any setting. Palliative care strategies are primarily designed to treat the patient's illness. Palliative care interventions relieve the symptoms of illness and treatment. Palliative care is provided only at the end of life, but unlike hospice care, it is focused strictly on comfort of the patient.
Ans: B,D Rationale Palliative care is not reserved for people who are at the end of life. Hospice and palliative care are not the same thing, The goal of palliative care is to help relieve the burdens of illness at any time along the continuum of that illness. Palliative care is not designed to treat the patient's illness. STUDY TIP: Remember that hos pice care is palliative, not curative. It is appropriate when a cure is not possible and the patient's comfort becomes the highest priority.
While caring for a hospice patient, the nurse observes that the patient is experiencing nearing death awareness. What are the signs observed by the nurse? Select all that apply. Weakness Confusion Inability to swallow Making hand gestures Holding unseen objects
Ans: B,D,E Rationale A patient experiencing nearing death awareness may communicate symbolically. Due to the fear of death, the patient may appear confused and make hand gestures such as reaching or appearing to hold an unseen object. Weakness and an inability to swallow are symptoms of a dying patient, but these do not indicate nearing death awareness.
While assessing the beliefs regarding death in various ethnic groups, the nurse learns that members of which religious groups practice cremation? Select all that apply. Muslims Hindus Jews Buddhists Christians
Ans: B,D,E Rationale Cremation refers to the act of burning the dead body to ashes at a high temperature. Hindus perform cremation and scatter the ashes in rivers that they consider sacred. Buddhists prefer cremation. Christians may perform cremation or bury the body. According to Islamic beliefs, Muslims bury the body as soon as possible. They do not perform cremation. Jewish people also quickly bury the body; they consider cremation to be inappropriate.
A nurse works with patients in a psychiatric clinic. Which conditions may cause disenfranchised grief in patients? Select all that apply. Death of a sibling Death of a pet Death of a parent Death of an ex-spouse Death of a stillborn baby
Ans: B,D,E Rationale Disenfranchised grief is encountered when a loss happens that cannot by openly acknowledged or publicly shared by the grieving person. It occurs when society does not want to acknowledge the grief. Losing a parent or sibling are not examples of disenfranchised grief as these are validated and recognized examples of loss.
Which nursing interventions would the nurse implement to provide comfort to a patient who is actively dying? Select all that apply. Reposition the patient hourly. Play comforting music in the room. Suction the patient every 2 hours. Give the patient a gentle bath. Use a moistening agent on the patient' lips.
Ans: B,D,E Rationale Playing comforting music provides peace and relaxation. A gentle bath helps maintain cleanliness and provides comfort. Moistening agents prevent lip dryness and provide comfort. Repositioning the patient hourly may help prevent skin breakdown but may also cause a dying patient discomfort. Suctioning removes secretions that may block the airway but does not provide comfort.
A 1-year-old child lost his mother in a car accident. The child refuses to eat and has sleep disturbance. Which factor is most likely responsible for this response? Coping strategies Nature of the loss Developmental stage Personal relationship
Ans: C Rationale Children experience the grieving process in ways that vary according to their age and developmental stage of life. In this case, the child does not understand the loss. The child is aware that the mother is not present. Changes in eating and sleep habits are due to this awareness. In coping strategies, the person uses life experiences to deal with the stress of the loss, which is not possible for a 1-year-old child. In this situation, the child is too young to understand the loss, thus the nature of the loss is not the reason affecting his behavior, health, and well-being. Similarly the child is too young to understand the quality and meaning of the lost personal relationship, thus this factor is not affecting the response.
The nursing instructor is teaching student nurses about anticipatory grief. Which example does the nurse give for anticipatory grief? A woman who has lost her husband in a bomb blast A woman who had an abortion at her partner's insistence A patient who is expected to live only a few days due to cancer A father committing suicide because his only son was murdered
Ans: C Rationale Anticipatory grief is grief experienced by an individual before the loss occurs. It can occur when an individual is diagnosed with any terminal disease; therefore, a person who is expected to live only a few more days due to cancer experiences anticipatory grief. The death of a person in a bomb blast is not an expected event, and a woman who lost her husband in this manner may experience complicated grief. A woman who underwent an abortion under duress may not be able to share her grief because abortion is an uncomfortable subject and may experience disenfranchised grief. A person being murdered is not an example of expected death, and a father committing suicide after losing his son in this manner is an example of exaggerated grief. STUDY TIP: When you anticipate an event, it has not yet happened. Anticipatory (the adjective form of the verb anticipate) grief occurs before the loss.
