Chapter 28: Grief: In Loss and Death My Nursing Test Banks

Fortinash: Psychiatric Mental Health Nursing, 5th Edition

Chapter 28: Grief: In Loss and Death

Test Bank

MULTIPLE CHOICE

1. Which physical disturbance is commonly assessed in patients experiencing acute grief?

a.

Hypersomnia

b.

Increased appetite

c.

Tightness in the chest

d.

Cardiovascular problems

ANS: C

Chest discomfort is common with the bereaved person. Anorexia is more common. There is no research to support the connection with cardiovascular involvement. Insomnia is more frequent than sleepiness.

DIF: Cognitive Level: Application REF: Page 650

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. When differentiating between bereavement symptoms and depression, the nurse will base the formulation on knowledge that in bereavement:

a.

Suicide thoughts are common.

b.

Symptoms remit and exacerbate.

c.

Guilt feelings are overwhelming.

d.

Psychomotor retardation is obvious.

ANS: B

Acute exacerbations are common especially around holidays and significant milestones. The remaining options are more common with depression.

DIF: Cognitive Level: Application REF: Page 649

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

3. A grief support group is held at the local community center to assist persons who are dealing with issues of loss. Which remark by one of the members would the nurse interpret as indicating unresolved feelings of guilt?

a.

I know that my husband had a good life.

b.

It seems I miss my son more as time goes on.

c.

I am still wishing I had gotten help to him sooner.

d.

The Christmas season is always a sad time for me.

ANS: C

Unresolved guilt reflects that the person should have done more. Expressing peace with a situation indicates closure on the husbands life. Missing indicates continued grieving but not guilt. Reflection on difficult times is not guilt.

DIF: Cognitive Level: Application REF: Page 654

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

4. A young woman had just learned of the accidental death of her husband. She begins to cry and states, Its not fair! How could he do this to me? This remark is assessed as:

a.

A plea for help

b.

An explosive episode

c.

An expression of anger

d.

Fear of making decisions alone

ANS: C

The remark indicates anger that her husband died on purpose. She is not asking for help nor is there data to support an explosive response. She is not stating fear.

DIF: Cognitive Level: Application REF: Page 646

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5. Family and friends rush to offer support to a friend who has lost her teenage son. Which of these persons, through an intended act of kindness, may contribute to prolonging the womans grief?

a.

The physician who prescribed antianxiety agents

b.

The nurse who offered to spend the night at her home

c.

The next-door teenager who provided care for the sons pet

d.

The accountant who assisted with stabilizing their financial affairs

ANS: A

Frequent use of anxiolytic medications can mask grief. The other options are usual offers of assistance.

DIF: Cognitive Level: Analysis REF: Page 654

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

6. When a hospitalized patient dies, his wife stares blankly at the nurse and states, It cant be. The nurse assesses this as indicating:

a.

Despair and protest

b.

Shock and disbelief

c.

Anger and hostility

d.

Disorganization and confusion

ANS: B

Shock and disbelief are often the first responses to a death, followed by protest and despair. The wifes statement does not indicate confusion or anger.

DIF: Cognitive Level: Application REF: Page 646

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

7. When asked, the nurse explains that grief work refers to:

a.

Establishing new methods of coping with stress

b.

Evaluating progress made toward accepting the loss

c.

The means by which one moves through the grief process

d.

Actively seeking assistance to cope with the loss experiences

ANS: C

Grief work is moving through the stages of grief. The remaining options can be components of grief work.

DIF: Cognitive Level: Application REF: Page 644

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

8. A teen is grieving the loss of her pet dog. She states to her mother, I miss my dog so much, but I know that if I start crying, I will never stop. The teen is expressing a fear of:

a.

Losing control over her emotions

b.

Appearing emotionally immature

c.

Embarrassing herself by crying in public

d.

Losing the support of her friends and family

ANS: A

The teens statement that she will never stop indicates a control concern. The statement does not indicate embarrassment, immaturity concerns, or lack of support.

