Deck 2 Module 27 Flashcards
A client is complaining of frequent headaches, chest tightness, palpitations, and menstrual irregularities. The client also reports having lost weight and experiencing difficulty eating and sleeping. The nurse notes that the client is tearful, sad, and lacks energy. Which question is most appropriate when assessing the source of the client’s symptoms?
A) “Can you tell me why you are so sad?”
B) “Have you experienced a loss of a loved one recently?”
C) “How long have you been grieving?”
D) “Why are you crying so much?”
B) “Have you experienced a loss of a loved one recently?”
Rationale:
The client is exhibiting the classic signs of grief and possibly unresolved grief, which affects the physical health of the client. Asking the client why she is sad does encourage her to express her feelings, but in this case the nurse needs to know the type of grief the client is experiencing and how long the client has been in this state in order to plan appropriate care. Asking the client why she is crying is a challenge, as is asking the client how long she has been grieving. The nurse should be supportive and nonjudgmental.
The nurse is caring for a homosexual client who has just died due to complication associated with acquired immune deficiency syndrome (AIDS). The client’s partner is still in the room and is dry-eyed and exhibiting somber behavior. The nurse offers condolences to the partner, realizing that the partner expects which to occur?
A) The client’s family will want to grieve with him.
B) The partner will want support from those around him on the unit.
C) The community will not allow the partner to grieve openly.
D) The boss at work will be supportive of bereavement leave.
C) The community will not allow the partner to grieve openly.
Rationale:
The nurse realizes that the client’s partner may be a victim of disenfranchised grief and expects that no one will acknowledge that the partner is grieving or offer support. The nurse extends condolences appropriately. The expectation of the gay partner is that the community, the partner’s family, and the workplace will all ignore the validity of his grief.
A hospice nurse is critically evaluating various models of grief used for terminally ill clients and their families. Which should the nurse recognize when applying these models to individual client cases?
A) No clear timetables exist, nor are there clear-cut stages of grief.
B) There is strong research proving that these models are not useful for many dying clients.
C) The models serve as clear and definitive predictors of grief behaviors.
D) The Kübler-Ross model is primarily used to describe anticipatory grief.
A) No clear timetables exist, nor are there clear-cut stages of grief.
Rationale:
Although the models of grief are useful in guiding the nursing care of clients who are experiencing loss, there are no clear-cut stages of grief, nor are there exact timetables. Kübler-Ross describes all stages of grief and grieving. None of the models clearly or definitively predict grief behaviors. No research exists that proves these models are not useful.
The client states to the nurse, “I have been having trouble sleeping since my boyfriend died unexpectedly 3 weeks ago.” The client also confides that the boyfriend was married and they were seeing each other secretly. For which reason is the client most likely experiencing sleeping difficulty when grieving? A) External grief B) Chronic grief C) Abbreviated grieving D) Disenfranchised grieving
D) Disenfranchised grieving
Rationale:
Sleep disturbances are common during the grieving period. This client is unable to grieve openly for her lost relationship, as extramarital affairs are not socially sanctioned. Abbreviated grieving is grieving that is brief but genuinely felt. This client’s grief is not yet chronic, as only 3 weeks have passed. External grieving is not a recognized type of grief response.
The nurse educator is developing a seminar to help children who have experienced a loss. Which information should the nurse include to help these children adapt?
A) Explain that magical thinking helps with the pain.
B) Remind the child that big children don’t cry.
C) Help create new memories.
D) Pretend that the individual has not really gone.
C) Help create new memories.
