Chapter 25 - Grief

2

A 45-year-old female client was diagnosed with stage IV ovarian cancer and given less than 6 months to live. The client's husband is at the bedside and states to the nurse, "I don't know how I am going to do this. How am I supposed to raise our children alone? I have much anxiety thinking about life without my wife." What type of grief is the husband experiencing? 1 Acute grief 2 Anticipatory grief 3 Complicated grief 4 Uncomplicated grief

c

A patient's fiancé died in an automobile accident several days ago. The patient reports crying and experiencing feelings of guilt and anger. This behavior is characteristic of which stage of acute grief? a. Denial b. Reorganization c. Development of awareness d. Preoccupation with the lost object

four tasks of mourning

1. Accept the reality of the loss. 2. Process the pain of grief while caring for the self. 3. Adjust to a world without the deceased. 4. Find an enduring connection with the deceased in the midst of embarking on a new life.

2

A 40-year old male client's wife passed away 2 years ago due to cancer. He is talking with the nurse and expresses, "I have no interest in anything anymore. There is no reason for me to live. Sometimes I feel like I want to end my life so I can be with my wife again." Which type of grief is the client experiencing? 1 Acute grief 2 Complicated grief 3 Uncomplicated grief 4 Disenfranchised grief

1

A 16-year-old female client lost her best friend to a tragic water skiing accident 3 months ago. The nurse asks the client's mother how the client has been since the death of her best friend. The mother states, "She wanted to get a tattoo in memory of her friend and I told her no. I found out that she and her other friend purposely burned themselves with cigarettes to feel the pain she felt. She keeps saying that there is no reason for her to live and wants to kill herself." What nursing intervention is the highest priority for this client? 1 Suicide precautions 2 Offer spiritual support 3 Refer the client to a psychiatrist 4 Give undivided attention to the client

3

A 35-year-old female client lost her husband to a motorcycle accident a few months ago. The nurse is performing an assessment and the client states, "I just have no one to go to. I am an only child and so was he. Both of our parents are gone, and we just moved here a year ago so I have no friends." Which nursing intervention is the highest priority for this client? 1 Create a therapeutic presence 2 Refer the client to spiritual counseling 3 Find bereavement groups in the community 4 Suggest the client be admitted to the hospital

2

A client experiencing the recent loss of a child is participating in short term therapy to assist with complicated grieving. Which intervention is focused on encouraging the client to fully express his or her grief? 1 Identifying strategies to help manage life without the child 2 Describing the significance of the loss of a child via role-playing 3 Engaging in a discussion about the changes that losing a child will create 4 Talking to a friend about distraction activities

3

A client is grieving the loss of his mother, and the nurse is interviewing the client to evaluate his coping skills after the loss. Which behavior by the client indicates he is mourning as "dual processes?" 1 "I should have done something more for my mother. How could I have let this happen to her?" 2 "Ever since my mother passed away, I get this pain in my throat and feel like I cannot breathe." 3 "I often reminisce about times with my mother, but I also be sure to take breaks from life and go on vacation and create new adventures." 4 "All I do every day is look at pictures of my mother and reminisce about all of the great times we had. It makes me very sad to see pictures of her."

4

A client says to the nurse, "I had my first depression after I got divorced about 10 years ago. I recognized what was happening to me because both of my parents suffer from depression." Which theory regarding the etiology of depression has the client described? 1 Cognitive theory 2 Biochemical factors Incorrect3 Learned helplessness Correct4 Stress-diathesis model

3

A family is grieving the loss of a loved one. The nurse is helping the family cope with the loss. What statement by the nurse ismost helpful to the family and follows the guidelines for dealing with loss? 1 "Try and do things out of the ordinary to help you cope with the loss and move on." 2 "I know that it is painful to relive the story of your loss. You only need to tell it once." 3 "It is okay not to get back into all of your daily routines right away. Give yourself time." 4 "If you are still experiencing depression after 6 months, be sure to seek professional assistance."

