Grief and Loss Prep U

A client states that her "life has gone down the tubes" since her divorce 6 months ago. Then, after she lost her job and apartment, she took an overdose of barbiturates so she "could go to sleep and never wake up." Which statement by the nurse should be made first? a) "It seems as if your self-esteem has been affected by all your losses." b) "I know you took an overdose of barbiturates. Are you thinking of suicide now?" c) "Helplessness is common after losing a job. Are you having trouble making decisions?" d) "You sound hopeless about the future since your divorce."

"I know you took an overdose of barbiturates. Are you thinking of suicide now?"

The nurse is aware that clients in the initial stages of a terminal diagnosis may present with which of the following behaviors? a) Criticizing medical care received b) Becoming isolated and refusing visitors c) Asking for other medical opinions d) Crying uncontrollably over the diagnosis

Asking for other medical opinions

A client with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is admitted to the labor and delivery unit. The client's condition rapidly deteriorates and despite efforts by the staff, the client dies. After the client's death, the nursing staff displays many emotions. With whom should the nurse-manager consult to help the staff cope with this unexpected death? a) The chaplain, because his educational background includes strategies for handling grief b) The social worker, so she can contact the family about funeral arrangements and pass along the information to the nursing staff c) The physician, so he can provide education about HELLP syndrome d) The human resource director, so she can arrange vacation time for the staff

The chaplain, because his educational background includes strategies for handling grief

A school-age boy with a spinal cord injury is moved to the rehabilitation unit. The nurse notes that the child tends to refuse to cooperate in care and to be hostile. The nurse interprets this behavior as indicative of which response? a) a reaction to sensory overload b) a stage of grief reaction c) a response to too much attention d) a phase of rebellion

a stage of grief reaction

A school-age boy with a spinal cord injury is moved to the rehabilitation unit. The nurse notes that the child tends to refuse to cooperate in care and to be hostile. The nurse interprets this behavior as indicative of which response? a) a phase of rebellion b) a response to too much attention c) a stage of grief reaction d) a reaction to sensory overload

a stage of grief reaction

At an emergency shelter, an earthquake victim tells the nurse that he is going to spend the night in his own bed at home. Which defense mechanism is the client exhibiting? a) rationalization b) denial c) intellectualization d) undoing

denial

The nurse is counseling the family of an older adult who died today. Which factor facilitates attainment of a positive bereavement outcome? a) being a spouse b) being a teenager c) possessing adequate financial resources d) having a history of anxiety

possessing adequate financial resources

During the interview at a crisis center, a newly widowed client reveals the wish "to join my husband in Heaven." After the nurse asks the client to sign a no-harm contract, which question is appropriate to use next? a) "Have you considered taking antidepressants?" b) "Do you have children who are willing to help you?" c) "Tell me what feelings you have been experiencing." d) "What was the cause of your husband's death?"

Tell me what feelings you have been experiencing."

Which philosophy should the nurse integrate into the plan of care for a client and family to help them best cope during the final stages of the client's illness? a) reliving the pleasant memories of days gone by b) planning ahead for the remaining good times that will be spent together c) expecting the worst and being grateful when it does not happen d) living each day as it comes as fully as possible

living each day as it comes as fully as possible

While caring for a male neonate diagnosed with gastroschisis, the nurse observes that the parents seem hesitant to touch the neonate because of his appearance. The nurse determines that the parents are most likely experiencing which stage of grief? a) denial b) anger c) bargaining d) shock

shock

The parents of a school-age child with a brain tumor have elected to have only comfort measures instituted for their dying child. The child has been experiencing significant discomfort and has been receiving pain medication. A nurse knows that the pain-management principle most effective in controlling the child's pain is: a) administering pain medication promptly when the child requests it. b) alternating stronger opioid pain medications with nonopioid agents. c) striving to prevent pain by routine administration of pain medication. d) using an age-appropriate tool for effectively assessing pain.

striving to prevent pain by routine administration of pain medication.

