Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 36 Grief and Loss in the Child-Bearing Family

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

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

Select all that apply.

1. "Perinatal loss refers to third-trimester fetal death in utero."
2. "Perinatal loss occurs more frequently in assisted reproduction."
3. "Perinatal loss rates have declined in the United States over the past few years."
4. "Perinatal loss includes 25% of stillbirths occurring before the onset of labor."
5. "Perinatal loss rarely causes an emotional problem for the family."

Page Ref: 977

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

Learning Outcome: 1 Discuss perinatal loss including etiology, diagnosis, and the nurse's role in facilitating the family's mourning process.

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. The nurse has returned from working as a maternal-child nurse volunteer for a non-governmental organization. After completing a community presentation about this experience, the nurse knows that learning has occurred when a participant states which of the following?
2. "Malaria is a chronic disease, and rarely causes fetal loss."
3. "Escherichia coli bacteria can cause diarrhea, but not stillbirth."
4. "Group B streptococci can cause infection and the death of the fetus."
5. "Viral infections don't cause fetal death in developing nations."

Page Ref: 977

Cognitive Level: Applying

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

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

Learning Outcome: 1 Discuss perinatal loss including etiology, diagnosis, and the nurse's role in facilitating the family's mourning process.

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. 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?
2. The mother verbalized that her problem-solving skills have been helpful during this process.
3. The mother repeatedly talks about her thoughts, feelings, and emotions about losing her child.
4. The mother talks little about her experience, and appears detached and unaffected by the loss of her child.
5. The mother has asked close friends, co-workers, and relatives not to call or visit.

Page Ref: 982

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. 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?
2. Allow the couple to adjust to the labor unit in the waiting area.
3. Place the couple in a labor room at the end of the hall with an empty room next door.
4. Encourage the father to go home and rest for a few hours.
5. Contact the mother's emergency contact person and explain the situation.

Page Ref: 990

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. A couple requests to see their stillborn infant. How should the nurse prepare the infant?

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

Select all that apply.

1. Wrapping the infant in a blanket
2. Removing all blankets from the infant
3. Placing a hat on the infant
4. Removing any identification from the infant
5. Placing a diaper on the infant is not necessary.

Page Ref: 994

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. Which of the following may lead to the development of disseminated intravascular coagulation (D I C), also called consumption coagulopathy, in the mother?
2. Hypertensive disorders
3. Abruptio placentae
4. Prolonged retention of the dead fetus
5. Heritable thrombophilias

Page Ref: 978

Cognitive Level: Applying

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

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

Learning Outcome: 1 Discuss perinatal loss including etiology, diagnosis, and the nurse's role in facilitating the family's mourning process.

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. 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?
2. Ultrasound
3. Serum progesterone levels
4. Computed tomography (C T) scan
5. Contraction stress test

Page Ref: 978

Cognitive Level: Applying

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

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

Learning Outcome: 1 Discuss perinatal loss including etiology, diagnosis, and the nurse's role in facilitating the family's mourning process.

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. 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?
2. An indication that the mother is in the anger phase of grief.
3. An abnormal response to the loss of the child.
4. Reactive stress management techniques in use.
5. Denial of the death of the child she delivered yesterday.

Page Ref: 980

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. 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?
2. Crying inconsolably
3. Expressing feelings of failure as a woman
4. Requesting family members to be present
5. Showing little emotion

Page Ref: 987

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. 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?
2. Lack of meaning or direction
3. Preoccupation
4. Flat affect
5. Dreams of the deceased

Page Ref: 981

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. 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?
2. "I seem to keep crying for no reason."
3. "The death of my son hasn't changed my life."
4. "I have not visited my son's gravesite."
5. "I feel happy all the time."

Page Ref: 979

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. A 15-year-old client has delivered a 22-week stillborn fetus. What does the nurse understand?
2. Grieving a fetal loss manifests with very similar behaviors regardless of the age of the client.
3. Teens tend to withhold emotions and need older adults with the same type of loss to help process the experience.
4. Most teens have had a great deal of contact with death and loss and have an established method of coping.
5. Assisting the client might be difficult because of her mistrust of authority figures.

