Chapter 13 (MN) Postpartal Period: Transition to Parenthood

Question 29. A new mother asks the nurse, "Why is my baby opening his mouth and turning his head?" What are the appropriate encouraging responses from the nurse? Select all that apply. 1. "Your baby is hungry. Great job on noticing the signs that he needs you." 2. "This is called 'rooting' and it is a normal infant response." 3. "He's hungry, go ahead and feed him." 4. "Why do you think? What could he be telling you?" 5. "Sometimes babies do that. I will get you a pacifier."

1,2,4 Rationales Option 1: This response encourages the mother to keep noticing the infant's cues to hunger. Option 2: What the infant is doing is called rooting and explaining it to the mother will help her know it's normal. Option 3: Though this is a correct response, it does not encourage the mother that she is doing a good job in recognizing her infant's hunger cues. Option 4: These are two open ended questions to help the mother brainstorm what might be going on to understand her infant's feeding cues. Option 5: This does not recognize the infant's hunger cues. [Page reference: 407-408]

Question 26. The nurse is caring for a patient on the postpartum unit. The patient is confined to a wheelchair and the nurse is educating on infant care. What are the appropriate nursing considerations for this patient? Select all that apply. 1. Discuss strategies for adapting infant care to limitations. 2. Review any need for assistance at home with the patient. 3. Schedule home health visits daily for the newborn after discharge. 4. Wait until the partner arrives to plan care, as the partner is not confined to a wheelchair. 5. Discuss safety considerations for infant care and transfer.

1,2,5 Rationales Option 1: It is important to make adaptations that are individualized to the patient's needs to care for the infant. Option 2: The parents may desire additional help at home or additional equipment to be acquired. Option 3: Home health may be appropriate; however, it would be discussed with the patient and provider first. Option 4: Limiting infant care to only the abled bodied parent is not an appropriate nursing response. Option 5: Safety is a top priority for all new parents. [Page reference: 412]

Question 47. The nurse is discussing the stages of "becoming a mother" with a patient. In what order will the nurse review the stages? 1-Increasing attachment to infant 2-Achieving maternal identity 3-Moving toward a new normal 4-Commitment and preparation for infant

4,1,3,2 Correct Correct Feedback [Page reference: 399-400]

Question 9. The nurse notes new a new mother is not making eye contact with her infant. What action should the nurse take? 1. Check for other positive indications for bonding. 2. Refer the patient to social work for work/behavior. 3. The nurse should delay discharge and make the patient stay another day. 4. Nothing, she is just a new and inexperienced mother.

1 Rationales Option 1: Eye contact with the infant is just one observation of positive bonding, but is also considered inappropriate in some cultures. It is best to look at all behaviors before drawing a conclusion. Option 2: This may be an appropriate response if the woman was not moving into the taking-hold stage of bonding. Option 3: The patient acting within her cultural beliefs is not a reason to delay discharge. Option 4: Though this may be true, this is not an action for the nurse to take. [Page reference: 404-405]

Question 33. Following discharge instructions, a patient asks the nurse about the en face position with the infant. The patient read this in a parenting book. What does the nurse include in the response? 1. "The parent holds the infant in a position that allows for face-to-face and eye contact." 2. "The parent places the infant on their stomach with the infant's face down." 3. "The parent places the infant's face against the breast to facilitate breastfeeding." 4. "The parent holds the infant in a position that facilitates gaining neck and head control."

1 Rationales Option 1: The en-face position is a position in which the mother and infant are face-to-face with eye contact. Option 2: The en-face position is a position in which the mother and infant are face-to-face with eye contact. Option 3: The en-face position is a position in which the mother and infant are face-to-face with eye contact. Option 4: The en-face position is a position in which the mother and infant are face-to-face with eye contact. [Page reference: 406]

Question 46. The nurse is describing the transition to parenthood during a childbirth education course. During the class, the nurse mentions that most knowledge of parental expectations comes through observation of other parents. What term does the nurse use to describe this knowledge acquisition? 1. Incidental 2. Intentional 3. Instructional 4. Interrogation

1 Rationales Option 1: The type of knowledge acquisition obtained through observations of others is called incidental learning. Option 2: Intentional learning occurs through formal instruction. Option 3: Instructions that are formal comprise intentional learning. Option 4: While asking questions can result in knowledge acquisition, this is likely intentional in nature [Page reference: 399]

Question 7. The postpartum nurse is reviewing the chart of a lesbian couple. When answering the patient's questions, which would prompt the nurse to provide further education? 1. "We both plan to breastfeed, but can we start with a bottle?" 2. "We both plan to breastfeed, can the baby latch onto my breast within the first hour?" 3. "We both plan to breastfeed therefore we should both do skin to skin contact." 4. "We both plan to breastfeed, but we will need a lactation consultant to help with options."

1 Rationales Option 1: This response shows the mothers does not understand the initiation of lactation starts with skin to skin contact and breastfeeding within one hour of birth. Option 2: This response shows the mother understands how important it is to start breastfeeding early on. Option 3: Skin to skin contact has been shown to aid in better breastfeeding. Option 4: This response shows that they will need professional help with the initiation of lactation in both mothers. [Page reference: 20-21]

Question 36. The nurse is caring for a primiparous woman who just delivered her child. Which action should the nurse take to adhere to the taking-in stage? 1. Help the mother change the diaper. 2. Give the patient time to reflect. 3. Start to teach about her new mother body. 4. Start to promote maternal independence.

