Exam 3 - Chapter 22

Question 1

1. After giving birth to a healthy infant boy, a primiparous woman, 16 years old, is admitted to the after birth unit. An appropriate nursing diagnosis for her at this time is risk for impaired parenting related to deficient knowledge of newborn care. In planning for the woman’s discharge, what should the nurse be certain to include in the plan of care?
   a. Instruct the patient how to feed and bathe her infant.
   b. Give the patient written information on bathing her infant.
   c. Advise the patient that all mothers instinctively know how to care for their infants.
   d. Provide time for the patient to bathe her infant after she views an infant bath demonstration.

Answer 1

ANS: D
Having the mother demonstrate infant care is a valuable method of assessing the patient’s understanding of her newly acquired knowledge, especially in this age group, because she may inadvertently neglect her child. Although verbalizing how to care for the infant is a form of patient education, it is not the most developmentally appropriate teaching for a teenage mother. Advising the patient that all mothers instinctively know how to care for their infants is an inappropriate statement; it is belittling and false.

Question 2

2. The nurse observes several interactions between a after birth woman and her new son. What behavior, if exhibited by this woman, would the nurse identify as a possible maladaptive behavior regarding parent-infant attachment?
   a. Talks and coos to her son
   b. Seldom makes eye contact with her son
   c. Cuddles her son close to her
   d. Tells visitors how well her son is feeding

Answer 2

ANS: B
The woman should be encouraged to hold her infant in the en face position and make eye contact with the infant. Normal infant-parent interactions include talking and cooing to her son, cuddling her son close to her, and telling visitors how well her son is feeding.

Question 3

3. The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is to:
   a. tell the mother she must pay attention to her infant.
   b. show the mother how the infant initiates interaction and pays attention to her.
   c. demonstrate for the mother different positions for holding her infant while feeding.
   d. arrange for the mother to watch a video on parent-infant interaction.

Answer 3

ANS: B
Pointing out the responsiveness of the infant is a positive strategy for facilitating parent-infant attachment. Telling the mother that she must pay attention to her infant may be perceived as derogatory and is not appropriate. Educating the young mother in infant care is important; however, pointing out the responsiveness of her baby is a better tool for facilitating mother-infant attachment. Videos are an educational tool that can demonstrate parent-infant attachment, but encouraging the mother to recognize the infant’s responsiveness is more appropriate.

Question 4

4. The nurse hears a primiparous woman talking to her son and telling him that his chin is just like his dad’s chin. This woman’s statement reflects:
   a. mutuality.
   b. synchrony.
   c. claiming.
   d. reciprocity.

Answer 4

ANS: C
Claiming refers to the process by which the child is identified in terms of likeness to other family members. Mutuality occurs when the infant’s behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics. Synchrony refers to the “fit” between the infant’s cues and the parent’s responses. Reciprocity is a type of body movement or behavior that provides the observer with cues.

Question 5

5. New parents express concern that, because of the mother’s emergency cesarean birth under general anesthesia, they did not have the opportunity to hold and bond with their daughter immediately after her birth. The nurse’s response should convey to the parents that:
   a. attachment, or bonding, is a process that occurs over time and does not require early contact.
   b. the time immediately after birth is a critical period for people.
   c. early contact is essential for optimum parent-infant relationships.
   d. they should just be happy that the infant is healthy.

Answer 5

ANS: A
Attachment, or bonding, is a process that occurs over time and does not require early contact. The formerly accepted definition of bonding held that the period immediately after birth was a critical time for bonding to occur. Research since has indicated that parent-infant attachment occurs over time. A delay does not inhibit the process. Parent-infant attachment involves activities such as touching, holding, and gazing; it is not exclusively eye contact. A response that conveys that the parents should just be happy that the infant is healthy is inappropriate because it is derogatory and belittling.

Question 6

6. During a phone follow-up conversation with a woman who is 4 days’ after birth, the woman tells the nurse, “I don’t know what’s wrong. I love my son, but I feel so let down. I seem to cry for no reason!” The nurse would recognize that the woman is experiencing:
   a. taking-in.
   b. postpartum depression (PPD).
   c. postpartum (PP) blues.
   d. attachment difficulty.

