Deck 38: Grief and Loss in the Childbearing Family

Question 1

The nurse is caring for a patient who has just experienced a stillbirth. Which factors does the nurse recognize as potentially complicating the parents' response to this loss?

A) Unsupportive family
B) Adolescent mother
C) Strong religious faith
D) Open communication between the parents
E) Persistent denial of the situation

Answer 1

Unsupportive family
Adolescent mother
Persistent denial of the situation

Question 2

The nurse is teaching a class on perinatal loss to student nurses. The nurse is discussing the relationship between attachment and the grief response, explaining that:

A) The mother has no attachment to the fetus before it is born.
B) The severity of the grieving has nothing to do with attachment to the fetus.
C) The intensity of the grief response can be assessed by determining the level of attachment to the anticipated infant.
D) The mother would feel grief only if it were a planned pregnancy.

Answer 2

The intensity of the grief response can be assessed by determining the level of attachment to the anticipated infant.

Question 3

The nurse considers the spiritual needs of a couple experiencing a fetal loss by:

A) Explaining the fetal loss in terms of the nurse's own religious beliefs.
B) Providing an atmosphere of acceptance regarding the couple's spiritual rites.
C) Referring the couple to the hospital chaplain at discharge.
D) Informing the couple of religious rituals that have helped other couples to cope with fetal loss.

Answer 3

Providing an atmosphere of acceptance regarding the couple's spiritual rites.

Question 4

The nurse is caring for a patient who has just been informed of the demise of her unborn fetus. Which common cognitive responses to loss would the nurse anticipate?

A) Denial and disbelief
B) Sense of unreality
C) Poor concentration
D) Palpitations
E) Loss of appetite

Question 5

A pregnant couple have been notified that their 32-week fetus is dead. The father is yelling at the staff, and his wife is crying uncontrollably. Their 5-year-old daughter is banging the head of her doll on the floor. Which nursing action would be most helpful at this time?

A) Tell the father that his behavior is inappropriate.
B) Sit with the family and quietly communicate sorrow at their loss.
C) Help the couple to understand that their daughter is acting inappropriately.
D) Encourage the couple to send their daughter to her grandparents.

Question 6

The patient in the first trimester of pregnancy questions the nurse about the causes of fetal death. The nurse explains that factors associated with perinatal loss include:

A) Maternal diabetes.
B) Paternal hypertension.
C) Fetal chromosomal disorders.
D) Maternal infections.
E) Placental abnormalities.

Question 7

The nurse has returned from working as a maternal-child nurse volunteer for a nongovernmental organization. After completing a community presentation about this experience, the nurse knows that learning has occurred when a participant states:

A) "Malaria is a chronic disease, and rarely causes fetal loss."
B) "Escherichia coli bacteria can cause diarrhea but not stillbirth."
C) "Group B streptococci can cause infection and the death of the fetus."
D) "Viral infections don't cause fetal death in underdeveloped nations."

Question 8

A patient has delivered a stillborn child at 26 weeks' gestation. She tells the nurse that none of her friends have called or visited, and that her husband's parents seem unwilling to talk about the loss. The nurse recognizes the mother's grief as:

A) Disenfranchised grief.
B) Bereavement.
C) An intuitive style of coping.
D) Denial.

Question 9

The multiparous patient at 33 weeks has experienced an intrauterine fetal demise. What finding requires immediate intervention?

A) Temperature
B) Platelet count 210,000
C) Fibrinogen level 50 mg/dl
D) Family refusing fetal autopsy
99)0°F

Question 10

The nurse is caring for a patient who experienced the birth of a stillborn son earlier in the day. The patient is from a culture that is very paternalistic and emphasizes the importance of male children over female. What behavior would the nurse expect in this patient?

A) Crying inconsolably
B) Expressing feelings of failure as a woman
C) Requesting family members to be present
D) Showing little emotion

Question 11

The community nurse has identified that the mother who gave birth to a stillborn baby last week is an intuitive griever. Which behavior has the nurse encountered that would lead to this assessment?

A) The mother verbalized that her problem-solving skills have been helpful during this process.
B) The mother repeatedly talks about her thoughts, feelings, and emotions about losing her child.
C) The mother talks little about her experience, and appears detached and unaffected by the loss of her child.
D) The mother has asked close friends, co-workers, and relatives not to call or visit.

