Grief and Bereavement

Question 1

Marge is a 75-year-old with end stage pancreatic cancer, whose condition has deteriorated
significantly over the past few days. She has become more withdrawn, and states that she does
not want to see anyone in her very large family, except her husband. Her family is very upset by
their lack of access to her in her final days. During your visit, Marge begins to cry, and states,
“They just don’t understand. They just have to say good-bye to me. I have to say good-bye to all
of them.” Of the following, which intervention would be most appropriate in helping Marge and
her family deal with their anticipatory grief?
a. Help Marge to prioritize her visitors.
b. Review old picture albums so Marge can say goodbye.
c. Collaborate with the IDT for patient and family support.
d. Ask family to visit Marge when she is sleeping

Answer 1

. c - Collaborating with the IDT to provide optimal support for the patient and family is the best approach, since there is no simple answer for such complex situations. It is common for patients who are in the dying process to withdraw from others, and this is often very difficult for their loved ones. Providing both patient and family support to allow them to express their feelings, as well as explore alternatives will validate the complex feelings of all parties, and support them in their anticipatory grief

Question 2

Frank is a 70-year-old retired police officer who has a diagnosis of end-stage prostate cancer. He
is a patient in the hospice house that you work in. He has been increasingly withdrawn over the
past several days. When giving him his night medications, he tells you “This is hopeless. I wish I
had my gun under my pillow. Then I could just get this over with.” Of the following, what would
be the most appropriate initial response?
a. Provide a supportive presence.
b. Admit Frank to a psychiatric facility.
c. Increase Frank’s anti-depressant medication.
d. Give Frank a sedative

Answer 2

. a - Providing a supportive, accepting and non-judgmental presence which permits Frank to openly discuss his feelings of hopelessness would be the best initial response. Taking time to sit with a patient, and allow the expression of difficult feelings is one of the most valuable interventions that can be provided. Additionally, patients who express a desire to harm themselves must have a timely and thorough psychosocial evaluation by an IDT member with this expertise, with appropriate interventions and safety precautions initiated

Question 3

. Erica is a 52-year-old with end-stage liver disease, who has a history of alcoholism and drug
abuse. She lives alone, and has no caregiver. She has two daughters, both in their twenties, who
live locally, but from whom she has been estranged for many years. During your visit, she begins
to cry, and relates how guilty she feels for all the years that “I chose drugs and alcohol over my
children”. What would be the most appropriate response?
a. Arrange a family meeting with her daughters.
b. Arrange to have a priest visit for confession.
c. Encourage her to journal about her feelings.
d. Call her daughters and let them know she is ill.

Answer 3

c - Journaling is a good starting point to help Erica begin to deal with her feelings of guilt. Depending upon her situation and the daughters’ feelings, a family meeting may be a possibility in the future. Each situation is certainly different, but often, illness may prove to be a bridge of relational healing which all parties can benefit from. This would allow Erica to spend her final days more peacefully, and provide an opportunity for her daughters to repair their relationship with their mother. Collaboration with other members of the IDT is a key component for optimal patient and family support.

Question 4

Beverly’s husband, Don, was one of your patients. During report this morning, you learn that Don died
during the night. When you call Beverly, she begins to cry and states that she does not know how she
is ever going to manage without him.
330. Of the following, which is the most appropriate response?
a. “You’ll be just fine.”
b. “Your feelings are understandable.”
c. “You should ask your doctor for an anti-depressant.”
d. “Don wouldn’t want you to feel that way.

Answer 4

b - “Your feelings are understandable” is a supportive statement that validates Beverly’s feelings, and does not communicate judgment. Grief is a very individual process, and survivors need to have indivi. dualized support, which includes collaboration with appropriate members of the IDT for optimal outcomes.

Question 5

A week after Don’s death, you stop in to visit with Beverly, to offer support. She states she is
doing better, is grateful to hospice, and would like to sign-up to be a hospice volunteer as soon
as possible. Of the following, which is the most appropriate response?
a. “That’s a great idea. I’ll ask the volunteer coordinator to call you.”
b. “Family members are not permitted to be hospice volunteers.”
c. “Maybe you should discuss it with your hospice bereavement counselor first.”
d. “I don’t think we need any volunteers at this time.”

Answer 5

c - Volunteers are the backbone of hospice, and are valuable members of any hospice organization. However, most hospices recommend that survivors wait for a specified period after the death of a loved one prior to becoming volunteers, since they are especially vulnerable during the early period of grieving. Discussing it with her bereavement counselor will support her desire to help the organization, but will ensure that Beverly’s welfare is the priority. Each hospice organization is different, and may have individual policies regarding this situation. That which is in the best interest of the survivor’s welfare is the ultimate priority

Question 6

Jim and Tina’s infant son, Jonathon, was born with a congenital heart defect, and died 9 hours
after birth. Of the following, which would most likely NOT be helpful for them?
a. General hospice bereavement group
b. Mementoes, such as Jonathon’s handprints and footprints
c. Time to hold Jonathon during and after his death
d. Support group with other parents whose children have die

Answer 6

a - A general hospice bereavement group would most likely not be helpful, since grief associated with the death of a child is such a unique experience. Of course, each individual’s bereavement experience is unique, but those with similar issues often find it more helpful to attend groups in which the members identify with each other’s situations.

