Chapter 20: Loss and Grief Nursing School Test Banks

Chapter 20: Loss and Grief
Test Bank

MULTIPLE CHOICE

1. The client is 21 years old and has just been given the diagnosis of terminal cancer. She is coping with a(n) ____ loss.
a. Expected
b. Imagined
c. Internal
d. Temporary
ANS: C
Internal losses are personal and include losses that involve the self. Expected loss occurs gradually; imagined loss is perceived; and temporary loss is reversible.

DIF: Cognitive Level: Comprehension REF: p. 224 OBJ: 1
TOP: Characteristics of Loss KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

2. The group best able to accept their losses and grow from their experiences is:
a. Adults
b. Toddlers
c. Adolescents
d. School-age children
ANS: A
Adults who have experienced loss learn to accept their losses and learn from their experiences.

DIF: Cognitive Level: Knowledge REF: p. 225 OBJ: 2
TOP: Loss Behaviors throughout the Life Cycle
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

3. The set of emotional reactions that accompany a loss is called:
a. Grief
b. Anxiety
c. Mourning
d. Bereavement
ANS: A
Grief is the set of emotional reactions that accompany a loss. Anxiety is a vague, uneasy feeling that is not specifically related to a loss. Mourning refers to the process of resolving a loss, and bereavement refers to the thoughts, feelings, and activities following a loss.

DIF: Cognitive Level: Knowledge REF: p. 226 OBJ: 3
TOP: The Nature of Grief and Mourning KEY: Nursing Process Step: N/A
MSC: Client Needs: Psychosocial Integrity

4. The behavioral state of thoughts, feelings, and activities that follow a loss is called:
a. Grief
b. Anxiety
c. Mourning
d. Bereavement
ANS: D
This state is different with every person. Grief is the set of emotional reactions that accompany a loss. Anxiety is a vague, uneasy feeling that is not specifically related to a loss. Mourning is the process of working through or resolving ones grief.

DIF: Cognitive Level: Knowledge REF: p. 226 OBJ: 3
TOP: The Nature of Grief and Mourning KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

5. Persons may refuse to acknowledge that a loss has occurred during the first stage of:
a. Crisis
b. The grieving process
c. The rage reaction
d. The denial process
ANS: B
The first step in the grieving process is denial.

DIF: Cognitive Level: Knowledge REF: p. 226 OBJ: 3
TOP: Stages of the Grieving Process KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

6. The client lost her husband of 50 years 10 months ago. She now sees every day as a gray fog with no light. She has begun to experience changes in eating, sleeping, and activity levels; angry, hostile moods; and an inability to concentrate or complete work tasks. What is the client experiencing?
a. Complicated grief
b. A normal grief reaction
c. Complicated depression
d. Bereavement-related depression
ANS: D
With bereavement-related depression, the griever feels the loss so intensely that despair and worthlessness overwhelm everything. This is not considered a normal grief reaction. Complicated grief refers to a constant yearning for the deceased without symptoms of depression. Complicated depression is not a grief reaction.

DIF: Cognitive Level: Application REF: p. 227 OBJ: 4
TOP: Unresolved Grief KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

7. The last stage of growth and development is called:
a. Dying
b. Old age
c. Wisdom
d. Maturity
ANS: A
Dying is the last stage of growth and development.

DIF: Cognitive Level: Knowledge REF: p. 228 OBJ: 7
TOP: The Dying Process KEY: Nursing Process Step: N/A
MSC: Client Needs: Health Promotion and Maintenance

8. The concerns of children in whom terminal conditions have been diagnosed focus on how the illness affects the childs:
a. Loss of a future
b. Family and friends
c. Social activities
d. Activities of daily living
ANS: D
Immediate concerns focus on how the illness affects the activities of daily living and limits their abilities. As individuals mature, concerns turn to the remaining three options.

DIF: Cognitive Level: Comprehension REF: p. 228 OBJ: 5
TOP: Age Differences and Dying KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

9. To make the remainder of a terminally ill persons life as meaningful and comfortable as possible is the goal of:
a. Hospice care
b. The stages of dying
c. The grieving process
d. Institutional care
ANS: A
The goal of hospice care is to make the remainder of a terminally ill persons life as meaningful and comfortable as is humanly possible. Hospice focuses not only on care of the client but on the family as well.