Page Ref: 982

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. 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?
2. Encourage open communication with the family and the healthcare team.
3. Ask the family to withhold questions until the next day.
4. Request that another nurse come and care for this family.
5. Contact a local funeral home to help the family with funeral plans.

Page Ref: 991

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. 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?
2. Powerlessness
3. Urinary Elimination, Impaired
4. Coping: Family, Readiness for Enhanced
5. Skin Integrity, Impaired

Page Ref: 989

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. 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?
2. "I should stay out of their room as much as possible."
3. "The parents might express their grief differently from each other."
4. "My role is to help the family communicate and cope."
5. "Hopelessness might be expressed by this family."

Page Ref: 992

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. 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?
2. Encourage the parents to look at the infant from across the room.
3. Offer the parents the choice of holding the infant in their arms.
4. Take the infant to the morgue immediately.
5. Call family members and inform them of the birth.

Page Ref: 994

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. 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.

1. "Use clichés; your daughter will find the repetition comforting."
2. "Remind her that she is young and can have more children."
3. "Keep talking about other things to keep her mind off the loss."
4. "Express your sadness, and sit silently with her if she doesn't respond."
5. "Encourage her to talk about the baby whenever she wants to."

Page Ref: 982, 1000

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. 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?
2. Base care on the reactions of previous clients who experienced stillbirth.
3. Express the belief that the family will be able to get through this experience.
4. Encourage the couple to keep their feelings to themselves.
5. Honor the birth by reminding the couple that their babies are happy in heaven.

Page Ref: 990

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

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

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. It is confirmed that a 14-week fetus has died. The patient has an unfavorable cervix. Which approaches to deliver the fetus should be reviewed with the patient?

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

Select all that apply.

1. Oxytocin
2. Misoprostol
3. Prostaglandins
4. Laminaria tent
5. Cesarean section

Page Ref: 978

Cognitive Level: Applying

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

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. The nurse is a caring for a patient who is recovering from the loss of her 24-week fetus. Which observations should the nurse identify as being the patient's behavioral responses to this loss?

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

Select all that apply.

1. Crying
2. Disorientation
3. Time confusion
4. Fear of being alone
5. Absent-mindedness

Page Ref: 981

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment: Nursing Process.

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. The fetus of a pregnant Latino American patient has died. When assisting the family with the perinatal loss, what should the nurse expect?

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

Select all that apply.

1. The fetus will be baptized
2. Pictures will be taken of the fetus
3. Cremation will occur within a day
4. The fetus will have an open casket
5. The mother will be dressed in black

Page Ref: 985

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Nursing Process.

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. The nurse is preparing to care for a patient who has just learned that her fetus has died. In which order should the nurse adhere to the RESPONDING approach to grieving families?
2. Genuine caring
3. Open communication
4. Nonjudgmental attitude
5. Decision making assistance
6. Spiritual and cultural accommodation
7. Recognition and validation of the loss

Page Ref: 990

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. The nurse is preparing to bathe and dress a fetus that has died. In which order should the nurse provide this postmortem care?
2. Pat dry
3. Apply gloves
4. Diaper and dress the fetus
5. Place in second basin of water to rinse
6. Place infant in lukewarm basin of water
7. Bathe according to skin integrity condition

Page Ref: 995

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. The nurse educator is teaching a group of students about maternal medical conditions that contribute to stillbirth. Which student statement indicates correct understanding of the material presented?
2. "Maternal hypertensive disorders often contribute to stillbirth."
3. "Maternal congenital anomalies contribute to stillbirth."
4. "Maternal chromosomal abnormalities contribute to stillbirth."
5. "Maternal malformations contribute to stillbirth."

Page Ref: 978

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 1 Discuss perinatal loss including etiology, diagnosis, and the nurse's role in facilitating the family's mourning process.

