Grief

Disenfranchised Grief

- An experienced loss that cannot be publicly shared or is not socially acceptable, such as suicide

Hospice Care

- Comprehensive care delivery system implemented when a client is not expected to live longer than 6 mths. - Further medical care aimed toward a cure is stopped, the focus becomes, enhancing the quality of life and supporting the client toward a peaceful and dignified death

Complicated Grief

- Difficult progression through the expected stages - Manifestations are more severe - Suicidal ideation, intense feeling of guilt, and lowered self-esteem - Somatic complaints persist for an extended period of time

Normal Grief

-uncomplicated -acceptance evident w/i 6 mths -somatic complaints-chest pain, palpitations, HA, nausea, changes in sleep patterns, and fatigue

In which stage of mourning described by Bowlby's attachment theory does the person feel unreal? 1 Numbing 2 Reorganization 3 Yearning and searching 4 Disorganization and despair

1 Numbing

Bereavement

includes both grief and mourning(the outward display of loss) as the individual deals with the death of a significant individual in their life

The nurse is caring for a patient who recently lost a spouse in an accident. Which statement indicates a need for further counseling to help the patient move through the normal grief process? 1 "I have good friends and a good daughter." 2 "I will discuss with my daughter what can we do." 3 "It's time to quit on life and be with my late husband." 4 "I am not able to take care of myself much, but I will try.

3 "It's time to quit on life and be with my late husband."

In which stage of mourning described by Bowlby's attachment theory does the person experience an inner and intense yearning for the lost person? 1 Numbing 2 Reorganization 3 Yearning and searching 4 Disorganization and despair

3 Yearning and searching

Which loss occurs when the lost person is physically present but not psychologically available? 1 Actual loss 2 Perceived loss 3 Situational loss 4 Ambiguous loss

4 Ambiguous loss

In which stage of mourning described by Bowlby's attachment theory does the person extends blame and expresses anger towards anyone who is responsible for the loss.? 1 Numbing 2 Reorganization 3 Yearning and searching 4 Disorganization and despair

4 Disorganization and despair

Which patient's condition can be categorized as masked grief? 1. A patient who is exhibiting psychosis due to grief 2. A patient who is depressed due to the death of a child 3. A patient who is trying to avoid the full realization of the loss 4. A patient who is unaware of behaving disruptively because of grief

4. A patient who is unaware of behaving disruptively because of grief (unaware that the disruptive behavior is due to loss)

Situational Loss

Any unanticipated loss caused by an external event

What are Kubler-Ross 5 stages of Grief

Denial, Anger, Bargaining, Depression, Acceptance

Pallative Care

Improved the quality of life of clients and their families facing EOL issues

Grief

Inner emotional response to loss and is exhibited in as many ways as there are individuals

Characterized by stunned and unreal feelings.

Numbing is the first stage of mourning

Characterized by shortness of breath, a feeling of lethargy, and loss of appetite due to emotional outbursts.

Yearning and searching is the second stage of bereavement

The nurse is assisting a deceased patient's family member in the grief process. Which nursing intervention indicates a need for correction? 1 Acknowledging the loss openly 2 Reinforcing the reality of the event 3 Avoiding reminiscence of the survivor 4 Reassure the survivor that difficulty in sleeping is normal behavior

3 Avoiding reminiscence of the survivor

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."

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.

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.

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.

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.

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.

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.

In which stage of mourning described by Bowlby's attachment theory does a person accept change, acquire new skills, and build new relationships? 1 Numbing 2 Reorganization 3 Yearning and searching 4 Disorganization and despair

2 Reorganization

The registered nurse delegates the task of caring for a body after death to nursing assistive personnel (NAP). Which nursing interventions are appropriate while caring for a body after death? Select all that apply. 1 Removing the dentures from the mouth 2 Identifying the patient using two identifiers 3 Elevating the patient's head on one pillow 4 Combing patient's hair or applying personal hairpieces 5 Instructing the family to stay away from the preparation of the body

2 Identifying the patient using two identifiers 3 Elevating the patient's head on one pillow 4 Combing patient's hair or applying personal hairpieces

