Perinatal Bereavement Certification (PBC) — Questions and Answers

Question 1: What is the impact of unresolved perinatal grief?

Better emotional health
Increased resilience
Stronger parenting skills
Emotional distress and long-term issues (Correct answer)

Correct answer: Emotional distress and long-term issues

Unresolved perinatal grief can lead to significant emotional distress, including prolonged depression, anxiety, post-traumatic stress disorder, and difficulty forming future attachments. Without proper support and processing, the intense sorrow and trauma can manifest as long-term psychological and relational issues, impacting personal well-being, relationships, and subsequent pregnancies. It underscores the importance of timely and compassionate bereavement care.

Question 2: A hospital bereavement team implements monthly peer support meetings for staff working with pregnancy loss families. This practice primarily addresses which risk?

Declining patient satisfaction scores
Staff disagreements about clinical protocols
Liability from undocumented client interactions
Isolation and secondary traumatic stress among bereavement staff (Correct answer)

Correct answer: Isolation and secondary traumatic stress among bereavement staff

Peer support meetings create communal spaces for processing grief work, reducing isolation and building collective resilience against secondary traumatic stress.

Question 3: What is the role of supervision in grief counseling?

To improve practice and ensure ethical care (Correct answer)
To punish mistakes
To avoid emotional connection
To reduce training

Correct answer: To improve practice and ensure ethical care

Supervision in grief counseling provides a structured opportunity for counselors to discuss their cases, receive guidance, and reflect on their practice with an experienced supervisor. This process helps counselors improve their skills, gain new perspectives, manage countertransference, and ensure they are adhering to ethical guidelines. It is essential for professional development and maintaining high-quality, ethical client care.

Question 4: When a bereavement professional's personal grief history is triggered by a client's perinatal loss, the most appropriate response is to:

Continue without intervention unless it affects observable performance
Immediately transfer the client to another provider
Seek personal therapy or supervision to process the overlap (Correct answer)
Disclose the personal history to normalize the client's experience

Correct answer: Seek personal therapy or supervision to process the overlap

Seeking therapy or supervision allows the professional to process triggered grief privately, maintaining their capacity to provide unimpaired, client-centered care.

Question 5: How should an PBC professional handle unexpected results that differ from predictions?

Blame external factors for the variance
Ignore the discrepancy if small
Repeat the exact same approach again
Analyze factors, document findings, and adjust the approach based on what was learned (Correct answer)

Correct answer: Analyze factors, document findings, and adjust the approach based on what was learned

Unexpected results are learning opportunities. Professional practice requires analysis of contributing factors and adaptation based on those findings.

Question 6: How do PBC professionals maintain digital competency?

Through ongoing training and staying current with technological advances (Correct answer)
Initial training skills remain sufficient indefinitely
Digital competency is not a professional requirement
By hiring IT support for all technology tasks

Correct answer: Through ongoing training and staying current with technological advances

Maintaining digital competency requires continuous learning and adaptation as technology evolves in the PBC profession.

Question 7: What psychological need is most affected in perinatal loss?

Attachment and identity (Correct answer)
Productivity
Curiosity
Achievement

Correct answer: Attachment and identity

Perinatal loss profoundly impacts parents' sense of attachment, as they lose the physical presence and future with their child, and their identity, as they grieve the loss of their role as a parent to that specific child. The hopes, dreams, and plans associated with the baby are shattered, affecting their self-perception and their place within their family and society. This deep psychological impact makes attachment and identity central to perinatal grief.

Question 8: How should siblings be included in perinatal memorialization activities?

Only adult siblings should be involved in any memorial activities
Siblings should be given age-appropriate opportunities to participate in remembrance activities (Correct answer)
Siblings should be completely excluded to protect them from grief
Siblings should create separate memorials entirely without parental involvement

Correct answer: Siblings should be given age-appropriate opportunities to participate in remembrance activities

Including siblings in age-appropriate memorial activities acknowledges their grief, validates their relationship with the baby, and supports family-wide healing.

Question 9: When advocating for systemic change in perinatal bereavement care at the institutional level, which action is most likely to produce lasting policy change?

Publishing a letter in the hospital newsletter
Presenting outcome data and family testimonials to hospital leadership (Correct answer)
Forming a peer support group among bereavement nurses
Updating the unit's supply of bereavement memory boxes

Correct answer: Presenting outcome data and family testimonials to hospital leadership

Presenting outcome data and family narratives to leadership provides the evidence and emotional weight needed to justify resource allocation and policy change.

Question 10: What is a risk register used for in Perinatal Bereavement Certification practice?

Managing project budgets
Recording employee attendance
Filing regulatory complaints
Tracking identified risks with their status, controls, and owners (Correct answer)

Correct answer: Tracking identified risks with their status, controls, and owners

A risk register is a comprehensive tool that documents all identified risks, their assessments, mitigation strategies, responsible parties, and current status.

Question 11: A mother who experienced a stillbirth six months ago reports she cannot pass the baby's nursery without panic attacks. This presentation is most consistent with:

Prolonged grief disorder with trauma features (Correct answer)
Normal acute grief
Adjustment disorder with depressed mood
Postpartum depression

Correct answer: Prolonged grief disorder with trauma features

Panic responses to grief-related triggers six months post-loss suggest trauma overlay consistent with prolonged grief disorder and warrant specialized assessment.

Question 12: A perinatal bereavement specialist receives a friend request on social media from a bereaved parent they currently support. What is the ethically correct action?

Accept to maintain connection and ongoing support
Ignore the request without explanation
Decline and address the request in the next clinical session (Correct answer)
Accept only on personal accounts, not professional ones

Correct answer: Decline and address the request in the next clinical session

Declining and then addressing the request therapeutically preserves professional boundaries while using the interaction as a clinical opportunity.

Question 13: During a multidisciplinary team meeting about a family experiencing a second-trimester loss, a physician dismisses the need for bereavement services saying 'it was too early.' What is the bereavement specialist's most appropriate response?

Acknowledge the physician's view and explain that grief is not determined by gestational age (Correct answer)
Defer to the physician's clinical judgment about gestational significance
Document the family's right to services and proceed without team discussion
Request an ethics consult to resolve the disagreement

Correct answer: Acknowledge the physician's view and explain that grief is not determined by gestational age

Educating colleagues that parental grief is not proportional to gestational age is an advocacy role within advanced professional practice.

