Question 1

A nursing student,who maintained a 4.0 GPA since starting nursing school,started working the past semester,is planning a wedding,and has moved into a new home.The student has not been able to maintain the 4.0 GPA this semester,and as a result is feeling like a failure.How is this loss best described?

Accepted Answer

Perceived losses are uniquely experienced by a grieving person and are often less obvious to others.A perceived loss is very real to the person who has had a loss.For example,a person perceives she is less loved by her parents and experiences a loss of self-esteem.People experience maturational losses as they go through a lifetime of normal developmental processes.For example,when a child goes to school for the first time she will spend less time with her parents,leading to a change in the parent-child relationship.Situational loss occurs as a result of an unpredictable life event.A situational loss often involves multiple losses.A divorce,for example,begins with the loss of a life companion,but often leads to financial strain,changes in living arrangements.People experience an actual loss when they can no longer touch,hear,see,or have near them valued people or objects.Examples include job loss.

Question 2

A nurse is caring for a 3-year-old niece whose mother has recently died of cancer.Because of the child's stage of development,the nurse expects that the child will most likely see the loss of her mother as which of the following?

Accepted Answer

Expressions of grief evolve as individuals mature.Toddlers,for example,cannot understand the permanence of death but feel anxiety over loss of objects and separation from parents.School-age children,although able to understand the significance of loss more completely,see their loss as a challenge to their emerging identity or self-concept.Middle-age adults often use grief experiences to re-examine or reprioritize their lives.Older adults anticipate grief as they encounter declining physical function or life opportunities,give up employment or social status,or lose loved ones.

Question 3

Which of the following would not be appropriate for a patient undergoing palliative care?

Accepted Answer

Palliative care is practiced in any setting and focuses on the prevention,reduction,or relief of physical,emotional,social,and spiritual symptoms of disease or treatment at the end of life when cure is no longer possible.The insertion of a peripherally inserted central line would be beneficial to provide the patient with medications to ease discomfort.Chemotherapy and radiation therapy would be useful in reducing disease symptoms.Knee replacement surgery would not be appropriate for an end-of-life patient.

Question 4

A middle-age patient with a terminal disease is speaking harshly to the nurse every time the call light is answered.The nurse identifies that this patient is experiencing the second stage of Kübler-Ross' stages of dying.What is the second stage?

Accepted Answer

Kübler-Ross' (1969)classic theory identifies five responses to loss: denial,anger,bargaining,depression,and acceptance.Individuals in the denial stage act as though nothing has changed.They cannot believe or understand that a loss has occurred.In the anger stage,a person resists the loss,is angry about the situation,and sometimes becomes angry with God.During bargaining,the individual postpones awareness of the loss and tries to prevent the loss from happening by making deals or promises.A person realizes the full significance of the loss during the depression stage.When depressed,the person feels overwhelmingly lonely or sad and withdraws from interactions with others.During the stage of acceptance,the individual begins to accept the reality and inevitability of loss and looks to the future.

Question 5

The parent of a child who drowned in a neighbor's pool that was not secured,would most likely file a wrongful death lawsuit against the neighbor during which of Bowlby's phases of mourning?

Accepted Answer

During the phase of disorganization and despair an individual spends much time thinking about how and why the loss occurred.The person often expresses anger at anyone he or she believes to be responsible.In the numbing phase,a person has periods of extremely intense emotion and reports feeling "stunned" or "unreal." The yearning and searching phase evokes emotional outbursts,tearful sobbing,and acute distress.To move forward,people need to experience this painful phase of grief.During the final phase of reorganization,which usually requires a year or more,the person accepts unaccustomed roles,acquires new skills,and builds new relationships.

Question 6

The nurse is admitting a 75-year-old patient into the gastrointestinal laboratory for a routine colonoscopy.During the assessment,the nurse learns that the patient's spouse died 4 months earlier because of stomach cancer and that the patient has not been sleeping well.Which phase of Bowlby's mourning phases does the nurse suspect?

Accepted Answer

The yearning and searching phase evokes emotional outbursts,tearful sobbing,and acute distress.Common physical symptoms include tightness in the chest and throat,shortness of breath,a feeling of weakness and lethargy,insomnia,and loss of appetite.In the numbing phase,a person has periods of extremely intense emotion and reports feeling "stunned" or "unreal." The person often expresses anger at anyone he or she believes to be responsible.During the final phase of reorganization,the person accepts unaccustomed roles,acquires new skills,and builds new relationships.

Question 7

A nurse who grew up in Korea has been in the United States for the past 4 years.The nurse is especially sensitive about the differences in how mourning is different between the native culture and that of Western society.The nurse should use which model of mourning to help understand an action-oriented process of grieving?

