Grief

43. A client with advanced bone cancer is experiencing cachexia. The nurse discusses the nutritional aspect of palliative care with the family. Why is it important to explain these nutritional interventions to the family? A. Enhance the quality of the client's life B. Reduce the likelihood of a respiratory infection C. Prevent the malabsorption syndrome from occurring D. Decrease the consequences of impaired glucose metabolism

Correct Answer: A Nutritional interventions to decrease cachexia will not necessarily contribute to survival, but they may enhance the client's quality of life.

13. A woman at 22 weeks' gestation is admitted with heavy bleeding and severe abdominal cramping. When told that no fetal heart sounds can be detected, the client says to the nurse, "We wanted this baby so badly." How should the nurse respond? A. "It must be difficult to lose this baby that was important to you both." B. "This is nature's way of dealing with babies that may have problems." C. "A curettage will give you a new start. I'll bet you'll get pregnant again soon." D. "You must be disappointed, but don't feel guilty. These things sometimes happen."

Correct Answer: A The correct response acknowledges the loss and the grieving process. It also encourages the expression of feelings. Suggesting that "this is nature's way" minimizes the loss and may reflect the nurse's beliefs. Predicting that another pregnancy will occur soon does not acknowledge the loss and cuts off communication. Guilt feelings were never expressed by the client.

38. An older woman comes to the mental health clinic and reports, "I've not been feeling right and haven't been able to sleep or eat since my husband died 8 months ago." The nurse determines that the client is experiencing grief associated with the loss of the husband. What supports this conclusion? A. Inability to talk about her loss B. Difficulty in expressing her loss C. Lack of sleep and the presence of symptoms of depression D. Prolonged period of grief and mourning after her husband's death

Correct Answer: C Insomnia, depressed mood, anxiety, and anorexia are common responses associated with loss, especially the death of a spouse. Eight months does not constitute a prolonged period of mourning, and therefore her grieving is not impaired.

3. Shortly after the death of her husband after a long illness, a woman visits the mental health clinic complaining of malaise, lethargy, and insomnia. The nurse, knowing that it is most important to help the wife cope with her husband's death, should attempt to determine the: A. Age of the wife B.Timing of the husband's death C. Socioeconomic status of the couple D. Adequacy of the wife's support system

Correct Answer: D Support is most important when coping with the crisis of death; the client must rely on the support system to cope with the loss.

32. A client with cancer of the lung says to the nurse, "If I could just be free of pain for a few days, I might be able to eat more and regain strength." Which stage of grieving does the nurse conclude the client is in? A. Bargaining B. Frustration C. Depression D. Rationalization

Correct Answer: A Bargaining is one of the stages of grieving, in which the client promises some type of desirable behavior to postpone the inevitability of death.

40. A client arrives at the clinic and tells the nurse about various aches and pains since her spouse's death 3 months ago. The client appears depressed and tense. What is the initial nursing intervention? A. Facilitating a discussion of the spouse's death B. Focusing on teaching the client relaxation exercises C. Asking the practitioner for a psychiatric consultation D. Helping the client recognize ambivalence toward the spouse.

Correct Answer: A Facilitating a discussion of the spouse's death will encourage the client to speak about the spouse and begin moving toward resolving the loss.

61. A female client's stream of consciousness is occupied exclusively with thoughts of her mother's death. The nurse plans to help the client through this stage of grieving, which is known as: A. Resolving the loss B. Shock and disbelief C. Developing awareness D. Restitution and recovery

Correct Answer: A Resolving a loss is a slow, painful, continuous process until a mental image of the dead person, almost devoid of negative or undesirable features, emerges. The shock-and-disbelief stage is usually dominated by a refusal to accept or comprehend the fact that a loved one has died.

