Grief and Loss - Videbeck Ch.10

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following are considered physiological signs the nurse expects to observe in a grieving individuals? Select all that apply. a. Palpitations b. Lack of energy c. Hypersomnia d. Weight gain e. Indigestion

a,b,e The client may experience indigestion, palpitations, and lack of energy due to grief. While experiencing grief, the client may sleep more than usual throughout the day rather than during one specific time of day. Grief may suppress the client's appetite resulting in weight loss and not weight gain.

Videbeck Ch.10 Chapter Study Guide Select all that apply. 1. Rando's Six Rs of grieving tasks include: a. React b. Read c. Readjust d. Recover e. Reinvest f. Restitution

a,c,e

Videbeck Ch.10 Chapter Study Guide Select all that apply. 2. Nursing interventions that are helpful for the grieving client include: a. Allowing denial when it is useful b. Assuring the client that it will get better c. Correcting faulty assumptions d. Discouraging negative, pessimistic conversation e. Providing attentive presence f. Reviewing coping behaviors

a,c,e,f

Videbeck Ch.10 Chapter Study Guide 1. which of the following give cause to the nurse that a client may be grieving for a loss? a. Sad affect, anger, anxiety, and sudden changes in mood b. Thoughts, feelings, behavior, and physiologic complaints c. Hallucinations, panic level of anxiety, and sense of impending doom d. Complaints of abdominal pain, ,diarrhea, and loss of appetite.

b

Videbeck Ch.10 Chapter Study Guide 4. Critical factors for successful integration of loss during the grieving process are a. the client's adequate perception, adequate support, and adequate coping b. the nurse's trustworthiness and healthy attitudes about grief c. accurate assessment and intervention by the nurse or helping person d. the client's predictable and steady movement from one stage of the process to the next

a

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which statement, made by the nurse, focuses on the purposeful assessment of a client coping with a terminal diagnosis? a. "Who do you want to share information about your prognosis with?" b. "How can I help you right now?" c. "Getting such news has to be upsetting; can we talk about your feelings?" d. "Social services will help make the arrangements for your hospice care."

a "Who do you want to share information about your prognosis with?" Purposeful assessment of support systems provides the grieving client with an awareness of those who can meet his or her emotional and spiritual needs for security and love. The nurse can help the client to identify his or her support systems and reach out and accept what they can offer. The remaining options provide attempts at support that the client may not be ready or able to accept at this time.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions The nurse most effectively explains to a terminally ill client's wife that the frustration and anger her spouse is exhibiting is associated with what aspect of dying? a. An expression of a universally held need of the dying b. A sign of the anger stage of grieving c. A symptom of poor acceptance of his inevitable death d. An unconscious means of facilitating separation with loved ones

a An expression of a universally held need of the dying The nurse most effectively explains to a terminally ill client's wife that the frustration and anger he is exhibiting are an expression of a universally held need of the dying. They are not signs of the anger stage of grieving, a symptom of poor acceptance of inevitable death, or an unconscious means of facilitating separation with loved ones.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following is a cognitive response to grief? a. Attempting to keep the lost one present b. Indigestion c. Guilt d. Anguish of abandonment

a Attempting to keep the lost one present Attempting to keep the lost one present is a cognitive response to grief. Indigestion is a physiologic response. Guilt is an emotional response. Anguish of abandonment is a spiritual response.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following stages of grieving, according to Kubler-Ross (1969), occurs when the person asks God or fate for more time to delay the inevitable loss? a. Bargaining b. Anger c. Depression d. Denial

a Bargaining Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. Denial is shock and disbelief regarding the loss. Anger may be expressed toward God, relatives, friends, or health care providers. Depression results when awareness of the loss becomes acute.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following can correctly be identified as a behavioral response to grief? a. Crying uncontrollably b. Lack of energy c. Palpitation d. Weight Loss

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

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions The final need, according to Maslow (1954), includes a. Self-acutalization b. Security and belonging c. Safety d. Physiologic

a Self-actualization Self-actualization is the final need and is the ability to realize one's full innate potential. Safety needs include a safe place to live and work. Physiological needs include food, air, and water, Security and belonging involve satisfying relationships.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions 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? a. Stages of grief reactions may overlap and are individualized b. Bereavement is a normal process, requiring little intervention c. Grief is an abnormal physical reaction to a loss d. All members of the family will react to loss in the same way

a Stages of grief reactions may overlap and are individualized Although reactions to grief and dying are similar, the stages of grief reactions overlap and vary among individuals. Each person is different, and family members may be at different reaction stages.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Considering the spiritual response to grief, which nursing intervention has the potential of providing the most support to a grieving client? a. asking, "Do you find comfort in your religion at times like this?" b. sitting silently with the client as he or she cries c. arranging for the hospital chaplain to visit the client d. explaining the stages of grief to the client

