OB Ch. 36
The mother of a client who has experienced a term stillbirth arrives at the hospital and goes to the nurses' desk. The mother asks what she should say to her daughter in this difficult time. What is the nurse's best response? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. -"Use clichés; your daughter will find the repetition comforting." -"Remind her that she is young and can have more children." -"Keep talking about other things to keep her mind off the loss." -"Express your sadness, and sit silently with her if she doesn't respond." -"Encourage her to talk about the baby whenever she wants to."
-"Express your sadness, and sit silently with her if she doesn't respond." -"Encourage her to talk about the baby whenever she wants to."
The nurse is planning an in-service presentation about perinatal loss. Which statements should the nurse include in this presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. -"Perinatal loss refers to third-trimester fetal death in utero." -"Perinatal loss occurs more frequently in assisted reproduction." -"Perinatal loss rates have declined in the United States over the past few years." -"Perinatal loss includes 25% of stillbirths occurring before the onset of labor." -"Perinatal loss rarely causes an emotional problem for the family."
-"Perinatal loss occurs more frequently in assisted reproduction." -"Perinatal loss rates have declined in the United States over the past few years."
The nurse is caring for a 15-year-old who just delivered a 32-weeks'-gestation stillborn infant with numerous defects. In caring for this client, the nurse knows which of the following? -The client will likely do no grieving, as she is so young and the pregnancy was probably a mistake in any case. -Adolescents have a sense of invulnerability, an "It can't happen to me" mentality. -The client's mother will handle her daughter's grief, so the nurse doesn't need to be concerned. -The nurse will remove the baby before the client sees it.
Adolescents have a sense of invulnerability, an "It can't happen to me" mentality. Though adolescents have a mature concept of death, it is often clouded by their sense of invulnerability, an "It can't happen to me" mentality.
The postpartum unit nurse is caring for a client who delivered a term stillborn infant yesterday. The mother is heard screaming at the nutrition services worker, "This food is horrible! You people are incompetent and can't cook a simple edible meal!" The nurse understands this as which of the following? -An indication the mother is in the anger phase of grief. -An abnormal response to the loss of the child. -Reactive stress management techniques in use. -Denial of the death of the child she delivered yesterday.
An indication the mother is in the anger phase of grief. Anger, resulting from feelings of loss, loneliness, and, perhaps, guilt, is a common reaction. Anger may be projected at significant others and/or healthcare team members.
A client has delivered a stillborn child at 26 weeks' gestation. She tells the nurse that none of her friends have called or visited, and that her husband's parents seem unwilling to talk about the loss. The nurse recognizes the mother's grief as which of the following? -Disenfranchised grief -Bereavement -An intuitive style of coping -Denial
Disenfranchised grief Disenfranchised grief is not supported by the usual societal customs. People are uncomfortable discussing the loss with the parents and often pull away when their support is most needed.
As the couple and their families begin to confront the pain of their loss, many normal manifestations of grief may be present. Which of the following would indicate an emotional response to the loss? -Lack of meaning or direction -Preoccupation -Flat affect -Dreams of the deceased
Flat affect Flat affect would be an emotional response to loss.
The nurse is working with a laboring woman who has a known intrauterine fetal demise. To facilitate the family's acceptance of the fetal loss, after delivery the nurse should do which of the following? -Encourage the parents to look at the infant from across the room. -Offer the parents the choice of holding the infant in their arms. -Take the infant to the morgue immediately. -Call family members and inform them of the birth.
Offer the parents the choice of holding the infant in their arms. The nurse should offer the couple the opportunity to see and hold the infant and reassure the couple that any decision they make for themselves is the right one.
A pregnant couple have been notified that their 32-week fetus is dead. The father is yelling at the staff, and his wife is crying uncontrollably. Their 5-year-old daughter is banging the head of her doll on the floor. Which nursing action would be most helpful at this time? -Tell the father that his behavior is inappropriate. -Sit with the family and quietly communicate sorrow at their loss. -Help the couple to understand that their daughter is acting inappropriately. -Encourage the couple to send their daughter to her grandparents.
Sit with the family and quietly communicate sorrow at their loss. Sitting down for a moment with the woman and her partner and acknowledging the loss in the event of a known demise or impending death will go a long way toward establishing a relationship of trust between the nurse and the parents.
