Chapter 22 Flashcards
- After giving birth to a healthy infant boy, a primiparous client, 16 years of age, is admitted to the postpartum unit. An appropriate nursing diagnosis for her at this time is “Deficient knowledge of infant care.” What should the nurse be certain to include in the plan of care as he or she prepares the client for discharge?
a. Teach the client how to feed and bathe her infant.
b. Give the client written information on bathing her infant.
c. Advise the client that all mothers instinctively know how to care for their infants.
d. Provide time for the client to bathe her infant after she views a demonstration of infant bathing.
ANS: D
Having the mother demonstrate infant care is a valuable method of assessing the client’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 client education or providing written information might be useful, neither is the most developmentally appropriate teaching method for a teenage mother. Advising the young woman that all mothers instinctively know how to care for their infants is inappropriate; it is belittling and false.
- A 30-year-old multiparous woman has a boy who is years old and has recently delivered an infant girl. She tells the nurse, “I don’t know how I’ll ever manage both children when I get home.” Which suggestion would assist this new mother in alleviating sibling rivalry?
a. Tell the older child that he is a big boy now and should love his new sister.
b. Let the older child stay with his grandparents for the first 6 weeks to allow him to adjust to the newborn.
c. Ask friends and relatives not to bring gifts to the older sibling because you do not want to spoil him.
d. Realize that the regression in habits and behaviors in the older child is a typical reaction and that he needs extra love and attention at this time.
ANS: D
The older child may regress in habits or behaviors (e.g., toileting, sleep habits) as a method of seeking attention. Parents need to distribute their attention in an equitable manner. Telling the older child that he should love his new sister is a negative approach to facilitating sibling acceptance of the new infant. Reactions of siblings may result from temporary separation from the mother. Removing the older child from the home when the new infant arrives may enhance negative behaviors from the older child caused by a separation from the mother. Providing small gifts from the infant to the older child is a strategy for facilitating sibling acceptance of the new infant.
- The nurse observes that a first-time mother appears to ignore her newborn. Which strategy should the nurse use to facilitate mother-infant attachment?
a. Tell the mother she must pay attention to her infant.
b. Show the mother how the infant initiates interaction and attends 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.
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, but 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.
- A nurse hears a primiparous woman talking to her son and telling him that his chin is just like his dad’s. This statement is most descriptive of which process?
a. Mutuality
b. Synchrony
c. Claiming
d. Reciprocity
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.
- 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. Which information should the nurse’s response convey?
a. Attachment, or bonding, is a process that occurs over time and does not require early contact.
b. Time immediately after birth is a critical period for humans.
c. Early contact is essential for optimal parent-infant relationships.
d. These new parents should just be happy that the infant is healthy.
ANS: A
Attachment occurs over time and does not require early contact. Although a delay in contact does not necessarily mean that attachment is inhibited, additional psychologic energy may be necessary to achieve the same effect. The formerly accepted definition of bonding held that the period immediately after birth was critical 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. Telling the parents that they should be happy that the infant is healthy is inappropriate; it may be received as derogatory and belittling.
- During a telephone follow-up conversation with a woman who is 4 days postpartum, 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!” Which condition might this new mother be experiencing?
a. Letting-go
b. Postpartum depression (PPD)
c. Postpartum blues
d. Attachment difficulty
ANS: C
During the postpartum blues, women are emotionally labile, often crying easily and for no apparent reason. This lability seems to peak around the fifth postpartum day. The letting-go phase is the period that occurs several weeks after childbirth. During this phase the woman wants to move forward as a family unit with all members, appropriately interacting to their new roles. PPD is an intense, pervasive sadness marked by severe, labile mood swings; it is more serious and persistent than the postpartum blues. Crying is not a maladaptive attachment response; it indicates postpartum blues.
- Which statement by the nurse can assist a new father in his transition to parenthood?
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
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, but 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.
- A nurse notes that an Eskimo 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. While evaluating this client’s behavior with her infant, what realization does the nurse make?
a. What appears to be a lack of interest in the newborn is, in fact, the cultural way of demonstrating intense love by attempting to ward off evil spirits.
b. The woman is inexperienced in caring for a newborn.
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.
