Med Surg: Chapter 9: Palliative care

The nurse finds that a terminally ill patient is experiencing nausea and vomiting. Which would be an appropriate nursing action? 1 Administer antiemetic drugs before meals, as ordered. 2 Encourage or provide three big meals rather than small, frequent meals. 3 No action is required because this issue is common during the last days of life. 4 Prevent family members from bringing home-cooked food, which might overwhelm the patient.

1 The nurse should assess contributing reasons for nausea and vomiting in the patient and administer antiemetic drugs before meals. Although nausea and vomiting are common complaints during the last days of life, they need to be managed to make the patient comfortable and maintain nourishment and hydration. The nurse can suggest that family members bring the patient's favorite foods, which can be given frequently in small amounts. Giving three big meals may be difficult due to nausea and vomiting and the patient's frail condition.

A home visit nurse observes that a patient, who lost his or her mother to cancer a month ago, is back to his normal life. The patient has donated the mother's belongings to charity so that somebody else can make better use of them. The patient says that his or her mother would also have done the same because she was very kind. What is the patient experiencing? 1 Adaptive grief 2 Anticipatory grief 3 Complicated grief 4 Prolonged grief disorder

1 The patient is experiencing adaptive grief. It is a healthy response in which the patient works in a positive way through the grief process and adapts to the loss. The patient may be able to see some positive outcomes of death and also garner positive memories of the loss. Anticipatory grief begins before the actual loss happens. It usually happens with family members and caregivers of a patient with chronic illness. Complicated grief and prolonged grief disorder are synonymous and refer to dysfunctional reactions to the loss. They are characterized by prolonged and intense mourning, and manifested by recurrent and severe distressing emotions and disturbing thoughts related to the loss of loved one, self-neglect, and denial of the loss for longer than six months.

An elderly patient admitted to the hospital for terminal stage breast cancer experiences shortness of breath. Which nursing interventions will benefit the patient? Select all that apply. 1 Turn a fan on in the room. 2 Elevate the head of the bed. 3 Elevate the legs of the patient. 4 Put the patient in lateral position. 5 Put the patient in supine position

1,2,4 Shortness of breath, or dyspnea, is a subjective symptom during terminal stages of life. The nurse can elevate the head and position the patient on the side to allow for chest expansion. The nurse can use a fan to facilitate movement of cool air. The other measures which can help this patient include administering oxygen and removing mucus from airways when required. Elevating the legs of the patient does not relieve dyspnea. Placing the patient in supine position may worsen the dyspnea by interfering with chest expansion.

The nurse is caring for a comatose patient admitted following cardiopulmonary arrest. The patient is intubated, mechanically ventilated, and receiving vasopressors to maintain the pulse and blood pressure. The nurse knows a clinical diagnosis of brain death requires what? Select all that apply. 1 Apnea 2 Comatose or unresponsive 3 Poor quality of life prognosis 4 Irreversible cognitive damage 5 Absence of brainstem reflexes

1,2,5 The American Academy of Neurology developed diagnostic criteria to determine brain death. The criteria for brain death include absence of brainstem reflexes, apnea, and comatose or unresponsive state. The criteria must be validated with specified accepted testing and results. Irreversible cognitive damage does not meet the criteria for brain death. A poor quality of life prognosis does not reflect brain death.

The nurse is caring for a patient who is at the end stage of a life-threatening condition. The patient feels uneasy and is unable to remain at rest. What nursing management should be performed to provide physical care to this patient? Select all that apply. 1 Use soothing music. 2 Restrain the patient. 3 Assess for spiritual distress. 4 Assess the patient's tolerance for activities. 5 Limit the number of people near the bedside.

1,3,5 Restlessness is a psychologic manifestation seen at the end of life characterized by an inability to remain relaxed and at rest. Appropriate nursing management for patients showing restlessness at the end of life includes the use of soothing music, because it may please and calm the patient. Assessing spiritual distress in a patient helps the nurse find the cause of restlessness and agitation. The number of patients near the bedside should be limited to prevent feelings of suffocation, agitation, and restlessness. Patients should not be restrained at the end of life because it may aggravate restlessness in the patient. The nurse assesses the patient's tolerance for activities when the patient shows weakness and fatigue.

