CHAPTER 20: LOSS AND BEREAVEMENT My Nursing Test Banks

CHAPTER 20: LOSS AND BEREAVEMENT

MULTIPLE CHOICE

1.Which of the following are the two major factors in childrens reaction to loss?

a.

number of siblings and birth order

c.

caregiver emotions and reactions

b.

self-esteem and body image

d.

age and cognitive development

ANS: D

Feedback

A

Incorrect. The number of siblings and birth order are not the two major factors in childrens reaction to loss.

B

Incorrect. The self-esteem and body image are not the two major factors in childrens reaction to loss.

C

Incorrect. The caregiver emotions and reactions are not the two major factors in childrens reaction to loss.

D

Correct. Two major factors in childrens reaction to loss are age and cognitive development.

PTS: 1 REF: p. 630 Situations Leading to Loss OBJ: Cognitive Level: Knowledge

2.Young children experience loss, separation, or bereavement in a myriad of situations. These early experiences:

a.

are almost always totally repressed and of little help to a person

b.

help shape an individuals ability to cope with loss later in adult life

c.

determine to a large extent whether a person will experience situational depression later

d.

cloud ones ability to think clearly and logically about similar experiences as an adult

ANS: B

Feedback

A

Incorrect. Childrens early experiences with loss, separation, or bereavement are not always totally repressed and of little help to a person as they age.

B

Correct. On average, children experience loss, separation, or bereavement through a myriad of situations that are not related to the death of a person. These early experiences are important and help shape an individuals ability to cope with loss later in adult life.

C

Incorrect. Childrens early experiences with loss, separation, or bereavement do not have to determine to a large extent whether a person will experience situational depression later.

D

Incorrect. Childrens early experiences with loss, separation, or bereavement do not have to cloud ones ability to think clearly and logically about similar experiences as an adult.

PTS: 1 REF: p. 630 Situations Leading to Loss OBJ: Cognitive Level: Knowledge

3.Caregivers may be excited about the family relocating to another city so they can have better jobs and a bigger home. After the move, however, the children will most likely:

a.

reflect the excitement modeled by the caregivers and suffer little emotional upset

b.

do better emotionally than the caregivers, as the children will acclimate to their new surroundings with greater ease

c.

grieve for the loss of comfortable and familiar people, surroundings, and things left behind

d.

appreciate the better surroundings and seek new friendships in the neighborhood

ANS: C

Feedback

A

Incorrect. After relocating to another city, the children will not most likely reflect the excitement modeled by the caregivers and suffer little emotional upset.

B

Incorrect. After relocating to another city, the children will not most likely do better emotionally than the caregivers, as the children will acclimate to their new surroundings with greater ease.

C

Correct. For children, the relocating to another city so they can have better jobs and a bigger home may be seen as a loss of comfortable and familiar things, people and surroundings; moving to a new school or even starting a new grade may trigger feelings of anxiety and loss.

D

Incorrect. After relocating to another city, the children will not most likely appreciate the better surroundings and seek new friendships in the neighborhood.

PTS:1REF:p. 630 Situations Leading to Loss

OBJ: Cognitive Level: Comprehension

4.Most preschoolers have a favorite toy or belonging that goes with them to the babysitter, the day care, or the health care provider. When the caregivers fail to bring that toy or belonging along on an outing, the child will most likely:

a.

start to learn how to rely on people for security rather than on objects

b.

suffer feelings of anxiety associated with loss and separation issues

c.

be angry with the caregivers for several days or weeks

d.

reject the toy or belonging then it is next presented

ANS: B

Feedback

A

Incorrect. When the caregivers fail to bring a toy or belonging along on an outing, the child will not start to learn how to rely on people for security rather than on objects, in fact, may feel unable to trust others.

B

Correct. Children at an early age develop attachments to objects such as a toy and items of clothing. When the caregivers fail to bring that toy or belonging along on an outing, the child will most likely suffer feelings of anxiety associated with loss and separation issues.

C

Incorrect. When the caregivers fail to bring a toy or belonging along on an outing, the child may not even know they are angry and may not express anger, they may only feel anxious.

D

Incorrect. Upon rejoining the toy or belonging, the child will not very likely reject the toy or belonging then it is next presented, instead will be gleefully reunited.

PTS:1REF:p. 630 Situations Leading to Loss

OBJ: Cognitive Level: Comprehension

5.When a child loses a pet, the way the child feels about the loss will:

a.

greatly depend on whether the pet died or was lost due to other causes

b.

depend on the age of the pet and how close the pet was to dying of natural causes

c.

be associated with how well-liked the pet was by the rest of the family

d.

be much the same, regardless of how the loss came about or other factors

ANS: D

Feedback

A

Incorrect. When a child loses a pet, the way the child feels about the loss will not greatly depend on whether the pet died or was lost due to other causes.

B

Incorrect. When a child loses a pet, the way the child feels about the loss will not depend on the age of the pet and how close the pet was to dying of natural causes.