1

A family is preparing arrangements after the death of their family member, who was a grandmother, mother, and sister. The family has decided to have a sitting shiva, which is a Jewish ritual. A sitting shiva is an example of which reaction to a loss? 1 Mourning 2 Acute grief 3 Bereavement 4 Anticipatory grief

1

A male client lost his wife months ago to a tragic boating accident. He has been attending psychotherapy on a weekly basis to help with grief work. What statement by the client is the highest concern to the nurse? 1 "Ever since my wife died 10 months ago, I haven't been able to work and I can't support my family." 2 "I have been able to look at a picture of my wife without crying and think of good memories instead." 3 "I joined this men's book club, which is something I wouldn't normally do, but I figured I could at least try it." 4 "Things have been okay. I've actually been cleaning my house every week and making lunches for my kids."

4

A nurse in a clinic is interviewing a client. The client states, "I just lost my brother a few days ago. I just have so many negative feelings. Why did he do this our family? How could he? I feel terrible being so upset with him. Why do I feel this way?" Which response by the nurse is the most appropriate for this client? 1 "It was probably his time. God has a plan for everyone." 2 "I try to focus on other positive things. The weather is wonderful right now." 3 "It is not his fault. Sometimes ones who are close to us pass away unexpectedly." 4 "You are experiencing a normal grief reaction called anger. Tell me about how you feel."

2

A nurse is assessing a client who has lost his wife last week. Which assessment finding most concerns the nurse and requires immediate intervention? 1 Self-soothing 2 Suicidal ideation 3 Social withdrawal 4 Reduced concentration

1,2,3,5

A nurse is assessing clients for risk factors that may complicate the successful completion of the mourning process. Which questions will help the nurse identify risk factors? Select all that apply. 1 Was the deceased a child? 2 Were there persistent, unresolved conflicts with the deceased? 3 Has the bereaved had difficulty resolving past significant losses? 4 Does the bereaved have a history of cancer, heart disease, or stroke? 5 Does the bereaved have a history of depression or other psychiatric illness?

1

A nurse is caring for a client in palliative care. The client has been extubated and comfort care measures are in place. When the client expires, a family member is at the bedside. Which reaction by the family member does the nurse expect first? 1 Denial 2 Depression 3 Acceptance 4 Restlessness

1,2,4,5

A nurse is caring for a client who is in palliative care. The family is at the bedside and is having a difficult time with the diagnosis. How can the nurse foster hope and connectedness for the client and family? Select all that apply. 1 Legacy-building 2 Uplifting memories 3 Discouraging humor 4 Encourage reminiscence 5 Encourage life review for clients

1

A nurse is caring for a terminally ill client in palliative care. The wife is at the bedside crying. She has expressed to the nurse her fear of her husband dying and how she will go on without him. What intervention is the most important for the nurse to implement? 1 Sit in silence with the wife 2 Asking the wife if she would like coffee 3 Telling the wife that everything will be okay 4 Telling the wife a story about a personal loss

2

A nurse is caring for a young widow and suggests community resources available to help her cope with the loss. Why is this intervention important? 1 To identify anxiety 2 To identify a support system 3 To assess suicidal tendency 4 To build a relationship with the client

2

A nurse is facilitating a bereavement group. A client is communicating to the group a story about his deceased wife. He is crying while stating, "She was the best person I've ever known. I feel so much sadness thinking about all of the things my kids will miss out on not having their mom around." Which response by the nurse is most appropriate to facilitate bereavement? 1 Say nothing. 2 "This must hurt terribly." 3 "Does anyone else feel this way?" 4 "Everyone feels that way sometimes."

d

A nurse working with a person whose spouse recently died uses cheer and humor to lift the person's spirits. At one point, the widowed person smiles briefly. What analysis of this scenario is correct? a. The nurse's technique was effective. b. Use of humor should be added to the plan of care. c. This approach may prove useful in other, similar situations. d. The nurse needs supervision; the communication technique was not appropriate.

