Pearson Grief and Loss
Which behavior exhibited by a child indicates that they have experienced childhood traumatic grief? A. The child refuses to go to the mall where the parent died from a heart attack. B. The child experiences sadness and loneliness after the loss of a parent. C. The child chooses not to attend after-hours school functions. D. The child prefers to stay at home most evenings and does not socialize.
Answer: A Childhood traumatic grief happens after the child experiences a loss associated with a traumatic death. The child associates the location of the death with horrible memories and refuses to go there. Therefore, the child refusing to go to the mall where the parent died of a heart attack is an example of childhood traumatic grief. Normal grief involves sadness and loneliness and is not related to childhood traumatic grief. If the child chooses not to participate in after-school activities, it may indicate depression, not childhood traumatic grief. Preferring to stay at home and not socializing may also indicate depression.
The nurse is caring for a patient who passed away 10 minutes ago. The nurse and the unlicensed assistive personnel prepare the body for the family to view. Which action by the nurse indicates a need for a coworker or the nurse manager to intervene? A. The nurse sobbing in the room with the patient's family B. The nurse providing the family extra time with the deceased to say their goodbyes C. The nurse providing extra chairs for the patient's room D. The nurse allowing the spouse to comb the patient's hair
Answer: A It can be emotionally draining to care for patients who are dying. The nurse must be supportive and provide empathy but should not be sobbing in the patient's room. This action requires a coworker or manager to intervene. Rather than turning to the patient's family, the nurse should use other resources for support including coworkers, professional therapists or social workers, and grief counseling resources offered through employers. It is appropriate for the nurse to allow a spouse to help prepare the body, such as combing the hair. The nurse should provide enough chairs, if possible, for the family to be in the room. The nurse can provide extra time for the family and can provide basic information to the family regarding the dying process and having kept the patient comfortable, if necessary.
The nurse is caring for a patient who experienced the loss of a child a month ago. Which finding would support the nurse documenting that the patient is in the early stages of experiencing grief? A. Staying at home except for work B. Resolving legal insurance paperwork C. Packing up clothes to donate D. Planning to move into a smaller home
Answer: A The parent is isolating themselves and does not want to leave the house except for work. This is a sign that the parent is experiencing grief. Intense feelings of grief over the loss of a loved one are generally believed to lessen over a few months, and to resolve—or at least partly resolve—within 1-2 years. Individuals who are unable to process their grief to a point of resolution may experience complicated grief; the nurse would need to monitor for this development. Resolving legal insurance matters, planning to move to a smaller home, and packing up clothes indicate bereavement and the ability to move on past the loss.
The nurse working in a bereavement center is developing a plan of care for a parent who lost a child a month ago due to an act of violence. Which intervention should the nurse include for this parent to help facilitate the grieving process? A. Assessing for signs of unhealthy coping mechanisms B. Discussing the legal case with the parent and if they caught the attacker C. Suggesting the use of antidepressants for long-term coping D. Encouraging the parent to sleep for 10-12 hours every night
Answer: A The parent lost their child in a violent and sudden manner and did not have any way to prepare for the death. Therefore, the parent is at a higher risk for maladaptive grieving behaviors. The use of antidepressants after a death would not be used for long-term coping. The nurse should not ask the parent about the legal case involving the attacker. While it is important for the nurse to suggest a good night's sleep, sleeping 10-12 hours every night is not conducive to healing and may be too much sleep.
The nurse is developing a plan of care for a patient who practices the Catholic faith and is preparing to deliver a fetus at 26 weeks with no detectable heartbeat. Which question addresses the patient spiritual beliefs? A. "Would you like me to arrange for a priest to come in?" B. "How can I help you prepare for your mourning period?" C. "Do you have a funeral home that you want us to call?" D. "Do you want me to plan on having a female nurse care for you?"
Answer: A The patient is Catholic and is preparing to deliver a stillborn fetus, so the nurse should offer to arrange for a priest to visit to provide support offering spiritual solace. The other options do not recognize the patient's spiritual beliefs.
