A nurse is collecting data from a middle-aged client whose partner died seven months ago.
Which of the following findings indicate that the client is experiencing maladaptive grieving?

The client has lost 10 lb.

The client visits his partner’s grave each month.

The client has been unable to return to work.

The client has difficulty sleeping

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Losing 10 lb after the death of a loved one is not uncommon, especially within the first few months of grieving. It can be due to decreased appetite, changes in eating habits, or increased physical activity. While it's important to monitor weight loss and ensure adequate nutrition, it doesn't necessarily indicate maladaptive grieving on its own.

Grief can often lead to changes in appetite and weight. Some people may experience a loss of appetite and unintentional weight loss, while others may find themselves overeating or gaining weight. These changes are often temporary and subside as the grieving process progresses.

It's important to consider the client's overall health and well-being when assessing weight loss. If the client is experiencing significant weight loss, it's important to rule out any underlying medical conditions that may be contributing to it.

Choice B rationale:

Visiting a loved one's grave is a common way to grieve and remember them. It can be a way to feel connected to the deceased, express love and sorrow, and find solace. It's a normal part of the grieving process and doesn't necessarily indicate maladaptive grieving.

Grieving individuals often find comfort in visiting the gravesite of their loved one. It can be a place to reflect, remember, and feel close to the deceased. Visiting a gravesite can also be a way to honor the loved one's memory and express continued love and respect.

The frequency of grave visits can vary from person to person. Some individuals may visit frequently, while others may only visit on special occasions or anniversaries. There is no right or wrong way to grieve, and what matters most is that the individual finds a way to express their grief in a way that feels right for them.

Choice D rationale:

Difficulty sleeping is a common symptom of grief. It can be caused by a variety of factors, including anxiety, sadness, and changes in sleep patterns. While it can be distressing, it's not always a sign of maladaptive grieving.

Grief can disrupt sleep patterns in a number of ways. It can make it difficult to fall asleep, stay asleep, or both. It can also lead to nightmares, night sweats, and early morning awakenings. These sleep disturbances can be both physically and emotionally draining.

There are a number of things that can be done to improve sleep during grief. These include establishing a regular sleep schedule, creating a relaxing bedtime routine, avoiding caffeine and alcohol, and getting regular exercise. If sleep problems persist, it's important to seek professional help.

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Correct Answer is D

Explanation

Choice A rationale:

Increased salivation is a common side effect of haloperidol, but it is not the most serious adverse effect that the nurse should monitor for. It can be managed with medications such as anticholinergics, and it often subsides with continued use of haloperidol. Choice B rationale:

Serotonin syndrome is a rare but potentially life-threatening condition that can occur when haloperidol is combined with other medications that increase serotonin levels, such as antidepressants. However, it is not a direct adverse effect of haloperidol itself.

Choice C rationale:

Increased menstrual bleeding is not a known side effect of haloperidol.

Choice D rationale:

Tardive dyskinesia is a serious and potentially irreversible movement disorder that can occur as a long-term side effect of haloperidol and other antipsychotic medications. It is characterized by involuntary, repetitive movements of the face, tongue, and limbs.

The risk of tardive dyskinesia increases with the length of time that a person takes haloperidol and with the dose of the medication.

There is no cure for tardive dyskinesia, but the symptoms can sometimes be managed with medications.

It is important for nurses to monitor patients who are taking haloperidol for signs of tardive dyskinesia, so that the medication can be discontinued if necessary.

A. Have consistent unit routines. B. Provide a stimulating environment. C. Schedule daily seclusion times. D. Discourage daytime napping.

Correct Answer is A

Explanation

The correct answer is Choice A.

Choice A rationale:

Having consistent unit routines can provide a sense of stability and predictability, which can be beneficial for a client in the manic phase of bipolar disorder.

Choice B rationale:

Providing a stimulating environment can potentially exacerbate symptoms of mania, making it an inappropriate intervention.

Choice C rationale:

Scheduling daily seclusion times is not typically recommended as it can lead to feelings of isolation.

Choice D rationale:

Discouraging daytime napping can potentially lead to fatigue and worsen symptoms, so it’s not typically recommended.

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A nurse is collecting data from a middle-aged client whose partner died seven months ago. Which of the following findings indicate that the client is experiencing maladaptive grieving?

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Correct Answer is A

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A nurse is collecting data from a middle-aged client whose partner died seven months ago.
Which of the following findings indicate that the client is experiencing maladaptive grieving?