Module 27 Grief and Loss
A nurse is caring for a child diagnosed with childhood traumatic grief after witnessing the death of a family member. Which clinical therapy or therapies will be most appropriate for the client? Select all that apply. A) Complicated grief treatment B) Psychotherapy C) Grief counseling D) Bereavement groups E) Provision of reassurance
CD
An obstetric nurse is reviewing risk factors for prenatal loss with a group of clients. Which clients are at a high risk for prenatal loss? Select all that apply. A) The woman who drinks one cup of coffee every morning B) The woman recovering from a gastrointestinal virus C) The unmarried 14-year-old woman living in the city D) The woman who lives in a rural area E) The woman who had a healthy baby 6 months ago resulting from a healthy pregnancy
CDE
The nurse is caring for a 3-year-old on the pediatric unit who was in an automobile accident. The client's mother was killed in the accident and the child has just been told that her mother is dead. How should the nurse expect the child to react to this information? A) The child will ask if mommy will cook her favorite meal when she wakes up. B) The child will cry and be depressed. C) The child will ask for her toys and ignore what has been said. D) The child will react with anger and may be violent.
A
The nurse is providing counseling to the family of a terminally ill client. The family has children of varying ages. What should the nurse teach the family about the reactions of children to death? A) "Older school-age children begin to understand that death is inevitable." B) "Adolescents tend to cope better with death than adults." C) "Preschool children view death as a spiritual release." D) "Toddlers perceive death as irreversible and unnatural."
A
The nurse is caring for a child who is terminally ill with cancer. Which outcome(s) would be appropriate for this client's care? Select all that apply. A) The child will eat three balanced meals each day. B) The child will not experience anticipatory grief. C) The child will engage in age-appropriate play as often as possible. D) The airway will be free of secretions. E) The child will not experience pain.
CDE
3) A hospice nurse is critically evaluating various models of grief used for terminally ill clients and their families. What should the nurse recognize when applying these models to individual client cases? A) No clear timetables exist, nor are there clear-cut stages of grief. B) There is strong research proving that these models are not useful for many dying clients. C) The models serve as clear and definitive predictors of grief behaviors. D) The Kübler-Ross model is primarily used to describe anticipatory grief.
A
A client of Native American descent comes to the hospital in early labor at 23 weeks' gestation. The client's parents, sisters, and brothers are with her as well as her husband. The client's family insists on remaining with her during labor. Hospital policy, however, limits visitors to two. Which action is most appropriate for the nurse to take in this situation? A) Ask the parents of the baby what their needs are regarding the family request. B) Call security to escort the family out of the hospital. C) Speak with the nurse manager about supporting the family's wishes. D) Show the family to the waiting room.
A
The graduate nurse accepts a job working on a long-term care unit. Nursing care that is required includes caring for clients at the end of life. Which behavior by the nurse indicates a healthy response to the dying client and family? A) Paying close attention to details regarding the pain and comfort measures for the client B) Delegating physical care of the client to the LPN and UAP C) Remaining out of the room at the moment of death to allow the client and family privacy D) Providing client care without explaining procedures
A
The home health nurse visiting an older Israeli client for a routine medication check determines that the client has declined since the last home visit. The nurse suggests that the client should be transported to the hospital; however, the family members state that they want the client to stay in the home. What should the nurse do? A) Follow the decision of the family. B) Call for an ambulance to transport the client to a hospital. C) Ask the client's preference regarding transport to the hospital. D) Encourage the family to take the client to the hospital.
A
A terminally ill client is demonstrating cognitive signs that the end of life is near. What did the nurse most likely assess in this client to come to this conclusion? Select all that apply. A) Inability to concentrate B) Rambling incoherently C) Nausea D) Dry mouth E) Shortness of breath
AB
8) A client is hospitalized for suicide ideation as a response to complicated grief. What collaborative intervention(s) would be appropriate for this client's care? Select all that apply. A) Social service consult B) Bereavement group C) Antidepressant medication D) Sleep medication E) Psychotherapy
ABC
7) The nurse is concerned that a client whose spouse died 2 years ago is experiencing complicated grief. What should the nurse consider when planning for the care that this client will need going forward? Select all that apply. A) Monitoring for suicidal behavior B) Psychotherapy C) Substance abuse assessment D) Alcohol abuse assessment E) Referral for home care
ABCD
5) The nurse is caring for a client who is diagnosed with dysfunctional grieving after the loss of a child. What treatment approaches are appropriate for the nurse to utilize for a client with dysfunctional grieving? Select all that apply. A) Antidepressants B) Instruction about maladaptive dependence on the nurse C) Talk therapies D) Cognitive therapy E) Anger management
ACD
A nurse is caring for an older adult with depression whose spouse died 2 months ago. When planning care for this client, what goals are most appropriate for this client? Select all that apply. A) The client will use healthy coping mechanisms. B) The client will attend psychotherapy as ordered. C) The client will move on to acceptance of the loss. D) The client will discuss any instances of suicidal thoughts with the nurse or another healthcare provider.
