Chapter 20 - Transition to parenthood EAQs

What should the nurse tell the parent to do if a well adjusted infant starts crying loudly and incessantly? Select all that apply.

"The baby could be hungry and need to be fed." "Please check if the baby is wet." "Try talking and cooing to the baby." As the patient is well attached with the baby, the most likely reason for the baby to cry in this situation would be that either the baby is hungry or wet. Therefore the nurse should tell the patient to feed the baby and check if the baby is wet. Talking and cooing helps in reducing the child's anxiety and helps decrease crying in the baby, so the nurse would need to suggest this. Based on this scenario, it is important that the baby is near the patient, so the nurse should not ask the patient to stay away from the baby for any length of time. Thus the nurse should not suggest the patient hand the baby to the grandmother. The baby is irritable and may not be able to sleep immediately. It is therefore more important to soothe the crying baby than to make the child sleep and place the baby in the cradle.

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?

"You should both spend more time with the baby." 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 assessing a postnatal patient, the nurse finds that the patient is a model by profession and is unable to restart her career after childbirth. What can the nurse suggest to the patient to help her feel better about herself?

"join a support group for mothers" Because of personal aspirations and the inability to achieve them after the childbirth, some women may experience depression and anxiety. Such feelings can hinder the care given by the mother to the infant. To provide moral support, the nurse should refer the patient to support groups. The members of the group can interact with each other and share their feelings. Placing the infant in a day care center may not provide effective care to the infant. Leaving the child with his or her grandparents may not help develop the infant-mother bond; this bond can be developed only if the mother is with the infant. The patient may feel rejected if the nurse becomes judgmental and advises that this is the time to care for the child.

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:

Cries easily for no apparent reason 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.

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?

Explain the importance of first milk to the patient 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.

A postpartum patient with hearing impairment asks the nurse, "How will I know when the baby cries?" What does the nurse instruct the parent to do?

Fit the infant's room with light devices that indicate when the baby cries. Parents who have a hearing impairment can be advised to install devices in the infant's room that convert the sound into light. This helps the parents to know when the infant cries. The mother cannot stay with the infant all day, as it may not be possible in a practical sense. Appointing a caretaker may not be as effective as installing the device, and it is not affordable for every family. Identifying the infant's routine to know the usual pattern of feeding and sleeping may not help the parents to know when the baby cries due to inconsistency in behavior

The nurse observes that a patient is providing appropriate care to the infant. Which behaviors did the nurse observe in the patient to come to this conclusion? Select all that apply.

Talking and gesturing to the infant Claiming proudly that their infant is unique Constantly touching the infant's palms and smiling Talking to the infant and making gestures indicates the attachment of the patient to the baby and indicates that the patient is recognizing the infant as an individual. Bragging about the uniqueness of the infant is a common behavior in new parents and indicates that the patient is developing attachment with the infant. Touching the infant's hands and smiling indicates feelings of love and attachment for the infant. If the parents constantly try to wake up the child from sleep, it indicates the parents are nervous or do not understand the needs of the infant for growth and development. Moving or squeezing the nipples continuously while feeding the baby may indicate that the mother wants to feed the baby hurriedly, which is not a sign of good infant care.

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?

Teach the mother kangaroo care 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.

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?

The baby used appealing facial expressions 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.

While assessing a Japanese patient, the nurse finds that the patient breastfeeds and bottle-feeds the infant until the infant is 2 or 3 months old. What is the reason behind this?

This provides adequate rest to the patient People belonging to the Japanese culture prefer to both breastfeed and bottle-feed their infants, as this helps the mothergetadequate rest. If the infant's hunger is not satisfied with breastfeeding alone, then the nurse can conclude that the patient has reduced milk production. It is more difficult to digest formula than that ofthe mother's milk. Thereforeboth breastfeeding and bottle-feeding the milk will not help to improve digestion in the infant.If the patient is conscious about her physique, she would completely avoid breastfeeding the infant.

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?

To provide comfort to the infant 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.

When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that characteristically the woman would:

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. 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.

The nurse finds that the infant is fussy and irritated after feeding. What does the nurse suggest that the patient do in order to comfort the infant?

