Psychiatric - Chp 10
Which of the following is Phase IV of Kubler-Ross's stages of grieving? a) Anger b) Bargaining c) Denial d) Depression
d) Depression
The psychiatric nurse helping various aged clients deal with loss understands that the primary psychological difference between the experiences is that generally a) It is felt less intensely by the older client b) The older client has better coping skills c) The younger client has fewer valued people to lose d) It is unexpected and sudden for the younger client
d) It is unexpected and sudden for the younger client
A nurse and physician are preparing to inform a patient that his prostate cancer has metastasized to his lungs and bones. Which of the following principles should guide this communication? a) Use a positive tone when speaking to the patient and emphasize any optimistic findings b) Ensure that detail is maximized in order to alleviate the patient's anxiety c) Supplement spoken information with printed and online resources d) Provide information in small amounts with frequent checks to confirm understanding
d) Provide information in small amounts with frequent checks to confirm understanding
The final need, according to Maslow (1954), includes a) Physiologic b) Security and belonging c) Safety d) Self-actualization
d) Self-actualization
A nurse who provides bereavement counseling is working with the family of a child who recently died from cancer. Which of the following statements may be a common expression of grief and guilt a by family member? a) Uncle: "It was for the best." b) 65-year-old grandparent: "It helped me prepare for my death." c) Parents: "We did everything we could and we are at peace." d) Sister: "It is all my fault; I wanted him to die."
d) Sister: "It is all my fault; I wanted him to die."
A hospice nurse is providing emotional care and support for a family who lost a son. The care will be provided based on what knowledge? a) Grief is an abnormal physical reaction to a loss b) All members of the family will react to loss in the same way c) Bereavement is a normal process, requiring little intervention d) Stages of grief reactions may overlap and are individualized
d) Stages of grief reactions may overlap and are individualized
A woman has had a breast removed to treat cancer. What type of loss will she most likely experience? a) maturational loss b) perceived loss c) anticipatory loss d) actual loss
d) actual loss
A man is diagnosed with terminal kidney failure. His wife demonstrates loss and grief behaviors. What type of loss is the wife experiencing? a) dysfunctional grieving b) bereavement c) maturational loss d) anticipatory loss
d) anticipatory loss
Physiologic responses of complicated grieving include a) tearfulness when recalling significant memories of the lost one b) impaired appetite, weight loss, lack of energy, palpitations c) depression, panic disorders chronic grief d) impaired immune system, increased serum prolactin level, increased morality rate from heart disease
d) impaired immune system, increased serum prolactin level, increased morality rate from heart disease
Which of the following types of losses is caused by an internal or external crisis that blocks or inhibits strivings toward fulfillment that may threaten personal goals and individual potential? a) Loss related to self-actualization b) Safety loss c) Physiologic loss d) Loss of self-esteem
a) Loss related to self-actualization
Which of the following are characteristics of complicated grief disorder? Select all that apply. a) Trouble accepting the death b) Excessive bitterness c) Feeling that life has meaning d) Increased trust of others
a) Trouble accepting the death b) Excessive bitterness
Which of the following terms describes the process by which a person experiences the grief? a) Attentive presence b) Grieving c) Mourning d) Grief
b) Grieving
Which of the following is a cognitive response to grief? a) Guilt b) Indigestion c) Attempting to keep the lost one present d) Anguish of abandonment
c) Attempting to keep the lost one present
The nurse is speaking to the caregivers of a client who is experiencing complicated grief. The nurse is explaining some of the consequences of complicated grief. What are the health-related consequences associated with complicated grief? Select all that apply a) Panic disorder b) Precipitation of a cardiac disease c) Neurofibromatosis d) Development of cancer e) Psychosomatic disorder
a) Panic disorder b) Precipitation of a cardiac disease e) Psychosomatic disorder
In which of the phases of Bowlby's grief process does the bereaved person begin to understand the loss's permanence? a) Phase of disorganization and despair b) Phase of numbing c) Phase of yearning and searching d) Phase of recognition
a) Phase of disorganization and despair
During which phase of Bowlby's grief process does the bereaved person begin to reestablish a sense of personal identity, direction, and purpose for living? a) Phase of recognition b) Phase of numbing c) Phase of disorganization and despair d) Phase of yearning and searching
a) Phase of recognition
An Islamic client has passed away. Which processes would be included in the burial procedure? Select all that apply. a) Reciting prayer of the deceased. b) Dressing of the body. c) Positioning of the body. d) Washing of the body. e) Cremation of the body.
a) Reciting prayer of the deceased. b) Dressing of the body. c) Positioning of the body. d) Washing of the body.
