Chapter 20 OB
With regard to parents early and extended contact with their infant and the relationships built, nurses should be aware that:
Extended contact is especially important for adolescents and low-income women because they are at risk for parenting inadequacies.
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:
Attachment, or bonding, is a process that occurs over time and does not require early contact.
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?
Seldom makes eye contact with her son
The nurse can help a father in his transition to parenthood by:
Pointing out that the infant turned at the sound of his voice.
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 would recognize that the woman is experiencing:
Postpartum (PP) blues.
After giving birth to a healthy infant boy, a primiparous woman, 16 years old, 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?
Provide time for the patient to bathe her infant after she views an infant bath demonstration.
The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is to:
Show the mother how the infant initiates interaction and pays attention to her.
In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. Which one is a facilitating behavior?
The parents hover around the infant, directing attention to and pointing at the infant.
In the United States the en face position is preferred immediately after birth. Nurses can facilitate this process by all of these actions except:
Washing both the infants face and the mothers face.
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:
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.
When the infants behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics, this is called:
mutuality
During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and accept the real baby? Letting go
ANS: A Accepting the real infant and relinquishing the fantasy infant occurs during the letting-go phase of maternal adjustment. During the taking-hold phase the mother assumes responsibility for her own care and shifts her attention to the infant. In the taking-in phase the mother is primarily focused on her own needs. There is no taking-on phase of maternal adjustment. PTS: 1 DIF: Cognitive Level: Knowledge REF: 516 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
The mother-baby nurse is able to recognize reciprocal attachment behavior. This refers to: The positive feedback an infant exhibits toward parents during the attachment process.
ANS: A In this definition, reciprocal refers to the feedback from the infant during the attachment process. This is a good time for bonding; however, it does not define reciprocal attachment. Reciprocal attachment applies to feedback behavior and is not unidirectional. PTS: 1 DIF: Cognitive Level: Application REF: 518 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
Which concerns about parenthood are often expressed by visually impaired mothers (Select all that apply)? a. Infant safety b. Transportation 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. PTS: 1 DIF: Cognitive Level: Comprehension REF: 524 OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance
A parent who has a hearing impairment is presented with a number of challenges in parenting. Which nursing approaches are appropriate for working with hearing-impaired new parents (Select all that apply)? a. Use devices that transform sound into light. d. Ascertain whether the patient can read lips before teaching. e. Written messages aid in communication.
ANS: A, D, E Section 504 of the Rehabilitation Act of 1973 requires that hospitals use various communication techniques and resources with the deaf and hard of hearing patient. This includes devices such as door alarms, cry alarms, and amplifiers. Before initiating communication, the nurse needs to be aware of the parents preferences for communication. Not all hearing-impaired patients know sign language. Do they wear a hearing aid? Do they read lips? Do they wish to have a sign language interpreter? If the parent relies on lip reading, the nurse should sit close enough so that the parent can visualize lip movements. The nurse should speak clearly in a regular voice volume, in short, simple sentences. Written messages such as on a black or white erasable board can be useful. Written materials should be reviewed with the parents before discharge. PTS: 1 DIF: Cognitive Level: Application REF: 524 OBJ: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment
The best way for the nurse to promote and support the maternal-infant bonding process is to: Assist the family with rooming-in.
ANS: C Close and frequent interaction between mother and infant, which is facilitated by rooming-in, is important in the bonding process. This is often referred to as the mother-baby care or couplet care. Having the mother express her feelings is important; however, it is not the best way to promote bonding. The mother needs time to rest and recuperate; she should not be expected to do all of the care. The patient needs to observe the infant during all stages so she will be aware of what to anticipate when they go home. PTS: 1 DIF: Cognitive Level: Comprehension REF: 516 OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
To promote bonding and attachment immediately after delivery, the most important nursing intervention is to: Assist the mother in assuming an en face position with her newborn.
ANS: B Assisting the mother in assuming an en face position with her newborn will support the bonding process. The mother should be given as much privacy as possible; however, nursing assessments must still be continued during this critical time. The mother has just delivered and is more focused on the infant; she will not be receptive to teaching at this time. This is a good time to initiate breastfeeding; however, the mother first needs time to explore the new infant and begin the bonding process. PTS: 1 DIF: Cognitive Level: Application REF: 519 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
A man calls the nurses station and states that his wife, who delivered 2 days ago, is happy one minute and crying the next. The man says, She was never like this before the baby was born. The nurses initial response could be to: Reassure him that this behavior is normal.
ANS: B Before providing further instructions, inform family members of the fact that postpartum blues are a normal process. Telling her partner to ignore the mood swings does not encourage further communication and may belittle the husbands concerns. Postpartum blues are usually short-lived; no medical intervention is needed. Client teaching is important; however, the new fathers anxieties need to be allayed before he will be receptive to teaching. PTS: 1 DIF: Cognitive Level: Application REF: 517 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
Other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that, despite what folk wisdom may say: Infants can learn to distinguish their mothers voice from others soon after birth.
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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 515 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance
When working with parents who have some form of sensory impairment, nurses should understand that ________ is an inaccurate statement. Visually impaired mothers cannot overcome the infants need for eye-to-eye contact.