An older adult has chronic body aches due to muscular dystrophy. The associated pain has put made the patient feel hopeless. The nurse suggests hospice care. When educating the family members about hospice care, which information should the nurse include? Select all that apply. 1 The hospice care ends with the death of the patient. 2 It is a patient- and family-centered approach to care. 3 The hospice team promotes patient dignity and self-esteem. 4 It is a place to take care of terminally ill patients. 5 The hospice team gives preference to the patient's wishes

2 It is a patient- and family-centered approach to care. 3 The hospice team promotes patient dignity and self-esteem. 5 The hospice team gives preference to the patient's wishes

Which type of loss does a toddler experience associated with separation anxiety from mom when starting preschool? 1 Actual loss 2 Perceived loss 3 Situational loss 4 Maturational loss

4 Maturational loss

A nurse is caring for a client who has stage 4 lung cancer and is 3 days postoperative following a wedge resection. The client states, "I told myself that I would go through with the surgery and quit smoking if I could just live long enough to attend my daughter's wedding." Based on Kübler-Ross' Five Stages of Grief, which stage is the client experiencing? A. Anger B. Denial C. Bargaining D. Acceptance

C. Bargaining

Necessary Loss

- Loss related to a change that is part of the cycle of life that is anticipated but still may be intensely felt. - This type of loss can be replaced by something different or better

Bowbly's Attachment Theory (4 stages)

- Numbing - Yearning and searching - Disorganization and despair - Reorganization

The nurse understands that grief can come in many forms. Exaggerated grief is a type of complicated grief. Which statements are true about exaggerated grief? Select all that apply. 1 Suicide is a risk for these patients. 2 The patient's grief is usually delayed. 3 The patient exhibits maladaptive behavior. 4 Exaggerated grief is triggered by a second loss. 5 The patient exhibits self-destructive behavior.

1 Suicide is a risk for these patients. 3 The patient exhibits maladaptive behavior. 5 The patient exhibits self-destructive behavior.

A patient is diagnosed with terminal stage cancer. Which findings in the patient indicate a lack of hope due to deteriorating physical condition? Select all that apply. 1 The patient sighs and has a negative view of the future. 2 The patient displays sad facial and voice expressions. 3 The patient wants to undergo more tests. 4 The patient feels weak, lacks energy, and has vague pains. 5 The patient shows a lack of interest and communicates minimally.

1 The patient sighs and has a negative view of the future. 2 The patient displays sad facial and voice expressions. 4 The patient feels weak, lacks energy, and has vague pains. 5 The patient shows a lack of interest and communicates minimally.

A patient diagnosed with final stage cancer is worried about dying and is rushing to complete tasks. Which type of grief is the patient experiencing? 1.Normal 2. Anticipatory 3. Complicated 4. Disenfranchised grief

2 Anticipatory

The nurse observes physical symptoms of yearning including lethargy, insomnia, and loss of appetite in a patient who witnessed the accidental death of a friend. Which theory of grief and mourning explains this type of grief? 1 Stages of dying 2 Attachment theory 3 Dual-process model 4 Rando's "R" process model

2 Attachment theory

Which statement is true about chronic grief? 1 Suicide is a risk factor for chronic grief. 2 Chronic grief may last for years or decades. 3 A patient with chronic grief may exhibit obsessions. 4 A patient with chronic grief is unaware that the disruptive behavior is due to a loss.

2 Chronic grief may last for years or decades

A patient who is in a hospice care facility develops anorexia. The patient reports feeling uncomfortable after eating but is otherwise peaceful. The patient's family members become very anxious due to the reduced food intake by the patient. Which is the most appropriate nursing action in this situation? 1 Encourage the patient to eat. 2 Support the grieving family. 3 Promote spiritual comfort and hope to the patient. 4 Maintain a comfortable and peaceful environment.

