Grief and Loss - Videbeck Ch.10, Chapter 10: Grief and Loss, Chapter 10

A young couple just ended their relationship after a 9-month engagement. One of the individuals is seeking short-term counseling to assist in grieving this loss. Which type of loss best describes what this client is experiencing? A) Safety loss B) Loss of security and sense of belonging C) Loss of self-esteem D) Loss related to self-actualization

B

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? Maturational loss Anticipatory grief Dysfunctional grieving Bereavement

Anticipatory loss occurs when a person displays loss and grief behaviors for a loss that has yet to take place. It is often seen in the families of clients with serious or life-threatening illnesses and serves to lessen the effect of the actual loss of a family member.

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 feelings related to the pet's death are insignificant. The client does not want to remember the memories of the pet. The client feels that the nurse would not consider the grief as significant. The client feels that the nurse would not be able to make the client feel better.

A loss, such as the death of a pet, may not be considered socially significant and, therefore, the accompanying grief would not be legitimized. The client feels that the nurse would not consider the grief as significant and would not take it seriously. This is reflective of disenfranchised grief. It is not likely that the client is trying to avoid the thoughts related to the loss. The client is less likely to feel that the nurse would not be able to help.

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 person cries frequently and loudly in the weeks following a child's death in an accident A person blames oneself for not doing more to make a spouse's recent death more comfortable A person has been experiencing chronic insomnia since the person's mother's death earlier this year

An inability to return to normal activities 18 months after a sibling's death is suggestive (though not definitive) of complicated grieving. Crying and having difficulties sleeping are not unusual and will often accompany healthy grieving. A feeling of "not doing enough" is common during grief and would only be considered dysfunctional if this became a long-term and all-encompassing belief.

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

Children face many challenges. Research shows that, like adults, children who experience major losses are at risk for mental health problems. The grieving process differs somewhat for children and adults because children's responses to loss reflect their developmental levels.

Which type of grief occurs when a person is stuck in a state of chronic grieving? complicated grief traumatic grief uncomplicated grief bereavement

During complicated grief, the person is frozen or stuck in a state of chronic mourning. Most bereaved people experience normal or uncomplicated grief after the loss of a loved one. Traumatic grief is a more difficult and prolonged grief in which external factors influence the reactions and potential long-term outcomes. Bereavement is the process of mourning and coping with the loss of a loved one.

A group of nursing students is reviewing information about grief and bereavement. The students demonstrate understanding of the information when they state: Grief and bereavement are used interchangeably as responses to loss. Bereavement is the process of mourning and grief is the emotional reaction. Grief involves confronting the stressor, but bereavement helps to avoid the stressor. Bereavement is influenced by culture, but grief is not.

Grief is an intense, emotional reaction to the loss of a loved one. The reaction is a biopsychosocial response that often includes spontaneous expression of pain, sadness, and desolation. Bereavement is the process of mourning and coping with the loss of a loved one. It begins immediately after the loss, but it can last months or years. Individual differences and cultural practices influence grieving and bereavement.

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

Hope is the ingredient of life that enables an individual to consider a future and to actively bring that future into being. One way the nurse can enable hope in the dying client is to provide honest information about the progress of the illness

A 74-year-old is being seen in the mental health clinic. The client has never fully regained the level of activity the client had prior to the death of the client's spouse. The client continues to have symptoms of depression and has not been able to work or volunteer. In addition, the client complains of "anxiety attacks" that occur nearly every night. What type of grief reaction is this client exhibiting? The client is experiencing a normal grief reaction and does not need any intervention at this time. The client is experiencing a prolonged reaction but within normal limits of the grieving process. The client is having a prolonged reaction to the spouse's death, but since the client is surrounded by family members who provide support, the client does not need any interventions at this time. The client is experiencing complicated grieving reaction. The client needs to have a comprehensive mental health assessment.

In the case of complicated grief, it is important to treat as soon as possible. Unresolved grieving can lead to other psychological, as well as physical, problems if left untreated. Even in the case of extensive family support, medications are often needed to assist the individual to recover completely from this type of grief reaction.

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

In this case, the charge nurse's best option for nursing assignment to this client is to assign the nurse who has worked with the client before and after the amputation. At present the client's ability to relate to others may be impaired. Limiting the number of new contacts initially will promote familiarity and trust and decrease the client's feelings of being overwhelmed.

The nurse is caring for a hospitalized client who just received the news that a mass in the neck is malignant. As the nurse engages in an assessment of the client's needs, the nurse asks, "Who has been a helpful person to you in the past when you were having a difficult time?" Which component of the assessment is the nurse exploring? perception of loss support while grieving coping behaviors anticipatory grieving

In this situation, the nurse asks this question to assess the the quality of the client's support system. The nurse intends to provide the grieving client with an awareness of those who can meet the client's emotional and spiritual needs for security and love. Asking about who was helpful in previously difficult times can make this decision easier for the client. When exploring the perception of loss, the nurse should ask open-ended questions to determine what the loss means to the client. When exploring coping behaviors, the nurse should ask questions about how the client has coped with difficulty in the past or look for clues such as changes in appetite or avoiding visitors. Anticipatory grieving refers to when people face an imminent loss and begin to grapple with the very real possibility of the loss. Question pertaining to this concept would be asked when exploring the client's perception of loss in the assessment.

