Chapter 36 Grief and Loss in the Childbearing Family My Nursing Test Banks

Olds Maternal-Newborn Nursing and Womens Health, 10e (Davidson)

Chapter 36 Grief and Loss in the Childbearing Family

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

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Perinatal loss refers to third-trimester fetal death in utero.

2. Perinatal loss occurs more frequently in assisted reproduction.

3. Perinatal loss rates have declined in the United States over the past few years.

4. Perinatal loss includes 25% of stillbirths occurring before the onset of labor.

5. Perinatal loss rarely causes an emotional problem for the family.

Answer: 2, 3

Explanation: 2. Pregnancies conceived by in vitro fertilization have higher rates of pregnancy loss and pregnancy complications.

3. Perinatal loss in industrialized countries has declined in recent years as early diagnosis of congenital anomalies and advances in genetic testing techniques have increased the use of elective termination.

Page Ref: 943

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1 Discuss perinatal loss including etiology, diagnosis, and the nurses role in facilitating the familys mourning process.

MNL LO: 5.5.2 Determine the care of the family experiencing a perinatal loss.

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2) 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 which of the following?

1. Malaria is a chronic disease, and rarely causes fetal loss.

2. Escherichia coli bacteria can cause diarrhea but not stillbirth.

3. Group B streptococci can cause infection and the death of the fetus.

4. Viral infections dont cause fetal death in developing nations.

Answer: 3

Explanation: 3. Group B streptococci can cause ascending infections prior to or after rupture of membranes.

Page Ref: 943

Cognitive Level: Applying

Client Need/Sub: Safe Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1 Discuss perinatal loss including etiology, diagnosis, and the nurses role in facilitating the familys mourning process.

3) 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?

1. The mother verbalized that her problem-solving skills have been helpful during this process.

2. The mother repeatedly talks about her thoughts, feelings, and emotions about losing her child.

3. The mother talks little about her experience, and appears detached and unaffected by the loss of her child.

4. The mother has asked close friends, co-workers, and relatives not to call or visit.

Answer: 2

Explanation: 2. Intuitive grievers tend to feel their way through the loss and seek emotional and psychosocial support.

Page Ref: 948

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 4. Assess presence and extent of pain and suffering. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2 Describe the physical, cognitive, emotional, behavioral, and spiritual responses ex

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perienced by parents during grieving associated with perinatal loss.

MNL LO: 5.5.1 Compare theories related to the grieving process.

4) 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?

1. Allow the couple to adjust to the labor unit in the waiting area.

2. Place the couple in a labor room at the end of the hall with an empty room next door.

3. Encourage the father to go home and rest for a few hours.

4. Contact the mothers emergency contact person and explain the situation.

Answer: 2

Explanation: 2. Upon arrival to the facility, the couple with a known or suspected fetal demise should immediately be placed in a private room. When possible, the woman should be in a room that is farthest away from other laboring women.

Page Ref: 955

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Identify nursing diagnoses and interventions to meet the special needs of parents and their families related to perinatal loss and grief.

MNL LO: 5.5.3 Implement specific nursing interventions related to caring for families experiencing perinatal loss.

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5) The client 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 which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Maternal diabetes

2. Paternal hypertension

3. Fetal chromosomal disorders

4. Maternal infections

5. Placental abnormalities

Answer: 1, 3, 4, 5

Explanation: 1. Fetal loss can be a result of a number of physiologic maladaptations, including maternal diabetes.

3. Chromosomal abnormalities can be associated with fetal loss.

4. Infections such as human parvovirus B19, syphilis, streptococcal infection, and Listeria can lead to fetal loss.

5. Placental abnormalities such as abruptio placentae and placenta previa can result in fetal death.

Page Ref: 943, 944

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Discuss perinatal loss including etiology, diagnosis, and the nurses role in facilitating the familys mourning process.

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

1. Remind the mother that she will be able to have another baby in the future.

2. Dress the infant in a gown and swaddle it in a receiving blanket.

3. Ask the woman whether she would like the doctor to prescribe a sedative for her.

4. Remove the baby from the delivery room as soon as possible.

Answer: 2

Explanation: 2. After bathing, the infant should be placed in a suitable-sized gown and then wrapped in a blanket.

