Chapter 42: Death and Loss Yoost & Crawford: Fundamentals of Nursing: Active Learning For Collaborative Practice, 2nd Edition

Chapter 42: Death and Loss
Yoost & Crawford: Fundamentals of Nursing: Active Learning for Collaborative

Practice, 2nd Edition
MULTIPLE CHOICE
1. 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 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 mother
b. Death anxiety related to feeling powerless
over situation
c. Powerlessness related to progression of
mother’s terminal illness
d. Complicated grieving related to desired
avoidance of mourning
ANS: B
The patient’s son is experiencing death anxiety because he is unable to change the outcome of
his mother’s imminent death. The son makes no mention of religious beliefs, so impaired
religiosity is not appropriate. Complicated grieving is applicable to individuals who have
recently experienced a loss. Chronic grief is grief that continues for a long period of time.
DIF: Applying OBJ: 42.5 TOP: Diagnosis

MSC: NCLEX Client Needs Category: Psychosocial Integrity: Grief and Loss
NOT: Concepts: Coping
2. 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
ANS: A
The patient and her children are experiencing anticipatory grief as they prepare for the expected
death of the patient. Reminiscence and life review are used to assist those experiencing
anticipatory grief with the realization that death is approaching.
DIF: Applying OBJ: 42.1 TOP: Assessment

NOT: Concepts: Family Dynamics
3. 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.
ANS: D
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.
DIF: Applying OBJ: 42.7 TOP: Implementation

MSC: NCLEX Client Needs Category: Psychosocial Integrity: End of Life Care
4. 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
ANS: D
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.
DIF: Understanding OBJ: 42.7 TOP: Implementation

NOT: Concepts: Health Care Law
5. 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. Moral distress
d. Masked grief
ANS: A
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. Moral distress occurs when people cannot act according to their moral values.
Masked grief occurs when a person’s bereavement behaviors interfere with his or her life, but the
person does not notice this.

6. 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.”
ANS: B
Anger is one of the stages of grief as identified by Elizabeth 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.

7. 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.
ANS: B
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.

NOT: Concepts: Palliation
8. 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.
ANS: D
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 be provided, and the body brought to the
morgue after an appropriate time of grieving has been provided to the family.

9. The nurse is caring for a patient who lost her husband 1 year ago after 55 years of marriage. The
patient no longer takes care of herself or cooks and rarely eats, stating she has no appetite. The
nurse determines that the Nursing diagnosis of complicated grieving applies to the patient.
Which is the priority goal for the patient?
a. The patient will shower every other day
and eat at least two meals a day.
b. The patient will identify personal
strengths that will increase coping ability.
c. The patient will discuss the meaning of
her loss with a family member or friend.
d. The patient will be provided with phone
numbers for local community resources.
ANS: A
The highest priority goal of this patient is self-care including showering and eating in order to
protect her health and safety. The other goals are lower priority after the patient’s necessary
activities of daily living are addressed. Goals should also reflect what the patient accomplishes;
so the goal of being provided with phone numbers is actually something for the nurse to do.
DIF: Applying OBJ: 42.6 TOP: Planning

10. The hospice nurse is caring for a several adult children shortly after the death of a parent. They
have various reactions as they deal with their loss. The nurse recognizes which reactions to be in
the cognitive domain?
a. They let the house get filthy because they
can’t be bothered to clean it.
b. They are tossing and turning all night and
are unable to get a good night’s sleep.
c. They are easily distracted and often lose
train of thought during conversation.
d. They have lost their appetites and have no
desire to eat anything.
ANS: C
Cognitive deficits include the inability to concentrate and follow a conversation. Letting the
house get filthy is a sign of apathy, which is in the behavioral domain. Insomnia falls within the
behavioral and physical domains. Loss of appetite is within the physical domain.

