Videbeck Chapter 10: Grief and Loss Q's
A community care nurse is visiting a client at home. The client was discharged from the hospital one week ago after having a mastectomy. After the nurse completes the physical examination, the nurse asks, "How are you feeling about your body changes?" The client tells the nurse she is not interested in talking right now and would prefer that the nurse leave. Which is the nurse's most effective use of communication skills? A. "I just want you to know that I am available to talk when you are feeling up to it." B. "Have I said something to offend you?" C. "I can sit with you here so that you don't feel alone." D. "It would be beneficial for you to connect with other people who have had this surgery."
A. "I just want you to know that I am available to talk when you are feeling up to it." The client is demonstrating adaptive denial in that she is gradually adjusting to the loss. The nurse should use a simple, nonjudgmental statement to acknowledge the client's loss, such as, "I just want you to know I am available to talk when you are feeling up to it." Effective communication skills can be useful in helping the client in adaptive denial move toward acceptance.
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 reorganization B. Phase of yearning and searching C. Phase of numbing D. Phase of disorganization and despair
A. Phase of reorganization During the phase of reorganization, the bereaved person begins to reestablish a sense of personal identity. During the phase of disorganization and despair, the bereaved person begins to understand the loss's permanence. During the phase of yearning and searching, reality begins to set in. During the phase of numbing, the common first response to the news of a loss is to be stunned, as though not perceiving reality.
A community mental health nurse has come to know that the mother of a long-term client has passed away. What are ways for the nurse to determine if the client will be at risk for complicated grief? Select all that apply. A. The client has low self-esteem. B. The client has attempted suicide in the past. C. The client is unable to trust others. D. The client has a history of cardiac diseases. E. The client has a large family.
A. The client has low self-esteem. B. The client has attempted suicide in the past. C. The client is unable to trust others. Complicated grief is the response to a loss that is outside the norm and that occurs when a person is void of emotions and grieves for a prolonged period. The people who are susceptible for complicated grieving include those who have low self-esteem, who are unable to trust other people, and who have made suicide attempts in the past. Having a huge family and a history of cardiac disease does not make a person susceptible to have complicated grief. People who do not have any kind of social support (e.g., those people without family) are more prone to have complicated grief. People who have a history of psychiatric disorders are also more likely to experience complicated grief.
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 recognize the negative effects of the loss on the client's life. B. The client will actively participate in social activities. 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 try to solve problems without any assistance.
A. The client will recognize the negative effects of the loss on the client's life. C. The client will develop healthy strategies for coping with loss. D. The client will identify the meaning of the loss. The treatment for a client experiencing grief should help the client to understand the meaning and the impact of the loss on the client's life. The client should be able to use healthy coping strategies to cope with the loss. The client has had a loss and the nurse cannot expect the client to participate in social activities right away. Once the client has completed the process of grieving, these skills would be developed. The client should be encouraged to seek support throughout the grieving process.
A client with poorly controlled type 1 diabetes has just been informed that an amputation of the lower leg is required. The nurse can anticipate that the client will experience a reaction to the loss of which human need according to Maslow's hierarchy? A. physiologic B. safety C. security and belonging D. self-actualization
A. physiologic The client is about to experience physiologic loss of the lower right leg. The client is most likely to experience a reaction to this loss of human need according to Maslow's hierarchy. Safety loss refers to the loss of a safe environment such as in domestic abuse, child abuse, or public violence. Loss of security and belonging refers to the loss of loved ones. This loss can accompany the changes in relationships such as births, marriage, divorce, illness and death. The loss of self-actualization refers to potential life losses as a result of internal or external inhibition of the ability to strive toward fulfillment of individual potential.
A client is crying uncontrollably after having experienced an assault by a family member. The nurse is aware that the client is experiencing which type of crisis? A. traumatic B. developmental C. familial D. situational
A. traumatic The client is undergoing a traumatic crisis, which is an unexpected and unusual event that can cause injury, trauma, destruction, or sacrifice. A developmental crisis is a significant maturational event such as graduation from high school or leaving home for the first time. The client experiencing a situational crisis would experience an internal or external event that challenges biopsychosocial integrity, requiring adaptation, but is not violent; examples include moving to another city or accepting a job promotion. The familial crisis is not a specific type of crisis; a crisis involving the family could be any of the three types mentioned.