2 Rationales Option 1: No duty should be happening right now. The mother will learn this, but not immediately after birth. Option 2: This is important for the patient. Labor, whether it's lengthy or not, it is hard. Women need time to reflect and love their new baby. Option 3: The mother will need to learn this, but not in this stage. Option 4: The mother will learn this later in the postpartum period. [Page reference: 400-401]

Question 11. During a prenatal visit with a lesbian couple, the couple expresses a desire to both breastfeed the infant following delivery. What is the best response by the nurse? 1. "It is only possible for the pregnant patient to breastfeed." 2. "I will let the provider know to discuss methods for inducing lactation." 3. "The infant will experience nipple confusion if both of you try to breastfeed." 4. "You should consider waiting to breastfeed when you carry the next infant yourself."

2 Rationales Option 1: This is not a true statement, as breastfeeding can be induced. Option 2: Acknowledging the patient request and passing the request to the provider is an appropriate response. Option 3: While this is a possibility, it undermines the patient request so is not a great response. Option 4: This is an option, however this response does not acknowledge the patient request. [Page reference: 403]

Question 25. A nurse working on the postpartum unit is caring for a patient who just delivered a male infant. The patient has 4-year-old twin girls at home. What are some concerns the nurse anticipates the mother may have? Select all that apply. 1. Hearing the infant over the other kids 2. Abandonment of the other children 3. Finding things for her spouse to help with 4. Enough time to care for another child 5. Getting enough sleep to care for all three

2,4,5 Rationales Option 1: While this could be a concern for some parents, this would not be a common consideration the mother would anticipate. Option 2: Multiparas commonly feel concerned that they are abandoning their other children to care for a new infant. Option 3: Multiparas are often concerned they will not have enough help, as opposed to too much help. Option 4: Determining how to divide ones time between more children can be challenging. Option 5: With one child, the mother can rest when the infant rests. When the family grows, the mother may be concerned with resting enough to keep up with the older children. [Page reference: 410-411]

Question 21. The postpartum nurse notices the patient holding the infant in the en-face position. What behavior does the nurse note in the chart about this behavior? 1. Bonding 2. Attachment 3. Parenting 4. Breastfeeding

Rationales Option 1: The en-face position occurs when the infant is chest to chest with the mother, allowing the infant and mother to look at each other closely. This position demonstrates bonding by the mother, and can be seen when breastfeeding. Option 2: The en-face position occurs when the infant is chest to chest with the mother, allowing the infant and mother to look at each other closely. This position demonstrates bonding by the mother, and can be seen when breastfeeding. Option 3: The en-face position occurs when the infant is chest to chest with the mother, allowing the infant and mother to look at each other closely. This position demonstrates bonding by the mother, and can be seen when breastfeeding. Option 4: The en-face position occurs when the infant is chest to chest with the mother, allowing the infant and mother to look at each other closely. This position demonstrates bonding by the mother, and can be seen when breastfeeding. [Page reference: 404,406]

Question 24. The nurse is caring for a patient after delivery. The patient and the father of the infant recently broke up. The nurse is discussing co-parenting with the patient. What would not be included in the conversation? 1. Parenting time is equally split between parents. 2. Parents share responsibility in parenting the child. 3. Parents support each other in child care decisions. 4. Parents can be apart and still co-parent successfully.

1 Rationales Option 1: Co-parenting describes a successful shared responsibility and decision-making for parenting, but does not indicate the time each parent spends with the child. Option 2: Co-parenting describes a successful shared responsibility and decision-making for parenting. Option 3: Co-parenting describes a successful shared responsibility and decision-making for parenting. Option 4: Co-parenting describes a successful shared responsibility and decision-making for parenting. [Page reference: 409]

Question 4. The parents of a newborn are ecstatic that the infant is easy to interact with the day after delivery. Later in that shift, the parents ask the nurse if the infant is okay, as the infant is not as responsive to stimuli at this time. What newborn state is the infant currently in? 1. Deep sleep 2. Quiet alert 3. Drowsy 4. Active alert

1 Rationales Option 1: During deep sleep, the infant will be less responsive to stimuli. It is best to not wake the infant during this stage. Option 2: The quiet alert state was likely earlier in the day when the infant was very interactive. Option 3: During a drowsy state, the infant will respond to gentle stimuli. Option 4: During active alert state, the infant requires comforting and a decrease in stimuli. [Page reference: 408]

Question 52. A nurse assigned to care for a couple on the postpartum unit approaches the charge nurse with a concern. The nurse is unsure if the parents are forming an attachment with the infant due to lack of eye contact. How should the charge nurse respond to the concern? 1. Ask the nurse if there are any other positive indications for bonding. 2. Tell the nurse to ask the patients if they are happy to have a baby. 3. Consider the use of a translator to clarify information. 4. Assign a new nurse to care for the couple and infant.