A woman has had a breast removed to treat cancer. What type of loss will she most likely experience? Physiologic loss Perceived loss Maturational loss Anticipatory loss

Loss occurs when a valued person, object, or situation is changed or made inaccessible so that its value is diminished or removed. Physiologic loss can be recognized by others as well as by the person sustaining the loss.

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

Ongoing self-examination is an effective method of keeping the therapeutic relationship goal-directed and acutely attentive to the client's needs. Honestly answering if a nurse is still effective in the care he or she gives grieving clients is the most effective way to determine overall therapeutic approach. The remaining options are more nurse than client focused.

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 Working through the pain of grief Adjustment to the environment that has changed due to the loss Emotional relocation of that which has been lost and moving on with life

The client is arranging a funeral ceremony for the client's child. Thus, the client is starting to acknowledge the loss. According to the Worden's tasks of grieving, the client is accepting the reality of the loss. Experiencing emotional and physical pain that has occurred due to the loss is the task of working through the pain of grief. The client is trying to learn the effective strategies that could reduce the stress associated with the loss. This is referred to as the task of adjustment to the environment that has changed due to the loss. If the client has relocated the memories associated with the loss and has started to form new relationships and friends, it indicates that the client is accomplishing the task of emotional relocation of that which has been lost and is moving on with life.

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 mosteffective use of communication skills? "I just want you to know that I am available to talk when you are feeling up to it." "Have I said something to offend you?" "I can sit with you here so that you don't feel alone." "It would be beneficial for you to connect with other people who have had this surgery."

The client is demonstrating adaptive denial in that she is gradually adjusting to the loss. The nurse should use a simple, nonjudgmental statement to acknowledge the client's loss, such as, "I just want you to know I am available to talk when you are feeling up to it." Effective communication skills can be useful in helping the client in adaptive denial move toward acceptance.

Which are considered physiological signs the nurse expects to observe in a grieving individual? Select all that apply. Hypersomnia Weight gain Indigestion Palpitations Lack of energy

The client may experience indigestion, palpitations, and lack of energy due to grief. While experiencing grief, the client may sleep more than usual throughout the day rather than during one specific time of day. Grief may suppress the client's appetite resulting in weight loss and not weight gain.

The client expresses grief about not being able to fulfill the wish to pursue doctoral studies. Which type of loss does this indicate? Loss of safety Loss of self-esteem Loss related to self-actualization Loss of security and a sense of belonging

The loss due to an external or internal crisis that inhibits the individual's desire for fulfillment of personal goals is referred to as loss related to self-actualization. In this case, the client is grieving about not being able to fulfill a wish to do doctoral studies, meaning the client is unable to fulfill a goal. Thus, this is a type of loss related to self-actualization. Safety loss refers to the loss of a safe environment. Loss of self-esteem refers to the change in how a person is valued at work or in relationships or by himself or herself. Loss of security and a sense of belonging refer to the changes in relationships that affect an individual's need to love and the feeling of being loved.

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 mostaccurate explanation for the client's grief response? emotional behavioral spiritual physiologic

The nurse can explain to the client that this is a behavioral response to grief. Drug and alcohol abuse indicate the client has developed a maladaptive response to the spiritual and emotional despair related to the death of the mother. Emotional responses to grief are characterized by the expression of a range of emotions over the course of the grieving process. Alcohol abuse is not an emotional response in grief, however, it is a behavior that is used to attempt to manage the emotional pain associated with the loss. Spiritual responses to grief are related to an individual's personal values regarding the spiritual dimension of the human experience. Although alcohol abuse is not a spiritual response to grief, it can be a behavioral response to the spiritual discord the client may be experiencing as he processes the mother's death. Physiologic responses to grief refer to the natural body responses that emerge for the body to adapt to loss. Although the client may use alcohol to try to treat a physiologic response to grief---for example, to promote sleep or calm anxiety---it remains a behavioral response.

A nurse has been present for the hospital death of a Muslim client who was surrounded by family members when the client passed. The nurse demonstrates appropriate cultural considerations when stating: "You probably won't cremate the body, will you?" "How would you like to complete the five steps of the burial process?" "Shall I ask the pastor to attend for support?" "Are there any rituals you will observe here for your loved one?"

The nurse is making the appropriate cultural considerations when asking the more open-ended question of "Are there any rituals you will observe here for your loved one?" The nurse demonstrates that effects of acculturation may have caused the family to lose, minimize, modify, or set aside specific culture related rituals. Asking the questions from any of the other options indicates the nurse has not accounted for acculturation and is making assumptions about the family's wishes for the deceased.