Question 7

x

Answer 7

x

Question 8

After a patient’s death, which member of the IDT typically coordinates bereavement support
transitioning for the patient’s family?
a. The patient’s nurse
b. The hospice volunteer
c. The hospice counselor
d. The hospice director

Answer 8

. c - The hospice counselor is typically the member of the IDT who coordinates bereavement support transitioning for the patient’s family. Other members of the IDT may also participate in this support as appropriate

Question 9

Which of the following would NOT be an appropriate closure activity for the hospice nurse to
participate in for a surviving family member?
a. Attending a movie together
b. Sending a card
c. Making a closure visit
d. Attending the memorial service

Answer 9

. a - Attending a movie with a surviving family member would not be an appropriate closure activity, as this blurs professional boundaries. All other options are common methods for closure. Typically, a closure visit, as a minimum, from the patient’s nurse is important to the family, since the nurse has usually been increasingly involved in the patient’s care over the period of declining patient status until death. Closure activities not only benefit families, but are also critical for hospice staff to perform as a means of self-care, since they deal with such a high volume of death and loss.

Question 10

What is not a factor that influences family functioning in grief?
a. Family System boundaries (rigid/open)
b. multigenerational legacy of losses
c. medical professionals in the family.
d. patterns of interaction (enmeshed/estranged)
e. sudden vs. linger death

Answer 10

C.
Other factors:
• Role “replacement”
• Blame, shame, guilt re. loss
• Sociopolitical, historical context of
death
• Communication
• Level of family, social economic
resources

Question 11

Kuber Ross work falls into what pre-modern grief theory?
A. Grief Work Theory
B. Stages Theory
C. Task Theory
D. Phase Theory

Answer 11

B. Stages Theory

Question 12

Dual Process Model of Grief, bereaved focus oscillates between:
A. Yearning/searching and re-organization
B. Continuing to have what we have lost
C. Loss Oriented and Restoration Oriented

Answer 12

C Loss Oriented and Restoration Oriented
( A. phase theory)
(B. Task theory)

Question 13

Common criticism of Stage Theories
A. confused with acting theories
B. not evidence based
C. Rigid, judgmental, labelling &
pathologizing

Answer 13

c.

Question 14

Which of these are Loss oriented focus of bereaved according to dual process model?
A. Intrusion of grief
B. Letting-go—continuing –
relocating bonds;
C. Denial/avoidance of
grief
D. Denial/Avoidance of restoration changes
E. All but D

Answer 14

E.

Question 15

Which of these are restoration focused for bereaved according to dual process theory?
A. tending to life changes
B. Doing new things
C.Grief work
D. Distraction from grief
E. New roles/identities
/relationships
F. All but C.

Answer 15

F

Question 16

Which post modern grief theory is focused on Maintaining a connection with the person who has died

Answer 16

Continuing Bonds (Klass, Silverman, & Nickman, 1996)

Question 17

Which post modern grief theory provides a framework for understanding complicated grief

Answer 17

Dual Process model

Question 18

5 categories of grief (bereaved)
(CADAT)

Answer 18

Complicated (or prolonged)
Ambiguous
Disenfranchised
Anticipatory
Traumatic

Question 19

Grief category for dying person

Answer 19

Preparatory grief

Question 20

Medicare Hospice Conditions for Participation Bereavement defines Bereavement Counseling as:
“Emotional, psychosocial, and spiritual support and services provided before and after the death of the patient to assist with issues related to grief, loss, and adjustment”
Who usually provides bereavement counseling before the death on hospice ID teams?

Answer 20

usually the role of the social worker and chaplain. Medicare standards do not state bereavement counselors must be the providers.

Question 21

According to Medicare Conditions of Participation what is the best way to ensure loss and grief needs are continually monitored and addressed?

Answer 21

strong lines of communication and collaboration between IDT and bereavement staff

Question 22

The state of mental and physical pain that is experienced when the loss of a significant object,
person or part of the self is realized. The highly personal and subjective, emotional response to
the event of a loss is which of the following?
a. Bereavement
b. Mourning
c. Grief
d. Loss

Answer 22

c - Grief is the correct answer. Mourning is the process of incorporating the experience of the loss into ongoing lives. the outward acknowledgement and expression of the loss. The social customs and cultural practices that follow a loss. Bereavement is the state of having experienced the death of a significant person/object. Loss is the generic term that signifies the absence of an object, person, position, ability or attribute. It signifies the absence of a possession or future possession. The meaning of the loss is determined primarily by the individual sustaining it

Question 23

The acknowledgment on the part of both patients and family members of the loss of future
togetherness that includes physical, psychological and social aspects:
a. Letting go.
b. Disenfranchised grief.
c. Bereavement
d. Mourning

Answer 23

. a - Letting go is the acknowledgement of the loss of future togetherness. Disenfranchised grief is the grief experienced in relation to a loss that is not cannot be openly acknowledged, publicly mourned, or socially supported. Bereavement is the state of having experience the death of a significant person/object. Mourning is the process of incorporating the experience of the loss into ongoing lives. the outward acknowledgement and expression of the loss. The social customs and cultural practices that follow a loss.

