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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Correct Answer is ["B","C","D"]
Explanation
Choice A reason:
Canceling Netflix by Internet service is not relevant to Mr. Jones’ discharge planning. While managing finances and subscriptions may be part of overall life management, it does not address the immediate safety and mental health needs of Mr. Jones.
Choice B reason:
Releasing information signed for family to secure Mr. Jones’ loaded gun or having the police secure the gun if needed prior to discharge is crucial for ensuring his safety. Removing access to firearms reduces the risk of self-harm and is an important step in discharge planning for someone with suicidal ideation.
Choice C reason:
Obtaining a psychiatric provider follow-up appointment as soon as possible and evaluating for PHP (Partial Hospitalization Program) or residential treatment with the treatment team is essential. Continuity of care and appropriate follow-up are critical for managing Mr. Jones’ depression and preventing relapse.
Choice D reason:
Assisting in developing a safety plan prior to discharge that is written with phone numbers and interventions is vital. A safety plan provides Mr. Jones with clear steps to take if he feels at risk of harming himself, including contact information for crisis services and supportive individuals.
Correct Answer is ["A","B","C","D"]
Explanation
Choice A reason:
Supportive friends and family members play a crucial role in the recovery process for individuals with depression. Social support can provide emotional comfort, reduce feelings of isolation, and encourage adherence to treatment plans. Having a strong support network can significantly improve mental health outcomes.
Choice B reason:
Attending outpatient therapy or a partial hospital program offers structured support and treatment for individuals with depression. These programs provide access to mental health professionals, group therapy, and other therapeutic activities that can help manage symptoms and promote recovery. They offer a higher level of care than standard outpatient visits but do not require full hospitalization.
Choice C reason:
Consistent daily structure and exercise that is not overwhelming can help manage depression by providing routine and physical activity. Regular exercise has been shown to improve mood, reduce anxiety, and increase overall well-being. Establishing a daily routine can also help individuals with depression feel more in control and reduce feelings of chaos or unpredictability.
Choice D reason:
A well-balanced diet and restful sleep are essential components of mental health. Proper nutrition supports brain function and overall health, while adequate sleep is crucial for emotional regulation and cognitive function. Addressing these basic needs can help improve mood and energy levels, making it easier to cope with depression.