Chapter 10: Grief and Loss

A nurse is assessing a 7-year-old child in a school. The nurse suspects that the child has an insecure relationship with the parents. Which statement said by the child would have led the nurse to this conclusion?

"Please don't tell my mom anything we've talked about."

Which assessment findings can most accurately be described as complicated grieving?

A person is unable to return to work after a sister's death 18 months ago

Which is a cognitive response to grief?

Attempting to keep the lost one present

A group of nursing students is reviewing information about grief and bereavement. The students demonstrate understanding of the information when they state:

Bereavement is the process of mourning and grief is the emotional reaction.

The spouse of a client who died of breast cancer is still grieving 2 years later. What type of grief is the spouse experiencing?

Complicated

A woman has had a breast removed to treat cancer. What type of loss will she most likely experience?

Physiologic loss

Which is the most frequent and persistent bereavement-associated symptom?

Sleep disturbances

Which statement is typical of the first stage of grieving described by Engel?

"No, not me."

A nurse has been present for the hospital death of a Muslim client who was surrounded by family members when the client passed. The nurse demonstrates appropriate cultural considerations when stating:

"Are there any rituals you will observe here for your loved one?"

What question should nurses ask themselves to determine if the care they provide to the grieving client has been both therapeutic and client focused?

"Do I have the strength to be present and to facilitate the client who is grieving?"

The nurse is performing an assessment of a client who has experienced a traumatic event. In understanding the client's ability to cope with the event, what question would the nurse ask first?

"How have you managed a stressful event before?"

A community care nurse is visiting a client at home. The client was discharged from the hospital one week ago after having a mastectomy. After the nurse completes the physical examination, the nurse asks, "How are you feeling about your body changes?" The client tells the nurse she is not interested in talking right now and would prefer that the nurse leave. Which is the nurse's most effective use of communication skills?

"I just want you to know that I am available to talk when you are feeling up to it."

Kübler-Ross defines five stages of psychosocial responses to dying and death. Which statement is characteristic of the bargaining stage?

"Just let me live to see my grandson born."

A Chinese client has just passed away. Which ritual would be performed in the funeral in order to assist the spirit of the deceased in the afterlife journey? Select all that apply.

-Burning incense -Reading scriptures

According to Mardi Horowitz (2001), life begins to feel "normal" again in which stage?

Completion

The nurse is speaking to the caregivers of a client who is experiencing complicated grief. The nurse is explaining some of the consequences of complicated grief. What are the health-related consequences associated with this type of grieving? Select all that apply.

-Panic disorder -Precipitation of a cardiac disease -Psychosomatic disorder

A community mental health nurse has come to know that the mother of a long-term client has passed away. What are ways for the nurse to determine if the client will be at risk for complicated grief? Select all that apply.

-The client is unable to trust others. -The client has attempted suicide in the past. -The client has low self-esteem.

The nurse is providing individual support to a female client who attends a group for people who have experienced loss of a family member to suicide. The client's son committed suicide one month ago. The client was not aware that her son experienced depression. Which risk factors for complicated grief are most likely for this client? Select all that apply.

-death by suicide -sudden, unexpected death -death of a child

A client is diagnosed with terminal kidney failure. The client's spouse demonstrates loss and grief behaviors. Which term accurately describes the spouse's experience?

Anticipatory grief

Which factor does not influence the grieving person's return to homeostasis?

Adequate self-awareness on the part of the nurse

The nurse most effectively explains to a terminally ill client's spouse that the frustration and anger the client is exhibiting is associated with what aspect of dying?

An expression of a universally held need of the dying

After receiving word from the oncologist that the client's tumor is malignant, the client says to the nurse, "If you people had the faintest clue what you were doing, I wouldn't be like this." The nurse should recognize that the client may be experiencing which stage of grief?

Anger

A client has just been diagnosed with terminal brain cancer and given approximately 2 months to live. The client wishes to visit the client's mother soon to "say goodbye." The nurse acknowledges this reaction as what?

