Loss and grieving Prep- U

The nurse is caring for a client who has terminal lung cancer and is unconscious. What assessment would indicate to the nurse that the client's death is imminent?

Mottling of the lower limbs

A client has been diagnosed with a terminal illness and has periods of depression and periods of anger. The client's spouse is concerned, feeling as though their loved one is not moving forward in the stages of grief. What teaching is most appropriate for the nurse to include?

Movement between stages can be progressive. Movement back and forth between stages is expected.

A client with a terminal illness is overheard by the nurse saying, "If I promise never to smoke another cigarette in my life, please let me recover from this lung cancer." How will the nurse document this stage of grief according to the Kübler-Ross model?

bargaining

What is Kübler-Ross's third stage of grief?

bargaining

The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the bargaining stage of grief is the one who states:

"I just want to see my son have a family of his own."

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. After the client has been pronounced dead, the nurse is responsible for preparing the body. Family members may need to see the client's body to accept the death fully; allow them to see the client's body before discharging to the mortician. The body is placed in normal anatomic position (flat) to avoid pooling of blood. In most cases it is unnecessary to wash the body, and some religions strictly forbid it. The nurse is legally responsible for placing identification tags on either the shroud or garment that the body is clothed in, and on the ankle to ensure that the body can be identified even if separated from its shroud.

A nursing instructor is describing the stages of grief as identified by Kübler-Ross. The instructor asks the students to place the stages in their usual sequence from first to last. The students demonstrate understanding when they place the stages in which order?

Denial Anger Bargaining Depression Acceptance

Although all of the following are factors that affect grief, which one is most likely to influence a person's expression of grief?

cultural influences

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

A nurse is providing care to a terminally ill client. Which finding would alert the nurse to the fact that the client is dying?

Pale, cool skin Irregular heart rate Decreased urine output

Which statement accurately describes the process known as grief reaction?

Reactions to grief may differ from client to family.

A home care nurse is providing care to an older adult client who is dying. The client's son asks the nurse how, when the time comes, he should tell his own children about their grandfather's death. Which suggestion by the nurse would be most appropriate?

Encourage the children to remember their grandfather. Help make the children feel loved and safe. Include the children in any rituals.

The wife of a client who has been diagnosed with a terminal illness asks the nurse about the differences between palliative care and hospice care. Which information would the nurse most likely include in the response?

Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness.

A client has been diagnosed with a terminal illness and has periods of depression and periods of anger, alternating with periods of acceptance. What teaching is most appropriate for the nurse to include when the client's spouse says that the client seems emotionally unstable?

Movement between stages of grief is normal.

Which signs assessed in a dying client would the nurse recognize as signs of death? Select all that apply.

Nausea, flatus, abdominal distention Cheyne-Stokes respirations Loss of movement, sensation, and reflexes

A home care nurse observes that the client denies the fact that she has lost her husband. The nurse interprets this denial as a psychological defense. Using the Parkes model, the nurse identifies that the client is in which stage?

Numbness

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."

Which factors affect the grieving process? Select all that apply.

meaning of loss circumstances of loss personal stressors sociocultural resources

A client has been declared brain dead following a motor vehicle accident. What assessment data would the nurse anticipate?

no ocular movement

When providing end-of-life care for clients, what will the nurse most often need to prioritize?

pain control and emotional support

A nurse is developing a plan of care for a dying client. Which physiologic basic human need should be addressed?

personal hygiene

An older adult client at a health care facility dies after a prolonged illness. Which is a psychological reaction associated with the different stages of grief?

refusal to accept death

Palliative care is a structured system for care delivery. What is its aim?

to prevent and relieve suffering

The daughter of an older client is concerned that her mother is depressed because she is reading the obituaries every day. What is the most appropriate nursing response?

"This is common in older adults and doesn't necessarily indicate depression."

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?"

Which phrase can do much to instill hope in the dying client?

"Let me tell you about your illness."

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."

A group of nursing students is reviewing the various models of grieving. The students demonstrate understanding of the information when they identify the stages of the grief cycle model listed. Place them in the proper sequence from first to last that would demonstrate the student's accurate understanding.

1. Shock 2. Protest 3. Disorganization 4. Reorganization

Which assessment finding would best support a nursing diagnosis of Dysfunctional Grieving?

A man is unable to return to work after his sister's death 18 months ago.

A nurse is caring for a client with HIV-related pneumonia. The client is unable to come to terms with the fact that she is dying and feels that life has been unfair to her. How can the nurse promote acceptance in this client?

Ask the client if she wants to meet and thank her loved ones.

Which of the following is an example of a perceived loss?

An older client grieves for the loss of his independence. Perceived loss, such as loss of youth, of financial independence, and of a valued environment, is experienced by the person but is intangible to others. Loss of a limb, of a child, of a valued object (e.g., money), and of a job are examples of actual loss by the person sustaining the loss.

