Grief Loss and Comfort PrepU Questions
A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage, according to Kübler-Ross?
Anger
In the Parkes model, a person uses denial as a psychological defense in the stage of:
numbness. (which is usually brief, trauma so overwhelms the bereaved survivor that he or she must use denial as a psychological defense)
the patient, family and health care providers are aware the patient is dying and openly acknowledge that reality
open awareness
based on an individuals beliefs related to death and dictate what they believe their patients want to know
personal mythologies
A nurse is working with a group of parents whose children have died from cystic fibrosis. The group is talking about "acceptance." Two parents discuss their unwillingness to accept their child's death. The nurse should understand that:
some individuals find the idea of "accepting" the death of a loved one unachievable.
the patient suspects what others know and attempts to learn the details; may be triggered by inconsistencies between family and health-care providers
suspected awareness
a progressive, irreversible illness that despite cure-focused medical treatment will result in the patient's death
terminal illness
a patient, family/illness barrier of discussion of end-of-life treatment
the lack of discussion
what is the goal in care for the terminally ill?
to promote autonomy
What question should nurses ask themselves to determine if the care they provide to the grieving client has been both therapeutic and client focused?
"Do I have the strength to be present and to facilitate the client who is grieving?"
The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the anger stage of grief is the one who states:
"Why did this have to happen to me?"
what percent of patients experience pain in the last 4 months of life?
46%
Which term refers to the period of time during which mourning of a loss takes place?
Bereavement (Bereavement is the period of time during which mourning of a loss takes place. Grief is defined as the personal feelings that accompany an anticipated or actual loss. Mourning is defined as the individual, family, group, and cultural expressions of grief and associated behaviors. Hospice is a coordinated program of interdisciplinary care and services provided primarily in the home to terminally ill clients and their families.)
C* O M F O R T
Communication: (compassion, non-verbal immediacy, presence)
Which factor is likely to have the greatest impact on how a client responds to grief?
Cultural influences (Both the physical and emotional manifestations of grief may be culturally influenced. Culture also influences a how a person expresses their of grief.)
Which term is used to describe the personal feelings that accompany an anticipated or actual loss?
Grief (Grief is defined as the personal feelings that accompany an anticipated or actual loss. Bereavement is a period during which mourning for a loss take place. Mourning is an expression of grief and associated behaviors. Spirituality is a personal belief system that focuses on a search for meaning and purpose of life.)
Which occurs in the second phase of Bowlby's grieving process?
Emotional yearning for the loved one
The family members of a dying client are finding it difficult to verbalize their feelings for and show tenderness to the client. Which nursing interventions should a nurse perform in such a situation?
Encourage the family members to express their feelings and listen to them in their frank communication.
C O M F* O R T
Family (patient AND family comprise the unit of care
Nursing students are reviewing information about grieving and its assessment findings. The students demonstrate an understanding of the information when they identify which of the following as a behavioral indicator?
Forgetfulness
Which of the following patients would least likely be experiencing loss?
Patient who is abusing substances
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?
Phase of recognition
Caregivers of a 9-year-old client in the terminal phase of a fatal illness ask the nurse for guidance in discussing death with the client. Which response is appropriate?
"At this developmental stage, most children have an adult concept of death and should be encouraged to discuss it." (By age 9 or 10, most children have an adult concept of death. Therefore, caregivers should discuss death with them in terms consistent with their developmental stage. In addition, school-age children respond well to concrete explanations about death and dying. Preschoolers, not school-age children, typically view death as temporary and reversible. While school-age children may fantasize about the unknown aspects of death, these fantasies may actually increase their anxiety. Although a child may fear death, accurate information about death can ease anxiety. )
A client has just expelled a hydatidiform mole. She's visibly upset over the loss and wants to know when she can try to become pregnant again. How should the nurse respond?
"You must wait at least 1 year before becoming pregnant again."
When talking with 10-year-old children about death, the nurse should incorporate which guidelines? Select all that apply.
-The children will be curious about the physical aspects of death. -The children will know that death is inevitable and irreversible. -Attitudes of the adults in their lives will influence the children.
