N137 Perinatal Loss, Bereavement and Grief

The nurse is caring for a client who had an intrauterine fetal death at 19 weeks of gestation. What will the nurse inform the client regarding the disposal of the body? 1 The client needs to undergo dilation and curettage. 2 The hospital provides free cremation for the dead fetus. 3 The client and her family can decide about the burial alternatives. 4 The hospital rules and regulation regarding the cremation of the fetus.

1 A fetus is considered to be a product of conception until 20 weeks of gestation. If there is spontaneous abortion before 20 weeks of gestation, the nurse should inform the client that she needs to undergo dilation and curettage for removal of the dead fetus. The nurse should inform the client about cremation and burial alternatives if the fetus is declared dead after 20 weeks of gestation. If the fetus has died after 20 weeks of gestation, the nurse should allow the client and her family members to decide about the methods of disposing the fetal body. In the same case, the nurse should also explain to the client about the hospital's rule about the cremation of the fetus.

The nurse is caring for a client whose pregnancy ended in a stillbirth and is experiencing loss. The client asks the nurse, "Do you think this happened because I didn't worry about proper nutrition during my first trimester?" Which response by the nurse enhances the process of healing in the client? 1 "Let's talk about your thoughts and feelings about this loss." 2 "You should stop thinking about the past and plan for the future." 3 "Please do not blame yourself, God wanted it to happen this way." 4 "Yes, you are right that proper diet decreases the risk of fetal death."

1 Clients experiencing loss may have severe questions surrounding the event of the loss and blame themselves, because they consider themselves responsible for fetal well-being. The nurse should encourage the clients to answer the questions by themselves. This helps them accept the reality and enhances the process of healing. Therefore, to promote healing the nurse would say, "Let's talk about what you are thinking." The client may feel that the nurse is unable to understand her feeling if the nurse advises her to stop thinking about the past. The nurse should not say that whatever happened is God's will, because it can cause spiritual distress in the client. The client may feel rejected if the nurse says that the stillbirth was caused by improper diet.

While interacting with the family members of a client who has given birth to a stillborn, the client's mother tells the nurse, "Why didn't God take me instead of my grandchild?" What does the nurse infer from this statement? 1 The grandparent has survivor guilt. 2 The grandparent feels hopeless. 3 The grandparent is promoting family coping. 4 The grandparent is reflecting religious beliefs.

1 Grandparents often express survival guilt after learning that their grandchild is dead. They often feel that the death is out of order, because they are still alive and their grandchild has died. Therefore, the statement "Why did not God take me away instead of my grandchild?" indicates the grandmother's survival guilt. The statement does not indicate that the grandparents are hopeless about the loss, nor does it indicate that the grandparent is promoting family coping. Though the grandparent mentioned God in the statement, it does not necessarily reflect the religious belief of the patient's family. Test-Taking Tip: The following are crucial requisites for doing well on the NCLEX exam: (1) A sound understanding of the subject; (2) The ability to follow explicitly the directions given at the beginning of the test; (3) The ability to comprehend what is read; (4) The patience to read each question and set of options carefully before deciding how to answer the question; (5) The ability to use the computer correctly to record answers; (6) The determination to do well; (7) A degree of confidence.

The nurse is questioning bereaved parents to learn what the loss of their child means to them. Which element of the nurse-patient relationship denotes the nurse's action? 1 Knowing 2 Enabling 3 Doing for 4 Being with

1 The nurse is trying to know the exact meaning of the loss of the child for the parents and their perception of the loss. This is categorized under the "knowing" element of the nurse-patient relationship. "Enabling" involves the nurse providing information about care, decision making, and choices to the couple in grief. The nurse performing any activity to provide care, comfort, and safety on behalf of the woman and her family comes under the element of "doing for." "Being with" is the caring presence of the nurse, which shows acceptance of various feelings of the family and the parents.

What are some causes of perinatal loss? Select all that apply. 1 Stillbirth 2 Fertility 3 Infertility 4 Miscarriage 5 Intrauterine fetal death (IUFD) 6 Death of live-born infant soon after birth

1,,3,4,5,6 Some causes of perinatal loss include: stillbirth, infertility, miscarriage, intrauterine fetal death (IUFD), and death of live-born infant soon after birth. Fertility is not a cause of perinatal loss.