Anticipatory

A group of nursing students is reviewing information about grief and bereavement. The students demonstrate understanding of the information when they state

Bereavement is the process of mourning and grief is the emotional reaction.

The nurse is caring for a client whose spouse passed away several years ago. Upon assessment, the nurse finds that the client has a history of signs and symptoms of depression since the spouse's death. Which term correctly describes the client's response to the loss?

Complicated grief

Which type of grief occurs when a person is stuck in a state of chronic grieving?

Complicated grief

The nurse is caring for a client who has just been diagnosed with cancer. The client states that the client will "never be able to cope with this situation." What is the nurse aware that coping is?

Coping is the physiologic and psychological processes that people use to adapt to change.

What question should nurses ask themselves to determine if the care they provide to the grieving client has been both therapeutic and client focused? "How long can I continue working with grieving clients?" "Do I have the strength to be present and to facilitate the client who is grieving?" "Do I still get personal satisfaction from my work with the grieving client?" "How do I personally react when I am working through the grieving process?"

Correct response: "Do I have the strength to be present and to facilitate the client who is grieving?" Explanation: Ongoing self-examination is an effective method of keeping the therapeutic relationship goal-directed and acutely attentive to the client's needs. Honestly answering if a nurse is still effective in the care he or she gives grieving clients is the most effective way to determine overall therapeutic approach. The remaining options are more nurse than client focused.

The client is scheduled to undergo an amputation of the lower right limb. The client is experiencing grief over the pending procedure. Which question should the nurse ask while assessing the client's perception of loss? "How can we relieve your anxiety?" "What do you usually do when you are excessively stressed?" "Do you feel like talking to anybody right now?" "How do you feel about the news?"

Correct response: "How do you feel about the news?" Explanation: Assessment of perception is to find out what the magnitude of loss is according to the client. By asking the client about how the client feels about the news, the nurse is trying to find out how the news has affected the client. By asking if the client feels like talking to anybody, the nurse is assessing the support system of the client. By asking how the anxiety can be relieved and what the client does when stressed, the nurse is assessing the coping skills of the client.

The nurse is working with a client who has experienced the death of a spouse. The nurse is aware that the client is in the acute mourning stage of grief with which client statement? "I am just remembering the happy times we experienced." "I am glad that my spouse is no longer in pain due to cancer." "I just want to be left alone by my family and friends." "I can't believe my spouse has actually died."

Correct response: "I just want to be left alone by my family and friends." Explanation: The client in an acute mourning stage can experience the need for social withdrawal, as with the client's statement of wanting to be left alone. The client who is remembering the happy times and the one who is glad of the lack of pain for the spouse is in the resolution stage of grief, with noted acceptance of the loss. The client who can't believe the spouse has actually died is in the shock stage of grief with denial and disbelief.

A community care nurse is visiting a client at home. The client was discharged from the hospital one week ago after having a mastectomy. After the nurse completes the physical examination, the nurse asks, "How are you feeling about your body changes?" The client tells the nurse she is not interested in talking right now and would prefer that the nurse leave. Which is the nurse's most effective use of communication skills? "It would be beneficial for you to connect with other people who have had this surgery." "I just want you to know that I am available to talk when you are feeling up to it." "Have I said something to offend you?" "I can sit with you here so that you don't feel alone."

Correct response: "I just want you to know that I am available to talk when you are feeling up to it." Explanation: The client is demonstrating adaptive denial in that she is gradually adjusting to the loss. The nurse should use a simple, nonjudgmental statement to acknowledge the client's loss, such as, "I just want you to know I am available to talk when you are feeling up to it." Effective communication skills can be useful in helping the client in adaptive denial move toward acceptance.

The nurse is assessing a client who is grieving the loss of a spouse. According to Kubler-Ross's stages of grieving, which statement indicates that the client is in the depression stage? "My spouse was laughing and happy yesterday. My spouse cannot be dead." "My spouse is gone. I am having a really hard time finding a reason to keep going." "Please send my spouse back to me dear God. I would never ever fight again." "Oh God. Why did you take my spouse away from me? What wrong did I do?"