Answer 6

ANS: C
During the PP blues women are emotionally labile, often crying easily and for no apparent reason. This lability seems to peak around the fifth PP day. The taking-in phase is the period after birth when the mother focuses on her own psychologic needs. Typically this period lasts 24 hours. PPD is an intense, pervasive sadness marked by severe, labile mood swings; it is more serious and persistent than the PP blues. Crying is not a maladaptive attachment response; it indicates PP blues.

Question 7

7. The nurse can help a father in his transition to parenthood by:
   a. pointing out that the infant turned at the sound of his voice.
   b. encouraging him to go home to get some sleep.
   c. telling him to tape the infant’s diaper a different way.
   d. suggesting that he let the infant sleep in the bassinet.

Answer 7

ANS: A
Infants respond to the sound of voices. Because attachment involves a reciprocal interchange, observing the interaction between parent and infant is very important. Separation of the parent and infant does not encourage parent-infant attachment. Educating the parent in infant care techniques is important; however, the manner in which a diaper is taped is not relevant and does not enhance parent-infant interactions. Parent-infant attachment involves touching, holding, and cuddling. It is appropriate for a father to want to hold the infant as the baby sleeps.

Question 8

8. The nurse notes that a Vietnamese woman does not cuddle or interact with her newborn other than to feed him, change his diapers or soiled clothes, and put him to bed. In evaluating the woman’s behavior with her infant, the nurse realizes that:
   a. what appears to be a lack of interest in the newborn is in fact the Vietnamese way of demonstrating intense love by attempting to ward off evil spirits.
   b. the woman is inexperienced in caring for newborns.
   c. the woman needs a referral to a social worker for further evaluation of her parenting behaviors once she goes home with the newborn.
   d. extra time needs to be planned for assisting the woman in bonding with her newborn.

Answer 8

ANS: A
The nurse may observe a Vietnamese woman who gives minimal care to her infant and refuses to cuddle or interact with her infant. The apparent lack of interest in the newborn is this cultural group’s attempt to ward off evil spirits and actually reflects an intense love and concern for the infant. It is important to educate the woman in infant care, but it is equally important to acknowledge her cultural beliefs and practices.

Question 9

9. Many first-time parents do not plan on their parents’ help immediately after the newborn arrives. What statement by the nurse is the most appropriate when counseling new parents about the involvement of grandparents?
   a. “You should tell your parents to leave you alone.”
   b. “Grandparents can help you with parenting skills and also help preserve family traditions.”
   c. “Grandparent involvement can be very disruptive to the family.”
   d. “They are getting old. You should let them be involved while they can.”

Answer 9

ANS: B
“Grandparents can help you with parenting skills and also help preserve family traditions” is the most appropriate response. Intergenerational help may be perceived as interference; however, a statement of this sort is not therapeutic to the adaptation of the family. Not only is “Grandparent involvement can be very disruptive to the family” invalid, it also is not an appropriate nursing response. Regardless of age, grandparents can help with parenting skills and preserve family traditions. Talking about the age of the grandparents is not the most appropriate statement, and it does not demonstrate sensitivity on the part of the nurse.

Question 10

10. When the infant’s behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics, this is called:
    a. mutuality.
    b. bonding.
    c. claiming.
    d. acquaintance.

Answer 10

ANS: A
Mutuality extends the concept of attachment to include this shared set of behaviors. Bonding is the process over time of parents forming an emotional attachment to their infant. Mutuality refers to a shared set of behaviors that is a part of the bonding process. Claiming is the process by which parents identify their new baby in terms of likeness to other family members and their differences and uniqueness. Like mutuality, acquaintance is part of attachment. It describes how parents get to know their baby during the immediate after birth period through eye contact, touching, and talking.