Question 24

Normal responses to grief/loss of health within patients and family systems include all of the
following except:
a. Variable states of emotions.
b. Open expression of anger.
c. Extreme weight loss and lethargy.
d. Socially responsive

Answer 24

. c - Normal responses to grief/loss of health include variable emotional states, open expression of anger, preoccupation with the loss, self-limiting time frame, lack of energy and slight weight loss, episodic insomnia, crying evident and provides some relief, socially responsive to others, vivid dreams, adapts without professional intervention. Extreme weight loss and lethargy are signs of a more severe depression related to the grief/loss experience

Question 25

. Examples of dysfunctional coping responses/styles include which of the following? a. Humor b. Guilt c. Aggression d. Spiritual rituals e. All of the above. f. Both b and c only

Answer 25

. f - Guilt and aggression are both examples of dysfunctional coping responses/styles along with fantasy, minimization, addictive behaviors and psychosis. Functional coping responses/styles include humor, normal grief work, problem-solving and spiritual rituals.

Question 26

In providing bereavement support and follow up to the wife of a patient you cared for at length, she tells you that she is distraught over the fact that her pre-school aged grandchildren act as if their grandfather never existed. She states that “they come over and play and act as if nothing has changed”. The proper response to help her better understand the actions of her young grandchildren would be: a. “Children often forget about the person who died quickly”. b. “Given their age, they likely do not understand that death is permanent”. c. “You should sit them down and talk about death and what it means”. d. “Tell their parents to explain that their grandfather is never coming back”.

Answer 26

b - Pre-school aged children typically view death as temporary or reversible as in cartoons. They are often told that the person “went to heaven”, so they assume that the person will “be back”. Given the situation, it is most likely that these young children do not understand that their grandfather’s death is permanent and therefore is the best response for the nurse to help the wife understand their actions. The options of C and D would likely cause more harm and option A does not provide a realistic rationale for the actions of the children.

Question 27

Which of the following are the Symptoms that preparatory grief and the normal dying experience are similar? a. anorexia b. weight changes c. constipation d. suicidal ideation

Answer 27

all but D

Question 28

What symptoms do preparatory grief and depression have in common? a. withdrawal from family/friends b. rumination about the past c. periods of sadness, crying d. anxiety e. feelings of worthlessness, guilt f. feelings of hopelessness g. suicidal ideation

Answer 28

a through d only

Question 29

An intervention used to address preparatory grief (of terminally ill patient)?

Answer 29

None--trick question! Preparatory grief is a normal life cycle event, not pathological

Question 30

distinguish the following symptoms and label: G (grief) D (Depression) 1. temporal variation of mood (good/bad days) 2. persistent flat affect 3. disturbed self esteem 4. distressing guilt generalized to all facets of life 5. distressing guilt focused on specific issues 6. feeling of worthlessness and being a burden 7. ability to feel pleasure 8. Social support most effective to resolve 9. Active desire for early death whose symptoms/social needs are reasonably met

Answer 30

1. G 2. D 3. D 4. D 5. G 6 D 7. G 8. G 9. D

Question 31

Normal responses to grief/loss of health within patients and family systems include all of the following except: a. Variable states of emotions. b. Open expression of anger. c. Extreme weight loss and lethargy. d. Socially responsive.

Answer 31

c - Normal responses to grief/loss of health include variable emotional states, open expression of anger, preoccupation with the loss, self-limiting time frame, lack of energy and slight weight loss, episodic insomnia, crying evident and provides some relief, socially responsive to others, vivid dreams, adapts without professional intervention. Extreme weight loss and lethargy are signs of a more severe depression related to the grief/loss experience

Question 32

The acknowledgment on the part of both patients and family members of the loss of future togetherness that includes physical, psychological and social aspects: a. Letting go. b. Disenfranchised grief. c. Bereavement d. Mourning

Answer 32

a - Letting go is the acknowledgement of the loss of future togetherness. Disenfranchised grief is the grief experienced in relation to a loss that is not cannot be openly acknowledged, publicly mourned, or socially supported. Bereavement is the state of having experience the death of a significant person/object. Mourning is the process of incorporating the experience of the loss into ongoing lives. the outward acknowledgement and expression of the loss. The social customs and cultural practices that follow a loss.