Videbeck Ch.10 Chapter Study Guide 1. which of the following give cause to the nurse that a client may be grieving for a loss? a. Sad affect, anger, anxiety, and sudden changes in mood b. Thoughts, feelings, behavior, and physiologic complaints c. Hallucinations, panic level of anxiety, and sense of impending doom d. Complaints of abdominal pain, ,diarrhea, and loss of appetite.

b

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 Situational Inhibited Maturational

Unresolved grief is abnormal or distorted; it may be either unresolved or inhibited. In unresolved grief, a person may have trouble expressing feelings of loss or may deny them; unresolved grief also describes a state of bereavement that extends over a lengthy period. With inhibited grief, a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations.

The nurse is informing the client about being diagnosed with cancer. Which is most likely going to be the client's initial reaction? Anger Shock Anxiety Depression

Upon receiving the diagnosis of the disease, the client is most likely to be in a state of shock or disbelief. Shock is considered a universal reaction to loss. During this phase, the client is unable to accept the loss. Anger is most likely the next reaction. It is where the client would express anger toward God, family, and health care providers. Anxiety occurs when the client is waiting for the diagnosis and also when the client accepts the loss and starts feeling helpless. Once the client has accepted the loss, the client starts having negative feelings such as depression.

Friends of a teenage male recently killed in a car accident are discussing their sense of loss. Which of the following comments best indicates that the friends are trying to make sense of the loss cognitively? A) "Why did he have to die so young?" B) "He shouldn't have been driving so recklessly." C) "If we had only stayed longer, he would not have been on that road." D) "It took the ambulance too long to get there."

a

The nurse is establishing outcomes for a grieving client. Which of the following is an appropriate outcome? A) The client will develop a plan for coping with the loss. B) The client will demonstrate self-reliance during the grief process. C) The client will suppress emotions related to the loss. D) The client will verbalize that loss will not adversely affect the quality of life.

a

The nurse is working with a client who lost her youngest child two months ago. When the nurse approaches, the client yells, "I don't want to talk to you. You have no idea what it's like to lose a child!" The nurse bases her response to the client on the understanding of which of the following? A) Hostility is a common behavioral response to grief. B) It is too soon after the loss to empathize with the client. C) Personality traits such as aggressiveness are exaggerated during the grief process. D) The nurse may have nonverbally indicated a judgmental attitude toward the client.

a

Videbeck Ch.10 Chapter Study Guide 4. Critical factors for successful integration of loss during the grieving process are a. the client's adequate perception, adequate support, and adequate coping b. the nurse's trustworthiness and healthy attitudes about grief c. accurate assessment and intervention by the nurse or helping person d. the client's predictable and steady movement from one stage of the process to the next

a

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which statement, made by the nurse, focuses on the purposeful assessment of a client coping with a terminal diagnosis? a. "Who do you want to share information about your prognosis with?" b. "How can I help you right now?" c. "Getting such news has to be upsetting; can we talk about your feelings?" d. "Social services will help make the arrangements for your hospice care."

a "Who do you want to share information about your prognosis with?" Purposeful assessment of support systems provides the grieving client with an awareness of those who can meet his or her emotional and spiritual needs for security and love. The nurse can help the client to identify his or her support systems and reach out and accept what they can offer. The remaining options provide attempts at support that the client may not be ready or able to accept at this time.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions The nurse most effectively explains to a terminally ill client's wife that the frustration and anger her spouse is exhibiting is associated with what aspect of dying? a. An expression of a universally held need of the dying b. A sign of the anger stage of grieving c. A symptom of poor acceptance of his inevitable death d. An unconscious means of facilitating separation with loved ones

a An expression of a universally held need of the dying The nurse most effectively explains to a terminally ill client's wife that the frustration and anger he is exhibiting are an expression of a universally held need of the dying. They are not signs of the anger stage of grieving, a symptom of poor acceptance of inevitable death, or an unconscious means of facilitating separation with loved ones.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following is a cognitive response to grief? a. Attempting to keep the lost one present b. Indigestion c. Guilt d. Anguish of abandonment

a Attempting to keep the lost one present Attempting to keep the lost one present is a cognitive response to grief. Indigestion is a physiologic response. Guilt is an emotional response. Anguish of abandonment is a spiritual response.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following stages of grieving, according to Kubler-Ross (1969), occurs when the person asks God or fate for more time to delay the inevitable loss? a. Bargaining b. Anger c. Depression d. Denial

a Bargaining Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. Denial is shock and disbelief regarding the loss. Anger may be expressed toward God, relatives, friends, or health care providers. Depression results when awareness of the loss becomes acute.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following can correctly be identified as a behavioral response to grief? a. Crying uncontrollably b. Lack of energy c. Palpitation d. Weight Loss

