ChAp 10 GrIeF Flashcards
(29 cards)
A child who has witnessed the murder of his classmate while at school would experience which kind of loss?
A)Physiologic loss
B)Loss of self-esteem
C)Loss related to self-actualization
D)Safety loss
Ans: D
Feedback: Safety loss is the loss of a safe environment. That feeling of safety is shattered when public violence occurs. Examples of physiologic loss include amputation of a limb, a mastectomy or hysterectomy, or loss of mobility. A loss of self-esteem includes any change in how a person is valued at work or in relationships or by himself or herself can threaten self-esteem. Loss related to self-actualization includes an external or internal crisis that blocks or inhibits strivings toward fulfillment that may threaten personal goals and individual potential.
Friends of a teenage male recently killed in a car accident are discussing their sense of loss. Which of the following comments best indicates that the friends are trying to make sense of the loss cognitively?
A)ìWhy did he have to die so young?î
B)ìHe shouldn’t have been driving so recklessly.î
C)ìIf we had only stayed longer, he would not have been on that road.î
D)ìIt took the ambulance too long to get there.î
Ans: A
Feedback: One of the cognitive responses to grief involves the grieving person making sense of the loss. He or she undergoes self-examination and questions accepted ways of thinking. The loss challenges old assumptions about life. Anger, sadness, and anxiety are the predominant emotional responses to loss. The grieving person may direct anger and resentment toward the dead person and his or her health practices, family members, or health-care providers or institutions.
The nurse is meeting a client for the first time who has just spontaneously lost her unborn child. After establishing rapport, the priority nursing intervention should focus on which of the following?A)Assessing the client’s support system
B)Exploring what this loss means for the client
C)Discussing helpful ways to cope with the loss
D)Assessing what knowledge the client desires about the situation
Ans: B
Feedback: Assessment begins with exploration of the client’s perception of the loss. What does the loss mean to the client? The question is valuable for beginning to facilitate the grief process. Further assessment and intervention will be determined based largely on the client’s perception of the event.
A woman has just delivered a stillborn baby boy. Which of the following would be the most appropriate nursing response?A)ìCan I do anything for you?î
B)ìIf something was wrong, it’s better this way.î
C)ìYour son is in heaven with God now.î
D)ìWould you like to hold your son?î
Ans: D
Feedback: The opportunity to hold the baby may help the woman deal with the first stage of grieving: denial; it also allows her to express emotions over the loss. Asking the client, ìCan I do anything for you,î is a closed-ended question and will likely be replied to with a yes or no answer. Stating, ìIf something was wrong, it’s better this way,î is not sensitive to the woman’s loss. Stating ìYour son is in heaven with God now,î would be inappropriate because it may not be consistent with the woman’s beliefs.
The nurse is working with a client who lost her youngest child 2 months ago. When the nurse approaches, the client, the client yells, ìI don’t want to talk to you. You have no idea what it’s like to lose a child!î The nurse bases her response to the client on the understanding of which of the following?
A)Hostility is a common behavioral response to grief.
B)It is too soon after the loss to empathize with the client.
C)Personality traits such as aggressiveness are exaggerated during the grief process.
D)The nurse may have nonverbally indicated a judgmental attitude toward the client.
Ans: A
Feedback: Behavioral responses to grief are often the easiest to observe. Irritability and hostility toward others reveal anger and frustration in the grief process.
A woman has just had a therapeutic abortion to end an unintended pregnancy.Afterward, the woman cries because although she wanted to have children in future years, this pregnancy was not well-timed. Which type of grief is this woman most likely to experience?A)Anticipatory grief
B)Absence of grief
C)Complicated grief
D)Disenfranchised grief
Ans: D
Feedback: Disenfranchised grief is grief over a loss that is not or cannot be acknowledged openly, mourned, publicly, or supported socially. Anticipatory grief occurs when a person experiences imminent loss and begin to grapple with the very real possibility of loss or death in the near future. It is not absence of grief as the woman is grieving. It is not currently complicated grief as the loss has just occurred and does not seem out of proportion to the loss.
The nurse is caring for a hospice client whose death is imminent. In preparing the family for the death of their loved one, then nurse prepares to assist the family in which of the following, regardless of the family’s cultural preferences? Select all that apply.
A)Dealing with the shock of losing a loved one
B)Burial plans after death had occurred
C)Efforts to stay connected to the client after death
D)Use of support from family and friendsE)Anger at the loss of a loved one
Ans: A, C, E
Feedback: Universal reactions include the initial response of shock and social disorientation, attempts to continue a relationship with the deceased, anger with those perceived as responsible for the death, and a time for mourning. Not all cultures bury their deceased. Some cultures mourn privately, not turning to the support of others.
The nurse is conducting a history and physical exam on a client who is grieving the unwanted loss of a marriage by divorce. Which of the following physical symptoms of grief would the nurse most likely expect to detect in the history?