1 Rationales Option 1: Eye contact with the infant is just one observation of positive bonding, but is also considered inappropriate in some cultures. It is best to look at all behaviors before drawing a conclusion. Option 2: While this is a possibility, the charge nurse does not stimulate critical reflection in the nurse with this answer. Option 3: This may be a possibility, however, this assumes that lack of eye contact is a problem. Option 4: There is no indication that assigning a new nurse to the family is required at this time. [Page reference: 404,406]

Question 48. The nurse is caring for a patient following the delivery of a 36-week infant due to maternal preeclampsia. The infant is stable and rooming-in with the mother. The nurse observes the mother demonstrating a slow response to the infant cues. What does nurse attribute this slow response to? 1. Magnesium sulfate infusion 2. Increased blood pressure 3. Hyperactive reflexes 4. Subtle cues due to prematurity

1 Rationales Option 1: Magnesium sulfate depresses the central nervous system and can contribute to slowed response time. This medication is common in preeclamptic patients for seizure prevention. Option 2: While increased blood pressure can occur in untreated preeclampsia, this is unlikely to contribute to a delay in response time. Option 3: Hyperactive reflexes can be demonstrated in untreated preeclampsia, however this does not contribute to a delay in response time. Option 4: A 36 week infant is considered premature, however, this late preterm infant would be expected to have cues similar to that of an early term infant. [Page reference: 400]

Question 22. A patient is in the office during the second trimester of pregnancy. The patient is concerned that her husband stated that he never fantasized about becoming a father as a child. What is the appropriate nursing response? 1. "Men often do not fantasize about fatherhood as children." 2. "He will probably not be a good father." 3. "He will come around eventually." 4. "That is very unusual, and counseling might be helpful."

1 Rationales Option 1: Men are different than women and generally do not fantasize about fatherhood as children, nor do they usually role-play while they are children. Option 2: This statement is inaccurate and is not beneficial to the patient's concern. Option 3: While this is likely true, this statement does not address the patient's concern. Option 4: The statement made by the husband is common for men, so this response is not accurate. [Page reference: 401]

Question 18. The phone triage nurse at an obstetrical office receives a call from a patient who delivered a healthy infant 1 week ago. The patient states that she is irritable and crying easily. What postpartum concern does the nurse educate the patient on? 1. Postpartum blues 2. Postpartum depression 3. Postpartum psychosis 4. Premenstrual syndrome

1 Rationales Option 1: Postpartum blues is a normal finding that occurs in many women in the first weeks after delivery. This is limited to transitory symptoms that do not impact care of the infant. Option 2: Postpartum depression is more serious than postpartum blues, and is abnormal when seen. Women are unable to care effectively for the infant with this condition. Option 3: Postpartum psychosis is rare, and is an emergency situation. Women may be delusional and have hallucinations. Option 4: Premenstrual syndrome often demonstrates mood swings and crying, however the timing of these symptoms fits postpartum blues. [Page reference: 412]

Question 2. A nurse is completing hospital orientation on the postpartum unit at a large hospital. During the orientation, the nurse participates in some classroom education on nursing theory. Which theorist would be included when discussing the early foundations of postpartum care? 1. Reba Rubin 2. Hildegard Peplau 3. Ramona Mercer 4. Jean Watson

1 Rationales Option 1: Reba Rubin formulated her theory surrounding the process of postpartum adaptation in 1984. Option 2: Hildegard Peplau is known for her theory work in the specialty area of mental health. Option 3: Ramona Mercer was a student and colleague of Rubin's and completed theoretical work on the maternal role attainment in 1995. Option 4: Jean Watson is best known for her caring theories in nursing. [Page reference: 400-401]

Question 37. The nurse walks into a postpartum room noting a screaming infant in a crib near the bedside. Both parents are asleep. Which statement by the mother shows the need for further assessment for ineffective bonding? 1. "Sorry, it won't stop crying, and we are so tired." 2. "We are so tired, she kept us up all night." 3. "We are so tired, we must have been sound asleep." 4. "We are so tired. What if this happens at home?"

1 Rationales Option 1: Referring to the child as "it" can reflect bonding issues. Option 2: This response acknowledges the infant's gender and shows the parents were caring for their baby all night. Option 3: This response does not show the mother having ineffective bonding because it doesn't mention the baby. Option 4: This response is normal to the new parent to worry a little. [Page reference: 398]

Question 42. The nurse assesses a mother's bonding with her new baby. Which action made by the mother does the nurse identify as the initial maternal phase? 1. The mother relives and speaks of the birthing experience 2. The mother responding and picking up the infant when she cries 3. The mother goes back to work. 4. The mother asking questions about infant care

1 Rationales Option 1: The mother reliving and speaking of the birthing experience represents the initial "taking in" maternal phase. Option 2: The mother responding and picking up the infant when she cries is a cue later during the second stage when the mother starts caring for the infant on her own. Option 3: The mother going back to work or school is part of the later "letting-go" maternal phase. Option 4: The mother asking questions about infant care comes later during the second stage when the mother is caring for her newborn. [Page reference: 401]

Question 15. The nurse enters the room of a postpartum patient just as the patient's mother is leaving the room. The patient appears upset, and tells the nurse that her mother does not think she should breastfeed the infant because it is gross. How should the nurse respond? 1. "Tell me how this makes you feel." 2. "You should listen to your mother." 3. "Breastfeeding is great for the infant." 4. "Just ignore people who upset you."

