Maternal Child Nursing Care Chapter 20 Transition to Parenthood
Parents can facilitate the adjustment of their other children to a new baby by: 1 having the children choose or make a gift to give to the new baby on its arrival home. 2 emphasizing activities that keep the new baby and other children together. 3 having the mother carry the new baby into the home so she can show him or her to the other children. 4 reducing stress on other children by limiting their involvement in the care of the new baby.
1 Having the sibling make or choose a gift for the new baby helps to make the child feel a part of the process. Special time should be set aside just for the other children without interruption from the newborn. Someone other than the mother should carry the baby into the home so she can give full attention to greeting her other children. Children should be actively involved in the care of the baby according to their ability without overwhelming them.
The nurse observes that a Spanish-speaking patient of Mexican descent does not like the nurses to lean in and admire her newborn. What is the most likely reason for this behavior? The mother: 1 Wants to protect the infant from evil eye. 2 Does not have good attachment with the baby. 3 Feels that the baby may acquire infection. 4 Feels that the baby may become fussy seeing new faces.
1 Mexican mothers may believe that excessive admiration may result in evil eye (mal de ojo). They feel that children are more susceptible to evil eye. This behavior does not indicate that the mother does not have a good attachment with the baby. Similarly, this evasive behavior does not indicate the mother is worried about infection or the baby becoming fussy after exposure to new faces.
The nurse is caring for a postpartum Native American patient who is unwilling to breastfeed the baby until after the breast milk has come in. What will the nurse do in this situation? 1 Explain the importance of first milk to the patient. 2 Ask the patient to give formula milk to the infant. 3 Use additional measures for milk ejection in the patient. 4 Apply antiinflammatory ointment around the patient's nipples.
1 Native American patients do not initiate breastfeeding until their breast milk comes in. They avoid feeding the first milk (colostrum) to the child. In this situation, the nurse should inform the patient about the health benefits of feeding colostrum to the child. Mother's milk is the best source of nutrition for the baby; the formula milk is not as nutritious. The mother is also unlikely to have problems ejecting milk. Native American mothers tend to avoid feeding the baby unless the colostrum stops ejecting and the mother starts ejecting milk. Because the patient has not yet started breastfeeding, it is unlikely that the patient has sore nipples, so the nurse would not need to apply antiinflammatory ointment.
The nurse observes that a patient of Southeast Asian descent avoids cuddling and touching her newborn. What can the nurse infer about the patient from these observations? The patient: 1 May be trying to protect the child from evil spirits. 2 Is depressed because of postpartum blues. 3 Is afraid of handling the child all by herself. 4 Is improving the baby's strength and immunity
1 Patients of Southeast Asian descent believe that minimal touching and cuddling of the newborn after birth protects the child from evil spirits. If the patient had postpartum blues, the patient may show different symptoms such as crying episodically. If the patient does not hold or feed the child, it would indicate that the patient is afraid of handling the child. Avoiding cuddling and touching the newborn does not indicate that the patient is improving the baby's strength and immunity. Southeast Asians believe that massaging the newborn would be helpful in improving the baby's strength and immunity.
During a home visit, the nurse observes that a newborn baby is well attached to the parents. Which infant behavior did the nurse most likely observe in the baby? 1 The baby used appealing facial expressions. 2 The baby sought attention from other adults. 3 The baby's body movements were jerky when touched. 4 The baby was unresponsive to the parents' caregiving.
1 The appealing facial expression of the infant is a normal behavioral pattern and is indicative of the infant's desire to seek the parents' attention. If the infant seeks attention from other adults, it indicates that the infant is not getting required attention from the parents. Jerky movements upon touching indicate that the infant is not reacting in a normal way to the parents and may suggest that the parents are not comfortable while handling the infant. If the infant does not respond properly to the care giving tasks of the parents, it indicates that the infant lacks adequate attachment with the parents.
The nurse is caring for a Chinese couple who have a newborn. What patient behavior indicates that the couple lacks interest in developing an attachment with the child? The couple: 1 Never talks to the infant. 2 Always calls the infant by name. 3 Allows grandparents to take care of the child. 4 Maintains good eye contact with the infant.
