Chapter 44: Loss, Grief, and Dying
Which does not coincide with Kübler-Ross's stages related to a dying client?
The dying client usually exhibits anger first
A client has a diagnosis of bladder cancer with metastasis. The client asks the nurse about the characteristics of hospice care. The nurse should explain that:
care is premised on the fact that dying is a normal process.
Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief?
coping strategies
The condition of a client with a traumatic brain injury continues to deteriorate despite medical efforts. The decision is made to terminally wean the client from mechanical ventilation. Which statement by the nurse is most significant in educating the family regarding terminal weaning?
"All efforts will be taken to make sure your loved one is comfortable and out of pain."
A client has been receiving dialysis for years and now states, "I have been thinking about this for a long time. I no longer wish to continue dialysis. I just want to die." What is the most appropriate statement by the nurse?
"Can you tell me about why you've made this decision?"
The nurse is assessing a client who was diagnosed with metastatic prostate cancer. Which information from the client's medical record indicates the client is experiencing depression?
Appears sullen, shakes head "yes" or "no," refuses visitors
A nurse is caring for a client whose spouse died more than 4 years ago. What assessment question will the nurse ask to determine if the client is experiencing abnormal grief?
"Have you gone through and donated your spouse's clothing?"
Which statement by the client indicates acceptance of dying?
"I have finalized all my financial arrangements for my family."
A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education?
"In hospice care, the nurses make most of the care decisions for the clients."
A nurse completing admission paperwork asks the client about having an advanced directive. The client states, "I do not know, what is an advanced directive?" What is the nurse's best response?
"It is a written document that identifies a person's preferences regarding which medical interventions to use in the event of a terminal condition."
After the health care provider has discussed euthanasia with a terminal client and family, the nurse assesses their understanding of the topic. Which statement by the family indicates that learning has occurred?
"It is all right to stop dialysis."
A client is informed of the diagnosis of leukemia based on recent testing results. The client states, "I do not have leukemia." Which additional statement indicates the client is experiencing denial?
"Mistakes are made with laboratory tests all the time."
A client diagnosed with a terminal illness is displaying periods of depression and anger alternating with acceptance. The client's spouse is concerned about the client's labile mood. When talking with the client's spouse, which statement made by the nurse best addresses principles of loss and grieving?
"Not everyone experiences grief in the same way and your loved one needs our support."
The nurse is caring for a client who recently lost an older adult parent. Which client statement alerts the nurse that the stage of depression may have started within the grief process?
"Please go away; I just want to be left alone."
The nurse is caring for a client who recently found out he has a terminal illness. The nurse notes that the client is hostile and yelling. Which statement by the nurse shows that she has understanding of the Kübler-Ross emotional responses to impending death?
"Sometimes a person returns to a previous stage."
The new hospice nurse is reviewing the concepts of loss and grief with the preceptor. Which statement leads the preceptor to believe that the nurse has an understanding of grief and loss?
"The client who is isolating himself from social contact after the death of his spouse is demonstrating a social expression of grief."
When preparing for palliative care with the dying client, the nurse should provide the family with which explanation?
"The goal of palliative care is to give clients the best quality of life by the aggressive management of symptoms."
When a client with end-stage renal failure states, "I am not ready to die," what is the appropriate nursing response?
"This must be very difficult for you."
"My father has been dead for over a year and my mother still can't talk about him without crying. Is that normal?" What is the best response by the nurse?
"The inability to talk about your dad without crying, even after a year, is still considered normal."
The nurse is providing care for a client that is terminally ill with cancer. The client states to the nurse, "Am I going to die?" What is the most therapeutic response by the nurse?
"What have you been told?"
A client is dying and the nurse has developed a strong rapport with the client and spouse. The spouse states to the nurse, "I just don't know how I am going to deal with the process. It makes me nervous to think I can't deal with it." What is the priority concern with the spouse of the client?
Anxiety related to unknown reaction to stages of death
Which situation is most likely to warrant an autopsy?
A client's death involves an allegation of a medical error.
Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning?
Administer sedation and analgesia
The nurse is caring for a client who has just expired. Which action will the nurse perform?
Allow the client's family to see the client's body before it is discharged
A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage, according to Kübler-Ross?
Anger
A client at a health care facility has died after a prolonged illness. A nurse is assigned to perform postmortem care for the client. Which intervention should the nurse perform when providing postmortem care?
Cleanse drainage from the skin.
A client who was brought to the emergency room for gunshot wounds dies in intensive care 15 hours later. Which statement concerning the need for an autopsy would apply to this client?
The coroner must be notified to determine the need for an autopsy
The nurse is taking care of a client recently involved in a motor vehicle accident during which a pet was thrown from the vehicle and died. The client states, "My heart aches and I can't eat or sleep." According to Kübler-Ross, what stage of grief is the client experiencing?
Depress
The nurse is providing care for a confused client who no longer is able to make health care decisions. Which document will the nurse review on the client's medical record to determine the designated person to make decisions on the client's behalf?