A nurse has been present for the hospital death of a Muslim client who was surrounded by family members when the client passed. The nurse demonstrates appropriate cultural considerations when stating: A. "How would you like to complete the five steps of the burial process?" B. "Are there any rituals you will observe here for your loved one?" C. "You probably won't cremate the body, will you?" D. "Shall I ask the pastor to attend for support?"
B. "Are there any rituals you will observe here for your loved one?" The nurse is making the appropriate cultural considerations when asking the more open-ended question of "Are there any rituals you will observe here for your loved one?" The nurse demonstrates that effects of acculturation may have caused the family to lose, minimize, modify, or set aside specific culture related rituals. Asking the questions from any of the other options indicates the nurse has not accounted for acculturation and is making assumptions about the family's wishes for the deceased.
A nurse is talking to a client who has been told the client has a terminal illness and is responding in an angry manner. What statement by the nurse would best facilitate the best possible client outcomes? A. "When you feel like talking about how you feel, let me know." B. "How much do you know and what do you want to know?" C. "I'm sorry you are in pain right now, but we have to talk about this." D. "Why are you so angry? The doctor told you why you will not live."
B. "How much do you know and what do you want to know?" Although the physician is usually responsible for deciding what, when, and how a client should be told about a terminal illness, the nurse may be involved in discussing the condition with the client. One basic rule to follow is to ask the client how much he or she already knows and how much he or she wants to know.
A nursing instructor lecturing about death and grief realizes a need for further instruction when a student states what? A. "Children are at risk for mental health problems after experiencing a loss." B. "The grieving process is the same for children and adults." C. "Children face many challenges while growing up." D. "Children's responses to loss reflect their developmental level."
B. "The grieving process is the same for children and adults." Children face many challenges. Research shows that, like adults, children who experience major losses are at risk for mental health problems. The grieving process differs somewhat for children and adults because children's responses to loss reflect their developmental levels.
Which likely takes place in the fourth stage of Kubler-Ross's stages of grieving? A. Anger B. Depression C. Bargaining D. Denial
B. Depression Depression occurs when the person shows evidence that he or she is sad and despairing over the inevitability of loss. Denial is shock and disbelief regarding the loss. Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. Anger may be expressed toward God, relatives, friends, or health care providers.
Which culture believes that leaving the body alone after death is disrespectful? A. Chinese Americans B. Orthodox Jewish Americans C. Native Americans D. Vietnamese Americans
B. Orthodox Jewish Americans
A client who has been in recovery from alcohol abuse for over one year tells the nurse he is drinking 5 to 6 beers per night since the client's mother's death. Which is the nurse's most accurate explanation for the client's grief response? A. physiologic B. behavioral C. emotional D. spiritual
B. behavioral The nurse can explain to the client that this is a behavioral response to grief. Drug and alcohol abuse indicate the client has developed a maladaptive response to the spiritual and emotional despair related to the death of the mother. Emotional responses to grief are characterized by the expression of a range of emotions over the course of the grieving process. Alcohol abuse is not an emotional response in grief, however, it is a behavior that is used to attempt to manage the emotional pain associated with the loss. Spiritual responses to grief are related to an individual's personal values regarding the spiritual dimension of the human experience. Although alcohol abuse is not a spiritual response to grief, it can be a behavioral response to the spiritual discord the client may be experiencing as he processes the mother's death. Physiologic responses to grief refer to the natural body responses that emerge for the body to adapt to loss. Although the client may use alcohol to try to treat a physiologic response to grief---for example, to promote sleep or calm anxiety---it remains a behavioral response.
Which phrase can do much to instill hope in the dying client? A. "This is a hopeless situation." B. "Nothing more can be done." C. "Let me tell you about your illness." D. "Everything will be fine, so don't worry."
C. "Let me tell you about your illness." Hope is the ingredient of life that enables an individual to consider a future and to actively bring that future into being. One way the nurse can enable hope in the dying client is to provide honest information about the progress of the illness.
A nurse is assessing a 7-year-old child in a school. The nurse suspects that the child has an insecure relationship with the parents. Which statement said by the child would have led the nurse to this conclusion? A. "I love playing with friends." B. "I love my dad and mom very much." C. "Please don't tell my mom anything we've talked about." D. "My mom and dad do not play with me."