A community mental health nurse has come to know that the mother of a long-term client has passed away. What are ways for the nurse to determine if the client will be at risk for complicated grief? Select all that apply.
-The client has low self-esteem. - The client is unable to trust others. -The client has attempted suicide in the past.
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
All nurses care for clients who are grieving. It is important for the nurse to understand the grieving process for which reason?
Allows for the nurse to facilitate the grieving process
Which is an example of a perceived loss?
An older client grieves for the loss of independence
term that states that the health care system has been built on management of acute illness and the use of technology to cure (when possible) and to extend life
death-denying
A mental health nurse is caring for a client with schizophrenia. The nurse observes the client laughing about the recent death of the client's father. The nurse would correctly document this mood as what?
Incongruent (The correct answer is incongruent affect or lack of harmony between one's voice and movements with one's speech or verbalized thoughts. Blunted affect is a severe reduction or limitation in the intensity of one's affective responses to a situation. Flat affect describes absence or near absence of any signs of affective responses. Labile affect is the abnormal fluctuation of one's expressions.)
C O M* F O R T
Mindfulness: (stay in the moment, adapt to rapid changes)
C O M F O* R T
Openings (seek a higher level of understanding of disease, culture, family, ect)
C O* M F O R T
Orientation: (cultural sensitivity, support health literacy)
what is the preferred method of administering analgesics to a hospice patient for pain?
PO, sublingual, or rectal
A client who is in the process of divorce tells the nurse the client will require some time off from work due to the inability to concentrate. According to Bowlby's phases of grieving, which phase best reflects this client's current experience?
disorganization and despair
what is the anorexia-cachexia syndrome characterized by?
disturbances in carbohydrate, protein, and fat metabolism; endocrine dysfunction, and anemia
A nurse is caring for a 5-year-old child with end-stage acquired immunodeficiency syndrome (AIDS). The child confides that the child is ready to go to heaven and see Grandpa. The nurse knows that the child's parents aren't comfortable with the idea of discontinuing treatment. What should the nurse do?
Talk with the parents about the dying process and make the parents aware of what the child has confided.
The husband of a client who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. What type of grief is the husband experiencing?
Unresolved grief
in a care-focused perspective, there is ____ ____ that can be done
always more
why are clinicicians reluctant to discuss disease and death openly with patients?
it feeds their own anxieties about death as well as misconceptions about what and how much patients want to know about their illnesses
the patient, family, and health care providers are aware the patient is dying but all pretend otherwise
mutual pretense awareness
A client tells the nurse the client been dating someone for three months after finalizing divorce one year ago. According to Rando (1984), the client is engaging in which grieving task?
re-investing
A mother of three young children has been diagnosed with stage III breast cancer and is distraught. Which statement best communicates a spirit of hopefulness to this client?
"Let's take this one day at a time; remember you have your daughter's dance recital next (Helping a client to find reasons to live and look forward to events promotes positive attitudes and ability to live for the moment, which in turn communicates a spirit of hopefulness. The statement about a second opinion is inappropriate because it gives the client false hope that her current diagnosis is inaccurate. Althought he client may choose another medical opinion, she needs to come to that decision without the nurse's advice. Reponses should not convey false hope to the client. Nurses and clients should not confuse hope with unrealistic optimism.)
Which statement is typical of the first stage of grieving described by Engel?
"No, not me." (According to Engel, the first stage of grief is shock and disbelief. In this initial stage, the surviving family members often refuse to accept the fact of the loss, followed by a stunned or numb response of "no, not me.")
The nurse most effectively explains to a terminally ill client's spouse that the frustration and anger the client is exhibiting is associated with what aspect of dying?
An expression of a universally held need of the dying (The nurse most effectively explains to a terminally ill client's spouse that the frustration and anger the client 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.)
Which term describes the process by which a person experiences grief?
Bereavement (Grieving, also known as bereavement, is the process by which a person experiences the grief. Homeostasis is the return to normal. 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.)
Which of the following would not be consistent with promoting nutrition in terminally ill patients?