Correct response: "My spouse is gone. I am having a really hard time finding a reason to keep going." Explanation: According to Kubler-Ross's stages of grieving, in the stage of depression, the client starts to become aware of the loss. The statement, "My spouse is gone. I am having a really hard time finding a reason to keep going," indicates that the client is aware of the loss and is in the stage of depression. The statement, "My spouse was laughing and happy yesterday. My spouse cannot be dead," indicates disbelief and the denial stage. The statement "Oh, God. Why did you take my spouse away from me? What wrong did I do?" indicates anger toward God and the anger stage. The statement, "Please send my spouse back to me, dear God. I would never ever fight with her again," indicates that the client is in the bargaining stage of grief.

A nurse is assessing a 7-year-old child in a school. The nurse suspects that the child has an insecure relationship with the parents. Which statement said by the child would have led the nurse to this conclusion? "I love my dad and mom very much." "My mom and dad do not play with me." "Please don't tell my mom anything we've talked about." "I love playing with friends."

Correct response: "Please don't tell my mom anything we've talked about." Explanation: An insecure attachment forms when a child has learned fear and helplessness because of intimidation, abuse, or excessive control by parents. The child demonstrates having a fear-based relationship with the mother. This indicates that the child has an insecure relationship with parents. The statement that the child loves playing with friends doesn't indicate anything about the relationship of the child with the parents. The statement that the client loves their parents suggests that the child has a secure relationship with the parents. The statement that the client's parents do not play with the client indicates that the child feels neglected by the parents.

A nursing instructor lecturing about death and grief realizes a need for further instruction when a student states what? "Children's responses to loss reflect their developmental level." "Children are at risk for mental health problems after experiencing a loss." "Children face many challenges while growing up." "The grieving process is the same for children and adults."

Correct response: "The grieving process is the same for children and adults." Explanation: Children face many challenges. Research shows that, like adults, children who experience major losses are at risk for mental health problems. The grieving process differs somewhat for children and adults because children's responses to loss reflect their developmental levels.

Which assessment findings can most accurately be described as complicated grieving? A person blames oneself for not doing more to make a spouse's recent death more comfortable A person has been experiencing chronic insomnia since the person's mother's death earlier this year A person cries frequently and loudly in the weeks following a child's death in an accident A person is unable to return to work after a sister's death 18 months ago

Correct response: A person is unable to return to work after a sister's death 18 months ago Explanation: An inability to return to normal activities 18 months after a sibling's death is suggestive (though not definitive) of complicated grieving. Crying and having difficulties sleeping are not unusual and will often accompany healthy grieving. A feeling of "not doing enough" is common during grief and would only be considered dysfunctional if this became a long-term and all-encompassing belief.

Which assessment findings can most accurately be described as complicated grieving? A person blames oneself for not doing more to make a spouse's recent death more comfortable A person has been experiencing chronic insomnia since the person's mother's death earlier this year A person is unable to return to work after a sister's death 18 months ago A person cries frequently and loudly in the weeks following a child's death in an accident

Correct response: A person is unable to return to work after a sister's death 18 months ago Explanation: An inability to return to normal activities 18 months after a sibling's death is suggestive (though not definitive) of complicated grieving. Crying and having difficulties sleeping are not unusual and will often accompany healthy grieving. A feeling of "not doing enough" is common during grief and would only be considered dysfunctional if this became a long-term and all-encompassing belief.

Which is an example of a perceived loss? A client mourns the loss of an amputated leg A client grieves for the loss of a spouse to cancer An older client grieves for the loss of independence A client grieves for the loss of a job

Correct response: An older client grieves for the loss of independence Explanation: Perceived loss, such as loss of youth, of financial independence, and of a valued environment, is experienced by the person but is intangible to others. The other answers are actual losses and can be recognized by others as well as by the person sustaining the loss; for example, loss of a limb, of a child, of a valued object such as money, and of a job.