DIF: Cognitive Level: Application REF: Page 654

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

9. During a grief-processing group, an elderly patient stated, For the first time since my husband died, Im having more good days than bad. This statement suggests that the patient has:

a.

Replaced old memories with new ones

b.

Reached the phase of reestablishment

c.

Completed her grief work successfully

d.

Determined she is ready to terminate the support group

ANS: B

Reestablishment is the gradual decrease in symptoms. There are not enough data to support the remaining options.

DIF: Cognitive Level: Application REF: Pages 644-645

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

10. A patient returned from attending the service memorializing his wife, who died after a sudden illness. Although those around him were visibly saddened, he smiled and remained in control. He refused support from friends, stating, I can handle anything that comes my way. The patients behavior is an example of _____ grief.

a.

Normal

b.

Inhibited

c.

Distorted

d.

Conflicted

ANS: B

The statement indicates inhibited grief that is characterized by minimal emotional expression of grief. There is not enough data to support conflicted grief, which involves ambivalence in the relationship with the departed. Distorted grief is not one of the standard types, and normal grief is not characterized by this behavior.

DIF: Cognitive Level: Application REF: Page 647

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

11. Which person would the nurse assess as experiencing chronic sorrow?

a.

The mother of a child diagnosed with asthma

b.

The father of an adult son who is a schizophrenic

c.

The daughter whose father experienced a hip replacement

d.

The wife whose husband has recently requested a trial separation

ANS: B

The only situation that presents as a long-term, chronic loss is having a child with a chronic disorder like schizophrenia. The other situations are resolving or at least hopeful for recovery.

DIF: Cognitive Level: Application REF: Page 648

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

12. A patient is being seen for symptoms of insomnia and significant weight loss that has occurred during the 2 months since her husbands death. What is the purpose of the query, Describe how it has been for you since your husband died?

a.

To display an attitude of concern and sympathy to the patient

b.

To learn whether the patient has a significant support system

c.

To rule out factors that may interfere with diagnosing her illness

d.

To determine the risk for pathologic grief and the need for grief therapy

ANS: D

The question is a common assessment question to determine the grief work that has been done. The query does not ask about support systems or specific factors, and the query is more than a display of concern.

DIF: Cognitive Level: Application REF: Page 650

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

13. A nurse plans care based upon the fact that anticipatory grief:

a.

Is associated with a high risk for depression

b.

Is associated with fewer expressions of guilt

c.

Prevents development of symptoms of depression

d.

Requires a longer period of time to effect resolution

ANS: A

Pre-mourning or anticipatory grief is associated with a high risk for depression or family withdrawal from the patient. It is normative and does not necessarily require a longer period of resolution or indicate fewer guilt expressions. It does not prevent depression.

DIF: Cognitive Level: Application REF: Page 646 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

14. A woman whose abusive husband was killed in an automobile accident 3 years earlier continues to idealize him and repeatedly talks about their wonderful relationship. Which outcome is most appropriate for the patient? Patient will:

a.

Enlist the emotional support of both family and friends.

b.

Keep a daily journal recording memories of time spent with her husband.

c.

Read information on the affects of physical abuse and the support groups available to her.

d.

Express both positive and negative feelings about her husband and their life together.

ANS: D

Chronic grief involves unresolved issues in a relationship with the person who died. In this case, a more realistic expression of their life together is needed. The remaining options are appropriate but do not address the primary need to establish realistic memories of the relationship.

DIF: Cognitive Level: Analysis REF: Page 648

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychosocial Integrity

15. During a bereavement group, one of the members states, I should have been the one to die. My husband had so much to offer. The member was expressing:

a.

An intention to commit suicide

b.

Ambivalence and low self-esteem

c.

Unresolved anger toward her husband

d.

A need for attention from group members

ANS: B

The statement suggests low self-esteem. There is no mention of suicidal ideation. This is not simply an attention-getting statement. The statement does not imply anger.

