Chapter 29: The Experience of Loss, Death, and Grief Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

1. The nurse is discussing future treatments with a client who has a terminal illness. The nurse notes that the client has not been eating and responds to the nurses information by saying, What does it matter? The most appropriate nursing diagnosis for this client is:

a.

Social isolation

b.

Spiritual distress

c.

Denial

d.

Hopelessness

ANS: d

d. A defining characteristic for the nursing diagnosis of hopelessness may include the client stating, What does it matter? when offered choices or information concerning him or her. The clients behavior of not eating also is an indicator of hopelessness.

a. This is not an example of social isolation. The client is not avoiding or restricted from seeing others.

b. Spiritual distress is not the most appropriate nursing diagnosis for this client. The focus should be on the clients lack of hope.

c. The clients behavior and verbalization does not indicate denial.

REF: Text Reference: p. 579

2. The nurse recognizes that anticipatory grieving can be most beneficial to a client or family because it can:

a.

Be done in private

b.

Be discussed with others

c.

Promote separation of the ill client from the family

d.

Help a person progress to a healthier emotional state

ANS: d

d. The benefit of anticipatory grief is that it allows time for the process of grief (i.e., to say good-bye and complete life affairs). Anticipatory grief allows time to grieve in private, to discuss the anticipated loss with others, and to let go of the loved one. Anticipatory grief can help a person progress to a healthier emotional state of acceptance and dealing with loss.

a. It is not most beneficial for grieving to take place only in private. It is important for grief to be acknowledged by others, and to be able to receive the support of others in the grieving process.

b. Anticipatory grieving can be discussed with others in most circumstances. However, at times, anticipatory grief may be disenfranchised grief as well, meaning it cannot be openly acknowledged, socially sanctioned, or publicly shared, such as a partner dying of AIDS. The benefit of anticipatory grieving is not so much that it can be discussed in most circumstances, as this discussion also can occur with normal grief when the actual loss has occurred.

c. Anticipatory grief is the process of disengaging or letting go that occurs before an actual loss or death has occurred. The benefit is not the separation of the ill client from the family as much as it is the process of being able to say good-bye, to put life affairs in order, and as a result, it can help a client or family to progress to a higher emotional state.

REF: Text Reference: p. 571

3. A newly graduated nurse is assigned to his first dying patient. The nurse is best prepared to care for this client if he:

a.

Completed a course dealing with death and dying

b.

Is able to control his own emotions about death

c.

Experiences the death of a loved one

d.

Has developed a personal understanding of his own feelings about death

ANS: d

d. When caring for clients experiencing grief, it is important for the nurse to assess his own emotional well-being and to understand his own feelings about death. The nurse who is aware of his own feelings will be less likely to place personal situations and values before those of the client.

a. Although course work on death and dying may add to the nurses knowledge base, it does not best prepare the nurse for caring for a dying client. The nurse needs to have an awareness of his own feelings about death first, as death can raise many emotions.

b. Being able to control ones own emotions is important; however, it is unlikely that the nurse would be able to do so if he has not first developed a personal understanding of his own feelings about death.

c. Experiencing the death of a loved one is not prerequisite to caring for a dying client. Experiencing death may help an individual mature in dealing with loss, or it may bring up many negative emotions if complicated grief is present. The nurse is best prepared by first developing an understanding of his own feelings about death.

REF: Text Reference: p. 578

4. An identified outcome for the family of the client with a terminal illness is that they will be able to provide psychological support to the dying client. To assist the family to meet this outcome, the nurse plans to include in the teaching plan:

a.

Demonstration of bathing techniques

b.

Application of oxygen devices

c.

Recognition of client needs and fears

d.

Information on when to contact the hospice nurse

ANS: c

c. A dying clients family is better prepared to provide psychological support if the nurse discusses with them ways to support the dying person and listen to needs and fears.

a. Demonstration of bathing techniques may help the family meet the dying clients physical needs, not to providing psychological support.

b. Application of oxygen devices may help the family provide physical needs for the client, not to provide psychological support for the client.

d. Information on when to contact the hospice nurse is important knowledge for the family to have and may help them feel they are being supported in caring for the dying client. However, contact information does not help the family provide psychological support to the dying client.

REF: Text Reference: p. 588

5. The nurse is assigned to a client who was recently diagnosed with a terminal illness. During morning care, the client asks about organ donation. The nurse should:

a.

