Perinatal Loss, Bereavement, and Grief: Clinical Scenario

Which statements would not be advisable to use as a basis for therapeutic discussion following a perinatal loss? (Select all that apply.) A. "This must be hard for you" B. "I'm sorry" C. "You're young, you can have other children" D. "You wanted a boy anyway, so now you have another chance" E. "I am sad for you"

"This must be hard for you," "I'm sorry," and "I am sad for you" are acceptable statements following perinatal loss. "You're young, you can have other children" and "You wanted a boy anyway, so now you have another chance" would not be considered therapeutic. C and D E*

###For which of these maternal diagnoses or incidents should prenatal testing be done? Select all that apply. Diabetes Hypotension Sickle cell disease Age over 25 Three or more miscarriage Chromosomal abnormality

(A, C, E, F)

What order of actions should the nurse follow to collect footprints from a deceased baby? A. Place the paper on a hard surface. B. Apply acetone to the baby's feet. C. Roll the foot forward, extending the toes. D. Place the heel of the baby on the paper.

Acetone should be applied to the baby's feet to improve the ink adherence and get clear prints. The printing paper is placed on a hard surface to get better impressions of the feet. The baby's heel is placed on the paper first and then the foot is rolled forward, extending the toes. This allows the nurse to get accurate footprints. (B, A, D, C)

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 assess for fetal well-being now that her pregnancy is at 32 weeks gestation? A. Kleihauer-Betke test B. Chorionic villi sampling (CVS) C. Contraction stress test (CST) D. Ultrasound

An ultrasound could be used to determine fetal well-being. The Kleihauer-Betke test is a blood test 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. There is no evidence to support the use of a CST at this time; determination of fetal well-being would first be evaluated with a nonstress test. (D)

***###Which of these phrases are appropriate for the nurse to say to bereaved parents? Select all that apply. A. "I'm sorry." B. "I'm sad for you." C. "What can I do for you?" D. "God had a purpose for her." E. "I'm here, and I want to listen." F. "You have to keep on going for her sake."

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." (A,B,C,E)

What sign would probably indicate acute stress in bereaving parents? A. Loneliness B. Depression C. Disorganization D. Search for meaning

Bereaving parents may experience the acute distress phase immediately following the loss of the child. Depression, shock, and intense crying are signs of acute distress. Loneliness and disorganization are the signs of intense grief. The parents search for the meaning of life during the reorganization phase of their bereavement. (B)

*A woman experiences the loss of a very early-term pregnancy. Her friends do not mention the loss, and someone suggests to her that she can "always try again." The woman feels confusion over her sadness and stops talking about it with others. What type of grief response is she most likely experiencing? A) Delayed B) Anticipated C) Exaggerated D) Disenfranchised

Disenfranchised

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? A. Acknowledging the client's feelings and helping to cope from the loss B. Allowing the client and family to spend time with the newborn's body C. Helping the client and family to accept reality and develop coping skills D. Interacting with the client and family to know how they perceive the loss

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.

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? A. "We have to contact the hospital's chaplain." B. "We need to name the baby before burial." C. "We have to accept the loss as a test from God." D. "We need to take a photograph of the baby's body."

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. (C)

***###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. A. "I'm very sorry for your loss." B. "This must be really hard for you." C. "We have to accept it, because it was God's will." D. "You should be thankful that the other child is alive." E. "Feel free to speak whenever you want to. I want to listen to you."

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. (C,D,E)

Which questions does the nurse ask to determine whether a 28-year-old client is at significant risk for pulmonary embolism? A. "Have you experienced any menstrual disturbances recently?" B. "Are you undergoing hormone replacement therapy?" C. "Do any of your family members have a history of factor V Leiden?" D. "Do any of your family members have a history of neurofibromatosis?"

Pulmonary embolism is most prevalent in clients with factor V Leiden (FVL). Because FVL is an autosomal dominant disorder, the nurse asks the client whether any family members have FVL. Menstrual disturbance and the presence of clots in the lungs are not associated with a mutation in the factor V gene. Hormonal replacement therapy would be prescribed for clients going through menopause, not clients with a pulmonary embolism. Neurofibromatosis is a disorder associated with the formation of tumors; it is not associated with pulmonary embolism.