The nurse is caring for a client who has been placed in palliative care for cancer. The client constantly looks at her photographs from her youth. According to the tasks of grieving by Rando, which task is being accomplished here? a) Recollect and re-experience b) Recognize c) React d) Relinquish
a) Recollect and re-experience
Which of the following is the most frequent and persistent bereavement-associated symptom? a) Sleep disturbances b) Indigestion c) Impaired appetite d) Headaches
a) Sleep disturbances
Which of the following statements is typical of the first stage of grieving described by Engel? a) "My husband was the best man in the world." b) "Why me?" c) "No, not me." d) "The funeral service helped me survive."
c) "No, not me."
The nurse has noted that a dying client is often teary at various times during the day. The nurse recognizes that crying may indicate the client is currently experiencing which stage of grief? a) Guilt b) Rejection c) Denial d) Fear
a) Guilt
A client is exhibiting dysfunctional grieving. When obtaining a health history, the nurse would expect which assessment finding to be noted? a) Hostility b) Stupor c) Euphoria d) Calmness
a) Hostility
Which experience could be the possible cause of grief due the loss of security and belonging in the client? a) Loss of a job b) Divorce c) Violence at workplace d) Amputation
a) Loss of a job
The client is scheduled to undergo an amputation of the lower right limb. The client is experiencing grief over the pending procedure. Which question should the nurse ask while assessing the client's perception of loss? a) "How do you feel about the news?" b) "What do you usually do when you are excessively stressed?" c) "Do you feel like talking to anybody right now?" d) How can we relieve your anxiety?"
a) "How do you feel about the news?"
The nurse anticipates that the psychiatric client at greatest risk for loss affecting their emotional quality of life is the a) 45-year-old severely depressed male b) 50-year-old male psychotic schizophrenic c) 24-year-old person diagnosed with borderline personality disorder d) 72-year-old female in the late stages of dementia
a) 45-year-old severely depressed male
All of the following are factors that influence the grieving person's return to homeostasis except ... a) Adequate self-awareness on the part of the nurse b) Adequate perception of the situation c) Adequate coping d) Adequate support systems
a) Adequate self-awareness on the part of the nurse
The nurse is performing a psychosocial assessment of an adolescent. The client tells the nurse "I like my dad a lot, but he keeps on forcing me to study, doesn't allow me to play, and I get pissed off about that. I feel like running away from home, but at the same time how could I ever be away from my dad?" What does this statement indicate? a) Ambivalent attachment b) Insecure attachment c) Dependent attachment d) Secure attachment
a) Ambivalent attachment
After receiving word from his oncologist that his tumor is malignant, the patient says to the nurse, "If you people had the faintest clue what you were doing, I wouldn't be like this." The nurse should recognize that the patient may be experiencing which stage of grief? a) Anger b) Bargaining c) Depression d) Denial
a) Anger
Responses to end-of-life suffering are commonly exhibited a) Behaviorally, emotionally, physically, and spiritually b) Verbally, nonverbally, written, and emotionally c) Verbally, behaviorally, culturally, and spiritually d) Culturally, intellectually, creatively, and physically
a) Behaviorally, emotionally, physically, and spiritually
The nurse is assessing a client who has recently experienced a divorce. The client tells the nurse that the memories of his wife are interfering a lot with his work. According to Horowitz's Stages of Loss and Adaptation, which stage is this indicative of? a) Denial and intrusion b) Completion c) Working through d) Outcry
a) Denial and intrusion
Which of the following is a term used to describe grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially? a) Disenfranchised grief b) Bereavement c) Mourning d) Anticipatory grieving
a) Disenfranchised grief
The nurse is assessing a client who is extremely depressed. The client is depressed but unwilling to discuss his feelings. After speaking with the client's caregiver,the nurse learns that the client's pet died recently. What is the reason for the client to not express the feelings related to grief? a) The client feels that the nurse would not consider the grief as significant. b) The client does not want to remember the memories of the pet. c) The client feels that the nurse would not be able to make the client feel better. d) The client feels that the feelings related to the pet's death are insignificant.
a) The client feels that the nurse would not consider the grief as significant.