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

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions The final need, according to Maslow (1954), includes a. Self-acutalization b. Security and belonging c. Safety d. Physiologic

a Self-actualization Self-actualization is the final need and is the ability to realize one's full innate potential. Safety needs include a safe place to live and work. Physiological needs include food, air, and water, Security and belonging involve satisfying relationships.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions A hospice nurse is providing emotional care and support for a family who lost a son. The care will be provided based on what knowledge? a. Stages of grief reactions may overlap and are individualized b. Bereavement is a normal process, requiring little intervention c. Grief is an abnormal physical reaction to a loss d. All members of the family will react to loss in the same way

a Stages of grief reactions may overlap and are individualized Although reactions to grief and dying are similar, the stages of grief reactions overlap and vary among individuals. Each person is different, and family members may be at different reaction stages.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Considering the spiritual response to grief, which nursing intervention has the potential of providing the most support to a grieving client? a. asking, "Do you find comfort in your religion at times like this?" b. sitting silently with the client as he or she cries c. arranging for the hospital chaplain to visit the client d. explaining the stages of grief to the client

a asking, "Do you find comfort in your religion at times like this?" Ministering to the spiritual needs of those grieving is an essential aspect of nursing care. The client's emotional and spiritual responses become intertwined as he or she grapples with pain. With an astute awareness of such suffering, nurses can promote a sens of well-being. Providing opportunities for clients to share their suffering assists in the psychological and spiritual transformation that can evolve through grieving. While the remaining options are not inappropriate when agreed to by the client, non of them directly assesses the client's spiritual response to the grieving process.

The bereaved client has worked through many processes of grief with the nurse. Which of the following are eventual outcomes of the emotional dimension of grieving? Select all that apply. A) The survivor begins to reestablish a sense of personal identity, direction, and purpose for living. B) The survivor begins to gain independence and confidence. C) The survivor develops new ways of managing life and new relationships. D) The survivor's life returns to the same state as it was before the loss. E) The survivor forgets about the loss.

a b c

Which of the following persons are most likely experiencing complicated grieving? Select all that apply. A) The spouse of a person who died 7 years ago and visits the grave several times a day. B) The grandchild of a soldier killed in war who visits the grave once a year on Memorial Day. C) A driver whose spouse and children all died as a result of his driving drunk. D) An adult who insisted for many years that she hated her deceased parent. E) The parent of a child who died after the having left the child in a car on a hot day.

a c d e

The nurse is caring for a hospice client whose death is imminent. In preparing the family for the death of their loved one, then nurse prepares to assist the family in which of the following, regardless of the family's cultural preferences? Select all that apply. A) Dealing with the shock of losing a loved one B) Burial plans after death had occurred C) Efforts to stay connected to the client after death D) Use of support from family and friends E) Anger at the loss of a loved one

a c e

While the nurse is observing the grieving client, which of the following are critical components in assessment of a person's grief? Select all that apply. A) Adequate perception regarding the loss B) Adequate time to experience the loss C) Adequate support while grieving for the loss D) Adequate opportunities to say goodbye to the person E) Adequate coping behaviors during the process

a c e

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions A Chinese client has just passed away. Which ritual would be performed in the funeral in order to assist the spirit of the decreased in the afterlife journey? Select all that apply. a. Burning incense b. Reading scriptures c. Performing Voodoo ritual d. Performing the five steps burial procedure e. Dressing the body in a white kimono

a,b The Chinese read scriptures and burn incense and believe that doing this would help in assisting the spirit of the deceased in the Journey of afterlife. A voodoo ritual is done by the Haitians to make peace with spirits. Dressing the body in white kimono is done in the Japanese to purify the spirit. The five steps burial procedures is followed in Islam.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Assessment of a client indicates complicated grief. Which statements would the nurse identify as supporting this reaction? Select all that apply. a. "I still wait for him to come right through the door every day." b. "I'm really struggling with trusting anybody anymore." c. "Life seems so empty now that he's gone. What will I do?" d. "I wish I could go back to the days before he die." e. "It's been 2 months, and I still want my son back."

a,b,c,d Complicated grief, which occurs in about 10% to 20% of bereaved persons, is characterized by the person being frozen or stuck in a state of chronic mourning. They feel bitter over their loss and wish that their lives could revert to the time when they were together. In addition, the person experiences an intense longing and yearning for the decreased for more than 6 months. Additionally, the person may have trouble accepting the death, an inability to trust others since the death, excessive bitterness related to the death, and feeling that life is meaningless without the decreased person.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions An Islamic client has passed away. Which processes would be included in the burial procedure? Select all that apply. a. Positioning of the body b. Dressing of the body c. Cremation of the body d. Washing of the body e. Reciting prayer of the deceased

a,b,d,e According to Islam, cremation of the body isn't permitted. Bodies are buried. The steps include in the Islamic funeral are dressing, washing, positioning, prayer of the decreased, and burial.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following are considered physiological signs the nurse expects to observe in a grieving individuals? Select all that apply. a. Palpitations b. Lack of energy c. Hypersomnia d. Weight gain e. Indigestion

a,b,e The client may experience indigestion, palpitations, and lack of energy due to grief. While experiencing grief, the client may sleep more than usual throughout the day rather than during one specific time of day. Grief may suppress the client's appetite resulting in weight loss and not weight gain.