*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? A. "Would you like to talk to the hospital chaplain?" B. "Do you believe that the loss was God's will?" C. "Are there any religious rituals you would like to follow?" D. "Can you describe what the baby's death means to you?"

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. (C)

***###What are some causes of perinatal loss? Select all that apply. A. Stillbirth B. Fertility C. Infertility D. Miscarriage E. Intrauterine fetal death (IUFD) F. Death of live-born infant soon after birth

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. (A, C, D, E, F)

Who described the dual process model of grief-managing strategies? A. Kübler-Ross B. Stroebe and Schut C. Klass and Nickman D. Cowles and Rodgers

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. (B)

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

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. (C)

*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? A. The mother is at risk for cultural problems because of her baby's death. B. The mother is at risk for complicated grieving because of her baby's death. C. The mother is at risk for uncomplicated grieving because of her mother's support. D. The mother is at risk for uncomplicated grieving because of her husband's support.

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. (B)

During a postpartum checkup, a woman who experienced perinatal loss says, "My husband has been very caring and concerned about me since it occurred." What is the nurse's best response? A. "Life must go on." B. "I am happy to hear that." C. "This happened for the best." D. "Keep going for the baby's sake."

The woman is experiencing posttraumatic growth. Therefore, the nurse should reply to the woman with simple comments such as "I am happy to hear that." The nurse should not reply with statements like "Life must go on," because these may remind the person of the loss, thereby resulting in more grief. A statement like, "This happened for the best" will give the impression that the nurse is referring to the loss as a good thing. The nurse should avoid saying, "Keep going on for the baby's sake," because this may remind the person of the lost infant. (B)

Which statement is accurate with regard to the emotional state of grief? A. It is a static concept applied to loss. B. Aspects of grief occur simultaneously across family units C. Duration of grief experiences is variable among individuals D. It represents a linear process.

There is no prescribed time limit for the expression of grief. Grief is a dynamic concept involving complex emotions. The expression of grief is individualized and may not occur simultaneously across family units. The process of grief represents an iterative process. (C)

*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? A. Talking and acknowledging the grief experienced by the client. B. Advising the client to talk to older women who have suffered perinatal loss. C. Using therapeutic communication to develop a good rapport with the client. D. Helping the client to find out resources that would help the patient overcome grief.

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. (B)

*The nurse is caring for a bereaved client who suffered a perinatal loss. What is the nurse's best response? A. "Life must go on." B. "I'm here to listen." C. "You can still have more children." D. "God has a purpose in all things."

While caring for a client with perinatal loss, the nurse should make statements that support and comfort the client and alleviate grief. "I'm here to listen." is a question that shows concern towards the patient. Statements like "Life must go on" may elevate the client's grief. The nurse should not make statements pertaining to having children, because this may increase anxiety and fear in the client about the next pregnancy. The nurse must be sensitive to the religious beliefs and spiritual needs of bereaved clients, and thus avoid making statements related to spiritual matters. (B)

***The nurse is caring for clients in a maternity unit. Which client is most likely to experience isolation during the grieving period? A. A client who is on bed rest for a high risk pregnancy B. A client whose newborn was born with a cleft palate C. A client who lost her newborn 6 hours after birth D. A client who had a miscarriage at 6 weeks of gestation

A client who miscarries during early pregnancy may experience loss and suffer from isolation, because it may be difficult to discuss the loss with friends and family who may not have known about the pregnancy yet. A client who is on bed rest for a high-risk pregnancy may experience fear and boredom, but it is not experiencing a loss. A client whose newborn has a cleft palate may be depressed, but she does not necessarily experience isolation and loss. A client who lost her newborn 6 hours after birth may have the support of family and friends who were ready for the birth. Therefore, the client may be less likely to experience isolation. (D)

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? A. The client needs to undergo dilation and curettage. B. The hospital provides free cremation for the dead fetus. C. The client and her family can decide about the burial alternatives. D. The hospital rules and regulation regarding the cremation of the fetus.

