Exam 3- Grief & Loss NCLEX Q's

Which client should the nurse assess for depression as a result of the grieving​ process? Adolescent client Older adult client Adult client ​School-age client

Older adult client The older adult client is at the greatest risk of developing​ depression; therefore, the nurse should assess this client for depression.

The nurse is providing care to an older adult client who is experiencing new symptoms of grief. Which item in the client​'s history might be the cause of these​ symptoms? The recent move to an assisted living facility Being diagnosed with type 1 diabetes mellitus as a child The loss of a pregnancy 20 years ago The loss of a spouse 5 years ago

The recent move to an assisted living facility Rationale While the loss of a pregnancy and of a spouse years ago may influence symptoms of​ grief, the recent move to an assisted living facility and the loss of independence associated with this move is the likely cause of the client​'s new symptoms of grief. The diagnosis of type 1 diabetes mellitus in childhood is not a factor in this client​'s grief.

A client tells the nurse that he engages in prayer and laughter every day. To which stress assessment question is this information​ applicable? ​"How long have the stressors been present in your​ life?" ​"What stress are you experiencing​ now" ​"How well do your coping strategies​ work?" ​"How do you handle​ stress?"

​"How do you handle​ stress?" Rationale Prayer and laughter are two examples of how a client handles stress. These actions do not address what stress the client is experiencing​ now, how long the stressors have been​ present, or how well the client​'s coping strategies work.

A client who is extremely distraught after losing her spouse of 45 years is sobbing with her head in her hands. The client​ says, open double quote"I don​'t want to go sit with a bunch of other old​ widows; I want to sit with Harold.close double quote" Based on this client​'s assessment​ findings, which collaborative therapy should the nurse​ recommend? A group hobby session ​Cognitive-behavioral therapy Church attendance on Wednesdays and Sundays Placement in a​ long-term care facility

​Cognitive-behavioral therapy Rationale The client experiencing grief over the loss of a spouse may need to attend a form of psychotherapy called​ cognitive-behavioral therapy, which helps the client move through each step of the grief process. Placement in a​ long-term care facility is not a realistic or appropriate option. A group hobby or church attendance does not address the client​'s needs based on the assessment findings.

A nurse is conducting a grief and loss assessment interview and understands that the current loss, the history of previous losses, and lifestyle are all a part of this assessment. What question will the nurse ask the client to assess the current loss? "Do you drink on a regular basis?" "Are you having trouble carrying on with your normal activities?" "What types of coping mechanisms have you employed to work through your grief? "Do you have an active support system?"

"Are you having trouble carrying on with your normal activities?" Rationale: A question that the nurse will ask the client to assess the current loss is: "Are you having trouble carrying on with your normal activities?" All other questions are appropriate questions to ask during the grief and loss assessment, however, are part of the lifestyle area of the assessment, not the current loss.

Which question is appropriate when assessing current​ loss? "When did the loss ​occur?" "Do you drink on a regular ​basis?" "Have you experienced similar losses in the ​past?" "Are you experiencing unresolved ​grief?

"When did the loss ​occur?" Asking when the loss occurred is appropriate when assessing current loss. The other questions are appropriate for assessing the history of​ loss, grief​ reactions, and lifestyle changes associated with grief.

Which is a psychological response to​ grief? Anger Personality changes Insomnia Decreased appetite

Anger is a psychological response to grief. Insomnia and decreased appetite are biological responses to grief. Personality changes are a behavioral response to grief.

Which type of medication is typically prescribed for​ anxiety? Select all that apply. Antihistamines Antidepressants Sleep aids Sedatives ​Beta-blockers

Antidepressants beta-blockers antihistamines There are no medications specifically for grief and​ loss, but clients might receive medications also used for anxiety if they are experiencing acute grief reactions.​ Antidepressants, beta-blockers, and antihistamines are prescribed for anxiety. Sleep aids and sedatives are no longer routinely prescribed for acute anxiety because of the risk of addiction and possible overdose.

Which nursing intervention supports a client who is experiencing​ grief? Using​ one-to-one observation Staying with the client Teaching relaxation techniques Asking​ open-ended questions

Asking​ open-ended questions Asking​ open-ended questions is an appropriate intervention for a client who is experiencing grief. Teaching relaxation​ techniques, staying with the​ client, and using​ one-to-one observation are appropriate interventions for a client who is suicidal.

