NCLEX · Grief, Loss, and End-of-Life

A client with terminal cancer says: 'I've made peace with dying. I just want to make sure my family will be okay.' How should the nurse interpret this statement?

Correct answer

The client has achieved Erikson's ego integrity and is in an advanced acceptance stage — their focus has shifted from personal survival to legacy and family welfare; this is a sign of healthy psychosocial adjustment to dying

  1. A The client is in denial
  2. B The client is expressing suicidal ideation
  3. C The client has achieved Erikson's ego integrity and is in an advanced acceptance stage — their focus has shifted from personal survival to legacy and family welfare; this is a sign of healthy psychosocial adjustment to dying
  4. D The client needs antidepressants

Why this is the answer

ACCEPTANCE IN TERMINAL ILLNESS: When a dying client expresses peace with death and redirects focus to legacy, relationships, and the welfare of others, this represents psychosocial maturity and acceptance — not pathology. ERIKSON'S EGO INTEGRITY: Late life developmental task; successful resolution = sense of meaning and acceptance; NURSING RESPONSE: Support this process; ask about legacy wishes (letters to family, recordings, life review); facilitate meaningful conversations between client and family (if client consents); involve social work or chaplaincy to support the family welfare concerns the client expressed; do NOT pathologise acceptance or prescribe antidepressants for a client who is NOT depressed but is appropriately and adaptively coping; DO assess for actual depression (anhedonia, hopelessness, suicidal ideation) — acceptance is different from depression; this client's statement shows forward focus, not hopelessness.
Source: NCLEX-PN PS — End of Life, Acceptance and Legacy