Chapter 38: Perinatal Loss and Grief My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 38: Perinatal Loss and Grief

Test Bank

MULTIPLE CHOICE

1. A family is visiting two surviving triplets. The third triplet died 2 days ago. What action indicates that the family has begun to grieve for the dead infant?

a.

They refer to the two live infants as twins

b.

They ask about the dead triplets current status

c.

They bring in play clothes for all three infants

d.

They refer to the dead infant in the past tense

ANS: D

Accepting that the infant is dead (in the past tense of the word) demonstrates acceptance of the reality and that the family has begun to grieve.

Parents of multiples are challenged with the task of parenting and grieving at the same time. Referring to the two live infants as twins does not acknowledge acceptance of the existence of their third child.

Bringing in play clothes for all three infants indicates that the parents are still in denial regarding the death of the third triplet.

The death of the third infant has imposed a confusing and ambivalent induction into parenthood for this couple. Clearly they are still in denial regarding the death of one of the triplets.

DIF: Cognitive Level: Comprehension REF: 947

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment

2. A newborn in the neonatal intensive care unit (NICU) is dying as a result of a massive infection. The parents speak to the neonatologist, who informs them of their sons prognosis. When the father sees his son, he says, He looks just fine to me. I cant understand what all this is about. The most appropriate response by the nurse is:

a.

Didnt the doctor tell you about your sons problems?

b.

This must be a difficult time for you. Tell me how youre doing.

c.

To stand beside him quietly

d.

Youll have to face up to the fact that he is going to die sooner or later.

ANS: B

The phase of intense grief can be very difficult, especially for fathers. Parents should be encouraged to share their feelings as the initial steps in the grieving process.

This father is in a phase of acute distress and is reaching out to the nurse as a source of direction in his grieving process. Shifting the focus is not in the best interest of the parent.

Nursing actions may help the parents actualize the loss of their infant through sharing and verbalization of feelings of grief.

Telling the father that his son is going to die sooner or later is dispassionate and inappropriate on the part of the nurse.

DIF: Cognitive Level: Application REF: 933

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning

3. A woman experienced a miscarriage at 10 weeks of gestation and had a dilation and curettage (D&C). She states that she is just fine and wants to go home as soon as possible. While you are assessing her responses to her loss, she tells you that she had purchased some baby things and had picked out a name. Based on your assessment of her responses, what nursing intervention would you do for her first?

a.

Ready her for discharge

b.

Notify pastoral care to offer her a blessing

c.

Ask her if she would like to see what was obtained from her D&C

d.

Ask her what name she had picked out for her baby

ANS: D

One appropriate way of actualizing the loss is to allow parents to name the infant. The nurse should follow this clients cues and inquire about naming the infant.

The client is looking for an opportunity to express her feelings of loss. The nurse should take this opportunity to offer support by allowing the woman to talk about her feelings. Getting the woman ready for discharge is not a priority nursing intervention at this time.

Although it may be therapeutic to offer religious support, the nurse should take this opportunity to offer support by allowing the woman to talk about her feelings.

It is completely inappropriate to ask the woman if she would like to view what was obtained from her D&C.

DIF: Cognitive Level: Application REF: 938

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation

4. During the initial acute distress phase of grieving, parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. The nurses role should be to:

a.

Take over as much as possible to relieve the pressure

b.

Encourage grandparents to take over

c.

Make sure the parents themselves approve the final decisions

d.

Leave them alone to work things out

ANS: C

The nurse is always the clients advocate. Nurses can offer support and guidance and leave room for the same from grandparents. In the end, however, nurses should let the parents make the final decisions.

It is essential the nurse be able to present options regarding burial, autopsy, and so on in a sensitive and respectful manner. The nurse should assist the parents in any way possible; however, it is not the nurses role to take over all arrangements.

Grandparents are often called on to help make difficult decisions regarding funeral arrangements or disposition of the body because they have more life experience with taking care of these painful, yet required arrangements. Some well-meaning relatives try to take over all decision making. It is critical for the nurse to remember that the parents themselves should approve all of the final decisions.

