Chapter 29: The Experience of Loss, Death and Grief

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ANS: D
1. The nurse is discussing future treatments with a client who has A defining characteristic for the nursing diagnosis of hopelessness
a terminal illness. The nurse notes that the client has not been may include the client stating, "What does it matter?" when offered
eating and responds to the nurse's information by stating, "What choices or information concerning him or her. The client's behav-
does it matter?" Which of the following is the most appropriate iour of not eating also is an indicator of hopelessness.
nursing diagnosis for this client? The client's behaviour and verbalization is not an example of social
a. Social isolation isolation. The client is not avoiding others or being restricted from
b. Spiritual distress seeing others.
c. Denial Spiritual distress is not the most appropriate nursing diagnosis for
d. Hopelessness this client. The focus should be on the client's lack of hope.
The client's behaviour and verbalization does not indicate denial.
ANS: D
The benefit of anticipatory grief is that it allows time for "letting go";
the dying client and his or her loved ones are able to say goodbye
and complete life affairs before the actual death or loss occurs.
It is not most beneficial for grieving to take place only in private. It
is important for grief to be acknowledged by others, and for those
grieving to be able to receive the support of others in the grieving
process.
2. The nurse recognizes that anticipatory grieving can be most
Anticipatory grieving can be discussed with others in most cir-
beneficial to a client or family for which of the following reasons?
cumstances. However, anticipatory grief may be disenfranchised
a. It can be done in private.
grief as well, meaning it cannot always be openly acknowledged,
b. It can be discussed with others.
socially sanctioned, or publicly shared, such as grief over the
c. It can promote separation of the ill client from the family.
death of a partner with acquired immune deficiency syndrome
d. It allows time for the dying client and his or her loved ones to
(AIDS). The discussion of grief with others can also take place with
say goodbye and complete life affairs before the actual death or
normal grief, after the loss has occurred. Anticipatory grieving is
loss occurs.
unique from normal grieving in that it allows time for "letting go"
before the death occurs.
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, this type of grieving can help a client or
family to progress to a higher emotional state.
ANS: D
When caring for clients experiencing grief, it is important for the
nurse to assess his or her own emotional well-being and to un-
derstand his or her own feelings about death. The nurse who is
aware of his or her own feelings will be less likely to place personal
situations and values before those of the client.
Although coursework on death and dying may add to the nurse's
3. The newly graduated nurse is assigned to his or her first dying
knowledge base, it does not best prepare the nurse for caring for
client. How can the nurse best prepare to care for this client?
a dying client. The nurse needs to have an awareness of his or her
a. Complete a course dealing with death and dying.
own feelings about death first, as death can raise many emotions.
b. Control his or her own emotions about death.
Being able to control one's own emotions is important; however, it
c. Draw on the experience of the death of a loved one.
is unlikely that the nurse would be able to do so if he or she has not
d. Develop an understanding of his or her own feelings about
first developed a personal understanding of his or her own feelings
death.
about death.
Experiencing the death of a loved one is not a 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 emo-
tions if complicated grief is present. The nurse is best prepared by
first developing an understanding of his or her own feelings about
death.
ANS: C
A dying client's family is better prepared to provide psychological
4. An identified outcome for the family of the client with a terminal
support if the nurse discusses with them ways to support the dying
illness is that they will be able to provide psychological support to
person and listen to needs and fears.
the dying client. To assist the family to meet this outcome, which
Demonstration of bathing techniques may help the family meet
of the following should the nurse plan to include in the teaching
the dying client's physical needs, but not provide psychological
plan?
support.
Application of oxygen devices may help the family meet physical
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 Chapter 29: The Experience of Loss, Death and Grief
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needs for the client, but not provide psychological support for the
client.
a. Demonstration of bathing techniques
Information on when to contact the hospice nurse is important
b. Application of oxygen devices
knowledge for the family to have and may help them feel they are
c. Recognition of client needs and fears
being supported in caring for the dying client. However, contact
d. Information on when to contact the hospice nurse
information does not help the family provide psychological support
to the dying client.
ANS: C
No topic that a dying client wishes to discuss should be avoided.
