Nokea
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.' How is the work of mourning best characterized?
- A. It is beginning.
- B. It is progressing abnormally.
- C. It is at or near completion.
- D. It has not yet begun.
Correct Answer: C
Rationale: The work of mourning has been successfully completed when the bereaved can remember both the positive and negative memories about the deceased and when the task of restructuring the relationship with the deceased is completed.
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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. Although your body is frail, your mind and spirit are healthy.'
- D. You want people to stop focusing on your weaknesses.'
Correct Answer: C
Rationale: The patient is asking for acknowledgment that he or she is not totally sick; even in the terminal state, strengths and capabilities are present.
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.' What response is this individual likely experiencing?
- A. Preoccupation with the image of the deceased
- B. Sensations of somatic distress
- C. Anger
- D. Guilt
Correct Answer: D
Rationale: Guilt is evident by the bereaved person's self-reproach. Preoccupation refers to dwelling on images of the deceased. Somatic distress would involve bodily symptoms. Anger is not evident from data given in this scenario.
A terminally ill patient tells the nurse, 'Life has been good. I am proud of my education. 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 focus on maintaining the patient's state of mind?
- A. Providing aggressive pain and symptom management
- B. Helping the patient reassess and explore existing conflicts
- C. Assisting the patient to focus on the meaning in life and death
- D. Supporting the patient's use of personal resources to meet challenges
Correct Answer: D
Rationale: The patient whose intrinsic strength and endurance have been a hallmark often wishes to approach dying by staying optimistic and in control.
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?' How should the nurse best counsel the family?
- A. Encouraging them to share their own feelings with the surviving parent and ask for the retelling to stop
- B. Support the ideas that retelling the story should be limited to once daily to avoid unnecessary stimulation
- C. Share with them that retelling memories is to be expected as part of the aging process
- D. Reassure them that repeating the story is a helpful and a necessary part of grieving
Correct Answer: D
Rationale: Nurses are encouraged to tell bereaved patients that telling the personal story of loss as many times as needed is acceptable and healthy.
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. What should be the mentor's focus when counseling the nurse?
- A. Implementing stress-reduction strategies
- B. Seeking therapy for dysfunctional grief
- C. Discussing the experience of disenfranchised grief
- D. Considering taking a leave of absence to pursue healing
Correct Answer: C
Rationale: The nurse is experiencing disenfranchised grief, which is not openly acknowledged or publicly mourned.