class 12 - chapter 44: loss, grief, and dying

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? "Once the endotracheal tube is removed, your loved one will no longer be able to breathe." "All efforts will be taken to make sure your loved one is comfortable and out of pain." "If you change your mind after we remove the breathing tube, just tell us and it will be reinserted." "Your loved one will not feel or be aware of anything that is happening once the breathing tube is removed."

"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? "Once you've started treatment, it's important to continue." "Have you discussed this with your health care provider?" "Can you tell me about why you've made this decision?" "Does your family agree with this decision?"

"Can you tell me about why you've made this decision?"

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?" "Do you keep photos of your spouse on your bedside table?" "Can you remember the good times together with your spouse?" "Do you cry on the anniversary of your spouse's death?"

"Have you gone through and donated your spouse's clothing?"

When reviewing a client's chart, the nurse notes that the client is in the disorganization stage of grief. Which assessment finding would support this conclusion? "A lot of the time I'm terrified that I'm going to die the same way." "I haven't let my children out of my sight. I am afraid something will happen to them." "I had a good time at my class reunion. It was nice to be out with other people again." "I feel like I have absolutely no idea what to do next."

"I feel like I have absolutely no idea what to do next."

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? "Unfortunately, we are unable to continue services past the 6 month period of time." "I will contact the health care provider to extend services since your family member meets the criteria." "We can discontinue the service for a period of time and then when your family member gets worse, readmit them." "We can admit your family member to the hospital for treatment and they can reinstate the hospice benefits."

"I will contact the health care provider to extend services since your family member meets the criteria."

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." "This does not seem real to me." "It is all my fault! I did not see the signs." "What am I going to do now that my parent is gone?"

"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? "Each stage of dying must be completed prior to moving to the next stage." "The process is the same from person to person." "Sometimes a person returns to a previous stage." "The duration of all stages is a few hours."

"Sometimes a person returns to a previous stage."

"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." "It isn't considered normal. Has she considered seeing a therapist about her grief." "In fact, the more that someone cries about a loss, the better they're dealing with it." "Did your mother cry a lot before your father died?"

"The inability to talk about your dad without crying, even after a year, is still considered normal."

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." "I'm sure you are angry and sad." "Yes, this is a terrible diagnosis you've received." "Have you talked with your spiritual leader about your fears?"

"This must be very difficult for you."

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? "You shouldn't worry about that right now." "I have to go and assist another client right now." "What have you been told?" "You will go when it is your time."

"What have you been told?"

The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the anger stage of grief is the one who states: "Why did this have to happen to me?" "I do not believe I have this disease." "I just want to see my son have a family of his own." "I don't care about anything. I have no energy."

"Why did this have to happen to me?"

Which assessment finding would best support a nursing concern of disordered grieving? A client is unable to return to work after their sibling's death 18 months ago. A client cries frequently and loudly in the weeks following their child's death in an accident. A client blames themself for not doing more to make their spouses's recent death more comfortable. A client has been experiencing chronic insomnia since their parent's death earlier this year.

A client is unable to return to work after their sibling's death 18 months ago.

Which situation is most likely to warrant an autopsy? A client's death involves an allegation of a medical error. A palliative client dies unwitnessed during the night. A client dies after unsuccessful cardiopulmonary resuscitation. A client's death is attributed to an infectious disease.

A client's death involves an allegation of a medical error.

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 treated for end-stage kidney failure who is on home hemodialysis a client with lung cancer who refused hospice and is living with a spouse a client found with an empty bottle for a newly-prescribed opioid by the bedside a client who was recently discharged from the hospital after a myocardial infarction

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 infant toddler school-aged child

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 treatment of the disease process eliminating all forms of medical and nursing care providing counseling related to the stages of death and dying

aggressive management of symptoms

What is Kübler-Ross's third stage of grief? depression bargaining denial anger

bargaining

Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief? coping strategies self-care activities pain management spiritual distress

coping strategies

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 anger bargaining acceptance

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? decreased pain difficulty swallowing increased urinary output increased sensory stimulation

difficulty swallowing

A client's son is named to make decisions for his mother in the event she cannot speak for herself. This is an example of a(an): exemplary representative. significant power. durable power of attorney. advance estate director.

durable power of attorney.

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 nutritional therapy urinary elimination

expression of feelings management of pain use of coping strategies

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? anticipatory grief pathologic grief grief reaction bargaining grief

grief reaction

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. non-heart-beating cadavers are not potential organ donors. clients must have an organ donor card to donate organs. nursing focus should be directed at organ donation once it is decided to withdraw life support.

hospitals are mandated to notify transplantation programs of potential donors.

