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varcarolis chapter 25. Care for the Dying and Those Who Grieve quizlet

Terms in this set (40)

1. A nurse working with a person whose spouse recently died uses cheer and humor to lift the person's spirits. At one point, the widowed person smiles briefly. What analysis of this scenario is correct?a. The nurse's technique was effective.b. Use of humor should be added to the plan of care.c. This approach may prove useful in other, similar situations.d. The nurse needs supervision; the communication technique was not appropriate.
D
2. A patient's fiancé died in an automobile accident several days ago. The patient reports crying and experiencing feelings of guilt and anger. This behavior is characteristic of which stage of acute grief?a. Denialb. Reorganizationc. Development of awarenessd. Preoccupation with the lost object
C
3. After the death of a spouse, an adult repeatedly says, "I should have made him go to the doctor when he said he didn't feel well." This individual is experiencing:a. preoccupation with the image of the deceased.b. sensations of somatic distress.c. anger.d. guilt.
D
4. A person whose spouse died two years earlier tells friends, "I think I'll start going out socially, maybe even take someone to dinner." This comment best demonstrates that the individual is:a. denying the significance of the loss.b. in a period of resolution of grief.c. actively working through grief.d. experiencing intrusion.
B
5. After the death of his wife, a man tells the nurse, "I can't live without her. She was my whole life." Which is the nurse's most therapeutic reply?a. "Each day will get a little better."b. "Her death is a terrible loss for you."c. "Remember, she's no longer suffering."d. "Your friends will help you cope with this."
B
6. Shortly after a man's wife dies, the man approaches the nurse who cared for his wife during her final hours of life and says angrily, "If you had given your undivided attention, she would still be alive." Which analysis applies?a. The comment summarizes the nurse's inadequacies.b. Anger is a phenomenon experienced during grieving.c. The patient had ambivalent feelings about his spouse.d. In some cultures, grief is expressed solely through anger.
B
7. After being notified that her husband died of heart failure, a wife approaches the nurse who cared for her husband. In the hospital hallway the wife shouts angrily, "He'd still be alive if you'd given him your undivided attention!" Select the nurse's best response.a. "I understand you're feeling upset. Let's go to our conference room, and I'll stay with you until your family comes."b. "Your husband's heart was severely damaged and could no longer pump. There's nothing anyone could have done."c. "I will call the nursing supervisor to discuss this matter with you."d. "It will be all right if you cry. Crying is a normal grief response."
A
8. An adult who was widowed 18 months ago says, "I can now remember good times we shared without getting upset. Sometimes I even think about the disappointments. I've become accustomed to sleeping in our bed alone." The work of mourning:a. is beginning.b. is progressing abnormally.c. is at or near completion.d. has not begun.
C
9. The mourning process is more difficult when the bereaved:a. was relatively independent of the deceased.b. has experienced a number of previous losses.c. accepts that death is expected for older adults.d. had few unresolved conflicts with the deceased.
B
10. A patient newly diagnosed with pancreatic cancer says, "My father also died of pancreatic cancer. I took care of him during his illness. I can't go through that." Select the highest priority nursing diagnosis.a. Anticipatory grievingb. Ineffective copingc. Ineffective deniald. Risk for suicide
D
11. A nurse talks with a person whose spouse died suddenly while jogging. Which is the appropriate statement for the nurse?a. "At least your spouse did not suffer."b. "It's better to go quickly as your spouse did."c. "The loss of your spouse must be very painful for you."d. "You'll begin to feel better after you get over the shock."
C
12. A recently widowed patient tells the health care provider, "I have so much epigastric discomfort. I wonder if I have an ulcer." Diagnostic tests are negative. The symptom demonstrates:a. early reorganization behavior.b. disorganization and depression.c. preoccupation with the deceased.d. normal phenomenon of mourning.
D
13. Which finding indicates the successful completion of an individual's grieving process?a. For two years, a person has kept the deceased spouse's belongings in their usual places.b. After 15 months, a widowed person realistically remembers both the pleasures and disappointments of the relationship with the spouse.c. Three years after the death, a person talks about the spouse as if the spouse was still alive and weeps when others mention the spouse's name.d. Eighteen months after the spouse's death, a person says, "I never cry or have feelings of loss even though we were always very close."
B
14. A child drowned while swimming in a local lake four years ago. Which behavior indicates that the parents are effectively coping with their loss? The parents:a. prohibit their other children from going swimming.b. keep a place set for the dead child at the family dinner table.c. keep their child's room exactly as the child left it four years ago.d. throw flowers on the lake at each anniversary date of the accident.
C
15. A patient diagnosed with metastatic brain cancer says, "I'm dying, but I'm still living. I want to be in control as long as I can." Which reply shows the nurse was actively listening?a. "Our staff will do their best to help you feel comfortable."b. "Most people do not know how to help and are afraid of death."c. "Your mind and spirit are healthy, although your body is frail."d. "You want people to stop focusing on your weaknesses."
