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Grief and Loss

1. A woman who is firmly committed to natural childbirth and who has attendedeach natural childbirth class in preparation for labor and delivery undergoes acaesarian delivery when her fetus displays signs of distress. Inconsolably she cries

and calls herself a failure as a mother. Her loss may be best describe as:A. ActualB. PerceivedC. PsychologicalD. Combination of the aboveAnswer:The correct answer is D. Each of the above is only partially correct because there areelements of the loss of the type of delivery she values, which are actual, perceived,and psychological.

2. The period of acceptance of loss and grief during which the person learns to deal

with experienced loss is termed as:A. Anticipatory grievingB. BereavementC. MourningD. Stages of death and dyingAnswer:The correct answer is C. Mourning is defined as the period of acceptance of loss andgrief during which the person learns to deal with experienced loss.

3. When you interview an 82 year old resident of a nursing home, she tells you thatshe never gotten over the death of her son 20 years ago. She reports that her life

fell apart after that and she never again felt like herself or was able to enjoy life.This type of grief is best describe as:

A. AbbreviatedB. AnticipatoryC. DysfunctionalD. InhibitedAnswer:The correct answer is C. Abbreviated grief and anticipatory grief is both types ofnormal grief, and given the length of this residents grief has lasted and its effects onher life, it is not normal. Because she is able to give expression to her grief, inhibitedgrief is not the correct answer. By a process of elimination, acceptance is the correct

choice.

4. A patient with AIDS whom you have been visiting a home tells you, Im nolonger afraid of dying, I made peace with everyone, and Im actually ready tomove on. This reflects his progress to which state of dying?

A. AcceptanceB. AngerC. Bargaining

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D. DenialAnswer:

The correct answer is A. The patients statement does not reflect anger,bargaining or denial; hence, by a process of elimination, acceptance is the correctanswer.

5. When you next visit this dying patient with AIDS, he breaks down and cries andtells you that it is unfair that he should have to die now when hes finally madepeace with his family and wants to live. You are shocked by this change in hismood. Your best reply would be:

A. You cant be feeling this way. You have to proceed through stages of dying in anorderly progression, and youve just move backward.

B. It does seem unfair. Tell me more about how you are feeling.C. Youll be alright who knows how much time any of us has to enjoy relationships

with those we love? Youre lucky to have had the opportunity to make yourpeace.

D. Tell me about your pain? Did it keep you awake last night?Answer:The correct answer is B; you want to validate that you have heard what the patient issaying and invite him to share more of his feelings, concerns, and fears.

6. Which definition of death is gaining in popularity, as more people believe thatcritical human functions are personality, conscious life, and the capacity forremembering, judging, reasoning, acting, enjoying, and worrying?

A. Heart-lung deathB. Higher-brain deathC. Personhood deathD. Whole-brain deathAnswer:The correct answer is B because the functions described are controlled by the cortexor the higher brain.

7. If your patient tells you that he has no one he trusts to make healthcare decisionsfor him should he become incapacitated, you should help him to prepare:

A. Combination advance medical directiveB. Durable power of attorney for health careC. Living WillAnswer:The correct answer is C. The living will is a document whose precise purpose is toallow individuals to record specific instructions about the type of healthcare theywould like to receive in particular end-of-life situations.8. Which of the nursing actions describe below would you correct if you saw a

nursing assistant doing this?A. Talking to a comatose patientB. Sitting on the bed of a dying patient holding her hand and crying

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C. Agreeing with a daughter of a dying resident with Alzheimers disease that theburdens associated with artificially feeding her father may outweigh the benefits

D. Telling a patient to sit back and relax and that she will wash him because itseasier that way.

Answer:

The correct answer is D. It is generally not good practice to perform basic self-caremeasures to a patient.

9. Which of the following nursing actions violates the standards of caring for thebody after a patient has been pronounced dead?

A. Keeping the patient in a comfortable sitting position until the family has arrivedand said their goodbyes.

B. Placing identification tags on both the shroud and the ankleC. Removing soiled dressings and tubesD. Preparing to transfer the body to the morgueAnswer:

The correct answer is A. Because the body should be placed in normal anatomicposition to avoid pulling of blood.

10. A 70 year old woman who has a number of strokes refuses further life-sustainingintervention, including artificial nutrition and hydration. She is competent,understands the consequences of her actions, is not depressed, and persists inrefusing treatment. Her doctor is adamant that she cannot be allowed to this way,and her daughter agrees. An ethics consult has been placed. Who is theappropriate decision maker?

A. PatientB. DaughterC. DoctorD. EthicsAnswer:The correct answer is A. Because the patient is competent, she has the right to refusetherapy even if this hastens her death.