A nurse is caring for a client who was recently diagnosed with a terminal illness. The client tells the nurse, “I am looking forward to seeing my grandchildren grow up.” The nurse should identify that the client is experiencing which of the following stages of grief?
Denial
Anger
Bargaining
Acceptance
The Correct Answer is A
Choice A Reason:
Denial is the first stage of grief, where individuals refuse to accept the reality of their situation. In this case, the client is looking forward to a future event (seeing their grandchildren grow up) despite being diagnosed with a terminal illness. This indicates that the client is not acknowledging the severity of their condition and is instead holding onto a hopeful but unrealistic outcome. Denial serves as a defense mechanism to protect the individual from the immediate shock and pain of their diagnosis.
Choice B Reason:
Anger is the second stage of grief, characterized by feelings of frustration and helplessness. Individuals in this stage may direct their anger towards themselves, others, or the situation. The client’s statement does not reflect anger or frustration but rather an unrealistic hope for the future, which aligns more with denial than anger.
Choice C Reason:
Bargaining is the third stage of grief, where individuals attempt to negotiate or make deals to alter their situation. This stage often involves “if only” or “what if” statements as the person tries to regain control. The client’s statement does not indicate any form of negotiation or deal-making but rather a refusal to accept the reality of their terminal illness.
Choice D Reason:
Acceptance is the final stage of grief, where individuals come to terms with their situation and begin to plan for the future realistically5. In this stage, there is an acknowledgment of the loss and a gradual adjustment to the new reality. The client’s statement about looking forward to seeing their grandchildren grow up does not reflect acceptance but rather a denial of the terminal nature of their illness.
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Correct Answer is B
Explanation
Choice A Reason:
Adjusting the head of the bed to 90° is a recommended practice for clients with dysphagia. This position helps facilitate swallowing and reduces the risk of aspiration by using gravity to assist the passage of food and liquids from the mouth to the stomach.
Choice B Reason:
Drinking thickened juice with a straw is not recommended for clients with dysphagia. Using a straw can increase the speed and force with which liquids enter the mouth, making it harder to control the swallow and increasing the risk of aspiration. Thickened liquids are designed to move more slowly, giving the client more control over swallowing, but using a straw negates this benefit.
Choice C Reason:
Taking frequent breaks while eating is a good practice for clients with dysphagia. It allows them to chew and swallow food thoroughly, reducing the risk of choking and aspiration. This practice also helps prevent fatigue, which can impair swallowing function.
Choice D Reason:
Tucking the chin when swallowing, also known as the chin-tuck maneuver, is a common technique used to help clients with dysphagia. This action helps protect the airway by narrowing the entrance to the larynx and directing the food or liquid down the esophagus.
Correct Answer is A
Explanation
Choice A reason:
“Why do you feel upset about this?” is a response that opens up a dialogue and allows the nurse to express their feelings and concerns. It shows that the nurse manager is interested in understanding the nurse’s perspective and is willing to listen. This approach can help identify any underlying issues and work towards a resolution. It is important for managers to create an environment where employees feel heard and supported.
Choice B reason:
“You should be working harder.” is a dismissive response that does not address the nurse’s concerns. It can make the nurse feel undervalued and unappreciated, leading to decreased morale and job satisfaction. This response does not foster a supportive work environment and can exacerbate feelings of frustration and resentment. Effective management involves acknowledging employees’ efforts and addressing their concerns constructively.
Choice C reason:
“I will reprimand your team members.” is a response that may seem supportive at first glance, but it can create a negative work environment. Reprimanding team members without understanding the full context can lead to resentment and conflict within the team. It is important for managers to address performance issues in a fair and constructive manner, focusing on solutions rather than punishment.
Choice D reason:
“You must feel frustrated.” is an empathetic response that acknowledges the nurse’s feelings. It shows that the nurse manager understands the nurse’s frustration and is willing to listen. This response can help build trust and rapport between the nurse and the manager, creating a more positive and supportive work environment. Empathy is a key component of effective leadership and can help address and resolve workplace issues.