Rationale:
Four tasks that help children adapt to loss are as follows: accept the loss and its permanence; experience the emotions associated with grief, such as anger, fear, sadness, guilt, and loneliness; adjust to daily life without the individual who has been lost; and come to see the relationship with the deceased as one based on memories in place of continuing experience. During the first task, the child must come to understand the loss. In the case of a death, the child must understand that the one who has been lost will not return. Although the child should not be forced to accept the death, nurses and other caregivers can explain and reinforce the reality that the beloved individual is not returning. During the second task, children experience emotions similarly to those of adults as they grieve loss. Nurses support children in this task by encouraging emotional expression and by helping parents to understand that these expressions are normal and appropriate. It also is helpful for adults to recognize that emotions can be triggered long after the loss by holidays, birthdays, or other special events. The third and fourth tasks of this model take time to process and accept. Adults can help children in these tasks by listening, by helping children adjust to changes in routines, and by encouraging activities that promote new memories.
The sibling of an adolescent client with Down syndrome was hit by a car and killed. The mother plans to hold the funeral before the client gets out of the hospital. Which is the most appropriate response by the nurse when the mother asks if this is the right decision to make?
A) “You should let the rest of the family decide on whether the client should attend the funeral.”
B) “You should make the decision when you are feeling better.”
C) “You made the right choice in holding the funeral now.”
D) “You should let the client choose to attend the funeral or not.”
D) “You should let the client choose to attend the funeral or not.”
Rationale:
The client with Down syndrome will experience grief and loss as any individual would. The client should be allowed to choose for himself, within reason, if he wants to attend the funeral. This client needs closure for the grief he will have. Telling the mother she did the right thing is not appropriate. Neither is it appropriate to advise her to let others make the decision or tell her to postpone the decision.
The nurse is seeing a family 3 months after a house fire that injured several of the family members and destroyed the family home. Which statement indicates that the goals for the children have been met?
A) “We are suing the builder for a defect that caused the fire.”
B) “We have hired an architect to plan our new home.”
C) “We are still living with relatives.”
D) “We have sent our children back to school and they are doing well.”
D) “We have sent our children back to school and they are doing well.”
Rationale:
Having the family state that the children are doing well in school indicates that they have adjusted. Telling the nurse that they are building a new home does not suggest that the children’s goals have been met. If the family is still living with relatives, they may still be dealing with grief by not moving on. To sue the builder could be an indication that the family is still in the anger phase of grief.
The nurse is caring for a child who is terminally ill with cancer. Which outcomes would be appropriate for this client’s care?
Select all that apply.
A) The child will eat three balanced meals each day.
B) The child will not experience anticipatory grief.
C) The child will engage in age-appropriate play as often as possible.
D) The airway will be free of secretions.
E) The child will not experience pain.
C) The child will engage in age-appropriate play as often as possible.
D) The airway will be free of secretions.
E) The child will not experience pain.
Rationale:
Priority outcomes for the child who is dying are pain control and airway patency. The nurse would want to encourage the child in age-appropriate play depending on the condition of the child. It is not reasonable to expect the dying child to eat all meals, nor is it appropriate that the child not experience anticipatory grieving.
A nurse is caring for a child who is diagnosed with complicated grief after the recent death of a parent. Which symptom supports this child’s nursing diagnosis?
A) Abnormal or nonexistent progression through the grieving process
B) Nightmares and/or sleeplessness
C) Confusion and restlessness
D) Preoccupation with death as a concept
B) Nightmares and/or sleeplessness
Rationale:
A child with complicated grief may have nightmares and/or sleeplessness. An abnormal or nonexistent progression through the grieving process is a manifestation of childhood traumatic grief. Confusion and restlessness as well as a preoccupation with death as a concept are all manifestations of normal grief.
A nurse is caring for a child diagnosed with childhood traumatic grief after witnessing the death of a family member. Which clinical therapy or therapies will be most appropriate for the client? Select all that apply. A) Complicated grief treatment B) Psychotherapy C) Grief counseling D) Bereavement groups E) Provision of reassurance
C) Grief counseling
D) Bereavement groups
Rationale:
A child experiencing childhood traumatic grief would most benefit from grief counseling and bereavement groups. Complicated grief treatment and psychotherapy are used in children experiencing complicated grief, not traumatic grief. Although providing reassurance is helpful treatment in normal grief, a child experiencing childhood traumatic grief requires more therapy than reassurance.
