# A nurse in a primary care clinic sees a 50-year-old client whose spouse died suddenly 2 months ago. The client has returned to work part-time and has lost 2 kg (4.4 lb) since the death. Which findings would the nurse interpret as expected at this point in bereavement? Select all that apply.

> source: MyMerci (mymerci.kr)  
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> language: en  
> subject: Grief and Loss  
> category: PSI

## Question

A nurse in a primary care clinic sees a 50-year-old client whose spouse died suddenly 2 months ago. The client has returned to work part-time and has lost 2 kg (4.4 lb) since the death. Which findings would the nurse interpret as expected at this point in bereavement? Select all that apply.

1

States, "I am worthless and deserve to suffer," about most areas of life

2

Briefly heard the spouse's voice calling while drifting off to sleep

3

Reports no pleasure in anything, including visits from grandchildren

4

Feels guilty about many things that have no connection to the death

5

Laughed while telling the daughter stories about their early marriage

6

Yearns for the spouse most days and cries on finding the spouse's things

## Explanation

At 2 months, intense yearning and crying with reminders are expected; prolonged grief disorder requires at least 12 months. Brief sensory experiences of the deceased and moments of laughter over shared memories are common in normal grief. Pervasive worthlessness, guilt unrelated to the loss, and loss of pleasure in everything point toward a depressive episode that needs further assessment.

## In-depth explanation

Quick answer
Yearning at 2 months, hearing the spouse's voice briefly, and laughing over memories are expected.

Why this is correct
Two details decide this item. Timing: at 2 months, daily yearning is expected, and a prolonged grief diagnosis is not considered before 12 months in adults. Pattern: in grief, pain comes in waves tied to reminders of the deceased, self-esteem is preserved, and positive emotions can coexist. Brief illusions of hearing or seeing the deceased are common and are not psychosis when the client recognizes them.

Easy analogy or mental picture
Grief is like ocean waves that crash and then recede; depression is like a fog that settles over everything and does not lift.

Memory hook
Grief keeps self-worth; depression attacks it.

NCLEX decision rule
Separate expected grief from depression by focus (the lost person vs global self-criticism), pattern (waves vs pervasive), and time since the loss.

Why the other choices are wrong
Worthlessness sounds like normal sadness after loss, but global self-loathing is a hallmark of depression rather than grief. Guilt is common in grief when it concerns the death (things said or not done), which makes this option tempting, but guilt about unrelated matters suggests depression. Loss of pleasure in everything, even grandchildren, looks like expected withdrawal, yet grief usually allows moments of comfort and joy; pervasive anhedonia needs assessment, including suicide risk.

References
1American Psychiatric Association — Prolonged Grief Disorder12-month time criterion and features distinguishing prolonged grief from normal grief
2NIMH — DepressionSymptoms of depression including worthlessness, excessive guilt, and loss of interest

## Clinical scenario

Scenario
50-year-old client, 2 months after the sudden death of a spouse; working part-time with modest weight loss.

## Key concepts

- **Prolonged grief disorder** — A DSM-5-TR diagnosis of intense, disabling grief persisting at least 12 months after a death in adults.
- **Bereavement** — The period of grief and mourning after the death of a loved one.
- **Anhedonia** — Loss of interest or pleasure in nearly all activities, a core feature of depression.

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