Chapter 37: The Experience of Loss, Death and Grief

Regarding grief in older adults, which understanding helps guide your relationship with an elderly pt? 1. Older adults have usually sustained many losses in life, which influence the current loss 2. Older adults with a poor memory experience grief less intensely 3. Older adults generally handle loss better because they have more experience with it 4. Social support is less important because an older adult's circle of friends has become smaller

1. Older adults have usually sustained many losses in life, which influence the current loss

Regarding the request for organ and tissue donation at the time of death, the nurse needs to be aware that: 1. Specially educated personnel make requests 2. Requests are usually made by the nurse caring for the pt. at the time of death 3. Only pts. 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. Specially educated personnel make requests

The nurse suggests that a pt. receive a palliative care consultation for symptom management related to anxiety and increasing pain. A family member asks the nurse if this means the the pt. is dying and is now "in hospice." What does the nurse tell the family member about palliative care? (SATA) 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 pt's illness 4. Palliative care interventions relieve the symptoms of illness and treatment

2, 4

A family member of a recently deceased pt. talks casually with the nurse at the time of the pt'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? 1. Denial 2. Anticipatory grief 3. Dysfunctional grief 4. Yearning and searching

2. Anticipatory grief

Which of the following nursing actions best reflects sensitivity to cultural differences related to end-of-life care? 1. Practice honesty with everyone, telling pts. about their illness, even if the new is not good 2. Ask family members if they prefer to help with the care of the body after death 3. Provide postmortem care at the time of death to relieve family members of this difficult job 4. Value pt. self-determination, understanding that each person makes his or her own decisions

2. Ask family members if they prefer to help with the care of the body after death

The nurse notes that a woman who recently began cancer treatment appears quiet and withdrawn, states that she does not believe the treatments will make any difference, does not ask about her progress, and missed 2 chemotherapy sessions. Based on the above assessment data, the nurse gathers more information to consider making which of the following nursing diagnoses? 1. Anxiety 2. Hopelessness 3. Spiritual distress 4. Complicated grieving

2. Hopelessness

A nurse is providing postmortem care. Which action is the priority? 1. Locating the pt'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. Providing culturally and religiously sensitive care in body preparation

A family member asks a home care nurse what he should do if the pt'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? 1. Encourage the family member to think more positively about the pt'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 pt, family, and health care team 4. Begin the discussion by asking the pt. to identify his or her beliefs about the goals of care while the family member is present

4. Begin the discussion by asking the pt. to identify his or her beliefs about the goals of care while the family member is present

In preparation for the eventual death of a female hospice patient of the Muslim faith, the nurse organizes a meeting of all hospice caregivers. A plan of care to be followed when this patient dies is prepared. This plan of care would include a. Male health care workers care for the body after death has occurred. b. Body preparation for autopsy. c. Body preparation for cremation. d. Female health care workers care for the body after death has occurred.

ANS: D Islamic culture calls for modesty and same-sex caregivers whenever possible. Muslim faith discourages cremation and autopsy to preserve the sanctity of the soul of the deceased.

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? 1. Delayed 2. Anticipated 3. Exaggerated 4. Disenfranchised

4. Disenfranchised

A man is hospitalized after surgery that amputated both lower extremities owing to injuries sustained during military service. The nurse should recognize his need to grieve for what type of loss? a. Maturational loss b. Situational loss c. Perceived loss d. Uncomplicated loss

ANS: B Loss of a body part from injury is a situational loss. Maturational losses occur as part of normal life transitions. Perceived loss is not obvious to other people. Uncomplicated is not a type of loss; it is a description of normal grief.

A pt. who has a serious, life-limiting chronic illness wants to continue to engage in self-care and live as normally as possible. Which of the following nursing responses reflect a helpful understanding of pt. self-care at the end of life? 1. " Learning to accept that you can't perform some activities anymore will bring you new 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. " Which activities are most important to you, and how can you continue to do them?"