A client with terminal lung cancer is experiencing shortness of breath. The nurse notes bilateral crackles and wheezes, despite oxygen at 4 liters per minute via nasal cannula and diuretic therapy. What nursing interventions are most appropriate for this client?
Select all that apply.
A) Elevate the head of the client’s bed to a Fowler’s position.
B) Change the client’s oxygen therapy to a nonrebreathing mask.
C) Administer morphine sulfate per physician order.
D) Move the client to a room closer to the nurse’s desk for closer observation.
E) Place a fan in the room to move air around the client.
A) Elevate the head of the client’s bed to a Fowler’s position.
C) Administer morphine sulfate per physician order.
E) Place a fan in the room to move air around the client.
Rationale:
Placing a fan to circulate air, elevating the head of the bed, and using morphine sulfate may relieve the client’s shortness of breath. Moving the client who is short of breath is not advisable. Lateral positions are appropriate for unconscious clients, but this client is conscious. Conscious clients who are short of breath do not tolerate oxygen therapy by mask.
The nurse identifies the nursing diagnosis of grieving as appropriate for the family of a terminally ill client. Which family behavior supports this diagnosis?
A) The family members are crying out loud and wringing their hands during visits.
B) The family is tearful and sad during visits with the client.
C) The family members state that they cannot care for the client at home.
D) Some family members state they cannot go on with life.
B) The family is tearful and sad during visits with the client.
Rationale:
Grieving prior to the actual loss is termed anticipatory grieving, which the family is demonstrating by being tearful and sad. Loud crying and wringing of hands might be the beginning of complicated grieving because the client is still alive. When the family members state that they cannot go on with life, they are demonstrating hopelessness. Being unable to care for the client in the home is an example of caregiver role strain.
A hospice nurse is caring for a client who has been given 6 months to live. Which nursing intervention would address the anxiety of the client and family associated with receiving a terminal diagnosis?
A) Encourage early pharmaceutical intervention with anti-anxiety and sedative medications to ease the grieving process.
B) Teach the family that while talking with the client about death and dying is permissible, they should not allow the client to dwell on death.
C) Explore the client and family’s history with other stressful life events and how successful coping was at that time.
D) Supply information about the client’s disease process and the expected trajectory of death only on a need-to-know basis.
C) Explore the client and family’s history with other stressful life events and how successful coping was at that time.
Rationale:
It is most helpful for the nurse to know how the client and family have dealt with previous stressful life events so that support of positive coping mechanisms can occur. The client who has received a terminal diagnosis needs to discuss the future and the implications of the diagnosis. The need for discussion and the amount of time needed will vary from client to client, so “dwelling” is an inappropriate descriptor. The client must be given facts about the disease process and projected trajectory so that final business and relationships can be addressed. Early use of anti-anxiety and sedative medications is not appropriate because these medications can adversely affect the client’s ability to think clearly about the future.
An older adult client in the terminal phases of a debilitating muscular disease believes the healthcare team has “failed” and “given up” and “aren’t trying as hard.” On which belief should the nurse plan interventions for this client?
A) When clients become terminal, physician care is no longer necessary.
B) This is a common fear in the terminally ill client.
C) Clients who feel this way are in denial of the facts of their care.
D) The client’s idea of abandonment is unfounded.
B) This is a common fear in the terminally ill client.
Rationale:
If the client feels that his terminal state is a reflection of failure of the medical system, this fear of abandonment is common. It may not be totally unfounded because failing to cure a client is frustrating and may reflect in the care provided to the client. Although nurses do provide much of the care given to terminal clients, physicians continue to be an integral part of care. There is no indication of denial in this client’s statements, but powerlessness or hopelessness may be evident.
The novice nurse accepts a job working on a long-term care unit. Nursing care that is required includes caring for clients at the end of life. Which behavior by the nurse indicates a healthy response to the dying client and family?