A client is diagnosed with terminal kidney failure. The client's spouse demonstrates loss and grief behaviors. Which term accurately describes the spouse's experience? Maturational loss Dysfunctional grieving Bereavement Anticipatory grief

Correct response: Anticipatory grief Explanation: Anticipatory loss occurs when a person displays loss and grief behaviors for a loss that has yet to take place. It is often seen in the families of clients with serious or life-threatening illnesses and serves to lessen the effect of the actual loss of a family member.

Which term describes the process by which a person experiences grief? Bereavement Mourning Attentive presence Homeostasis

Correct response: Bereavement Explanation: Grieving, also known as bereavement, is the process by which a person experiences the grief. Homeostasis is the return to normal. Mourning is the outward expression of grief. Attentive presence is being with the client and focusing intently on communicating with and understanding him or her.

Which can correctly be identified as a behavioral response to grief? Weight loss Palpitations Crying uncontrollably Lack of energy

Correct response: Crying uncontrollably Explanation: Crying uncontrollably is a behavioral response to grief. Physiologic responses to grief include weight loss, lack of energy, and palpitations.

The nurse is assessing a client who is recently divorced. The client tells the nurse that the memories of the client's former spouse are interfering with an ability to concentrate at work. According to Horowitz's stages of loss and adaptation, this is indicative of which stage? Outcry Denial and intrusion Completion Working through

Correct response: Denial and intrusion Explanation: According to Horowitz's stages of loss and adaptation, in the stage of denial and intrusion, the client at times becomes so intensely preoccupied with the memories of the loss that they intrude into every moment and activity of the client's day. In the stage of outcry, the client realizes the loss for the first time. Outcry could be expressed outwardly or suppressed internally. Completion is the stage where the client becomes normal and the memories of the loss do not intrude in the day-to-day life any longer. In working through this stage, the client does think about the loss but also tries to find ways to manage with the loss.

Which likely takes place in the fourth stage of Kubler-Ross's stages of grieving? Depression Bargaining Anger Denial

Correct response: Depression Explanation: Depression occurs when the person shows evidence that he or she is sad and despairing over the inevitability of loss. Denial is shock and disbelief regarding the loss. Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. Anger may be expressed toward God, relatives, friends, or health care providers.

The client expresses grief about not being able to fulfill the wish to pursue doctoral studies. Which type of loss does this indicate? Loss related to self-actualization Loss of self-esteem Loss of security and a sense of belonging Loss of safety

Correct response: Loss related to self-actualization Explanation: The loss due to an external or internal crisis that inhibits the individual's desire for fulfillment of personal goals is referred to as loss related to self-actualization. In this case, the client is grieving about not being able to fulfill a wish to do doctoral studies, meaning the client is unable to fulfill a goal. Thus, this is a type of loss related to self-actualization. Safety loss refers to the loss of a safe environment. Loss of self-esteem refers to the change in how a person is valued at work or in relationships or by himself or herself. Loss of security and a sense of belonging refer to the changes in relationships that affect an individual's need to love and the feeling of being loved.

Which culture believes that leaving the body alone after death is disrespectful? Native Americans Orthodox Jewish Americans Chinese Americans Vietnamese Americans

Correct response: Orthodox Jewish Americans Explanation: Orthodox Jewish Americans believe that leaving the body alone after death is disrespectful.

The nurse is speaking to the caregivers of a client who is experiencing complicated grief. The nurse is explaining some of the consequences of complicated grief. What are the health-related consequences associated with this type of grieving? Select all that apply. Development of cancer Panic disorder Psychosomatic disorder Precipitation of a cardiac disease Neurofibromatosis

Correct response: Panic disorder Psychosomatic disorder Precipitation of a cardiac disease Explanation: The health complications related to complicated grief are psychiatric conditions like panic disorder and psychosomatic disorder, and it may also cause precipitation of a cardiac disease. Neurofibromatoses is a genetic disease and is not related to grief. Cancer occurs due to mutations in the cell. It not related to complicated grief.

