Professional Documents
Culture Documents
the postpartum unit. An appropriate nursing diagnosis for her at this time is Risk for
impaired parenting related to deficient knowledge of newborn care. In planning for the
woman’s discharge, what should the nurse be certain to include in the plan of care?
c. Advise the patient that all mothers instinctively know how to care for their infants.
Provide time for the patient to bathe her infant after she views an infant bath
d.
demonstration.
ANS: D
Having the mother demonstrate infant care is a valuable method of assessing the client’s
understanding of her newly acquired knowledge, especially in this age group, because she
may inadvertently neglect her child. Although verbalizing how to care for the infant is a form
of patient education, it is not the most developmentally appropriate teaching for a teenage
mother. Advising the patient that all mothers instinctively know how to care for their infants
1. The nurse observes several interactions between a postpartum woman and her new
son.What behavior, if exhibited by this woman, would the nurse identify as a possible
2023
TOPMARKSOLUTIONS
ANS: B
The woman should be encouraged to hold her infant in the en face position and make eye
contact with the infant. Normal infant-parent interactions include talking and cooing to her
son, cuddling her son close to her, and telling visitors how well her son is feeding.
PTS: 1 DIF: Cognitive Level: Application REF: 524
2. The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy
thatthe nurse can use to facilitate mother-infant attachment in this mother is to:
b. Show the mother how the infant initiates interaction and pays attention to her.
c. Demonstrate for the mother different positions for holding her infant while feeding.
ANS: B
Pointing out the responsiveness of the infant is a positive strategy for facilitating
parent-infant attachment. Telling the mother that she must pay attention to her infant may be
2023
TOPMARKSOLUTIONS
perceived as derogatory and is not appropriate. Educating the young mother in infant care is
important; however, pointing out the responsiveness of her baby is a better tool for
facilitating mother-infant attachment. Videos are an educational tool that can demonstrate
parent-infant attachment, but encouraging the mother to recognize the infant’s responsiveness
is more appropriate.
PTS: 1 DIF: Cognitive Level: Application REF: 516
OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
3. The nurse hears a primiparous woman talking to her son and telling him that his chin
a. Mutuality. c. Claiming.
b. Synchrony. d. Reciprocity.
ANS: C
Claiming refers to the process by which the child is identified in terms of likeness to other
family members. Mutuality occurs when the infant’s behaviors and characteristics call forth a
corresponding set of maternal behaviors and characteristics. Synchrony refers to the “fit”
between the infant’s cues and the parent’s responses. Reciprocity is a type of body movement
4. New parents express concern that, because of the mother’s emergency cesarean birth
undergeneral anesthesia, they did not have the opportunity to hold and bond with their
daughter immediately after her birth. The nurse’s response should convey to the parents
that:
Attachment, or bonding, is a process that occurs over time and does not require early
a.
contact.
2023
TOPMARKSOLUTIONS
ANS: A
Attachment, or bonding, is a process that occurs over time and does not require early contact.
The formerly accepted definition of bonding held that the period immediately after birth was
a critical time for bonding to occur. Research since has indicated that parent-infant
attachment occurs over time. A delay does not inhibit the process. Parent-infant attachment
involves activities such as touching, holding, and gazing; it is not exclusively eye contact. A
response that conveys that the parents should just be happy that the infant is healthy is
OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
the woman tells the nurse, “I don’t know what’s wrong. I love my son, but I feel so let
down. Iseem to cry for no reason!” The nurse would recognize that the woman is
experiencing:
ANS: C
During the PP blues women are emotionally labile, often crying easily and for no apparent
reason. This lability seems to peak around the fifth PP day. The taking-in phase is the period
after birth when the mother focuses on her own psychologic needs. Typically this period lasts
24 hours. PPD is an intense, pervasive sadness marked by severe, labile mood swings; it is
more serious and persistent than the PP blues. Crying is not a maladaptive attachment
2023
TOPMARKSOLUTIONS
a. Pointing out that the infant turned at the sound of his voice.
ANS: A
Infants respond to the sound of voices. Because attachment involves a reciprocal interchange,
observing the interaction between parent and infant is very important. Separation of the
parent and infant does not encourage parent-infant attachment. Educating the parent in infant
care techniques is important; however, the manner in which a diaper is taped is not relevant
OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
7. The nurse notes that a Vietnamese woman does not cuddle or interact with her
newborn other than to feed him, change his diapers or soiled clothes, and put him to bed. In
evaluatingthe woman’s behavior with her infant, the nurse realizes that:
What appears to be a lack of interest in the newborn is in fact the Vietnamese way of
a.
demonstrating intense love by attempting to ward off evil spirits.
2023
TOPMARKSOLUTIONS
The woman needs a referral to a social worker for further evaluation of her parenting
c.
behaviors once she goes home with the newborn.
d. Extra time needs to be planned for assisting the woman in bonding with her newborn.
ANS: A
The nurse may observe a Vietnamese woman who gives minimal care to her infant and
refuses to cuddle or interact with her infant. The apparent lack of interest in the newborn is
this cultural group’s attempt to ward off evil spirits and actually reflects an intense love and
concern for the infant. It is important to educate the woman in infant care, but it is equally
8. Many first-time parents do not plan on their parents’ help immediately after the
newbornarrives. What statement by the nurse is the most appropriate when counseling
“Grandparents can help you with parenting skills and also help preserve family
b.
traditions.”
d. “They are getting old. You should let them be involved while they can.”