A nurse assesses a client who is grieving and notes that the client is in the numbness phase according to the Parkes grief model. Which defense would the nurse expect the client to most likely use?

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

What is a proper action to take when preparing a child for death?

Expect the child to alternate between grieving and normal functioning. The nurse should know her own feelings and beliefs. Encourage remembrance of deceased.

Which does not coincide with Kübler-Ross's stages related to a dying client?

The dying client usually exhibits anger first.

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

difficulty swallowing

A critical care nurse is aware of the legislation that surrounds organ donation. When caring for a potential organ donor, the nurse is aware that:

hospitals are mandated to notify transplantation programs of potential donors.

A nurse is assessing a client's grief response. Which concept would be most important for the nurse to keep in mind during the assessment to determine whether the client's response is normal or altered?

severity of the symptoms and the pattern of change over time

The husband of a client who died of breast cancer is still grieving for his wife 2 years later. What type of grief is he experiencing?

unresolved Unresolved grief is abnormal or distorted; it may be either unresolved or inhibited. In unresolved grief, a person may have trouble expressing feelings of loss or may deny them; unresolved grief also describes a state of bereavement that extends over a lengthy period. With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations. Maturational losses are losses that predictably occur during the life cycle. Situational losses are losses that are caused by unexpected or unusual circumstances.

A client with a diagnosis of lung cancer is seen in the clinic for follow-up care. Which nursing interventions are essential to include in this client's plan of care to address grief? Select all that apply.

Assist the client to form a support system. Help the client establish coping strategies. Promote good nutrition and sleep habits. Encourage participation in religious rituals.

The nurse is caring for a client who has just died after a long diagnosis of dementia. Which nursing assessment is the priority for documentation?

"No breathing and no pulse at 0840."

A woman has had a breast removed to treat cancer. What type of loss will she most likely experience?

Actual loss

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 home hospice client who has Medicare is experiencing extreme pain at home and is refusing to receive inpatient care due to concerns over the cost of inpatient care. What teaching will the nurse include in the plan of care?

Inpatient pain management for hospice patients is covered by Medicare.

When preparing for the death of a client, the nurse should provide the client's family with which interventions? Select all that apply

Listen to concerns, fears, and worries. Encourage rest and proper nutrition. Explain the dying process and allow grieving. Utilize therapeutic communication techniques.

A nurse is conducting grief resolution for a client who lost his wife in a motor vehicle accident in which he was the driver. Which interventions best accomplish this goal? Select all that apply.

Listen to expressions of grief. Include significant others in discussions and decisions as appropriate. Communicate acceptance of discussing the loss.

A client visits the health care facility for a regular check-up. The nurse is aware that the client lost his wife 2 months earlier. What would lead the nurse to suspect dysfunctional grief?

The client begins abusing alcohol.

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

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 is caring for a young client who is dying of acute renal failure. What care should the nurse take when helping dying clients to cope?

Provide opportunities for the client to express his feelings freely.

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.

The nurse is taking care of a client who was hospitalized for an ulcerative colitis exacerbation. Recently, the client's parent died from colon cancer. Which question would be essential to ask this client at the start of the assessment of her loss reaction?

What type of relationship did you have with your parent?

A client has been declared brain dead following a suicide attempt. What assessment data would the nurse anticipate? Select all that apply.

absence of breathing drive when disconnected from ventilator absence of pharyngeal and tracheal flexes no ocular movement

A client has been diagnosed with a terminal illness and has made an appointment with an attorney to complete a will. How will the nurse document this stage of grief according the Kübler-Ross Model?

acceptance

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

A hospice nurse has developed a care plan for a client with liver cancer. The care plan focuses on providing palliative care for this client. The goal of palliative care is best described as providing clients with life-threatening illnesses a dignified quality of life through which means?

aggressive management of symptoms

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage, according to Kübler-Ross?

anger

A man is diagnosed with terminal kidney failure. His wife demonstrates loss and grief behaviors. What type of loss is the wife experiencing?

anticipatory loss Anticipatory loss occurs when a person displays loss and grief behaviors for a loss that has yet to take place. It is often seen in the families of clients with serious or life-threatening illnesses, and serves to lessen the effect of the actual loss of a family member. Maturational losses are losses that predictably occur during the life cycle. Bereavement is a state of intense grief, as after the loss of a loved one. Dysfunctional grieving is prolonged grief.

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

bargaining

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.

A nurse assesses a terminally ill client with a DNR order, with findings of decreased blood pressure, urinary and bowel incontinence, loss of reflexes, and Cheyne-Stokes respirations. Based on these findings, the nurse recognizes that:

these are signs of impending death.

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