ch 10: grief/loss

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? developmental traumatic situational familial

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.

What question should nurses ask themselves to determine if the care they provide to the grieving client has been both therapeutic and client focused? "How long can I continue working with grieving clients?" "How do I personally react when I am working through the grieving process?" "Do I still get personal satisfaction from my work with the grieving client?" "Do I have the strength to be present and to facilitate the client who is grieving?"

"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.

The nurse is assessing a client who reports feeling hopeless since a divorce. Which would be an appropriate question for the nurse to ask in order to determine mental health status for this client? "Do you ever use drugs to help feel less emotional pain?" "Is there a history of mental illness in your immediate family?" "Would you consider marrying again?" "Do you feel that someone else could ever love you?"

"Do you ever use drugs to help feel less emotional pain?" Negative circumstances such as poverty, poor physical health, unemployment, divorce, abuse, neglect, and unresolved childhood loss generally precipitate feelings of hopelessness, helplessness, or worthlessness. These negative responses place a person at risk for depression, substance abuse, or other mental health disorders. History of mental illness, marrying again, and the client's thoughts on whether another person would love the client again are appropriate general assessment questions but not as directly focused on the client's mental health status as substance use.

The nurse is performing an initial psychological assessment on a client who has been rescued from a flood. Which question would be most important in helping determine the amount of support needed by the client? "Do you have any possessions you were able to rescue?" "What makes you feel most sad right now about this?" "Have you thought about where you can stay right now?" "Do you own your home or are you renting it from someone?"

"Have you thought about where you can stay right now?" The nurse should be determining the client's ability to solve problems with a psychological assessment. Asking if the client has been able to think about a possible solution to a living arrangement can help the nurse assess this. Once the nurse has an assessment of the client's problem-solving and coping skills, the nurse can plan further support needs. Asking about possessions is not a problem-solving question and neither is whether the client owns or rents the home. The nurse would want to explore the client's feelings but this would not necessarily give information on problem-solving or coping skills.

Which statement by a client would alert the nurse that the client is experiencing complicated grief? "I blame myself for my brother having committed suicide." "I am still so angry about my grandmother's death even after a year." "It's been a week, but it still seems unreal that my mother has died." "I keep imagining the scene of my spouse's accident that caused death."

"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.

Which phrase can do much to instill hope in the dying client? "Let me tell you about your illness." "Everything will be fine, so don't worry." "This is a hopeless situation." "Nothing more can be done."

"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 nursing instructor lecturing about death and grief realizes a need for further instruction when a student states what? "Children's responses to loss reflect their developmental level." "The grieving process is the same for children and adults." "Children face many challenges while growing up." "Children are at risk for mental health problems after experiencing a loss."

"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 client should the nurse anticipate will be at greatest risk for alteration in quality of life as a result of loss? 45-year-old with severe depression 50-year-old with psychosis in the context of schizophrenia 72-year-old in the late stages of dementia 24-year-old diagnosed with borderline personality disorder

45-year-old with severe depression

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? Bereavement Anticipatory Mourning Loss

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.

Which term describes the process by which a person experiences grief? Homeostasis Bereavement Attentive presence Mourning

Bereavement Grieving, also known as bereavement, is the process by which a person experiences the grief. Homeostasis is the return to normal. Mourning is the outward expression of grief. Attentive presence is being with the client and focusing intently on communicating with and understanding him or her.

Which can correctly be identified as a behavioral response to grief? Weight loss Crying uncontrollably Lack of energy Palpitations

Crying uncontrollably Crying uncontrollably is a behavioral response to grief. Physiologic responses to grief include weight loss, lack of energy, and palpitations.

Which factor is likely to have the greatest impact on how a client responds to grief? Cultural influences Religious influences Cause of death Socioeconomic factors

Cultural influences Both the physical and emotional manifestations of grief may be culturally influenced. Culture also influences a how a person expresses their of grief.

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." According to the Kubler-Ross's stages of grieving, which stage of grief is the client in? Bargaining Denial Depression Anger

Denial According to Kubler-Ross's stages of grieving, in the denial stage the client is in shock or disbelief about the loss. The statement by the client indicates that he or she does not believe that they have cancer, thus the client is in the denial stage. In the anger stage, the client would express anger of the loss toward God, friends, or health care providers. In the bargaining stage, the client tends to ask God or fate for more time and delay the loss. In the stage of depression, the client becomes aware of the loss.

