Fundamentals Ch. 36 Grief and Loss

Which action would the nurse take to decrease nausea for a terminally ill patient? 1 Provide cool air in the patient's room. 2 Encourage massage therapy for the patient. 3 Encourage the patient to lie on the right side. 4 Provide background music of patient's choice.

3 The patient is encouraged to lie on the right side when nausea is present. The nurse would provide cool air in the room if the patient is suspected to have an ineffective breathing pattern, not for nausea. The nurse would use massage therapy and background music of the patient's choice for pain, not for nausea.

Which theory includes denial and acceptance? 1 Stages of dying 2 Attachment theory 3 Rando's "R" process model 4 Grief tasks model

1 Stages of dying by Kübler-Ross explains denial, anger, bargaining, depression, and acceptance. Attachment theory by Bowlby explains numbing, yearning, and searching; it does not include denial and acceptance. Rando's "R" process model includes recognize, react, recollect and re-experience, relinquish, readjust, and reinvest; it does not include denial and acceptance. The grief tasks model by Worden accepts the reality of the loss, experiences the pain of grief, adjusts to a world in which the deceased is missing, and emotionally relocates the deceased and moves on with life; it does not include denial and acceptance.

Which action would the nurse take for a patient who is experiencing the second stage of Kübler-Ross's stages of dying to reduce these symptoms in the patient? 1 Be supportive by asking if the patient wants to talk. 2 Enhance the self-esteem of the patient. 3 Provide health education to the patient. 4 Teach proper decision-making to the patient.

1 The nurse would be supportive by asking if the patient wants to talk because anger is the second stage of Kübler-Ross's stages of dying. The patient may exhibit intense feelings of anger at God, other people, or at the situation. The nurse would remain supportive by letting patients and family members know that feelings such as anger are normal and by saying, "I see that you're upset right now, and that's understandable. I just want you to know I'm here to talk with you if you want." Enhancing the patient's self-esteem will reduce the hopelessness of the patient but will not reduce anger. Providing health education will improve the patient's health condition. However, it does not help reduce anger. Teaching proper decision-making will reduce feelings of powerlessness in the patient but will not reduce anger.

If the family of a dying patient is highly emotional and critical of the nursing care, which action by the nurse would be appropriate? 1 Listen to concerns. 2 Explain interventions in technical terms. 3 Request that the nursing supervisor talk to the family. 4 Avoid the patient's family to reduce confrontations.

1 The nurse would listen to concerns. When a patient approaches the end of life, family members also suffer. The family of a dying patient often responds emotionally. Explaining interventions in highly technical terms may increase the family's sense of stress as they try to understand the process; this action would be inappropriate. Asking for a nursing supervisor is inappropriate; the nurse is responsible for therapeutic communication with patients and families. Avoidance of the family is inappropriate and may actually increase the family's criticalness.

Regarding grief in older adults, which understanding helps guide the nurse's relationship with an elderly patient? 1 Older adults have usually sustained many losses in life, which influence the current loss. 2 The changes in memory from aging allow older adults to experience grief less intensely. 3 Older adults generally handle loss better because they have more experience with it. 4 Social support is less important because an older adult's circle of friends has become smaller.

1 The nurse would remember older adults have usually sustained many losses in life, which influence the current loss. For people at any age, each loss influences the way one responds to subsequent losses. There is little evidence grief experiences differ because of age alone; therefore it is inappropriate to think that older adults experience grief less intensely. Sometimes many losses overpower an older person's coping resources instead of making the person stronger. The loss of a social network makes it more (not less) important to find resources and sources of social support for grieving older adults.

Which action would the nurse take immediately after the death of a patient with family members present? 1 Raise the side rails of the bed. 2 Place a chair close to the bed. 3 Cover the hands of the patient. 4 Remove the family from the bedside.

2 Immediately after death, the nurse would place a chair close to the bed to make the patient accessible to the family. The nurse would lower the side rails of the bed, not raise them. The nurse would expose the hands of the patient, not cover them. The nurse would encourage the family to continue to be with the patient, not remove them from the bedside.

Which type of grief describes a patient who lost a sibling in a motor vehicle accident and 2 weeks later loses a job, but the patient seems more upset about the job loss? 1 Delayed 2 Masked 3 Exaggerated 4 Disenfranchised

1 The patient is experiencing delayed grief. In delayed grief a person's grief response is unusually delayed or postponed because the loss is so overwhelming that the person must avoid the full realization of the loss. A delayed grief response is frequently triggered by a second loss, sometimes seemingly not as significant as the first loss—for example the patient lost a sibling but the full realization of the loss comes after the loss of a job. Masked grief is the grieving response wherein a person's normal functioning is disrupted, but the person does not realize that the disruption in functioning is because of the loss; this is not the case in this situation. In exaggerated grief, the person often exhibits self-destructive behavior or obsessions; this is not the case in this situation. Disenfranchised grief is a loss that is not socially sanctioned, cannot be openly shared, or seems to be of lesser significance to others; loss of a sibling and job are socially sanctioned and significant, making this situation unrelated to disenfranchised grief.

Which type of loss is illustrated when a young adult loses a limb from diabetes and is very upset about it? 1 Actual 2 Perceived 3 Necessary 4 Maturational

1 The young adult has suffered an actual loss because the patient can no longer feel, see, or know the lost limb. A perceived loss is experienced by the person alone and is less obvious to other people; losing a limb is obvious, not less obvious, to others. Necessary losses are natural and positive; they occur because of normal life changes. Losing a limb is not natural. A maturational loss is a form of loss after expected, normal life changes across the life span; losing a limb is not an expected, normal life change.

Which nursing intervention would be helpful to a terminal patient experiencing hopelessness from chronic pain? Select all that apply. One, some, or all responses may be correct. 1 Treating the chronic pain 2 Setting appropriate goals 3 Identifying sources of social support 4 Motivating the patient to get a job 5 Allowing extended times for privacy

1, 2, 3 Nursing interventions include treating the chronic pain, setting appropriate goals, and identifying sources of social support. Treating the pain helps the patient gain hope. Setting up appropriate goals helps prioritize the problems, so matters of lesser importance will not receive much attention. Social support can help with hopelessness. Motivating the patient to get a job is not appropriate because of the patient's diagnosis, which is terminal. The nurse needs to provide frequent conversations with the patient, not allow extended times for privacy so that the patient does not feel even more hopeless and isolated.