You have identified three nursing diagnoses for a pt. who is having anxiety and hopelessness as a result of a loss. Which general approach do you take to prioritize the nursing diagnoses? (SATA) 1. Use family members and physician orders as primary resources for prioritizing your actions 2. Address the nursing diagnosis that most affects the medical diagnosis 3. Ask the pt. to identify the most distressing symptom and first address that diagnosis 4. Use nursing knowledge to address the problem that is the underlying cause of other diagnoses

3, 4

Which approach to helping grieving people is most consistent with postmodern grief theories? 1. Help the pt. identify the tasks to be accomplished during his or her grief 2. Encourage people to recognize stages of grieving in anticipation of what is to come 3. Listen carefully to a person's story of how his or her grief experience is unfolding 4. Offer general grief timelines to help the person know when a phase will pass

3. Listen carefully to a person's story of how his or her grief experience is unfolding

A self-care goal you set when caring for dying and grieving pts. includes: 1. Learning not to take loses so seriously 2. Limiting involvement with pts who are grieving 3. Maintaining life balance and reflecting on the meaning of your work 4. Admitting that you are not well suited to care for people who are grieving and asking the charge nurse not to assign you to care for these pts.

3. Maintaining life balance and reflecting on the meaning of your work

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 your therapeutic communication with this pt? 1. Younger pts. are usually less talkative about their diagnosis 2. All pts. benefit by talking about their feelings with another person 3. Avoid discussing illness-related topics with quiet pts. 4. Remain alert for signals that the pt. wants to discuss his illness

4. Remain alert for signals that the pt. wants to discuss his illness

A nurse has the responsibility of managing a deceased pt's post-mortem care. Arrange the steps for post-mortem care in the proper order: 1. Bathe the body of the deceased 2. Collect any needed specimens 3. Remove all tubes and indwelling lines 4. Position the body for family visit/viewing 5. Speak to the family members about their possible participation 6. Confirm that request for organ/tissue donation and/or autopsy has been made 7. Notify a support person for the family 8. Accurately tag the body, indicating the identity of the deceased and safety issues regarding infection control 9. Elevate the head of the bed

6, 9, 2, 5, 7, 3, 1, 4, 8

The nurse is using Bowlby's phases of mourning as a framework for assessing the client's response to the traumatic loss of her leg. During the "yearning and searching" phase, how does the nurse anticipate the client may respond? a. Crying off and on b. Becoming angry at the nurse c. Acting stunned by the loss d. Discussing the change in role that will occur

ANS: A During the "yearning and searching" phase of Bowlby's phases of mourning, the nurse anticipates that the client may have outbursts of tearful sobbing and acute distress. During Bowlby's "disorganization and despair" phase of mourning, the nurse anticipates that the client may express anger at anyone who might be responsible, including the nurse. During the "numbing" phase of Bowlby's phases of mourning, the nurse anticipates that the client may act stunned by the loss. During the "reorganization" phase of Bowlby's phases of mourning, the nurse anticipates that the client may discuss the change in role that will occur.

The mother of a recently murdered child keeps the child's room intact. Family members are encouraging her to redecorate and move forward in life. The visiting nurse recognizes this behavior as _____ grief. a. Normal b. End-of-life c. Abnormal d. Complicated

ANS: A Family members will grieve differently. One sign of normal grief is keeping the deceased individual's room intact as a way to keep that person alive in the minds of survivors. This is happening after the family member is deceased, so it is not end-of-life grief. It is not abnormal or complicated grief; the child died recently.

A correctional facility nurse is called to the scene of a deceased inmate. The correction officer wants to quickly move the body to the funeral home because he is not comfortable with death. The inmate's body will need to be transported where? a. Coroner's office for an autopsy b. Police department for an investigation c. Directly to the inmate's family d. Warden for inspection

ANS: A Law often requires that an autopsy be performed if death occurred during incarceration; as the result of foul play, homicide, or suicide; or as an accidental death, as occurs in car accidents. The nurse must understand the policies that are applied in cases of foul play death and must ensure that the decedent's body is properly cared for after death, despite the emotional feelings of individuals in close contact with the decedent.

After the anticipated demise of a chronically ill patient, the unit nurse is found crying in the staff lounge. The best response to her crying colleague would be a. "It is normal to feel this way. Give yourself some time to mourn." b. "Your other patients still need you, so hurry back to them." c. "You're being a bad role model to the unit's nursing students." d. "Why don't you take a sedative to cope?"

