Ch 43 Grief & Loss (Psychological & Developmental Variables)

The shift changed while the nursing staff was waiting for the adult children of a deceased client to arrive. The oncoming nurse has never met the family. Which of the following initial greetings is most appropriate? 1. "I'm very sorry for your loss." 2. "I'll take you in to view the body." 3. "I didn't know your father but I am sure he was a wonderful person." 4. "How long will you want to stay with your father?"

1. "I'm very sorry for your loss." [this statement acknowledges the familys grief simply]

When asked to sign the permission form for surgical removal of a large but noncancerous lesion on her face, the client begins to cry. Which of the following is the most appropriate response? 1. "Tell me what it means to you to have this surgery." 2. "You must be very glad to be having this lesion removed." 3. "I cry when I am happy or relieved sometimes, too." 4. "Isn't it wonderful that the lesion is not cancer?"

1. "Tell me what it means to you to have this surgery." [the nurse needs to assess and explore the meaning of the clients crying]

Elizabeth Kubler-Ross's Stages of Grieving are: ______________ . (5)

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

A client's family tells the nurse that their culture does not permit a dead person to be left alone before burial. Hospital policy states that after 6:00 PM when mortuaries are closed, bodies are to be stored in the hospital morgue refrigerator until the next day. How would the nurse best manage this situation? 1. Gently explain the policy to the family and then implement it. 2. Inquire of the nursing supervisor how an exception to the policy could be made. 3. Call the client's primary care provider for advice. 4. Move the deceased to an empty room and assign an aide to stay with the body.

2. Inquire of the nursing supervisor how an exception to the policy could be made. [when possible modifications of policy that demonstrate respect for the individual differences should be explored]

After a nurse questions a client about relationship abuse, the client responds the she is ready to leave the abusive relationship, although past attempts were not successful due to fear, lack of support, lack of confidence, and financial considerations. She asks the nurse for help. An example of perceived loss is: 1. Loss of partner 2. Loss of dreams 3. Loss of residence 4. Loss of current lifestyle

2. Loss of dreams [Perceived loss is experienced by one person but cannot be directly verified by others. Loss of partner, residence, and lifestyle can be seen and acknowledged by others, even if they are not favorable. Dreams are something of which only the client is aware. She may have dreamed of a happier relationship that she finally acknowledge was not forthcoming, or the dream may be of a different origin. Only the client knows.]

10. In working with a dying client, the nurse demonstrates assisting the client to die with dignity when performing which action? 1. Allows the client to make as many decisions about care as is possible 2. Shares with the client the nurse's own views about life after death 3. Avoids talking about dying and focuses on the present 4. Relieves the client of as much responsibility for self-care as is possible

1. Allows the client to make as many decisions about care as is possible [assisting the client to die with dignity involves allowing the client to participate in and choose the direction of remainder of his/her life]

The ability of an individual to cope with death is dependent upon a number of factors. Which person likely will have the most difficulty coping with a death? 1. A parent whose 17-year-old child died in an auto accident the night before graduation 2. A child of 8 years whose grandparent dies a week before a planned visit 3. The spouse of an alcoholic who is killed in an automobile accident 4. The grandparent of a child born with Tay-Sachs disease

1. A parent whose 17-year-old child died in an auto accident the night before graduation [Many factors affect the grieving experience. These include age, significance of the loss, culture, spiritual beliefs, gender, socioeconomic status, social support systems, and the cause of the death. In our culture, the death of an older person is accepted more easily than that of a younger person. The death is more easily accepted if it is anticipated, and if the person who died did not contribute to the death. Usually, the closer the individual is to the person who died, the more difficult it is to cope with the death.]

