Chapter 37: Perinatal Loss, Bereavement, and Grief
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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
NURSINGTB.COM
2. A newborn in the neonatal intensive care unit (NICU) is dying 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.
PTS: 1 DIF: Cognitive Level: Apply
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.
PTS: 1 DIF: Cognitive Level: Understand
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 familN
yUmR SbIeNr iGs TmBos.t ClikOeM
em ly 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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity
5. 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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
6. 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 terN mU. RSINGTB.COM
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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
7. 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
NURSINGTB.COM
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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
NURSINGTB.COM
2. A newborn in the neonatal intensive care unit (NICU) is dying 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.
PTS: 1 DIF: Cognitive Level: Apply
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.
PTS: 1 DIF: Cognitive Level: Understand
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 familN
yUmR SbIeNr iGs TmBos.t ClikOeM
em ly 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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity
5. 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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
6. 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 terN mU. RSINGTB.COM
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.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
7. 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
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