Question 33

The state of mental and physical pain that is experienced when the loss of a significant object, person or part of the self is realized. The highly personal and subjective, emotional response to the event of a loss is which of the following? a. Bereavement b. Mourning c. Grief d. Loss

Answer 33

c - Grief is the correct answer. Mourning is the process of incorporating the experience of the loss into ongoing lives. the outward acknowledgement and expression of the loss. The social customs and cultural practices that follow a loss. Bereavement is the state of having experienced the death of a significant person/object. Loss is the generic term that signifies the absence of an object, person, position, ability or attribute. It signifies the absence of a possession or future possession. The meaning of the loss is determined primarily by the individual sustaining it.

Question 34

Which of the following is the correct term for the form of severe suffering from any cause (physical, emotional or spiritual) that is so severe that even intensively aggressive interventions are often insufficient to alleviate? a. Terminal restlessness b. Terminal sedation c. Terminal distress d. Terminal anguish

Answer 34

d - Terminal anguish is the correct term for this form of severe suffering described as a tormented state of mind related to longstanding, unresolved spiritual issues, emotional problems, interpersonal conflicts, and/or suppressed unpleasant memories. Terminal restlessness is a specific form of delirium observed in patients in last hours or days of life. Terminal sedation (palliative sedation) is the monitored use of medications to induce sedation as a means to control refractory and unendurable symptoms near the end of life, potentially caused by terminal anguish. Terminal distress is not a recognized term in hospice/palliative care.

Question 35

Janet was transferred home with hospice care one week ago and has remained unresponsive. Her NG feedings were discontinued but she continues to be physically stable with no signs of imminent death. Her husband and daughters are her primary caregivers but the daughters are now questioning their decision to abide by her living will by stating “She is so strong, and is fighting to live. We need to do everything for her”; while their father, the patient’s husband remains adamant that they do what Janet would have wanted. At the nursing visit, you witness a very heated dispute between the family members that ends with the daughter’s threatening to call the police and protective services to report their father “killing” their mother; and the father breaking down in tears stating he “was only trying to do what she would have wanted”. What is the best course of action for the nurse to take to address this dispute? a. Advise everyone to leave the home to “cool off” while you care for the patient. b. Encourage the father to tell his daughters that the decision has been made and cannot be changed. c. Instruct the family that their behavior is unacceptable and could result in the patient being discharged from hospice. d. Notify the interdisciplinary team (IDT) and arrange for a family meeting to discuss the patient’s plan of care and wishes in a more effective manner.

Answer 35

d - The best action would be for the nurse to involve the IDT and arrange a family meeting to allow for a discussion in an open, respectful method of communication and to remind everyone of the patient’s wishes which are to be honored and upheld

Question 36

Janet is a 68-year-old previously healthy woman who suffered a traumatic subdural hematoma two weeks ago with significant brain damage that has remained unchanged since the incident. She has since remained unresponsive except for opening her eyes occasionally at random. She does not follow commands. She has been receiving nasogastric tube feedings despite having a living will that notes she does not wish to be fed artificially if her condition is irreversible. She requires total care for all activities of daily living. The patient is physically stable however, and needs to be transferred within the next 10-14 days as her insurance will no longer pay for her hospital stay. You are asked by the care manager as the palliative care/hospice nurse to meet with the family and review the plan of care and options for discharge. 345. When meeting with the family what should be the nurse’s first priority to address? a. Identify which nursing home they want patient to be transferred to and make necessary arrangements. b. Discuss the patient’s wishes outlined in the living will and adapt the plan of care accordingly. c. Inform the family that all support will be removed and patient sent home with hospice as her care in the hospital is no longer paid for. d. Review with the family that you do not believe the patient’s care should be changed as there is still hope for her to recover.

Answer 36

b - The priority for the nurse in this case is to discuss the patient’s wishes listed in the living will. This is necessary despite the underlying implications of needing to modify the care plan for institutional/financial reasons. Hospice and palliative care approaches the patient/family from the perspective that this is their experience. Goals are patient/family goals rather than nurse/physician directed goals. The family may or may not wish a transfer to a nursing home or home with or without hospice, and certainly giving hope for a recovery would be inadvisable given the clinical data. 346. Janet was transferred home with hospice care

Question 37

Jim and Tina’s infant son, Jonathon, was born with a congenital heart defect, and died 9 hours after birth. Of the following, which would most likely NOT be helpful for them? a. General hospice bereavement group b. Mementoes, such as Jonathon’s handprints and footprints c. Time to hold Jonathon during and after his death d. Support group with other parents whose children have died

Answer 37

a - A general hospice bereavement group would most likely not be helpful, since grief associated with the death of a child is such a unique experience. Of course, each individual’s bereavement experience is unique, but those with similar issues often find it more helpful to attend groups in which the members identify with each other’s situations.

Question 38

A week after Don’s death, you stop in to visit with Beverly, to offer support. She states she is doing better, is grateful to hospice, and would like to sign up to be a hospice volunteer as soon as possible. Of the following, which is the most appropriate response? a. “That’s a great idea. I’ll ask the volunteer coordinator to call you.” b. “Family members are not permitted to be hospice volunteers.” c. “Maybe you should discuss it with your hospice bereavement counselor first.” d. “I don’t think we need any volunteers at this time.”