Parents of a 9-year-old child in the terminal phase of a fatal illness ask the nurse for guidance in discussing death with their child. Which response is appropriate? a) "At this developmental stage, most children have an adult concept of death and should be encouraged to discuss it." b) "Children of that age view death as temporary and reversible, which makes it hard to explain." c) "At this developmental stage, children are afraid of death, so it's best not to discuss it with them." d) "Children of that age typically fantasize about what dying will be like, which is much better than knowing the truth."

"At this developmental stage, most children have an adult concept of death and should be encouraged to discuss it."

The nurse observes that a client is very sad and dejected after a myocardial infarction. What is the best response to the statement, "Life will never be the same"? a) "You're very concerned when you think about how this will change your life." b) "This heart attack really saddens you." c) "I don't understand. You have survived this heart attack. Why do you think life will never be the same?" d) "Hope has important healing powers. You need to be a little more hopeful of your recovery from this heart attack."

"You're very concerned when you think about how this will change your life."

A mother states that she is very angry with the health care provider (HCP) who diagnosed her child with leukemia. Which statement helps the nurse understand this mother's reaction? a) Anger is rarely demonstrated by parents when coping with a sick child. b) The mother cannot overcome her anger in an acceptable manner. c) Parents of sick children are usually unable to control their anger. d) Anger is a natural result of a sense of loss and helplessness.

Anger is a natural result of a sense of loss and helplessness.

A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client? a) Chronic low self-esteem b) Anticipatory grieving c) Impaired swallowing d) Disturbed body image

Anticipatory Grieving

A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client? a) Anticipatory grieving b) Impaired swallowing c) Chronic low self-esteem d) Disturbed body image

Anticipatory grieving

The physician has indicated that a client has a poor prognosis for recovery, and the family is very concerned. How would the nurse best support the family? a) Attune to their grieving, explain what is happening, and encourage involvement in the care. b) Encourage realistic expectations of recovery and reinforce the reality of the prognosis. c) Reassure the client's family that parents really have difficulty getting over the horrors of this happening to a family member. d) Identify the strongest family member and encourage that person to help the family adjust to this situation.

Attune to their grieving, explain what is happening, and encourage involvement in the care.

A 19-year-old male with cystic fibrosis (CF) is hospitalized for a serious lung infection and is in need of a lung transplant. However, he has a rare blood type that complicates the process of obtaining a donor organ. He has also been diagnosed with bipolar disorder and treated successfully since mid-adolescence with medication and therapy. The client requests to see a chaplain to help him make plans for a funeral and donation of his body to science after death. How should the nurse interpret the client's request? a) It is a signal of the depressive side of his bipolar disorder, and he should be checked for suicidal thoughts/plans. b) It is a signal of an exacerbation of the client's CF and warrants further assessment by his lung specialist. c) It is a signal of the client's growing awareness that he is likely to have a shortened lifespan and should be supported by unit staff. d) It is a signal of delirium as a result of the many medications the client is taking and requires further assessment by the pharmacist or health care provider (HCP).

It is a signal of the client's growing awareness that he is likely to have a shortened lifespan and should be supported by unit staff.

On entering the room of a client who has undergone a dilatation and curettage (D&C;) for a spontaneous abortion, the nurse finds the client crying. Which comment by the nurse would be most appropriate? a) "It is important that you do not try to get pregnant too soon." b) "Are you having a great deal of uterine pain?" c) "Commonly spontaneous abortion means a defective embryo." d) "I am truly sorry you lost your baby."

I am truly sorry you lost your baby

A nurse is caring for a 5-year-old boy with end-stage acquired immunodeficiency syndrome (AIDS). The child confides that he is ready to go to heaven and see his grandpa. The nurse knows that the child's parents aren't comfortable with the idea of discontinuing treatment. What should she do? a) Talk with the parents about the dying process and make them aware of what their child has confided. b) Listen to the child but recognize that he's too young to make his own decisions. c) Tell the physician that the family would like to discontinue treatment. d) Tell the child that she will talk with his parents and change their minds.

