Nursing Test IV

Grief and Loss; Practice Test

1. Sue lost her mother at the young age of 17. After the loss of her mother; Sue put
all of her energy into helping her with her 3 younger sisters. Two years after Sue’s
mom died a casual aquantance of Sue’s passed away. Sue handled this death by
crying and withdrawing from friend and family. As A nurse you would notice that
sue’s intensified grief is most likely a sign of which type of grief?
A. Distorted or exaggerated Grief
B. Anticipatory Grief
C. Chronic or Prolonged Grief
D. Delayed or Inhibited Grief
The correct answer would be D. Delayed or Inhibited Grief. Sue never took
the time to grieve over her mother; she put all of her energy into something else.
Therefore when her aquantance passed away Sue felt overwhelmed by the feelings
she never acknowledged with her mother’s death. Distorted or exaggerated grief
would be another possibility but given the fact that the newly deceased was only a
casual acquantance it would most likely be Delayed or Inhibited Grief

2. Missy is 23 years old and looking forward to being married the following day.
Missy’s mother feels happy that her daughter is starting a new phase in her life but is
feeling a little bit sad as well. When talking to Missy’s mother you would explain this
feeling to her as a sign of what?
A. Anticipated Grief
B. Lifestyle Loss
C. Situational Loss
D. Maturational Loss
E. Self Loss
F. All of the above

The correct answer would be D. Maturational losses are necessary losses such
as a child going to school, getting married, or graduating from school
3. After the suicide of her best friend Marry feels a sense of guilt, shame and anger
because she had not answered the phone when her friend called shortly before her
death. Which of the following statements is the most accurate when talking about
Marry’s feelings
A. Marry’s feelings are normal and are a form of perceived
loss.
B. Marry’s feelings are normal and are a form of
situational loss.
C. Marry’s feelings are not normal and are a form of
situational loss.
D. Marrys feelings are not normal and are a form of
physical loss.
The correct answer would be C. Marry’s feelings are normal and are a form of
situational loss. Situational loss occurs when the death is sudden such as a car
accident, suicide or murder.

4. Marc is a 32 year old male, he is going through a divorce; his daughter is getting
married next week; what types and forms of losses is Marc experiencing? (select all
that apply):
A. Situational loss D. Physical loss
B. Relationships loss E. Health/Self Loss
C. Maturational Loss F. All of the above
The correct answers would be C and B; A divorce or separation is a type of
relationship loss; another type of relationship loss would be moving; Marc is also
experiencing Maturational Loss because his daughter is getting married.

5. Jackie is a 21 year old who just recently has had a mastectomy. After the
mastectomy Jackie felt withdrew and told her doctor that she no longer feels like a
woman. What type of loss is Jackie experiencing?
A. Actual loss
B. Psychological loss
C. Perceived Loss
D. All of the above
The correct answer is B. A psychological loss occurs when a persons self
image is altered, such as a loss of breast.
6. Ted loses his friend in a vehicle accident. Ted is most likely experiencing which
form of loss.
A. Situational loss B. psychological loss
C. Physical loss D. Anticipatory loss
Ted would be experiencing A. a situational loss occurs when the loss is sudden such
as a vehicle accident, suicide or homicide.

7. Johns family lost everything they owned in hurricaine Katrina but thankfully no one
was hurt, what type of loss is his family experiencing? (select all that apply)
A. Personal Possions loss
B. Relationship Loss
C. Life style and known environment loss
D. Health and Self Loss
John and his family are experiencing two types of loss Personal possesions loss
and Lifestyle and know environment loss which is the type of loss people experience
during a natural disaster

8.Cindy found that her husband of 50 years has cancer. The doctor told the family
that her husband has less than 2 years to live. Over the next 2 years cindy cares for
her husband. When he dies will cindy be experiencing?
A. Anticipatory Loss B. Physical Loss
C. Situational Loss D. Phsychological loss
E. All of the above
Cindy will be experiencing Anticipatory loss when is a loss in which the family
have time to prepare for the loss because they know that it is coming.