11. The hospice nurse is caring for a patient who is terminally ill. The patient’s spouse is the primary
caregiver, providing constant care and spending all his or her time meeting the patient’s needs.
The spouse says to the nurse “After my spouse dies, I will finally get that colonoscopy my
provider has been bugging me about.” What does the nurse understand about this statement?
a. The spouse is looking forward to being
freed from the caretaker role.
b. The spouse has neglected his or her own
physical needs for too long.
c. The spouse is making some realistic plans
for life after the death.
d. The spouse is in denial that the patient is
dying and the important role of caregiver
will end.
ANS: C
Often caregivers neglect their own needs while in the caregiver role. The spouse understands the
patient will die soon and is being realistic in understanding his or her own physical needs have
been neglected. This shows healthy coping.
DIF: Understanding OBJ: 42.3 TOP: Assessment

12. The nurse is caring for a patient who has just died in a motor vehicle accident. What is the
priority action of the nurse before the patient’s family arrives to see the patient’s body?
a. Gently wash the body and provide
perineal care.
b. Remove the patient’s dentures and
jewelry.
c. Ensure that the death certificate has been
signed.
d. Determine which funeral home will pick
up the body.
ANS: A
Release of bowel and bladder contents often occur at the time of death, and the perineal care is a
priority before the family arrives. The body should be gently cleaned to remove blood and debris
from the accident. The patient’s dentures and jewelry should not be removed from the body. The
death certificate does not need to be signed before the family arrives. The family can decide
which funeral home will be used and notify the nurse after their arrival.

NOT: Concepts: Caregiving
13. The nurse is caring for a patient who is terminally ill with metastatic bone cancer. The patient
tells the nurse that he is not afraid of death but does not want to be in pain and suffer before he
dies. Which intervention by the nurse will be most appropriate to meet this patient’s wishes?
a. Establish around-the-clock dosing for pain
medications with additional doses for
breakthrough pain.
b. Assist the patient to reminisce and review
his life, spending as much time as possible
with loved ones.
c. Use therapeutic touch, guided imagery,
and soft music to put the patient at ease
and relieve anxiety.
d. Encourage the patient to participate in
prayer and meditation along with
preferred religious practices.
ANS: A
The patient’s primary wish is to die without pain, and the best intervention to meet this goal is
administration of pain medication around the clock with extra doses for breakthrough pain. The
other interventions may make the patient more comfortable but will not address his primary
desire for adequate pain management.

NOT: Concepts: Pain
14. The home care nurse is caring for a terminally ill patient who states that he wants to set up a
scholarship in his name at the local university before he dies. What is the best action by the
nurse?
a. Suggest that the patient think it over and
wait a few days before contacting the
school.
b. Direct the patient to ask his family about
the possibility of starting a scholarship.
c. Assess the patient’s mental status to
ensure that he is competent to make the
decision.
d. Assist the patient to find the necessary
information about endowed scholarships.
ANS: D
As the patient’s advocate, the nurse should help provide the necessary information for the patient
to set up a scholarship if that is his decision. The patient does not need to discuss the subject with
his family first, and assessment of the patient’s mental status is not needed. The patient may not
have the time to wait a few days before contacting the university.

15. Which statement by the patient indicates to the nurse that it may be an appropriate time to
consider hospice care rather than further aggressive measures to treat his terminal illness?
a. “I am praying every day that this last
round of chemotherapy will work.”
b. “I want to spend what time I have left at
home with my grandchildren.”
c. “I need to meet with my financial planner
to make sure my life insurance is all set.”
d. “I am concerned that my wife won’t be
able to live on her own after my death.”
ANS: B
Hospice care is provided to patients who are terminally ill and wish to have no further aggressive
treatment in attempt to cure the disease. The patient’s statement that she just wants to be home
with her grandchildren indicates a readiness for hospice care.

16. The hospice nurse is caring for a terminally ill patient who will probably die within the next hour
or two. The patient’s daughter is keeping a vigil by the bedside and asks what she can do to help
her father at this time. What is the appropriate response of the nurse?
a. “Just let him know you are here, talk to
him, and let him know that you love him.”
b. “You can try to feed him a few bites of ice
cream to keep his mouth from getting
dry.”
c. “You can take this time to ensure that
arrangements are set with the funeral
home.”
d. “You should let me know when your
father’s breathing pattern changes.”
ANS: A
The patient’s daughter should be encouraged to spend the last moments of her father’s life with
him, reassuring him with her presence. The daughter should be encouraged to continue talking
with him because the patient may still hear her even if his eyes are closed and he does not speak.
The nurse is responsible for monitoring the patient for breathing changes. Oral intake will lead to
nausea and/or aspiration. This is not the time to make arrangements with the funeral home.
DIF: Applying OBJ: 42.7 TOP: Caring

17. The nurse is caring for an Islamic patient who has just died. The family is traveling from
overseas. Which action is the priority for the nurse to take right after the patient dies?
a. Arranging for embalming to preserve the
body until burial
b. Rearrange the furniture so the bed can
face Mecca
c. Arranging for transportation of the body
to the crematorium
d. Bringing in fruit for the patient’s journey
to the other world
ANS: B
After death, a patient’s body can be turned to face Mecca which is the holy site for Muslims. The
nurse would need to find out which direction that is. The family will work with the funeral home
to determine when and where burial will take place. Buddhists often bring fruit when someone
dies.

