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NSG 221 Exam 2 – Comprehensive Study Guide on Grief, Cultural Considerations, Aggression, and Substance Abuse

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This document provides a complete NSG 221 Exam 2 study guide, covering grief stages (Kubler-Ross and Engel models), types of loss, and physiologic, emotional, behavioral, spiritual, and cognitive grief responses. It includes cultural considerations for death rituals across diverse communities, stages of anger and aggression management, disruptive behavior disorders, workplace bullying regulations, substance abuse risk factors, withdrawal symptoms, and nursing interventions. Designed for in-depth preparation with clear definitions and examples.

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Institution
NSG 221
Course
NSG 221

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1. Mourning Rituals: Mourning is the outward expression of grief. Rituals of mourn-
ing include having a wake, sitting shiva, holding religious ceremonies, and arranging
funerals.
2. Physiologic Loss: Examples include amputation of a limb, a mastectomy or
hysterectomy, or loss of mobility.
3. Safety Loss: Loss of a safe environment is evident in domestic violence, child
abuse, or public violence. A person's home should be a safe haven with trust
that family members will provide protection, not harm or violence. Some public
institutions, such as schools and churches, are often associated with safety as well.
That feeling of safety is shattered when violence occurs on campus or in a holy
place.
4. Loss of Security and a Sense of Belonging: The loss of a loved one affects
the need to love and the feeling of being loved. Loss accompanies changes in
relationships, such as birth, marriage, divorce, illness, and death; as the meaning of
a relationship changes, a person may lose roles within a family or group.
5. Loss of Self-Esteem: Any change in how a person is valued at work or in
relationships or by him or herself can threaten self-esteem. It may be an actual
change or the person's perception of a change in value. Death of a loved one,
a broken relationship, loss of a job, and retirement are examples of change that
represent loss and can result in a threat to self-esteem.
6. Loss Related to Self-Actualization: An external or internal crisis that blocks
or inhibits striving toward fulfillment may threaten personal goals and individual
potential. A person who wanted to go to college, write books, and teach at a
university reaches a point in life when it becomes evident that those plans will never
materialize or a person loses hope that he or she will find a mate and have children.
These are losses that the person will grieve.
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7. Kubler-Ross Name of 5 Stages: 1. Denial
2. Anger

,9. Kubler-Ross 5 Stages of Grief: Anger: 2. Anger may be expressed toward God,
relatives, friends, or health care providers.
10. Kubler-Ross 5 Stages of Grief: Bargaining: 3. Bargaining occurs when the
person asks God or fate for more time to delay the inevitable loss.
11. Kubler-Ross 5 Stages of Grief: Depression: 4. Depression results when
awareness of the loss becomes acute.




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, 12. Kubler-Ross 5 Stages of Grief: Acceptance: 5. Acceptance occurs when the
person shows evidence of coming to terms with death.
This model became a prototype for care providers as they looked for ways to
understand and assist their clients in the grieving process.
13. Engel Name of 5 Stages of Loss: 1. Shock and Disbelief
2. Developing Awareness
3. Restitution
4. Resolution of Loss
5. Recovery
14. Engel Stages of Loss: Shock & Belief: 1. Shock and disbelief: The initial
reaction to a loss is a stunned, numb feeling accompanied by refusal to acknowledge
the reality of the loss in an attempt to protect the self against overwhelming stress.
15. Engel Stages of Loss: Developing Awareness: 2. Developing awareness: As
the individual begins to acknowledge the loss, there may be crying, feelings of
helplessness, frustration, despair, and anger that can be directed at self or others,
including God or the deceased person.
16. Engel Stages of Loss: Restitution: 3. Restitution: Participation in the rituals
associated with death, such as a funeral, wake, family gathering, or religious cere-
monies that help the individual accept the reality of the loss and begin the recovery
process.
17. Engel Stages of Loss: Resolution of Loss: 4. Resolution of the loss: The
individual is preoccupied with the loss, the lost person or object is idealized, and the
mourner may even imitate the lost person. Eventually, the preoccupation decreases,
usually in a year or perhaps more.
18. Engel Stages of Loss: Recovery: 5. Recovery: The previous preoccupation
and obsession ends, and the individual is able to go on with life in a way that
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encompasses the loss.
19. Treatment for Alcohol Withdrawl Symptoms:: Chlordiazepoxide (Librium)

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