C

Incorrect. When a child loses a pet, the way the child feels about the loss will not be associated with how well-liked the pet was by the rest of the family.

D

Correct. Regardless of the cause of the loss of a pet, the way the child feels about the loss will be much the same, no matter how the loss came about or any other factors

PTS:1REF:p. 631 Situations Leading to Loss

OBJ: Cognitive Level: Comprehension

6.A leading cause of separation in families is:

a.

military assignment

c.

temporary separation

b.

divorce

d.

jail or prison time

ANS: B

Feedback

A

Incorrect. A military assignment is not a leading cause of separation in families.

B

Correct. Divorce, an extremely stressful event in the life of a family, is a leading cause of separation experienced by families and children.

C

Incorrect. A temporary separation is not a leading cause of separation in families.

D

Incorrect. Jail or prison time is not a leading cause of separation in families.

PTS: 1 REF: p. 631 Situations Leading to Loss OBJ: Cognitive Level: Knowledge

7.A mother shares with the pediatric nurse that her 3-year-old has started thumb sucking and bed-wetting again after about a year of not engaging in these behaviors. The pediatric nurse notices the child clinging to the mother. Based on the childs behaviors, the pediatric nurse would in the assessment phase most need to ask the mother:

a.

Has there been any loss or change in your lives such as separation, divorce, or relocation?

b.

Are you rewarding your child whenever she urinates in the potty or does not suck her thumb?

c.

Has your child been sick or had a contagious disease, fever, diarrhea, or vomiting?

d.

Has your child been getting enough attention from you in the past few weeks?

ANS: A

Feedback

A

Correct. In regards to divorce, preschoolers sensing conflict tend to feel confused and bewildered. They perceive divorce as one parent leaving. They often assume that this is their fault. They next fear abandonment by the remaining parent, leading to becoming clinging. They may lose any independence recently acquired, may regress to wetting the bed, thumb sucking, even bottle feeding.

B

Incorrect. Hearing from a mother that her 3-year-old has started thumb sucking and bed-wetting again after about a year of not engaging in these behaviors, the pediatric nurse would not most need to ask the mother: Are you rewarding your child whenever she urinates in the potty or does not suck her thumb?

C

Incorrect. Hearing from a mother that her 3-year-old has started thumb sucking and bed-wetting again after about a year of not engaging in these behaviors, the pediatric nurse would not most need to ask the mother: Has your child been sick or had a contagious disease, fever, diarrhea, or vomiting?

D

Incorrect. Hearing from a mother that her 3-year-old has started thumb sucking and bed-wetting again after about a year of not engaging in these behaviors, the pediatric nurse would not most need to ask the mother: Has your child been getting enough attention from you in the past few weeks?

PTS:1REF:p. 631 Situations Leading to Loss

OBJ: Cognitive Level: Application

8.The nurse is working with a custodial father of a preschooler who has become more aggressive in his play. This preschoolers increase in aggression occurred about the time the caregivers divorced. The nurse will talk to the father about the most probable cause of the escalation in violence, which is:

a.

watching more television after the divorce

b.

a decrease in the gentle influence of the mother

c.

confusion and acting out feelings of confusion

d.

an increase in the more masculine influence of the father

ANS: C

Feedback

A

Incorrect. Asking about the preschoolers increase in aggression, the nurse would not most likely talk to the father about linking the escalation in violence to watching more television after the divorce.

B

Incorrect. Asking about the preschoolers increase in aggression, the nurse would not most likely talk to the father about linking the escalation in violence to a decrease in the gentle influence of the mother.

C

Correct. Preschoolers may experience nightmares or sleep disturbances and their play may become more aggressive as they attempt to act out their feelings of confusion during the time of a divorce.

D

Incorrect. Asking about the preschoolers increase in aggression, the nurse would not most likely talk to the father about linking the escalation in violence to an increase in the more masculine influence of the father.

PTS:1REF:p. 632 Situations Leading to Loss

OBJ: Cognitive Level: Comprehension

9.A mother is talking with the school nurse about her school-aged child, who thinks up reasons for her mother to meet with her ex-husband, the childs father. The child even acts out then visiting with the father so the mother will come and talk with the father. When something breaks in the mothers home, the child says, Dad could fix this. The nurse talks to the mother about a common theme with school-aged children, which is:

a.

the mother will be carried away by an evil person and the child needs help to keep her

b.

a fantasy that the caregivers will reunite and efforts to make this fantasy come true

c.

only the biological parents can fulfill the emotional needs of the children

d.

the mother is sad and only the father can fix the sadness that the mother is experiencing

ANS: B

Feedback

A

Incorrect. Discussing the school-aged child of a divorce with the mother, the nurse will not identify as a common theme that the mother will be carried away by an evil person and the child needs help to keep her.

B

Correct. The school-aged child may have fantasies of reunification of parents and family, and may lie in an attempt to make this fantasy come true.

C

Incorrect. Discussing the school-aged child of a divorce with the mother, the nurse will not identify as a common theme that only the biological parents can fulfill the emotional needs of the children.

