Chapter 10 Prep U

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

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.

Which statement by a client would alert the nurse that the client is experiencing complicated grief?

Correct response: "I am still so angry about my grandmother's death even after a year." Explanation: The client who is experiencing complicated grief can have continued bitterness and anger even after a prolonged period. The client experiencing traumatic grief has external factors that influence the reactions and potential long-term outcomes; these factors can include suddenness of death, as well as violence or destruction- these can be involved with a car accident or suicide. With uncomplicated grief, the client would still be mourning a loved one's loss for some time such as with the mother, but this would be considered normal.

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

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

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?

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?

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.

Which phrase can do much to instill hope in the dying client?

Correct response: "Let me tell you about your illness." Explanation: Hope is the ingredient of life that enables an individual to consider a future and to actively bring that future into being. One way the nurse can enable hope in the dying client is to provide honest information about the progress of the illness.

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?

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.

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

Correct response: "No, not me." Explanation: According to Engel, the first stage of grief is shock and disbelief. In this initial stage, the surviving family members often refuse to accept the fact of the loss, followed by a stunned or numb response of "no, not me."

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?

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.

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?

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?

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 client should the nurse anticipate will be at greatest risk for alteration in quality of life as a result of loss?

Correct response: 45-year-old with severe depression Explanation: The nurse anticipates that the client at greatest risk for loss affecting their quality of life is the 45-year-old male with depression. Due to the conditions of the other clients, they are not at the greatest risk.

Which client is most at risk for experiencing anticipatory grief?

Correct response: 61-year-old spouse of a client experiencing symptomology of moderate-stage Alzheimer disease Explanation: The nurse recognizes that the client most at risk for experiencing anticipatory grief is the 61-year-old spouse of a client experiencing symptomology of moderate-stage Alzheimer disease. The other individuals are not at risk for experiencing anticipatory grief.

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?

Correct response: Anger Explanation: The client's hostile statement indicates that the client may be in the anger stage of grief, during which an individual may become difficult or demanding.

A nurse is caring for a client with terminal cancer. The client states, "If I promise to change my bad habits, the cancer will go away." The nurse knows that this statement is an example of which of Kubler-Ross's stages of grief?

Correct response: Bargaining Explanation: This scenario is an example of bargaining to prolong one's life. Denial serves as a temporary escape from reality. In the anger stage, the client appears difficult, demanding, and ungrateful. In the acceptance stage, the client has achieved an inner and outer peace due to a personal victory over fear.

Which term describes the process by which a person experiences grief?

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.

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

Correct response: Completion Explanation: During the completion phase, life begins to feel "normal" again, although life is different after the loss. During the working through phase, the person still thinks about the loss but also begins to find new ways of managing life after loss. During the denial and intrusion phase, people move back and forth between denial and intrusion. In the outcry phase, the first realization of loss occurs. Outcry may be outward, expressed by screaming, yelling, crying, or collapse.

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?

Correct response: Complicated grief Explanation: Prolonged grieving and suffering from clinical depression may be considered outside the norm of the grieving process. The client suffering from complicated grief may suffer from these symptoms or may experience a void of emotion or suffer grief disproportionate to the event. Disenfranchised grief is the grief over the loss that cannot be expressed openly. Anger is the step in the grieving process where the client is developing awareness of the loss and expresses anger towards God, caregivers, or the health care providers. Outcry is also a phase of grief that accompanies outward expression of grief such as sobbing tearfully and crying loudly. The client starts developing awareness about the grief in this phase.

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

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.

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

Correct response: Cultural influences Explanation: Both the physical and emotional manifestations of grief may be culturally influenced. Culture also influences a how a person expresses their of grief.

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?

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.

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?

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.

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

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?

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

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?

Correct response: Recollect Explanation: The client is being treated for cancer. The client looks at the photographs from youth that remind the client of earlier days when the client was healthy and beautiful. This indicates that the task of recollecting and reexperiencing is being accomplished. In the task of reacting, the client responds emotionally to the loss. In the task of recognizing, the client begins to develop the sense of awareness of the loss. In the task of relinquishing, the client starts accepting the loss and its influence in the client's life.

