Loss and Grieving

The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the bargaining stage of grief is the one who states:

"I just want to see my son have a family of his own."

A group of nursing students is reviewing information about children and their perceptions about death. The students demonstrate understanding of the information when they state that a child's concept about death matures at about which age?

9 years

Which of the following assessment findings would best support a nursing diagnosis of Dysfunctional Grieving?

A man is unable to return to work after his sister's death 18 months ago.

A nursing instructor is describing the stages of grief as identified by Kübler-Ross. The instructor asks the students to place the stages in their usual sequence from first to last. The students demonstrate understanding when they place the stages in which order?

Denial Anger Bargaining Depression Acceptance

The nurse is assessing a client who was diagnosed with metastatic prostate cancer. The nurse notes that the client is exhibiting signs of loss, grief, and intense sadness. Based upon this assessment data, the nurse will document that the client is in what stage of death and dying?

Depression

A male client with a diagnosis of lung cancer is seen in the clinic for follow-up care. Which nursing interventions are essential to include in this client's plan of care to address his grief? (Select all that apply.)

• Assist the client to form a support system • Help the client establish coping strategies • Promote good nutrition and sleep habits • Encourage participation in religious rituals

A terminally ill client states to the nurse, "My situation is hopeless; I have no control over anything." The nurse implements which of the following interventions to enable hope for the client?

• Encourage the client to discuss his feelings. • Sit in a chair next to the client. • Hold the client's hand.

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 nurse is conducting grief resolution for a patient 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 loss.

With the help of the nurse, the parents of an infant who died shortly after birth arrange for a funeral service. What stage of grief, according to Engel, involves the rituals surrounding loss, including funeral services?

Restitution

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 nurse assesses a terminally ill client with a DNR order, with findings of decreased blood pressure, urinary and bowel incontinence, loss of reflexes, and Cheyne-Stokes respirations. Based on these findings, the nurse recognizes that:

these are signs of impending death.

Palliative care is a structured system for care delivery that has what as its aim?

To prevent and relieve suffering

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 nurse is interviewing an older adult client who experienced a recent loss of his son due to an unexpected illness. Which question would be most appropriate for the nurse to ask when assessing the client's sociocultural stressors and resources?

"What are the traditional rituals for dealing with loss?"

The cardiac nurse, who has been caring for a hospitalized terminally ill client for 3 days, finds that the client has expired. The nurse manager knows that the nurse can legally care for these clients when the nurse states which of the following

"Hospitals are mandated to notify transplant programs of potential donors."

The psychiatrist is evaluating a client who has recently learned she has a terminal illness. Which of the following statements indicates to the psychiatrist that the client is in the Kübler-Ross stage of bargaining?

"Just let me go on vacation with my wife; then I'll be satisfied."

Kübler-Ross defines five stages of psychosocial responses to dying and death. Which statement is characteristic of the bargaining stage?

"Just let me live to see my grandson born."

Which of the following phrases can do much to instill hope in the dying patient?

"Let me tell you about your illness."

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 of the following statements 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

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 the best quality of life through which means?

Aggressive management of symptoms.

Which of the following is an example of a perceived loss?

An older client grieves for the loss of his independence.

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 man is diagnosed with terminal kidney failure. His wife demonstrates loss and grief behaviors. What type of loss is the wife experiencing?

Anticipatory loss

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 of the following signs indicates approaching death?

Breathing becomes noisy

A client at a health care facility has died after a prolonged illness. A nurse is assigned to perform post-mortem care for the client. Which of the following interventions should the nurse perform when providing post-mortem care?

Cleanse drainage from the skin.

Although all of the following are factors that affect grief, which one is most likely to influence a person's expression of grief?

Cultural influences

The nurse is giving palliative care to a client with a diagnosis of COPD. What is the goal of palliative care?

Improve the client's and family's quality of life.

The nurse is caring for a patient who has terminal lung cancer and is unconscious. What assessment would indicate to the nurse that the patient's death is imminent?

Mottling of the lower limbs

A nurse is caring for a young client with acute renal failure who is dying. What care should the nurse take when helping dying clients to cope?

Provide opportunities for the client to express his or her feelings freely.

A nurse is caring for a client with a terminal illness. Which of the following is true of a terminal illness?

Recovery is beyond reasonable expectation.

An elderly client at a health care facility dies after a prolonged illness. Which of the following is a psychological reaction associated with the different stages of grief?

Refusal to accept death

A nurse who provides bereavement counseling is working with the family of a child who recently died from cancer. Which of the following statements may be a common expression of grief and guilt by a family member?

Sister: "It is all my fault; I wanted him to die."

A dying patient is crying. She states, "I can't pray. I can't forgive myself." What would be an appropriate nursing diagnosis based on this data?

Spiritual Distress

A hospice nurse is providing emotional care and support for a family who lost a son. The care will be provided based on what knowledge?

Stages of grief reactions may overlap and are individualized.

A nurse visits the grieving family of a client who died following an accident. Which of the following signs by a family member indicates resolution of grief?

Talks about the deceased without becoming overwhelmed

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

The dying client usually exhibits anger first.

A patient 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 patient 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.

A nurse providing palliative care for a dying man and his family knows that the goal of palliative care is what?

To aggressively treat the symptoms of the disease.

The husband of a client who died of breast cancer is still grieving for his wife two years later. What type of grief is he experiencing?

Unresolved