1.

The nurse who is caring for a client experiencing grief recognizes that a healthy grief response includes: (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. a. Complicated grief. b. Disenfranchised grief. c. Anticipatory grief. d. Unresolved grief. e. Abbreviated grief. Grade: User Responses: Feedback: 1 b.Disenfranchised grief.,c.Anticipatory grief.,e.Abbreviated grief. a.Rationale: Cognitive Level: Remembering Nursing Process: Assessment Client Need: Psychosocial Integrity Healthy grieving may be experienced as abbreviated, or shortlived, grief. Anticipatory grief, or grief that is experienced before the loss/deat h actually occurs, is a healthy form of grieving. Disenfranchised grief occurs when the emotions are felt privately, but not expressed in public. This is a healthy form of grieving that may be part of the clients cultural response to loss. Complicated grief is an unhealthy grief response. Unresolved grief, which is extended in length and severity, is considered an unhealthy grief response.

2.

A nurse must tell a family of a clients death and anticipates that different family members may display different stages of death according to Kbler Ross, including: (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. a. Depression. b. Rejection. c. Anger. d. Denial. e. Shock. Grade: User Responses: Feedback: 1 a.Depression.,c.Anger.,d.Denial. a.Rationale: Cognitive Level: Understanding Nursing Process: Assessment Client Need: Psychosocial Integrity Rejection is not one of the stages of death. Denial is the most likely response when informing the family of the clients death. Depression is another potential response to death, according to K bler-Ross. Anger is the second stage of death, but people experiencing a loss can move through the stages in any order. Shock is not one of Kbler-Rosss stages of death.

3.

When caring for a dying client, the nurse anticipates death will occur soon when assessing: (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. a. Increased sense of taste. b. Blurred vision. c. Decreased blood pressure. d. Difficulty speaking. e. Tachycardia. Grade: User Responses: Feedback: 1 b.Blurred vision.,c.Decreased blood pressure.,d.Difficulty speaking. a.Rationale: Cognitive Level: Remembering Nursing Process: Assessment Client Need: Physiological Integrity Loss of muscle tone makes it difficult for the client to speak. Slowing of the circulation causes a reduction in blood pressure. Sensory impairment just prior to death causes blurring of vision. Slowing of the circulation results in bradycardia or slow pulse. Sensory impairment causes loss of taste.

4.

The nurse is providing care to an unconscious client who is dying and anticipates impending death when assessing the clinical manifestation of: a. Regular, shallow respirations. b. Faster and weaker pulse. c. Improved appetite. d. Mottling and cyanosis of the extremities. Grade: User Responses: Feedback: 1 d.Mottling and cyanosis of the extremities. a.Rationale: Clinical manifestations of impending clinical death include mottling and cyanosis of the extremities, normally beginning with the most distal extremities and gradually moving more medially. Cognitive Level: Understanding Nursing Process: Assessment Client Need: Physiological Integrity

5.

How can the nurse be most helpful to the family of a client whose death is imminent? a. Ease the familys burden by ensuring that all physical care is done by the nurse. b. Limit information provided to avoid overwhelming the family. c. Repeat information often so the family can take in what is occurring. d. Lead the family in prayer or meditation for the client. Grade: User Responses: Feedback: 1 c.Repeat information often so the family can take in what is occurring. a.Rationale: The nurse may need to repeat instructions and information because the stress the family is experiencing may limit their ability to hear and understand. Cognitive Level: Applying Nursing Process: Implementation Client Need: Psychosocial Integrity

6.

The nurse suggests that hospice care might be a good option for a dying client. A family member responds negatively to this suggestion, stating I dont want her to die in a nursing home! The nurses best response is: a. Hospice care will require hospitalization until the time of death. b. The client can remain in the home with hospice care. c. Hospice care will allow the client the best chance of recovery. d. The hospice facilities allow visitors. Grade: User Responses: Feedback: 1 b.The client can remain in the home with hospice care. a.Rationale: Hospice care can be provided in a variety of settings, including the clients home. Cognitive Level: Applying Nursing Process: Implementation Client Need: Physiological Integrity

7.

After a nurse questions a client about relationship abuse, the client claims to be ready to leave the abusive relationship, although past attempts were not successful due to fear, lack of support, lack of confidence, and financial considerations. The client asks the nurse for help. The nurse identifies the perceived loss experienced by the client is: a. Loss of dreams. b. Loss of residence. c. Loss of current lifestyle. d. Loss of partner. Grade: User Responses: Feedback: 1 a.Loss of dreams. a.Rationale: Dreams are something of which only the client is aware. She may have dreamed of a happier relationship that she finally acknowledged was not forthcoming, or the dream may be of a different origin. Only the client knows. Cognitive Level: Analyzing Nursing Process: Assessment Client Need: Psychosocial Integrity

8.

The nurse is caring for a client who lost her husband of 43 years earlier this month. The client describes the spouse to the nurse, often crying as she relates a specific story. The nurse recognizes this as: a. Anticipatory grief. b. A sign of complicated grieving. c. Part of the normal grieving process. d. Prolonged grieving. Grade: User Responses: Feedback: 1 c.Part of the normal grieving process. a.Rationale: Part of the normal process of grieving may be manifested by crying, verbalizations of loss, sleep disturbance, loss of appetite, and difficulty concentrating. This clients behavior is within the acceptable limits of normal grieving. Cognitive Level: Analyzing Nursing Process: Assessment Client Need: Psychosocial Integrity

9.