Question 11

11. In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. Which one is a facilitating behavior?
    a. The parents have difficulty naming the infant.
    b. The parents hover around the infant, directing attention to and pointing at the infant.
    c. The parents make no effort to interpret the actions or needs of the infant.
    d. The parents do not move from fingertip touch to palmar contact and holding.

Answer 11

ANS: B
Hovering over the infant and obviously paying attention to the baby are facilitating behaviors. Inhibiting behaviors include difficulty naming the infant, making no effort to interpret the actions or needs of the infant, and not moving from fingertip touch to palmar contact and holding.

Question 12

12. With regard to parents’ early and extended contact with their infant and the relationships built, nurses should be aware that:
    a. immediate contact is essential for the parent-child relationship.
    b. skin-to-skin contact is preferable to contact with the body totally wrapped in a blanket.
    c. extended contact is especially important for adolescents and low-income women because they are at risk for parenting inadequacies.
    d. mothers need to take precedence over their partners and other family matters.

Answer 12

ANS: C
Nurses should encourage any activity that optimizes family extended contact. Immediate contact facilitates the attachment process but is not essential; otherwise, adopted infants would not establish the affectionate ties they do. The mode of infant-mother contact does not appear to have any important effect. Mothers and their partners are considered equally important.

Question 13

13. In the United States the en face position is preferred immediately after birth. Nurses can facilitate this process by all of these actions except:
    a. washing both the infant’s face and the mother’s face.
    b. placing the infant on the mother’s abdomen or breast with their heads on the same plane.
    c. dimming the lights.
    d. delaying the instillation of prophylactic antibiotic ointment in the infant’s eyes.

Answer 13

ANS: A
To facilitate the position in which the parent’s and infant’s faces are approximately 8 inches apart on the same plane, allowing them to make eye contact, the nurse can place the infant at the proper height on the mother’s body, dim the light so that the infant’s eyes open, and delay putting ointment in the infant’s eyes.

Question 14

14. Other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that, despite what folk wisdom may say:
    a. high-pitched voices irritate newborns.
    b. infants can learn to distinguish their mother’s voice from others soon after birth.
    c. all babies in the hospital smell alike.
    d. a mother’s breast milk has no distinctive odor.

Answer 14

ANS: B
Infants know the sound of their mother’s voice early. Infants respond positively to high-pitched voices. Each infant has a unique odor. Infants quickly learn to distinguish the odor of their mother’s breast milk.

Question 15

15. After they are born, a crying infant may be soothed by being held in a position in which the newborn can hear the mother’s heartbeat. This phenomenon is known as:
    a. entrainment.
    b. reciprocity.
    c. synchrony.
    d. biorhythmicity.

Answer 15

ANS: D
The newborn is in rhythm with the mother. The infant develops a personal biorhythm with the parents’ help over time. Entrainment is the movement of newborns in time to the structure of adult speech. Reciprocity is body movement or behavior that gives cues to the person’s desires. These take several weeks to develop with a new baby. Synchrony is the fit between the infant’s behavioral cues and the parent’s responses.

Question 16

16. Of the many factors that influence parental responses, nurses should be conscious of negative stereotypes that apply to specific patient populations. Which response could be an inappropriate stereotype of adolescent mothers?
    a. An adolescent mother’s egocentricity and unmet developmental needs interfere with her ability to parent effectively.
    b. An adolescent mother is likely to use less verbal instruction, be less responsive, and interact less positively than other mothers.
    c. Adolescent mothers have a higher documented incidence of child abuse.
    d. Mothers older than 35 often deal with more stress related to work and career issues and decreasing libido.

Answer 16

ANS: C
Adolescent mothers are more inclined to have a number of parenting difficulties that benefit from counseling; however, a higher incidence of child abuse is not one of them. Midlife mothers have many competencies, but they are more likely to have to deal with career issues and the accompanying stress

Question 17

17. When working with parents who have some form of sensory impairment, nurses should understand that ________ is an inaccurate statement.
    a. “One of the major difficulties visually impaired parents experience is the skepticism of health care professionals.”
    b. “Visually impaired mothers cannot overcome the infant’s need for eye-to-eye contact.”
    c. “The best approach for the nurse is to assess the parents’ capabilities rather than focusing on their disabilities.”
    d. “Technologic advances, including the Internet, can provide deaf parents with a full range of parenting activities and information.”