Question 12

The postpartum unit nurse is caring for a patient who delivered a term stillborn infant yesterday. The mother is heard screaming at the nutrition services worker, "This food is horrible! You people are incompetent and can't cook a simple edible meal!" The nurse understands this as:

A) An indication the mother is in the anger phase of grief.
B) An abnormal response to the loss of the child.
C) Reactive stress management techniques in use.
D) Denial of the death of the child she delivered yesterday.

Question 13

A couple request to see their stillborn infant. The nurse should prepare the infant by:

A) Wrapping the infant in a blanket.
B) Removing all blankets from the infant.
C) Placing a hat on the infant.
D) Removing any identification from the infant.
E) Placing a diaper on the infant.

Question 14

The nurse is caring for a couple who are in the labor/delivery room immediately after the delivery of a stillborn baby with visible defects. Which of the following actions by the nurse is appropriate?

A) Discourage the parents from naming the baby.
B) Advise the parents that the baby's defects would be too upsetting for them to see.
C) Transport the baby to the morgue as soon as possible.
D) Offer the parents the choice to see and hold the baby.

Question 15

The patient at 37 weeks' gestation calls the clinic nurse to report that neither she nor her partner has felt fetal movement for the past 48 hours. The nurse anticipates that the physician will order which test to assess fetal viability?

A) Ultrasound
B) Serum progesterone levels
C) Computed tomography (CT) scan
D) Contraction stress test

Question 16

A patient has just delivered her third child, who was stillborn and had obvious severe defects. Which statement by the nurse is most helpful?

A) "Thank goodness you have other children."
B) "I am so happy that your other children are healthy."
C) "These things happen. They are the will of God."
D) "It is all right for you to cry. I will stay here with you."

Question 17

The nurse is anticipating the arrival of a couple in the labor unit. It has been determined that the 37-week fetus has died in utero from unknown causes. What should the nurse include in the plan of care for this couple?

A) Allow the couple to adjust to the labor unit in the waiting area.
B) Place the couple in a labor room at the end of the hall with an empty room next door.
C) Encourage the father to go home and rest for a few hours.
D) Contact the mother's emergency contact person and explain the situation.

Question 18

The nurse is caring for a patient who finally conceived after several unsuccessful attempts at in vitro fertilization. The patient has just been diagnosed with a perinatal loss. The nurse's plan of care should include:

A) Giving accurate and honest information.
B) Encouraging the couple to try right away to get pregnant again.
C) Validating the many losses the patient has experienced.
D) Providing possible explanations for the fetal demise.
E) Assessing where the patient is in the grieving process, and communicating with compassion.

Question 19

The nurse is planning an in-service presentation about perinatal loss. Which statements should the nurse include in this presentation?

A) "Perinatal loss refers to third-trimester fetal death in utero."
B) "Perinatal loss occurs more frequently in assisted reproduction."
C) "Perinatal loss rates have declined in the United States over the past few years."
D) "Perinatal loss is most frequent in the last 4 weeks of pregnancy."
E) "Perinatal loss rarely causes an emotional problem for the family."

Question 20

A woman has just delivered a stillborn child at 26 weeks' gestation. Which nursing action is appropriate at this time?

A) Remind the mother that she will be able to have another baby in the future.
B) Dress the infant in a gown and swaddle it in a receiving blanket.
C) Ask the woman whether she would like the doctor to prescribe a sedative for her.
D) Remove the baby from the delivery room as soon as possible.

Question 21

The nurse is caring for a patient from a patriarchal culture who has just experienced fetal demise at 30 weeks. The reason for the demise is not readily apparent. Being culturally sensitive, the nurse knows that:

A) The patient will feel that she is a failure at reproduction.
B) The patient will have no feeling toward the fetus.
C) The husband will be very supportive of his wife.
D) The father will not be allowed to see the baby.

Question 22

A 15-year-old patient has delivered a 22-week stillborn fetus. The nurse understands that:

A) Grieving a fetal loss manifests with very similar behaviors regardless of the age of the patient.
B) Teens tend to withhold emotions, and need older adults with the same type of loss to help process the experience.
C) Most teens have had a great deal of contact with death and loss and have an established method of coping.
D) Assisting the patient might be difficult because of her mistrust of authority figures.

Question 23

The labor and delivery nurse is caring for a patient whose labor is being induced due to fetal death in utero at 35 weeks' gestation. In planning intrapartum care for this patient, which nursing diagnosis is most likely to be applied?