A) Paying close attention to details regarding the pain and comfort measures for the client
B) Delegating physical care of the client to the LPN and UAP
C) Remaining out of the room at the moment of death to allow the client and family privacy
D) Providing client care without explaining procedures
A) Paying close attention to details regarding the pain and comfort measures for the client
Rationale:
The nurse who pays attention to the care of the dying client has most likely dealt with personal feelings and fears regarding death. The nurse in the other options demonstrates a fear of and discomfort with the process of dying.
A nurse educator is teaching a group of nursing students about the feelings associated with losing a client. The educator suggests which activity as the most helpful when a nurse is coping with feelings of grief?
A) Keeping a scrapbook of pictures of clients after they have died
B) Attending the wake or funeral of the client
C) Taking a week off from work in order to grieve
D) Leaving the unit to go home immediately after the client has died
B) Attending the wake or funeral of the client
Rationale:
Nurses need closure for their grief in much the same way families do. Attending the wake and/or funeral allows the nurse time to say goodbye and offers support to the family. Keeping a scrapbook of pictures of dead clients is not a healthy way to resolve grief. Taking a week off from work is probably not healthy or realistic. Leaving the unit immediately after the client’s death is desertion of a sort. The nurse should stay with the family and give death care with the family to the client, as this will also help with closure.
A terminally ill client is demonstrating cognitive signs that the end of life is near. Which assessment findings support the nurse’s conclusion? Select all that apply. A) Inability to concentrate B) Rambling incoherently C) Nausea D) Dry mouth E) Shortness of breath
A) Inability to concentrate
B) Rambling incoherently
Rationale:
Clients at the end of life may experience confusion as the result of infection, electrolyte abnormalities, medications, illness progression, and pain, as well as from many other causes. During periods of altered consciousness, the client may begin rambling or acting contrary to normal behaviors; concentration is also poor during these periods. Nausea and dry mouth indicate dehydration. Shortness of breath indicates difficulty in breathing that is associated with end of life.
The hospice nurse reviews the care provided to a dying client. Which observations indicate that outcomes have been reached for this client?
Select all that apply.
A) The client discusses fears regarding death.
B) The client expresses the intention to recover from the illness.
C) The client is medicated for pain as needed.
D) The client is resting comfortably.
E) The family is informed of any changes in the client’s condition.
A) The client discusses fears regarding death.
C) The client is medicated for pain as needed.
D) The client is resting comfortably.
E) The family is informed of any changes in the client’s condition.
Rationale:
Outcomes for the dying client are centered on physiological comfort and emotional support. A client should never have to fear dying in pain. Desired outcomes include: the client expresses fears related to death or the dying process; the client informs the nurse about increases in pain; the client is made comfortable; the client’s family remains informed of any changes in the client’s condition. The client expressing the intention to recover from the illness does not demonstrate that care provided has been effective.
An older adult client with terminal liver disease is concerned about going home and living alone. The client is currently independent with care. The client is afraid of dying alone and does not want to lose control of body functions. Which should the nurse recognize about the client’s concerns?
A) Appropriate for the situation and will obtain an order for hospice care
B) Unrealistic fears because the client shows no symptoms at present
C) Common fears and concerns of the dying client
D) Signs of depression
C) Common fears and concerns of the dying client
Rationale:
Common fears of the dying client include death itself; thoughts of a long or painful death; facing death alone; loss of body control, such as bowel and bladder incontinence; and loss of consciousness. Withdrawing and not expressing these fears may be more of a sign of depression than talking about them. They are realistic concerns because they are expressed by the client at this stage. The client is not ready for hospice care because a time frame of 6 months has not been identified and the client is still independent.
An older adult client is informed that it is no longer safe for the client to drive at night due to the development of night blindness. Which client statement prompts the nurse to plan a family care conference for the client?
A) “I will limit my driving to daytime hours.”
B) “I guess I’ll get help when I need to go out at night.”
