MH 13

The grandfather of a three-year-old client died two days ago. Based on an understanding of normal growth and development, the nurse should anticipate hearing the client make which type of comment? Select all that apply. "Grandfather and I are going for ice cream tomorrow." "Grandfather is gone, and now I have to be strong and not cry." "Grandfather will be waiting for me when I die." "Grandfather would not have died if I had wished a little harder." "Grandfather will be back to take me to the ball game next week."

"Grandfather and I are going for ice cream tomorrow." "Grandfather will be back to take me to the ball game next week." The notions that the grandfather will return to take the child to the ball game and go out for ice cream are correct. Preschool-age children believe death is reversible. They do not have a developed sense of death, and they are unable to understand the permanent impact of death and dying. Children between five and nine years of age believe wishes or unrelated actions can be responsible for death (thinking the grandfather would not have died if the child had wished harder). The other two responses indicate the child is aware the death is permanent.

Which statement by the client would support the nursing concern of complicated grieving in a parent who is dealing with the death of her infant son 30 months ago? "I sometimes cry in my son's old bedroom because he's not there anymore." "When children play in playgrounds, it makes me angry that my son will never be able to play like other children." "I think of my son and I am sad that my new baby will never be able to know his brother." "I watch other toddlers in the neighborhood play, and I wish my son were still alive."

"When children play in playgrounds, it makes me angry that my son will never be able to play like other children." Feeling anger when watching other children play is correct. Although the loss of a child can be devastating, the ability of a parent to resolve anger is part of the grieving process. The client's behavior indicates that she has not moved past the initial stage of grief in which preoccupation with feelings of loss and intense emotional pain are prevalent. The other options are more average responses to the death of a child.

What is the nurse's most appropriate interpretation of a father who recently lost his eldest son to cancer who refuses to share his feelings in a support group and has not shown any tears related to the loss? A dysfunctional expression of grief, and the client should be referred to counseling A common expression of how men grieve loss and death A common expression of denial and refusal to accept death or loss The father's attempt to be strong for the rest of the family

A common expression of how men grieve loss and death A common expression of how men grieve is correct. Male or masculine expressions of loss or death are commonly limited and less overt. Intense feelings are usually experienced privately with a general reluctance to discuss these with others. Referring the client to counseling would not be indicated at this time because the father is probably not experiencing dysfunctional grief. There are not enough data in the other two options to support them.

What would be an appropriate outcome criterion for a client who has just lost a spouse through death? Select all that apply. Avoid sharing loss with significant others. Accept professional assistance if needed. Attend grief support groups. Plan a memorial tribute for the spouse. Stop expressing feelings about the spouse's death

Accept professional assistance if needed. Attend grief support groups. Accepting professional assistance and attending support groups are correct. A major outcome of grief counseling is to assist the client in sharing his or her loss and to accept support from others. It is critical for the spouse to share the feelings of loss and grief with others. A vital part of normal grieving is expressing feelings of loss and grief in a supportive, interpersonal environment, particularly with those who are most significant in the grieving person's life. It is too early to memorialize the spouse; the client must grieve the loss of client first

A client who underwent a gastric banding surgical procedure has a body mass index (BMI) of 24.8 and states, "I'm too fat. I always have been." The nurse concludes that this client has a disturbed body image related to which type(s) of psychological loss? Select all that apply. Actual Anticipatory Painful Perceived Permanent

Actual Perceived Actual and perceived are correct. A perceived loss is experienced by one person but cannot be verified by others (e.g., loss of self-esteem or body image). An actual loss can be identified by others and can arise in response to a significant change in a person's appearance, body, or life circumstances, such as weight loss after surgery. An anticipatory loss is experienced before the loss actually occurs (e.g., terminal illness). A permanent loss is an irreversible deprivation (e.g., paralysis). A painful loss is a generalized term that does not have universal meaning.