Answer 17

ANS: B
Other sensory output can be provided by the parent, other people can participate, and other coping devices can be used. The skepticism, open or hidden, of health care professionals places an additional and unneeded hurdle for the parents. After the parents’ capabilities have been assessed (including some the nurse may not have expected), the nurse can help find ways to assist the parents that play to their strengths. The Internet affords an extra teaching tool for the deaf, as do videos with subtitles or nurses signing. A number of electronic devices can turn sound into light flashes to help pick up a child’s cry. Sign language is readily acquired by young children.

Question 18

18. With regard to the adaptation of other family members, mainly siblings and grandparents, to the newborn, nurses should be aware that:
    a. sibling rivalry cannot be dismissed as overblown psychobabble; negative feelings and behaviors can take a long time to blow over.
    b. participation in preparation classes helps both siblings and grandparents.
    c. in the United States paternal and maternal grandparents consider themselves of equal importance and status.
    d. in the past few decades the number of grandparents providing permanent care to their grandchildren has been declining.

Answer 18

ANS: B
Preparing older siblings and grandparents helps everyone to adapt. Sibling rivalry should be expected initially, but the negative behaviors associated with it have been overemphasized and stop in a comparatively short time. In the United States, in contrast to other cultures, paternal grandparents frequently consider themselves secondary to maternal grandparents. The number of grandparents providing permanent child care has been on the increase.

Question 19

19. Nursing activities that promote parent-infant attachment are many and varied. One activity that should not be overlooked is management of the environment. While providing routine mother-baby care, the nurse should ensure that:
    a. the baby is able to return to the nursery at night so that the new mother can sleep.
    b. routine times for care are established to reassure the parents.
    c. the father should be encouraged to go home at night to prepare for mother-baby discharge.
    d. an environment that fosters as much privacy as possible should be created.

Answer 19

ANS: D
Care providers need to knock before gaining entry. Nursing care activities should be grouped. Once the baby has demonstrated adjustment to extrauterine life (either in the mother’s room or the transitional nursery), all care should be provided in one location. This important principle of family-centered maternity care fosters attachment by giving parents the opportunity to learn about their infant 24 hours a day. One nurse should provide care to both mother and baby in this couplet care or rooming-in model. It is not necessary for the baby to return to the nursery at night. In fact, the mother will sleep better with the infant close by. Care should be individualized to meet the parents’ needs, not the routines of the staff. Teaching goals should be developed in collaboration with the parents. The father, or other significant other, should be permitted to sleep in the room with the mother. The maternity unit should develop policies that allow for the presence of significant others as much as the new mother desires.

Question 20

20. The early after birth period is a time of emotional and physical vulnerability. Many mothers can easily become psychologically overwhelmed by the reality of their new parental responsibilities. Fatigue compounds these issues. Although the baby blues are a common occurrence in the after birth period, about one-half million women in America experience a more severe syndrome known as postpartum depression (PPD). Which statement regarding PPD is essential for the nurse to be aware of when attempting to formulate a nursing diagnosis?
    a. PPD symptoms are consistently severe.
    b. This syndrome affects only new mothers.
    c. PPD can easily go undetected.
    d. Only mental health professionals should teach new parents about this condition.

Answer 20

ANS: C
PPD can go undetected because parents do not voluntarily admit to this type of emotional distress out of embarrassment, fear, or guilt. PPD symptoms range from mild to severe, with women having both good and bad days. Both mothers and fathers should be screened. PPD may also affect new fathers. The nurse should include information on PPD and how to differentiate this from the baby blues for all patients on discharge. Nurses also can urge new parents to report symptoms and seek follow-up care promptly if symptoms occur.

