Deck 30: The Experience of Loss,death,and Grief

Question 1

A client who is Chinese American has just died on the unit.The nurse is prepared to provide after-death care to the client and anticipates the probable preferences of a family from this cultural background will include:
1) Pastoral care
2) Preparation for organ donation
3) Time for the family to bathe the client
4) Preparation for quick removal out of the hospital

Answer 1

3
Some families of Chinese Americans will prefer to bathe the client themselves.They often believe the body should remain intact;organ donation and autopsy are uncommon.Chinese Americans do not prefer pastoral care for after-death care of a family member.Organ donation is uncommon for Chinese Americans.Chinese Americans may desire time to bathe the client.Quick removal from the hospital is not preferred.

Question 2

A nursing intervention to assist the client with a nursing diagnosis of sleep pattern disturbance related to the loss of spouse and fear of nightmares should be to:
1) Administer sleeping medication per order
2) Refer the client to a psychologist or psychotherapist
3) Have the client complete a detailed sleep pattern assessment
4) Sit with the client while encouraging verbalization of feelings

Answer 2

4
A nursing intervention to facilitate grief work is to offer the client encouragement to explore and verbalize feelings of grief.This encouragement refocuses the client on current needs and minimizes dysfunctional adaptation behaviors (e.g. ,not sleeping)by facilitating resolution of grief through problem-solving skills.Administering sleeping medication may help the client get to sleep but does not resolve the issue of grief.Without addressing the grief,the client may develop another dysfunctional adaptation behavior.It is not necessary to refer the client to a psychologist or psychotherapist at this time.The client needs to be encouraged to verbalize his or her feelings.Having the client complete a detailed sleep pattern assessment may help the nurse identify the number of hours of sleep the client is obtaining,but it does not address the issue causing the sleep disturbance,which is grief from the loss of the spouse.

Question 3

To maintain the client's sense of self-worth during the end of life while working with a client in an inpatient hospice unit,the nurse should:
1) Leave the client alone to deal with final affairs
2) Call upon the client's spiritual advisor to manage care
3) Include regular visits throughout the day into the client's care plan
4) Facilitate the arrangements to have a grief counselor visit the client

Answer 3

3
Spending time to let clients share their life experiences,particularly what has been meaningful,enables the nurse to know clients better.Knowing clients then facilitates choice of therapies that promote client decision-making and autonomy.Planning regular visits also helps the client maintain a sense of self-worth,because it demonstrates that he or she is worthy of the nurse's time and attention.The client should not be left alone to feel abandoned or isolated.Nurses can help clients meet spiritual needs by facilitating connections to a spiritual practice or community and supporting the expression of culturally held beliefs.A client's spiritual advisor may also be called upon but is not the only source of spiritual support.The nurse who turns care over to the spiritual advisor is not promoting the client's sense of self-worth,as it may imply the client is not worthy of the nurse's time or attention.A grief counselor may be requested to visit if the client is experiencing complicated grief.Having a grief counselor visit is not an intervention that will help maintain a client's sense of self-worth.

Question 4

To provide comfort for the client,while preparing to assist the client in the end stage of her life in response to anticipated symptom development,the nurse plans to:
1) Decrease the client's fluid intake
2) Limit the use of over-the-counter analgesics
3) Provide larger meals with more appealing seasoning
4) Determine valued activities and schedule rest periods

Question 5

The mother of a child who was killed in an automobile accident is diagnosed with excessive grief.The nurse realizes that this diagnosis increases her risk of:
1) Attempting suicide
2) Developing anorexia nervosa
3) Becoming chronically depressed
4) Developing a psychiatric phobia

Question 6

A newly graduated nurse is best prepared for the assignment of his first dying patient if he:
1) Completed a course dealing with death and dying
2) Is able to control his own personal emotions about death
3) Has previously experienced the death of a dear loved one
4) Has developed a personal understanding of his own feelings about death

Question 7

A nurse-initiated or independent activity for promotion of respiratory function in a terminally ill client is to:
1) Limit fluids
2) Position the client upright
3) Reduce narcotic analgesic use
4) Administer bronchodilators as needed

Question 8

The nurse is providing care to a dying client.Which of the following is the primary concern? The nurse should:
1) Promote optimism in the client and be a source of encouragement
2) Promote dignity and self-esteem in as many interventions as is appropriate
3) Allow the client to be alone and expect isolation on the part of the dying person
4) Intervene in the client's activities and promote as near normal functions as possible

