Deck 26: Loss and Grief

Question 1

A nursing student,who maintained a 4.0 GPA since starting nursing school,started working the past semester,is planning a wedding,and has moved into a new home.The student has not been able to maintain the 4.0 GPA this semester,and as a result is feeling like a failure.How is this loss best described?

A) Maturational
B) Situational
C) Actual
D) Perceived

Answer 1

Perceived

Question 2

A nurse is caring for a 3-year-old niece whose mother has recently died of cancer.Because of the child's stage of development,the nurse expects that the child will most likely see the loss of her mother as which of the following?

A) An opportunity to re-examine their lives
B) A threat to her self-concept
C) Temporary
D) A challenge to her emerging identity

Answer 2

Temporary

Question 3

Which of the following would not be appropriate for a patient undergoing palliative care?

A) Insertion of a peripherally inserted central line
B) Chemotherapy
C) Radiation treatment
D) Knee replacement surgery

Answer 3

Knee replacement surgery

Question 4

A middle-age patient with a terminal disease is speaking harshly to the nurse every time the call light is answered.The nurse identifies that this patient is experiencing the second stage of Kübler-Ross' stages of dying.What is the second stage?

A) Anger
B) Denial
C) Bargaining
D) Acceptance
E) Depression

Question 5

The parent of a child who drowned in a neighbor's pool that was not secured,would most likely file a wrongful death lawsuit against the neighbor during which of Bowlby's phases of mourning?

A) Numbing
B) Yearning and searching
C) Disorganization and despair
D) Reorganization

Question 6

The nurse is admitting a 75-year-old patient into the gastrointestinal laboratory for a routine colonoscopy.During the assessment,the nurse learns that the patient's spouse died 4 months earlier because of stomach cancer and that the patient has not been sleeping well.Which phase of Bowlby's mourning phases does the nurse suspect?

A) The numbing phase
B) The yearning/searching phase
C) The disorganization phase
D) The reorganization phase

Question 7

A nurse who grew up in Korea has been in the United States for the past 4 years.The nurse is especially sensitive about the differences in how mourning is different between the native culture and that of Western society.The nurse should use which model of mourning to help understand an action-oriented process of grieving?

A) Bowlby's Four Phases
B) Worden's Four Tasks
C) Rando's R Process
D) Kübler-Ross' Five Stages

Question 8

The patient's home has been demolished by a tornado.The patient's spouse and child were killed and the spouse is in need of a leg amputation.The nurse realizes that which of the following is true?

A) The patient will deal with his losses using usual coping strategies.
B) A patient's normal coping strategies are always adequate.
C) Patients usually seek new strategies to deal with loss.
D) At the end of life, people still rely on the usual coping strategies.

Question 9

A 45-year-old widow,who is being seen in a mental health clinic for clinical depression and alcohol dependency,lost her husband and her son in a boating accident 10 months earlier,and has become increasingly despondent and withdrawn.She verbalizes that she feels overwhelmed by her loss.Her daughter urged her mother to seek help.Which type of complicated grief best explains Eleanor's behavior?

A) Chronic
B) Delayed
C) Exaggerated
D) Masked

Question 10

A widow,whose spouse died 3 years ago,has recently started dating and is thinking about going back to school to complete a degree she had started at an earlier age.Which of Bowlby's phases of mourning best describes this behavior?

A) Numbing
B) Yearning and searching
C) Disorganization and despair
D) Reorganization

Question 11

Bowlby's phases of mourning are founded on which of the following human instincts?

A) Attachment
B) Numbing
C) Searching
D) Grief

Question 12

A recently widowed mother of two worked with her late husband while he was starting his own business and was managing the accounting paperwork.The family had no life or health insurance.When her husband suddenly died,she was left with a large hospital bill,funeral expenses,unemployment,and no means of support.How are the multiple losses that this woman is experiencing best described?

A) Maturational
B) Situational
C) Actual
D) Perceived

Question 13

A businessman who had been employed at one company since graduating from college was recently downsized at work and is unemployed.He was always very proud of this job and is grieving the loss.What type of loss is this?