The nurse is assessing a client who has lost his family in an accident. According to George Engel's Stages of Grieving, which behavior indicates that the client is in the stage of resolution of the loss? a) The client repeatedly views his family photos. b) The client is crying continuously and is feeling helpless. c) The client is performing a funeral ritual for his deceased family. d) The client is numb and is not accepting the loss.
a) The client repeatedly views his family photos.
A nurse is caring for a Jewish client with terminal illness who is on a ventilator. The spouse of the client intends to stay near the client when the ventilator is removed. What is the reason for such a request, according to the Jewish culture? Choose the best answer. a) The soul of the deceased should not be alone while leaving the body. b) The soul of the deceased should not be disturbed by the other spirits. c) The soul of the deceased should pass through the body of a close family member. d) The soul of the deceased should comfortably be able to travel into the afterlife.
a) The soul of the deceased should not be alone while leaving the body.
A Haitian American client has expired. The family members of the deceased are performing a vodun (voodoo) ritual for the client. Which belief is associated with the ritual? a) To make peace with the spirits b) To assist the spirit of the deceased in the afterlife journey c) To ward off depression of the bereaved d) To help the spirit buy a drink as it moves to the afterlife
a) To make peace with the spirits
A client lost his father in accident. On the advice of the psychologist, the client has started practicing effective coping strategies. According to the Horowitz's Stages of Loss and Adaptation, which stage is this indicative of? a) Working through b) Outcry c) Completion d) Denial and intrusion
a) Working through
A 16-year-old client is having difficulty coping following the drowning death of her boyfriend. Which of the following behaviors does the nurse least expect to observe in this adolescent? a) Worrying about increased drug use in her school b) Refusing to discuss the death with friends and parents c) Recurring dreams of her boyfriend in the river d) Failing grades in school
a) Worrying about increased drug use in her school
Nursing interventions that are helpful for the grieving client include: a) allowing denial when it is helpful b) assuring the client that it will get better c) correcting faulty assumptions d) discouraging negative, pessimistic conversation e) providing attentive presence f) reviewing past coping behaviors
a) allowing denial when it is helpful c) correcting faulty assumptions e) providing attentive presence f) reviewing past coping behaviors
Although all of the following are factors that affect grief, which one is most likely to influence a person's expression of grief? a) cultural influences b) cause of death c) religious influences d) socioeconomic factors
a) cultural influences
Rando's six Rs of grieving tasks include: a) react b) read c) readjust d) recover e) reinvest f) restitution
a) react c) readjust f) restitution
Critical factors for successful integration of loss during the grieving process are a) the client's adequate perception, adequate support and adequate coping b) the nurse's trustworthiness and healthy attitudes about grief c) accurate assessment and intervention by the nurse or helping person d) the client's predictable and steady movement from one stage of the process to the next
a) the client's adequate perception, adequate support and adequate coping
A client is arranging a funeral ceremony for his child. According to the Worden's tasks of grieving, which task is being accomplished? a) Adjustment to the environment that has changed due to the loss b) Acceptance of the reality of the loss c) Emotional relocation of that which has been lost and moving on with life d) Working through the pain of grief
b) Acceptance of the reality of the loss
The nurse most effectively explains to a terminally ill client's wife that the frustration and anger he is exhibiting are a) A symptom of poor acceptance of his inevitable death b) An expression of a universally held need of the dying c) An unconscious means of facilitating separation with loved ones d) A sign of the anger stage of grieving
b) An expression of a universally held need of the dying
According to Mardi Horowitz (2001), life begins to feel "normal" again in which of the following stages? a) Outcry b) Completion c) Denial and intrusion d) Working through
b) Completion
Which type of grief occurs when the person is frozen or stuck in a state of chronic grieving? a) Bereavement b) Complicated grief c) Traumatic grief d) Uncomplicated grief
