2. Call the presence of the ring to the attention of the funeral director.
3. Tape the ring to the client’s finger.
4. Document fully whatever action is taken.
Question 19
Type: MCSA
A client recovering from back surgery is seen crying softly in bed. Upon assessment, the nurse learns that the
client has been told of the future inability to perform certain sports, activities, and employment types because of
the surgery. The nurse interprets this client’s reaction as a response to which type of loss?
1. Situational loss
2. Anticipatory loss
3. Psychological loss
4. Developmental loss
Question 20
Type: MCSA
An older client has just relocated from home to an assisted living facility. The nurse is concerned because the
client has been withdrawn and is crying periodically throughout the day. What type of loss is this client
demonstrating?
1. External objects
2. Familiar environment
3. Loved ones
4. Psychological
Question 21
Type: MCMA
A client with terminal cancer of the lung complains of being short of breath with bilateral crackles and wheezes,
despite oxygen at 4 L via nasal cannula and diuretic therapy. What nursing interventions are appropriate for this
client?
Standard Text: Select all that apply.
1. Move the client to a room closer to the nurse’s desk for closer observation.
2. Help the client assume a position lying on the right side.
3. Place a fan in the room to move air around the client.
4. Change the client’s oxygen therapy to a non-rebreathing mask.
5. Elevate the head of the client’s bed to a Fowler’s position.
6. Consider use of a p.r.n. morphine sulfate order.
Question 22
Type: MCMA
The nurse is providing postmortem care for a client whose family would like to view the body before it is
transported to the morgue. What interventions are necessary for this preparation?
Standard Text: Select all that apply.
1. Provide a total bed bath.
2. Place absorbent pads beneath the body.
3. Remove dentures.
4. Dress the client in street clothes.
5. Place a pillow under the head.
6. Tape the eyelids closed.
Question 23
Type: SEQ
The spouse of a deceased client is working through the stages of grief. If the nurse applies Martocchio’s five
clusters of grief to this situation, the spouse would progress through the clusters in which order?
Standard Text: Click and drag the options below to move them up or down.
Choice 1. Reorganization and restitution
Choice 2. Yearning and protest
Choice 3. Identification in bereavement
Choice 4. Shock and disbelief
Choice 5. Anguish, disorganization, and despair
Question 24
Type: MCMA
The nurse determines that a client, after learning of the death of a close family member, is demonstrating normal
signs of grief. What did the nurse assess in this client?
Standard Text: Select all that apply.
1. Crying
2. Weakness
3. Inability to sleep
4. No appetite
5. Inability to concentrate on conversations
Question 25
Type: MCMA
The nurse is concerned that a client is experiencing complicated grieving after the unexpected death of a son. The
nurse most likely assessed
Standard Text: Select all that apply.
1. the client’s denying the son’s death.
2. depression.
3. sudden weight loss because of not eating.
4. crying.
5. verbalizing the desire to not live anymore.
Question 26
Type: MCMA
When observing an older client’s response upon learning of the death of a close family friend, the nurse realizes
that the significance of the loss to the client is dependent upon which factors
Standard Text: Select all that apply.
1. Importance of the person to the client
2. Amount of changes that will occur because of the loss
3. The client’s beliefs
4. The client’s values
5. The client’s socioeconomic status
Question 27
Type: MCMA
The nurse is planning care to help a client work through the grieving process. What would be appropriate to
include in this plan of care?
Standard Text: Select all that apply.
1. Listen to the client.
2. Clarify and reflect the client’s feelings.
3. Reassure the client that all will be well.
4. Be silent.
5. Provide advice to the client.
Question 28
Type: MCMA
The nurse is providing emotional support to a client who just learned the outcome of a biopsy. What actions will
be the best for the nurse to provide at this time?
4. Provide information about community resources or support groups.
5. Acknowledge the grief of the client.
Question 29
Type: MCSA
A terminally ill client is demonstrating gurgling respirations. The nurse realizes that this client is
1. improving.
2. experiencing pain.
3. trying to talk.
4. nearing death.
Question 30
Type: MCMA
The nurse determines that a terminally ill client is nearing death. What did the nurse assess to make this clinical
decision?
Standard Text: Select all that apply.
1. Diarrhea
2. Muscle spasms
3. Slow, weak pulse
4. Decreased blood pressure
5. Cyanosis of the extremities
Question 31
Type: MCSA
While caring for a client who is approaching death, the nurse notices the client’s facial expression of extreme
sadness. What should the nurse do?
1. Leave the client alone.
2. Provide physical care to increase comfort.
3. Acknowledge the client’s expression, and ask whether the client would like to talk about her feelings.
4. Offer to provide pain medication.
Question 32
Type: MCMA
The spouse of a dying client is sitting quietly in the client’s room, looking at the floor. What can the nurse do to
help the client and spouse during this time?
Standard Text: Select all that apply.
1. Encourage the spouse to move closer to the client, if desired.
2. Permit the spouse to sit alone.
3. Leave the spouse and client in the room alone together as much as possible.
4. Recommend that the spouse return home to get some rest.
5. Suggest the spouse read to the client, if desired.
Question 33
Type: MCMA
The family members of a client who has just died want to spend time with the client. What should the nurse do to
prepare the client for the family?
Standard Text: Select all that apply.
1. Check the client’s religion to make sure care is in compliance with religious expectations.
2. Remove equipment from the room.
3. Permit the family to view the client before postmortem care is done.
4. Change the linens.
5. Place the client in a natural body position.