Videbeck Ch.10 Chapter Study Guide Select all that apply. 1. Rando's Six Rs of grieving tasks include: a. React b. Read c. Readjust d. Recover e. Reinvest f. Restitution

a,c,e

Videbeck Ch.10 Chapter Study Guide Select all that apply. 2. Nursing interventions that are helpful for the grieving client include: a. Allowing denial when it is useful b. Assuring the client that it will get better c. Correcting faulty assumptions d. Discouraging negative, pessimistic conversation e. Providing attentive presence f. Reviewing coping behaviors

a,c,e,f

A client is scheduled for a mastectomy for breast cancer. She is quiet, shows little emotion, and states that she has no questions. The nurse's assessment would need to focus on... A) the client's plans for reconstructive surgery. B) the meaning of the mastectomy to the client. C) whether the client truly understands the surgery. D) why the client seems depressed.

b

A client states to a nurse, "They found a lump in my neck, and now they tell me I have an incurable disease." The client is young and appears to find this information hard to believe. The client's statement shows the pattern of response called... A) restitution. B) shock and disbelief. C) physiologic grieving. D) recovery.

b

After the death of a client's wife, a man tells the nurse "I can never live without my wife. My wife was my whole life." Which is the most therapeutic response from the nurse? A) "Remember, your wife is no longer suffering." B) "Your wife's death is a terrible loss for you." C) "Each day will get a little better." D) "Your friends will help you cope with this."

b

The nurse is conducting a history and physical exam on a client who is grieving the unwanted loss of a marriage by divorce. Which of the following physical symptoms of grief would the nurse most likely expect to detect in the history? A) Hair loss B) Insomnia C) Compulsive behaviors D) Vomiting

b

The nurse is having an initial meeting with a client who has just spontaneously lost her unborn child. After establishing rapport, the priority nursing intervention should focus on which of the following? A) Assessing the client's support system B) Exploring what this loss means for the client C) Discussing helpful ways to cope with the loss D) Assessing what knowledge the client desires about the situation

b

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions The client's mother passed away and the client is crying incessantly. According to the George Engel's Stages of Grieving, which stage of grief is the client in? a. Shock and disbelief b. Developing awareness c. Restitution d. Resolution of the loss

b Developing awareness Crying indicates that the client is starting to acknowledge that his mother has passed away. According to the George Engel's Stage of Grieving, the client is in the stage of developing awareness. Restitution is the stage of grief where the clients start participating in the rituals associated with loss. This helps the individual accept the loss and thus begins the recovery process. Shock and disbelief is the first stage where the client becomes numb and is unable to acknowledge the loss. Resolution of the loss is the stage of grief where an individual is extremely preoccupied with the loss.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following is a term used to describe grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially? a. Mourning b. Disenfranchised grief c. Anticipatory grieving d. Bereavement

b Disenfranchised grief Disenfranchised grief is grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially. Anticipatory grieving is when people facing imminent loss begin to grapple with the very real possibility of the loss or death in the near future. Bereavement refers to the process by which a person experiences the grief. Mourning is the outward expression of grief.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following is the most frequent and persistent bereavement-associated symptom? a. Impaired appetite b. Sleep disturbances c. Headaches d. Indigestion

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

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions During which phase of Bowlby's grief process does the bereaved person begin to reestablish a sense of personal identity, direction, and purpose for living? a. Phase of yearning and searching b. Phase of recognition c. Phase of numbing d. Phase of disorganization and despair

b Phase of recognition During the phase of rcognition, the bereaved person begins to reestablish a sense of personal identity. During the phase of disorganization and despair, the bereaved person begins to understand the loss'permanence. During the phase of yearning and searching, reality begins to set in. During the phase of numbing, the common first response to the news of a loss is to be stunned, as though not perceiving reality.

The nurse is assessing the new grieving widow. Which of the following are critical components to assess in a grieving person? Select all that apply. A) Genetic risk B) Perception of the loss C) Support system D) Coping behaviors E) Religion

b c d e

Which of the following losses are likely to result in disenfranchised grief? Select all that apply. A) A young adult whose spouse has just died suddenly B) A family whose long-time pet snake has just died C) A nurse who has just witnessed the death of a patient D) A couple who has just experienced pregnancy loss E) The gay lover of a man who just died from AIDS F) The mother and sister of a soldier who was killed in war

b c d e

A client comes to the physician's office for an annual checkup. During the interview, the nurse learns that the client's husband died unexpectedly of a heart attack two months ago. The most appropriate response by the nurse would be... A) "At least you and your husband enjoyed life right until the end." B) "It's better to go quickly like your husband did instead of suffering." C) "The loss of your husband must be very painful for you." D) "You'll feel better after you get over the shock of your husband's death."

