Loss, Grief and Dying Davis Edge Questions

Which are factors that affect a person's grief and grieving process? Select all that apply. 1. Support system 2. Significance of the loss 3. Gender 4. Unresolved conflicts 5. Length of time of grief

1: A strong support system can help a person through the grieving process. 2: The greater the significance of the loss, the more intense the grief. 4: If a person experiences a loss in which there are unresolved conflicts, this may make the relationship seem unfinished, and it may intensify grieving.

The nurse is talking with family members of a client who has been diagnosed with terminal cancer. Which physiological changes should the nurse tell the family to expect in the client 1 to 2 weeks prior to death? Select All That Apply. 1. Yellowish skin color 2. Increased perspiration 3. Nonproductive cough 4. Elevated blood pressure 5. Anorexia and ketosis

1: A week or 2 weeks prior to death, the client will experience cardiovascular changes that can cause a change in skin color, creating a yellowish pallor. 2: The client will develop increased perspiration within 1 to 2 weeks of death. 3: Within 1 to 2 weeks of death, the client will develop a rattling pulmonary congestion with a nonproductive cough.

Which types of loss describe loss of something tangible? Select all that apply. 1. External loss 2. Physical loss 3. Loss of relationship 4. Perceived loss 5. Environmental loss

1: An external loss is the loss of something of sentimental or monetary value. 2: Physical loss involves the loss of a body part, such as a limb, or functional ability. 3: The loss of a relationship is an actual loss of something tangible.

The nurse is preparing to provide postmortem care for a client of Orthodox Jewish faith. What should the nurse do first, since the nurse practices another faith? 1. Handle the body as little as possible. 2. Call in the chaplain to perform any rituals. 3. Perform routine postmortem care as soon as possible. 4. Notify the ethics committee prior to performing postmortem care.

1: According to the Orthodox Jewish faith, a non-Jewish person should handle the deceased body as little as possible.

How should a nurse behave in the presence of a client who is dying? 1. Communicate as though the client can still hear and understand everything being said. 2. Converse about the client to family members in the client's presence, since the client is unresponsive. 3. Avoid speaking altogether when providing care for a dying client. 4. Speak in a very loud voice, since dying clients experience hearing loss.

1: In most instances, dying clients who are unresponsive are able to hear and understand everything being said.

A hospice nurse observes a widower drinking heavily after the loss of a spouse. Which type of grief is this person experiencing? 1. Masked grief 2. Delayed grief 3. Anticipatory grief 4. Disenfranchised grief

1: Masked grief is expressed grief through maladaptive behaviors that can include alcohol abuse, drug use, or increased fighting.

A client's caregiver frantically calls the hospice nurse because the client stops breathing for short amounts of time and then takes slow, shallow breaths. What is the nurse's best response? 1. "This breathing pattern indicates death may occur in hours or days." 2. "Notify the emergency medical services, as this is not expected to happen." 3. "This is a normal pattern for someone who will pass away in 1 to 2 weeks." 4. "Document the breathing pattern on a sheet of paper, and we will notify the health-care provider."

1: This breathing pattern is referred to as Cheyne-Stokes breathing and is an expected finding in clients who will pass away within hours or days.

Which would be appropriate nursing diagnoses when dying or grieving is the primary problem? Select all that apply. 1. Grieving related to recent death of spouse 2. Ineffective coping related to extended grief period 3. Spiritual distress related to impending death of family member 4. Self-care deficit related to exhaustion from caring for a terminally ill family member 5. Knowledge deficit related to not understanding appropriate grieving process

1: A state of grief following the death of a spouse is an appropriate nursing diagnosis. 3: A person facing an impending death of a loved one may certainly exhibit spiritual distress. 4: Caregiver fatigue is common among those who are caregivers for chronically or terminally ill family members.

A hospice nurse informs the nursing supervisor of "feeling overwhelmed and upset due to dealing with dying clients." What information can the nursing supervisor provide to alleviate the hospice nurse's concerns? Select All That Apply. 1. "These feelings of grief are normal and acceptable." 2. "Do you need to discuss your feelings with a counselor or chaplain?" 3. "You should do something for yourself, such as a movie or bubble bath, to relax." 4. "Maybe you can take a short leave of absence to gather your thoughts and composure." 5. "Explain to the family your feelings of grief and spend time with the family discussing the client."

1: Grief is natural for a nurse who deals with death on a daily basis. 2: It would be appropriate for the nursing supervisor to provide the nurse with resources to discuss feelings. 3: The nursing supervisor could suggest the nurse do something relaxing as a way to decompress and process grief.

