Chapter 10 Grief and Loss

Chapter 10: Grief and Loss A client who has been in recovery from alcohol abuse for over one year tells the nurse he is drinking 5 to 6 beers per night since the client's mother's death. Which is the nurse's most accurate expl anation for the client's grief response? A. B. C. D. Emotional behavioral spiritual spiritual A community care nurse is visiting a client at home. The client was discharged from the hospital one week ago after having a mastectomy. After the nurse completes the physical examination, the nurse asks, "How are you feeling about your body changes?" The client tells the nurse she is not interested in talking right now and would prefer that the nurse leave. Which is the nurse's most effecti ve use of communication skills? A. "I just want you to know that I am available to talk when you are feeling up to it." B. "Have I said something to offend you?" C. "I can sit with you here so that you don't feel alone." D. "It would be beneficial for you to connect with other people who have had this surgery." A nurse is counseling a client with depression on what to do in case the client has suicidal thoughts. Which option may provide the most immediate help for the client? A. a telephone hotline B. an office visit C. an emergency clinic D. an outpatient clinic Which is the most frequent and persistent bereav ement-associated symptom? A. B. C. D. Sleep disturbances Headaches Impaired appetite Indigestion The nurse is assessing a client who reports feeling hopeless since a divorce. Which would be an appropriate question for the nurse to ask in order to determine mental health status for this client? A. B. C. D. "Is there a history of mental illness in your immediate family?" “Do you ever use drugs to help feel less emotional pain?" "Would you consider marrying again?" "Do you feel that someone else could ever love you?" The spouse of a client who died of breast cancer is still grieving 2 years later. What type of grief is the spouse experiencing? A. B. C. D. Complicated Situational Inhibited Inhibited Which statement by a client would alert the nurse that the client is experiencing complicated grief? A. B. C. D. “I keep imagining the scene of my spouse’s accident that caused death.” “I blame myself for my brother having committed suicide.” “I am still so angry about my grandmother’s death even after a year.” "It’s been a week, but it still seems unreal that my mother has died.” The nurse is working with a group of clients in the prewarning phase of a disaster. Which situation best describes this phase? A. B. C. D. The clients are reviewing evacuation routes for a flood. The clients are being rescued from a house fire. The clients are being transported to a shelter The clients are cleaning up a site damaged by a tornado. Which factor does not influence the grieving person's return to homeostasis? A. B. C. D. Adequate support systems Adequate coping Adequate perception of the situation Adequate self-awareness on the part of the nurse Which type of grief occurs when a person is stuck in a state of chronic grieving? A. B. C. D. Bereavement bereavement complicated grief uncomplicated grief Which phrase can do much to instill hope in the dying client? A. B. C. D. “This is a hopeless situation.” “Nothing more can be done.” “Everything will be fine, so don't worry.” "Let me tell you about your illness.” What question should nurses ask themselves to determine if the care they provide to the grieving client has been both therapeutic and client focused? A. How do I personally react when I am working through the grieving process?" B. "How long can I continue working with grieving clients?" C. "Do I have the strength to be present and to facilitate the client who is grieving?" D. "Do I still get personal satisfaction from my work with the grieving client?" 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? A. B. C. D. Anger Outcry Complicated grief Disenfranchised grief A 74-year-old is being seen in the mental health clinic. The client has never fully regained the level of activity the client had prior to the death of the client's spouse. The client continues to have symptoms of depression and has not been able to work or volunteer. In addition, the client complains of “anxiety attacks” that occur nearly every night. What type of grief reaction is this client exhibiting? A. The client is experiencing a normal grief reaction and does not need any intervention at this time. B. The client is experiencing a normal grief reaction and does not need any intervention at this time. C. The client is having a prolonged reaction to the spouse's death, but since the client is surrounded by family members who provide support, the client does not need any interventions at this time. D. The client is experiencing complicated grieving reaction. The client needs to have a comprehensive mental health assessment. The client expresses grief about not being able to fulfill the wish to pursue doctoral studies. Which type of loss does this indicate? A. B. C. D. Loss of safety Loss of self-esteem Loss related to self-actualization Loss of security and a