49. A client who is at 28 weeks' gestation and in active labor is crying. She says, "I just know that this baby is going to die. What's the use of doing all this to save it?" The nurse concludes that the client is: A. Depressed and needs firm, positive support during labor B. Experiencing anticipatory grief and withdrawing from bonding C. In need of sedation to help her cope with the impending birth D. Demonstrating difficulty dealing with the birth by using the word "it"

Correct Answer: B Anticipatory grief is expected with a potential loss; expression of feelings should be encouraged.

51. According to Kübler-Ross, during which stage of grieving are individuals with serious health problems most likely to seek other medical opinions? A. Anger B. Denial C. Bargaining D. Depression

Correct Answer: B Denial includes feelings that the health care provider has made a mistake, so the client seeks additional opinions.

50. A child dies after an explosion at school. The parents arrive at the hospital a few minutes later and are told what happened. The parents ask the nurse whether they may see their child. What is the best response by the nurse? A. "It would be best to wait a while." B. "You may see her now." C. "You'll have to wait until the doctor can be with you." D. "It will be less traumatic if you see your child at the funeral home."

Correct Answer: B Seeing their child as soon as possible will validate the death for them and trigger the grieving process. Making the parents wait will delay and prolong the grieving process; the response offers no explanation for the wait.

53. A nurse is assessing the needs of a client who just learned that a tumor is malignant, has metastasized to several organs, and that the illness is terminal. What behavior does the nurse expect the client to exhibit during the initial stage of grieving? A. Crying uncontrollably B. Criticizing medical care C. Refusing to receive visitors D. Asking for a second opinion

Correct Answer: D

36. Nurses who care for the terminally ill apply the theories of Kübler-Ross in planning care. According to Kübler-Ross, individuals who experience a terminal illness go through a grieving process. Place the stages of this process in the order identified by Kübler-Ross.

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance The five stages, denial, anger, bargaining, depression and acceptance are a part of the framework that makes up our learning to live with the one we lost.

55. A 6-week-old infant and his mother arrive in the emergency department in an ambulance. The father arrives several minutes later with two children, 7 and 9 years old. The infant is not breathing, and the eventual diagnosis is sudden infant death syndrome (SIDS). The parents take turns holding the infant in another room. The nurse remains present and provides emotional support to the parents. What is an important short-term goal for this family? A Identifying the problems that they will be facing as a result of the loss of the infant B. Accepting that there was nothing that they could have done to prevent the infant's death. C. Including the infant's siblings in the events and grieving in the wake of the infant's death D. Seeking out other families who have lost infants to SIDS and obtaining support from them

Correct Answer: C The other children need to be involved with the grieving process and to work through their own feelings.

29. A client who is dying appears happy and tells a nurse a joke about the situation despite becoming sicker and weaker. What is the nurse's most therapeutic response? A. "Why are you always telling jokes?" B. "Your laughter is a cover for your fear." C. "Does it help to joke about your illness?" D. "The one who laughs on the outside cries on the inside."

Correct Answer: C The response "Does it help to joke about your illness?" is a nonjudgmental way to point out the client's behavior. The response "Why are you always telling jokes?" is confrontational; the client may not be able to answer the question.

37. An adolescent child is in the terminal stage of cancer. The parents ask how they will know when death is imminent. The nurse discusses the physical manifestations with the parents. What are the signs and symptoms of approaching death? Select all that apply. A. Thirst B. Weak pulse C. Increased pulse rate D. Difficulty swallowing E. Loss of bladder control

Correct Answer: B, D, E

30. Shortly after the death of her husband after a long illness, a woman visits the mental health clinic complaining of malaise, lethargy, and insomnia. The nurse, knowing that it is most important to help the wife cope with her husband's death, should attempt to determine the: A. Age of the wife B. Timing of the husband's death C. Socioeconomic status of the couple D. Adequacy of the wife's support system

Correct Answer: D Support is most important when coping with the crisis of death; the client must rely on the support system to cope with the loss.