A client with terminal cancer is in the last few hours of life and agitated. Which factors can cause agitation in this client? Select All That Apply. 1. Hepatic failure 2. Visual changes 3. Cerebral hypoxia 4. Bowel incontinence 5. Medication side effects

1: Hepatic, or liver, failure can lead to anxiety as toxins build up. This is common as clients approach death. 3: Lack of oxygen to areas of the brain can cause anxiety in terminally ill clients approaching death. 5: Medications such as narcotic analgesics can cause anxiety in a terminally ill client approaching death.

Which findings related to circulation would the nurse expect to find in a client within hours to days of death? Select All That Apply. 1. Mottling of the extremities 2. Decreased blood pressure 3. Bounding peripheral pulses 4. Diminished urinary output 5. Cheyne-Stokes respirations

1: Mottling of the extremities occurs when circulation decreases in a client nearing death. 2: As circulation begins to decrease, so will the client's blood pressure. 4: Urinary output decreases when circulation is diminished, due to decreased renal perfusion.

Which are the main premises of hospice care? Select all that apply. 1. Quality of life is as important as the length of life. 2. All illnesses should be treated aggressively. 3. Lifesaving measures should always be implemented, even if the illness is not curable. 4. Those who are terminally ill should be allowed to face death with dignity surrounded by family and loved ones. 5. No efforts will be made to treat or reduce symptoms of illness.

1: One of the main premises of hospice is to maintain the quality of life for as long as possible. 4: Part of improving the quality of life for dying persons is allowing them to make decisions for themselves and to be with loved ones in their final days.

A nurse is explaining the benefits of hospice services to a client with end-stage chronic obstructive pulmonary disease. Which statements best explain hospice? Select All That Apply. 1. Quality of life is more important than length of life. 2. Clients have the right to die with dignity. 3. Clients should be surrounded by family when they are dying. 4. Emergency medical treatment can be provided for hospice clients. 5. Hospice services are provided for clients with six months or less life expectancy.

1: One of the premises of hospice is that quality of life is more important than quantity. 2: All clients have the right to die with dignity, and hospice promotes dignity. 3: Hospice services believe that clients should be surrounded by family when they are dying. 5: The prescribing health-care provider for hospice services must document that the client has a life expectancy of less 6 six months.

Which are effective ways of working through grief? Select all that apply. 1. Recalling memories 2. Trying to find distractions 3. Facilitating life review 4. Bibliotherapy 5. Expressing feelings

1: Recalling memories can be very therapeutic for clients and families at end of life. A nurse can ask questions about particular objects or photos. 3: Reviewing and finding meaning in one's life can be therapeutic and reassuring. Recognizing a person's unique contributions can validate the client's life. 4: Bibliotherapy is the use of guided reading to increase awareness and understanding and promote healing. 5: Expressing and sharing feelings can be very helpful for clients and families as they deal with end-of-life issues and grief.

Which tasks will the nurse perform when preparing the client's body for the morgue? Select All That Apply. 1. Gently pressing on the eyelids to close the eyes 2. Removing any pillows from underneath the head 3. Padding wrists with gauze and tying the wrists together 4. Wrapping the body in a shroud or placing it in a body bag 5. Placing dentures in a cup and sending them with the body

1: The nurse should close the client's eyes prior to rigor mortis occurring. This is done by gently pressing on the eyelids to close the eyes. 3: The wrists should be padded with gauze and tied together to prevent bruising. 4: The body should be wrapped in a shroud or placed in a body bag.

Which legal responsibilities does the nurse have when a client dies? Select All That Apply. 1. Find out if the client is an organ donor. 2. Return the client's personal items to the family. 3. Notify the health-care providers of the client's death. 4. Sign the death certificate after pronouncing the client deceased. 5. Wash and clean up the body prior to the family viewing it.

1: The nurse should find out if the client is an organ donor. If so, the nurse can begin the process of preserving the organs. 2: The nurse should gather the client's personal belongings and give them to the family to prevent items being lost. 3: The nurse is responsible for notifying health-care providers of the client's death.