ANS: A Nurses often witness suffering on a daily basis. Nurses, as humans, also experience grief and loss when they have been intensely involved in the patient's suffering and death. Offer comfort and understanding to colleagues, and maintain a stable patient care environment. It is inappropriate to create guilt by telling a grieving nurse to hurry back to her patients or by indicating that she is a bad role model. Suggesting that a colleague take sedative during a shift is dangerous for the safety of patients in her care.

"I know it seems strange, but I feel guilty being pregnant after the death of my son last year," said a woman during her routine obstetrical examination. The nurse spends extra time with this woman, helping her to better bond with her unborn child. This demonstrates which nursing technique? a. Facilitating mourning b. Providing curative therapy c. Promoting spirituality d. Eradicating grief

ANS: A The nurse facilitates mourning in family members who are still surviving. By acknowledging the pregnant woman's emotions, the nurse helps the mother bond with her fetus and recognize the emotions that still exist for the deceased child. The nurse is not attempting to help the patient eradicate grief, which would be unrealistic. Curative therapy and spiritual promotion are not addressed by the nurse's statement.

Hospice nursing care has a different focus for the dying client. Which of the following should the nurse know about client care provided through a hospice? a. It is designed to meet the client's individual wishes, as much as possible. b. It is usually aimed at offering curative treatment for the client. c. It is involved in teaching families to provide postmortem care. d. It does not include an interdisciplinary care team.

ANS: A The nurse's role in hospice nursing care is to meet the primary wishes of the dying client and to be open to the individual desires of each client. The nurse supports a client's choice in maintaining comfort and dignity. Hospice care is for the terminally ill. It is not aimed at offering curative treatment, but rather the emphasis is on palliative care. Hospice care may provide bereavement follow-up for the family after a client's death, but hospice nurses typically do not teach the family postmortem care. Hospice care programs include provision of an interdisciplinary care team of physicians, nurses, spiritual advisers, social workers, and counsellors.

How should the nurse promote comfort for the terminally ill client, specific to nausea and vomiting? a. Provide frequent mouth care. b. Suction oral secretions. c. Increase the fluid intake. d. Offer a high-residue diet.

ANS: A To promote comfort for the terminally ill client, specific to nausea and vomiting, the nurse should administer anti-emetics, provide oral care at least every two to four hours, offer a clear liquid diet and ice chips, and avoid liquids that increase stomach acidity such as coffee, milk, and citrus acid juices. Suctioning would remove respiratory secretions. Increasing the fluid intake may help prevent constipation. A low-residue diet may help prevent diarrhea.

A dying patient with liver and renal failure requires pain medication. The nurse anticipates that the medication dose will be a. Given at appropriate milligrams per kilogram medication levels. b. A decreased dose from milligrams per kilogram levels. c. An increased dose from milligrams per kilogram levels. d. Given at midrange for dosing at recommended levels.

ANS: B A dying individual will likely have a decline in renal and liver functioning. Because of reduced organ functioning, a decreased dose would be in order, so the individual does not develop toxic levels of the medications.

A severely depressed patient cannot state any positive attributes to his or her life. The nurse patiently sits with this patient and assists the patient to identify several activities the patient is actually looking forward to in life. The nurse is helping the patient to demonstrate which spiritual concept? a. Time management b. Hope c. Charity d. Faith

ANS: B The concept of hope is vital to nursing; it enables a person to anticipate positive experiences. Being patient and friendly and creating positive relationships are key concepts in all areas of nursing, but especially with depressed patients. The nurse's actions do not address time management, charity, or faith.

A client has been diagnosed with terminal cancer of the liver and is receiving chemotherapy on a medical unit. In an in-depth conversation with the nurse, the client states, "It can't be happening to me." According to Kübler-Ross, with which of the following is this stage of dying associated? a. Anxiety b. Denial c. Confrontation d. Depression

ANS: B According to Kübler-Ross, the client is in the denial stage of dying. The client may act as though nothing has happened, may refuse to believe or understand that a loss has occurred and may seem stunned, as though it is "unreal" or difficult to believe. No stage of anxiety is found in Kübler-Ross's five stages of dying. No stage of confrontation is found in Kübler-Ross's five stages of dying. During depression, the individual may feel overwhelmingly lonely and withdraw from interpersonal interaction. Depression is one of Kübler-Ross's five stages of dying, but is not represented by this example.