DIF: Cognitive Level: Application REF: Page 653

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

16. The community health nurse is visiting a patient diagnosed with dysfunctional grieving since the death of his wife and child over a year ago. Which actions should the nurse implement first?

a.

Promote interaction with others.

b.

Assess risk of self-directed violence.

c.

Facilitate expression of feelings related to the loss.

d.

Determine the degree of ambivalence toward the loss.

ANS: B

Safety issues would be the priority in cases of depression and dysfunctional grief. The remaining options are appropriate actions after risk is assessed.

DIF: Cognitive Level: Analysis REF: Page 647

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

17. An adult patient shares that, When my mother died when we were children, I never saw my father show any emotion. What do you think will happen with those unexpressed feelings? Which response is most appropriate?

a.

Pent-up emotions may lead to depression or other disorders.

b.

Your father probably has worked through his grief by this time.

c.

Maybe you can teach him how to best express his own feelings.

d.

If feelings are not effectively expressed, the person can become suicidal.

ANS: A

Inhibited expression of grief can lead to depression. It cannot be assumed that the grieving process has been completed. The adult child should not be made to feel responsible for counseling the father. Unexpressed feelings do not necessarily lead to suicidality.

DIF: Cognitive Level: Application REF: Page 647

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

18. An elderly couple who lived in the same home for the past 50 years have moved into an adult retirement center in a nearby town. Changes in lifestyle such as this couple is experiencing should alert the nurse to the possibility of:

a.

Acute grief

b.

Traumatic grief

c.

Chronic sorrow

d.

Adventitious crisis

ANS: A

Adjustment to life cycle transitions may initiate acute grief. This could be a situational crisis but not an adventitious crisis. There are no indications that this will become chronic and lacks the magnitude needed to result in traumatic grief.

DIF: Cognitive Level: Application REF: Page 642 | Page 646

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

19. A teenage boy has lost his best friend as a result of a hunting accident. His parents report that he is eating and sleeping very little and expresses little interest in school. They are concerned that he talks about the accident repeatedly. These behaviors are generally seen as:

a.

Expressing responsibility for his friends death

b.

Attempts to avoid dealing with his pain

c.

Expressions of a normal grief reaction

d.

Indications of a risk for self-harm

ANS: C

The teen is displaying normal grief responses. He is not avoiding his pain but rather expressing it various ways. There are no data to support that he feels responsible. He has not expressed suicidal ideation.

DIF: Cognitive Level: Application REF: Page 643

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20. An outcome for a patient experiencing anticipatory grieving for a spouse diagnosed with terminal cancer would be that the patient will:

a.

Continue to be emotionally involved with the dying spouse

b.

Develop protective mental mechanisms to allay the pain of spousal loss

c.

Not voice threats of physical violence that is either self or others directed

d.

Agree to stay at home and care for the spouse with appropriate assistance

ANS: A

Some families who are experiencing anticipatory grieving withdraw prematurely from the ill member, so this is an important outcome. There are no protective mechanisms to prevent loss experiences. Anticipatory grieving does not imply violence. A contract to stay home and care for the spouse even with assistance is not helpful.

DIF: Cognitive Level: Application REF: Page 646

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychosocial Integrity

21. Which patient would the nurse determine to be at highest risk for dysfunctional grief? The patient:

a.

Whose 16-year-old daughter was raped and killed while going on an errand for the patient

b.

Whose 86-year-old mother, with whom she has shared her home, died after a long illness.

c.

Who attended a support group and had been assisted by hospice to care for her terminally ill husband

d.

Who attended a bereavement group, where she learned to express feelings after the deaths of her twin daughters

ANS: A

The traumatic nature of the death makes this patient at highest risk. The death of the mother was of an elderly person and expected. The remaining options involve patients involved with hospice or support groups that lessen the likelihood for dysfunctional grief.