Which are responses parents and families may experience with perinatal loss? Select all that apply. 1 Mourning 2 Numbness 3 Loss and grief 4 Shock and anger 5 Happiness and guilt 6 Psychologic distress

1,2,3,4,6 The responses parents and families may experience with perinatal loss include: mourning, numbness, loss and grief, shock and anger, sadness (not happiness) and guilt, and psychologic distress.

Which of these phrases are appropriate for the nurse to say to bereaved parents? Select all that apply. 1 "I'm sorry." 2 "I'm sad for you." 3 "What can I do for you?" 4 "God had a purpose for her." 5 "I'm here, and I want to listen." 6 "You have to keep on going for her sake."

1,2,3,5 Appropriate phrases for the nurse to say to bereaved parents include: "I'm sorry." "I'm sad for you." "What can I do for you?" and "I'm here, and I want to listen." Inappropriate phrases for the nurse to say to bereaved parents include: "God had a purpose for her" and "You have to keep on going for her sake."

For which of these maternal diagnoses or incidents should prenatal testing be done? Select all that apply. 1 Diabetes 2 Hypotension 3 Sickle cell disease 4 Age over 25 5 Three or more miscarriages 6 Chromosomal abnormality

1,3,5,6 The maternal diagnoses or incidents for which prenatal testing should be done include: diabetes; hypertension (not hypotension); sickle cell disease; age over 35 (not 25); three or more miscarriages; and chromosomal abnormalities.

Which are signs/symptoms of complicated grief? Select all that apply. 1 Excessive bitterness 2 Ability to trust others 3 A state of complete happiness 4 Intense and continued guilt or anger 5 Intense longing and yearning for the deceased 6 Feeling that life is empty or meaningless, hopelessness, and loneliness

1,4,5,6 The signs/symptoms of complicated grief include: excessive bitterness; inability (not ability) to trust others; a state of chronic mourning (not complete happiness); intense and continued guilt or anger; intense longing and yearning for the deceased; and feeling that life is empty or meaningless, hopelessness, and loneliness.

When identified in a client, what condition requires a referral to a mental health care professional? 1 Ambiguous loss 2 Complicated grief 3 Posttraumatic growth 4 Disenfranchised grief

2 Complicated grief is the inability of the person to recover from the bereaved state even after a significant passage of time. In this condition, the client should be referred to a mental health care professional. Ambiguous loss is the grief or loss of the object not seen or experienced, such as miscarriage or loss of the fetus. Disenfranchised grief is characterized by limited expressions of grief in cases where the relationship with the deceased is not socially acceptable or not considered important. Posttraumatic growth is the improvement in the quality of life of the bereaved person after the loss. Posttraumatic growth is a positive outcome and does not require a referral to the mental health care professional. Test-Taking Tip: Do not read information into questions, and avoid speculating. Reading into questions creates errors in judgment.

A pregnant client asks the nurse for a second opinion after being informed about the death of the fetus. What does the nurse infer from the client's behavior? 1 The client has professional mistrust. 2 The client is experiencing maternal denial. 3 The client is going through complicated grief. 4 The client is going through disenfranchised grief.

2 Denial is the first stage of grief when a client suffers a perinatal loss. In this stage, the client does not believe the truth and asks the nurse for a second opinion. Denial is followed by anger and grief. If a client asks for a second opinion about the perinatal loss, it does not mean that the client mistrusts the professional opinion. Rather, it is indicative of the client's denial. Complicated grief is a complex situation in which grief may not resolve over time and the bereaved client grieves chronically. This type of grief is not associated with asking the nurse for a second opinion. A client experiencing disfranchised grief shows symptoms of depression and remains isolated. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in 1 to 2 minutes.

The nurse is caring for a client whose baby died 24 hours after birth. Which nursing action is in accordance to the fourth concept of Swanson's caring theory? 1 Acknowledging the client's feelings and helping to cope from the loss 2 Allowing the client and family to spend time with the newborn's body 3 Helping the client and family to accept reality and develop coping skills 4 Interacting with the client and family to know how they perceive the loss

2 Enabling is the fourth concept of Swanson's caring theory. During the enabling phase, the nurse should make the client and family feel comfortable and allow them to create memories of the newborn and spend time with the newborn's body. "Being with" is the second concept of the Swanson's caring theory. The concept of "being with" states that the nurse should be with the client and acknowledge the client's feelings. The fifth concept is maintaining belief. According to this concept, the nurse should identify coping skills and encourage the family to accept the loss. Knowing is the first concept of Swanson's caring theory. According to the concept of knowing, the nurse interacts with the client and family to know how they perceive the loss.

