ACHPN - Advanced Certified Hospice and Palliative Nurse Examination Grief and Bereavement Care Questions and Answers — Questions and Answers
Question 1: A 70-year-old woman whose husband died 14 months ago reports persistent, intense yearning for him, a sense of disbelief about the death, and difficulty moving on with her life. She has withdrawn from social activities she previously enjoyed. These findings are most suggestive of which of the following?
- Major Depressive Disorder
- Anticipatory grief
- Normal (uncomplicated) bereavement
- Prolonged Grief Disorder (Correct answer)
Correct answer: Prolonged Grief Disorder
The patient's symptoms, including intense yearning, disbelief, and social impairment persisting for more than 12 months after the loss, are hallmark characteristics of Prolonged Grief Disorder (formerly known as complicated grief) as defined by the DSM-5-TR. While there can be overlap, this presentation is distinct from Major Depressive Disorder, which centers more on pervasive low mood and anhedonia. Normal grief is typically less persistent and impairing over this time frame, and anticipatory grief occurs before the death.
Question 2: The Dual Process Model of coping with bereavement, developed by Stroebe and Schut, proposes that effective coping involves a dynamic oscillation between which two orientations?
- Denial and anger, and bargaining and acceptance
- Loss-orientation and restoration-orientation (Correct answer)
- Accepting the reality of the loss and adjusting to a new environment
- Confronting the pain of grief and reinvesting in new relationships
Correct answer: Loss-orientation and restoration-orientation
The core concept of the Dual Process Model is the oscillation between loss-oriented activities (e.g., grief work, focusing on the deceased) and restoration-oriented activities (e.g., attending to life changes, learning new skills). This dynamic process suggests that it is healthy for a bereaved person to move back and forth between confronting their grief and taking a break from it to focus on other aspects of life. The other options describe components of different grief theories, such as those by Kübler-Ross or Worden.
Question 3: Which of the following is considered a significant risk factor for developing complicated grief?
- A high level of social support from family and friends
- The patient had a long, predictable illness trajectory
- The death was sudden, unexpected, and traumatic (Correct answer)
- The bereaved individual has a history of secure attachment styles
Correct answer: The death was sudden, unexpected, and traumatic
A sudden, violent, or traumatic death is a major risk factor for complicated grief (now often called Prolonged Grief Disorder). Such circumstances prevent the bereaved from engaging in anticipatory grieving and can introduce elements of trauma that complicate the bereavement process. A strong social support system, a predictable death, and secure attachment styles are generally considered protective factors.
Question 4: A hospice patient's long-term, same-sex partner is not acknowledged by the patient's biological family and is excluded from funeral planning. The partner is at high risk for experiencing which type of grief?
- Disenfranchised grief (Correct answer)
- Delayed grief
- Collective grief
- Abbreviated grief
Correct answer: Disenfranchised grief
Disenfranchised grief occurs when a loss is not or cannot be openly acknowledged, publicly mourned, or socially supported. This scenario, where a significant relationship is not recognized by the family, is a classic example. The partner's grief is not validated, and they are denied participation in social mourning rituals, which can profoundly complicate their bereavement.
Question 5: The wife of a patient who recently died on hospice care tells the ACHPN during a bereavement visit, "I should have made him go to the doctor sooner. This is all my fault." Which response by the nurse is most therapeutic?
- "His illness was very aggressive; even the doctors couldn't stop it."
- "Tell me more about why you feel it was your fault." (Correct answer)
- "It's very common to feel that way, but you can't blame yourself."
- "Let's try to focus on the good care you provided him here at the end."
Correct answer: "Tell me more about why you feel it was your fault."
The most therapeutic response is an open-ended statement that invites the bereaved person to explore the source of their guilt. This approach validates their feelings by showing a willingness to listen without being dismissive or immediately trying to 'fix' the feeling. The other options, while well-intentioned, can shut down the conversation or prematurely offer reassurance before the feeling is fully understood.
Question 6: An ACHPN is counseling the adult daughter of a patient who is declining rapidly. The daughter appears emotionally exhausted and states, "I feel like I'm already grieving for him." What is the most appropriate initial intervention by the ACHPN to address the daughter's anticipatory grief?
- Suggest a psychiatric referral for an antidepressant medication.
- Recommend she take a break and get more rest away from the bedside.
- Provide literature on the stages of grief so she can identify where she is.
- Acknowledge and validate her feelings as a normal part of the process. (Correct answer)
Correct answer: Acknowledge and validate her feelings as a normal part of the process.
The first and most important intervention for anticipatory grief is to acknowledge and validate the person's experience. Stating that these feelings are normal and expected provides immediate support, reduces feelings of isolation, and normalizes the complex emotions associated with grieving for someone who is still living. While other interventions might be useful later, validation is the crucial first step.
ACHPN - Advanced Certified Hospice and Palliative Nurse Examination Grief and Bereavement Care Questions and Answers
A 70-year-old woman whose husband died 14 months ago reports persistent, intense yearning for him, a sense of disbelief about the death, and difficulty moving on with her life.
She has withdrawn from social activities she previously enjoyed.
These findings are most suggestive of which of the following?