D

Incorrect. Discussing the school-aged child of a divorce with the mother, the nurse will not identify as a common theme that the mother is sad and only the father can fix the sadness that the mother is experiencing.

PTS:1REF:p. 632 Situations Leading to Loss

OBJ: Cognitive Level: Comprehension

10.Which of the following best describes the term parentification?

a.

raising the caregivers up onto a pedestal

b.

assuming the caregiver (parental) role

c.

believing ones caregivers can do nothing right

d.

holding onto caregivers out of a fear of abandonment

ANS: B

Feedback

A

Incorrect. Parentification is not best described as raising the caregivers up onto a pedestal.

B

Correct. Parentification, the role of assuming the caregiver (parent) role, is common among older school-age children (9-12 years). These children of divorce may experience conflicts with loyalty and also exhibit outbursts of anger toward either or both parents. Parentification is also common in the adolescent group.

C

Incorrect. Parentification is not best described as believing ones caregivers can do nothing right.

D

Incorrect. Parentification is not best described as holding onto caregivers out of a fear of abandonment.

PTS:1REF:p. 632 Childrens Awareness of Death

OBJ: Cognitive Level: Knowledge

11.The school nurse is working with a group of school-aged children whose caregivers are in the process of divorcing or who have recently divorced. Which of the following topics will be most important for this age group to explore?

a.

which of their caregivers is at fault in the breakdown of relationships in the family

b.

how they would like the custody battles to be resolved and who they would like to live with

c.

the impact of the divorce on understanding the day-to-day schoolwork

d.

feelings of guilt, believing their caregivers emotional distress is related to how they behaved

ANS: D

Feedback

A

Incorrect. Working with a group of school-aged children whose caregivers are in the process of divorcing or who have recently divorced, the school nurse would not select as the most important topic for this age group to explore: which of their caregivers is at fault in the breakdown of relationships in the family.

B

Incorrect. Working with a group of school-aged children whose caregivers are in the process of divorcing or who have recently divorced, the school nurse would not select as the most important topic for this age group to explore: how they would like the custody battles to be resolved and who they would like to live with.

C

Incorrect. Working with a group of school-aged children whose caregivers are in the process of divorcing or who have recently divorced, the school nurse would not select as the most important topic for this age group to explore: the impact of the divorce on understanding the day-to-day schoolwork.

D

Correct. School-age children (9-12 years) may believe their parents emotional distress is related to how they have been behaving and can perceive the divorce as a rejection of themselves, resulting in feelings of guilt.

PTS:1REF:p. 632 Loss and Bereavement

OBJ: Cognitive Level: Application

12.Parentification is common in children and adolescents who are 9 years old or older and is especially common in which of the following circumstances?

a.

then daily activities of the home are neglected

b.

then the caregivers are very authoritarian

c.

during the holiday season

d.

then there are several older siblings

ANS: A

Feedback

A

Correct. Parentification is common in children and adolescents who are 9 years old or older and is especially common then daily activities of the home are neglected.

B

Incorrect. Parentification is common in children and adolescents who are 9 years old or older but does not become more or less common then the caregivers are very authoritarian.

C

Incorrect. Parentification is common in children and adolescents who are 9 years old or older but is not especially common during the holiday season, it is not seasonal.

D

Incorrect. Parentification is common in children and adolescents who are 9 years old or older but not especially common then there are several older siblings.

PTS:1REF:p. 632 Situations Leading to Loss

OBJ: Cognitive Level: Comprehension

13.A school nurse notices that one of the adolescents has begun spending a lot of time and energy at school, volunteering for projects and doing extra work. The nurse knows that often then adolescents begin to spend all their energies in school activities, they are doing so because they want to:

a.

get good recommendations from teachers for entering college

b.

avoid thinking about a difficult or troubling situation at home

c.

get praise from teachers and peers for a job well done

d.

do things for others in an altruistic period of their life

ANS: B

Feedback

A

Incorrect. The nurse knows that often then adolescents begin to spend all their energies in school activities, they are not doing so simply because they want to get good recommendations from teachers for entering college.

B

Correct. For some adolescents, school may become a refuge from turmoil at home, and they spend all their energies in school activities to avoid thinking about the situation at home.

C

Incorrect. The nurse knows that often then adolescents begin to spend all their energies in school activities, they are not doing so simply because they want to get praise from teachers and peers for a job well done.

D

Incorrect. The nurse knows that often then adolescents begin to spend all their energies in school activities, they are not doing so simply because they want to do things for others in an altruistic period of their life.

PTS:1REF:p. 632 Childrens Awareness of Death

OBJ: Cognitive Level: Comprehension

14.You are the nurse working with a 4-year-old child who was injured in an automobile accident in which the childs mother was killed. From your knowledge of children and how they view death, you will suspect that this child will view the death of the mother from which of the following ideas of death?

a.

universal

c.

nonfunctional

b.

temporary

d.

causal

ANS: B

Feedback

A

Incorrect. Working with a 4-year-old child who was injured in an automobile accident in which the childs mother was killed, you will suspect that this child will view the death of the mother as temporary and reversible. A 4-year-old child lives in a concrete world view, and cannot comprehend an abstraction such as the universality of death.