Durable power of attorney form
The husband of a client with terminal cancer is afraid of hurting his wife during sexual intercourse. Which action by the nurse is likely to be most helpful in reducing this client's fears?
Encourage discussion between the husband and wife regarding their intimacy needs
A client diagnosed with liver failure in hospice care died 10 hours ago. The client's spouse is having difficulty leaving the room and is crying uncontrollably. What situation does the nurse identify is happening with this client's spouse?
Grief reaction
The nurse is receiving a change of shift report on a client who has a terminal illness and has exhibited a slow and progressive decline in the health status over the past several days. Which data supports the client's impending death? Select all that apply.
Gurgling sounds emanating from the client's throat with each breath Distended abdomen with last bowel movement documented 7 days ago Cyanotic nail beds in hands and feet bilaterally
A nurse is providing care to a 9 1/2-year old child who is terminally ill. When talking with the child, the nurse would need to understand that the child most likely views death as which type of event? Select all that apply.
Irreversible Universal Inevitable
The experience of parting with an object, person, belief, or relationship that one values is defined as
Loss
A nurse is providing care to a terminally ill client. Which finding would alert the nurse to the fact that the client is dying? Select all that apply.
Pale, cool skin Decreased urine output Irregular heart rate
When assessing a person who is grieving using the grief cycle model, which concept would be most important for the nurse to keep in mind? Select all that apply.
People vary widely in their responses to loss. Stages occur at varying rates among people. Some people actually skip some stages of grief altogether.
A nurse at the health care facility cares for several clients. Some of the clients may require end-of-life care. Which case may require the service of a coroner?
The client did not have any recent medical consultation.
A client in a long-term care facility has signed a form stating that he does not want to be resuscitated. He develops an upper respiratory infection that progresses to pneumonia. His health rapidly deteriorates, and he is no longer competent. The client's family states that they want everything possible done for the client. What should happen in this case?
The client should be treated with antibiotics for pneumonia
A client with end-stage chronic obstructive pulmonary disease (COPD) has reached the end of the 6-month period for hospice services and the family caregiver states, "I don't know what we will do if they cut off our hospice services." What is the best response by the hospice nurse?
The client should be treated with antibiotics for pneumonia.
A client severely injured in a motor vehicle accident is rushed to the health care facility with severe head injuries and profuse loss of blood. Which sign indicates approaching death?
The client's breathing becomes noisy
Which are signs of a "good death"? Select all that apply.
The person dies with dignity. The person is prepared for death. The person has a sense of completion of life.
A nurse is explaining the preparation of a death certificate to a student nurse. Which statements accurately describe this process? (Select all that apply.)
U.S. law requires that a death certificate be prepared for each person who dies. A health care provider's signature is required on a death certificate. It is the nurse's responsibility to ensure that the health care provider has signed a death certificate. A death certificate is signed by the pathologist, the coroner, and others in special cases.
The nurse is caring for several clients in the home care setting. Which client, when found deceased, will the nurse report as a case for the medical examiner?
a client found with an empty bottle for a newly-prescribed opioid by the bedside
A client has recently lost a parent. The client spent about 6 months deeply mourning the loss and is just now able to function at the pre-loss level. During this process, a strong social support network was able to assist the client. What developmental stage of life does the nurse identify the client is in?
adult
The spouse of a recently deceased client states, "I just can't believe he left me. He swore he would never leave me and I feel betrayed!" Using Kübler-Ross stages of grief, what stage does the nurse identify the client is experiencing?
anger
What is Kübler-Ross's third stage of grief?
bargaining
A widow develops cancer within 6 months of her husband's death. This may be a result of:
bereavement.
A client is informed about the results of a biopsy, which indicate a malignant tumor that has spread. The client states, "Well once you remove the tumor, I will be just fine." What stage of the grief process does the nurse identify the client is experiencing?
denial
The nurse has noted that a dying client is increasingly withdrawn and is often teary at various times during the day. The nurse recognizes that the client may be experiencing which of Kübler-Ross's stages of grief?
depression
When preparing the care plan for a dying client, it is important for the nurse to include a goal that addresses which needs? Select all that apply
expression of feelings management of pain use of coping strategies
The client is a young parent whose spouse died 3 months ago. The client is tearful and unkempt, eats a poor diet, and has lost 50 lb (22.6 kg) since the death of the spouse. The client states, "I cannot do this anymore." Which nursing concern is best supported by these data?
ineffective coping related to failure of previously used coping mechanisms
Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal?
leaving the wife's room and belongings intact
A couple has sent their youngest child to college in another state and both are experiencing "empty nest syndrome." This is an example of:
maturational loss
The nurse is giving palliative care to a client with a diagnosis of COPD. What is the goal of palliative care?
to improve the client's and family's quality of life
Palliative care is a structured system for care delivery. What is its aim?
to prevent and relieve suffering
The husband of a client who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. What type of grief is the husband experiencing?
unresolved grief