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. (A)

A newborn with hypoplastic heart syndrome died after 12 hours of resuscitation. The nurse allows the parents to take the newborn's pictures, and provides a certificate along with the identification band. The nurse also refers the client to memorial services. Which behavior of the parents a month after the loss is an indication of positive outcomes of the above nursing intervention? A. The parents have reduced spiritual distress. B. The parents try not to dwell on the loss. C. The parents do not have intense longing and yearning. D. The parents are trying to have another child.

Allowing the parents to take the pictures of the newborn and providing a birth certificate to the family helps the parents accept the reality of death and complete their grieving process. Therefore, it helps to prevent the accumulation of grief and symptoms of complicated grief such as intense longing and yearning. The nurse should refer the client to memorial services in order to prevent isolation and risk of complicated grieving. Facilitating spiritual rituals or referral to a religious figure helps to reduce spiritual distress in the parents, but the nurse's actions are not specific to this purpose. If the parents are trying not to dwell on the loss it could be an indication that they are not allowing themselves to grieve, but it is not an indication that the nurse's interventions helped. If the parents are trying to have another child it does not necessarily mean the nurse helped them through their grief. (C)

Which priority action would be most beneficial in helping a couple deal with fetal loss following the delivery of a stillborn? A. Allow all family members to come in immediately after the delivery to console the couple. B. Provide a quiet environment for the couple for several hours restricting any visitors or family members. C. Take a photograph of the stillborn prior to the patient's discharge to use as a keepsake. D. Allow the parents to hold and view the baby following delivery if they so request.

Bonding with the stillborn by holding and viewing after delivery is well documented by research to provide a source of comfort and closure. Although it will be important for family members to comfort the couple, it is more important for the family unit to be alone to adapt to the delivery. Providing a quiet environment is important but it not the priority action to be taken at this time. Taking a photograph is important as a keepsake but it is typically taken before the stillborn leaves the hospital. (D)

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? A. "Let's talk about your thoughts and feelings about this loss." B. "You should stop thinking about the past and plan for the future." C. "Please do not blame yourself, God wanted it to happen this way." D. "Yes, you are right that proper diet decreases the risk of fetal death."

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. (A)

A client has given birth to a stillborn. The nurse asks the client, "Would you like to hold your baby?" What is the nurse trying to assess by asking this question to the client? A. Hopelessness B. Powerlessness C. Spiritual distress D. Emotional closeness

Clients may experience a sense of unreality, loss of innocence, and powerlessness after experiencing a perinatal loss. To diagnose these symptoms, the nurse asks the client if she wants to hold the baby after its death. Refusing to hold the baby indicates that the client is experiencing a feeling of powerlessness. Hopelessness can be identified if the client experiences complicated grief. Asking the client to hold the baby after its death will not indicate whether the client feels hopeless. A client's spiritual distress can be diagnosed if the nurse asks a question related to the client's spiritual beliefs. Emotional closeness is an issue for the client to address with her family in the period following a loss. There is no need for the nurse to diagnose emotional closeness immediately after delivery. (B)

The nurse is caring for a client who lost her baby immediately after birth. The client blames herself for the loss. Which nursing interventions are designed to promote feelings of self-worth in the client? Select all that apply. A. Attending the memorial services and funeral B. Helping the client identify positive coping mechanisms C. Giving the client the newborn's photograph and footprints D. Encouraging the client to share her feelings with her partner E. Identifying the client's perception and feeling about fetal death

Clients may experience low self-esteem related to fetal death due to a sense of failure to become a mother. The nurse should help the client identify and follow positive coping skills because it improves the client's self-esteem and self-worth. The nurse should identify the client's perception and feelings about fetal death and should correct any misconceptions and alleviate guilt. This promotes feelings of self-worth. The nurse may attend memorial services and the funeral to support the parents, but this intervention does not promote feelings of self-worth. The nurse would provide photographs and footprints in order to make the client acknowledge the reality of death. The nurse should encourage the client to share her feelings with her partner in order clarify possible effects on the family. (B, E)

