Ch 37 Loss and Grief

A patient is diagnosed with cancer and is in the terminal stage. The patient tells the nurse, "I would do whatever you say. Please relieve me of this illness." Which stage of dying is the patient in?

1 Anger 2 Denial 3 Depression Correct4 Bargaining The patient expresses a willingness to do anything if the nurse helps to relieve the patient of the illness. This indicates that the patient is in the bargaining stage. In this stage the patient makes promises to self or significant others to behave differently in exchange for relief from the illness. In the anger stage, the patient expresses resistance and sometimes feels intense anger at another person or the situation. In the denial stage, the patient may not accept the truth. Denial provides psychological protection to the patient who cannot yet bear a loss. In the depression stage, the patient realizes the whole impact of the loss. In this stage the patient feels overwhelmingly sad, hopeless, and lonely.

The nurse is reviewing the data of patients who have experienced loss. Which patients are experiencing tangible loss? Select all that apply.

Correct 1 A patient who lost a child Correct 2 A patient who lost a hand 3 A patient who lost self-esteem 4 A patient who lacks confidence Correct 5 A patient whose house is robbed Body parts or functions, relationships, or possessions are considered tangible things. Therefore, a patient who lost a body part such as hand; a patient who lost parent-child relationship due to death of child; and a patient who lost possessions due to robbery are all experiencing tangible loss. A patient who experiences a loss of self-esteem or confidence is experiencing intangible loss.

A young adult lost a limb in a motor-vehicle accident and is very upset about it. How should the nurse classify the loss to help plan further interventions?

Correct1 Actual loss 2 Perceived loss 3 Necessary loss 4 Maturational loss The young adult has suffered an actual loss, because the patient can no longer feel, see, or know the lost limb. A perceived loss is experienced by the person only and is less obvious to other people. Necessary losses are natural and positive; they occur due to normal life changes. A necessary loss is replaced by something different or better. A maturational loss is a form of loss secondary to normally expected life changes across the life span.

Which theory of grief and mourning includes denial and acceptance?

Correct1 Stages of dying 2 Attachment theory 3 Dual process model 4 Trajectories of bereavement Stages of dying, a theory of grief and mourning, explains denial, anger, bargaining, depression, and acceptance. Attachment theory explains numbing, yearning, and searching. The dual process model explains loss-oriented activities and restoration-oriented activities. Trajectories of bereavement explain common grief, chronic grief, and chronic depression.

After the death of a patient, the family members are limiting their public displays of emotion. What could be the culture of the patient?

Western European

The registered nurse is teaching a nursing student how to relate the patient's situation to the type of grief the patient might experience. Which statement if made by the nursing student indicates a need for correction?

1 "An older adult with dementia is experiencing anticipatory grief." Correct2 "A person whose spouse was kidnapped and is still missing is experiencing delayed grief." 3 "A woman is experiencing disenfranchised grief after the death of her ex-husband." 4 "A person exhibiting obsessions after the death of his or her lover is experiencing exaggerated grief." When a person is gone or missing after a kidnapping, it indicates ambiguous loss, which is a type of disenfranchised grief. Delayed grief is frequently triggered by a second loss in which the grief is delayed or postponed because the loss is so overwhelming that the person must avoid full realization of loss. An older adult with dementia may experience anticipatory grief. People experience disenfranchised grief when their relationship to the deceased person is not socially sanctioned, cannot be shared openly, or seems of lesser significance. A woman whose ex-husband dies may experience disenfranchised grief. A person exhibiting obsessions or psychiatric may be experiencing exaggerated grief.

After speaking with a female patient experiencing depression, the nurse suspects that the patient has chronic grief. Which statement made by the patient would support the suspicion?

1 "I lost my beloved pet last week." 2 "I have been on chemotherapy for 6 months to treat cancer." 3 "My pregnancy was terminated when I was in an auto accident." Correct4 "I witnessed the sudden death of one of my close friends when we were children." A patient may experience normal grief after witnessing the sudden death of a close friend, but it may extend for a longer period of time when it is sudden or unexpected. Therefore, the patient may experience chronic grief. A patient who lost his or her beloved pet may experience normal grief. A patient who is on chemotherapy for 6 months to treat cancer may experience anticipatory grief. A patient may experience disenfranchised grief after a terminated pregnancy because of an accident.

Which statement about complicated grief indicates a need for correction? Select all that apply.