During this time of acute distress the nurse should be present to provide quiet support, answer questions, obtain information, and act as an advocate.

DIF: Cognitive Level: Comprehension REF: 933

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation

5. A nurse concludes that grieving parents have progressed to the reorganization/recovery phase during a follow-up visit a year later if:

a.

They say they feel no pain

b.

They are discussing sex and a future pregnancy, even if they have not sorted out their feelings yet

c.

They have abandoned those moments of bittersweet grief

d.

Their questions have progressed from why? to why us?

ANS: B

Many couples have conflicting feelings about sexuality and future pregnancies.

A little pain is always present, certainly past the first year, when recovery begins to peak.

Bittersweet grief describes the brief grief response that occurs with reminders of a loss, often on anniversary dates. Most couples never abandon it. Recovery is ongoing.

Typically a couples search for meaning progresses from why? in the acute phase to why me? in the intense phase to What does this loss mean to my life? in the reorganizational phase.

DIF: Cognitive Level: Comprehension REF: 933

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Diagnosis

6. A nurse caring for a family during a loss might notice that survivor guilt is sometimes experienced by the infants:

a.

Siblings

b.

Mother

c.

Father

d.

Grandparents

ANS: D

Survivor guilt sometimes is felt by grandparents because they feel that the death is out of order as they are still alive while their grandchild has died. They are angry that they are alive and their grandchild is not.

The siblings of the expected infant also experience a profound loss. A young child will respond to the reactions of the parents and may act out. Older children have a more complete understanding of the loss. School-age children are likely to be frightened, whereas teenagers are at a loss on how to react.

The mother of the infant is experiencing intense grief at this time. She may be dealing with questions such as why me or why my baby and is unlikely to be experiencing survival guilt.

It is important to realize that fathers can be experiencing deep pain beneath their calm and quiet appearance and may need help acknowledging these feelings. This is not the same as survivor guilt.

DIF: Cognitive Level: Comprehension REF: 935

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Evaluation

7. When helping the mother, father, and other family members actualize the loss of the infant, nurses should:

a.

Use the words lost or gone rather than dead or died

b.

Make sure the family understands that it is important to name the baby

c.

If the parents choose to visit with the baby, apply powder and lotion to the baby and wrap the infant in a pretty blanket

d.

Set a firm time for ending the visit with the baby so that the parents know when to let go

ANS: C

Presenting the baby in a nice way stimulates the parents senses and provides pleasant memories of their baby.

Nurses must use dead and died to assist the bereaved in accepting reality.

Although naming the baby can be helpful, it is important not to create the sense that parents have to name the baby. In fact, some cultural taboos and religious rules prohibit the naming of an infant who has died.

Parents need different time periods with their baby to say good-bye. Nurses need to be careful not to rush the process.

DIF: Cognitive Level: Comprehension REF: 940

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning

8. Nurses who want to help parents with their decision making about an autopsy or who may be required to be involved in seeking consent for autopsies should be aware that:

a.

Autopsies are usually covered by insurance

b.

Autopsies must be done within a few hours after delivery

c.

In the current litigious society, more autopsies are performed than in the past

d.

Some religions prohibit autopsy

ANS: D

Some religions prohibit autopsy or limit the choice to times when it may help prevent further loss.

The cost of the autopsy must be considered because it is not covered by insurance and can be very expensive.

There is no rush to perform an autopsy unless evidence of contagious disease or maternal infection is present at the time of death.

The rate of autopsies is declining, in part because of medical facilities fear that errors by the staff might be revealed, resulting in litigation.

DIF: Cognitive Level: Comprehension REF: 940

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Planning

9. With regard to organ donation after an infants death, nurses should be aware that:

a.

Federal law requires medical staff to ask the parents about organ donation and then to contact their states organ procurement organization (OPO) to handle the procedure if the parents agree

b.

Organ donation can aid grieving by giving the family an opportunity to see something positive about the experience

c.

The most common donation is the infants kidneys

d.

Corneas can be donated if the infant was either stillborn or alive as long as the pregnancy went full term

ANS: B

Some see organ donation as a healing experience.