b) Complicated grief
Which of the following occurs in Phase II of Bowlby's grieving process? a) Numbness and denial b) Emotional yearning for the loved one c) Cognitive disorganization d) Reintegrating sense of self
b) Emotional yearning for the loved one
To most effectively assist a grieving client, the nurse a) Provides both written and oral information explaining the grieving process b) Encourages the client to express their grief verbally c) Encourages the client to participate in a grief support group d) Affords the client sufficient private time during the day to grieve
b) Encourages the client to express their grief verbally
The client expresses grief about not being able to fulfill the wish to pursue doctoral studies. Which type of loss does this indicate? a) Loss of self-esteem b) Loss related to self-actualization c) Loss of safety d) Loss of security and a sense of belonging
b) Loss related to self-actualization
The nurse is caring for a depressed client whose mother was killed in a car accident. What are some physiological alterations related to grief the nurse expects to find? Select all that apply. a) Hypersomnia b) Palpitations c) Lack of energy d) Indigestion e) Weight gain
b) Palpitations c) Lack of energy d) Indigestion
A Chinese client has expired. Which ritual would be performed in the funeral in order to assist the spirit of the deceased in the afterlife journey? Select all that apply. a) Performing the five step burial procedure b) Reading scriptures c) Burning incense d) Performing Voodoo ritual e) Dressing the body in a white kimono
b) Reading scriptures c) Burning incense
A 74-year-old widow is being seen in the mental health clinic. She has never fully regained the level of activity she had prior to her husband's death. She continues to have symptoms of depression and has not been able to work or volunteer. In addition, she complains of "anxiety attacks" that occur nearly every night. What type of grief reaction is this client exhibiting? a) She is experiencing a prolonged reaction but within normal limits of the grieving process. b) She is experiencing an unresolved, or dysfunctional, grieving reaction. She needs to have a comprehensive mental health assessment. c) She is having a prolonged reaction to her husband's death, but since she is surrounded by family members who support her, she does not need any interventions at this time. d) She is experiencing a normal grief reaction and does not need any intervention at this time.
b) She is experiencing an unresolved, or dysfunctional, grieving reaction. She needs to have a comprehensive mental health assessment.
The nurse is informing the client about being diagnosed with leprosy. What would most likely be the first emotional response of the client? a) Anxiety b) Shock c) Depression d) Anger
b) Shock
Which of the following is a behavioral response to grief? a) Palpitations b) Tearfully sobbing c) Lack of energy d) Weight loss
b) Tearfully sobbing
The nurse is assessing a client who is deeply upset and is not expressing feelings. At the end of the assessment, the nurse concludes that the client is extremely depressed because of the death of a loved one. The client had disenfranchised grief. What is the most likely reason for the client not being willing to speak about it to the nurse? Select all that apply. a) The client feels that the nurse would not be able to make them feel better. b) The client feels uncomfortable speaking about the relationship with the deceased. c) The client wants to forget about the person who is dead. d) The client does not yet feel ready to talk about the feelings.
b) The client feels uncomfortable speaking about the relationship with the deceased.
The client's mother recently passed away. The nurse is hesitant to pass this information to the client as the client is susceptible to complicated grief. What characteristics of the client would have indicated this to the nurse? Select all that apply. a) The client has a history of cardiac diseases. b) The client has low self-esteem. c) The client is unable to trust others. d) The client has a huge family. e) The client has attempted suicide in the past
b) The client has low self-esteem. c) The client is unable to trust others. e) The client has attempted suicide in the past
The nurse is assessing a client who has been diagnosed with leukemia. Which behavior of the client would indicate an emotional outcry? a) The client refuses to believe the diagnosis. b) The client is verbally abusive. c) The client is openly discussing treatment methods with the nurse. d) The client is giving money for charity.
b) The client is verbally abusive.