Which aspects of anticipatory grief are associated with positive outcomes for the caregiver of a palliative patient? Select all that apply. 1 Strong spiritual beliefs 2 Advanced age of the patient 3 Medical diagnosis of the patient 4 Acceptance of the expected death of the patient 5 Adequate time for the caregiver to prepare for the death

1,4,5 Acceptance of an impending loss, spiritual beliefs, and adequate preparation time are all associated with positive outcomes regarding anticipatory grief. The age and diagnosis of the patient are not key factors in influencing the quality of the anticipatory grief of the caregiver.

A nurse observes a patient in the last stages of life. In the ICU the patient is talking to people who are not around. How should the nurse explain the condition of the patient to the caregivers? 1 The patient is having terminal delirium. 2 This experience is a part of the transition from this life. 3 The patient is having hallucinations, which are a side effect of medications. 4 It is abnormal behavior and should be reported to the primary health care provider

2 A dying patient usually has vision-like experiences in which the patient talks to people who are not around or sees places not visible. This helps the person come to terms with the meaning of life and assist in the transition from life to death. This experience is not considered abnormal, because it is a part of the dying process. This experience is not considered to be terminal delirium. Terminal delirium describes an unusual communication stage in which a patient may become restless, agitated, or perform repetitive tasks. This experience is not considered to be hallucinations caused due to medications. It does not need to be reported to the primary health care provider.

The dying patient is experiencing confusion, restlessness, and skin breakdown. What nursing interventions will best meet this patient's needs? 1 Encourage more physical activity. 2 Assess for pain, constipation, and urinary retention. 3 Assess for spiritual distress and restrain in varying positions. 4 Assess for quality, intensity, location, and contributing factors of discomfort.

2 Assessing for all reversible causes of delirium (e.g., pain, constipation, urinary retention, dyspnea, sensory hyperstimulation) so they can be reversed may help decrease confusion and restlessness. Encouraging more physical activity may prevent further skin breakdown, but it will be difficult because weakness and fatigue are expected at the end of life. Keeping the skin clean and dry and preventing shearing forces better will avoid further skin breakdown. Spiritual distress may be a cause of restlessness, but the patient should not be restrained.

The family of a patient who has reached the end stages of pancreatic cancer is concerned that the patient has suddenly become very religious, despite rarely having participated in religion throughout his or her life. Which therapeutic statement by the nurse provides the best explanation of this behavior? 1 "Sometimes near the end, patients begin to have visions that often are religious." 2 "It is common for patients facing death to turn to religion to help provide order to the world." 3 "It is good that your family member has decided to turn to religion so that the soul will be saved upon leaving the body." 4 "I wouldn't worry too much about it; if it is what your family member needs at this point in time, we just need to provide support."

2 When patients are facing the end of life, they often turn to religion to help provide order to the world. The question does not contain enough data to determine whether the patient is having visions. Stating that it is good that the patient has turned to religion places the nurse's subjective values on the behavior and would not be appropriate in this situation. Telling the family not to worry is dismissive and not a therapeutic response.

The nurse is providing palliative care to a patient who is in the last stage of cancer. What does the nurse monitor in the patient as part of neurologic assessment? Select all that apply. 1 Urine output 2 Pupil response 3 Nutritional intake 4 Presence of reflexes 5 Level of consciousness

2,4,5 A patient who is in the last stage of cancer and is approaching death requires multiple system monitoring. Most systems begin to fail during the end of life. Pupil responses, the presence of reflexes, and the level of consciousness should be monitored in the patient as part of the neurologic assessment. The urine output is monitored to assess renal functioning. The nutritional intake is monitored to assess gastrointestinal functioning.

The nurse is caring for a patient whose spouse died two weeks ago. The nurse observes that the patient does not engage in active conversation and looks sad. Which stage of grief is the patient in? 1 Denial 2 Anger 3 Depression 4 Acceptance

3 The patient is in the depression stage of grief. The patient does not engage in active conversation and may feel numb. The patient may feel sad and angry. The denial stage is characterized by denial of the loss and withdrawal. In the anger stage, the patient may be angry with self and others for letting the loss happen. In the acceptance stage, the patient comes to terms with the loss and accepts the reality.

What is the focus of the nurse in nursing management related to physical care at the end of life? Select all that apply. 1 Disease cure 2 Drug treatment 3 Patient comfort 4 Symptom management 5 Oxygen need assessment

3,4,5 Nursing management related to physical care at the end of life focuses on comfort and symptom management rather than treatment for curing a disease or disorder. The priority is meeting the patient's physiologic and safety needs. Physical care focuses on the need for oxygen, nutrition, pain relief, mobility, elimination, and skin care. Disease cure is not a priority focus; rather, the management of symptoms is given more priority. Relaxation strategies focus on providing physical care and not drug treatment.