Which is a symptom of complicated​ grief? Loss of appetite Difficulty concentrating Auditory hallucinations Sleep disturbances

Auditory hallucinations Individuals with complicated grief may experience auditory hallucinations. Sleep​ disturbances, loss of​ appetite, and difficulty concentrating are symptoms of normal grief.

A client tells the nurse that since he lost his​ job, he cannot sleep at night and has no energy to get out of bed. Which type of grief response should the nurse educate this client about based on the symptoms​ exhibited? Biological Biophysical Behavioral Psychological

Biological Rationale Biological responses are physical manifestations a client may develop in response to grief and​ loss; they may include sleep​ problems, decreased​ energy, lack of​ appetite, or weight loss. Psychological responses to grief or loss affect the emotions of the client​ (e.g., anger,​ tearfulness, depression). Behavioral responses to grief and loss are identified in clients who change their normal patterns of​ behavior; these changes can include such personality changes as a lack of social interactions with other individuals. There are no biophysical responses to grief and loss.

The nurse is preparing to assess a client who is experiencing grief and loss. When the nurse enters the​ room, the client is on his knees at the end of the bed and sobbing "​Why, ​God, ​why?" What should the nurse include in the​ assessment? Select all that apply. Community assessment Family assessment Financial assessment Spiritual assessment Client assessment

Community assessment Family assessment Client assessment Rationale The nurse should conduct an assessment to determine available coping resources for the client. This usually includes a client​ assessment, a family​ assessment, and a community assessment. The client who is sobbing as he cries out to God may need a spiritual​ assessment, but a spiritual assessment is a part of the community assessment. A financial assessment is not a routine part of an assessment to determine a client​'s coping resources.

While assessing a​ 76-year-old female client who fell off a stepstool in her​ kitchen, the nurse learns that the client is recently widowed. Which area should the nurse investigate to provide holistic health care for this​ client? Select all that apply. Physical therapy resources Community resources Family resources Spiritual resources Dietary resources

Community resources Family resources Spiritual resources Dietary resources Rationale A client experiencing a loss will have to address many lifestyle changes in the​ days, months, and years to come. A client who has been married for many years and recently widowed should be assessed for resources available to help in the daily living routine. These include​ family, community,​ spiritual, and dietary resources. While physical therapy may be​ necessary, this is not something the nurse would address at this time.

A client learns of the death of a family member. Which manifestation of grief should the nurse expect in this​ client? Agitation Palpitations Restlessness Crying

Crying Rationale Crying is an expected manifestation of grief. Agitation is an emotional response to stress. Restlessness and palpitations are physical manifestations of stress.

Arrange Elisabeth​ Kübler-Ross's stages of grieving in the correct sequence. ​ Acceptance Bargaining Depression Anger Denial

Denial Anger Acceptance Bargaining Depression

Arrange Elisabeth​ Kübler-Ross's stages of grieving in the correct sequence.

Denial Anger Bargaining Depression Acceptance

The nurse is comforting the adult daughter of a client who has just passed away. When planning​ care, the nurse should include interventions based on which type of​ loss? Perceived Situational Developmental Anticipatory

Developmental Rationale A developmental loss is one that is expected to occur throughout the course of​ life, such as the death of aging​ parents; the nurse should provide interventions to address this type of loss. A perceived loss is one that cannot be verified by others. An anticipatory loss is one that is experienced before the loss actually occurs. A situational loss is one that is due to an external circumstance.

The nurse is assessing a client who just lost her spouse as the result of cancer. Which question allows the nurse to determine whether socioeconomic factors may cause an alteration in the grieving​ process? Do you have any family close by that I can ​call? Do you have ​children? Are there any special requests you have regarding​ after-death ​care? Do you have any financial ​concerns?

Do you have any financial ​concerns? Rationale Asking about any financial concerns helps the nurse determine whether socioeconomic factors will impact the grieving process. The other questions help determine whether the client will experience alterations in grieving but do not address socioeconomic factors.