During which phase of Bowlby's grief process does the bereaved person begin to reestablish a sense of personal identity, direction, and purpose for living? Phase of numbing Phase of reorganization Phase of disorganization and despair Phase of yearning and searching

Correct response: Phase of reorganization Explanation: During the phase of reorganization, the bereaved person begins to reestablish a sense of personal identity. During the phase of disorganization and despair, the bereaved person begins to understand the loss's permanence. During the phase of yearning and searching, reality begins to set in. During the phase of numbing, the common first response to the news of a loss is to be stunned, as though not perceiving reality.

During which phase of Bowlby's grief process does the bereaved person begin to reestablish a sense of personal identity, direction, and purpose for living? Phase of reorganization Phase of numbing Phase of yearning and searching Phase of disorganization and despair

Correct response: Phase of reorganization Explanation: During the phase of reorganization, the bereaved person begins to reestablish a sense of personal identity. During the phase of disorganization and despair, the bereaved person begins to understand the loss's permanence. During the phase of yearning and searching, reality begins to set in. During the phase of numbing, the common first response to the news of a loss is to be stunned, as though not perceiving reality.

Which is the most frequent and persistent bereavement-associated symptom? Sleep disturbances Indigestion Impaired appetite Headaches

Correct response: Sleep disturbances Explanation: Sleep disturbances are the most frequent and persistent bereavement-associated symptom.

A nurse is assessing a client who is depressed but unwilling to discuss the client's feelings. After speaking with the client's caregiver, the nurse learns that the client's pet died recently. Which is the most likely reason the client has hesitated to express the client's feelings? The client does not want to remember the memories of the pet. The client feels that the nurse would not consider the grief as significant. The client feels that the feelings related to the pet's death are insignificant. The client feels that the nurse would not be able to make the client feel better.

Correct response: The client feels that the nurse would not consider the grief as significant. Explanation: A loss, such as the death of a pet, may not be considered socially significant and, therefore, the accompanying grief would not be legitimized. The client feels that the nurse would not consider the grief as significant and would not take it seriously. This is reflective of disenfranchised grief. It is not likely that the client is trying to avoid the thoughts related to the loss. The client is less likely to feel that the nurse would not be able to help.

A nurse is counseling a client with depression on what to do in case the client has suicidal thoughts. Which option may provide the most immediate help for the client? an outpatient clinic an emergency clinic an office visit a telephone hotline

Correct response: a telephone hotline Explanation: A telephone hotline is an immediate solution for a client to speak with to help with mental health services if having thoughts of suicide. The client would then want to transport to an emergency clinic for face-to-face evaluation and treatment. An outpatient clinic or office visit would not provide emergency treatment for a client who is suicidal.

Considering the spiritual response to grief, which nursing intervention has the potential of providing the most support to a grieving client? sitting silently with the client as he or she cries explaining the stages of grief to the client asking, "Do you find comfort in your religion at times like this?" arranging for the hospital chaplain to visit the client

Correct response: asking, "Do you find comfort in your religion at times like this?" Explanation: Ministering to the spiritual needs of those grieving is an essential aspect of nursing care. The client's emotional and spiritual responses become intertwined as he or she grapples with pain. With an astute awareness of such suffering, nurses can promote a sense of well-being. Providing opportunities for clients to share their suffering assists in the psychological and spiritual transformation that can evolve through grieving. While the remaining options are not inappropriate when agreed to by the client, none of them directly assesses the client's spiritual response to the grieving process.