A)Headaches
B)Insomnia
C)Weight loss
D)GI upset
Ans: B
Feedback: Those grieving may complain of insomnia, headaches, impaired appetite, weight loss, lack of energy, palpitations, indigestion, and changes in the immune and endocrine systems. Sleep disturbances are among the most frequent and persistent bereavement-associated symptoms.
Kubler-Ross developed a model of five stages to explain what people experience as theygrieve and mourn. Which is stage V of Kubler-Ross’s stages of grieving?
A)Denial
B)Bargaining
C)Acceptance
D)Anger
Ans: C
Feedback: Acceptance occurs when the person shows evidence of coming to terms with death. Denial is shock and disbelief regarding the loss. Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. Anger may be expressed toward God, relatives, friends, or health-care providers.
Which of the following terms is used to describe the process by which a person experiences the grief?A)Anticipatory grieving
B)Disenfranchised grief
C)Bereavement
D)Mourning
Ans: C
Feedback: Bereavement refers to the process by which a person experiences the grief. Anticipatory grieving is when people facing imminent loss begin to grapple with the very real possibility of the loss or death in the near future. Disenfranchised grief is grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially. Mourning is the outward expression of grief.
The nurse approaches a client who looks very sad and is sitting alone crying. The best response by the nurse in this situation is
A)ìI’m sorry you are sad. Is there anything I can do to help you feel better?î
B)ìPlease don’t cry. It will get better.î
C)ìYou look very sad. What is happening?î
D)ìWhat is bothering you?î
Ans: C
Feedback: It is essential to accept the person’s feelings without trying to dissuade him or her from feeling angry or upset. The nurse needs to encourage the person to express any and all feelings without trying to calm or placate him or her.
The nurse is establishing outcomes for a grieving client. Which of the following is an appropriate outcome?
A)The client will develop a plan for coping with the loss.
B)The client will demonstrate self-reliance during the grief process.
C)The client will suppress emotions related to the loss.
D)The client will verbalize that loss will not adversely affect the quality of life
Ans: A
Feedback: Examples of outcomes for the grieving client are as follows: - Identify the effects of his or her loss. - Identify the meaning of his or her loss. - Seek adequate support while expressing grief. - Develop a plan for coping with the loss. - Apply effective coping strategies while expressing and assimilating all dimensions of human response to loss in his or her life. - Recognize the negative effects of the loss on his or her life. - Seek or accept professional assistance if needed to promote the grieving process.
A young client tells the nurse that her husband died 3 months ago, and she is feeling alone and vulnerable. Which statement by the client would indicate that her coping skills are adequate?
A)ìI can’t understand why this happened to me.î
B)ìI’m mentally healthy. I can solve my own problems.î
C)ìI will find a support group.î
D)ìWhat can I do? My husband abandoned me.î
Ans: C
Feedback: Finding a support group indicates that the client recognizes her need for help and is taking action to get the support she needs. The other choices are not indications that the client’s coping skills are adequate for the situation.
Which of the following is most likely to prevent the client from experiencing complicated grief?A)Tendency to suppress emotions
B)History of depression
C)Places trusts familiar others
D)Dependent on others to meet needs
Ans: C
Feedback: People who are vulnerable to complicated grieving include those with low self-esteem, low trust in others, a previous psychiatric disorder, previous suicide threats or attempts, or absent or unhelpful family members.
After being laid off from work, a client becomes increasingly withdrawn and fatigued, spends entire days in bed, is unkempt, and is eating and sleeping poorly. The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross?
A)Anger
B)Bargaining
C)Denial
D)Depression
Ans: D
Feedback: The client’s symptoms are characteristics of depression, which usually occurs when awareness of the loss becomes acute. Anger may be expressed toward God, relatives, friends, or health-care providers. Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. Denial is shock and disbelief regarding the loss.
Which of the following are eventual outcomes of the emotional dimension of grieving?Select all that apply.
A)The survivor begins to reestablish a sense of personal identity, direction, and purpose for living.
B)The survivor begins to gain independence and confidence.
C)The survivor develops new ways of managing life and new relationships.
D)The survivor’s life returns to the same state as it was before the loss.E)The survivor forgets about the loss.
Ans: A, B, C
Feedback: Eventually, the bereaved person begins to reestablish a sense of personal identity, direction, and purpose for living. He or she gains independence and confidence. New ways of managing life emerge and new relationships form. The person’s life is reorganized and seems ìnormalî again, although different than that before the loss. The person still misses the deceased, but thinking of him or her no longer evokes painful feelings.
A married couple has just received the news that the husband has terminal cancer. Thewife tells the nurse, ìMaybe if we get another opinion and start treatment right way there is a chance of survival.î The nurse documents that the wife is expressing signs of which of Kubler-Ross’s stages of grief?