C
16. A terminally ill patient says, "I know I'm not going to get well, but still..." and the patient's voice trails off. Which response by the nurse would be therapeutic?a. "What do you hope for?"b. "No, you're not going to get well."c. "Do you have questions about what is happening?"d. "I'm happy you are being realistic about your future."
A
17. A woman whose husband is terminally ill says, "I don't want to cry in front of him. I don't want him to know how close he is to death or how sad I am." Which response by the nurse would be most therapeutic?a. "You're right to protect him at a time when he is so vulnerable."b. "He might be more comforted than disturbed by your tears."c. "It's important for you to know that time is running out."d. "You definitely need to be honest about your feelings."
B
18. A family of a terminally ill patient asks the nurse, "What can we say when our family member mentions death is coming soon?" Which response could the nurse suggest?a. "We think you will be around for a long time."b. "We don't want you to give up trying to get well."c. "We don't think we're ready to talk about this yet."d. "We feel so sad when we think of life without you."
D
19. As death approaches, a patient diagnosed with acquired immunodeficiency syndrome (AIDS) says, "I don't want to see a lot of visitors anymore. Just my parents and my sibling can come in for a while each day." What action should the nurse take?a. Ask the patient to reconsider the decision because many interested and caring friends can be sources of support.b. Discuss the request with the parents and sibling. Suggest that they explain the patient's decision to friends.c. Suggest that the patient discuss these wishes with the health care provider.d. Place a "no visitors" sign on the patient's door.
B
20. A nurse manager notices that a staff member spends minimal time with a patient diagnosed with AIDS who is terminally ill. The patient says, "I'm having intense emotional reactions to this illness. Sometimes I feel angry, but other times I feel afraid or abandoned." The nurse manager can correctly hypothesize that the most likely reason for the staff member's avoidance is:a. fear of infection transmission.b. feelings of inadequacy in dealing with complex emotional needs.c. knowledge that the patient needs time alone with family and friends.d. belief that the patient's former lifestyle included high-risk behaviors.
B
21. A terminally ill patient tells the nurse, "Life has been good. I am proud of being self-educated. I overcame adversity with willpower. I always gave my best and expected things to turn out well. I intend to die as I lived: optimistically." The nurse planning care for this patient recognizes a critical need to:a. provide aggressive pain and symptom management.b. help the patient reassess and explore existing conflicts.c. assist the patient to focus on the meaning in life and death.d. support the patient's use of personal resources to meet challenges.
D
22. The spouse of a patient in hospice care angrily tells the nurse, "The care provided by the aide and other family members is inadequate, so I must do everything myself. Can't anyone do things right?" The palliative care nurse should:a. provide teaching about anticipatory grieving.b. assign new personnel to the patient's care.c. arrange hospitalization for the patient.d. refer the spouse for crisis counseling.
A
23. An individual was killed during a store robbery 2 weeks ago. The widowed spouse, who is diagnosed with schizoaffective disorder, cries spontaneously when talking about the death. Which is the nurse's most therapeutic comment?a. "I'm worried about how much you're crying. Your grief over your spouse's death has gone on too long."b. "The unexpected death of your spouse must be painful. I'm glad you're able to talk to me about your feelings."c. "This loss is harder to accept because of your mental illness. Let's refer you to the partial hospitalization program."d. "Your crying shows me you aren't coping well. I made an appointment for you to see the psychiatrist for medication adjustment."
B
24. Children of a widowed parent confer with the nurse; their surviving parent repeatedly relates the details of finding the deceased parent not breathing, performing cardiopulmonary resuscitation, going to the hospital by ambulance, and seeing the pronouncement of death. The family asks, "What can we do?" The nurse should counsel the family:a. to share their own feelings with the surviving parent and ask for the retelling to stop.b. that retelling the story should be limited to once daily to avoid unnecessary stimulation.c. that retelling memories is to be expected as part of the aging process.d. that repeating the story is a helpful and a necessary part of grieving.
D
25. A widow grieving her husband's sudden death tells the nurse, "I'm not feeling well. Yesterday, I saw my husband walk through the door, stop, and smile at me. Then he just faded away." Which is the nurse's most appropriate action?a. Assess for recent substance abuse.b. Suggest a referral to the mental health clinic.c. Arrange for an evaluation for antidepressant medication.d. Counsel the widow that visualizations are a normal part of grieving.
D
26. A grieving patient tells a nurse, "It's been eight months since my spouse died. I thought I would feel better by now, but lately I feel worse. I have no energy. I am lonely, but I don't want to be around people. What should I do?" What is the nurse's best counsel?a. Seek psychotherapy.b. Become active in a church.c. Go to the spouse's grave every day.d. Understand this is a normal response.
D
27. A nurse cared for a terminally ill patient for over a month and always looked forward to spending time with the patient. When the patient died, the nurse experienced sadness and felt mildly depressed. Eventually, the nurse explains these feelings to a mentor. The mentor should counsel the nurse:a. about stress-reduction strategies.b. to seek therapy for dysfunctional grief.c. about the experience of disenfranchised grief.d. to consider taking a leave of absence to pursue healing.