1

A nurse is facilitating a community bereavement group. The nurse is listening to a young client describe his experience through the grieving process. He is tearful and states, "I lost my father and I am so scared of what is going to happen next. How will I be able to keep my mom and little sisters safe? My dad always kept us safe and now it is up to me. I am terrified for the future." What response by the nurse is the most appropriate for this client? 1 "It must be scary to go through this." 2 "Try not to cry, you must try to be strong." 3 "You need to try to get over those feelings and move on." 4 "It sounds like your family is relying on you for too much."

3

A nurse is facilitating a grief support group and is learning about each of the clients. Which client is at the highest risk for complicated grief? 1 A female client who lost her husband 6 months ago and feels socially isolated 2 A male client who lost his wife after a long battle with cancer and cannot sleep 3 A male client who lost his wife suddenly and has a history of posttraumatic stress disorder 4 A female client who lost her youngest son and has lost interest in hobbies that used to bring happiness

3,4,5

A nurse is interviewing a bereaved caregiver of a terminally ill client. How can the nurse help the caregiver to gather information about her loved one's diagnosis, medical care, and treatment options? Select all that apply. 1 "I am unable to give you the information about the treatment plan." 2 "The doctor has told you everything you need to know so you are all set." 3 "It sounds like you need further explanation. Let me explain it another way." 4 "I understand that you want to be sure you have all of the correct information." 5 "Please feel free to ask questions and I will do my best to answer them for you."

4

A nurse is interviewing a client who has lost his mother suddenly. The client is crying and states, "This is all my fault. I should have listened to her when she said she was not feeling well. I should have been there for her. I am so afraid and feel so alone in this." What would be the most appropriate response by the nurse to the client? 1 "I can get you a referral for a psychiatrist." 2 "You seem like you are feeling angry. This is common. What are your thoughts about this?" 3 "I'm going to need to get you a referral. This is not a normal feeling during the mourning process." 4 "You seem like you are feeling guilty. This is a common reaction during the mourning process. What are some of your thoughts about this?"

3

A nurse is interviewing a client who lost her husband. Which statement made by the client would indicate to the nurse that the client is suffering from persistent complex bereavement disorder? 1 "I have had several dreams in the past week and my husband has been in all of them." 2 "I haven't been able to get a full night's sleep since my husband passed away 2 weeks ago." 3 "It's been over a year. There are days when I want to die so I can be with him again. I can't do this anymore." 4 "I know it's only been a week, but I should have made him go to the doctor and maybe this wouldn't have happened."

1,2,4

A nurse is with a client who is experiencing acute grief. What interventions are appropriate to help a client in grief? Select all that apply. 1 "This must be very difficult for you." 2 Maintaining eye contact with the client 3 "I heard it is supposed to rain later today." 4 Actively listening to the client express her feelings 5 "I've been through something like this before. Don't be sad."

4

A nurse leads a bereavement group. Which participant's comment most clearly demonstrates that the work of grief has been completed? 1 "I feel like I'm getting stronger every day. I haven't even cried since my loss." 2 "Our time together was too short. I only wish we had done more things together." 3 "I know our life together was a blessing that I did not deserve. I wish I had said 'I love you' more often." 4 "I finally took my first vacation since my loss. I hadn't gone to the beach in so long, because my loved one didn't like the ocean. It was so relaxing."

1

A nurse on an inpatient psychiatric unit is interviewing a client who is grieving the loss of his close family member. The client has a history of depression and was admitted to the psychiatric unit for major depression. While the nurse is assessing the client, the client is slow to respond to questions about the death of the family member. What action by the nurse is the most therapeutic? 1 Allow for silence 2 Ask the question again 3 Change the subject to avoid sadness 4 Give a handout to the client with common grief symptoms