A nurse encounters a family that experienced the death of their adult child last year. The parents are talking about the upcoming anniversary of their child's death. The nurse spends time with them discussing their child's life and death. The nurse's action best demonstrates which nursing principle? a. Pain management technique b. Facilitating normal mourning c. Grief evaluation d. Palliative care

ANS: B Anniversary reactions can reopen grief processes. A nurse should openly acknowledge the loss and talk about the common renewal of grief feeling around the anniversary of the individual's death. This facilitates normal mourning. The nurse is not attempting to alleviate a physical pain. The actions are of open communication, not evaluation. Palliative care refers to comfort measures for symptom relief.

A woman is called into her supervisor's office regarding her deteriorating work performance since the loss of her husband 2 years ago. The woman begins sobbing and saying that she is "falling apart" at home as well. The woman is escorted to the nurse's office, where the nurse recognizes the woman's symptoms as which of the following? a. Normal grief b. Complicated grief c. Disenfranchised grief d. Perceived grief

ANS: B Complicated or dysfunctional grief occurs when an individual has a complicated grieving process that interferes with common routines of life for excessively long periods of time. Normal grief is the most common reaction to death; it involves a complex range of normal coping strategies. Disenfranchised grief involves a relationship that is not socially sanctioned. Perceived grief is not a type of grief; perceived loss is a loss that is not obvious to other people.

An Orthodox Jewish Rabbi has been pronounced dead. The nursing assistant respectfully asks family members to leave the room and go home as postmortem care is provided. Which of the following statements from the supervising nurse reflects correct knowledge of Jewish culture? a. "I wish they would go home because we have work to do here." b. "Family members stay with the body until burial the next day." c. "I should have called a male colleague to handle the body." d. "I thought they would quietly leave after praying and touching the Rabbi's head."

ANS: B Jewish culture calls for family members or religious officials to stay with the decedent's body until the time of burial. A male provider is unnecessary. Requesting or expecting the family to go home is not providing culturally sensitive care.

Which of the following statements is true regarding cultural beliefs and death? a. The ethical decisions surrounding a client's death should be based on hospital policy and not culture. b. Maintaining rituals and practices allows a sense of acceptance of the dying process. c. The nurse must decide which cultural practices will be incorporated in care of the dying. d. Regardless of culture, following hospital practices will help focus client and family on the dying process.

ANS: B Maintaining the integrity of rituals and mourning practices gives families a sense of acceptance of the client's death and an inner peace. The nurse should be familiar with policies and procedures, but ethical decisions should be made with an understanding and appreciation of the client's culture. The nurse must assess the terminally ill client's and family's wishes for end-of-life care and develop a plan of care by integrating client culture and spiritual beliefs. On the contrary, the nurse must assess the terminally ill client's and family's wishes for end-of-life care and develop a plan of care by integrating client culture and spiritual beliefs.

Which of the following is a nurse-initiated or independent activity for promotion of respiratory function in a terminally ill client? a. Limiting fluids b. Positioning the client upright c. Reducing narcotic analgesic use d. Administering bronchodilators

ANS: B Positioning the client upright is an independent nursing intervention for the promotion of respiratory function in a terminally ill client. Limiting fluids may not promote respiratory function, and the nurse should not do so unless a client is on a fluid-restricted diet. Reducing narcotic analgesic use is not a nurse-initiated activity to promote respiratory function. A respiratory rate should be assessed before administering narcotics to prevent further respiratory depression. Management of dyspnea (air hunger) involves judicious administration of morphine and anxiolytics for relief of respiratory distress. The administration of bronchodilators would require a physician's order. It is not an independent nursing activity.