A client who has been in recovery from alcohol abuse for over one year tells the nurse he is drinking 5 to 6 beers per night since the client's mother's death. Which is the nurse's most accurate explanation for the client's grief response? spiritual emotional physiologic behavioral

Correct response: behavioral Explanation: The nurse can explain to the client that this is a behavioral response to grief. Drug and alcohol abuse indicate the client has developed a maladaptive response to the spiritual and emotional despair related to the death of the mother. Emotional responses to grief are characterized by the expression of a range of emotions over the course of the grieving process. Alcohol abuse is not an emotional response in grief, however, it is a behavior that is used to attempt to manage the emotional pain associated with the loss. Spiritual responses to grief are related to an individual's personal values regarding the spiritual dimension of the human experience. Although alcohol abuse is not a spiritual response to grief, it can be a behavioral response to the spiritual discord the client may be experiencing as he processes the mother's death. Physiologic responses to grief refer to the natural body responses that emerge for the body to adapt to loss. Although the client may use alcohol to try to treat a physiologic response to grief---for example, to promote sleep or calm anxiety---it remains a behavioral response.

The nurse is providing individual support to a female client who attends a group for people who have experienced loss of a family member to suicide. The client's son committed suicide one month ago. The client was not aware that her son experienced depression. Which risk factors for complicated grief are most likely for this client? (Select all that apply.) death of a child death by suicide sudden, unexpected death low self-esteem low trust in others

Correct response: death of a child sudden, unexpected death death by suicide Explanation: Risk factors for vulnerability include the death of a child, that the death was unexpected (the client was not aware her son was experiencing depression) and that the death was by suicide. The client would be considered at risk for complicated grief. Within the information provided in the question, there is no indication that the client has low self-esteem or low trust in others. These are, however, factors that, if present, can complicate grief.

A client who has recently lost his same-sex partner in a motor vehicle accident tells the nurse, "My family doesn't speak to me because of my lifestyle. I feel like I have no one to talk to about my loss." The client is experiencing: disenfranchised grief. complicated grieving. insecure attachment. ambivalent attachment.

Correct response: disenfranchised grief. Explanation: Disenfranchised grief is grief over a loss that is not or cannot be acknowledged openly or socially supported. In this case, the client would benefit from the support of his family members after the loss of his loved one, however, because the loss is associated with a lifestyle the family does not accept, he cannot access the family's support. Complicated grief refers to a grief response that is outside the norm. Preexisting mental health conditions such as depression can serve to complicate grief. Ambivalent attachment refers to characteristics of vulnerability where the client is unclear about how strongly he or she feels about the deceased person. Insecure attachment refers to characteristics of vulnerability in which the person grieving the deceased experienced dysfunction in their relationship with that person when they were alive.

A client who is in the process of divorce tells the nurse the client will require some time off from work due to the inability to concentrate. According to Bowlby's phases of grieving, which phase best reflects this client's current experience? disorganization and despair shock, numbness, and protest reorganization yearning

Correct response: disorganization and despair Explanation: This client is currently experiencing disorganization and despair, a phase in which cognitive disorganization and emotional despair cause difficulty with functioning in the everyday world. Experiencing the phase of shock, numbness, and protest is characterized by the person being void of feeling and denying the loss. Yearning refers to the emotions attached to wanting the return of the loved one or relationship and a protest of the permanence of the loss. Reorganizing refers to the phase in which people reintegrate the self and begin to pull their lives back together.

A client is experiencing a high level of stimulation after a terrorist attack. In providing psychological first aid to the client, which intervention would be best for the nurse to select? providing information to the client about the attack orienting the client to the circumstances that have occurred telling the client about the need to go to the hospital explaining to the client that the client is safe

Correct response: explaining to the client that the client is safe Explanation: The client who has arousal as a result of a crisis such as a terrorist attack needs safety, comfort and consolation. Explaining to the client that the client is safe offers comfort to help decrease the arousal or high level of stimulation that is being experienced (the A in ABCs). With the C in the ABCs of psychological first aid, the nurse is helping with cognition difficulty such as disorientation by providing orientation including information about the attack. The nurse is also helping with cognition by telling the client about needing to go to the hospital which provides clear direction.