Question 9

The nurse is using Bowlby's phases of mourning as a framework for assessing the client's response to the traumatic loss of her leg.During the "yearning and searching" phase,the nurse anticipates that the client may respond by:
1) Crying intermittently
2) Becoming angry at the nurse
3) Acting stunned by the eventual loss
4) Discussing the change in role that will occur

Question 10

There is a different focus for the client with hospice nursing care.The nurse is aware that client care provided through a hospice is:
1) Designed to meet the client's individual wishes,as much as possible
2) Aimed at offering curative treatment plans intended for client recovery
3) Involved in teaching families and/or caregivers to provide postmortem care
4) Offered primarily for hospitalized clients for whom at-home care is not possible

Question 11

To promote comfort for the terminally ill client specific to nausea and vomiting,the nurse should:
1) Provide mouth care
2) Offer high-protein foods
3) Increase the fluid intake
4) Offer a high-residue diet

Question 12

The wife of a client recently diagnosed with end-stage renal failure shares with the nurse that,"He just accepts this;I want a second opinion." The nurse recognizes that while the client has reached the acceptance stage of grieving,his wife is experiencing the:
1) Anger stage
2) Denial stage
3) Depression stage
4) Bargaining stage

Question 13

A client has a terminal illness and is discussing future treatments with the nurse.The nurse notes that he has not been eating and his response to the nurse's information is,"What does it matter?" The most appropriate nursing diagnosis for this client is:
1) Denial
2) Hopelessness
3) Social isolation
4) Spiritual distress

Question 14

The family of a client with a terminal illness will be able to help provide some psychological support to their family member.To assist the family to meet this outcome,the nurse plans to include in the teaching plan:
1) Demonstration of bathing techniques
2) Application of oxygen delivery devices
3) Recognition of the client's needs and fears
4) Information on when to contact the hospice nurse

Question 15

The nurse recognizes that which of the following clients is at greatest risk for complicated (dysfunctional)grief?
1) A 26-year-old who is diagnosed with rheumatoid arthritis
2) The 58-year-old only child whose mother recently died of cancer
3) A teenage parent whose child died of sudden infant death syndrome (SIDS)
4) A 50-year-old diabetic client who has experienced an above-the-knee amputation

Question 16

A terminally ill client shares with the nurse that he,"needs to tell someone what I want when the end comes." The nurse's most therapeutic response is:
1) "We can talk about that now if you want to.Let me close the door and pull up a chair."
2) "I imagine you would like to discuss matters with your primary care provider.I'll let him know you want to talk."
3) "Let me finish with my client care,I'll be back in 10 minutes,and we can talk as long as you need to."
4) "If you haven't discussed your feelings with your family yet,I'd suggest you do that when they visit this evening."

Question 17

A client,who is receiving chemotherapy on a medical unit due to a recent diagnosis of terminal cancer of the liver,has an in-depth conversation with the nurse.The client says,"This cannot be happening to me." The nurse identifies that this stage is associated with,according to Kübler-Ross:
1) Anxiety
2) Denial
3) Confrontation
4) Depression

Question 18

The nurse finds a client who has been diagnosed with terminal lung cancer quietly crying.Which of the following nursing responses most reflects a need for additional guidance regarding therapeutic communication with a dying client?
1) "If there is anything I can do to help,just ask."
2) "Would you like some medication to help you sleep?"
3) "Do you want me to call your wife so you two can talk?"
4) "Try not to be sad;let's find something to be thankful for."

Question 19

A client that was recently diagnosed with a terminal illness asks his nurse about organ donation.The nurse should:
1) Have the client first discuss the subject with the family
2) Suggest the client delay making a decision at this time
3) Assist the client to obtain the necessary information to make this decision
4) Contact the client's physician so consent can be obtained from the family

Question 20

One of the benefits of anticipatory grieving to a client or family is that it can:
1) Be done in private
2) Be discussed with others
3) Promote separation of the ill client from the family
4) Help a person progress to a healthier emotional state

Question 21

Experiencing normal grief over losses allows the adolescent to successfully:
1) Move past the loss
2) Regain a sense of security
3) Develop effectual coping skills
4) Deal with an actual loss later in life

Question 22

Which of the following statements shows the best understanding of Kübler-Ross's Five Stages of Dying?
1) "Crying is an expected behavior of the Depression Stage."
2) "There are tasks the client completes as they work toward acceptance."
3) "People grieve in the manner in which they are most culturally comfortable"
4) "Given enough time and support,most achieves acceptance of their own death."