The nurse is caring for a patient who has had a traumatic brain injury. The family wishes to withdraw life support. The patient has been identified as an organ donor. What is the nurse's priority action for this patient's care? 1 Contact social work to facilitate organ donation. 2 Call the funeral home to pick up the deceased patient. 3 Prepare to initiate tube feedings and artificial ventilation. 4 Notify the primary healthcare provider that the patient is an organ donor.

4 The primary healthcare provider needs to be notified that the patient is an organ donor, because some organs are only viable for a few hours after death. Social work does not facilitate organ donation; this is handled by a liaison for organ donation at the hospital. The funeral home will need to be notified, but not at this time because the patient is not dead. The nurse should not prepare for artificial ventilation and tube feedings if the family has decided to withdraw life support.

The nurse is providing physical care to the end-of-life patient who remains in a state of confusion, incoherence, and anxiety and who often hallucinates. The nurse anticipates that the patient's condition is caused by the administration of opioids and corticosteroids. What nursing management does the nurse implement for this patient? Select all that apply. 1 Assess for spiritual distress. 2 Encourage consumption of ice chips. 3 Assess the patient's tolerance for activities. 4 Stay physically close to the frightened patient. 5 Provide a room that is quiet, well-lit, and familiar

4,5 Delirium is a serious disturbance in a person's mental abilities that results in a decreased understanding of one's environment and confused thinking. The nursing management for a patient showing the characteristics of delirium includes providing comfort to the frightened patient by staying physically close and providing a room that is quiet, well-lit, and familiar, to reduce the effects of delirium. Spiritual distress is assessed if the patient is experiencing restlessness. Consumption of ice chips is encouraged if the patient is dehydrated. A patient's tolerance for activities is assessed if the patient is weak.

A parent in a large family unexpectedly suffers a myocardial infarction and passes away. Place the spouse's reactions to the death in sequence according to the Grief Wheel. Correct 1. "I cannot believe what is happening. This can't be real." Correct 2. "I should have done more to help my spouse control the blood pressure." Correct 3. "What am I going to do without my spouse? I have no future!" Correct 4. "It is not the same without my spouse, but I must go on with my life."

According to the Grief Wheel, the first stage of grief is shock. The spouse's reaction to the death in disbelief is representative of shock. The next stage is protest, which can present as anger, guilt, sadness, fear, yearning, or searching. The spouse expresses guilt with the statement, "I should have done more to help my spouse control the blood pressure." The third stage of the Grief Wheel is disorganization. In this stage, the spouse expresses feelings of despair and apathy stating, "What am I going to do without my spouse? I have no future." The final stage of the Grief Wheel is reorganization. In this phase, the spouse gradually moves to a "new normal" but acknowledges things are "not the same."

What do the psychologic responses to grief include? Select all that apply. 1 Illness 2 Anxiety 3 Sadness 4 Depression 5 Sleeping problems 6 Changes in appetite

Anxiety, sadness, and depression are all psychologic responses to grief. Illness, sleeping problems, and changes in appetite are physiologic reactions to grief.

The nurse is providing psychosocial care to a patient at the end of life. The patient maintains the ability to hear the nurse but is unable to respond to the nurse. The nurse converses with the patient as though the patient is alert, using a soft voice and gentle touch. Which end-of-life symptom is the nurse addressing with these actions? 1 Withdrawal 2 Spiritual needs 3 Vision like experiences 4 Unusual communication

1 A patient in a state of withdrawal maintains the ability to hear the nurse but is unable to respond appropriately. The nurse should converse with the patient as though he or she is alert, using a soft voice and gentle touch. The patient may request spiritual support to satisfy the patient's spiritual needs and encourage a visit by an appropriate spiritual care provider. Vision-like experiences are seen if the person talks to people and sees objects that are not present. In the event of vision-like experiences, the nurse affirms that these are a normal part of the patient's transition from this life. Unusual communication characterized by confused and garbled speech is a common occurrence at the end of life. In the event of unusual communication, the nurse listens carefully to identify patterns in the patient's communication and avoid mislabeling behaviors

A patient with metastatic liver carcinoma is receiving morphine for palliation. The patient reports that the pain is not subsiding and is restless and anxious. The nurse tells the patient, "It is too soon for your next morphine dose. You are receiving the maximum dose each time you get it. I will come back when it is time for another dose." How would this nursing response be classified? 1 Below the expected standard of care 2 Above the expected standard of care 3 Realistic and appropriate for the patient 4 Helpful and therapeutic for the patient

1 A standard of care is said to be present when the nursing practice is safe and competent. The nursing action would have been up to the standard of care if the nurse used all possible resources to help the patient. The nurse's approach is unsafe. The nurse is most likely to be considered incompetent and negligent.