B

Correct. Younger children are more likely than older children to state death is not universal, is avoidable, and occurs in the remote future. In essence, death is temporary and reversible.

C

Incorrect. Working with a 4-year-old child who was injured in an automobile accident in which the childs mother was killed, you will suspect that this child will view the death of the mother as temporary and reversible. A 4-year-old child lives in a concrete world view, and cannot comprehend an abstraction such as nonfunctionality.

D

Incorrect. Working with a 4-year-old child who was injured in an automobile accident in which the childs mother was killed, you will suspect that this child will view the death of the mother as temporary and reversible. A 4-year-old child lives in a concrete world view, and cannot comprehend an abstraction such as the causality of death.

PTS:1REF:p. 632 Childrens Awareness of Death

OBJ: Cognitive Level: Comprehension

15.A caregiver asks the nurse for advice on how to explain the death of a grandfather to a 5-year-old child. The nurse shares with the caregiver that children of this age look at death differently than adults do and that children would best understand and benefit from the explanation:

a.

Your grandfather has gone to rest.

c.

His body and his heart fore out.

b.

Your grandfather worked too hard.

d.

He has gone to a much better place.

ANS: C

Feedback

A

Incorrect. Providing advice to a caregiver about how best to explain the death of a grandfather to a 5-year-old child, the nurse shares with the caregiver that children of this age look at death differently than adults do, and would suggest the avoidance of abstractions such as: Your grandfather has gone to rest. So then is the nap over.

B

Incorrect. Providing advice to a caregiver about how best to explain the death of a grandfather to a 5-year-old child, the nurse shares with the caregiver that children of this age look at death differently than adults do, and would suggest the avoidance of abstractions such as: Your grandfather worked too hard.

C

Correct. By the age of 5, childrens definition of death is more focused on function. People die then they are unable to breathe, eat, talk, and walk. This reflects Piagets second stage of cognitive development, or the preoperational stage, and reflects egocentricity and tangible, concrete thinking. The grandfather died because he could not breathe, eat, talk and walk.

D

Incorrect. Providing advice to a caregiver about how best to explain the death of a grandfather to a 5-year-old child, the nurse shares with the caregiver that children of this age look at death differently than adults do, and would suggest the avoidance of abstractions such as: He has gone to a much better place.

PTS:1REF:p. 632 Childrens Awareness of Death

OBJ: Cognitive Level: Application

16.A father is concerned that his 14-year-old son is engaging in high-risk behavior by inline-skating in traffic. He is afraid the son will kill himself accidentally. The nurse explains that this behavior in adolescents is believed to be due to which of the following attitudes?

a.

underlying suicidal wish

c.

belief that death wont happen to me

b.

need for attention

d.

need to excel in some skill or activity

ANS: C

Feedback

A

Incorrect. Explaining the high-risk behavior of inline-skating in traffic to the father of a 14-year-old son, the nurse does not explain that this behavior in adolescents is believed to be due to an underlying suicidal wish.

B

Incorrect. Explaining the high-risk behavior of inline-skating in traffic to the father of a 14-year-old son, the nurse does not explain that this behavior in adolescents is believed to be due to a need for attention.

C

Correct. Although the adolescent is capable of understanding and conceptualizing death as permanent and universal, often there is an exclusion of the self from this concept. In other words, there is the notion it wont happen to me.

D

Incorrect. Explaining the high-risk behavior of inline-skating in traffic to the father of a 14-year-old son, the nurse does not explain that this behavior in adolescents is believed to be due to a need to excel in some skill or activity.

PTS:1REF:p. 633 Childrens Awareness of Death

OBJ: Cognitive Level: Application

17.The school nurse becomes aware that a student has experienced the loss of a family member and is returning to school after a few days absence. The best action on the part of the nurse is to plan with other members of the school team for:

a.

opportunities for this student to talk about her feelings and to have supportive counseling

b.

making sure the student gets to spend lots of time with peers at school and out of school

c.

psychological testing of the student to see what impact the death had on her

d.

the teachers to reduce the homework assignments to about half that of other students

ANS: A

Feedback

A

Correct. Becoming aware that a student has experienced the loss of a family member and is returning to school after a few days absence, the best action on the part of the school nurse is to plan with other members of the school team to provide opportunities for this student to talk about her feelings and to have supportive counseling.

B

Incorrect. Becoming aware that a student has experienced the loss of a family member and is returning to school after a few days absence, the best action on the part of the school nurse is not to make sure the student gets to spend lots of time with peers at school and out of school.

C

Incorrect. Becoming aware that a student has experienced the loss of a family member and is returning to school after a few days absence, the best action on the part of the school nurse is not to make available psychological testing of the student to see what impact the death had on her.