The nurse is caring for a client whose pregnancy ended in a stillbirth. The client has breast engorgement associated with breast milk production. What information will the nurse first provide to the client? A. Various methods of suppressing lactation B. Importance of a visit to the lactation consultant C. Procedures for expressing and donating breast milk D. Explaining that this problem would disappear in due time

Clients who have experienced stillbirth may have varied reactions to this traumatic experience. A client whose pregnancy ended in a stillbirth would still be able to produce breast milk. In this situation, the nurse should explain to the client the importance of visiting a lactation counselor. The lactation counselor would listen to the preferences of the client regarding suppressing the production of breast milk or donating breast milk. The nurse needs to find out whether the client wants to suppress lactation or donate breast milk and, accordingly, give suggestions. Breast milk production may take a long time to cease. Thus, breast milk should either be donated or milk production should be suppressed. (B)

When identified in a client, what condition requires a referral to a mental health care professional? A. Ambiguous loss B. Complicated grief C. Posttraumatic growth D. Disenfranchised grief

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. (B)

*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? A. The client has professional mistrust. B. The client is experiencing maternal denial. C. The client is going through complicated grief. D. The client is going through disenfranchised grief.

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. (B)

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? A. The grandparent has survivor guilt. B. The grandparent feels hopeless. C. The grandparent is promoting family coping. D. The grandparent is reflecting religious beliefs.

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. (A)

The nurse asks permission to order an autopsy of a stillborn baby. One of the family members refuses to authorize the autopsy. In addition, the parents indicate their decision through a representative rather than speaking directly with the health care workers. Based on the parents' behavior, what can the nurse infer about the parents and family? A. They may be Jewish. B. They may be Amish. C. They may be Muslim. D. They may be Hispanic.

In Hispanic families, the concept of la familia is very strong. Hispanic parents may make decisions by discussing them with family members, and then communicate these decisions through a person elected by the family, rather than by the parents themselves. The parents may not directly communicate with the nurse regarding their opinions and decisions; rather they may communicate through a representative. Amish families would not likely use a third person to communicate. The loss of a baby profoundly affects Jewish families. They follow cultural and spiritual rituals, like baby naming, burial, and mourning rituals. Jewish parents are likely to actively participate in decisionmaking and communicate directly with the health care members. In Muslim families, husbands and other family members make decisions on behalf of the women. Muslim parents communicate directly with the nurse and other staff. (D)

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? A. "God needed another angel in heaven and now your baby always has a guardian." B. "I don't know why this terrible thing happened, but I am here to support and help you." C. "I am sorry for your loss, but at least you still have another baby to love and care for." D. "Quite often twins are at a risk of umbilical cord accidents, and these are sometimes fatal."

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. (B)

*The nurse is caring for a Jewish couple who recently sustained a perinatal loss. The nurse learns that the couple wants to name the baby. What does the nurse infer from the couple's action? A. Naming the deceased baby is a part of Jewish religious ritual. B. The name of the deceased baby is required to be documented in the death certificate. C. Naming the deceased baby will distract the couple from profound grief. D. Naming the deceased baby helps to avoid keeping the same name for the future children.

Naming a deceased baby is part of Jewish religious ritual, and it makes the neonatal death more real to the couple and their family. The name of a deceased baby does not need to be documented on the death certificate of perinatal loss. Naming the perinatal loss will not help alleviate the associated grief. Couples often name their future child the same name they had planned to assign to the deceased baby. (A)

What nursing interventions can be implemented with helping the bereaved parents acknowledge and express their feelings? Select all that apply. A. The nurse should talk patiently during the story of loss or grief. B. The nurse should give advice and use clichés in offering support to the bereaved. C. Nurses need to be very comfortable with death and grief to support and care for bereaved individuals effectively. D. Leaning forward, nodding the head, and saying "Uh-huh" or "Tell me more" is often enough encouragement for the bereaved person to tell his or her story. E. Sitting through the silence can be therapeutic; silence gives the bereaved person an opportunity to collect thoughts and process what he or she is sharing. F. The nurse should have a presence of self, the willingness to be alongside quietly supporting the bereaved parents in whatever expressions of feelings or emotions are appropriate for them.

