Chapter 36 Loss and Grief-Fundamentals of Nursing

Chapter 36: Loss and Grief
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MULTIPLE CHOICE ra




1. A nursing attendant encounters a family who experienced the death of their adult child las
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t year. The parents are talking about the upcoming anniversary of their child’s death. The n
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ursing attendant spends time with them discussing their child’s life and death. Which nur
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sing principle does the nursing attendant ’s action best demonstrate?
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Facilitation of normal mourning ra ra ra




b. Pain-management technique ra




c. Grief evaluation ra




d. Palliative care ra




ACCURATE ra



ANSWER:-A
Anniversary reactions can reopen grief processes. A nursing attendant should openly ackno
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wledge the loss and talk about the common renewal of grief feeling around the anniversary o
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f the individual’s death; this facilitates normal mourning. The nursing attendant is not attem
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pting to alleviate a physical pain. The actions are of open communication, not evaluation. Pal
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liative care refers to comfort measures for symptom relief.
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DIF:Apply (application) ra



OBJ:Identify the nursing attendant ’s role when caring for hospital client s who are experiencing
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loss, grief, or death. TOP:Implementation MSC:
ra ra Psychosocial Integrity
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2. A hospital client diagnosed with terminal cancer asks the nursing attendant what the crite
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ri
a are for hospice care. Which information should the nursing attendant share with the hos
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pi tal client ? ar ra




a. It is for those needing assistance with pain management.
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b. It is for those having a terminal illness, such as cancer.
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c. It is for those with completion of an advance directive.
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d. It is for those expected to live less than 6 months.
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ACCURATE ANSWER:-D ra



Hospital client s accepted into a hospice program usually have less than 6 months to live. H
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ospital client s with a terminal illness are not eligible until that point. Palliative care provide
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s assistance with pain management when a hospital client is not eligible for hospice care. An
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advance directive can be completed by any person, even those who are healthy.
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DIF:Understand (comprehension) ra



OBJ:Discuss the criteria for hospice care. ra ra ra ra ra ar



TOP:Teaching/Learning MSC: Psychosocial Integrity ra ra




3. A terminally ill hospital client is experiencing constipation secondary to pain medication.
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Which is the best method for the nursing attendant to improve the hospital client ’s const
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ipation problem? ra




a. Contact the health care provider to discontinue pain medication. ra ra ra ra ra ra ra ra




b. Administer enemas twice daily for 7 days. ra ra ra ra ra ra

, c. Massage the hospital client ’s abdomen. ra ra ra ra ra



d. Use a laxative. ra ra




ACCURATE ANSWER:-D ra



Opioid medication is known to slow peristalsis, which places the hospital client at high risk f
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or constipation. Laxatives are indicated for opioidinduced constipation. Massaging the hospital
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client ’s abdomen may cause further discomfort
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. Discontinuing pain medication is inappropriate for a terminally ill hospital client . Enema ad
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ministration twice a day is not the best step in the treatment of opioid-induced constipation.
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DIF:Apply (application) ra



OBJ:Prioritize interventions for symptom management in hospital client s at the ra ra ra ra ra ra ra ra ra ra ar



end of life. TOP:Implementation
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Reduction of Risk Potential ra ra ra




4. A severely depressed hospital client cannot state any positive attributes to life. The nursing
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ar


attendant hospital client ly sits with this hospital client and assists the hospital client to id
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entify several activities the hospital client is actually looking forward to in life. Which spiri
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tual concept is the nursing attendant trying to promote? a. Time management
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b. Reminiscence
c. Hope
d. Faith
ACCURATE ANSWER:-C ra



Hope gives a person the ability to see life as enduring or having meaning or purpose. The nurs
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ing attendant ’s actions do not address time management, reminiscence, or faith. Time manage
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ment is organizing and prioritizing activities to be completed in a timely manner. Reminiscen
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ce is the relationship by mentally or verbally anecdotally relieving and remembering the perso
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n and past experiences. Faith is belief in a higher power.
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DIF:Apply (application) ra