Maintaining a balanced diet One should not be overly concerned about a "balanced" diet for terminally ill patients. Offering small portions of favorite foods, avoiding arguments at mealtime, and offering cool foods rather that hot foods are all tips that promote nutrition in terminally ill patients
C O M F O R* T
Relating (communication is non-linear, prioritize the turning point in illness)
A nurse is assessing a client and attempting to differentiate if the client is experiencing grief or depression. Which of the following would the nurse identify as indicative of grief?
Self-blame (Blaming one's self or others is characteristic of grief. Sleep problems occur with depression and grief. Weight gain or loss and feelings of worthlessness are associated with depression.)
A client diagnosed with advanced lung cancer has a nursing diagnosis of Ineffective Coping. What assessment data would provide evidence to the nurse for this diagnosis?
The client states, "I am sure the doctors have misdiagnosed me."
"My father has been dead for over a year and my mother still can't talk about him without crying. Is that normal?" What is the best response by the nurse?
The inability to talk about your dad without crying, even after a year, is still considered normal."
The nurse is assessing an older adult client with lower back pain. In the course of assessment, the nurse learns that the client lost a spouse 10 weeks ago. The client laughs inappropriately and states, "My spouse just up and left me!" Which is the nurse's best response?
The nurse should recognize the incongruity between content and behavior and find ways of exploring further.
what is a key factor in acceptance of and planning for death
awareness of the prognosis
why have families become increasingly distanced from the death experience?
because place of death has shifted from home to hospitals
A client was recently in a motor vehicle accident, which resulted in an amputation of the right leg. The client is withdrawn, doesn't want to get out of bed, and has been crying a lot. What behaviors is the client demonstrating?
bereavement (The client is exhibiting a symptom of bereavement that includes emotional, physical, social, and cognitive responses.)
A widow develops cancer within 6 months of her husband's death. This may be a result of:
bereavement. (Physical health and psychosocial adjustment are intricately intertwined. The bereaved are known to be at greater risk for mortality and morbidity than are comparable non-bereaved people.)
the patient is unaware of their terminal state, whereas others are; characterized by a conspiracy between family and health care providers to guard the "secret"
closed awareness
Which type of grief occurs when a person is stuck in a state of chronic grieving?
complicated grief
Which nursing activity supports the principles of palliative care for a dying infant and the infant's family?
creating a therapeutic, homelike environment for the infant and the infant's family (The goal of palliative care is to make the infant and the infant's family as comfortable as possible. )
A widow has just returned home from the funeral of her husband. She feels alone in her home. Her family has left to go back to their home in another area of the country. What stage of Engel's model does this represent?
developing awareness
drugs that stimulate appetite in patients with anorexia:
dexamethasone (Decadron), megestrol acetate (Megace), and dronabinol (Marinol)
a type of comprehensive care for patients whose disease is not responsive to cure
palliative care
focus of care on the dying is motivated by:
-aging population -life-threatening illnesses -prolonged chronic illnesses due to advanced medicine and technology
what do you do in response to the question "Am I dying?
-establish eye contact -acknowledge the patient's fears, followed by an open ended question -listen, ask additional open ended questions, and provide only realistic reassurance
A group of nursing students is reviewing information about grief and bereavement. The students demonstrate understanding of the information when they state:
Bereavement is the process of mourning and grief is the emotional reaction. (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.)
The nurse is caring for a client whose spouse passed away several years ago. Upon assessment, the nurse finds that the client has a history of signs and symptoms of depression since the spouse's death. Which term correctly describes the client's response to the loss?
Complicated Grief
C O M F O R T*
Team (assures continuity of care, patient and family are a part of the team)
A client is crying continuously from having lost a friend in an accident. According to the tasks of grieving by Rando, which task of grief is expected to be accomplished next?
Recollect and reexperience
The nurse is providing individual support to a female client who attends a group for people who have experienced loss of a family member to suicide. The client's son committed suicide one month ago. The client was not aware that her son experienced depression. Which risk factors for complicated grief are most likely for this client? (Select all that apply.)
death of a child sudden, unexpected death death by suicide