What would be the most appropriate action by the community nurse for a client, who is crying and says, "My mother's funeral was yesterday. I'm so sad."? Encourage the client to think about something other than the mother's death. Allow the client to talk about personal memories of the mother. Ask the client to describe what led to the mother's death. Explore the nature of the client's relationship with the mother.

Allow the client to talk about personal memories of the mother. Allowing the client to talk about personal memories is correct. Even though great emotional pain is felt after a loss, it is necessary for the grieving person to talk about memories of the lost person. This process begins early in the grief experience. Encouraging the client to think about something else and asking the client to describe what led to the mother's death would actively prevent the reminiscing that is necessary in early grieving. Additionally, asking the client to describe what led to the death would also change the focus from the grieving person's feelings to a more impersonal and clinical topic. As for exploring the nature of the client's relationship with the mother, while it is true that people with a high level of ambivalence about the lost person may have difficulty resolving grief, this sort of exploration is inappropriate at this time. The client needs to express initial feelings of loss before moving on to other grieving tasks, which include reviewing the relationship.

A 20-year-old client has just learned that both parents and two older siblings were killed in an automobile accident. The client is screaming "There is no God!!" while covering the ears and crying. The emergency department nurse should conclude these behaviors are consistent with which stage of the grieving process? Denial Anger Bargaining Depression

Anger Anger is correct. Although the stages of grief should be used with caution in labeling expected behaviors and feelings, many clients will experience the five stages of grief as denial or shock, anger, bargaining, depression, and acceptance.

What type of grief should the nurse suspect in a client who reports that since her husband's death four years ago, she has experienced migraine headaches and severe nausea each year around the date of her husband's death? Anniversary grief experience Disenfranchised grief Delayed grief Unresolved grief

Anniversary grief experience Anniversary grief experience is correct. Somatic complaints may be experienced around the date of a loss. This is called an anniversary grief response and is not a dysfunctional grief experience if the physical symptoms occur only around the specific date of the loss and the individual has otherwise returned to a full life. Individuals who have been together for many years often have these experiences for many years. Delayed grief is a postponed response in which the bereaved person may not grieve sufficiently at the time of the loss but instead has a disproportionate reaction to a later loss, which can be much more minor than the original loss. Disenfranchised grief is a response to a loss, which the individual is not regarded as having the right to grieve, or is unable to acknowledge the loss to other persons. Unresolved grief is a response that is prolonged or extended in length and severity of response.

Which nursing care measure should the nurse identify as a teaching priority for a family and child newly diagnosed with leukemia? Comfort measures Anticipatory grieving Distraction activities Bereavement counseling

Anticipatory grieving Anticipatory grieving is correct. The child and family will be overwhelmed with such a life-threatening illness; anticipating the loss of a child would be a priority for the family. The other options suggest pertinent interventions, but during the initial period following learning of the diagnosis, the first need of the family is to react emotionally and begin to adjust to the losses implied by the diagnosis.

It is important for the nurse to deal with personal feelings about adoption, grief, and loss prior to advising a mother who recently placed her newborn baby up for adoption. This self-awareness would do which of the following? Prevent the nurse from sharing any personal feelings with the client. Assist the nurse to avoid discussing unpleasant feelings with the client. Assist the nurse to help the client express grief fully. Prevent the nurse from being personally affected by the client's choice in adoption.

Assist the nurse to help the client express grief fully. Assisting the nurse to help the client express grief fully is correct. Self-awareness is a key component of any nurse-client experience. The nurse must be able to examine personal feelings, actions, and reactions in order to better assist the client in fully expressing his or her own feelings and thoughts. A firm understanding and acceptance of self allows the nurse to acknowledge a client's differences and uniqueness. In order to be empathetic to the client, the nurse must be aware of his or her own feelings. The other options do not focus on self-awareness

A frail 79-year-old female calls the home health nurse and says, "I am a failure, and I can no longer care adequately for my husband who has Alzheimer disease." She has been his primary caregiver for over five years; now he has become despondent, is unable to ambulate, and is difficult to manage. The nurse should determine that which priority nursing concern is most appropriate? Caregiver stress related to overwhelming caregiving tasks and expectations Ineffective grief resolution related to not accepting personal limitations Inability to cope related to chronic illness Isolation of the family related to altered state of health