Nursing interventions that can be implemented with helping the bereaved parents acknowledge and express their feelings include: the nurse should listen (not talk) patiently during the story of loss or grief; the nurse should resist the temptation to give advice or use clichés in offering support to the bereaved (not give advice and use clichés); nurses need to be comfortable with their own feelings of loss and grief to support and care for bereaved individuals effectively (not to be very comfortable about death and grief); leaning forward, nodding the head, and saying "Uh-huh" or "Tell me more" is often enough encouragement for the bereaved person to tell his or her story; sitting through the silence can be therapeutic because silence gives the bereaved person an opportunity to collect thoughts and process what he or she is sharing; and the nurse should have a presence of self, the willingness to be alongside quietly supporting the bereaved parents in whatever expressions of feelings or emotions are appropriate for them. (D,E,F)

What nursing interventions can be utilized when helping parents hold their fetus after death? Select all that apply. A. The nurse is advocating for what the client wants. B. It is important to determine what each person desires and needs. C. The nurse should not give an explanation about what the parent(s) will see in preparation for visiting the baby. D. In preparing the baby's body for the parents to see, nurses generally cover the head with a small cap and clothe the baby. E. Encouraging reluctant individuals to hold or see the body by telling them that not seeing the body could make grieving more difficult is inappropriate. F. The nurse might ask helpful questions such as, "Some parents have found it helpful to see or hold their baby. Would you like time to consider this?"

Nursing interventions that can be utilized when helping parents hold their fetus after death include: the nurse is advocating for what the client wants; it is important to determine what each person desires and needs; in preparing the baby's body for the parents to see, nurses generally cover the head with a small cap and clothe the baby; encouraging reluctant individuals to hold or see the body by telling them that not seeing the body could make grieving more difficult is inappropriate; and the nurse might ask helpful questions such as, "Some parents have found it helpful to see or hold their baby. Would you like time to consider this?" The nurse should give an explanation about what the parent(s) will see in preparation for visiting the baby. (A, B, D, E, F)

The most appropriate statement that the nurse can make to bereaved parents is: A. "You have an angel in heaven." B. "I understand how you must feel." C. "You're young and can have other children." D. "I'm sorry."

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. The statement in C is not a therapeutic response for the nurse to make. (D)

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

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. (D)

Complicated bereavement: A. Occurs when, in multiple births, one child dies and the other or others live. B. Is a state in which the parents are ambivalent, as with an abortion. C. Is an extremely intense grief reaction that persists for a long time. D. Is felt by the family of adolescent mothers who lose their babies.

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, abortion can generate complicated emotional responses, and families of lost adolescent pregnancies may have to deal with complicated issues, but these situations are not complicated bereavement. (C)

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

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. (C)

***###Due to an adulterated infant formula, many infants in Nigeria suffered from severe food poisoning. The nurse is caring for parents who lost their infants at this time. Based on the grieving behavior, which parents are at risk of complicated grief? A. Parents who blame themselves for the infant's death B. Parents who are angry at the manufactures of infant formula and want to file a case C. Parents who offer prayers and promise to devote their lives to God if their infant returns D. Parents who do not mourn or blame others for their infant's death, and remain neutral

Parents who do not mourn publicly or acknowledge their grief may have limited social support and disenfranchised grief. Due to lack of acknowledgement and social support, they remain isolated and the grief may not resolve over time, resulting in complicated grief. While experiencing grief, clients blame themselves or others for the loss; they may cope with the loss and accept the reality. While experiencing grief, the clients may bargain and pray to their god(s). These methods help clients cope with the loss. (D)

A pregnant client tells the nurse, "I previously had a miscarriage, and now I can't sleep for fear of it happening again." What is the best nursing intervention for the client? A. Contact a perinatal loss support group. B. Refer the client to a genetic counselor. C. Perform an early ultrasound examination. D. Explain all the tests involved during the pregnancy.

