Loss and Grief

1.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

ANS: C

People experience an actual loss when they can no longer touch, hear, see, or have near them valued people or objects. Examples include job loss. People experience maturational losses as they go through a lifetime of normal developmental processes. For example, when a child goes to school for the first time she will spend less time with her parents, leading to a change in the parent-child relationship. Situational loss occurs as a result of an unpredictable life event. A situational loss often involves multiple losses. A divorce, for example, begins with the loss of a life companion, but often leads to financial strain and changes in living arrangements. Perceived losses are uniquely experienced by a grieving person and are often less obvious to others. A perceived loss is very real to the person who has had a loss. For example, a person perceives she is less loved by her parents and experiences a loss of self-esteem.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:655OBJ:Discuss five categories of loss.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

2.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

ANS: D

Perceived losses are uniquely experienced by a grieving person and are often less obvious to others. A perceived loss is very real to the person who has had a loss. For example, a person perceives she is less loved by her parents and experiences a loss of self-esteem. People experience maturational losses as they go through a lifetime of normal developmental processes. For example, when a child goes to school for the first time she will spend less time with her parents, leading to a change in the parent-child relationship. Situational loss occurs as a result of an unpredictable life event. A situational loss often involves multiple losses. A divorce, for example, begins with the loss of a life companion, but often leads to financial strain, changes in living arrangements. People experience an actual loss when they can no longer touch, hear, see, or have near them valued people or objects. Examples include job loss.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:655OBJ:Discuss five categories of loss.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

3.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

ANS: A

People experience maturational losses as they go through a lifetime of normal developmental processes. For example, when a child goes to school for the first time she will spend less time with her parents, leading to a change in the parent-child relationship. Situational loss occurs as a result of an unpredictable life event. A situational loss often involves multiple losses. A divorce, for example, begins with the loss of a life companion, but often leads to financial strain, changes in living arrangements. People experience an actual loss when they can no longer touch, hear, see, or have near them valued people or objects. Examples include the loss job. Perceived losses are uniquely experienced by a grieving person and are often less obvious to others. A perceived loss is very real to the person who has had a loss. For example, a person perceives she is less loved by her parents and experiences a loss of self-esteem.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:655OBJ:Discuss five categories of loss.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

4.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

ANS: B

Situational loss occurs as a result of an unpredictable life event. A situational loss often involves multiple losses. A divorce, for example, begins with the loss of a life companion, but often leads to financial strain and changes in living arrangements. People experience maturational losses as they go through a lifetime of normal developmental processes. For example, when a child goes to school for the first time she will spend less time with her parents, leading to a change in the parent-child relationship. People experience an actual loss when they can no longer touch, hear, see, or have near them valued people or objects. Examples include the loss job. Perceived losses are uniquely experienced by a grieving person and are often less obvious to others. A perceived loss is very real to the person who has had a loss. For example, a person perceives she is less loved by her parents and experiences a loss of self-esteem.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:656OBJ:Discuss five categories of loss.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

5.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

ANS: A

Kübler-Ross’ (1969) classic theory identifies five responses to loss: denial, anger, bargaining, depression, and acceptance. Individuals in the denial stage act as though nothing has changed. They cannot believe or understand that a loss has occurred. In the anger stage, a person resists the loss, is angry about the situation, and sometimes becomes angry with God. During bargaining, the individual postpones awareness of the loss and tries to prevent the loss from happening by making deals or promises. A person realizes the full significance of the loss during the depression stage. When depressed, the person feels overwhelmingly lonely or sad and withdraws from interactions with others. During the stage of acceptance, the individual begins to accept the reality and inevitability of loss and looks to the future.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:656OBJ:Review grief and loss theories.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

6.Bowlby’s phases of mourning are founded on which of the following human instincts?

a.
Attachment
b.
Numbing
c.
Searching
d.
Grief

ANS: A

Attachment, the foundation of Bowlby’s (1980) four phases of mourning, is an instinctive behavior, which leads to the development of life-long bonds of affection between children and their primary caregivers. In the numbing phase, a person has periods of extremely intense emotion and reports feeling “stunned” or “unreal.” The numbing phase lasts from several hours to a week. The yearning and searching phase evokes emotional outbursts, tearful sobbing, and acute distress. To move forward, people need to experience this painful phase of grief.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:656OBJ:Review grief and loss theories.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