ACD
The hospice nurse reviews the care provided to a dying client. Which observations indicate that outcomes have been reached for this client? Select all that apply. A) The client discusses fears regarding death. B) The client expresses the intention to recover from the illness. C) The client is medicated for pain as needed. D) The client is resting comfortably. E) The family is informed of any changes in the client's condition.
ACDE
) A client with terminal lung cancer is experiencing shortness of breath. The nurse notes bilateral crackles and wheezes, despite oxygen at 4 liters per minute via nasal cannula and diuretic therapy. What nursing intervention or interventions are most appropriate for this client? Select all that apply. A) Elevate the head of the client's bed to a Fowler's position. B) Change the client's oxygen therapy to a nonrebreathing mask. C) Administer morphine sulfate per physician order. D) Move the client to a room closer to the nurse's desk for closer observation. E) Place a fan in the room to move air around the client.
ACE
1) A client is complaining of frequent headaches, chest tightness, palpitations, and menstrual irregularities. The client also reports having lost weight and she is experiencing difficulty eating and sleeping. The nurse notes that the client is tearful, sad, and lacks energy. Which question should the nurse ask this client to explore the source of these symptoms? A) "Can you tell me why you are so sad?" B) "Have you experienced a loss of a loved one recently?" C) "How long have you been grieving?" D) "Why are you crying so much?"
B
1) The nurse is caring for client on the unit who has just died. The client's adolescent daughter is very quiet, and the nurse attempts to talk with her. The adolescent remains silent, not wishing to talk about the loss. What should the nurse do to assist the adolescent? A) Ask the doctor to prescribe a sedative for the adolescent. B) Ask the adolescent if any friends are available to talk. C) Provide the adolescent with paper, pens, and pencils. D) Notifying the hospital chaplain to come talk with the adolescent.
B
4) During a home care visit, an elderly male client tells the nurse that his wife died 3 years ago. Which action by the client would the nurse interpret as being a possible indicator that this client is experiencing complicated grief? A) The client tells the nurse that his wife was an awful cook and that he has eaten better meals since she died. B) The client shows the nurse his wife's craft room and states that it remains just as she left it before she died. C) The client has an album of photographs of his wife open on the living room table. D) The client indicates that he sends his laundry out to be done because he had never figured out how the washer works.
B
A client with severe right-sided abdominal pain is experiencing a miscarriage. Which nursing diagnosis is most appropriate for this client? A) Anxiety B) Grieving C) Interrupted Family Processes D) Ineffective Coping
B
A nurse educator is teaching a group of nursing students about the feelings associated with losing a client. The educator suggests which activity as the most helpful when a nurse is coping with feelings of grief? A) Keeping a scrapbook of pictures of clients after they have died B) Attending the wake or funeral of the client C) Taking a week off from work in order to grieve D) Leaving the unit to go home immediately after the client has died
B
A nurse is caring for a child who has been diagnosed with complicated grief after the recent death of a parent. Which symptom is the child most likely displaying? A) Abnormal or nonexistent progression through the grieving process B) Nightmares and/or sleeplessness C) Confusion and restlessness D) Preoccupation with death as a concept
B
A nurse is caring for a client who just found out she has had a miscarriage. The nurse understands that the client will likely grieve over the loss. What is true regarding perinatal loss grieving? A) The grief experienced by fathers after perinatal loss appears similarly to the grief experienced by mothers after perinatal loss. B) Postpartum depression may occur in women who have experienced perinatal loss. C) Grief is typically less severe when the perinatal loss occurs before 20 weeks' gestation. D) Perinatal loss refers only to emotional changes that occur after perinatal loss.