A patient who is scheduled to have a below-the-knee amputation tells the nurse that they feel like this is the end of life. Which type of grief should the nurse document this patient is experiencing? A. Anticipatory grief B. Perceived grief C. Complicated grief D. Disenfranchised grief
Answer: A The patient is experiencing anticipatory grief, because the patient has not lost the limb yet. There is no type of perceived grief, only perceived loss that is loss evident to the person but not visible to others. Complicated grief is not diagnosed until 6 months after the loss is experienced and has become debilitating and makes performing activities of daily living complicated. Disenfranchised grief is when a person is unable to tell others of their grief; it may be socially unrecognized.
The hospice nurse is working with the spouse and family of a patient who is diagnosed with terminal cancer. The spouse tells the nurse that it will be impossible to move on without their partner. Which type of grieving is the spouse experiencing? A. Anticipatory grieving B. Disenfranchised grieving C. Complicated grieving D. Perceived grieving
Answer: A The spouse is exhibiting signs of anticipatory grieving, because they know that their spouse has a terminal diagnosis and will die. They are trying to picture what life will be like without their spouse. Disenfranchised grieving occurs when a person cannot tell others of the loss, such as an abortion. Complicated grieving is life-altering grieving that lasts past 6 months after the loss. A perceived loss, not perceived grieving, is a loss that is not visible, such as loss of independence or self-esteem.
The nurse is assessing a patient who just lost their significant other yesterday to cancer documents that the family of the significant other did not approve of the relationship nor accepts the patient's grief. Which patient statement supports this assessment finding? A. "My partner's family will not allow me to help plan the funeral." B. "My partner's family disagrees with his wishes to be cremated." C. "My partner's family is leaving me stuck with all the medical bills." D. "My partner's family asked for some personal mementos and pictures."
Answer: A When the partner's family refuses to allow the patient to help plan the funeral, this can indicate a lack of acceptance of the relationship, as the nurse determined in the assessment. Leaving the patient with medical bills does not indicate a lack of acceptance; it is just poor judgment on behalf of the partner's family. Asking for personal mementos is the family's way of mourning. The family disagreeing with the partner's final wishes indicates a discrepancy between the partner and his family and does not indicate lack of support of the relationship.
The nurse is caring for a 7-year-old child whose older sibling passed away. Which response should the nurse monitor in the child? A. Loss may impair development B. Loss of independence may occur C. Loss becomes a part of normal development D. Loss often includes a loss of health
Answer: A Rationale: A child who experiences a loss may have developmental impairments. The other descriptions reflect the ways in which grief can affect adults, not children.
The nurse is caring for a child who is grieving the loss of a close grandparent. Which behavior observed by the nurse is a manifestation of the grieving process? (Select all that apply.) A. Irritability B. Bedwetting C. Increased socialization D. Changes in eating habits E. Changes in sleeping habits
Answer: A, B, D, E Rationale: Typical behavior changes in children, depending upon age, during the grieving process include regression, bedwetting, irritability, anger, aggression, changes in eating and sleeping habits, guilt, and decreased, not increased, socialization.
The nurse is assessing a 5-year-old client who has recently lost a grandparent. The mother is requesting an antidepressant for the child to help with grieving. Which statement by the nurse is most appropriate in this situation? (Select all that apply) A. "Very few children require medications for depression." B. "I agree that an antidepressant is needed. I'll speak with your physician." C. "Antidepressants now could cause additional problems later in your child's life." D. "Antidepressants have few side effects, so a prescription here could truly be beneficial." E. "Antidepressants can actually interfere with your child developing their own coping mechanisms."
Answer: A, C, E Rationale: Children who are having trouble working through the grief process typically can benefit from nonpharmacologic options. Therapy or group counseling can be very effective. Most pediatric patients do not require medications for depression. In fact, antidepressants may interfere with the child's development of coping mechanisms and create additional problems in the future.
