Fundamentals of Nursing EAQs Ch. 42 Death and Loss

The nurse has identified three nursing diagnoses for a patient who is having anxiety and hopelessness as a result of a loss. Which approach should the nurse take when prioritizing nursing diagnoses? Select all that apply.

- Ask the patient to identify the most distressing symptom and address that problem first. - Use nursing knowledge to address the problem that is the underlying cause of other diagnoses.

Which cultural practices are commonly followed by Asian Americans during mourning? Select all that apply.

- Displaying a memorial of the deceased at home - Providing warm clothes for the deceased to wear

An older adult with muscular dystrophy has chronic body aches and is in a state of hopelessness. On a home visit, a nurse finds that the patient eats less and has lost significant weight. Which nursing interventions would promote nutritional status in the patient? Select all that apply.

- Encourage consumption of food that the patient prefers - Arrange for home delivery of food - Plan for social activities that involve eating

Which intervention should the nurse implement in the care plan for a patient who is grieving the loss of a loved one? Select all that apply.

- Encourage the patient to include exercise. - Instruct the patient to consume a healthy diet. - Provide education about the stages of grief.

A patient in a rehabilitation clinic is recovering from the loss of a limb in a motor vehicle accident. In addition to wound care and physical therapy, which factors would the nurse assess to help the patient recover? Select all that apply.

- Family support - Behaviors indicating a grief response - The patient's point of view on the loss

A patient, newly diagnosed with colon cancer, has become withdrawn from family members. Which strategy should a nurse use to assist the patient at this time?

Encourage the patient to identify fears and verbalize feelings.

Which nursing action is best when caring for a patient who is nearing death?

Hold the patient's hand and state, "You're not alone."

The nurse is using Sheldon's stages of grief to assess a patient who lost both legs in an accident. Which behavior does the nurse anticipate from this patient during the "pangs of grief" stage?

Overwhelming sadness and anger

An adult woman is recovering from a mastectomy for breast cancer and is frequently tearful when left alone. The nurse's approach should be based on an understanding of which concept?

Patients need support in dealing with the loss of a body part.

A nurse is providing postmortem care. Which action is priority?

Providing culturally and religiously sensitive care in body preparation

The nurse is providing hospice care to a terminally ill patient who is describing bright lights and spiritual entities. Which conclusion does the nurse make regarding the patient's condition?

The patient is approaching the end of life.

The nurse observes noisy breathing when caring for a terminally ill patient. Which condition in the patient would be evaluated to determine the cause?

Thick secretions in the airway

The nurse is assessing the psychosocial condition of a patient with penile cancer and his wife. The patient's wife is indifferent to the patient. Which question would the nurse ask the couple to obtain pertinent psychosocial information?

"Can you describe to me how you feel about the current medical condition?"

A patient diagnosed with terminal lung cancer asks the nurse, "How long can I live if I quit smoking and drinking?" The nurse identifies that the patient is in which stage of grief according to Kübler-Ross?

Bargaining

The nurse determines that a patient is in the reorganization stage of grief. Which behavior has the nurse observed in this patient?

Being involved in activities and enjoying life

The nurse is using Kübler-Ross's five stages of grief to assess a patient whose son was murdered. Which response might the patient give during the anger stage?

"I will fight for justice. My son's murderer will pay!"

Which phrase describe grief?

A person's emotional response to loss

The nurse is providing bereavement support to a 7-year-old child whose mother died in an accident. How would the nurse respond when the child says, "Mama, what happened to you? Please get up and eat something"?

Tell the truth that the child's mother died and will not return

Which nursing action best reflects sensitivity to cultural differences related to end-of-life care?

Ask family members if they prefer to help with the care of the body after death.

The nurse assesses that a patient is experiencing complicated grief. The patient states, "I am very busy with my normal daily routine since my husband died, and I don't have time to think about it." Which type of complicated grief does the nurse identify in this patient?

Delayed

Which sign or symptom is characteristic of rigor mortis?

The joints of the body stiffen

A patient with prostate cancer is in the terminal stage of the disease and wishes to have home care. How can the nurse help the family achieve optimal end-of-life care? Select all that apply.

