Fundamentals Nursing Chapter 42 Loss, Grief, and Dying

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 is caring for a client that has been recently informed that biopsy results have returned with a diagnosis of metastatic liver cancer. The client states to the nurse, "I think they have misdiagnosed me or got someone else's results mixed up with mine. There is no way I am sick enough to have cancer." What stage of the dying process is the client 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The nurse has noted that a dying client is increasingly withdrawn and is often teary at various times during the day.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

The hospice nurse is visiting the wife of a client who died 10 months ago. The wife states, "My life is meaningless since my husband died." The nurse recognizes that the client is in which stage of grief?

Disorganization

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

A client with a terminal illness is being cared for at home. When caring for a client who is in home care, the nurse discusses the importance of respite care. Which of the following interventions leads to respite care?

Encouraging the caregiver to identify surrogate caregivers

A terminally ill client told her family, "I am ready to die." Her family is very upset that she has given up and wants the nurse to intervene. Which nursing intervention is most appropriate?

Explain to the family that acceptance is part of the grieving process.

A client is being discharged from the hospital with terminal brain cancer and a life expectancy of 1 month. When planning this client's discharge, it is most important for the nurse to include a referral to which agency?

Hospice

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.

After the death of a terminally ill spouse, a client reports frequent headaches and loss of appetite. The client states, "How am I going to live without him?" What type of grief is the client experiencing?

Inhibited grief

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.

A widower who continues to improve his level of functioning better than before the loss is best described at which stage of the Grief Cycle Model?

Reorganization

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

Shock *In the shock and disbelief stage, the survivor either refuses to accept the loss or shows intellectual acceptance of the loss but denies the emotional impact.

The children of a male client with late-stage Alzheimer's 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 do which of the following?

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

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. Which of the following should happen in this case?

The client should be treated with antibiotics for pneumonia.

The hospice nurse is assessing the wife of a client who died 14 months ago. The nurse is concerned that the wife is still grieving the death of her husband. Which objective assessment finding would suggest that the wife is not still grieving?

The wife's hair is clean and styled.

The husband of a patient 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 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 terminally ill client states, "I am ready to die." What stage of grief does the nurse suspect?

acceptance

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 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 caregiver of a client who is terminally ill is becoming short tempered with the client and states, "I just can't take this anymore." Which nursing response is most appropriate?

"Have you considered respite care so that you can rest for a few days?"

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."

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."

Which client statement would cause the nurse to suspect that the stage of bargaining has been reached in the grief process?

"If I can just live long enough to see my daughter get married."

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."

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."

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 nurse is documenting care provided following the death of a client with terminal cancer who lived in a long-term care facility. Which statement will the nurse document first?

"No breathing noted and no pulse at 0932."

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."

"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."

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."

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?"

The client has a new diagnosis that requires high-risk treatment. The client is indecisive about treatment and states, "I don't know what to do." The nurse determines that the most appropriate outcome is that the client will:

report feelings of peace about the decision regarding treatment.

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 physician-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 of the following would be an example of assisted suicide?

Administering a lethal dose of medication

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 middle-age woman is mentally preparing for the death of her mother. What is the term for this mental preparation?

Anticipatory grieving

An appropriate nursing diagnosis for the family of a client dying of cancer, whose members have expressed sorrow over the forthcoming loss, would be:

Anticipatory grieving related to loss of family member, as evidenced by sorrow

Which statement regarding perceptions of death by children is accurate?

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

The nurse is caring for a client who is dying. She overhears the client saying, "God, if you will only let me live to see my daughter get married, I promise I will start going to church again." The nurse understands that the client is in which stage of grief according to Kübler-Ross?

Bargaining

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

Bargaining

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 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?

Client's breathing becomes noisy.

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 male client with newly diagnosed terminal pancreatic cancer, which nursing diagnosis would be most appropriate?

Death anxiety

A client has been asked to undergo a series of diagnostic tests following a routine blood test that indicates leukemia. The client refuses to believe the diagnosis and feels that there has been an error in the reports. Which stage of grief is the client going through?

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 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 widow has just returned home from the funeral of her husband. She feels alone in her home. Her family has left to go back to their home in another area of the country. What stage of Engel's model does this represent?

developing awareness

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

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

The experience of parting with an object, person, belief, or relationship that one values is defined as:

loss

Which care environment would the nurse suggest to a client with no family near by who is diagnosed with end-stage lung disease?

residential care

The nurse is making sure that all factors are in place for a client's death certificate. What potential error does the nurse identify may occur?

the client had a condition that has the potential to temporarily suspend life process.

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 physician and the nurse that they do not want the client to know the severity of the diagnosis. How will the nurse respond?

understanding that this directive would violate the client's rights

A nurse is assessing the spouse of a client who has just died. Which subjective findings of grief would the nurse expect to assess? Select all that apply.

• Detachment • Bitterness • Preoccupation with the loss

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.

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 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

A nurse is assessing a dying client for realism of expectations and perception of condition. Which interview questions address this concern? Select all that apply.

• Have you had any previous experience with this condition before? • How do you see the next few weeks playing out? • What do you think may be happening in the midst of all of this?

The nurse anticipates a dying client to exhibit which signs of impending death? (Select all that apply.)

• Incontinence • Restlessness • Loss of sensation • Cheyne-Stokes respirations

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

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.

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.

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 • Place an identification tag on the client's ankle • Provide emotional support to the client's family • Ensure the death certificate has been signed

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 physician 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.

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 physician's signature is required on a death certificate. • It is the nurse's responsibility to ensure that the physician has signed a death certificate. • A death certificate is signed by the pathologist, the coroner, and others in special cases.

The hospice nurse is caring for a client with allow natural death (AND) orders. The nurse assesses that the client has a slow, irregular heart rate, has cooling of the extremities, and is agitated. Which interventions can the nurse implement? (Select all that apply.)

• Use medication to lower client consciousness to limit awareness of suffering • Allow the client to stop drinking fluids • Do not perform cardiopulmonary resuscitation

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 hospice nurse is assessing a client with end-stage chronic obstructive pulmonary disease (COPD). Which assessment findings would suggest that the client is dying? Select all that apply.

• jaundiced skin • Cheyne-Stokes respirations • decreased urine output