Deck 3 Module 27 Flashcards
The nurse is preparing to assess a client whose spouse died several weeks ago. Which of the following symptoms is the nurse most likely to observe in the client as part of the classic grief response? Select all that apply. A) Weight loss B) Frequent headaches C) Difficulty sleeping D) Excessive energy E) Increased appetite
A) Weight loss
B) Frequent headaches
C) Difficulty sleeping
Rationale:
Classic signs of grief include sleep disturbances, decreased appetite, weight loss, and somatic complaints such as abdominal pain or frequent headaches. In addition, clients who are experiencing grief often report intermittent periods of decreased motivation, energy, or activity.
The nurse is caring for a client who has just died due to an intentional drug overdose. The client’s partner is still in the room but is dry-eyed and exhibiting somber behavior. The nurse should recognize that the partner’s behavior is most likely related to which of the following factors?
A) The partner is waiting to grieve until the client’s family can join him.
B) The partner is seeking support from staff members on the unit.
C) The partner anticipates that others will find the client’s actions socially unacceptable.
D) The partner is concerned that others may view him as weak if he shows too much emotion.
C) The partner anticipates that others will find the client’s actions socially unacceptable.
Rationale:
The nurse should recognize that the partner may be experiencing disenfranchised grief, which occurs when individuals cannot acknowledge their loss to others. Disenfranchised grief is more common in situations in which the loss is considered socially inappropriate or unacceptable, such as the loss of someone from suicide or a drug overdose.
The nurse is planning care for a group of clients who are experiencing grief. Which principle from accepted grief models should the nurse use to guide care?
A) No clear timetables for grief exist, nor are there clear-cut stages of grief.
B) There is strong research evidence indicating that these models are not useful for many dying clients.
C) These models serve as clear and definitive predictors of grief behaviors.
D) The Kübler-Ross model is primarily used to describe anticipatory grief.
A) No clear timetables for grief exist, nor are there clear-cut stages of grief.
Rationale:
Although models of grief are useful in guiding the nursing care of clients who are experiencing loss, there are no clear-cut stages of grief, nor are there exact timetables. The Kübler-Ross model describes all stages of grief and grieving, not just anticipatory grief. None of these models clearly or definitively predict grief behaviors. No research exists that proves these models are not useful.
During a home care visit, an older adult client states to the nurse, “My wife died 3 years ago.” Which action is a possible indicator that the client is experiencing complicated grief?
A) The client tells the nurse that his wife was an awful cook and that he has eaten better meals since she died.
B) The client says he hasn’t seen the doctor since his wife died because the doctor’s office reminds him of his wife.
C) The client has an album of photographs of his wife open on the living room table.
D) The client indicates that he sends his laundry out to be done because he doesn’t know how the washer works.
B) The client says he hasn’t seen the doctor since his wife died because the doctor’s office reminds him of his wife.
Rationale:
Refusing to go to the doctor’s office for over 3 years is considered outside the normal limits of the grieving process for older adults. Talking about the deceased wife’s good and bad points and showing photographs of her are normal responses to grief. Sending out the laundry is a healthy response to a problem that this client identified.
The nurse is caring for a client who is diagnosed with complicated grieving after the loss of a child. Which treatment approaches does the nurse anticipate being included in the collaborative plan of care for this client? Select all that apply. A) Antidepressants B) Electroconvulsive therapy C) Talk therapies D) Cognitive therapy E) Anger management
A) Antidepressants
C) Talk therapies
D) Cognitive therapy
Rationale:
The treatment for complicated grieving is similar to the treatment for depression. Cognitive therapy, talk therapies, and antidepressants are all common treatment options. The description does not indicate that the client has a problem with anger management. Electroconvulsive therapy is typically reserved as a “last resort” treatment for severe depression or bipolar disorder, so it would not be included in an early plan of care.