The nurse has returned from working as a maternald-child nurse volunteer for a nongovernmental organization. After completing a community presentation about this experience, the nurse knows that learning has occurred when a participant states which of the following? -"Malaria is a chronic disease, and rarely causes fetal loss." -"Escherichia coli bacteria can cause diarrhea but not stillbirth." -"Group B streptococci can cause infection and the death of the fetus." -"Viral infections don't cause fetal death in developing nations."
"Group B streptococci can cause infection and the death of the fetus." Group B streptococci can cause ascending infections prior to or after rupture of membranes.
The nurse is caring for a client who has just experienced a stillbirth. Which factors does the nurse recognize as potentially complicating the parents' response to this loss? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. -Unsupportive family -Adolescent mother -Strong religious faith -Open communication between the parents -Persistent denial of the situation
-Unsupportive family -Adolescent mother -Persistent denial of the situation
The nurse is caring for a client who has just been informed of the demise of her unborn fetus. Which common cognitive responses to loss would the nurse anticipate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. -Denial and disbelief -Sense of unreality -Poor concentration -Palpitations -Loss of appetite
-Denial and disbelief -Sense of unreality -Poor concentration
The nurse is caring for a client who finally conceived after several unsuccessful attempts at in vitro fertilization. The client has just been diagnosed with a perinatal loss. What should the nurse's plan of care include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. -Giving accurate and honest information -Encouraging the couple to try right away to get pregnant again -Validating the many losses the client has experienced -Providing possible explanations for the fetal demise -Assessing where the client is in the grieving process, and communicating with compassion
-Giving accurate and honest information -Validating the many losses the client has experienced -Assessing where the client is in the grieving process, and communicating with compassion
Which nursing diagnoses can apply to the couple experiencing a perinatal loss? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. -Grieving related to the imminent loss of a child -Fear related to discomfort of labor and unknown outcome -Knowledge, Deficient related to lack of information about involution -Powerlessness related to lack of control in current situational crisis -Spiritual Distress, Risk for related to intense suffering secondary to unexpected fetal loss
-Grieving related to the imminent loss of a child -Powerlessness related to lack of control in current situational crisis -Spiritual Distress, Risk for related to intense suffering secondary to unexpected fetal loss
The client in the first trimester of pregnancy questions the nurse about the causes of fetal death. The nurse explains that factors associated with perinatal loss include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. -Maternal diabetes -Paternal hypertension -Fetal chromosomal disorders -Maternal infections -Placental abnormalities
-Maternal diabetes -Fetal chromosomal disorders -Maternal infections -Placental abnormalities
Which nursing interventions would be included in the plan of care for a family that has just been informed of a perinatal loss? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. -Provide the parents with a private place and time to express their grief. -Offer reassurance that parents can have a subsequent successful pregnancy. -Allow the parents to participate in personal grief rituals. -Encourage interaction with other families. -Offer to give the family mementos of the infant such as footprints, crib card, and lock of hair.
-Provide the parents with a private place and time to express their grief. -Allow the parents to participate in personal grief rituals. -Offer to give the family mementos of the infant such as footprints, crib card, and lock of hair.
What of the following nursing interventions are appropriate when caring for the family experiencing a stillbirth? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. -Use active listening techniques. -Avoid the use of clichés. -Avoid periods of silence. -Wrap the infant in a blanket before the parents see the infant. -Do not permit the parents of an infant with birth defects to hold the infant.
-Use active listening techniques. -Avoid the use of clichés. -Wrap the infant in a blanket before the parents see the infant.
A couple request to see their stillborn infant. How should the nurse prepare the infant? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. -Wrapping the infant in a blanket -Removing all blankets from the infant -Placing a hat on the infant -Removing any identification from the infant -Placing a diaper on the infant
-Wrapping the infant in a blanket -Placing a hat on the infant
A client has delivered a stillborn infant at 28 weeks' gestation. Which nursing action is appropriate? -Discuss funeral options for the baby. -Encourage the couple to try to get pregnant again soon. -Ask the couple whether or not they would like to hold the baby. -Advise the couple that the baby's death was probably for the best.
Ask the couple whether or not they would like to hold the baby. Some parents will hold their infant for a short time before returning him or her to the nurse, whereas others will wish to spend a great deal of time with their infant. Allow the infant to remain with the parents for as long as they desire.