The nurse is teaching a course on grieving to new staff members at a local hospital. Which manifestation should the nurse include in the presentation as expected alterations or manifestations of​ grief? Select all that apply. Having difficulty concentrating Selling the family home Experiencing auditory hallucinations Moving in with a friend or family member Becoming distrustful of others

Having difficulty concentrating Selling the family home Moving in with a friend or family member Rationale Selling the family​ home, moving in with a friend or family​ member, and having difficulty concentrating are expected alterations or manifestations of grief. Becoming distrustful of others or experiencing auditory hallucinations are manifestations of complicated grief and require immediate intervention by the health care team.

The nurse is planning care for a client who is experiencing overwhelming grief and loss after the death of a parent. Which intervention by the nurse helps reduce this client​'s ​anxiety? Teaching family members to encourage the client​'s expressions of grief. Teaching about safe administration and side effects of medications. Encouraging the client to resume normal activities when​ ready, to promote physical and psychological health. Helping the client gain insight into maladaptive behaviors.

Helping the client gain insight into maladaptive behaviors. Rationale Helping the client gain insight into maladaptive behaviors helps reduce the client​'s anxiety. Teaching about medications and side effects is appropriate only when the client is prescribed antianxiety or other medications to treat stress. Teaching family members to encourage the client​'s expressions of grief and encouraging the client to resume activities when ready are appropriate interventions to facilitate the client​'s grief work.

The nurse is providing care to a pediatric client whose mother is terminally ill. Which intervention by the nurse allows the pediatric client to express​ grief? Administering medication to the client. Allowing the client to talk about the loss. Telling the client that the parent will be in a better place. Implementing imaginary games with the client.

Implementing imaginary games with the client. Rationale Imaginary games allow the pediatric client to express grief. Administering medication and allowing the client to talk about the loss are appropriate interventions for adults who are experiencing grief. Telling the client that the parent will be in a better place is not an appropriate intervention.

A nurse caring for a grieving family is aware that complicated grief may occur. A manifestation of complicated grief is: Not seeking support after a loss due to feelings of shame, guilt, or lack of recognition of the loss Hiding grief from others as opposed to allowing support from friends and family Intense grieving for 6 months or more with little to no indication of grief resolution More pronounced feelings of anger and depression due to resentment over the unacknowledged loss

Intense grieving for 6 months or more with little to no indication of grief resolution Rationale: Complicated grief is an alteration in the grieving process defined as prolonged or intensified grief causing an individual to be unable to proceed with the grieving process. A manifestation of complicated grief is intense grieving for 6 months or more with little to no indication of grief resolution. All other manifestations are for disenfranchised grief, another alteration in the grieving process.

The nurse is providing care to a client who lost a child in a car crash 7 months ago. The client states that she has been feeling better over the last​ month, but that all of a sudden for the past week she has felt like the death just occurred. Which question allows the nurse to assess the reason for this resurgence of​ grief? How many hours of sleep are you getting each ​night? Did you recently sell your ​home? Have you been experiencing ​anger? Is this time of year significant for any ​reason?

Is this time of year significant for any ​reason? Rationale It is not uncommon for a resurgence of grief to occur on​ holidays, birthdays, and other days of​ significance; asking the client whether this time of year has any special meaning helps the nurse determine whether this is what the client is experiencing. The other questions allow the nurse to assess expected alterations and manifestations of grief.

A nurse is caring for a client who is grieving the loss of a spouse. The nurse understands that grief is a combination of various factors including all except: Moral Psychological Biological Behavioral

Moral Grief is the combination of various psychological, biological, and behavioral responses to a loss. Morality is not a factor in grief.

A nurse is caring for the family of a client who died. The nurse observes the family celebrating with music and dancing. The appropriate response from the nurse is: Observe the practice but do not intervene unless asked by the family. Observe the practice but notify the family that the practice is inappropriate. Observe the practice and suggest a different coping mechanism for the family. Observe the practice and participate once it appears appropriate.

Observe the practice but do not intervene unless asked by the family. Rationale: Accurate assessment of the grieving process requires awareness of an individual's cultural influences. Certain cultures see death as a beginning rather than an end and choose to celebrate the individual's life on earth and the movement to the next life. The nurse should observe the practice but do not intervene unless asked by the family. A nurse who suggests a different coping mechanism or tells the family the practice is inappropriate, is not culturally aware of the variety of mourning practices. The nurse should not participate in the celebration unless asked by the family.