4

A nurse providing hospice care to a client is helping the family say goodbye to promote successful bereavement. How can the nurse help the family say goodbye? 1 Telling the family that the client is unresponsive and will not hear them 2 Encouraging the family to talk about humorous stories about the client's life 3 Encouraging the family to pretend that time will never run out and not to feel sadness 4 Telling the family to have out-of-town family members speak to the client through the telephone

4

A nurse reports to the nurse manager that she is overwhelmed with work. She tearfully states to the nurse manager, "There is so much death all of the time. My work never seems to be enough." Which response by the nurse manager is mostappropriate? 1 "Have you tried to talk to a therapist?" 2 "I'm not sure if there is anything I can do to help." 3 "We all have those days and I've been in nursing for many years. You need to have a thicker skin in order to be a nurse." 4 "I was thinking of starting a support group for the nursing staff. Many nurses have been coming to me with similar concerns."

3

A nurse who facilitates a community bereavement group is reassessing clients in the group. It has been 2 years since the clients have experienced losses in their lives. Which client is the highest priority and needs reevaluation? 1 A client who starting dating again after losing his wife 2 A client who cried on his wife's birthday and still loves to read 3 A client who has not found satisfaction in the activities of her daily life 4 A client who has returned to work and goes to the movies on weekends

2

A nurse who has worked for a community hospice organization for eight years says, "My clients and their families experience overwhelming suffering. No matter how much I do, it's never enough." Which problem should the nursing supervisor mostsuspect? 1 The nurse is experiencing spiritual distress. 2 The nurse is at risk for burnout and compassion fatigue. 3 The nurse is not receiving adequate recognition from others. 4 The nurse is at risk for over-helping, which creates dependency.

d

A patient newly diagnosed with pancreatic cancer says, "My father also died of pancreatic cancer. I took care of him during his illness. I can't go through that." Select the highest priority nursing diagnosis. a. Anticipatory grieving b. Ineffective coping c. Ineffective denial d. Risk for suicide

b

A person whose spouse died two years earlier tells friends, "I think I'll start going out socially, maybe even take someone to dinner." This comment best demonstrates that the individual is: a. denying the significance of the loss. b. in a period of resolution of grief. c. actively working through grief. d. experiencing intrusion.

disenfranchised grief

A situation in which certain people, although they are bereaved, are prevented from mourning publicly by cultural customs or social restrictions.

1

A toddler died in a tragic accident 16 years ago. Once a year, the toddler's parents place flowers at the accident site. How would the nurse characterize the parents' behavior? 1 Mourning 2 Bereavement 3 Complicated grief 4 Disenfranchised grief

4

A widow is demonstrating signs of complicated grief after the death of her spouse 18 months ago. Which information included in her mental health assessment should the nurse most identify as requiring further investigation? 1 Her husband died of poorly managed diabetes 2 They had been happily married for over 50 years 3 The couple lost a 4-year-old child 4 His death was a result of a failed robbery attempt

c

An adult who was widowed 18 months ago says, "I can now remember good times we shared without getting upset. Sometimes I even think about the disappointments. I've become accustomed to sleeping in our bed alone." The work of mourning: a. is beginning. b. is progressing abnormally. c. is at or near completion. d. has not begun.

a

After being notified that her husband died of heart failure, a wife approaches the nurse who cared for her husband. In the hospital hallway the wife shouts angrily, "He'd still be alive if you'd given him your undivided attention!" Select the nurse's best response. a. "I understand you're feeling upset. Let's go to our conference room, and I'll stay with you until your family comes." b. "Your husband's heart was severely damaged and could no longer pump. There's nothing anyone could have done." c. "I will call the nursing supervisor to discuss this matter with you." d. "It will be all right if you cry. Crying is a normal grief response."

b

After the death of his wife, a man tells the nurse, "I can't live without her. She was my whole life." Which is the nurse's most therapeutic reply? a. "Each day will get a little better." b. "Her death is a terrible loss for you." c. "Remember, she's no longer suffering." d. "Your friends will help you cope with this."

