Chapter 15: Transition to Parenthood My Nursing Test Banks

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 15: Transition to Parenthood

Test Bank 

MULTIPLE CHOICE

1. After giving birth to a healthy infant boy, a primiparous woman, 16, is admitted to the postpartum 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 womans discharge, what should the nurse be certain to include in the plan of care?

a. Tell the woman how to feed and bathe her infant.
b. Give the woman written information on bathing her infant.
c. Advise the woman that all mothers instinctively know how to care for their infants.
d. Provide time for the woman to bathe her infant after she views an infant bath demonstration.

ANS: D

Feedback
A 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.
B Although providing written information is useful, it is not the most developmentally appropriate teaching for a teenage mother.
C This statement is inappropriate; it is belittling and false.
D Having the mother demonstrate infant care is a valuable method of assessing the patients understanding of her newly acquired knowledge, especially in this age group, because she may inadvertently neglect her child.

DIF:Cognitive Level: ApplicationREF:430

OBJ:Client Needs: Health Promotion and Maintenance

TOP:Nursing Process: Diagnosis, Planning

2. The nurse observes several interactions between a postpartum 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

ANS: B

Feedback
A Talking and cooing to the baby are normal infant-parent interactions.
B The woman should be encouraged to hold her infant in the en face position and make eye contact with the infant.
C Cuddling is a normal infant-parent interaction.
D Discussing the babys behavior in a positive manner is a normal infant-parent interaction.

DIF:Cognitive Level: ApplicationREF:422

OBJ:Client Needs: Psychosocial Integrity

TOP:Nursing Process: Assessment, Diagnosis

3. New parents express concern that, because of the mothers emergency cesarean birth under general anesthesia, they did not have the opportunity to hold and bond with their daughter immediately after her birth. The nurses 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.

ANS: A

Feedback
A This statement is accurate.
B 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.
C Parent-infant attachment involves activities such as touching, holding, and gazing; it is not exclusively eye contact.
D This response is inappropriate because it is derogatory and belittling.

DIF:Cognitive Level: ApplicationREF:417

OBJ:Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

4. 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 infants diaper a different way.
d. Suggesting that he let the infant sleep in the bassinet.

ANS: A

Feedback
A Infants respond to the sound of voices. Because attachment involves a reciprocal interchange, observing the interaction between parent and infant is very important.
B Separation of the parent and infant does not encourage parent-infant attachment.
C 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.
D Parent-infant attachment involves touching, holding, and cuddling. It is appropriate for a father to want to hold the infant as the baby sleeps.

DIF:Cognitive Level: ApplicationREF:422

OBJ:Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

5. 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 womans 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.

ANS: A

Feedback
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 groups attempt to ward off evil spirits and actually reflects an intense love and concern for the infant.
B Cultural beliefs are important determinates of parenting behaviors. The womans lack of interest is a Vietnamese cultural behavior.
C Cultural beliefs are important determinates of parenting behaviors. The womans lack of interest is a Vietnamese cultural behavior. The lack of infant interaction is not a form of infant neglect but rather a demonstration of love and concern for the infant.
D The nurse may observe the woman and may be concerned by the apparent lack of interest in the newborn when, in fact, this is a cultural display of 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.

DIF:Cognitive Level: ComprehensionREF:432

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Evaluation

6. 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 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.

ANS: B

Feedback
A This would be an inhibiting behavior.
B Hovering over the infant and obviously paying attention to the baby are facilitating behaviors.
C This would be an inhibiting behavior.
D This would be an inhibiting behavior.

DIF:Cognitive Level: ComprehensionREF:419

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

7. 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.

ANS: C

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

DIF:Cognitive Level: ComprehensionREF:421

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Planning

8. 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 infants face and the mothers face.
b. Placing the infant on the mothers abdomen or breast with their heads on the same plane.
c. Dimming the lights.
d. Delaying the instillation of prophylactic antibiotic ointment in the infants eyes.

ANS: A

Feedback
A To facilitate the position in which the parents and infants 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 mothers body, dim the light so that the infants eyes open, and delay putting ointment in the infants eyes.
B To facilitate the position in which the parents and infants 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 mothers body, dim the light so that the infants eyes open, and delay putting ointment in the infants eyes.
C To facilitate the position in which the parents and infants 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 mothers body, dim the light so that the infants eyes open, and delay putting ointment in the infants eyes.
D To facilitate the position in which the parents and infants 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 mothers body, dim the light so that the infants eyes open, and delay putting ointment in the infants eyes.