1 Rationales Option 1: Understanding how the mother's statement makes the patient feel, will allow for the nurse to guide the patient through the concern. Option 2: Family members will often offer advice to new parents, but good and bad advice. It is important for the parents to make decisions for themselves and stay true to their parenting decisions. Option 3: This is a true statement, however it does not address the conflict the patient is experiencing due to her mother's statement. Option 4: Family members will often offer advice to new parents, but good and bad advice. It is important for the parents to make decisions for themselves and stay true to their parenting decisions. [Page reference: 407]

Question 12. A new nurse is assigned to care for a lesbian couple on the mother-baby unit. The nurse is heterosexual has never cared for a homosexual patient before. What is important for the nurse to do prior to meeting the couple? 1. Perform self-reflection of personal beliefs on homosexuality. 2. Review the laws for same-sex parents. 3. Ask the previous nurse if both parents are called mom. 4. Discuss the care with the charge nurse for the shift.

1 Rationales Option 1: When caring for patients who may be different from oneself, it is imperative to reflect on one's personal beliefs and consider the impact that beliefs have on behavior. Option 2: While it may be important to understand the laws that pertain to this couple, it would not be the most time sensitive consideration. Option 3: This information would not impact the care of the patient in a significant manner. Option 4: While planning care and consulting with the charge nurse can be important, it is not the most time sensitive item for the patient. [Page reference: 403]

Question 44. The nurse is caring for a patient that speaks Spanish. When using an interpreter, it's inappropriate to use which phrase when talking to the patient? 1. \"Tell her it\"s okay and I will be here with her.\" 2. \"You\"re 5cm dilated, which means you are halfway to having to push.\" 3. \"You baby needs to eat, how can I help you feed her?\" 4. \"Did you baby have a wet diaper or a dirty diaper?\"

1 Rationales Option 1: When using an interpreter, avoid saying, "Tell him/her...." Option 2: "You\"re 5cm dilated, which means you are halfway to having to push." This statement gives the patient information and clarification of the information. Option 3: "Your baby needs to eat, how can I help you feed her?" This statement offers help and doesn't expect the patient to do anything by herself. Option 4: \"Did you baby have a wet diaper or a dirty diaper?\" This statement is closed ended with choices. Instead of Yes or No questions. [Page reference: 412]

Question 43. Why is it important for nurses to understand cultural competence for parental phases? 1. Cultural beliefs can influence the woman's behaviors and the amount of time she spends in each phase. 2. Cultural beliefs influence the degree of the father\"s care for the infant. 3. Cultural beliefs can affect the role of extended family members. 4. Cultural beliefs can influence the infant\"s name. 5. Cultural beliefs can influence parental decisions when disciplining a young child.

1,2,3,4 Rationales Option 1: Cultural beliefs influence the ways parents relate to and care for their infants, including the role of fathers during the postpartum period and care of infants. An awareness of variations across cultural practices is an important component in providing appropriate care. Option 2: Cultural beliefs affect the mother and the father for influencing parental care for the infant. Option 3: Cultural beliefs can influence how the extended family helps the new parents in transitioning to parenthood Option 4: Cultural beliefs can influence a baby's name due to traditions. Option 5: Disciplining a child should be the same throughout cultures through positive parenting. [Page reference: 407]

Question 45. During an office visit at 2-weeks postpartum, the gravida 3, para 3 patient, she mentions an increase in stress level following delivery of this child. The nurse explains that the increase may be attributed to which considerations? Select all that apply. 1. Increase in childcare tasks 2. Financial concerns 3. Lack of paternal participation 4. Increase in fatigue level 5. Decrease in partner intimacy

1,2,4 Rationales Option 1: While this is the third child, there is now even more childcare tasks that need to be completed. Option 2: Financial considerations can increase stress and relate to the costs of another child, medical bills, and missed work. Option 3: Without definitive information to indicate the father is not participating, this answer cannot be assumed. Option 4: Fatigue is a common occurrence following delivery of a child and can increase the level of stress. Option 5: Lack of intimacy could be a concern; however, it is not expected. [Page reference: 410-411]

Question 8. The father of a 5-week-old newborn calls the labor and delivery department. He mentions his wife is constantly crying and won't sleep. What are appropriate nursing interventions based on this information? Select all that apply. 1. Explain signs and symptoms of postpartum depression 2. Provide resources 3. Let it go for another week or so 4. Ask what he has done at home so far 5. Ask to speak to her and refer to physician

1,2,4,5 Rationales Option 1: This is important for the father to know to understand why she may be feeling this way. Option 2: This is important for the father to be able to contact the right people to help. Option 3: Letting it go can turn into psychosis and suicidal thoughts. Option 4: This can help gather what he has done to try to help and encourages him that calling is the best help he could do. Option 5: It's important to triage the patient over the phone to make sure she is safe. [Page reference: 412]

Question 53. The nurse educator for the Neonatal Intensive Care Unit (NICU) is preparing a pamphlet for parents when the newborn is admitted to the NICU after delivery. Attachment is a common area of concern that new parents have in these situations. What suggestions can the nurse include in the pamphlet on enhancing attachment? Select all that apply. 1. Take pictures of the infant for the mother 2. Take a wheelchair to visit the infant when possible 3. Include the times that the parents can call the NICU 4. Offer suggestions for visiting times for the NICU 5. Provide a breast pump so the new mother