1 The couple does not attempt to talk to the infant. This indicates that they lack interest in developing a bond with the infant. Calling the infant by name indicates the couple is giving importance to the individuality of the infant. In Chinese culture, the newborn is taken care of by the grandparents. This is done to promote rest and recovery in the mother after childbirth. Maintaining eye contact with the infant is a sign of attention by the parents toward the infant.
The mother of a newborn reports that the child vomits milk immediately after breastfeeding. The infant's laboratory report does not show any abnormalities. What is the most appropriate nursing intervention in this situation? 1 Teach the mother kangaroo care. 2 Ask the mother to give the child formula. 3 Ask the mother to feed the child cow's milk. 4 Teach other family members to feed the baby
1 The most likely cause of the infant's vomiting is insufficient attachment between infant and parent. Therefore the nurse should advise the parent to maintain skin contact with the child while feeding. To accomplish this, the nurse should teach the mother kangaroo care, which promotes attachment between the infant and the mother. Breast milk provides optimal nutrition to the baby. If the patient is able to breastfeed the baby, the nurse should encourage the patient to continue breastfeeding rather than switching to formula or cow's milk. The nurse's primary goal should be to improve the attachment between the infant and mother so that the nurse does not need to involve other family members for feeding unless absolutely necessary.
The nurse observes that the newborn is responding well to the parent. Which behavior from the newborn did the nurse observe to come to this conclusion? The newborn: 1 Was dancing in tune with the parent's voice. 2 Looked at the wall upon hearing the parent's voice. 3 Was not kicking its legs in tune to the parent's voice. 4 Was not waving its arms in tune to the parent's voice.
1 When parents speak, infants tend to get excited and dance in tune with the parent's voice. This indicates that the infant is responding well to the patient. The newborn should ideally look at the parent when the parent tries to communicate. If the newborn looks toward the wall, it indicates that the newborn is not responding well to the parent. If the newborn keeps the upper and lower limbs still when the parent interacts, it indicates that the newborn is not responding well to the patient.
A patient reports having difficulty ejecting milk while breastfeeding the infant. Which nursing interventions would help the patient breastfeed the newborn with greater ease? Select all that apply. 1 Teach the patient about the infant's rooting and sucking reflexes. 2 Ask the patient to breastfeed the newborn immediately after birth. 3 Explain frequent milk expression and kangaroo care to the patient. 4 Talk to the patient about the newborn's capabilities for interaction. 5 Ensure the newborn has good contact with the patient immediately after birth.
1, 2, 3 The patient reports having problems with lactation. Thus the nurse should assist in establishing and maintaining a successful breastfeeding process for the patient. To do this, the nurse should teach the patient about the infant's rooting and sucking reflexes. The patient should be asked to immediately breastfeed the child after birth. Then the nurse has to explain frequent milk expression and kangaroo care to the patient for optimized milk supply. Placing the newborn skin-to-skin with the parent immediately after birth is not useful for breastfeeding. The nurse has to talk to the patient about the infant's capabilities for interaction while teaching the patient how to nurture the infant in the first year of life, but these interventions are not in response to problems with lactation.
When working with parents who have some form of sensory impairment, what information should nurses consider when writing a plan of care? Select all that apply. 1 One of the major difficulties visually impaired parents experience is the skepticism of health care professionals. 2 The best approach for the nurse is to assess the parents' capabilities rather than focusing on their disabilities. 3 Technologic advances, including the Internet, can provide deaf parents with a full range of parenting activities and information 4 Childbirth education and other materials are available in Braille.
1, 2, 3, 4 The skepticism, open or hidden, of health care professionals presents 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 focus on 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 child's cry. Sign language is acquired readily by young children. Childbirth education and other materials are available in Braille. Other sensory output can be provided by the parent, other people can participate, and other coping devices can be used.