28. The grieving spouse of a client who has just died says to the nurse, "We should have spent more time together. I always felt that my work came first." What should the nurse conclude that the spouse is experiencing? A. Displaced anger B. Feelings of guilt C. Shame for past behavior D. Ambivalent feelings about the spouse

Correct Answer: B The spouse is expressing the typical feelings of guilt associated with the death of a loved one; often there is initial guilt over what might have been.

25. Relatives of the victims of a home invasion in which several family members were killed receive crisis intervention services. Which therapy is most beneficial after the immediate event has passed? A. Grief B. Family C. Psychoanalytical D. Psychoeducational

Correct Answer: A Grief therapy provides guidance as one completes the tasks of successful mourning; its goal is to prevent unresolved and dysfunctional grief.

7. The grieving spouse of a client who has just died says to the nurse, "We should have spent more time together. I always felt that my work came first." What should the nurse conclude that the spouse is experiencing? A. Displaced anger B. Feelings of guilt C. Shame for past behavior D. Ambivalent feelings about the spouse

Correct Answer: B The spouse is expressing the typical feelings of guilt associated with the death of a loved one; often there is initial guilt over what might have been.

52. Kübler-Ross has identified the five stages of dying/grief. Place the following nursing statements, reflecting the five stages, in the correct order.

Correct Answer: 1. "You do understand that your child experienced fatal head trauma in the automobile accident?" 2. "Being angry at your partner for dying and leaving you alone is a natural grief reaction." 3. "Have you discussed with your oncologist how long radiation therapy might prolong your life?" 4. "Can we talk about the benefits of agreeing to take an antidepressant medication?" 5. "I've collected the information you requested concerning end-of- life planning."

5. After counseling an older widowed client, a nurse concludes that the grieving process has been successfully completed when the client: A. Is able to plan to start new relationships B. Talks about the deceased spouse at great length C. Ignores the deceased spouse's less-than-perfect qualities D. Decides to leave the deceased spouse's study as it was before the death

Correct Answer: A A healthy resolution helps the person move away from the old, safe, familiar relationship to establish new ones. Talking about the deceased spouse at great length is termed obsessional review; the mourner can talk of nothing else but the deceased and events surrounding the death. A reduction in obsessional review is a healthy sign.

39. The nurse is caring for a client who has a newborn with a neurological impairment. What is the most important nursing action? A. Assisting the client with the grieving process B. Performing frequent neurologic assessments of the newborn C. Arranging for social services to discuss possible placement of the newborn D. Obtaining a prescription for an antidepressant to help the client cope with the depressing news

Correct Answer: A Grieving is expected and necessary whenever a newborn is born less than healthy. More information is needed to come to this conclusion; the frequency of assessments depends on the severity and type of the neurological problem.

6. A nurse should base care for grieving clients on the knowledge that the grieving process may last longer for people who have: A. Feelings of guilt B. Ambivalent feelings about death C. Failed to remarry after several years D. Close relationships with family members

Correct Answer: A Guilt feelings can prolong the grieving process because the individual is overwhelmed by both guilt and grief and consequently the energy needed to cope with both is excessive.

31. What is the most appropriate long-term goal for a client experiencing dysfunctional grieving after the death of a spouse? A. Resuming previously enjoyed activities B. Eating at least two meals a day with another person C. Decreasing negativistic thinking about other people D. Relocating to a state in which other family members reside

Correct Answer: A Resuming previously enjoyed activities is realistic, specific, and measurable; it relates to the client's acceptance of a new reason for being.

8. What is the most appropriate long-term goal for a client experiencing dysfunctional grieving after the death of a spouse? A. Resuming previously enjoyed activities B. Eating at least two meals a day with another person C. Decreasing negativistic thinking about other people D. Relocating to a state in which other family members reside

Correct Answer: A Resuming previously enjoyed activities is realistic, specific, and measurable; it relates to the client's acceptance of a new reason for being.

