Chapter 39- Loss and Grieving Nursing School Test Banks

 

1.

The nurse is caring for a patient who is dying. She overhears the patient saying, God, if you will only let me live to see my daughter get married, I promise I will start going to church again. The nurse understands that the patient is in which stage of grief according to Kubler-Ross?

A)

Denial

B)

Bargaining

C)

Depression

D)

Anger

E)

Acceptance

Ans:

B

Feedback:

Kubler-Ross proposed five stages of grief: (a) denial, (b) anger, (c) bargaining, (d) depression, and (e) acceptance. Denial may range from complete denial of the illness and impending death to denial of the effect that dying will have on self and others. In the second stage, anger may be directed toward fate, God, family members, healthcare providers, or others. Bargaining occurs as the patient seeks to delay the dreaded event; the patient bargains with God for more time and, in return, promises to do something to repay God for this favor. Depression occurs when the patient acknowledges the reality and inevitability of the impending death. In the final stage, acceptance, the patient comes to terms with the loss, begins to detach from supportive people, and loses interest in worldly activities.

2.

The nurse is preparing a presentation on preparing children for death. What information should the nurse include? Select all that apply.

A)

Encourage forgetting of the deceased

B)

Encourage expression of feelings

C)

Provide for stability and safety

D)

Praise stoicism

E)

Talk openly about death and the feelings associated with it

Ans:

B, C, E

Feedback:

In preparing children for death, encourage expression of feelings, provide for stability and safety, and talk openly about death.. Dont praise stoicism, encourage forgetting of the deceased, or force the child to participate in mourning rituals.

3.

A nurse is caring for a patient whose husband died over four years ago. The nurse suspects that the patient has abnormal grief. Which of the assessment findings would support this?

A)

Talking about her husband as if he were still alive

B)

Keeping photos of her husband on her bedside table

C)

Talking and laughing about the time when he forgot their anniversary

D)

Crying on the anniversary of his death

Ans:

A

Feedback:

Abnormal grief responses if present beyond 3 years include leaving the deceaseds room and belongings intact, reporting physical symptoms similar to those the deceased had before death, and talking about the deceased as if they were still alive.

4.

My father has been dead for over a year and my mother still cant talk about him without crying. Is that normal? What is the best response by the nurse?

A)

The inability to talk about your dad without crying, even after a year, is still considered normal.

B)

It is not normal. Your mother needs to see a therapist about her grief.

C)

Everyone deals with loss differently. You just need to be patient with your mother.

D)

Did your mother cry a lot before your father died?

Ans:

A

Feedback:

Normal responses to bereavement after 1 year include the inability to speak of the deceased without intense emotion, clinical signs of depression, and feelings of meaningless.

5.

When reviewing a patients chart, the nurse notes that the patient is in the disorganization stage of grief. Which assessment finding would support this diagnosis?

A)

It doesnt matter what I look like.

B)

I havent let my children out of my sight. I am afraid something will happen to them.

C)

I had a good time at my class reunion. It was nice to be out with other people again.

D)

Im sick all of the time. I just cant get rid of this cold.

Ans:

D

Feedback:

In the protest stage of grief the patient may exhibit preoccupation with thoughts of the deceased, searching for the deceased, dreams/nightmares, hallucinations, and concerns about others health and safety. In the shock stage the patient may exhibit slowed and disorganized thinking, blocking of thoughts, neglect of appearance, and wishes to join the deceased. In the disorganization stage of grief the patient may exhibit difficulty making decisions, aimlessness, decreased resistance to illness, and loss of interest in people, work, and usual activities. In the reorganization stage of grief the patient may exhibit a realistic memory of the deceased, be comfortable when remembering the deceased and return to previous level of ability.

6.

The hospice nurse is visiting the wife of a patient who died 10 months ago. The wife states, My life is meaningless since my husband died. The nurse recognizes that the patient is in which stage of grief?