Answer 38

c - Volunteers are the backbone of hospice, and are valuable members of any hospice organization. However, most hospices recommend that survivors wait for a specified period after the death of a loved one prior to becoming volunteers, since they are especially vulnerable during the early period of grieving. Discussing it with her bereavement counselor will support her desire to help the organization, but will ensure that Beverly’s welfare is the priority. Each hospice organization is different, and may have individual policies regarding this situation. That which is in the best interest of the survivor’s welfare is the ultimate priority.

Question 39

Beverly’s husband, Don, was one of your patients. During report this morning, you learn that Don died during the night. When you call Beverly, she begins to cry and states that she does not know how she is ever going to manage without him. 330. Of the following, which is the most appropriate response? a. “You’ll be just fine.” b. “Your feelings are understandable.” c. “You should ask your doctor for an anti-depressant.” d. “Don wouldn’t want you to feel that way.”

Answer 39

b - “Your feelings are understandable” is a supportive statement that validates Beverly’s feelings, and does not communicate judgment. Grief is a very individual process, and survivors need to have individualized support, which includes collaboration with appropriate members of the IDT for optimal outcomes.

Question 40

Ted is a 72-year-old veteran who proudly displays his many service awards and medals around his den. When you visit, he talks at length about his time in the military, but usually you do not have the time you would like to stay and listen to his stories. Of the following, what would be a helpful intervention to support Ted’s life review? a. Ask him to write down his stories for you. b. Tell him he’ll have to limit his stories to the time you have available. c. Request a hospice volunteer who is a veteran to visit him. d. Try to work on other paperwork during the visit so you can stay longer.

Answer 40

c - Requesting a hospice volunteer who is a veteran to visit with him is a wonderful option to support Ted’s life review. Veterans uniquely identify with each other, and the relationship would be life-enhancing for both.

Question 41

Joan acknowledges her difficult feelings toward her daughter Becky and agrees to talk with her, to try to improve their relationship before she dies. She requests that you attend their meeting to support them both. Of the following, what is an effective tool of communication when discussing difficult topics? a. Using “I” statements b. Using extremes like “never, or always” c. Assigning blame d. Keeping score

Answer 41

a - Using “I” statements is a very effective tool of communication when discussing difficult topics. This allows the person to express their own feelings, rather than projecting feelings onto others or assigning blame. Collaboration with the hospice counselor will be crucial, and having her present at the meeting would be optimal.

Question 42

When you are alone with Becky during one of your visits to her mother, she begins to cry and states that “I made so many mistakes and she’s never forgiven me for them. I know she hates me. That’s why she favors Kay so much.” Of the following, what would be the most helpful response for Becky? a. “We all make mistakes.” b. “I’m sure your mother doesn’t feel that way.” c. “Maybe you should talk to your mother about your feelings.” d. “You should journal about it.”

Answer 42

c - Suggesting that she talk to her mother about her feelings may help her to consider discussing them with her. Often, words and actions can be misinterpreted, and clarification can be a healing balm to relationships that have been unresolved for extended periods of time. Collaboration with the hospice social worker and chaplain is crucial to ensure that optimal support is being provided.

Question 43

Up to date research shows counseling bereaved family members to A. Let it go B. Support continuing bonds with the deceased C. Let time heal leads to better outcomes for many bereaved family members.

Answer 43

b. Support continuing bonds

Question 44

Anticipatory grief encompasses grief in anticipation of the future loss of a loved one and A. relief the loved one will not suffer much longer B. previously experienced and current losses as a result of the terminal illness.

Answer 44

B

Question 45

Benefit of support groups A. provide a way for people to develop a better understanding of their situation. B. counter isolation or shame over the illness C. explore their thoughts and feelings D. Learn new ways of approaching problems E. All the above

Answer 45

E

Question 46

Death of a loved one can serve as an implement to childhood development. T/F The reactions of those who play influential roles in the world of the child affect how the child copes and continues to grow . T/F

Answer 46

T T

Question 47

Clinical skill set of Palliative Care and Hospice social work includes: Assisting families to help children with illness, death, and dying T/F

Answer 47

T

Question 48

Common fears for children who lose a sibling a. Parents grief so great they may no longer be able to care for them. b. Parents could never love them as much as the loved their sibling c. Parents will be disappointed in them.

Answer 48

A, B

Question 49

Why is sibling loss dubbed a "double loss"?