4. A client, who is in a late stage of pancreatic cancer, intellectually understands the terminal nature of the illness. Behaviors that indicate the client is emotionally accepting of impending death are that the client is: A. Revising the client's will and planning a visit to a friend B. Alternately crying and talking openly about death C. Getting second, third, and fourth medical opinions D. Refusing to follow treatments and stating they won't help anyway

Correct Answer: A Revising the will and planning a visit to a friend are realistic, productive, and constructive ways of using this time.

54. Fourteen months after the traumatic death of a spouse, a client comes to the mental health clinic complaining of continuing depression and states, "I haven't been seeing any of my friends or attending any of the activities I previously enjoyed. My children are married and live in another state, and I almost never see them." What does the nurse determine that the client is experiencing? A. Difficulty grieving B. Ineffective family interactions C. Problems in communicating with others D. Low motivation to resume daily activities

Correct Answer: A The client's grieving process is severe and extended, indicating dysfunction.

35. A woman at 22 weeks' gestation is admitted with heavy bleeding and severe abdominal cramping. When told that no fetal heart sounds can be detected, the client says to the nurse, "We wanted this baby so badly." How should the nurse respond? A. "It must be difficult to lose this baby that was important to you both." B. "This is nature's way of dealing with babies that may have problems." C. "A curettage will give you a new start. I'll bet you'll get pregnant again soon." D. "You must be disappointed, but don't feel guilty. These things sometimes happen."

Correct Answer: A The correct response acknowledges the loss and the grieving process. It also encourages the expression of feelings. Suggesting that "this is nature's way" minimizes the loss and may reflect the nurse's beliefs. Predicting that another pregnancy will occur soon does not acknowledge the loss and cuts off communication. Guilt feelings were never expressed by the client.

18. An older widow with lung cancer is now in the terminal stage of her illness. Her family is puzzled by her mood changes and apparent anger at them. The nurse explains to the family that the client is: A. Trying to avoid her situation B. Coping with her impending death C. Attempting to reduce family dependence on her D. Hurting because the family will not take her home to die

Correct Answer: B Anger is associated with one of the stages of dying; understanding the stages leading to the acceptance of death may help the family to accept the client's moods and anger.

58. A 68-year-old client who has metastatic carcinoma is told by the practitioner that death will occur within a month or two. Later the nurse enters the client's room and finds the client crying. Before responding, the nurse should consider that: A. Crying relieves depression and helps the client face reality. B. Crying releases tension and frees psychic energy for coping. C. Nurses should not interfere with a client's behavior and defenses. D. Accepting a client's tears maintains and strengthens the nurse-client bond.

Correct Answer: B Crying is an expression of an emotion that, if not expressed, increases anxiety and tension; the increased anxiety and tension use additional psychic energy and hinder coping. Crying does not relieve depression, nor does it help a client face reality.

9. A 28-year-old woman is recovering from her third consecutive spontaneous abortion in 2 years. What is the most therapeutic nursing intervention for this client at her follow-up appointment? A. Focusing on the client's physical needs B. Encouraging the client to verbalize her feelings about the loss C. Reminding the client that she will be able to become pregnant again D. Encouraging the client to think of herself, her husband, and their future

Correct Answer: B Focusing on the client's physical needs demonstrates understanding of grief work; however, the nurse should first help the client resolve the current problem. Although this is important, it focuses only on a part of the necessary interventions; the client needs help to cope with her loss.

24. A nurse is providing education to a community group about hospice. The nurse clarifies that the primary goal of hospice is help clients do what? A. Have the option of assisted suicide B. Remain comfortable until the end of life C. Explore the newest treatments for their form of cancer D. Release family members from participating in care

Correct Answer: B Hospice care attempts to break the cycle of fear and pain; care focuses on keeping the client as comfortable and high functioning as possible. Hospice care is provided after all treatments have failed; this care is provided during terminal stages of illness. Family members can be involved in the client's care; hospice services provide a supportive environment for both client and family.