While caring for a postpartum patient, the nurse observes that the patient's older child is not adapting well to the newborn and may have feelings of sibling rivalry. What behavior of the older child would make the nurse conclude this? 1 Watches the baby silently in the hospital 2 Always tries to grab the parents' attention 3 Always wants to be with the mother and newborn 4 Asks to feed the newborn with a milk bottle
2 Children may feel insecure when parents pay more attention to a newborn sibling. The older child may develop feelings of sibling rivalry and exhibit negative behaviors, such as increased attention seeking and aggression toward the baby. Therefore trying to grab the attention of the parents indicates that the child has not adapted well to the newborn. Positive behaviors, such as increased interest and concern for the baby, indicate effective adaptation. Therefore expressing a desire to stay with the mother and newborn in hospital, watching the baby silently, and being willing to feed the baby does not indicate a lack of adaptation.
After assessing a postpartum patient 2 days after childbirth, the nurse instructs the patient to soak in a warm water tub for 20 minutes every day. What is the most likely reason for this instruction? The patient: 1 Is unable to stay warm. 2 Cries easily for no apparent reason. 3 Is joyful and has a feeling of well-being. 4 Has trouble maintaining direct eye contact with the infant.
2 Most postpartum women often experience a "blue" period 2 days after childbirth, during which women may be emotional and cry for no explainable reason. This is called postpartum blues and is the natural hormonal reaction after giving birth. The nurse may instruct the patient to soak in a tub for 20 minutes on a regular basis to promote relaxation and help the patient cope with the postpartum blues. Postpartum women do not typically have trouble staying warm, so this is not the reason for the nurse's suggestion. Soaking in the tub does not facilitate eye contact, so the nurse would more likely encourage the mother to hold the baby en face position if this were the problem.
While speaking to the newborn's father in a well child visit, the nurse finds out that the newborn's father is feeling depressed and bored, as the mother spends most of her time with the infant. What instruction should the nurse give to the father in this situation? 1 "Spend more time with your friends." 2 "Share your feelings with your partner." 3 "Work fewer hours and come home early." 4 "Try to distract yourself with other activities."
2 Postpartum women spend most of their time caring for the infant, especially those mothers who breastfeed and may not easily be able to share child care duties with their partners. As a result, the infant's father may feel depressed, bored, and jealous of the infant. The infant's father should express these feelings so that the mother can make more time for her partner. It is not appropriate to tell the father to spend more time with his friends, as this does not solve the problem in the home. Even if the father comes home early from work, the mother may not be able to spend time with the father, so this suggestion is not necessarily helpful. Engaging in other activities may relieve the infant's father from boredom but not from depression and jealousy. The father would get relieved of these feelings by having the mother's attention and care.
A mother who had a vaginal delivery reports being restless and having insomnia and regular episodes of headache 4 days after childbirth. What would the nurse infer about the mother's clinical condition from these symptoms? The mother: 1 Is experiencing pain from the episiotomy. 2 Likely has postpartum blues. 3 Is in the pink postpartum period. 4 Was given spinal anesthesia during the delivery process.
2 The depressed phase after pregnancy and delivery is known as postpartum blues, or "baby blues," where the mother may experience restlessness, insomnia, and headache. Episiotomy would cause other symptoms related to pain, such as restlessness and insomnia, but it would not cause the mother to experience headaches. The pink phase of the postpartum period is the period where the woman experiences a sense of heightened joy and feelings of well-being. Anesthesia is not given during vaginal delivery, so this is not a factor in her postpartum symptoms.
The nurse observes several interactions between a postpartum woman and her new son. What behavior (if exhibited by this woman) does the nurse identify as a possible maladaptive behavior regarding parent-infant attachment? 1 Talks and coos to her son 2 Seldom makes eye contact with her son 3 Cuddles her son close to her 4 Tells visitors how well her son is feeding
2 The woman should be encouraged to hold her infant in the en face position and make eye contact with him. Talking and cooing to her son is a normal infant-parent interaction. Cuddling is a normal infant-parent interaction. Sharing her son's success at feeding is a normal infant-parent interaction.
