M: Ch 8

7. Margaret, a 36-year-old divorcee with a successful modeling career, finds out that her 18-year-old married daughter is expecting her first child. Which is a major factor in determining how Margaret will respond to becoming a grandmother? a. Her age b. Her career c. Being divorced d. Age of the daughter

ANS: A Age is a major factor in determining the emotional response of prospective grandparents. Young grandparents may not be happy with the stereotype of grandparents as being old. Career responsibilities may have demands that make the grandparents not as accessible but are not a major factor in determining the woman's response to becoming a grandmother. Being divorced is not a major factor that determines the adaptation of grandparents. The age of the daughter is not a major factor that determines the adaptation of grandparents. The age of the grandparent is a major factor. PTS: 1 DIF: Cognitive Level: Understanding REF: 131 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

23. The nurse is assessing a client in her 37th week of pregnancy for the psychological responses commonly experienced as birth nears. Which psychological responses should the nurse expect to asses? (Select all that apply.) a. The client is excited to see her baby. b. The client has not started to prepare the nursery for the new baby. c. The client expresses concern about how to know if labor has started. d. The client and her spouse are concerned about getting to the birth center in time. e. The client and her spouse have not discussed how they will share household tasks.

ANS: A, C, D As birth nears, the expectant client will express a desire to see the baby. Most pregnant clients are concerned with their ability to determine when they are in labor. Many couples are anxious about getting to the birth facility in time for the birth. As birth nears, a nesting behavior occurs, which means getting the nursery ready. Not preparing the nursery at this stage is not a response that the nurse should expect to assess. Negotiation of tasks is done during this stage. No discussion of division of household chores is not a response that the nurse should expect to assess at this stage. PTS: 1 DIF: Cognitive Level: Analysis REF: 127 OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

9. Which is a major concern among members of lower socioeconomic groups? a. Practicing preventive health care b. Meeting health needs as they occur c. Maintaining an optimistic view of life d. Maintaining group health insurance for their families

ANS: B Because of their economic uncertainty, lower socioeconomic groups place more emphasis on meeting the needs of the present rather than on future goals. Lower socioeconomic groups may value health care but generally cannot afford preventive health care. They may struggle for basic needs and often do not see a way to improve their situation. It is difficult to maintain optimism. Lower socioeconomic groups usually do not have group health insurance. PTS: 1 DIF: Cognitive Level: Understanding REF: 134 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. An expectant client in her third trimester reports that she developed a strong tie to her baby from the beginning and now is really in tune to her baby's temperament. The nurse interprets this as the development of which maternal task of pregnancy? a. Learning to give of herself b. Developing attachment with the baby c. Securing acceptance of the baby by others d. Seeking safe passage for herself and her baby

ANS: B Developing a strong tie in the first trimester and progressing to be in tune is the process of commitment, attachment, and interconnection with the infant. This stage begins in the first trimester and continues throughout the neonatal period. Learning to give of herself is the task that occurs during pregnancy as the woman allows her body to give space to the fetus. She continues with giving to others in the form of food and presents. Securing acceptance of the baby is a process that continues throughout pregnancy as the woman reworks relationships. Seeking safe passage is the task that ends with birth. During this task, the woman seeks health care and carries out cultural practices. PTS: 1 DIF: Cognitive Level: Analysis REF: 129 OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

8. Which comment made by a new mother to her own mother is most likely to encourage the grandmother's participation in the infant's care? a. "Could you help me with the housework today?" b. "The baby is spitting up a lot. What should I do?" c. "I know you are busy, so I'll get John's mother to help me." d. "The baby has a stomachache. I'll call the nurse to find out what to do."