Caregiver stress related to overwhelming caregiving tasks and expectations As the care receiver becomes more chronically ill and the caregiving burden becomes more demanding, a great strain can be placed on the caregiver's emotional and physical health. There is not enough data to suggest ineffective coping, dysfunctional grief, or social isolation

A client is diagnosed with lung cancer and is expected to die within three months. What should the nurse assist the client to do at this time? Select all that apply. Avoid discussing the future or making future plans, as the future is uncertain. Verbalize need to avoid taking narcotic analgesics since they can cause clouded thinking. Allow caregivers to provide as much care as possible to reduce stress and to preserve energy. Discuss feelings of impending death and acknowledge the inevitable outcome. Explore what the person believes about the grieving process

Discuss feelings of impending death and acknowledge the inevitable outcome. Explore what the person believes about the grieving process This client needs to be assisted to move through the final developmental landmarks and tasks at the end of life, which include closure and completion in relations with family and friends. This will also assist the family to engage in anticipatory grieving. Avoiding discussing the future would actively prevent the client from moving through the final developmental landmarks and end-of-life tasks. Relief of pain is of highest priority when the client is terminal. The nurse should be aware of the fact that there are means of using narcotic analgesics without causing clouding of consciousness. At end of life, the dying person should be allowed to be as independent as possible in order to preserve self-esteem.

A client arrives at a clinic in a very agitated state saying, "My life partner of 15 years has died of cancer and the family will not allow me to attend the funeral. They never accepted our relationship." The nurse should plan to facilitate the grieving process for this client because circumstances place the client at risk for which type of grief? Inhibited Disenfranchised Delayed Unresolved

Disenfranchised Disenfranchised is correct. Disenfranchised grief is a response to a loss or death in which the individual is not regarded as having the right to grieve or is unable to acknowledge the loss to other persons. Delayed grief is a postponed response in which the bereaved person may have a reaction at the time of the loss, but it is not sufficient to the loss. However, a later loss may trigger a reaction that is out of proportion to the meaning of the current loss. Inhibited grief is a suppressed response to loss that may be expressed by somatic complaints, such as physical symptoms around the anniversary of a loss or during holidays. Unresolved grief is a response that is prolonged or extended in length and severity of response.

A client whose spouse died four months ago is admitted for inpatient psychiatric care. The client has been unable to work since the spouse's death and has lost 9 kg (20 lb). The client cries frequently and says, "No, I won't believe it. It's not true." The client further describes feeling "numb" and "empty." The admitting medical diagnosis is major depression. The nurse identifies which of the following as the priority concern? Disenfranchised grief Dysfunctional grief Distorted grief Normal grief

Dysfunctional grief Dysfunctional grief is correct. The client is showing denial, which is the earliest reaction to loss. This first stage of grieving is normally short-lived, and the grieving person moves on to other grief responses, like anger. The total time for acute grieving is very individualized, but feelings of numbness, emptiness, and active denial of the death four months later indicates that this client's mourning is not progressing normally. Disenfranchised grief is not present because there is nothing in the situation (such as a clandestine relationship) that would prevent the client from expressing grief. The client does not exhibit great hostility or self-destructive behavior, which may be seen with distorted grief. This client's reaction is not consistent with the normal pattern of grieving.

During a counseling session, a 21-year-old client with schizophrenia verbalizes feelings of sadness and anger about being unable to keep a job or continue attending college. What priority concern should the nurse address? Inability to cope related to feelings of hopelessness and anger Anxiety related to fear of unknown and fear of failure Grief related to perceived inability to achieve developmental milestones Ineffective grieving process related to unrealistic expectations of abilities and lack of achievement

Grief related to perceived inability to achieve developmental milestones Grief related to perceived inability to achieve developmental milestones is correct. Schizophrenia most often occurs in young adults who are in the prime of life and attempting to achieve a normal adulthood. The individual experiences many losses, and the nurse should assist the client through the grieving process. The situation does not indicate that the client is experiencing significant anxiety. This situation does not indicate that the client is experiencing impaired coping or that hopelessness is present. Sadness and hopelessness are different emotions. The client's grieving is not dysfunctional, as the client is actively grieving a recent loss.