The federal Gift of Life Act made state OPOs responsible for deciding whether to request a donation and for making that request.

The most common donation is the cornea.

For cornea donation the infant must have been born alive at 36 weeks of gestation or later.

DIF: Cognitive Level: Comprehension REF: 941

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning

10. What is appropriate for a nurse to say to bereaved parents?

a.

This happened for the best.

b.

God had a purpose for him.

c.

I know how you feel.

d.

What can I do for you?

ANS: D

Acknowledging the loss and being open to listening is the best the nurse can do.

No bereaved parent would find that comforting. Nurses should resist the temptation to give advice or to use clichs.

Nurses must resist the impulse to speak for God to people in pain. They also should resist the temptation to give advice or to use clichs.

Unless you have lost a child yourself, you dont. Nurses should resist the temptation to give advice or to use clichs.

DIF: Cognitive Level: Comprehension REF: 942

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation

11. In helping bereaved parents cope and move on, nurses should keep in mind that:

a.

A perinatal or parental grief support group is more likely to be helpful if the needs of the parents are matched with the focus of the group

b.

When pictures of the infant are taken for keepsakes, no close-ups should be taken of any congenital anomalies

c.

No significant differences exist in grieving individuals from various cultures, ethnic groups, and religions

d.

In emergency situations, nurses who are so disposed must resist the temptation to baptize the infant in the absence of a priest or minister

ANS: A

For example, a religious-based group may not work for nonreligious parents.

Close-up pictures of the baby must be taken as the infant was, congenital anomalies and all.

Although death and grieving are events shared by all people, mourning rituals, traditions, and taboos vary by culture, ethnicity, and religion. Differences must be respected.

Baptism for some religious groups can be performed by a layperson, such as a nurse, in an emergency situation when a priest is not available.

DIF: Cognitive Level: Comprehension REF: 946

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning

12. Many women and their partners, whether infertile or not, will experience perinatal loss. The nurse who cares for these families should understand that those experiencing a silent or hidden loss will also grieve and require the support of caregivers, family, and friends. A(n) _________________ is not an example of a silent loss.

a.

Ectopic pregnancy

b.

Stillbirth

c.

Miscarriage

d.

Induced abortion

ANS: B

Stillbirth is particularly devastating because it occurs suddenly and at the end of the pregnancy. It is not a silent loss because the expectant parents and their family are preparing for the delivery of a healthy infant.

Approximately 20 of each 1000 pregnancies result in an ectopic pregnancy, which are those that take place outside the uterus, most commonly in a fallopian tube. Others in the womans network may not yet have knowledge of the pregnancy and subsequent loss. Hidden or silent losses are those that occur early in the pregnancy.

Approximately 15% of pregnancies end in miscarriage. This is also a hidden loss because miscarriage occurs early in the pregnancy. Families and friends may not feel comfortable bringing up the loss with the woman or her partner. Feelings of helplessness or loss of control are common, especially if there is no identified cause for the miscarriage. The nurse must be supportive especially if the couple has had repeated miscarriages.

Abortions are induced for a number of reasons, often for congenital anomalies. This often occurs earlier in the pregnancy prior to many in the mothers support network having knowledge of the event.

DIF: Cognitive Level: Knowledge REF: 931

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning

COMPLETION

1. The term _________________________ refers to the grief response that occurs with reminders of loss. This typically happens on special anniversary dates of the loss.

ANS:

Bittersweet grief

Parents have shared that they will never forget the baby who has died, and they are not the same people as before the loss. Grief feelings also can be triggered during subsequent pregnancies and after birth as well as on anniversaries.

DIF: Cognitive Level: Comprehension REF: 934

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

TRUE/FALSE

1. Society tends to minimize perinatal loss because of the prevailing belief that there are no barriers to getting pregnant and the expectation that once a woman is pregnant, a healthy, live infant will result. Is this statement true or false?

ANS: T

Because of these perceptions, grieving parents often do not receive the support they need, and society often allows much too short a time for mothers to grieve (and even less for fathers).

DIF: Cognitive Level: Comprehension REF: 932

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Evaluation

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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