CHAPTER 10

The nurse is working with a client who lost her youngest child 2 months ago. When the nurse approaches, the client, the client yells, I don't want to talk to you. You have no idea what it's like to lose a child! The nurse bases her response to the client on the understanding of which of the following? A) Hostility is a common behavioral response to grief. B) It is too soon after the loss to empathize with the client. C) Personality traits such as aggressiveness are exaggerated during the grief process. D) The nurse may have nonverbally indicated a judgmental attitude toward the client.

Ans: A Behavioral responses to grief are often the easiest to observe. Irritability and hostility toward others reveal anger and frustration in the grief process.

The nurse is establishing outcomes for a grieving client. Which of the following is an appropriate outcome? A) The client will develop a plan for coping with the loss. B) The client will demonstrate self-reliance during the grief process. C) The client will suppress emotions related to the loss. D) The client will verbalize that loss will not adversely affect the quality of life.

Ans: A Examples of outcomes for the grieving client are as follows: -Identify the effects of his or her loss. -Identify the meaning of his or her loss. -Seek adequate support while expressing grief. -Develop a plan for coping with the loss.

Friends of a teenage male recently killed in a car accident are discussing their sense of loss. Which of the following comments best indicates that the friends are trying to make sense of the loss cognitively? A) Why did he have to die so young? B) He shouldn't have been driving so recklessly. C) If we had only stayed longer, he would not have been on that road. D) It took the ambulance too long to get there.

Ans: A One of the cognitive responses to grief involves the grieving person making sense of the loss. He or she undergoes self-examination and questions accepted ways of thinking. The loss challenges old assumptions about life. Anger, sadness, and anxiety are the predominant emotional responses to loss. The grieving person may direct anger and resentment toward the dead person and his or her health practices, family members, or health-care providers or institutions.

The bereaved client has worked through many processes of grief with the nurse. Which of the following are eventual outcomes of the emotional dimension of grieving? Select all that apply. A) The survivor begins to reestablish a sense of personal identity, direction, and purpose for living. B) The survivor begins to gain independence and confidence. C) The survivor develops new ways of managing life and new relationships. D) The survivor's life returns to the same state as it was before the loss. E) The survivor forgets about the loss.

Ans: A, B, C Eventually, the bereaved person begins to reestablish a sense of personal identity, direction, and purpose for living. He or she gains independence and confidence. New ways of managing life emerge and new relationships form. The person's life is reorganized and seems "normal" again, although different than that before the loss. The person still misses the deceased, but thinking of him or her no longer evokes painful feelings

Which of the following persons are most likely experiencing complicated grieving? Select all that apply. A) The spouse of a person who died 7 years ago and visits the grave several times a day. B) The grandchild of a soldier killed in war who visits the grave once a year on Memorial Day. C) A driver whose spouse and children all died as a result of his driving drunk. D) An adult who insisted for many years that he or she hated his or her deceased parent. E) The parent of a child who died after the having left the child in a car on a hot day.

Ans: A, C, D, E The spouse of a person who died 7 years ago and visits the grave several times a day is likely experiencing complicated grieving as this is a prolonged period of time with expression of grief that is exaggerated. A driver whose spouse and children all died as a result of his driving drunk likely experiences feelings of guilt as well as loss. An adult who insisted for many years that he or she hated his or her deceased parent is likely experiencing complicated grief as he or she has experienced an ambivalent attachment. The parent of a child who died after having left the child in a car on a hot day is likely experiencing guilt as well as loss.

The nurse is caring for a hospice client whose death is imminent. In preparing the family for the death of their loved one, then nurse prepares to assist the family in which of the following, regardless of the family's cultural preferences? Select all that apply. A) Dealing with the shock of losing a loved one B) Burial plans after death had occurred C) Efforts to stay connected to the client after death D) Use of support from family and friends E) Anger at the loss of a loved one

Ans: A, C, E Universal reactions include the initial response of shock and social disorientation, attempts to continue a relationship with the deceased, anger with those perceived as responsible for the death, and a time for mourning. Not all cultures bury their deceased. Some cultures mourn privately, not turning to the support of others.

Which of the following are critical components in assessment of a person's grief? Select all that apply. A) Adequate perception regarding the loss B) Adequate time to experience the loss C) Adequate support while grieving for the loss D) Adequate opportunities to say goodbye to the person E) Adequate coping behaviors during the process

Ans: A, C, E While observing for client responses in the dimensions of grieving, the nurse explores three critical components in assessment: Adequate perception regarding the loss Adequate support while grieving for the loss Adequate coping behaviors during the process The time to experience the loss varies significantly from person to person, and the reality is that there may not be adequate opportunities to say goodbye to the person.