A client tells the nurse that her boyfriend died 3 weeks ago. The client states that she has been unable to grieve openly because her boyfriend was married and no one knew of their relationship. The nurse recognizes that the client is experiencing which type of grief? A) External grief B) Chronic grief C) Abbreviated grieving D) Disenfranchised grieving
D) Disenfranchised grieving
Rationale:
) Sleep disturbances are common with all types of grief. This client is likely experiencing the form of grief known as disenfranchised grieving, which occurs when individuals cannot acknowledge their loss to others. Disenfranchised grieving is common in situations where the loss is not socially recognized, as is the case with this client, because extramarital affairs are not socially sanctioned. Abbreviated grieving is grieving that is brief but genuinely felt. This client’s grief is not yet chronic, as only 3 weeks have passed. External grieving is not a recognized type of grief response.
The nurse is concerned that a client whose spouse died 2 years ago is experiencing complicated grief. Which interventions should the nurse consider when planning care for this client? Select all that apply. A) Monitoring for suicidal behavior B) Psychotherapy C) Substance abuse assessment D) Alcohol abuse assessment E) Hypnosis
A) Monitoring for suicidal behavior
B) Psychotherapy
C) Substance abuse assessment
D) Alcohol abuse assessment
Rationale:
Nursing care for the client with complicated grief includes psychotherapy, monitoring for suicidal behaviors, and assessment for signs of alcohol and/or substance abuse. There is no evidence that the client would benefit from hypnosis.
A client is hospitalized for suicidal ideations as a response to complicated grief. Which collaborative interventions can the nurse anticipate including in this client's care? Select all that apply. A) Social service consult B) Bereavement group C) Antidepressant medication D) Sleep medication E) Psychotherapy
A) Social service consult
B) Bereavement group
C) Antidepressant medication
E) Psychotherapy
Rationale:
A) Treatment for complicated grief often involves a form of psychotherapy, which may be used in combination with antidepressants. Collaboration may also include requesting a referral to a social worker who can provide expert guidance about coping with loss or assist with linking clients with additional resources. Bereavement groups can be a resource for clients who have experienced a loss. Although impaired sleep patterns may be associated with grieving, medications to promote sleep usually are not indicated for these clients.
The nurse is caring for a client on the unit who has just died. The client’s adolescent daughter is very quiet, and the nurse attempts to talk with her. The adolescent remains silent, not wishing to talk about the loss. Which action by the nurse is appropriate to assist the adolescent?
A) Ask the doctor to prescribe a sedative for the adolescent.
B) Ask the adolescent if any friends are available to talk.
C) Provide the adolescent with paper, pens, and pencils.
D) Notifying the hospital chaplain to come talk with the adolescent.
B) Ask the adolescent if any friends are available to talk.
Rationale:
Adolescent grief responses are very similar to those of most adults, and they may display a wide range of emotions, including depression, denial, and anger. Adolescents should be encouraged, but not forced, to voice their feelings about the loss. Sometimes individuals in this age group feel more comfortable talking to peers or those outside the family. Asking the doctor to prescribe a sedative will only delay the grieving process. Calling the chaplain is an option, but it would be better if the adolescent were given a choice. Providing paper, pens, and pencils is more appropriate for younger children dealing with grief and loss.
The community nurse is developing a seminar to help children who have experienced a loss. Which information should the nurse include to help these children adapt?
A) Explain that magical thinking helps with the pain.
B) Remind the child that big children don’t cry.
C) Help create new memories.
D) Pretend that the individual has not really gone.
C) Help create new memories.
Rationale:
Adults can help children adapt to a loss by listening, helping the child adjust to changes in routines, and encouraging activities that promote new memories. Adults should reinforce that the beloved individual is not returning, not encourage magical thinking or pretend that the individual is not really gone. Adults should encourage children to express their emotions, not tell them not to cry.
The nurse is caring for a 3-year-old client on the pediatric unit who was in an automobile accident. The client’s mother was killed in the accident, and the client recently learned of her mother’s death. Which nursing intervention would be most appropriate to support the developmental needs of this client?
A) Work with the surviving family members to ensure that the client’s routine remains as normal as possible after release from the hospital.