The nurse assesses that a patient is experiencing complicated grief. The patient states, "I am very busy with my normal daily routine since my husband died, and I don't have time to think about it." Which type of complicated grief does the nurse identify in this patient? Chronic grief Masked grief Delayed grief Exaggerated grief
Ans: C Rationale Complicated grief occurs in a person who is unable to undergo the normal stages of grieving. It includes four types of grief: chronic grief, delayed grief, exaggerated grief, and masked grief. The patient in this question chooses to not think about her pain by keeping busy with household activities; this may indicate delayed grief. Grief reactions that last for at least 6 months after the loss indicate chronic grief. If the behavior of the grieving person interferes with normal functioning, it indicates masked grief. When a grieving person is unable to perform normal daily activities, it indicates exaggerated grief.
A nurse is caring for a patient who is nearing death. What is the best nursing action? Tell the patient, "You'll be going home soon." Encourage the patient to interact with family members. Hold the patient's hand and state, "You're not alone." Discuss what to expect with the family members at the bedside.
Ans: C Rationale 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 he or she is going to die soon may increase his or her sense of anxiety. Discussing the process with family members does not focus on the patient.
A patient is diagnosed with penile cancer. The patient's wife is indifferent to the patient. The nurse is assessing the psychosocial condition of this patient and his wife. What does the nurse ask the wife and husband to obtain the psychosocial information? "Have you contacted a lawyer about a legal divorce? It is essential, isn't it?" "Do you wish to have children in the future?" "Can you describe to me how you feel about the current medical condition?" "Do you feel the need to approach a marriage counselor?"
Ans: C Rationale In the assessment of psychosocial problems of cancer survivors, the nurse asks specific questions to elicit psychosocial information. Asking the patient to describe his feelings associated with the disease condition helps the nurse to know about the psychosocial impact of the disease. It also helps to assess the coping skills of the patient. The nurse does not speak about divorce at this point. Asking if the couple wishes to have children in the future does not help to determine the psychosocial condition of the patient. Asking about the need for a marriage counselor may help to assess if the couple is interested in continuing with their marriage; however, it does not help in assessing the psychosocial condition of the patient.
In which stage of dying does a patient realize the full impact of the loss? Anger Denial Depression Bargaining
Ans: C Rationale In the depression stage, the patient realizes the whole impact of the loss. At this stage, the patient feels hopeless and lonely. In the anger stage, the patient expresses resistance and intense anger at God, other people, or the situation itself. In the denial stage, the patient is psychologically not ready to accept the loss. In the bargaining stage, the patient postpones awareness of the loss and makes promises to self, God, or loved ones that he or she will live or believe differently if the loss is prevented from taking place. In the bargaining stage, the patient does not accept the truth.
A woman experiences the loss of a very early term pregnancy. Her friends do not mention the loss, and someone suggests to her that she can "always try again." The woman feels confusion over her sadness and stops talking about it with others. What type of grief response is she most likely experiencing? Delayed Anticipated Exaggerated Disenfranchised
Ans: D Rationale This woman's friends are not fully acknowledging the value of her pregnancy because of the short length of time the woman was pregnant or because, by comparison, the loss seems less than losing a child after birth. The loss does not seem "legitimate." Thus the woman does not experience sympathy from others and feels disenfranchised.