"Gently rub the infant's back." The nurse should encourage the patient to soothe and quiet the infant, such as gently rubbing the baby's back after feeding. This makes the infant feel relaxed and comforted. Stretching the arms and legs of the infant may increase the infant's discomfort and lead to further fussing. Establishing eye contact with the infant is not the best way to comfort the infant after feeding because it does not provide physical comfort that the child may need. Singing and cooing may not be helpful in comforting a fussing infant, and the patient should try to reduce the baby's stimulation.

Which statement made by the father of an infant indicates that he is in the phase of confronting reality?

"I'm very worried about my ability to take care of my child." The infant's father is in the phase of confronting reality since he is dealing with the expectations associated with the child's birth and his role as a father. It is natural for the father to feel disappointed and frustrated during the phase of confronting reality. The father feels a sense of completeness and meaning in the reaping rewards phase, such as when he sees his child smile. In the phase of creating the role of an involved father, the father learns to care for the infant through activities such as changing diapers. The father experiences a desire for deep emotional involvement with the infant in the expectations and intentions phase. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.

The student nurse is caring for a Chinese patient who delivered a baby via cesarean section. The student nurse is concerned that the grandparents seem more actively involved in the infant's care than the mother. What is the best response from the nurse when the student expresses these concerns?

"It's a common cultural practice in Chinese families." In Chinese families, if a mother gives birth to a baby through cesarean, then the extended family members, including the grandparents, take active participation in the care of the newborn in order to give the new mother sufficient time to rest and recover. Active participation in the infant's care does not indicate domination of the grandparents, nor does it imply the mother is less attached to the infant. The grandparents taking part in the infant's care is a normal cultural practice and is not a matter of concern to be discussed for this family.

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?

"Share your feelings with your partner." 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.

. 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?

Always tries to grab the parents' attention 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.

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.

Asked a family member to stay overnight Takes a nap when the baby is sleeping 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 assessing a postpartum patient, the nurse finds that the patient has bonded well with her newborn. Which behavior best indicates that the patient has bonded well? The patient:

Correlates the feautures of the infant with her partner A good indication of bonding may be when the patient identifies characteristics that are similar in both the father and the infant. This indicates that the patient has a special bonding with the child. Waking a sleeping baby is not an indication of good bonding, and the nurse should remind the patient about the baby's need to get plenty of rest. Good bonding is also not demonstrated if the patient places the baby in the prone position after feeding, as this may cause the child to vomit. If the patient asks her mother to change the baby's diaper, it may indicate that the patient is afraid of handling the baby, which is not a good sign of proper bonding.

The nurse is caring for a pregnant patient in the late stage of pregnancy. What nursing interventions would facilitate the mother's immediate attachment with the newborn after birth? Select all that apply.

Explaining the process of attachment to the parents Discussing the infant's behavioral pattern with the parents Placing the infant with skin-to-skin contact with the parents The nurse should clearly explain the complexity of the attachment process to the parents. This helps the parents prepare for the process of attachment with the infant. The nurse should discuss the behavioral patterns of the newborn so that the parents can distinguish between normal and abnormal behaviors. Asking the parents to have proper skin contact with the infant enables the infant to get the feel of the mother's skin, thus promoting early attachment. The parents should be allowed to hold and examine the infant after birth, because it promotes caring and ensures that the parents understand about the baby's health. In the case of multiple children, the parents should be taught about the individuality of each infant in order to ensure infant identity.

The parents who have brought their newborn in for a well child visit inform the nurse that their older child is trying to act like a baby and is displaying regressed toileting and sleeping habits. What suggestion should the nurse give to the parents in this situation?

Give your older child a T-shirt that says, "I'm a big brother." Children may become insecure with the arrival of a younger sibling if they feel they will get less attention and care from their parents. During this phase, children often exhibit negative behaviors such as a regression in toilet training and sleeping habits. These behaviors can be prevented by making the child feel proud of their role as older sibling, perhaps by giving a T-shirt that says, "I'm a big brother." Toilet training is usually achieved when the child is 2 years of age. However, the older child has regression due to sibling rivalry and would not need to be toilet trained again. The older child does not have any health problems, so there is no need to consult a PHP for further evaluation. The older child should be encouraged to be independent and to sleep alone. Therefore the nurse should not suggest the parents let the older child sleep in their laps.

Which culturally appropriate beliefs should the maternity nurse use to incorporate parental-infant attachment into the plan of care? Select all that apply.

Jordanian mothers have a 40-day lying-in after birth. Japanese mothers rest for the first 2 months after childbirth. 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.