The nurse is teaching a course on grieving to new staff members. Which should the nurse include in the presentation as an expected manifestation of grief? (Select all that apply.) A. Selling the family home B. Becoming distrustful of others C. Having difficulty concentrating D. Experiencing auditory hallucinations E. Moving in with a friend or family member
Answer: A, C, E Rationale: Selling the family home, moving in with a friend or family member, and having difficulty concentrating are expected alterations or manifestations of grief. Becoming distrustful of others or experiencing auditory hallucinations are manifestations of complicated grief and require immediate intervention by the healthcare team.
Which clinical manifestation noted in an older adult indicates to the nurse that the client is experiencing complicated grief? (Select all that apply.) A. Depression B. Obsession with death C. Planning one's own funeral D. Distrust of family and friends E. Avoidance of people or places that arouse memories
Answer: A, D, E Rationale: Depression, avoidance of people and places associated with the loss, and distrust of family and friends who are perceived as not understanding the grief are common in complicated grief. Obsession with death and planning one's own funeral are not typical symptoms of complicated grief in an older adult.
The nurse is leading a support group for parents who have lost children. The nurse is assessing the patients as they interact. Which exhibited patient behavior indicates unhealthy coping? A. The patient preserving mementos of the child B. The patient looking disheveled and unkempt C. The patient discussing the loss with others D. The patient stating difficulty getting motivated every day
Answer: B A sign of maladaptive grief is having difficulty meeting daily needs such as bathing, grooming, and other activities of daily living. Signs of healthy grieving would be an ability to discuss the loss with others, preserving mementos of the child, and decreased motivation.
The nurse is caring for a patient who received test results indicating a new diagnosis of lung cancer. Which patient statement indicates that they are experiencing the bargaining stage of Kübler-Ross's stages of grieving? A. "I will plan to shave my head and get a wig for when my hair falls out." B. "I will volunteer to help the homeless if this cancer goes away." C. "I will discuss my options with my spouse and opt for the best treatment." D. "I will start getting my affairs in order in case the surgery doesn't go well."
Answer: B According to Kübler-Ross, the bargaining stage of grief is when a person decides to bargain with a higher power or become a better person for more time. Therefore, the patient who states they will volunteer to help the homeless if the cancer is successfully treated indicates the bargaining stage. The other three options demonstrate acceptance.
The nurse is working with a family who sustained the loss of a parent. The child is having a difficult time coping with the loss. The parent asks about antidepressants. Which information is most important for the nurse to provide about the use of antidepressant medications in children? A. Appetite suppression B. Risk of suicidal ideations C. Increased need for sleep D. No need to continue counseling
Answer: B Antidepressants increase the risk of suicidal ideations, especially in children. Therefore, the nurse would educate the parent about signs to observe for in the child. Antidepressants typically increase, not decrease, appetite. While antidepressants can have diverse effects on sleep depending on classification, it is not as important as the safety risk for suicidal ideations. Counseling should be continued while the patient is receiving antidepressants.
The nurse is caring for a patient at the primary care clinic who experienced a miscarriage after 20 weeks' gestation. The spouse reports that the patient lies in bed all the time, has missed several days of work, and does not want to eat. Which intervention should the nurse expect the healthcare provider to order? A. Blood transfusions B. Antidepressants C. Inpatient hospitalization D. Antibiotics
Answer: B Antidepressants, often coupled with hormone therapy, have been shown to be effective in the treatment of postpartum depression and depression from perinatal loss; medication can also be used in combination with other forms of therapy and counseling. Unless this patient develops postpartum psychosis, she is not at risk for self-harm nor harm to others, so the patient would not need inpatient hospitalization. The patient is not at risk for infection, because there is no evidence of placental retention or infection. There is no evidence of blood loss, so there is no need for blood transfusions.
The nurse is talking to a 25-year-old man whose life partner was recently killed in the line of duty as a police officer. The patient tells you that his family has never approved of his sexual orientation and does not accept his grief over the death of his boyfriend. Which question should the nurse ask the patient in order to obtain further information needed to develop an appropriate plan of care? A. "I can see it must be difficult to have your family not accept your grief." B. "What is it like to have your family not accept your grief?" C. "Are you saying that it is difficult to have your family not accept your grief?" D. "Is it difficult to have your family not accept your grief?"