A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. Recognizing the needs of women during this stage, the nurse should: 1 foster an active role in the baby's care. 2 provide time for the mother to reflect on the events of and her behavior during childbirth. 3 recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now. 4 promote maternal independence by encouraging her to meet her own hygiene and comfort needs.
2 Women express a need to review their childbirth experience and evaluate their performance. After the mother's needs are met, she is more able to take an active role, not only in her own care but also in the care of her newborn. Short teaching sessions (using written materials to reinforce the content presented) are a more effective approach. The focus of the taking-in stage is nurturing the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition. Test-Taking Tip: After choosing an answer, go back and reread the question stem along with your chosen answer. Does it fit correctly? The choice that grammatically fits the stem and contains the correct information is the best choice.
Which culturally appropriate beliefs should the maternity nurse use to incorporate parental-infant attachment into the plan of care? Select all that apply. 1 Asian mothers are encouraged to return to work as soon as possible. 2 Jordanian mothers have a 40-day lying-in after birth. 3 Japanese mothers rest for the first 2 months after childbirth. 4 Encourage Hispanics to eat plenty of fish and pork to increase vitamin intake. 5 Encourage Vietnamese mothers to cuddle with the newborn.
2, 3 Jordanian mothers have a 40-day lying-in after birth, during which their mothers or sisters care for the baby. Japanese mothers rest for the first 2 months after childbirth. Asian mothers must remain at home with the baby up to 30 days after birth and are not supposed to engage in household chores, including care of the baby. Hispanic practice involves many food restrictions after childbirth, such as avoiding fish, pork, and citrus foods. Vietnamese mothers may give minimal care to their babies and refuse to cuddle or further interact with the baby to ward off "evil" spirits.
When helping a woman cope with postpartum blues, what suggestions should the nurse offer? Select all that apply. 1 Have the father take over care of the baby, because postpartum blues are exclusively a female problem. 2 Get plenty of rest. 3 Plan to get out of the house occasionally. 4 Do not ask for help because this will not foster independence. 5 Use La Leche League or community mental health centers.
2, 3, 5 Suggestions for coping with postpartum blues include: (1) Remember that the "blues" are normal and that both the mother and the father or partner may experience them. (2) Get plenty of rest; nap when the baby does if possible. Go to bed early, and let friends and family know when to visit and how they can help. (Remember, you are not "Supermom.") (3) Use relaxation techniques learned in childbirth classes (or ask the nurse to teach you and your partner some techniques). (4) Do something for yourself. Take advantage of the time your partner or family members care for the baby—soak in the tub (a 20-minute soak can be the equivalent of a 2-hour nap), or go for a walk. (5) Plan a day out of the house—go to the mall with the baby, being sure to take a stroller or carriage, or go out to eat with friends without the baby. Many communities have churches or other agencies that provide child care programs such as Mothers' Morning Out. (6) Talk to your partner about the way you feel—for example, about feeling tied down, how the birth met your expectations, and things that will help you (do not be afraid to ask for specifics). (7) If you are breastfeeding, give yourself and your baby time to learn. (8) Seek out and use community resources such as La Leche League or community mental health centers.
During the postnatal visit, the patient tells the nurse, "I'm feeling irritated and tired. I haven't slept properly for days." The nurse suggests a few interventions to help the patient with relaxation and rest. Which techniques adopted by the patient indicate effective learning? Select all that apply. 1 Installed bright lights in the room 2 Asked a family member to stay overnight 3 Organized a small dinner party at her home 4 Takes a nap when the baby is sleeping 5 Started drinking coffee 3 times a day
2, 4 After the baby's birth, the patient feels irritated and stressed due to lack of sleep. The nurse should suggest interventions that help the patient rest. For example, if the patient's family can be called upon to help with the household chores while the patient looks after the baby and rests, this can help the patient feel more relaxed in the early days of parenting. The patient should try to adjust her schedule to nap when the baby sleeps if possible. Installing bright lights is not an effective technique, as it does not promote sleep. Organizing a dinner party may increase the number of visitors and guests in the home, which, in turn, can increase the household work, causing the patient to become even more fatigued and tired. Coffee contains caffeine and may cause insomnia by stimulating the central nervous system (CNS). Therefore, drinking coffee 3 times a day does not support relaxation.