1,2,5 Rationales Option 1: Pictures for the mother can enhance the relationship and attachment the parent feels towards the newborn when there is distance due to a NICU stay. Option 2: Visiting the infant as much as possible once able enhances the relationship, bonding and attachment. Option 3: Limiting the times that parents can call or visit the NICU limits the attachment with the infant. Option 4: Limiting the times that parents can call or visit the NICU limits the attachment with the infant. Option 5: Allowing the mother to pump breastmilk offers a connection to parent the infant that is in the NICU and can enhance the feelings of attachment. [Page reference: 405]

Question 27. What actions can the nurse suggest for the patient to provide assistance to the multiparous mother who has concerns about her child feeling abandoned when the new baby arrives? Select all that apply. 1. Spend time with the other child 2. Make her the older child a little helper 3. Take the sibling to the sitter so she can sleep 4. Meal prep 5. Invest in an infant carrier

1,2,5 Rationales Option 1: The oldest child needs to feel part of the family and sometimes spends extra time with the sibling that makes them feel included. Option 2: Having the sibling act as if they are a big help can make them feel wanted. Option 3: This response can be used if the mother is extremely exhausted, but not to help aid her the bonding process. Option 4: While meal prep is helpful to a new mother planning dinner every night, it does not specifically address the needs of her older child. Option 5: Carrying the infant around can help the mother share time with their other child. [Page reference: 410-411]

Question 1. The nurse is preparing information for parents prior to discharge from the hospital. The couple delivered their first son and have one daughter at home. What information does the nurse include on the list of educational topics for the family? Select all that apply. 1. Swaddling methods 2. Sippy cups 3. Breastfeeding 4. Diaper changes 5. Circumcision care

1,3,4,5 Rationales Option 1: Even though this is not the first child, the nurse should always plan to teach all topics to new parents. Option 2: Sippy cups is not a required topic at this time, as this is something that would occur much later on. Option 3: Even though this is not the first child, the nurse should always plan to teach all topics to new parents. Option 4: Even though this is not the first child, the nurse should always plan to teach all topics to new parents. Option 5: Since this is the first male infant, the nurse should expect to review circumcision care with the parents. [Page reference: 7]

Question 35. The nurse is assessing the interaction between a newborn and his father. Which statement by the father shows progressed infant-father bonding? Select all that apply. 1. "I will stay awake with the baby while his mother sleeps." 2. "We're tired, can you take him to the nursery?" 3. "I don't change diapers." 4. "Will you help me wrap him up?" 5. "He looks like his mom."

1,4 Rationales Option 1: This response shows the father is confident and comfortable with his child. Option 2: This response shows apprehension to keep the infant close. Option 3: This response shows the father is not comfortable, nor does he want to care for the baby. Option 4: This response shows an attempt at wanting to care for the infant. Option 5: This does not show the bonding between the baby and his father. [Page reference: 404,406]

Question 5. The parents of a newborn are ecstatic that the infant is easy to interact with the day after delivery. The nurse takes this opportunity to discuss infant alert states. What knowledge related to infant states will the nurse base the appropriate response on? 1. Deep sleep 2. Quiet alert 3. Drowsy 4. Active alert

2 Rationales Option 1: During deep sleep, the infant will be less responsive to stimuli. It is best to not wake the infant during this stage. Option 2: Quiet alert is the best state for infant interaction. Option 3: During a drowsy state, the infant will respond to gentle stimuli. Option 4: During active alert, the infant requires comforting and a decrease in stimuli. [Page reference: 408]

Question 14. When planning care for the following patients, the postpartum nurse anticipates some delayed bonding with three of the assigned couplets. Which couple does the nurse anticipate having little to no concerns with newborn bonding? 1. Infant born at 28 weeks gestation 2. Labor lasting 8 hours 3. Gestational diabetes during the pregnancy 4. Patient recently separated from spouse

2 Rationales Option 1: Premature infants that are separated from the mother can lead to delayed bonding concerns. Option 2: Long or difficult labors can contribute to bonding delays, this labor length is average and does not indicate a concern. Option 3: Pregnancy complications can contribute to delayed bonding following delivery. Option 4: Lack of social support systems can impact bonding with the infant. [Page reference: 404]

Question 19. The nurse enters the room of a postpartum patient and partner to find the patient sitting in the chair holding the infant in a cradle hold position. The partner states the mother is crying and states that she wants to hold the baby but is very uncomfortable. What position would the nurse help the patient into for more comfort? 1. Cross cradle hold in chair 2. Side-lying position in bed with infant 3. Place infant in bassinet 4. In the bed in a cradle position

2 Rationales Option 1: The cross cradle position would cause similar discomfort to the mother. Option 2: The side-lying position is okay to utilize as long as the mother does not fall asleep with the infant. Since there is family in the room, this position would be okay. Option 3: Placing the infant in the bassinet does not allow the mother to hold the infant as desired. Option 4: A cradle position in the bed would cause the same discomfort for the patient. [Page reference: 407]

Question 6. When discussing feeding options with a lesbian couple for their newborn, the nurse notes that both women would like to breastfeed. What is the appropriate nursing response? 1. "Because only one of you conceived, only one of you can breastfeed." 2. "It's not uncommon for both mothers to breastfeed. I will get you in touch with a lactation consultant nurse to help." 3. "Even though you both want to breastfeed, I can only help the patient." 4. "That's great you both want to breastfeed, but only one will be able to lactate."