Which statement made by a patient would exemplify normal grief and loss because of midlife developmental changes? Select all that apply. One, some, or all responses may be correct. 1 "I got remarried recently." 2 "I am the head of my family now." 3 "I am my aging father's caregiver." 4 "I was 7 years old when my parents got a divorce." 5 "I have been living far away from my hometown for 8 years."

1, 2, 3 Statements include "I got remarried recently," "I am the head of my family now," and "I am my aging father's caregiver." Major life transitions such as changes in marital status, adapting to new family roles, and caring for aging parents occur for midlife adults. These are necessary losses that can trigger a normal grief response in adults. School-age children may experience necessary loss and feel grief at loss of a loved one during the divorce of their parents. Living away from home is a developmental necessary loss common for young adults, not midlife developmental changes.

Which stage of dying is included in the theory by Kübler-Ross? Select all that apply. One, some, or all responses may be correct. 1 Denial 2 Depression 3 Anticipation 4 Acceptance 5 Preparation

1, 2, 4 The stages include denial, depression, and acceptance. The five stages of dying as defined by Kübler-Ross are denial, anger, bargaining, depression, and acceptance. Anticipation and preparation are not part of the stages of dying, so these would not be relevant.

Which finding in the patient would indicate grief? Select all that apply. One, some, or all responses may be correct. 1 Lack of energy 2 Loss of interest 3 Desire to move around 4 Increased communication 5 Insomnia

1, 2, 5 Grief reactions include a lack of energy, loss of interest, and insomnia. Grief leads to fatigue and lack of energy causing a lack of movement, not a desire to move around. Grief leads to distancing from people, leading to decreased communication, not increased.

Which nursing intervention would the nurse include in the care plan for a terminally ill patient? Select all that apply. One, some, or all responses may be correct. 1 Maintain comfort. 2 Discuss options for euthanasia. 3 Preserve dignity and quality of life. 4 Provide social support to family members. 5 Offer economic support to family members.

1, 3, 4 The nursing care plan should focus on maintaining comfort, preserving dignity and quality of life, and providing social support to family members. Terminally ill patients should be allowed to spend the rest of their days in as much comfort and peace as is possible given the patient's condition. The plan should also include providing social support to family members to prepare to grieve their loss. Euthanasia is a controversial issue, and nurses do not take part in that decision. The nurse would not provide economic support to family members.Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses. For this question, the choice about euthanasia would be excluded as a possible answer.

Which physical change in the patient suggests that death is near? Select all that apply. One, some, or all responses may be correct. 1 Noisy respirations 2 Increased urine output 3 Decreased muscle tone 4 Decreased intake of food 5 Decreased periods of sleeping

1, 3, 4 The physical changes include noisy respirations, decreased muscle tone, and decreased intake of food. As a patient nears death, body systems tend to slow down. Noisy respirations are caused by pooling of secretions in the airway. Muscle tone is reduced as the muscles become flaccid. Food intake is usually reduced because of the failure of the gastrointestinal system to function properly. Urine output is decreased (not increased) because fluid intake is reduced and the urinary system stops working. A dying patient has increased (not decreased) periods of sleeping. The patient tends to sleep most of the time because the brain and nervous system slow down their functions.Test-Taking Tip: The key to the correct response is knowing that the body systems slow down as the patient approaches death. When evaluating questions like this one, ask yourself whether each choice is an increase in function or a decrease in function for that particular system. Both incorrect choices reflect an increase in function: one for the urinary system, and the other for the nervous system. The correct choices reflect decreased function, consistent with the patient being near death.

Which nursing action to facilitate mourning would be performed for the family after the patient died? Select all that apply. One, some, or all responses may be correct. 1 Supporting the family's efforts to adjust to the loss 2 Keeping the family busy, not allowing too much time to dwell on grief 3 Offering the family wine to help them relax and overcome grief 4 Helping the family accept the reality of the loss 5 Instructing the family to resume normal life as soon as possible

1, 4 Nursing actions include supporting the family's efforts to adjust to the loss and helping the family accept the reality of the loss. The nurse would provide support to the family to help them adjust to their loss and to accept the reality of the loss. The family should be allowed to grieve because it helps them come to terms with the loss; thus the nurse would not keep the family busy. Use of wine to get over the crisis is an ineffective way of coping and should be discouraged. The nurse would not try to hurry the family but should allow time for grieving and continuity of care; therefore the nurse would not instruct the family to resume normal life as soon as possible.

Which physical change is observed in a patient who is in the last hours of life? Select all that apply. One, some, or all responses may be correct. 1 Sagging mouth 2 Light-colored urine 3 Absence of mottling 4 Relaxed jaw muscles 5 Increased pulmonary secretions

1, 4, 5 Physical changes observed in a patient who is in the last hours of life include a sagging mouth, relaxed jaw muscles, and increased pulmonary secretions. The patient will have dark-colored urine, not light-colored urine. The patient will have mottling, not an absence of mottling.

Which statement made by a patient would exemplify the normal grief process? Select all that apply. One, some, or all responses may be correct. 1 "I can't believe I have colon cancer." 2 "I often forget my residential address." 3 "I witnessed the death of my married lover recently." 4 "I have lost interest in doing my regular work since I lost my beloved pet." 5 "I feel lonely since the death of my spouse, even though I have many friends."

1, 4, 5 Statements include "I can't believe I have colon cancer," "I have lost interest in doing my regular work since I lost my beloved pet," and "I feel lonely since the death of my spouse, even though I have many friends." In normal grief the patient may have feelings such as disbelief, yearning, anger, and depression. The patient may feel disbelief after a cancer diagnosis. The patient may also feel lonely, helpless, and lose interest in usual work because of depression. Therefore losing interest in work after the loss of a beloved pet and feeling lonely after the death of a spouse are signs of normal grief. Forgetting the residential address may indicate dementia and lead to anticipatory grief, not normal grief, and forgetting residential address is not a sign of normal grief. A patient who witnesses the death of a married lover may experience disenfranchised grief, not normal grief.

Which assessment activity is appropriate when planning care for a patient with breast cancer who is sad and disappointed? Select all that apply. One, some, or all responses may be correct. 1 Observe nonverbal behavior. 2 Observe the relatives' manners. 3 Assess economic background. 4 Assess response to care options. 5 Observe interactions with others.