- Advise the family members to apply for hospice care - Provide grief support measures - Educate the family on the dying process

A patient says to the nurse, "I lost my wife a few days ago in an accident. Since then, I've been feeling lonely, unable to sleep, and cannot concentrate on anything. I'm also feeling tightness in my chest, and I think I'm going crazy." Which response by the nurse is best?

"These are all normal reactions; let's discuss some ways to handle it."

A patient who has a serious, life-limiting chronic illness wants to continue to engage in self-care and live as normally as possible. Which nursing response reflects a helpful understanding of patient self-care at the end of life?

"Which activities are most important to you, and how can you continue to do them?"

The health care provider shows a patient a chest radiograph and delivers a diagnosis of stage 2 lung cancer. Which statement made by the patient leads the nurse to conclude that the patient is in the first stage of grief according to the Kübler-Ross model?

"I don't think these results are mine."

An older adult has chronic body aches due to muscular dystrophy. The associated pain has put the patient in a state of hopelessness. A nurse suggests hospice care. Which information would the nurse include when educating the family members about hospice care? Select all that apply.

- It uses a patient- and family-centered approach to care. - The hospice team promotes patient dignity and self-esteem. - The hospice team gives preference to the patient's wishes.

A patient is diagnosed with breast cancer and expresses sadness and disappointment. Which assessment activities are appropriate when planning care for this patient? Select all that apply.

- Observe her nonverbal behavior - Assess her response to care options. - Observe her interactions with others.

A hospice nurse is caring for the family of a patient who has just died. Which interventions should the nurse implement in caring for the family? Select all that apply.

- Offer family members the option to view the body - Be present

The nurse suggests that a patient receive a palliative care consultation for symptom management related to anxiety and increasing pain. A family member asks the nurse if this means that the patient is dying and is now "in hospice." Which explanation does the nurse give the family member about palliative care? Select all that apply.

- Palliative care is for any patient, any time, any disease, in any setting. - Palliative care interventions relieve the symptoms of illness and treatment.

Which nursing interventions should the nurse implement to provide comfort to a patient who is actively dying? Select all that apply.

- Play comforting music in the room. - Give the patient a gentle bath. - Use a moistening agent on the patient's lips.

A patient is terminally ill due to a chronic respiratory illness. Which interventions would the nurse include in the care plan for this patient? Select all that apply.

- Provide comfort. - Preserve dignity and quality of life. - Provide social support to family members.

Which emotions and experiences are common during Sheldon's "pangs of grief" stage? Select all that apply.

- Sadness - Insomnia - Social withdraw

Which are stages of grief and loss according to Sheldon's theory? Select all that apply.

- Shock - Despair - Pangs of grief

A nurse understands that grief can come in many forms. Exaggerated grief is a type of complicated grief. Which statements are true about exaggerated grief? Select all that apply.

- Suicide is a risk for these patients. - The patient exhibits maladaptive behavior. - The patient exhibits self-destructive behavior.

A patient has passed away after a massive heart attack 5 days following hospitalization. Which nursing actions are performed for the family to facilitate mourning? Select all that apply.

- Supporting the family's efforts to adjust to the loss - Helping the family accept the reality of the loss

In which stage of mourning described by Bowlby's model of grief does a person accept change, acquire new skills, and build new relationships?

Anger

A woman experiences the loss of a very early term pregnancy. Her friends do not mention the loss, and someone suggests to her that she can "always try again." The woman feels confusion over her sadness and stops talking about it with others. Which type of grief response is this patient most likely experiencing?

Disenfranchised

The nurse notes that a patient refuses to share feelings and does not express grief. After communicating with the patient, the nurse discovers that the patient's former spouse recently died. Which type of grief does this patient behavior reflect?

Disenfranchised

A patient diagnosed with colorectal cancer underwent successful surgery. However, chemotherapy will be needed because the cancer has spread to other organs. The patient asks the nurse whether the spread of cancer will stop if she stops smoking and consuming alcohol. Which stage of grieving is the patient experiencing?

Bargaining

How can the nurse actively communicate with a terminally ill patient?

By asking open-ended questions

A nurse is caring for a patient who is terminally ill. The nurse finds that the patient experiences chronic pain, deficient food intake, fatigue, and hopelessness. In this situation, which nursing diagnosis does the nurse identify as most important to address?

Chronic pain

A patient lost a sibling in a car accident and lost his job on the same day. The patient does not seem upset about the job loss. Which type of grief is indicated by the patient's presentation?