A)

Shock

B)

Protest

C)

Disorganization

D)

Reorganization

Ans:

C

Feedback:

In the protest stage of grief the patient may exhibit preoccupation with thoughts of the deceased, searching for the deceased, dreams/nightmares, hallucinations, and concerns about others health and safety. In the shock stage the patient may exhibit slowed and disorganized thinking, blocking of thoughts, and wishes to join the deceased. In the disorganization stage of grief the patient may exhibit difficulty making decisions, aimlessness, and loss of interest in people, work, and usual activities. In the reorganization stage of grief, the patient may exhibit a realistic memory of the deceased, be comfortable when remembering the deceased and return to previous level of ability.

7.

The wife of a recently deceased patient states that she cant think of anything other than her husband. She wakes up at night and goes to look for him before realizing that he is dead. The nurse understands that the wife is in which stage of grief?

A)

Shock

B)

Protest

C)

Disorganization

D)

Reorganization

Ans:

B

Feedback:

In the protest stage of grief, the patient may exhibit preoccupation with thoughts of the deceased, searching for the deceased, dreams/nightmares, hallucinations, and concerns about others health and safety. In the shock stage, the patient may exhibit slowed and disorganized thinking, blocking of thoughts, and wishes to join the deceased. In the disorganization stage of grief the patient may exhibit difficulty making decisions, aimlessness, and loss of interest in people, work, and usual activities. In the reorganization stage of grief the patient may exhibit a realistic memory of the deceased, be comfortable when remembering the deceased, and return to previous level of ability.

8.

The nurse is preparing the body of a patient who was killed in a car accident for the family to view. Which of the following steps would be contraindicated ?

A)

Removal of all IVs and other medical tubing.

B)

Clean, position, and cover the patient with a sheet, exposing only the head and a hand.

C)

Inform the family that they can have as much time alone with the patient as they wish.

D)

Respect all religious and cultural practices of the family.

Ans:

A

Feedback:

In an effort to limit exposure to the disturbing sight of equipment and medical supplies, the nurse should, if possible, remove unneeded items and clean, position, and cover the patient. However, under some circumstances (such as an unexpected death), intravenous and other lines and tubes should not be removed, as the body may need to be examined by a medical examiner. Having time alone with the patient is an important step for some families, whereas others appreciate the presence of a nurse, a spiritual leader, or friends. Religious and cultural beliefs and customs should be observed as much as possible.

9.

A nurse has just finished a presentation on hospice and palliative care. Which statement by a participant would indicate a need for further education?

A)

Palliative care provides pain relief and other distressing symptoms.

B)

Hospice care programs focus on quality rather than length of life.

C)

In hospice care, the nurses make most of the care decisions for the patients.

D)

Hospice focuses on treatments and care aimed only at relieving symptoms in the last few months of life

E)

Palliative care affirms life and regards dying as a normal process.

Ans:

C

Feedback:

The philosophy of hospice is that patients and families are empowered to achieve as much control over their lives as possible. Hospice focuses on relieving symptoms and supporting patients with a life expectancy of six months or less, rather than years, and their families. However, palliative care may be given at any time during a patients illness, from diagnosis to end of life.

10.

The nurse is preparing a care plan for a patient with the nursing diagnosis of Dysfunctional Grieving. Which of the following nursing interventions should the nurse include? Select all that apply.

A)

Provide the patient with information regarding a grief support group.

B)

Encourage the patient to have regular check-ups with their healthcare provider.

C)

Avoid talking about the loss if it upsets the patient.

D)

Refer the patient to a grief specialist.

E)

Encourage the patient to talk about only the positives of the deceased person.

Ans:

A, B, D

Feedback:

Encourage the mourner to remember and talk about both negative and positive memories of the deceased. Encourage patients to continue contact with their primary healthcare provider (physician or nurse) as well, because the grief process often decreases resistance to disease and exacerbates existing illnesses. Support groups and grief specialists can offer additional support to the patient.

11.

The hospice nurse is assessing the wife of a patient who died 14 months ago. The nurse is concerned that the wife is still grieving the death of her husband. Which of the following objective assessment findings would suggest that the wife is NOT still grieving?

