Professional Communications-Chapter 10 Grief and Loss (PREPU)

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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." "Have I said something to offend you?" "I can sit with you here so that you don't feel alone." "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." 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? "This is a hopeless situation." "Nothing more can be done." "Everything will be fine, so don't worry." "Let me tell you about your illness."

"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.

In which ways can anticipatory grief be helpful for the client and family? Clear examination of treatment options Admission to hospice care An earlier and less painful death Acceptance of impending death

Acceptance of impending death Explanation: Anticipatory grief allows the individual and others to get used to the reality of the loss or death and to complete unfinished business.

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? Denial Anger Bargaining Depression

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.

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 Completion Denial and intrusion Working through

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 Denial Bargaining Anger

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 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? React Recognize Relinquish Recollect

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 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 feelings related to the pet's death are insignificant. 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 nurse would not be able to make the client feel better.

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 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 safety security and belonging self-actualization

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 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: "You probably won't cremate the body, will you?" "How would you like to complete the five steps of the burial process?" "Shall I ask the pastor to attend for support?" "Are there any rituals you will observe here for your loved one?"

"Are there any rituals you will observe here for your loved one?" Explanation: The nurse is making the appropriate cultural considerations when asking the more open-ended question of "Are there any rituals you will observe here for your loved one?" The nurse demonstrates that effects of acculturation may have caused the family to lose, minimize, modify, or set aside specific culture related rituals. Asking the questions from any of the other options indicates the nurse has not accounted for acculturation and is making assumptions about the family's wishes for the deceased.

The nurse is assessing a client who reports feeling hopeless since a divorce. Which would be an appropriate question for the nurse to ask in order to determine mental health status for this client? "Do you ever use drugs to help feel less emotional pain?" "Is there a history of mental illness in your immediate family?" "Would you consider marrying again?" "Do you feel that someone else could ever love you?"

"Do you ever use drugs to help feel less emotional pain?" Explanation: Negative circumstances such as poverty, poor physical health, unemployment, divorce, abuse, neglect, and unresolved childhood loss generally precipitate feelings of hopelessness, helplessness, or worthlessness. These negative responses place a person at risk for depression, substance abuse, or other mental health disorders. History of mental illness, marrying again, and the client's thoughts on whether another person would love the client again are appropriate general assessment questions but not as directly focused on the client's mental health status as substance use.

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." "Oh God. Why did you take my spouse away from me? What wrong did I do?" "Please send my spouse back to me dear God. I would never ever fight again." "My spouse is gone. I am having a really hard time finding a reason to keep going."

"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? "No, not me." "Why me?" "My husband was the best man in the world." "The funeral service helped me survive."

"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 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 Bereavement Mourning Loss

Anticipatory Explanation: Anticipatory grief refers to the reactions that occur when an individual, family, significant other, or friends are expecting a loss or death to occur. Bereavement is the process of grief that includes feelings of sadness, insomnia, poor appetite, deprivation, and desolation. Mourning describes an individual's outward expression of grief regarding the loss of a loved object or person. Loss is a change in the status of a significant object or situation.

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 Anticipatory grief Dysfunctional grieving Bereavement

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 stages of grieving, according to Kubler-Ross (1969), occurs when the person asks God or fate for more time to delay the inevitable loss? Bargaining Denial Anger Depression

Bargaining Explanation: 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.

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

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.

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 Situational Inhibited Maturational

Complicated Explanation: Unresolved grief is abnormal or distorted; it may be either unresolved or inhibited. In unresolved grief, a person may have trouble expressing feelings of loss or may deny them; unresolved grief also describes a state of bereavement that extends over a lengthy period. With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations.

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

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

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? Anger Denial Bargaining Depression

Denial Explanation: According to Kubler-Ross's stages of grieving, in the denial stage the client is in shock or disbelief about the loss. The statement by the client indicates that he or she does not believe that they have cancer, thus the client is in the denial stage. In the anger stage, the client would express anger of the loss toward God, friends, or health care providers. In the bargaining stage, the client tends to ask God or fate for more time and delay the loss. In the stage of depression, the client becomes aware of the loss.

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 It gives all involved a chance to hope that there has been a mistake made It provides an opportunity to adjust to the realization that death will occur It affords the individual a chance to prepare for the death experience

It provides the individual with a temporary escape from the reality of dying Explanation: The nurse explains that the purpose of the denial stage of grief is to provide the individual with a temporary escape from the reality of dying. Its purpose is not to give all involved a chance to hope a mistake has been made, not to provide an opportunity to adjust to the realization that death will occur, and not to afford the individual a chance to prepare for the death experience.

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

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.

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? emotional behavioral spiritual physiologic

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? complicated grief traumatic grief uncomplicated grief bereavement

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.

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 sudden, unexpected death death by suicide low self-esteem low trust in others

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.

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? perception of loss support while grieving coping behaviors anticipatory grieving

support while grieving Explanation: In this situation, the nurse asks this question to assess the the quality of the client's support system. The nurse intends to provide the grieving client with an awareness of those who can meet the client's emotional and spiritual needs for security and love. Asking about who was helpful in previously difficult times can make this decision easier for the client. When exploring the perception of loss, the nurse should ask open-ended questions to determine what the loss means to the client. When exploring coping behaviors, the nurse should ask questions about how the client has coped with difficulty in the past or look for clues such as changes in appetite or avoiding visitors. Anticipatory grieving refers to when people face an imminent loss and begin to grapple with the very real possibility of the loss. Question pertaining to this concept would be asked when exploring the client's perception of loss in the assessment.