ANS: B Looking to the grandmother for advice encourages her to become involved in the care of the infant. Housework does not encourage the grandmother to participate in the infant's care. Getting John's mother to help and calling the nurse about advice excludes the grandmother. PTS: 1 DIF: Cognitive Level: Analysis REF: 131 OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

4. What is the term for the step in maternal role attainment that relates to the woman giving up certain aspects of her previous life? a. Fantasy b. Grief work c. Role-playing d. Looking for a fit

ANS: B The woman experiences sadness as she realizes that she must give up certain aspects of her previous self and that she can never go back. This is called grief work. Fantasies allow the woman to try on a variety of possibilities or behaviors. This usually deals with how the child will look and the characteristics of the child. Role-playing involves searching for opportunities to provide care for infants in the presence of another person. Looking for a fit is when the woman observes the behaviors of mothers and compares them with her own expectations. PTS: 1 DIF: Cognitive Level: Understanding REF: 128, 129 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

24. A Vietnamese client who speaks little English is admitted to the labor and birth unit in early labor. The nurse plans to use an interpreter during an initial assessment. Which should the nurse plan to implement with regard to using an interpreter? (Select all that apply.) a. Face the interpreter when speaking. b. Listen carefully to what the client says. c. Speak slowly and smile when appropriate. d. Plan to use a male interpreter, even if a female interpreter is available. e. Ask the interpreter to explain exactly what is said as much as possible, instead of paraphrasing.

ANS: B, C, E The nurse planning to use an interpreter should listen carefully to what the client says. The nurse should speak slowly and smile when appropriate. Ask the interpreter to explain exactly what is said, as much as possible, instead of paraphrasing. It is preferable to use a trained female interpreter when one is available instead of a male interpreter. The nurse should face the client when speaking, not the interpreter. PTS: 1 DIF: Cognitive Level: Application REF: 137 OBJ: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity

6. Which situation best describes a man trying on fathering behaviors? a. Reading books on newborn care b. Spending more time with his siblings c. Coaching a little league baseball team d. Exhibiting physical symptoms related to pregnancy

ANS: C Coaching a little league baseball team shows interaction with children and assuming the behavior and role of a father. This best describes a man trying on the role of being a father. Men do not normally read information that is provided in advance. The nurse should be prepared to present information after the baby is born, when it is more relevant. The man will normally seek closer ties with his father. Exhibiting physical symptoms related to pregnancy is called couvade. PTS: 1 DIF: Cognitive Level: Understanding REF: 131 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

1. Which comment made by a client in her first trimester indicates ambivalent feelings? a. "My body is changing so quickly." b. "I haven't felt well since this pregnancy began." c. "I'm concerned about the amount of weight I've gained." d. "I wanted to become pregnant, but I'm scared about being a mother."

ANS: D Ambivalence refers to conflicting feelings. Expressing a concern about being a mother indicates conflicting or ambivalent feelings. Not feeling well since the pregnancy began does not reflect conflicting feelings. The woman is trying to confirm the pregnancy when she is stating the rapid changes to her body. She is not expressing conflicting feelings. By expressing concerns over gaining weight, which is normal, the woman is trying to confirm the pregnancy. PTS: 1 DIF: Cognitive Level: Analysis REF: 124 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

20. The nurse reveals to the patient that the over-the-counter test is verified and that she is pregnant. The patient confides to the nurse, "We have wanted to be pregnant for some time. These last few days I have been questioning our decision. I am feeling really bad right now." What is the nurse's best response? a. "You will come around in time and you will grow to love this baby." b. "Don't feel bad. It is the hormones of pregnancy talking right now." c. "Why do you think you are feeling bad when you wanted to be pregnant?" d. "Your feelings are understandable. Ambivalence is not uncommon right now."