A)

Stating, I think about him all of the time.

B)

Weight loss of 40 pounds in the last 14 months

C)

Stating, I cant go on living like this.

D)

Hair is clean and styled.

Ans:

D

Feedback:

Many of the subjective manifestations of grief have concomitant objective manifestations: Dejected physical appearance, slowed motor function, weeping, outbursts of anger, emotional blunting, unkempt appearance, sleep, appetite disturbance (excessive weight loss or gain). Direct quotes are subjective data.

12.

A nursing instructor has finished presenting information to a group of nursing students on the factors that influence the grieving process. Which statement by a student would indicate a need for further education?

A)

The age of the person who died can dramatically affect the grieving process.

B)

A death that occurs as a result of homicide or suicide is just as stressful as a death from natural causes.

C)

Some people find strength in dealing with loss through their religious beliefs, whereas others experience greater distress due to their beliefs.

D)

Absence of social supports can create additional stressors for the grieving person.

Ans:

B

Feedback:

Many factors influence the grieving process, including the meaning of the loss to the individual, the circumstances of the loss, personal resources and stressors, and sociocultural resources and stressors.

13.

The hospice nurse is caring for a patient with lung cancer. The patients daughter states, My mom isnt happy with anything I do for her. She is constantly yelling at me. The nurse understands that the patient is in which stage of grief according to Kbler-Ross?

A)

Depression

B)

Anger

C)

Acceptance

D)

Bargaining

E)

Denial

Ans:

B

Feedback:

Kbler-Ross proposed five stages of grief: (a) denial, (b) anger, (c) bargaining, (d) depression, and (e) acceptance. Denial may range from complete denial of the illness and impending death to denial of the effect that dying will have on self and others. In the second stage, anger may be directed toward fate, God, family members, healthcare providers, or others. Bargaining occurs as the patient seeks to delay the dreaded event; the patient bargains with God for more time and, in return, promises to do something to repay God for this favor. Depression occurs when the patient acknowledges the reality and inevitability of the impending death. In the final stage, acceptance, the patient comes to terms with the loss, begins to detach from supportive people, and loses interest in worldly activities.

14.

An appropriate nursing diagnosis for the family of a patient dying of cancer whose members have expressed sorrow over the forthcoming loss would be

A)

Anticipatory grieving related to the loss of family member as evidenced by sorrow

B)

Dysfunctional grieving related to the loss of family member as manifested by behaviors indicating anxiety

C)

Potential for grieving related to the loss of family member and sorrow

D)

Dysfunctional grieving related to the future loss of family member manifested by the familys developmental regression

Ans:

A

Feedback:

Anticipatory grieving comprises the intellectual and emotional responses and behaviors by which individuals, families, and communities work through the process of modifying self-concept based on the perception of loss.

15.

A widow develops cancer within 6 months of her husbands death. This may be a result of

A)

Social isolation

B)

Alcohol intake

C)

Bereavement

D)

Multiple losses

Ans:

C

Feedback:

Physical health and psychosocial adjustment are intricately intertwined. The bereaved are known to be at greater risk for mortality and morbidity than are comparable nonbereaved people.

16.

Which of the following manifestations of grief by the patient who lost his wife 3 years earlier is considered abnormal?

A)

Showing a photograph of the decedent

B)

Talking about his wifes absent-mindedness

C)

Telling the nurse how his life has changed

D)

Leaving the wifes room and belongings intact

Ans:

D

Feedback:

Bereavement experts reported that they considered almost all bereavement manifestations to be normal during the early stages of grief but considered most of the manifestations to be abnormal if they continue beyond 3 years.

17.

To adequately assist a patient and family from a different culture with the death and dying process, the nurse must

A)

Understand the patients cultural beliefs

B)

Progress through the stages of grief

C)

Experience death in his own life

D)

Have felt distress and anger

Ans:

A

Feedback:

Nurses should gain knowledge of the specific cultural and religious beliefs of the patients they are serving and help their patients deal with loss in a manner that is congruent with their cultural and religious beliefs and practices.

