The hospice nurse is caring for a terminally ill patient. The patient's son is
distraught because the patient will probably die within the next few days
... [Show More] and there
is nothing he can do about it. What is the most appropriate nursing diagnosis for
the patient's son currently?
a. Chronic grief related to impending death of parent.
b. Death anxiety related to feeling powerless over situation.
c. Risk for conflicting religious belief related to being distraught over impending
death of parent.
d. Complicated grieving related to desired avoidance of mourning.
b. Death anxiety related to feeling powerless over situation.
The patient's son is experiencing death anxiety because he is unable to change the
outcome of his parent's imminent death. Risk for conflicting religious belief is not
appropriate as the son does not mention religious beliefs. Complicated grieving is
applicable to individuals who have recently experienced a loss. Chronic grief is
grief that continues for a long period of time.
The nurse is caring for a terminally ill patient whose children have come home to
be with their mother during her last few days. They spend time looking through
picture albums, watching old home movies, and remembering fun times spent
together. The nurse identifies which term that best describes the activity of the
patient's children?
a. Anticipatory grieving
b. Bereavement
c. Caregiver role strain
d. Death anxiety
a. Anticipatory grieving
Anticipatory grief is defined as the cognitive, affective, cultural, and social
reactions to an expected death, felt by the patient as well as family members and
friends. This type of grief is experienced before an actual loss occurs and can arise
when a person is initially diagnosed with an acute illness, chronic disease, orterminal disease. Reminiscence and life review are used to assist those
experiencing anticipatory grief with the realization that death is approaching.
The nurse is caring for a female patient who died a few minutes previously. The
patient's family comes in to the room and immediately starts to wash the body in
preparation for burial. What is the most appropriate action of the nurse currently?
a. Inform the patient's family that the body must be transported to the morgue.
b. Instruct the patient's family that hospital staff will provide postmortem care. c.
Obtain needed signatures for organ donation and autopsy.
d. Offer to provide any needed supplies and provide privacy for the family.
d. Offer to provide any needed supplies and provide privacy for the family.
The most appropriate action of the nurse currently is to allow the family to wash
the patient's body in accordance with their wishes and cultural values. The family
may wish to participate in this procedure or may complete this procedure in
private. Health care personnel should abide by their wishes as much as possible.
Signatures may be obtained from the next of kin when washing is complete. The
patient's body may be transported to the morgue or funeral home after washing is
completed.
The nurse is caring for an emergency room patient who died because of a mishap
with a loaded gun. The patient's body will be transported to the coroner's office for
an autopsy. Which items will the nursing staff remove from the body before it
leaves the hospital?
a. Endotracheal tube
b. Foley catheter and IV line
c. Dentures
d. Necklace and watch
d. Necklace and watch
Medical devices and tubes are not removed from the body if an autopsy is to be
performed. The patient's necklace and watch may be removed and given to the
patient's family members before the body is transported to the coroner's office for
autopsy. Dentures should be left in the patient's mouth.The nurse is caring for a patient who suffered a miscarriage at 24 weeks of
pregnancy. The patient is devastated by the loss but her husband minimizes her
grief by stating, "Quit crying. It's not like you lost a real baby." What term best
describes the anguish felt by the patient?
a. Disenfranchised grief
b. Delayed grief
c. Complicated grief
d. Masked grief
a. Disenfranchised grief
The patient is experiencing disenfranchised grief because she cannot share the pain
of her loss with her husband. The husband is not willing to support his wife as she
mourns the loss of her pregnancy or recognize the grief that she is going through.
Delayed grief is suppression of the grief process. Complicated grief occurs when
the affected person is not able to progress through the normal stages of grieving. It
is characterized by distressing symptoms lasting at least 6 months after the death of
a significant person. Masked grief occurs when a person's bereavement behaviors
interfere with his or her life, but the person does not notice this.
A patient has recently been given a terminal diagnosis. When family members offer
to help, the patient snaps and yells at them, but then angrily accuses them of not
helping. The patient's spouse is frustrated and asks the hospice nurse what to do
about this situation. What response by the nurse is best?
a. "Don't worry. Your spouse will get over this phase soon."
b. "Anger is an expected part of the grieving process."
c. "Would your spouse be open to professional counseling?"
d. "This diagnosis is difficult to handle; just be patient."
b. "Anger is an expected part of the grieving process."
Anger is one of the stages of grief as identified by Elisabeth Kubler-Ross. The
nurse would first explain this to the spouse. Telling the spouse the patient will get
over the phase soon or that the diagnosis is difficult to handle is false reassurance
and dismissive of the concerns. It is too early to consider counseling although the
patient may need it later. This is also a yes/no question which is not therapeutic.The nurse is caring for a terminally ill patient who appears to be calmly having a
conversation with someone even though there is nobody else in the room. The
patient reaches out and appears to take something out of thin air and hold it close.
Which is the appropriate action of the nurse?
a. Reorient the patient and reassure that nobody else is in the room.
b. Be present but quiet and let the patient continue the conversation.
c. Carefully assess the patient's mental status and level of attention.
d. Obtain a set of vital signs and check the patient's pulse oximetry.
b. Be present but quiet and let the patient continue the conversation.
Patients who are near death sometimes have a special communication with loved
ones who have already died. It is important to recognize that these experiences can
be comforting to the dying patient, and nurses would not contradict or argue with
the person. It is imperative to simply be present with the person, listen, and be
open to any attempts to communicate. It is acceptable to ask gentle questions such
as "What are you seeing?" or "How does that make you feel?" Having an open
discussion with the family while describing what is occurring may provide further
insight to the nurse as the health care provider, as well as promoting a sense of
understanding and acceptance for the family. As long as the patient is calm and
content, the best action of the nurse is to be present but let the patient continue the
conversation undisturbed.
The nurse is caring for a patient who died a few minutes ago. The patient's family
is at the bedside and very demonstrative in their grief, weeping loudly and holding
on to the patient's body. What is the most appropriate action of the nurse?
a. Inform the family that the patient's body must be taken to the morgue shortly.
b. Ask the family members to step outside while postmortem care is provided. c.
Obtain required signatures for the body to be taken to the funeral home.
d. Provide privacy and allow the patient's family to grieve over the body.
d. Provide privacy and allow the patient's family to grieve over the body.
The nurse should allow the patient's family to grieve in private over the loss of
their loved one. Some cultures favor free expression of emotions after death, and
the nurse should respect this. Signatures can be obtained, postmortem care can beprovided, and the body brought to the morgue after an appropriate time of grieving
has been provided to the family. [Show Less]