A) Maturational
B) Situational
C) Actual
D) Perceived

Question 14

A patient's daughter died in a ski accident.The patient stated,"I cannot believe my daughter has died." According to Worden's tasks of mourning,the patient is experiencing task:

A) I.
B) II.
C) III.
D) IV.

Question 15

A parent of three children has the oldest child start school this year,and the parent cries as the child is left at kindergarten on the first day.How is the loss that the parent is experiencing best described?

A) Maturational
B) Situational
C) Actual
D) Perceived

Question 16

A patient has been suffering from liver cancer for more than a year.The family has requested hospice services.The family members are taking turns staying with the patient.They have been reminiscing with the patient about her life and are now saying their good-byes.The type of grief that this family is experiencing is best described as which of the following?

A) Normal
B) Anticipatory
C) Complicated
D) Disenfranchised

Question 17

A young widower who lost his wife in Afghanistan has worked through the first task of Worden's mourning theory.He asks you if he will ever feel able to move forward with his life.According to Worden's theory,what is your best response?

A) "You will never love anyone as much as your wife."
B) "Nobody will ever be able to take your wife's place."
C) "It takes time to adjust to this type of loss, typically at least a year."
D) "Some people are able to move forward faster by suppressing the pain."

Question 18

The nurse is caring for a patient of the Chinese community who is dying.The nurse needs to understand the Chinese community's beliefs regarding death,but it is most important to keep in mind which of the following?

A) Most survivors in Chinese society wail loudly to communicate their loss.
B) People in the Chinese culture believe that talking about death is healthy.
C) Chinese people are strong believers in reincarnation.
D) Regardless of cultural or religious beliefs, people respond to death in their own unique way.

Question 19

A patient has been admitted to the hospital with advanced colon cancer and is receiving palliative care at this time.The nurse feels anxious in caring for this patient,but realizes which of the following?

A) The patient needs the nurse's presence and personal connection.
B) Remaining silent would signify a noncaring attitude.
C) All people react to loss in the same way.
D) Reminiscing only makes a difficult situation worse.

Question 20

A 34-year-old single mother of three had been involved in a secret relationship with her boss,a married man who was 24 years her senior.When her boss suddenly died as the result of a heart attack,the woman had difficulty expressing the extent of her loss.The grief that she was experiencing could best be described as which of the following?

A) Disenfranchised
B) Complicated
C) Normal
D) Anticipatory

Question 21

Which of the following is true for a patient to receive home hospice care?

A) A primary caregiver must be living in the home.
B) Caregiver support is available 9 AM to 5 PM daily.
C) If the patient goes to the hospital, all prehospital orders are canceled.
D) In the hospital, the home hospice care person must provide personal care.

Question 22

For a nurse to be effective in assisting patients with problems associated with loss and grief,what should the nurse do? (Select all that apply.)

A) Help people acknowledge the reality of their loss.
B) Encourage the use of a support network.
C) Reinforce that people all grieve in the same way.
D) Assure people that it will take a year to get over the loss, but it will end.
E) Provide continuing support even after an extended time.

Question 23

A businessman has been diagnosed with multiple sclerosis and has poor prognosis because the disease is progressing very quickly.To help the patient maintain a sense of hope,what should the nurse do?

A) Help the patient set realistic goals.
B) Assure the patient that he will be well cared for and does not need to do anything.
C) Impress on the family the importance of limiting visiting hours to provide rest.
D) Withhold negative information about the patient's disease processes.

Question 24

What should the nurse caring for a dying patient understand about the patient? (Select all that apply.)

A) The patient has the right to be in control.
B) The patient must be compliant with his medical regimen.
C) The patient should expect to be free from pain.
D) The patient should be lied to so as to maintain his sense of hope.
E) The patient has the right to die in peace and dignity.

Question 25

The charge nurse on the evening shift of a busy medical unit in an acute care hospital received a call from a physician's office that they are admitting a patient who is dying of lung cancer.She is told that the patient's family is out of town and is not expected to make it to the hospital before the patient expires.What is the best room for the nurse to place this patient?