The nurse is preparing a care plan for a client experiencing grief. What are the expected outcomes of a successful intervention? Select all that apply. a) The client will try to solve problems without any assistance. b) The client will recognize the negative effects of the loss on their life. c) The client will develop healthy strategies for coping with loss. d) The client will identify the meaning of the loss. e) The client will actively participate in social activities.
b) The client will recognize the negative effects of the loss on their life. c) The client will develop healthy strategies for coping with loss. d) The client will identify the meaning of the loss.
A common barrier to effective spiritual care for the terminally ill is a result of a) Slow response by most health care providers to arrange for the intervention b) The client's reluctance to express a need c) Lack of availability of various spiritual advisers d) A flaw in the American end-of-life care delivery system
b) The client's reluctance to express a need
The nurse is caring for a client who is extremely depressed after receiving a diagnosis of cancer. Which body language should the nurse adopt while speaking to the client in order to demonstrate an attentive presence? Select all that apply. a) The nurse should sit at the left side of the client. b) The nurse should stand facing the client. c) The nurse should maintain moderate eye contact while the client speaks. d) The nurse should keep her arms folded. e) The nurse should lean slightly toward the client.
b) The nurse should stand facing the client. c) The nurse should maintain moderate eye contact while the client speaks. e) The nurse should lean slightly toward the client.
A client belonging to the Vietnamese culture has passed away. The caregivers of the client ask the nurse to allow them to put some rice grains in the mouth and place money with the deceased client. What is the belief associated with this ritual? a) This ritual would bless the deceased. b) This ritual would help the spirit buy a drink as it moves to the afterlife. c) This ritual would help making peace with the spirits. d) This ritual would assist the spirit in the journey of afterlife.
b) This ritual would help the spirit buy a drink as it moves to the afterlife.
Which of the following give cues to the nurse that a client may be grieving for a loss? a) sad affect, anger, anxiety, and sudden changes in mood b) thoughts, feelings, behavior, and physiologic complaints c) hallucinations, panic level of anxiety and sense of impeding doom d) complaints of abdominal pain, diarrhea, and loss of appetite
b) thoughts, feelings, behavior, and physiologic complaints
The nurse shows a need for further instructions regarding the concept of human suffering when heard stating a) "Physical pain isn't always the greatest manifestation of suffering." b) "Assessing for suffering is a nursing responsibility." c) "While suffering can include emotional symptoms, it is primarily a physical manifestation." d) "There isn't always an effective intervention for client suffering."
c) "While suffering can include emotional symptoms, it is primarily a physical manifestation."
Which of the following assessment findings would best support a nursing diagnosis of Complicated Grieving? a) A man blames himself for not doing more to make his wife's recent death more comfortable b) A woman cries frequently and loudly in the weeks following her child's death in an accident c) A man is unable to return to work after his sister's death 18 months ago d) A woman has been experiencing chronic insomnia since her mother's death earlier this year
c) A man is unable to return to work after his sister's death 18 months ago
Anticipatory grief has the potential to facilitate what? a) Admission to hospice care b) Clear examination of treatment options c) Acceptance of impending death d) An earlier and less painful death
c) Acceptance of impending death
A woman has responded to her recent diagnosis of lung cancer by making extensive plans for overseas travel with her children, despite the fact that her oncologist has informed her of her extremely poor prognosis. The patient is adamant that she does not want to discuss her cancer and the nurse consequently recognizes that the patient is likely in the denial stage of grief. How can the nurse best facilitate the patient's healthy grieving? a) Enlist the assistance of another nurse to help the patient face the reality of her situation b) Supplement conversations with the patient by using written material about her diagnosis c) Address the patient's diagnosis and prognosis at a later time or date d) Restate the patient's situation in more specific and detailed terms
c) Address the patient's diagnosis and prognosis at a later time or date
A client has just been diagnosed with terminal brain cancer and given approximately two months to live. He wishes to visit his mother soon to "say goodbye." The nurse acknowledges this reaction as which of the following? a) Loss b) Bereavement c) Anticipatory d) Mourning
c) Anticipatory