a asking, "Do you find comfort in your religion at times like this?" 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 sens 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, non of them directly assesses the client's spiritual response to the grieving process.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions A Chinese client has just passed away. Which ritual would be performed in the funeral in order to assist the spirit of the decreased in the afterlife journey? Select all that apply. a. Burning incense b. Reading scriptures c. Performing Voodoo ritual d. Performing the five steps burial procedure e. Dressing the body in a white kimono

a,b The Chinese read scriptures and burn incense and believe that doing this would help in assisting the spirit of the deceased in the Journey of afterlife. A voodoo ritual is done by the Haitians to make peace with spirits. Dressing the body in white kimono is done in the Japanese to purify the spirit. The five steps burial procedures is followed in Islam.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Assessment of a client indicates complicated grief. Which statements would the nurse identify as supporting this reaction? Select all that apply. a. "I still wait for him to come right through the door every day." b. "I'm really struggling with trusting anybody anymore." c. "Life seems so empty now that he's gone. What will I do?" d. "I wish I could go back to the days before he die." e. "It's been 2 months, and I still want my son back."

a,b,c,d Complicated grief, which occurs in about 10% to 20% of bereaved persons, is characterized by the person being frozen or stuck in a state of chronic mourning. They feel bitter over their loss and wish that their lives could revert to the time when they were together. In addition, the person experiences an intense longing and yearning for the decreased for more than 6 months. Additionally, the person may have trouble accepting the death, an inability to trust others since the death, excessive bitterness related to the death, and feeling that life is meaningless without the decreased person.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions An Islamic client has passed away. Which processes would be included in the burial procedure? Select all that apply. a. Positioning of the body b. Dressing of the body c. Cremation of the body d. Washing of the body e. Reciting prayer of the deceased

a,b,d,e According to Islam, cremation of the body isn't permitted. Bodies are buried. The steps include in the Islamic funeral are dressing, washing, positioning, prayer of the decreased, and burial.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions The client's mother passed away and the client is crying incessantly. According to the George Engel's Stages of Grieving, which stage of grief is the client in? a. Shock and disbelief b. Developing awareness c. Restitution d. Resolution of the loss

b Developing awareness Crying indicates that the client is starting to acknowledge that his mother has passed away. According to the George Engel's Stage of Grieving, the client is in the stage of developing awareness. Restitution is the stage of grief where the clients start participating in the rituals associated with loss. This helps the individual accept the loss and thus begins the recovery process. Shock and disbelief is the first stage where the client becomes numb and is unable to acknowledge the loss. Resolution of the loss is the stage of grief where an individual is extremely preoccupied with the loss.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following is a term used to describe grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially? a. Mourning b. Disenfranchised grief c. Anticipatory grieving d. Bereavement

b Disenfranchised grief Disenfranchised grief is grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially. Anticipatory grieving is when people facing imminent loss begin to grapple with the very real possibility of the loss or death in the near future. Bereavement refers to the process by which a person experiences the grief. Mourning is the outward expression of grief.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following is the most frequent and persistent bereavement-associated symptom? a. Impaired appetite b. Sleep disturbances c. Headaches d. Indigestion

b Sleep disturbances Sleep disturbances are the most frequent and persistent bereavement-associated symptom.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions 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? a. Phase of yearning and searching b. Phase of recognition c. Phase of numbing d. Phase of disorganization and despair

b Phase of recognition During the phase of rcognition, 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'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.

Videbeck Ch.10 Chapter Study Guide 2. Situations that are considered risk factors for complicated grief are a. inadequate support and old age b. childbirth, marriage, and divorce c. death of a spouse or child, death by suicide, and sudden and unexpected death d. inadequate perception of the grieving crisis

c

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions What question should nurses ask themselves to determine if the care they provide to the grieving client has been both therapeutic and client focused? a. "How long can I continue working with grieving clients?" b. "How do I personally react when I am working through the grieving process?" c. "Do I have the strength to be present and to facilitate the client who is grieving?" d. "Do I still get personal satisfaction from my work with the grieving client?"

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

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following factors does not influence on the grieving person's return to homeostasis? a. Adequate perception of the situation b. Adequate coping c. Adequate self-awareness on the part of the nurse d. Adequate support systems

c Adequate self-awareness on the part of the nurse Adequate self-awareness on the part of the nurse dose not influence the grieving person's return to homeostasis as it is an individual experience. All other options do influence the grieving person's return to homeostasis.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions According to Mardi Horowitz (2001), life begins to fell "normal" again in which of the following stages? a. Working through b. Outcry c. Completion d. Denial and intrusion

c Completion 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.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions The nurse is caring for a client whose spouse passed away several year ago. Upon assessment, the nurse finds that the client has a history of signs and symptoms of depression since the spouse's death. Which of the following terms correctly describes the client's response to her loss? a. Anger b. Disenfranchised grief c. Complicated grief d. Outcry

c Complicated grief 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 they may experience a void of emotion of 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 healthcare providers (Kubler-Ross, 1969). Outcry is also a phase of grief which accompanies outward expression of grief such as sobbing tearfully and crying loudly. The client starts developing awareness about the grief in this phase (Horowitz).