1, 4, 5 The nurse would observe nonverbal behavior, assess responses to care options, and observe interactions with others. Nonverbal behavior such as sad expressions and closed eyes may indicate grief. Observing the patient's responses to care options can give the nurse an idea about feelings and perspectives. Interactions with others may reveal a lack of interest and unwillingness to meet others or could indicate the strength of the patient's support system. Observing the relatives' manners will not contribute in planning care for the patient; the assessment is on the patient. Assessment of the economic background is not relevant for assessment of feelings.

Which intervention would the nurse implement in caring for the family of a patient who has just died? Select all that apply. One, some, or all responses may be correct. 1 Offer family members the option to view the body. 2 Tell the family that the nurse knows how they feel. 3 Give the family advice on how to grieve. 4 Explain that their loved one is in a "better place." 5 Use periods of silence during the conversation.

1, 5 Interventions include offering family members the option to view the body and using periods of silence during the conversation. The nurse would offer family members the option to view the body and respect their decision to do so. The nurse would use periods of silence or quiet during the conversation to help the family members express their emotions. The nurse does not have to talk but can emotionally support the family simply by being present. The nurse would not tell the family that the nurse knows how they feel; that is untrue and belittling to the family. Giving the family advice on how to grieve is inappropriate; all must grieve in their own way. Explaining that their loved one is in a "better place" is inappropriate because it focuses on the nurse's belief, not the family's; instead use therapeutic techniques of listening and support.

A parent of an adolescent tells the nurse, "Shortly after we moved to a new neighborhood, my son lost interest in school and friends." Which type of loss does the nurse suspect? 1 Actual 2 Perceived 3 Situational 4 Maturational

2 A perceived loss is often experienced internally and is not always obvious. It can be a loss of confidence or change in a social group, such as when the son moved to a new place. An actual loss occurs when a person who has died can no longer be seen or heard. A situational loss occurs with a sudden, external event such as an accident. A maturational loss is a normal life change loss.

Which person is experiencing anticipatory grief? 1 Person whose former spouse is dead. 2 Person who is caring for a family member with severe dementia. 3 Person who has a conflicted relationship with the deceased. 4 Person whose husband's body is not found after a terrorist attack.

2 A person who is caring for a family member with severe dementia experiences anticipatory grief. In this grief people predict loss and begin to prepare for it. A person whose former spouse is dead experiences disenfranchised grief, not anticipatory grief. A person who has a conflicted relationship with the deceased experiences complicated grief, not anticipatory grief. A person whose husband's body is not found after a terrorist attack may experience disenfranchised or complicated grief, but not anticipatory grief.

Which information is true about chronic grief? 1 Suicide is a high risk. 2 It may last for years or decades. 3 Obsessions are common. 4 Unaware that disruptive behavior occurs frequently.

2 Chronic grief may last for years or decades. Patients who experience exaggerated (not chronic) grief have a risk of suicide. A person experiencing exaggerated (not chronic) grief may exhibit obsessions. A person with masked (not chronic) grief is unaware that the disruptive behavior is because of loss.

Which type of complicated grief response is observed in a patient who is unaware that the disruptive behavior is a result of a loss? 1 Chronic 2 Masked 3 Delayed 4 Exaggerated

2 In masked grief, the patient is unaware that the disruptive behavior is a result of a loss. In chronic grief, the patient may experience a normal grief response that lasts for an extended period of time; however disruptive behavior does not occur. A person's grief response may be delayed because the loss is so overwhelming that the person must avoid the full realization of the loss; it does not cause disruptive behavior. In exaggerated grief, the person may exhibit self-destructive or maladaptive behavior, obsessions, or psychiatric disorders, and the patient is aware of these behaviors. In this situation, the patient is unaware.Test-Taking Tip: Identifying content and what is being asked about that content is critical to you choosing the correct response. Be alert for words in the question that are the same or similar in nature to those in one or two of the answer choices.

In which stage of mourning described by Bowlby's attachment theory does a person accept change, acquire new skills, and build new relationships? 1 Numbing 2 Reorganization 3 Yearning and searching 4 Disorganization and despair

2 In the reorganization stage of mourning, the person accepts change, acquires new skills, and builds new relationships. In this stage the person is trying to create separation from a lost relationship. In the numbing stage, the person feels unreal; the person does not accept change, acquire new skills, or build new relationships. In the yearning and searching stage, the person experiences acute distress and physical symptoms; the person does not accept change, acquire new skills, or build new relationships. In the disorganization and despair stage, the person extends blame and expresses anger toward anyone who is responsible for the loss; the person does not accept change, acquire new skills, or build new relationships in this stage.

Which symptom would be the nurse's priority for a terminally ill patient? 1 Fatigue 2 Pain 3 Hopelessness 4 Imbalanced nutrition

2 Pain is the priority for a terminally ill patient. A patient's need for pain relief at the end of life takes priority. The nurse would address the pain first. Once the pain is reduced, the patient may feel more energized instead of fatigued, feel more hopeful, and have a better appetite, which will improve nutrition.

Which stage of the Kübler-Ross theory is reflected in the patient's statement, "I will seek a second opinion and have the tests done again at another hospital?" 1 Anger 2 Denial 3 Bargaining 4 Depression

2 Saying "I will seek a second opinion and have the tests done again at another hospital" indicates denial. The Kübler-Ross theory (1969) consists of five stages. When the patient is unable to accept the fact that he or she is dying, it indicates denial. As a result, the patient wants to perform the tests again at another hospital. Anger is the expression of resistance or anger toward God or other people, not seeking a second opinion. Bargaining is characterized by postponing awareness of the loss by trying to prevent it from happening, not by seeking a second opinion. Depression is characterized by the individual realizing the full impact of the loss. The patient is not realizing the full impact; in fact, the patient in this situation is in denial wanting a second opinion as a form of psychological protection.Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response

Which nursing response reflects a helpful understanding of patient self-care at the end of life? 1 "Learning to accept that you can't perform some activities anymore will bring you more acceptance and peace." 2 "What will you do to continue the activities that are most important to you?" 3 "Why not try and let people in your life help you with these things?" 4 "Spending more of your time resting or reading will conserve your energy."

2 The correct response is "What will you do to continue the activities that are most important to you?" This maintains self-care. Even seriously ill people want to carry on with life, doing what they can to maintain their identity and purpose. The response of learning to accept that you cannot perform some activities is inappropriate because the nurse would not encourage patients to scale back on their most valued activities. Saying why not try and let people in your life help you is inappropriate because it uses "why" and it is taking self-care away from the patient. The response of spending more time resting and reading is inappropriate because it does not indicate an understanding of self-care.