OBJ:Develop a nursing care plan for a hospital client and family experiencing loss ara ra ra ra ra ra ra ra ra ra ra ra ar



nd grief. TOP:Implementation
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5. In preparation for the eventual death of a hospice hospital client , the nursing attendant o
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rganizes a meeting of all hospice nursing attendant s. A plan of care to be followed when th
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is hospital client dies is prepared. Which information will be included in the plan?
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Avoid discussing the death with immediate family members.
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b. Discuss expectations of normal grieving with the family and friends. ra ra ra ra ra ra ra ra ra




c. Encourage the hospital client ’s family and friends to verbally express their needs. ra ra ra ra ra ra ra ra ra ra ra ra




d. Assure family members they will not be expected to assist with postmortem care.
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ACCURATE ANSWER:-C ra



Families and friends should be encouraged to express both their concerns and needs so the st
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aff can effectively care for them. Avoiding the discussion of deathrelated issues, reinforcing expec
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ted grieving behaviors and in any way limiting contact with t
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he hospital client during or after the death process is inappropriate.
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DIF:Apply (application) ra



OBJ:Develop a nursing care plan for a hospital client and family experiencing loss ara ra ra ra ra ra ra ra ra ra ra ra ar



nd grief. TOP:Planning
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, 6. Family members gather in the emergency department after learning that a family member
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was ra



involved in a motor vehicle accident. After learning of the family member’s unexpected deat
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h, tar



he surviving family members begin to cry and scream in despair. Which phase does the nur
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sin g attendant determine the family is in according to the Attachment Theory? a. Numbing
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b. Reorganization
c. Yearning and searching ra ra




d. Disorganization and despair ra ra




ACCURATE ANSWER:-C ra



Yearning and searching characterize the second bereavement phase in the Attachment Theory.
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Emotional outbursts of tearful sobbing and acute distress are common in this phase. During t
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he numbing phase, the family is protected from the full impact of the loss. During disorganiza
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tion and despair, the reason why the loss occurred is constantly examined.
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Reorganization is the last stage of the Attachment Theory in which the person accepts thecha ra ra ra ra ra ra ra ra ra ra ra ra ra ra ra



nge and builds new relationships.
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DIF:Apply (application) ra



OBJ:Examine grief theories. TOP:Evaluation ra ra ar



MSC: Psychosocial Integrity ra ra




7. A nursing assistive personnel (NAP) is caring for a dying hospital client . Which action by
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t he NAP will cause the nursing attendant to intervene? a. Elevating head of bed
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b. Making the hospital client eat ra ra ra ra




c. Giving mouth care every 2 to 4 hours ra ra ra ra ra ra ra




d. Keeping skin clean, dry, and moisturized ra ra ra ra ra




ACCURATE ANSWER:-B ra



Hospital client s should never be forced to eat so the nursing attendant will intervene to corr
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ect this inappropriate behavior. Eating in the last days of life often causes the hospital client
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pain and discomfort. Equally, as the body is shutting down the nutrients in food are not able to
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be absorbed. Therefore, forcing hospital client s to eat serves no beneficial purpose for the hos
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pital client . All the rest are correct and do not need the nursing attendant to intervene. Elevat
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ing the head of the bed is appropriate and will promote ease of breathing and lung expansion
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and facilitate postural drainage. Giving mouth care will protect membranes if dehydrated, na
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useated, or vomiting. Keeping skin clean, dry, and moisturized will decrease skin discomfort
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and prevent skin breakdown.
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DIF:Apply (application) ra



OBJ:Determine ways to collaborate with family members and the interdisciplinary team to provide
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palliative care. TOP:Implementation MSC: Management of Care
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8. An Orthodox Jewish rabbi has been pronounced dead. The nursing assistive personnel
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respectfully ask family members to leave the room and go home as postmortem care is
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provided. Which statement from the supervising nursing attendant is best?
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―I should have called a male colleague to handle the body.‖
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b. ―Family members stay with the body as part of the mourning ritual.‖ ra ra ar ar ra ar ra ra ar ra ra




c. ―I wish they would go home because we have work to do here.‖
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d. ―Family will quietly leave after praying and touching the rabbi’s head.‖ ra ra ra ra ra ra ra ra ra ra




ACCURATE ANSWER:-B ra