Performing an early ultrasound will help alleviate the client's fear about the prior miscarriage. Ultrasound examination will reveal the fetal heart rate (FHR), which helps in interpreting the condition of the fetus. A normal FHR indicates that the fetus is healthy and this will comfort the client. A perinatal loss support group should be recommended in the event of a miscarriage with the current pregnancy. Referring the client to a perinatal group makes the client think that the nurse expects another loss. Referring the client to a genetic counselor is appropriate only in the event of a genetic anomaly, which is not relevant for this client at this time. Explaining to the client about all the procedures and tests involved during the pregnancy will not alleviate the client's fear. (C)

The nurse is caring for a postpartum client who lost her 2-day-old newborn and is experiencing intense grief. Which interventions followed by the nurse help alleviate the physical symptoms of grief in the client? Select all that apply. A. Gives warm milk to the client B. Provides galactagogues to the client C. Teaches Kegel exercises to the client D. Provides fiber-rich foods to the client E. Massages the client's back and lower limbs

Physical symptoms of intense grief are lack of sleep and musculoskeletal pain. Therefore, the nurse should provide warm milk to promote sleep and provide massage to relieve pain. Galactogogues stimulate breast milk production and cause the accumulation of milk, resulting in breast engorgement. Kegel exercises increase uterine muscle tone, but do not reduce the physical symptoms of intense grief. Intense grief does not cause constipation, so the nurse need not provide fiber-rich foods to the client. (A, E)

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. A. The couple does not engage in sexual activity. B. The couple avoids talking about the loss with friends. C. The couple feels sad looking at other pregnant females. D. The couple goes to the church and reads the Bible on a daily basis. E. The couple is actively involved in helping other patients cope with perinatal loss.

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. (D,E)

The nurse is caring for a client whose pregnancy ended in stillbirth 2 months ago. The nurse finds that the client experiences feelings of loneliness, emptiness, and yearning. What additional symptoms of grief may the nurse find in the client? Select all that apply. A. Guilt B. Shock C. Numbness D. Resentment E. Disorganization

Pregnancy loss can lead to intense grief and feelings of loneliness, emptiness, and yearning. The client may feel guilty and blame herself for the fetal death, because she may assume that she was responsible for the fetal well-being. The client experiences helplessness because she could not save her fetus and, therefore, has resentment. The client experiences disorganization and depression due to the loss. The client experiences shock and numbness in the acute phase of distress, but not while experiencing intense grief. (A, D, E)

The nurse is reviewing the reports of pregnant clients to identify the client who may require a selective reduction procedure. Which client would the nurse select? Select all that apply. A. A client with two fetuses and preeclampsia B. A client with a single fetus and polyhydramnios C. A client with three fetuses and high maternal body weight D. A client with four fetuses and high risk of preterm delivery E. A client with two fetuses who had undergone infertility treatment

Selective reduction is a procedure in which the number of developing embryos in a client with multifetal pregnancy is reduced so that the other fetuses can be safely carried to near term. Preeclampsia and a high risk of preterm delivery are the risk factors that may warrant the use of this procedure. Therefore, a client with two fetuses and preeclampsia may undergo a selective reduction procedure. A client with four fetuses and high risk of preterm delivery may also be required to undergo a selective reduction procedure to reduce the risk. A client with a single fetus does not need selective reduction irrespective of ployhydramnios. A pregnant client with three fetuses would normally have excess weight gain. Therefore, high maternal body weight is not a criterion for selective reduction. Women who have undergone infertility treatment are more prone to have mutifetal gestation; they may not need selective reduction unless a risk is associated. (A, D)

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

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. (C)

*The nurse is paying a home visit to a postpartum client whose baby died immediately after birth. The nurse finds that the client is less weepy and is now showing an interest in reading books and magazines. What does the nurse infer from the client's actions? A. The client is in denial over the baby's death. B. The client is not grieving over the baby's death. C. The client was not interested in having the baby. D. The client is trying to alleviate her grief.