11. A client with chronic kidney disease has been on hemodialysis for two years. The client relates to a nurse in the dialysis unit in an angry, critical manner and frequently does not follow the prescribed diet or take prescribed medications. What does the nurse identify as the most likely underlying cause of this behavior? A. A constructive method of accepting reality B. A defense against underlying depression and fear C. An attempt to punish the nurse and the members of the staff D. An effort to maintain the previous lifestyle as much as possible

Correct Answer: B Hostility and nonadherence to a treatment regimen are forms of anger that are associated with grieving.

20. The nurse determines that to help a couple work through their feelings about the husband's terminal illness, it is important to: A. Refer the husband to the psychotherapist for assistance in coping with his anger. B. Assist the couple to express their feelings about his terminal illness to each other. C. Encourage the wife to verbalize her feelings to a therapist during a therapy session. D. Place the couple in a couples' therapy group that addresses the terminal illness of one partner.

Correct Answer: B It is important for the couple to discuss their feelings to maintain open communication and support each other.

48. An infant is born with a life-threatening congenital heart defect and is admitted to the neonatal intensive care unit. What is the priority nursing intervention at this time? A. Having the hospital chaplain visit the parents B. Assisting the parents with the grieving process C. Obtaining a prescription for a sedative to ease the parents' anxiety D. Arranging for a social worker to talk to the parents about available resources

Correct Answer: B Parental grieving is expected and necessary whenever an infant is born with severe problems; the parents are grieving the loss of a "normal baby."

26. The nurse is providing care for parents who have experienced a stillbirth. What is the most appropriate intervention? A. Giving a detailed explanation of what may have caused the stillbirth B. Providing the parents the opportunity to say goodbye to their newborn C. Explaining that autopsy is not recommended in the setting of a stillbirth D. Waiting to provide any information about follow-up care until the parents have had an opportunity to adjust to the grief

Correct Answer: B Parents should be given the opportunity to say goodbye to a stillborn baby. Because the parents may not think to ask to see the baby, the nurse should provide this opportunity.

16. After a difficult labor a client gives birth to a 9-lb boy who dies shortly afterward. That evening the client tearfully describes to the nurse her projected image of her son and what his future might have been. What is the nurse's most therapeutic response? A. "I guess you wanted a son very much." B. "It must be difficult to think of him now." C. "I'm sure he would have been a wonderful child." D. "If you dwell on this now, your grief will be harder to bear."

Correct Answer: B Stating that it must be difficult to think of him now demonstrates empathy; the nurse is attempting to show understanding of the client's feelings.

27. After a difficult labor a client gives birth to a 9-lb boy who dies shortly afterward. That evening the client tearfully describes to the nurse her projected image of her son and what his future might have been. What is the nurse's most therapeutic response? A. "I guess you wanted a son very much." B. "It must be difficult to think of him now." C. "I'm sure he would have been a wonderful child." D. "If you dwell on this now, your grief will be harder to bear."

Correct Answer: B Stating that it must be difficult to think of him now demonstrates empathy; the nurse is attempting to show understanding of the client's feelings.

41. A client with an inoperable temporal lobe tumor is experiencing frightening audio hallucinations, especially when alone. How can the nurse best help the client cope with these hallucinations? A. By moving the client to a four-bed room closer to the nurses' station B. By suggesting that the client turn on the radio or television when alone C. By working out a schedule for visitors so the client will never be alone D. By having family or friends remain with the client until the hallucinations stop

Correct Answer: B Stimuli such as a television or radio encourage the client to remain reality oriented; research has shown that competing stimuli are useful in controlling hallucinations.

33. A client who has been pregnant for 5 months experiences a spontaneous abortion after an accident. The client tells the nurse that she feels depressed over the loss of her son. She describes how he would have looked and how bright he would have been. What is the client demonstrating? A. Panic level of anxiety B. Typical grief syndrome C. Pathological grief reaction D. Diminished ability to test reality

Correct Answer: B The client is grieving the loss of a fantasized child; talking about it is part of the typical grief reaction. The client is sad, not out of control or immobilized. The client is coping with the loss effectively. The client recognizes the loss but is lamenting what could have been.