Which experience could be the possible cause of grief due the loss of security and belonging for the client? Amputation Violence at workplace Divorce Failure to achieve promotion at work

Divorce The needs of security and sense of belonging are in the third level, according to the Maslow's hierarchy of needs. The loss of a loved one affects the need to love and the feeling of being loved. These losses which accompany changes in relationships include divorce, marriage, and birth. Amputation is an example of physiologic loss. A failure to achieve a promotion at work is a loss related to self-esteem. Violence at the workplace is a loss related to safety.

When working with a grieving client, which is the most effective intervention a nurse can use? Encourages the client to participate in a grief support group Provides both written and oral information explaining the grieving process Encourages the client to express grief verbally Affords the client sufficient private time during the day to grieve

Encourages the client to express grief verbally The best way to help an individual who is grieving is to listen, be empathic, acknowledge the loss, and experience the event at his or her own pace. He or she should be encouraged to express grief verbally. The other methods of grieving may be effective but are likely not most effective.

Which culture believes that leaving the body alone after death is disrespectful? Native Americans Vietnamese Americans Orthodox Jewish Americans Chinese Americans

Orthodox Jewish Americans.. Orthodox Jewish Americans believe that leaving the body alone after death is disrespectful.

Which is the most frequent and persistent bereavement-associated symptom? Indigestion Headaches Impaired appetite Sleep disturbances

Sleep disturbances Sleep disturbances are the most frequent and persistent bereavement-associated symptom.

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 has disenfranchised grief. What is the most likely reason for the client not being willing to speak about it to the nurse? The client does not yet feel ready to talk about the feelings. The client feels that the nurse would not be able to make the client feel better. The client wants to forget about the person who is dead. The client feels uncomfortable speaking about the relationship with the deceased.

The client feels uncomfortable speaking about the relationship with the deceased. Disenfranchised grief is the grief over a loss that cannot be acknowledged openly or publicly or is considered socially unacceptable. These include the loss of loved one in secret or closeted same-sex relationships, cohabitation without marriage, and extramarital affairs. The stigma associated with the relationship of the client and the deceased would not allow the client to comfortably express his or her feelings about the relationship to the nurse. The need to forget about the deceased, feeling of not being ready to talk to the nurse, and believing that the nurse will not be able to make the client feel better are less likely reasons for the client to not express feelings.

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. The client has a history of cardiac diseases. The client has attempted suicide in the past. The client has low self-esteem. The client is unable to trust others. The client has a large family.

The client has attempted suicide in the past. The client has low self-esteem. 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.

Which outcome will the nurse evaluate to determine whether a client has successfully stabilized when engaged in the grieving process? The client will verbalize acceptance of his or her terminal diagnosis. The client will verbally identify his or her terminal diagnosis within 48 hours. The client will verbalize decreased suicidal thoughts within 48 hours. The client will express his or her feelings both verbally and nonverbally.

The client will verbalize acceptance of his or her terminal diagnosis. Stabilization requires a sufficient amount of time to accept the presence of the source of their grieve. The remaining options present immediate outcomes of being aware of the grief and its effects.

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. The nurse should sit on one side of the client. The nurse should keep her arms folded. The nurse should lean slightly toward the client. The nurse should maintain moderate eye contact while the client speaks. The nurse should stand facing the client.

The nurse should lean slightly toward the client. The nurse should maintain moderate eye contact while the client speaks. The nurse should stand facing the client. While speaking to a client who is experiencing grief, the nurse should maintain an attentive presence. The body language indicative of attentive presence includes facing the client (whether sitting or standing), slightly leaning toward the client, and maintaining moderate eye contact while speaking to the client. Keeping the arms folded while listening to the client closes off the nurse from the client. Sitting to the left or right of the client, unless the client has a hearing loss, also would close off communication between the nurse and the client.

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? behavioral physiologic spiritual emotional

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.

The nurse is providing individual support to a female client who attends a group for people who have experienced loss of a family member to suicide. The client's son committed suicide one month ago. The client was not aware that her son experienced depression. Which risk factors for complicated grief are most likely for this client? (Select all that apply.) low trust in others death of a child sudden, unexpected death death by suicide low self-esteem

death of a child sudden, unexpected death death by suicide Risk factors for vulnerability include the death of a child, that the death was unexpected (the client was not aware her son was experiencing depression) and that the death was by suicide. The client would be considered at risk for complicated grief. Within the information provided in the question, there is no indication that the client has low self-esteem or low trust in others. These are, however, factors that, if present, can complicate grief.

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 nurse with previous experience working with clients who have amputations a nurse who often has been assigned to the client 3 previous night shifts a nurse who is just returning to work from a one-week vacation the nurse who has worked with the client before and after the amputation

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.