Fundamentals Final

Which statement made by a client with terminal illness indicates acceptance of the diagnosis?

"I have made my will and made arrangements for my daughter to live with her grandparents."

A nurse is caring for a terminally ill patient who says, "I just can't sleep. I keep worrying about what my family will do when I am gone." What response by the nurse is most appropriate?

"What seems to be concerning you the most?"

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."

"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 client tells the nurse, "My attorney is coming in today to complete a will." Which statement is another indication that the client is accepting death?

"My family is strong, and they will be okay."

A nurse is caring for a client who has stage IV lung cancer and is 3 days postoperative following a wedge resection. The client states, "I told myself that I would go through with the surgery and quit smoking, if I could just live long enough to attend my child's wedding." Based on the Kubler-Ross model, which stage of grief is the client experiencing?

Bargaining

It has been determined that a client who sustained a head injury following a motorcycle accident is brain dead. The client did not have an organ donation directive. However, the client did have records to indicate a wish not to have prolonged life support. What is the most appropriate action for the nurse?

Contact the organ procurement team to discuss organ donation with the family.

A nurse is caring for a client who has a terminal illness. Death is expected within 24 hr. The client's family is at the bedside and asks the nurse what to expect at this time. Which of the following findings should the nurse include?

Decreased muscle tone

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

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

The dying client usually exhibits anger first.

Which situation is most likely to warrant an autopsy?

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

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."

The nursing student is learning how to care for clients whose death is expected within a limited period of time. Which statement makes the faculty member believe the student has mastered this topic?

"Many clients know they have a terminal illness by picking up on nonverbal communication."

A nursing instructor has finished presenting information to a group of nursing students on the factors that influence the grieving process. Which statement by a student would indicate a need for further education?

"A death that occurs as a result of natural causes is just as stressful as a death from homicide or suicide."

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 psychologist is teaching students about the factors that affect a person's reaction to grief. Which statements by the students about developmental considerations are accurate? Select all that apply.

"Death of a parent can delay a child's development." "Sense of loss for a child is just as great as it is for an adult."

A patient tells a nurse that their daughter has been appointed to make decisions for them should they become incapacitated. What follow-up question would the nurse ask?

"Do we have a copy of your durable power of attorney for health care?"

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?"

A terminally ill client asks the nurse what assisted suicide is. Which response is best for the nurse to provide?

"It is when a lethal combination of drugs is made available to the client wishing to die."

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 diagnosis?

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

A group of nursing students in a leadership course are studying the ANA position regarding assisted suicide. The professor asks the students for the best response to a note written by a ventilator-dependent patient "help me end my suffering, I don't want to live anymore." Which nursing response is consistent with the ANA's position?

"I will do everything possible to keep you comfortable but will not administer medication to cause your death."

The nurse is talking with the family after their loved one died. What words of support and comfort would be most therapeutic for the nurse to say after this event?

"I would like to sit here with you and listen."

A home health care nurse has been caring for a patient with advanced AIDS who is working through the stages of death and dying. The nurse documents the patient has entered the acceptance phase of death when the patient makes which statement?

"I've made peace with everyone, and I'm actually ready to move on."

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 patient tells the nurse it is unfair that they should have to die now when they have finally made peace with their family. Which response by the nurse would be most appropriate?

"It does seem unfair. Tell me more about how you are feeling."

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."

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."

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

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."

The nurse visits a client in the home who is at the end stage of life from stage IV colon cancer and observes that the client is in obvious pain. The nurse asks the spouse when the client last had medication for pain and the spouse reports withholding the pain medication, fearing the client will become addicted. How should the nurse respond to the spouse?

"The fear of addiction should not prevent the client from obtaining adequate pain relief so let us discuss the schedule of medication."

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."

A client is admitted to the hospital with a medical diagnosis of terminal lung cancer. Which question is most important for the nurse to ask first?

"What have you been told about your condition?"

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?"

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?"

A nurse is consoling the partner of a client who just died after a long battle with liver cancer. The grieving partner states, "I hate them for leaving me." Which of the following statements should the nurse make to facilitate mourning for the partner? (SATA)

"Would you like me to contact the chaplain to come and speak with you?" "You know, it is quite normal to feel anger toward your loved one at this time." "Tell me more about how you are feeling."

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 nurse midwife is assisting a patient whose birth plan states she is firmly committed to natural childbirth. When informed the infant is in distress and a cesarean delivery is necessary, the pregnant patient sobs inconsolably, calling herself a failure. The nurse offers emotional support based on what likely types of losses? Select all that apply.

