Mental Health Chapter 10

Which assessment findings can most accurately be described as complicated grieving?

A person is unable to return to work after a sister's death 18 months ago

A parent states to the school nurse, "should I be worried, they barely knew their grandmother and since she died last week, they won't let go of that stuffed bear and aren't playing or smiling." The nurse observes the child is quiet, eyes downcast, and is tightly holding the bear. Which intervention does the nurse implement?

Ask the child to tell you about their grandmother and the bear.

The nurse is talking with a client that is diagnosed with stage IV liver cancer. Which statment made by the client indicates the client is experiencing the bargaining stage of grief?

"Please Lord, just give me time to see my child graduate college."

The spouse of a client who died of breast cancer is still grieving 2 years later. What type of grief is the spouse experiencing?

Complicated

A client is being seen in the clinic after a natural disaster. The client is crying but believes that their social support is adequate. What is the appropriate nursing action to support the client?

Provide counseling and support during the visit.

Which is the most frequent and persistent bereavement-associated symptom?

Sleep disturbances

Which statement by a client would alert the nurse that the client is experiencing complicated grief?

"I am still so angry about my grandmother's death even after a year."

A female client tells the nurse she has had low appetite and motivation since the recent breakup of a long-term relationship. The client states, "I just can't stand not having her around. I need her back." The client is experiencing which of Bowlby's phases of grieving?

yearning

A 75-year-old client recently experienced their partner passing away. The client is socially isolating and has not seen any friends or family in 3 weeks. Which priority question should the nurse ask the client?

"Are you having any thoughts of suicide or harming yourself?"

What question should nurses ask themselves to determine if the care they provide to the grieving client has been both therapeutic and client focused?

"Do I have the strength to be present and to facilitate the client who is grieving?"

The client is scheduled to undergo an amputation of the lower right limb. The client is experiencing grief over the pending procedure. Which question should the nurse ask while assessing the client's perception of loss?

"How do you feel about the news?"

A nurse is talking to a client who has been told the client has a terminal illness and is responding in an angry manner. What statement by the nurse would best facilitate the best possible client outcomes?

"How much do you know and what do you want to know?"

A client is being evaluated after acute grief. Which statement made by the client would indicate that the client has reached the adaptation phase?

"I have created a memory area of my partner that I visit when I am missing them."

A community care nurse is visiting a client at home. The client was discharged from the hospital one week ago after having a mastectomy. After the nurse completes the physical examination, the nurse asks, "How are you feeling about your body changes?" The client tells the nurse she is not interested in talking right now and would prefer that the nurse leave. Which is the nurse's most effective use of communication skills?

"I just want you to know that I am available to talk when you are feeling up to it."

The nurse is assessing a client who is grieving the loss of a spouse. According to Kubler-Ross's stages of grieving, which statement indicates that the client is in the depression stage?

"My spouse is gone. I am having a really hard time finding a reason to keep going."

Which statement is typical of the first stage of grieving described by Engel?

"No, not me."

A new nurse graduate has learned about cultural differences related to grief within clients. Which statement made by the nurse demonstrates the need for follow-up teaching for the nurse?

"Rituals surrounding loss are similar among each culture."

The nurse is caring for a client with a terminal illness. Which will the nurse explain to the spouse regarding the frustration and anger the client is exhibiting?

"This is an expression of a universally held need of the dying."

An intensive-care unit (ICU) nurse is taking a self-reflection inventory related to death, dying, and grieving in their career. Which question should the nurse reflect on to increase self-awareness?

"What are the losses in my life and how do they affect me?"

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

A client diagnosed with terminal cancer is making plans to take flying lessons because that has always been the client's personal goal and it will allow the client to visit the client's elderly parents. What stage of death and dying according to Kübler-Ross is best illustrated in this description?

Acceptance

In which ways can anticipatory grief be helpful for the client and family?

Acceptance of impending death

A client is arranging a funeral ceremony for the client's child. According to the Worden's tasks of grieving, which task is being accomplished?

Acceptance of the reality of the loss

Which factor does not influence the grieving person's return to homeostasis?

Adequate self-awareness on the part of the nurse

Which is an example of a perceived loss?

An older client grieves for the loss of independence

A client is diagnosed with terminal kidney failure. The client's spouse demonstrates loss and grief behaviors. Which term accurately describes the spouse's experience?

Anticipatory grief

Which term describes the process by which a person experiences grief?

Bereavement

According to Mardi Horowitz (2001), life begins to feel "normal" again in which stage?

Completion

Which factor is likely to have the greatest impact on how a client responds to grief?

Cultural influences

The nurse is assessing a client who is recently divorced. The client tells the nurse that the memories of the client's former spouse are interfering with an ability to concentrate at work. According to Horowitz's stages of loss and adaptation, this is indicative of which stage?

Denial and intrusion

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?

Denial

Which likely takes place in the fourth stage of Kubler-Ross's stages of grieving?

Depression

A client's children have downplayed their grief following the death of their mother's partner, claiming that their mother and her partner were only together for a few months and that "he was no good for her anyways." The client is at risk of experiencing which type of grief?

Disenfranchised grief

Which experience could be the possible cause of grief due the loss of security and belonging for the client?