c

A client has just been informed of a diagnosis of terminal cancer. The client states, "God has to have mercy on me because my children need me. He knows I'll change if he gets me through this." The nurse documents that the wife is expressing signs of which of Kubler-Ross's stages of grief? A) Denial B) Anger C) Bargaining D) Depression

c

A nurse cared for a terminally ill client over a period of a month. The nurse found that spending time with the client was a pleasure. When the client died, the nurse experienced feelings of sadness, sleeping poorly, lacking energy, and feeling mildly depressed. Eventually the nurse explained the feelings to the nurse supervisor. The nurse supervisor is aware of which of the following? A) The nurse needs to use stress reduction strategies. B) The nurse needs to seek therapy for dysfunctional grief. C) The nurse is experiencing disenfranchised grief. D) The nurse needs to consider taking a leave of absence to pursue healing.

c

A young client tells the nurse that her husband died 3 months ago, and she is feeling alone and vulnerable. Which of the client would indicate that her coping skills are adequate? A) I can't understand why this happened to me. B) I'm mentally healthy. I can solve my own problems. C) I will find a support group. D) What can I do? My husband abandoned me.

c

An elderly woman who lives alone is beginning to have difficulty maintaining her household and performing daily tasks. The nurse asks her to identify someone who can help her. The woman replies, "I don't need help. I've been managing for years." Which of the following responses helps the client shift from denial to consciously coping with her situation? A) "You don't think you need any help? But your family is worried about you." B) "It must be hard to lose your independence. I'll ask a social worker to see what can be arranged." C) "If you were to need help with your house, who might you ask for help?" D) "If you don't ask for some help, then the only option is to move to an assisted living facility."

c

Kubler-Ross developed a model of five stages to explain what people experience as they grieve and mourn. Which is stage five of Kubler-Ross's stages of grieving? A) Denial B) Bargaining C) Acceptance D) Anger

c

The client says to the nurse, "I really want to see my first grandchild born before I die. Is that too much to ask?" The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross? A) Acceptance B) Anger C) Bargaining D) Depression

c

The most effective way for the nurse to provide culturally competent care to individuals who are grieving is which of the following? A) Understand the practices associated with a client's culture. B) Suggest developing a new ritual to make mourning meaningful. C) Ask the client which rituals are personally meaningful. D) Contact a spiritual leader from the client's culture to become involved.

c

The nurse approaches a client who looks very sad and is sitting alone crying. The best response by the nurse in this situation is... A) "I'm sorry you are sad. Is there anything I can do to help you feel better?" B) "Please don't cry. It will get better." C) "You look very sad. What is happening?" D) "What is bothering you?"

c

The nurse visits with a client who was recently in a motor vehicle accident. Which of the following is most likely to prevent the client from experiencing complicated grief? A) Tendency to suppress emotions B) History of depression C) Places trust in others who are familiar D) Social isolation

c

Videbeck Ch.10 Chapter Study Guide 2. Situations that are considered risk factors for complicated grief are a. inadequate support and old age b. childbirth, marriage, and divorce c. death of a spouse or child, death by suicide, and sudden and unexpected death d. inadequate perception of the grieving crisis

c

Which of the following terms is used to describe the process by which a person experiences the grief? A) Anticipatory grieving B) Disenfranchised grief C) Bereavement D) Mourning

c

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions What question should nurses ask themselves to determine if the care they provide to the grieving client has been both therapeutic and client focused? a. "How long can I continue working with grieving clients?" b. "How do I personally react when I am working through the grieving process?" c. "Do I have the strength to be present and to facilitate the client who is grieving?" d. "Do I still get personal satisfaction from my work with the grieving client?"

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

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following factors does not influence on the grieving person's return to homeostasis? a. Adequate perception of the situation b. Adequate coping c. Adequate self-awareness on the part of the nurse d. Adequate support systems

c Adequate self-awareness on the part of the nurse Adequate self-awareness on the part of the nurse dose not influence the grieving person's return to homeostasis as it is an individual experience. All other options do influence the grieving person's return to homeostasis.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions According to Mardi Horowitz (2001), life begins to fell "normal" again in which of the following stages? a. Working through b. Outcry c. Completion d. Denial and intrusion

c Completion During the completion phase, life begins to feel "normal" again, although life is different after the loss. During the working through phase, the person still thinks about the loss but also begins to find new ways of managing life after loss. During the denial and intrusion phase, people move back and forth between denial and intrusion. In the outcry phase, the first realization of loss occurs. Outcry may be outward, expressed by screaming, yelling, crying, or collapse.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions The nurse is caring for a client whose spouse passed away several year ago. Upon assessment, the nurse finds that the client has a history of signs and symptoms of depression since the spouse's death. Which of the following terms correctly describes the client's response to her loss? a. Anger b. Disenfranchised grief c. Complicated grief d. Outcry

c Complicated grief Prolonged grieving and suffering from clinical depression may be considered outside the norm of the grieving process. The client suffering from complicated grief may suffer from these symptoms or they may experience a void of emotion of suffer grief disproportionate to the event. Disenfranchised grief is the grief over the loss that cannot be expressed openly. anger is the step in the grieving process where the client is developing awareness of the loss and expresses anger towards God, caregivers, or the healthcare providers (Kubler-Ross, 1969). Outcry is also a phase of grief which accompanies outward expression of grief such as sobbing tearfully and crying loudly. The client starts developing awareness about the grief in this phase (Horowitz).