Which strategy would the nurse use to assist the patient newly diagnosed with colon cancer who is withdrawn? 1 Obtain a prescription for a psychiatric evaluation. 2 Encourage the patient to identify fears and verbalize feelings. 3 Allow the patient to remain withdrawn to avoid drawing attention to this behavior. 4 Explain to the patient that newer treatments permit many people to survive colon cancer.

2 The nurse encourages the patient to identify fears and verbalize feelings. The nurse recognizes that the patient could be expressing feelings of grief, and allowing the patient to verbalize feelings will help the patient move through the phases of the grief process. The patient does not need a psychiatric evaluation, as this is a normal grief process to the diagnosis of colon cancer; it is not a psychiatric disorder. The patient should not be left alone, because the patient needs support to cope with the illness. Explaining newer treatment options at this time is too early; the patient needs to process the information first.Test-Taking Tip: Look for answers that focus on the patient or are directed toward feelings. Review the choices for this question again and notice that the correct answer focuses on the patient's feelings.

Which condition is the nurse managing when applying topical moisturizer to a dying patient's dry, scaly dermis? 1 Infection 2 Skin irritation 3 Corneal drying 4 Buccal discomfort

2 The nurse is managing skin irritation. Skin irritation leads to skin/dermal dryness and scaling. Topical moisturizers help reduce such irritation. Anti-infective medications (not topical moisturizer) would be beneficial in reducing infections. Artificial tears and optical lubricants (not topical moisturizer) are beneficial for reducing corneal drying. Buccal discomfort occurs in the mouth, not the dermis/skin.

Which action would the nurse take for a dying patient with chronic dull pain who does not have a support person to provide home care? 1 Hospitalize the patient in the intensive care unit. 2 Arrange for inpatient hospice care. 3 Provide acute care to the patient. 4 Seclude the patient in a separate room.

2 The nurse would arrange for inpatient hospice care. The patient is terminally ill and has chronic dull pain. The patient also does not have a support person to provide care in the home. Based on this, the patient needs inpatient hospice care to improve the quality of life during the last days of life. The patient does not need hospitalization in the intensive care unit because the condition cannot be cured. Acute care refers to the short-term treatment for an episode of illness or severe injury. In this situation, the patient has an irreversible terminal illness that cannot be managed by acute care. Seclusion would make the patient depressed and is inappropriate.STUDY TIP: Remember that hospice care is palliative, not curative. It is appropriate when a cure is not possible and the patient's comfort becomes the highest priority.

Which nursing action reflects sensitivity to cultural differences related to end-of-life care? 1 Realize that not showing emotions means the family was not close. 2 Ask family members if they prefer to help with care of the body after death. 3 Provide postmortem care at the time of death to relieve family members of this difficult job. 4 Value patient self-determination, understanding that each person makes his or her own decisions.

2 The nurse would ask family members if they prefer to help with care of the body after death. Giving people options in caregiving after death allows them to honor their cultural beliefs. In some cultures, holding back public displays of emotions is the accepted behavior after death while in others, public display of wailing is acceptable; therefore the nurse cannot assume the family was not close. In some cultures, preparing the body is accepted and desired; thus the nurse would not assume and provide postmortem care. In some cultures, self-determination may not be a given right for every person. Remember that every culture and person is different.

Which action would the nurse take for a dying patient who is breathing loudly? 1 Administer narcotics. 2 Elevate the head of the bed. 3 Apply lip balm to the patient's lips. 4 Position patient on the right side.

2 The nurse would elevate the head of the bed. Noisy breathing may be caused by the movement of secretions in the airway during inspiratory and expiratory phases. Elevating the patient's head facilitates postural drainage and comforts the patient. Administering narcotics is appropriate if the patient has tachypnea, not loud breathing. Applying lip balm to the patient's lips is for mucous membrane discomfort, not for loud breathing. Positioning the patient on the right side helps treat nausea, not loud breathing.

Which type of grief is exemplified when a father refuses to accept the death of a child and no longer has a job, avoids communication with others, and remains aloof? 1 Normal 2 Complicated 3 Anticipatory 4 Disenfranchised

2 The patient is experiencing complicated grief. In complicated grief, a person has a difficult time moving forward after a loss. The patient experiences a chronic and disruptive yearning for the deceased; has trouble accepting the death and trusting others; and/or feels excessively bitter, emotionally numb, or anxious about the future. In normal grief, the person shows a common reaction characterized by complex emotional, cognitive, social, and spiritual responses to loss and death; however, in this case the father did not move on. In anticipatory grief, the grief extends over a long period of time beginning before the actual loss occurs; the person absorbs loss gradually and prepares for its inevitability. In this situation the grief occurred after the loss, not before. Disenfranchised grief occurs when the relationship of the person with the deceased is not socially sanctioned, cannot be openly shared, or seems to be of lesser significance; the bond of a father and child is a socially sanctioned and accepted type of relationship.

Which action is the priority in providing postmortem care? 1 Dressing the patient in the patient's own clothing 2 Providing culturally and religiously sensitive care in body preparation 3 Transporting the body to the morgue as soon as possible to prevent body decomposition 4 Performing postmortem care to protect the family of the deceased from having to see the body

2 The priority is providing culturally religiously sensitive care in body preparation. At the end of life, religious and cultural expectations are important for respecting and providing dignity to the deceased and for the lasting memories held by the family about the way their loved one's death occurred. Sensitive care contributes to feelings of closure, appropriateness of the death rituals, and fulfilled family obligations. Dressing the patient in the patient's own clothing is not the priority. The patient's wishes or family's wishes would be honored for clothing. A body should be placed in the morgue soon after death, but it is more important to provide sensitive and dignified care to the deceased. Performing postmortem care to protect the family is not the priority; in fact, some families may want to participate in the preparation of the body.

Which theoretical description of grief is exemplified when a female family member of a recently deceased patient talks casually with the nurse at the time of the patient's death and expresses relief that she will not have to visit the hospital anymore? 1 Denial 2 Anticipatory grief 3 Dysfunctional grief 4 Yearning and searching

2 The theoretical description is anticipatory grief. A person who has been anticipating a loss (anticipatory grief) for some time may have already experienced many of the emotions (e.g., sadness, shock) commonly associated with death. Denial is a stage of dying that a patient would experience; the female family member was not dying. Everyone experiences and expresses grief differently; therefore dysfunctional grief is inappropriate in this situation. Yearning and searching are aspects of Bowlby's attachment theory and does not explain this woman's actions.STUDY TIP: Were you surprised by the family member's casual discussion in the question? Consider that a family member who has anticipatory grief may already have progressed through the stages of grief. Remember that various family members can be at different stages of grieving at the time of death of a loved one. Now imagine what the family member would say if he or she were exhibiting denial, dysfunctional grief, or yearning and searching. If any of these terms are unclear to you, return to the text for review.