Have the client first discuss the subject with the family

b.

Suggest the client delay making a decision at this time

c.

Assist the client to obtain the necessary information to make this decision

d.

Contact the physician so consent can be obtained from the family

ANS: c

c. No topic that a dying client wishes to discuss should be avoided. The nurse should respond to questions openly and honestly. As client advocate, the nurse should assist the client to obtain the necessary information to make this decision.

a. The nurse should provide the client with information with which to make such a decision. Although the nurse may suggest that the client discuss this option after having obtained information, it is up to the client to discuss the subject with the family.

b. The nurse should respect the client and provide the necessary information for him or her to make a decision, rather than dismissing the clients question.

d. It is not necessary to contact the physician or the family for consent for organ donation if the client is capable of making this decision.

REF: Text Reference: p. 584

6. A client has been diagnosed with terminal cancer of the liver and is receiving chemotherapy on a medical unit. In an in-depth conversation with the nurse, the client states, I wonder why this happened to me? According to Kbler-Ross, the nurse identifies that this stage is associated with:

a.

Anxiety

b.

Denial

c.

Confrontation

d.

Depression

ANS: b

b. According to Kbler-Ross, the client is in the denial stage of dying. The client may act as though nothing has happened, may refuse to believe or understand that a loss has occurred and may seem stunned, as though it is unreal or difficult to believe.

a. No stage of anxiety is found in Kbler-Rosss five stages of dying.

c. No stage of confrontation is found in Kbler-Rosss five stages of dying.

d. During depression, the individual may feel overwhelmingly lonely and withdraw from interpersonal interaction.

REF: Text Reference: p. 570

7. 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 that the probable preferences of a family from this cultural background will include:

a.

Pastoral care

b.

Preparation for organ donation

c.

Time for the family to bathe the client

d.

Preparation for quick removal from the hospital

ANS: c

c. 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.

a. Chinese Americans do not prefer pastoral care for after-death care of a family member.

b. Organ donation is uncommon for Chinese Americans.

d. Chinese Americans may desire time to bathe the client. Quick removal from the hospital is not preferred.

REF: Text Reference: p. 589

8. Which of the following is the primary concern of the nurse for providing care to a dying client? The nurse should:

a.

Promote optimism in the client and be a source of encouragement

b.

Intervene in the clients activities of daily living and promote as near normal functions as possible

c.

Allow the client to be alone and expect isolation on the part of the dying person

d.

Promote dignity and self-esteem in as many interventions as possible

ANS: d

d. The focus in planning nursing care is to support the client physically, emotionally, developmentally, and spiritually in the expression of grief. When caring for the dying client, it is important to devise a plan that helps a client to die with dignity and offers family members the assurance that their loved one is cared for with care and compassion.

a. Optimism should not be the primary focus when caring for the dying client. The nurse should promote the clients self-esteem and allow the client to die with dignity.

b. The client should be allowed to make choices and perform as many activities of daily living independently as possible. This allows the client to maintain self-esteem and dignity.

c. The client does not need to be left alone. The presence of the nurse or the family may indicate to the client that he or she is being cared for and is worthy of attention.

REF: Text Reference: p. 580

9. Hospice nursing care has a different focus for client. The nurse is aware that client care provided through a hospice is:

a.

Designed to meet the clients individual wishes, as much as possible

b.

Usually aimed at offering curative treatment for the client

c.

Involved in teaching families to provide postmortem care

d.

Offered primarily for hospitalized clients

ANS: a

a. The nurses role in hospice is to meet the primary wishes of the dying client and to be open to individual desires of each client. The nurse supports a clients choice in maintaining comfort and dignity.

b. Hospice care is for the terminally ill. It is not aimed at offering curative treatment, but rather the emphasis is on palliative care.

c. Hospice care may provide bereavement follow-up for the family after a clients death, but hospice nurses typically do not teach the family postmortem care.

d. Hospice care is primarily for home care, but a client in hospice may become hospitalized.

REF: Text Reference: p. 588

10. The nurse is preparing to assist the client in the end stage of her life. To provide comfort for the client in response to anticipated symptom development, the nurse plans to:

a.

Decrease the clients fluid intake

b.

Limit the use of analgesics

c.

Provide larger meals with more seasoning

d.