2 Support the grieving family.

Which patient's condition can be categorized as delayed grief? 1 A patient who is exhibiting psychosis due to grief 2 A patient who is depressed due to the death of a child 3 A patient who is trying to avoid the full realization of the loss 4 A patient who is unaware of behaving disruptively because of grief

3 A patient who is trying to avoid the full realization of the loss

A patient who lost a spouse in an accident says, "I miss my partner. I will never get my partner back." Which stage of dying, according to Kübler-Ross theory of grief and mourning, is reflected in the patient's statement? 1 Anger 2 Denial 3 Bargaining 4 Acceptance

4 Acceptance

A nurse is caring for a client who has terminal lung cancer. The nurse observes the client's family assisting with all ADLs. Which of the following rationales for self-care should the nurse communicate to the family? A. Allowing the client to function independently will strengthen her muscles and promote healing. B. The client needs to be given privacy at times for self-reflecting and organizing her life. C. The client's sense of loss can be lessened through retaining control of certain areas of her life. D. Performing ADLs is required prior to discharge from an acute care facility.

C. The client's sense of loss can be lessened through retaining control of certain areas of her life.

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.

Characterized by repeating the accident stories many times and realizing the loss as permanent.

Disorganization and despair is the third stage of mourning

Stage of mourning, which usually occurs a year after the loss.

Reorganization is the last stage of mourning

Anticipatory Grief

- Implies 'letting go' of an object or person before the loss, as in a terminal illness - Individuals have the opportunity to start the grieving process before the actual loss

Perceived Loss

- Loss defined by the client that is not obvious or verifiable to others

Maturational or Developmental Loss

- Loss normally expected due to the developmental processing of life. - Associated with normal life transitions and help to develop coping skills

Actual Loss

- Loss of a valued person, item, or status, such as loss of a job

Which physical changes occur a few days prior to death in a patient? Select all that apply. 1 Mottling of skin 2 Very high peripheral pulses 3 Increased bowel movements 4 Cheyne-Stokes breathing pattern 5 Patches of varying colors of pallor on the skin

1 Mottling of skin 4 Cheyne-Stokes breathing pattern 5 Patches of varying colors of pallor on the skin

Regarding grief in older adults, which understanding helps guide the nurse's relationship with an elderly patient? 1 Older adult has usually sustained many losses in life, which influence the current loss. 2 Older adults with poor memory experience grief less intensely. 3 Older adults generally handle loss better because they have more experience with it. 4 Social support is less important because an older adult's circle of friends has become smaller.

1 Older adults have usually sustained many losses in life, which influence the current loss.

A young adult lost a limb in a motor vehicle accident and is very upset about it. How should the nurse classify the loss to help plan further interventions? 1 Actual loss 2 Perceived loss 3 Necessary loss 4 Maturational loss

1 Actual loss

A patient lost a sibling in a car accident. On the same day, the patient lost his job, but the patient does not seem upset about the job loss. Which grief type is indicated by the patient's presentation? 1 Delayed grief 2 Masked grief 3 Exaggerated grief 4 Disenfranchised grief

1 Delayed grief

Regarding the request for organ and tissue donation at the time of death, what should the nurse keep in mind? 1 Specially educated personnel make requests. 2 Requests are usually made by the nurse caring for the patient at the time of death. 3 Only patients who have given prior instruction regarding donation become donors. 4 Professionals need to be very selective in whom they ask for organ and tissue donation

1 Specially educated personnel make requests.

Which theory of grief and mourning includes denial and acceptance? 1 Stages of dying 2 Attachment theory 3 Dual-process model 4 Trajectories of bereavement

1 Stages of dying

After communicating with a patient, the nurse suspects normal grief. Which statements if made by the patient would support the suspicion? Select all that apply. 1 "I was diagnosed with colon cancer." 2 "I often forget my residential address." 3 "I witnessed the death of my married lover recently." 4 "I have lost interest in doing my regular work since I lost my beloved pet." 5 "I often feel lonely since the death of my spouse, even though I have many friends.

1 "I was diagnosed with colon cancer." 4 "I have lost interest in doing my regular work since I lost my beloved pet." 5 "I often feel lonely since the death of my spouse, even though I have many friends.