A client comes to the physician's office for an annual checkup. During the interview, the nurse learns that the client's husband died unexpectedly of a heart attack 2 months ago. The most appropriate response by the nurse would be, A) At least you and your husband enjoyed life right until the end. B) It's better to go quickly like your husband did instead of suffering. C) The loss of your husband must be very painful for you. D) You'll feel better after you get over the shock of your husband's death

Ans: C The nurse makes an empathetic response, acknowledging the client's loss

A young couple just ended their relationship after a 9-month engagement. The one of the individuals is seeking short-term counseling to assist in grieving this loss. Which type of loss best describes what this client is experiencing? A) Safety loss B) Loss of security and sense of belonging C) Loss of self-esteem D) Loss related to self-actualization

Ans: B Types of loss include safety loss (loss of a safe environment), loss of security and a sense of belonging (loss of a loved one affects the need to love and the feeling of being loved), loss of self-esteem (any change in how a person is valued at work or in relationships or by him or herself), or loss related to self-actualization (external or internal crisis that blocks or inhibits strivings toward fulfillment).

A client is scheduled for a mastectomy for breast cancer. She is quiet, shows little emotion, and states that she has no questions. The nurse's assessment would need to focus on A) the client's plans for reconstructive surgery. B) the meaning of the mastectomy to the client. C) whether the client truly understands the surgery. D) why the client seems depressed

Ans: B Assessment begins with exploration of the client's perception of the loss. A client who is scheduled for a mastectomy would possibly be having anticipatory loss of a physiologic nature.

The nurse is meeting a client for the first time who has just spontaneously lost her unborn child. After establishing rapport, the priority nursing intervention should focus on which of the following? A) Assessing the client's support system B) Exploring what this loss means for the client C) Discussing helpful ways to cope with the loss D) Assessing what knowledge the client desires about the situation

Ans: B Assessment begins with exploration of the client's perception of the loss. What does the loss mean to the client? The question is valuable for beginning to facilitate the grief process. Further assessment and intervention will be determined based largely on the client's perception of the event.

The nurse is conducting a history and physical exam on a client who is grieving the unwanted loss of a marriage by divorce. Which of the following physical symptoms of grief would the nurse most likely expect to detect in the history? A) Headaches B) Insomnia C) Weight loss D) GI upset

Ans: B Those grieving may complain of insomnia, headaches, impaired appetite, weight loss, lack of energy, palpitations, indigestion, and changes in the immune and endocrine systems. Sleep disturbances are among the most frequent and persistent bereavement-associated symptoms

Which of the following are critical components to assess in a grieving person? Select all that apply. A) Genetic risk B) Perception of the loss C) Support system D) Coping behaviors E) Religion

Ans: B, C, D The interaction of the dimensions of human response is fluid and dynamic. What a person thinks about during grieving affects his or her feelings, and those feelings influence his or her behavior. The critical factors of perception, support, and coping are interrelated as well and provide a framework for assessing and assisting the client. Genetic risk and religion are not critical components to assess in a grieving person.

Which of the following losses are likely to result in disenfranchised grief? Select all that apply. A) A young adult whose spouse has just died suddenly B) A family whose long-time pet snake has just died C) A nurse who has just witnessed the death of a patient D) A couple who has just experienced pregnancy loss E) The gay lover of a man who just died from AIDS F) The mother and sister of a soldier who was killed in war

Ans: B, C, D, E Circumstances that can result in disenfranchised grief include a relationship that has no legitimacy, the loss itself is not recognized, the griever is not recognized, or the loss involves social stigma.

Kubler-Ross developed a model of five stages to explain what people experience as they grieve and mourn. Which is stage V of Kubler-Ross's stages of grieving? A) Denial B) Bargaining C) Acceptance D) Anger

Ans: C Acceptance occurs when the person shows evidence of coming to terms with death.

A client has just been informed of a diagnosis of terminal cancer. The client states, "God has to have mercy on me because my children need me. He knows I'll change if he gets me through this." The nurse documents that the wife is expressing signs of which of Kubler-Ross's stages of grief? A) Denial B) Anger C) Bargaining D) Depression

Ans: C Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss.

Which of the following terms is used to describe the process by which a person experiences the grief? A) Anticipatory grieving B) Disenfranchised grief C) Bereavement D) Mourning

Ans: C Bereavement refers to the process by which a person experiences the grief.

The client says to the nurse, I really want to see my first grandchild born before I die. Is that too much to ask? The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross? A) Acceptance B) Anger C) Bargaining D) Depression

Ans: C Clients often set goals such as living until a certain time or to experience a particular event, and then they will be ready to die: that is the bargain

A young client tells the nurse that her husband died 3 months ago, and she is feeling alone and vulnerable. Which statement by the client would indicate that her coping skills are adequate? A) I can't understand why this happened to me. B) I'm mentally healthy. I can solve my own problems. C) I will find a support group. D) What can I do? My husband abandoned me.