Talk with the parents about the dying process and make them aware of what their child has confided.

A nurse is working with a dying client and the client's family. Which communication technique is most important to use? a) Avoid asking for more information from the client and family members. b) Offer the family different coping mechanisms. c) Use active listening and silence when communicating. d) Allow the family to initiate communication when they are ready.

Use active listening and silence when communicating.

Which child should the nurse identify as being most at risk for an episode of major depression? a) a 16-year-old male who has been struggling in school, making only Cs and Ds b) a 14-year-old female who recently moved to a new school after her parents' divorce c) a 10-year-old male who has never liked school and has few friends d) a 13-year-old female who was upset over not being chosen as a cheerleader

a 14-year-old female who recently moved to a new school after her parents' divorce

A terminally ill client's husband tells the nurse, "I wish we had taken that trip to Europe last year. We just kept putting it off, and now I am furious that we did not go." The nurse interprets the husband's statement as indicating which stage of adaptation to dying? a) depression b) bargaining c) denial d) anger

anger

When planning a visit to the parents of an infant who died of sudden infant death syndrome (SIDS) at home, the nurse should visit the parents at which time? a) two weeks after the funeral b) as soon after the infant's death as possible c) a few days after the funeral d) as soon as the parents are ready to talk

as soon as the parents are ready to talk

A client is admitted with fatigue, anorexia, weight loss, and inability to sleep, which started 1 month after the death of his spouse. Which nursing diagnosis is most appropriate for this client? a) Activity intolerance b) Ineffective role performance c) Complicated grieving d) Low self-esteem

complicated grieving

At an emergency shelter, an earthquake victim tells the nurse that he is going to spend the night in his own bed at home. Which defense mechanism is the client exhibiting? a) undoing b) intellectualization c) denial d) rationalization

denial

Which philosophy should the nurse integrate into the plan of care for a client and family to help them best cope during the final stages of the client's illness? a) planning ahead for the remaining good times that will be spent together b) expecting the worst and being grateful when it does not happen c) living each day as it comes as fully as possible d) reliving the pleasant memories of days gone by

living each day as it comes as fully as possible

A successful real estate agent brought to the clinic after being arrested for harassing and stalking his ex-wife denies any other symptoms or problems except anger about being arrested. The ex-wife reports to the police, "He is fine except for this irrational belief that we will remarry." When collaborating with the health care provider (HCP) about a plan of care, which intervention would be most effective for the client at this time? a) a joint session with the client and his ex-wife b) referral to an outpatient therapist c) a prescription for olanzapine 10 mg daily d) a prescription for fluoxetine 20 mg every morning

referral to an outpatient therapist

While caring for a male neonate diagnosed with gastroschisis, the nurse observes that the parents seem hesitant to touch the neonate because of his appearance. The nurse determines that the parents are most likely experiencing which stage of grief? a) denial b) anger c) bargaining d) shock

shock

A client who has experienced the loss of her husband through divorce, the loss of her job and apartment, and the development of drug dependency is suffering situational low self-esteem. Which outcome is most appropriate initially? a) The client will identify two positive qualities. b) The client will prioritize problems. c) The client will explore her strengths. d) The client will discuss her feelings related to her losses.

the client will discuss her feelings related to her losses

A client recently diagnosed with lung cancer tells the nurse that she has been having difficulty sleeping and is often preoccupied with thoughts about how her life has changed. She says, "I wish my life could just go on the way it was." Which issue should the nurse discuss with the client first? a) relieving anxiety b) managing insomnia c) understanding grief d) preparing a will

understanding grief

A client at a follow-up appointment after having a miscarriage 2 weeks previously yells at the nurse, "How could God do this to me? I have never done anything wrong." Which response by the nurse would be most appropriate at this time? a) "God can handle your anger. It is okay." b) "You are a strong person. You will get through this." c) "I know you are angry. It is so hard to lose your baby." d) "It is not God's fault. It was an accident."