57. A nurse is counseling a recently widowed client, who says, "His death has complicated my life even more than the hassles he caused when he was alive!" The nurse realizes the client is having difficulty with the grieving process and nurse concludes that the relationship with the husband was probably: A. Loving B. Long-term C. Ambivalent D. Subservient

Correct Answer: C If the relationship was ambivalent, the surviving spouse now has feelings of both anger and guilt to resolve. A loving relationship evokes fewer feelings of guilt and is followed by a less complicated grieving process.

58. An older woman comes to the mental health clinic and reports, "I've not been feeling right and haven't been able to sleep or eat since my husband died 8 months ago." The nurse determines that the client is experiencing grief associated with the loss of the husband. What supports this conclusion? A. Inability to talk about her loss B. Difficulty in expressing her loss C. Lack of sleep and the presence of symptoms of depression D. Prolonged period of grief and mourning after her husband's death

Correct Answer: C Insomnia, depressed mood, anxiety, and anorexia are common responses associated with loss, especially the death of a spouse. Eight months does not constitute a prolonged period of mourning, and therefore her grieving is not impaired. The client is communicating information about not "feeling right" since her husband's death.

21. A terminally ill client in a hospice unit for several weeks is receiving a morphine drip. The dose is now above the typical recommended dosage. The client's spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. What should the nurse do? A. Add a placebo to the morphine to appease the spouse. B. Discuss with the spouse the risk for morphine addiction. C. Assess the client's pain before increasing the dose of morphine. D. Check the client's heart rate before increasing the morphine to the next level.

Correct Answer: C Over time clients receiving morphine develop tolerance and require increasing doses to relieve pain, thus requiring continuing reassessments.

45. A terminally ill client repeatedly tells the nurse all the details of a daughter's wedding that will take place in 6 months and how important it is for her to attend. What Kübler-Ross stage of grieving does the nurse identify? A. Anger B. Denial C. Bargaining D. Acceptance

Correct Answer: C The client, looking forward to attending a future event, is bargaining for time. During the anger stage of grieving the client verbally or physically expresses feelings through the extremes of expression such as irritation to rage. During denial the client is in shock and is unable to face the reality of the situation. During acceptance the client comes to terms with the situation and may have a decreased interest in people and surroundings.

44. A 6-week-old infant and his mother arrive in the emergency department in an ambulance. The father arrives several minutes later with two children, 7 and 9 years old. The infant is not breathing, and the eventual diagnosis is sudden infant death syndrome (SIDS). The parents take turns holding the infant in another room. The nurse remains present and provides emotional support to the parents. What is an important short-term goal for this family? A. Identifying the problems that they will be facing as a result of the loss of the infant B. Accepting that there was nothing that they could have done to prevent the infant's death. C. Including the infant's siblings in the events and grieving in the wake of the infant's death D. Seeking out other families who have lost infants to SIDS and obtaining support from them

Correct Answer: C The other children need to be involved with the grieving process and to work through their own feelings.

60. A clinically depressed young mother whose husband has been killed tells the nurse that she sees no purpose in life and feels like ending it all. What is the best response by the nurse? A. "How much consideration have you given to the method you'd use to kill yourself?" B. "Death is hard on everyone, but people make it through every day. You'll see; things will get better." C. "It can be hard to lose someone you care about so much; it can seem that life isn't worth living right now." D. "You feel that way now, but you still have your whole life ahead of you. Why don't you try to make a new start?"

Correct Answer: C The response "It can be hard to lose someone you care about so much; it can seem that life isn't worth living right now" validates the client's experience and opens a channel of communication for further exploration; empathy helps build trust. Asking how much consideration the client has given to the method she would use to kill herself is premature; the nurse should first explore the client's feelings before discussing thoughts and plans.