Question 14: A family from a tradition that prohibits autopsy on religious grounds has lost a newborn. The specialist should:

Acknowledge their beliefs and clarify that autopsy is voluntary in most cases (Correct answer)
Present autopsy as the only way to obtain answers and encourage consent
Document religious objection and proceed without family discussion
Explain that autopsies are legally required in all neonatal deaths

Correct answer: Acknowledge their beliefs and clarify that autopsy is voluntary in most cases

Informed consent for autopsy requires presenting it as optional and respecting religious objections.

Question 15: When a perinatal loss occurs as the result of a homicide (e.g., domestic violence causing fetal death), which legal classification typically applies in states with fetal homicide laws?

Such events are treated as civil matters only, not criminal offenses
The crime is classified only as assault on the mother, not a separate offense
Federal law exclusively governs all homicide charges involving fetal death
Many states classify intentional fetal death as feticide or fetal homicide, a separate criminal charge (Correct answer)

Correct answer: Many states classify intentional fetal death as feticide or fetal homicide, a separate criminal charge

Over 38 states have enacted fetal homicide laws that allow separate criminal charges when a fetus is killed as a result of a crime against the mother.

Question 16: A bereaved parent asks their perinatal bereavement counselor to attend the baby's memorial service as a personal guest and sit with the family. What is the most ethically appropriate response?

Accept as a gesture of compassionate care without restriction
Attend briefly in a professional capacity if appropriate, maintaining the therapeutic role (Correct answer)
Consult the parent's partner before deciding
Decline entirely to avoid any boundary crossing

Correct answer: Attend briefly in a professional capacity if appropriate, maintaining the therapeutic role

Attending a memorial in a professional capacity may be appropriate in bereavement care, but the clinician must maintain their professional role rather than acting as a personal guest.

Question 17: According to Worden's Task II of mourning, 'Working through the pain of grief,' which clinical intervention best supports a bereaved parent?

Focusing immediately on future pregnancy planning
Discouraging discussion of the baby to avoid prolonging pain
Encouraging the parent to suppress emotions until they feel ready
Creating space for parents to express their pain without judgment (Correct answer)

Correct answer: Creating space for parents to express their pain without judgment

Task II requires the mourner to experience and process emotional pain; the counselor's role is to provide a safe, non-judgmental space to facilitate this work.

Question 18: Which of the following is a core principle of the Dual Process Model (Stroebe & Schut) as applied to perinatal bereavement counseling?

The model applies only to spousal bereavement, not perinatal loss
Oscillation between loss-oriented and restoration-oriented coping is healthy and adaptive (Correct answer)
Grievers should remain focused on loss-oriented coping to fully process the death
Restoration-oriented coping should be delayed until acute grief has resolved

Correct answer: Oscillation between loss-oriented and restoration-oriented coping is healthy and adaptive

The Dual Process Model holds that healthy grieving involves oscillating between confronting the loss and engaging with daily life restoration tasks.

Question 19: Which organizational strategy best supports the wellness of bereavement staff working with perinatal loss families?

Rotating all staff out of bereavement roles every 30 days
Encouraging staff to resolve stress privately to maintain professionalism
Prohibiting staff from discussing cases outside formal sessions
Structured debriefs after difficult cases and manageable caseloads (Correct answer)

Correct answer: Structured debriefs after difficult cases and manageable caseloads

Regular structured debriefs and appropriate caseload limits are evidence-based organizational interventions that reduce burnout and secondary trauma.

Question 20: Which of the following is considered a supportive response?

You should move on.
Don’t cry, it will be okay.
I’m here for you if you need anything. (Correct answer)
At least you can try again.

Correct answer: I’m here for you if you need anything.

"I’m here for you if you need anything" is a supportive response because it offers unconditional presence and practical help without minimizing the person's pain or offering platitudes. It respects their individual grieving process and empowers them to ask for support when they are ready. This statement validates their experience and provides a sense of security and care.

Question 21: When implementing advanced professional practice practices, what should PBC professionals prioritize?

Cost reduction as the sole objective
Personal preferences and comfort level
Alignment with professional standards, stakeholder needs, and organizational goals (Correct answer)
Speed of implementation above all else

Correct answer: Alignment with professional standards, stakeholder needs, and organizational goals

Effective implementation of advanced professional practice requires balancing professional standards, stakeholder needs, and organizational objectives for optimal results.

Question 22: Which statement best reflects a healthy professional identity for a PBC-certified perinatal bereavement specialist?

Self-care is a luxury that detracts from the quality of client services
Showing any emotional response to client losses is unprofessional
My clients' needs must always come before my own mental health
I can be deeply committed to my clients while also protecting my own wellbeing (Correct answer)

Correct answer: I can be deeply committed to my clients while also protecting my own wellbeing

A healthy professional identity integrates deep client commitment with intentional self-preservation, recognizing that sustainable care requires a well-resourced caregiver.

Question 23: What is the benefit of standardized digital reporting in Perinatal Bereavement Certification practice?

It is only needed for government-related work
It replaces the need for professional communication
It ensures consistency, enables comparison, and facilitates compliance (Correct answer)
It unnecessarily limits professional creativity

Correct answer: It ensures consistency, enables comparison, and facilitates compliance

Standardized digital reporting creates consistency across Perinatal Bereavement Certification practice, enables meaningful comparisons, and streamlines regulatory compliance.

Question 24: Under the Affordable Care Act, mental health and substance use disorder benefits must be provided at parity with medical benefits. How does this affect perinatal bereavement services?

Hospitals are exempt from parity rules for grief counseling
Parity only applies to inpatient psychiatric services, not outpatient grief support
Parity rules only apply to employer-sponsored plans with 500 or more employees
Insurers cannot impose more restrictive limits on bereavement counseling than on comparable medical services (Correct answer)

Correct answer: Insurers cannot impose more restrictive limits on bereavement counseling than on comparable medical services

Mental Health Parity rules require that grief counseling and bereavement support cannot face more restrictive cost-sharing or visit limits than equivalent medical services.

Question 25: When a perinatal loss involves a potential medical error, what ethical and legal obligation does the healthcare team have toward the family?

Only disclose if the family specifically asks whether an error occurred
Disclose the error honestly in keeping with transparency and many states' disclosure laws (Correct answer)
Avoid disclosing the error to prevent litigation
Disclose only after the hospital's legal team has reviewed the case for liability

Correct answer: Disclose the error honestly in keeping with transparency and many states' disclosure laws

Many states have disclosure laws and accreditation standards require transparent communication with patients and families when unanticipated outcomes occur.