B
A nurse is caring for an older adult experiencing grief whose spouse recently died. What is true regarding an older adult's response to grief? A) Grief in an older adult initially presents differently than in a younger adult. B) Older adults may seem to experience the emotional aspects of grief more acutely than younger adults. C) Manifestations of grief in older adults are usually less severe than those observed in younger clients. D) Manifestations of grief in older adults are usually trust issues, suspecting once close friends and family members of judging their pain or not understanding their emotions.
B
An older client in the terminal phases of a debilitating muscular disease believes the healthcare team has "failed" and "given up" on him and "aren't trying as hard." On which belief should the nurse plan interventions for this client? A) When clients become terminal, physician care is no longer necessary. B) This is a common fear in the terminally ill client. C) Clients who feel this way are in denial of the facts of their care. D) The client's idea of abandonment is unfounded.
B
The antepartum nurse is caring for parents who have lost their baby at 20 weeks' gestation. Which intervention is most appropriate for the nurse to implement with this family? A) Calling social services to help with burial plans B) Explaining the causative factor of the fetal loss C) Telling the parents they can have another baby D) Obtaining an order for counseling for the parents
B
The nurse identifies the diagnosis of grieving as appropriate for the family of a terminally ill client. Which family behavior supports this diagnosis? A) The family members are crying out loud and wringing their hands during visits. B) The family is tearful and sad during visits with the client. C) The family members state that they cannot care for the client at home. D) Some family members state they cannot go on with life.
B
The nurse is caring for a 40-year-old client who just had amniocentesis and was told that the fetus has Down syndrome. What is an appropriate outcome goal for this client? A) To complete the work of grieving during the hospital stay B) To begin the process of grieving the loss of a normal baby C) To accept the upcoming birth of a baby with special needs D) To consider the possibility of a therapeutic abortion
B
The nurse is completing a home care visit of an 86-year-old client who is dying of end-stage renal failure and dementia. The client has been taking narcotic medication for the treatment of chronic arthritic pain. During the visit, the family tells the nurse that the client seems more restless and is grimacing and crying. What should the nurse do to help this client and family? A) Teach the family alternative methods for pain relief instead of administering pain medication to this client. B) The client may be in pain and an adjustment to the pain medication or administration schedule is needed. C) Encourage the family to continue to administer the pain medication as needed. D) Realize the client is being uncooperative because of a personality disorder.
B
and died alone. What should the nurse plan to address with the client during the grief process? A) Assisting the family through the complicated grief process B) Planning care related to the guilt and grief the mother may feel C) Obtaining a psychological consult for the mother D) Helping the family to arrange the funeral and burial plans
B
A hospice nurse is caring for a client who has been given 6 months to live. Which nursing intervention would address the anxiety of the client and family associated with receiving a terminal diagnosis? A) Encourage early pharmaceutical intervention with anti-anxiety and sedative medications to ease the grieving process. B) Teach the family that while talking with the client about death and dying is permissible, they should not allow the client to dwell on death. coping was D) Supply information about the client's disease process and the expected trajectory of death only on a need-to-know basis.
C
A primigravida is hospitalized at 32 weeks' gestation after a second hemorrhage from a complete placenta previa. The client delivers a stillborn infant 1 week later. Which intervention should the nurse perform to help this family in the grieving process? A) Remove all baby supplies from the mother's room. B) Refrain from talking about the baby. C) Facilitate and support the family viewing and holding the infant. D) Ask to have the mother moved off the postpartum floor.
C
An older client whose spouse died 6 months ago tells the nurse stories about things her husband did over the years. When care has been completed, the client thanks the nurse for listening when her own children will not. From which type of care would this client benefit? A) Antidepressant medication B) Group therapy C) Individual therapy D) Psychotherapy
C
An older client with terminal liver disease is concerned about going home and living on his own. The client is independent with care at this time and does not want to see this end. The client is afraid of dying alone and doesn't want to lose control of body functions. What should the nurse recognize about the client's concerns? A) Appropriate for the situation and will obtain an order for hospice care B) Unrealistic fears because the client shows no symptoms at present C) Common fears and concerns of the dying client D) Signs of depression
C
The nurse educator is developing a seminar to help children who have experienced a loss. Which information should the nurse include to help these children adapt? A) Explain that magical thinking helps with the pain. B) Remind the child that big children don't cry. C) Help create new memories. D) Pretend that the individual has not really gone.