A) Powerlessness
B) Ineffective Elimination
C) Effective Family Coping
D) Energy Field Disturbance

Question 24

What of the following nursing interventions are appropriate when caring for the family experiencing a stillbirth?

A) Use active listening techniques.
B) Avoid the use of cliches.
C) Avoid periods of silence.
D) Wrap the infant in a blanket before the parents see the infant.
E) Do not permit the parents of an infant with birth defects to hold the infant.

Question 25

A patient has experienced a stillbirth. Which statement by the nurse would be appropriate?

A) "You are young. You can try again."
B) "At least you have your other children."
C) "I'm sure you had many dreams and hopes for the future."
D) "It's a blessing in disguise."

Question 26

Which nursing interventions would be included in the plan of care for a family that has just been informed of a perinatal loss?

A) Provide the parents with a private place and time to express their grief.
B) Offer reassurance that parents can have a subsequent successful pregnancy.
C) Allow the parents to participate in personal grief rituals.
D) Encourage interaction with other families.
E) Offer to give the family mementos of the infant such as footprints, crib card, and lock of hair.

Question 27

The nurse is working with a family who experienced the stillbirth of a son 2 months ago. Which statement by the mother would be expected?

A) "I seem to keep crying for no reason."
B) "The death of my son hasn't changed my life."
C) "I have not visited my son's gravesite."
D) "I feel happy all the time."

Question 28

The nurse is caring for a 15-year-old who just delivered a 32-weeks'-gestation stillborn infant with numerous defects. In caring for this patient, the nurse knows that:

A) The patient will likely do no grieving, as she is so young and the pregnancy was probably a mistake in any case.
B) Adolescents have a sense of invulnerability, an "It can't happen to me" mentality.
C) The patient's mother will handle her daughter's grief, so the nurse doesn't need to be concerned.
D) The nurse will remove the baby before the patient sees it.

Question 29

Which nursing diagnoses can apply to the couple experiencing a perinatal loss?

A) Grieving related to the imminent loss of a child
B) Fear related to discomfort of labor and unknown outcome
C) Deficient Knowledge related to lack of information about involution
D) Powerlessness related to lack of control in current situational crisis
E) Risk for Spiritual Distress related to intense suffering secondary to unexpected fetal loss

Question 30

The nurse is working with a laboring woman who has a known intrauterine fetal demise. To facilitate the family's acceptance of the fetal loss, after delivery the nurse should:

A) Encourage the parents to look at the infant from across the room.
B) Offer the parents the choice of holding the infant in their arms.
C) Take the infant to the morgue immediately.
D) Call family members and inform them of the birth.

Question 31

The nurse is present when a mother and her partner are told that their 35-week fetus has died. Which nursing intervention should the nurse perform first?

A) Encourage open communication with the family and the healthcare team.
B) Ask the family to withhold questions until the next day.
C) Request that another nurse come and care for this family.
D) Contact a local funeral home to help the family with funeral plans.

Question 32

A patient has delivered a stillborn infant at 28 weeks' gestation. Which nursing action is appropriate?

A) Discuss funeral options for the baby.
B) Encourage the couple to try to get pregnant again soon.
C) Ask the couple whether or not they would like to hold the baby.
D) Advise the couple that the baby's death was probably for the best.

Question 33

The community nurse is planning care for a family that experienced the loss of twins at 20 weeks. Which of these steps should be part of the nurse's care of this family?

A) Base care on the reactions of previous patients who experienced stillbirth.
B) Express the belief that the family will be able to get through this experience.
C) Encourage the couple to keep their feelings to themselves.
D) Honor the birth by reminding the couple that their baby is happy in heaven.

Question 34

The nurse is supervising care by a new graduate nurse who is working with a couple who have experienced a stillbirth. Which statement made by the new nurse indicates that further instruction is necessary?

A) "I should stay out of their room as much as possible."
B) "The parents might express their grief differently from each other."
C) "My role is to help the family communicate and cope."
D) "Hopelessness might be expressed by this family."

Question 35

The mother of a patient who has experienced a term stillbirth arrives at the hospital and goes to the nurses' desk. The mother asks what she should say to her daughter in this difficult time. What is the nurse's best response?

A) "Use cliches; your daughter will find the repetition comforting."
B) "Remind her that she is young and can have more children."
C) "Keep talking about other things to keep her mind off the loss."
D) "Express your sadness, and sit silently with her if she doesn't respond."
E) "Encourage her to talk about the baby whenever she wants to."