Ans: C Finding a support group indicates that the client recognizes her need for help and is taking action to get the support she needs.

The nurse approaches a client who looks very sad and is sitting alone crying. The best response by the nurse in this situation is, A) I'm sorry you are sad. Is there anything I can do to help you feel better? B) Please don't cry. It will get better. C) You look very sad. What is happening? D) What is bothering you?

Ans: C It is essential to accept the person's feelings without trying to dissuade him or her from feeling angry or upset. The nurse needs to encourage the person to express any and all feelings without trying to calm or placate him or her

The nurse visits with a client who was recently in a motor vehicle accident. Which of the following is most likely to prevent the client from experiencing complicated grief? A) Tendency to suppress emotions B) History of depression C) Places trusts familiar others D) Dependent on others to meet needs

Ans: C People who are vulnerable to complicated grieving include those with low self-esteem, low trust in others, a previous psychiatric disorder, previous suicide threats or attempts, or absent or unhelpful family members.

The most effective way for the nurse to provide culturally competent care to individuals who are grieving is which of the following? A) Understand the practices associated with a client's culture. B) Suggest developing a new ritual to make mourning meaningful. C) Ask the client what rituals are personally meaningful. D) Contact a spiritual leader from the client's culture to become involved.

Ans: C Rather than assuming that he or she understands a particular culture's grieving behaviors, the nurse must encourage clients to discover and use what is effective and meaningful to them

An elderly woman who lives alone is beginning to have difficulty maintaining her household and performing daily tasks. The nurse asks her to identify someone who can help her. The woman replies, I don't need help. I've been managing for years. Which of the following responses helps the client shift from denial to consciously coping with her situation? A) You don't think you need any help? But your family is worried about you. B) It must be hard to lose your independence. I'll ask a social worker to see what can be arranged. C) If you were to need help with your house, who might you ask for help? D) If you don't ask for some help. then the only option is to move to an assisted living facility.

Ans: C The nurse can help the client to reach out and accept what others want to give in support of his or her grieving process. Help the client shift from an unconscious mechanism of denial to conscious coping with reality by using reflective communication skills. Do not force people through the coping process by insisting they take certain actions.

A woman has just been served divorce papers from her husband. She has no financial resources and little social support. She states, He's not really leaving. He'll be back. The most appropriate response by the nurse would be which of the following? A) Has he done this before? B) I'll call social services and get you signed up for financial assistance. C) You have to face reality. Here are the papers. D) How is this affecting you right now?

Ans: D Adaptive denial, in which the client gradually adjusts to the reality of the loss, can help the client let go of previous (before the loss) perceptions while creating new ways of thinking about himself or herself, others, and the world. While taking in the loss in its entirety all at once seems overwhelming, gradually dealing with the loss in smaller increments seems much more manageable. Help the client shift from an unconscious mechanism of denial to conscious coping with reality by using reflective communication skills.

The nurse is working with a woman who lost her partner nearly 3 weeks prior. The woman has recently become less emotional and expressed that few things in her life have meaning right now. Which response by the nurse is most appropriate at this time? A) I am concerned. You are starting to show signs of ineffective grieving. B) You must feel some anger. It is alright to let that out. C) Let's look at the things in your life that you still enjoy. D) You are just starting to accept that this loss is real.

Ans: D As the bereaved person begins to understand the loss's permanence, he or she recognizes that patterns of thinking, feeling, and acting attached to life with the deceased must change. As the person relinquishes all hope of recovering the lost one, he or she inevitably experiences moments of depression, apathy, or despair. The acute sharp pain initially experienced with the loss becomes less intense and less frequent

A client with terminal cancer has been told he has 3 or 4 months to live. Which of the following would indicate to the nurse that further interventions are needed? A) The client says he wants to live life to the fullest. B) The client hopes for a peaceful and dignified death. C) The client is reviewing his life and talking about death. D) The client says he is well and is making future plans.

Ans: D Choice D would indicate that the client is proceeding as though there is no impending loss, so the nurse would need to assist the client with grieving as the client is in denial

A woman has just had a therapeutic abortion to end an unintended pregnancy. Afterward, the woman cries because although she wanted to have children in future years, this pregnancy was not well-timed. Which type of grief is this woman most likely to experience? A) Anticipatory grief B) Absence of grief C) Complicated grief D) Disenfranchised grief

Ans: D Disenfranchised grief is grief over a loss that is not or cannot be acknowledged openly, mourned, publicly, or supported socially

A couple came to the emergency department with their 5-month-old son. He was pronounced dead of sudden infant death syndrome (SIDS). In the next day or two, it will be important for this couple to A) accept that they could do nothing to prevent this death. B) delay the grieving process until they are ready to cope. C) minimize their discussion of the death with others. D) plan funeral arrangements for their son.