A pregnant client with congenital twins visits a prenatal clinic for an ultrasound examination. The nurse finds that one of the twins has no heartbeat. The client asks the nurse, "Why did this happen?" What is the best response by the nurse? 1 "God needed another angel in heaven and now your baby always has a guardian." 2 "I don't know why this terrible thing happened, but I am here to support and help you." 3 "I am sorry for your loss, but at least you still have another baby to love and care for." 4 "Quite often twins are at a risk of umbilical cord accidents, and these are sometimes fatal."

2 It is important for the nurse to acknowledge the loss and let the client know that she has support. To acknowledge the loss, the nurse states, "I don't know why this terrible thing happened." To support the client, the nurse states, "I am here to support and help you." The nurse should not make statements about God, because not every client is religious and this may be offensive to some clients. The nurse should not use the phrase "at least," because it will not diminish the client's grief associated with the loss. Telling the client about umbilical cord accidents, although true, does not comfort the patient. Test-Taking Tip: Make educated guesses when necessary.

Who described the dual process model of grief-managing strategies? 1 Kübler-Ross 2 Stroebe and Schut 3 Klass and Nickman 4 Cowles and Rodgers

2 Strobe and Schut described the dual process model of individual management of grief and bereavement. Kübler-Ross, a Swiss-American psychiatrist, was the author of the book "Death and Dying," in which she described five stages of grief, including, denial, anger, bargaining, depression, and acceptance. Klass and Nickman proposed the continuing bonds theory of management of grief and bereavement. Cowles and Rodgers were involved in identifying the attributes of grief. Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors.

A client tells the nurse about the funeral arrangements for her newborn son. About what is the client providing the nurse with information? 1 Grief process 2 Mourning process 3 Expression of loss 4 Family reaction

2 The mourning process is reflected by traditions and rituals such as the funeral arrangements. The grief process represents the emotional expression of loss. The expression of loss is related to the meaning of perception. Providing information related to funeral arrangements is not an indicator of family reaction.

What is the nurse's role in helping parents with decisions regarding autopsies, organ donation, and disposition of the body? 1 The nurse's primary responsibility is to encourage and support parents, because choices made during the time of their loss will influence their memories for a lifetime. 2 The nurse's primary responsibility is to help parents and advocate for them, because choices made during the time of their loss will influence their memories for a lifetime. 3 The nurse's primary responsibility is to support parents in any decision made, because choices made during the time of their loss will influence their memories for a lifetime. 4 The nurse's primary responsibility is to send parents to the appropriate departments for each decision made, because choices made during the time of their loss will influence their memories for a lifetime.

2 The nurse's role in helping parents with decisions regarding autopsies, organ donation, and disposition of the body is to help them and to advocate for them, because choices made during the time of their loss will influence their memories for a lifetime. Encouraging and supporting parents, supporting them in any decision made, or sending them to appropriate departments for each decision made are not as important as helping and advocating for the parents during a vulnerable time.

A woman is diagnosed with having a stillborn. At first she appears stunned by the news, cries a little, and then asks you to call her mother. What phase of bereavement is the woman experiencing? 1 Anticipatory grief 2 Acute distress 3 Intense grief 4 Reorganization

2 The parent grieves in preparation for the infant's possible death, although the parent clings to the hope that the child will survive. Anticipatory grief applies to the grief related to a potential loss of an infant. The immediate reaction to news of a perinatal loss or infant death encompasses a period of acute distress. Disbelief and denial can occur. However, parents also feel very sad and depressed. Intense outbursts of emotion and crying are normal. However, lack of affect, euphoria, and calmness may occur and may reflect numbness, denial, or personal ways of coping with stress. Intense grief occurs in the first few months after the death of the infant. This phase encompasses many different emotions, including loneliness, emptiness, yearning, guilt, anger, and fear. Reorganization occurs after a long and intense search for meaning. Parents are better able to function at work and home, experience a return of self-esteem and confidence, can cope with new challenges, and have placed the loss in perspective. STUDY TIP: Laughter is a great stress reliever. Watching a short program that makes you laugh, reading something funny, or sharing humor with friends helps decrease stress.