A nurse is caring for a client with terminal cancer. The client states, "If I promise to change my bad habits, the cancer will go away." The nurse knows that this statement is an example of which of Kubler-Ross' stages of grief? a) Acceptance b) Denial c) Bargaining d) Anger
c) Bargaining
A patient diagnosed with terminal cancer is making plans to take flying lessons because that has always been the patient's personal goal and it will allow her to visit her elderly parents. What stage of death and dying according to Kübler-Ross is best illustrated in this description? a) Acceptance b) Depression c) Bargaining d) Anger
c) Bargaining
The nurse is caring for a client whose spouse passed away several years ago. Upon assessment, the nurse finds that the client has been clinically depressed since the spouse's death and has not made any progress in the grief process. What is this behavior indicative of? a) Outcry b) Anger c) Complicated grief d) Disenfranchised grief
c) Complicated grief
The client's mother passed away and the client is crying incessantly. According to the George Engel's Stages of Grieving, which stage of grief is the client in? a) Resolution of the loss b) Restitution c) Developing awareness d) Shock and disbelief
c) Developing awareness
Which culture believes that leaving the body alone after death is disrespectful? a) Chinese Americans b) Vietnamese Americans c) Orthodox Jewish Americans d) Native Americans
c) Orthodox Jewish Americans
A 5-year-old child appears to be experiencing no emotional maladjustment over the death of his grandmother, who provided much of his care. The most appropriate nursing intervention is to ... a) Encourage the parents to regularly discuss the grandmother's death with the child b) Educate the parents to delayed behaviors that may occur in this age group c) Suggest to the parents that the child should be assessed by a child psychologist d) Assure the parents that this is a typical response for a child of this age
c) Suggest to the parents that the child should be assessed by a child psychologist
The nurse recognizes that the client most at risk for experiencing anticipatory grief is a) The 24-year-old woman whose fiancé has suddenly broken off their wedding engagement b) The 18-year-old person who failed to earn a sports scholarship to college c) The 61-year-old spouse of a client experiencing symptomology of moderate-stage Alzheimer disease. d) The 45-year-old person whose company is scheduled for major layoffs
c) The 61-year-old spouse of a client experiencing symptomology of moderate-stage Alzheimer disease.
The nurse explains that the purpose of the denial stage of grief is a) To give all involved a chance to hope that there has been a mistake made b) To provide an opportunity to adjust to the realization that death will occur c) To provide the individual with a temporary escape from the reality of dying d) To afford the individual a chance to prepare for the death experience
c) To provide the individual with a temporary escape from the reality of dying
Situations that are considered risk actors for complicated grief are a) inadequate support and old age b) childbirth, marriage, and divorce c) death of a spouse or child, death by suicide, and sudden and unexpected death d) inadequate perception of the grieving crisis
c) death of a spouse or child, death by suicide, and sudden and unexpected death
A group of nursing students is reviewing information about grief and bereavement. The students demonstrate understanding of the information when they identify which of the following? a) Bereavement is influenced by culture, but grief is not. b) Grief involves confronting the stress, but bereavement helps avoid the stresses. c) Grief and bereavement are used interchangeably as responses to loss. d) Bereavement is the process of mourning and grief is the emotional reaction.
d) Bereavement is the process of mourning and grief is the emotional reaction.
Kübler-Ross defines five stages of psychosocial responses to dying and death. Which of the following statements is characteristic of the bargaining stage? a) "Why did this happen to me? I always exercised." b) "I've had a good life and I can die in peace." c) "The doctors must have made a mistake." d) "Just let me live to see my grandson born."
d) "Just let me live to see my grandson born."
The nurse is assessing a client who is grieving the loss of his wife. According to Kubler-Ross's stages of grieving, which statement indicates that the client is in the depression stage? a) "My wife was laughing and happy yesterday. She cannot be dead." b) "Please send her back to me dear God. I would never ever fight with her again." c) "Oh God. Why did You take her away from me? What wrong did I do?" d) "My wife is gone. May God bless her and give me the strength to look after everybody."
d) "My wife is gone. May God bless her and give me the strength to look after everybody."
The client has been recently diagnosed with cancer. When the nurse tells the client about the diagnosis, the client says "I have been eating healthy food and working out regularly. I cannot acquire cancer. Could you please ask the lab people to perform the tests again?" According to the Kubler-Ross's stages of grieving, which stage of grief is the client in? a) Depression b) Anger c) Bargaining d) Denial
d) Denial
