Exhibits

The nurse is reviewing provider orders for Mrs. Thompson who is in the end- of-life stage. Match each provider order with its appropriate category: anticipated, nonessential, or contraindicated. Select the correct category for each given order.

A. Listen actively and attentively to the client and family concerns and emotions. Active listening is the most important action at the end-of-life stage. The client and family may have fears, emotional distress, or unanswered questions, and the nurse should provide empathetic support and reassurance. Listening fosters trust, emotional comfort, and dignity in care.
B. Encourage the client to make decisions about treatment options and advance care planning. While advance care planning is important, Mrs. Thompson has already expressed her wishes and designated decision-makers. At this stage, the focus should be on comfort rather than making new treatment decisions.
C. Provide detailed medical information and prognosis to the client. While some information may be appropriate, overloading the client with medical details may increase stress. The nurse should provide information as needed but prioritize emotional support.
D. Discuss funeral arrangements and end-of-life wishes with the client. This may be appropriate if the client initiates the conversation, but forcing discussions about funeral plans may not be beneficial. The nurse’s role is to support emotional well-being rather than focus on logistics.

The nurse identifies that the client is currently in Kübler-Ross's anger stage of grief as evidenced by feeling like life is not fair.

Anger. In this stage, individuals express frustration, resentment, or questioning of fairness. The client’s statement, "Why is this happening to me? I have always been healthy," reflects anger and a sense of injustice regarding their diagnosis. The refusal of medications and care further supports emotional distress and resistance.

Denial and Isolation. This stage is characterized by disbelief regarding the diagnosis or refusal to accept reality. On Day 1, the client questioned the accuracy of their test results, suggesting denial. However, by Day 3, their emotions had shifted to frustration, making denial no longer the most fitting condition.

Bargaining. This stage involves making deals with a higher power or attempting to negotiate for more time or a different outcome. The client has not displayed behaviors indicative of bargaining, such as promising to change habits or seeking alternative treatments.

Acceptance. Acceptance is marked by established methods of coping and coming to terms with the diagnosis. The client is still struggling emotionally, refusing care, and expressing frustration, which indicates they have not yet reached this stage.

Depression. This stage is characterized by feelings of deep sadness for potential missed experiences. The client’s emotional response is more aligned with anger rather than deep sorrow, withdrawal, or despair, which are typical signs of depression in the grieving process.