The nurse is caring for a mother who delivered a stillborn at 35 weeks gestation. What should the nurse include in her plan of care? 1 The mother is at risk for cultural problems because of her baby's death. 2 The mother is at risk for complicated grieving because of her baby's death. 3 The mother is at risk for uncomplicated grieving because of her mother's support. 4 The mother is at risk for uncomplicated grieving because of her husband's support.

2 The plan of care should include: the mother is at risk for complicated grieving because of her baby's death. The plan of care would not include: the mother is at risk for cultural problems because of her baby's death; the mother is at risk for uncomplicated grieving because of her mother's support; or the mother is at risk for uncomplicated grieving because of her husband's support.

The new graduate nurse is preparing a care plan for an adolescent client who has suffered perinatal loss. Which planning strategy documented by the nurse needs correction? 1 Talking and acknowledging the grief experienced by the client 2 Advising the client to talk to older women who have suffered perinatal loss. 3 Using therapeutic communication to develop a good rapport with the client. 4 Helping the client to find out resources that would help the patient overcome grief.

2 When compared to adults, adolescents lack maturity and cognitive abilities. While caring for an adolescent client who has suffered a perinatal loss, the nurse should not advise the client to talk to older women. This is because the client's perception of the loss may be very different from older women who have experienced similar losses. The nurse should instead encourage the client to talk to other adolescent females who have experienced perinatal loss. Acknowledging the grief experienced by the client will help the client express her feelings more freely to the nurse. Developing a good bond is the first step to help the client overcome the grief of the loss. The nurse should also suggest support groups that would help the client cope with the grief effectively.

The nurse is talking to a client who is depressed because her pregnancy ended in a stillbirth. Which concept of the nurse-client relationship, according to the Swanson's caring theory, is the nurse following when trying to assess the client's perception of loss? 1 Enabling 2 Doing for 3 Knowing 4 Being with

3 According to the Swanson's caring theory, while caring for a client with perinatal loss the nurse should first assess the client to understand her perception of loss. This concept is referred to as knowing. In this case, the nurse is trying to assess the client's phase of grief, so the nurse is following the concept of knowing. Enabling is the concept according to which the nurse offers the client and her family various options for care. Doing for refers to interventions provided by the nurse to provide physical care, comfort, and safety to the client. Being with denotes that the nurse is conveying acceptance of the various feelings and perceptions of the client.

The nurse is caring for a Muslim client who gave birth to a stillborn. Which could be the best statement from the client's partner in the family coping session? 1 "We have to contact the hospital's chaplain." 2 "We need to name the baby before burial." 3 "We have to accept the loss as a test from God." 4 "We need to take a photograph of the baby's body."

3 In many Muslim families, perinatal loss is considered a test from God that the family should accept. A Muslim client who suffers perinatal loss is likely to hear this type of comforting statement from her partner and other family members. The hospital chaplain may be contacted when the family believes in baptizing the baby, but baptism is not a religious ritual practiced by Muslims. Naming the baby is a religious ritual of many Jewish families, but may not be as an important religious marker for Muslim patients. Taking photographs of the baby is usually not culturally acceptable for Muslims. Test-Taking Tip: When using this program, be sure to note if you guess at an answer. This will permit you to identify areas that need further review. Also it will help you to see how correct your guessing can be.

What constitutes defining bereavement as "complicated bereavement"? 1 Occurs when, in multiple births, one child dies and the other or others live 2 Is a state in which the parents are ambivalent, as with an abortion 3 Is an extremely intense grief reaction that persists for a long time 4 Is felt by the family of adolescent mothers who lose their babies

3 Parents showing signs of complicated grief should be referred for counseling. Multiple births in which not all the babies survive creates a complicated parenting situation, but this is not complicated bereavement. Abortion can generate complicated emotional responses, but those do not constitute complicated bereavement. Families of lost adolescent pregnancies may have to deal with complicated issues, but this is not complicated bereavement. STUDY TIP: The old standbys of enough sleep and adequate nutritional intake also help keep excessive stress at bay. Although nursing students learn about the body's energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage.

The nurse is caring for a client who has delivered a stillborn child. Which question asked by the nurse will best identify the client's religious needs? 1 "Would you like to talk to the hospital chaplain?" 2 "Do you believe that the loss was God's will?" 3 "Are there any religious rituals you would like to follow?" 4 "Can you describe what the baby's death means to you?"