A terminally ill patient is hospitalized with severe bone pain. The patient cries and moans with any movement and is able to express severe pain. The health care provider increases the dosage of morphine. What is the nurse's priority action? 1 Administer the medication. 2 Administer the originally ordered dose. 3 Call the primary health care provider and question the order. 4 Withhold the medication because it will hasten the patient's death.

1 Administering the medication is the highest priority. The code of ethics for nurses addresses the responsibility of the nurse to relieve suffering. Furthermore, failure of the nurse to act assertively to achieve pain relief for the patient and failure to effectively use resources to obtain that pain relief would be considered below the standard of care and unsafe and incompetent practice. To administer the original ordered dose is also a medication error.

A patient has been declared brain dead. In spite of the total loss of brain function, which sign would the nurse most likely find in this patient? 1 Presence of a heartbeat 2 Presence of pain perception 3 Presence of normal breathing 4 Presence of pupillary reflexes

1 Brain death is a clinical diagnosis that can be made in a patient whose heart continues to beat and is mechanically ventilated. All cerebral and brainstem functions are lost in this patient. A person with brain death does not have normal breathing and is dependent on a ventilator. Because all the cerebral and brainstem functions are lost, the patient does not have pupillary reflexes or pain perception.

A nurse who does not believe in God is caring for a terminally ill patient. The patient asked the nurse to arrange for a pastoral visit. What action should the nurse take? 1 Arrange for a chaplain. 2 Refuse to arrange for a chaplain. 3 Educate the patient about atheism. 4 Share views about God with the patient.

1 Some dying patients need the presence of a chaplain. This gives them spiritual support and help with the process of transition from life. The nurse must respect the views of the patient irrespective of the nurse's ideas. Therefore the nurse should arrange for the chaplain. It is also inappropriate to share the nurse's view about God or the nurse's spiritual beliefs with the patient.

A patient died from sepsis while in the hospital. The patient's spouse is now blaming the primary health care provider for the patient's death and is shouting at the staff. According to the Kubler-Ross model of grief, which stage is the spouse in? 1 Anger 2 Denial 3 Bargaining 4 Depression

1 The Kubler-Ross model of grief has five stages. These include denial, anger, bargaining, depression, and acceptance. The reaction of the man indicates that he is angry and therefore is in the anger stage of grief reaction. In the bargaining stage, the person tends to bargain the loss with a promised change in behavior. In the depression stage, the person may feel numb due to the realization of the loss. In the denial stage, the person may deny the loss and may withdraw.

A nurse is caring for a patient who is in the terminal stage of colon cancer. Two primary health care providers have certified that the patient's prognosis is terminal, with less than six months to live. The manager of a hospice care program reports that the patient is not eligible to receive hospice care. What is the most likely reason the manager has made this determination? 1 The patient does not agree to hospice care. 2 The patient is not covered under Medicare or Medicaid for hospice care. 3 Hospice nurses did not receive training to provide care in terminal stages of cancer. 4 The hospice care center does not provide service 24 hours a day, seven days a week

1 The first criterion for entering a hospice care program is that the patient should agree to accept hospice care. The patient should be willing to improve the quality of life during the last days of life. Because two health care providers have certified that the patient's prognosis is terminal with less than six months to live, the patient can be provided insurance by Medicare or Medicaid for hospice care. Hospice care centers provide care 24 hours a day, seven days a week. Hospice nurses are an integral part of the hospice care team; they are well educated and trained to provide care in terminal stages of cancer.

A terminally ill patient, who has been on bed rest for the past six months, is receiving corticosteroids for an acute asthma attack. The patient is also taking morphine for pain. The blood reports indicate anemia and eosinophilia. The nurse recognizes that the patient has which risk factors for skin breakdown? Select all that apply. 1 Anemia 2 Asthma 3 Immobility 4 Use of morphine 5 Use of corticosteroids

1,3 A nurse must be aware of the reasons for skin breakdown. Anemia results in poor circulation and predisposes a patient to skin breakdown. Immobility puts undue pressure on the bony prominences and increases the risk of skin breakdown. Morphine and corticosteroids can result in delirium, but do not increase the risk of skin breakdown. Asthma is a respiratory disorder and is not related to skin breakdown.