7.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

ANS: D

During the final phase of reorganization, which usually requires a year or more, the person accepts unaccustomed roles, acquires new skills, and builds new relationships. In the numbing phase, a person has periods of extremely intense emotion and reports feeling “stunned” or “unreal.” The numbing phase lasts from several hours to a week. The yearning and searching phase evokes emotional outbursts, tearful sobbing, and acute distress. To move forward, people need to experience this painful phase of grief. During the phase of disorganization and despair an individual spends much time thinking about how and why the loss occurred. The person often expresses anger at anyone he or she believes to be responsible. Gradually this phase gives way to an acceptance that the loss is permanent.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:656OBJ:Review grief and loss theories.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

8.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

ANS: C

During the phase of disorganization and despair an individual spends much time thinking about how and why the loss occurred. The person often expresses anger at anyone he or she believes to be responsible. In the numbing phase, a person has periods of extremely intense emotion and reports feeling “stunned” or “unreal.” The yearning and searching phase evokes emotional outbursts, tearful sobbing, and acute distress. To move forward, people need to experience this painful phase of grief. During the final phase of reorganization, which usually requires a year or more, the person accepts unaccustomed roles, acquires new skills, and builds new relationships.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:656OBJ:Review grief and loss theories.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

9.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

ANS: B

The yearning and searching phase evokes emotional outbursts, tearful sobbing, and acute distress. Common physical symptoms include tightness in the chest and throat, shortness of breath, a feeling of weakness and lethargy, insomnia, and loss of appetite. In the numbing phase, a person has periods of extremely intense emotion and reports feeling “stunned” or “unreal.” The person often expresses anger at anyone he or she believes to be responsible. During the final phase of reorganization, the person accepts unaccustomed roles, acquires new skills, and builds new relationships.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:656OBJ:Review grief and loss theories.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

10.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

ANS: C

Rando’s R Process Model of mourning is specific to Western society. Mourning is an action-oriented process involving recognizing the loss, reacting to the pain of separation, reminiscence, relinquishing old attachments, and readjusting to life after loss. Attachment, the foundation of Bowlby’s (1980) four phases of mourning, is an instinctive behavior, which leads to the development of life-long bonds of affection between children and their primary caregivers. The four tasks of mourning theory (Worden, 1982) describes how individuals help themselves through mourning and ask others for help. Kübler-Ross’ (1969) classic theory identifies five responses to loss: denial, anger, bargaining, depression, and acceptance.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:657OBJ:Review grief and loss theories.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

11.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.”

ANS: C

Although the time needed varies from person to person, moving through Worden’s tasks typically takes a minimum of 1 year. The other responses are not helpful to the patient.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:656OBJ:Review grief and loss theories.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

12.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.

ANS: A

Task II is working through the pain of grief. It is impossible to experience a loss without some degree of emotional pain. Individuals who deny or suppress the pain often prolong their grief. Task I occurs when the individual accepts the reality of the loss. Task III occurs when people adjust to the environment in which the deceased is missing. Task IV occurs when the person emotionally relocates the deceased and moves on with life.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:656OBJ:Review grief and loss theories.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

13.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

ANS: B

The process of “letting go” that occurs before an actual loss or death has occurred is called anticipatory grief. Normal or uncomplicated grief consists of commonly expected emotional and behavioral reactions to a loss (e.g., resentment, sorrow, anger, crying, loneliness, and temporary withdrawal from activities). Complicated grief happens when a person has difficulty progressing through the loss experience. The person does not accept the reality of the loss, and the intense feelings associated with acute grief do not go away. Disenfranchised grief occurs in situations in which others view a person’s loss as insignificant or invalid.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:657OBJ:Describe types of grief.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