The nurse is working with a group of clients in a grief support group for people who have lost spouses in the past 3 months. The nurse notices each person is in a different phase of grieving. Which factors can impede a person's response to loss? Select All That Apply. 1. Having had a fight with the spouse before he or she died 2. Having lost a spouse with whom he or she had a close relationship 3. Having had other family members pass away within the past 2 years 4. Having few people to assist him or her during the time of loss 5. Having poor or limited financial resources to afford burial expenses 6. Having the funeral service performed a week later to allow family to come in from out of town

1: Unresolved conflicts between the surviving spouse and the deceased can influence the speed of the grieving process. 2: A person may take longer to grieve when he or she had a close relationship with the person who died. 3: Previous losses can influence the grieving process. Someone who has experienced multiple losses may take longer to heal and respond than someone who has not experienced multiple losses. 4: The amount of people the person has in his or her support system can impact the amount of time a person experiences grieving.

According to John Bowlby's phases of grief, which client action indicates the yearning and searching phase of grieving? 1. Spraying the deceased person's cologne on his or her pillow 2. Displaying feelings of helplessness and disorientation 3. Beginning to forget appointments and tasks that need to be completed 4. Including activities in daily life such as reading, traveling, and exercising

1: When a person is in the yearning and searching phase of grieving, he or she is looking for ways to connect with the deceased person. Spraying the deceased person's cologne on the pillow indicates looking for ways to maintain a connection.

Which are appropriate questions a nurse could ask to help establish a client's goals at end of life? Select all that apply. 1. "What is your pain goal, on a scale of 0-10?" 2. "Whom would you like to have in the room with you?" 3. "What would you do to prevent dying?" 4. "Is there anything you would still like to do?" 5. "Why do you think you got this illness?"

1:If a client has pain, working together with the client to set and achieve pain goals can help the client maintain control over end-of-life care. 2: Identifying the support person(s) the client would like to have will help put the client more at ease and avoid conflict. 4: Understanding any unfulfilled desires or wishes can assist with end-of-life goal setting.

The nurse is caring for a client who is recovering from a new permanent colostomy secondary to colorectal cancer. The client received the first chemotherapy treatment 2 weeks ago and is beginning to experience alopecia. Which types of loss might this client be experiencing? Select All That Apply. 1. Actual loss 2. Physical loss 3. External loss 4. Perceived loss 5. Environmental loss

1:The client with alopecia secondary to chemotherapy is experiencing the actual hair loss. 2: A client who has a permanent colostomy formed from colorectal cancer has sustained a physical loss.

Which finding would lead the nurse to believe a 6-year-old child who lost a parent is experiencing magical thinking? 1. The child places a memento in the parent's coffin. 2. The child remains hidden during the funeral service. 3. The child begins to act like a baby and wets his or her pants. 4. The child is acting out and performing risky behaviors.

2: A child who experiences magical thinking may believe he or she caused the parent to die. Behaviors such as hiding during the funeral indicate guilt on the child's part.

Which factor can both support and hinder a person's ability to grieve the loss of a family member? 1. The deceased person was elderly. 2. The family members have strong spiritual beliefs. 3. The family has given the person permission to die. 4. The members of the family have a good support system.

2: A person's spirituality or religious beliefs may provide comfort that the deceased is in a better place and in no more pain. It can also hinder grieving if the family believes in an afterlife and that the deceased is not at rest.

Which describes the change in the body that occurs when blood stops circulating? 1. Rigor mortis 2. Algor mortis 3. Livor mortis 4. Decomposition

2: Algor mortis occurs when the blood stops circulating and the body drops to room temperature.

A client's record includes an order written by a physician to not initiate resuscitative efforts in the event of a cardiopulmonary arrest. The nurse recognizes this order as which? 1. An advanced directive 2. Do not resuscitate (DNR) 3. Euthanasia 4. Durable power of attorney (DPOA)

2: Do not resuscitate is an order written by a physician, directing other members of the health-care team to not initiate resuscitative efforts in the event of a client experiencing a cardiac arrest.

Which factor most strongly affects the intensity of one's grief after a loss? 1. The coping skills of the person experiencing the loss 2. The meaning the person attaches to the loss 3. The length of the relationship with the person lost 4. Support systems available after the loss

2: Grief and loss are very individual, and a person's reaction to the loss and intensity of grief is related to the meaning attached to the loss.

Which would be an appropriate nursing intervention for a terminally ill client who loves the outdoors and nature? 1. Explain to the client that he or she should try to remember the feeling of being outside. 2. Make arrangements to allow the client to be outside with family members for a period of time each day. 3. Inform the client that it is against hospital policy to go outside, but the client can look out the window. 4. Encourage the client to use technology to simulate sights and sounds of the outdoors.

2: If possible, the nurse should allow the client to experience being outside as much as possible during end-of-life care.