Question 26: What is the primary purpose of setting clear professional boundaries in perinatal bereavement work?

To reduce the number of clients served
To comply with licensing board minimums
To protect both the professional's wellbeing and the therapeutic relationship (Correct answer)
To avoid liability from difficult cases

Correct answer: To protect both the professional's wellbeing and the therapeutic relationship

Clear professional boundaries sustain the helper's capacity to provide consistent, ethical support while preventing dependency and overinvolvement.

Question 27: A perinatal bereavement counselor is subpoenaed for medical records relating to a patient's pregnancy loss. What is the appropriate first step?

Notify the patient only if she requests notification
Immediately provide all requested records to comply with the subpoena
Consult with the facility's legal counsel before releasing any records (Correct answer)
Refuse to comply because mental health records are always privileged

Correct answer: Consult with the facility's legal counsel before releasing any records

A subpoena is a legal order but does not automatically override HIPAA; legal counsel must review before disclosure to determine proper authorization.

Question 28: Why is documentation important in PBC risk management?

It slows down critical operations
It creates an audit trail and demonstrates due diligence (Correct answer)
It is optional administrative work
It only benefits legal teams during litigation

Correct answer: It creates an audit trail and demonstrates due diligence

Documentation in risk management creates accountability, supports decision-making, and demonstrates professional due diligence.

Question 29: In perinatal bereavement ethics, the concept of 'dual relationships' refers to:

Using two different therapeutic frameworks concurrently
Having both a professional and a personal relationship with a client (Correct answer)
Providing care to both parents in a couple simultaneously
Collaborating with two healthcare teams for the same client

Correct answer: Having both a professional and a personal relationship with a client

Dual relationships arise when a clinician holds both a professional role and another type of relationship (e.g., friend, neighbor) with the same person.

Question 30: What is the role of empathy in grief support?

To remain emotionally detached
To foster connection and understanding (Correct answer)
To challenge their emotions
To create emotional distance

Correct answer: To foster connection and understanding

Empathy is crucial in grief support because it allows the counselor to understand and share the feelings of the grieving individual from their perspective. By demonstrating empathy, counselors can foster a deep connection, build trust, and create a safe space where clients feel truly understood and less alone in their pain. This connection is fundamental for effective therapeutic work and healing.

Question 31: Why should counselors avoid dual relationships with clients?

They build trust faster
They ensure better care
They increase empathy
They compromise professional boundaries (Correct answer)

Correct answer: They compromise professional boundaries

Dual relationships occur when a counselor has another, non-professional relationship with a client (e.g., friend, business partner). These relationships are generally avoided because they can compromise professional boundaries, create conflicts of interest, impair the counselor's objectivity, and potentially exploit the client. Maintaining clear professional boundaries is crucial for the integrity and effectiveness of the therapeutic relationship.

Question 32: Which intervention is most appropriate when a bereaved sibling (age 5) asks 'Where did the baby go?'

Say the baby is in heaven watching over the family
Use simple, honest language appropriate to the child's developmental stage, such as 'the baby's body stopped working' (Correct answer)
Defer the question entirely to the parents to answer
Redirect the child to play to avoid distressing them

Correct answer: Use simple, honest language appropriate to the child's developmental stage, such as 'the baby's body stopped working'

Developmentally appropriate, honest language helps young children understand death without creating confusion or magical thinking.

Question 33: What is the most effective communication approach for PBC professionals?

Relying solely on written correspondence
Using technical jargon exclusively
Minimizing all verbal communications
Adapting communication style to the audience while maintaining accuracy (Correct answer)

Correct answer: Adapting communication style to the audience while maintaining accuracy

Effective PBC professionals adapt their communication style to the audience's needs and knowledge level while ensuring accuracy and completeness.

Question 34: When developing a hospital-based perinatal bereavement program, which element is considered foundational for staff sustainability?

Mandatory bereavement training for all clinical staff
Creating a dedicated bereavement nursing role
Regular staff debriefing and vicarious trauma support (Correct answer)
Standardizing memory-making protocols across all units

Correct answer: Regular staff debriefing and vicarious trauma support

Regular debriefing and vicarious trauma support protects staff from compassion fatigue and sustains program quality over time.

Question 35: A perinatal bereavement specialist employed by a hospital is asked by a health insurance company to provide a clinical summary of a bereaved patient's counseling sessions for utilization review. What is the correct response?

Obtain the patient's written authorization before releasing psychotherapy notes or detailed clinical summaries (Correct answer)
Provide a summary but omit any diagnosis to protect the patient
Provide the full summary immediately to facilitate continued coverage for the patient
Decline entirely because insurance companies have no legal right to request clinical information

Correct answer: Obtain the patient's written authorization before releasing psychotherapy notes or detailed clinical summaries

HIPAA provides extra protections for psychotherapy notes, requiring specific patient authorization separate from a general release, before they can be shared with insurers.

Question 36: How does continuing bonds theory differ from traditional grief models?

Maintaining emotional connection (Correct answer)
Isolating from memories
Avoiding emotional triggers
Encourages forgetting the loss

Correct answer: Maintaining emotional connection

Unlike traditional grief models that often imply a need to 'let go' or 'move on' from the deceased, continuing bonds theory suggests that healthy grieving involves maintaining an ongoing emotional connection with the person who died. For perinatal loss, this means parents can find comfort and healing by remembering their baby, incorporating their memory into their lives, and feeling a continued sense of relationship. This perspective validates the enduring nature of love and attachment.

Question 37: A bereaved parent reports feeling angry at the medical team who cared for their stillborn baby. Which intervention best reflects advanced perinatal bereavement practice?

Validate the anger as a normal grief response without defending the medical team (Correct answer)
Redirect the parent to focus on positive memories
Explain the clinical decisions made during the delivery
Encourage the parent to file a formal complaint to process their feelings

Correct answer: Validate the anger as a normal grief response without defending the medical team

Validating anger as a normal grief response without taking sides allows the parent to feel heard and supports healthy grief processing.

Question 38: What is the primary value of case analysis in Perinatal Bereavement Certification professional development?

Memorizing specific outcomes for replication
Replacing all hands-on practical experience
Developing critical thinking by applying theory to realistic scenarios (Correct answer)
Learning exclusively from documented failures

Correct answer: Developing critical thinking by applying theory to realistic scenarios

Case analysis develops critical thinking skills by challenging professionals to apply theoretical knowledge to realistic, complex scenarios.