What is the reason for nurses to have self-awareness when dealing with parents whose child has recently died? It prevents the nurse from being personally affected by the loss. It assists the nurse to help the parents express their grief fully. It assists the nurse to avoid discussing unpleasant feelings with the parents. It prevents the nurse from sharing any personal feelings with the parents.

It assists the nurse to help the parents express their grief fully. Assisting the nurse to help the parents express their grief fully is correct. The capacity for self-awareness allows the nurse to reflect and make choices. Nurses who understand their own feelings and beliefs will be able to be therapeutic when clients need to address issues which are disturbing and difficult. The death of a child will personally affect the nurse, and it is critical for the nurse to share these feelings with others, including the parents. The nurse must be available both physically and emotionally for the parents in discussing unpleasant and difficult feelings.

A terminally ill 78-year-old female client tells the nurse she does not want her adult children to know she is dying. Later that day when the adult children visit, they tell the nurse that they know their mother is dying but will not talk about this in front of her. The nurse mentions in the intershift report that this family's situation is one that can be characterized in which way? Closed awareness Mutual pretense Open awareness Mutual concern

Mutual Pretense Mutual pretense is correct. With mutual pretense, the client, family, and/or healthcare providers know that the prognosis is terminal but agree not to talk about it and make an effort not to raise the subject. In closed awareness, the client and family are unaware of impending loss or death. There is no mutual concern. In open awareness, the client and involved individuals know about the impending loss or death and feel comfortable discussing it, even though it may be difficult.

The terminally ill client and family are discussing plans for the client's funeral. The nurse recognizes this as an example of communication indicating which kind of awareness? Denied awareness Mutual pretense Closed awareness Open awareness

Open awareness Open awareness is correct. In open awareness, the client and individuals involved know about the impending loss or death and feel comfortable discussing it, even though it may be difficult. In closed awareness, the client and family are unaware of impending loss or death. In mutual pretense, the client, family, and healthcare provider know that the prognosis is terminal but do not talk about it and make an effort not to raise the subject. Denied awareness is not a term used in this context, and since the family is having an open discussion, there is no indication that denial is involved.

A child, aged four, says, "If I can make a big enough wish, my daddy will not be dead anymore." The nurse should conclude that the child is doing which of the following? Delusional and should be evaluated by a psychiatrist Making up the story in order to avoid feeling sad and scared Expressing magical thinking common to much older children Voicing thoughts that are normal for children his age

Voicing thoughts that are normal for children his age Preschool-age children (ages three to five) do not understand the finality of death, but instead may see it as separation. They engage in magical thinking and truly believe in the power of wishes. Magical thinking is most common in preschool-age children. The child is not experiencing delusions or making up a story to avoid negative feelings.

When questioned by a client about what an advance directive or living will is, the nurse should respond that this document indicates which of the following? What treatment should be provided or omitted if the client becomes incapacitated Which practitioners should be allowed to provide end-of-life care Details about preferred caregivers for end-of-life care Which family members are to be responsible for making end-of-life decisions

What treatment should be provided or omitted if the client becomes incapacitated Advance directive is a general term that refers to a client's written instructions about future medical care in the event that the client becomes unable to speak or is incapacitated. Specific instructions about what medical treatment the client chooses to omit or refuse (e.g., ventilator support) in the event that the client is unable to make those decisions is also included. Advance directives do not specify particular practitioners or family members preferred for providing end-of-life care. When an advance directive document is created, the individual makes the decisions about future treatment to be administered or withheld (which family members are to be responsible). Advance directives are not the same as designating another person to make medical decisions for the individual; this is a specific legal process known as healthcare proxy or medical power of attorney.