A client has been recently diagnosed with terminal cancer. The client states, "This cannot be happening to me." The nurse identifies that the client is in what stage of grieving process?

Depression

Anger

Bargaining

Denial

Answer and Explanation

The Correct Answer is D

D. Denial is often the initial stage of the grieving process, characterized by disbelief or avoidance of the reality of the situation. Clients may refuse to accept the diagnosis or its implications, clinging to the hope that it is not true. The client's statement of "This cannot be happening to me" is consistent with denial, as they are expressing disbelief or resistance to the reality of their diagnosis.
A. This stage involves feelings of sadness, despair, and hopelessness. While depression is a common response to a terminal diagnosis, the client's statement of "This cannot be happening to me" suggests that they may still be in an earlier stage of grief.
B. Anger is another common stage of the grieving process, characterized by feelings of frustration, resentment, and hostility. Clients may direct their anger towards themselves, others, or even a higher power. While anger can be a prominent reaction to a terminal diagnosis, the client's statement does not explicitly express anger but rather disbelief or resistance.
C. Bargaining is a stage in which individuals may attempt to negotiate or make deals in an effort to change or postpone the inevitable outcome. For example, a client may pray for more time or promise to change their behavior in exchange for a better outcome. The client's statement of "This cannot be happening to me" does not reflect bargaining but rather denial or disbelief.

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Correct Answer is B

Explanation

B. This statement aligns with the concept of allostatic load, which refers to the cumulative physiological toll that chronic stress places on the body over time. Initially, the body's stress response system (the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system) is designed to help individuals cope with acute stressors. However, when stress becomes chronic, these physiological responses can become dysregulated and maladaptive, leading to negative health outcomes such as cardiovascular disease, immune dysfunction, and mental health disorders.
A. Chronic stress has been associated with various changes in gene expression and epigenetic modifications. However, these changes typically occur over longer periods and are not the primary mechanism by which chronic stress leads to illness in most cases.
C. Chronic stress can lead to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system, which are responsible for producing and regulating corticosteroids (such as cortisol) and catecholamines (such as adrenaline and noradrenaline). While acute stress typically results in increased production of these stress hormones, chronic stress can lead to desensitization and dysregulation of these systems, resulting in alterations in hormone levels and potential deficits in the availability of these stress mediators. However, deficits in corticosteroids and catecholamines are not the sole mechanism by which chronic stress leads to illness.
D. While chronic stress can certainly contribute to psychological fatigue and depletion of energy reserves, this is not the primary mechanism by which chronic stress leads to illness. The physiological responses to chronic stress, such as dysregulation of stress hormones, inflammation, and oxidative stress, are more directly linked to the development of various illnesses.

A. Offer a bedtime snack B. Pull curtains around the bed for privacy C. Limit unnecessary noise on the unit D. Provide a backrub

Correct Answer is C

Explanation

C. Excessive noise in the hospital environment, including alarms, conversations, and equipment noises, can disrupt sleep and negatively impact sleep quality. Therefore, limiting unnecessary noise on the unit is a crucial nursing intervention for improving sleep quality in the acute care setting. This may involve implementing quiet hours, reducing unnecessary conversations and activities during nighttime hours, and using noise-reducing strategies such as earplugs or white noise machines.
A. While providing a bedtime snack may help alleviate hunger and promote comfort, especially if the client is on a restricted diet or experiencing appetite changes, it may not directly address factors affecting sleep quality. Additionally, consuming food close to bedtime may not be suitable for all patients, especially those with dietary restrictions or certain medical conditions. Therefore, while a bedtime snack may be beneficial in some cases, it may not be the most important intervention for improving sleep quality in the acute care setting.
B. Pulling curtains around the bed can help create a sense of privacy and reduce visual distractions, which may contribute to a more conducive sleep environment. Enhanced privacy can also promote relaxation and feelings of security, potentially improving sleep quality. However, while privacy curtains can mitigate some external disturbances, they may not completely eliminate factors that affect sleep, such as noise or light.
D. Providing a backrub can promote relaxation, relieve tension, and enhance comfort, which may contribute to improved sleep quality for some patients. Massage therapy has been shown to reduce stress and promote relaxation, potentially facilitating better sleep. However, while backrubs can be a beneficial adjunct to promoting relaxation and comfort, they may not address all factors that affect sleep quality in the acute care setting.

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A client has been recently diagnosed with terminal cancer. The client states, "This cannot be happening to me." The nurse identifies that the client is in what stage of grieving process?

Nursing Test Bank

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Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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