3 Questions like, "Are there any religious rituals you would like to follow?" are direct questions through which the nurse can determine the religious needs of the client's family. Meeting a hospital chaplain is recommended, but it cannot be used to determine the religious needs of the client's family. The question,"Do you believe the loss was God's will?" may help to identify the religious beliefs of the family; however, the nurse should not ask the client's family about their opinion on the baby's death, because it elevates the grief associated with the perinatal loss. Test-Taking Tip: Try putting questions and answers in your own words to test your understanding.

The nurse is caring for a client suffering from survivor's guilt. What is survivor's guilt? 1 When a child loses his or her younger sibling. 2 When a parent loses his or her other parent/partner and feels guilty about surviving. 3 When grandparents feel that death is out of order because they are alive and their grandchild has died. 4 When young children respond with clinging and changes in eating and sleeping patterns because of the death of a baby (sister or brother).

3 Survivor's guilt is when grandparents feel that death is out of order because they are alive and their grandchild has died. When a child loses his/her younger sibling, a parent loses another parent/partner, or when young children respond with clinging and changes in eating and sleeping patterns because of the death of a baby are not considered survivor's guilt.

What are the five concepts of Swanson's caring theory that describe key elements in the nurse-client relationship? 1 Believing, acknowledging, caring, sharing, and supporting 2 Acknowledging, caring, sharing, encouraging, and supporting 3 Knowing, being with, doing for, enabling, and maintaining belief 4 Caring, sharing time, doing with, encouraging, and spiritual beliefs

3 The five concepts of Swanson's caring theory that describe key elements in the nurse-client relationship include: knowing, being with, doing for, enabling, and maintaining belief. Believing, acknowledging, caring, sharing, and supporting; acknowledging, caring, sharing, encouraging, and supporting; and caring, sharing time, doing with, encouraging, and spiritual beliefs are not the five concepts of Swanson's caring theory.

A pregnant client who is at term has been informed that the fetus has died. This finding was verified at the physician's office by an ultrasound, because the client stated that she had not felt the baby move for a few days. Subsequently, the client is going to be admitted to the obstetrical unit. When developing a plan of care, the nurse would focus on which priority measure? 1 Referral to a perinatologist 2 Including case management to participate in the client's care when she is admitted to the hospital. 3 Incorporate perinatal palliative care into the client's plan of care 4 Provide the client with phone numbers so as to make funeral arrangements.

3 The incorporation of a perinatal palliative care plan would be the priority intervention at this time to help assist the client and family members deal with the tragedy of the situation. At this point, a referral to a perinatologist would not be necessary, because the determination has already been made that the fetus is dead. Although case management may be included in the plan of care, it is not the priority measure. Although phone numbers may be provided to the client regarding funeral arrangements, it is not the priority intervention at this time.

A pregnant client experiences severe bleeding at 30 weeks of gestation. While performing the ultrasound, the nurse discovers that the fetus is dead. How does the nurse present this information to the client? 1 "Your baby has left us." 2 "You have lost your baby." 3 "The baby has no heartbeat." 4 "The baby has passed away."

3 The nurse should be very careful while informing a client about fetal death and should convey this information without any ambiguity. Telling the client that the fetus has no heartbeat clearly indicates that the fetus has died. Telling the client that the baby has left us or that the client has lost her baby may not give a clear indication that the fetus is dead. Saying that the baby has passed away may also be somewhat ambiguous. Therefore, the nurse should not use euphemisms to convey messages about fetal death.

What words should the nurse use to convey perinatal loss to the parents and family? 1 "The baby is lost." 2 "The baby is gone." 3 "The baby has died." 4 "The baby has passed."

3 The nurse should use words such as "has died," which most clearly conveys the situation. Using words such as "lost,""gone,"or "passed" creates ambiguity in the situation. Listeners may interpret these words in different ways. Therefore, the nurse should avoid using these words while conveying perinatal loss to the parents and family.

During a follow-up phone call near the anniversary of an infant's death, the husband reports to the nurse, "My wife has been unable to move on and resume her normal life even after a year." What does the nurse infer from the wife's behavior? 1 The wife is mourning. 2 The wife is experiencing ambiguous loss. 3 The wife is experiencing complicated grief. 4 The wife is experiencing disenfranchised grief.