9. Joanne was a pleasant 17 year old. Her mother died when she was 18 from a
sudden car accident. For the next 18 months Joanne was angry all the time, could
not hold a job; quit school and quit answering the phone when her friends and family
called. What following statement is the most true?
A. Joanne is suffering from normal grief due to her situational loss
B. Joanne is suffering from normal loss due to her psychological loss
C. Joanne is suffering from dysfunctional grief due to her situational
loss
D. Joanne is suffering from dysfunctional grief due to her psychological
loss

10. Matt has just found out he has 6 months to live. According to Kubler Ross’s
stages of dying when matt states that the tests must be wrong what would the best
response be?
A. Immediately explain that he has to figure out who is going to take
care of his son, and get his finances together.
B. Tell him all the details you can to help him understand what is going
to happen then tell him you will be back to answer any questions
 C. Give him minimum information and let him ask any questions that
he may have
D. A;C
E. A;B
The correct answer would be C. according to Kubler Ross’s stage of denial you
would want to give small bits of information to a pt in denial

11. Fred just found out his wife killed in a car accident; when the cop told Fred he
immediately dropped to his knees and told god that he would go to church every
Sunday for the rest of his life if he would just bring his wife back to him. According to
Kubler which stage is Fred in
A. Acceptance B. Anger
C. Depression D. Bargaining
Fred is experiencing bargaining. The third stage in kublers stages of grief and
death reactions

12. Shirley was always upbeat and arctic. She always joked with everyone and loved
to have fun. As a nurse what would be your best manorism while caring for Shirley
while she is dying?
A. Be as quiety as possible to show respect
B. Joke with Shirley when talking to her
C. Do all physical care at once so you do not have to disturb her many
times
D. Give her short continous care
E. Do not do any heigene care, there is no need.
The correct answers are B and D. It is okay to joke with a pt if that is the type
of personality they have; you want to provide all care is very short intervals or as
mrs young said..short continous care; and you always want to keep a dying patient as
comfortable as possible

13. Which of the following are signs of physical impending death

A. Quiet Respirations B. Chyne Stroke C. Mottled
D. Death Rattle E. decreased muscle sensation
F. Increased BP G. decreased Bp H. Clammy skin
I. decreased temp J. Dry skin K. Cold skin
L. Red skin M. Increased temp N. low circulation
O. increased circulation P. Incontinence Q. Cyanotic Skin
R. Decreased GI S. Increased GI T. Pitting Edema
U. Increased muscle sensation V. Pain W. No gag reflex
Impending physical death signs are, altered repsirations, roisy irregular, schyne
shokes, air hunger, death rattle. Aletered vital signa; decreased bp, increased temp.
skin; mottled, cyanotic, cold clammy, slowed blood circulation causes pitting edema.
Loss of muscle tone, sensation,reflexes, gag reflex. Decreased peristalisis-Gi and
Urinary tract; bowel and bladder incontinence; pain

14. The most important priority of care for a dying pt is

A. Hydration B. Vital sing monitoring
C. Pain Management D. Care of pt family
The most important priority of care for a dying pt is pain management

15. The period of acceptance of loss and grief during which the person learns to deal
with loss is known as
A. Normal Grief B. Anticipatory grief
C. Mourning D. Bereavement
Mourning is the period of acceptance of loss and grief during which the person
 learns to deal with the loss it is also the outward social expression of grief and
behaviors associated with loss

16. Sally’s husband died 2 years ago, sally has kept her husbands night stand with
his glasses the same as they were when he was alive. She has never emptied his ash
try that is on the nightstand and his tie is still laying over the arm of the chair in the
corner and his clothes still hang in the closet. Sally is displaying what type of grief.
A. Chronic or prolonged Grief
B. Distorted or Exagerated grief
C. Delayed or Inhibited Grief
D. Anticipatory grief
Sue is displaying Chronic or prolonged grief where the grieving one will keep a
lot of the personal possessions for a long time after a death. This is a dysfunctional
grief.

17. The active total care of a pt whose disease is not responsive to curative
treatment is know as what type of care
A. Hospice Care B. Geriatric Care
C. Necessary Care D. Palliative Care
The correct answer is Palliative care; hospice is the last stage in palliative care
19. Complete the following paragraph by putting the words from the word bank
where they belong
Living Wills Advanced Directive Durable Power of Attorney
____________________ can minimize problems allowing an individual to decide
specific healthcare options while _____________________ gives specific instructions
concerning the kind of healthcare desired or not desired in specific situations;
________________________ is when an individual appoints a trusted person to make
healthcare decisions in case the individual becomes incapacitated.
Answer: advanced directives; living wills; Durable power of attorneys