D

Incorrect. Becoming aware that a student has experienced the loss of a family member and is returning to school after a few days absence, the best action on the part of the school nurse is to not to make sure the teachers reduce the homework assignments to about half that of other students.

PTS:1REF:p. 632 Childrens Awareness of Death

OBJ: Cognitive Level: Application

18.In working with children and families who have experienced a loss of a family member, the nurse keeps in mind:

a.

people experiencing a loss follow a predictable pattern in terms of grief and bereavement

b.

individuals who have a mental illness themselves, or in the family, will grieve differently

c.

each persons response to a loss is different and each persons bereavement is different

d.

people who are close to the grieving person can often predict their grieving pattern

ANS: C

Feedback

A

Incorrect. In working with children and families who have experienced a loss of a family member, the nurse realizes that people experiencing a loss do not follow a predictable pattern in terms of grief and bereavement.

B

Incorrect. In working with children and families who have experienced a loss of a family member, the nurse is not most attuned to mental illness and the grieving process.

C

Correct. One can describe grief as the reaction an individual has to a loss, and bereavement as the behaviors one exhibits after the loss. Each persons response is different; therefore, each persons bereavement will be different.

D

Incorrect. In working with children and families who have experienced a loss of a family member, the nurse keeps in mind that grief and bereavement is individual and largely unpredictable.

PTS:1REF:p. 634 Childrens Awareness of Death

OBJ: Cognitive Level: Comprehension

19.Which of the following best defines the term grieving?

a.

an individuals reaction to a loss

b.

an adaptation to a loss

c.

the process from the loss to the adaptation

d.

a time of shock and disbelief

ANS: A

Feedback

A

Correct. An individuals reaction to a loss best defines the term grieving.

B

Incorrect. An adaptation to a loss does not best define the term grieving.

C

Incorrect. The process from the loss to the adaptation does not best define the term grieving.

D

Incorrect. A time of shock and disbelief does not best define the term grieving.

PTS:1REF:p. 634 Childrens Awareness of Death

OBJ: Cognitive Level: Knowledge

20.According to Kubler-Ross, the first stage of the grieving process is:

a.

denial

c.

bargaining

b.

anger

d.

depression

ANS: A

Feedback

A

Correct. Kubler-Ross identified five distinct stages of the grieving process: 1) denial; 2) anger; 3) bargaining; 4) depression; 5) acceptance. The first stage is denial.

B

Incorrect. Anger is Kubler-Rosss second stage of the grieving process.

C

Incorrect. Bargaining is Kubler-Rosss third stage of the grieving process.

D

Incorrect. Depression is Kubler-Rosss fourth stage of the grieving process.

PTS:1REF:p. 634 Childrens Awareness of Death

OBJ: Cognitive Level: Knowledge

21.According to Kubler-Ross, the last stage of the grieving process is called:

a.

anger resolution

c.

acceptance

b.

mood norming

d.

final peace

ANS: C

Feedback

A

Incorrect. According to Kubler-Ross, the last stage of the grieving process is not called anger resolution.

B

Incorrect. According to Kubler-Ross, the last stage of the grieving process is not called mood norming.

C

Correct. According to Kubler-Ross, the last stage of the grieving process is called acceptance.

D

Incorrect. According to Kubler-Ross, the last stage of the grieving process is not called final peace.

PTS: 1 REF: p. 634 Grief and Bereavement OBJ: Cognitive Level: Knowledge

22.The nurse is working with a family going through a divorce. The mother tells the nurse how good her young son has been in washing windows and doing household chores. The nurse realizes that this child is most likely:

a.

in denial

c.

depressed

b.

bargaining

d.

angry

ANS: B

Feedback

A

Incorrect. Working with a family going through a divorce, the nurse realizes that the young son who has been washing windows and doing household chores is not most likely in denial.

B

Correct. Bargaining is seen at a time then there is an impending loss, such as death, loss of good health, an appendage, even a way of life. Bargaining is an attempt to postpone the occurrence of the event, in this case by being extra good to his mom.

C

Incorrect. Working with a family going through a divorce, the nurse realizes that the young son who has been washing windows and doing household chores is not most likely depressed.

D

Incorrect. Working with a family going through a divorce, the nurse realizes that the young son who has been washing windows and doing household chores is not most likely angry.

PTS:1REF:p. 634 Grief and Bereavement

OBJ: Cognitive Level: Application

23.Which of the following statements by a child would indicate her acceptance of a mothers death?

a.

She is taking a long nap.

c.

God is not very loving.

b.

I am going to be a good girl.

d.

My mother is in heaven.

ANS: D

Feedback

A

Incorrect. She is taking a long nap indicates denial, early in the grieving process, and a long way from acceptance.

B

Incorrect. I am going to be a good girl indicates bargaining, a hope to change the outcome, on the path to acceptance.

C

Incorrect. God is not very loving indicates a residual anger, on the path to acceptance.

D

Correct. My mother is in heaven indicates complete acceptance of a mothers death by a child. It indicates the griever is consciously aware of what has happened and the finality of death.