Question 39: Why is grief after miscarriage often misunderstood?

It is supported publicly
It's widely accepted
It lacks formal acknowledgment (Correct answer)
It is a common event

Correct answer: It lacks formal acknowledgment

Grief after miscarriage is frequently misunderstood because society often fails to formally acknowledge the significance of the loss. There's a common misconception that early pregnancy loss is less impactful, leading to a lack of public rituals, support, and open discussion. This absence of recognition can leave grieving parents feeling isolated, invalidated, and unable to fully process their profound sorrow.

Question 40: How should PBC professionals measure success in advanced professional practice?

Through subjective self-assessment only
By comparing only to minimum requirements
Success measurement is not applicable
Using defined metrics, benchmarks, and regular evaluation against established goals (Correct answer)

Correct answer: Using defined metrics, benchmarks, and regular evaluation against established goals

Success in advanced professional practice is measured through defined metrics and benchmarks, with regular evaluation against established professional goals.

Question 41: Therese Rando identified which factor as a 'high-risk' predictor for complicated mourning following perinatal loss?

A sudden, unexpected loss with little opportunity to prepare (Correct answer)
Previous experience with grief
Strong religious faith
Having supportive family present at delivery

Correct answer: A sudden, unexpected loss with little opportunity to prepare

Rando identified sudden, unexpected death — common in perinatal loss — as a significant risk factor for complicated mourning due to the absence of anticipatory grief.

Question 42: How should a PBC-certified professional approach sibling support when a family has surviving children after a perinatal loss?

Recommend formal child psychotherapy for all surviving siblings as a standard protocol
Focus exclusively on parental grief and leave sibling support to school counselors
Advise parents to shield siblings from information about the loss to protect them
Provide age-appropriate guidance on how to explain the loss and include siblings in memorial activities (Correct answer)

Correct answer: Provide age-appropriate guidance on how to explain the loss and include siblings in memorial activities

Age-appropriate explanations and inclusive memorial participation support healthy grief processing in surviving siblings and maintain family cohesion.

Question 43: Under Title VI of the Civil Rights Act, what obligation does a hospital have when a non-English-speaking parent experiences a perinatal loss?

Offer language services only if the hospital receives more than $1 million in federal funds
Provide meaningful access to language services, including professional interpreters (Correct answer)
Provide written materials in English only, as this is the official U.S. language
Request that a bilingual family member translate all communications

Correct answer: Provide meaningful access to language services, including professional interpreters

Title VI requires federally funded entities to provide meaningful access to services for individuals with limited English proficiency, including professional interpreter services.

Question 44: What is the benefit of interdisciplinary collaboration in Perinatal Bereavement Certification practice?

It is only relevant for complex or unusual projects
It creates confusion and inefficiency
It significantly slows down decision-making processes
It brings diverse expertise and perspectives that improve outcomes (Correct answer)

Correct answer: It brings diverse expertise and perspectives that improve outcomes

Interdisciplinary collaboration enhances Perinatal Bereavement Certification practice by combining diverse expertise, perspectives, and skills for more comprehensive and effective outcomes.

Question 45: What does maintaining confidentiality involve?

Recording all sessions for training
Keeping shared information private (Correct answer)
Sharing client stories publicly
Using client data for marketing

Correct answer: Keeping shared information private

Maintaining confidentiality means that all information shared by a client during counseling sessions is kept private and not disclosed to others without their explicit consent, except in specific legal or ethical circumstances (e.g., threat of harm). This ethical principle is fundamental to building trust and ensuring a safe space where clients feel secure enough to share their deepest feelings and experiences without fear of judgment or exposure.

Question 46: What is the value of active listening in PBC professional practice?

It simply means remaining silent while others speak
It ensures accurate understanding and demonstrates respect for the speaker (Correct answer)
It is only important in counseling roles
It unnecessarily slows down conversations

Correct answer: It ensures accurate understanding and demonstrates respect for the speaker

Active listening in PBC practice ensures accurate understanding, builds trust, and demonstrates respect, leading to better professional outcomes.

Question 47: In Rando's 'Six R Processes' of mourning, what does the second 'R' — 'React to the separation' — primarily involve?

Experiencing the pain of the loss emotionally and physically (Correct answer)
Relinquishing old attachments
Reorganizing the assumptive world
Relocating the deceased within one's life

Correct answer: Experiencing the pain of the loss emotionally and physically

The second R requires the mourner to fully experience and express the psychological, behavioral, social, and physical pain caused by the loss.

Question 48: If a hospital chaplain provides bereavement counseling after a perinatal loss, which of the following most accurately describes the chaplain's HIPAA obligations?

Chaplains employed by or working under contract with a covered entity must comply with HIPAA (Correct answer)
Chaplains may share patient information freely because bereavement counseling is not treatment
Chaplains are exempt from HIPAA because they provide spiritual, not medical, care
Only licensed chaplains (CPE-certified) are subject to HIPAA requirements

Correct answer: Chaplains employed by or working under contract with a covered entity must comply with HIPAA

Healthcare chaplains working within a covered entity's workforce or as business associates are bound by HIPAA's privacy and security requirements.

Question 49: Which interprofessional collaboration is most valuable for comprehensive community-based perinatal bereavement support?

Referral-only models where each professional works in isolation
Partnerships between hospitals, community organizations, mental health providers, and faith communities (Correct answer)
Exclusive reliance on hospital-based services for all post-loss support
Limiting collaboration to providers within the same organization

Correct answer: Partnerships between hospitals, community organizations, mental health providers, and faith communities

Integrated partnerships across sectors create a seamless continuum of care that addresses the medical, psychological, social, and spiritual dimensions of perinatal bereavement.

Question 50: Which approach best supports fathers and non-birthing partners in community perinatal bereavement programs?

Assuming fathers grieve less intensely and focus resources on the birthing parent
Directing fathers only to general grief groups not specific to perinatal loss
Restricting perinatal bereavement groups to birthing parents only
Creating dedicated or inclusive spaces that validate their grief experience and unique needs (Correct answer)

Correct answer: Creating dedicated or inclusive spaces that validate their grief experience and unique needs

Fathers and non-birthing partners experience significant grief that is often disenfranchised; dedicated or inclusive programming validates and addresses their needs.