Which type of loss occurs when a person loses confidence because of rejection by a friend? 1 Actual 2 Perceived 3 Situational 4 Maturational

2 This is a perceived loss. Perceived loss is defined as a person experiencing loss that is less obvious to other people. A person who lost confidence because of rejection by a friend may experience perceived loss. Actual loss occurs when a person can no longer see, feel, or hear a person or object. It occurs when there is a loss of body part or job, not a loss of confidence because of rejection. A person who meets unexpected external events such as sustaining an injury with physical changes in an automobile accident experiences situational loss; situational loss is not when a person loses confidence because of rejection. Maturational loss is a form of necessary loss that includes all expected normal life changes across the life span; rejection from a friend is not considered a normal life change.

Which nursing action would be beneficial for a terminally ill patient with diarrhea? 1 Inserting a Foley catheter 2 Providing a bedside commode 3 Ambulating the patient regularly 4 Administering promotility agents

2 providing a bedside commode

When educating the family members about hospice care, which information would the nurse include? Select all that apply. One, some, or all responses may be correct. 1 The hospice care ends with the death of the patient. 2 It is a patient- and family-centered approach to care. 3 The hospice team promotes patient dignity and self-esteem. 4 It is a place to take care of terminally ill patients. 5 The hospice team gives preference to the patient's wishes.

2, 3, 5, The nurse would share the following information: It is a patient- and family-centered approach to care; the hospice team promotes patient dignity and self-esteem; and the hospice team gives preference to the patient's wishes. Hospice provides therapeutic care, psychosocial care, and symptom management. It also promotes patients' dignity and self-esteem. In situations involving differences of opinion between the patient and the family members, the hospice team favors the patient's wishes. Hospice care does not end with the death of the patient; hospice may make frequent visits after the death of the patient to help the family in the grieving process. Hospice is not a place, but a philosophy of care for the terminally ill.

Which intervention would the nurse include in the nursing care plan to relieve nausea in a terminally ill patient? Select all that apply. One, some, or all responses may be correct. 1 Avoid ice chips. 2 Administer antiemetic agents if prescribed. 3 Offer liquids that increase stomach acidity. 4 Provide oral care at least every 2 to 4 hours. 5 Discontinue foods that cause nausea.

2, 4, 5 Interventions include administering antiemetic agents if prescribed, providing oral care at least every 2 to 4 hours, and discontinuing foods that cause nausea. Nausea in a terminally ill patient may be caused by pain, medication, or decreased blood flow to the gastrointestinal (GI) tract because of impending death. Antiemetic agents may help prevent nausea. Oral care helps keep the mouth moist, may help relieve nausea, and should be provided every 2 to 4 hours. Foods that may cause nausea should be avoided. Providing these types of foods would increase the patient's discomfort by aggravating nausea. The nurse would offer (not avoid) the patient ice chips or a moist cloth to the lips to keep the mouth moist. Liquids that increase stomach acidity should be avoided because they can worsen the nausea.

Which type of death may cause disenfranchised grief in patients? Select all that apply. One, some, or all responses may be correct. 1 A sibling 2 A prison inmate 3 A parent 4 An ex-spouse 5 A married lover

2, 4, 5 The death of a prison inmate, an ex-spouse, or a married lover can cause disenfranchised grief because of the perception that these relationships are less significant or are socially unacceptable compared to relationships with siblings and parents, which are socially sanctioned.

Which type of grief is exemplified when the survivor of a motor vehicle accident attempts suicide because of feeling responsible for the friend's death? 1 Delayed 2 Masked 3 Exaggerated 4 Ambiguous The patient is experiencing exaggerated grief. The person with exaggerated grief is at a high risk of suicide. In certain situations, a loss is so overwhelming that the person takes time to realize and react to it, which is referred to as delayed grief. In this situation the response was not delayed. In masked grief, the person shows disruptive behavior but is unaware that the disruptive behavior is a result of the loss; that did not occur in this situation. Ambiguous loss occurs when the person who is lost is physically present but not psychologically available, as in severe dementia or brain injury; in this situation the survivor physically lost a friend.

3

Which patient statement would support the nurse's conclusion that a terminal patient is in the bargaining stage according to the Kübler-Ross theory? 1 "I will accept whatever comes to me." 2 "I don't know why God did this to me." 3 "I will go to church every day if I can be cured." 4 "I don't know whether these test reports are mine."

3 A patient statement that indicates the bargaining stage is "I will go to church every day if I can be cured." The Kübler-Ross theory includes five stages of dying. The bargaining stage is characterized by postponing awareness of the loss by trying to prevent it from happening. When the patient accepts whatever comes, it indicates the acceptance stage, not bargaining. When the patient questions or blames God, it indicates anger, not bargaining. When the patient denies the results of test reports, it indicates denial, not bargaining.

Which action would the nurse take when caring for a patient who is nearing death? 1 Tell the patient, "You'll be going home soon." 2 Encourage the patient to interact with family members. 3 Hold the patient's hand and state, "You're not alone." 4 Discuss what to expect with the family members at the bedside.

3 Holding the hand of a dying patient and stating "You're not alone" communicates concern and caring even if the patient is unable to respond and is the action to take. Telling a dying patient "You'll be going home soon" is inappropriate; home may mean something totally different to the patient as compared to the nurse. Encouraging the patient to interact with family members is inappropriate at this time; the nurse needs to encourage the family to continue to talk to the patient, not vice versa. Discussing the process with family members does not focus on the patient, and the patient can still hear even though he or she may be unable to respond, which could increase anxiety.Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.

In which stage of dying does a patient realize the full impact of the loss? 1 Anger 2 Denial 3 Depression 4 Bargaining

3 In the depression stage, the patient realizes the full impact of the loss. At this stage, the patient feels hopeless and lonely. In the anger stage, the patient expresses resistance and intense anger at God, other people, or the situation itself, and does not experience the full impact of the loss. In the denial stage, the patient is psychologically not ready to accept the loss; thus the patient is not ready to realize the full impact of the loss when in denial. In the bargaining stage, the patient postpones awareness of the loss by preventing it from happening; realizing the full impact of the loss does not occur in bargaining.