C
The nurse is caring for a client whose wife died 3 years ago. The client tells the nurse that he continues to have dinner with her every Saturday night. He includes a table setting for her and prepares their "usual" steak dinner. He also lights a candle for her each week marking the time of her death. Which is the most appropriate nursing diagnosis for the nurse to select during planning this client's care? A) Risk for Bereavement B) Ineffective Coping C) Complicated Grieving D) Death Anxiety
C
A 90-year-old client is informed that it is no longer safe for the client to drive at night due to the development of night blindness. Which client statement prompts the nurse to plan a family care conference for the client? A) "I will limit my driving to daytime hours." B) "I guess I'll get help when I need to go out at night." C) "In the summer, I will be able to drive longer." D) "I expected this to happen eventually, but I think I still see okay at night."
D
A nurse working in labor and delivery is planning care for a client who is arriving to the unit from a local obstetrician's office with a suspected perinatal loss. What nursing implementation is best for this client and the client's family? A) Place the client in a room closest to the nurse's station to closely observe the client. B) Call the hospital chaplain to ensure the chaplain can be in the client's room when the client arrives. C) Call the local funeral home and notify them of the client's situation. D) Place the client in the room furthest from the other clients.
D
The brother of a 16-year-old client with Down syndrome was hit by a car and killed. The mother plans to hold the funeral before the client gets out of the hospital so that he does not have to experience the grief. What should the nurse respond when the mother asks if this is the right decision to make? A) "You should let the rest of the family decide on whether the client should attend the funeral." B) "You should make the decision when you are feeling better." C) "You made the right choice in holding the funeral now." D) "You should let the client choose to attend the funeral or not."
D
The nurse is caring for a client who lost his wife of 30 years 1 year ago. During care, the client asks the nurse to help him complete the following tasks as he is expecting a visit from a female friend: pick out a clean shirt, help him shave, and comb his hair. Which goal for grieving has this client met? A) The client is working through the pain of his wife's death. B) The client has adjusted to the hospital environment and the role of the nurse. C) The client has accepted his disability by asking the nurse for help. D) The client has emotionally moved on with his life.
D
The nurse is caring for a premature baby who was born at 28 weeks' gestation. The baby's parents tell a visiting family member, "we'll be ready to bring the baby home in a few weeks." Which is the most therapeutic response by the nurse in this situation? A) "A therapist could help you resolve your feelings of denial." B) "I'm glad he's doing so well." C) "Do you have the nursery ready yet?" D) "Although your baby is doing quite well, he probably won't be ready to come home for a few months."
D
The nurse is caring for an adolescent client who has just learned she is pregnant. In order to decrease the risk of perinatal loss with this client, the nurse wants to assess the client for specific risk factors. What information will the nurse want to question specifically for the adolescent who was just informed she is pregnant? A) "Please tell me about your dietary habits." B) "When was your last menstrual period?" C) "Is this your first pregnancy?" D) "Do you use any substances such as drugs, alcohol, or tobacco products?"
D
The nurse is caring for an adolescent client with cystic fibrosis who is intubated with an endotracheal tube and is breathing with the assistance of a ventilator. The client is currently alert and oriented to his surroundings but has been told by his parents that survival may not be likely. Which is the most appropriate nursing diagnosis for this client? A) Potential for Imbalanced Nutrition, More Than Body Requirements related to inactivity B) Potential for Fear of Future Pain related to medical procedures C) Anxiety related to leaving chores undone at home D) Powerlessness related to inability to speak to or communicate with friends
D
The nurse is seeing a family 3 months after a house fire that injured several of the family members and destroyed the family home. Which statement indicates that the goals for the children have been met? A) "We are suing the builder for a defect that caused the fire." B) "We have hired an architect to plan our new home." C) "We are still living with relatives." D) "We have sent our children back to school and they are doing well."
D
tells the nurse that she has been having problems sleeping since her boyfriend died unexpectedly 3 weeks ago. The client confides to the nurse that her boyfriend was married, and they were seeing each other secretly. For which reason is the client most likely experiencing sleeping difficulty when grieving? A) External grief B) Chronic grief C) Abbreviated grieving D) Disenfranchised grieving
D
2) The nurse is caring for a male client who has just died of AIDS. The client's partner, also male, is still in the room and is dry-eyed and exhibiting somber behavior. The nurse offers condolences to the partner, realizing that the partner expects what to occur? A) The client's family will want to grieve with him. B) The partner will want support from those around him on the unit. C) The community will not allow the partner to grieve openly. D) The boss at work will be supportive of bereavement leave
c