Question 51: How should a PBC-certified professional address a bereaved family's concern that their social network does not understand their grief after a first-trimester loss?

Suggest the loss may not warrant extended grief given the early gestational age
Defer the concern to a psychiatrist as it may indicate pathological grief
Advise the family to limit grief expression to avoid burdening their social network
Validate the disenfranchisement, educate about pregnancy loss grief, and connect them with communities of shared experience (Correct answer)

Correct answer: Validate the disenfranchisement, educate about pregnancy loss grief, and connect them with communities of shared experience

Disenfranchised grief is common after early pregnancy loss; validation, psychoeducation, and peer community connections are the most effective professional responses.

Question 52: A perinatal bereavement nurse experiences intense sadness after caring for multiple bereaved families in one week. This is best described as:

Compassion fatigue
Secondary traumatic stress (Correct answer)
Burnout
Occupational grief

Correct answer: Secondary traumatic stress

Secondary traumatic stress results from indirect exposure to traumatic events through empathic engagement and mirrors PTSD symptoms in caregivers.

Question 53: How should a PBC-certified professional respond when they recognize signs of burnout in themselves?

Immediately resign from bereavement roles
Increase productivity to rebuild sense of competence
Continue working to avoid disrupting client care
Seek supervision, adjust caseload, and engage in restorative self-care practices (Correct answer)

Correct answer: Seek supervision, adjust caseload, and engage in restorative self-care practices

A proactive, multi-pronged response including supervision, caseload adjustment, and self-care is the ethical and evidence-based approach to managing burnout.

Question 54: The NURSE mnemonic in bereavement communication stands for:

Notify, Understand, Review, Sustain, Evaluate
Name, Understand, Respect, Support, Empathize
Normalize, Uplift, Reassure, Summarize, Educate
Name, Understand, Respect, Support, Explore (Correct answer)

Correct answer: Name, Understand, Respect, Support, Explore

NURSE (Name, Understand, Respect, Support, Explore) is an evidence-based framework for responding to emotional cues in difficult conversations.

Question 55: A bereaved mother states she finds comfort talking to her stillborn daughter's photo each morning. According to the continuing bonds theory, this behavior is best described as:

A healthy internalization maintaining relational connection (Correct answer)
Complicated grief needing immediate referral
Regression to magical thinking
Pathological denial requiring clinical intervention

Correct answer: A healthy internalization maintaining relational connection

Continuing bonds theory supports that maintaining symbolic connection with the deceased through rituals like talking to a photo is a healthy grief adaptation.

Question 56: Which U.S. federal law governs workplace accommodations that may be required for employees experiencing pregnancy loss, including miscarriage or stillbirth?

The Pregnant Workers Fairness Act (PWFA) only
Pregnancy Discrimination Act (PDA) only
FMLA and potentially the ADA for complications arising from pregnancy loss (Correct answer)
Family and Medical Leave Act (FMLA) only

Correct answer: FMLA and potentially the ADA for complications arising from pregnancy loss

Both FMLA (for qualifying employers) and ADA (if physical or mental health complications arise) may apply to employees experiencing pregnancy loss.

Question 57: When a perinatal bereavement specialist reviews the literature to update care protocols, which level of evidence should be prioritized?

Expert opinion from experienced bereavement nurses
Systematic reviews and meta-analyses of perinatal bereavement interventions (Correct answer)
Anecdotal reports from hospital quality improvement meetings
Case studies of individual family experiences

Correct answer: Systematic reviews and meta-analyses of perinatal bereavement interventions

Systematic reviews and meta-analyses represent the highest level of evidence and should anchor evidence-based protocol development.

Question 58: A perinatal bereavement counselor who begins experiencing intrusive images from clients' stories and difficulty sleeping is experiencing which warning sign?

Secondary traumatic stress requiring professional support (Correct answer)
Empathy deficit requiring additional training
Grief for their own personal losses
Normal adjustment to a new caseload

Correct answer: Secondary traumatic stress requiring professional support

Intrusive imagery and sleep disruption are hallmark symptoms of secondary traumatic stress and signal the need for intervention and support.

Question 59: Which model specifically addresses the oscillation between loss-orientation and restoration-orientation in bereavement?

Bowlby's Attachment Theory
Worden's Tasks of Mourning
Dual Process Model by Stroebe & Schut (Correct answer)
Kübler-Ross Stage Model

Correct answer: Dual Process Model by Stroebe & Schut

Stroebe and Schut's Dual Process Model (1999) describes healthy grieving as a dynamic oscillation between confronting loss and attending to life changes and restoration.

Question 60: A bereaved mother is admitted for a subsequent pregnancy after a prior stillbirth. Which approach best integrates perinatal bereavement competency into her current care?

Transfer care to a high-risk obstetrics team to manage her emotional risk
Screen for anxiety and pregnancy-specific grief using validated tools at each visit (Correct answer)
Avoid mentioning the prior loss to prevent unnecessary distress
Reassure her that this baby is healthy to counteract her fear

Correct answer: Screen for anxiety and pregnancy-specific grief using validated tools at each visit

Using validated screening tools acknowledges the ongoing psychological impact of prior loss and enables targeted, evidence-based support throughout the subsequent pregnancy.

Question 61: A hospital-based perinatal bereavement nurse realizes she is personally grieving a recent pregnancy loss while providing care to a newly bereaved family. The FIRST priority should be to:

Immediately transfer the case to a colleague and seek personal support (Correct answer)
Request extended bereavement leave before addressing the situation
Use her experience as a therapeutic tool to build rapport
Continue care while being transparent with the family about her own loss

Correct answer: Immediately transfer the case to a colleague and seek personal support

When a clinician's personal grief may impair their ability to provide competent care, transferring the case and seeking support is the appropriate first step.

Question 62: What is the role of internal audits in Perinatal Bereavement Certification compliance management?

They verify adherence to regulations and identify areas needing improvement (Correct answer)
They only assess financial compliance
They are only needed for large organizations
They replace external regulatory inspections

Correct answer: They verify adherence to regulations and identify areas needing improvement

Internal audits proactively verify compliance, identify gaps, and drive improvement before external inspections or incidents reveal problems.

Question 63: What should a counselor do if a client expresses intent to self-harm?