Which approach to helping grieving people is most consistent with high-quality care? 1 Helping the patient identify tasks to be accomplished during grief 2 Encouraging people to recognize stages of grieving in anticipation of what is to come 3 Listening carefully to a person's story of how the grief experience is unfolding 4 Offering general grief timelines to help the person know when a phase will pass

3 Listening carefully to a person's story of how the grief experience is unfolding is most consistent with high-quality care. Although helping the patient identify tasks, encouraging people to recognize stages, and offering general grief timelines are helpful, the nurse needs to focus on the patient's journey, not theories nor the nurse's directing.Test-Taking Tip: Because grieving is different for each person, your responses to questions about grieving need to allow for individual variation. The incorrect choices for this question involve the nurse's attempt at directing grief. Instead, the nurse needs to support grieving individuals in their experiences.

Which question would the nurse ask to evaluate outcomes for a critically ill patient? 1 "Are family members available when you need them?" 2 "Are you comfortable talking about your grief?" 3 "Do you have a specific request that I have not met?" 4 "Do you have a particular religious preference?"

3 The nurse would ask, "Do you have a specific request that I have not met?" While evaluating patient outcomes, the nurse would ask the patient a few questions to validate achievement of goals and expectations. Asking the patient about specific requests helps validate the achievement of goals and expectations. Asking about family member availability is an assessment question, not an evaluation question. Asking the patient about his or her comfort level talking about grief is an assessment question and would not help the nurse validate the patient outcomes. Asking the patient about religious preferences is an assessment question, not an evaluation question.

Which type of loss is exemplified when a patient sustains severe injuries leading to loss of function from a motor vehicle accident? 1 Actual 2 Perceived 3 Situational 4 Maturational

3 The patient is experiencing situational loss because of a sudden and unpredictable external event such as an accident. An actual loss is a loss in which a person can no longer feel, hear, see, or know a person or object; actual loss involves death of a loved one or loss of a body part, not severe injuries leading to loss of function. Perceived loss is a loss in which a person is experiencing a loss, but the loss is less obvious to other people; sustained severe injuries are not less obvious to other people, making perceived loss incorrect. Maturational loss is a form of necessary loss that includes all normally expected life changes across the life span; a motor vehicle accident is not a normal expected life change.

Which statement indicates a patient is experiencing the anger stage of the Kübler-Ross theory of dying? 1 "I knew this would happen to me some day." 2 "I believe someday or another we all have to die." 3 "I know this was the doctor's fault for not finding this earlier." 4 "I want to die with my family members around me at home."

3 The statement, "I know this was the doctor's fault for not finding this earlier" indicates anger. The anger stage is characterized by expressing anger or resistance at God, the situation, or others. When the patient thinks sickness is inevitable (i.e., "I knew this would happen to me"), it indicates depression, not anger. When the patient admits that someday we all have to die, it indicates acceptance, not anger. When the patient accepts the loss and wants to die with family members around him or her at home, it indicates acceptance, not anger.

Which stage of the attachment theory of grief and mourning is characterized by emotional outbursts of tearful sobbing? 1 Numbing 2 Reorganization 3 Yearning and searching 4 Disorganization and despair

3 The yearning and searching stage of the attachment theory is characterized by emotional outbursts of tearful sobbing. Numbing involves protecting the person from the full impact of the loss, but it does not involve emotional outbursts of tearful sobbing. Reorganization involves accepting the change and assuming unfamiliar roles, but it does not involve emotional outbursts of tearful sobbing. Disorganization and despair are characterized by endless examinations of how and why the loss occurred, but they do not involve emotional outbursts of tearful sobbing.

Which patient's condition can be categorized as delayed grief? 1 Exhibiting psychosis because of grief 2 Having depression because of death of a child 3 Trying to avoid the full realization of the loss 4 Being unaware that grief is causing disruptive behavior

3 Trying to avoid the full realization of the loss is delayed grief. In delayed grief, the person may postpone the grief response because the loss is so overwhelming the person must avoid the full realization of the loss. A patient who is exhibiting psychosis may be experiencing exaggerated grief, not delayed grief. A patient who is depressed because of the death of a child may be experiencing normal grief, not delayed grief. A patient who is unaware of behaving disruptively as a result of grief may be experiencing masked grief, not delayed grief.

Which nursing intervention is appropriate for a dying patient who has fatigue? 1 Increase fiber in the patient's diet. 2 Encourage the patient to eat small, frequent meals of preferred foods. 3 Educate the patient about energy conservation. 4 Provide an opportunity for the patient to express feelings through active listening.

3 When caring for a dying patient who has fatigue, the nurse would educate the patient about energy conservation. The nurse would increase fiber in the diet of a terminally ill patient who has constipation, not for one who is fatigued. The nurse would encourage the patient to eat small, frequent meals of preferred foods if the patient is experiencing altered nutrition, but not for fatigue. The nurse would provide an opportunity for the patient to express feelings through active listening to address any feelings of anxiety or depression, but not for fatigue.

Which behavioral symptom observed by the nurse indicates normal grief? 1 Hopelessness 2 Muscle weakness 3 Distancing from people 4 Sense of depersonalization

3 Distancing from people is a behavioral symptom observed in a patient with normal grief. Hopelessness is a feeling (not a behavioral symptom) observed in a patient with normal grief. Muscle weakness is a physical symptom (not a behavioral symptom) observed in a patient with normal grief. A sense of depersonalization is a physical sensation (not a behavioral symptom) observed in a patient with normal grief. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.

Which activity would the nurse identify as an aspect of Worden's grief tasks model? Select all that apply. One, some, or all responses may be correct. 1 Block the pain of grief 2 Deny the reality of the loss 3 Experience the pain of grief 4 Adjust to a world in which the deceased is missing 5 Emotionally relocate the deceased and move on with life

3, 4, 5 Activities include experiencing the pain of grief, adjusting to a world in which the deceased is missing, and emotionally relocating the deceased and moving on with life. Once a person accepts the reality of loss, the person may experience the pain of grief. Grief is manifested by loneliness, sadness, or despair. This stage is followed by adjustments to a world in which the deceased is missing. The final stage is to emotionally relocate the deceased and move on with life. Blocking the pain and denying the loss do not help one move on, and they are not activities of the grief tasks model.