The registered nurse is teaching a nursing student how to perform an assessment of grief and loss for a patient in the last stages of cancer. Which statement made by the nursing student indicates effective learning? Select all that apply. 1 "I will honestly communicate with the patient." 2 "I will gather information from the patient only." 3 "I will only listen to verbal responses of the patient." 4 "I will communicate with the patient using closed-ended questions." 5 "I will establish a good relationship with the patient by providing a therapeutic touch."

1 "I will honestly communicate with the patient." 5 "I will establish a good relationship with the patient by providing a therapeutic touch."

The nurse is attending to a terminally ill patient. Which behaviors show that the patient is in a stage of dying? Select all that apply. 1 Denial 2 Depression 3 Anticipation 4 Acceptance 5 Preparation

1 Denial 2 Depression 4 Acceptance

A terminally ill patient is bedridden. On examination, the nurse finds that the patient has dyspnea. Which possible causes of dyspnea should the nurse evaluate in the patient? Select all that apply. 1 Fever 2 Anxiety 3 Anemia 4 Lack of fluid intake 5 Trigeminal nerve stimulation

1 Fever 2 Anxiety 3 Anemia

The nurse is closely monitoring a patient who is critically ill with a chronic disease. Which physical changes indicate that the patient will die soon, and the nurse should inform the family? Select all that apply. 1 Inability to swallow 2 Increased muscle tone 3 Increased urine output 4 Increased periods of sleeping 5 Coolness and cyanosis in extremities

1 Inability to swallow 4 Increased periods of sleeping 5 Coolness and cyanosis in extremities

The nurse is caring for a terminally ill patient. Which physical changes in the patient suggest that death is near? Select all that apply. 1 Noisy respirations 2 Increased urine output 3 Decreased muscle tone 4 Decreased intake of food 5 Decreased periods of sleeping

1 Noisy respirations 3 Decreased muscle tone 4 Decreased intake of food

The nurse finds that a terminally ill patient who is in a home hospice setting is dehydrated. Which nursing actions should the nurse perform? Select all that apply. 1 Offer ice chips. 2 Apply a moist cloth to the patient's lips. 3 Keep the tongue moist. 4 Give fluids through a nasogastric tube. 5 Provide mouth care every 8 hours

1 Offer ice chips. 2 Apply a moist cloth to the patient's lips. 3 Keep the tongue moist.

Which statements are true regarding factors that influence grief and loss? Select all that apply. 1 Religious practices help to navigate the loss. 2 Increased ill temper is a common expression of grief. 3 School-age children always understand the cause of loss. 4 Hope plays a vital role in a patient's adjustment to loss and death. 5 Socioeconomic status influences a person's grief process in an indirect way.

1 Religious practices help to navigate the loss. 2 Increased ill temper is a common expression of grief. 4 Hope plays a vital role in a patient's adjustment to loss and death.

A patient has been brought to the hospital in a gasping state. The patient dies despite receiving basic life support measures. What fit the role of the nurse in obtaining an autopsy? Select all that apply. 1 Respecting the family's wishes and final decisions 2 Informing the family that all the organs will be replaced 3 Answering questions and supporting the family's choices 4 Obtaining autopsy permission from the family members 5 Signing the request for an autopsy

1 Respecting the family's wishes and final decisions 2 Informing the family that all the organs will be replaced 3 Answering questions and supporting the family's choices 4 Obtaining autopsy permission from the family members

Which physical changes are observed in a patient who is in his or her last hours of life? Select all that apply. 1 Sagging mouth 2 Light-colored urine 3 Increased urination 4 Relaxed jaw muscles 5 Increased pulmonary secretions

1 Sagging mouth 4 Relaxed jaw muscles

Which nursing actions help to promote the dignity of the patient experiencing grief? Select all that apply. 1 Sharing time with the patient 2 Respecting the patient as a whole person 3 Valuing the things that the patient cares about 4 Suggesting a family member stay through the night 5 Reassuring the patient that someone is close at hand