Page Ref: 959

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Identify nursing diagnoses and interventions to meet the special needs of parents and their families related to perinatal loss and grief.

MNL LO: 5.5.3 Implement specific nursing interventions related to caring for families experiencing perinatal loss.

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7) The nurse is teaching a class on perinatal loss to student nurses. What would the nurse explain about the relationship between attachment and the grief response?

1. The mother has no attachment to the fetus before it is born.

2. The severity of the grieving has nothing to do with attachment to the fetus.

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

4. The mother would feel grief only if it were a planned pregnancy.

Answer: 3

Explanation: 3. The intensity to which the grief will be experienced is best understood from the aspect of the level of attachment the grieving person had to the deceased and usually entails finding personal meaning in the loss for successful integration into the grieving persons life.

Page Ref: 946

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 4. Assess presence and extent of pain and suffering. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2 Describe the physical, cognitive, emotional, behavioral, and spiritual responses experienced by parents during grieving associated with perinatal loss.

MNL LO: 5.5.1 Compare theories related to the grieving process.

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8) A couple request to see their stillborn infant. How should the nurse prepare the infant?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Wrapping the infant in a blanket

2. Removing all blankets from the infant

3. Placing a hat on the infant

4. Removing any identification from the infant

5. Placing a diaper on the infant

Answer: 1, 3

Explanation: 1. After bathing, the infant should be placed in a suitable-sized gown and then wrapped in a blanket. Many parents will eventually remove the covering to inspect the infant; however, applying a covering allows them time to adjust to the appearance at their own pace.

3. A hat can be applied to cover birth defects. This allows the parents an opportunity to view the infant before seeing the birth defect.

Page Ref: 959

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Identify nursing diagnoses and interventions to meet the special needs of parents and their families related to perinatal loss and grief.

MNL LO: 5.5.3 Implement specific nursing interventions related to caring for families experiencing perinatal loss.

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9) Which of the following may lead to the development of disseminated intravascular coagulation (DIC), also called consumption coagulopathy, in the mother?

1. Hypertensive disorders

2. Abruptio placentae

3. Prolonged retention of the dead fetus

4. Heritable thrombophilias

Answer: 3

Explanation: 3. Prolonged retention of the dead fetus may lead to the development of disseminated intravascular coagulation (DIC), also called consumption coagulopathy, in the mother.

Page Ref: 944

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: VII. 1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities, and populations. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Discuss perinatal loss including etiology, diagnosis, and the nurses role in facilitating the familys mourning process.

10) How does the nurse consider the spiritual needs of a couple experiencing a fetal loss?

1. Explaining the fetal loss in terms of the nurses own religious beliefs

2. Providing an atmosphere of acceptance regarding the couples spiritual rites

3. Referring the couple to the hospital chaplain at discharge

4. Informing the couple of religious rituals that have helped other couples to cope with fetal loss

Answer: 2

Explanation: 2. The nurse can facilitate the spiritual needs of the couple by providing an atmosphere of acceptance regarding spiritual rites and encouraging the couples use of spiritual writings, prayers, and observances.

Page Ref: 949

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Respect the patients dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Describe the physical, cognitive, emotional, behavioral, and spiritual responses experienced by parents during grieving associated with perinatal loss.

MNL LO: 5.5.2 Determine the care of the family experiencing a perinatal loss.

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

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Denial and disbelief

2. Sense of unreality

3. Poor concentration

4. Palpitations

5. Loss of appetite

Answer: 1, 2, 3

Explanation: 1. Denial and disbelief are common cognitive responses to fetal loss.

2. A sense of unreality is a common cognitive response to fetal loss.

3. Poor concentration is a common cognitive response to loss.

Page Ref: 947

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. C. 8. Appreciate the role of the nurse in relief of all types and sources of pain or suffering. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Respect the patients dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Describe the physical, cognitive, emotional, behavioral, and spiritual responses experienced by parents during grieving associated with perinatal loss.

MNL LO: 5.5.1 Compare theories related to the grieving process.

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12) 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?

1. Discourage the parents from naming the baby.

2. Advise the parents that the babys defects would be too upsetting for them to see.

3. Transport the baby to the morgue as soon as possible.

4. Offer the parents the choice to see and hold the baby.

Answer: 4

Explanation: 4. The nurse should offer the couple the opportunity to see and hold the infant, and reassure the couple that any decision they make for themselves is the right one.

