PBC Case Analysis & Practical Application 2 — Questions and Answers
Question 1: A nurse is caring for a patient who delivered a stillborn at 38 weeks. The patient's mother keeps saying 'at least you can have another baby.' What is the nurse's best immediate action?
- Agree with the grandmother to avoid family conflict
- Redirect the grandmother privately and validate the patient's unique loss (Correct answer)
- Ask the grandmother to leave the room permanently
- Document the comment and take no further action
Correct answer: Redirect the grandmother privately and validate the patient's unique loss
Redirecting the grandmother privately and validating the patient's grief honors the patient's experience without creating family conflict.
Question 2: Parents who experienced a second-trimester loss at 20 weeks are asking about naming their baby. Which response best supports perinatal bereavement standards?
- Explain that naming is typically reserved for losses after viability
- Encourage them to name the baby if it feels meaningful to them (Correct answer)
- Suggest they wait a few weeks before deciding
- Inform them the hospital does not have a policy on this
Correct answer: Encourage them to name the baby if it feels meaningful to them
Encouraging parents to name their baby if it is meaningful to them affirms the reality and significance of their loss at any gestational age.
Question 3: A couple declines an autopsy after their infant's death but later expresses regret about not knowing the cause. How should the bereavement counselor respond?
- Reassure them that autopsies rarely provide useful information
- Explore whether placental pathology or genetic testing results are still available (Correct answer)
- Encourage them to accept uncertainty as part of the grief process
- Refer them immediately to a genetic counselor
Correct answer: Explore whether placental pathology or genetic testing results are still available
Placental pathology and genetic testing may still yield information even when a full autopsy was declined, giving the family some answers.
Question 4: A nurse walks into a postpartum room and finds a mother holding her stillborn, dressed in clothes the family brought. The nurse feels uncomfortable. What is the priority action?
- Offer to take the baby to the morgue promptly to reduce the mother's attachment
- Acknowledge the moment warmly and support the mother's time with her baby (Correct answer)
- Ask the charge nurse to handle the situation instead
- Document the situation and check back in one hour
Correct answer: Acknowledge the moment warmly and support the mother's time with her baby
Acknowledging the moment warmly and supporting the mother's time with her baby is the cornerstone of bereavement care and therapeutic presence.
Question 5: A father who lost twins at 28 weeks becomes angry at staff during a care conference, saying 'you didn't do enough.' Which communication strategy is most appropriate?
- Defend the clinical team's actions with detailed medical data
- Acknowledge his pain and anger without becoming defensive (Correct answer)
- Involve hospital administration immediately to manage liability
- End the conference and reschedule when he is calmer
Correct answer: Acknowledge his pain and anger without becoming defensive
Acknowledging the father's pain and anger without defensiveness validates his grief and maintains therapeutic alliance.
Question 6: A patient who lost a baby at 24 weeks is being discharged. She refuses to take the memory box assembled by nursing staff. What is the nurse's best response?
- Place the items in the memory box and give them to the father instead
- Inform her she will regret not taking it later
- Respect her decision and let her know the box will be kept for her if she changes her mind (Correct answer)
- Document her refusal and discard the memory box per protocol
Correct answer: Respect her decision and let her know the box will be kept for her if she changes her mind
Respecting the patient's decision while preserving the option honors both her autonomy and her potential future need.
Question 7: During a follow-up bereavement call six weeks after a neonatal death, the mother reports she cannot get out of bed and has stopped eating. What is the nurse's priority?
- Normalize this as typical grief and call back in another month
- Assess for complicated grief and depression and connect her with mental health resources (Correct answer)
- Recommend she join an online support group immediately
- Advise her to speak with her OB at her postpartum visit next week
Correct answer: Assess for complicated grief and depression and connect her with mental health resources
Functional impairment such as inability to get out of bed or eat requires immediate assessment for complicated grief or major depression and timely mental health referral.
PBC Case Analysis & Practical Application 2
A nurse is caring for a patient who delivered a stillborn at 38 weeks.
The patient's mother keeps saying 'at least you can have another baby.' What is the nurse's best immediate action?