Accepted Answer

Rando's R Process Model of mourning is specific to Western society.Mourning is an action-oriented process involving recognizing the loss,reacting to the pain of separation,reminiscence,relinquishing old attachments,and readjusting to life after loss.Attachment,the foundation of Bowlby's (1980)four phases of mourning,is an instinctive behavior,which leads to the development of life-long bonds of affection between children and their primary caregivers.The four tasks of mourning theory (Worden,1982)describes how individuals help themselves through mourning and ask others for help.Kübler-Ross' (1969)classic theory identifies five responses to loss: denial,anger,bargaining,depression,and acceptance.

Question 8

The patient's home has been demolished by a tornado.The patient's spouse and child were killed and the spouse is in need of a leg amputation.The nurse realizes that which of the following is true?

Accepted Answer

Individuals respond to loss by using their usual coping strategies.Sometimes when people experience multiple losses or lose something of great significance,their usual coping strategies are inadequate.At the end of life,people often find new coping mechanisms and new resources to maintain control and stability.

Question 9

A 45-year-old widow,who is being seen in a mental health clinic for clinical depression and alcohol dependency,lost her husband and her son in a boating accident 10 months earlier,and has become increasingly despondent and withdrawn.She verbalizes that she feels overwhelmed by her loss.Her daughter urged her mother to seek help.Which type of complicated grief best explains Eleanor's behavior?

Accepted Answer

People having an exaggerated grief response are overwhelmed by their loss,have difficulties functioning,and display significant behavioral dysfunction.Chronic grief occurs when the active acute mourning experienced in normal grief reactions does not decrease and continues over long periods of time.When people consciously or unconsciously avoid the pain of loss and do not experience common grief reactions at the time of the loss,they have a delayed grief reaction.Masked grief occurs after a significant loss in which some people are unable to recognize that the behaviors making normal functioning difficult are a result of their loss.For example,a person who loses a pet develops changes in sleeping patterns but does not see the connection between the two events.

Question 10

A widow,whose spouse died 3 years ago,has recently started dating and is thinking about going back to school to complete a degree she had started at an earlier age.Which of Bowlby's phases of mourning best describes this behavior?

Accepted Answer

During the final phase of reorganization,which usually requires a year or more,the person accepts unaccustomed roles,acquires new skills,and builds new relationships.In the numbing phase,a person has periods of extremely intense emotion and reports feeling "stunned" or "unreal." The numbing phase lasts from several hours to a week.The yearning and searching phase evokes emotional outbursts,tearful sobbing,and acute distress.To move forward,people need to experience this painful phase of grief.During the phase of disorganization and despair an individual spends much time thinking about how and why the loss occurred.The person often expresses anger at anyone he or she believes to be responsible.Gradually this phase gives way to an acceptance that the loss is permanent.

Question 11

Bowlby's phases of mourning are founded on which of the following human instincts?

Accepted Answer

Attachment,the foundation of Bowlby's (1980)four phases of mourning,is an instinctive behavior,which leads to the development of life-long bonds of affection between children and their primary caregivers.In the numbing phase,a person has periods of extremely intense emotion and reports feeling "stunned" or "unreal." The numbing phase lasts from several hours to a week.The yearning and searching phase evokes emotional outbursts,tearful sobbing,and acute distress.To move forward,people need to experience this painful phase of grief.

Question 12

A recently widowed mother of two worked with her late husband while he was starting his own business and was managing the accounting paperwork.The family had no life or health insurance.When her husband suddenly died,she was left with a large hospital bill,funeral expenses,unemployment,and no means of support.How are the multiple losses that this woman is experiencing best described?

Accepted Answer

Situational loss occurs as a result of an unpredictable life event.A situational loss often involves multiple losses.A divorce,for example,begins with the loss of a life companion,but often leads to financial strain and changes in living arrangements.People experience maturational losses as they go through a lifetime of normal developmental processes.For example,when a child goes to school for the first time she will spend less time with her parents,leading to a change in the parent-child relationship.People experience an actual loss when they can no longer touch,hear,see,or have near them valued people or objects.Examples include the loss job.Perceived losses are uniquely experienced by a grieving person and are often less obvious to others.A perceived loss is very real to the person who has had a loss.For example,a person perceives she is less loved by her parents and experiences a loss of self-esteem.

Question 13

A businessman who had been employed at one company since graduating from college was recently downsized at work and is unemployed.He was always very proud of this job and is grieving the loss.What type of loss is this?

Accepted Answer

People experience an actual loss when they can no longer touch,hear,see,or have near them valued people or objects.Examples include job loss.People experience maturational losses as they go through a lifetime of normal developmental processes.For example,when a child goes to school for the first time she will spend less time with her parents,leading to a change in the parent-child relationship.Situational loss occurs as a result of an unpredictable life event.A situational loss often involves multiple losses.A divorce,for example,begins with the loss of a life companion,but often leads to financial strain and changes in living arrangements.Perceived losses are uniquely experienced by a grieving person and are often less obvious to others.A perceived loss is very real to the person who has had a loss.For example,a person perceives she is less loved by her parents and experiences a loss of self-esteem.