1

Disenfranchised grief is defined as a grief to acknowledge losses that are not socially sanctioned, openly acknowledged, or publicly mourned. Which client is experiencing disenfranchised grief? 1 A man whose wife had a miscarriage 2 A young man whose mother is in hospice care 3 A man who lost his wife 2 years ago and is having suicidal thoughts 4 A wife who lost her husband to a sudden death from a motor vehicle collision

1,2,3,4

Nurses have a critical role in helping families and caregivers say goodbye to their loved ones. Dr. Ira Byock provides a simple structure to the process in the Four Gifts of resolving relationships. What are the four phases of communication included in the Four Gifts of resolving relationships? Select all that apply. 1 Love 2 Farewell 3 Gratitude 4 Forgiveness 5 Bereavement

uncomplicated grief

normal grief, natural response to a loss

1

Recognizing that grief and mourning are different processes, which statement reflects a client's progress towards completing the mourning process? 1 "He had his faults but I know he loved me." 2 "I know that I have to go on but I can't do it yet." 3 "My love of gardening has not given me pleasure since losing him." 4 "It's only been 2 years since he died but it seems so much longer

3

Some of the most widely known early grief theorists describe common psychological and behavioral phenomena experienced by those who are grieving a loss. What is the most accurate definition of grief work? 1 A process that aims at recreating a new life 2 A process that deals with recognizing the loss 3 The process of grief recovery or how a person adjusts to the loss 4 The griever constructs and reconstructs the world around him through the experience as a survivor of loss

1,2,3,5

Successful mourning means a client engages in a complex process of finding a new and durable connection to who he is now and to the person who died. What steps are included in the Four Tasks of Mourning? Select all that apply. 1 Accept the reality of the loss 2 Adjust to a world without the deceased 3 Process the pain of grief while caring for self 4 Forgiveness (I forgive you, please forgive me.) 5 Find an enduring connection with the deceased in the midst of embarking on a new life

love, farewell, gratitude, forgiveness

The four phases of communication that clients move through to resolve relationships are

1,3,4,5

The grandmother of a 34-year old female client passed away a week ago, and the client is experiencing uncomplicated grief. Select the client responses that are included in uncomplicated grief. Select all that apply. 1 Poor appetite 2 Suicidal ideation 3 Depressed mood 4 Searching for the deceased 5 Dreams about the deceased

b

The mourning process is more difficult when the bereaved: a. was relatively independent of the deceased. b. has experienced a number of previous losses. c. accepts that death is expected for older adults. d. had few unresolved conflicts with the deceased.

4

The nurse is assessing a group of clients for psychotherapy. Which client is most at risk and in need of psychotherapy? 1 A 26-year-old male client who lost his mother to cancer and a history of depression 2 A 45-year-old female client who lost her sister to cancer and no history of mental illness 3 A 70-year-old male client who lost his wife suddenly and no previous history of mental illness 4 A 27-year-old female client who lost her 3-year-old son suddenly and has a history of depression

3

The nurse is interviewing a client who was working through the grieving process after losing his wife 6 months ago. What statement by the client indicates to the nurse that the grief work is over and the client successfully met the desired outcome? 1 "I feel angry a majority of the time and I do not know how to deal with it. I think I need help." 2 "I have started to go back to work, but I know that the future is going to be terrible without her." 3 "I miss my wife terribly, but I have finally begun to travel more often which is something I have always wanted to do." 4 "I miss my wife and I have frequent dreams about her. Everything reminds me of her and I break down crying when I think of her."

2

The nurse is interviewing a client whose wife passed away one week ago from a stroke. Which statement by the client indicates to the nurse that the client is experiencing anger during bereavement? 1 "It's all my fault. I should have forced her to go to the doctor." 2 "How could she leave me like this? Why did she do this to me?" 3 "I really should have paid more attention to her symptoms so I could help her." 4 "I feel as though my entire left side is numb and I have been feeling very weak."