ANS: A
The nurse may observe an Eskimo mother 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. Inexperience in caring for newborns is not an issue. Cultural beliefs are important determinates of parenting behaviors. The woman’s “lack of interest” is an Eskimo cultural behavior. Referring the woman to a social worker is not necessary in this situation. The lack of infant interaction is not a form of infant neglect; rather, it is a demonstration of love and concern for the infant. The nurse may observe the woman and may be concerned by the apparent lack of interest in the newborn when in fact her behavior is a cultural display of love and concern for the infant. Teaching the woman infant care is important, but acknowledging her cultural beliefs and practices is equally important.
- Many first-time parents do not plan on having their parents’ help immediately after the newborn arrives. Which statement by the nurse is the most appropriate when counseling new parents regarding the involvement of grandparents?
a. “You should tell your parents to leave you alone.”
b. “Grandparents can help you with parenting skills.”
c. “Grandparent involvement can be very disruptive to the family.”
d. “They are getting old. You should let them be involved while they can.”
ANS: B
Telling the parents that grandparents can help with parenting skills and therefore help preserve family traditions is the most appropriate response. Intergenerational help may be perceived as interference, but telling the parents that their parents should be told to leave them alone is not therapeutic to the adaptation of the family. Telling the parents that grandparent involvement can be disruptive to the family is an invalid statement and not an appropriate nursing response. Regardless of age, grandparents can help with parenting skills and preserve family traditions.
- In follow-up appointments or visits with parents and their new baby, it is useful if the nurse can identify infant behaviors that can either facilitate or inhibit attachment. What is an inhibiting behavior?
a. The infant cries only when hungry or wet.
b. The infant’s activity is somewhat predictable.
c. The infant clings to the parents.
d. The infant seeks attention from any adult in the room.
ANS: D
Parents want to be the focus of the infant’s existence, just as the infant is the focus of their existence. Facilitating and inhibiting behaviors build or discourage bonding (attitudes); they do not reflect any value judgments on what might be healthy or unhealthy. The infant who shows no preference for his or her parents over other adults is exhibiting an inhibiting behavior. An infant who cries only when hungry or wet is exhibiting a facilitating behavior. An infant who has a predictable attention span is exhibiting a facilitating behavior. The infant who clings to his or her parents, enjoys being cuddled and held, and is easily consoled is displaying facilitating behaviors.
- In addition to eye contact, other early sensual contacts between the infant and mother involve sound and smell. What other statement regarding the senses is correct?
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. Mother’s breast milk has no distinctive odor.
ANS: B
Infants know the sound of their mother’s voice at an early age. Infants positively respond to high-pitched voices. Each infant has a unique odor. Infants quickly learn to distinguish the odor of their mother’s breast milk.
- After birth, 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 what?
a. Entrainment
b. Reciprocity
c. Synchrony
d. Biorhythmicity
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 a newborn 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.
- The postpartum nurse should be cognizant of what with regard to the adaptation of other family members (primarily siblings and grandparents) to the newborn?
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. Since 1990, the number of grandparents providing permanent care to their grandchildren has been declining.
ANS: B
Preparing older siblings, as well as grandparents, helps with everyone’s adaptation. Sibling rivalry should be initially expected, 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 rising.
- While providing routine mother-baby care, which activities should the nurse encourage to facilitate the parent-infant attachment?
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 discharge of the mother and baby.
d. An environment that fosters as much privacy as possible should be created.
ANS: D
Care providers need to knock before gaining entry. Nursing care activities should be grouped. Once the baby has demonstrated an 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 offering 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 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.
- A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment after childbirth. Recognizing the needs of women during this stage, how should the nurse respond?
a. Foster an active role in the baby’s care.
b. Provide time for the mother to reflect on the events of her labor and delivery.
c. Recognize the woman’s limited attention span by giving her written materials to read when she gets home rather than doing a teaching session while she is in the hospital.
d. Promote maternal independence by encouraging her to meet her own hygiene and comfort needs.
ANS: B
During this stage, the new mother is excited and talkative. It is important that she be able to fulfill her desire to review her birth experience. During this stage, the new mother still relies upon others to meet her physical needs. Once these are met, she will be more able to take an active role, not only in her own care but also in the care of her newborn, which happens during the taking-hold stage. Short teaching sessions, using written materials to reinforce the content presented, is a more effective approach. The focus of the taking-in or dependency stage is to nurture the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition.