When providing postmortem care, the nurse appropriately: a. Positions the arms over the chest and ties the wrists together. b. Places the body in an upright position with three pillows under the head. c. Removes all jewelry, except a wedding band in some instances, which is taped to the finger. d. Removes dentures. Grade: User Responses: Feedback: 1 c.Removes all jewelry, except a wedding band in some instances, which is taped to the finger. a.Rationale: All jewelry is removed, except a wedding band in some instances, which is taped to the finger. Personal items are given to the family when they leave. Cognitive Level: Remembering Nursing Process: Implementation Client Need: Physiological Integrity

10.

The nurse demonstrates an important principle of postmortem care by: a. Calling the mortician to declare death. b. Pulling the sheet over the clients face until the family is comfortably seated in the room. c. Preparing the body to look as clean and natural as possible. d. Removing all indwelling catheters and tubes. Grade: User Responses: Feedback: 1 c.Preparing the body to look as clean and natural as possible. a.Rationale: It is important to prepare the body to look as natural as possible for family viewing and preserving client dignity. Cognitive Level: Understanding Nursing Process: Implementation Client Need: Psychosocial Integrity

11.

The nurse displays an effective therapeutic strategy for communicating with a client who is dying by: a. Staying with the client and talking about pleasant events. b. Helping the client to express primary concerns or thoughts. c. Encouraging the client to save energy by remaining as silent as possible. d. Offering reassurance and sympathy. Grade: User Responses: Feedback: 1 b.Helping the client to express primary concerns or thoughts. a.Rationale: It is therapeutic to acknowledge that clients who are dying may have specific topics they wish to discuss or share. The nurse should help clients to express the things that are most important to them to discuss. Cognitive Level: Understanding Nursing Process: Implementation Client Need: Psychosocial Integrity

12.

The nurse recognizes that a clients response to a loss or death is affected by: (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. a. The location of the death. b. The clients support systems. c. The clients perception of the significance of the loss. d. The clients age. e. The cause of death.

Grade: User Responses: Feedback:

1 b.The clients support systems.,c.The clients perception of the significance of the loss.,d.The clients age.,e.The cause of death. a.Rationale: Cognitive Level: Understanding Nursing Process: Assessment Client Need: Psychosocial Integrity The clients age will affect how he or she perceives, responds to, and copes with the loss. The significance, or importance, of the loss will affect the persons response. The client with strong support systems will cope more effectively than the client who lacks support. Clients who lose someone to a long-term illness tend to cope better than those whose loss was sudden or unexpected. The location where the death occurred plays little to no role in how the client copes with the death.

13.

The nurse identifies the client at greatest risk for difficulty coping with a death as: a. The spouse of a client who died of complications of Parkinsons disease. b. An 8-year-old child whose grandparent died a week before a planned visit. c. A mother whose 17-year-old child died in an auto accident the night before graduation. d. The grandparent of a child who died shortly after being born with severe anomalies. Grade: User Responses: Feedback: 1 c.A mother whose 17-year-old child died in an auto accident the night before graduation. a.Rationale: The age of the client and situation surrounding the loss, as well as the fact that this is a mother who lost a child, puts the mother at risk for having difficulty coping with the loss. Cognitive Level: Analyzing Nursing Process: Assessment Client Need: Psychosocial Integrity

14.

A client asks the nurses advice about having her 8-year-old son participate in the funeral services for a grandparent. The nurses best response is: a. Tell your son about the death after the services are over. b. Allow your son to participate in the services as he feels comfortable. c. Have the child attend school as usual, rather than disrupt his routine. d. Tell your son of the death, but keep him away from the services. Grade: User Responses: Feedback: 1 b.Allow your son to participate in the services as he feels comfortable. a.Rationale: The child can be given the opportunity to participate in whatever part of the ritual he feels comfortable with, and to grieve with others in the family. Cognitive Level: Applying Nursing Process: Implementation Client Need: Psychosocial Integrity

15.

When asked to sign the permission form for surgical removal of a large but noncancerous lesion on the face, the client begins to cry. The nurses most appropriate response is: a. I cry when I am happy or relieved sometimes, too. b. You must be very happy to finally have this lesion removed. c. Isnt it wonderful that the lesion is not cancerous? d. Tell me what it means to you to have this surgery. Grade: User Responses: Feedback: 1 d.Tell me what it means to you to have this surgery. a.Rationale: The nurse needs to assess and explore the meaning of the client's crying. Allow the client to define the meaning. Cognitive Level: Applying Nursing Process: Implementation Client Need: Psychosocial Integrity

16.

The nurse is working with the family of a client with a terminal illness. To assist the family in understanding the grieving process, the nurse teaches that: a. Anger at the client is not appropriate. b. Crying will subside in a few days after the loss. c. It is best to move on to the next phase of life quickly. d. Feeling sad, guilty, and lonely is a part of the process. Grade: User Responses: Feedback: 1 d.Feeling sad, guilty, and lonely is a part of the process. a.Rationale: Feelings of sadness, guilt, loneliness, and anger are normal aspects of the grieving process. Cognitive Level: Applying Nursing Process: Implementation Client Need: Psychosocial Integrity