Davis Edge: Transition to Parenthood

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1

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

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

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

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

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

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

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

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

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

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

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

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

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 Rationales

2

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

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.

2

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

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

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. Rationales

2, 3, 4

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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