3 The wife is grieving for the loss of the child a year after the child's death. This indicates that the mother's grief has not resolved with time. Therefore, the wife's grief may be considered complicated grief. Mourning involves following the traditions and rituals; however, the wife is not following any rituals. Therefore, the wife is not mourning. Ambiguous loss is the grief caused by the loss of an object that is missing, such as the death of an unborn fetus. In this case, an infant child has died. People who experience grief do not always openly express feelings of sadness. So, the person receives limited support from the family. This type of grief is known as disenfranchised grief, but this is not the case with the wife. Test-Taking Tip: Pace yourself when taking practice quizzes. Because most nursing exams have specified time limits, you should pace yourself during the practice testing period accordingly. It is helpful to estimate the time that can be spent on each item and still complete the examination in the allotted time. You can obtain this figure by dividing the testing time by the number of items on the test. For example, a 1-hour (60-minute) testing period with 50 items averages 1.2 minutes per question. The NCLEX exam is not a timed test. Both the number of questions and the time to complete the test varies according to each candidate's performance. However, if the test taker uses the maximum of 5 hours to answer the maximum of 265 questions, each question equals 1.3 minutes.

Where should a nurse remove a child's lock of hair for the parents' memorabilia in the event of perinatal loss? 1 The back of the head 2 The forehead 3 The nape of the neck 4 The top of the head

3 To remove a lock of hair for memorabilia, the nurse should select an area that does not disrupt the appearance of the baby. The nape of the neck is considered the most appropriate area to take a hair lock for the memorabilia. The hair lock should not be taken from the areas such as the back of the head, the forehead, or the top of the head. Taking a hair lock from these areas would make the lack of hair in that area noticeable.

A pregnant client who was pregnant with twins had to abort one fetus to prevent severe complications with the pregnancy. The trainee nurse is talking to the grieving client. Which statement of nurse indicates nontherapeutic communication? Select all that apply. 1 "I'm very sorry for your loss." 2 "This must be really hard for you." 3 "We have to accept it, because it was God's will." 4 "You should be thankful that the other child is alive." 5 "Feel free to speak whenever you want to. I want to listen to you."

3,4 Losing a fetus can be really depressing for a client with multiple gestation. The nurse should be very careful while providing support to the client. The nurse should be empathetic and should avoid using clichés to console the client. The nurse's statement that the client should accept the loss as God's will and be thankful that the other child is alive may further aggravate the client's feelings of anger and grief. The statement that the nurse is sorry for the client and that experiencing this loss must be hard for the client indicates that the nurse is acknowledging the client's loss. This is a therapeutic response of the nurse. The nurse's statement that the client should feel free to talk to nurse indicates that the nurse is encouraging the client to express her feelings.

A Gravida III, Para 0 is concerned about the potential outcome for this pregnancy because all of her prior pregnancies have resulted in stillborn deliveries. Which diagnostic test would help to assess for fetal well-being now that she is at 32 weeks gestation? 1 Kleihauer-Betke test 2 Chorionic villi sampling 3 Contraction Stress Test 4 Ultrasound

4 An ultrasound could be used to determine fetal well-being. The Kleihauer-Betke test is a blood test determinant to evaluate for the presence of fetal blood in maternal circulation. There is no evidence to support the use of this test at this time. CVS testing is typically done earlier in the pregnancy, between 10 and 12 weeks; this client is at 32 weeks gestation. There is no evidence to support the use of a CST at this time. Determination of fetal well-being would first be evaluated by an NST.

A newborn has just died in the neonatal unit. What is the most appropriate statement that the nurse can make to the bereaved parents? 1 "You have an angel in heaven." 2 "I understand how you must feel." 3 "You're young and can have other children." 4 "I'm sorry."