Ignore it
Keep it confidential
Report it to appropriate authorities (Correct answer)
Tell a friend for advice

Correct answer: Report it to appropriate authorities

If a client expresses intent to self-harm, a counselor has an ethical and legal duty to break confidentiality and report this information to appropriate authorities, such as emergency services or a crisis hotline. This is a critical safety measure to protect the client from immediate danger. The counselor's primary responsibility shifts to ensuring the client's safety, even if it means overriding confidentiality.

Question 64: For a loss occurring at less than 20 weeks gestation, which adaptation to memorialization is most appropriate?

No memorialization activities are appropriate at this gestational age
Limit all activities to verbal acknowledgment only
Standard memory box protocols apply without any modifications
Adapt materials and activities to the physical realities of early loss while still fully honoring the family's grief (Correct answer)

Correct answer: Adapt materials and activities to the physical realities of early loss while still fully honoring the family's grief

Early losses may require adapted approaches such as smaller prints or soft photography techniques, but the family's grief and need for acknowledgment is equally valid at any gestational age.

Question 65: Which type of support group model is most commonly used for parents who have experienced perinatal loss in the United States?

Medically led psychotherapy groups in hospital settings only
Grief groups open to all types of loss regardless of specificity
Online forums without any facilitation or structure
Peer-led support groups such as those offered by SHARE or Star Legacy Foundation (Correct answer)

Correct answer: Peer-led support groups such as those offered by SHARE or Star Legacy Foundation

Peer-led organizations like SHARE Pregnancy & Infant Loss Support and Star Legacy Foundation provide community-based support specifically tailored to perinatal bereavement.

Question 66: How should PBC professionals stay current with regulatory changes?

Actively monitor updates through professional associations and continuing education (Correct answer)
Rely on colleagues for all regulatory information
Regulations change too infrequently to monitor
Wait until notified by regulators

Correct answer: Actively monitor updates through professional associations and continuing education

PBC professionals must proactively monitor regulatory changes through professional associations, government publications, and continuing education.

Question 67: A PBC-certified professional notices they are becoming emotionally numb and dreading client sessions after months of intensive bereavement work. This is most consistent with which phenomenon?

Professional isolation
Acute stress disorder
Secondary traumatic stress (Correct answer)
Adjustment disorder

Correct answer: Secondary traumatic stress

Secondary traumatic stress mirrors PTSD symptoms and arises from indirect exposure to clients' traumatic experiences over time.

Question 68: Which family dynamic is commonly observed in couples following a perinatal loss that bereavement professionals should address proactively?

Absence of grief in the non-birthing partner
Uniform grief responses that resolve within a predictable timeline
Differing grieving styles between partners that can cause relational conflict (Correct answer)
Increased marital satisfaction due to shared adversity

Correct answer: Differing grieving styles between partners that can cause relational conflict

Couples frequently grieve differently due to individual coping styles, gender socialization, and social roles, which can create misunderstanding and relational strain.

Question 69: What role does documentation play in Perinatal Bereavement Certification client communications?

It should replace all verbal communication
It is an unnecessary administrative burden
It creates clear records of discussions, decisions, and agreements (Correct answer)
It only matters for legal disputes

Correct answer: It creates clear records of discussions, decisions, and agreements

Documentation in client communications creates permanent records that ensure clarity, prevent misunderstandings, and provide references for future interactions.

Question 70: Which of the following best describes the purpose of a 'life review' narrative in perinatal bereavement legacy building?

A medical summary of prenatal care prepared for future pregnancies
A written account that tells the baby's story and acknowledges their brief life (Correct answer)
A clinical assessment of prenatal care quality and outcomes
A legal document required for estate planning after perinatal loss

Correct answer: A written account that tells the baby's story and acknowledges their brief life

A life review narrative is a written account created to honor the baby's story, helping families acknowledge their baby's existence and preserve their memory across time.

Question 71: When is the most appropriate time to introduce memorialization options to a bereaved family in a hospital setting?

After the family has left the hospital and is stable at home
Before or shortly after delivery, while still in the hospital (Correct answer)
At the six-month grief follow-up appointment
Only upon explicit family request, never proactively

Correct answer: Before or shortly after delivery, while still in the hospital

Offering memorialization options before or shortly after delivery, while the family is in the hospital, ensures opportunities to create irreplaceable mementos are not lost.

Question 72: Which federal law requires hospitals to provide information about advance directives to patients upon admission, which may be relevant in perinatal end-of-life situations?

Americans with Disabilities Act (ADA)
Emergency Medical Treatment and Labor Act (EMTALA)
Health Insurance Portability and Accountability Act (HIPAA)
Patient Self-Determination Act (PSDA) (Correct answer)

Correct answer: Patient Self-Determination Act (PSDA)

The Patient Self-Determination Act requires healthcare facilities to inform patients of their rights to make advance directives regarding their own care.

Question 73: How do PBC professionals effectively transfer training knowledge to workplace practice?

Training knowledge and workplace practice are unrelated
By passing the certification examination only
Through supervised practice, mentoring, and progressive independence with feedback (Correct answer)
Knowledge automatically transfers after certification

Correct answer: Through supervised practice, mentoring, and progressive independence with feedback

Knowledge transfer requires structured practice opportunities with mentoring, feedback, and gradually increasing independence and responsibility.

Question 74: What is reflective practice in Perinatal Bereavement Certification professional growth?

Systematically examining experiences to gain insight and improve future practice (Correct answer)
Maintaining a personal journal unrelated to work
Simply avoiding past mistakes
Reflecting only on positive outcomes and successes

Correct answer: Systematically examining experiences to gain insight and improve future practice

Reflective practice involves systematically examining both successes and failures to extract insights that improve future professional performance.

Question 75: How do PBC professionals build credibility with clients?

Through consistent competence, transparency, and ethical behavior over time (Correct answer)
Through competitive pricing exclusively
Through aggressive marketing alone
By always agreeing with client requests

Correct answer: Through consistent competence, transparency, and ethical behavior over time

Professional credibility is built through demonstrated competence, transparent communication, ethical conduct, and reliable delivery over time.

Question 76: What does Worden’s Task-Based Model of Grief suggest?

Replacing grief with new goals
Tasks to work through grief (Correct answer)
Spiritual healing only
Ignoring grief

Correct answer: Tasks to work through grief

Worden's Task-Based Model of Grief proposes that grieving individuals must actively engage in four tasks to successfully mourn. These tasks include accepting the reality of the loss, processing the pain of grief, adjusting to a world without the deceased, and finding an enduring connection with the deceased while embarking on a new life. This model emphasizes active participation rather than passive progression through stages.