The nurse anticipates a dying client to exhibit which signs of impending death? Select all that apply. incontinence restlessness loss of sensation flushed extremities increased body temperature Cheyne-Stokes respirations

incontinence restlessness loss of sensation Cheyne-Stokes respirations

The experience of parting with an object, person, belief, or relationship that one values is defined as: loss. bereavement. grief. death.

loss

The children of a male client with late-stage Alzheimer disease have informed the nurse on the unit that their father possesses a living will. The nurse should recognize that this document is most likely to: specify the treatment measures that the client wants and does not want. dictate how the client wants his estate handled after his death, and by whom. make legal provisions for active euthanasia. give permission for organ donation.

specify the treatment measures that the client wants and does not want.

Palliative care is a structured system for care delivery. What is its aim? to give traditional medical care to prevent and relieve suffering to bridge between curative care and hospice care to provide care while there is still hope

to prevent and relieve suffering

Following surgery, the surgeon informed the client's spouse that invasive cancer was found during the procedure and the client may only have days to live. The client's spouse has told the health care provider and the nurse that they do not want the client to know the severity of the diagnosis. How will the nurse respond? not disclosing any information to the client understanding that learning about impending death will create unnecessary worry understanding that this directive would violate the client's rights understanding that the client's spouse has the right to direct care for the dying client

understanding that this directive would violate the client's rights

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? Restitution Awareness Outcome Idealization

Idealization

A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education? "Palliative care provides relief from pain and other distressing symptoms." "Hospice care programs focus on quality rather than length of life." "In hospice care, nurses take on the responsibility of making care decisions for clients." "Palliative care affirms life and regards dying as a normal process."

"In hospice care, nurses take on the responsibility of making care decisions for clients."

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." "There is no way I can stay in the hospital because my parent is sick." "I do not think my parent really has cancer. I think my parent needs to get a third opinion." "It is fine if my parent dies. We have not been close for years."

"My parent is suffering with cancer and death will be a relief of the pain."

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? "I think you are correct. Something is wrong with your loved one." "Not everyone experiences grief in the same way and your loved one needs our support." "Sometimes people become suicidal and we will place your loved one in restraints." "Most people go through all sorts of feelings and your loved one is no different."

"Not everyone experiences grief in the same way and your loved one needs our support."

Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning? Administer sedation and analgesia. Provide an explanation of the process. Offer emotional support to the family. Have the client's family remain at the bedside.

Administer sedation and analgesia.

Assisted suicide is expressly prohibited under statutory or common law in the overwhelming majority of states. Yet public support for assisted suicide has resulted in a number of state ballot initiatives. The issue of assisted suicide is opposed by nursing and medical organizations as a violation of the ethical traditions of nursing and medicine. Which scenario would be an example of assisted suicide? Administering a lethal dose of medication Administering a morphine infusion Granting a client's request not to initiate enteral feeding when the client is unable to eat Neglecting to resuscitate a client with a "do not resuscitate" status

Administering a lethal dose of medication

The nurse is caring for a client who has just expired. Which action will the nurse perform? Provide a complete bath. Place the client in a semi-Fowler's position. Allow the client's family to see the client's body before it is discharged. Have the nurse technician place identification tags on the outside of the shroud.

Allow the client's family to see the client's body before it is discharged.

The hospice nurse is caring for a client with lung cancer. The client's daughter states, "My mom isn't happy with anything I do for her. It's not like her to be so hypercritical." The nurse understands that the client is likely in which stage of grief according to Kübler-Ross? Depression Anger Bargaining Denial

Anger

Which statement regarding perceptions of death by children is accurate? Toddlers perceive death as irreversible and unnatural. Preschool-age children view death as a spiritual release. At about age 9, the child perceives death as irreversible. Adolescents tend to respond to death and grief better than adults

At about age 9, the child perceives death as irreversible.

A graduate nurse enters a client's room and finds the client unresponsive, not breathing, and without a carotid pulse. The graduate nurse is aware that the client has mentioned that he does not wish to be resuscitated, but there is no DNR order on the client's chart. What is the nurse's best action? Call a code and begin resuscitating the client. Initiate a slow-code until the health care provider arrives. Consult with the charge nurse or nurse manager before calling the code. Respect the client's wishes and avoid calling a code.

Call a code and begin resuscitating the client.

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? Avoid replacing dentures in the mouth. Place a rolled towel under the head. Cleanse drainage from the skin. Apply hairpins and clips.

Cleanse drainage from the skin.

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. The stages of grief occur linearly and are static. Some people actually skip some stages of grief altogether. The stages are relatively discrete and identifiable.

People vary widely in their responses to loss. Stages occur at varying rates among people. Some people actually skip some stages of grief altogether.