ANS: D Early in pregnancy, ambivalence is not uncommon because pregnancy is a life-changing event, even if planned and strongly desired. The client needs reassurance and validation of these natural feelings. Although it is true that the patient will "grow to love the baby," this statement does not acknowledge her ambivalent feelings. "Don't feel bad" dismisses the patient's natural feelings and is a nontherapeutic response. "Why" is nontherapeutic and places the patient on the defensive in her response. PTS: 1 DIF: Cognitive Level: Application REF: 124 OBJ: Nursing Process Step: Implementation MSC: Client Needs: Health Promotion and Maintenance

13. Which client may require more help and understanding when integrating the newborn into the family? a. A primipara from an upper income family b. A primipara who comes from a large family c. A multipara (gravida 2) who has a supportive husband and mother d. A multipara (gravida 6) who has two children younger than 3 years

ANS: D Pregnancy tasks are more complex for the multipara (gravida 6), and she may need special assistance to integrate the infant into the family structure. A primipara from an upper income family has the financial resources to assist her with daily care of the home. This leaves her free to concentrate on the newborn's needs. The primipara with a large support system has help available to her. The multipara (gravida 2) who has a supportive husband and mother has a support system to assist with integrating the infant into the family structure. PTS: 1 DIF: Cognitive Level: Analysis REF: 133 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

16. A pregnant client comes into the medical clinic stating that her family and friends are telling her that she is always talking about the pregnancy and nothing else. She is concerned that something is wrong with her. What psychological behavior is she exhibiting? a. Antepartum obsession b. Ambivalence c. Uncertainty d. Introversion

ANS: D The client is exhibiting behaviors associated with introversion and/or narcissism. These are normal findings during pregnancy as long as they do not become obsessive to the exclusion of everything else. The client is talking about the pregnancy but there is no evidence that it is affecting her perception of reality and/or ability to perform ADLs. It is normal for pregnant women to focus on the self as being of prime importance in their life initially during the pregnancy. Some women may feel ambivalent about their pregnancy, which is a normal reaction. However, this client's behavior does not support this finding. Some women react with uncertainty at the news of being pregnant, which is a normal reaction. However, this client's behavior does not support this finding. PTS: 1 DIF: Cognitive Level: Application REF: 125 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

11. While teaching an Asian client about prenatal care, the nurse notes that the client refuses to make eye contact. Which is the most likely cause? a. A submissive attitude b. Lack of understanding c. Embarrassment about the subject d. Cultural beliefs about eye contact

ANS: D The nurse must understand that making eye contact means different things in different cultures. The nurse should have a basic understanding of normal responses of various cultures within her community. Asians believe that eye contact shows disrespect, not submission. Many Asian women may nod and smile during client teaching, but this does not show understanding. They are responding that they heard you; validation of information is important. Modesty is important in some cultures, but the main response with this questions is the cultural beliefs. PTS: 1 DIF: Cognitive Level: Understanding REF: 138 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

14. An Asian-American expectant father tells the nurse that he seems to be gaining weight, just like his wife. The nurse recognizes that this behavior is most likely a reflection of which? a. Couvade b. Embarrassment c. Ambivalence regarding the pregnancy d. Limited interest in the well-being of his wife

ANS: A Couvade is when expectant fathers sometimes experience physical symptoms similar to those of pregnant women, such as loss of appetite, nausea, headache, fatigue, and weight gain. The father did not express anything that would indicate embarrassment. There is no indication in the father's statement that he is ambivalent to the pregnancy. There is no data in the question that indicates that the father is not interested in his wife. PTS: 1 DIF: Cognitive Level: Understanding REF: 131 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

22. In some Middle Eastern and African cultures, female genital mutilation is a prerequisite for marriage. Women who now live in North America need care from nurses who are knowledgeable about the procedure and comfortable with the abnormal appearance of their genitalia. When caring for this client, the nurse can formulate a diagnosis with the understanding that the client may be at risk for which of the following? (Select all that apply.) a. Infection b. Laceration c. Hemorrhage d. Obstructed labor e. Increased signs of pain response

ANS: A, B, C, D The client is at risk for infection, laceration, hemorrhage, and obstructed labor. Female genital mutilation, cutting, or circumcision involves removal of some or all of the external female genitalia. The labia majora are often stitched together over the vaginal and urethral openings as part of this practice. Enlargement of the vaginal opening may be performed before or during the birth. The woman is unlikely to give any verbal or nonverbal signs of pain. This lack of response does not indicate lack of pain. In fact, pelvic examinations are likely to be very painful because the introitus is so small, and inelastic scar tissue makes the area especially sensitive. A pediatric speculum may be necessary, and the client should be made as comfortable as possible. PTS: 1 DIF: Cognitive Level: Analysis REF: 136 OBJ: Nursing Process Step: Diagnosis MSC: Client Needs: Psychosocial Integrity

