Chapter 5: Psycho-Social-Cultural Aspects of the Antepartum Period by Chapman and Durham

9. A pregnant client at 20 weeks' gestation comes to the clinic for her prenatal visit. Which of the following client statements would indicate a need for further assessment?

"I hate it when the baby moves." Experiencing quickening as unpleasant may be a sign of maladaptation to pregnancy and needs further assessment by the nurse. b. This is an expected finding in maternal adaptation and development of the maternal role.

Jenny, a 21-year-old single woman, comes for her first prenatal appointment at 31 weeks' gestation with her first pregnancy. The clinic nurse's most appropriate statement is:

"Jenny, by your information, you are 31 weeks' gestation in this pregnancy. Do you have questions for me before I begin your prenatal history and information sharing?" The initial interview time with the patient should be used to build a positive, nonthreatening relationship and to gain her confidence by respecting her choices and advocating for continued prenatal care. The prenatal nurse's objective is to provide a user-friendly service that is efficient, effective, caring, and patient centered.

The perinatal nurse screens all pregnant women early in pregnancy for maternal attachment risk factors, which include (select all that apply):

-Adolescence -Low educational level -History of depression Maternal attachment to the fetus is an important area to assess and can be useful in identifying families at risk for maladaptive behaviors. The nurse should assess for indicators such as unintended pregnancy, domestic violence, difficulties in the partner relationship, sexually transmitted infections, limited financial resources, substance use, adolescence, poor social support systems, low educational level, the presence of mental conditions, or adolescence that might interfere with the patient's ability to bond with and care for the infant. A strong support system can facilitate the patient's ability to bond with and care for the infant.

Strategies for culturally responsive care include (select all that apply):

-Examining one's own biases -Learning another language The only actions among the choices that are culturally responsive are examining one's own biases and learning another language. Ethnocentrism and stereotyping are not culturally responsive actions.

The clinic nurse encourages paternal attachment during pregnancy by including the father in (select all that apply):

-Ultrasound appointments -Prenatal class information -History taking and obtaining prenatal screening information Pregnancy is psychologically stressful for men; some enjoy the role of nurturer, but others feel alienated and begin to stray from the relationship. The nurse can be instrumental in promoting early paternal attachment. Involvement of the father during examinations and tests and prenatal classes, along with thorough explanations of the need for them, can minimize the father's feelings of being left out. A history and prenatal screening should be conducted at the first prenatal visit with the woman alone to ensure confidentiality and an open discussion of any problems or concerns she may have. The history should include information about the current pregnancy; the obstetric and gynecologic history; and a cultural assessment, and a medical, nutritional, social, and family (including the father's) medical history.

What is the most common expected emotional reaction of a woman to the news that she is pregnant?

Ambivalence Ambivalence is a normal expected reaction to the news of pregnancy, whether or not the pregnancy is planned or wanted.

Sally is in her third trimester and has begun to sing and talk to the fetus. Sally is probably exhibiting signs of:

Attachment Correct, because talking to the fetus is a sign of positive maternal adaptation. All other answers indicate pathology.

A pregnant client asks the nurse why she should attend childbirth classes. The nurse's response would be based on which of the following information?

Childbirth classes will help new families develop skills to meet the challenges of childbirth and parenting. Correct. These are the stated goals of childbirth education (ICEA, Lamaze).

The clinic nurse visits with Wayne, a 32-year-old man whose partner is pregnant for the first time and is at 12 weeks. Wayne describes nausea and vomiting, fatigue, and weight gain. His symptoms are best described as:

Couvade syndrome In preparation for parenthood, the male partner moves through a series of developmental tasks. During the first trimester, the father begins to deal with the reality of the pregnancy and may worry about financial strain and his ability to be a good father. Feelings of confusion and guilt often surface with the recognition that he is not as excited about the pregnancy as his partner, and couvade syndrome, the experience of maternal signs and symptoms, may develop.

Jane's husband Brian has begun to put on weight. What is this a possible sign of?

Couvade syndrome Correct. Couvade syndrome has symptoms that mimic changes of pregnancy.

The nurse is interviewing a pregnant client who states she plans to drink chamomile tea to ensure an effective labor. The nurse knows that this is an example of:

Cultural prescription Correct. Cultural prescription is an expected behavior of the pregnant woman during the childbearing period.

When providing a psychosocial assessment on a pregnant woman at 21 weeks' gestation, the nurse would expect to observe which of the following signs?

Happiness The nurse would expect the patient to exhibit signs of happiness at this time.

Taboos are cultural restrictions that:

Have serious supernatural consequences Taboos are believed to have serious supernatural consequences. Taboos are not known to have clinical or superstitious consequences and are not functional or neutral practices.

Which of the following would be a priority for the nurse when caring for a pregnant woman who has recently emigrated from another country?

Identify her support system. Correct, because lack of social support has been correlated with an increased risk of pregnancy complications and difficult adaptation to pregnancy. Pregnant women who are recent immigrants face many challenges in obtaining needed social support, and the nurse should first identify her support system to plan further interventions and referrals.

Cathy is pregnant for the second time. Her son, Steven, has just turned 2 years old. She asks you what she should do to help him get ready for the expected birth. What is the nurse's most appropriate response?

If Steven's sleeping arrangements need to be changed, it should be done well in advance of the birth. Children still sleeping in a crib should be moved to a bed at least 2 months before the baby is due, as this age group is particularly sensitive to disruptions of the physical environment.

14. An example of a cultural prescriptive belief during pregnancy is:

Remain active during pregnancy The belief that the patient should remain active during pregnancy is the only example of a cultural prescriptive belief. All of the other answers are examples of cultural restrictive beliefs.

Which statement best exemplifies adaptation to pregnancy in relation to the adolescent?

The pregnant adolescent faces the challenge of multiple developmental tasks. Correct. Pregnant adolescents face conflicting and multiple developmental tasks of pregnancy and adolescence at the same time.

A woman presents for prenatal care at 6 weeks' gestation by LMP. Which of the following findings would the nurse expect to see?

Maternal ambivalence Ambivalence is a common feeling of women during the first trimester.

Which of the following information regarding sexual activity would the nurse give a pregnant woman who is 35 weeks' gestation?

Sexual activity may require different positions to accommodate the woman's comfort. Correct. An enlarging abdomen creates feelings of awkwardness and bulkiness and may require couples to modify intercourse positions for the pregnant woman's comfort.

A first-time father is experiencing couvade syndrome. He is likely to exhibit which of the following symptoms or behaviors?

Urinary frequency Urinary frequency is a common symptom of couvade.