Page Ref: 959

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Respect the patients dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Identify nursing diagnoses and interventions to meet the special needs of parents and their families related to perinatal loss and grief.

MNL LO: 5.5.3 Implement specific nursing interventions related to caring for families experiencing perinatal loss.

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13) 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?

1. Tell the father that his behavior is inappropriate.

2. Sit with the family and quietly communicate sorrow at their loss.

3. Help the couple to understand that their daughter is acting inappropriately.

4. Encourage the couple to send their daughter to her grandparents.

Answer: 2

Explanation: 2. Sitting down for a moment with the woman and her partner and acknowledging the loss in the event of a known demise or impending death will go a long way toward establishing a relationship of trust between the nurse and the parents.

Page Ref: 955

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. C. 8. Appreciate the role of the nurse in relief of all types and sources of pain or suffering. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Respect the patients dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Identify nursing diagnoses and interventions to meet the special needs of parents and their families related to perinatal loss and grief.

MNL LO: 5.5.3 Implement specific nursing interventions related to caring for families experiencing perinatal loss.

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14) The client 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?

1. Ultrasound

2. Serum progesterone levels

3. Computed tomography (CT) scan

4. Contraction stress test

Answer: 1

Explanation: 1. Diagnosis of intrauterine fetal death (IUFD) is confirmed by visualization of the fetal heart with absence of heart action on ultrasound.

Page Ref: 944

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Discuss perinatal loss including etiology, diagnosis, and the nurses role in facilitating the familys mourning process.

MNL LO: 5.5.2 Determine the care of the family experiencing a perinatal loss.

15) The postpartum unit nurse is caring for a client 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 cant cook a simple edible meal! The nurse understands this as which of the following?

1. An indication the mother is in the anger phase of grief.

2. An abnormal response to the loss of the child.

3. Reactive stress management techniques in use.

4. Denial of the death of the child she delivered yesterday.

Answer: 1

Explanation: 1. Anger, resulting from feelings of loss, loneliness, and, perhaps, guilt, is a common reaction. Anger may be projected at significant others and/or healthcare team members.

Page Ref: 946, 947

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. C. 9. Recognize that patient expectations influence outcomes in management of pain or suffering. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Respect the patients dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2 Describe the physical, cognitive, emotional, behavioral, and spiritual responses

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experienced by parents during grieving associated with perinatal loss.

MNL LO: 5.5.1 Compare theories related to the grieving process.

16) The nurse is caring for a client who experienced the birth of a stillborn son earlier in the day. The client is from a culture where a womans status is dominated by themes of motherhood and childrearing. What behavior would the nurse expect in this client?

1. Crying inconsolably

2. Expressing feelings of failure as a woman

3. Requesting family members to be present

4. Showing little emotion

Answer: 2

Explanation: 2. Mothers will often blame themselves, whether by commission or omission, particularly in cultures where a womans status is dominated by themes of motherhood and childrearing.

Page Ref: 952

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 4. Assess presence and extent of pain and suffering. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: The role of family, culture, and community in a persons development. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3 Delineate the personal, societal, and cultural issues that may complicate responses to perinatal loss.

MNL LO: 5.5.1 Compare theories related to the grieving process.

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

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Unsupportive family

2. Adolescent mother

3. Strong religious faith

4. Open communication between the parents

5. Persistent denial of the situation

Answer: 1, 2, 5

Explanation: 1. Features of bereaved individuals circumstances that will put them at risk include an unsupportive or unavailable family.

2. With regard to age, adolescent parents probably pose the greatest challenge to nursing interventions.

5. Persistent denial hampers the grieving and healing processes.

Page Ref: 947, 948

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 4. Assess presence and extent of pain and suffering. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3 Delineate the personal, societal, and cultural issues that may complicate responses to perinatal loss.

MNL LO: 5.5.1 Compare theories related to the grieving process.

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18) The nurse is caring for a client who finally conceived after several unsuccessful attempts at in vitro fertilization. The client has just been diagnosed with a perinatal loss. What should the nurses plan of care include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Giving accurate and honest information

2. Encouraging the couple to try right away to get pregnant again

3. Validating the many losses the client has experienced

4. Providing possible explanations for the fetal demise

5. Assessing where the client is in the grieving process, and communicating with compassion

Answer: 1, 3, 5

Explanation: 1. Families can cope with extreme situations when they are properly informed in an honest and forthright manner.