Question 77: Which of the following is a healthy expression of grief?

Avoiding all social contact
Blaming others constantly
Talking openly about the loss (Correct answer)
Suppressing emotions

Correct answer: Talking openly about the loss

Talking openly about the loss is a healthy expression of grief because it allows individuals to acknowledge their pain, share their feelings, and process the reality of what has happened. Suppressing emotions can prolong grief and lead to mental health issues. Sharing with trusted friends, family, or a counselor can provide validation and support, which are crucial for healing.

Question 78: When facilitating legacy building activities, the primary focus of the bereavement counselor should be:

Completing institutional documentation requirements efficiently
Following the family's lead and honoring their unique needs and preferences (Correct answer)
Ensuring all families create identical standardized mementos for consistency
Educating families about the formal stages of grief throughout the process

Correct answer: Following the family's lead and honoring their unique needs and preferences

Family-centered bereavement care requires that legacy activities be individualized to each family's unique values, culture, and needs rather than following a one-size-fits-all protocol.

Question 79: A PBC-certified professional who frequently attends continuing education on perinatal bereavement topics is demonstrating which dimension of self-care?

Compliance with a mandatory training requirement only
Overcorrection for perceived skill deficits
Professional self-care through ongoing development and competence maintenance (Correct answer)
Avoidance of direct client work through academic activity

Correct answer: Professional self-care through ongoing development and competence maintenance

Investing in professional development is a recognized dimension of self-care that sustains competence, confidence, and engagement in bereavement practice.

Question 80: In the context of perinatal bereavement, 'disenfranchised grief' most commonly occurs when:

The grief is expressed loudly in public settings
Society does not recognize the depth of the loss, such as after early miscarriage (Correct answer)
Parents are given private time with their deceased infant
Parents choose not to see the baby

Correct answer: Society does not recognize the depth of the loss, such as after early miscarriage

Doka's disenfranchised grief describes losses that society fails to acknowledge as significant, such as early pregnancy loss, leaving parents without social support.

Question 81: A hospital social worker learns that a bereaved mother is undocumented and fears her immigration status may be affected by interacting with hospital staff. What legal framework guides the social worker's response?

Provide care without discrimination; EMTALA and HIPAA apply regardless of immigration status (Correct answer)
Delay care until immigration status is verified to protect the hospital from liability
Refer the patient to a federally qualified health center instead
Report the patient's status to immigration authorities as required by federal law

Correct answer: Provide care without discrimination; EMTALA and HIPAA apply regardless of immigration status

EMTALA requires emergency care regardless of immigration status, and HIPAA protects PHI including information about immigration status from unauthorized disclosure.

Question 82: Why is non-verbal communication important in grief support?

It replaces all verbal cues
It reveals unconscious bias
It confuses the client
It conveys empathy and understanding (Correct answer)

Correct answer: It conveys empathy and understanding

Non-verbal communication, such as maintaining appropriate eye contact, offering a gentle touch (if culturally appropriate), nodding, and having an open posture, can powerfully convey empathy and understanding. These cues signal to the grieving individual that the counselor is present, attentive, and compassionate, even without words. This helps build trust and creates a safe space for emotional expression.

Question 83: What is the primary goal of grief counseling in perinatal loss?

To support emotional healing and processing of grief (Correct answer)
To avoid discussing the loss
To discourage expression of emotions
To offer legal advice

Correct answer: To support emotional healing and processing of grief

The primary goal of grief counseling in perinatal loss is to provide a safe and compassionate space for individuals and families to navigate the profound emotional pain associated with losing a baby. Counselors help them process complex feelings like sadness, guilt, and anger, facilitating emotional healing. This support validates their experience and helps them integrate the loss into their lives in a healthy way.

Question 84: How do PBC professionals evaluate the quality of research evidence?

Research quality cannot be meaningfully evaluated
By assessing methodology, sample size, peer review, and relevance (Correct answer)
By the publication date alone
By the prestige of the author or institution

Correct answer: By assessing methodology, sample size, peer review, and relevance

Evaluating research quality requires examining the methodology, sample characteristics, peer review process, and relevance to the specific practice context.

Question 85: What is a common characteristic of perinatal grief?

Relief
Joy
Intense sadness and guilt (Correct answer)
Excitement

Correct answer: Intense sadness and guilt

Perinatal grief is unique due to the profound loss of a hoped-for future and the intense bond formed during pregnancy. This often manifests as deep sadness, accompanied by feelings of guilt or self-blame, as parents may question what they could have done differently. These intense emotions are characteristic because the loss is often invisible to others, leading to complex and isolating grief.

Question 86: Which federal civil rights protection applies if a hospital bereavement program excludes LGBTQ+ parents who experience pregnancy loss?

Title VII of the Civil Rights Act applies exclusively to employment, not care
Section 1557 of the Affordable Care Act, which prohibits sex discrimination in health programs (Correct answer)
No federal law prohibits such exclusion in healthcare settings
Only state anti-discrimination laws would apply in such cases

Correct answer: Section 1557 of the Affordable Care Act, which prohibits sex discrimination in health programs

Section 1557 of the ACA prohibits discrimination based on sex in federally funded health programs, and federal courts have interpreted this to include LGBTQ+ individuals.

Question 87: Why are ethical standards important in grief counseling?

To guide respectful and professional care (Correct answer)
To control client behavior
To simplify documentation
To promote counselor preferences

Correct answer: To guide respectful and professional care

Ethical standards are paramount in grief counseling as they provide a framework for delivering respectful, safe, and professional care. These standards ensure that counselors prioritize the client's well-being, maintain confidentiality, establish clear boundaries, and practice within their competence. Adherence to ethics protects both the client and the counselor, fostering trust and accountability in the therapeutic relationship.

Question 88: What distinguishes burnout from secondary traumatic stress in perinatal bereavement professionals?

Burnout is more severe and always requires leave of absence
Burnout is caused by personal problems unrelated to work
Burnout develops from chronic workplace stress; secondary traumatic stress develops from exposure to clients' traumatic material (Correct answer)
Secondary traumatic stress only affects newer professionals

Correct answer: Burnout develops from chronic workplace stress; secondary traumatic stress develops from exposure to clients' traumatic material

Burnout results from cumulative organizational and job demands, while secondary traumatic stress arises specifically from absorbing clients' traumatic experiences.

Question 89: Which of the following items is most commonly included in a perinatal memory box?