Question 14

A patient's daughter died in a ski accident.The patient stated,"I cannot believe my daughter has died." According to Worden's tasks of mourning,the patient is experiencing task:

Accepted Answer

Task II is working through the pain of grief.It is impossible to experience a loss without some degree of emotional pain.Individuals who deny or suppress the pain often prolong their grief.Task I occurs when the individual accepts the reality of the loss.Task III occurs when people adjust to the environment in which the deceased is missing.Task IV occurs when the person emotionally relocates the deceased and moves on with life.

Question 15

A parent of three children has the oldest child start school this year,and the parent cries as the child is left at kindergarten on the first day.How is the loss that the parent is experiencing best described?

Accepted Answer

People experience maturational losses as they go through a lifetime of normal developmental processes.For example,when a child goes to school for the first time she will spend less time with her parents,leading to a change in the parent-child relationship.Situational loss occurs as a result of an unpredictable life event.A situational loss often involves multiple losses.A divorce,for example,begins with the loss of a life companion,but often leads to financial strain,changes in living arrangements.People experience an actual loss when they can no longer touch,hear,see,or have near them valued people or objects.Examples include the loss job.Perceived losses are uniquely experienced by a grieving person and are often less obvious to others.A perceived loss is very real to the person who has had a loss.For example,a person perceives she is less loved by her parents and experiences a loss of self-esteem.

Question 16

A patient has been suffering from liver cancer for more than a year.The family has requested hospice services.The family members are taking turns staying with the patient.They have been reminiscing with the patient about her life and are now saying their good-byes.The type of grief that this family is experiencing is best described as which of the following?

Accepted Answer

The process of "letting go" that occurs before an actual loss or death has occurred is called anticipatory grief.Normal or uncomplicated grief consists of commonly expected emotional and behavioral reactions to a loss (e.g.,resentment,sorrow,anger,crying,loneliness,and temporary withdrawal from activities).Complicated grief happens when a person has difficulty progressing through the loss experience.The person does not accept the reality of the loss,and the intense feelings associated with acute grief do not go away.Disenfranchised grief occurs in situations in which others view a person's loss as insignificant or invalid.

Question 17

A young widower who lost his wife in Afghanistan has worked through the first task of Worden's mourning theory.He asks you if he will ever feel able to move forward with his life.According to Worden's theory,what is your best response?

Accepted Answer

Although the time needed varies from person to person,moving through Worden's tasks typically takes a minimum of 1 year.The other responses are not helpful to the patient.

Question 18

The nurse is caring for a patient of the Chinese community who is dying.The nurse needs to understand the Chinese community's beliefs regarding death,but it is most important to keep in mind which of the following?

Accepted Answer

In Western societies,many people grieve privately and restrain their emotions.In other cultures,survivors wail loudly and publicly display their sorrow to communicate the significance of their loss to others.Some Chinese communities consider death to be a taboo subject and believe that discussion of the topic brings bad luck.Most people practicing the Hindu religion believe in reincarnation and use those beliefs to interpret events surrounding the death of a loved one.Although members of a cultural or religious group often share similar beliefs,people still respond in their own unique way.

Question 19

A patient has been admitted to the hospital with advanced colon cancer and is receiving palliative care at this time.The nurse feels anxious in caring for this patient,but realizes which of the following?

Accepted Answer

Many nurses become anxious when caring for dying patients or people coping with grief and loss.Confidence helps you to understand that even if there is nothing you can do or say to change the situation,the patient needs your compassionate presence and a personal connection.Confidence helps you accept the responsibility to remain present even in difficult situations.By silently sharing a moment of sadness with a patient or family member,you communicate caring and send the message that you respect and accept their feelings in the moment.Do not assume that other people react to loss or grief as you do or that a particular behavior necessarily indicates grief.Encouraging patients to tell stories about their loved one gives them an opportunity to provide information in a natural,unstructured,and meaningful way.

Question 20

A 34-year-old single mother of three had been involved in a secret relationship with her boss,a married man who was 24 years her senior.When her boss suddenly died as the result of a heart attack,the woman had difficulty expressing the extent of her loss.The grief that she was experiencing could best be described as which of the following?

Accepted Answer

Disenfranchised grief occurs in situations in which others view a person's loss as insignificant or invalid.For example,a grieving woman does not experience support from her parents when experiencing the loss of her ex-husband.Complicated grief happens when a person has difficulty progressing through the loss experience.The person does not accept the reality of the loss,and the intense feelings associated with acute grief do not go away.Normal or uncomplicated grief consists of commonly expected emotional and behavioral reactions to a loss (e.g.,resentment,sorrow,anger,crying,loneliness,and temporary withdrawal from activities).The process of "letting go" before an actual loss or death has occurred is called anticipatory grief.

Quiz 26: Loss and Grief