3. The nurse should be compassionate, give accurate and honest information, and validate the many losses incurred.

5. The nurse caring for a couple who has had a previous loss needs to be kind, compassionate, and patient.

Page Ref: 952, 963, 964

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 7. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Differentiate between helpful and nonhelpful responses in caring for families experiencing perinatal loss.

MNL LO: 5.5.2 Determine the care of the family experiencing a perinatal loss.

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19) A client 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 husbands parents seem unwilling to talk about the loss. The nurse recognizes the mothers grief as which of the following?

1. Disenfranchised grief

2. Bereavement

3. An intuitive style of coping

4. Denial

Answer: 1

Explanation: 1. Disenfranchised grief is not supported by the usual societal customs. People are uncomfortable discussing the loss with the parents and often pull away when their support is most needed.

Page Ref: 945

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. C. 9. Recognize that patient expectations influence outcomes in management of pain or suffering. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2 Describe the physical, cognitive, emotional, behavioral, and spiritual responses experienced by parents during grieving associated with perinatal loss.

MNL LO: 5.5.1 Compare theories related to the grieving process.

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

1. Thank goodness you have other children.

2. I am so happy that your other children are healthy.

3. These things happen. They are the will of God.

4. It is all right for you to cry. I will stay here with you.

Answer: 4

Explanation: 4. The nurse needs to let the client know that crying is a normal reaction to the loss event, and that the nurse will stay with her to offer support and understanding.

Page Ref: 964

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. C. 8. Appreciate the role of the nurse in relief of all types and sources of pain or suffering. | AACN Essentials Competencies: IX. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Differentiate between helpful and nonhelpful responses in caring for families experiencing perinatal loss.

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MNL LO: 5.5.2 Determine the care of the family experiencing a perinatal loss.

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21) As the couple and their families begin to confront the pain of their loss, many normal manifestations of grief may be present. Which of the following would indicate an emotional response to the loss?

1. Lack of meaning or direction

2. Preoccupation

3. Flat affect

4. Dreams of the deceased

Answer: 3

Explanation: 3. Flat affect would be an emotional response to loss.

Page Ref: 947

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Describe the physical, cognitive, emotional, behavioral, and spiritual responses experienced by parents during grieving associated with perinatal loss.

MNL LO: 5.5.1 Compare theories related to the grieving process.

22) 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?

1. I seem to keep crying for no reason.

2. The death of my son hasnt changed my life.

3. I have not visited my sons gravesite.

4. I feel happy all the time.

Answer: 1

Explanation: 1. Mourning may be manifested by certain behaviors and rituals, such as weeping, which help the person experience, accept, and adjust to the loss.

Page Ref: 945

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2 Describe the physical, cognitive, emotional, behavioral, and spiritual responses experienced by parents during grieving associated with perinatal loss.

MNL LO: 5.5.1 Compare theories related to the grieving process.

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23) A 15-year-old client has delivered a 22-week stillborn fetus. What does the nurse understand?

1. Grieving a fetal loss manifests with very similar behaviors regardless of the age of the client.

2. Teens tend to withhold emotions and need older adults with the same type of loss to help process the experience.

3. Most teens have had a great deal of contact with death and loss and have an established method of coping.

4. Assisting the client might be difficult because of her mistrust of authority figures.

Answer: 4

Explanation: 4. Adolescents rely heavily on peer support and have a natural mistrust of authority figures, which can make assisting them more difficult.

Page Ref: 947

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3 Delineate the personal, societal, and cultural issues that may complicate responses to perinatal loss.

MNL LO: 5.5.2 Determine the care of the family experiencing a perinatal loss.

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24) 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?

1. Encourage open communication with the family and the healthcare team.

2. Ask the family to withhold questions until the next day.

3. Request that another nurse come and care for this family.

4. Contact a local funeral home to help the family with funeral plans.

Answer: 1

Explanation: 1. The top priority for the nurse is to encourage open communications. The nurse functions as an advocate for the family in organizing interdisciplinary involvement, maintaining continuity of care, offering the opportunity for open communication, and ensuring that the familys wishes regarding their loss experience are honored.