Actual Perceived Psychological

Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning?

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

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

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 nurse is about to perform postmortem care of a client. The family wishes to view the body. Which of the following actions should the nurse take? (SATA)

Apply fresh linens and place a clean gown on the body. Remove all equipment from the bedside. Dim the lights in the room.

The nurse makes a home visit for a client whose 12-year-old child died 4 years ago. The nurse finds the child's room with all belongings still intact. The client also speaks as if the child is still alive. Which action would the nurse take in this situation?

Arrange for individual counseling for the client.

Which statement regarding perceptions of death by children is accurate?

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.

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 patient with end-stage breast cancer has been in the medical intensive care unit for 3 weeks. Her husband tells the nurse that his wife was very clear about not wanting aggressive treatment that would merely prolong her dying. Which type of order could the nurse suggest the husband discuss with his wife's health care provider?

Comfort Measures Only

A client has been declared brain dead following a fall from a roof. The client's advance directives state they do not wish to have prolonged life measures, and that only the heart, kidneys, and liver should be donated. The client's spouse wants to also donate the client's corneas. What is the appropriate nursing action?

Contact the organ procurement team to discuss organ donation with the spouse.

The nurse is preparing a presentation on preparing children for death. What information should the nurse include? Select all that apply.

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

A client comes to the hospital because of complications related to newly diagnosed terminal cancer. The client is concerned about how his wife is coping with the diagnosis. Which information is important for the nurse to obtain to assess factors that may affect the family member's grief? Select all that apply.

Financial concerns Cultural practices Religious beliefs Social support

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

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 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.

The hospice nurse is educating a client's family on the physical signs of approaching death. The nurse identifies that the education has been effective when the family says they will know that death is imminent when they see which related symptoms? Select all that apply.

Irregular respiratory rate Restlessness Bowel incontinence Cyanosis of dependent areas

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.

The nurse is discussing end-of-life decisions with a client who has terminal cancer. Which statements describe the client's options? (Select all that apply.)

Living wills provide specific instructions about the kinds of health care that should be provided or foregone in particular situations. The Patient Self-Determination Act of 1990 requires all hospitals to inform their clients about advance directives. The status of advance directives varies from state to state.

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? Select all that apply.

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

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 in the intensive care unit is preparing a patient's family for terminal weaning from mechanical ventilation. What nursing actions would facilitate this process? Select all that apply.

Offering the family information about the advantages and disadvantages of continued ventilatory support Explaining to the family what will happen at each phase of the weaning and offer support Validating orders for sedation and analgesia to promote comfort and dignity

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 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.

A nurse is caring for a client who has terminal lung cancer. The nurse observes the client's family assisting with all ADLs. Which of the following rationales for self-care should the nurse communicate to the family?

The client's sense of loss can be lessened through retaining control of some areas of life.

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.

A hospice nurse who cared for a dying patient and their family documents that the family is experiencing a period of mourning. Which behaviors would the nurse expect to see at this stage? Select all that apply.

The family arranges for a funeral for their loved one. The family arranges for a memorial scholarship for their loved one. The patient's daughter writes a poem expressing her sorrow.

The nurse is teaching a client with terminal cancer who is interested in hospice care. Which home hospice benefits will the nurse explain? Select all that apply.

The nurse and health care provider are on call 24 hours, every day of the week. Counseling services are available. Pain will be managed with medication, if needed. Homemaker services can be included.

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. Encourage remembrance of deceased. Expect the child to alternate between grieving and normal functioning.

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.

An older adult who recently moved into a long-term care facility tells the nurse their only son died 20 years ago, and they haven't enjoyed life since. When giving report to the next shift, the nurse tells the oncoming nurse the resident seems to be suffering from which type of grief?

Unresolved

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

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 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

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

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 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

A widow develops cancer within 6 months of her husband's death. This may be a result of:

bereavement

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

When planning care for a 55-year-old client with newly diagnosed terminal pancreatic cancer, which nursing concern is most appropriate for the care plan?

death anxiety

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 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?

depression

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 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):

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

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

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.

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

A nurse is providing postmortem care. Which of the following nursing actions is a legal responsibility?

placing ID tags on the shroud and ankle

Which stage of grieving is exhibited by the husband of a victim of sudden death who refuses to accept that she is dead?

shock

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.

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