While caring for an Algerian patient, the nurse suggests that the patient give kangaroo care to the infant. The mother is unwilling to follow the suggestion of the nurse. What is the reason for this unwillingness? The patient is attempting to: 1 Protect the infant from evil spirits. 2 Prevent others from touching the baby. 3 Protect the infant physically and psychologically. 4 Take adequate rest after the birth of the child.
3 Algerian mothers tightly wrap the infant in swaddling clothes to protect them physically and physiologically, a custom followed by Algerians as a part of the acquaintance process. Algerians follow this custom to give physical and psychological protection but not to protect the infant from evil spirits. Vietnamese mothers interact minimally with the infants to protect them from evil spirits. The mother has to accept the assistance from others, as she alone cannot take care of the baby. Therefore she cannot avoid others touching the infant. Asian and Jordanian mothers hand over the baby to the grandparents immediately after birth. They do this to get some rest after childbirth.
The nurse instructs a group of nursing students about relationship issues in couples who are first-time parents. The nurse asks a student for suggestions to give new parents to prevent relationship problems. Which student response indicates the need for further teaching? 1 "Appreciate each other for the assistance." 2 "Assess your relationship on a regular basis." 3 "You should both spend more time with the baby." 4 "Share your personal expectations with each other.
3 Couples that become new parents may develop new challenges in their personal relationship because they will spend most of their time taking care of the baby. Therefore the couple needs to make time to spend together rather than spending all of their time focused on the baby. This can be accomplished by scheduling time for one another, apart from the time dedicated to caring for the infant. The couple has to share their expectations with each other and should appreciate each other for their assistance in the child care activities.
While teaching the patient about breastfeeding, the nurse instructs the patient to rub the infant's back after feeding. What is the reason for this instruction? 1 To develop trust in the infant 2 To quiet and soothe the infant 3 To provide comfort to the infant 4 To promote attachment with the infant
3 Patting or gently rubbing the infant's back provides comfort to the infant after feeding. Gentle stroking on the infant's back helps to soothe and quiet the infant. Making eye contact with the infant helps to develop a bond and enhances the trust between the mother and infant. Touching the infant with the mother's fingertips and caressing the infant's trunk help to develop attachment with the infant.
The nurse is caring for a North American, postpartum patient who is visually impaired. The nurse finds that the mother is having a difficult time establishing attachment with the infant. What suggestion would the nurse give the mother in order to create an effective interaction with the infant? 1 "Ask the infant's father to stand nearby." 2 "Hold the newborn's hand while talking." 3 "Nod and smile while talking to the infant." 4 "Get informed of the actions of the infant."
3 The infant wants to interact with the mother by looking at the mother's eyes and facial expressions. Visually impaired mothers may show impassive facial expressions, which makes the infant uninterested. The infant may abandon the mother and try to interact with other family members. The mother can interact efficiently by nodding and smiling frequently while talking. This conceals the impassive facial expressions of the mother. Because the father cannot improve the facial expressions of the mother by standing nearby, the father cannot improve the interaction between the mother and infant by standing nearby. As the infant looks at the face of the mother to interact, holding the newborn's hand while talking will not improve the interaction either. The mother should give spontaneous responses to the child's actions. Waiting for others to tell her about the infant's actions may not be helpful in this situation.
When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that characteristically the woman would: 1 express a strong need to review events and her behavior during the process of labor and birth. 2 exhibit a reduced attention span, limiting readiness to learn. 3 vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. 4 have reestablished her role as a spouse/partner.
3 Vacillating between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn is characteristic of the taking-in stage, which lasts for the first few days after birth. Expressing a strong need to review events and her behavior during the process of labor and birth is characteristic of the taking-in stage, which lasts for the first few days after birth. One week after birth, the woman should exhibit behaviors characteristic of the taking-hold stage. This stage lasts for as long as 4 to 5 weeks after birth. Reestablishing her role as a spouse/partner reflects the letting-go stage, which indicates that psychosocial recovery is complete. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.