Question 21

21. The mother-baby nurse is able to recognize reciprocal attachment behavior. This refers to:
    a. the positive feedback an infant exhibits toward parents during the attachment process.
    b. behavior during the sensitive period when the infant is in the quiet alert stage.
    c. unidirectional behavior exhibited by the infant, initiated and enhanced by eye contact.
    d. behavior by the infant during the sensitive period to elicit feelings of “falling in love” from the parents.

Answer 21

ANS: A
In this definition, “reciprocal” refers to the feedback from the infant during the attachment process. This is a good time for bonding; however, it does not define reciprocal attachment. Reciprocal attachment applies to feedback behavior and is not unidirectional.

Question 22

22. The after birth woman who continually repeats the story of her labor, delivery, and recovery experience is:
    a. providing others with her knowledge of events.
    b. making the birth experience “real.”
    c. taking hold of the events leading to her labor and delivery.
    d. accepting her response to labor and delivery.

Answer 22

ANS: B
Reliving the birth experience makes the event real and helps the mother realize that the pregnancy is over and that the infant is born and is now a separate individual. The retelling of the story is to satisfy her needs, not the needs of others. This new mother is in the taking-in phase, trying to make the birth experience seem real and separate the infant from herself.

Question 23

23. On observing a woman on her first after birth day sitting in bed while her newborn lies awake in the bassinet, the nurse should:
    a. realize that this situation is perfectly acceptable.
    b. offer to hand the baby to the woman.
    c. hand the baby to the woman.
    d. explain “taking in” to the woman.

Answer 23

ANS: C
During the “taking-in” phase of maternal adaptation (the mother may be passive and dependent), the nurse should encourage bonding when the infant is in the quiet alert stage. This is done best by simply giving the baby to the mother. The patient is exhibiting expected behavior during the taking-in phase; however, interventions by the nurse can facilitate infant bonding. The patient will learn best during the taking-hold phase.

Question 24

24. A nurse is observing a family. The mother is holding the baby she delivered less than 24 hours ago. Her husband is watching his wife and asking questions about newborn care. The 4-year-old brother is punching his mother on the back. The nurse should:
    a. report the incident to the social services department.
    b. advise the parents that the toddler needs to be reprimanded.
    c. report to oncoming staff that the mother is probably not a good disciplinarian.
    d. realize that this is a normal family adjusting to family change.

Answer 24

ANS: D
The observed behaviors are normal variations of families adjusting to change. There is no need to report this one incident. Giving advice at this point would make the parents feel inadequate.

Question 25

25. The best way for the nurse to promote and support the maternal-infant bonding process is to:
    a. help the mother identify her positive feelings toward the newborn.
    b. encourage the mother to provide all newborn care.
    c. assist the family with rooming-in.
    d. return the newborn to the nursery during sleep periods.

Answer 25

ANS: C
Close and frequent interaction between mother and infant, which is facilitated by rooming-in, is important in the bonding process. This is often referred to as the mother-baby care or couplet care. Having the mother express her feelings is important; however, it is not the best way to promote bonding. The mother needs time to rest and recuperate; she should not be expected to do all of the care. The patient needs to observe the infant during all stages so she will be aware of what to anticipate when they go home.

Question 26

26. During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and accept the real baby?
    a. Letting go
    b. Taking hold
    c. Taking in
    d. Taking on

Answer 26

ANS: A
Accepting the real infant and relinquishing the fantasy infant occurs during the letting-go phase of maternal adjustment. During the taking-hold phase the mother assumes responsibility for her own care and shifts her attention to the infant. In the taking-in phase the mother is primarily focused on her own needs. There is no taking-on phase of maternal adjustment.

Question 27

27. A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled for discharge. As you prepare her for discharge, she begins to cry. Your initial action should be to:
    a. assess her for pain.
    b. point out how lucky she is to have a healthy baby.
    c. explain that she is experiencing after birth blues.
    d. allow her time to express her feelings.

Answer 27

ANS: D
Although many women experience transient after birth blues, they need assistance in expressing their feelings. This condition affects 50% to 80% of new mothers. There should be no assumption that the patient is in pain, when in fact she may have no pain whatsoever. This is “blocking” communication and inappropriate in this situation. The patient needs the opportunity to express her feelings first; patient teaching can occur later.