19. Which of the following would be considered to be a system barrier to the birth of prenatal care? a. Adolescent pregnant client b. Inability to schedule an appointment with the health care provider because of a busy medical practice c. Pregnant client has no health insurance d. Having to sign in for the initial appointment and complete health history records

ANS: B A delay in the ability to schedule an appointment with a health care provider is an example of a system barrier to the birth of prenatal care. An adolescent pregnant client would not be considered to be a system barrier but rather a psychosocial factor that would affect the pregnancy state. Having no health insurance is an example of a financial barrier to the birth of prenatal care. Completing a health history record is part of a comprehensive assessment. PTS: 1 DIF: Cognitive Level: Application REF: 134 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. A client who is 7 months pregnant states, "I'm worried that something will happen to my baby." Which is the nurse's best response? a. "Your baby is doing fine." b. "Tell me about your concerns." c. "There is nothing to worry about." d. "The doctor is taking good care of you and your baby."

ANS: B Encouraging the client to discuss her feelings is the best approach. The nurse should not disregard or belittle the client's feelings. Responding that your baby is doing fine disregards the client's feelings and treats them as unimportant. Responding that there is nothing to worry about does not answer the client's concerns. Saying that the doctor is taking good care of you and your baby is belittling the client's concerns. PTS: 1 DIF: Cognitive Level: Application REF: 128 OBJ: Nursing Process Step: Implementation MSC: Client Needs: Psychosocial Integrity

17. During the course of the pregnancy, the client states that she feels a deep connection with her unborn child. This behavior illustrates the maternal task acquisition of: a. safe passage. b. gaining acceptance. c. fostering an interconnection. d. developing empathy through physical actions.

ANS: C During pregnancy, it is important for the mother to relate to and connect with the unborn child as part of the initial attachment and bonding experience. Safe passage refers to securing safety as a primary concern through the pregnancy and birth process. Gaining acceptance relates to behaviors acknowledging the pregnancy as a part of one's maternal role. Pregnant woman may appear to be more nurturing during pregnancy, but this is not necessarily associated through physical actions. PTS: 1 DIF: Cognitive Level: Application REF: 128 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

18. A pregnant client relates a story of how her boyfriend is feeling her aches and pains associated with her pregnancy. She is concerned that her boyfriend is making fun of her concerns. How would you respond to this client statement? a. Tell her not to worry because it is natural for her boyfriend to make her feel better by identifying with her pregnancy. b. Refer the client to a psychologist for counseling to deal with this problem because it is clearly upsetting her. c. Explain that her boyfriend may be experiencing couvade syndrome and that this is a normal finding seen with male partners. d. Ask the client specifically to define her concerns related to her relationship with her boyfriend and suggest methods to stop this type of behavior by her significant other.

ANS: C Provide factual information that will help reduce stress and modify acceptance. Telling her not to worry does not address the possibility that her boyfriend may be experiencing couvade syndrome. The client is expressing concern but does not have all the facts related to couvade syndrome and requires education, rather than referral. Couvade syndrome is not an abnormal condition and should be treated with acceptance and understanding. PTS: 1 DIF: Cognitive Level: Application REF: 131 OBJ: Nursing Process Step: Implementation MSC: Client Needs: Psychosocial Integrity

10. Which comment made by a new mother exhibits understanding of her toddler's response to a new sibling? a. "I can't believe he is sucking his thumb again." b. "He is being difficult and I don't have time to deal with him." c. "When we brought the baby home, we made Michael stop sleeping in the crib." d. "My husband is going to stay with the baby so I can take Michael to the park tomorrow."