A 15-year-old client has delivered a 22-week stillborn fetus. What does the nurse understand? -Grieving a fetal loss manifests with very similar behaviors regardless of the age of the client. -Teens tend to withhold emotions and need older adults with the same type of loss to help process the experience. -Most teens have had a great deal of contact with death and loss and have an established method of coping. -Assisting the client might be difficult because of her mistrust of authority figures.
Assisting the client might be difficult because of her mistrust of authority figures. Adolescents rely heavily on peer support and have a natural mistrust of authority figures, which can make assisting them more difficult.
A woman has just delivered a stillborn child at 26 weeks' gestation. Which nursing action is appropriate at this time? -Remind the mother that she will be able to have another baby in the future. -Dress the infant in a gown and swaddle it in a receiving blanket. -Ask the woman whether she would like the doctor to prescribe a sedative for her. -Remove the baby from the delivery room as soon as possible.
Dress the infant in a gown and swaddle it in a receiving blanket. After bathing, the infant should be placed in a suitable-sized gown and then wrapped in a blanket.
The nurse is present when a mother and her partner are told that their 35-week fetus has died. Which nursing intervention should the nurse perform first? -Encourage open communication with the family and the healthcare team. -Ask the family to withhold questions until the next day. -Request that another nurse come and care for this family. -Contact a local funeral home to help the family with funeral plans.
Encourage open communication with the family and the healthcare team. The top priority for the nurse is to encourage open communications. The nurse functions as an advocate for the family in organizing interdisciplinary involvement, maintaining continuity of care, offering the opportunity for open communication, and ensuring that the family's wishes regarding their loss experience are honored.
The community nurse is planning care for a family that experienced the loss of twins at 20 weeks. Which of these steps should be part of the nurse's care of this family? -Base care on the reactions of previous clients who experienced stillbirth. -Express the belief that the family will be able to get through this experience. -Encourage the couple to keep their feelings to themselves. -Honor the birth by reminding the couple that their babies are happy in heaven.
Express the belief that the family will be able to get through this experience. Maintaining belief is defined as believing in the parents' capacity to get through the event and face a future with meaning and it is one of the attributes of caring theory.
The nurse is caring for a client who experienced the birth of a stillborn son earlier in the day. The client is from a culture where a woman's status is dominated by themes of motherhood and childrearing. What behavior would the nurse expect in this client? -Crying inconsolably -Expressing feelings of failure as a woman -Requesting family members to be present -Showing little emotion
Expressing feelings of failure as a woman Mothers will often blame themselves, whether by commission or omission, particularly in cultures where a woman's status is dominated by themes of motherhood and childrearing.
The nurse is caring for a couple who are in the labor/delivery room immediately after the delivery of a stillborn baby with visible defects. Which of the following actions by the nurse is appropriate? -Discourage the parents from naming the baby. -Advise the parents that the baby's defects would be too upsetting for them to see. -Transport the baby to the morgue as soon as possible. -Offer the parents the choice to see and hold the baby.
Offer the parents the choice to see and hold the baby. The nurse should offer the couple the opportunity to see and hold the infant, and reassure the couple that any decision they make for themselves is the right one.
The nurse is anticipating the arrival of a couple in the labor unit. It has been determined that the 37-week fetus has died in utero from unknown causes. What should the nurse include in the plan of care for this couple? -Allow the couple to adjust to the labor unit in the waiting area. -Place the couple in a labor room at the end of the hall with an empty room next door. -Encourage the father to go home and rest for a few hours. -Contact the mother's emergency contact person and explain the situation.
Place the couple in a labor room at the end of the hall with an empty room next door. Upon arrival to the facility, the couple with a known or suspected fetal demise should immediately be placed in a private room. When possible, the woman should be in a room that is farthest away from other laboring women.
The labor and delivery nurse is caring for a client whose labor is being induced due to fetal death in utero at 35 weeks' gestation. In planning intrapartum care for this client, which nursing diagnosis is most likely to be applied? -Powerlessness -Urinary Elimination, Impaired -Coping: Family, Readiness for Enhanced -Skin Integrity, Impaired
Powerlessness Powerlessness is commonly experienced by families who face fetal loss. Powerlessness is related to lack of control in current situational crisis.