The nurse is assessing a patient who is emotionally overwhelmed because of the death of the patient's father. The nurse finds that the patient is taking illicit drugs. What type of grief does the nurse infer from the patient's behavior? Denial stage Bargaining stage Exaggerated grief Disenfranchised grief
Ans: C Rationale The consumption of drugs indicates self-destructive behavior, which is characteristic of exaggerated grief. In the denial stage, the patient denies the truth, but does not show self-destructive behavior. In the bargaining stage, a terminally ill patient may seek ways to change his or her situation or outcome. In cases of disenfranchised grief, the patient does not express grief openly, because society may not accept the expression of grief for an ex-spouse, ex-partner, or ex-lover.
A 62-year-old patient is diagnosed with colorectal cancer and is scheduled for surgery. Following the surgery, the health care provider informs the patient the surgery was successful. However, the patient is told that she needs chemotherapy as the cancer had spread to other organs. The patient asks the nurse whether the spread of cancer will stop if she stops smoking and consuming alcohol. Which stage of grieving is the patient experiencing? Denial Anger Bargaining Resolution
Ans: C Rationale The patient is experiencing the bargaining stage of grief. In this stage, the patient offers to live a healthier life in exchange for better health. The stage of denial indicates that the patient is unable to accept illness or disability. In the stage of anger, the patient tends to blame him- or herself and others for the condition. The anger is often directed toward the nurse and family members. In the stage of resolution, the patient starts accepting his illness and asks questions related to the illness and care. STUDY TIP: Memorize the stages of grief with a mnemonic such as "DABRA": denial, anger, bargaining, resolution, and acceptance.
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 does the nurse take to prioritize the nursing diagnoses? Select all that apply. Use family members and physician orders as primary resources for prioritizing actions. Address the nursing diagnosis that most affects the medical diagnosis. Ask the patient to identify the most distressing symptom and first address that diagnosis. Use nursing knowledge to address the problem that is the underlying cause of other diagnoses. Focus first on the diagnosis that will be easiest to address.
Ans: C,D Rationale When the nurse is prioritizing nursing diagnoses, the he or she 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, a patient may not understand that pain contributes to decreased appetite or depression. Nursing knowledge along with the patient's perceptions help the nurse determine the diagnosis with the highest priority.
A nurse is caring for terminally ill patients in a hospice setting. The senior nurse explains the Grief Tasks Model by Worden to the junior staff. Which activities should the nurse identify as aspects of this Grief Tasks Model? Select all that apply. Block the pain of grief. Deny the reality of the loss. Experience the pain of grief. Adjust to a world in which the deceased is missing. Emotionally relocate the deceased and move on with life.
Ans: C,D,E Rationale According to Worden's Grief Tasks Model, it takes about a year to come to terms with the loss experienced. However, it may differ from person to person. Once the reality of the loss is accepted, the person may experience pain of grief. It is manifested by loneliness, sadness, or despair. This stage is followed by adjustments to the world in which the deceased is missing. The family members may start performing roles of the deceased even if they don't like to. The final stage is to emotionally relocate the deceased and move on with life. Blocking the pain and denying the loss does not help with moving on.
A patient in a rehabilitation clinic is recovering from the loss of a limb in a motor vehicle accident. In addition to wound care and physical therapy, what factors should the nurse assess to help the patient recover? Select all that apply. Religion Culture Family support Behaviors indicating a grief response The patient's point of view on the loss
Ans: C,D,E Rationale Assessing family support helps the nurse to understand whether the patient would be able to cope with the loss. The patient may exhibit behaviors indicating a grief response. The nurse should be watchful for a negative response. It is important to understand the patient's loss from his or her point of view to know the significance of the loss. The patient's religion and culture also affect the patient's coping; however, their assessment is less important after loss of a body part and more important during death.
What are the different stages of mourning based on Bowlby's attachment theory? Select all that apply. Depression Bargaining Reorganization Searching and yearning Shock and numbness
Ans: C,D,E Rationale Bowlby's attachment theory describes the experience of mourning based on his studies of children separated from their parents during World War II. There are four stages of mourning, which are shock and numbness, searching and yearning, disorganization and despair, and reorganization. Depression and bargaining are stages of dying in Kübler-Ross's classic behavioral theory.
The nurse is using Kubler-Ross's five stages of grief to assess a patient whose son was murdered. What would be a possible response from the patient during the anger stage? "I will have to lead the rest of my life without him." "I talked with my son this morning." "I lost my only son; is there any reason to live?" "I will fight for justice. My son's murderer will pay!"