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following types of loosses is caused by an internal or external crissi that blockes or inhibits strivings toward fulfillment that may threaten personal goals and individual potential? a. Safety Loss b. Loss of Self-esteem c. Loss related to self-actualization d. Physiologic loss

c Loss related to self-actualization Loss related to self-actualization is caused by an internal or external crisis that blocks or inhibits striving toward fulfillment that may threaten personal goals and individual potential. Safety loss is loss of a safe environment, which may be noted in domestic or public violence. Physiologic loss encompasses amputation of a limb, loss of adequate air exchange, or decrease in pancreatic functioning. Loss of self-esteem occurs when there is a change in how a person is valued at work or in relationships.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions During which phase Bowlby's grief process dose reality begin to set in? a. Phase of numbing b. Phase of disorganization and despair c. Phase of yearning and searching d. Phase of recognition

c Phase of yearning and searching During the phase or yearning and searching, reality begins to set in. During the phase of disorganization and despair, the bereaved person begins to understand the loss's permanence. During the phase of numbing, the common first response to the news of a loss is to be stunned, as though not perceiving reality. During the phase of recognition, the bereaved person begins to reestablish a sense of personal identity.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions The nurse is assessing a client who has lost his family in an accident. According to George Engel's Stages of Grieving, which behavior indicates that the client is in the stage of resolution of the loss? a. The client is crying continuously and is feeling helpless. b. The client is performing a funeral ritual for his decreased family. c. The client repeatedly views his family photos. d. The client is numb and is not accepting the loss.

c The client repeatedly views his family photos. According go George Engel's Stages of Grieving, in the stage of resolution of the loss the client is preoccupied with the loss of or the person lost is idealized. In this case, the client repeatedly views family photos which indicates that the client is preoccupied with the memories related to the family members. Thus, the client is in the stage of resolution of the loss. If the client is numb and is not accepting the loss, the client is in the stage of shock and disbelief. If the client is crying continuously and is feeling helpless, the client is in the stage of developing awareness. If the client is performing a funeral ritual for his decreased family, the client is in the stage of restitution.

A client who has been grieving the loss of his wife 2 weeks ago says to the nurse, "The best part of my day is when I am back at work. Is that wrong?" The nurse states to the client that work and other daily activities serve which purpose? A) "You cannot work effectively this soon. You should finish grieving first." B) "Working reminds you of your loss. It may be too early to go back." C) "Working is your way of avoiding grief, which will make it harder for you to move on." D) "Working is letting you take an emotional break from grieving. There's nothing wrong with that."

d

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which outcome will the nurse evaluate to determine whether a client has successfully stabilized when engaged in the grieving process? a. The client will verbally identify his or her terminal diagnosis within 4 hours. b. The client will verbalize decreased suicidal thoughts within 48 hours. c. The client will verbalize acceptance of his or her terminal diagnosis. d. The client will express his or her feelings both verbally and nonverbally.

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

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which client will the nurse identify as having the greatest risk for developing disenfranchised grief? a. a single adult whose 14 years old pet dog has died b. a man who is grieving the loss of a business he founded 25 years ago c. the wife of a man who was shot to death by police during a robbery d. a teenager who has lost his grandfather to cancer

c the wife of a man who was shot to death by police during a robbery Disenfranchised grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially. The death of someone who is incarcerated or executed for crimes carries a social stigma that often prevents family members from publicly grieving or receiving support for their loss. While the other options suggest others experiencing loss, the correct option adds the component of social stigma to the burden of the loss.

. A nurse is caring for a client who is mourning the loss of a loved one. Which factor would the nurse expect to make the mourning process more difficult for the client? A) The client was relatively independent of the deceased. B) The client had few unresolved conflicts in the relationship with the deceased. C) The client has a good support system with meaningful relationships evident. D) The client has experienced a number of previous losses.

d

A child who has witnessed the murder of his classmate while at school would experience which kind of loss? A) Physiologic loss B) Loss of self-esteem C) Loss related to self-actualization D) Safety loss

d

A client grieving her husband's sudden death tells the bereavement nurse, "I am not feeling very well. Yesterday, I was sitting in my kitchen and a saw my husband walk through the door and stop and smile at me. Then he just faded away. I think I must be going crazy." The most appropriate action for the nurse to take is to... A) assess for recent substance use. B) suggest a referral to the mental health clinic. C) arrange for a prescription for risperidone. D) counsel that visualizations are a normal part of grieving.