"I know you are angry. It is so hard to lose your baby."

After the nurse has taught the parents of a 5-year-old boy who has leukemia how to talk with their child about death and dying, which statement would indicate that the parents have age-appropriate expectations about their child's reaction to his impending death? a) "He will understand how much his siblings will miss him." b) "He will accept his death as caused by his disease." c) "He is too young to understand what is happening to him." d) "He might think he has caused his death because he has misbehaved."

"He might think he has caused his death because he has misbehaved."

A client has just expelled a hydatidiform mole. She's visibly upset over the loss and wants to know when she can try to become pregnant again. How should the nurse respond? a) "I can see that you're upset; however, you must wait at least 1 year before becoming pregnant again." b) "Pregnancy should be avoided until all of your testing is normal." c) "Let me check with your physician and get you something that will help you relax." d) "I can see you're upset. Why don't we discuss this with you at a later time when you're feeling better."

"I can see that you're upset; however, you must wait at least 1 year before becoming pregnant again."

A client has just expelled a hydatidiform mole. She's visibly upset over the loss and wants to know when she can try to become pregnant again. How should the nurse respond? a) "Pregnancy should be avoided until all of your testing is normal." b) "I can see that you're upset; however, you must wait at least 1 year before becoming pregnant again." c) "Let me check with your physician and get you something that will help you relax." d) "I can see you're upset. Why don't we discuss this with you at a later time when you're feeling better."

"I can see that you're upset; however, you must wait at least 1 year before becoming pregnant again."

A nurse has been caring for an adolescent client in a residential facility. The child has been through a series of foster placements since infancy with no success in any placement until the age of 7 when placed with a middle-aged single woman. The client thrived there until the woman was killed in a car accident. The client attempted suicide after her foster mother died in response to the loss and the child was placed in the residential facility. The nurse has become close to this client and wants to help her address her issues and move on with her life. Which comment to the manager demonstrates that the nurse understands the client's issues and is able to respond appropriately to the client's needs? a) "She just needs someone who will love her and give her the things she has missed out on in life. An adoptive family needs to be found for her as soon as possible." b) "I know her well and am familiar with her issues. I think the best chance for success for her would be if she was adopted into my family." c) "I am not sure she can get past all the loss and rejection she has experienced. I do not think adoption will ever be a viable option for her." d) "It is difficult for her to love and trust again after her losses. In this facility, she can learn to deal with her loss in a less emotionally charged environment than a foster home."

"It is difficult for her to love and trust again after her losses. In this facility, she can learn to deal with her loss in a less emotionally charged environment than a foster home."

A client in the final stages of terminal cancer tells his nurse: "I wish I could just be allowed to die. I'm tired of fighting this illness. I have lived a good life. I continue my chemotherapy and radiation treatments only because my family wants me to." What is the nurse's best response? a) "Would you like to meet with your family and your physician about this matter?" b) "Would you like to talk with your minister about the significance of death?" c) "I know you are tired of fighting this illness, but death will come in due time." d) "Would you like to talk with a psychologist about your thoughts and feelings?"

"Would you like to meet with your family and your physician about this matter?"

The client, who is dying from acquired immunodeficiency syndrome (AIDS), is admitted to the inpatient psychiatric unit because he attempted suicide. His close friend recently died from AIDS. The client states to the nurse, "What is the use of living? My time is running out." What is the nurse's best response? a) "Life is precious and worth living." b) "Do not give up. There could be a cure for AIDS tomorrow." c) "You are in a lot of pain. What are you feeling?" d) "Let us talk about making some good use of that time."

"You are in a lot of pain. What are you feeling?"

The client, who is dying from acquired immunodeficiency syndrome (AIDS), is admitted to the inpatient psychiatric unit because he attempted suicide. His close friend recently died from AIDS. The client states to the nurse, "What is the use of living? My time is running out." What is the nurse's best response? a) "Do not give up. There could be a cure for AIDS tomorrow." b) "You are in a lot of pain. What are you feeling?" c) "Let us talk about making some good use of that time." d) "Life is precious and worth living."