While caring for a Hispanic patient, the nurse asks the infant's father to hold the baby after its birth. The father is unwilling to see the baby. What reason would the nurse attribute to this unwillingness? The father: 1 Is too scared to hold the baby. 2 Has no time to visit the baby. 3 Is not following the traditional Hispanic custom. 4 Is doing it to integrate the individuals into the family
4 According to traditional Hispanic customs, fathers do not see their wives or infants until they are cleaned and dressed. It is believed that this custom incorporates the individuals into the family and integrates the family. It does not imply that the father is too scared to hold the baby. In this situation, the father is following the traditional Hispanic custom by not seeing the baby after birth. It does not implicate that the father has no time to see the baby. The father would want to see the baby as soon as it is cleaned and dressed.
Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should: 1 tell the woman she can rest after she feeds her baby. 2 recognize this as a behavior of the taking-hold stage. 3 record the behavior as ineffective maternal-newborn attachment. 4 take the baby back to the nursery, reassuring the woman that her rest is a priority at this time.
4 Mothers need to reestablish their own well-being to effectively care for their baby. The woman should not be told what to do and needs to care for her own well-being. Because the woman needs to rest does not indicate ineffective maternal-newborn attachment. The behavior described is typical of this stage and is not a reflection of ineffective attachment unless it persists. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies.
The nurse is caring for a postpartum patient with a hearing impairment. The nurse finds that the patient's partner is also hearing-impaired. What does the nurse suggest to both parents to improve vocalization in the newborn? 1 Interact with the infant using sign language. 2 Play rhymes and music at a very high volume. 3 Ask a family member or friend to talk to the baby. 4 Show the infant recordings of television programs.
4 While interacting with the parents of an infant who are hearing-impaired, the nurse should suggest that the parents show video recordings to the infant to improve vocalization, as this helps the newborn become familiar with human voices. Interacting with the child using sign language can enhance communication, but may not help to improve vocalization. Playing rhymes and music at a very high volume may damage the eardrum of the infant and can lead to hearing impairment. Asking a family member or friend to talk to the baby is a good solution, but it may not be a practical solution if the parents care for the child independently.
The nurse observes that a postpartum patient does not talk or smile during breastfeeding but instead quietly maintains her gaze on the infant. What does the nurse infer from this observation? The patient: 1 Aims to soothe and quiet the infant. 2 Is experiencing postpartum blues. 3 Is not properly bonding with the infant. 4 Wants the infant to suck the milk without interruption.
4 While learning to breastfeed, women may refrain from talking or smiling excessively so that the infant will not be distracted and will continue to feed. The patient does not avoid talking to soothe and quiet the infant; instead, she may gently stroke the infant to provide comfort after feeding. Avoiding speaking with the infant is not helpful for coping with depression and is not a typical behavior of postpartum blues. The mother's quiet behavior during breastfeeding does not indicate that she has not properly bonded with the baby.
While caring for a patient, the nurse notices that the newborn's paternal grandparents visit the newborn and leave after an hour. The maternal grandparents, on the other hand, stay all day with the couple to look after the newborn. What could be the reason for this in terms of traditional paternal grandparents' cultural behaviors? 1 They care for the second born child. 2 Typically, they are called to care for baby after 6 months. 3 They feel that they are responsible only for the financial expenses of the child. 4 They do not feel responsible for the care of the newborn or new mother.
4 While no family follows just one pattern, in American culture the paternal grandparents are typically considered secondary to the maternal grandparents after the baby is born. This is because a woman may be closer to her own parents and feel more comfortable accepting their help than that of her partner's family. As a result, paternal grandparents may be naturally less involved with the newborn. There are no cultural rules in the American culture dictating that paternal grandparents care for the second-born child or bond with the baby only after 6 months. Grandparents are not typically responsible for the financial expenses of the baby in the United States.