sense of belonging A nurse is assessing a client who is depressed but unwilling to discuss the client's feelings. After speaking with the client's caregiver, the nurse learns that the client’s pet died recently. Which is the most likely reason the client has hesitated to express the client's feelings? A. B. C. D. The client feels that the feelings related to the pet’s death are insignificant. The client does not want to remember the memories of the pet. The client feels that the nurse would not consider the grief as significant. The client does not want to remember the memories of the pet. A nurse is caring for a client with terminal cancer. The client states, “If I promise to change my bad habits, the cancer will go away.” The nurse knows that this statement is an example of which of Kubler-Ross's stages of grief? A. B. C. D. Denial Anger Bargaining Acceptance A client is diagnosed with terminal kidney failure. The client's spouse demonstrates loss and grief behaviors. Which term accurately describes the spouse's experience? A. B. C. D. Maturational loss Anticipatory grief Dysfunctional grieving Bereavement Which client should the nurse anticipate will be at greatest risk for alteration in quality of life as a result of loss? A. B. C. D. 45-year-old with severe depression 50-year-old with psychosis in the context of schizophrenia 72-year-old in the late stages of dementia 24-year-old diagnosed with borderline personality disorder After losing the client's father in a car accident, a client has started practicing effective coping strategies. According to Horowitz’s stages of loss and adaptation, which stage is this indicative of? A. B. C. D. Outcry Completion Working through Denial and intrusion A client is experiencing a high level of stimulation after a terrorist attack. In providing psychological first aid to the client, which intervention would be best for the nurse to select? A. B. C. D. orienting the client to the circumstances that have occurred explaining to the client that the client is safe providing information to the client about the attack telling the client about the need to go to the hospital 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. A. The client has a large family. B. C. D. E. The client has low self-esteem. The client is unable to trust others. The client has a history of cardiac diseases. The client has attempted suicide in the past. The nurse is assessing a client who is recently divorced. The client tells the nurse that the memories of the client's former spouse are interfering with an ability to concentrate at work. According to Horowitz’s stages of loss and adaptation, this is indicative of which stage? A. B. C. D. Outcry Completion Denial and intrusion Working through Which statement is typical of the first stage of grieving described by Engel? A. B. C. D. “No, not me.” “Why me?” “My husband was the best man in the world.” “The funeral service helped me survive.” 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? A. B. C. D. shock, numbness, and protest yearning disorganization and despair reorganization Which can correctly be identified as a behavioral response to grief? A. B. C. D. Crying uncontrollably Weight loss Lack of energy Palpitations A nurse is assessing a 7-year-old child in a school. The nurse suspects that the child has an insecure relationship with the parents. Which statement said by the child would have led the nurse to this conclusion? A. “I love playing with friends.” B. “I love my dad and mom very much.” C. “My mom and dad do not play with me.” D. “Please don't tell my mom anything we've talked about.” A nurse is talking to a client who has been told the client has a terminal illness and is responding in an angry manner. What statement by the nurse would best facilitate the best possible client outcomes? A. “Why are you so angry? The doctor told you why you will not live.” B. “I'm sorry you are in pain right now, but we have to talk about this.” C. “How much do you know and what do you want to know?” D. “When you feel like talking about how you feel, let me know.” 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.) A. B. C. D. E. death of a child sudden, unexpected death death by suicide low self-esteem low trust in others A client with poorly controlled type 1 diabetes has just been informed that an amputation of the lower leg is required. The nurse can anticipate that the client will experience a reaction to the loss of which human need according to Maslow's hierarchy? A. B. C. D. physiologic Safety Security and belonging Self-actualization A nurse in charge on a unit with a client who is receiving postoperative care for a below the knee amputation is deciding which nurse to assign to this client. Which nurse would be most beneficial for the client? A. B. C. D. the nurse who has worked with the client before and after the amputation a nurse who is just returning to work from a one-week vacation a nurse who often has been assigned to the client 3 previous night shifts a nurse with previous experience working with clients who have amputations 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? A. B. C. D. Phase