DIF: Cognitive Level: Application REF: Page 648

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

22. Which intervention will the nurse planning care for a patient with acute grief implement?

a.

Providing information about the grief process

b.

Encouraging dependence on the nurse for support

c.

Suggesting utilization of community resources in a few weeks

d.

Advising the patient to minimize contact with nonfamily members

ANS: A

Patient education is always helpful. Limiting contact with support is not helpful. Postponing use of resources and encouraging dependence on the nurse are unhelpful and therefore incorrect.

DIF: Cognitive Level: Application REF: Page 653 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

23. The nurse determines that the most effective point of intervention for bereavement is:

a.

Promotion of mental and spiritual health across the life span

b.

At the time a newly discovered loss is impending

c.

Immediately after the loss has occurred

d.

When requested by the patient

ANS: A

Effective health promotion before stress and loss regardless of age is most helpful. The remaining options provide help around the time of loss, which is helpful but not as effective as long-term help throughout a persons life.

DIF: Cognitive Level: Analysis REF: Pages 648-649

TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

24. The nurse counseling a patient with acute grief would assess the patient for:

a.

Severe depressive symptoms

b.

Conflicted and unresolved issues

c.

Increased arousal and hypervigilance

d.

Preoccupation with the image of the deceased

ANS: D

Acute grief can involve images of the deceased. Acute grief does not include severe depression or conflicted issues. Hypervigilance is a PTSD symptom.

DIF: Cognitive Level: Application REF: Pages 646-647

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

25. Which person has the greatest potential for developing dysfunctional grief?

a.

A teen who has always been one of the popular kids

b.

A widow who regularly states, I really loved my deceased wife

c.

A woman whose husband died as a result of a sudden, traumatic injury

d.

An adult who has dealt with the loss of several family members over the years

ANS: C

A sudden separation could increase risk for dysfunctional grieving. An extensive social support network and a loving relationship do not predispose to dysfunctional grief. Appropriate grief work in the past would not increase the risk for dysfunction.

DIF: Cognitive Level: Application REF: Page 648

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

26. The common element seen in every type of bereavement is:

a.

Bereavement is a predictable process that is a result of loss.

b.

The individual has experienced the loss of something of importance.

c.

Acute depression is generally experienced by all who grieve for a loss.

d.

The course of the grieving will be determined by the seriousness of the loss.

ANS: B

Each type of loss means that something meaningful has been taken away, whether it is physical, psychological, social, or symbolic. The remaining options are not true statements regarding bereavement.

DIF: Cognitive Level: Application REF: Page 641

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

27. Which statement best explains how a mother of several children should prepare to help them cope with the loss of a dear aunt?

a.

Children are resilient and simply need love as they grieve.

b.

People regardless of age or gender experience stages of grief.

c.

Each child will grieve in a unique way and on their own timetable.

d.

Extreme reactions are more commonly observed in the young griever.

ANS: C

No two people regardless of age will grieve the same way, even in the same family. Each persons grief has unique characteristics and a timetable all its own. It is not necessarily true that young grievers experience severe reactions to loss and require only love during this experience. Although most individuals do experience the various stages of grief, that information is not the most instructive for the mother.

DIF: Cognitive Level: Application REF: Page 648

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. The patients daughter was murdered while they were customers in a local bank. Which statements would support the patients diagnosis of posttraumatic stress disorder (PTSD)? Select all that apply:

a.

I feel numb, like a robot going through the motions of existing.

b.

Im so nervous and jump at the slightest noise.

c.

I have not slept very well at all since I lost her.

d.

I cant stop reliving the last time I saw her alive.

e.

Id love nothing better than to kill that murderer.

ANS: A, B, C, D

The traumatic nature of the murder and the patients symptoms of hypervigilance, intrusive thoughts, and numbness indicate PTSD. Homicidal thoughts are not generally associated with PTSD.

DIF: Cognitive Level: Analysis REF: Page 647

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

Copyright 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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