PTS:1REF:p. 632 Loss and Bereavement

OBJ: Cognitive Level: Application

24.According to Wordens four tasks of mourning, before children can deal with the loss, they must:

a.

be at least 6 years old

b.

be able to do abstract thinking

c.

have at least one close relative, adult, or friend to talk to

d.

believe the deceased person is dead and will not return to life

ANS: D

Feedback

A

Incorrect. According to Wordens four tasks of mourning, before children can deal with the loss, they must be told about the death in appropriate age-related language, and does not say they must be at least 6 years old.

B

Incorrect. According to Wordens four tasks of mourning, before children can deal with the loss, they must be told about the death in appropriate age-related language, and does not say they must be able to do abstract thinking.

C

Incorrect. According to Wordens four tasks of mourning, before children can deal with the loss, they must be told about the death in appropriate age-related language, and does not say they must have at least one close relative, adult, or friend to talk to.

D

Correct. Worden suggests that before children can deal with the loss of a death, they must believe the deceased is dead and will not return to life.

PTS:1REF:p. 634 Grief and Bereavement

OBJ: Cognitive Level: Comprehension

25.A childs ability to process the pain of loss will depend most on:

a.

the childs intelligence quotient

b.

how verbal the child is

c.

observations of the adults experiences of loss

d.

emotional maturity

ANS: C

Feedback

A

Incorrect. Worden does not conclude that a childs ability to process the pain of loss will depend most on the childs intelligence quotient.

B

Incorrect. Worden does not conclude that a childs ability to process the pain of loss will depend most on how verbal the child is.

C

Correct. Wordens second task of mourning, to experience the pain or emotional aspects of the loss, requires to behaviors and feelings of the child to be recognized and acknowledged. A childs ability to process the pain of loss will be influenced by observing an adults experience of the loss.

D

Incorrect. Worden does not conclude that a childs ability to process the pain of loss will depend most on emotional maturity.

PTS:1REF:p. 634 Childrens Responses to Death

OBJ: Cognitive Level: Comprehension

26.You are the nurse working with a child whose grandparent died. When the child has completed the first three tasks of mourning according to Worden and is ready to work on the fourth task, you would most help him by:

a.

keeping the child busy so he doesnt have time to think about his loss

b.

reminding the child that the grandparent is not returning to life

c.

keeping the child focused on the family members he has left in his life

d.

helping the child make a scrapbook or write a poem about the grandparent

ANS: D

Feedback

A

Incorrect. Working with a child whose grandparent has died, then the child has completed the first three tasks of mourning according to Worden and is ready to work on the fourth task, you would not most help him by keeping the child busy so he doesnt have time to think about his loss.

B

Incorrect. Working with a child whose grandparent has died, then the child has completed the first three tasks of mourning according to Worden and is ready to work on the fourth task, you would not most help him reminding the child that the grandparent is not returning to life.

C

Incorrect. Working with a child whose grandparent has died, then the child has completed the first three tasks of mourning according to Worden and is ready to work on the fourth task, you would not most help him by keeping the child focused on the family members he has left in his life.

D

Correct. Working with a child whose grandparent has died, then the child has completed the first three tasks of mourning according to Worden and is ready to work on the fourth task, you would most help him by helping the child make a scrapbook or write a poem about the grandparent. The fourth task of mourning involves finding a new and appropriate place for the deceased in ones emotional life, i.e., finding ways to memorialize the person.

PTS:1REF:p. 635 Childrens Responses to Death

OBJ: Cognitive Level: Application

27.Caregivers share with the school nurse that their child, who was so depressed and upset for a month by the death of a grandparent, is now engaging in all his old activities, laughing and enjoying life, and acting as if nothing ever happened. The nurse will tell the caregivers that the most likely explanation for this change in behavior is that:

a.

Children do not grieve the same as adults, and this is probably normal.

b.

The child received a lot of attention for the depressed behavior and has gotten enough attention.

c.

Children are very resilient, and your child is more so than most.

d.

Your child is just in an emotional plateau and resting from the depression.

ANS: A

Feedback

A

Correct. Children may have long periods then they are overcome with grief which is then followed by an interval then they do not seem to be affected by the loss. Nurses must help grieving caregivers understand the childs behavior is a normal process of grieving since children do not grieve the same as adults.

B

Incorrect. In explaining to the caregiver the deep depression followed by a return to life as if no death had occurred, the nurse will not tell the parent that the child was only seeking attention, but that this is normal for children.

C

Incorrect. In explaining to the caregiver the deep depression followed by a return to life as if no death had occurred, the nurse will not tell the parent that children are resilient as though they do not grieve, but that this is normal for children.

D

Incorrect. In explaining to the caregiver the deep depression followed by a return to life as if no death had occurred, the nurse will not tell the parent that the child is just in an emotional plateau and resting from the depression, but that this is normal for children.