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following types of loosses is caused by an internal or external crissi that blockes or inhibits strivings toward fulfillment that may threaten personal goals and individual potential? a. Safety Loss b. Loss of Self-esteem c. Loss related to self-actualization d. Physiologic loss

c Loss related to self-actualization Loss related to self-actualization is caused by an internal or external crisis that blocks or inhibits striving toward fulfillment that may threaten personal goals and individual potential. Safety loss is loss of a safe environment, which may be noted in domestic or public violence. Physiologic loss encompasses amputation of a limb, loss of adequate air exchange, or decrease in pancreatic functioning. Loss of self-esteem occurs when there is a change in how a person is valued at work or in relationships.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions During which phase Bowlby's grief process dose reality begin to set in? a. Phase of numbing b. Phase of disorganization and despair c. Phase of yearning and searching d. Phase of recognition

c Phase of yearning and searching During the phase or yearning and searching, reality begins to set in. During the phase of disorganization and despair, the bereaved person begins to understand the loss's permanence. 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 the phase of recognition, the bereaved person begins to reestablish a sense of personal identity.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions The nurse is assessing a client who has lost his family in an accident. According to George Engel's Stages of Grieving, which behavior indicates that the client is in the stage of resolution of the loss? a. The client is crying continuously and is feeling helpless. b. The client is performing a funeral ritual for his decreased family. c. The client repeatedly views his family photos. d. The client is numb and is not accepting the loss.

c The client repeatedly views his family photos. According go George Engel's Stages of Grieving, in the stage of resolution of the loss the client is preoccupied with the loss of or the person lost is idealized. In this case, the client repeatedly views family photos which indicates that the client is preoccupied with the memories related to the family members. Thus, the client is in the stage of resolution of the loss. If the client is numb and is not accepting the loss, the client is in the stage of shock and disbelief. If the client is crying continuously and is feeling helpless, the client is in the stage of developing awareness. If the client is performing a funeral ritual for his decreased family, the client is in the stage of restitution.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which outcome will the nurse evaluate to determine whether a client has successfully stabilized when engaged in the grieving process? a. The client will verbally identify his or her terminal diagnosis within 4 hours. b. The client will verbalize decreased suicidal thoughts within 48 hours. c. The client will verbalize acceptance of his or her terminal diagnosis. d. The client will express his or her feelings both verbally and nonverbally.

c The client will verbalize acceptance of his or her terminal diagnosis. Stabilization requires a sufficient amount of time to accept the presence of the source of their grieve. The remaining options present immediate outcomes of being aware of the grief and its effects.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which client will the nurse identify as having the greatest risk for developing disenfranchised grief? a. a single adult whose 14 years old pet dog has died b. a man who is grieving the loss of a business he founded 25 years ago c. the wife of a man who was shot to death by police during a robbery d. a teenager who has lost his grandfather to cancer

c the wife of a man who was shot to death by police during a robbery Disenfranchised grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially. The death of someone who is incarcerated or executed for crimes carries a social stigma that often prevents family members from publicly grieving or receiving support for their loss. While the other options suggest others experiencing loss, the correct option adds the component of social stigma to the burden of the loss.

Videbeck Ch.10 Chapter Study Guide 3. Physiologic responses of complicated grieving include a. tearfulness when recalling significant memories of the lost one b. impaired appetite, weight loss, lack of energy, palpitations c. depression, panic disorders, chronic grief d. impaired immune system, increased serum prolactin level, increased mortality rate from heart disease

d

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following likely takes place in the fourth sstage of Kubler-Ross's stage of grieving? a. Bargaining b. Denial c. Anger d. Depression

d Depression 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.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following occurs in the second phase of Bowlby's grieving process? a. Cognitive disorganization b. Numbness and denial c. Reintegrating sense of self d. Emotional yearning for the loved one

d Emotional yearning for the loved one Emotional yearning for the loved one occurs in Phase II of Bowlby's grieving process. Numbness and denial occur in Phase I. Cognitive disorganization occurs in Phase III. Reintegrating a sense of self occurs in Phase IV.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following terms describes the process by which a person experiences the grief? a. Grief b. Morning c. Attentive presence d. Grieving

d Grieving Grieving is the process by which a person experiences the grief. Grief refers to the subjective emotions and affect that are a normal response to the experience of loss. 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.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following cultures believes that leaving the body along after death is disrespectful? a. Vietnamese Americans b. Native Americans c. Chinese Americans d. Orthodox Jewish Americans

d Orthodox Jewish Americans believe that leaving the body alone after death is disrespectful.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions In which of the phases of Bowlby's grief process does the bereaved person begin to understand the loss's permanence? a. Phase of numbing b. Phase of recognition c. Phase of yearning and searching d. Phase of disorganization and despair

d Phase of disorganization and despair 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 the phase of recognition, the bereaved person begins to reestablish a sense of personal identity.