C. "Please don't tell my mom anything we've talked about." An insecure attachment forms when a child has learned fear and helplessness because of intimidation, abuse, or excessive control by parents. The child demonstrates having a fear-based relationship with the mother. This indicates that the child has an insecure relationship with parents. The statement that the child loves playing with friends doesn't indicate anything about the relationship of the child with the parents. The statement that the client loves their parents suggests that the child has a secure relationship with the parents. The statement that the client's parents do not play with the client indicates that the child feels neglected by the parents.
The spouse of a client who died of breast cancer is still grieving 2 years later. What type of grief is the spouse experiencing? A. Inhibited B. Situational C. Complicated D. Maturational
C. Complicated Unresolved grief is abnormal or distorted; it may be either unresolved or inhibited. In unresolved grief, a person may have trouble expressing feelings of loss or may deny them; unresolved grief also describes a state of bereavement that extends over a lengthy period. With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations.
The nurse is assessing a client who is recently divorced. The client tells the nurse that the memories of the client's former spouse are interfering with an ability to concentrate at work. According to Horowitz's stages of loss and adaptation, this is indicative of which stage? A. Working through B. Outcry C. Denial and intrusion D. Completion
C. Denial and intrusion According to Horowitz's stages of loss and adaptation, in the stage of denial and intrusion, the client at times becomes so intensely preoccupied with the memories of the loss that they intrude into every moment and activity of the client's day. In the stage of outcry, the client realizes the loss for the first time. Outcry could be expressed outwardly or suppressed internally. Completion is the stage where the client becomes normal and the memories of the loss do not intrude in the day-to-day life any longer. In working through this stage, the client does think about the loss but also tries to find ways to manage with the loss.
After losing the client's father in a car accident, a client has started practicing effective coping strategies. According to Horowitz's stages of loss and adaptation, which stage is this indicative of? A. Outcry B. Completion C. Working through D. Denial and intrusion
C. Working through According to Horowitz's stages of loss and adaptation, in the working through stage the client begins to find new ways of managing life after loss. In this case, the client has consulted a psychologist and is trying to learn effective coping strategies. This indicates that the client has started to find ways to manage with the loss. Thus, the client is in the working through stage. In the stage of outcry, the client realizes the loss for the first time. This outcry could be expressed outwardly or suppressed internally. Completion is the stage where the client becomes normal and the memories of the loss do not intrude into the day-to-day life any longer. In the stage of denial and intrusion, the client at times becomes so intensely preoccupied with the memories of loss that they intrude into every moment and activity of the client.
Which type of grief occurs when a person is stuck in a state of chronic grieving? A. traumatic grief B. bereavement C. complicated grief D. uncomplicated grief
C. complicated grief During complicated grief, the person is frozen or stuck in a state of chronic mourning. Most bereaved people experience normal or uncomplicated grief after the loss of a loved one. Traumatic grief is a more difficult and prolonged grief in which external factors influence the reactions and potential long-term outcomes. Bereavement is the process of mourning and coping with the loss of a loved one.
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's stages of grief? A. Anger B. Acceptance C. Denial D. Bargaining
D. Bargaining This scenario is an example of bargaining to prolong one's life. Denial serves as a temporary escape from reality. In the anger stage, the client appears difficult, demanding, and ungrateful. In the acceptance stage, the client has achieved an inner and outer peace due to a personal victory over fear.
What question should nurses ask themselves to determine if the care they provide to the grieving client has been both therapeutic and client focused? A. "Do I still get personal satisfaction from my work with the grieving client?" B. "How do I personally react when I am working through the grieving process?" C. "How long can I continue working with grieving clients?" D. "Do I have the strength to be present and to facilitate the client who is grieving?"
D. "Do I have the strength to be present and to facilitate the client who is grieving?" Ongoing self-examination is an effective method of keeping the therapeutic relationship goal-directed and acutely attentive to the client's needs. Honestly answering if a nurse is still effective in the care he or she gives grieving clients is the most effective way to determine overall therapeutic approach. The remaining options are more nurse than client focused.
Which statement by a client would alert the nurse that the client is experiencing complicated grief? A. "I keep imagining the scene of my spouse's accident that caused death." B. "I blame myself for my brother having committed suicide." C. "It's been a week, but it still seems unreal that my mother has died." D. "I am still so angry about my grandmother's death even after a year."
