Chapter 37 Perinatal Loss, Bereavement, and Grief

Chapter 37  Perinatal Loss, Bereavement, and Grief

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. A family is visiting two surviving triplets. The third triplet died 2 days ago. What action indicates that the family has begun to grieve for the dead infant?
a.
Refers to the two live infants as twins
b.
Asks about the dead triplet’s current status
c.
Brings in play clothes for all three infants
d.
Refers to the dead infant in the past tense

ANS: D
Accepting that the infant is dead (in the past tense of the word) demonstrates an acceptance of the reality and that the family has begun to grieve. Parents of multiples are challenged with the task of parenting and grieving at the same time. Referring to the two live infants as twins does not acknowledge an acceptance of the existence of their third child. Bringing in play clothes for all three infants indicates that the parents are still in denial regarding the death of the third triplet. The death of the third infant has imposed a confusing and ambivalent induction into parenthood for this couple. If the two live infants are referred to as twins and/or if play clothes for all three infants are still considered, then the family is clearly still in denial regarding the death of one of the triplets.

DIF: Cognitive Level: Understand REF: p. 927
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

2. A newborn in the neonatal intensive care unit (NICU) is dying as a result of a massive infection. The parents speak to the neonatologist, who informs them of their son’s prognosis. When the father sees his son, he says, “He looks just fine to me. I can’t understand what all this is about.” What is the most appropriate response or reaction by the nurse at this time?
a.
“Didn’t the physician tell you about your son’s problems?”
b.
“This must be a difficult time for you. Tell me how you’re doing.”
c.
Quietly stand beside the infant’s father.
d.
“You’ll have to face up to the fact that he is going to die sooner or later.”

ANS: B
The phase of intense grief can be very difficult, especially for fathers. Parents should be encouraged to share their feelings during the initial steps in the grieving process. This father is in a phase of acute distress and is reaching out to the nurse as a source of direction in his grieving process. Shifting the focus is not in the best interest of the parent. Nursing actions may help the parents actualize the loss of their infant through a sharing and verbalization of their feelings of grief. Telling the father that his son is going to die sooner or later is dispassionate and an inappropriate statement on the part of the nurse.

DIF: Cognitive Level: Apply REF: p. 911 TOP: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity

3. During the initial acute distress phase of grieving, parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. What is the nurse’s role at this time?
a.
To take over as much as possible to relieve the pressure
b.
To encourage the grandparents to take over
c.
To ensure that the parents, themselves, approve the final decisions
d.
To leave them alone to work things out

ANS: C
The nurse is always the client’s advocate. Nurses can offer support and guidance and yet leave room for the same from grandparents. In the end, however, nurses should let the parents make the final decisions. For the nurse to be able to present options regarding burial and autopsy, among other issues, in a sensitive and respectful manner is essential. The nurse should assist the parents in any way possible; however, taking over all arrangements is not the nurse’s role. Grandparents are often called on to help make the difficult decisions regarding funeral arrangements or the disposition of the body because they have more life experiences with taking care of these painful, yet required arrangements. Some well-meaning relatives may try to take over all decision-making responsibilities. The nurse must remember that the parents, themselves, should approve all of the final decisions. During this time of acute distress, the nurse should be present to provide quiet support, answer questions, obtain information, and act as a client advocate.

DIF: Cognitive Level: Understand REF: p. 921
TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

4. A nurse caring for a family during a loss might notice that a family member is experiencing survivor guilt. Which family member is most likely to exhibit this guilt?
a.
Siblings
b.
Mother
c.
Father
d.
Grandparents

ANS: D
Survivor guilt is sometimes felt by grandparents because they feel that the death is out of order; they are still alive, while their grandchild has died. They may express anger that they are alive and their grandchild is not. The siblings of the expired infant may also experience a profound loss. A young child will respond to the reactions of the parents and may act out. Older children have a more complete understanding of the loss. School-age children are likely to be frightened, whereas teenagers are at a loss on how to react. The mother of the infant is experiencing intense grief at this time. She may be dealing with questions such as, “Why me?” or “Why my baby?” and is unlikely to be experiencing survival guilt. Realizing that fathers can be experiencing deep pain beneath their calm and quiet appearance and may need help acknowledging these feelings is important. This need, however, is not the same as survivor guilt.

DIF: Cognitive Level: Understand REF: p. 916 TOP: Nursing Process: Evaluation
MSC: Client Needs: Psychosocial Integrity

5. When assisting the mother, father, and other family members to actualize the loss of an infant, which action is most helpful?
a.
Using the words lost or gone rather than dead or died
b.
Making sure the family understands that naming the baby is important
c.
Ensuring the baby is clothed or wrapped if the parents choose to visit with the baby
d.
Setting a firm time for ending the visit with the baby so that the parents know when to let go

ANS: C
Presenting the baby as nicely as possible stimulates the parents’ senses and provides pleasant memories of their baby. Baby lotion or powder can be applied, and the baby should be wrapped in a soft blanket, clothed, and have a cap placed on his or her head. Nurses must use the words dead and died to assist the bereaved in accepting the reality. Although naming the baby can be helpful, creating the sense that the parents have to name the baby is not important. In fact, some cultural taboos and religious rules prohibit the naming of an infant who has died. Parents need different times with their baby to say “good-bye.” Nurses need to be careful not to rush the process.

DIF: Cognitive Level: Apply REF: p. 919 TOP: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity