NCLEX · Grief, Loss, and End-of-Life

A client whose spouse died three weeks ago says, 'Sometimes I think I see him in a crowd and I reach out. Then I remember.' Which interpretation is MOST accurate?

Correct answer

This is a NORMAL grief response; brief illusions of a deceased loved one are common in the early grieving period and do not indicate psychosis

  1. A This indicates a psychotic disorder requiring hospitalization
  2. B This is a NORMAL grief response; brief illusions of a deceased loved one are common in the early grieving period and do not indicate psychosis
  3. C The client should be put on antipsychotics immediately
  4. D The client should be told the deceased is not coming back

Why this is the answer

NORMAL GRIEF includes a wide range of experiences that are sometimes distressing but are NOT pathological. Briefly seeing or hearing a deceased loved one (illusions, hypnagogic hallucinations, or simply misidentification of strangers) is very common in early grief — it reflects the mind's difficulty processing that the loved one is truly gone. The client in this scenario CORRECTS THEMSELVES (recognizes it as a mistake) — this is NOT a fixed delusion or ongoing hallucination; it is a transient experience tied to grief, and the client has insight. KÜBLER-ROSS STAGES OF GRIEF (these are stages, not a linear progression; clients move back and forth): DENIAL (shock, disbelief); ANGER (toward self, others, the situation, God); BARGAINING ('If only...', 'What if...'); DEPRESSION (sadness, withdrawal, weeping); ACCEPTANCE (coming to terms). Normal grief experiences include: crying, sadness, anger, guilt, anxiety, insomnia, appetite changes, yearning for the deceased, brief illusions, forgetting the person is dead, reviewing memories repeatedly, social withdrawal. COMPLICATED GRIEF (prolonged grief disorder): grief that is unusually intense, prolonged (typically lasting more than 12 months), or that significantly impairs functioning; symptoms include: inability to accept the death, persistent yearning that doesn't improve over time, difficulty with daily function; REQUIRES clinical assessment and likely therapy. CULTURAL CONSIDERATIONS: grief expressions vary widely by culture — what looks like pathological grief in one cultural lens may be normal in another; assess within cultural context. NURSING APPROACH to grief: empathic listening; normalizing grief responses without minimizing them; assess for complicated grief and suicidal ideation; connect to support resources (grief counseling, support groups, chaplain/spiritual care); avoid platitudes ('Everything happens for a reason').
Source: NCLEX-PN Test Plan: Psychosocial — Grief and Loss