Question 1

A recently widowed patient tells the nurse, "I am having epigastric discomfort. I think I have developed an ulcer." Diagnostic tests are negative. Which phenomenon of bereavement is evident?

Accepted Answer

Sensations of somatic distress are often experienced during the acute stage of grieving. They include tightness in the throat, shortness of breath, exhaustion, and pain or sensations such as those experienced by the dead person.

Question 2

Four teenagers died in an automobile accident. One week later, which behaviour by parents indicates adaptive mourning?

Accepted Answer

Loss of a child is among the highest-risk situations for maladaptive grieving. The parents who create a scholarship fund or organize support networks in the child's name are openly expressing their feelings and memorializing their child. The other parents in this question are isolating themselves or denying their feelings, or both.

Question 3

A child drowned while swimming in a local lake 2 years ago. Which behaviour indicates the child's parents are mourning in an effective way?

Accepted Answer

Loss of a child is among the highest-risk situations for maladaptive grieving. The parents who throw flowers on the lake on each anniversary date of the accident are openly expressing their feelings. The other behaviours indicate the parents are isolating themselves or denying their feelings, or both.

Question 4

A patient with a new diagnosis of cancer says, "My father died of pancreatic cancer. I took care of him during his illness, so I know what is ahead for me." Which nursing diagnosis applies?

Accepted Answer

The patient's experience demonstrates anticipatory grieving. The other diagnoses may apply but are not supported by the comment.

Question 5

A husband whose wife is terminally ill says, "I don't want to cry in front of her. I need to be strong for her." Select the nurse's most therapeutic response.

Accepted Answer

Many people try to protect the dying person from experiencing emotions; however, emotional honesty is important to both the patient and the family. The patient may be reassured knowing that the family is facing the inevitable. Giving advice and making judgemental statements are not helpful.

Question 6

A patient who was widowed 18 months ago says, "I can remember good times we had without getting upset. Sometimes I even think about the disappointments. I am still trying to become accustomed to sleeping in the bed all alone."

Accepted Answer

The work of mourning has been successfully completed when the bereaved can acknowledge both positive and negative memories about the deceased and when the task of restructuring the relationship with the deceased is completed.

Question 7

When is the grieving process is more difficult?

Accepted Answer

The following factors can complicate bereavement: high dependency on the deceased, ambivalence toward the deceased, a poor or absent support system, a high number of past losses or other recent losses, poor physical or mental health, and young age of the deceased. Data do not support the other options.

Question 8

Nursing staff spend minimal time with a patient terminally ill with AIDS. The patient confides in the nurse leader, "I am having many confusing emotions. Sometimes I feel angry, sometimes afraid, sometimes abandoned." What is the most likely reason for the staff's avoidance of this patient?

Accepted Answer

Supporting patients at the end of life, as they grow weaker, sicker, and ultimately die, can be overwhelming, challenging the nurse's sense of competency and professionalism. Many nurses tend to be more comfortable with meeting physical needs than in focusing on emotional needs. Standard precautions are necessary for all patients. The patient's lifestyle is irrelevant.

Question 9

After the death of his wife, a man says, "I can't live without her . . . she was my whole life." Select the nurse's most therapeutic reply.

Accepted Answer

A statement that validates the bereaved person's loss is more helpful than banal clichés. It signifies understanding. The other options are clichés.

Question 10

A terminally ill patient says, "I know I will never get well, but . . ." and the patient's voice trails off. Select the most therapeutic response by the nurse.

Accepted Answer

This open-ended response is an example of following the patient's lead. It provides an opportunity for the patient to speak about whatever is on his mind. The distracters are not therapeutic; they block further communication, refocus the conversation, give advice, or suggest the nurse is uncomfortable with the topic.

Question 11

Which is a pathological intensification of death and outcry?

Accepted Answer

Panic, dissociative reactions, and reactive psychoses are all pathological intensifications of death and outcry. Self-punitive feelings is a pathological intensification of dying, not death. Inappropriate hostile feelings is a pathological intensification of dying, not death.

Question 12

A widower tells friends, "I am going to take my neighbour out for dinner. It's time for me to be more sociable again." Which phenomenon of bereavement is evident?

Accepted Answer

Toward the end of bereavement, the person renews interest in people and activities. At the same time, the person is released from the relationship with the deceased. The patient is seeking to move into new relationships.

Question 13

Which finding indicates successful completion of an individual's grieving process?

Accepted Answer

The work of grieving is over when the bereaved can remember the individual realistically and acknowledge both the pleasure and disappointments associated with the loved one. The individual is then free to enter into new relationships and activities. The other options suggest maladaptive grief.

Question 14

After a spouse's death, a patient repeatedly says, "I should have recognized what was happening and been more helpful." This individual is experiencing which of the following?

Accepted Answer

Guilt is expressed by the bereaved person's self-reproach. Preoccupation with the image of the deceased is not evident here. Somatic distress would involve bodily symptoms. Anger cannot be assessed from the data given in the scenario.

Question 15

As death approaches, a patient with AIDS says, "I do not have enough energy for many visitors anymore, and I am embarrassed about how I look. I only want to see my parents and sister." What action should the nurse take?

Accepted Answer

The correct response empowers the patient. As some patients approach death, they begin to withdraw. In the stage of acceptance, many patients are exhausted, and interactions of a social nature are a burden. Many prefer to have someone present at the bedside who will sit without talking constantly.

Question 16

A wife received news that her husband died of heart failure, and she called her family to come to the hospital. She angrily tells the nurse who cared for him, "He would still be alive if you had given him your undivided attention." Select the nurse's best response.

Accepted Answer

When a bereaved family member behaves in a disturbed manner, the nurse should show patience and tact, while offering sympathy and warmth. The distracters are defensive, evasive, or placating.

Question 17

A nurse talks with a woman who recently learned that her husband died while jogging. Select the appropriate statement for the nurse.

Accepted Answer

The most helpful responses by others validate the bereaved person's experience of loss. Avoid clichés because they are ineffective.

Question 18

A woman just received notification that her husband died. She approaches the nurse who cared for him during his last hours and says angrily, "If you had given him your undivided attention, he would still be alive." Which analysis applies?

Accepted Answer

Anger may protect the bereaved from facing the devastating reality of loss. Anger expressed during mourning is not directed toward the nurse personally, even though accusations and blame may make her feel as though it is.

Question 19

Family members of a dying patient ask the nurse, "What can we say when our loved one says, 'Death is coming soon?'" To promote communication, which response could the nurse suggest for family members?

Accepted Answer

The correct response is emotionally honest. It allows the family opportunities to express emotions, address issues in the relationship, and say farewell. The distracters are evasive.

Question 20

A patient with pancreatic cancer says, "I know I am dying, but I am still alive. I want to be in control as long as I can." Which reply by the nurse shows active listening?

Accepted Answer

The patient has strengths and capabilities and is asking for acknowledgment that he is not incapacitated, even though the diagnosis is likely terminal. It is important for the nurse to provide the patient with ways to have control over decisions affecting health and living situations. The correct answer provides that acknowledgment. The other responses are tangential.

Quiz 33: Care for the Dying and for Those Who Grieve