Which of the following may lead to the development of disseminated intravascular coagulation (DIC), also called consumption coagulopathy, in the mother? -Hypertensive disorders -Abruptio placentae -Prolonged retention of the dead fetus -Heritable thrombophilias
Prolonged retention of the dead fetus Prolonged retention of the dead fetus may lead to the development of disseminated intravascular coagulation (DIC), also called consumption coagulopathy, in the mother.
How does the nurse consider the spiritual needs of a couple experiencing a fetal loss? -Explaining the fetal loss in terms of the nurse's own religious beliefs -Providing an atmosphere of acceptance regarding the couple's spiritual rites -Referring the couple to the hospital chaplain at discharge -Informing the couple of religious rituals that have helped other couples to cope with fetal loss
Providing an atmosphere of acceptance regarding the couple's spiritual rites The nurse can facilitate the spiritual needs of the couple by providing an atmosphere of acceptance regarding spiritual rites and encouraging the couple's use of spiritual writings, prayers, and observances.
The nurse is teaching a class on perinatal loss to student nurses. What would the nurse explain about the relationship between attachment and the grief response? -The mother has no attachment to the fetus before it is born. -The severity of the grieving has nothing to do with attachment to the fetus. -The intensity of the grief response can be assessed by determining the level of attachment to the anticipated infant. -The mother would feel grief only if it were a planned pregnancy.
The intensity of the grief response can be assessed by determining the level of attachment to the anticipated infant. The intensity to which the grief will be experienced is best understood from the aspect of the level of attachment the grieving person had to the deceased and usually entails finding personal meaning in the loss for successful integration into the grieving person's life.
The community nurse has identified that the mother who gave birth to a stillborn baby last week is an intuitive griever. Which behavior has the nurse encountered that would lead to this assessment? -The mother verbalized that her problem-solving skills have been helpful during this process. -The mother repeatedly talks about her thoughts, feelings, and emotions about losing her child. -The mother talks little about her experience, and appears detached and unaffected by the loss of her child. -The mother has asked close friends, co-workers, and relatives not to call or visit.
The mother repeatedly talks about her thoughts, feelings, and emotions about losing her child. Intuitive grievers tend to feel their way through the loss and seek emotional and psychosocial support.
The client at 37 weeks' gestation calls the clinic nurse to report that neither she nor her partner has felt fetal movement for the past 48 hours. The nurse anticipates that the physician will order which test to assess fetal viability? -Ultrasound -Serum progesterone levels -Computed tomography (CT) scan -Contraction stress test
Ultrasound Diagnosis of intrauterine fetal death (IUFD) is confirmed by visualization of the fetal heart with absence of heart action on ultrasound.
The nurse is working with a family who experienced the stillbirth of a son 2 months ago. Which statement by the mother would be expected? -"I seem to keep crying for no reason." -"The death of my son hasn't changed my life." -"I have not visited my son's gravesite." -"I feel happy all the time."
"I seem to keep crying for no reason." Mourning may be manifested by certain behaviors and rituals, such as weeping, which help the person experience, accept, and adjust to the loss.
The nurse is supervising care by a new graduate nurse who is working with a couple who have experienced a stillbirth. Which statement made by the new nurse indicates that further instruction is necessary? -"I should stay out of their room as much as possible." -"The parents might express their grief differently from each other." -"My role is to help the family communicate and cope." -"Hopelessness might be expressed by this family."
"I should stay out of their room as much as possible." Families experiencing perinatal loss need support. The nurse should stay with the couple so they do not feel alone and isolated; however, cues that the couple wants to be alone should be assessed continuously.
A client has experienced a stillbirth. Which statement by the nurse would be appropriate? -"You are young. You can try again." -"At least you have your other children." -"I'm sure you had many dreams and hopes for the future." -"It's a blessing in disguise."
"I'm sure you had many dreams and hopes for the future." Perinatal loss is unique in that the parents have not had experiences with the child that was to be, and attachment is based mostly upon hopes and dreams for the future relationship.
A client has just delivered her third child, who was stillborn and had obvious severe defects. Which statement by the nurse is most helpful? -"Thank goodness you have other children." -"I am so happy that your other children are healthy." -"These things happen. They are the will of God." -"It is all right for you to cry. I will stay here with you."
"It is all right for you to cry. I will stay here with you." The nurse needs to let the client know that crying is a normal reaction to the loss event, and that the nurse will stay with her to offer support and understanding.