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. Which is the criterion that practitioners use to diagnosis fetal demise in utero?
2. Absence of fetal movement
3. Absence of fetal heartbeat
4. Increased serum estriol
5. Increased serum testosterone

Page Ref: 978

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Discuss perinatal loss including etiology, diagnosis, and the nurse's role in facilitating the family's mourning process.

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. The nurse is providing care to a pregnant client who experienced a fetal demise in utero. The client opted to wait more than 24 hours prior to scheduling the induction procedure. Which complication is the client at increased risk for based on this data?
2. Anxiety
3. Hemorrhage
4. Hypertension
5. Mania

Page Ref: 978

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Nursing Process: Planning.

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. A couple who experienced a fetal demise would like to determine the specific cause. Which method of fetal testing will the nurse prepare for based on this request?
2. Diabetes testing
3. Urine toxicology testing
4. Infectious disease studies
5. Chromosomal studies

Page Ref: 979

Cognitive Level: Analyzing

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

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Discuss perinatal loss including etiology, diagnosis, and the nurse's role in facilitating the family's mourning process.

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. The nurse is providing care to a couple who have experienced a perinatal loss. Which is an expected early physical response to the loss?
2. Confusion
3. Preoccupation
4. Loss of appetite
5. Poor concentration

Page Ref: 981

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Nursing Process: Assessment.

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. The nurse is providing care to a Hispanic client who has experienced a stillbirth. Which action by the nurse is appropriate when providing culturally competent care to the client and family members?
2. Asking the paternal grandfather if they will sit in shiva
3. Asking the oldest male member of the family if he would like to participate in the cremation
4. Asking the parents if they wish to have their baby baptized
5. Asking the parents if they wish to participate in the ritual of painting the baby's body

Page Ref: 984

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Nursing Process: Implementation.

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. The nurse is providing care to a couple who have experienced a stillbirth. Which is a therapeutic statement from the nurse when providing care to the client?
2. "You are young; you can try again."
3. "It's a blessing in disguise."
4. "God needed another angel in heaven."
5. "I am here to listen if you would like to talk about it."

Page Ref: 991

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Communication and Documentation.

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. The nurse is preparing a stillborn newborn to be held by the parents. Which action by the nurse is appropriate?
2. Using baby lotion so that the newborn smells like a baby
3. Placing cotton in the newborn's nostrils if seepage is noted
4. Using a washcloth when bathing the newborn's skin to decrease tissue sloughing
5. Placing the newborn in the provided outfit and blanket

Page Ref: 995

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Nursing Process: Implementation.

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. Which nursing action is appropriate prior to presenting the stillborn newborn to the parents for holding?
2. Staying with the family while they hold and say goodbye to their newborn
3. Telling the family that they should not hold their baby because it will be too painful
4. Preparing the family by telling them what they will see, feel, and smell
5. Telling the family that they can have up to thirty minutes with their baby

Page Ref: 995

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Nursing Process: Implementation.

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. Which items will the nurse include in a memory box for a couple who have experienced a stillbirth?

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

Select all that apply.

1. Pictures
2. I D bracelet
3. Memory card
4. Bereavement clothing
5. Grief and loss pamphlets

Page Ref: 995

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Nursing Process: Implementation.

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. The nurse is providing care to a couple who have experienced a perinatal loss. Which nursing diagnosis is appropriate to include in the plan of care?
2. Acute Pain
3. Complicated Grieving
4. Powerlessness
5. Insomnia

Page Ref: 989

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

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

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.

1. The nurse is assessing a client's risk for death during the postpartum period. Which finding would cause the nurse to increase surveillance for this client?
2. Maternal age of 25
3. History of bipolar disorder
4. Increased body mass index
5. Decreased blood pressure

Page Ref: 988

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice: Apply evidence to support decision making in situations characterized by ambiguity and uncertainty. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Discuss perinatal loss including etiology, diagnosis, and the nurse's role in facilitating the family's mourning process.

M N L L O: Demonstrate use of the nursing process in the care of the childbearing family experiencing grief and loss.