2 Rationales Option 1: This is a big misconception. Anyone can lactate if given the right tools and supplements. Option 2: Lactation consultants can help introduce lactation to both mothers. Option 3: Even though the patient who delivered is the nurse's patient, the family-centered care model is what should be reflected in care. Option 4: Women are able to lactate through other avenues than childbirth. [Page reference: 403]

Question 17. A nurse in the provider office is assessing a patient who is deaf and uses sign language for communication. The patient is married to a partner who is also deaf. The couple expresses interest in attempting pregnancy. How does the nurse best respond to the couple? 1. "That is a terrible idea, you are both hard of hearing." 2. "Are there adaptations that would help you with an infant?" 3. "How would you know the baby was crying?" 4. "The provider will talk to you about ways to prevent pregnancy."

2 Rationales Option 1: This is a judgmental statement, and should not even be considered by the nurse. Option 2: Most parents with sensory impairments have considered the need for adaptations in caring for a newborn. Curiosity is okay to demonstrate when rapport is established. Option 3: While this appears to address the need for adaptations, it is worded in a confrontational manner. Option 4: This indicates that the couple should not attempt pregnancy. [Page reference: 411-412]

Question 10. During discharge education, the nurse notes the postpartum patient starting to fall asleep. What is the appropriate nursing response to the patient? 1. "You will need to stay awake to learn this important information." 2. "You should rest while the baby is asleep, and I will come back later to review this information." 3. "You will not be able to go home until tomorrow, since you are having trouble staying awake still." 4. "You can nap and I will just review this information with your partner."

2 Rationales Option 1: While the information is important, this response is not therapeutic and does not acknowledge the fatigue experienced by new parents. Option 2: Learning occurs best when the new parents are well rested. A good time to rest is when the infant is resting. The nurse should return when the patient is well rested to allow for an effective educational session. Option 3: Fatigue is a common occurrence in new parents and does not impact discharge timing. Option 4: Discharge education should be provided to both the patient and partner, so this is not the best option. [Page reference: 415]

Question 23. The nurse is caring for a patient on the postpartum unit. The patient is confined to a wheelchair and the nurse is preparing discharge instructions. What should the nurse consider for this patient? Select all that apply. 1. Call child protective services for follow-up on the infant. 2. Discuss the needs for the home setting to successfully care for the infant. 3. Review standard discharge instructions for new parents. 4. Consider referral to social services for further assistance and resources. 5. Ask if there are able-bodied family members who will be caring for the baby.

2,3,4 Rationales Option 1: There is no indication that child services need to be involved in this case. Option 2: Discussing the needs that may be necessary in the home setting is appropriate for discharge. Option 3: All standard instructions should be reviewed, including infant care and postpartum recovery. Option 4: If additional requirements are needed in the home setting, social work can be of assistance. Option 5: This is not an appropriate consideration, as there is no reason to assume the patient cannot care for the infant. [Page reference: 412]

Question 41. The nurse understands that different factors influence role transitions for new parents. Which of these factors are included? Select all that apply. 1. Living on their own 2. How they were parented 3. Length of the relationship between partners 4. Education 5. Finances

2,3,4,5 Rationales Option 1: The couple living on their own is not an identified factor of parenthood transition. The other factors do impact parenthood transition. Option 2: Seeing how they were raised can spill over into the right or wrong ways to parent. Option 3: If the partners have not been together very long, they are still learning one another, so conflict may arise when parenting. Option 4: Low education can hinder parenting choices. Option 5: It's important to have finances under control in order to provide needs for the infant. [Page reference: 398-399]

Question 28. In preparing a childbirth education class, the nurse is planning to discuss the adaptations that family members experience as a result of a new infant in the home. What family members should the nurse include in addition to the parents? Select all that apply. 1. Grandparents of the infant who live across the country and visit once a year 2. Siblings of the parents who will be babysitting often 3. Children of the parents 4. Mother's cousin who lives in the same house as the baby 5. Step-grandmother of the infant who visits often

2,3,4,5 Rationales Option 1: While grandparents are often involved in an infants' care, some family structures do not allow for them to be present often. Option 2: All immediate family members can be impacted by the addition of a new baby. Option 3: All immediate family members can be impacted by the addition of a new baby. Option 4: While extended family members will not always be impacted by a newborn, some family structures include extended family members in the home. Option 5: All immediate family members can be impacted by the addition of a new baby. [Page reference: 409-410]

Question 49. The nurse is preparing a class for first time expectant fathers and are all anticipating delivery in the next couple of months. What known themes for expectant fathers will the nurse include during the class? Select all that apply. 1. Paternal involvement. 2. Fathering older children. 3. Parenting support. 4. College savings. 5. Being there for the child.