Delayed grief

A 1-year-old child lost his mother in a car accident. The child refuses to eat and has sleep disturbance. Which factor is most likely responsible for this response?

Developmental stage

Which stages of dying are based on Kübler-Ross's classic behavioral theory? Select all that apply.

- Anger - Denial - Depression

Which types of grief are considered types of complicated grief? Select all that apply.

- Chronic - Delayed - Masked - Exaggerated

While caring for a hospice patient, the nurse observes that the patient is experiencing nearing death awareness. Which signs might be observed by the nurse? Select all that apply.

- Confusion - Making hand gestures - Holding unseen objects

Which behavior shows that a terminally ill patient is experiencing the stages of grief? Select all that apply.

- Denial - Depression - Acceptance

A nurse is caring for terminally ill patients in a hospice setting. The senior nurse explains Worden's Grief Tasks Model to the junior staff. Which activities would the nurse identify as aspects of this Grief Tasks Model? Select all that apply.

- Experiencing the pain of grief - Adjusting to a world in which the deceased is missing - Emotionally relocating the deceased and move on with life

A patient's breast biopsy results are positive for cancer. The patient says that there is some mistake and that she cannot have breast cancer. Which actions would the nurse take to provide further information to this patient? Select all that apply.

- Explain the situation to her relative or significant other. - Carefully explain the significance and need for prompt tumor removal.

A patient is upset due to the terminal illness of his parent. How should the nurse educate the patient about anticipatory grief and its management? Select all that apply.

- Explain to the patient that he will eventually become mentally prepared for the loss. - Explain that his grief cannot be controlled by willpower, as it is an unconscious process.

A patient is being evaluated in the emergency room with a complaint of gasping for breath. Despite receiving basic life support measures, the patient expires. Which actions does the nurse take in providing postmortem care? Select all that apply.

- Follow through with any organ donation arrangements - Clean any soiled areas of the body and apply a clean gown - Accommodate the family's religious wishes, if possible

Which cultural practices are commonly followed by African Americans when mourning? Select all that apply.

- Having music and singing at the wake and funeral - Including a meal for friends after the wake and funeral

After assessment, the nurse finds that a patient is near death. Which findings led the nurse to this conclusion? Select all that apply.

- Hearing the death rattle - Decreased urine output - Decreased blood pressure

While assessing the beliefs regarding death in various ethnic groups, the nurse learns that members of which religious groups practice cremation? Select all that apply.

- Hindus - Buddhists - Christians

A nurse is explaining hospice care to the family members of a patient who has had a massive stroke. Which information would the nurse provide to the family members? Select all that apply.

- Hospice is a program that provides care for terminally ill patients. - Hospice manages the patient's pain and provides comfort. - Hospice services are available at home as well as hospital settings.

A patient is diagnosed with advanced leukemia and is hopeless about the treatment. Which nursing interventions would help the patient overcome hopelessness? Select all that apply.

- Treat chronic pain - Identify sources of social support - Provide opportunities to express positive life events

Which behaviors does the nurse avoid when addressing his or her own feelings of loss and fear of mortality in order to provide effective care to a patient who is dying? Select all that apply.

- Using defense mechanisms - Avoiding the expression of emotions - Focusing only on the patient's physical needs

Which patient is most likely to experience disenfranchised grief?

29-year-old who has undergone an abortion

A family member of a recently deceased patient talks casually with the nurse at the time of the patient's death and expresses relief that she will not have to visit at the hospital anymore. Which theoretical description of grief best applies to this family member?

Anticipatory

According to Sheldon's theory of grief, which emotional experiences are seen in an individual during the despair stage?

Loss of meaning and direction in life

Two friends were involved in a motor vehicle accident; one died, and the survivor attempted suicide due to feeling responsible for the friend's death. Which grief type is indicated by the patient's presentation?

Exaggerated

The nurse is assessing a patient who is emotionally overwhelmed because of the death of the patient's father. The nurse learns that the patient is taking illicit drugs. Which type of grief does the nurse infer from the patient's behavior?

Exaggerated grief

The registered nurse is evaluating a student nurse who is preparing a body for autopsy in the morgue. Which nursing action implemented by the student nurse indicates the need for further teaching?

Removing the nasogastric tube from the body