The nurse has had three patients die during the past 2 days. Which approach is most appropriate to manage the nurse's sadness? a. Telling the next patients why the nurse is sad b. Talking with a colleague or writing in a journal c. Exercising vigorously rather than sleeping d. Avoiding friends until the nurse feels better

ANS: B Self-care strategies for nurses include talking with a close colleague and reflecting on feelings by writing in a journal. It is inappropriate for a nurse to talk with patients to resolve the nurse's grief. Although exercise is important for self-care, sleep is also important. Shutting oneself away from friends is not self-care; the nurse should spend time with people who are nurturing.

A patient cancels a scheduled appointment because she will be attending a Shiva for a family member. Recognizing the importance of this cultural ritual, the nurse's best comment would be which of the following? a. "Congratulations, what's the baby's name?" b. "I'm so sorry for your loss." c. "Missionary church outreach is so important." d. "Can I buy a ticket to this fundraiser?"

ANS: B The Jewish mourning ritual of Shiva incorporates the community's helping behaviors toward those experiencing death, sets expectations for behaviors of the survivor, and provides the community with sustaining traditions and rituals. An understanding of the religious and cultural significance of Shiva allows the nurse to know how to appropriately respond.

An identified outcome for the family of the client with a terminal illness is that they will be able to provide psychological support to the dying client. To assist the family to meet this outcome, which of the following should the nurse plan to include in the teaching plan? a. Demonstration of bathing techniques b. Application of oxygen devices c. Recognition of client needs and fears d. Information on when to contact the hospice nurse

ANS: C A dying client's family is better prepared to provide psychological support if the nurse discusses with them ways to support the dying person and listen to needs and fears. Demonstration of bathing techniques may help the family meet the dying client's physical needs, but not provide psychological support. Application of oxygen devices may help the family meet physical needs for the client, but not provide psychological support for the client. Information on when to contact the hospice nurse is important knowledge for the family to have and may help them feel they are being supported in caring for the dying client. However, contact information does not help the family provide psychological support to the dying client.

A couple is informed that their fetus' condition is incompatible with life after birth. Nurses can best help the couple with their end-of-life decision making by offering them which of the following? a. An advance directive to complete b. Brief discussion and funeral guidance c. Time and careful explanations d. Instructions on how to proceed

ANS: C Families can have limited knowledge when asked to make important ethical decisions. Nurses have the time, patience, and knowledge base to assist the family to understand their ethical situation and to help them make their own educated decision. Advance directives are completed by the person who is dying. Funeral guidance is best provided by a chaplain or a caretaker.

During a follow-up visit, a woman is describing new onset of marital discord with her terminally ill spouse. Using the Kübler-Ross behavioral theory, the nurse recognizes that the spouse is in which stage of dying? a. Denial b. Bargaining c. Anger d. Depression

ANS: C Kübler-Ross' traditional theory involves five stages of dying. The anger stage of adjustment to an impending death can involve resistance, anger at God, anger at people, and anger at the situation. Denial would involve failure to accept a death. Bargaining is an action to delay acceptance of death by bartering. Depression would present as withdrawal from others.

Validation of a dying person's life would be demonstrated by which nursing action? a. Taking pictures of visitors b. Calling the organ donation coordinator c. Listening to family stories about the person d. Providing quiet visiting time

ANS: C Listening to family members' stories validates the importance of the dying individual's life and reinforces the dignity of the person's life. Taking pictures of visitors does not address the value of a person's life. Calling organ donation and providing private visiting time are components of the dying process, but they do not validate a dying person's life.

The nurse is assigned to a client who was recently diagnosed with a terminal illness. During morning care, the client asks about organ donation. How should the nurse respond? a. Have the client first discuss the subject with the family. b. Suggest the client delay making a decision at this time. c. Assist the client to obtain the necessary information to make this decision. d. Contact the physician so consent can be obtained from the family.

ANS: C No topic that a dying client wishes to discuss should be avoided. The nurse should respond to questions openly and honestly. As client advocate, the nurse should assist the client to obtain the necessary information to make this decision. The nurse should provide the client with information with which to make such a decision. Although the nurse may suggest that the client discuss the subject with the family after having obtained information, it is up to the client to discuss the subject with his family. The nurse should respect the client and provide the necessary information for him or her to make a decision, rather than dismissing the client's question. It is not necessary to contact the physician or the family for consent for organ donation if the client is capable of making this decision.