The client expresses bereavement and grief over the loss of her baby. However, if the client is focusing on normal and less dramatic day-to-day activities, such as bathing or reading a magazine, the nurse should understand that the client is trying to alleviate her profound grief to avoid depression. If the client is in denial over the baby's death, then the client would continuously ask the nurse to bring in the baby. Just because the client is not crying does not mean that the client is not experiencing grief over the baby's death. Trying to get over her grief does not mean that the client never wanted to have the baby. (D)

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. The phase of bereavement the woman is experiencing is called: A. Anticipatory grief. B. Acute distress. C. Intense grief. D. Reorganization.

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, but lack of affect, euphoria, and calmness may occur and may reflect numbness, denial, or personal ways of coping with stress. Anticipatory grief applies to the grief related to a potential loss of an infant. The parent grieves in preparation of the infant's possible death, although the parent clings to the hope that the child will survive. 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. (B)

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? A. Referral to a perinatologist B. Including case management to participate in the client's care when she is admitted to the hospital. C. Incorporate perinatal palliative care into the client's plan of care D. Provide the client with phone numbers so as to make funeral arrangements.

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. (C)

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

The incorporation of a perinatal palliative care plan would be the priority intervention at this time to help the patient 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 and phone numbers may be provided to the patient regarding funeral arrangements, these actions are not the priority measure. (C)

A patient tells the nurse about the funeral arrangements for her newborn son. The patient is thereby providing the nurse with information about: A. Grief process. B. Mourning process. C. Expression of loss. D. Family reaction.

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. (B)

The nurse is planning a grief conference for a couple who is grieving the loss of their child who was declared dead at birth. What will the nurse include as the objective of the grief conference? Select all that apply. A. To explain to the couple about the cause of the loss B. To find out the couple's plans of having a child in the future C. To find out which rituals were followed during the cremation of the child D. To explain to the couple about the possibility of similar losses in the future E. To help the couple find the support centers that would help them overcome grief

The nurse can conduct a grief conference when the clients who experienced perinatal loss return for a follow-up visit. During a grief conference, the nurse should explain to the couple about the exact cause of the fetal loss and the possibility of such losses in future. The nurse can inform the couple about the support groups that can help them cope with the loss. The purpose of the conference is to find out about the coping status of the couple. The nurse should not discuss their plans about having another child, because the couple may not have recovered from their loss yet. The rituals followed during the cremation of the fetus need not be discussed in the grief conference. (A, D, E)

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? A. Knowing B. Enabling C. Doing for D. Being with

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. (A)

The nurse is counseling a couple who recently suffered a perinatal loss. Which is the most important point that the nurse should emphasize while counseling? A. There is a chance to conceive again. B. They should avoid talking about the baby. C. The expressions of grief vary between sexes. D. They should arrange a funeral to alleviate the grief.

The nurse should be aware of the difference in the expression of grief between men and women. Women express more grief than men.The nurse should keep this in mind while counseling the couple after they have experienced a perinatal loss and help them prepare for the future. The nurse should be careful when discussing about conceiving again, because the client may perceive it as indifference. The nurse should not emphasize that the couple should avoid talking about the loss, because women experience more grief and find it comforting to talk more openly about the loss. Therefore, couples should not be told to avoid talking about the loss. Men try to overcome grief by getting back into daily routines. Arranging the funeral to alleviate the grief depends on the religious and cultural bearings of the couple. (C)

*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? A. "Your baby has left us." B. "You have lost your baby." C. "The baby has no heartbeat." D. "The baby has passed away."

