# A nurse is caring for a client at 28 weeks gestation who has just been diagnosed with intrauterine fetal demise (IUFD). Which nursing intervention should be the priority?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=543074  
> language: ko  
> subject: Maternal Newborn Health

## 문제

A nurse is caring for a client at 28 weeks gestation who has just been diagnosed with intrauterine fetal demise (IUFD). Which nursing intervention should be the priority?

## 보기

1. Provide emotional support and allow the client to express grief **✔ 정답**
2. Prepare the client for immediate cesarean delivery
3. Administer oxytocin to induce labor contractions
4. Obtain fetal heart rate monitoring strips

**정답: 1**

## 해설

Emotional support is the priority to address immediate psychological trauma. Other interventions (preparing for C-section, oxytocin, FHR monitoring) are not appropriate or secondary after IUFD is confirmed.

## 심화 해설

Clinical Context & Priority Setting

When a client at 28 weeks gestation receives a diagnosis of intrauterine fetal demise (IUFD), the immediate physiological emergency of delivery is not the primary concern unless there are maternal indications such as hemorrhage or infection. The diagnosis has already been confirmed, meaning the fetus has no cardiac activity. Therefore, the priority shifts from fetal surveillance to the psychosocial integrity of the mother. In NCLEX-RN prioritization, the nurse must address the most immediate emotional safety and coping crisis once physiological stability is established.

Rationale for the Correct Answer (Option 1)

Providing emotional support and allowing the expression of grief is the priority intervention. The diagnosis of IUFD is a profound traumatic event that shatters the expectations of pregnancy. According to the qualitative findings on the lived experiences of nurses caring for mothers with stillbirth, the emotional impact on the mother is immediate and severe, requiring nurses to create a safe, non-judgmental space for grief . The nurse’s role is to acknowledge the loss, use therapeutic communication, and validate the mother’s feelings. This aligns with the NCLEX psychosocial integrity framework, where coping mechanisms and grief support take precedence after a terminal diagnosis.

Analysis of Incorrect Options

**Option 2: Prepare the client for immediate cesarean delivery**

This is not the priority and may be clinically inappropriate. In the absence of maternal hemodynamic instability, disseminated intravascular coagulation (DIC), or chorioamnionitis, immediate surgical intervention via cesarean delivery is not the standard of care for IUFD. Vaginal delivery is generally preferred to avoid surgical morbidity, and the timing can often allow the mother to process the initial shock before induction.

**Option 3: Administer oxytocin to induce labor contractions**

While induction of labor is the eventual management plan for IUFD, it is not the immediate priority nursing intervention upon initial diagnosis. The mother needs time to comprehend the loss before physical interventions begin. Administering oxytocin prematurely, without emotional preparation and informed consent, can compound the psychological trauma. The nurse must first establish a therapeutic rapport and ensure the client is emotionally ready for the induction process .

**Option 4: Obtain fetal heart rate monitoring strips**

This intervention is contraindicated and diagnostically irrelevant. The diagnosis of IUFD is confirmed by ultrasound demonstrating the absence of fetal cardiac activity. Applying a fetal heart rate monitor would only risk detecting the maternal heart rate, leading to false hope and confusion, which would be psychologically damaging to the client.

Clinical Application of the Evidence

The research by DeMarco and Simpson highlights that the nurse's initial response sets the tone for the entire bereavement care trajectory . The study underscores that nurses must navigate their own emotional distress to be fully present for the mother. Effective care begins with silence, presence, and acknowledging the devastating loss, rather than rushing to clinical tasks. This validates that the psychosocial intervention of supporting grief is the foundational priority before proceeding with physiological management such as induction.

## 임상 시나리오

Nursing Care for Intrauterine Fetal Demise (IUFD)

When caring for a client diagnosed with IUFD, the immediate priority is psychosocial support. The nurse must create a safe, non-judgmental environment to allow the client and family to process the loss.

- **Initial Response:** Acknowledge the loss directly using clear, compassionate language (e.g., "I am so sorry to tell you that your baby's heart has stopped."). Avoid euphemisms.

- **Therapeutic Communication:** Use active listening and silence. Validate emotions by saying, "It is okay to feel angry, sad, or numb. There is no right way to grieve."

- **Facilitating Grief:** Offer options for memory-making, such as holding the baby, taking photographs, or collecting footprints, but respect the family's decision if they decline.

- **Physiological Care:** Once emotional support is initiated, prepare for labor induction. Monitor for maternal complications like disseminated intravascular coagulation (DIC) or infection.

- **Interdisciplinary Support:** Collaborate with social work, chaplaincy, and bereavement counselors to provide comprehensive, ongoing support.

Reference: Qualitative findings on nurses' lived experiences emphasize that immediate acknowledgment and emotional validation are critical to preventing complicated grief.

## 핵심 개념

- **Intrauterine Fetal Demise (IUFD)** — Fetal death occurring after 20 weeks of gestation, confirmed by the absence of fetal cardiac activity.
- **Therapeutic Communication** — A nurse-patient interaction technique using open-ended questions, active listening, and validation to create a safe space for emotional expression.
- **Psychosocial Integrity** — An NCLEX-RN category focusing on the client's emotional, mental, and social well-being, including coping mechanisms and grief support.
- **Prioritization** — The process of ranking nursing actions based on urgency, typically addressing physiological needs first, followed by safety and psychosocial needs.

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