of disorganization and despair Phase of yearning and searching Phase of reorganization Phase of numbing Which culture believes that leaving the body alone after death is disrespectful? A. B. C. D. Native Americans Orthodox Jewish Americans Chinese Americans Vietnamese Americans A nurse has been present for the hospital death of a Muslim client who was surrounded by family members when the client passed. The nurse demonstrates appropriate cultural considerations when stating: A. B. C. D. “You probably won't cremate the body, will you?" "How would you like to complete the five steps of the burial process?" "Shall I ask the pastor to attend for support?" "Are there any rituals you will observe here for your loved one?" According to Mardi Horowitz (2001), life begins to feel "normal" again in which stage? A. B. C. D. Completion Working through Denial and intrusion Outcry A client has responded to the recent diagnosis of lung cancer by making extensive plans for overseas travel with the client's children, despite the fact that the oncologist has informed the client of the extremely poor prognosis. The nurse consequently recognizes that the client is likely in the denial stage of grief. How can the nurse best facilitate adaptive grieving for this client? A. B. C. D. Enlist the assistance of another nurse to help the client face the reality of the situation Supplement conversations with the client by using written material about the diagnosis Restate the client’s situation in more specific and detailed terms Address the client’s diagnosis and prognosis at a later time or date The nurse is providing discharge instructions for a client who has received a prescription for lorazepam after the death of a loved one. Which phase of psychopharmacologic treatment does this describe? A. B. C. D. Initiation Maintenance Stabilization Diagnosis A client who has recently lost his same-sex partner in a motor vehicle accident tells the nurse, "My family doesn't speak to me because of my lifestyle. I feel like I have no one to talk to about my loss." The client is experiencing: A. B. C. D. complicated grieving. disenfranchised grief. ambivalent attachment. insecure attachment. Which factor is likely to have the greatest impact on how a client responds to grief? A. B. C. D. Socioeconomic factors Cultural influences Religious influences Cause of death The client is scheduled to undergo an amputation of the lower right limb. The client is experiencing grief over the pending procedure. Which question should the nurse ask while assessing the client’s perception of loss? A. B. C. D. “How do you feel about the news?” “Do you feel like talking to anybody right now?” "How can we relieve your anxiety?” “What do you usually do when you are excessively stressed?” A client diagnosed with terminal cancer is making plans to take flying lessons because that has always been the client's personal goal and it will allow the client to visit the client's elderly parents. What stage of death and dying according to Kübler-Ross is best illustrated in this description? A. B. C. D. Bargaining Anger Depression Acceptance The nurse is assessing a client who is grieving the loss of a spouse. According to Kubler-Ross’s stages of grieving, which statement indicates that the client is in the depression stage? A. B. C. D. “My spouse was laughing and happy yesterday. My spouse cannot be dead.” “Oh God. Why did you take my spouse away from me? What wrong did I do?” “Please send my spouse back to me dear God. I would never ever fight again.” “My spouse is gone. I am having a really hard time finding a reason to keep going.” Which term describes the process by which a person experiences grief? A. Bereavement B. Homeostasis C. Mourning D. Attentive presence A client is exhibiting a behavioral response to grief. When obtaining a health history, the nurse would expect which assessment finding to be noted? A. B. C. D. Stupor Hostility Sadness Calmness Which are considered physiological signs the nurse expects to observe in a grieving individual? Select all that apply. A. B. C. D. E. Hypersomnia Weight gain Indigestion Palpitations Lack of energy The nurse is performing an initial psychological assessment on a client who has been rescued from a flood. Which question would be most important in helping determine the amount of support needed by the client? A. B. C. D. “Have you thought about where you can stay right now?” “Do you have any possessions you were able to rescue?” "Do you own your home or are you renting it from someone?” "What makes you feel most sad right now about this?” The client has been recently diagnosed with cancer. When the nurse tells the client about the diagnosis, the client says, “I have been eating healthy food and working out regularly.” According to the Kubler-Ross’s stages of grieving, which stage of grief is the client in? A. Anger B. Denial C. Bargaining D. Depression Which experience could be the possible cause of grief due the loss of security and belonging for the client? A. B. C. D. Divorce Amputation Failure to achieve promotion at work Violence at workplace