DIF: Cognitive Level: Knowledge REF: p. 231 OBJ: 9
TOP: Hospice Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

10. When care is provided for a dying client in pain, addiction to analgesics is:
a. Not an issue
b. To be evaluated daily
c. To be carefully avoided
d. To be prevented with pain management techniques
ANS: A
Addiction is not an issue when care is provided for the terminally ill; the goal is to make the client comfortable and pain free.

DIF: Cognitive Level: Comprehension REF: p. 231 OBJ: 9
TOP: Meeting the Needs of Dying Clients
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity

11. Decisions about a terminally ill clients remaining time belong to the:
a. Person
b. Family members
c. Medical care team
d. Spiritual advisor
ANS: A
In a good death, a person controls his or her own destiny.

DIF: Cognitive Level: Comprehension REF: p. 230 OBJ: 8
TOP: Therapeutic Interventions KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity

12. To assist them with their grief experiences, many health care facilities offer caregivers who work with dying clients:
a. Extra income
b. Support groups
c. Time off from work
d. Peer evaluation groups
ANS: B
Many health care facilities offer support groups for caregivers who work with dying clients to help them work through their own grief experiences.

DIF: Cognitive Level: Knowledge REF: p. 228 OBJ: 9
TOP: Caregivers Grief KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

13. The father of three young children dies. The wife expresses how worried she is about how to raise the children on her own without the support of her husband. She finds herself crying and living through each day without accomplishing anything. In which grieving stage is this behavior typically experienced?
a. Denial
b. Depression and identification
c. Acceptance and recovery
d. Yearning
ANS: D
This is the second stage of grieving, in which the person longs for the deceased and feels overwhelmed by the loss. Denial is the first stage of grieving, when the person is in shock and rejects the loss of another; depression and identification is the third stage of grieving, characterized by depressed feelings followed by a period of sharing memories and seeking support from others; and acceptance and recovery is the phase of the grieving process during which individuals begin to focus their energies toward the living and their lives begin to stabilize.

DIF: Cognitive Level: Application REF: p. 226 OBJ: 3
TOP: The Grieving Process KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

14. Three years after the loss of her husband of 35 years, the wife has a full-time job but finds that she cannot sleep well at night, has frequent mood changes, and attends the couples night out with friends that she and her husband attended. Upon seeking counseling, she discovers that she is exhibiting symptoms of:
a. Bereavement-related depression
b. Complicated grief
c. Anticipatory grief
d. Caregiver grief
ANS: B
These are characteristic symptoms of complicated grief in which an individual experiences persistent yearning for the deceased person without signs of depression. Bereavement-related depression refers to depression following a loss that consumes every aspect of a persons life; anticipatory grief refers to grief felt in anticipation of a loss; and caregiver grief refers to grief felt by health care providers.

DIF: Cognitive Level: Application REF: p. 227 OBJ: 4
TOP: Unresolved Grief KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

15. The 39-year-old daughter of a client with a terminal illness tells the nurse that she thinks something is wrong with her because she frequently cries, is often sad, and cant imagine losing her mother. The nurse assures the daughter that these are normal feelings associated with:
a. Bereavement-related depression
b. Complicated grief
c. Anticipatory grief
d. Caregiver grief
ANS: C
These symptoms are typically experienced with grief that is felt in anticipation of a loss. Bereavement-related depression refers to depression following a loss that consumes every aspect of a persons life; complicated grief is displayed as persistent yearning for the deceased person without signs of depression; and caregiver grief refers to grief experienced by health care providers.

DIF: Cognitive Level: Application REF: p. 227 OBJ: 4
TOP: Stages of the Grieving Process KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

16. A family experiences the loss of their wife and mother to a car accident. Which family member reacts by asking When is mommy coming back?
a. The 17-year-old son
b. The 11-year-old daughter
c. The 4-year-old son
d. The 7-year-old daughter
ANS: C
Because of their sense of time, preschoolers cannot understand a permanent loss such as death. The school-aged and adolescent children have an adult concept and understanding of loss and death.

DIF: Cognitive Level: Application REF: p. 225 OBJ: 4
TOP: Stages of the Grieving Process KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

17. A 10-year-old patient on a childrens oncology unit has had an unsuccessful bone marrow transplant. The family is distraught but remains positive in front of the child. One night the child asks the nurse about death and dying. What counseling should the nurse give to the parents?
a. Avoid talking about death in front of the child.
b. Change the subject if the child asks about dying.
c. Allow the child to have an honest discussion about dying.
d. Allow the physician to discuss this with the child.
ANS: C
Children are remarkably observant and have an intuitive ability to understand the seriousness of their illness and its outcomes. Whenever possible, parents should be encouraged to communicate with the dying child. Open discussions of the illness and its outcomes help children cope with feelings of isolation, anxiety, and guilt over causing distress in the family. The other options continue to isolate the child and encourage suppression of feelings.

