2200 - Loss
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 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 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 is caring for a client with a terminal illness. Which statement is true of a terminal illness?
Recovery is beyond reasonable expectation.
With the help of the nurse, the parents of an infant who died shortly after birth arrange for a funeral service. Which stage of grief, according to Engel, involves the rituals surrounding loss, including funeral services?
Restitution
The client is terminal and has unrelieved and intractable pain. The nurse is administering hydromorphone intravenously. The client states, "I want you to give me additional medication so I will die. I can't go on any longer." What action would the nurse take?
State, "This is not something I or any of the nurses can do."
The nurse is caring for a client with terminal illness and congestive heart failure. Which documentation on the client's medical record supports eligibility for hospice care?
The client has 6 months or less to live.
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?
"I will contact the health care provider to extend services since your family member meets the criteria."
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 trying to help the client cope with the dying process. Which nursing statement is most appropriate?
"It must be very difficult for you."
Which phrase can do much to instill hope in the dying client?
"Let me tell you about your illness."
A nurse is teaching a client about problem-focused coping methods. Which examples would the nurse most likely include? Select all that apply.
"Make a time schedule and stick to it." "Try finding out more about a situation."
During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving?
"My parent is suffering with cancer and death will be a relief of the pain."
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."
A woman has had a breast removed to treat cancer. What type of loss will she most likely experience?
Actual loss
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.
Which of the following is an example of a perceived loss?
An older client grieves for the loss of his independence.
A client with a terminal diagnosis states, "I am so glad I had a good life. I am ready to die." How will the nurse assist the client to communicate this acceptance of death to the family?
Ask the client how the nurse can best support the discussion with family
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
The hospice nurse is caring for several clients on the unit. Which client is exhibiting signs or symptoms of impending death?
Client with circumoral cyanosis and abdominal mottling
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?
Correct response: Ask the client if she wants to meet and thank her loved ones.
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
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 taking care of a client who is experiencing the shock phase of grieving. Which nursing intervention is best for this client?
Help the client accept the reality of the loss and to begin to reorganize his or her life.
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 who has died an unexplained death has numerous catheters and drainage tubes in place and is being prepared for an autopsy. In providing care to the body after the client has been pronounced dead, how shall the nurse manage the tubes prior to the autopsy?
The nurse will not remove any tubes from the body.
The nurse is caring for a client with terminal illness. Which should the nurse teach the family about physiological signs of imminent death?
There will be changes in vital signs, skin color, and responsiveness.
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
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
What is Kübler-Ross's third stage of grief?
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 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
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
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
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
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 wife of a man who is dying tells the nurse: "Harold was so good to me. He was like a saint with his patience. I will miss him terribly" Which stage of grief is this woman experiencing, according to Engel?
Idealization
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? Select all that apply.
Include the children in any rituals. Encourage the children to remember their grandfather. Help make the children feel loved and safe.
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.