Which is the most common issue that requires special consideration when providing end-of-life care of the elderly client? 1. Lack of family engagement due to the client being older 2. Failure to provide adequate symptom management 3. Lack of adequate support systems due to loss of family members 4. Ineffective physiological response to treatments or medications

2: There is research to support that elderly clients may not get adequate symptom management due to fear of suppressing respirations and hastening death.

A client is diagnosed with stage IV terminal cancer. The nurse notices that one minute the client is depressed and crying, and the next minute he or she is throwing items across the room. According to Dr. Elisabeth Kübler-Ross, which statement best explains the client's behavior? 1. A person goes through the stages of grief in a linear fashion. 2. A person may go through two or three stages of grief at the same time. 3. A person will go through each stage before moving on to the next stage. 4. A person is stuck in a stage until the nurse helps the person to move on to the next stage.

2: This client is going through more than one stage at a time. According to Dr. Elisabeth Kübler-Ross, this explains why the client is vacillating between depression and anger.

An elderly client is admitted to the hospital for treatment of heart failure. The client tells the nurse about the recent loss of his or her child and several friends in the past few years. Which findings should the nurse assess the client based on these multiple losses? Select All That Apply. 1. Elevated blood glucose levels 2. Decreased cognitive performance 3. Increased appetite and weight gain 4. Decreased independent functioning 5. Accelerated onset of physical disabilities

2: Elderly clients who have suffered the loss of a child are shown to have decreased cognitive performance. 4: An elderly client may sustain decreases in independent functioning after experiencing the loss of a child. 5: When an elderly client experiences the loss of a child, the nurse should observe for faster onset of physical disabilities.

The nurse is caring for a client who has passed away, and the family is leaving the room after spending 30 minutes with the deceased client. Which processes would the nurse expect to find occurring in the deceased client? Select All That Apply. 1. Rigor mortis 2. Livor mortis 3. Algor mortis 4. Skin breakdown 5. Neck hyperextension

2: Livor mortis occurs when blood stops circulating, breaks down, and releases hemoglobin. This accounts for a bluish and mottled skin appearance. 3: Algor mortis happens when blood ceases circulating. This allows for the body temperature to drop 1.88°F (1°C) every hour until the body reaches room temperature.

According to the Uniform Determination of Death Act of 1981, which factors must be present to declare an individual dead? Select All That Apply. 1. No response to painful stimuli 2. Irreversible cessation of cardiac functions 3. Permanent ending of respiratory functions 4. Permanent cessation of all brain functions 5. Inability to verbally communicate physical needs

2: The presence of irreversible cessation of cardiac functions is one indicator of death according to the Uniform Determination of Death Act of 1981. 3: According to the Uniform Determination of Death Act of 1981, the permanent ending of respiratory function is an indicator of death. 4: The Uniform Determination of Death Act of 1981 states that one of the indicators of death is the permanent cessation of all brain functions.

The nurse is caring for a client who is in a persistent vegetative state. A family member who visits notices the client is crying and informs the nurse the client is improving and responding to stimuli. What is the nurse's best response? 1. "Let me notify the health-care provider of this change in the client's condition." 2. "Those tears are probably from eye irritation. I can instill some eye drops." 3. "Clients in a persistent vegetative state have reflex reactions such as crying." 4. "I do not think that the client cried. This does not happen for clients in a persistent vegetative state."

3: Crying, grimacing, and laughing are spontaneous movements and are common in clients in a persistent vegetative state. This can cause the family to have false optimism and grieve all over again.

An adolescent is talking to a nurse about the loss of his or her parent. Which adolescent behavior indicates a need for intervention? 1. Attends grief and loss counseling every 2 weeks 2. Makes a scrapbook with photos of the family 3. Begins to cut his or her arms or legs 4. Stays in his or her room frequently talking on the phone with friends

3: Destructive behaviors such as cutting indicate an inability to adapt. This behavior requires a nursing intervention.

What actions should the nurse take if he or she begins to have feelings of grief while caring for dying clients? 1. The nurse should remind himself or herself that he or she is a professional and suppress these feelings. 2. Transfer to another type of care with less exposure to dying clients. 3. Acknowledge the grief and speak with coworkers who have similar job responsibilities. 4. Take a leave of absence until the grief subsides.

3: Nurses who work with dying clients usually form relationships with clients and families. It is normal to experience grief when a client dies.