A mental health nurse is working with a client who is experiencing a complicated grief reaction and is seeking treatment in the form of Complicated Grief Treatment (CGT). Which statement is false regarding CGT? During the first process, the individual accepts the loss. The use of antidepressants alone may be just as effective as CGT. CGT has been shown to be helpful to clients on its own. Combining the use of antidepressants with CGT has proved to be quite effective.

Rationale: Complicated Grief Treatment (CGT) is a form of psychotherapy administered over 16 sessions in accordance with a published manual that describes this treatment. During the first process, the individual accepts the loss; during the restoration process, the individual begins to move on to a life without the deceased. CGT has been shown to be helpful to clients on its own, but some have used it in combination with antidepressants. While recent studies have shown that antidepressants may be helpful to those with depression related to grief, they do not appear to be as effective for clients with complicated grief. However, combining the use of antidepressants with CGT has proved to be quite effective in helping clients to work through their grief.

A palliative care nurse is caring for a terminally ill client and his family. The nurse understands that nursing implications for the grieving family include all except: Assist family members in understanding the signs of grief and acceptance of death. Help the dying client grieve for their own loss of life. Recognize complicated grief if symptoms occurs up to 2 months after a loss. Provide referral to assistance such as support groups and spiritual resources.

Recognize complicated grief if symptoms occurs up to 2 months after a loss. Rationale: Grief is an important consideration when working with end-of-life clients. Not only are these clients learning how to come to terms with the loss of their own lives, but their families experience a variety of hardships during this time. Nursing implications for the grieving family include: helping the dying client grieve for their own loss of life; assisting family members in understanding the signs of grief and acceptance of death; and provide referral to assistance such as support groups and spiritual resources. Complicated grief is diagnosed if it occurs at 6 months after a loss. The normal process of grief begins to fade 3 to 6 months after the loss.

The​ nurse, who is caring for the spouse of a client who died of traumatic​ injuries, is reviewing Engel​'s theory on the stages of grief. For which stage of grief should the nurse plan priority care based on Engel​'s ​theory? Outcome Shock Idealization Restitution

Shock Rationale The nurse should plan priority care based on​ shock, which according to Engel is the first stage of grief that the spouse experiences after the client​'s death.​ Restitution, outcome, and idealization are all later stages of grief in Engel​'s theory.

The nurse is providing care to a client who recently lost her child in a car crash. The client presents with difficulty breathing and diaphoresis. Based on these​ symptoms, which nursing intervention is the priority for this​ client? Using body language that encourages the client to talk. Staying with the client and treating the symptoms. Listening to the client​'s concerns. Asking the client​ open-ended questions.

Staying with the client and treating the symptoms. Rationale The client is experiencing an anxiety​ attack, and the priority intervention is to stay and treat the symptoms. The other interventions may be appropriate for a client experiencing​ grief, but client safety is the first concern.

A client is prescribed paroxetine​ (Paxil) to treat symptoms of stress after the unexpected death of her spouse. What should the nurse instruct the client about this​ medication? Select all that apply. This medication should not be taken with St. John​'s wort. This medication takes 4 to 6 weeks to achieve the full effect. This medication can cause bradycardia. This medication may cause difficulties in achieving an orgasm. This medication should not be stopped abruptly.

This medication should not be taken with St. John​'s wort. This medication takes 4 to 6 weeks to achieve the full effect. This medication may cause difficulties in achieving an orgasm. This medication should not be stopped abruptly. Rationale Paroxetine​ (Paxil) takes 4 to 6 weeks to achieve the full therapeutic​ effect; should not be stopped​ abruptly; may cause difficulties in achieving an​ orgasm; and should not be taken with St. John​'s wort. This medication does not cause bradycardia.

A palliative care nurse understands that nurses can employ various interventions to help clients with their grief. An example of an independent intervention which can be utilized is: Requesting a referral to group therapy, bereavement groups, and grief therapists Requesting a referral to a social worker who can provide expert guidance about coping with loss Facilitating meetings between the hospital chaplain and the client Using active listening techniques to show full engagement in the interaction

Using active listening techniques to show full engagement in the interaction Rationale: An independent intervention for clients with alterations in grief include using active listening techniques to show full engagement in interaction. All other interventions are important, however, are collaborative in nature rather than independent.