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. (C)

***###The nurse is caring for a client who lost her newborn 8 hours after the birth. The nurse interacts with the client in an isolated room, identifies the client's perception and feelings about death, and refers the client to counseling. What is the rationale behind these interventions? A. To reduce spiritual distress in the client B. To improve the client's relationship with the family C. To improve and maintain the client's self-esteem D. To reduce the client's risk of complicated grieving

The nurse should provide the client private time for expression of feelings through therapeutic communication and active listening. This helps the client express her feelings openly without any judgment, thereby promoting self-esteem. The client will exhibit positive self-comments as evidence of her decreasing sense of failure. In order to reduce spiritual distress, the nurse should assess the client's spiritual preference and facilitate spiritual rituals. In order to improve the client's relationship with family members, the nurse should encourage the partners to talk about their loss. In order to reduce the risk of complicated grieving, the nurse should allow the client to hold and view the infant and refer appropriate support groups. (C)

What is the nurse's role in helping parents with decisions regarding autopsies, organ donation, and disposition of the body? A. 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. B. 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. C. 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. D. 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.

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. (B)

***###Which are responses parents and families may experience with perinatal loss? Select all that apply. A. Mourning B. Numbness C. Loss and grief D. Shock and anger E. Happiness and guilt F. Psychologic distress

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. (A,B,C,D,F)

***###Which are signs/symptoms of complicated grief? Select all that apply. A. Excessive bitterness B. Ability to trust others C. A state of complete happiness D. Intense and continued guilt or anger E. Intense longing and yearning for the deceased F. Feeling that life is empty or meaningless, hopelessness, and loneliness

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. (A, D, E, F)

After giving birth to a stillborn infant, the woman turns to the nurse and says, "I just finished painting the baby's room. Do you think that caused my baby to die?" The nurse's best response to this woman is: A. "That's an old wives' tale; lots of women are around paint during pregnancy, and this doesn't happen to them." B. "That's not likely. Paint is associated with elevated pediatric lead levels." C. Silence. D. "I can understand your need to find an answer to what caused this. What else are you thinking about?"

The statement in D is very appropriate for the nurse. It demonstrates caring and compassion and allows the mother to vent her thoughts and feelings, which is therapeutic in the process of grieving. The nurse should resist the temptation to give advice or to use clichés in offering support to the bereaved. Trying to give bereaved parents answers when no clear answers exist or trying to squelch their guilt feelings does not help the process of grief. Additionally the response in B probably would increase the mother's feelings of guilt. 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, which silence would not do. (D)

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

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. (D)

*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? A. The wife is mourning. B. The wife is experiencing ambiguous loss. C. The wife is experiencing complicated grief. D. The wife is experiencing disenfranchised grief.

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. (C)

Which statement is accurate with regard to the emotional state of grief? A. It is a static concept applied to loss. B. Aspects of grief occur simultaneously across family units. C. Time limit for grief experiences is variable among individuals. D. It represents a linear process.

There is no prescribed time limit for the expression of grief. Grief is a dynamic concept involving complex emotions. The expression of grief is individualized and may not occur simultaneously across family units. The process of grief represents an iterative process. (C)

Where should a nurse remove a child's lock of hair for the parents' memorabilia in the event of perinatal loss? A. The back of the head B. The forehead C. The nape of the neck D. The top of the head

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. (C)

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? A. Acute grief B. Complicated grief C. Posttraumatic growth D. Posttraumatic stress disorder

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. (D)

The nurse is caring for a woman who experienced a perinatal loss. The nurse finds that the woman is experiencing an intense stage of grieving. What observation did the nurse find in the client? A. The woman weeps when she experiences leakage of breast milk. B. The woman notes the date of birth of the stillborn child. C. The woman cries suddenly and becomes emotional. D. The woman looks at the ultrasound photos of the fetus.

Weeping on leakage of breast milk is a sign that the woman is slowly getting through the pain and is adjusting to the life without the expected child. This behavior is observed when the woman is experiencing intense grief. Noting the date of birth of a stillborn child is characteristic of the reorganization phase. Preserving and looking at memorabilia, like the ultrasound pictures of the fetus, show that the woman is cherishing the memories of her pregnancy. This is also a sign of the reorganization phase. If the nurse finds that the woman is emotional and cries spontaneously, the woman is said to be in an acute phase of grief. (A)

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? A. Encourage the older child to stay with the parents. B. Encourage the older child to stay with grandparents. C. Encourage the older child to stay with small children. D. Encourage the older child to spend time with friends.

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. (D)