A client is crying continuously from having lost a friend in an accident. According to the tasks of grieving by Rando, which task of grief is expected to be accomplished next?

Correct response: Recollect and re-experience. Explanation: The client is expressing grief (crying) for the friend's death, which indicates that the client is accomplishing the task of reaction. After this task, the client is likely to review memories related to the friend. This task of grief is referred to as the task of recollecting and reexperiencing. In the task of readjusting, the client begins to return to daily life after accepting the loss. In the task of reinvesting, the client accepts the changes that have occurred and starts forming new relationships and commitments.

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?

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 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?

Correct response: The client is experiencing complicated grieving reaction. The client needs to have a comprehensive mental health assessment. Explanation: In the case of complicated grief, it is important to treat as soon as possible. Unresolved grieving can lead to other psychological, as well as physical, problems if left untreated. Even in the case of extensive family support, medications are often needed to assist the individual to recover completely from this type of grief reaction.

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?

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.

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?

Correct response: Working through Explanation: According to Horowitz's stages of loss and adaptation, in the working through stage the client begins to find new ways of managing life after loss. In this case, the client has consulted a psychologist and is trying to learn effective coping strategies. This indicates that the client has started to find ways to manage with the loss. Thus, the client is in the working through stage. In the stage of outcry, the client realizes the loss for the first time. This 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 into the day-to-day life any longer. In the stage of denial and intrusion, the client at times becomes so intensely preoccupied with the memories of loss that they intrude into every moment and activity of the client.

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?

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.

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

Correct response: complicated grief Explanation: During complicated grief, the person is frozen or stuck in a state of chronic mourning. Most bereaved people experience normal or uncomplicated grief after the loss of a loved one. Traumatic grief is a more difficult and prolonged grief in which external factors influence the reactions and potential long-term outcomes. Bereavement is the process of mourning and coping with the loss of a loved one.

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:

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 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?

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 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?

Correct response: re-investing Explanation: According to Rando (1984), the client is in the grieving task of re-investing where accepting of changes has occurred and a person is re-entering the world, forming new relationships and commitments. According to Rando (1984), re-adjusting is the grieving task of beginning to return to daily life, loss feels less acute and overwhelming. The client has already completed this task of grieving. According to Rando (1984), re-collecting and re-experiencing involves reviewing and re-living memories of the loss. Resolution of the loss is not a grieving task according to Rando. This is a stage in Engel's stages of grieving and refers to preoccupation with loss, where the lost person or object (marriage) is idealized and the mourner may even imitate the lost person.

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.

Correct response: ✓ The client has low self-esteem. ✓ The client is unable to trust others. ✓ The client has attempted suicide in the past. Explanation: Complicated grief is the response to a loss that is outside the norm and that occurs when a person is void of emotions and grieves for a prolonged period. The people who are susceptible for complicated grieving include those who have low self-esteem, who are unable to trust other people, and who have made suicide attempts in the past. Having a huge family and a history of cardiac disease does not make a person susceptible to have complicated grief. People who do not have any kind of social support (e.g., those people without family) are more prone to have complicated grief. People who have a history of psychiatric disorders are also more likely to experience complicated grief.

A nurse notifies a client of the death of a parent after a motor vehicle crash. Which physical symptoms would the nurse assess the client for based on the grieving process? Select all that apply.

Correct response: ✓ difficulty breathing ✓ a hollow feeling in the abdomen ✓ lack of strength Explanation: Upon notification of the loss of a loved one, the client can have symptoms such as shortness of breath, an empty feeling in the abdomen, a lack of muscular power or strength, and headache. Other physiologic symptoms experienced in the aftermath of loss include insomnia, impaired appetite, weight loss, lack of energy, palpitations, indigestion, and changes in the immune and endocrine systems. Difficulty with urinating is not typically a physical response to the loss of a loved one.