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 Denial Anger Bargaining

Depression

The partner of a client with terminal cancer is afraid of hurting the client during sexual intercourse. Which action by the nurse is likely to be most helpful in reducing this client's fears? Encourage discussion between the client and their partner regarding their intimacy needs Reassure the client's partner that they cannot hurt the client during sexual intercourse Inform the client's partner that the client cannot have sexual intercourse due to fatigue Suggest other ways the couple can spend time together, such as watching television together

Encourage discussion between the client and their partner regarding their intimacy needs

The nurse is preparing a presentation on preparing children for the death of a family member or friend. What information should the nurse include? Select all that apply. Encourage the child's distraction as much as possible Encourage expression of feelings Provide for stability and safety Praise stoicism Talk openly about death and the feelings associated with it

Encourage expression of feelings Provide for stability and safety Talk openly about death and the feelings associated with it

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 A regular apical pulse of 90 beats/minute Systolic blood pressure which rose from 100 to 110 mm Hg Cyanotic nail beds in hands and feet bilaterally

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

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 differs from palliative care in its foundational philosophy. Hospice care focuses on quality of life while palliative care focuses on length of life. Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness. Hospice provides physical and psychological support; palliative care provides social and spiritual support.

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

The oncology nurse is learning to care for dying clients. Which ideals should guide the nurse in facilitating a good death for these clients? Select all that apply. The care of the dying client should be guided by the values and preferences of the nurse. Care for dying clients should focus on pharmacologic relief of pain. Independence and dignity are central issues for many dying clients. A good death is one that allows a person to die on his family's terms. The characteristics of a good death vary for each client.

Independence and dignity are central issues for many dying clients. The characteristics of a good death vary for each client.

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 clients is covered by Medicare. Medicare does not cover costs that are not directly related to the diagnosis. Medicare does not cover pain control in the home; it must be in the inpatient care. Worry about payment should not be a concern for the client.

Inpatient pain management for hospice clients is covered by Medicare.

A client has developed cancer within eight months of their spouse's death. The nurse will consider the possibility of what cause? Unsafe living conditions Increased alcohol intake Physical effects of bereavement Self-harm

Physical effects of bereavement

The nurse is working with a client's whose wife died four years ago. Which assessment finding will prompt the nurse to prioritize assessment for dysfunctional grief? Displaying multiple photographs of his wife Talking humorously about his wife's absent-mindedness Explaining to the nurse the ways in which his life has changed Leaving his wife's clothes and belongings intact

Leaving his wife's clothes and belongings intact

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 Regular deep respirations Decreased urine output Irregular heart rate Strong, bounding pulse

Pale, cool skin Decreased urine output Irregular heart rate

A nurse caring for a client with a terminal illness understands which statement to be true? Recovery will be slow. Recovery is not expected. Recovery will be longer than 3 months. Recovery is dependent on selected treatment.

Recovery is not expected.

The nurse provides postmortem care for a client who is not undergoing an autopsy. To achieve the desired outcome of this procedure, which nursing actions should be included? Select all that apply. Remove any tubes and replace soiled dressings. Wash the client's body with soap and water. Place an identification tag on the client's ankle. Provide emotional support to the client's family. Ensure the death certificate has been signed.

Remove any tubes and replace soiled dressings. Place an identification tag on the client's ankle. Provide emotional support to the client's family. Ensure the death certificate has been signed.

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 was diagnosed with acute kidney failure. The client was being administered oxygen therapy. The client did not have any recent medical consultation. The client is an older adult with a history of hypertension.

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 resuscitated if he experiences respiratory arrest. The client should be treated with antibiotics for pneumonia. The wishes of his family should be followed. Pharmacologic interventions should not be initiated.

The client should be treated with antibiotics for pneumonia.

The home health nurse is visiting a client who has been living alone for the past 5 years following the death of the spouse. Which behavior suggests the client may be experiencing abnormal grief? The client becomes teary when talking about the deceased spouse. The client talks as if the loss just happened. The client's living environment is extremely clean and neat. The client reports attending church on a weekly basis.

The client talks as if the loss just happened.

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 frequency of urination decreases. The arms and legs are warm to touch. The client is calm and peaceful. The client's breathing becomes noisy.

The client's breathing becomes noisy.

A client that has been shot in the chest is now deceased, and the nurse is delegated to provide postmortem care. In which situation should the delegating charge nurse intervene while the nurse is providing postmortem care? The nurse is preparing to remove the IV lines from the deceased. The nurse tapes the endotracheal tube to prevent accidental removal. The nurse uses the provided tags for identification of the deceased. The nurse provides privacy and maintains dignity while performing postmortem care.

The nurse is preparing to remove the IV lines from the deceased.

What is a proper action to take when preparing a child for death? Select all that apply. The nurse should know her own feelings and beliefs. Praise stoicism. Encourage remembrance of deceased. Compare the child to the deceased. Expect the child to alternate between grieving and normal functioning.

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

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? Anticipatory grief Inhibited grief Normal grief Unresolved grief

Unresolved grief