d

A client with terminal cancer has been told he has 3 or 4 months to live. Which of the following would indicate to the nurse that further interventions are needed? A) The client says he wants to live life to the fullest. B) The client hopes for a peaceful and dignified death. C) The client is reviewing his life and talking about death. D) The client says he is well and is making future plans.

d

A couple came to the emergency department with their 5-month-old son. He was pronounced dead of sudden infant death syndrome (SIDS). In the next day or two, it will be important for this couple to do which of the following? A) postpone notification of the extended family B) delay the grieving process until they are ready to cope C) minimize their discussion of the death with others D) plan funeral arrangements for their son

d

A nurse has been caring for a gunshot victim who has just died. Various family and friends are present. One of the visitors privately discloses to the nurse that she and the client were having an illicit affair. Which of the following is the best action by the nurse after learning of this relationship? A) Give the name of a clergy to the visitor and suggest she contact him for support B) Encourage the visitor to ask for support from the friends who are present C) Ignore the information about the affair and tend to the family D) Privately offer support to the visitor who was having the affair with the client

d

A woman has just been served divorce papers from her husband. She has no financial resources and little social support. She states, "He's not really leaving. He'll be back." The most appropriate response by the nurse would be which of the following? A) "Has he done this before?" B) "I'll call social services and get you signed up for financial assistance." C) "You have to face reality. Here are the papers." D) "How is this affecting you right now?"

d

A woman has just delivered a stillborn baby boy. Which of the following would be the most appropriate nursing response? A) "Can I do anything for you?" B) "If something was wrong, it's better this way." C) "Your son is in heaven with God now." D) "Would you like to hold your son?"

d

A woman has just had a therapeutic abortion to end an unintended pregnancy. Afterward, the woman cries because although she wanted to have children in future years, this pregnancy was not well-timed. Which type of grief is this woman most likely to experience? A) Anticipatory grief B) Absence of grief C) Complicated grief D) Disenfranchised grief

d

After being laid off from work, a client becomes increasingly withdrawn and fatigued, spends entire days in bed, is unkempt, and is eating and sleeping poorly. The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross? A) Anger B) Bargaining C) Denial D) Depression

d

The nurse is working with a woman who lost her partner nearly 3 weeks ago. The woman has recently become less emotional and expressed an interest in possibly returning to work. Which response by the nurse is most appropriate at this time? A) "I am concerned. You are starting to show signs of ineffective grieving." B) "You must feel some anger. It is all right to let that out." C) "Let's look at the things in your life that you still enjoy." D) "You are just starting to accept that this loss is real."

d

Videbeck Ch.10 Chapter Study Guide 3. Physiologic responses of complicated grieving include a. tearfulness when recalling significant memories of the lost one b. impaired appetite, weight loss, lack of energy, palpitations c. depression, panic disorders, chronic grief d. impaired immune system, increased serum prolactin level, increased mortality rate from heart disease

d

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following likely takes place in the fourth sstage of Kubler-Ross's stage of grieving? a. Bargaining b. Denial c. Anger d. Depression

d Depression Depression occurs when the person shows evidence that he or she is sad and despairing over the inevitability of loss. Denial is shock and disbelief regarding the loss. Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. Anger may be expressed toward God, relatives, friends, or health care providers.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following occurs in the second phase of Bowlby's grieving process? a. Cognitive disorganization b. Numbness and denial c. Reintegrating sense of self d. Emotional yearning for the loved one

d Emotional yearning for the loved one Emotional yearning for the loved one occurs in Phase II of Bowlby's grieving process. Numbness and denial occur in Phase I. Cognitive disorganization occurs in Phase III. Reintegrating a sense of self occurs in Phase IV.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following terms describes the process by which a person experiences the grief? a. Grief b. Morning c. Attentive presence d. Grieving

d Grieving Grieving is the process by which a person experiences the grief. Grief refers to the subjective emotions and affect that are a normal response to the experience of loss. Mourning is the outward expression of grief. Attentive presence is being with the client and focusing intently on communicating with and understanding him or her.

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions Which of the following cultures believes that leaving the body along after death is disrespectful? a. Vietnamese Americans b. Native Americans c. Chinese Americans d. Orthodox Jewish Americans

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

Videbeck Ch.10 Grief and Loss NCLEX-Style Review Questions In which of the phases of Bowlby's grief process does the bereaved person begin to understand the loss's permanence? a. Phase of numbing b. Phase of recognition c. Phase of yearning and searching d. Phase of disorganization and despair

d Phase of disorganization and despair During the phase of disorganization and despair, the bereaved person begins to understand the loss's permanence. During the phase of yearning and searching, reality begins to set in. During the phase of numbing, the common first response to the news of a loss is to be stunned, as though not perceiving reality. During the phase of recognition, the bereaved person begins to reestablish a sense of personal identity.