14. The grieving wife of a client who has just died says to the nurse, "We should've spent more time together. I always felt that the children's needs came first." The nurse recognizes that the wife is experiencing: A. Displaced anger B. Shame for past behaviors C. Expected feelings of guilt D. Ambivalent feelings about her husband

Correct Answer: C The wife is expressing the expected feelings of guilt associated with the death of a loved one; there is initially guilt over what might have been. She is expressing guilt, not shame. There is no evidence to indicate that she is experiencing displaced anger or ambivalent feelings about her husband.

2. A client whose wife recently died appears extremely depressed. The client says, "What's the use in talking? I'd rather be dead. I can't go on without my wife." What is the best response by the nurse? A. "Would you rather be dead?" B. "What does death mean to you?" C. "Are you thinking about killing yourself?" D. "Do you understand why you feel that way?"

Correct Answer: C The response "Are you thinking about killing yourself?" is the most important assessment to make because suicide is a possibility with every depressed client.

42. Which statements made by a terminally ill client address areas of concern regarding end-of-life care nursing care? Select all that apply. A. "I want my children to carry in my casket." B. "I've prepaid all my funeral expenses so I won't be a burden." C. "My living will states that I want no heroic measures to prolong my life." D. "Pain is a concern of mine, so I've discussed that thoroughly with my doctor." E. "I've made arrangements that will allow me to spend my final days in my own home."

Correct Answer: C, D, E A living will addresses the type of care that an individual desires when she is dying. The statement "I've made arrangements that will allow me to spend my final days in my own home" provides an understanding of the client's wishes regarding where her death will occur. Pain control is often a major area of concern in regard to end-of-life care. Actual funeral and financial arrangements are not considered topics related to end-of-life nursing care.

17. A 76-year-old widower is terminally ill. He is very quiet and is unwilling to have visitors. During the initial contact with this client, the nurse should: A. Assess what the client knows about death and the dying process. B. Avoid talking about his condition unless he initiates the discussion. C. Encourage him to accept phone calls from those who wish to visit with him. D. Explore the extent to which he understands his situation and what the information means to him.

Correct Answer: D A starting point for working with all clients is ascertaining what is known, their understanding of their particular situation, and its meaning to them. It is not merely understanding what death and the dying process means but also how the individual feels about the current situation.

46. A nurse in a hospice program cares for clients and family members who are coping with imminent loss. What is the most important factor in predicting a person's potential reaction to grief? A. Family interactions B. Social support system C. Emotional relationships D. Earlier experiences with grief

Correct Answer: D How a person has handled grief in the past provides clues to how he or she will cope with grief in the present.

59. Often when a family member is dying, the client and the family are at different stages of grieving. During which stage of a client's grieving is the family likely to require more emotional nursing care than the client? A. Anger B. Denial C. Depression D. Acceptance

Correct Answer: D In the stage of acceptance, the client frequently detaches from the environment and may become indifferent to family members. In addition, the family may take longer to accept the inevitable death than does the client.

10. A client whose spouse died 2 years ago is brought to the psychiatric unit by a family member, who states that the widowed spouse has no interests, is neglecting personal hygiene, and has become totally isolated. The nurse completes a history and physical examination that verifies the family member's concerns. What is most important for the nurse to explore with the client at this time? A. Feelings about the spouse's death B. The real cause of the depressed behavior C. The relationship with the deceased spouse D. Whether suicide has been considered recently

Correct Answer: D The client is depressed; it is important to know whether the client is considering suicide so the nurse can provide a safe environment and related therapeutic care. Concern for the client's safety takes priority at this time over the client's feelings, the underlying cause of the behavior, or the dynamics of the marital relationship.

15. A nurse is assessing the grief response of a family member whose relative has died. What must the nurse consider first about the family to conduct an effective assessment? A. Personality traits B. Educational level C. Socioeconomic class D. Cultural background

Correct Answer: D The degree of anguish experienced or expressed is most often set or imposed by the cultural background of the individual, so cultural background must be assessed before care is planned.