Answer: B Open-ended questions are exploratory questions to which the nurse may or may not know the answer. Asking what it is like to have his family not accept his grief over the death of his partner is an open-ended question that invites further communication. Asking whether it is difficult to have the family not accept his grief or to confirm that the patient is saying it is difficult to have his family not accept the grief are questions to which the patient can answer with just a yes or no. The nurse's acknowledgment that it must be difficult to have the family not accept the grief is an example of reflection.
A 6-year-old child tells the school nurse that their stepfather, who was physically abusive, has died. The child reports being confused that they are both happy and sad that their stepfather died. The nurse should document that the child is experiencing which type of grief reaction? A. Anticipatory grief B. Complicated grief reaction C. Disenfranchised grief D. Childhood traumatic grief
Answer: B The child is experiencing differing emotions, because they are sad that a person close to their life has died, but happy that they will no longer be a victim of abuse. This is a complicated grief response. Disenfranchised grief would be from a loss that the person cannot share, such as an abortion. Anticipatory grief would be grief that a person experiences knowing that someone will soon die. Childhood traumatic grief occurs when a child witnesses the traumatic death of a person.
Which intervention should the nurse include in the plan of care for a child who is dying? A. Providing 24-hour live-in assistance to care for the child B. Allowing the parents to assist with the child's care C. Suggesting that the child be hospitalized for all care D. Minimizing the number of visitors allowed at one time
Answer: B The nurse should always allow the parents to participate in the care of their own child, no matter what the stage of life or dying is. The nurse should not suggest that the parents hospitalize the child, because care can be managed well in the child's home. The parents should decide if they want live-in assistance. The nurse does not need to limit the number of visitors, because it should be up to the patient and family.
The nurse is visiting a family whose 15-year-old child died. The family has two remaining children, aged 11 and 9. Which information should the nurse provide the siblings regarding the loss of their older sibling? A. The reality of their sibling's death and that it is final B. That the death of their sibling is not their fault C. The importance of talking with the school counselor D. The need to help their parents with chores
Answer: B The nurse should explain to the parents that children between the ages of 8-11 may believe that they are responsible for the death of a close family member because of negative thoughts or misbehaviors. Therefore, the parents need to explain that the death is not their fault. The parents should not be instructed to enforce chores just as a result of grieving. The children may not feel comfortable discussing this with the school counselor, but they should be encouraged to discuss the loss with the parents. Children between 8-11 years understand that death is permanent.
An older patient who has been admitted to a mental health unit for treatment of depression and failure to thrive. The patient reports losing their spouse 4 months ago. The healthcare provider has prescribed nutritional supplements and antidepressant medication along with counseling. During a follow-up visit, which assessment finding indicates improvement in the patient's status? A. Changing code status to do not resuscitate B. Gaining 2 pounds in one week C. Initiation of total parenteral nutrition D. Lying in bed half the day
Answer: B The older adult who is exhibiting symptoms of depression severe enough to be diagnosed with failure to thrive is malnourished due to lack of intake. Therefore, a weight gain of 2 pounds in one week indicates improvement in appetite. Lying in bed half the day indicates a lack of energy or motivation, which are findings of depression. The initiation of total parenteral nutrition indicates the patient's nutritional status has worsened and needs supplementation. The patient changing their code status to do not resuscitate without having a terminal diagnosis indicates a willingness to die.
The nurse is assigned to care for four patients today in a medical-surgical unit. Which patient should the nurse expect to experience anticipatory grief? A. The patient who lost a spouse 2 months ago to metastatic cancer B. The patient who is scheduled for a mastectomy this afternoon C. The patient who had an above-the-knee amputation last month D. The patient diagnosed with type 2 diabetes mellitus 2 months ago
Answer: B The patient who is having a mastectomy this afternoon would be at highest risk for having anticipatory grieving due to the upcoming loss of a breast. The patient who underwent an above-the-knee amputation, the patient who lost a spouse 2 months ago, and the patient diagnosed 2 months ago with type 2 diabetes have already experienced their initial losses and thus have moved beyond anticipatory grieving.