Divorce

When working with a grieving client, which is the most effective intervention a nurse can use?

Encourages the client to express grief verbally

The client expresses grief about not being able to fulfill the wish to pursue doctoral studies. Which type of loss does this indicate?

Loss related to self-actualization

Which explanation would be the nurse's best response when asked about the denial stage of grief?

It provides the individual with a temporary escape from the reality of dying

Which culture believes that leaving the body alone after death is disrespectful?

Orthodox Jewish Americans

The nurse is caring for a client who has been placed in palliative care. The nurse observes the client constantly looking at photographs from youth. According to the tasks of grieving by Rando, which task is being accomplished here?

Recollect

A client is crying continuously from having lost a friend in an accident. According to the tasks of grieving by Rando, which task of grief is expected to be accomplished next?

Recollect and reexperience

A hospice nurse is providing emotional care and support for a family who lost a child in a motor vehicle accident. Which principles will guide the nurse's emotional support?

Stages of grief reactions may overlap and are individualized.

A nurse is assessing a client who is depressed but unwilling to discuss the client's feelings. After speaking with the client's caregiver, the nurse learns that the client's pet died recently. Which is the most likely reason the client has hesitated to express the client's feelings?

The client feels that the nurse would not consider the grief as significant.

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 low self-esteem. The client is unable to trust others. The client has attempted suicide in the past.

An adult client is grieving the loss of a parent while being evaluated for another unrelated problem. The client has had a previous psychiatric diagnosis and displays mistrust toward others. Which outcome should be identified for the client?

The client will seek or accept professional assistance, if needed, to promote the grieving process.

The nurse is assessing a client who has been diagnosed with leukemia. Which behavior of the client would indicate that the client is experiencing the anger stage of Kubler-Ross' stages of grieving?

Verbally abusive to others

The nurse is caring for a middle-aged male client experiencing complicated grief following the death of their spouse. The treatment plan includes working with the client to manage anger impulses. Which outcome is appropriate?

Verbally identify the loss within 24 to 48 hours.

After losing the client's father in a car accident, a client has started practicing effective coping strategies. According to Horowitz's stages of loss and adaptation, which stage is this indicative of?

Working through

A nurse is caring for a group of clients experiencing loss and grief. Which client would have the highest anticipated grieving response?

a client whose partner of 14 years died in a motor vehicle crash

A client has recently been diagnosed with pancreatic cancer and tells the nurse, "I have lived a wonderful life and gotten to do and see so many things. My children and spouse will be fine." The nurse identifies that the client is experiencing which stage of Kubler-Ross' stages of grieving?

acceptance

A client diagnosed with major depressive disorder is feeling agony over a future imminent loss of their job. Which finding would the nurse document in the client's medical record?

anticipatory grief

A client is attending a support session with a nurse after hearing about the sudden death of the client's best friend due to heart attack. The client asks, "I just don't understand how this could have happened? He exercised every day." Which behavior is the client exhibiting?

attempting to make sense of the loss

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

Which type of grief occurs when a person is stuck in a state of chronic grieving?

complicated grief

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.)

death of a child sudden, unexpected death death by suicide

The client is experiencing grief after the death of a spouse. Which physiological sign(s) will the nurse assess the client for? Select all that apply.

hypersomnia indigestion palpitations lack of energy

A mental-health nurse is seeking individual counseling for the death of previous clients. The nurse expresses to the therapist, "I felt like I had to hide my sadness. I felt like it wasn't acceptable to talk about my feelings." What is the nurse experiencing?

disenfranchised grief

A client who has recently lost his same-sex partner in a motor vehicle accident tells the nurse, "My family doesn't speak to me because of my lifestyle. I feel like I have no one to talk to about my loss." The client is experiencing

disenfranchised grief.

A client who is in the process of divorce tells the nurse the client will require some time off from work due to the inability to concentrate. According to Bowlby's phases of grieving, which phase best reflects this client's current experience?

disorganization and despair

The nurse is caring for a client that was recently diagnosed with a terminal illness. According to Bowlby, which phase is the beginning of the grieving process?

experiencing numbness and denying the loss

The nurse observes a group of individuals who have experienced the traumatic loss of their homes and personal belongings due to a natural disaster. The nurse anticipates which of the following clients may be at highest risk for the development of complicated grieving?

older adult who had lived in the home their entire life

A client is experiencing a maturational crisis after their last adult child moved out of the family home. What positive outcome would the nurse identify after the crisis has resolved?

personal growth

A client with poorly controlled type 1 diabetes has just been informed that an amputation of the lower leg is required. The nurse can anticipate that the client will experience a reaction to the loss of which human need according to Maslow's hierarchy?

physiologic

A client tells the nurse the client been dating someone for three months after finalizing divorce one year ago. According to Rando (1984), the client is engaging in which grieving task?

re-investing

The nurse is providing discharge instructions for a client who has received a prescription for lorazepam after the death of a loved one. Which phase of psychopharmacologic treatment does this describe?

stabilization

An adult client is being counseled for grief after the death of their partner. The client talks out loud at times and says, "What would you do in this situation?", even when they are by themselves. What is the nurse's interpretation of the situation?

the client is coping by attempting to keep the lost one present

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?

the nurse who has worked with the client before and after the amputation