ANS: D It is important for a mother to seek time alone with her toddler to reassure him that he is loved. It is normal for a child to regress when a new sibling is introduced into the home. The toddler may have feelings of jealousy and resentment toward the new baby taking attention away from him. Frequent reassurance of parental love and affection are important. Changes in sleeping arrangements should be made several weeks before the birth so the child does not feel displaced by the new baby. PTS: 1 DIF: Cognitive Level: Analysis REF: 132 OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

3. An expectant client asks the nurse about the behavior of "mimicry." Which is an example of mimicry that the nurse should relate to the client? a. Daydreaming about the newborn b. Imagining oneself as a good mother c. Babysitting for a neighbor's children d. Wearing maternity clothes before they are needed

ANS: D Mimicry involves observing and copying the behaviors of other women who are pregnant or are mothers. Wearing maternity clothes before they are needed helps the expectant mother feel what it's like to be obviously pregnant. Daydreaming is a type of fantasy in which the woman tries out a variety of behaviors in preparation for motherhood. Imagining herself as a good mother is the woman's effort to look for a good role fit. She observes behavior of other mothers and compares them with her own expectations. Babysitting other children is a form of role-playing in which the woman practices the expected role of motherhood. PTS: 1 DIF: Cognitive Level: Application REF: 128 OBJ: Nursing Process Step: Implementation MSC: Client Needs: Health Promotion and Maintenance

21. A patient arrives to the clinic 2 hours late for her prenatal appointment. This is the third time she has been late. What is the nurse's best action in response to this patient's tardiness? a. Ask the patient if she has a way to tell the time. b. Ask the patient if she is deliberately being late for her appointments. c. Determine if the patient wants this baby and if this is her way of acting out. d. Determine if the patient arrives after the start time for other types of appointments.

ANS: D Time orientation is viewed differently by other cultures. Native-Americans, Middle Easterners, Hispanics, and American Eskimos tend to emphasize the moment rather than the future. This causes conflicts in the health care setting, in which tests or appointments are scheduled at particular times. If a woman does not place the same importance on keeping appointments, she may encounter anger and frustration in the health care setting. Asking if she has a way to tell time does not get to the potential root of the problem. Asking if she is deliberately late is inconsiderate and nontherapeutic. Although her action may be an acting-out behavior, there are other considerations that must be considered first. PTS: 1 DIF: Cognitive Level: Application REF: 138 OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE

12. The nurse in labor and birth is caring for a Muslim client during the active phase of labor. The nurse notes that the client quickly draws away when touched. Which intervention should the nurse implement? a. Ask the charge nurse to reassign you to another client. b. Assume that she doesn't like you and decrease your time with her. c. Continue to touch her as much as you need to while providing care. d. Limit touching to a minimum because physical contact may not be acceptable in her culture.

ANS: D Touching is an important component of communication in various cultures, but if the client appears to find it offensive, the nurse should respect her cultural beliefs and limit touching her. Asking the charge nurse to reassign you could be offensive to the client. A Muslim's response to touch does not reflect like or dislike. By continuing to touch her, the nurse is showing disrespect for her cultural beliefs. PTS: 1 DIF: Cognitive Level: Application REF: 138 OBJ: Nursing Process Step: Implementation MSC: Client Needs: Psychosocial Integrity

15. An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. What should the nurse tell the couple? a. Intercourse is safe until the third trimester. b. Safer sex practices should be used once the membranes rupture. c. Intercourse should be avoided if any spotting from the vagina occurs afterward. d. Intercourse and orgasm are often contraindicated if a history of or signs of preterm labor are present.

ANS: D Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman is at risk for or has a history of preterm labor. Intercourse can continue as long as the pregnancy is progressing normally. Rupture of the membranes may require abstaining from intercourse. Safer sex practices are always recommended. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. PTS: 1 DIF: Cognitive Level: Application REF: 126 OBJ: Nursing Process Step: Implementation MSC: Client Needs: Health Promotion and Maintenance