1 A delayed grief response is frequently triggered by a second loss. 2 In complicated grief, a person requires prolonged time to move forward after a loss. Correct 3 Exaggerated grief is a normal grief response, except that it extends for a longer period of time. Correct 4 Specific types of complicated grief include chronic, exaggerated, delayed, and anticipatory grief. 5 A loss due to homicide, suicide, or a sudden accident has the potential to become complicated grief. Chronic grief is a normal grief response, except that it extends for a longer period of time. Specific types of complicated grief include chronic, exaggerated, delayed, and masked grief, but not anticipatory grief. A delayed grief response is a type of complicated grief frequently triggered by a second loss. In complicated grief, a person requires prolonged time to move forward after a loss. Loss due to homicide, suicide, sudden accidents, or the death of a child has the potential to become complicated grief.

Which patient's condition can be categorized as delayed grief?

1 A patient who is exhibiting psychosis due to grief 2 A patient who is depressed due to death of a child Correct3 A patient who is trying to avoid the full realization of the loss 4 A patient who is unaware of behaving disruptively because of grief In delayed grief, the person may postpone the grief response because the loss is so overwhelming that the person must avoid the full realization of the loss. A patient who is exhibiting psychosis may be experiencing exaggerated grief. A patient who is depressed due to the death of a child may be experiencing normal grief. A patient who is unaware of behaving disruptively as a result of grief may be experiencing masked grief.

A person lost confidence due to rejection by a friend. Which loss is represented in this situation?

1 Actual loss Correct2 Perceived loss 3 Situational loss 4 Maturational loss Perceived loss is defined as person experiencing loss that is less obvious to other people. A person who lost confidence due to rejection by a friend may experience perceived loss. Actual loss occurs when a person can no longer see, feel, or hear a person or object. It occurs when there is a loss of body part or job. A person who meets unexpected external events such as sustaining an injury with physical changes in an automobile accident experiences situational loss. Maturational loss is a form of necessary loss that includes all expected normal life changes across the life span.

A patient has sustained severe injuries due to a motor-vehicle accident. The patient is unable to return to work due to physical disability. This affects the economic status of the patient. How should the nurse classify the loss to help plan further interventions?

1 Actual loss 2 Perceived loss Correct3 Situational loss 4 Maturational loss The patient is experiencing situational loss due to a sudden and unpredictable external event such as an accident. The economic status of the patient is affected due to the physical disability caused as a result of the accident. An actual loss is a loss in which a person can no longer feel, hear, see, or know a person or object. Perceived loss is a loss in which a person is experiencing a loss, but the loss is less obvious to other people. Maturational loss is a form of necessary loss that includes all normally expected life changes across the life span. Topics

A patient is experiencing memory loss due to a severe brain injury sustained in a car accident. The patient is unable to recollect her own name or that of family members and is unable to perform activities of daily living. Which loss has the patient sustained that may need further evaluation?

1 Actual loss 2 Perceived loss 3 Necessary loss Correct4 Ambiguous loss An ambiguous loss is a type of disenfranchised grief. It occurs when the individual is physically present but not psychologically available. An actual loss is a loss in which a person can no longer feel, hear, see, or know a person or object. A perceived loss occurs when a person is experiencing a loss, but that loss is less obvious to other people. Necessary losses are natural and positive.

Which type of loss does a toddler experience associated with separation anxiety from mom when starting preschool?

1 Actual loss 2 Perceived loss 3 Situational loss Correct4 Maturational loss A maturational loss is a form of necessary loss that includes all normally expected life changes across a patient's life span. When a toddler experiences separation anxiety from mom when starting preschool, it is a maturational loss. An actual loss is the loss of a body part, or death of a family member. Perceived loss is perceiving rejection by a friend as a loss. A situational loss is brought on by sudden and unpredictable events such as an auto accident.

In which stage of dying does a patient realize the full impact of the loss?

1 Anger 2 Denial Correct3 Depression 4 Bargaining In the depression stage, the patient realizes the whole impact of the loss. At this stage the patient feels hopeless and lonely. In the anger stage, the patient expresses resistance and intense anger at God, other people, or the situation itself. In the denial stage, the patient is psychologically not ready to accept the loss. In the bargaining stage, the patient postpones awareness of the loss. In this stage the person makes promises to self, God, or loved ones to live or believe differently to try to prevent the loss from taking place. In this stage the patient does not accept the truth.

A 1-year-old child lost his mother in a car accident. The child refuses to eat and has a sleep disturbance. Which factor is most likely responsible for this response?