A client is assessed for recurring episodes of fainting and blurred vision. A diagnostic scan reveals the client has an ominous mass in the brain. When the client is told this news, the client appears stoic and does not cry. According to Horowitz's stages of loss and adaptation, this client is in which stage? working through denial and intrusion outcry completion

Correct response: outcry Explanation: According to Horowitz's stages of loss and adaptation, outcry is the stage in which people first realize their loss. Outcry can be suppressed as the person appears stoic trying to maintain emotional control. Denial and intrusion refer to when people become so distracted or involved in other activities that they don't think about the loss but at other times the loss is ever-present and intrudes into every aspect of the person's life. Working through refers to the passing of time with which the person spends less time thinking about the loss and finding new ways of managing life after grieving. Completion refers to when life begins to feel "normal" again after loss, although life is different because it has changed as a result of the loss.

A client with poorly controlled type 1 diabetes has just been informed that an amputation of the lower leg is required. The nurse can anticipate that the client will experience a reaction to the loss of which human need according to Maslow's hierarchy? safety security and belonging physiologic self-actualization

Correct response: physiologic Explanation: The client is about to experience physiologic loss of the lower right leg. The client is most likely to experience a reaction to this loss of human need according to Maslow's hierarchy. Safety loss refers to the loss of a safe environment such as in domestic abuse, child abuse, or public violence. Loss of security and belonging refers to the loss of loved ones. This loss can accompany the changes in relationships such as births, marriage, divorce, illness and death. The loss of self-actualization refers to potential life losses as a result of internal or external inhibition of the ability to strive toward fulfillment of individual potential.

A nurse in charge on a unit with a client who is receiving postoperative care for a below the knee amputation is deciding which nurse to assign to this client. Which nurse would be most beneficial for the client? the nurse who has worked with the client before and after the amputation a nurse who often has been assigned to the client 3 previous night shifts a nurse who is just returning to work from a one-week vacation a nurse with previous experience working with clients who have amputations

Correct response: the nurse who has worked with the client before and after the amputation Explanation: In this case, the charge nurse's best option for nursing assignment to this client is to assign the nurse who has worked with the client before and after the amputation. At present the client's ability to relate to others may be impaired. Limiting the number of new contacts initially will promote familiarity and trust and decrease the client's feelings of being overwhelmed.

Which can correctly be identified as a behavioral response to grief?

Crying uncontrollably

Which factor is likely to have the greatest impact on how a client responds to grief?

Cultural influences

The client has been recently diagnosed with cancer. When the nurse tells the client about the diagnosis, the client says, "I have been eating healthy food and working out regularly." According to the Kubler-Ross's stages of grieving, which stage of grief is the client in?

Denial

After losing the client's father in a car accident, a client has started practicing effective coping strategies. According to Horowitz's stages of loss and adaptation, which stage is this indicative of?

Denial and intrusion

The nurse is assessing a client who is recently divorced. The client tells the nurse that the memories of the client's former spouse are interfering with an ability to concentrate at work. According to Horowitz's stages of loss and adaptation, this is indicative of which stage?

Denial and intrusion

Which likely takes place in the fourth stage of Kubler-Ross's stages of grieving?

Depression

Which is a term used to describe grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially?

Disenfranchised grief

The client expresses grief about not being able to fulfill the wish to pursue doctoral studies. Which type of loss does this indicate?

Loss related to self-actualization

Which explanation would be the nurse's best response when asked about the denial stage of grief?

It provides the individual with a temporary escape from the reality of dying

Which culture believes that leaving the body alone after death is disrespectful?

Orthodox Jewish Americans

A client is assessed for recurring episodes of fainting and blurred vision. A diagnostic scan reveals the client has an ominous mass in the brain. When the client is told this news, the client appears stoic and does not cry. According to Horowitz's stages of loss and adaptation, this client is in which stage?

Outcry

In which of the phases of Bowlby's grief process does the bereaved person begin to understand the loss's permanence?

Phase of disorganization and despair

During which phase of Bowlby's grief process does the bereaved person begin to reestablish a sense of personal identity, direction, and purpose for living?

Phase of recognition

The nurse is caring for a client who has been placed in palliative care. The nurse observes the client constantly looking at photographs from youth. According to the tasks of grieving by Rando, which task is being accomplished here?

