Edward is a 20-year-old college student. The student’s roommates tell the school nurse that their friend has seemed more moody than usual since a grandparent died of a COVID-19 infection last month. They also report that the patient sleeps all day and sometimes doesn’t wake up until noon or later. They tell the nurse that they invite the patient to go with them to the dining hall most meals, but he declines most of the time and, when he does go, he will only eat a few bites. Edward admits to feeling “empty most days” and “doesn’t do much most days” and that “nothing is really fun anymore.”Edward states he “abandoned his grandfather who died alone in the ICU.” The nurse determines his depressive symptoms may be complicated due to “survivor’s guilt” and identifies his grief as (choose the best answer):
Anger
Bargaining
Denial
Complex or disenfranchised grief
The Correct Answer is D
Choice A reason:
Anger is a common stage of grief where individuals may feel frustration and helplessness. While Edward may experience anger, his primary issue appears to be more complex, involving feelings of guilt and abandonment, which are indicative of a more complicated form of grief.
Choice B reason:
Bargaining is another stage of grief where individuals may try to make deals or promises in an attempt to reverse or lessen the loss. Edward’s feelings of guilt and abandonment do not align with the bargaining stage but rather suggest a deeper, more complicated grief process.
Choice C reason:
Denial is the initial stage of grief where individuals may refuse to accept the reality of the loss. Edward’s acknowledgment of his feelings and his depressive symptoms indicate that he is not in denial but rather struggling with more complex emotions related to his loss.
Choice D reason:
Complex or disenfranchised grief refers to a prolonged and intense form of grief that can occur when the loss is not openly acknowledged or socially supported. Edward’s feelings of guilt and abandonment, along with his depressive symptoms, suggest that he is experiencing a more complicated form of grief that requires specialized support and intervention.
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View Related questions
Correct Answer is A
Explanation
Choice A reason:
Duloxetine (Cymbalta) is an SNRI antidepressant commonly used for both chronic pain and depression. It works by increasing the levels of serotonin and norepinephrine in the brain, which helps improve mood and alleviate pain. Duloxetine is often prescribed for conditions such as fibromyalgia, diabetic neuropathy, and chronic musculoskeletal pain, in addition to its use in treating major depressive disorder.
Choice B reason:
Sertraline (Zoloft) is an SSRI antidepressant used primarily to treat depression, anxiety disorders, and other mood disorders. While it is effective for these conditions, it is not specifically indicated for chronic pain management.
Choice C reason:
Fluoxetine (Prozac) is another SSRI antidepressant used to treat depression, anxiety disorders, and certain eating disorders. Like sertraline, it is not typically used for chronic pain management.
Choice D reason:
Citalopram (Celexa) is also an SSRI antidepressant used to treat depression. It is not indicated for chronic pain management and is primarily used to improve mood and alleviate symptoms of depression.
Correct Answer is ["A","C","D"]
Explanation
Choice A reason:
If Mr. Greene has memory retention and a neurological evaluation that has demonstrated understanding of how to follow the sliding scale and recognize proper dosage, use, and potential side effects of insulin, he is a candidate for self-administration. This ensures he can manage his insulin therapy safely and effectively.
Choice B reason:
If Mr. Greene states “I can do it” but has severe hand tremors, he is not a candidate for self-administration of insulin. Severe hand tremors can impair his ability to accurately draw up and administer the correct dose of insulin, increasing the risk of errors.
Choice C reason:
If Mr. Greene demonstrates the ability to self-administer insulin over a period of time successfully using the “Teach Back” method by a number of staff or visiting nurse, he is a candidate for self-administration. The “Teach Back” method confirms that he understands and can perform the procedure correctly.
Choice D reason:
If Mr. Greene no longer is actively suicidal and has hand-eye coordination that is accurate, he is a candidate for self-administration of insulin. Accurate hand-eye coordination is essential for safely drawing up and administering insulin.