1 Coping strategies 2 Nature of the loss Correct3 Human development 4 Personal relationship Human development is responsible for this response. In this case, the child does not understand the loss, although the child is aware that the mother is not present. Changes in eating and sleep habits are due to this awareness. In coping strategies, the person uses life experiences to deal with the stress of the loss. In this situation the child is too young to understand the loss; thus, the nature of the loss is not the reason affecting the child's behavior, health, and well-being. Similarly the child is too young to understand the quality and meaning of the lost personal relationship. Thus this factor is also not affecting the response.

A woman experiences the loss of a very early term pregnancy. Her friends do not mention the loss, and someone suggests to her that she can "always try again." The woman feels confusion over her sadness and stops talking about it with others. Which type of grief response is she most likely experiencing?

1 Delayed 2 Anticipated 3 Exaggerated Correct4 Disenfranchised This woman's friends are not fully acknowledging the value of her pregnancy because of the short length of time the woman was pregnant or because, by comparison, the loss seems less than losing a child after birth. The loss does not seem "legitimate." Thus the woman does not experience sympathy from others and feels disenfranchised. Delayed grief is a type of complicated grief in which the person's response is unusually delayed or postponed because the loss is so overwhelming. Anticipated grief occurs before the actual loss or death occurs. Exaggerated grief is also a type of complicated grief in which the person often exhibits self-destructive or maladaptive behaviors.

A family member of a recently deceased patient talks casually with the nurse at the time of the patient's death and expresses relief that she will not have to visit at the hospital anymore. Which theoretical description of grief best describes this family member's response?

1 Denial Correct2 Anticipatory grief 3 Dysfunctional grief 4 Yearning and searching A person who has been anticipating a loss for some time may have already experienced many of the emotions (e.g., sadness, shock) commonly associated with death. Denial is a stage of dying that a patient would experience. Yearning and searching are aspects of Bowlby's Attachment Theory.

The nurse is caring for a child diagnosed with muscular dystrophy. The parent of the patient feels severe grief and loss after seeing the child suffering. Which type of grief is the parent experiencing?

1 Normal Correct2 Anticipatory 3 Complicated 4 Disenfranchised grief When experiencing anticipatory grief, family members grieve the impending loss of companionship, control, sense of freedom, and the mental and physical changes the loved one will experience. Normal grief is a common and universal reaction to loss or death that may be unexpected or traumatic. In complicated grief, a patient has a prolonged or significantly difficult time moving forward after a loss. Disenfranchised grief is experienced by a patient when the relationship to the deceased person is not socially sanctioned, cannot be shared openly, or seems of lesser significance.

The nurse is caring for a patient who recently lost parents in a road accident. The nurse assesses that the patient has shortness of breath, a feeling of lethargy, and loss of appetite. Which stage of mourning should the nurse suspect in the patient according to Bowlby's attachment theory?

1 Numbing 2 Reorganization Correct3 Yearning and searching 4 Disorganization and despair Attachment is an instinctive behavior that leads to the development of love, protection, and support between children and their primary caregivers. A failure of the attachment between children and their primary caregivers results in mourning. Bowlby's attachment theory describes four stages of mourning: numbing, yearning and searching, disorganization and despair, and reorganization. Yearning and searching is the second stage of bereavement characterized by shortness of breath, a feeling of lethargy, and loss of appetite due to emotional outbursts. Numbing is the first stage of mourning characterized by stunned and unreal feelings. Reorganization is the last stage of mourning, which usually occurs a year after the loss. Disorganization and despair is the third stage of mourning, which is characterized by repeating the accident stories many times and realizing the loss as permanent.

Which stage of the attachment theory of grief and mourning is characterized by emotional outbursts of tearful sobbing?

1 Numbing 2 Reorganization Correct3 Yearning and searching 4 Disorganization and despair The attachment theory of grief and mourning was proposed by Bowlby in 1980. The yearning and searching stage of attachment theory is characterized by emotional outbursts of tearful sobbing. Numbing involves protecting the person from the full impact of the loss. Reorganization involves accepting the change and assuming unfamiliar loses. Disorganization and despair is characterized by endless examination of how and why the loss occurred.

A patient lost a romantic partner in a car accident. The patient is extremely upset about this loss. The patient experiences loss of sleep, appetite, and sluggishness. The patient reports feeling tightness in the chest and throat, and also has shortness of breath. Which stage of mourning is supported by this patient's presentation?

