Nokea
A stillborn baby was delivered a few hours ago. After the birth, the family has remained together, holding and touching the baby. The registered nurse is orienting a new nurse, and has provided education on how to communicate with the family. Which statement by the new nurse indicates that teaching has been effective?
- A. How can I assist you with ways to remember your baby?'
- B. You seem upset. Do you think a tranquilizer would help?'
- C. I feel so bad. I don't understand why this happened either.'
- D. I can allow another 15 minutes together for you to grieve.'
Correct Answer: A
Rationale: Nurses should be able to explore measures that assist the family with creating memories of the infant so that the existence of the child is confirmed, and the parents can complete the grieving process. The correct option identifies this measure and also demonstrates a caring and empathetic client-focused response while providing the family with the option to express their needs. Option 2 devalues the parents' feelings and is inappropriate. Option 3 is inappropriate and reflects a lack of knowledge on the nurse's part. Option 4 appears that the nurse is uncaring.
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A client diagnosed with diabetes mellitus requires the immediate amputation of a leg. The client is very upset and states, 'This is the doctor's fault! I did everything that I was told to do!' When considering the grieving process, how should the nurse respond to the client's statement?
- A. Notify the agency's risk management department.
- B. Help the client consider alternatives to treatment.
- C. Allow the client to use anger as a coping mechanism.
- D. Ask the client to list all previous health care providers.
Correct Answer: C
Rationale: Anger is a stage in the grieving process and an expected response to impending loss. Usually a client directs the anger toward himself or herself, God or another spiritual being, or the caregivers; thus far the client's behavior demonstrates effective coping. Notifying the risk management department is premature, especially because the client has said nothing about legal action. Analyzing alternative treatment options and previous health care providers is likely to interfere with effective coping, and it can delay lifesaving treatment.
When a client is dead on arrival (DOA) to the emergency department, the family states that they do not want an autopsy performed. Which statement should the nurse make in response to the family?
- A. Autopsies are mandatory for clients who are DOA.'
- B. Federal law requires autopsies for clients who are DOA.'
- C. The medical examiner makes the decision about autopsies.'
- D. I will make sure the medical examiner is aware of your request.'
Correct Answer: D
Rationale: The nurse should notify the medical examiner or the coroner when a family wishes to avoid having an autopsy on a deceased family member. Normally the medical examiner will honor the family request unless there is a state law requiring the autopsy. Depending on the state, it is not mandatory for every client who is DOA to have an autopsy. However, many states require an autopsy in specific circumstances, including sudden death, a suspicious death, and death within 24 hours of admission to the hospital. Autopsy is not a requirement under federal law.
The nurse is interacting with the family of a client who is unconscious as a result of a head injury. Which approach should the nurse use to help the family cope with their concerns?
- A. Explain equipment and procedures on an ongoing basis.
- B. Discuss displaying their grief only when not in the room with the client.
- C. Discourage them from touching the client in order to minimize stimulation.
- D. Explain that they need their rest so they should adhere to regular visiting hours.
Correct Answer: A
Rationale: Families often need assistance to cope with the sudden severe illness of a loved one. The nurse should explain all equipment, treatments, and procedures, and he or she should supplement or reinforce the information given by the primary health care provider. Displaying grief is a normal process and should not be discouraged. The family should be encouraged to touch and speak to the client and become involved in the client's care in some way if they are comfortable with doing so. The nurse should allow the family to stay with the client whenever possible. This is important for both the client and the family.
A client diagnosed with incurable cancer has a life expectancy of a few weeks. Which response indicates that the client's partner is reacting with an expected coping response?
- A. Refusing to visit the client
- B. Expresses anger with his God
- C. Not allowing the death to occur at home
- D. Sending the children to live with relatives
Correct Answer: B
Rationale: Anger is a normal stage of the grieving process and is an expected coping response when facing the imminent loss of a loved one. Expressing anger toward a spiritual entity, such as God, is a common way for individuals to process their grief. Refusing to visit the client indicates avoidance or denial, which may not be constructive. Not allowing the death to occur at home or sending children to live with relatives may reflect practical decisions but do not directly indicate an expected emotional coping response related to grief.
Shortly after a client dies, the nurse asks the family about funeral arrangements. When the family refuses to discuss the issue, which intervention by the nurse is appropriate for their stage of grief?
- A. Displaying acceptance of the family's issues
- B. Providing information about funerals in general
- C. Probing for information about funeral arrangements
- D. Asking the family if they would like time alone with the client
Correct Answer: D
Rationale: The family is exhibiting the first stage of grief: denial. By asking the family if they would like time alone with the client, the nurse supports the family's feelings and allows the family to process the death. Option 1 is a suitable intervention for the acceptance or reorganization and restitution stage of grief. Eliminate options 2 and 3 because they are not appropriate at this time since the family has indicated their desire not to discuss funeral arrangements.