Developmental milestone charts and growth calendars
Insurance documentation and billing records
Legal forms and medical records
Ink or clay hand and footprints, a lock of hair, and photographs (Correct answer)

Correct answer: Ink or clay hand and footprints, a lock of hair, and photographs

Ink or clay hand and footprints, locks of hair, and photographs are standard tangible mementos that families can cherish as lasting reminders of their baby.

Question 90: According to Kübler-Ross, which of the following is a stage of grief?

Motivation
Gratitude
Celebration
Acceptance (Correct answer)

Correct answer: Acceptance

Elisabeth Kübler-Ross's model outlines five stages of grief: denial, anger, bargaining, depression, and acceptance. Acceptance is the final stage, where the individual comes to terms with the reality of the loss and finds a way to move forward, not necessarily forgetting, but integrating the loss into their life. It signifies a shift towards finding peace and meaning after the initial shock and pain.

Question 91: What is the primary purpose of a hospital's informed consent process when offering genetic testing after a pregnancy loss?

To comply with state vital statistics requirements for fetal death certificates
To ensure parents understand the benefits, risks, limitations, and implications of genetic testing so they can make autonomous decisions (Correct answer)
To protect the hospital from malpractice liability
To fulfill insurance authorization requirements before testing begins

Correct answer: To ensure parents understand the benefits, risks, limitations, and implications of genetic testing so they can make autonomous decisions

Informed consent ensures that patients understand what genetic testing involves and what the results may mean for them and future pregnancies, enabling autonomous decision-making.

Question 92: How should an PBC professional respond to discovering a compliance violation?

Blame the regulatory framework for being unclear
Report promptly, investigate root cause, and implement corrective actions (Correct answer)
Wait for external auditors to identify it
Conceal it if the impact is minor

Correct answer: Report promptly, investigate root cause, and implement corrective actions

Professional responsibility requires prompt reporting, thorough investigation, and corrective action when compliance violations are discovered, regardless of severity.

Question 93: What is disenfranchised grief in the context of perinatal loss?

Culturally celebrated grief
Public grieving
Grief without social recognition (Correct answer)
Collective mourning

Correct answer: Grief without social recognition

Disenfranchised grief refers to grief that is not openly acknowledged, publicly mourned, or socially supported. In the context of perinatal loss, this often occurs because society may not fully recognize the profound bond between parents and their unborn or newly born child, leading to a lack of validation for their sorrow. This absence of recognition can make the grieving process more isolating and difficult for parents.

Question 94: Which approach is most effective for supporting someone in grief?

Giving advice immediately
Correcting their feelings
Avoiding the topic
Active listening and presence (Correct answer)

Correct answer: Active listening and presence

Active listening and presence are the most effective approaches for supporting someone in grief because they demonstrate genuine empathy and respect for the grieving person's experience. Active listening involves fully concentrating on what they are saying, both verbally and non-verbally, without judgment or interruption. Simply being present and offering a compassionate ear allows the individual to feel heard and supported, which is often more helpful than unsolicited advice or attempts to fix their pain.

Question 95: Which professional boundary issue is most common and most important to address in perinatal bereavement nursing practice?

Taking extra time with bereaved families during busy shifts
Attending a bereaved family's memorial service
Following up with families via the hospital phone system
Sharing personal contact information with grieving families (Correct answer)

Correct answer: Sharing personal contact information with grieving families

Sharing personal contact information blurs professional boundaries and can create dependency relationships that are harmful to both family and provider.

Question 96: A memorial walk or run event organized by a perinatal bereavement organization primarily serves which purpose for bereaved families?

Physical rehabilitation after the physical trauma of loss
Community connection, public acknowledgment of loss, and peer support among bereaved families (Correct answer)
Fundraising with no direct therapeutic value for participants
Medical follow-up monitoring for at-risk parents

Correct answer: Community connection, public acknowledgment of loss, and peer support among bereaved families

Memorial walks and events provide bereaved families with community connection, public acknowledgment of their loss, and opportunities to connect with others who share similar experiences.

Question 97: What does the Dual Process Model of Grief propose?

Grief should be avoided entirely
Only focus on the loss
Oscillating between confronting and avoiding grief (Correct answer)
Suppress emotional expression

Correct answer: Oscillating between confronting and avoiding grief

The Dual Process Model of Grief, proposed by Stroebe and Schut, suggests that grieving individuals oscillate between two types of stressors: loss-oriented stressors (confronting the loss, experiencing pain) and restoration-oriented stressors (adjusting to life without the deceased, engaging in new activities). This oscillation allows individuals to both process their pain and take breaks from it, which is considered a healthy and adaptive way to cope with loss.

Question 98: Which theorist introduced the concept of 'continuing bonds' as a healthy aspect of grief, replacing the goal of 'letting go'?

Bowlby
Klass, Silverman & Nickman (Correct answer)
Kübler-Ross
Worden

Correct answer: Klass, Silverman & Nickman

Klass, Silverman & Nickman's 1996 work challenged the detachment model, proposing that maintaining an ongoing relationship with the deceased is normal and healthy.

Question 99: A hospital's bereavement policy requires staff to offer an autopsy after stillbirth. If parents decline, what is the legally appropriate response?

Require a second physician to counsel the family before accepting the refusal
Document the refusal and respect the parents' decision, as autopsy consent is voluntary (Correct answer)
Notify child protective services of the refusal
Perform the autopsy anyway because it is required for fetal death certificates

Correct answer: Document the refusal and respect the parents' decision, as autopsy consent is voluntary

Autopsy after perinatal loss is voluntary; informed consent is required, and parents have the legal right to decline without adverse consequence.

Question 100: Why is follow-up important in grief counseling?

To discharge the client faster
To reinforce behavior change
To collect data
To show continued support and monitor well-being (Correct answer)

Correct answer: To show continued support and monitor well-being

Follow-up is important in grief counseling to demonstrate ongoing care and commitment to the grieving individual's well-being beyond initial sessions. It allows counselors to monitor the client's progress, assess their coping mechanisms, and identify any emerging challenges or signs of complicated grief. This continued support reinforces the therapeutic relationship and ensures that the individual feels consistently supported throughout their healing journey.

Perinatal Bereavement Certification (PBC)

The PBC certification recognizes healthcare professionals who demonstrate specialized knowledge and skills in providing compassionate care to families experiencing perinatal loss.

100

Questions

120 min

Time Limit

70%

To Pass

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