"You are in a lot of pain. What are you feeling?"

Which response would be most appropriate for the nurse when comforting a primiparous client whose critically ill neonate delivered at 25 weeks dies while the mother is present? a) "This is probably for the best because his organs were so immature." b) "You can stay with your baby as long as you want and say anything you want." c) "If you want me to, I can call the chaplain to stay with you." d) "You should try to get pregnant again soon to get over this loss."

"You can stay with your baby as long as you want and say anything you want."

Which nursing activity supports the principles of palliative care for a dying infant and his family? a) Minimizing noise and disruption to decrease stress for the infant b) Creating a therapeutic, homelike environment for the infant and his family c) Maintaining routines and structure for the infant and his family d) Clustering care activities to provide as much rest as possible for the infant

Creating a therapeutic, homelike environment for the infant and his family

A partner of a man diagnosed with Karposi's Sarcoma has refused antiretroviral therapy. The partner confides in the nurse that, "He has just given up. I know if he just takes the medication he will get better and we can go back to the life we once had." The nurse identifies that the partner is experiencing which stage of grieving? a) Depression stage b) Bargaining stage c) Anger stage d) Denial stage

Denial

Elisabeth Kübler-Ross identifies five stages of death and dying. The nurse identifies that loss, grief, and intense sadness are symptoms of which stage? a) Denial and isolation b) Bargaining c) Anger d) Depression

Depression

A client gives birth to a stillborn neonate at 36 weeks' gestation. When caring for this client, which strategy by the nurse would be most helpful? a) Encourage the client to see, touch, and hold the dead neonate. b) Let the child's father decide what information the client receives. c) Be selective in providing the information that the client seeks. d) Provide information about possible causes of the stillbirth only if the client requests it.

Encourage the client to see, touch, and hold the dead neonate.

The parents of a 3-month-old infant have been told that their infant has died of sudden infant death syndrome. Which intervention is most important to include in the plan of care to assist the parents with their grieving process? a) Give them a package containing the infant's clothing. b) Ask them if they would like to call their religious advisor. c) Provide an opportunity for them to see the infant. d) Reassure them that the infant's death was not their fault.

Provide an opportunity for them to see the infant.

The widow of a client who successfully completed suicide tearfully says, "I feel guilty because I am so angry at him for killing himself. It must have been what he wanted." After assisting the widow with dealing with her feelings, which intervention is most helpful? a) Refer her to a group for survivors of suicide. b) Suggest she receive individual therapy by the nurse. c) Provide her with the local suicide hotline number. d) Encourage her to receive counseling from a chaplain.

Refer her to a group for survivors of suicide.

A client with end-stage pancreatic cancer has decided to terminate medical intervention. What should a nurse anticipate when consulting with palliative care? a) Decreased need for antidepressant medication b) Decreased need for nutritional supplementation c) Decreased need for pain medications d) Referral for bereavement counseling

Referral for bereavement counseling

A client with end-stage pancreatic cancer has decided to terminate medical intervention. What should a nurse anticipate when consulting with palliative care? a) Decreased need for antidepressant medication b) Decreased need for nutritional supplementation c) Decreased need for pain medications d) Referral for bereavement counseling

Referral for bereavement counseling

An adult is dying from metastatic lung cancer, and all treatments have been discontinued. The client's breathing pattern is labored, with gurgling sounds. The client's spouse asks the nurse, "Can you do something to help with the breathing?" Which is the nurse's best response in this situation? a) Reposition the client, elevate the head of the bed, and provide a cool compress. b) Suction the client so that the client's spouse knows all interventions were performed. c) Explain to the spouse that it is standard practice not to suction clients when treatments have been discontinued. d) Direct the unlicensed assistive personnel (UAP) to assess the client's vital signs and provide oral care.