ANS: B Other sensory output can be provided by the parent, other people can participate, and other coping devices can be used. The skepticism, open or hidden, of health care professionals places an additional and unneeded hurdle for the parents. After the parents capabilities have been assessed (including some the nurse may not have expected), the nurse can help find ways to assist the parents that play to their strengths. The Internet affords an extra teaching tool for the deaf, as do videos with subtitles or nurses signing. A number of electronic devices can turn sound into light flashes to help pick up a childs cry. Sign language is readily acquired by young children. PTS: 1 DIF: Cognitive Level: Comprehension REF: 523 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance
With regard to the adaptation of other family members, mainly siblings and grandparents, to the newborn, nurses should be aware that: Participation in preparation classes helps both siblings and grandparents.
ANS: B Preparing older siblings and grandparents helps everyone to adapt. Sibling rivalry should be expected initially, but the negative behaviors associated with it have been overemphasized and stop in a comparatively short time. In the United States, in contrast to other cultures, paternal grandparents frequently consider themselves secondary to maternal grandparents. The number of grandparents providing permanent child care has been on the increase. PTS: 1 DIF: Cognitive Level: Comprehension REF: 525 OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
The postpartum woman who continually repeats the story of her labor, delivery, and recovery experience is: Making the birth experience real.
ANS: B Reliving the birth experience makes the event real and helps the mother realize that the pregnancy is over and that the infant is born and is now a separate individual. The retelling of the story is to satisfy her needs, not the needs of others. This new mother is in the taking-in phase, trying to make the birth experience seem real and separate the infant from herself. PTS: 1 DIF: Cognitive Level: Knowledge REF: 516 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
Of the many factors that influence parental responses, nurses should be conscious of negative stereotypes that apply to specific patient populations. Which response could be an inappropriate stereotype of adolescent mothers? Adolescent mothers have a higher documented incidence of child abuse.
ANS: C Adolescent mothers are more inclined to have a number of parenting difficulties that benefit from counseling; however, a higher incidence of child abuse is not one of them. Midlife mothers have many competencies, but they are more likely to have to deal with career issues and the accompanying stress. PTS: 1 DIF: Cognitive Level: Comprehension REF: 521 OBJ: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity
On observing a woman on her first postpartum day sitting in bed while her newborn lies awake in the bassinet, the nurse should: Hand the baby to the woman.
ANS: C During the taking-in phase of maternal adaptation (the mother may be passive and dependent), the nurse should encourage bonding when the infant is in the quiet alert stage. This is done best by simply giving the baby to the mother. The patient is exhibiting expected behavior during the taking-in phase; however, interventions by the nurse can facilitate infant bonding. The patient will learn best during the taking-hold phase. PTS: 1 DIF: Cognitive Level: Application REF: 516 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
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? PPD can easily go undetected.
ANS: C PPD can go undetected because parents do not voluntarily admit to this type of emotional distress out of embarrassment, fear, or guilt. PPD symptoms range from mild to severe, with women having both good and bad days. Both mothers and fathers should be screened. PPD may also affect new fathers. The nurse should include information on PPD and how to differentiate this from the baby blues for all clients on discharge. Nurses also can urge new parents to report symptoms and seek follow-up care promptly if symptoms occur. PTS: 1 DIF: Cognitive Level: Synthesis REF: 517 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity
A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled for discharge. As you prepare her for discharge, she begins to cry. Your initial action should be to Allow her time to express her feelings.
ANS: D Although many women experience transient postpartum blues, they need assistance in expressing their feelings. This condition affects 50% to 80% of new mothers. There should be no assumption that the patient is in pain, when in fact she may have no pain whatsoever. This is blocking communication and inappropriate in this situation. The patient needs the opportunity to express her feelings first; patient teaching can occur later. PTS: 1 DIF: Cognitive Level: Application REF: 517 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
A nurse is observing a family. The mother is holding the baby she delivered less than 24 hours ago. Her husband is watching his wife and asking questions about newborn care. The 4-year-old brother is punching his mother on the back. The nurse should: Realize that this is a normal family adjusting to family change.
ANS: D The observed behaviors are normal variations of families adjusting to change. There is no need to report this one incident. Giving advice at this point would make the parents feel inadequate. PTS: 1 DIF: Cognitive Level: Analysis REF: 518 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
Nursing activities that promote parent-infant attachment are many and varied. One activity that should not be overlooked is management of the environment. While providing routine mother-baby care, the nurse should ensure that: 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. PTS: 1 DIF: Cognitive Level: Application REF: 528 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
After they are born, 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: 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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 515 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
A new father states, I know nothing about babies, but he seems to be interested in learning. This is an ideal opportunity for the nurse to: Include him in teaching sessions.
ANS: D The nurse must be sensitive to the fathers needs and include him whenever possible. As fathers take on their new role, the nurse should praise every attempt, even if his early care is awkward. It is important to note the bonding process of the mother and the father; however, that does not satisfy the expressed needs of the father. The new father should be encouraged in caring for his baby by pointing out the things that he does right. Criticizing him will discourage him. PTS: 1 DIF: Cognitive Level: Application REF: 521 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance
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?
Grandparents can help you with parenting skills and also help preserve family traditions.
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:
claiming