Which stage is included in Bowlby's attachment theory? Select all that apply. One, some, or all responses may be correct. 1 Depression 2 Bargaining 3 Reorganization 4 Yearning and searching 5 Disorganization and despair

3, 4, 5 Stages include reorganization, yearning and searching, and disorganization and despair. There are four stages of mourning: numbing, yearning and searching, disorganization and despair, and reorganization. In the reorganization stage, the last stage of mourning, a person accepts the loss and starts living with it. Yearning and searching are in the second stage of bereavement in which a person is in acute distress. This stage is characterized by emotional outbursts such as crying. In the stage of disorganization and despair, a person endlessly tries to find out how and why the loss occurred. Depression and bargaining are stages of dying in Kübler-Ross's classic theory, not Bowlby's.

Which patient is likely to experience anticipatory grief? 1 A man diagnosed with gallstones 2 A teenager who fractured the left leg 3 An older adult diagnosed with a stage 1 pressure injury 4 A middle-age adult diagnosed with amyotrophic lateral sclerosis (ALS)

4 A middle-age adult diagnosed with ALS is likely to experience anticipatory grief, because there is no cure for this disease. In situations of prolonged or predicted loss, such as in ALS, anticipatory grief is common. Gallstones can be cured and does not require anticipatory grieving. A leg fracture can be treated completely and does not require anticipatory grief. Stage I pressure injury can be cured with appropriate treatment; therefore anticipatory grief is unnecessary.

According to attachment theory, which action represents disorganization and despair? 1 Feeling lethargic and loss of appetite 2 Emotional outbursts of tearful sobbing 3 Separating oneself from the lost relationship 4 Endless examination of how and why the loss has occurred

4 According to attachment theory, endless examination of how and why the loss has occurred represents disorganization and despair. Feeling lethargic, loss of appetite, and emotional outbursts of tearful sobbing represent yearning and searching, not disorganization and despair. In the stage of reorganization (not disorganization and despair), the person separates him- or herself from the lost relationship.Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items with four options. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining.

Which loss occurs when the lost person is physically present but not psychologically available? 1 Actual 2 Maturational 3 Necessary 4 Ambiguous

4 Ambiguous loss is a type of disenfranchised grief that occurs when the person is physically present but not psychologically available. Actual loss occurs when a person no longer can see, feel, or hear a person or object; in this situation the patient is still physically present, making it unrelated to actual loss. Maturational loss is related to normal, expected changes that occur during the life span; a person physically present but unavailable psychologically is not a normal life change. A necessary loss is positive and expected; being unavailable psychologically is not positive.

Which type of complicated grief is exhibited by a person with maladaptive behaviors and obsessions? 1 Chronic 2 Masked 3 Delayed 4 Exaggerated

4 Exaggerated grief is a type of complicated grief that involves maladaptive behaviors and obsessions in the patient. Chronic grief is a normal grief response, which lasts a long time, sometimes even decades. It can be characterized by intense grieving, but it does not include maladaptive behaviors and obsessions. Masked grief interferes with normal functioning, but it does not involve maladaptive behaviors and obsessions. Delayed grief is a delayed response to grief and does not involve maladaptive behaviors and obsessions.

Which observations made by the nurse when evaluating the terminally ill patient's outcomes indicate the use of experience as a critical thinking skill? 1 Clinical symptoms of an improved level of comfort 2 Perseverance in seeking successful comfort measures 3 Characteristics of the resolution of grief in the patient 4 Previous responses to planned nursing interventions for symptom management

4 Experience is the critical thinking skill a nurse will use to evaluate the previous responses to planned nursing interventions for symptom management. A clinical symptom of an improved level of comfort is evaluated by using the critical thinking skill of knowledge, not experience. Perseverance in seeking successful comfort measures is evaluated using attitudes (not experience) as a critical thinking skill. Characteristics of the resolution of grief in the patient are evaluated by using knowledge (not experience) as a critical thinking skill.

Which type of grief is exemplified when a patient states, "I have been depressed since the death of my ex-husband?" 1 Normal 2 Anticipatory 3 Complicated 4 Disenfranchised

4 In disenfranchised grief, the patient may be depressed because of the death of an ex-spouse or extramarital partner. Normal grief is a common and universal reaction, and the patient may have feelings such as disbelief, yearning, anger, and depression; but being depressed after the death of an ex-husband is not a type of normal grief. The patient may experience anticipatory grief before the actual loss or death occurs; in this situation an actual loss has occurred so is not anticipatory. In complicated grief, a person has a prolonged or significantly difficult time moving forward after a loss; this situation is grief after the loss of an ex-husband, indicating disenfranchised grief. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items with four options. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining.

Which statement about hospice care needs correction? 1 It is available in homes. 2 It provides care for terminally ill patients. 3 It gives priority to managing a patient's pain and other symptoms. 4 It accepts the patient into the program when the survival period is 10 months.

4 It accepts the patient into the program when the survival period is 10 months needs correction. Hospice services accept the patient into the program when the survival period is less than 6 months, not 10 months. The rest of the statements do not need correction because they give correct information. Hospice is available in home, hospital, extended care, and nursing home settings. This model of care provides care for terminally ill patients. It gives priority to managing a patient's pain and other symptoms.

Which condition in the patient would the nurse assess for to determine the cause of noisy breathing in a terminally ill patient? 1 Anemia 2 Increased oxygen demand 3 Antiemetic medications 4 Thick secretions in the airway

4 Noisy breathing, also known as a death rattle, is caused by thick secretions in the airway. Decreased muscle tone, swallowing, and coughing are also causes of noisy breathing in a terminally ill patient. Noisy breathing refers to the sound of secretions moving in the airway during inspiratory and expiratory phases. It indicates the last stage of life. It does not occur because of an anemia, increased oxygen demand, or antiemetic medications. Anemic conditions and increased oxygen demand cause dyspnea or shortness of breath. Antiemetics are used for nausea and vomiting; they are not the cause of noisy breathing.

Which technique would the nurse use to communicate actively with a terminally ill patient? 1 Asking closed-ended questions 2 Sympathizing with the patient 3 Avoiding sensitive issues 4 Asking open-ended questions

4 The nurse can actively communicate with patients by asking open-ended questions. This helps patients expand their thoughts and tell their stories. The nurse would avoid using closed-ended questions, such as ones with a "yes" or "no" response, because they will not help the nurse understand the feelings and emotions of the patients, and closed-ended questions are not active communication. Being sympathetic will not necessarily allow patients to express feelings and will not allow active communication. The nurse would not avoid sensitive issue as this would not facilitate active communication. Do not avoid talking about a topic; nurses must use therapeutic techniques to discuss sensitive issues.Test-Taking Tip: Look for answers that support patient-centered care. Asking open-ended questions allows the patient to lead the discussion, which supports patient-centered care.

