Loss, Grieving, and Death Flashcards
Which of the following may be considered normal or “healthy” types of grief? Select all that apply.
1. Abbreviated grief
2. Anticipatory grief
3. Disenfranchised grief
4. Complicated grief
5. Unresolved grief
6. Inhibited grief
- Answer: 1, 2, and 3. Rationale: Correct answers include abbreviated (normal grief that is briefly experienced), anticipatory grief (experienced before the loss/death but appropriate), and disenfranchised grief (the emotions are felt privately, just not expressed in public). Unhealthy/abnormal types of grief include complicated grief (option 4) in several different forms: Unresolved grief is extended in length and severity (option 5). With inhibited grief, symptoms are suppressed, and other effects, including somatic, are experienced instead (option 6). Cognitive Level: Remembering. Client Need: Psychosocial Integrity. Nursing Process: Diagnosing. Learning Outcome: 43-2.
A client’s family tells the nurse that their culture does not permit a dead person to be left alone before burial. Hospital policy states that after 6:00 pm when mortuaries are closed, bodies are to be stored in the hospital morgue refrigerator until the next day. How would the nurse best manage this situation?
1. Gently explain the policy to the family and then implement it.
2. Inquire of the nursing supervisor how an exception to the policy could be made.
3. Call the client’s primary care provider for advice.
4. Move the deceased to an empty room and assign an aide to stay with the body.
- Answer: 2. Rationale: When possible, modifications of policy that demonstrate respect for individual differences should be explored. The primary care provider is in no position to modify the implementation of hospital policy (option 3). Utilizing an empty room and a staff member for a deceased client is an inappropriate use of resources (option 4). Cognitive Level: Analyzing. Client Need: Psychosocial Integrity. Nursing Process: Planning. Learning Outcome: 43-8.
The shift changed while the nursing staff was waiting for the adult children of a deceased client to arrive. The oncoming nurse has never met the family. Which of the following initial greetings is most appropriate?
1. “I’m very sorry for your loss.”
2. “I’ll take you in to view the body.” 3. “I didn’t know your father but I am sure he was a wonderful person.”
4. “How long will you want to stay with your father?”
- Answer: 1. Rationale: This statement acknowledges the family’s grief simply. Avoid statements that may be interpreted as overly impersonal (option 2), false support (option 3), or harsh (option 4). Cognitive Level: Application. Client Need: Psychosocial Integrity. Nursing Process: Implementation. Learning Outcome: 43-8.
At which age does a child begin to accept that he or she will someday die?
1. Less than 5 years old
2. 5–9 years old
3. 9–12 years old
4. 12–18 years old
- Answer: 3. Rationale: Until children are about 5 years old, they believe that death is reversible. Between ages 5 and 9, the child knows death is irreversible but believes it can be avoided (option 2). Between 9 and 12 years of age, the child recognizes that he, too, will someday die (option 3). At 12 to 18 years old, the child builds on previous beliefs and may fear death, but often pretends not to care about it (option 4). Cognitive Level: Remembering. Client Need: Psychosocial Integrity. Nursing Process: Assessment. Learning Outcome: 43-4.
An 82-year-old man has been told by his primary care provider that it is no longer safe for him to drive a car. Which statement by the client would indicate beginning positive adaptation to this loss?
1. “I told the doctor I would stop driving, but I am not going to yet.”
2. “I always knew this day would come, but I hoped it wouldn’t be now.”
3. “What does he know? I’m a better driver than he will ever be.”
4. “Well, at least I have friends and family who can take me places.”
- Answer: 4. Rationale: Adaptive responses indicate the client can put the loss into perspective and begin to develop strategies for coping with the loss. Although the other options are responses the client might likely give and feel, and are not pathologic, they do not demonstrate movement toward a goal of adaptation nor problem solving. Cognitive Level: Application. Client Need: Psychosocial Integrity. Nursing Process: Evaluation. Learning Outcome: 40-3.
When asked to sign the permission form for surgical removal of a large but noncancerous lesion on her face, the client begins to cry. Which of the following is the most appropriate response?
1. “Tell me what it means to you to have this surgery.”