B) Do not correct the client when she expresses the belief that her mother will “wake up and come home.”
C) Provide the client with the same level of reassurance and attention as any other client on the unit.
D) Avoid answering the client when she asks questions about her mother’s death.
A) Work with the surviving family members to ensure that the client’s routine remains as normal as possible after release from the hospital.
Rationale:
For grieving clients between the ages of 2 and 4, caregivers should to try to maintain as a normal a routine as possible. Children in this age range will also benefit from extra reassurance and attention. It is easy to believe that children of this age do not understand the concept of loss and death, but they most certainly do notice and understand when change occurs. Therefore, it is important to provide honest answers to questions about grief when they are asked.
The nurse is providing counseling to the family of a terminally ill client. The family has children of varying ages. Which statement regarding the reactions of children to death is appropriate for the nurse to include in the counseling session?
A) “Older school-age children begin to understand that death is irreversible.”
B) “Adolescents tend to cope better with death than adults.”
C) “Preschool children view death as a spiritual release.”
D) “Toddlers are able to fully comprehend the ideas related to death.”
A) “Older school-age children begin to understand that death is irreversible.”
Rationale:
At about age 8, a child’s concept of death matures, and most understand that death is irreversible and that the individual is gone and will not be coming back. Toddlers are not able to fully comprehend ideas related to death, and preschoolers view death as reversible. Adults generally cope better with death than adolescents.
The home health nurse is visiting an older client with a terminal illness for a routine medication check. The nurse determines that the client has declined since the last home visit. The nurse suggests that the client should be transported to the hospital; however, the family members state that they want the client to stay in the home. Which action by the nurse is most appropriate?
A) Follow the decision of the family.
B) Call for an ambulance to transport the client to a hospital.
C) Ask the client’s preference regarding transport to the hospital.
D) Encourage the family to take the client to the hospital.
C) Ask the client’s preference regarding transport to the hospital.
Rationale:
For cultures that see death as inevitable, clients often prefer to die in their homes with their families. The nurse should ascertain that this is what the client wishes and respect that. Calling for an ambulance is inappropriate, as is encouraging the family to take the client to a hospital against their wishes. The nurse would not follow the family’s wishes without finding out what the client wants.
The nurse is interviewing an older adult client whose spouse died 4 years ago. The client states, “I keep our home exactly the way it was the day my husband died. I still buy and prepare all his favorite foods, and I launder his dress shirts each week.” The client begins to cry, explaining that caring for her husband was her sole purpose in life, so she sees no need to go on living if she can’t carry out these activities. The client’s comments are suggestive of which of the following conditions?
A) Anticipatory grieving
B) Self-care deficit in the area of feeding
C) Complicated grieving
D) Death anxiety
C) Complicated grieving
Rationale:
Complicated grieving is grieving that continues more than 6 months after a loss and involves extreme distress, significant functional impairment, and, in some cases, suicidal ideation. This client’s comments are suggestive of all these characteristics. Anticipatory grieving occurs prior to a loss, which is not the case in this scenario. Similarly, death anxiety is associated with the anticipation of death–not with the period following death. This situation does not indicate that the client is having self-care problems in the area of feeding.
An older adult client whose spouse died 6 months ago tells the nurse stories about the deceased spouse. When care has been completed, the client thanks the nurse for listening and states, "My children will not listen to these stories." From which type of intervention would this client most likely benefit? A) Antidepressant medication B) Referral to a support group C) Occupational therapy D) Referral to a social worker
B) Referral to a support group
Rationale:
This client would most likely benefit from participation in a support group, which provides an environment in which to share stories, discuss concerns, and receive personal encouragement and support that may otherwise be lacking. Antidepressant medication is often used for depression or complicated grieving, and nothing in the above scenario suggests the client is affected by either of these conditions. Occupational therapy would not be appropriate because the client is not describing problems in participating in activities of daily living. Similarly, referral to a social worker is not necessary at this point, because nothing in the client’s comments suggests the need for targeted social services.