The parents of a 4-year-old child state that their child has been regressing in their toilet training, demanding extra attention, and has no interest in playing. The family has recently experienced the death of the grandmother, who lived with them in the household. How should the nurse respond to the family's concerns? A. "This is common behavior for a 4-year-old child due to learning and testing independence." B. "These are expected behaviors for a child their age in dealing with the loss of a close grandparent." C. "I'm sure you have been busy with the recent loss, and your child just needs your attention." D. "Maybe your child has an infection? It is best to let the doctor evaluate the symptoms."
Answer: B This child is grieving the loss of the grandparent. These are expected behaviors for a child their age in dealing with grief. These would not be the behaviors of a child testing their learning and independence. Although the child is seeking attention, it is not because their parents are busy. The child does not exhibit any manifestations of an infection.
The nurse is caring for a patient who sustained a limb loss from military combat. Which assessment finding indicates that the patient is recovering from his loss? A. Sits in a room during scheduled activities B. Runs a half marathon with a limb prosthesis C. Uses the wheelchair for mobility instead of the prosthesis D. Verbalizes frustration with the exercise program and gait training
Answer: B When the patient uses the new limb prosthesis and runs a half marathon, this indicates acceptance of the loss. Staying in their room during activities could indicate depression. Using the wheelchair instead of the prosthesis could indicate despair. Verbalizing frustration with the exercise program indicates anger.
The nurse is comforting the adult daughter of a client who has just passed away. On which type of loss should the nurse base the interventions when developing a plan of care? A. Perceived B. Actual C. Developmental D. Anticipatory
Answer: B Rationale: An actual loss is one that can be identified and recognized by others, such as the loss of a family member. A developmental loss is one that is expected to occur throughout the course of life, such as losses of function associated with aging; the nurse should provide interventions to address this type of loss. A perceived loss is one that cannot be verified by others. An anticipatory loss is one that is experienced before the loss actually occurs.
The nurse is assessing a 5-year-old child who experienced the loss of an older sibling. Which behavior should be expected based on the child's developmental level? A. Yelling at the parents that the death is their fault B. Watching out the window for the sibling to come home C. Planting a tree in the back yard in memory D. Going into the sibling's room and playing with their toys
Answer: B Rationale: Children between the ages of 5-7 years old do not fully understand the concept of dying and that it is permanent. Therefore, watching out the window for the sibling to come home is a behavior that is appropriate for this developmental age. Planting a tree in the backyard in the sibling's memory and yelling at the parents by assigning blame are behaviors displayed by an adolescent. Going into the sibling's room to play with their toys would be appropriate for a toddler or preschool-aged child.
The nurse is providing care to an older adult client who is experiencing new symptoms of grief. Which item in the client's history should the nurse consider as the possible cause of these symptoms? A. The loss of a pregnancy 20 years ago B. The recent move to an assisted-living facility C. The loss of a spouse 5 years ago D. Being diagnosed with type 1 diabetes mellitus as a child
Answer: B Rationale: While the loss of a pregnancy and of a spouse years ago may influence symptoms of grief, the recent move to an assisted-living facility and the loss of independence associated with this move is the likely cause of the client's new symptoms of grief. The diagnosis of type 1 diabetes mellitus in childhood is not a factor in this client's grief.
The nurse is working with a family whose father passed away and discovers that the 9-year-old child is worried that the other parent may die. Which behavior noted in the child supports this finding? (Select all that apply.) A. The child enjoys going to school every day B. The child sleeps in the parent's bed at night C. The child goes over to friends' houses to play D. The child prefers to stay at home all the time E. The child stays awake at night to watch the parent sleep
Answer: B, D, E Rationale: Children who have lost a parent become worried that they will lose the other parent. Their behaviors center on spending time with the remaining parent, including sleeping in the parent's bed, staying home all the time, and staying awake at night to watch the parent sleep. Enjoying going to school and friends' houses do not indicate a fear of losing the other parent.