18. The nurse is caring for a patient whose mother recently passed away. The patient states that she
has not been able to concentrate or sleep since the funeral and is consuming increasing amounts
of alcohol to get through each day. The nurse knows which goal to be most appropriate for this
patient?
a. The patient will be referred to medical
social services for evaluation and
counseling.
b. The patient will be encouraged to describe
previous stressors and coping
mechanisms.
c. Nursing staff support patient’s coping
attempts and encourage verbalization of
feelings.
d. The patient will use effective coping
strategies with no alcohol consumption.
ANS: D
Goals are met by the patient rather than nursing or medical staff. The patient’s use of effective
coping strategies without drinking alcohol is an appropriate goal. Referring the patient for
counseling and encouraging the patient to verbalize stressors are interventions rather than goals.
DIF: Applying OBJ: 42.6 TOP: Planning

19. The nurse sees a young child in the clinic whose mother has only a few weeks to live. The child
has been misbehaving at school recently and is suspended after picking fights with other students
and defying teachers. The nurse identifies which stage of grieving that the patient is
experiencing?
a. Denial
b. Anger
c. Bargaining
d. Depression
ANS: B
The patient is angry over the impending death of the mother and is acting out this anger at school
by picking fights and defying his teachers. Denial is a temporary defense while processing the
information. Bargaining is negotiation to change the predicted outcome. Depression includes
crying and sadness.

20. The nurse is caring for a terminally ill patient whose family is insistent that additional
chemotherapy be administered even though the patient will most likely die within the next few
days. What is the best response of the nurse?
a. “The insurance company will not pay for
chemotherapy at this stage.”
b. “The focus right now needs to be on
keeping your loved one comfortable.”
c. “I will call the provider and relay your
wishes.”
d. “The patient needs to get stronger first
before chemotherapy can be
administered.”
ANS: B
Nurses advocate for patients to ensure that they are aware of their options for care that include
interventions, treatments, anticipated outcomes, as well as risk and benefits of any decision made
concerning medical care. The nurse must function as the patient’s advocate and encourage what
is in the best interest of the patient. Chemotherapy will not extend the patient’s life when death is
expected within the next few days and will only make the patient suffer needlessly when it is
administered. The patient will not get stronger over the next few days, and this criterion for
chemotherapy will never be met.

21. The nurse is caring for a patient who is having difficulty coping after being in a motor vehicle
crash in which her brother was killed. The patient was driving the car and blames herself for the
accident. What is the priority nursing intervention of the nurse?
a. Check to make sure that the patient does
not want to hurt or kill herself.
b. Educate the patient about available
support systems for grief resolution.
c. Enhance the patient’s coping skills to
alleviate depression and anxiety.
d. Encourage the patient to meet with a
spiritual leader for guidance.
ANS: A
The highest priority for the nurse is to ensure the safety of the patient, so assessment of potential
suicidal tendencies is paramount. The other interventions can take place once the nurse is
confident that the patient will not try to hurt or kill herself.

22. The nurse is caring for a terminally ill patient who will probably die within the next 2 weeks.
What is the priority nursing intervention?
a. Encouraging the patient to limit fluid
intake to minimize congestion
b. Limiting the use of pain medications so
that the patient can visit with family
c. Helping the patient to identify and
complete desired tasks and activities
d. Completing funeral arrangements with the
patient’s next of kin
ANS: C
The priority intervention for the nurse currently is to help the patient identify and complete
desired tasks and activities while the patient is still able to do so. Pain management is a high
priority at this time, so analgesics should never be limited unless requested by the patient. The
patient can drink as much or as little fluid as desired.