A)Denial
B)Anger
C)Bargaining
D)Depression
Ans: C
Feedback: Kubler-Ross developed a model of five stages to explain what people experience as they grieve and mourn: (1) Denial is shock and disbelief regarding the loss. (2) Anger may be expressed toward God, relatives, friends, or health-care providers. (3) Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. (4) Depression results when awareness of the loss becomes acute. (5) Acceptance occurs when the person shows evidence of coming to terms with death.
An elderly woman who lives alone is beginning to have difficulty maintaining herhousehold and performing daily tasks. The nurse asks her to identify someone who canhelp her. The woman replies, ìI don’t need help. I’ve been managing for years.î Which ofthe following responses helps the client shift from denial to consciously coping with her situation?
A)ìYou don’t think you need any help? But your family is worried about you.î
B)ìIt must be hard to lose your independence. I’ll ask a social worker to see what can be arranged.î
C)ìIf you were to need help with your house, who might you ask for help?îD)ìIf you don’t ask for some help. then the only option is to move to an assisted living facility.î
Ans: C
Feedback: The nurse can help the client to reach out and accept what others want to give in support of his or her grieving process. Help the client shift from an unconscious mechanism of denial to conscious coping with reality by using reflective communication skills. Do not force people through the coping process by insisting they take certain actions.
A couple came to the emergency department with their 5-month-old son. He was pronounced dead of sudden infant death syndrome (SIDS). In the next day or two, it will be important for this couple to
A)accept that they could do nothing to prevent this death.
B)delay the grieving process until they are ready to cope.
C)minimize their discussion of the death with others.
D)plan funeral arrangements for their son.
Ans: D
Feedback: Funerals are often the beginning outward sign of mourning and help begin the grieving process. This couple will need to talk about their son’s death repeatedly as they begin to grieve. It will not likely be possible for them to accept that they could do nothing to prevent this death within this time period, but they must begin to hear this. They should not delay the grieving process.
A client who has been grieving the loss of his wife 2 weeks ago says to the nurse, ìThe best part of my day is when I am back at work. Is that wrong?î The nurse educates that work and other daily activities serve which purpose?
A)ìYou cannot work effectively this soon. You should finish grieving first.î
B)ìWorking reminds you of your loss. It may be too early to go back.î
C)ìWorking is your way of avoiding grief, which will make it harder for you to move on.î
D)ìWorking is letting you take an emotional break from grieving. There’s nothingwrong with that.î
Ans: D
Feedback: The bereaved person can often take a break from the exhausting process of grieving. Going back to a routine of work or focusing on other members of the family may provide that respite. Familiar routines can affirm the client’s talents and abilities and can renew feelings of self-worth.
The client says to the nurse, ìI really want to see my first grandchild born before I die. Is that too much to ask?î The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross?A)Acceptance
B)Anger
C)Bargaining
D)Depression
Ans: C
Feedback: Clients often set goals such as living until a certain time or to experience a particular event, and then they will be ready to die: that is the bargain. Acceptance occurs when the person shows evidence of coming to terms with death. Anger may be expressed toward God, relatives, friends, or health-care providers. Depression results when awareness of the loss becomes acute.
The most effective way for the nurse to provide culturally competent care to individuals who are grieving is which of the following?
A)Understand the practices associated with a client’s culture.
B)Suggest developing a new ritual to make mourning meaningful.
C)Ask the client what rituals are personally meaningful.
D)Contact a spiritual leader from the client’s culture to become involved.
Ans: C
Feedback: Rather than assuming that he or she understands a particular culture’s grieving behaviors, the nurse must encourage clients to discover and use what is effective and meaningful to them.
A young couple just ended their relationship after a 9-month engagement. The one ofthe individuals is seeking short-term counseling to assist in grieving this loss. Which type of loss best describes what this client is experiencing?
A)Safety loss
B)Loss of security and sense of belonging
C)Loss of self-esteem
D)Loss related to self-actualization
Ans: B
Feedback: Types of loss include safety loss (loss of a safe environment), loss of security and a sense of belonging (loss of a loved one affects the need to love and the feeling of being loved), loss of self-esteem (any change in how a person is valued at work or in relationships or by him or herself), or loss related to self-actualization (external or internal crisis that blocks or inhibits strivings toward fulfillment).
A client is scheduled for a mastectomy for breast cancer. She is quiet, shows little emotion, and states that she has no questions. The nurse’s assessment would need to focus on
A)the client’s plans for reconstructive surgery.
B)the meaning of the mastectomy to the client.
C)whether the client truly understands the surgery.
D)why the client seems depressed
Ans:
B Feedback: Assessment begins with exploration of the client’s perception of the loss. A client who is scheduled for a mastectomy would possibly be having anticipatory loss of a physiologic nature. It would not be appropriate to discuss the client’s plans for reconstructive surgery as this is not likely what is causing the client to be quiet and show little emotion. It is important to ascertain whether the client truly understands the surgery when witnessing the client’s signature of the operative consent, but there is no indication that this is what is being addressed at this time. It would not be appropriate to assume that the client is depressed or not. It would be better to explore the client’s perception of the loss.