Recollect

A hospice nurse is providing emotional care and support for a family who lost a son. The care will be provided based on what knowledge?

Stages of grief reactions may overlap and are individualized

A nurse is assessing a client who is depressed but unwilling to discuss the client's feelings. After speaking with the client's caregiver, the nurse learns that the client's pet died recently. Which is the most likely reason the client has hesitated to express the client's feelings?

The client feels that the nurse would not consider the grief as significant.

A community mental health nurse has come to know that the mother of a long-term client has passed away. What are ways for the nurse to determine if the client will be at risk for complicated grief? Select all that apply.

The client has low self-esteem. The client is unable to trust others. The client has attempted suicide in the past.

A 74-year-old is being seen in the mental health clinic. The client has never fully regained the level of activity the client had prior to the death of the client's spouse. The client continues to have symptoms of depression and has not been able to work or volunteer. In addition, the client complains of "anxiety attacks" that occur nearly every night. What type of grief reaction is this client exhibiting?

The client is experiencing complicated grieving reaction. The client needs to have a comprehensive mental health assessment.

The nurse is assessing a client who has been diagnosed with leukemia. Which behavior of the client would indicate that the client is experiencing the anger stage of Kubler-Ross's stages of grieving?

The client is verbally abusive.

A nurse is caring for a Jewish client with a terminal illness who is on a ventilator. The spouse of the client intends to stay near the client when the ventilator is removed. What is the reason for such a request, according to the Jewish culture? Choose the best answer.

The soul of the deceased should not be alone while leaving the body.

After losing the client's father in a car accident, a client has started practicing effective coping strategies. According to Horowitz's stages of loss and adaptation, which stage is this indicative of?

Working through

A female client who has recently been diagnosed with end-stage lymphoma tells the nurse, "I need to be able to go to my son's wedding. God, will you please just give me a little more time so I can see my first grandchild?" The nurse identifies that the client is experiencing which stage of Kubler-Ross' stages of grieving?

bargaining

A client who has been in recovery from alcohol abuse for over one year tells the nurse he is drinking 5 to 6 beers per night since the client's mother's death. Which is the nurse's most accurate explanation for the client's grief response?

behavioral

A client who is in the process of divorce tells the nurse the client will require some time off from work due to the inability to concentrate. According to Bowlby's phases of grieving, which phase best reflects this client's current experience?

disorganization and despair

A nurse is facilitating a support group for family members of people who have committed suicide. One client states,"My kids and I are just not the same. It was so selfish of my husband to do this." The nurse can accurately identify this as which type of response to grief?

emotional

A client is assessed for recurring episodes of fainting and blurred vision. A diagnostic scan reveals the client has an ominous mass in the brain. When the client is told this news, the client appears stoic and does not cry. According to Horowitz's stages of loss and adaptation, this client is in which stage?

outcry

A client with poorly controlled type 1 diabetes has just been informed that an amputation of the lower leg is required. The nurse can anticipate that the client will experience a reaction to the loss of which human need according to Maslow's hierarchy?

physiologic

A client continues to complain of chest pain and headaches after a disaster, even though all diagnostic tests are negative. In looking at risk factors for these symptoms, what would the nurse assess for?

post-traumatic stress disorder

A client tells the nurse the client been dating someone for three months after finalizing divorce one year ago. According to Rando (1984), the client is engaging in which grieving task?

re-investing

The nurse is informing the client about being diagnosed with cancer. Which is most likely going to be the client's initial reaction?

shock

The nurse is caring for a hospitalized client who just received the news that a mass in the neck is malignant. As the nurse engages in an assessment of the client's needs, the nurse asks, "Who has been a helpful person to you in the past when you were having a difficult time?" Which component of the assessment is the nurse exploring?

support while grieving

A nurse in charge on a unit with a client who is receiving postoperative care for a below the knee amputation is deciding which nurse to assign to this client. Which nurse would be most beneficial for the client?

the nurse who has worked with the client before and after the amputation