DIF: Cognitive Level: Application REF: p. 228 OBJ: 7
TOP: Age Differences and Dying KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

18. Which age group through the life cycle has the most difficult time relating to their own death?
a. Toddler
b. Preschool
c. Adolescent
d. Adult
ANS: C
Death is particularly difficult to accept during adolescence because the developmental task at this age is to define who one is and to establish an identity. Loss at this age may make a person stand out from their peer group.

DIF: Cognitive Level: Application REF: p. 225 OBJ: 4
TOP: Loss Behaviors throughout the Life Cycle
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

19. A person with terminal cancer makes a call to a family member she has not spoken to in 30 years in order to make amends. According to Kbler-Ross, what stage of dying is this person in?
a. Denial
b. Working
c. Resistance
d. Acceptance
ANS: B
In the working or review stage, the individual begins to deal with unfinished business. In the denial or resistance phase the individual fights the issue, and in the acceptance stage the individual is comfortable with death.

DIF: Cognitive Level: Application REF: p. 230 OBJ: 7
TOP: Stages of Dying KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

20. Which of the following are therapeutic interventions for unresolved grief? (Select all that apply.)
a. Listening
b. Providing emotional support
c. Keeping the griever medicated
d. Referring to appropriate resources
e. Forcing the client to eat properly
f. Telling the client that he or she must learn to cope
g. Encouraging return to work as soon as possible
ANS: A, B, D
Listening, providing emotional support, and referring to appropriate resources are interventions for unresolved grief.

DIF: Cognitive Level: Comprehension REF: p. 227 OBJ: 4
TOP: Unresolved Grief KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

21. Loss of which of the following can result in the individuals experiencing external losses? (Select all that apply.)
a. Spouse
b. Possession
c. Career
d. Limb
e. Favorite piece of jewelry
f. Friendship
ANS: A, B, E, F
External losses are considered losses that occur outside of the individual and include objects, possessions, the environment, loved ones, and support. Loss of career or limb is an internal loss that is more personal and involves some part of oneself.

DIF: Cognitive Level: Comprehension REF: p. 224 OBJ: 1
TOP: The Nature of Loss KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

22. According to Glaser and Strauss, the closed awareness model can be applied to family, friends, care providers, and the dying individual. Which of the following statements are true of the closed awareness model? (Select all that apply.)
a. Medical personnel and family keep the condition secret from the client.
b. Caregivers and client know about impending death but do not talk about it.
c. Caregivers and client accept death and have open conversations.
d. Dying client feels isolated from the ability to share with family.
e. Dying client becomes suspicious of the truth, and information is tightly controlled by family.
ANS: A, D, E
The closed awareness model is one in which the goal of care providers and family seek to keep the truth from the client. The belief centers around the rationale that telling the client the seriousness of the condition would be too upsetting. As the client begins to realize the seriousness of his condition, caregivers limit and control information. The mutual pretense model is one in which both client and family know about the pending death, but do not discuss it. In the open awareness model, the client and family have open communication and accept death.

DIF: Cognitive Level: Application REF: p. 230 OBJ: 7
TOP: Stages of Dying KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

OTHER

23. Place the steps of grieving in proper chronological order. (Separate letters by a comma and space as follows: A, B, C, D.)
A. Acceptance and recovery
B. Depression and identification
C. Denial
D. Yearning

ANS:
C, D, B, A
Not all individuals move through this process step-by-step. They may skip a step or may move back and forth between steps. If grieving is dysfunctional, an individual may skip a step completely.

DIF: Cognitive Level: Application REF: p. 226 OBJ: 3
TOP: Stages of the Grieving Process KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

COMPLETION

24. __________ occurs when an individual who has experienced a loss is working through or resolving his or her grief.

ANS:
Mourning
This period can be intense and painful, and its duration varies among individuals.

DIF: Cognitive Level: Knowledge REF: p. 226 OBJ: 2
TOP: The Nature of Grief and Mourning KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

25. Following the funeral of her husband, the wife is seen crying and holding his picture. She is demonstrating __________.

ANS:
bereavement
Bereavement is the behavioral state of the thoughts, feelings, and activities following a loss.

DIF: Cognitive Level: Knowledge REF: p. 226 OBJ: 2
TOP: The Nature of Grief and Mourning KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

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