Ans: D Rationale Kubler-Ross's five stages of grief explain the emotional stages experienced by an individual during the process of grieving. The five stages are denial, anger, bargaining, depression, and acceptance. Anger is the second stage, during which the patient truly recognizes the circumstances of the loss. Patients may become angry with themselves or others and declare that they will punish the person responsible. Acceptance is the fifth stage, during which the person comes to the reality of loss and understands that he or she should lead the remaining part of life without the person who has died. Denial is the first stage. In this case, the reality of the son's death is hard to face, so the patient may refuse to accept the situation. Depression is the fourth stage, during which the person comes to terms with the death of the son, becomes sad, cries, and may declare that there is no reason to live.
The primary health care provider shows a patient a chest radiograph and delivers a diagnosis of stage-2 lung cancer.Which statement made by the patient leads the nurse to conclude that the patient is in the first stage of grief according to the Kubler-Ross model? "I am going to die; it's all over." "Why did God let this happen to me?" "I will quit smoking; I want to live." "I don't think these results are mine."
Ans: D Rationale According to Kubler-Ross, there are five stages of grief, based on the emotional responses experienced by an individual during the process of grieving: denial, anger, bargaining, depression, and acceptance. Denial is the first stage; because the reality of death is hard to face, the person may not initially accept the situation. Depression is the fourth stage, during which the patient understands the certainty of death becomes sad, cries, and may state that it's all over and that he or she is going to die. Anger is the second stage, during which patients may become angry with themselves or with others. Bargaining is the third stage, during which the patient is ready to change his or her ways to improve his or her health condition.
According to Sheldon's theory of grief, which emotional experiences are seen in an individual during the despair stage? Belief and disbelief Sadness, anger, and guilt Development of new relationships Loss of meaning and direction in life
Ans: D Rationale According to Sheldon, an individual experiences four different stages during the grieving process. This includes the initial shock, "pangs of grief," despair, and adjustment. Despair is the third stage; common emotions and experiences in this stage include loss of meaning and direction in life. Initial shock is the first stage, during which common emotions and experiences include numbness, disbelief, and relief. "Pangs of grief" is the second stage; common emotions and experiences in this stage include sadness, anger, guilt, feelings of vulnerability and anxiety, regret, insomnia, social withdrawal, hallucinations of the dead person, restlessness, and searching behavior. Adjustment refers to the final stage, during which an individual develops new relationships or interests. STUDY TIP: Consider that Sheldon's last two stages, despair and adjustment, are similar to Kubler-Ross's last two stages, depression and acceptance.
Which patient is most likely to experience disenfranchised grief? A 30-year-old patient with a diagnosis of inoperable lung cancer A 45-year-old patient with diabetes who has had a leg amputation A 50-year-old patient whose parent just died of a brain tumor A 29-year-old patient who has undergone an abortion
Ans: D Rationale Disenfranchised grief is a loss that is not accepted by society or that of a grieving individual who cannot publicly share his or her grief. People at risk of disenfranchised grief include mothers who have terminated a pregnancy, ex-spouses, ex-partners, friends, lovers, mistresses, and coworkers. A patient who had an abortion may not be able to share the grief because abortions are uncomfortable to discuss. A patient with a diagnosis of inoperable lung cancer, a patient with diabetes who has undergone a leg amputation, and a patient whose mother has died from a brain tumor would likely be able to share their grief publicly; therefore, these are not examples of disenfranchised grief.
A family member asks a home care nurse what he should do if the patient's serious chronic illness worsens even with increased medical interventions. How does the nurse best begin a conversation about the goals of care at the end of life? Encourage the family member to think more positively about the patient's new therapy. Avoid the discussion because it has to do with medical, not nursing, diagnoses. Initiate a discussion about advance directives with the patient, family, and health care team. Begin the discussion by asking the patient to identify his or her beliefs about the goals of care while the family member is present.