20. True or False: Hospice care focuses on only the patient’s needs during the final
stages in life.
Correct answer is False; hospice focuses on both the patient and the family
during the final phase of palliative care.
Depression _____ 1. First stage
21. What of the following criteria must a patient have in order to qualify for hospice
A. Pt must desire to use services
Bargaining______ B. Pt must meet certain financial criteria
en anger saddness and mourning
2. Secondhave tappered off; not a happy state or even a true acceptance of the loss; more so a sen
Stage
C. Pt must live alone and have no caregiver
D. Pt must be terminally ill and less than 6 months to live
ing painful emotions, temporary escape from intense emotional pain;
Anger_______ Correct answer A;D Pt must have a desire for the services, pt must have a
3. Third stage
family caregiver to provide daily basic care; pt must be terminally ill and have less
h, despair, hopelessness, helplessness; when reality of loss is realized; others may pressure grieving ones to hime or deny
than 6 months to live
Denial______
higher power; anger may 4.
resurface if negotiation is not honored.
Fourth stage
22. A pt on hospice is comfort only measures and developes pneumonnia as a nurse
what would you do?
power, acknowledge this encourace venting about feelings in an appropriate manor
Acceptance______ A. Increase pain meds to decrease respirations
5. Fifth Stage
B. Treat the pneumonia; and keep pt comfortable by using prescribed
pain meds
C. Nothing unless the pt complains of being uncomfortable
D. Increase pain meds to decrease pain
Depression - 4;C Bargaining - 3;D Anger
The correct - 2;E
answer Denial-
would be B,1;B
you would treat the patient for the pneumonia
Acceptance - 5;A but you would not give any life sustaining measures

23. Match the following words to the correct letter and number
24. The best way a nurse can learn to help patients deal with death would be to
A. Tell the pt that it will get better
B. Leave the pt alone
C. Be aware of her own feelings about death before trying to help a pt
deal with theirs
D. All of the above
The best way a nurse can learn to help patients deal with death would by to
be aware of her own feelings about death.

25. The state of grieving during which a person goes through grief reaction is called
what?
A. Moving on B. Acceptance
C. Mourning D. Bereavement
The correct answer is D, bereavement also includes grief and mourning and
does not proceed in sequential stages

26. True or False - With Kubler Ross’s Stages of grief and death reactions each phase
must be met sequentially and can only be experienced once per grieving process.
Answer: False. these stages do not always occur in sequence in all people
and many people go through the various stages more than once.

Match the following age to the following correct description

27. Older adults 28. Adults 29. Adolescents 30. 6-12 year old 31.Toddler to 5
year old 32. Infants
A. Realizes the finality of death, death is viewed a negative; they
personify death; cope by using rituals “If we get past it its not there”; often still feel
responsible for death due to bad thoughts or behaviors; wonder if its contagious;
Regreesion,aggression, withdrawal, school phobias, “what if someone dies while I’m
at school”; somatic symptoms; clinging behaviours, verbal uncooperativness
B. Death is undeniable; may be accepted as inevitable; season of loss;
bereavement overload; age doesn’t mean that they are ready to die; some fear
death; others welcome relief of pain and suffering
C. Seldom effected by death unless of older relatives
D. Death is seen as reversible like in cartoons and movies or sleep;
magical thinking and difficulty distinguishing fantasy and reality; they think they did
something wrong to cause death; feel guilt; shame; and punishment; likes to talk
about heaven; greatest fear is separation from parents and safety; few defense
mechanisms to deal with loss; often denies; distances self by giggling, jiling,
regression, and attention seeking behaviors
E. Loss of attachments; sense of change in environment; affected more
by any lifestyle; change; rituals are important; react to emotions of adults by being
more irritable and crying; prolonged separation significant in future cocial, physical
and emotional growth; become quiet, lose wieght, sleep less when separated from
mom
F. Understand meaning and ramification of death; deny own mortality;
engage in high risk behaviors; remnants of magical thinking; difficutly coping with
death; may consider themselves as along en alienated from peers and family
27. B
28. C
29. F
30. A
31. D
32. E

33. A terminally ill infant is most likely to display

 A. Magical thinking and fears separation from parents; he/she thinks
the illness is a punishment; and will distance themselves from impending loss b/c
they don’t understand
B. Will appear listless, unresponsive, decreased activity and show
weight loss.
C. A fear of the unk