A) A private room near the nurse's station
B) A semiprivate room halfway down the hall with another terminally ill patient
C) A private room at the end of the hall
D) A semiprivate room with instructions for staff to enter only when necessary

Question 26

The nurse is caring for a patient with terminal lung cancer.The patient is in a great deal of pain and is anxious.The nurse contacts the health care provider to request pain medication for the patient and is given an order for morphine,but the family of the patient refuses to let the patient have it based on religious grounds.This is most likely because the patient and family are members of which of the following faiths?

A) Jewish
B) Hindu
C) Catholic
D) Christian

Question 27

A nurse is caring for a patient who has become depressed because her children have gone away to college.The nurse assesses this type of depression as what type of loss?

A) Actual
B) Perceived
C) Maturational
D) Situational

Question 28

A nurse is caring for a patient with a terminal illness whose prognosis is grim.The nurse informs the family about hospice care.What should the nurse let them know about hospice care?

A) It is designed for people who have less than a 6-month life expectancy.
B) It is provided in the hospital setting.
C) It helps to hasten the death process to relieve suffering.
D) It has predetermined goals that will be explained at the right time.

Question 29

The nurse is caring for a patient who has just passed away.What should she do?

A) Provide postmortem care in a manner consistent with religious or cultural beliefs.
B) Place the body in a supine position to prevent disfigurement.
C) Ask family to leave the room since they do not know how to provide care.
D) Remove all tubes before determining if an autopsy will be done.

Question 30

An older extended care resident was dying.The family came to visit,but one of the great-granddaughters had difficulty accepting the impending death.What is the best thing that the nurse can do to help her feel more comfortable?

A) Telling her that she probably should not visit if it upsets her so much.
B) Tell her to avoid talking about the past and focus on the present.
C) Ask her if she would like to brush the resident's hair.
D) Ask the family to leave at the end of visiting hours so that they can rest.

Question 31

The patient is on a ventilator and has a heartbeat,but is brain dead.What should the nurse do?

A) Provide a private area to discuss organ donation.
B) Explain that as long as the heart is beating, the patient is alive.
C) Inform the family that the organs will be harvested when he is off the ventilator.
D) Stress the importance of leaving the patient on the ventilator to harvest the corneas.

Question 32

A nurse is assigned to care for a dying patient.To deal with this experience and future experiences with dying patients,the nurse should do which of the following?

A) Avoid going to funerals of former patients.
B) Develop a "hard shell" against emotional stress to avoid compassion fatigue.
C) Understand that people dying is part of the job to get used to.
D) Frequently evaluate his or her own emotional well-being.

Question 33

The nurse is caring for a terminally ill patient.In order to provide optimal care,the nurse tries to anticipate patient needs.What does the nurse understand about this patient?

A) As patients approach death, they breathe more through their nose.
B) Eye blinking may increase as well as tear production.
C) Immobility and opioid medications can lead to diarrhea.
D) Anxiety in the dying may have a physical cause.

Question 34

A woman is attending a nurse-facilitated grief support group.The woman's son was killed in Iraq 18 months earlier.She confides that while at the gravesite yesterday,she broke down and the feelings of hurt were as deep as the day she found out about the death.She states,"I will never get over this feeling of intense grief." The nurse discovers that yesterday would have been her son's 21st birthday.What is the nurse's best response?

A) "That kind of reaction is very rare after so long a time. It would be best to avoid the cemetery on dates that might trigger this type of reaction."
B) "What happened to you yesterday is understandable and common in people who have lost loved ones."
C) "I find that hard to believe. We all grieve basically the same way, and I know that I would not react that way after such a long time."
D) "The fact that you reacted so strongly is concerning to me. This could be the beginning of some bigger issues."

Question 35

A patient suffering from lung cancer experiences nausea and vomiting.When rendering palliative care,the nurse knows that this type of care:

A) is only done in intensive care units.
B) is for the elderly.
C) requires an interdisciplinary team.
D) utilizes standard medical treatments to provide care.

Question 36

When a person has difficulty progressing through his or her loss experience,he or she experiences complicated grief.What are the types of complicated grief? (Select all that apply.)

A) Chronic
B) Delayed
C) Exaggerated
D) Masked
E) Disenfranchised