PTS:1REF:p. 635 Childrens Responses to Death

OBJ: Cognitive Level: Application

28.A school-aged child reacted very little to the death of an older brother who had lived away from the family for several years and yet seemed overcome with grief at the death of an elderly lady who was her babysitter. The most logical and likely explanation for this difference in the amount of observable grief is which of the following?

a.

She is hiding the grief for her brother because it is so painful.

b.

There was a closer relationship with the babysitter than with the brother.

c.

This child values the elderly more than she does younger people.

d.

She was mad at her brother for being so uncaring as to die.

ANS: B

Feedback

A

Incorrect. Having been overcome with grief at the death of an elderly lady who was her babysitter, the most likely explanation for reacting very little to the death of an older brother is not that she is hiding the grief for her brother because it is so painful.

B

Correct. A major factor influencing how children react to grief is the relationship with the deceased. For example, a child may have little reaction to the death of an older sibling where there has been little contact or interaction, yet may react significantly to the loss of the after-school care provider.

C

Incorrect. Having been overcome with grief at the death of an elderly lady who was her babysitter, the most likely explanation for reacting very little to the death of an older brother is not that this child values the elderly more than she does younger people.

D

Incorrect. Having been overcome with grief at the death of an elderly lady who was her babysitter, the most likely explanation for reacting very little to the death of an older brother is not that she was mad at her brother for being so uncaring as to die.

PTS:1

REF: p. 635 Reactions of Family to a Child with a Life-Threatening or Terminal Illness

OBJ: Cognitive Level: Application

29.A school-aged childs great-uncle dies, and the child expresses a desire to go to the funeral. The best action on the part of the caregivers is most often to:

a.

have the child stay at home with a relative

b.

send the child to school as usual

c.

include the child in appropriate activities related to the funeral and burial

d.

call all the other caregivers and see if anyone else is taking their child

ANS: C

Feedback

A

Incorrect. The school-aged child having expressed a desire to go to the funeral, the best action on the part of the caregivers is not to have the child stay at home with a relative.

B

Incorrect. The school-aged child having expressed a desire to go to the funeral, the best action on the part of the caregivers is not to send the child to school as usual.

C

Correct. Children should be included in activities related to funeral and burial rites then appropriate.

D

Incorrect. The school-aged child having expressed a desire to go to the funeral, the best action on the part of the caregivers is not to call all the other caregivers and see if anyone else is taking their child.

PTS:1REF:p. 638 Disasters or Traumatic Events

OBJ: Cognitive Level: Application

30.A caregiver talks with the nurse about how badly her surviving child has behaved after the death of a sibling. Which of the following statements by the nurse would most likely be true?

a.

When children have a tendency to misbehave, it gets worse during a crisis.

b.

Children always misbehave to an extreme degree after the death of a sibling.

c.

The closer the relationship was between siblings before the death of one, the more behavior problems the surviving siblings demonstrate afterward.

d.

You probably were distracted by all that was going on during this crisis and did not discipline this child as much as you normally would have, so the child misbehaved.

ANS: C

Feedback

A

Incorrect. After a caregiver tells the nurse about how badly her surviving child has behaved after the death of a sibling, the nurse would not most likely state as absolutely true: When children have a tendency to misbehave, it gets worse during a crisis.

B

Incorrect. After a caregiver tells the nurse about how badly her surviving child has behaved after the death of a sibling, the nurse would not most likely state as absolutely true: Children always misbehave to an extreme degree after the death of a sibling.

C

Correct. The closer the relationship was before death, the more behavior problems the surviving siblings demonstrate afterward.

D

Incorrect. After a caregiver tells the nurse about how badly her surviving child has behaved after the death of a sibling, the nurse would not most likely state as absolutely true: You probably were distracted by all that was going on during this crisis and did not discipline this child as much as you normally would have, so the child misbehaved.

PTS:1REF:p. 638 Childrens Responses to Death

OBJ: Cognitive Level: Application

31.When a child in a family dies, the most neglected member of the family during the grieving process is usually the:

a.

mother

c.

grandparents

b.

father

d.

siblings

ANS: D

Feedback

A

Incorrect. When a child in a family dies, the most neglected member of the family during the grieving process is not usually the mother.

B

Incorrect. When a child in a family dies, the most neglected member of the family during the grieving process is not usually the father.

C

Incorrect. When a child in a family dies, the most neglected member of the family during the grieving process is not usually the grandparents.

D

Correct. It is important for nurses to understand because grieving parents may be emotionally unavailable to surviving children and because support is generally directed toward parents, siblings are often the most neglected family members then a child dies.

PTS:1

REF: p. 638 Reactions of Family to a Child with a Life-Threatening or Terminal Illness

OBJ: Cognitive Level: Comprehension

32.You are assigned to care for a young adolescent who is in the terminal stage of an illness. This early adolescent says to you: I dont want to die. What would be your best response?

a.

You may not die, as miracles do sometimes happen.

b.

Tell me more about what you are thinking.

c.

I dont want you to die either.

d.

Why do you think you might die?