Determine valued activities and schedule rest periods

ANS: d

d. To promote comfort in the terminally ill client, the nurse should help the client to identify values or desired tasks and then help the client to conserve energy for those tasks.

a. Decreasing the clients fluid intake may make the terminally ill client more prone to dehydration and constipation. The nurse should take measures to help maintain oral intake, such as administering antiemetics, applying topical analgesics to oral lesions, and offering ice chips.

b. The use of analgesics should not be limited. Controlling the terminally ill clients level of pain is a primary concern in promoting comfort.

c. Nausea, vomiting, and anorexia may increase the terminally ill clients likelihood of inadequate nutrition. The nurse should serve smaller portions and bland foods, which may be more palatable.

REF: Text Reference: p. 586

11. The nurse is working with a client on an inpatient hospice unit. To maintain the clients sense of self-worth during the end of life, the nurse should:

a.

Leave the client alone to deal with final affairs

b.

Call on the clients spiritual advisor to take over care

c.

Plan regular visits throughout the day

d.

Have a grief counselor visit

ANS: c

c. 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 nurses time and attention.

a. The client should not be left alone to feel abandoned or isolated.

b. 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 clients spiritual advisor also may be called on, but is not the only source of spiritual support. The nurse who turns care over to the spiritual advisor is not promoting the clients sense of self-worth, as it may imply the client is not worthy of the nurses time or attention.

d. 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 clients sense of self-worth.

REF: Text Reference: p. 587

12. 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:

a.

Administer sleeping medication per order

b.

Refer the client to a psychologist or psychotherapist

c.

Have the client complete a detailed sleep-pattern assessment

d.

Sit with the client and encourage verbalization of feelings

ANS: d

d. 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.

a. 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.

b. 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.

c. 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.

REF: Text Reference: p. 583

13. To promote comfort for the terminally ill client specific to nausea and vomiting, the nurse should:

a.

Provide prompt mouth care

b.

Offer high-protein foods

c.

Increase the fluid intake

d.

Offer a high-residue diet

ANS: b

b. To promote comfort for the terminally ill client specific to nausea and vomiting, the nurse should administer antiemetics, provide oral care at least every 2 to 4 hours, offer clear liquid diet and ice chips, avoid liquids that increase stomach acidity such as coffee, milk, and citrus acid juices, and offer high-protein foods in smaller portions and of a bland nature.

a. Oral care should be provided every 2 to 4 hours.

c. Increasing the fluid intake may help prevent constipation.

d. A low-residue diet may help prevent diarrhea.

REF: Text Reference: p. 586

14. A nurse-initiated or independent activity for promotion of respiratory function in a terminally ill client is to:

a.

Limit fluids

b.

Position the client upright

c.

Reduce narcotic analgesic use

d.

Administer bronchodilators

ANS: b

b. Positioning the client upright is an independent nursing intervention for the promotion of respiratory function in a terminally ill client.

a. Limiting fluids may not promote respiratory function, and unless a client is on a fluid-restricted diet, the nurse should not do so.

c. Reducing narcotic analgesic use is not a nurse-initiated activity to promote respiratory function. A respiratory rate should be assessed before administering narcotics to prevent further respiratory depression. Management of air hunger involves judicious administration of morphine and anxiolytics for relief of respiratory distress.

d. The administration of bronchodilators would require a physicians order. It is not an independent nursing activity.

REF: Text Reference: p. 586

15. The nurse is using Bowlbys phases of mourning as a framework for assessing the clients response to the traumatic loss of her leg. During the yearning and searching phase, the nurse anticipates that the client may respond by:

a.

Crying off and on

b.

Becoming angry at the nurse

c.

Acting stunned by the loss

d.

Discussing the change in role that will occur

ANS: a

a. During the yearning and searching phase of Bowlbys phases of mourning, the nurse anticipates that the client may have outbursts of tearful sobbing and acute distress.

b. During Bowlbys disorganization and despair phase of mourning, the nurse anticipates that the client may express anger at anyone who might be responsible, including the nurse.

c. During the numbing phase of Bowlbys phases of mourning, the nurse anticipates that the client may act stunned by the loss.

d. During the reorganization phase of Bowlbys phases of mourning, the nurse anticipates that the client may discuss the change in role that will occur.

REF: Text Reference: p. 570

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