Chapter 25: Care for the Dying and Those Who Grieve Flashcards
A nurse working with a person whose spouse recently died uses cheer and humor to lift the persons spirits. At one point, the widowed person smiles briefly. What analysis of this scenario is correct?
a. The nurses technique was effective.
b. Use of humor should be added to the plan of care.
c. This approach may prove useful in other, similar situations.
d. The nurse needs supervision; the communication technique was not appropriate.
ANS: D
Clinical supervision will review the nurses actions and thoughts and help the nurse arrive at a more therapeutic approach. Attempts at cheering up a patient who is depressed serve only to emphasize the disparity between the patients mood and that of others. Active listening should be the technique used by the nurse. The incorrect
options suggest the approach is therapeutic when it is not.
A patients fianc died in an automobile accident several days ago. The patient reports crying and
experiencing feelings of guilt and anger. This behavior is characteristic of which stage of acute grief?
a. Denial
b. Reorganization
c. Development of awareness
d. Preoccupation with the lost object
ANS: C
As denial fades, an awareness of the finality of the loss develops and is accompanied by painful feelings of
loss, anger with others, and guilt for taking or not taking specific actions. Reorganization implies the
movement toward healing. Denial is manifested by the inability to believe the reality of an event.
Preoccupation with the lost object would involve the patient dwelling on thoughts of the deceased.
After the death of a spouse, an adult repeatedly says, I should have made him go to the doctor when he said he didnt feel well. This individual is experiencing:
a. preoccupation with the image of the deceased.
b. sensations of somatic distress.
c. anger.
d. guilt.
ANS: D
Guilt is evident by the bereaved persons self-reproach. Preoccupation refers to dwelling on images of the deceased. Somatic distress would involve bodily symptoms. Anger is not evident from data given in this
scenario.
A person whose spouse died two years earlier tells friends, I think Ill start going out socially, maybe even
take someone to dinner. This comment best demonstrates that the individual is:
a. denying the significance of the loss.
b. in a period of resolution of grief.
c. actively working through grief.
d. experiencing intrusion.
ANS: B
Toward the end of the grief process, the person renews his or her interest in people and activities. This
behavior indicates resolution. At the same time, the person is released from the relationship with the deceased. The patient has progressed beyond grief. The patient is seeking to move into new relationships so that he or she
is not alone.
After the death of his wife, a man tells the nurse, I cant live without her. She was my whole life. Which is
the nurses most therapeutic reply?
a. Each day will get a little better.
b. Her death is a terrible loss for you.
c. Remember, shes no longer suffering.
d. Your friends will help you cope with this.
ANS: B
The correct response demonstrates the use of reflection, a therapeutic communication technique. A statement that validates the bereaved persons loss is more helpful than banalities and clichs; it signifies understanding. The other options are clichs.
Shortly after a mans wife dies, the man approaches the nurse who cared for his wife during her final hours of life and says angrily, If you had given your undivided attention, she would still be alive. Which analysis applies?
a. The comment summarizes the nurses inadequacies.
b. Anger is a phenomenon experienced during grieving.
c. The patient had ambivalent feelings about his spouse.
d. In some cultures, grief is expressed solely through anger.
ANS: B
Anger may protect the bereaved from facing the devastating reality of the loss. Anger expressed during
mourning is not directed toward the nurse, personally, although accusations and blame may make him or her feel as though it is.
After being notified that her husband died of heart failure, a wife approaches the nurse who cared for her husband. In the hospital hallway the wife shouts angrily, He’d still be alive if you’d given him your undivided attention! Select the nurses best response.
a. I understand you’re feeling upset. Lets go to our conference room, and Ill stay with you until your family
comes.
b. Your husbands heart was severely damaged and could no longer pump. There’s nothing anyone could have
done.
c. I will call the nursing supervisor to discuss this matter with you.
d. It will be all right if you cry. Crying is a normal grief response.
ANS: A
When a bereaved family member behaves in a disturbed manner, the nurse should show patience and tact while offering sympathy and warmth. Moving the individual to a private area so as not to disturb others is important. The incorrect options are defensive, evasive, or placating.