1 Numbing 2 Reorganization Correct3 Yearning and searching 4 Disorganization and despair The patient is in the yearning and searching stage of mourning. In this stage, the patient experiences tightness in the chest and throat, shortness of breath, a feeling of lethargy, insomnia, and loss of appetite. In the numbing stage, the patient feels stunned. In the reorganization stage, the person accepts the truth and begins to separate from the lost relationship. In the disorganization and despair stage, the person expresses anger at anyone who seems responsible for the loss.

The nurse observes physical symptoms of yearning including lethargy, insomnia, and loss of appetite in a patient who witnessed the accidental death of a friend. Which theory of grief and mourning explains this type of grief?

1 Stages of dying Correct2 Attachment theory 3 Dual process model 4 Rando's "R" process model The attachment theory of grief and mourning by Bowlby (1980) explains numbing, yearning and searching, disorganization and despair, and reorganization. The yearning and searching stage of this theory explains emotional outbursts of tearful sobbing and acute distress. Common physical symptoms in this stage include tightness in the chest and throat, shortness of breath, a feeling of lethargy, insomnia, and loss of appetite. The Kübler-Ross (1969) theory of grief and mourning explains denial, anger, bargaining, depression, and acceptance. The dual process model theory for grief and mourning by Stroebe and Schut (1999) explains loss-oriented activities and restoration-oriented activities. Rando's "R" process model for grief and mourning (1993) explains recognizing, reacting, reminiscing, relinquishing, readjusting, and reminiscence.

A patient is upset due to a terminal illness of a parent. How should the nurse educate the patient about anticipatory grief and its management? Select all that apply.

1 Emphasize high-dose sedation. 2 Instruct the patient to avoid meeting with the parent to overcome grief. 3 Explain to the patient that grief may aggravate the situation. Correct 4 Explain that the patient will eventually get mentally prepared for the loss. Correct 5 Explain that this grief cannot be controlled by willpower, because it is an unconscious process. Because the parent has a terminal illness, the patient will eventually prepare for the inevitability that the parent will die. Grief cannot be controlled by willpower, because it is an unconscious process. High-dose sedation should be advised only after obtaining the opinion of the health care provider and only for severe grief. Avoiding the parents is not a justifiable way of escaping grief. Grief does not last long and the patient may even experience relief once the parent passes away.

A patient is experiencing complicated grief and is having trouble moving forward in life. Which terms refer to specific types of complicated grief? Select all that apply.

1 Normal grief Correct 2 Delayed grief Correct 3 Masked grief Correct 4 Exaggerated grief 5 Disenfranchised grief A patient experiencing complicated grief has a difficult time moving forward after a loss. There are three types of complicated grief: delayed grief, masked grief, and exaggerated grief. Delayed grief is a response that is postponed because the loss was too overwhelming for the person to realize it. Masked grief is a response wherein the grief interferes with normal functioning of the person, but the person is not aware that the disruptive behavior is due to grief. Exaggerated grief refers to the exaggerated grief response, wherein the person demonstrates self-destructive and maladaptive behaviors. Normal grief and disenfranchised grief are not types of complicated grief. Normal grief is a common reaction characterized by complex (emotional, cognitive, and social) responses to loss and death. Disenfranchised grief is experienced by a person whose relationship with the deceased person is not supported socially or is considered to be of less significance.

Which actions done by a patient in a mental health clinic support the nurse's observation that the patient has low self-esteem due to experiencing a recent loss of an important possession? Select all that apply.

1 The patient shows dependence on others. Correct 2 The patient explains sentiment attached to the lost possession. 3 The patient stays lonely in the hospital setting. 4 The patient shows inconsistency in different situations. Correct 5 The patient insists on the usefulness of the lost possession. Loss is a process of losing someone or something. The implication of the loss is based on the type of loss. Loss of an important possession or object leads to grief, which depends on its value. The loss of possession that leads to low self-esteem is characterized by explaining the sentiment attached to it and the usefulness of it. Dependency on others is an implication of loss of life that includes death of a family member, friend, or co-worker. Loneliness is an implication due to the loss of a known environment such as suddenly leaving home, getting a new job, or hospitalization. The patient's inconsistency in different situations would indicate an alteration of personal identity that occurs due to loss of a job or a specific body part.

The nurse assesses a middle-aged adult and finds that the patient is experiencing normal grief and loss due to midlife developmental changes. Which statements if made by the patient would support the nurse's conclusion? Select all that apply.