14.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

ANS: C

People having an exaggerated grief response are overwhelmed by their loss, have difficulties functioning, and display significant behavioral dysfunction. Chronic grief occurs when the active acute mourning experienced in normal grief reactions does not decrease and continues over long periods of time. When people consciously or unconsciously avoid the pain of loss and do not experience common grief reactions at the time of the loss, they have a delayed grief reaction. Masked grief occurs after a significant loss in which some people are unable to recognize that the behaviors making normal functioning difficult are a result of their loss. For example, a person who loses a pet develops changes in sleeping patterns but does not see the connection between the two events.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:657OBJ:Describe types of grief.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

15.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

ANS: A

Disenfranchised grief occurs in situations in which others view a person’s loss as insignificant or invalid. For example, a grieving woman does not experience support from her parents when experiencing the loss of her ex-husband. Complicated grief happens when a person has difficulty progressing through the loss experience. The person does not accept the reality of the loss, and the intense feelings associated with acute grief do not go away. Normal or uncomplicated grief consists of commonly expected emotional and behavioral reactions to a loss (e.g., resentment, sorrow, anger, crying, loneliness, and temporary withdrawal from activities). The process of “letting go” before an actual loss or death has occurred is called anticipatory grief.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:657OBJ:Describe types of grief.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

16.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

ANS: C

Expressions of grief evolve as individuals mature. Toddlers, for example, cannot understand the permanence of death but feel anxiety over loss of objects and separation from parents. School-age children, although able to understand the significance of loss more completely, see their loss as a challenge to their emerging identity or self-concept. Middle-age adults often use grief experiences to re-examine or reprioritize their lives. Older adults anticipate grief as they encounter declining physical function or life opportunities, give up employment or social status, or lose loved ones.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 658 OBJ: Discuss variables that influence a person’s response to grief.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

17.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.

ANS: A

Individuals respond to loss by using their usual coping strategies. Sometimes when people experience multiple losses or lose something of great significance, their usual coping strategies are inadequate. At the end of life, people often find new coping mechanisms and new resources to maintain control and stability.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 658 OBJ: Discuss variables that influence a person’s response to grief.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

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.

ANS: D

In Western societies, many people grieve privately and restrain their emotions. In other cultures, survivors wail loudly and publicly display their sorrow to communicate the significance of their loss to others. Some Chinese communities consider death to be a taboo subject and believe that discussion of the topic brings bad luck. Most people practicing the Hindu religion believe in reincarnation and use those beliefs to interpret events surrounding the death of a loved one. Although members of a cultural or religious group often share similar beliefs, people still respond in their own unique way.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 658-659 OBJ: Discuss variables that influence a person’s response to grief.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

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.

ANS: A

Many nurses become anxious when caring for dying patients or people coping with grief and loss. Confidence helps you to understand that even if there is nothing you can do or say to change the situation, the patient needs your compassionate presence and a personal connection. Confidence helps you accept the responsibility to remain present even in difficult situations. By silently sharing a moment of sadness with a patient or family member, you communicate caring and send the message that you respect and accept their feelings in the moment. Do not assume that other people react to loss or grief as you do or that a particular behavior necessarily indicates grief. Encouraging patients to tell stories about their loved one gives them an opportunity to provide information in a natural, unstructured, and meaningful way.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:659

OBJ: Identify nursing interventions for helping patients cope with loss, death, and grief.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

20.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

ANS: D

Palliative care is practiced in any setting and focuses on the prevention, reduction, or relief of physical, emotional, social, and spiritual symptoms of disease or treatment at the end of life when cure is no longer possible. The insertion of a peripherally inserted central line would be beneficial to provide the patient with medications to ease discomfort. Chemotherapy and radiation therapy would be useful in reducing disease symptoms. Knee replacement surgery would not be appropriate for an end-of-life patient.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 666 OBJ: Discuss principles of palliative and hospice care.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

21.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.

ANS: C

Palliative care is practiced in any setting and focuses on the prevention, reduction, or relief of physical, emotional, social, and spiritual symptoms of disease or treatment at the end of life when cure is no longer possible. People of any age or diagnosis receive palliative care at any time and in any setting. Expert palliative care involves an interdisciplinary team composed of health care professionals—nurses, social workers, spiritual care professionals, nutritionists, physicians, psychologists, and pharmacists. Therapists who use complementary healing interventions (e.g., massage, music, healing touch, or aromatherapy) also work with palliative care

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 666 OBJ: Discuss principles of palliative and hospice care.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

22.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.