2. “You must be very glad to be having this lesion removed.”
3. “I cry when I am happy or relieved sometimes, too.”
4. “Isn’t it wonderful that the lesion is not cancer?”
- Answer: 1. Rationale: The nurse needs to assess and explore the meaning of the client’s crying. Options 2 and 4 leap to assumptions about the meaning of the tears and ignore the possibility of the client’s distress. Option 3 suggests that the client has the same feelings as the nurse, which may not be correct. Cognitive Level: Application. Client Need: Psychosocial Integrity. Nursing Process: Implementation. Learning Outcome: 43-3.
A nursing care plan includes the desired outcome of “quality of life” for a client with a chronic degenerative illness who is likely to live for many more years. Which of the following is one example that would indicate the outcome has been met?
1. The client demonstrates having adequate financial resources to pay for health care for many more years. 2. The client spends the majority of his or her time in spiritual reflection.
3. The client has no signs or symptoms of preventive complications of the illness.
4. The client verbalizes satisfaction with current relationships with other people.
- Answer: 4. Rationale: Quality of life is determined by the client and expressed in terms of his or her satisfaction with a variety of aspects of life. Although being able to pay for care (option 1), having apparent spiritual peace (option 2), and absence of physiological complications (option 3) may appear to contribute to good quality of life, only the client’s expression of satisfaction can provide the data the nurse requires to evaluate the goal. Cognitive Level: Analyzing. Client Need: Psychosocial Integrity. Nursing Process: Evaluation. Learning Outcome: 43-5.
- The nurse is caring for a family in a shelter 2 days after the loss of their home due to a fire. The fire caused minor burns to several members of the family but no life-threatening conditions. Which of the following is the most important assessment data for the nurse to gather at this time?
- Availability of insurance coverage for rebuilding the house
- Family members’ understanding of the extent of their physical injuries 3. Psychological support resources available from friends or other sources
- Family members’ grief responses and coping behaviors
- Answer: 4. Rationale: To plan with and assist the family, the nurse needs more data regarding the family’s reactions to their loss. Information on issues such as insurance coverage (option 1) can wait until later and may be more appropriately the responsibility of social services rather than the nurse. It is important for the nurse to determine their understanding of their injuries but they are stated as minor (option 2). Once the nurse has assessed the family’s responses it will be important to determine availability of outside resources to assist them (option 3). Cognitive Level: Analyzing. Client Need: Psychosocial Integrity. Nursing Process: Assessment. Learning Outcome: 43-1.
The client has been close to death for some time and the family asks how the nurse will know when the client has actually died. Which of the following would be the most accurate response from the nurse?
1. When the blood pressure can no longer be measured
2. When the gag reflex is no longer present
3. When there is no apical pulse
4. When the extremities are cool and dark in color
- Answer: 3. Rationale: If there is no heartbeat, the client has died. Before death, the blood pressure may not be able to be heard on auscultation because it is very low (option 1). Loss of the gag reflex (option 2) occurs with loss of muscle tone but can exist in many circumstances unrelated to dying. Vasodilation and pooling of fluids at the end of life may cause cool and darkened extremities but these are not reliable signs of death (option 4). Cognitive Level: Comprehension. Client Need: Physiological Integrity. Nursing Process: Diagnosing. Learning Outcome: 43-6.
In working with a dying client, the nurse demonstrates assisting the client to die with dignity when performing which action?
1. Allows the client to make as many decisions about care as is possible
2. Shares with the client the nurse’s own views about life after death
3. Avoids talking about dying and focuses on the present
4. Relieves the client of as much responsibility for self-care as is possible
- Answer: 1. Rationale: Assisting the client to die with dignity involves allowing the client to participate in and choose the direction of the remainder of his or her life. Sharing the nurse’s own views about life after death (option 2) does not enhance client dignity. The nurse should not assume that avoiding talking about dying and emphasizing the present (option 3) is therapeutic for the client. Only if the client wishes to have someone else perform care is doing so supporting death with dignity (option 4). Otherwise, it may have the opposite effect. Cognitive Level: Application. Client Need: Psychological Integrity. Nursing Process: Planning. Learning Outcome: 43-7.