A patient is pronounced brain dead following a massive stroke. Which criteria are included when pronouncing brain death? Select all that apply. 1 Apnea 2 Aphasia 3 Loss of heartbeat 4 Unresponsiveness 5 Absence of brainstem reflexes

1,4,5 The criteria for brain death include apnea, coma or unresponsiveness, and absence of brainstem reflexes. A patient is called brain dead when all brain functions are irreversibly damaged and lost, including those of the brainstem. Even after brain death, the heart may continue to function, and respiration can be maintained by mechanical ventilators. Aphasia is the loss of ability to understand words that are heard, but is not related to brain death.

The patient's right to decide whether he or she wants cardiopulmonary resuscitation (CPR) performed is an example of what? 1 Self-efficacy 2 Self-determination 3 Decisional capacity 4 Advance care planning

2 Self-determination is the patient's right to decide whether CPR will be performed. Decisional capacity refers to the ability to consent to or refuse care. Self-efficacy is one's own beliefs about his or her capability to succeed in a situation. Advance care planning is a process that involves having patients think through and document their values and goals for treatment and talk about their values and goals with others.

A person who has recently lost a family member has powerful feelings of anger, guilt, and fear. The nurse notices that the person yearns and starts searching for the dead person. Which state of grief does the nurse identify in the person according to the grief wheel model? 1 Shock 2 Protest 3 Reorganization 4 Disorganization

2 The nurse anticipates protest in a grieving person who is experiencing sadness, anger, and guilt at the same time. The nurse will anticipate that a person is in a state of shock if he or she is numb, hysterical, and/or is unable to think straight. The nurse anticipates that a person is in a state of reorganization if he or she gradually returns to normal functioning and experiences different feelings. The nurse anticipates that a person is in a state of disorganization if he or she exhibits despair, anxiety, apathy, and confusion.

A terminally ill and dying patient fears that his or her loved ones are unable to cope with his or her imminent death and will stop visiting. The nurse provides companionship for the patient, holds the patient's hand, and listens to the patient. With which of the patient's fears is the nurse dealing in this situation? 1 Fear of pain 2 Fear of abandonment 3 Fear of meaninglessness 4 Fear of shortness of breath

2 The patient is afraid that his or her loved ones are unable to cope with his or her imminent death and will abandon the patient. Therefore the nurse provides a partner to the patient, holds the patient's hand, and listens to the patient. The nurse assures the patient that drugs will be administered promptly if the patient has a fear of pain. The nurse helps the patient and the family members identify the positive qualities of the patient's life if the patient shows a fear of meaninglessness. Anxiety reducing agents are administered if the patient has fear of shortness of breath.

The nurse cares for a patient in the terminal stage of leukemia who has opted for hospice care. When is the patient considered to be eligible for hospice care? 1 When it is certain that the patient is going to die within nine months 2 When two primary health care providers certify that the patient has less than six months to live 3 When a primary health care provider certifies that the patient has less than six months to live 4 When one primary health care provider guarantees that the patient cannot recover further

2 To be eligible for hospice care, two primary health care providers should certify that the patient is in the terminal stage and has less than six months to live. The certification should be from two primary health care providers, not just one. It is also important that primary health care providers do not guarantee the death of the patient within nine months. Scope for further recovery is not a criterion for hospice care.

The student nurse is completing an assessment on a patient newly admitted to a hospice unit. The patient strongly indicates he or she is not affiliated with and does not participate in any specific religion. Which statement by the nursing student to the nursing instructor is most reflective of this situation? 1 "The patient vehemently indicated that he or she has no religious affiliation and no strong spiritual beliefs." 2 "I know that religion is the way that individuals express their spirituality; this patient chooses not to do that." 3 "I need to ask questions concerning potential spiritual needs and what provides the patient with strength and hope." 4 "Because the patient seems so angry concerning the question about religious affiliation, I think it is best not to ask any further questions."

3 An individual may not be involved in any formal religion but still have deep spirituality; thus, the nursing student needs to ask follow-up questions concerning spirituality. Religion is a formal, organized system of beliefs, whereas spirituality refers to a person's efforts to find meaning in life. They do not refer to the same concept. Many individuals feel very strongly about religion; the nursing student should not avoid asking further questions based upon this response.