ANS: A

Hospice care provides services for patients who are at the end of life. Patients who meet the criteria for hospice care generally have less than 6 months to live. Hospice teams provide care in many settings—home, hospital, or extended care facilities—and provide physical, emotional, and spiritual care for patients and family members. Hospice care focuses exclusively on palliative care interventions to relieve the symptoms and burdens of illness or treatment and help patients live as fully as possible until death. Nurses base hospice care on a patient’s goals and support patient and family preferences for maintaining comfort and a high quality of life.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 666 OBJ: Discuss principles of palliative and hospice care.

TOP:Integrated Process: Communication and Documentation

MSC: NCLEX: Psychosocial Integrity

23.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.

ANS: A

For a patient to receive home hospice care, a primary caregiver must be living in the home. The primary caregiver receives support from professional and volunteer hospice team members who are available 24 hours a day. If a patient receiving home hospice care goes to the hospital for the management of acute symptoms, a hospice nurse coordinates care between the home and hospital settings.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 666 OBJ: Discuss principles of palliative and hospice care.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24.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.

ANS: A

To help patients feel more hopeful, remind them of their strengths and reinforce their expressions of courage, positive thinking, and realistic goal setting. Patients feel more hopeful when they have a sense of control. Family members of dying persons identified the importance of maintaining connections. When people have strong relationships and a sense of emotional connectedness to others, they know that help is available. Offer information to patients about their illness, correct misinformation, and clarify patient’s perceptions.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:667

OBJ: Identify nursing interventions for helping patients cope with loss, death, and grief.

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

25.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.”

ANS: B

Reinforce the understanding that people grieve differently and that feelings change or resolve over time. Some people have “anniversary reactions” (heightened or renewed feelings of loss or grief) months or years after a loss. They worry that they are losing ground when signs of grief reappear after a period of relative calm. Offer reassurance that anniversary reactions are common, and encourage pleasant reminiscence.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:667

OBJ: Identify nursing interventions for helping patients cope with loss, death, and grief.

TOP:Integrated Process: Communication and Documentation

MSC: NCLEX: Psychosocial Integrity

26.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.

ANS: C

Suggest simple and appropriate tasks for family members to perform (e.g., offering help with meals, simple hygiene or comfort activities, or filling out a menu). Family members who are having difficulty accepting the patient’s impending death sometimes avoid visits. When family members visit, reassure them that their presence is important, encourage interaction, and offer information about what the patient was talking about or has recently experienced. Encourage family members to discuss normal family activities, reminisce about enjoyable times, and ask about the patient’s concerns. Some people feel lonely or fearful at night and want a family member to stay with them. In acute care settings or extended care facilities, allow visitors to remain with patients who are dying, and relax other visiting restrictions.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:669

OBJ: Identify ways to educate and involve family members in providing palliative care.

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

27.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

ANS: B

Unless family members need privacy or are remaining with the patient around the clock, avoid placing patients in a private room. Patients who are dying often feel a sense of involvement and companionship when sharing a room and have more opportunities to interact with staff and visitors.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:669

OBJ: Identify nursing interventions for helping patients cope with loss, death, and grief.

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

28.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.

ANS: A

Provide a private area for the family to discuss organ donation if this is an option. Many people do not understand “brain death.” Family members often believe that the person is still alive because his or her heart is still beating. For their loved one to donate major organs (e.g., heart, lungs, liver), the body must be kept in good functional condition so the organs will not become damaged before donation. The patient remains on a ventilator until his or her organs are removed. Nonvital tissues such as corneas, skin, long bones, and middle ear bones can be removed at the time of death without maintaining vital functions.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:670

OBJ: Identify ways to educate and involve family members in providing palliative care.

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

29.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.