2,3,5 Rationales Option 1: Paternal involvement is not a theme that has been identified for expectant fathers. It could be assumed that fathers choosing to attend a class intend to be involved in the child's life. Option 2: It is common for fathers to focus on parenting the children as the get a little older. It would be beneficial to discuss this with the expectant fathers and ways to parent during the infant and toddler years. Option 3: While maternal support is generally a given, support for the fathers during the transition to parenthood is important. Many fathers gain this support from the women in their lives. Option 4: Heaviness of the fathering role may include financial considerations, however, college is not a particular theme by itself. Option 5: Being there and being present in the child's life is a common theme that is present among fathers. [Page reference: 401-402]

Question 34. The student nurse is assisting with discharging an adolescent patient on the postpartum unit. Discharge education on newborn care will need to be provided. What is the student nurse's priority action in preparing the education session ? 1. Prepare a video for the adolescent to watch on newborn care. 2. Ask the maternal grandmother what has already been taught at home on newborn care. 3. Ask the adolescent what she knows about newborn care. 4. Insist that the father of the infant be present for the discharge education.

3 Rationales Option 1: Adolescents learn in a variety of styles. It is best to determine the learning style prior to choosing the learning modality. Option 2: It is often best to include the maternal grandmother in nursing care of an adolescent, however this is not always the case. Option 3: When planning a teaching session, it is always best to ask what the patient already knows. Option 4: The father may or may not be involved, and this is up to the patient. [Page reference: 402]

Question 16. The nurse is caring for a patient on the postpartum unit. The patient and the father of the infant are separated. The father states that he plans to be involved with the infant, as it is helpful for the infant to have two parents to assist with infant development. What term does the nurse use to identify the concept the father is describing? 1. Marriage 2. Joint custody 3. Co-parenting 4. Cohabitating

3 Rationales Option 1: Co-parenting does not require marriage to occur. Option 2: Joint custody can represent a form of co-parenting, but it is a legal document. Option 3: Co-parenting is the process of equal parenting opportunities for both parents. Option 4: Co-parenting does not require cohabitation to occur. [Page reference: 409]

Question 20. The nurse is preparing to offer discharge instructions to a postpartum patient. What does the nurse do to prepare for the education session? 1. Ask the partner to leave the room. 2. Turn off all lights in the room. 3. Turn off the TV in the room. 4. Open the door and curtain to the hallway.

3 Rationales Option 1: The partner should be included in all discharge education. Option 2: Lighting should be adequate to provide discharge education to the patient. Option 3: Turning off the TV limits the distractions during the educational session. Option 4: Opening the door increases the amount of distraction that occurs during the session. [Page reference: 53]

Question 31. The partner of a patient approaches the nurse caring for the patient,12 hours after delivery of a healthy baby girl. The partner expresses concern that the patient appears indecisive and challenged to make even a simple decision. What phase does the nurse explain that this is finding is attributed to? 1. Taking-hold 2. Taking-ground 3. Taking-in 4. Taking-rest

3 Rationales Option 1: The taking hold phase begins about 24 to 48 hours after delivery and lasts for a few weeks as the new mother becomes more independent in infant care. Option 2: This is not one of the phases of postpartum women. Option 3: Taking in is the phase that occurs from delivery until around 24 to 48 hours. During this phase, the mother relies on others for decision-making. Option 4: While rest is important during the postpartum period, this is not a phase for postpartum women. [Page reference: 400-401]

Question 51. During the initial prenatal visit with a newly pregnant lesbian couple following artificial insemination with donor sperm, the couple questions the legal parental rights for the infant. What is the best response by the nurse? 1. "As long as you are married, you will both have parental rights." 2. "There are no states that recognize the parental rights of a lesbian partner." 3. "You will likely need to legally adopt the child to establish parental rights as the non-birthing mother." 4. "This is something you should have considered before the pregnancy."

3 Rationales Option 1: While this may be the case in some states, it is not true in all states. Option 2: Some states do recognize the parental rights for homosexual couples. Option 3: It is generally recommended that the partner legally adopt the infant to ensure parental rights. Option 4: This is not a therapeutic response to the patient's question. [Page reference: 403-404]

Question 38. The nurse is providing teaching to new parents regarding the levels of fatigue that may occur following childbirth. Which statement should the nurse include in the teaching? 1. "You are going to feel less fatigued after 3 months of having your infant at home." 2. "Since you are younger parents, you will feel less fatigued than an older parent would." 3. "Older mothers tend to report higher levels of stress than younger mothers." 4. "Mothers tend to be more fatigued than fathers following the birth of a new infant."

4 Rationales Option 1: A study has shown that both maternal and paternal fatigue increased after childbirth, and the fatigue had remained consistent for over 6 months. Option 2: In a longitudinal study performed on new parents, age was not a contributing factor to fatigue. Option 3: A study has shown that younger mothers are more likely than older mothers to feel stress and depressive symptoms. Option 4: A longitudinal study has shown that mothers tend to feel more fatigued than fathers following childbirth. [Page reference: 398]

Question 40. The nurse is assessing a new mother who brought her 6-month-old infant for a well check. The mother is 16-years-old and her mother came with her to the visit. The infant's grandmother is holding the new baby and answering all of the questions. What part of the becoming a mother process does the nurse note to be lacking? 1. Commitment, attachment and preparation 2. Acquaintance and learning to care 3. Learning a new normal 4. Achieving maternal identity

4 Rationales Option 1: Commitment, attachment and preparation is seen by the mother coming to the appointment with her mother. Option 2: Acquaintance and leaning to care is not seen in this background of the question. Option 3: Indeed, the new mother must learn a new role, but the identity of the mother is what the nurse sees lacking. Option 4: Achievement of a maternal identity begins around 4 months. [Page reference: 402]

Question 54. While in the room assessing an infant on the day of discharge, the nurse notes that the infant is awake and alert. The parents question why the infant is making cooing sounds. What is the appropriate nursing response? 1. "Cooing demonstrates a normal neonatal reflex. 2. "Those sounds don't mean anything." 3. "Only worry if the baby is crying." 4. "Cooing is one way the infant tries to communicate early on."