The nurse should respond to questions openly and honestly. As
5. The nurse is assigned to a client who was recently diagnosed client advocate, the nurse should assist the client to obtain the
with a terminal illness. During morning care, the client asks about necessary information to make this decision.
organ donation. How should the nurse respond? The nurse should provide the client with information with which
a. Have the client first discuss the subject with the family. to make such a decision. Although the nurse may suggest that
b. Suggest the client delay making a decision at this time. the client discuss the subject with the family after having obtained
c. Assist the client to obtain the necessary information to make information, it is up to the client to discuss the subject with his
this decision. family.
d. Contact the physician so consent can be obtained from the The nurse should respect the client and provide the necessary in-
family. formation for him or her to make a decision, rather than dismissing
the client's question.
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.
ANS: B
According to Kübler-Ross, the client is in the denial stage of dying.
6. A client has been diagnosed with terminal cancer of the liver
The client may act as though nothing has happened, may refuse
and is receiving chemotherapy on a medical unit. In an in-depth
to believe or understand that a loss has occurred and may seem
conversation with the nurse, the client states, "It can't be happen-
stunned, as though it is "unreal" or difficult to believe.
ing to me." According to Kübler-Ross, with which of the following
No stage of anxiety is found in Kübler-Ross's five stages of dying.
is this stage of dying associated?
No stage of confrontation is found in Kübler-Ross's five stages of
a. Anxiety
dying.
b. Denial
During depression, the individual may feel overwhelmingly lonely
c. Confrontation
and withdraw from interpersonal interaction. Depression is one of
d. Depression
Kübler-Ross's five stages of dying, but is not represented by this
example.
ANS: B
Maintaining the integrity of rituals and mourning practices gives
7. Which of the following statements is true regarding cultural
families a sense of acceptance of the client's death and an inner
beliefs and death?
peace.
a. The ethical decisions surrounding a client's death should be
The nurse should be familiar with policies and procedures, but
based on hospital policy and not culture.
ethical decisions should be made with an understanding and
b. Maintaining rituals and practices allows a sense of acceptance
appreciation of the client's culture.
of the dying process.
The nurse must assess the terminally ill client's and family's wish-
c. The nurse must decide which cultural practices will be incorpo-
es for end-of-life care and develop a plan of care by integrating
rated in care of the dying.
client culture and spiritual beliefs.
d. Regardless of culture, following hospital practices will help focus
On the contrary, the nurse must assess the terminally ill client's
client and family on the dying process.
and family's wishes for end-of-life care and develop a plan of care
by integrating client culture and spiritual beliefs.
ANS: D
The focus in planning nursing care is to promote self-esteem and
8. Which of the following is the primary concern of the nurse in dignity by taking a therapeutic stance that conveys respect for
providing care to a dying client? the client as a whole person, with feelings, accomplishments, and
a. Promoting optimism in the client and being a source of encour- passions independent of the illness experience.
agement Optimism should not be the primary focus when caring for the
b. Intervening in the client's activities of daily living to allow the dying client. The nurse should promote the client's self-esteem
client to focus on his or her emotional state and allow the client to die in comfort and with dignity.
c. Allowing the client to be alone and expecting isolation on the The client should be allowed to make choices and perform as
part of the dying person many activities of daily living independently as possible. This al-
d. Selecting interventions designed to maintain the client's dignity lows the client to maintain self-esteem and dignity.
and self-esteem 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.

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 Chapter 29: The Experience of Loss, Death and Grief
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9. Hospice nursing care has a different focus for the dying client.
Which of the following should the nurse know about client care
provided through a hospice?
a. It is designed to meet the client's individual wishes, as much as
possible.
b. It is usually aimed at offering curative treatment for the client.
c. It is involved in teaching families to provide postmortem care.
d. It does not include an interdisciplinary care team.
10. The nurse is preparing to assist the client in the end stage of the client to conserve energy for those tasks.
her life. How should the nurse provide comfort for the client who Spending more time with the client conveys caring, and allows
is showing fatigue?
a. Spend more time with the client.
b. Limit the use of analgesics.
c. Provide larger meals with more seasoning.
d. Determine valued activities and schedule rest periods.
11. The nurse is working with a client on an inpatient hospice unit.
Which of the following actions should the nurse take in order to
maintain the client's sense of self-worth during the end of life?
a. Leaving the client alone to deal with final affairs
b. Calling on the client's spiritual advisor to take over care
c. Spending time with the client and allowing him or her to share
life experiences
d. Having a grief counsellor visit
.
12. Which of the following would be a nursing intervention to assist imizes dysfunctional adaptation behaviours (e.g., not sleeping) by
the client with a nursing diagnosis of Sleep pattern disturbance facilitating resolution of grief through problem-solving skills.
related to the loss of spouse and fear of nightmares?
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. behaviour.
d. Sit with the client and encourage verbalization of feelings.
ANS: A
The nurse's role in hospice nursing care is to meet the primary
wishes of the dying client and to be open to the individual desires
of each client. The nurse supports a client's choice in maintaining
comfort and dignity.
Hospice care is for the terminally ill. It is not aimed at offering
curative treatment, but rather the emphasis is on palliative care.
Hospice care may provide bereavement follow-up for the family
after a client's death, but hospice nurses typically do not teach the
family postmortem care.
Hospice care programs include provision of an interdisciplinary
care team of physicians, nurses, spiritual advisers, social workers,
and counsellors.
ANS: D
To promote comfort in the terminally ill client, the nurse should
help the client to identify values or desired tasks and then help
verbalization, but is not the best way to promote comfort for a
fatigued client.
The use of analgesics should not be limited. Controlling the ter-
minally ill client's level of pain is a primary concern in promoting
comfort.
Nausea, vomiting, and anorexia may increase the terminally ill
client's likelihood of inadequate nutrition. The nurse should serve
smaller portions and bland foods, which may be more palatable.
ANS: C
Taking time to let the client share his or her life experiences,
particularly what has been meaningful, enables the nurse to know
the client better. Knowing the client then facilitates choice of thera-
pies 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.
The nurses can help the client meet spiritual needs by facilitating
connections to a spiritual practice or community and supporting
the expression of culturally held beliefs. The client's spiritual ad-
visor 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 client's sense of self-worth, as it may imply the
client is not worthy of the nurse's time or attention.
A grief counsellor may be requested to visit if the client is expe-
riencing complicated grief. Having a grief counsellor visit may be
less helpful than spending time with the client, to help maintain a
client's sense of self-worth
ANS: 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 min-
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
It is not necessary to refer the client to a psychologist or psy-
chotherapist 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
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 Chapter 29: The Experience of Loss, Death and Grief
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is obtaining, but it does not address the issue causing the sleep
disturbance, which is grief from the loss of the spouse.
ANS: A
To promote comfort for the terminally ill client, specific to nausea
13. How should the nurse promote comfort for the terminally ill
and vomiting, the nurse should administer anti-emetics, provide
client, specific to nausea and vomiting?
oral care at least every two to four hours, offer a clear liquid diet
a. Provide frequent mouth care.
and ice chips, and avoid liquids that increase stomach acidity such
b. Suction oral secretions.
as coffee, milk, and citrus acid juices.
c. Increase the fluid intake.
Suctioning would remove respiratory secretions.
d. Offer a high-residue diet.
Increasing the fluid intake may help prevent constipation.
A low-residue diet may help prevent diarrhea.
ANS: B
Positioning the client upright is an independent nursing interven-
tion for the promotion of respiratory function in a terminally ill client.
14. Which of the following is a nurse-initiated or independent Limiting fluids may not promote respiratory function, and the nurse
activity for promotion of respiratory function in a terminally ill should not do so unless a client is on a fluid-restricted diet.
client? Reducing narcotic analgesic use is not a nurse-initiated activity
a. Limiting fluids to promote respiratory function. A respiratory rate should be as-
b. Positioning the client upright sessed before administering narcotics to prevent further respira-
c. Reducing narcotic analgesic use tory depression. Management of dyspnea (air hunger) involves
d. Administering bronchodilators judicious administration of morphine and anxiolytics for relief of
respiratory distress.
The administration of bronchodilators would require a physician's
order. It is not an independent nursing activity.
ANS: A
During the "yearning and searching" phase of Bowlby's phases of
15. The nurse is using Bowlby's phases of mourning as a frame- mourning, the nurse anticipates that the client may have outbursts
work for assessing the client's response to the traumatic loss of of tearful sobbing and acute distress.
her leg. During the "yearning and searching" phase, how does the During Bowlby's "disorganization and despair" phase of mourning,
nurse anticipate the client may respond? the nurse anticipates that the client may express anger at anyone
a. Crying off and on who might be responsible, including the nurse.
b. Becoming angry at the nurse During the "numbing" phase of Bowlby's phases of mourning, the
c. Acting stunned by the loss nurse anticipates that the client may act stunned by the loss.
d. Discussing the change in role that will occur During the "reorganization" phase of Bowlby's phases of mourn-
ing, the nurse anticipates that the client may discuss the change
in role that will occur.

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