ANS: D

Frequently evaluate your own emotional well-being. We all have feelings and memories about previous illnesses and death. Knowing more about your own grief and past experiences will help you care for others more insightfully. Being a professional caregiver involves knowing when to get away from a situation and how best to take care of one’s self. Many nurses, especially those who routinely provide hospice care, attend a viewing at the mortuary or the funeral to show support for the family, honor the deceased’s memory, and cope with their own grief. Develop your own support systems, take restful time away from your work, and find a person with whom you can safely share your feelings and concerns. Experiencing repeated deaths of patients can feel overwhelming at times. If you work in an area in which you experience multiple losses and fail to acknowledge your own feelings of loss, you may begin to feel overwhelmed by intense emotions (e.g., frustration, anger, guilt, sadness, or dissatisfaction with life) and become vulnerable to compassion fatigue.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:672

OBJ: Discuss nurses’ experiences of loss when caring for dying patients.

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

30.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

ANS: B

Members of religious faiths that believe in reincarnation (e.g., Hindu religion) support refusal of nourishment and pain medications because of the implications for the dying person’s next life. Orthodox Jews stay with a person who is dying throughout the entire process and have community members (minyan) praying at the bedside. Members of the Catholic Church often receive an anointing by a priest and Holy Communion. Christians usually believe in heaven or an afterlife.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 658 OBJ: Discuss variables that influence a person’s response to grief.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

31.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

ANS: C

People experience maturational losses as they go through a lifetime of normal developmental processes. For example, when a child goes to school for the first time she will spend less time with her parents, leading to a change in the parent-child relationship. People experience an actual loss when they can no longer touch, hear, see, or have near them valued people or objects. Examples include the loss of a body part, pet, friend, life partner, or job. Perceived losses are uniquely experienced by a grieving person and are often less obvious to others. A perceived loss is very real to the person who has had the loss. For example, a person perceives that she is less loved by her parents and experiences a loss of self-esteem. Situational loss occurs as a result of an unpredictable life event.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:655-656OBJ:Discuss five categories of loss.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

32.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.

ANS: D

Anxiety has physical causes such as shortness of breath, pain, fear of death, spiritual concerns, and relationship concerns. As patients approach death, they breathe through the mouth, the tongue becomes dry, and lips become dry and cracked. Blinking reflexes diminish near death; and eyes often remain open, causing drying of cornea. Opioid medications and immobility slow peristalsis.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF: 668 OBJ: Discuss principles of palliative and hospice care.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

33.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.

ANS: A

A nurse assumes responsibility for postmortem care (i.e., care of the body after death). Give postmortem care with dignity and sensitivity and in a manner consistent with a patient’s religious or cultural beliefs. Because a body undergoes many physical changes after death, elevate the head of the bed to 30 degrees or place the patient’s head on pillows to prevent pooling of blood, which can discolor the face. Ask family members if and how they would like to help care for the body. Make arrangements for a member of the professional staff (e.g., spiritual care provider) to stay with family members if they do not wish to participate in body care. Remove all catheters, tubes, or indwelling devices from the patient’s body, except in the case of autopsy. In that case leave medical devices in place.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF: 671 OBJ: List the steps in caring for a body after death.

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1.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

ANS: A, B, C, D

The four types of complicated grief are chronic, delayed, exaggerated, and masked.Disenfranchised grief occurs in situations in which others view a person’s loss as insignificant or invalid. This is not a type of complicated grief.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:657OBJ:Describe types of grief.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2.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.

ANS: A, C, E

The Dying Person’s Bill of Rights states that the patient has the right to be treated as a living human being until he dies, be in control, express his feelings and emotions about his approaching death in his own way, be free from pain, have his questions answered honestly and not be deceived, and die in peace and dignity.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF: 660 OBJ: Discuss principles of palliative and hospice care.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

3.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.

ANS: A, B, C, E

Nursing interventions help people acknowledge the reality of their loss. Encourage them to rely on their support network of family members, friends, professionals, and community resources. Reinforce the understanding that people grieve differently and that feelings change or resolve over time. Some people have “anniversary reactions” (heightened or renewed feelings of loss or grief) months or years after a loss. Offer reassurance that anniversary reactions are common, and encourage pleasant reminiscence. Provide continuing support. If you see the patient or family after an extended time, it is appropriate to ask them how they are doing after the loss. This gives them the opportunity to talk and lets them know that their loved one is remembered. The nurse should not tell people there is a specific timeline for grieving.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:667

OBJ: Identify nursing interventions for helping patients cope with loss, death, and grief.

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity