Loss and Grieving - Adaptive Quizzing

After counseling an older widowed client, a nurse concludes that the grieving process has been successfully completed when the client does what? 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

A Rationale: 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. With a positive outcome to the grieving process, the mourner is able to see and accept the dead person's negative and positive qualities. Leaving the deceased spouse's study as it was before the death is an example of mummification, a pathological outcome to the grieving process.

A mother whose child has been killed in a school bus accident tells the nurse that her child was just getting over the chickenpox and did not want to go to school but she insisted that the child go. The mother cries bitterly and says that her child's death is her fault. The nurse understands that perceiving a death as preventable most often will influence the grieving process in that it may do what? A) Grow in intensity and duration B) Progress to a psychiatric illness C) Be easier to understand and to accept D) Cause the mourner to experience a pathological grief reaction

A Rationale: Deaths that are perceived as preventable cause more guilt for the mourners and therefore increase the intensity and duration of the grieving process. Perceiving a death as preventable will not necessarily result in a pathological reaction, but it will usually make it harder to understand and accept the death.

Which nursing interventions enhance comfort in an imminently dying client in the hospital? Select all that apply. A) Frequently repositioning the client B) Maintaining oral hygiene in the client C) Limiting frequent visits of the family members D) Measuring the vital signs of client frequently E) Applying body lotion to the client's skin daily

A, B, E Rationale: The nurse provides comfort care to the client who is in the process of dying to ensure client comfort. Prolonged bed rest may cause back pain and skin issues; to reduce the pain, the nurse frequently repositions the client on the bed. Poor oral and skin hygiene may cause discomfort to the client, so the nurse carefully maintains the client's oral and skin hygiene. The nurse does not limit the visitation of family members because these visits may reduce the client's emotional stress. There is no need to measure the vital signs regularly in an imminently dying client, and doing so may increase discomfort in the client.

A client who recently was told by her primary healthcare provider that she has extensive terminal metastatic carcinoma of the breast tells the nurse that she believes an error has been made. She states that she does not have breast cancer, and she is not going to die. The nurse determines that the client is experiencing which stage of death and dying? A) Anger B) Denial C) Bargaining D) Acceptance

B Rationale: The client has difficulty accepting the inevitability of death and is attempting to deny the reality of it. In the anger stage the client strikes out with "Why me?" and "How could God do this?" type of statements. The client is angry at life and still angrier to be removed from it by death. In the bargaining stage the client tries to bargain for more time. The reality of death is no longer denied, but the client attempts to manipulate and extend the remaining time. In the acceptance stage the client accepts the inevitability of death and peacefully awaits it.

A terminally ill client tells the nurse, "I would love to learn to speak German before I die." The nurse's response to the client's desire to learn a foreign language should be based on an understanding of what? A) Activities that support the client's denial should not be encouraged. B) Clients should be encouraged to set meaningful goals for themselves. C) Energies expended on such an activity would not justify the outcome. D) The client's time should be focused on goals that are easily attainable.

B Rationale: The client's goal is meaningful, and the nurse should do everything possible to help the client achieve it. The evidence does not demonstrate that the client is in denial. There is no reason to dissuade the client from a meaningful goal despite its difficulty. If the client wants to work toward a goal, the energy expenditure is justified.

A nurse is aware that a coworker's mother died 16 months ago. The coworker cries every time someone says the word "mother" and when the mother's name is mentioned. What does the nurse conclude about this behavior? A) It is an expected response. B) Most people cry when their mother dies. C) The coworker may need help with grieving. D) The coworker was extremely attached to the mother.

C Rationale: Crying is a release, but the individual should have developed effective coping mechanisms by this time. The coworker may need help with the grieving process. Excessive crying 16 months after the death of a loved one is not an expected response. People express grief in a variety of ways, not necessarily by crying. Concluding that the coworker was extremely attached to the mother is an assumption and is not a valid conclusion.

A dying client is coping with feelings regarding impending death. The nurse bases care on the theory of death and dying by Kübler-Ross. During which stage of grieving should the nurse primarily use nonverbal interventions? A) Anger B) Denial C) Bargaining D) Acceptance

D Rationale Communication and interventions during the acceptance stage are mainly nonverbal (e.g., holding the client's hand). The nurse should be quiet but available. During the anger stage the nurse should accept that the client is angry. The anger stage requires verbal communication. During the denial stage the nurse should accept the client's behavior but not reinforce the denial. The denial stage requires verbal communication. During the bargaining stage the nurse should listen intently but not provide false reassurance. The bargaining stage requires verbal communication.

A client says, "Since my husband died I've got nothing to live for. I just want to die." The nurse hears the nursing assistant say, "Things will get better soon." What does the nurse identify this response as? A) Offering advice B) Belittling the client C) Changing the subject D) Providing false reassurance

D Rationale: False reassurance is an effort to be supportive, often involving the use of clichés, and is not based in fact. Offering advice tells the client what to do; clients should be encouraged to solve their problems. Belittling statements demean the client or minimize client concerns. The nursing assistant's statement did not change the subject.

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

D Rationale: How a person has handled grief in the past provides clues to how he or she will cope with grief in the present. Although family interactions, social support system, and emotional relationships are all important, none is the paramount predictor of a client's reaction to grief.

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

D Rationale: 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. Although personality traits do enter into the grief process, they are not as important in the developing awareness stage as is cultural background. Educational level has no relationship to the grieving process; nor does socioeconomic class.