The nurse is working with a client on an inpatient hospice unit. Which of the following actions should the nurse take in order to maintain the client's sense of self-worth during the end of life? a. Leaving the client alone to deal with final affairs b. Calling on the client's spiritual advisor to take over care c. Spending time with the client and allowing him or her to share life experiences d. Having a grief counsellor visit .

ANS: C Taking time to let the client share his or her life experiences, particularly what has been meaningful, enables the nurse to know the client better. Knowing the client then facilitates choice of therapies that promote client decision making and autonomy. Planning regular visits also helps the client maintain a sense of self-worth, because it demonstrates that he or she is worthy of the nurse's time and attention. The client should not be left alone to feel abandoned or isolated. The nurses can help the client meet spiritual needs by facilitating connections to a spiritual practice or community and supporting the expression of culturally held beliefs. The client's spiritual advisor also may be called on, but is not the only source of spiritual support. The nurse who turns care over to the spiritual advisor is not promoting the client's sense of self-worth, as it may imply the client is not worthy of the nurse's time or attention. A grief counsellor may be requested to visit if the client is experiencing complicated grief. Having a grief counsellor visit may be less helpful than spending time with the client, to help maintain a client's sense of self-worth

The father has recently begun to attend his children's school functions since the death of his wife. This would best be described as which task in the Worden Grief Tasks Model? a. Task I b. Task II c. Task III d. Task IV

ANS: C The Worden Grief Tasks Model consists of four tasks. Task III is seen when the surviving family member begins to adjust to life without the deceased. Task I is accepting the reality of the loss, Task II is working through the pain of grief, and Task IV is emotionally relocating the deceased and moving on with life.

A cancer patient asks the nurse what the criteria are for hospice care. What should the nurse answer? a. Having a terminal illness, such as cancer b. Needing assistance with pain management c. Expected to live less than 6 to 12 more months d. Completion of an advance directive

ANS: C The criterion for hospice care is being expected to live less than 6 to 12 more months. Patients with a terminal illness are not eligible until that point. Palliative care provides assistance with pain management when a patient is not eligible for hospice care. An advance directive can be completed by any person, even those who are healthy.

Enuresis is reported in a previously toilet trained toddler. While gathering a health history from the grandparent, the nurse asks about which factor as the most likely cause? a. Lack of outside playtime b. Having too many toys c. Dietary changes d. Recent parental death

ANS: D A child's stage of development and chronological age will influence how he or she grieves. Toddlers can show grief through changes in their eating patterns, changes in their sleeping patterns, fussiness or irritability, and changes in their bowel and bladder habits. It is common for younger children to regress when under increased stress. Lack of outside playtime, dietary changes, and having too many toys are unlikely to cause enuresis.

The nurse is discussing future treatments with a client who has a terminal illness. The nurse notes that the client has not been eating and responds to the nurse's information by stating, "What does it matter?" Which of the following is the most appropriate nursing diagnosis for this client? a. Social isolation b. Spiritual distress c. Denial d. Hopelessness

ANS: D A defining characteristic for the nursing diagnosis of hopelessness may include the client stating, "What does it matter?" when offered choices or information concerning him or her. The client's behaviour of not eating also is an indicator of hopelessness. The client's behaviour and verbalization is not an example of social isolation. The client is not avoiding others or being restricted from seeing others. Spiritual distress is not the most appropriate nursing diagnosis for this client. The focus should be on the client's lack of hope. The client's behaviour and verbalization does not indicate denial.

Which of the following would be a nursing intervention to assist the client with a nursing diagnosis of Sleep pattern disturbance related to the loss of spouse and fear of nightmares? a. Administer sleeping medication per order. b. Refer the client to a psychologist or psychotherapist. c. Have the client complete a detailed sleep-pattern assessment. d. Sit with the client and encourage verbalization of feelings.