1 Sharing time with the patient 2 Respecting the patient as a whole person 3 Valuing the things that the patient cares about

A patient is diagnosed with advanced leukemia. The patient is hopeless about the treatment. Which nursing interventions would help the patient to overcome the lack of hope? Select all that apply. 1 Treating chronic pain 2 Advising dietary modification 3 Providing economical support 4 Identifying sources of social support 5 Providing opportunities to express positive life events

1 Treating chronic pain 4 Identifying sources of social support 5 Providing opportunities to express positive life events

Which patient's condition can be categorized as exaggerated grief? 1 A patient who is exhibiting psychosis due to grief 2 A patient who is depressed due to the death of a child 3 A patient who is trying to avoid the full realization of the loss 4 A patient who is unaware of behaving disruptively because of grief

1 . A patient who is exhibiting psychosis due to grief (and are at risk for suicide, exhibit obsessions, the person blames self for the loss..)

A nurse is evaluating outcomes for a critically ill patient, and wants to validate the achievement of goals and expectations. Which question asked by the nurse indicates a need for correction? 1 "Are you receiving high-quality care?" 2 "Are you comfortable talking about your grief?" 3 "Do you have a specific request that I have not met?" 4 "Are your needs being addressed in a timely manner?

2 "Are you comfortable talking about your grief?"

A patient who has a serious, life-limiting chronic illness wants to continue to engage in self-care and live as normally as possible. Which nursing responses reflect a helpful understanding of patient self-care at the end of life? 1 "Learning to accept that you can't perform some activities anymore will bring you more acceptance and peace." 2 "Which activities are most important to you, and how can you continue to do them?" 3 "People in your life want to help you with things; allow them to do what they want for you." 4 "Spending more of your time resting or reading will conserve your energy."

2 "Which activities are most important to you, and how can you continue to do them?"

The nurse is caring for a child diagnosed with muscular dystrophy. The parent of the patient feels severe grief and loss after seeing the child suffering. Which type of grief is the parent experiencing? 1 Normal 2 Anticipatory 3 Complicated 4 Disenfranchised grief

2 Anticipatory

A patient diagnosed with terminal stage cancer says, "I will seek a second opinion and have the tests done again at another hospital." Which stage of the Kübler-Ross theory is reflected in the patient's statement? 1 Anger 2 Denial 3 Bargaining 4 Depression

2 Denial

A patient is in the terminal stages of acquired immunodeficiency syndrome (AIDS) and reports chronic dull pain. On assessment, the nurse finds that the patient does not have a family and has nobody to provide care. Which is the most appropriate nursing action in this situation? 1 Hospitalize the patient in the intensive care unit. 2 Provide hospice care to the patient. 3 Provide acute care to the patient. 4 Seclude the patient in a separate room.

2 Provide hospice care to the patient.

The nurse is providing postmortem care. Which action is the priority? 1 Locating the patient's clothing 2 Providing culturally and religiously sensitive care in body preparation 3 Transporting the body to the morgue as soon as possible to prevent body decomposition 4 Providing all postmortem care to protect the family of the deceased from having to see the body

2 Providing culturally and religiously sensitive care in body preparation

After communicating with a patient, the nurse suspects anticipatory grief. Which statements if made by the patient would support the suspicion? Select all that apply. 1 "I was diagnosed with colon cancer." 2 "I often forget my residential address." 3 "I witnessed the death of my married lover recently." 4 "I have lost interest in doing my regular work since I lost my beloved pet." 5 "I often feel lonely since the death of my spouse, even though I have many friends.

2 "I often forget my residential address."