Page Ref: 965

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Identify nursing diagnoses and interventions to meet the special needs of parents and their families related to perinatal loss and grief.

MNL LO: 5.5.3 Implement specific nursing interventions related to caring for families experiencing perinatal loss.

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

1. Powerlessness

2. Urinary Elimination, Impaired

3. Coping: Family, Readiness for Enhanced

4. Skin Integrity, Impaired

Answer: 1

Explanation: 1. Powerlessness is commonly experienced by families who face fetal loss. Powerlessness is related to lack of control in current situational crisis.

Page Ref: 954

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 4 Identify nursing diagnoses and interventions to meet the special needs of parents and their families related to perinatal loss and grief.

MNL LO: 5.5.2 Determine the care of the family experiencing a perinatal loss.

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26) 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?

1. I should stay out of their room as much as possible.

2. The parents might express their grief differently from each other.

3. My role is to help the family communicate and cope.

4. Hopelessness might be expressed by this family.

Answer: 1

Explanation: 1. Families experiencing perinatal loss need support. The nurse should stay with the couple so they do not feel alone and isolated; however, cues that the couple wants to be alone should be assessed continuously.

Page Ref: 956

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2 Describe the physical, cognitive, emotional, behavioral, and spiritual responses experienced by parents during grieving associated with perinatal loss.

MNL LO: 5.5.2 Determine the care of the family experiencing a perinatal loss.

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

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Grieving related to the imminent loss of a child

2. Fear related to discomfort of labor and unknown outcome

3. Knowledge, Deficient related to lack of information about involution

4. Powerlessness related to lack of control in current situational crisis

5. Spiritual Distress, Risk for related to intense suffering secondary to unexpected fetal loss

Answer: 1, 4, 5

Explanation: 1. The nurse should anticipate that the family will experience the grieving process for the lost fetus.

4. The parents are faced with the sudden and unanticipated death of the unborn child, which occurred without any input or control on their part.

5. Spiritual distress is a common reaction of parents who experience an unanticipated loss.

Page Ref: 954

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 4 Identify nursing diagnoses and interventions to meet the special needs of parents and their families related to perinatal loss and grief.

MNL LO: 5.5.2 Determine the care of the family experiencing a perinatal loss.

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

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Provide the parents with a private place and time to express their grief.

2. Offer reassurance that parents can have a subsequent successful pregnancy.

3. Allow the parents to participate in personal grief rituals.

4. Encourage interaction with other families.

5. Offer to give the family mementos of the infant such as footprints, crib card, and lock of hair.

Answer: 1, 3, 5

Explanation: 1. The couple with a known or suspected fetal demise should immediately be placed in a private room. When possible, the woman should be in a room that is farthest away from other laboring women.

3. The nurse should assist the couple in exploring their feelings and help them to make decisions about who will be present and what rituals will occur during and following the birth.

5. In a fetal demise, mementos are some of the few memories the parents have to provide them comfort after the death of their baby. Every effort should be made to offer as many quality mementos as possible, such as pictures and hand- or footprint molds and cards.

Page Ref: 955, 957, 960

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Identify nursing diagnoses and interventions to meet the special needs of parents and their families related to perinatal loss and grief.

MNL LO: 5.5.3 Implement specific nursing interventions related to caring for families experiencing perinatal loss.

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

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Use active listening techniques.

2. Avoid the use of clichs.

3. Avoid periods of silence.

4. Wrap the infant in a blanket before the parents see the infant.

5. Do not permit the parents of an infant with birth defects to hold the infant.

Answer: 1, 2, 4

Explanation: 1. It is important to allow the parents to verbalize their concerns.

2. The nurse can facilitate a healthy mourning process for the family by using active listening techniques and avoiding the use of clichs and platitudes.

4. The infant should be wrapped in a blanket to allow parents to see the infant before viewing any deformities.

Page Ref: 954, 959, 962

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Identify nursing diagnoses and interventions to meet the special needs of parents and their families related to perinatal loss and grief.

MNL LO: 5.5.3 Implement specific nursing interventions related to caring for families experiencing perinatal loss.

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30) 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 client, the nurse knows which of the following?