Which is the most appropriate action by the nurse to ensure effective communication about childcare with the hearing-impaired parents of an infant?

Keep hands away from the face and speak to the parents While instructing the hearing-impaired parents of an infant about childcare, the nurse should ensure that his or her hands are away from the face. This minimizes distraction and helps the parents understand better. The nurse should always stand or sit at the same level as the parents and directly face them while speaking. The nurse should avoid standing in front of a light source while speaking to hearing-impaired parents. The light might cast a dark shadow, and the parents might not be able to lip-read what the nurse is saying. The nurse should attempt to explain in new ways concepts that the parents fail to understand, rather than repeating the same words.

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:

May be trying to protect the child from evil spirits 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.

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:

Never talks to the infant 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 nurse is caring for a visually impaired patient after the birth of her baby. Which action indicates that the nurse is providing effective care to the patient? The nurse:

Orients the patient to the hospital room and the hospital routines. The patient should be oriented to the hospital room, along with the routine in the health care facility. This enables the patient to be comfortable and move about more independently. Verbal explanation may not be sufficient for the patient to understand the procedures as the patient is visually impaired. The patient should be allowed to touch the equipment in her room, because this will help her become more oriented in the environment. The care for the newborn should be demonstrated by touch. The baby is to be handed to the patient after birth, even though the patient is visually challenged. However, the nurse should properly supervise the patient when holding the baby.

Which statement regarding postpartum depression (PPD) is essential for the nurse to be aware of when attempting to formulate a plan of care?

PPD can easily go undetected PPD can go undetected because parents do not admit voluntarily to this type of emotional distress out of embarrassment, fear, or guilt. PPD symptoms range from mild to severe, with women having good days and bad days. Screening should be done for mothers and fathers. PPD may also occur in new fathers. The nurse should include information on PPD and how to differentiate this from the baby blues for all patients on discharge. Nurses also can urge new parents to report symptoms and seek follow-up care promptly if they occur.

Four days after delivery, the mother reports feeling restless, sad, and unable to sleep. What response should the nurse give to the patient?

Practice some relaxing techniques Based on the reported symptoms, the patient is experiencing the postpartum blues. The nurse should suggest some relaxing techniques to the patient to cope with the symptoms. Usually the postpartum blues subside 10 days after the birth, but it may not be so in all cases. The nurse should not tell the patient that the feelings will go away after few days but should help the patient cope with the symptoms. Restricting the number of visitors to the patient may cause the patient to feel lonely and depressed. Therefore the patient should be instructed to plan the visiting hours and resting hours accordingly. Other family members should look after the baby also. However, this is the crucial time for the mother and baby to bond with each other.

A new parent reports inadequate sleep leading to fatigue. Which measures does the nurse suggest to promote sleep in the new parent? Select all that apply.

Take a nap when the infant sleeps. Make the bedroom dark and quiet while sleeping. Take help from family members for care of the infant. The parent may not get enough sleep because of the demands of infant care and household responsibilities. Therefore the parent should adjust sleep time to the infant's sleep time, and nap when the infant sleeps. Sleep can be promoted by making the bedroom dark and quiet. The family members can help the parent with infant care to give the parent time to rest. Performing strenuous exercise is not advised, because it can cause fatigue in the new parent. Increasing coffee consumption can interfere with the sleep quality by stimulating the central nervous system (CNS).

Shortly after birth, the nurse places a newborn on the bare chest of its mother, and the mother complains that she is not able to make eye contact with the baby. What would be the most suitable intervention employed by the nurse in this situation?

Teach the mother to hold the newborn in an en face position. En face position involves placing a baby and the parent on the same plane about 8 inches apart to promote good eye contact, while maintaining close physical contact. The kangaroo care method encourages proper skin contact between mother and baby, but it is not useful for maintaining good eye contact. The nurse should not forcibly open the baby's eyes. Mothers are encouraged to maintain eye contact when the child is active and alert. Antibiotic eyedrops are not immediately put in the newborn's eyes but can wait until after the mother and infant have bonded and started the attachment process.

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?

They do not feel responsible for the care of the newborn or new mother 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.

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:

Wants the infant to suck the milk without interruption 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.

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:

Wants to protect the infant from evil eye 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.

Parents can facilitate the adjustment of their other children to a new baby by:

having the children choose or make a gift to give to the new baby on its arrival home. 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.

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:

provide time for the mother to reflect on the events of and her behavior during childbirth. 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.