Ans: D Rationale If the nurse asks the patient first what he or she believes is best, the nurse knows how to discuss that option in more detail and give realistic ways of reaching that desired goal. Discussing other possible options after the patient's preference helps family members know and understand the patient's wishes.
What is the characteristic of rigor mortis? The body appears pale. The body becomes cool. The skin color appears bluish. The joints of the body stiffen.
Ans: D Rationale Rigor mortis indicates stiffening of the joints. Pallor mortis indicates paleness of the body after death due to the lack of capillary circulation. After death, the body temperature drops and the body becomes cool, which is called algor mortis. Livor mortis is the bluish color of the body due to the loss of blood supply. STUDY TIP: Connect the word "rigor" with the term "rigid" to help you recall that it indicates stiffening of the joints. "Mortis" refers to death, as in the terms "mortuary" and "mortician."
A nurse is caring for a terminally ill patient. How can the nurse actively communicate with the patient? By asking closed-ended questions By sympathizing with the patient By discussing sensitive issues By asking open-ended questions
Ans: D Rationale The nurse can actively communicate with patients by asking open-ended questions. This helps patients expand their thoughts and tell their stories. The nurse can obtain more information from patients with open-ended questions. Asking a closed-ended question (one with a yes/no response) would not help the nurse understand the feelings and emotions of patients, and thus should be avoided. Providing sympathy to patients would not necessarily allow them to express feelings; however, empathizing with patients would help them relate to the nurse and express their feelings in the process. Discussing sensitive issues can create barriers to communication; therefore, sensitive issues should be avoided unless the patient brings them up.
A young man is diagnosed with a serious, life-changing illness. His conversations during his first 2 days of hospitalization are abrupt, superficial, and unrelated to his illness. What understanding about communication enhances the nurse's therapeutic communication with this patient? Younger patients are usually less talkative about their diagnosis. All patients benefit by talking about their feelings with another person. Avoid discussing illness-related topics with quiet patients. Remain alert for signals that the patient wants to discuss his illness.
Ans: D Rationale The nurse should make no presumptions about this patient other than the fact that he is not yet ready to talk about his situation. However, the nurse should stay alert for a time when the patient might want to express his feelings. Some people do not work through their problems by talking to others.
A patient is upset due to the terminal illness of his parent. How should the nurse educate the patient about anticipatory grief and its management? Select all that apply. Emphasize high-dose sedation. Instruct the patient to avoid meeting his parents to overcome grief. Explain to the patient that grief may aggravate his situation. Explain to the patient that he will eventually become mentally prepared for the loss. Explain that his grief cannot be controlled by willpower, as it is an unconscious process.
Ans: D,E Rationale Since it is a terminal illness of a parent, the patient will eventually prepare for the inevitability that the parent will die. Grief cannot be controlled by willpower, as it is an unconscious process. High-dose sedation should be advised only after obtaining the health care provider's opinion and only for severe grief. Avoiding parents is not a justifiable way of escaping grief. Grief does not last long and the patient may even be relieved once the parent passes away.
An older adult has chronic body aches due to muscular dystrophy. The associated pain has put the patient in a state of hopelessness. What nursing interventions would be helpful to this patient? Select all that apply. Treat the chronic pain. Set appropriate goals. Identify sources of social support. Motivate the patient to get a job. Suggest the use of heating pads.
Ans:A,B,C Rationale Treating the pain helps the patient gain hope. Setting up appropriate goals helps in prioritizing the problems, while 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.
The nurse observes noisy breathing when caring for a terminally ill patient. What condition in the patient would be evaluated for determining the cause? Anemia Increased oxygen demand Anticholinergic medications Thick secretions in the airway
Ans:D Rationale Noisy breathing, also known as a death rattle, is caused by thick secretions in the airway and decreased muscle tone, swallow, and cough. Noisy breathing refers to the sound of secretions moving in the airway during inspiratory and expiratory phases. It indicates the last stage of life. It does not occur due to an anemic condition, increased oxygen demand, or anticholinergic medications. Anemic conditions and increased oxygen demand cause dyspnea or shortness of breath. Anticholinergic medications are helpful to relieve noisy breathing by decreasing the secretions.