C) “In the summer, I will be able to drive longer.”
D) “I expected this to happen eventually, but I think I still see okay at night.”
D) “I expected this to happen eventually, but I think I still see okay at night.”
Rationale:
The client is not being realistic by stating that he still sees okay at night. The nurse realizes that he may continue to drive or may become depressed. A family conference could help assist the client to make safe plans for going out at night. Limiting driving to daytime hours, planning for help to go out at night, and anticipating more hours of daytime in the summer demonstrate acceptance and compliance by the client.
An older adult client has just learned of the death of an adult child as a result of an automobile accident. The adult child was in another city and died alone. Which action by the nurse is appropriate to address the client during the grieving process?
A) Assisting the family through the complicated grief process
B) Planning care related to the guilt and grief the mother may feel
C) Obtaining a psychological consult for the mother
D) Helping the family to arrange the funeral and burial plans
B) Planning care related to the guilt and grief the mother may feel
Rationale:
The mother and family of the dead son are very likely going to face feelings of guilt for not having been with the son when he died. The nurse plans care for the family and does not obtain a consult unless grief becomes unhealthy. The nurse does not help the family make funeral or burial plans. There is no evidence that the mother or family is experiencing complicated grief at this time.
The nurse is caring for a client whose spouse died 3 years ago. The client states to the nurse, “I have dinner with my wife every Saturday night.” The client tells the nurse that he includes a table setting for her and prepares their "usual" steak dinner. He also lights a candle for her each week marking the time of her death. Based on this data, which nursing diagnosis is most appropriate for this client when planning care? A) Risk for Bereavement B) Ineffective Coping C) Complicated Grieving D) Death Anxiety
C) Complicated Grieving
Rationale:
The client exhibits complicated grieving through ritualistic behaviors, and his grieving has not come to the point of resolution after 3 years. Death anxiety is anxiety associated with the anticipation of death. The client is able to perform tasks to care for himself, but he has gone beyond ineffective coping to the dysfunctional. Bereavement is a state of loss that is transient and is not a nursing diagnosis.
The nurse is caring for a client who lost a spouse of 30 years, 1 year ago. During care, the client asks the nurse with help in completing certain tasks: pick out a clean shirt, help with shaving, and combing the hair. The client is expecting a visit today from a “special lady friend.” Which goal for grieving has this client met?
A) The client is working through the pain of his wife’s death.
B) The client has adjusted to the hospital environment and the role of the nurse.
C) The client has accepted his disability by asking the nurse for help.
D) The client has emotionally moved on with his life.
D) The client has emotionally moved on with his life.
Rationale:
The client has met the goal of moving on with his life, demonstrated by the fact that he is planning to see a lady friend and is asking the nurse to help him prepare for the visit. The pain of grief is over at this point or the client would not be interested in company. There is no evidence that the client is disabled or that he has adjusted to the hospital environment and the role of the nurse.
The nurse is completing a home care visit of an older adult client who is dying of end-stage renal failure and dementia. The client has been taking narcotic medication for the treatment of chronic arthritic pain. During the visit, the family tells the nurse that the client seems more restless and is grimacing and crying. Which action by the nurse is appropriate?
A) Teach the family alternative methods for pain relief instead of administering pain medication to this client.
B) Tell the family that the client may be in pain and an adjustment to the pain medication or administration schedule is needed.
C) Encourage the family to continue to administer the pain medication as needed.
D) Realize the client is being uncooperative because of a personality disorder.
B) Tell the family that the client may be in pain and an adjustment to the pain medication or administration schedule is needed.
Rationale:
Clients with dementia may not be able to accurately express their pain. Other behavior changes, such as agitation, restlessness, and grimacing, often indicate ineffective management of pain. Therefore, adjustments to the pain medication or schedule are warranted. Personality disorders with the presence of dementia are difficult to identify and to differentiate the source of the behavior. Although alternative measures augment pain relief, medications and their administration should be examined as a priority of the assessment.