ANS: D A nursing intervention to facilitate grief work is to offer the client encouragement to explore and verbalize feelings of grief. This encouragement refocuses the client on current needs and minimizes dysfunctional adaptation behaviours (e.g., not sleeping) by facilitating resolution of grief through problem-solving skills. Administering sleeping medication may help the client get to sleep, but does not resolve the issue of grief. Without addressing the grief, the client may develop another dysfunctional adaptation behaviour. It is not necessary to refer the client to a psychologist or psychotherapist at this time. The client needs to be encouraged to verbalize his or her feelings. Having the client complete a detailed sleep-pattern assessment may help the nurse identify the number of hours of sleep the client is obtaining, but it does not address the issue causing the sleep disturbance, which is grief from the loss of the spouse.

A family is grieving after learning of a family member's accidental death. The transplant coordinator requests to talk with the family about possible organ and tissue donation. The nurse recognizes that a. All religions allow for organ donation. b. Life support must be removed before organ and tissue retrieval occurs. c. The best time for organ and tissue donation is immediately after the autopsy. d. The transplant coordinator is working in accordance with federal law.

ANS: D It is a federal law to require facilities to develop policies about organ donation. The transplant coordinator has additional education on providing answers about organ donation. Not all religions allow for organ donation. A patient may be on life support during organ removal to preserve organ tissues. Autopsy compromises organ integrity; removal should occur prior.

A terminally ill patient is experiencing constipation secondary to pain medication. What is the best way for the nurse to improve the patient's constipation problem? a. Massage the patient's abdomen. b. Contact the provider to discontinue pain medication. c. Administer enemas twice daily for 7 days. d. Use a stimulant laxative and increase fluid intake.

ANS: D Opioid medication is known to slow gastrointestinal transit time, which places the patient at high risk for constipation. Stimulant laxatives are indicated for opioid-induced constipation. Added water to the diet will allow water to be pulled into the GI tract, softening up stool. Massaging the patient's abdomen may cause further discomfort. Discontinuing pain medication is inappropriate for a terminally ill patient. Enema administration is not the first step in the treatment of opioid-induced constipation.

Mrs. Harrison's father died a week ago. Mr. Harrison is experiencing headaches and fatigue, and keeps shouting at his wife to turn down the television, although he has not done so in the past. Mrs. Harrison is having trouble sleeping, has no appetite, and says she feels like she is choking all the time. How should the nurse interpret these assessment findings as the basis for a follow-up assessment? a. Mrs. Harrison is grieving and Mr. Harrison is angry. b. Mrs. Harrison is ill and Mr. Harrison is grieving. c. Both Mr. and Mrs. Harrison likely are in denial. d. Both Mr. and Mr. Harrison likely are grieving.

ANS: D Symptoms of normal grief include headache, fatigue, oversensitivity to noise, insomnia, appetite disturbance, and choking sensation. Different people manifest different symptoms. Denial is assessed when the person indicates that he is not accepting that the loss happened.

The nurse recognizes that anticipatory grieving can be most beneficial to a client or family for which of the following reasons? a. It can be done in private. b. It can be discussed with others. c. It can promote separation of the ill client from the family. d. It allows time for the dying client and his or her loved ones to say goodbye and complete life affairs before the actual death or loss occurs.

ANS: D The benefit of anticipatory grief is that it allows time for "letting go"; the dying client and his or her loved ones are able to say goodbye and complete life affairs before the actual death or loss occurs. It is not most beneficial for grieving to take place only in private. It is important for grief to be acknowledged by others, and for those grieving to be able to receive the support of others in the grieving process. Anticipatory grieving can be discussed with others in most circumstances. However, anticipatory grief may be disenfranchised grief as well, meaning it cannot always be openly acknowledged, socially sanctioned, or publicly shared, such as grief over the death of a partner with acquired immune deficiency syndrome (AIDS). The discussion of grief with others can also take place with normal grief, after the loss has occurred. Anticipatory grieving is unique from normal grieving in that it allows time for "letting go" before the death occurs. Anticipatory grief is the process of disengaging or "letting go" that occurs before an actual loss or death has occurred. The benefit is not the separation of the ill client from the family as much as it is the process of being able to say good-bye, to put life affairs in order, and as a result, this type of grieving can help a client or family to progress to a higher emotional state.