A patient is experiencing complicated grief and is having trouble moving forward in life. Which terms refer to specific types of complicated grief? Select all that apply. 1 Normal grief 2 Delayed grief 3 Masked grief 4 Exaggerated grief 5 Disenfranchised grief

2 Delayed grief 3 Masked grief 4 Exaggerated grief

Which patient's condition can be categorized as normal grief? 1 A patient who is exhibiting psychosis due to grief 2 A patient who is depressed due to the death of a child 3 A patient who is trying to avoid the full realization of the loss 4 A patient who is unaware of behaving disruptively because of grief

2. A patient who is depressed due to the death of a child A the common and universal reaction to loss or death that may be unexpected or traumatic

The registered nurse is teaching a nursing student about non-pharmacological interventions that decrease nausea for terminally ill patients. Which statement made by the nursing student nurse indicates effective learning? 1 "I will provide cool air in the room." 2 "I will provide massage therapy to the patient." 3 "I will encourage the patient to lie on the right side." 4 "I will provide background music of patient's choice."

3 "I will encourage the patient to lie on the right side."

The nurse is caring for a patient with grief and loss due to the death of a grandfather. Which behavioral symptom observed by nurse indicates normal grief? 1 Hopelessness 2 Muscle weakness 3 Distancing from people 4 Sense of depersonalization

3 Distancing from people

Two friends were involved in a motor vehicle accident. One of them died, and the survivor attempted suicide due to feeling responsible for the friend's death. Which grief type is indicated by the patient's presentation? 1 Delayed grief 2 Masked grief 3 Exaggerated grief 4 Uncomplicated grief

3 Exaggerated grief

A 1-year-old child lost his mother in a car accident. The child refuses to eat and has a sleep disturbance. Which factor is most likely responsible for this response? 1 Coping strategies 2 Nature of the loss 3 Human development 4 Personal relationship

3 Human development

Which approach to helping grieving people is most consistent with postmodern grief theories? 1 Helping the patient identify the tasks to be accomplished during grief 2 Encouraging people to recognize stages of grieving in anticipation of what is to come 3 Listening carefully to a person's story of how the grief experience is unfolding 4 Offering general grief timelines to help the person know when a phase will pass

3 Listening carefully to a person's story of how the grief experience is unfolding

A patient who is experiencing severe pain during end-of-life care tells the nurse, "I do not want medication for pain and I want to be awake when my family visits me." Which is the best intervention that the nurse can provide in this situation? 1 Distract the patient and administer the medication. 2 Administer the medication when the family visits the patient. 3 Provide alternative pain management therapies such as heat or cold. 4 Firmly instruct the patient that medicines are necessary for treatment

3 Provide alternative pain management therapies such as heat or cold.

A patient has sustained severe injuries due to a motor-vehicle accident. The patient is unable to return to work due to physical disability. This affects the economic status of the patient. How should the nurse classify the loss to help plan further interventions? 1 Actual loss 2 Perceived loss 3 Situational loss 4 Maturational loss

3 Situational loss

The nurse is caring for a patient who recently lost his parents in a road accident. The nurse assesses that the patient has shortness of breath, a feeling of lethargy, and loss of appetite. Which stage of mourning should the nurse suspect in the patient according to Bowlby's attachment theory? 1 Numbing 2 Reorganization 3 Yearning and searching 4 Disorganization and despair

3 Yearning and searching

Which stage of the attachment theory of grief and mourning is characterized by emotional outbursts of tearful sobbing? 1 Numbing 2 Reorganization 3 Yearning and searching 4 Disorganization and despair

3 Yearning and searching

After communicating with a patient, the nurse suspects disenfranchised grief. Which statements if made by the patient would support the suspicion? Select all that apply. 1 "I was diagnosed with colon cancer." 2 "I often forget my residential address." 3 "I witnessed the death of my married lover recently." 4 "I have lost interest in doing my regular work since I lost my beloved pet." 5 "I often feel lonely since the death of my spouse, even though I have many friends.

3 "I witnessed the death of my married lover recently."