Answer 49

Loss of sibling and those experiences throughout life that change without the presence of this siblings plus loss of parental support in parents emotional unavailability while they grieve (child may surppress their own grief to not further upset parents)

Question 50

Timeline for child's grief (all that apply) A. Expected to lessen over time B. follow a progressive path C. follows child's developmental continuum D. losses are revisited throughout life into adulthood

Answer 50

C, D

Question 51

When a child loses a parent, the nature of the child's relationship with the surviving parent is the single most important factor influencing the child's response to death. T/F

Answer 51

T (Haine, Ayers..etc) 2008

Question 52

Interventions for bereaved children or those anticipating death of significant person include: A. individual counseling B. children's bereavement group C. Family treatment D. Family or children's bereavement camp/retreat E. parent's support group F. parent guidance

Answer 52

all the above

Question 53

Primary concerns for children who are aware of their own impending deaths?

Answer 53

how their parents will function afterwards

Question 54

Important role for social workers to provide education regarding the nature of normative grief and its variability? Effective social work is to explore what people have heard and believe in order to clear up any false information?

Answer 54

true true

Question 55

grief myths that can intensify survivor anxiety A. "time heals" B. "grief will automatically get better" C. "it takes one year after the death to resolve grief" D. "don't make any major decisions first year after death" E,. "all losses are the same in impact" F. "best to forget and let go" G. "grief occurs in predictable stages" H. "people need psychotherapy and medications to get through normal grief".

Answer 55

all the above

Question 56

Depression or Grief reactions? A. individual is focused on how loss has impacted them B. Individual is focused on the self and feelings of worthlessness. C. emotions are fixed D. emotions are charged and all over the board (fluctuate) E. Pleasure is fleeting at first but comes in glimpses F. Unable to feel pleasure G. Physical symptoms come and go H. prolonged and marked functional impairment and psychomotor retardation

Answer 56

A. Grief B. Depression C. Depression D. Grief E. Grief F. Depression G. Grief H. Depression

Question 57

A mourner who finds ways of staying connected to the person who has died--constructing an ongoing internal relationship with their loved one while accommodating world without the person is example of what loss theory?

Answer 57

Continuing bonds theory (Klass, Silverman, Nickman 1996) examples: writting letters, talking to, praying to, naming someone after loved one

Question 58

Mourner includes loss oriented activities and restoration oriented activities--grieving is understood to be an oscillation between the two is an example of what loss theory?

Answer 58

Dual Process (Stroebe, Schut, Stroebe 2005) loss oriented: crying, looking at pictures, talking about the deceased, yearning, pining, letting go, denial avoidance of need for restoration changes, Restoration oriented: Doing new things, taking on new roles, creating new rituals.denial avoidance of grief, distraction from grief, attending to life changes

Question 59

variable influencing the grief process A, mourners relationship to the deceased B. mourner's attachment and loss history C. mourner's prior history of depression/anxiety D. mourner's concurrent stressors E. mourner's support system F. mourner's spirituality G, mourner's gender H. mourner's culture Which variable is often linked to the construction of meaning?

Answer 59

all Spirtuality

Question 60

Since the efficacy of bereavement interventions is not clear, the most important assumption social workers can dispell when working with uncomplicated mourners is

Answer 60

the assumption "there is a right way to grieve"

Question 61

Label intuitive or instrumental grief a. more feeling than thinking b. waves of emotion c. more thinking than feeling d. exploring, expressing feelings, processing emotions e. doing and actively responding to grief

Answer 61

a. intuitive b. intuitive c. instrumental d. intuitive e. instrumental

Question 62

label symptoms of acute grief: physical/affective/cognitive/spiritual a. obsessive thinking, inability to concentrate b. searching for meaning c. jealousy, anxiety d. disorientation/confusion e. nausea, loss of appetite f. rehearsing/reviewing circumstances g. hypersexuality, sensitivity to noise h. fantasizing, obsessive thinking i. guilt, emancipation

Answer 62

a. cognitive b. spiritual c.affective d. cognitive e. physical f. cognitive g. physical h. cognitive i. affective

Question 63

label symptoms of family grief: communication/structural/extra familial relationships a. withdrawal from friends b. overprotection of members c. confusion in family hierarchy;roles d. reconnection or cut off from certain members e. dyads become triads f. isolation g. noticeable increase/decrease or changes in communication

Answer 63

a. Extra familial b. Extra familial c. structural d. communication e. structural f. Extra familial f. communication

Question 64

which kind of loss can traumatize due to the continual re experiencing of the loss? A. Disenfranchised B. child losing parent C. ambiguous

Answer 64

C. Ambiguous

Question 65

which grief is present with following behaviors. Ambiguous/complicated/disenfrancised? recent phobia about illness or death rumination about troubling aspects of death self destructive impulses excessive avoidance or reminders of the deceased radical changes in life compulsion to imitate the deceased unwilling to move deceased possessions or throws out immediately?

Answer 65

Complicated or persistant complex

Question 66

Types of complicated/persistant complex grief reactions a. chronic grief reaction b. delayed grief reaction e. exaggerated grief reaction f. disassociation reaction g. masked grief reactions

Answer 66

All but F.