C
1. Which actions by a nurse contribute to protecting the rights of patients who are terminally ill? Select all that apply.a. Maintain hope for a positive prognosis.b. Hug the patient when sadness is expressed.c. Offer choices that promote personal control.d. Provide interventions that convey respect.e. Support the patient's quest for spiritual growth.
CDE
2. Which statements by a patient who is terminally ill give the nurse information relevant to spiritual assessment? Select all that apply.a. "I feel an inner peace with my decision to use hospice services."b. "I trust my health care provider to prescribe enough medication to keep me free of pain."c. "I have prepared advance directives to spare my children the need to make difficult decisions."d. "I plan to use these last weeks to experience the process of dying as fully as I experienced the richness of living."e. "Listening to hymns helps deepen my relaxation and the relief I get from my pain medication."
ADE
3. Psychotherapy for individuals at risk for complicated grief focuses on which goals? Select all that apply.a. Exploring emotional responses to a lossb. Identifying ways to break bonds with the deceasedc. Solving problems related to moving forward in lifed. Learning about the stages and symptoms of grievinge. Using antipsychotic medications for dysfunctional grief
ACD
The nurse is talking to an adolescent about the death of his father 2 years ago. Which statement indicates a healthy progression in resolving this loss?1. "I never really had any feelings about his death."2. "I drive my father's old car which is nearly broken down, but I cannot give it up as it reminds me of him."3. "I still can barely make it through the day without sobbing."4. "Of course I loved my father, but he was not perfect."
4
Which statement indicates that a patient has successfully mourned a loss in his/her life?1. "She was so strong after her husband died. She never cried the whole time. She kept a stiff upper lip."2. "She was a wreck when her sister died. She cried and cried. It took her about a year before she resumed her usual activities with any zest."3. "You know, he still talks about his mother as if she were alive today, and she's been dead for 4 years."4. "He never talked about his wife after she died. He just picked up and went on life's way."
2
After having a mastectomy, a patient shows no emotion, asks no questions and smiles almost continually. The nursing priority is to focus on:1. identification of the patient's support system2. a knowledge deficit pertaining to her illness3. referral for the patient to see a psychiatrist4. the meaning of the mastectomy to the patient
4
A patient tells the nurse that his wife of 50 years died unexpectedly 6 weeks ago. The best response from the nurse would be:1. "It must be comforting to know you had a wonderful marriage."2. "It often takes 6 weeks to get over a loss such as yours"3. "Certain medications might be very helpful for you at this time."4. "This must be a difficult time for you now."
4
Which responses of a child to a father's untimely death represent an early stage of normal grieving? Select all that apply.1. The child lies in bed, banging his head against the mattress, shouting, "No, no, no!"2. The child refuses to go to school 2 weeks after his father's funeral, claiming "aches and pains all over my body."3. The child begins to obsessively attend to his game card collection and spends hours sorting and ordering cards for the first month after his father's death4. The child repeatedly comes home from school and reports "seeing Dad" around a corner, but then "he just disappears."
1234
1. Sixteen years ago a toddler died in a tragic accident. Once a year, the parents place flowers at the accident site. How would the nurse characterize the parents' behavior?a. Mourningb. Bereavementc. Complicated griefd. Disenfranchised grief
A
2. A recently widowed adult says, "I've been calling my neighbors often but they act like they don't want to talk to me. I just need to talk about it, you know?" What is the nurse's best action?a. Say to the person, "You may call me anytime you need to talk."b. Ask the person, "What do you mean by 'I just need to talk about it'?"c. Educate the person about the importance of finding alternative activities.d. Tell the person the location and time of a local bereavement support group.
D
3. A physician informed an adult of the results of diagnostic tests that showed lung cancer. Later in the day the patient says to the nurse, "My doctor said I have breathing problems, right?" Which nursing diagnosis is applicable?a. Denial related to acceptance of new diagnosisb. Chronic sorrow related to unresolved life conflictsc. Situational low self-esteem related to stress of new diagnosisd. Acute confusion related to metastatic changes to cerebral function
A
4. A nurse leads a bereavement group. Which participant's comment best demonstrates that the work of grief has been successfully completed?a. "Our time together was too short. I only wish we had done more things together."b. "I know our life together was a blessing that I did not deserve. I wish I had said 'I love you' more often."c. "Other people knew my loved one as a good and helpful person. I hope people see me in the same way."d. "Our best vacations always involved water. When I see pictures of the ocean, those memories come flooding in."
D
5. A nurse who has worked for a community hospice organization for 8 years says, "My patients and their families experience overwhelming suffering. No matter how much I do, it's never enough." Which problem should the nursing supervisor suspect?a. The nurse is experiencing spiritual distress.b. The nurse is at risk for burnout and compassion fatigue.c. The nurse is not receiving adequate recognition from others.d. The nurse is at risk for overhelping, which creates dependency.
B
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