Which symptom is the nurse addressing when advising the patient's caregiver to increase fiber in the patient's diet? 1 Fatigue 2 Nausea 3 Diarrhea 4 Constipation

4 The nurse is addressing constipation. There are many reasons for constipation, such as opioids, other medications, lack of bulk in the diet, or reduced fluid intake. Increasing fiber in the diet is helpful in treating constipation. Promoting energy conservation techniques and advising rest are useful for treating fatigue; fiber will not help fatigue. Administering antiemetics or promotility agents and encouraging the patient to lie on the right side reduces nausea. Fiber does not help nausea; in fact, it can make nausea worse. If the patient has diarrhea, easy access to toileting should be provided; fiber does not help with diarrhea.

Which critical thinking skill does the nurse use when considering how the patient's cultural perspectives affect the meaning of loss or death? 1 Attitudes 2 Standards 3 Experience 4 Knowledge

4 The nurse uses knowledge as the critical thinking skill to understand the patient's cultural perspectives on the meaning of loss or death. Attitudes is the critical thinking skill that involves taking risks if necessary to develop a close relationship with the patient to understand loss; it does not focus on cultural perspectives affecting the meaning of loss/death in a patient. Standards is the critical thinking approach used for applying principles outlined in professional and clinical standards, not considering how cultural perspectives affect the meaning of loss/death. Experience is the critical thinking approach used to care for a patient who experienced a physical or emotional loss or death and personal experience with loss/death, not the effect of culture on loss/death.

Which action would the nurse take for a patient newly diagnosed with a serious, life-changing illness whose conversations are abrupt, superficial, and unrelated to the illness? 1 Strongly suggest the patient talk about feelings. 2 Focus on the family to obtain the information needed. 3 Avoid discussing illness-related topics with quiet patients. 4 Remain alert for signals that the patient wants to talk.

4 The nurse would remain alert for signals that the patient wants to talk. The nurse would make no presumptions about this patient other than the fact that the patient is not yet ready to talk about the situation but would stay alert for a time when ready to talk. Strongly suggesting the patient talk is nontherapeutic as some people do not work through their problems by talking to others. The patient, not the family, is the focus even when that patient is reluctant to talk. The nurse does not avoid discussing illness-related topics as this is nontherapeutic; the nurse would talk about illness-related topics.

Which stage of dying, according to the Kübler-Ross theory, is reflected in the patient's statement, "I miss my partner. I will never get my partner back?" 1 Anger 2 Denial 3 Bargaining 4 Acceptance

4 The patient is exhibiting the acceptance stage. The Kübler-Ross theory consists of five stages of dying. When the patient accepts the death of the partner, it indicates acceptance. When the patient says that the partner will be missed and he or she will never get the partner back, it does not indicate anger, denial, or bargaining. When the patient expresses anger or resistance toward God or others, it indicates anger. When the patient cannot accept the loss, it indicates denial. When the patient postpones awareness of the loss by trying to prevent it from happening, it indicates bargaining.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

Which stage of dying is being described when a terminally ill patient tells the nurse, "I would do whatever you say. Please relieve me of this illness?" 1 Anger 2 Denial 3 Depression 4 Bargaining

4 This indicates the patient is in the bargaining stage. The patient expresses a willingness to do anything if the nurse helps relieve the patient of the illness. In this stage, the patient makes promises to self or significant others to behave differently in exchange for relief from the illness. In the anger stage, the patient expresses resistance and sometimes feels intense anger at another person or the situation; the patient in this scenario is not expressing anger. In the denial stage, the patient may not accept the truth; in this situation the patient is not denying. In the depression stage, the patient realizes the whole impact of the loss. In depression the patient feels overwhelmingly sad and lonely; in this scenario, the patient is not expressing any of these types of emotions.

Which type of grief response describes a woman who experiences the loss of a very early term pregnancy and her friend suggests to her that she can "always try again?" 1 Delayed 2 Anticipatory 3 Exaggerated 4 Disenfranchised

4 This is disenfranchised grief. This woman's friend is not fully acknowledging the value of her pregnancy because of the short length of time the woman was pregnant or because, by comparison, the loss seems less than losing a child after birth. The loss does not seem "legitimate." Thus the woman does not experience sympathy from others and feels disenfranchised. Delayed grief is a type of complicated grief in which the person's response is unusually delayed or postponed because the loss is so overwhelming; the woman in this scenario did not wait to grieve. Anticipatory grief occurs before the actual loss or death occurs; the woman in this situation did not experience grief until she lost the baby. Exaggerated grief is also a type of complicated grief in which the person often exhibits self-destructive or maladaptive behaviors; the woman did not experience maladaptive behaviors in this situation. STUDY TIP: In a study group, discuss the different types of disenfranchised grief. If one or more of you is willing and can share a personal experience of disenfranchised grief with the rest of the group, it will help everyone remember this term.

Which approach would the nurse use to begin a conversation about the goals of care for end of life? 1 Encourage family members to think more positively. 2 Avoid the discussion because it has to do with medical, not nursing, diagnoses. 3 Initiate a discussion about advance directives with the patient, family, and health care team. 4 Ask the patient to identify beliefs about the goals of care.

4 To begin a conversation, the nurse would ask the patient to identify beliefs about the goals of care. By first determining what the patient believes is best, the nurse can then discuss that option in more detail and give realistic ways of reaching the desired goal. Although encouraging family members is appropriate, encouraging them to think more positively is not. The nurse must support the family as they grieve. The nurse would not avoid the discussion because it is within the realm of nursing; it is not just medical. Initiating a discussion about advance directives with the patient, family, and health care team should first be done upon admission to the agency and should be with the patient first, then later with the family members and health care team.Test-Taking Tip: Always consider the patient's feelings when making your choice.

Which type of loss does a toddler experience when starting preschool? 1 Actual 2 Perceived 3 Situational 4 Maturational

4 When a toddler starts preschool, it is a maturational loss. A maturational loss is a form of necessary loss that includes all normally expected life changes across a patient's life span. An actual loss is the loss of a body part or death of a family member; actual loss does not occur when starting preschool. Perceived loss is uniquely defined by the person experiencing the loss and is less obvious to other people, such as rejection by a friend, but not when starting preschool. A situational loss is brought on by sudden and unpredictable events such as an automobile accident, not when starting preschool.