The nurse is planning care for a patient who is experiencing overwhelming grief and loss after the death of a parent. Which nursing intervention may help reduce this patient's anxiety? A. Encouraging the patient to resume normal activities when ready and to promote physical and psychologic health B. Teaching family members to encourage the patient's expressions of grief C. Referring the patient to a grief therapist, group therapy, or a bereavement group D. Teaching about safe administration and side effects of medications
Answer: C A referral to an individual or group that can provide expert guidance about coping with loss and assistance with linking with additional resources will help this patient begin to process grief and help reduce anxiety. Teaching about medications and side effects is appropriate only when the patient is prescribed antianxiety or other medications to treat stress. Sometimes, brief courses of anxiolytics are prescribed to assist grieving patients. If signs of depression are present, the patient may be prescribed an antidepressant. Teaching family members to encourage the patient's expressions of grief and encouraging the patient to resume activities when ready are appropriate interventions to facilitate the patient's grief work.
The nurse is teaching a group of parents how a child's developmental level affects their concept of death and loss. Which finding should the nurse expect to see in an 8-year-old child as opposed to an adolescent? A. The 8-year-old child may expect the deceased person to return, whereas an adolescent displays developmental regression. B. The 8-year-old child may become aggressive and prefer solitude, whereas an adolescent believes that the death is their fault. C. The 8-year-old child may become withdrawn and prefer solitude, whereas an adolescent directs anger toward the parent. D. The 8-year-old child may begin wetting the bed and show regression, whereas an adolescent refuses to discuss the loss with peers.
Answer: C An 8-year-old child may become aggressive and believe that the death is their fault or become withdrawn and prefer solitude. Adolescents may direct their grief toward their parents. Toddlers may regress in toilet training and experience bedwetting. Toddlers and early school-age children see death as reversible and that the person will come back. Adolescents prefer to discuss the loss with their peers or those outside the family, but do not regress, nor do they believe that the death is their fault.
The nurse is caring for a patient who experienced a miscarriage at 17 weeks of gestation. Which type of grief should the nurse assess for during the 2-week follow-up visit? A. Bittersweet B. Anticipatory C. Disenfranchised D. Dysfunctional
Answer: C Disenfranchised grief occurs when the person feels marginalized or forgotten by support persons or society. Perinatal loss is not usually recognized by society. Bittersweet grief occurs in response to memories that linger after the loss. The person may have processed the loss, but at certain times the feelings of grief may return. Anticipatory grieving occurs when there is foreknowledge of an impending loss. Dysfunctional grieving manifests as prolonged or exaggerated grief.
An older adult is dealing with the loss of a spouse 2 months ago and reports feeling empty and alone. The patient has lost weight and acknowledges having a poor appetite. Which intervention would most benefit this patient? A. Incorporating snacks throughout the day B. Using antidepressant medications C. Including nutritional supplements every day D. Recommending going out to eat and socializing
Answer: C The nurse would recommend easy ways to increase caloric intake, such as using nutritional supplements. This can be something the patient can drink throughout the day. The patient is grieving and may not have the energy to go out to eat and socialize. Snacks can help but may consist of empty calories. The patient lost their spouse 2 months ago and is still actively grieving; they may not need antidepressant medications at this time and it is not within the nurse's scope of practice to recommend medications.
An older patient with a history of hypertension and coronary heart disease is experiencing complicated grief. The patient has been prescribed an antidepressant. The nurse should monitor for which side effect? A. Severe headaches B. Sudden rise in blood pressure C. Suicidal thoughts D. Slowing of the heart rate
Answer: C The use of antidepressants can cause suicidal thoughts and result in the patient harming themselves. Elevated blood pressure, bradycardia, or severe headaches are not seen with the use of antidepressants.