23. The nurse is caring for a terminally ill patient who is actively dying and refuses to eat anything
other than a few bites of ice cream. The patient’s family member approaches the nurse and
requests that a feeding tube be inserted so that her loved one will not starve to death. What is the
best response of the nurse?
a. “Loss of appetite is a natural part of the
dying process. Tube feedings would be
uncomfortable and cause nausea.”
b. “I will contact the provider to obtain an
order to insert the tube and start tube
feedings.”
c. “Intravenous fluids would be more
comfortable for the patient than a tube
feeding. I will call the doctor to get the
order.”
d. “I will listen to the patient’s abdomen to
make sure that bowel sounds are present
and try encouraging oral fluids.”
ANS: A
Common physical symptoms at the end of life include anorexia and cachexia. Tube feedings will
cause discomfort as the tube is inserted and nausea as the GI tract is given food that it cannot
handle. Encouraging oral intake will lead to increased secretions and congestion as well as
possible aspiration of fluids. Intravenous fluids will increase congestion and edema. The nurse
would educate the family on this part of the dying process.

MULTIPLE RESPONSE
1. The nurse is caring for a patient who just died after a lengthy illness. Which portions of
postmortem care may be delegated by the nurse to the nursing assistant? (Select all that apply.)
a. Gently washing the body and closing the
patient’s eyes
b. Offering support and empathy to the
patient’s family members
c. Documenting the patient’s time of death
in the medical record
d. Notifying all of the patient’s consulting
providers of the patient’s death
e. Removing the patient’s hospital ID band,
IV lines, and urinary catheter
f. Gathering the patient’s belongings so they
may be taken home by the family
ANS: A, B, F
The nurse assistant can gently wash the patient’s body, close the patient’s eyes, and gather the
patient’s belongings. Offering support and empathy to the patient’s family members would be
done by all of the involved members of the nursing staff. Documenting the time of death in the
chart and notifying all of the patient’s providers is performed by the nurse. The nurse assistant
can remove the patient’s IV lines and urinary catheter if allowed by policy, but the hospital ID
band would be left in place.
DIF: Understanding OBJ: 42.7 TOP: Implementation

NOT: Concepts: Collaboration
2. The nurse is caring for a patient who has just died. Which assessment findings by the physician
and nurse are used to confirm that death has occurred? (Select all that apply.)
a. The patient was incontinent of bowel and
bladder.
b. The patient’s pupils are fixed and dilated.
c. The provider does not hear a heartbeat.
d. The patient’s extremities are cool and
mottled.
e. The patient has no palpable peripheral
pulses.
f. The patient’s face is relaxed and the
mouth is open.
ANS: A, B, C, E
Assessment findings that confirm death has occurred include lack of pulse/heartbeat and fixed
dilated pupils. Cool, mottled extremities, relaxed muscles, and incontinence of bowel and/or
stool are common assessment findings in patients who are dying.


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Chapter 42: Death and Loss

Yoost & Crawford: Fundamentals of Nursing: Active Learning for Collaborative

DIF: Applying OBJ: 42.5 TOP: Diagnosis

DIF: Applying OBJ: 42.1 TOP: Assessment

DIF: Applying OBJ: 42.7 TOP: Implementation

DIF: Understanding OBJ: 42.7 TOP: Implementation

DIF: Applying OBJ: 42.2 TOP: Assessment

DIF: Applying OBJ: 42.3 TOP: Implementation

DIF: Applying OBJ: 42.7 TOP: Implementation

DIF: Applying OBJ: 42.7 TOP: Implementation

DIF: Applying OBJ: 42.6 TOP: Planning

DIF: Applying OBJ: 42.1 TOP: Assessment

DIF: Understanding OBJ: 42.3 TOP: Assessment

DIF: Applying OBJ: 42.7 TOP: Implementation

DIF: Applying OBJ: 42.7 TOP: Implementation

DIF: Applying OBJ: 42.7 TOP: Implementation

DIF: Understanding OBJ: 42.7 TOP: Assessment

DIF: Applying OBJ: 42.7 TOP: Caring

DIF: Applying OBJ: 42.7 TOP: Implementation

DIF: Applying OBJ: 42.6 TOP: Planning

DIF: Understanding OBJ: 42.1 TOP: Assessment

DIF: Applying OBJ: 42.7 TOP: Caring

DIF: Applying OBJ: 42.7 TOP: Assessment

DIF: Applying OBJ: 42.7 TOP: Implementation

DIF: Applying OBJ: 42.7 TOP: Caring

DIF: Understanding OBJ: 42.7 TOP: Implementation

DIF: Understanding OBJ: 42.4 TOP: Assessment

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