Question 28

8. A man calls the nurse’s station and states that his wife, who delivered 2 days ago, is happy one minute and crying the next. The man says, “She was never like this before the baby was born.” The nurse’s initial response could be to:
   a. tell him to ignore the mood swings, as they will go away.
   b. reassure him that this behavior is normal.
   c. advise him to get immediate psychological help for her.
   d. instruct him in the signs, symptoms, and duration of after birth blues.

Answer 28

ANS: B
Before providing further instructions, inform family members of the fact that after birth blues are a normal process. Telling her partner to “ignore the mood swings” does not encourage further communication and may belittle the husband’s concerns. After birth blues are usually short-lived; no medical intervention is needed. Patient teaching is important; however, the new father’s anxieties need to be allayed before he will be receptive to teaching.

Question 29

29. To promote bonding and attachment immediately after delivery, the most important nursing intervention is to:
    a. allow the mother quiet time with her infant.
    b. assist the mother in assuming an en face position with her newborn.
    c. teach the mother about the concepts of bonding and attachment.
    d. assist the mother in feeding her baby.

Answer 29

ANS: B
Assisting the mother in assuming an en face position with her newborn will support the bonding process. The mother should be given as much privacy as possible; however, nursing assessments must still be continued during this critical time. The mother has just delivered and is more focused on the infant; she will not be receptive to teaching at this time. This is a good time to initiate breastfeeding; however, the mother first needs time to explore the new infant and begin the bonding process.

Question 30

0. A new father states, “I know nothing about babies,” but he seems to be interested in learning. This is an ideal opportunity for the nurse to:
   a. continue to observe his interaction with the newborn.
   b. tell him when he does something wrong.
   c. show no concern, as he will learn on his own.
   d. include him in teaching sessions.

Answer 30

ANS: D
The nurse must be sensitive to the father’s needs and include him whenever possible. As fathers take on their new role, the nurse should praise every attempt, even if his early care is awkward. It is important to note the bonding process of the mother and the father; however, that does not satisfy the expressed needs of the father. The new father should be encouraged in caring for his baby by pointing out the things that he does right. Criticizing him will discourage him.

Question 31

1. Which concerns about parenthood are often expressed by visually impaired mothers? (Select all that apply.)
   a. Infant safety
   b. Transportation
   c. The ability to care for the infant
   d. Missing out visually
   e. Needing extra time for parenting activities to accommodate the visual limitations

Answer 31

ANS: A, B, D, E
Concerns expressed by visually impaired mothers include infant safety, extra time needed for parenting activities, transportation, handling other people’s reactions, providing proper discipline, and missing out visually. Blind people sense reluctance on the part of others to acknowledge that they have a right to be parents; however, blind parents are fully capable of caring for their infants.

Question 32

2. A parent who has a hearing impairment is presented with a number of challenges in parenting. Which nursing approaches are appropriate for working with hearing-impaired new parents? (Select all that apply.)
   a. Use devices that transform sound into light.
   b. Assume that the patient knows sign language.
   c. Speak quickly and loudly.
   d. Ascertain whether the patient can read lips before teaching.
   e. Written messages aid in communication.

Answer 32

ANS: A, D, E
Section 504 of the Rehabilitation Act of 1973 requires that hospitals use various communication techniques and resources with the deaf and hard of hearing patient. This includes devices such as door alarms, cry alarms, and amplifiers. Before initiating communication, the nurse needs to be aware of the parents’ preferences for communication. Not all hearing-impaired patients know sign language. Do they wear a hearing aid? Do they read lips? Do they wish to have a sign language interpreter? If the parent relies on lipreading, the nurse should sit close enough so that the parent can visualize lip movements. The nurse should speak clearly in a regular voice volume, in short, simple sentences. Written messages such as on a black or white erasable board can be useful. Written materials should be reviewed with the parents before discharge.