Chapter 37 Flashcards Preview

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Flashcards in Chapter 37 Deck (24):
1

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.

2

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.

3

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.

4

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.

5

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.

6

6. Parents are often asked if they would like to have an autopsy performed on their infant. Nurses who are assisting parents with this decision should be aware of which information?
a. Autopsies are usually covered by insurance.
b. Autopsies must be performed within a few hours after the infant’s death.
c. In the current litigious society, more autopsies are performed than in the past.
d. Some religions prohibit autopsy.

ANS: D
Some religions prohibit autopsies or limit the choice to the times when it may help prevent further loss. The cost of the autopsy must be considered; it is not covered by insurance and can be very expensive. There is no rush to perform an autopsy unless evidence of a contagious disease or maternal infection is present at the time of death. The rate of autopsies is declining, in part because of a fear by medical facilities that errors by the staff might be revealed, resulting in litigation.

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7. Parents have asked the nurse about organ donation after that infant’s death. Which information regarding organ donation is important for the nurse to understand?
a. Federal law requires the medical staff to ask the parents about organ donation and then to contact their state’s organ procurement organization (OPO) to handle the procedure if the parents agree.
b. Organ donation can aid grieving by giving the family an opportunity to see something positive about the experience.
c. Most common donation is the infant’s kidneys.
d. Corneas can be donated if the infant was either stillborn or alive as long as the pregnancy went full term.

ANS: B
Evidence indicates that organ donation can promote healing among the surviving family members. The federal Gift of Life Act made state OPOs responsible for deciding whether to request a donation and for making that request. The most common donation is the cornea. For cornea donation, the infant must have been born alive at 36 weeks of gestation or later.

8

8. Which statement is the most appropriate for the nurse to make when caring for bereaved parents?
a. “This happened for the best.”
b. “You have an angel in heaven.”
c. “I know how you feel.”
d. “What can I do for you?”

ANS: D
Acknowledging the loss and being open to listening is the best action that the nurse can do. No bereaved parent would find the statement “This has happened for the best” to be comforting in any way, and it may sound judgmental. Nurses must resist the impulse to speak about the afterlife to people in pain. They should also resist the temptation to give advice or to use clichés. Unless the nurse has lost a child, he or she does not understand how the parents feel.

9

9. 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?” What is the nurse’s most appropriate response?
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?”

ANS: D
The statement “I can understand your need to find an answer to what caused this. What else are you thinking about?” 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. In addition, trying to give bereaved parents answers when no clear answers exist or trying to squelch their guilt feeling does not help the process of grieving. Silence would probably 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 then listening with care. The nurse should encourage the mother to express her thoughts.

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10. Which options for saying “good-bye” would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl?
a. The nurse should not discuss any options at this time; plenty of time will be available after the baby is born.
b. “Would you like a picture taken of your baby after birth?”
c. “When your baby is born, would you like to see and hold her?”
d. “What funeral home do you want notified after the baby is born?”

ANS: C
Mothers and fathers may find it helpful to see their infant after delivery. The parents’ wishes should be respected. Interventions and support from the nursing and medical staff after a prenatal loss are extremely important in the healing of the parents. The initial intervention should be directly related to the parents’ wishes concerning seeing or holding their dead infant. Although information about funeral home notification may be relevant, this information is not the most appropriate option at this time. Burial arrangements can be discussed after the infant is born.

11

11. During a follow-up home visit, the nurse plans to evaluate whether parents have progressed to the second stage of grieving (phase of intense grief). Which behavior would the nurse not anticipate finding?
a. Guilt, particularly in the mother
b. Numbness or lack of response
c. Bitterness or irritability
d. Fear and anxiety, especially about getting pregnant again

ANS: B
The second phase of grieving encompasses a wide range of intense emotions, including guilt, anger, bitterness, fear, and anxiety. What the nurse would hope not to see is numbness or unresponsiveness, which indicates that the parents are still in denial or shock.

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12. Which finding would indicate to the nurse that the grieving parents have progressed to the reorganization phase of grieving?
a. The parents say that they “feel no pain.”
b. The parents are discussing sex and a future pregnancy, even if they have not yet sorted out their feelings.
c. The parents have abandoned those moments of “bittersweet grief.”
d. The parents’ questions have progressed from “Why?” to “Why us?”

ANS: B
Many couples have conflicting feelings about sexuality and future pregnancies. A little pain is always present, certainly beyond the first year when recovery begins to peak. Bittersweet grief describes the brief grief response that occurs with reminders of a loss, such as anniversary dates. Most couples never abandon these reminders. Recovery is ongoing. Typically, a couple’s search for meaning progresses from “Why?” in the acute phase to “Why me?” in the intense phase to “What does this loss mean to my life?” in the reorganizational phase.

13

13. Which statement most accurately describes complicated grief?
a. Occurs when, in multiple births, one child dies and the other or others live
b. Is a state during 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

ANS: C
Parents showing signs of complicated grief should be referred for counseling. Multiple births, in which not all of the babies survive, create a complicated parenting situation but not complicated bereavement. Abortion can generate complicated emotional responses, but these responses do not constitute complicated bereavement. Families of lost adolescent pregnancies may have to deal with complicated issues, but these issues are not complicated bereavement.

14

14. A client is diagnosed with having a stillborn infant. At first, she appears stunned by the news, cries a little, and then asks the nurse to call her mother. What is the proper term for the phase of bereavement that this client is experiencing?
a. Anticipatory grief
b. Acute distress
c. Intense grief
d. Reorganization

ANS: B
The immediate reaction to news of a perinatal loss or infant death encompasses a period of acute distress. Disbelief and denial can occur. However, parents also feel very sad and depressed. Intense outbursts of emotion and crying are normal. However, a 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 he or she 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.

15

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.”

Ans: D
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.

16

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?”

Ans: D
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.

17

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.

Ans: B
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.

18

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.

Ans: C
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.

19

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.

Ans: C
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.

20

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.

Ans: B
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.

21

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.

Ans: C
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.

22

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.

Ans: D
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.

23

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

Ans: D
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.

24

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”

Ans: C, D, E
“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.