4 Rationales Option 1: Cooing is normal, but would not be considered a reflex. It is a communication method for newborns. Option 2: This response does not address the parents question. Option 3: Parents should respond to all infant cues as they are learning how their baby communicates. Option 4: Cooing is an early communication method. [Page reference: 408]

Question 32. A nurse on the postpartum unit is instructing a new mother on diaper changes for the newborn. The patient is legally blind. What learning method would the nurse use for the patient? 1. Demonstration with the infant on the warmer 2. Video with return demonstration 3. Handouts in braille with step-by-step instructions 4. Self-demonstration by the mother with verbal cues

4 Rationales Option 1: For a patient who has limited vision, it is best to allow the patient to be close to the infant and provide direct care while talking through the directions for hands on activities. Option 2: For a patient who has limited vision, it is best to allow the patient to be close to the infant and provide direct care while talking through the directions for hands on activities. Option 3: For a patient who has limited vision, it is best to allow the patient to be close to the infant and provide direct care while talking through the directions for hands on activities. Option 4: For a patient who has limited vision, it is best to allow the patient to be close to the infant and provide direct care while talking through the directions for hands on activities. [Page reference: 411-412]

Question 30. The nurse is performing follow up phone calls to postpartum mothers. She calls a woman who is 4-days postpartum and the woman says, "I don't know what's wrong. I keep crying for no reason." The nurse recognizes the statement as what nursing diagnosis? 1. Lack of taking-hold 2. Attachment/bonding issues 3. Postpartum depression 4. Postpartum blues

4 Rationales Option 1: Lack of taking hold does not accompany crying for no reason. Option 2: Attachment and bonding issues are not present by the woman's response. Option 3: The woman has no other signs or symptoms to be diagnosed with postpartum depression Option 4: Crying for no reason is a sign of postpartum blues. [Page reference: 412]

Question 3. The nurse is preparing information for a sibling class for children of parents who are pregnant with another child. While compiling the list of topics, what information would not be appropriate for the nurse to include? 1. Feeling a sense of loss for the youngest child 2. Allowing the child to feel the baby move during the pregnancy 3. Allowing a visit to the hospital to hold the new infant 4. Having the children stay with a grandparent for the first month after delivery

4 Rationales Option 1: This is a common occurrence, especially for the youngest child who is no longer the baby of the family. Option 2: Allowing the child to feel the baby can help to prepare the child. Option 3: Allowing the child to hold the baby as soon as possible helps with the transition and understanding. Option 4: It is best to have the siblings meet the baby as soon as possible after delivery. [Page reference: 410]

Question 39. A nurse observes a 14-year-old and her new baby. The nurse notes the grandmother doing most of the holding and care of the infant. What is the appropriate nursing intervention? 1. Show the patient more baby care videos and ask if she is depressed 2. Tell the mother, "It\"s time to grow up." 3. Point out how well the grandmother is doing with the infant. 4. Tell the patient how well she does when she does the care for the infant.

4 Rationales Option 1: Videos may not help the 14-year-old bond with her baby. She may be depressed, but it's not a quick response by simply asking. Questionnaires are recommended to evaluate postpartum depression. Option 2: It's not appropriate to say this to a patient. Option 3: If the patient thinks the grandmother is doing a better job at caring for her infant than the mother, she may not continue to try at the age of 14. Option 4: This will help build the confidence of the mother if she knows she is doing well at caring for her baby. [Page reference: 402, 403]

Question 13. A patient on the postpartum unit mentions a concern to the nurse about the baby bonding between the infant and father. The nurse discusses the relationships formed between parents and infants. Which component does the nurse discuss as bidirectional? 1. Love 2. Admiration 3. Bonding 4. Attachment

4 Rationales Option 1: While love may be an emotion that is felt, it is not used to describe a relationship component. Option 2: Admiration may be an emotion that new parents feel towards the infant, but is not bidirectional. Option 3: Bonding is unidirectional and involves the parent bonding with the infant. Option 4: Attachment is bidirectional and involves the attachment formed by the parent with the infant and by the infant with the parent. [Page reference: 401-402]

Question 50. The nurse is discharging a 14-year-old patient, who lives with her parents in a suburban neighborhood, following the delivery of a healthy female infant. During the nurse's discharge education, who is most likely to be included? 1. The mother's best friend 2. The school counselor 3. The pastor of the patient's church 4. The grandparents of the infant

4 Rationales Option 1: While the adolescent may request inclusion of the friend, this is not considered most important to the nurse. Option 2: The school counselor will be important when planning for the mother to return to school, but not at the time of discharge. Option 3: The pastor can offer support to the family, but would not be needed to participate in the discharge teaching. Option 4: A majority of adolescent parents still live at home, so it is important to include the parents of the mother in the discharge education. [Page reference: 402, 403]