D. "I am still so angry about my grandmother's death even after a year." The client who is experiencing complicated grief can have continued bitterness and anger even after a prolonged period. The client experiencing traumatic grief has external factors that influence the reactions and potential long-term outcomes; these factors can include suddenness of death, as well as violence or destruction- these can be involved with a car accident or suicide. With uncomplicated grief, the client would still be mourning a loved one's loss for some time such as with the mother, but this would be considered normal.
A client has just been diagnosed with terminal brain cancer and given approximately 2 months to live. The client wishes to visit the client's mother soon to "say goodbye." The nurse acknowledges this reaction as what? A. Loss B. Bereavement C. Mourning D. Anticipatory
D. Anticipatory Anticipatory grief refers to the reactions that occur when an individual, family, significant other, or friends are expecting a loss or death to occur. Bereavement is the process of grief that includes feelings of sadness, insomnia, poor appetite, deprivation, and desolation. Mourning describes an individual's outward expression of grief regarding the loss of a loved object or person. Loss is a change in the status of a significant object or situation.
A client is diagnosed with terminal kidney failure. The client's spouse demonstrates loss and grief behaviors. Which term accurately describes the spouse's experience? A. Maturational loss B. Bereavement C. Dysfunctional grieving D. Anticipatory grief
D. Anticipatory grief Anticipatory loss occurs when a person displays loss and grief behaviors for a loss that has yet to take place. It is often seen in the families of clients with serious or life-threatening illnesses and serves to lessen the effect of the actual loss of a family member.
A client who is in the process of divorce tells the nurse the client will require some time off from work due to the inability to concentrate. According to Bowlby's phases of grieving, which phase best reflects this client's current experience? A. reorganization B. shock, numbness, and protest C. yearning D. disorganization and despair
D. disorganization and despair This client is currently experiencing disorganization and despair, a phase in which cognitive disorganization and emotional despair cause difficulty with functioning in the everyday world. Experiencing the phase of shock, numbness, and protest is characterized by the person being void of feeling and denying the loss. Yearning refers to the emotions attached to wanting the return of the loved one or relationship and a protest of the permanence of the loss. Reorganizing refers to the phase in which people reintegrate the self and begin to pull their lives back together.
A client is experiencing a high level of stimulation after a terrorist attack. In providing psychological first aid to the client, which intervention would be best for the nurse to select? A. providing information to the client about the attack B. orienting the client to the circumstances that have occurred C. telling the client about the need to go to the hospital D. explaining to the client that the client is safe
D. explaining to the client that the client is safe The client who has arousal as a result of a crisis such as a terrorist attack needs safety, comfort and consolation. Explaining to the client that the client is safe offers comfort to help decrease the arousal or high level of stimulation that is being experienced (the A in ABCs). With the C in the ABCs of psychological first aid, the nurse is helping with cognition difficulty such as disorientation by providing orientation including information about the attack. The nurse is also helping with cognition by telling the client about needing to go to the hospital which provides clear direction
The nurse meets with a client who reports meeting with siblings yesterday to chose a coffin for the deceased mother. How can the nurse most accurately describe this process to the client? A. grieving B. bereavement C. anticipatory grieving D. mourning
D. mourning Mourning is the outward expression of grief and includes rituals such as tending to details of funeral arrangements. Anticipatory grieving is best explained as the process when people are facing an imminent loss and they begin to grapple with the very real possibility of loss or death in the near future. Grieving refers to the subjective emotions and affect that are a normal response to the experience of loss. The terms grieving and bereavement are often used interchangeably.
A nurse in charge on a unit with a client who is receiving postoperative care for a below the knee amputation is deciding which nurse to assign to this client. Which nurse would be most beneficial for the client? A. a nurse with previous experience working with clients who have amputations B. a nurse who is just returning to work from a one-week vacation C. a nurse who often has been assigned to the client 3 previous night shifts D. the nurse who has worked with the client before and after the amputation
D. the nurse who has worked with the client before and after the amputation In this case, the charge nurse's best option for nursing assignment to this client is to assign the nurse who has worked with the client before and after the amputation. At present the client's ability to relate to others may be impaired. Limiting the number of new contacts initially will promote familiarity and trust and decrease the client's feelings of being overwhelmed.