Ans: D Funerals are often the beginning outward sign of mourning and help begin the grieving process.

A nurse has been caring for a gunshot victim who has just died. Various family and friends are present. One of the visitors privately discloses to the nurse that she and the client were having an illicit affair. Which of the following is the best action by the nurse after learning of this relationship? A) Give the name of a clergy to the visitor and suggest she contact him for support B) Encourage the visitor to ask for support from the friends who are present C) Ignore the information about the affair and tend to the family D) Privately offer support to the visitor who was having the affair with the client

Ans: D Relationships between lovers, friends, neighbors, foster parents, colleagues, and caregivers may be long-lasting and intense, but people suffering loss in these relationships may not be able to mourn publicly with the social support and recognition given to family members

A child who has witnessed the murder of his classmate while at school would experience which kind of loss? A) Physiologic loss B) Loss of self-esteem C) Loss related to self-actualization D) Safety loss

Ans: D Safety loss is the loss of a safe environment. That feeling of safety is shattered when public violence occurs

A client who has been grieving the loss of his wife 2 weeks ago says to the nurse, The best part of my day is when I am back at work. Is that wrong? The nurse educates that work and other daily activities serve which purpose? A) You cannot work effectively this soon. You should finish grieving first. B) Working reminds you of your loss. It may be too early to go back. C) Working is your way of avoiding grief, which will make it harder for you to move on. D) Working is letting you take an emotional break from grieving. There's nothing wrong with that.

Ans: D The bereaved person can often take a break from the exhausting process of grieving. Going back to a routine of work or focusing on other members of the family may provide that respite. Familiar routines can affirm the client's talents and abilities and can renew feelings of self-worth.

After being laid off from work, a client becomes increasingly withdrawn and fatigued, spends entire days in bed, is unkempt, and is eating and sleeping poorly. The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross? A) Anger B) Bargaining C) Denial D) Depression

Ans: D The client's symptoms are characteristics of depression, which usually occurs when awareness of the loss becomes acute

A woman has just delivered a stillborn baby boy. Which of the following would be the most appropriate nursing response? A) Can I do anything for you? B) If something was wrong, it's better this way. C) Your son is in heaven with God now. D) Would you like to hold your son?

Ans: D The opportunity to hold the baby may help the woman deal with the first stage of grieving: denial; it also allows her to express emotions over the loss.

After the death of a client's wife, a man tells the nurse "I can never live without my wife. My wife was my whole life." Which is the most therapeutic response from the nurse? A) "Remember, your wife is no longer suffering." B) "Your wife's death is a terrible loss for you." C) "Each day will get a little better." D) "Your friends will help you cope with this."

B) "Your wife's death is a terrible loss for you."

A client states to a nurse, "They found a lump in my neck, and now they tell me I have an incurable disease." The client is young and appears to find this information hard to believe. The client's statement shows the pattern of response called... A) restitution. B) shock and disbelief. C) physiologic grieving. D) recovery.

B) shock and disbelief.

A nurse cared for a terminally ill client over a period of a month. The nurse found that spending time with the client was a pleasure. When the client died, the nurse experienced feelings of sadness, sleeping poorly, lacking energy, and feeling mildly depressed. Eventually the nurse explained the feelings to the nurse supervisor. The nurse supervisor is aware of which of the following? A) The nurse needs to use stress reduction strategies. B) The nurse needs to seek therapy for dysfunctional grief. C) The nurse is experiencing disenfranchised grief. D) The nurse needs to consider taking a leave of absence to pursue healing.

C) The nurse is experiencing disenfranchised grief.

A nurse is caring for a client who is mourning the loss of a loved one. Which factor would the nurse expect to make the mourning process more difficult for the client? A) The client was relatively independent of the deceased. B) The client had few unresolved conflicts in the relationship with the deceased. C) The client has a good support system with meaningful relationships evident. D) The client has experienced a number of previous losses.

D) The client has experienced a number of previous losses.

A client grieving her husband's sudden death tells the bereavement nurse, "I am not feeling very well. Yesterday, I was sitting in my kitchen and a saw my husband walk through the door and stop and smile at me. Then he just faded away. I think I must be going crazy." The most appropriate action for the nurse to take is to... A) assess for recent substance use. B) suggest a referral to the mental health clinic. C) arrange for a prescription for risperidone. D) counsel that visualizations are a normal part of grieving.

D) counsel that visualizations are a normal part of grieving.