18.

Which of the following statements about grief should the nurse include in the teaching plan developed to address a group of young adults?

A)

Individuals from lower socioeconomic classes tend to have a better outcome about loss.

B)

Nutrition and wellness have little effect on the outcome of grief.

C)

A familys developmental state does not affect the grief process.

D)

Multiple losses may strain the individuals ability to cope effectively.

Ans:

D

Feedback:

Young adults often experience many losses within a short period of time, which places them particularly at risk for poor outcomes. These multiple losses, coupled with their inexperience with loss and grief, make them particularly at risk.

19.

Which of the following statements regarding perceptions of death by children is accurate?

A)

Toddlers perceive death as irreversible and unnatural.

B)

Preschool-age children view death as a spiritual release.

C)

At age 9, the child perceives death as irreversible.

D)

Adolescents tend to respond better than adults with death.

Ans:

C

Feedback:

At about 9 years of age, the childs concept of death matures, and the child perceives death realistically as irreversible, universal, inevitable, and natural.

20.

A pediatric nurse recognizes that preschoolers think of death as

A)

A long sleep

B)

Irreversible

C)

Inevitable

D)

Natural

Ans:

A

Feedback:

Preschoolers think of death as a long sleep.

21.

A widower who continues to improve his level of functioning higher than before the loss is best described at which stage of the Grief Cycle Model?

A)

Shock

B)

Protest

C)

Disorganization

D)

Reorganization

Ans:

D

Feedback:

People who have sufficient resources during this period are likely to continue to improve their level of functioning and often emerge from the grief cycle at a higher level of functioning than before the loss.

22.

Which of the following stages of grieving is displayed by a woman who appears depressed and withdrawn?

A)

Shock

B)

Protest

C)

Disorganization

D)

Reorganization

Ans:

C

Feedback:

The disorganization stage is characterized by severe depression, social withdrawal, and lack of interest in people and activities.

23.

In the Parkes Model, a person uses denial as a psychological defense in the stage of

A)

Numbness

B)

Yearning

C)

Disorganization

D)

Reorganization

Ans:

A

Feedback:

In the numbness stage, which is usually brief, trauma so overwhelms the bereaved survivor that he or she must use denial as a psychological defense.

24.

A widow has just returned home from the funeral of her husband. She feels alone in her home. Her family has left to go back to their home in another area of the country. What stage of Engels model does this represent?

A)

Shock and disbelief

B)

Developing awareness

C)

Restitution

D)

Resolving the grief

Ans:

B

Feedback:

Developing awareness occurs as the reality and meaning of the loss penetrate the persons consciousness.

25.

Which of the following stages of grieving is exhibited by the husband of a victim of sudden death who refuses to accept that she is dead?

A)

Shock

B)

Protest

C)

Depression

D)

Doubt

Ans:

A

Feedback:

In the shock and disbelief stage, the survivor either refuses to accept the loss or shows intellectual acceptance of the loss but denies the emotional impact.

26.

The term bereavement is best defined as a

A)

Psychological response to a loss

B)

Socially conventional behavior after a loss

C)

Period of time after a loss of a loved one

D)

State of desolation that occurs after a loss

Ans:

D

Feedback:

Bereavement is a state of desolation that occurs as the result of a loss, particularly the death of a significant other.

27.

A middle-age woman is mentally preparing for the death of her mother. This is termed

A)

Grieving

B)

Anticipatory grieving

C)

Bereavement

D)

Loss

Ans:

B

Feedback:

Anticipatory grief is the characteristic pattern of psychological and physiologic responses a person makes to the impending loss (real or imagined) of a significant person, object, belief, or relationship.

28.

The experience of parting with an object, person, belief, or relationship that one values is

A)

Loss

B)

Bereavement

C)

Grief

D)

Death

Ans:

A

Feedback:

Loss is defined as the experience of parting with an object, person, belief, or relationship that one values; the loss requires a reorganization of one or more aspects of the persons life.

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