Reosition the client, elevate the head of the bed, and provide a cool compress

A client with a spinal cord injury who has been active in sports and outdoor activities talks almost obsessively about his past activities. In tears, one day he asks the nurse, "Why am I unable to stop talking about these things? I know those days are gone forever." Which response by the nurse conveys the best understanding of the client's behavior? a) "Reviewing your losses is a way to help you work through your grief and loss." b) "It is a simple escape mechanism to go back and live again in happier times." c) "Be patient. It takes time to adjust to such a massive loss." d) "Talking about the past is a form of denial. We have to help you focus on today."

Reviewing your losses is a way to help you work through your grief and loss."

A nurse is completing an admission interview of a client newly diagnosed with multiple myeloma. The client tells the nurse he is concerned that his insurance coverage and limited savings will not pay for all of his family's needs when he is not working. Based on this information, to whom would the nurse initiate a referral? a) Hospital accounts b) Social services c) Pastoral care d) Case management

Social Services

A client gives birth to a neonate prematurely at 28 weeks' gestation. The neonate is placed in the neonatal intensive care unit (NICU). Three days later, the neonate's father seems withdrawn and barely speaks to the staff when visiting his child in the NICU. Which interpretation of his behavior is most appropriate? a) The father needs antidepressants. b) The father has depression because of grieving. c) The father is exhibiting diplaced anger at the nursing staff. d) The father denies the seriousness of his child's condition.

The father has depression because of grieving

A multipara at 16 weeks' gestation is diagnosed as having a fetus with probable anencephaly. The client is a devout Baptist and has decided to continue the pregnancy and donate the neonatal organs after the death of the neonate. The nurse should: a) explore the nurse's own feelings about the issues of anencephaly and organ donation. b) ask the client if her family agrees with her decision. c) advise the client that the prolonged neonatal death will be very painful for her. d) contact the client's minister to discuss the client's options related to the pregnancy.

explore the nurse's own feelings about the issues of anencephaly and organ donation.

The wife of an older adult who has been admitted to the hospital with kidney failure tells the nurse, "I know he does not want to die in a hospital, but it is so hard for me to take care of him at home. He said he does not want any more treatment, but I am not ready to let him go. We have so many arrangements to decide before he dies." Which statement by the nurse to the client's wife would be most appropriate? Select all that apply. a) "He is not going to die that soon judging by his current symptoms." b) "What kind of arrangements do you think need to be made before he dies?" c) "I can imagine that it is hard for you to care for him at home." d) "What do you and your husband know about advance directives?" e) "What are your fears about your husband dying?" f) "We can discuss types of hospice and home care available."

• "What are your fears about your husband dying?" • "I can imagine that it is hard for you to care for him at home." • "What do you and your husband know about advance directives?" • "We can discuss types of hospice and home care available." • "What kind of arrangements do you think need to be made before he dies?"

A nurse is assisting a grieving client and his/her spouse to deal with their loss of their 24-week-old infant. Which of the following actions would be most appropriate from the nurse? Select all that apply. a) Control their emotions so as to not upset the parents. b) Provide an early opportunity for the couple to see their child if they desire. c) Offer to stay with the grieving parents. d) Remind them that there must have been something wrong with the baby. e) Answer the parents' questions accurately.

• Provide an early opportunity for the couple to see their child if they desire. • Offer to stay with the grieving parents. • Answer the parents' questions accurately.

When talking with 10-year-old children about death, the nurse should incorporate which guidelines? Select all that apply. a) Teaching about death and dying should not start before age 11 years. b) The children will know that death is inevitable and irreversible. c) The children will be curious about the physical aspects of death. d) Telling children that death is the same as going to sleep as a way of relieving fear is appropriate. e) Logical explanations are not appropriate. f) Attitudes of the adults in their lives will influence the children.

• The children will know that death is inevitable and irreversible. • The children will be curious about the physical aspects of death. • Attitudes of the adults in their lives will influence the children.