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 do you feel about the news?" "Do you feel like talking to anybody right now?" "How can we relieve your anxiety?" "What do you usually do when you are excessively stressed?"

"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.

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 playing with friends." "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."

"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? "The grieving process is the same for children and adults." "Children are at risk for mental health problems after experiencing a loss." "Children face many challenges while growing up." "Children's responses to loss reflect their developmental level."

"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 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 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 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.

A client is arranging a funeral ceremony for the client's child. According to the Worden's tasks of grieving, which task is being accomplished? Acceptance of the reality of the loss Working through the pain of grief Adjustment to the environment that has changed due to the loss Emotional relocation of that which has been lost and moving on with life

Acceptance of the reality of the loss Explanation: The client is arranging a funeral ceremony for the client's child. Thus, the client is starting to acknowledge the loss. According to the Worden's tasks of grieving, the client is accepting the reality of the loss. Experiencing emotional and physical pain that has occurred due to the loss is the task of working through the pain of grief. The client is trying to learn the effective strategies that could reduce the stress associated with the loss. This is referred to as the task of adjustment to the environment that has changed due to the loss. If the client has relocated the memories associated with the loss and has started to form new relationships and friends, it indicates that the client is accomplishing the task of emotional relocation of that which has been lost and is moving on with life.

A group of nursing students is reviewing information about grief and bereavement. The students demonstrate understanding of the information when they state: Grief and bereavement are used interchangeably as responses to loss. Bereavement is the process of mourning and grief is the emotional reaction. Grief involves confronting the stressor, but bereavement helps to avoid the stressor. Bereavement is influenced by culture, but grief is not.

Bereavement is the process of mourning and grief is the emotional reaction. Explanation: Grief is an intense, emotional reaction to the loss of a loved one. The reaction is a biopsychosocial response that often includes spontaneous expression of pain, sadness, and desolation. Bereavement is the process of mourning and coping with the loss of a loved one. It begins immediately after the loss, but it can last months or years. Individual differences and cultural practices influence grieving and bereavement.

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? Anger Outcry Complicated grief Disenfranchised grief

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

Orthodox Jewish Americans

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 Phase of yearning and searching Phase of numbing Phase of recognition

Phase of disorganization and despair Explanation: 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.

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 Phase of disorganization and despair Phase of yearning and searching Phase of numbing

Phase of recognition Explanation: During the phase of recognition, 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.

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

Physiologic loss Explanation: Loss occurs when a valued person, object, or situation is changed or made inaccessible so that its value is diminished or removed. Physiologic loss can be recognized by others as well as by the person sustaining the loss.

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

Shock Explanation: Upon receiving the diagnosis of the disease, the client is most likely to be in a state of shock or disbelief. Shock is considered a universal reaction to loss. During this phase, the client is unable to accept the loss. Anger is most likely the next reaction. It is where the client would express anger toward God, family, and health care providers. Anxiety occurs when the client is waiting for the diagnosis and also when the client accepts the loss and starts feeling helpless. Once the client has accepted the loss, the client starts having negative feelings such as depression.

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

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

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 a normal grief reaction and does not need any intervention at this time. The client is experiencing a prolonged reaction but within normal limits of the grieving process. The client is having a prolonged reaction to the spouse's death, but since the client is surrounded by family members who provide support, the client does not need any interventions at this time. The client is experiencing complicated grieving reaction. The client needs to have a comprehensive mental health assessment.

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 client has experienced the death of a spouse. They were married for 50 years; the client depended on the spouse for simple activities of daily living. While assessing the client for depression, of what should the nurse be most aware? The client's risk for physical illness is relatively high. The client's risk of morbidity remains the same as before the spouse's death. The client's should be advised to relocate after the death of the spouse. The client's pessimism will not have an effect on health.

The client's risk for physical illness is relatively high. Explanation: The client's risk for illness is relatively high. Data suggests acute stress can suppress the immune system. Death of a spouse is a significant stress to the remaining spouse. This client is at risk for illness because of the suppressed immune system. It is better for the client not to relocate or add additional stressors until the time of acute stress has resolved. Optimism, social support, and coping skills will assist the client to moderate the affects of the acute stress.

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 disturbed by the other spirits. The soul of the deceased should not be alone while leaving the body. The soul of the deceased should comfortably be able to travel into the afterlife. The soul of the deceased should pass through the body of a close family member.

The soul of the deceased should not be alone while leaving the body. Explanation: The Orthodox Jewish people believe that the soul should not leave the body while the person is alone. Thus a close relative is supposed to be there with a person who is dying. The purpose of this custom is not to prevent disturbance from the other spirits, to help the soul travel comfortably to the afterlife, or to make the soul of the deceased pass through the body of a close family member.

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? Outcry Completion Working through Denial and intrusion

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 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 denial and intrusion working through completion

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.


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