While caring for her dying husband, who is still coherent, the wife states that her husband is Methodist but she is a devout Roman Catholic. When assessing spiritual preferences concerning end-of-life care for the dying husband, which is considered the nurse's best resource? 1 A priest 2 Hospice staff 3 The dying husband 4 The wife of the dying husband

3 Assessment of spiritual needs for palliative care is a key consideration, and individual choices should be respected. The preferences of the patient and family related to spiritual guidance or pastoral care services should be assessed and appropriate referrals made. The patient is the most reliable source for the spiritual assessment. The priest, hospice staff, and patient's wife may have some insight, but the patient is still coherent and able to communicate his wishes.

A patient with bronchial carcinoma reports anorexia and nausea. What measures should the nurse implement to help this patient? 1 Offer bland food with spices. 2 Provide large meals twice a day. 3 Provide small portions of favorite foods. 4 Immediately put the patient on intravenous fluids.

3 Nausea, anorexia, and vomiting can occur because of complications of the disease or the medications used for treatment. The nurse can offer small portions of favorite and culturally appropriate foods to the patient. It will help in increasing the nutritional status of the patient. The patient should be provided appropriate oral care after vomiting to remove any bad taste from the mouth. Providing large meals and bland food with spices may worsen the nausea and vomiting. Intravenous fluids should be started only when the patient is not able to eat or drink anything orally.

The nurse is arranging discharge for a patient with a history of congestive heart failure and suggests a consultation with the palliative care team. How does palliative care differ from hospice care? 1 Palliative care is aimed at improving quality of life. 2 Palliative care emphasizes symptom management. 3 Palliative care permits the patient to receive simultaneous curative care. 4 Palliative care is aimed at providing compassion, concern, and support to patients and families.

3 Palliative care differs from hospice care in that palliative care permits the patient to receive curative care simultaneously. Patients cannot receive curative care via hospice services. Both hospice and palliative care modalities emphasize symptom management. Hospice care and palliative care provide compassion, concern, and support to patients and families. Both care modalities are aimed at improving quality (not quantity) of life.

While providing psychosocial care to a patient at the end of life, the nurse notices that the patient becomes restless, agitated, and performs repetitive tasks. Which nursing management is most appropriate for this patient? 1 Converse using a soft voice and gentle touch 2 Encourage a visit by an appropriate spiritual care provider 3 Encourage the family to talk with and reassure the dying person 4 Affirm the dying person's experience as a part of the transition from this life

3 Restlessness, agitation and the performance of repetitive tasks may indicate that a dying patient has an unresolved issue preventing him or her from letting go. In this case, the most appropriate nursing management is to encourage the family to talk with and reassure the dying person. If the patient is showing signs of withdrawal, the most appropriate nursing management is to converse using a soft voice and gentle touch. If the patient indicates a spiritual need, the nurse encourages a visit by an appropriate spiritual care provider. If the patient talks to people who are not there or has vision-like experiences, the appropriate nursing action is to affirm that the dying person's experience is a part of transition from this life.

A nurse observes a parent who has recently lost a child in an accident. The parent is a pastor. The nurse concludes that the parent is in a state of spiritual distress. Which behavior would have led the nurse interpret this? 1 The parent has not accepted the death of his child. 2 The parent is calm and has accepted the death of the child. 3 The parent has started having atheistic views since the death. 4 The parent has started praying relentlessly with the hope of getting the child back.

3 The parent is a pastor and hence is a firm believer in God. The parent has started having atheistic views after the death of the child, which portrays spiritual distress. Not accepting the death of the child indicates that the person is in a stage of denial. Having a calm composure and accepting the death of the child indicates that the parent is in the stage of acceptance. Praying relentlessly with the hope of getting the child back is a behavior that indicates that the parent is in the bargaining stage of grief.

A nurse is assessing a patient who has recently lost family members in an accident. The patient has completely lost hope in life, is extremely passive, and is confused most of the time. According to the grief wheel, which stage of grief is indicated by these behavioral symptoms? Incorrect1 Stage of shock 2 Stage of protest 3 Stage of disorganization 4 Stage of reorganization

According to the grief wheel model, hopelessness, apathy, and confusion are features of the stage of disorganization. In the stage of shock, the patient becomes numb and is in denial. Anger, guilt, and sadness are all characteristic behavioral features of the stage of protest. In the stage of reorganization, the patient gradually starts accepting the situation and returns to normal functioning.