PBC Risk Assessment & Mitigation 2 — Questions and Answers
Question 1: A nurse identifies that a bereaved mother has no social support network and has stopped eating regularly two weeks after her stillbirth. Which risk factor most increases the clinician's concern for complicated grief?
- Return to work within 3 weeks
- Social isolation combined with self-neglect behaviors (Correct answer)
- Requesting information about the autopsy results
- Expressing anger toward hospital staff
Correct answer: Social isolation combined with self-neglect behaviors
Social isolation paired with self-neglect behaviors (not eating) signals heightened risk for complicated grief and possible depression.
Question 2: Which screening tool is most commonly recommended to assess postpartum depression risk in bereaved mothers following perinatal loss?
- GAD-7
- Edinburgh Postnatal Depression Scale (EPDS) (Correct answer)
- PHQ-2
- Columbia Suicide Severity Rating Scale (C-SSRS)
Correct answer: Edinburgh Postnatal Depression Scale (EPDS)
The EPDS is the gold-standard validated tool for identifying postpartum depression risk, including in bereaved mothers.
Question 3: A father discloses he has been drinking heavily every night since his infant's death three weeks ago. The bereavement counselor's PRIORITY action is to:
- Schedule weekly follow-up grief sessions
- Assess the frequency and quantity of alcohol use and refer for substance evaluation (Correct answer)
- Encourage him to join a fathers' bereavement support group
- Provide psychoeducation about normal grief responses
Correct answer: Assess the frequency and quantity of alcohol use and refer for substance evaluation
Escalating alcohol use after loss is a significant risk factor requiring formal assessment and possible referral before other grief interventions.
Question 4: During a bereavement follow-up call, a mother states, 'I don't see the point of going on without my baby.' The clinician should FIRST:
- Validate her grief and schedule a follow-up appointment
- Directly ask if she is having thoughts of suicide (Correct answer)
- Notify her partner immediately
- Document the statement and review at the next team meeting
Correct answer: Directly ask if she is having thoughts of suicide
Statements suggesting hopelessness require direct, compassionate inquiry about suicidal ideation as an immediate priority.
Question 5: Which prior history finding places a bereaved parent at the HIGHEST risk for developing prolonged grief disorder following perinatal loss?
- History of anxiety treated with medication
- Previous episode of major depressive disorder
- Prior perinatal loss with incomplete grief processing (Correct answer)
- Family history of cardiovascular disease
Correct answer: Prior perinatal loss with incomplete grief processing
A prior perinatal loss that was never adequately grieved creates unresolved grief that compounds with new loss, elevating risk for prolonged grief disorder.
Question 6: A couple reports significant conflict and communication breakdown one month after their neonatal death. The bereavement specialist recognizes this as:
- A pathological response requiring couples therapy referral immediately
- A common manifestation of divergent grieving styles that warrants assessment and psychoeducation (Correct answer)
- Evidence that the relationship will not survive the loss
- A sign that one partner has complicated grief and the other does not
Correct answer: A common manifestation of divergent grieving styles that warrants assessment and psychoeducation
Divergent grieving styles commonly cause relationship strain; psychoeducation about these differences and assessment of coping are the appropriate first steps.
Question 7: A hospital's perinatal bereavement program conducts a risk stratification at the time of loss. Which factor would place a family in the HIGH-risk tier requiring proactive intensive follow-up?
- Single marital status alone
- Concurrent mental health diagnosis, substance use history, or previous traumatic loss (Correct answer)
- Employment instability at time of loss
- Cultural background that discourages open expression of grief
Correct answer: Concurrent mental health diagnosis, substance use history, or previous traumatic loss
Pre-existing mental health diagnoses, substance use history, and prior traumatic loss are evidence-based criteria for high-risk stratification requiring intensified follow-up.
PBC Risk Assessment & Mitigation 2
A nurse identifies that a bereaved mother has no social support network and has stopped eating regularly two weeks after her stillbirth.
Which risk factor most increases the clinician's concern for complicated grief?