1,3,4,5

The nurse is taking a spiritual history for a client who is receiving palliative care. What questions asked by the nurse address all of the components of a spiritual history? Select all that apply. 1 "Are you a part of a religious community?" 2 "Are you having any thoughts of harming yourself?" 3 "Would a referral to our chaplain be helpful to you?" 4 "What role do your beliefs play in regaining your health?" 5 "Do you have spiritual beliefs that help you cope with stress?"

2

The nurses in an inpatient psychiatric unit are being encouraged to perform self-care while at work, which is an initiative by the organization to increase job satisfaction to prevent burnout. Which definition most accurately defines burnout? 1 The ability to be with someone who is suffering 2 A decreased work performance due to negative behaviors and thoughts 3 The individualized response to a loss that is perceived, real, or anticipated 4 The emotional pain or cost of working with traumatized persons that may result in stress

1,2,3,5

What interventions should the nurse implement to help families of clients in palliative care grieve? Select all that apply. 1 Helping family say goodbye 2 Helping family maintain hope 3 Use of therapeutic presence 4 Filling moments of silence with conversation 5 Helping caregivers make sense of their feelings

4

What is the term used for the emotional pain or cost of working with traumatized persons that may result in a stress response for a nurse? 1 Grief 2 Burnout 3 Compassion 4 Compassion fatigue

2,3,4,5

Which actions are associated with addressing the needs of health care providers who are frequently involved in the compassionate care of grieving clients? Select all that apply. 1 Changing unit assignments on a regular basis 2 Advocating for facility sponsored exercise programs 3 Earning a certification associated with grief counseling 4 Consciously making an effort to support and encourage staff members 5 Attending weekly scheduled debriefing and support sessions

4

Which assessment finding is a risk factor that could complicate successful completion of mourning? 1 The bereaved denies a history of psychiatric illness 2 The bereaved has not had any past significant losses 3 The bereaved has a strong support system of family and friends 4 The bereaved depended on the deceased to provide financial stability

4

Which statement by the terminally ill client demonstrates an understanding of the concept of palliative care? 1 "The focus of hospice and palliative care are very similar." 2 "When I'm ready to die, I'll certainly consider palliative care." 3 "Palliative care will focus on the management of my cancer pain." 4 "I'm dying and palliative care will help preserve my quality of life."

complicated grief

a type of grief that impedes a person's future life, usually because the person clings to sorrow or is buffeted by contradictory emotions

FICA tool

for assessing spiritual history

anticipatory grief

grief experienced prior to a loss

2

hich assessment findings most accurately describe a client experiencing uncomplicated grief? 1 A caregiver at the bedside of a client who is terminally ill in hospice care 2 A young male complaining of insomnia after losing his mother 2 weeks ago 3 A young female who has thoughts of harming herself after losing her father 3 months ago 4 A fan mourning the death of a country music singer who passed away suddenly in a car accident

4

nurse is facilitating a community bereavement group. The nurse discerns that a client is feeling a large amount of guilt after the death of his father. What is an empathic response by the nurse? 1 "This must be very painful for you." 2 "Would you like to see a psychiatrist?" 3 "Let me get you some printed materials about guilt." 4 "Are you feeling guilty? What are your thoughts about this?"

mourning

outward expressions of grief, including cultural practices and rituals marking the anniversary of a death

4

ropriate for the nurse to ask a client using the FICA tool? 1 "Do you have an advance directive?" 2 "Are you having any thoughts of hurting yourself?" 3 "Have you experienced a significant loss in the past?" 4 "Do you have spiritual beliefs that help you cope with stress?"

bereavement

state of sorrow over the death or departure of a loved one

2

that she is experiencing guilt? 1 "How could he do this to me and leave me here all alone?" 2 "I should have known the signs and taken him to a doctor sooner." 3 "The doctor didn't do everything he could. He should still be here with me!" 4 "I just can't stop thinking about my husband. Everything I see reminds me of him."

denial

the common first response to death is

Acute Grief

the result of unexpected death of a family member and can result in an exacerbation of any pre-existing medical or psychiatric problems