The registered nurse is coordinating patient and family care during and after the death of a patient. Which actions performed by the nurse pertain to the cultural and religious rituals of the patient? Select all that apply. 1 Providing safe and appropriate postmortem care 2 Gathering and recording much of the remaining information surrounding a death 3 Allowing the family members to place the body on the floor with the head facing north 4 Allowing the members of an extended family to stay with the deceased for up to 8 hours after death 5 Explaining to family members that an autopsy does not deform the body and that all organs are replaced in the body

3 Allowing the family members to place the body on the floor with the head facing north 4 Allowing the members of an extended family to stay with the deceased for up to 8 hours after death 5 Explaining to family members that an autopsy does not deform the body and that all organs are replaced in the body

A patient in a rehabilitation clinic is recovering from the loss of a limb in a motor vehicle accident. In addition to providing wound care and physical therapy, which factors should the nurse assess to help the patient recover? Select all that apply. 1 Religion 2 Culture 3 Family support 4 Behaviors indicating a grief response 5 The patient's point of view of the loss

3 Family support 4 Behaviors indicating a grief response 5 The patient's point of view of the loss

After speaking with a female patient experiencing depression, the nurse suspects that the patient has chronic grief. Which statement made by the patient would support the suspicion? 1 "I lost my beloved pet last week." 2 "I have been on chemotherapy for 6 months to treat cancer." 3 "My pregnancy was terminated when I was in an auto accident." 4 "I witnessed the sudden death of one of my close friends when we were children."

4 "I witnessed the sudden death of one of my close friends when we were children."

A patient is experiencing memory loss due to a severe brain injury sustained in a car accident. The patient is unable to recollect her own name or that of family members and is unable to perform activities of daily living. Which loss has the patient sustained that may need a further evaluation? 1 Actual loss 2 Perceived loss 3 Necessary loss 4 Ambiguous loss

4 Ambiguous loss

A family member asks the home care nurse what to do if the patient's serious chronic illness worsens even with increased medical interventions. How should the nurse best begin a conversation about the goals of care at the end of life? 1 Encourage the family member to think more positively about the patient's new therapy. 2 Avoid the discussion because it has to do with medical, not nursing, diagnoses. 3 Initiate a discussion about advance directives with the patient, family, and health care team. 4 Ask the patient to identify beliefs about the goals of care while the family member is present.

4 Ask the patient to identify beliefs about the goals of care while the family member is present.

The nurse is caring for a terminally ill patient. How can the nurse actively communicate with the patient? 1 By asking close-ended questions 2 By sympathizing with the patient 3 By discussing sensitive issues 4 By asking open-ended questions

4 By asking open-ended questions

Which critical thinking skill does the nurse use when considering how cultural perspectives impact the meaning of loss/death in a patient? 1 Attitudes 2 Standards 3 Experience 4 Knowledge

4 Knowledge

While caring for the body of a deceased patient, the nurse attaches an eagle feather to the patient. Which culture is reflected in the nurse's action? 1 Chinese 2 Hispanic 3 Buddhist 4 Native American

4 Native American

After the death of a patient, the family members are limiting their public displays of emotion. What could be the culture of the patient? 1 Latino 2 Islamic 3 Hispanic 4 Western European

4 Western European

A patient is upset due to a terminal illness of a parent. How should the nurse educate the patient about anticipatory grief and its management? Select all that apply. 1 Emphasize high-dose sedation. 2 Instruct the patient to avoid meeting with the parent to overcome grief. 3 Explain to the patient that grief may aggravate the situation. 4 Explain that the patient will eventually get mentally prepared for the loss. 5 Explain that this grief cannot be controlled by willpower, because it is an unconscious process.

4 Explain that the patient will eventually get mentally prepared for the loss. 5 Explain that this grief cannot be controlled by willpower, because it is an unconscious process.

A nurse is consoling the partner of a client who just expired after a long battle with liver cancer. The partner is displaying grief and states, "I hate him for leaving me." Which of the following statements by the nurse successfully facilitate mourning for the grieving partner? (Select all that apply.) A. "Would you like me to contact the chaplain to come to speak with you?" B. "You will feel better soon. You have been expecting this for a while now." C. "Let's talk about your children and how they are going to react." D. "You know, it is quite normal to feel anger toward your husband at this time." E. "Tell me more about how you are feeling."

A. Would you like me to contact the chaplain to come to speak with you?" D. "You know, it is quite normal to feel anger toward your husband at this time." E. "Tell me more about how you are feeling."

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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

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.

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.

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.

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.

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.