An adult who was widowed 18 months ago says, I can now remember good times we shared without getting upset. Sometimes I even think about the disappointments. I’ve become accustomed to sleeping in our bed alone. The work of mourning:
a. is beginning.
b. is progressing abnormally.
c. is at or near completion.
d. has not begun.
ANS: C
The work of mourning has been successfully completed when the bereaved can remember both the positive and negative memories about the deceased and when the task of restructuring the relationship with the deceased is completed.
The mourning process is more difficult when the bereaved:
a. was relatively independent of the deceased.
b. has experienced a number of previous losses.
c. accepts that death is expected for older adults.
d. had few unresolved conflicts with the deceased.
ANS: B
Factors that have negative effects on the mourning process include a high dependency on the deceased,
ambivalence toward the deceased, a poor or absent support system, a high number of past losses or other recent losses, poor physical or mental health, and young age of the deceased. Data do not support the incorrect options.
A patient newly diagnosed with pancreatic cancer says, My father also died of pancreatic cancer. I took care of him during his illness. I cant go through that. Select the highest priority nursing diagnosis.
a. Anticipatory grieving
b. Ineffective coping
c. Ineffective denial
d. Risk for suicide
ANS: D
The patients statement has a subtle message of suicide. Suicide is a risk for people with major losses, including terminal disease. The nurse will need to monitor the suicide risk vigilantly. The other diagnoses may apply but are lower priority.
A nurse talks with a person whose spouse died suddenly while jogging. Which is the appropriate statement
for the nurse?
a. At least your spouse did not suffer.
b. Its better to go quickly as your spouse did.
c. The loss of your spouse must be very painful for you.
d. Youll begin to feel better after you get over the shock.
ANS: C
The most helpful responses by others validate the bereaved persons experience of loss. Avoid banalities; they increase the individuals sense of isolation.
A recently widowed patient tells the health care provider, I have so much epigastric discomfort. I wonder if I have an ulcer. Diagnostic tests are negative. The symptom demonstrates:
a. early reorganization behavior.
b. disorganization and depression.
c. preoccupation with the deceased.
d. normal phenomenon of mourning.
ANS: D
Sensations of somatic distress are often experienced during the acute stage of grieving. They include tightness in the throat, shortness of breath, exhaustion, and pain or sensations such as those experienced by the dead person.
Which finding indicates the successful completion of an individuals grieving process?
a. For two years, a person has kept the deceased spouses belongings in their usual places.
b. After 15 months, a widowed person realistically remembers both the pleasures and disappointments of the
relationship with the spouse.
c. Three years after the death, a person talks about the spouse as if the spouse was still alive and weeps when
others mention the spouses name.
d. Eighteen months after the spouses death, a person says, I never cry or have feelings of loss even though we
were always very close.
ANS: B
The work of grieving is over when the bereaved can remember the individual realistically and acknowledge both the pleasure and disappointments associated with the loved one. The individual is then free to enter into new relationships and activities. The other options suggest unresolved grief.
A child drowned while swimming in a local lake four years ago. Which behavior indicates that the parents
are effectively coping with their loss? The parents:
a. prohibit their other children from going swimming.
b. keep a place set for the dead child at the family dinner table.
c. keep their childs room exactly as the child left it four years ago.
d. throw flowers on the lake at each anniversary date of the accident.
ANS: D
The loss of a child is among the highest risk situations for dysfunctional grieving. The parents who throw flowers across the lake on each anniversary date of the accident are effectively using a ritual to express their feelings openly. The other behaviors indicate the parents are isolating themselves or denying their feelings or both.
A patient diagnosed with metastatic brain cancer says, Im dying, but Im still living. I want to be in control
as long as I can. Which reply shows the nurse was actively listening?
a. Our staff will do their best to help you feel comfortable.
b. Most people do not know how to help and are afraid of death.
c. Your mind and spirit are healthy, although your body is frail.
d. You want people to stop focusing on your weaknesses.
ANS: C
The patient is asking for acknowledgment that he or she is not totally sick; even in the terminal state, strengths and capabilities are present. The correct response provides that acknowledgment through use of reflection. The
other responses are nontherapeutic.