The nurse is providing a presentation to a support group for those who have lost a loved one. Which statement by the nurse defines the concept of complicated grief in an older adult? A. "Complicated grief in older adults affects only those who are in a nursing home or hospital." B. "All people grieve differently, so complicated grief is not an accurate label for everyone." C. "Complicated grief is an abnormal grieving process that lasts longer than 6 months." D. "Complicated grief does not occur in older adults."
Answer: C Rationale: Complicated grief in older adults is an abnormal grieving process that lasts longer than 6 months. Complicated grief usually applies to older adults, no matter what their age or location.
The nurse is conducting a support group for parents who have experienced the loss of a child. The clients are talking among themselves. Which behavior noted by the nurse indicates that a client is experiencing complicated grief? A. The client has difficulty concentrating and staying on task B. The client reports eating only 25% of meals C. The client talks to people who aren't there D. The client verbalizes having difficulty sleeping
Answer: C Rationale: Individuals with complicated grief may experience auditory hallucinations. Sleep disturbances, loss of appetite, and difficulty concentrating are symptoms of normal grief.
The nurse manager of an oncology unit is working with a new nurse who has experienced the loss of several clients over the past 6 months. Which action should the nurse manager suggest to the new nurse to help prevent burnout when caring for dying clients? A. Talking about other, more positive topics with dying clients B. Expressing personal feelings about death to clients C. Assessing personal needs to grieve and process loss D. Not approaching work personally
Answer: C Rationale: Nurses who experience more frequent deaths should assess their own needs to grieve and process a loss in order to avoid burnout. Nurses who assess their feelings about death and handle them properly do not impose their feelings on their clients. Nurses who are not prepared may cope by offering false hope or by encouraging the client and family to talk about something other than the death at hand. Expressing personal feelings about death does not help with personal grieving. It is easy for nurses to form bonds with individual clients who have terminal illnesses or are fatally injured. Nurses also feel grief when a client dies, so it is difficult to not approach work personally.
Which factor should the nurse discuss with the parents of a stillborn infant prior to allowing them a viewing? A. The need for taping the hands together B. Time limitations for visit C. The appearance of the newborn D. Opportunity for a keepsake
Answer: C Rationale: The nurse should prepare the parents of a stillborn infant for the way the baby may appear. This includes maceration and discoloration of the skin. The nurse does not place a time limitation on the visit. After the infant has been born, the nurse can explore whether the parents would like keepsakes of the child, such as a picture, a lock of hair, or foot- or handprints. The newborn's hands are not taped together prior to viewing by the parents.
The nurse is caring for a patient who lost his spouse to cancer a year ago. Which assessment finding supports the diagnosis of complicated grief? A. Anger B. Crying C. Confusion D. Distrustful of family
Answer: D A patient with complicated grief may distrust others. Crying, anger, and confusion are expected alterations and manifestations of grief.
The nurse is consoling the family of a patient who has just passed away. The patient and family practice the Jewish faith. It is currently the Sabbath day. Which intervention should the nurse perform first? A. Preparing the body to be taken to the morgue as soon as possible B. Notifying the funeral home to take the patient C. Moving the patient to a private room to allow grieving D. Keeping the patient in the room until the Sabbath is over
Answer: D According to the Jewish faith and culture, if a person dies on the Sabbath, they are to be left where they are and cannot be moved until the Sabbath is over. Therefore, the nurse would not move the body to a private room, would not take the patient to the morgue, and would not notify the funeral home to take the patient.
The nurse assesses a child who has been taking antidepressants to manage childhood traumatic grief. Which question should the nurse ask the child to determine the presence of negative effects of the medication? A. "Have you been seeing the counselor while taking this medication?" B. "At what time of the day do you take the medication?" C. "Do you feel any relief from the depression?" D. "Do you ever have thoughts of harming yourself?"
