Chapter 22: Transition to Parenthood My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 22: Transition to Parenthood

Test Bank

MULTIPLE CHOICE

1. After giving birth to a healthy infant boy, a primiparous woman, age 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 should 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

Having the mother demonstrate infant care is a valuable method of assessing the clients 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, it is not the most developmentally appropriate teaching for a teenage mother.

Although providing written information is useful, it is not the most developmentally appropriate teaching for a teenage mother.

Advising the woman that all mothers instinctively know how to care for their infants is inappropriate; it is belittling and false.

DIF: Cognitive Level: Application REF: 513

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis, Planning

2. A 30-year-old multiparous woman has a boy who is 2 years old and now an infant girl. She tells the nurse, I dont know how Ill ever manage both children when I get home. Which suggestion would best help this woman alleviate 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 and 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 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.

DIF: Cognitive Level: Analysis REF: 524

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

3. A nurse observes that a 15-year-old new mother appears to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is:

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 infants responsiveness is more appropriate.

DIF: Cognitive Level: Application REF: 519

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

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

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 infants behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics.

Synchrony refers to the fit between the infants cues and the parents responses.

Reciprocity is a type of body movement or behavior that provides the observer with cues.

DIF: Cognitive Level: Comprehension REF: 508

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Evaluation

5. 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 humans

c.

Early contact is essential for optimum parent-infant relationships

d.

They 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 because it is derogatory and belittling.

DIF: Cognitive Level: Application REF: 507

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

6. During a phone follow-up conversation with a woman who is 4 days postpartum, the woman tells the nurse, I dont know whats wrong. I love my son, but I feel so let down. I seem to cry for no reason! The nurse recognizes that the woman is 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 postdelivery. During this phase the woman wants to move forward as a family unit with all members interacting appropriate 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.

DIF: Cognitive Level: Comprehension REF: 515

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment, Diagnosis

7. A nurse can assist 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

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.

DIF: Cognitive Level: Application REF: 516

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

8. A 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

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.

Inexperience in caring for newborns is not an issue. Cultural beliefs are important determinates of parenting behaviors. The womans lack of interest is a Vietnamese 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, but rather 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 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: Comprehension REF: 522

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Evaluation

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.

ANS: B

Telling the parents that grandparents can help with parenting skills and 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.

DIF: Cognitive Level: Analysis REF: 525

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning

10. 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 infants 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 infants 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 that shows no preference for his or her parents over other adults is exhibiting an inhibiting behavior.

An infant that cries only when hungry or wet is exhibiting a facilitating behavior.

An infant that has a predictable attention span is exhibiting a facilitating behavior.

The infant that clings to his or her parents, enjoys being cuddled and held, and is easily consoled is displaying facilitating behaviors.

DIF: Cognitive Level: Comprehension REF: 508

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

11. 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

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.

DIF: Cognitive Level: Comprehension REF: 510

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning

12. 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

As newborns become functionally able to sustain eye contact with their parents, they spend time in mutual gazing, often in the en face position, a position in which the parents and infants faces are approximately 20 cm apart and on the same plane. Washing the infants or mothers face is not necessary at this time and would interrupt the process.

Nurses and physicians or midwives can facilitate eye contact immediately after birth by placing the infant on the mothers abdomen or breasts with the mothers and the infants faces on the same plane.

Dimming the lights encourages the infants eyes to stay open.

To promote eye contact, instillation of prophylactic antibiotic ointment into the infants eyes can be delayed until after the infant and parents have had some time together in the first hour after birth.

DIF: Cognitive Level: Comprehension REF: 511

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

13. In addition to eye contact other 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

Infants know the sound of their mothers voice early.

Infants respond positively to high-pitched voices.

Each infant has a unique odor.

Infants quickly learn to distinguish the odor of their mothers breast milk.

DIF: Cognitive Level: Knowledge REF: 511

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

14. 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

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 persons desires. These take several weeks to develop with a new baby.

Synchrony is the fit between the infants behavioral cues and the parents responses.

DIF: Cognitive Level: Knowledge REF: 512

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

15. 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, as well as decreasing libido

ANS: 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.

As adolescent mothers move through the transition to parenthood, they can feel different from their peers, excluded from fun activities and prematurely forced to enter the adult role. The conflict between their own desires and the infants demands further contribute to the normal psychosocial stress of childbirth and parenting.

Adolescent mothers provide warm and attentive physical care; however, they use less verbal interaction than older parents, and adolescents tend to be less responsive and to interact less positively with their infants then older mothers.

Midlife mothers have many competencies; however, they are more likely to have to deal with career and sexual issues than are younger mothers.

DIF: Cognitive Level: Comprehension REF: 519

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Evaluation

16. 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

Preparing older siblings, as well as grandparents, helps with everyones adaptation.

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 rising.

DIF: Cognitive Level: Comprehension REF: 524, 525

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning

17. Nursing activities that promote parent-infant attachment are many and varied. One activity that should not be overlooked is the 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

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 mothers 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.

DIF: Cognitive Level: Application REF: 509

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

18. A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. Recognizing the needs of women during this stage, the nurse should:

a.

Foster an active role in the babys care

b.

Provide time for the mother to reflect on the events of her labor and delivery

c.

Recognize the womans limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now

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. This 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.

DIF: Cognitive Level: Comprehension REF: 514

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning, Implementation

MULTIPLE RESPONSE

1. What concerns about parenthood are often expressed by visually impaired mothers? Choose 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

ANS: A, B, D, E

Concerns expressed by visually impaired mothers include infant safety, extra time needed for parenting activities, transportation, handling other peoples 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.

DIF: Cognitive Level: Comprehension REF: 523

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

COMPLETION

1. ____________________ is the process by which the parent and infant come to love and accept each other.

ANS:

Attachment

By using the terms attachment and bonding, Klaus and Kennell originally proposed that the period shortly after birth is important to mother and infant attachment. Attachment is developed and maintained by proximity to and interaction with the infant. It also occurs through a mutually satisfying experience.

DIF: Cognitive Level: Comprehension REF: 507

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Evaluation

TRUE/FALSE

1. Hearing-impaired parents face many challenges related to 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 clients. Is this statement true or false?

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 clients. This includes providing certified interpreters who are proficient in sign language.

DIF: Cognitive Level: Comprehension REF: 523

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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