Question 67

difference between traumatic and complicated grief

Answer 67

Traumatic grief have elements of sudden, horrific, shocking encounters in addition to loss and is restricted to events that would independently be classifieds as trauma.

Question 68

Meaning making has been reported to increase coping and decrease distress among the bereaved T/F?

Answer 68

T

Question 69

components of meaning making a. sense making (consistent with mourner's perspective onlife) b. benefit finding (contributed to growth, perspective, relationships) c. narrative reconstruction (self narrative includes the death) d. Continued bonds (deceased can be absent and present in one's life during bereavement) e. Rumination (can't stop thinking about the death)

Answer 69

ALL BUT E

Question 70

pick 2 meaning making theorist: A. Calhoun and Tedeschi B. Park and Folkman C. Neimeyer

Answer 70

A and C

Question 71

Adolescent and emerging adult experience of grief T/F A. people generally respond to teens in helpful ways B. disenfranchisement is common C. Teens appear to grieve like adults D. Teens are usually open with their needs E. They avoid discussion

Answer 71

A. F B. T C. T (they aren't adults cognitively or emotionally) D. F feel compelled to hide reactions E. T Silence is interpreted to mean they don't need help

Question 72

effect of stress and trauma on school aged children T/F A. Effects cortisol response B. abrupt return to school after loss good for childen C. Easy for children to verbalize their loss

Answer 72

A. T B. F forces children to remain in restoration orientation in order to function at school C. F difficulty finding words to express grief can lead to acting out.

Question 73

help child understand that grief means: a. Change in some things b. Missing someone C. Deep feelings D. Growing up or staying little

Answer 73

all

Question 74

Anticipatory or preparatory grief? 1. grief an individual experiences before the death of someone close to them. 2. grief that people who are dying go through

Answer 74

1. anticipatory 2. preparatory

Question 75

6 dimensions of anticipatory mourning: 1. recognize the loss 2. react to the separation 3. recollect and re experience the lost relationship 4. relinquish the old attachments and the old assumptive world. 5. readjust and adapt to new without forgetting old 6. reinvest

Answer 75

all the above

Question 76

Which are grief assessment tools 1. Brief Grief questionnaire 2. Loss screening 3. Core bereavement items

Answer 76

1.(Shear and Essock) 3. (Burnett, et al)

Question 77

choose 5 basic principles of grief therapy 1. understand the experience of grief and loss 2. share your losses with bereaved 3. help design pathways to adaptation 4. recognize obstacles to adaptation to the loss 5. have access to supplies of information/activities, resources 6. contribute only when there is a specific reason to do so

Answer 77

all but # 2

Question 78

liminal aspect of therapeutic rituals

Answer 78

elements that are visible yet retain symbolic meaning (fire, water, earth, wind) candles, flowers, music

Question 79

grief monitoring diary journaling mapping grief mindfulness

Question 80

Grief monitoring diary mapping grief mindfulness

Question 81

interventions that support meaning making and growth as potential outcomes of the grief process

Answer 81

grief monitoring diary mapping grief mindfulness journaling memory boxes renewing the bond guided imagery ritualizing transition digital storytelling internet forums: Whatsyour grief aftertalk.com

Question 82

interventions for preparatory grief?

Answer 82

allow sharing of fears and feelings non judgmentally encourage dying to tell life stories dying may need to share feelings with loved ones encourage legacy work (video, letters, crafts)

Question 83

The state of mental and physical pain that is experienced when the loss of a significant object, person or part of the self is realized. The highly personal and subjective, emotional response to the event of a loss is which of the following? a. Bereavement b. Mourning c. Grief d. Loss

Answer 83

c - Grief is the correct answer. Mourning is the process of incorporating the experience of the loss into ongoing lives. the outward acknowledgement and expression of the loss. The social customs and cultural practices that follow a loss. Bereavement is the state of having experienced the death of a significant person/object. Loss is the generic term that signifies the absence of an object, person, position, ability or attribute. It signifies the absence of a possession or future possession. The meaning of the loss is determined primarily by the individual sustaining it.

Question 84

The acknowledgment on the part of both patients and family members of the loss of future togetherness that includes physical, psychological and social aspects: a. Letting go. b. Disenfranchised grief. c. Bereavement d. Mourning

Answer 84

a - Letting go is the acknowledgement of the loss of future togetherness. Disenfranchised grief is the grief experienced in relation to a loss that is not cannot be openly acknowledged, publicly mourned, or socially supported. Bereavement is the state of having experience the death of a significant person/object. Mourning is the process of incorporating the experience of the loss into ongoing lives. the outward acknowledgement and expression of the loss. The social customs and cultural practices that follow a loss.

Question 85

Normal responses to grief/loss of health within patients and family systems include all of the following except: a. Variable states of emotions. b. Open expression of anger. c. Extreme weight loss and lethargy. d. Socially responsive.