Answer: D Antidepressants, especially when used in children, can cause suicidal ideations. Therefore, the nurse would assess if the child has any plan or intent to commit suicide. Asking if the child has obtained any relief from the depression is a positive medication effect. The nurse asking if the child is seeing a counselor still is unrelated to the medication effects. Determining when the child takes the medication does not relate to negative side effects.
The nurse is discussing the loss of an infant who was stillborn at 38 weeks' gestation with the parents. Which statement by the nurse supports the cultural beliefs of the family? A. "I imagine that you have a hard time watching others with newborn babies because of your loss." B. "I am sure that you find it hard to understand why this happened this far into the pregnancy." C. "I know some people say that the loss is God's plan, but I am sure it does not make sense." D. "Have you been able to discuss this loss with any of your family or friends?"
Answer: D Many cultures have a difficult time being open with discussing stillbirths and miscarriages. Therefore, the nurse would assess if the patient has a support system within their community. Telling the patient that the nurse understands that it must be difficult to have had this happen so far into the pregnancy does not address cultural needs. The nurse would not state that they imagine that it must be difficult for the patient to see others with newborn babies. It would be inappropriate for the nurse to state that it is God's plan.
The parish nurse is visiting the home of an older patient who just lost their spouse a couple of months ago. The patient has a diminished appetite, does not want to leave the house, and does not enjoy activities anymore. The nurse should consider that which factor would most impact the grieving process? A. Inability to use a computer B. Difficulty cooking for one C. Paperwork related to the estate D. Loss of ability to drive
Answer: D Older adult patients who lose a spouse may suffer multiple losses in a short amount of time. Some losses are intangible, such as loss of independence and mobility, isolation, and loss of vision/hearing. Therefore, losing the ability to drive would potentiate the loss of a spouse, because it also affects independence. While the paperwork for settling an estate can be overwhelming, it is not a loss. An inability to use a computer for an older adult can impede paying bills and managing bank accounts, but it is not a loss. It is difficult to cook for one, but it is not a loss.
The nurse is discussing Kübler-Ross's stages of grieving with a group of patients who are undergoing cancer treatment. A patient states that they will become a better person and help others if the cancer treatment is successful. In which stage of grieving should the nurse place this patient? A. Denial B. Depression C. Acceptance D. Bargaining
Answer: D The patient is in the bargaining stage of grief, because the patient states that they will become a better person and help others if the cancer is cured. The patient is not denying the cancer diagnosis, nor is the patient showing signs of depression or acceptance.
The nurse is talking with a child who has sustained the loss of a parent. Which behavior should the nurse expect the child to display in relation to the grief? A. Being withdrawn at both home and school B. Acting out at home and being withdrawn at school C. Acting out at both home and school D. Being withdrawn at home but acting out at school
Answer: D While behavioral responses to grief vary depending on developmental age, temperament, and other factors, common behaviors manifested by children in response to grief are usually withdrawing at home and acting out at school.
A 36-year-old client recently had an elective abortion. The client does not wish to share this experience with their family members. Which type of grief is this client likely to be experiencing? A. Developmental B. Complicated C. Anticipatory D. Disenfranchised
Answer: D Rationale: Disenfranchised grief occurs when the person is unable to acknowledge the loss to others; this is the type of grief that often occurs for clients who have an abortion. Complicated grief occurs when coping strategies have not been successful. Anticipatory grief is grief that is experienced before the event occurs. Developmental losses, not grief, are associated with development stages, such as aging.
The nurse is working with a client who lost a spouse. The client is undergoing complicated grief treatment. Which behavior indicates that the client has moved past the restoration phase? A. The client goes back to work after the funeral B. The client puts up pictures of their spouse around their home C. The client donates spouse's clothing to shelters D. The client begins to go out on dates with others
Answer: D Rationale: In the restoration phase, the client begins to move forward with life without the spouse. By beginning to go out on dates with others, the client has moved on past the restoration stage. Going back to work after the funeral does not indicate moving on in life without the spouse, as many people have to work to survive. Donating the spouse's clothing indicates acceptance that the spouse has died. Putting up pictures of the spouse throughout the home shows that the client is still grieving the loss.