Which of the following is the primary concern of the nurse in providing care to a dying client? a. Promoting optimism in the client and being a source of encouragement b. Intervening in the client's activities of daily living to allow the client to focus on his or her emotional state c. Allowing the client to be alone and expecting isolation on the part of the dying person d. Selecting interventions designed to maintain the client's dignity and self-esteem

ANS: D The focus in planning nursing care is to promote self-esteem and dignity by taking a therapeutic stance that conveys respect for the client as a whole person, with feelings, accomplishments, and passions independent of the illness experience. Optimism should not be the primary focus when caring for the dying client. The nurse should promote the client's self-esteem and allow the client to die in comfort and with dignity. The client should be allowed to make choices and perform as many activities of daily living independently as possible. This allows the client to maintain self-esteem and dignity. The client does not need to be left alone. The presence of the nurse or the family may indicate to the client that he or she is being cared for and is worthy of attention.

The palliative team's primary obligation to a patient in severe pain includes which of the following? a. Supporting the patient's nurse in her grief b. Providing postmortem care for the patient c. Teaching the patient the stages of grief d. Enhancing the patient's quality of life

ANS: D The primary goal of palliative care is to help patients and families achieve the best quality of life. Providing support for the patient's nurse is not the primary obligation when the patient is experiencing severe pain. Not all collaborative team members would be able to provide postmortem care, as is the case for nutritionists, social workers, and pharmacists. Teaching about stages of grief should not be the focus when severe pain is present.

The nurse is preparing to assist the client in the end stage of her life. How should the nurse provide comfort for the client who is showing fatigue? a. Spend more time with the client. b. Limit the use of analgesics. c. Provide larger meals with more seasoning. d. Determine valued activities and schedule rest periods.

ANS: D To promote comfort in the terminally ill client, the nurse should help the client to identify values or desired tasks and then help the client to conserve energy for those tasks. Spending more time with the client conveys caring, and allows verbalization, but is not the best way to promote comfort for a fatigued client. The use of analgesics should not be limited. Controlling the terminally ill client's level of pain is a primary concern in promoting comfort. Nausea, vomiting, and anorexia may increase the terminally ill client's likelihood of inadequate nutrition. The nurse should serve smaller portions and bland foods, which may be more palatable.

The newly graduated nurse is assigned to his or her first dying client. How can the nurse best prepare to care for this client? a. Complete a course dealing with death and dying. b. Control his or her own emotions about death. c. Draw on the experience of the death of a loved one. d. Develop an understanding of his or her own feelings about death.

ANS: D When caring for clients experiencing grief, it is important for the nurse to assess his or her own emotional well-being and to understand his or her own feelings about death. The nurse who is aware of his or her own feelings will be less likely to place personal situations and values before those of the client. Although coursework on death and dying may add to the nurse's knowledge base, it does not best prepare the nurse for caring for a dying client. The nurse needs to have an awareness of his or her own feelings about death first, as death can raise many emotions. Being able to control one's own emotions is important; however, it is unlikely that the nurse would be able to do so if he or she has not first developed a personal understanding of his or her own feelings about death. Experiencing the death of a loved one is not a prerequisite to caring for a dying client. Experiencing death may help an individual mature in dealing with loss, or it may bring up many negative emotions if complicated grief is present. The nurse is best prepared by first developing an understanding of his or her own feelings about death.

Family members gather in the emergency department after learning that a family member was involved in a motor vehicle accident. After learning of the family member's unexpected death, the surviving family members begin to cry and scream in despair. The nurse recognizes this as the Bowlby Attachment Theory stage of a. Numbing. b. Disorganization and despair. c. Bargaining. d. Yearning and searching.

ANS: D Yearning and searching characterize the second bereavement phase in the Bowlby Attachment Theory. Emotional outbursts are common in this phase. During the numbing phase, the family may feel a sense of unreality. During disorganization and despair, the reason why the loss occurred is constantly questioned. Bargaining is part of the Kübler-Ross stages, not of the Bowlby Attachment Theory.