1. Which of the following may be considered normal or "healthy" types of grief? Select all that apply. 1. Abbreviated grief 2. Anticipatory grief 3. Disenfranchised grief 4. Complicated grief 5. Unresolved grief 6. Inhibited grief

1. Abbreviated grief 2. Anticipatory grief 3. Disenfranchised grief

Following the death of a child, one of the parents begins to falsely accuse other members of the family of blaming the child's death on the parent. This leads to family members avoiding the mentioned parent for fear of the false accusation. The parent takes this as proof that the family truly believes the accusation. This sets up a destructive cycle of family dysfunction. Which nursing diagnosis is most appropriate for this family? 1. Impaired family processes related to impaired adjustment 2. Impaired adjustment related to loneliness 3. Loneliness related to fear 4. Dysfunctional grieving related to loss of relationships

1. Impaired family processes related to impaired adjustment [The first part of the diagnostic statement reflects the concern at hand, while the second part is the etiology or cause. There are a number of concerns present in this scenario. Following the child's death, the whole family is impaired in processing the event, adjusting, and grieving. In addition, the parent is alienating the family with false accusations, resulting in lack of support, dysfunctional grieving, and loneliness. If the parent improved adjustment to the death, family processing would improve.]

Proper handling of the body following death is an important intervention for the client, family, and nurse. An intervention that reflects an important principle of postmortem care is: 1. Preparing the body to look as clean and natural as possible 2. Pulling the sheet over the patient's face until the family is comfortably seated in the room 3. Humor is helpful in relieving stress. However, use humor only after family has left. 4. Calling the physician to verify the time of death before taking the body to the morgue

1. Preparing the body to look as clean and natural as possible [The body is to be handled with dignity at all times. This does not include using humor at this time. After the body is cleaned and the linen freshened, the sheet is pulled to cover the patient's shoulders. Laws and policies differ regarding the nurse's ability to declare death. Even if a physician is required to declare death, the time of death cannot be verified exactly.]

While the nurse is discussing a client's likely death with family members, one of the offspring inquires, "We plan on taking turns being here for now, but we all want to be here at the time of death. Is there any way we can tell when that time is close?" The nurse's best response is: 1. "Often, there is a lucid moment during the last hour that lasts about 15 minutes. First look for relaxation followed by clearing of the eyes, looking around, focusing on faces, and clearing of the throat. Call the others in at that time." 2. "I wish I could tell you that there was a way to know. It could be minutes from now or another three days. One just never knows." 3. "You can expect more muscle relaxation and less movement. Breathing will become irregular and shallow, and change speed. Call me if you hear mucus in the throat. The pulse and blood pressure will decrease." 4. "You can expect the muscles to become rigid, with staring eyes and mouth closed. The head is pulled back with nuchal rigidity. Don't be alarmed when you hear a death rattle in the throat. "

3. "You can expect more muscle relaxation and less movement. Breathing will become irregular and shallow, and change speed. Call me if you hear mucus in the throat. The pulse and blood pressure will decrease." [Muscles relax with decreased activity. Muscle rigidity is not a usual pattern. The gag reflex is lost, and mucus accumulates in the back of the throat. Vision is blurred. A lucid moment is not a pattern in death. It is difficult to pinpoint the exact time when death will occur, but the imminence of clinical death can be detected.]

At which age does a child begin to accept that he or she will someday die? 1. Less than 5 years old 2. 5-9 years old 3. 9-12 years old 4. 12-18 years old

3. 9-12 years old [until children are about 5 years old they believe that death is reversible]

A family with five children experiences a stillbirth. While intervening with the family, one member expresses a view that causes special concern for the nurse. This person is: 1. A 3-year-old who wonders if the baby will come home after it gets better 2. A 5-year-old who cries, believing the death occurred because the child drew with magic markers on one of the baby blankets 3. A 13-year-old who assumes blame as punishment for shoplifting 4. A 15-year-old who says, "I still can't believe it is true."

3. A 13-year-old who assumes blame as punishment for shoplifting [A child of 3 does not understand the concept of death, or its permanence. A child of 5 may associate death with unrelated actions. A 15-year-old is expected to follow similar stages of grief, including denial.]

The client has been close to death for some time and the family asks how the nurse will know when the client has actually died. Which of the following would be the most accurate response from the nurse? 1. When the blood pressure can no longer be measured 2. When the gag reflex is no longer present 3. When there is no apical pulse 4. When the extremities are cool and dark in color

3. When there is no apical pulse [if there is no heartbeat the client has died]

A 22-year-old client with recent paraplegia lashes out and curses at the nurse about the breakfast meal. The nurse's best response is: 1. "I know you are angry, but I cannot let you make me become the object of your anger. I will send up the dietician." 2. "This is not about breakfast. Tell me what you are really angry about." 3. "I understand you are angry. I'll shut the door and let you cool off." 4. "I hear a lot of anger in your voice that is quite normal and healthy to hear. Is it a new breakfast you want or something else?"