DIF:Cognitive Level: ComprehensionREF:422

OBJ:Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

9. In addition to eye contact, early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that, despite what folk wisdom might say:

a. High-pitched voices irritate newborns.
b. Infants can learn to distinguish their mothers voice from others soon after birth.
c. All babies in the hospital smell alike.
d. A mothers breast milk has no distinctive odor.

ANS: B

Feedback
A Infants respond positively to high-pitched voices.
B Infants know the sound of their mothers voice early.
C Each infant has a unique odor.
D Incorrect: Infants quickly learn to distinguish the odor of their mothers breast milk.

DIF:Cognitive Level: KnowledgeREF:422

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

10. After birth a crying infant may be soothed by being held in a position in which the newborn can hear the mothers heartbeat. This phenomenon is known as:

a. Entrainment.
b. Reciprocity.
c. Synchrony.
d. Biorhythmicity.

ANS: D

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

DIF:Cognitive Level: KnowledgeREF:422

OBJ:Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

11. Of the many factors that influence parental responses, nurses should be aware that all of these statements regarding age are true except:

a. An adolescent mothers 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.

ANS: C

Feedback
A Adolescent mothers are more inclined to have a number of parenting difficulties that benefit from counseling, but a higher incidence of child abuse is not one of them.
B Adolescent mothers are more inclined to have a number of parenting difficulties that benefit from counseling, but a higher incidence of child abuse is not one of them.
C Adolescent mothers are more inclined to have a number of parenting difficulties that benefit from counseling, but a higher incidence of child abuse is not one of them.
D Incorrect: Midlife mothers have many competencies but are more likely to have to deal with career and sexual issues than are younger mothers.

DIF:Cognitive Level: ComprehensionREF:430

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Evaluation

12. When dealing with parents who have some form of sensory impairment, nurses should realize that all of these statements are true except:

a. One of the major difficulties visually impaired parents experience is the skepticism of health care professionals.
b. Visually impaired mothers cannot overcome the infants 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.

ANS: B

Feedback
A The skepticism, open or hidden, of health care professionals places an additional and unneeded hurdle before the parents.
B Other sensory output can be provided by the parent, other people can participate, and other coping devices can be used.
C 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.
D 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 childs cry. Sign language is acquired readily by young children.

DIF:Cognitive Level: ComprehensionREF:433

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

13. 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. Since 1990 the number of grandparents providing permanent care to their grandchildren has been declining.

ANS: B

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

DIF:Cognitive Level: ComprehensionREF:434, 435

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Planning

14. The early postpartum 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 postpartum 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.

ANS: C

Feedback
A PPD symptoms range from mild to severe, with women having both good and bad days.
B Both mothers and fathers should be screened. PPD in new fathers ranges from 1% to 26%.
C PPD can go undetected because parents do not voluntarily admit to this type of emotional distress out of embarrassment, fear, or guilt.
D 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 they occur.

DIF:Cognitive Level: SynthesisREF:425

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Diagnosis

15. The nurse hears a primiparous woman talking to her son and telling him that his chin is just like his dads chin. This womans statement reflects:

a. Mutuality.
b. Synchrony.
c. Claiming.
d. Reciprocity.

ANS: C

Feedback
A Mutuality occurs when the infants behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics.
B Synchrony refers to the fit between the infants cues and the parents responses.
C Claiming refers to the process by which the child is identified in terms of likeness to other family members.
D Reciprocity is a type of body movement or behavior that provides the observer with cues.

DIF:Cognitive Level: ComprehensionREF:418

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Evaluation

TRUE/FALSE

1. Hearing impaired parents face- many challenges in caregiving and parenting, particularly if their deafness dates back to infancy or early childhood. In order to ensure that the learning needs of these families are met, legislation has been passed that directs hospitals to use various communication techniques and resources with their deaf patients.

ANS: T

Section 504 of the Rehabilitation Act of 1973 requires that hospitals or other institutions that receive funding from the U.S. Department of Health and Human Services use a variety of communication techniques and resources with their deaf patients. This includes providing certified interpreters who are proficient in sign language.

DIF:Cognitive Level: ComprehensionREF:433

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

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