34. A family has decided to withhold extraordinary care for a newborn with severe abnormalities. How should the nurse interpret this decision? A. The newborn has no rights. B. It is the same as euthanasia. C. It is illegal professional practice. D. The newborn is being allowed to die.

Correct Answer: D The family's decision means that extraordinary care does not have to be employed; the infant's basic needs will be met and nature will be allowed to take its course.

47. A hospice nurse is caring for a dying client and his wife. What factor will be a major determinant in the mourning outcome for the wife? A. Duration of the relationship shared by the couple B. Age of the wife at the time of the husband's death C. Health of the surviving spouse at the time of the death D. Importance of the deceased person as a source of support

Correct Answer: D The more dependent the client was on the deceased for support, the more difficult the grieving process will be. Emotional and financial considerations are major factors.

1. In an effort to foster a healthy grief response to the birth of a stillborn child, the nurse responds to the mother's questions about the cause by saying: A. "This often happens when something is wrong with the baby." B. "It's God's will; we have to have faith that it was for the best." C. "You're young, and you'll have other children—wait and see." D. "You may be wondering whether something you did caused this."

Correct Answer: D The mother must be helped to identify her feelings. Telling her that she is young and will have other children" is false reassurance; it does not encourage the client to explore her feelings. Many stillborn children are apparently free of any defects. Telling the woman that it was God's will and that we have to have faith that it was for the best is based on the nurse's religious beliefs; there is no indication that the client has the same beliefs, so this closes off communication.

19. A nurse is with the parents of a 3-year-old child who has just died. The most therapeutic question for the nurse to ask the parents is: A. "Do you feel ready to consent to an autopsy?" B. "Have you made a decision made about organ donation?" C. "Would you like to talk about how you'll tell your other children?" D. "Can I be of any help with traditional practices that are important to you?"

Correct Answer: D The nurse should be sensitive to any cultural or religious beliefs that may help the parents cope with their grief. Immediately discussing the topic of autopsy or organ donation is insensitive to the parents' grief at this time. The parents are too involved with their own grief at this time to consider their other children's grief.

22. A hospice nurse visits the home of a female client in the terminal stage of cancer 3 days each week to provide physical care and emotional support. The nurse observes that the client's adolescent children are having difficulty talking with their mother. The nurse suggests a family meeting, knowing that: A. It is important to solve family problems before death occurs. B. They will be unable to deal with their feelings until after their mother dies. C. A deeper level of knowledge will help the children understand what their mother is going through. D. The opening of communication increases the ability of family members to work through their reactions to the terminal illness.

Correct Answer: D The opening of communication among family members is therapeutic. Anxiety and stress tend to close communication; this in turn impairs the family's ability to work through the grieving process.

23. A female client terminally ill with cancer says to the nurse, "My husband is avoiding me. He doesn't love me anymore because of this awful tumor!" What is the nurse's most appropriate response? A. "What makes you think he doesn't love you?" B. "Avoidance is a defense. He needs your help to cope." C. "Do you think he's having difficulty dealing with your illness?" D. "You seem very upset. Tell me how your husband is avoiding you."

Correct Answer: D The response "You seem very upset. Tell me how your husband is avoiding you" validates the client's feelings and encourages the client to look at the basis or reality of the expressed concern. The response "What makes you think he doesn't love you?" ignores the client's statement; the client has already told the nurse the basis for the feelings.

12. A terminally ill client is moving gradually toward resolution of feelings about impending death. In a plan of care based on Elisabeth Kübler-Ross' research, the nurse should use nonverbal interventions after having assessed that the client is in the: A. Anger stage B. Denial stage C. Bargaining stage D. Acceptance stage

Correct Answer: D When acceptance is reached, the individual is beginning to withdraw from life; communication is simple, concise, and most often nonverbal. Kübler-Ross research has shown that this stage usually requires verbal interventions and communication. The client has moved past the anger, denial, and bargaining stages.