4. "I hear a lot of anger in your voice that is quite normal and healthy to hear. Is it a new breakfast you want or something else?" [Acknowledging the client's anger and helping the client understand the source of the anger is helpful. Do not take the anger personally. Allow choices and control when possible.]

An 82-year-old man has been told by his primary care provider that it is no longer safe for him to drive a car. Which statement by the client would indicate beginning positive adaptation to this loss? 1. "I told the doctor I would stop driving, but I am not going to yet." 2. "I always knew this day would come, but I hoped it wouldn't be now." 3. "What does he know? I'm a better driver than he will ever be." 4. "Well, at least I have friends and family who can take me places."

4. "Well, at least I have friends and family who can take me places." [adaptive responses indicate the client can put the loss into perspective and begin to develop strategies for coping with the loss, toward a goal for adaption and problem solving]

The nurse is caring for a family in a shelter 2 days after the loss of their home due to a fire. The fire caused minor burns to several members of the family but no life-threatening conditions. Which of the following is the most important assessment data for the nurse to gather at this time? 1. Availability of insurance coverage for rebuilding the house 2. Family members' understanding of the extent of their physical injuries 3. Psychological support resources available from friends or other sources 4. Family members' grief responses and coping behaviors

4. Family members' grief responses and coping behaviors [to plan with and assist the family the nurse needs more data regarding the familys reactions to their loss]

While talking to adult children of a dying client, the nurse finds them tearful, with ambivalent feelings toward the client. The client often expresses beliefs of a wasted life. The children say that the client was a parent who often showed love but followed it with criticism, anger, damaging accusations, and emotional abuse. The nurse suggests an intervention that may be helpful to the client and other family members. The most likely intervention to be helpful is: 1. Listening to relaxation tapes before visiting each other. If negative feelings arise, listen to the tapes together. 2. Having a nurse present in the room at all times when one of them visits the client. The nurse will intervene with conflict resolution if problems arise. 3. Assuring the client and children that the past no longer matters. The only time that matters is the present and the future. 4. Making a videotape of each child telling a story of a time when the client showed love, while the client tells of a special love for each child. Plan a time to watch it together.

4. Making a videotape of each child telling a story of a time when the client showed love, while the client tells of a special love for each child. Plan a time to watch it together. [Relaxation tapes help with stress reduction, but do not help resolve problems experienced by the client and children. Staffing needs do not permit a nurse to be with one client continually, and families require privacy as well. Assurance that the past no longer matters is an assurance lacking concrete properties]

A nursing care plan includes the desired outcome of "quality of life" for a client with a chronic degenerative illness who is likely to live for many more years. Which of the following is one example that would indicate the outcome has been met? 1. The client demonstrates having adequate financial resources to pay for health care for many more years. 2. The client spends the majority of his or her time in spiritual reflection. 3. The client has no signs or symptoms of preventive complications of the illness. 4. The client verbalizes satisfaction with current relationships with other persons.

4. The client verbalizes satisfaction with current relationships with other persons. [quality of life is determined by the client and expressed in terms of his/her satisfaction with variety of aspects of life]

A client questions the nurse about the difference between a living will and power of attorney. The nurse's best response is: 1. A lawyer carries a living will, while a designated family member or friend carries out advanced directives. 2. In a living will, the client specifies medical treatments to be carried out when incapable of making decisions, while durable power of attorney allows the client to include both treatments to be carried out and treatments to be omitted in the event of terminal illness. 3. The living will indicates when a client wishes life support to be discontinued, while durable power of attorney give that power to another in the event of terminal illness. 4. The living will allows the client to indicate specific medical treatments to be omitted in the event of terminal illness, while durable power of attorney legally appoints another to make those decisions on the behalf of the client.

4. The living will allows the client to indicate specific medical treatments to be omitted in the event of terminal illness, while durable power of attorney legally appoints another to make those decisions on the behalf of the client. [A living will is a legal document that expresses an individual's decision on the use of artificial life support systems. Power of attorney is a written instrument which authorizes one person to act as another's agent or attorney]