Correct 1 "I got married recently." Correct 2 "I am the head of my family now." Correct 3 "I am my grandfather's caregiver." 4 "My parents got divorced when I was 7 years old." 5 "I have been living far away from my hometown for 8 years." Major life transitions such as changes in marital status, adapting to new family roles, and caring for aging parents occur for midlife adults. These are necessary losses that can trigger a normal grief response in midlife adults. School children may experience necessary loss and feel grief at loss of a loved one during the divorce of their parents. Living away from home is a developmental necessary loss common for young adults.

After communicating with a patient, the nurse suspects normal grief. Which statements if made by the patient would support the suspicion? Select all that apply.

Correct 1 "I was diagnosed with colon cancer." 2 "I often forget my residential address." 3 "I witnessed the death of my married lover recently." Correct 4 "I have lost interest in doing my regular work since I lost my beloved pet." Correct 5 "I often feel lonely since the death of my spouse, even though I have many friends." In normal grief, the patient may have feelings such as disbelief, yearning, anger, and depression. The patient may feel depressed after a cancer diagnosis. The patient may also feel lonely, helpless, and lose interest in usual work due to depression. Therefore, depression due to a cancer diagnosis, loss of beloved pet, or death of a spouse would support the nurse's suspicion. Forgetting the residential address may indicate dementia and lead to anticipatory grief. A patient that witnesses the death of a married lover may experience disenfranchised grief.

The nurse is attending to a terminally ill patient. Which behaviors show that the patient is in a stage of dying? Select all that apply.

Correct 1 Denial Correct 2 Depression 3 Anticipation Correct 4 Acceptance 5 Preparation The five stages of dying as defined by Kübler-Ross are denial, anger, bargaining, depression, and acceptance. Anticipation and preparation are not part of the stages of dying so these would not be relevant to the nurse's observation and diagnosis.

Which statements are true regarding factors that influence grief and loss? Select all that apply.

Correct 1 Religious practices help to navigate the loss. Correct 2 Increased ill temper is a common expression of grief. 3 School-age children always understand the cause of loss. Correct 4 Hope plays a vital role in a patient's adjustment to loss and death. 5 Socioeconomic status influences a person's grief process in an indirect way. Religious practices and beliefs help to navigate the loss and grief. One of the common expressions of grief includes increased ill temper. Hope has a vital role in a patient's adjustment to loss and death. School-age children do not always understand the cause of loss. Socioeconomic status influences a person's grief process in both direct and indirect ways.

The nurse is interviewing a patient and finds that the patient has recently been fired from a job. How should the nurse classify this type of loss?

Correct1 Actual loss 2 Maturational loss 3 Perceived loss 4 Situational loss When a person can no longer see, hear, feel, or know a person or an object, the loss is an actual loss, such as losing a job. A maturational loss includes all normally expected life changes across the life span, which are necessary for the development of coping skills. These coping skills can be used when a person experiences unplanned, unwanted, or unexpected loss. A perceived loss is defined by the person experiencing the loss but is less obvious to other people. A situational loss occurs as a result of a sudden unpredictable external event. It may be associated with physical disability, loss of function, and self-esteem.

A patient lost a sibling in a car accident. On the same day, the patient lost his job, but the patient does not seem upset about the job loss. Which grief type is indicated by the patient's presentation?

Correct1 Delayed grief 2 Masked grief 3 Exaggerated grief 4 Disenfranchised grief Delayed grief is characterized by two losses. One loss may be less important than the other, causing a delay in the response to one of the losses. The loss of the job is less important than the loss of the sibling, so the person shows a delayed response to the second loss. Masked grief is the grieving response wherein a person's normal functioning is disrupted, but the person does not realize that the disruption in functioning is due to the loss. In exaggerated grief, the person blames self for the loss. Disenfranchised grief is a loss that is not socially sanctioned, cannot be openly shared, or seems to be of lesser significance to others.

Regarding grief in older adults, which understanding helps guide the nurse's relationship with an elderly patient?

Correct1 Older adults have usually sustained many losses in life, which influence the current loss. 2 Older adults with poor memory experience grief less intensely. 3 Older adults generally handle loss better because they have more experience with it. 4 Social support is less important because an older adult's circle of friends has become smaller. Older adults have usually sustained more losses because they have lived longer. For people at any age, each loss influences the way one responds to subsequent losses. The loss of a social network makes it more important to find resources and sources of social support for grieving older adults. Sometimes many losses overpower a person's coping resources instead of making the person stronger.