Answer 85

c - Normal responses to grief/loss of health include variable emotional states, open expression of anger, preoccupation with the loss, self-limiting time frame, lack of energy and slight weight loss, episodic insomnia, crying evident and provides some relief, socially responsive to others, vivid dreams, adapts without professional intervention. Extreme weight loss and lethargy are signs of a more severe depression related to the grief/loss experience.

Question 86

Examples of dysfunctional coping responses/styles include which of the following? a. Humor b. Guilt c. Aggression d. Spiritual rituals e. All of the above. f. Both b and c only

Answer 86

f - Guilt and aggression are both examples of dysfunctional coping responses/styles along with fantasy, minimization, addictive behaviors and psychosis. Functional coping responses/styles include humor, normal grief work, problem-solving and spiritual rituals.

Question 87

In providing bereavement support and follow up to the wife of a patient you cared for at length, she tells you that she is distraught over the fact that her pre-school aged grandchildren act as if their grandfather never existed. She states that “they come over and play and act as if nothing has changed”. The proper response to help her better understand the actions of her young grandchildren would be: a. “Children often forget about the person who died quickly”. b. “Given their age, they likely do not understand that death is permanent”. c. “You should sit them down and talk about death and what it means”. d. “Tell their parents to explain that their grandfather is never coming back”.

Answer 87

b - Pre-school aged children typically view death as temporary or reversible as in cartoons. They are often told that the person “went to heaven”, so they assume that the person will “be back”. Given the situation, it is most likely that these young children do not understand that their grandfather’s death is permanent and therefore is the best response for the nurse to help the wife understand their actions. The options of C and D would likely cause more harm and option A does not provide a realistic rationale for the actions of the children

Question 88

Common responses of children to serious illness include all of the following except: a. Magical thinking b. Feelings of guilt c. Increased attention and focus d. Anger and acting out behavior

Answer 88

c - Children’s common responses to serious illness include decreased attention and ability to focus, magical thinking, feelings of guilt, anger and acting out behaviors, fears of abandonment and contracting the disease/illness, along with frustrations regarding a change in lifestyle and possible activities.

Question 89

is a 44-year-old man with advanced lung cancer who is currently on your palliative care program but is beginning to decline in status. He has a significant history of aggression, anger and violence towards his family members including his siblings, parents, and spouse. He is divorced, and has 3 children ages 12-16 who he has not seen in several years because of his history. He tells you that he really wants to be able to make amends with his family while he still can and maybe even make a few “good” memories that they will be able to share after he is gone. 390. What should be your next step in helping Jimmy accomplish this goal? a. Inform the IDT of his goal and obtain their guidance/input into how to proceed. b. Obtain the contact information from his previous medical records for his family members and give it to Jimmy. c. Obtain the contact information of each family member from previous medical records and call each person yourself. d. Inform Jimmy that you do not think making contact with his family is a good idea given his history.

Answer 89

a - The next step to help Jimmy accomplish this goal would be to gain input from the interdisciplinary team (IDT) regarding how best to proceed given his violent history. It would not be advisable to obtain/make contact with family members personally, or to share that information with the patient as of now. Telling Jimmy that his goal is not a good idea would likely be crushing to him and the IDT should discuss and outline what the best course of action should be to not only accomplish Jimmy’s goal, but to make for a meaningful, and healthy interaction/communication with his estranged family members. This is vitally important given that there are children involved as well. The social worker and chaplain will be essential to this process. Enhancing quality of life and relationships is the primary goal of hospice and palliative care

Question 90

The communication efforts have been positive, although challenging at times, in regards to Jimmy’s parents and siblings. He now wishes to make the same efforts with his children and ex-wife. During your interdisciplinary team (IDT) meeting, the social worker states that she is strongly opposed to this given the ages of the children and Jimmy’s history of violence. She feels that they “should not be re-exposed to him as it could potentially damage them emotionally and psychologically”. What is your best response to this statement? a. Argue with her that it is not her decision, and that patient advocacy and life closure forgo any other concerns she may have. b. Survey the other IDT members to determine if others share the same viewpoint and if so develop a plan of how to proceed. c. Advise her that she will have to be the one to tell the patient that his goal will not be recognized. d. Tell her that you no longer need her help on the case and will take over to make sure this patient attains his goal of reuniting with his children.

Answer 90

b - The best response is to survey the other team members and then develop a plan of how to proceed based upon responses. It may be that more planning and attention to the needs of these children are necessary than what was needed for the parents/siblings. A child life specialist or other expert in children’s grief/loss may be consulted and involved in this process. The child’s mother certainly needs to be agreeable and involved as well. The creativity and compassion of the IDT is needed to resolve this conflict and do what is in the best interests of the patient as well as the children/family. The other options here are not effective methods of communication, teamwork, or ensuring the patient receives the best physical, emotional, social and spiritual care possible to facilitate effective life closure. It is the responsibility of each and every member of the hospice/palliative are IDT to respect and ensure the rights of dying patients and their families.

Question 91

the goal of grief work

Answer 91

accept the reality and to liberate self from the strong attachment to the lost object