1. The client will likely do no grieving, as she is so young and the pregnancy was probably a mistake in any case.

2. Adolescents have a sense of invulnerability, an It cant happen to me mentality.

3. The clients mother will handle her daughters grief, so the nurse doesnt need to be concerned.

4. The nurse will remove the baby before the client sees it.

Answer: 2

Explanation: 2. Though adolescents have a mature concept of death, it is often clouded by their sense of invulnerability, an It cant happen to me mentality.

Page Ref: 947

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3 Delineate the personal, societal, and cultural issues that may complicate responses to perinatal loss.

MNL LO: 5.5.3 Implement specific nursing interventions related to caring for families experiencing perinatal loss.

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31) The nurse is working with a laboring woman who has a known intrauterine fetal demise. To facilitate the familys acceptance of the fetal loss, after delivery the nurse should do which of the following?

1. Encourage the parents to look at the infant from across the room.

2. Offer the parents the choice of holding the infant in their arms.

3. Take the infant to the morgue immediately.

4. Call family members and inform them of the birth.

Answer: 2

Explanation: 2. The nurse should offer the couple the opportunity to see and hold the infant and reassure the couple that any decision they make for themselves is the right one.

Page Ref: 959

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Identify nursing diagnoses and interventions to meet the special needs of parents and their families related to perinatal loss and grief.

MNL LO: 5.5.3 Implement specific nursing interventions related to caring for families experiencing perinatal loss.

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32) The mother of a client 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 nurses best response?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Use clichs; your daughter will find the repetition comforting.

2. Remind her that she is young and can have more children.

3. Keep talking about other things to keep her mind off the loss.

4. Express your sadness, and sit silently with her if she doesnt respond.

5. Encourage her to talk about the baby whenever she wants to.

Answer: 4, 5

Explanation: 4. Silence is commonly what is needed most, and simply saying Im sorry for your loss might help to facilitate communication.

5. Talking is a way for the client experiencing grief and begin to come to terms with what has happened, and is important for resolution of grief. Intuitive grievers will need to talk about the event.

Page Ref: 948, 954, 955

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patients emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Differentiate between helpful and nonhelpful responses in caring for families experiencing perinatal loss.

MNL LO: 5.5.1 Compare theories related to the grieving process.

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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 nurses care of this family?

1. Base care on the reactions of previous clients who experienced stillbirth.

2. Express the belief that the family will be able to get through this experience.

3. Encourage the couple to keep their feelings to themselves.

4. Honor the birth by reminding the couple that their babies are happy in heaven.

Answer: 2

Explanation: 2. Maintaining belief is defined as believing in the parents capacity to get through the event and face a future with meaning and it is one of the attributes of caring theory.

Page Ref: 955

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3 Delineate the personal, societal, and cultural issues that may complicate responses to perinatal loss.

MNL LO: 5.5.1 Compare theories related to the grieving process.

34) A client has experienced a stillbirth. Which statement by the nurse would be appropriate?

1. You are young. You can try again.

2. At least you have your other children.

3. Im sure you had many dreams and hopes for the future.

4. Its a blessing in disguise.

Answer: 3

Explanation: 3. Perinatal loss is unique in that the parents have not had experiences with the child that was to be, and attachment is based mostly upon hopes and dreams for the future relationship.

Page Ref: 945

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Differentiate between helpful and nonhelpful responses in caring for families experiencing perinatal loss.

MNL LO: 5.5.2 Determine the care of the family experiencing a perinatal loss.

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35) A client has delivered a stillborn infant at 28 weeks gestation. Which nursing action is appropriate?

1. Discuss funeral options for the baby.

2. Encourage the couple to try to get pregnant again soon.

3. Ask the couple whether or not they would like to hold the baby.

4. Advise the couple that the babys death was probably for the best.

Answer: 3

Explanation: 3. Some parents will hold their infant for a short time before returning him or her to the nurse, whereas others will wish to spend a great deal of time with their infant. Allow the infant to remain with the parents for as long as they desire.

Page Ref: 959

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: QSEN Competencies: I. B. 6. Elicit expectations of patient and family for relief of pain, discomfort, or suffering. | AACN Essentials Competencies: IX. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4 Identify nursing diagnoses and interventions to meet the special needs of parents and their families related to perinatal loss and grief.

MNL LO: 5.5.3 Implement specific nursing interventions related to caring for families experiencing perinatal loss.

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