What is the goal of palliative care? 1. To aggressively treat a serious illness 2. To work collaboratively to cure an illness 3. To provide comfort care to those whose illnesses are no longer curable 4. Respecting the client's decision to not perform heroic lifesaving efforts

3: Palliative care is aggressively planned comfort measures implemented when a person has an illness that is not curable.

Why is it important to close the eyes and mouth of the deceased person within 2 hours after death? 1. Because the eyes will begin to dry and change in appearance 2. Because blood vessels in the eyes will rupture and the eyes will shrink 3. Because rigor mortis begins about 2 hours after death, and the body will become rigid and unmovable 4. Because the funeral home will expect this to be done prior to picking up the body

3: Rigor mortis, which begins about 2 hours after death, will make the soft tissues and muscles rigid, and will make repositioning or movement impossible for several days.

A nurse is caring for a client who is in the dying process. He has been ill and bedridden for over a year. His wife has previously been showing signs of grief and loss, but she is now behaving in a detached manner. The nurse knows this is which type of grief reaction? 1. Complicated grief 2. Chronic grief 3. Anticipatory grief 4. Delayed grief

3: This is grief that begins before a loss occurs. The grieving person may go through the grieving process and detach before the actual loss.

A 55-year-old client is upset and discussing recent losses with the nurse. Which type of losses is this client most likely experiencing based on his or her age? Select All That Apply. 1. Changes in relationships 2. Loss and death of friends 3. Children leaving the home 4. Stress and job-related issues 5. New-onset medical problems

3: A 55-year-old client is likely to experience the loss of children as they leave the home to establish their own independent lives. 4: A 55-year-old client may experience stress and issues related to his or her job. 5: A 55-year-old client may experience the onset of new medical problems.

Although the dying process is unique to each person, there are similar phases and experiences that people go through. List in order these phases of the active dying stage of a person dying of a serious illness. 1: Diminished respirations and changes in breathing pattern 2: Increased energy and mental awareness 3: Decreased circulatory function 4: Withdrawal from others 5; Death

4,3,2,1,5 Early stages of the dying process include withdrawal from others and decreased heart rate and blood pressure accompanied by pallor and fatigue. Hours or days before death, the person will experience a surge in energy and mental clarity and a desire to be with family members. The final stages of dying are associated with diminished respirations and changes in respiratory patterns. Finally, death occurs.

According to Elisabeth Kübler-Ross's five stages of grieving, which statement indicates a client is in the bargaining stage of grief? 1. "I do not believe the diagnostic test results. I want a second opinion. I do not have cancer." 2. "I do not understand this! Why is this happening to me?" 3. "I know that I smoked cigarettes for over 40 years, so it is understandable I developed lung cancer." 4. "I know there is no cure for this disease, but I want to live long enough to see my granddaughter get married. I will be a better person in order to have that."

4: A client who is in the bargaining stage of grieving will bargain with a higher power for more time to live to experience a significant life event.

Which condition is the result of loss of higher cerebral function? 1. Coma 2. Brain death 3. Anticipatory grief 4. Persistent vegetative state

4: A persistent vegetative state occurs when all higher cerebral function is lost, including all awareness of the person's environment.

A nurse is caring for a 22-year-old who has lost his or her leg due to a motor vehicle crash. The client is very withdrawn and is not interested in pursuing physical therapy. The client says, "What's the point? I will never have a normal life now." The nurse knows the client is experiencing which type of loss?

4: A physical loss is the loss of a physical part or functional ability.

A client's family is arguing and crying intermittently as their loved one approaches death. Which appropriate action should the nurse take? 1. Tell the family firmly to stop the behavior. 2. Notify the physician and call an interdisciplinary team meeting. 3. Limit family visits. 4. Offer chaplain services provided by the hospital.

4: Discord within the family is a sign of spiritual grief. The family may benefit from chaplain services.

The health-care provider has prescribed palliative care and comfort measures only for a terminally ill client. Which order written by a consulting health-care provider should the nurse question? 1. Narcotic analgesics every 4 hours as needed 2. Supplemental oxygen administration as needed 3. Antianxiety medications to alleviate agitation and restlessness 4. Chemotherapeutic medications to treat malignant tumors

4: Palliative care includes comfort measures only. A client would not receive treatment for the terminal condition. Therefore, the nurse would question the order for chemotherapeutic medications, which are meant to combat the disease rather than to provide comfort.

Which term describes the period of time after a spouse dies when a person adjusts to the change in his or her life? 1. Loss 2. Grief 3. Mourning 4. Bereavement

4: The bereavement period is the time frame after the spouse dies when the person adjusts to the change in his or her life.