Question 23

Which of the following interventions best reflects the nurse's attempt to honor the terminally ill client's cultural values?
1) Interviewing both the client and the family to identify preferred end-of-life care
2) Talking openly and without biases about the client's end-of-life care preferences
3) Providing the family with the opportunity to realize the client's end-of-life wishes
4) Becoming familiar with the death rituals most common among the nurse's client population

Question 24

A terminally ill client is reporting a sense of anxiety and dyspnea.The nurse's initial intervention is to:
1) Assess the client's vital signs and administer the prescribed antianxiety medication
2) Determine the cause of the client's dyspnea and provide both emotional and physical support
3) Position the client in a semi-Fowler's position and provide supplemental oxygen via nasal cannula
4) Remain with the client and encourage him to express the concerns he is experiencing regarding his death

Question 25

The nurse is caring for a terminal ill client in the final stages of the death process when the client's daughter asks,"Why are you putting drops in dad's eyes?" The nurse responds more accurately by telling the daughter that:
1) "His blinking reflex is gone and these drops lubricate his corneas."
2) "The drops will keep the corneas moist since you have donated them."
3) "They are artificial tears that will keep his eyes from becoming dry and painful."
4) "They were prescribed for him but I won't instill them if you prefer that I don't"

Question 26

The nurse most effectively addresses the protection of a terminally ill,incontinent client's skin from irritation and breakdown by:
1) Using adult diapers and changing them as soon as they become wet or otherwise soiled
2) Assessing the client's bed frequently for wetness and assuring clean,dry linens and clothing
3) Securing an order for an indwelling catheter and keeping the perineal area free of fecal matter
4) Offering the client frequent opportunities to toilet and responding promptly to requests to toilet

Question 27

A client who recently experienced an amputation of the left thumb has a perceived loss of physical attractiveness.The nurse recognizes that such a loss is:
1) More easily assessed than actual losses
2) Much less personal than an actual loss
3) Universally experienced by all amputees
4) Capable of producing grief similar to an actual loss

Question 28

Which of the following nursing assessment data best reflects the successful achievement of the dying client's right to be pain free?
1) Introducing the client to effective alternative pain management techniques
2) Educating the client on the appropriate use of a patient-controlled analgesia device
3) Pain rated as a 3 out of 10 after the administration of the prescribed pain medication
4) Informed the primary care provider of the client's need for additional pain medication.

Question 29

Which of the following statements,made by a nurse regarding the means by which older adults usually express and manage grief,reflects a need for further instruction and clarification?
1) "The greater the loss the greater the sense of grief."
2) "Managing depression will help the grieving adult cope."
3) "Having lived a long,happy life makes grieving easier to deal with."
4) "The longer you live,the more experience you have with grieving a death."

Question 30

The son of a client in the initial stage of the dying process is concerned that,"Mom just isn't eating much." The nurse responds most therapeutically by answering:
1) "Her body systems are beginning to shut down and she just doesn't need as much food."
2) "Her pain medication may be making her nauseated.Has she complained or been vomiting?"
3) "We can off her frequent,small portions of her favorite foods.Can you suggest some things she might enjoy?"
4) "Right now solid foods are not as important as drinking.Just be sure she continues to take in plenty of fluids."

Question 31

A terminal ill client's pain is being managed with opioid analgesics.When he reports experiencing constipation,the nurse's most therapeutic response is:
1) "It's a side effect of the pain medication you are taking."
2) "I'll discuss adding some additional bulk to your diet with your wife."
3) "Try drinking more liquids while you are awake to help soften your stool."
4) "I'll see about getting a prescription for a laxative in order to avoid the problem."

Question 32

In order to most effectively address the discomfort of limited oral fluid intake for a client in the latter stages of the dying process,the nurse should:
1) Provide mouth care at least every 2 hours
2) Offer ice chips each time the client is visited
3) Provide the client frequent sips of a favorite beverage
4) Moisten the client's lips with an appropriate water based lubricant