NURS 1089 Ch 43 Prep U
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."
The condition of a client with a traumatic brain injury continues to deteriorate despite medical efforts. The decision is made to terminally wean the client from mechanical ventilation. Which statement by the nurse is most significant in educating the family regarding terminal weaning?
"All efforts will be taken to make sure your loved one is comfortable and out of pain."
A nurse is caring for a client whose spouse died more than 4 years ago. What assessment question will the nurse ask to determine if the client is experiencing abnormal grief?
"Have you gone through and donated your spouse's clothing?"
A client with end-stage chronic obstructive pulmonary disease (COPD) has reached the end of the 6-month period for hospice services and the family caregiver states, "I don't know what we will do if they cut off our hospice services." What is the best response by the hospice nurse?
"I will contact the health care provider to extend services since your family member meets the criteria."
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."
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."
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 nursing student is learning how to care for clients whose death is expected within a limited period of time. Which statement makes the faculty member believe the student has mastered this topic?
"Many clients know they have a terminal illness by picking up on nonverbal communication."
A client is informed of the diagnosis of leukemia based on recent testing results. The client states, "I do not have leukemia." Which additional statement indicates the client is experiencing denial?
"Mistakes are made with laboratory tests all the time."
During an interview of the client at the community clinic, the nurse finds that the client is providing care for a parent, who is terminally ill. Which statement by the client indicates anticipatory grieving?
"My parent is suffering with cancer and death will be a relief of the pain."
A client diagnosed with a terminal illness is displaying periods of depression and anger alternating with acceptance. The client's spouse is concerned about the client's labile mood. When talking with the client's spouse, which statement made by the nurse bestaddresses principles of loss and grieving?
"Not everyone experiences grief in the same way and your loved one needs our support."
The nurse is caring for a client who recently lost an older adult parent. Which client statement alerts the nurse that the stage of depression may have started within the grief process?
"Please go away; I just want to be left alone."
Family members of a dying client are in the room with their loved one. As the client nears death, what should the nurse tell the family?
"Please stay with your loved one and talk to him."
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."
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 bestresponse 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 for a client that is terminally ill with cancer. The client states to the nurse, "Am I going to die?" What is the most therapeutic response by the nurse?
"What have you been told?"
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?"
signs patient is near death
-noisy breathing -loss of control over bladder and bowels due to loss of neurological control -arms and legs cold to touch -not calm and peaceful -sudden restlessness due to hunger for oxygen
Which situation is most likely to warrant an autopsy?
A client's death involves an allegation of a medical error.
Which assessment finding 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.
Which priority intervention should the nurse plan to implement to reduce a client's discomfort during terminal weaning?
Administer sedation and analgesia.
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.
Which statement regarding perceptions of death by children is accurate?
At about age 9, the child perceives death as irreversible.
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.
Cheyne-Stokes respirations decreased urine output jaundiced skin -irregular heartbeat -weak, rapid, irregular pulse -shallow, labored, faster or slower, irregular -fecal retention or impaction due to reduced gastrointestinal motility -incontinence due to relaxation of sphincter muscles -difficulty swallowing -increased somnolence -decreased responsiveness to external stimuli
The hospice nurse is caring for a client who is dying. Which intervention(s) should be included in the plan of care?
Cluster nursing activities. Provide cool foods and fluids. Gently massage the arms and legs. Routinely administer pain medications.
It has been determined that a client who sustained a head injury following a motorcycle accident is brain dead. The client did not have an organ donation directive. However, the client did have records to indicate a wish not to have prolonged life support. What is the most appropriate action for the nurse?
Contact the organ procurement team to discuss organ donation with the family.
The nurse is receiving a change of shift report on a client who has a terminal illness and has exhibited a slow and progressive decline in the health status over the past several days. Which data supports the client's impending death? Select all that apply.
Gurgling sounds emanating from the client's throat with each breath Distended abdomen with last bowel movement documented 7 days ago Cyanotic nail beds in hands and feet bilaterally -systolic bp would decrease -apical pulse can be slow/irregular
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.
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.
Which signs assessed in a dying client would the nurse recognize as signs of death? Select all that apply.
Nausea, flatus, abdominal distention Cheyne-Stokes respirations Loss of movement, sensation, and reflexes
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.
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. What should happen in this case?
The client should be treated with antibiotics for pneumonia.
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?
The client's breathing becomes noisy.
A client who was brought to the emergency room for gunshot wounds dies in intensive care 15 hours later. Which statement concerning the need for an autopsy would apply to this client?
The coroner must be notified to determine the need for an autopsy.
Which are signs of a "good death"? Select all that apply.
The person dies with dignity. The person is prepared for death. The person has a sense of completion of life.
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.
Universal Inevitable Irreversible
The husband of a client 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?
The nurse is caring for several clients in the home care setting. Which client, when found deceased, will the nurse report as a case for the medical examiner?
a client found with an empty bottle for a newly-prescribed opioid by the bedside
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 The goal of palliative care is to provide clients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms.
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 to the Kübler-Ross model?
bargaining
What is Kübler-Ross's third stage of grief?
bargaining
A widow develops cancer within 6 months of her husband's death. This may be a result of:
bereavement. (loss, grief, sadness)
Upon admission, the nurse should give priority to addressing which need of a client who is displaying symptoms of dysfunctional grief?
coping strategies
A client is informed about the results of a biopsy, which indicate a malignant tumor that has spread. The client states, "Well once you remove the tumor, I will be just fine." What stage of the grief process does the nurse identify the client is experiencing?
denial
Kübler-Ross's stages of grief
denial anger bargaining depression acceptance
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
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
A nurse is providing postmortem care. Which of the following nursing actions is a legal responsibility?
placing ID tags on the shroud and ankle
The nurse is talking with the son of a client with end-stage renal failure and late-stage dementia. The client can no longer live at home, and the son states, "I live 500 miles away. I don't know what to do." Which type of living arrangement will the nurse teach the son about?
residential care
Which care environment would the nurse suggest to a client with no family nearby who is diagnosed with end-stage lung disease?
residential care
Applying Engel's models of grief, place the phases below in the order in which they would occur from first to last.
shock and disbelief developing awareness restitution resolving the loss idealization outcome
The nurse is giving palliative care to a client with a diagnosis of COPD. What is the goal of palliative care?
to improve the client's and family's quality of life