ANS: B

Feedback

A

Incorrect. In response to the youths comment, You may not die, as miracles do sometimes happen, trivializes his heartfelt expression, and would not be your best response.

B

Correct. Do not trivialize the youths comment, or deflect it, instead engage the issue in a matter of fact way. The best response would be something along the lines of, Tell me more about what you are thinking.

C

Incorrect. In response to the youths comment, I dont want you to die either, is already taken for granted, but does not engage the adolescents heartfelt expression.

D

Incorrect. In response to the youths comment, Why do you think you might die? is better than some responses, but engages indirectly the adolescents heartfelt expression.

PTS:1

REF: p. 644 Reactions of Family to a Child with a Life-Threatening or Terminal Illness

OBJ: Cognitive Level: Application

33.When planning the nursing care for a child admitted with a terminal illness, which of the following interventions would be important in working with the child and family?

a.

Minimize the number of staff interacting with the child and family.

b.

Do as much as possible for the child so the caregivers dont have to work.

c.

Limit the amount of time the caregivers can be with the child so they dont tire out.

d.

Let the family guide the amount of communication related to grieving.

ANS: A

Feedback

A

Correct. When planning the nursing care for a child admitted with a terminal illness, it is very important to minimize the number of staff interacting with the child and family. This action decreases the risk of overwhelming and confusing family members, and allows for more accurate identification of the familys needs.

B

Incorrect. When planning the nursing care for a child admitted with a terminal illness, it is better to encourage the family to participate in the childs care.

C

Incorrect. When planning the nursing care for a child admitted with a terminal illness, it is better to not limit the amount of time the caregivers can be with the child.

D

Incorrect. When planning the nursing care for a child admitted with a terminal illness, it is better to anticipate the need for grieving and provide the family with private space to meet and grieve.

PTS: 1 REF: p. 642   Loss and Bereavement

OBJ: Cognitive Level: Application

34.Which of the following groups best lists those who must be supported then a shooting occurs in a school?

a.

students and their teachers

b.

students, school staff, families, and community

c.

only those who ask for and accept help and support

d.

those who demonstrate symptoms indicating a need

ANS: B

Feedback

A

Incorrect. When a shooting occurs in a school, the students and their teachers must be supported along with the entire staff, the families, and the community at large.

B

Correct. The consequences of a shooting occurring in a school is felt by everyone in the community and beyond, and has ramifications nationwide. When support is provided it must be provided to the community at large, i.e., students, school staff, families, and community.

C

Incorrect. When a shooting occurs in a school, the students and their teachers must be supported along with the entire staff, the families, and the community at large, not only those who ask for and accept help and support.

D

Incorrect. When a shooting occurs in a school, the students and their teachers must be supported along with the entire staff, the families, and the community at large, not only those who demonstrate symptoms indicating a need.

PTS: 1 REF: p. 639   Loss and Bereavement

OBJ: Cognitive Level: Application

35.You are responsible for preparing a deceased newborn for the family to view. Which of the following descriptions represents the best way for you to prepare the newborn?

a.

naked and wrapped in a sheet

c.

in a diaper and small hospital shirt

b.

clothed in an outfit of clothes

d.

in a diaper and wrapped in a blanket

ANS: B

Feedback

A

Incorrect. In preparing a deceased newborn for the family to view, it would be totally inappropriate to present the newborn naked and wrapped in a sheet.

B

Correct. When preparing the deceased newborn for viewing by the parents, it is important the newborn be washed and dressed appropriately. This helps parents see their deceased newborn as a child. Clothing the infant in an outfit and wrapping it in a blanket selected by the parents helps the family take ownership of the deceased and the loss.

C

Incorrect. In preparing a deceased newborn for the family to view, it would be inappropriate to present the newborn in a diaper and small hospital shirt.

D

Incorrect. In preparing a deceased newborn for the family to view, it would be inappropriate to present the newborn in a diaper and wrapped in a blanket.

PTS:1REF:p. 644 Situations Leading to Loss

OBJ: Cognitive Level: Application

36.You have prepared a deceased newborn for the family to visit. You would invite them to:

a.

visit the child in the utility room for a few minutes

b.

provide chairs and allow them to hold the baby as long as they wish

c.

visit with the deceased newborn until the funeral home personnel come

d.

enter alone without any presentation or remarks by the nurse

ANS: B

Feedback

A

Incorrect. The area for viewing the deceased newborn should be clean, quiet, and in an area appropriate for the living, which does not include the utility room.

B

Correct. The area for viewing the deceased newborn should be clean, quiet, and in an area appropriate for the living. The deceased newborn can be placed in a bassinette, fully clothed and swaddled in a blanket. Chairs should be provided. Parents should be allowed to hold the baby and to stay as long as they wish.

C

Incorrect. Parents should be allowed to hold the baby and to stay as long as they wish, not until the funeral home personnel come.

D

Incorrect. A nurse should be available to present the baby to the parents just as would be done if the newborn were alive.

PTS:1REF:p. 644 Situations Leading to Loss

OBJ: Cognitive Level: Application

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