4 One of the most important goals of the nurse is to validate the experience and feelings of the parents by encouraging them to tell their stories and listening with care. At the very least, the nurse should acknowledge the loss with a simple but sincere comment, such as, "I'm sorry." The initial impulse may be to reduce one's sense of helplessness and to say or do something that you think will reduce their pain. Although such a response may seem supportive at the time, it can stifle the further expression of emotion. The nurse should resist the temptation to give advice or to use clichés when offering support to the bereaved. This is not a therapeutic response for the nurse to make. STUDY TIP: Regular exercise, even if only a 10-minute brisk walk each day, aids in reducing stress. Although you may have been able to enjoy regular sessions at the health club or at an exercise class several times a week, you now may have to cut down on that time without giving up a set schedule for an exercise routine. Using an exercise bicycle that has a book rack on it at home, the YMCA, or a health club can help you accomplish two goals at once. You can exercise while beginning a reading assignment or while studying notes for an exam. Listening to lecture recordings while doing floor exercises is another option. At least a couple of times a week, however, the exercise routine should be done without the mental connection to school; time for the mind to unwind is necessary, too.

Which of these is a true statement about Miles' Conceptual Model of Parental Grief? 1 Parental grief responses occur in three phases: grief, depression, and recovery. 2 Parental grief responses are a long-term process that can extend for months and years. 3 Parental grief responses occur in three phases: shock, depression, and rehabilitation. 4 Parental grief responses occur in three overlapping phases: acute distress and shock, intense grief, and reorganization.

4 The true statement about Miles' Conceptual Model of Parental Grief is that Miles hypothesized that parental grief responses occur in three overlapping phases: acute distress and shock, intense grief, and reorganization. Grief can be long-term and extend for months and years, but this is not part of Miles' Conceptual Model of Parental Grief. Miles' three phases are not shock, depression, and rehabilitation, nor grief, depression, and recovery.

The nurse is assessing a female client who lost her neonate 1 year ago. The nurse finds that the client is unwilling to speak about her lost child and has panic attacks upon seeing any objects that remind her of the child. The client has clinical depression and is involved with substance abuse. Which condition does the nurse interpret from these findings? 1 Acute grief 2 Complicated grief 3 Posttraumatic growth 4 Posttraumatic stress disorder

4 Unwillingness to speak about the dead child and having panic attacks upon seeing objects related to the child indicates posttraumatic stress disorder. Clients with posttraumatic stress disorder are extremely depressed and may also indulge in substance abuse in order to cope with the depression. Acute grief is characterized by feelings such as shock and numbness. Persistence of extreme grief reaction for a long period of time is referred to as complicated grief. However, clients with complicated grief do not necessarily experience panic attacks. Posttraumatic growth refers to personal and spiritual growth in response to a traumatic experience or loss.

The nurse is caring for a family who has experienced infant death. The nurse finds that the couple's 16-year-old adolescent is grieving. What is the best way for the nurse to reach out to the older child in this situation? 1 Encourage the older child to stay with the parents. 2 Encourage the older child to stay with grandparents. 3 Encourage the older child to stay with small children. 4 Encourage the older child to spend time with friends.

4 While caring for an adolescent sibling of a deceased baby, the nurse should be aware that adolescents usually feel most comfortable with their friends and people of similar age group. Therefore, the nurse should advise the older child to spend time with friends. The older child may not feel comfortable expressing his or her feelings to the parents or grandparents, because they are in grief. The older child may not be comfortable spending time with small children, because this may increase the grief and bring forth memories of the lost child. Test-Taking Tip: Do not spend too much time on one question, because it can compromise your overall performance. There is no deduction for incorrect answers, so you are not penalized for guessing. You cannot leave an answer blank; therefore, guess. Go for it! Remember: You do not have to get all the questions correct to pass.

The nurse has been providing therapy to a grieving couple whose newborn died after 2 days of birth. During the follow-up assessment the nurse finds that the couple shows signs of posttraumatic growth. What did the nurse observe in the couple? Select all that apply. 1 The couple does not engage in sexual activity. 2 The couple avoids talking about the loss with friends. 3 The couple feels sad looking at other pregnant females. 4 The couple goes to the church and reads the Bible on a daily basis. 5 The couple is actively involved in helping other patients cope with perinatal loss.

4,5 Posttraumatic growth refers to the development of personal strength, spiritual thoughts, and new opportunities as a response to a perinatal loss. Going to church and reading the Bible would result in spiritual growth of the couple. Active involvement in helping other patients cope with perinatal loss indicates that the couple is able to appreciate life and help others feel strong in such a sensitive period. Avoiding sexual activity indicates that the couple has not been able to cope with grief. Avoiding emotional support from friends indicates maladaptive behavior, and does not indicate posttraumatic growth. Feeling sad by looking at other pregnant females indicates that the couple has not been able to cope with the perinatal loss.