ANS: B
2023
TOPMARKSOLUTIONS
“Grandparents can help you with parenting skills and also help preserve family traditions” is
however, a statement of this sort is not therapeutic to the adaptation of the family. Not only is
“Grandparent involvement can be very disruptive to the family” invalid, it also is not an
appropriate nursing response. Regardless of age, grandparents can help with parenting skills
and preserve family traditions. Talking about the age of the grandparents is not the most
appropriate statement, and it does not demonstrate sensitivity on the part of the nurse.
PTS: 1 DIF: Cognitive Level: Analysis REF: 526
9. When the infant’s behaviors and characteristics call forth a corresponding set of maternal
a. Mutuality. c. Claiming.
b. Bonding. d. Acquaintance.
ANS: A
Mutuality extends the concept of attachment to include this shared set of behaviors. Bonding
is the process over time of parents forming an emotional attachment to their infant. Mutuality
Claiming is the process by which parents identify their new baby in terms of likeness to other
family members and their differences and uniqueness. Like mutuality, acquaintance is part of
attachment. It describes how parents get to know their baby during the immediate postpartum
10. In follow-up appointments or visits with parents and their new baby, it may be
useful ifthe nurse can identify parental behaviors that can either facilitate or inhibit
2023
TOPMARKSOLUTIONS
b. The parents hover around the infant, directing attention to and pointing at the infant.
c. The parents make no effort to interpret the actions or needs of the infant.
d. The parents do not move from fingertip touch to palmar contact and holding.
ANS: B
Hovering over the infant and obviously paying attention to the baby are facilitating behaviors.
Inhibiting behaviors include difficulty naming the infant, making no effort to interpret the
actions or needs of the infant, and not moving from fingertip touch to palmar contact and
holding.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 511
OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
11. With regard to parents’ early and extended contact with their infant and the
b. Skin-to-skin contact is preferable to contact with the body totally wrapped in a blanket.
d. Mothers need to take precedence over their partners and other family matters.
ANS: C
2023
TOPMARKSOLUTIONS
Nurses should encourage any activity that optimizes family extended contact. Immediate
contact facilitates the attachment process but is not essential; otherwise, adopted infants
would not establish the affectionate ties they do. The mode of infant-mother contact does not
appear to have any important effect. Mothers and their partners are considered equally
important.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 514
12. In the United States the en face position is preferred immediately after birth. Nurses
b. Placing the infant on the mother’s abdomen or breast with their heads on the same plane.
ANS: A
To facilitate the position in which the parent’s and infant’s faces are approximately 8 inches
apart on the same plane, allowing them to make eye contact, the nurse can place the infant at
the proper height on the mother’s body, dim the light so that the infant’s eyes open, and delay
OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
13. Other early sensual contacts between infant and mother involve sound and smell.
2023
TOPMARKSOLUTIONS
b. Infants can learn to distinguish their mother’s voice from others soon after birth.
ANS: B
Infants know the sound of their mother’s voice early. Infants respond positively to
high-pitched voices. Each infant has a unique odor. Infants quickly learn to distinguish the
OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance
14. After they are born, a crying infant may be soothed by being held in a position in
whichthe newborn can hear the mother’s heartbeat. This phenomenon is known as:
a. Entrainment. c. Synchrony.
b. Reciprocity. d. Biorhythmicity.
ANS: D
The newborn is in rhythm with the mother. The infant develops a personal biorhythm with
the parents’ help over time. Entrainment is the movement of newborns in time to the structure
of adult speech. Reciprocity is body movement or behavior that gives cues to the person’s
desires. These take several weeks to develop with a new baby. Synchrony is the fit between
OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
2023
TOPMARKSOLUTIONS
15. Of the many factors that influence parental responses, nurses should be conscious of
negative stereotypes that apply to specific patient populations. Which response could be
An adolescent mother’s egocentricity and unmet developmental needs interfere with her
a.
ability to parent effectively.
An adolescent mother is likely to use less verbal instruction, be less responsive, and
b.
interact less positively than other mothers.
Mothers older than 35 often deal with more stress related to work and career issues and
d.
decreasing libido.
ANS: C
Adolescent mothers are more inclined to have a number of parenting difficulties that benefit
from counseling; however, a higher incidence of child abuse is not one of them. Midlife
mothers have many competencies, but they are more likely to have to deal with career issues
16. When working with parents who have some form of sensory
One of the major difficulties visually impaired parents experience is the skepticism of
a.
health care professionals.
b. Visually impaired mothers cannot overcome the infant’s need for eye-to-eye contact.
2023
TOPMARKSOLUTIONS
The best approach for the nurse is to assess the parents’ capabilities rather than focusing
c.
on their disabilities.
Technologic advances, including the Internet, can provide deaf parents with a full range
d.
of parenting activities and information.
ANS: B
Other sensory output can be provided by the parent, other people can participate, and other
coping devices can be used. The skepticism, open or hidden, of health care professionals
places 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 play to 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 readily
OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance
17. With regard to the adaptation of other family members, mainly siblings and
In the United States paternal and maternal grandparents consider themselves of equal
c.
importance and status.
2023
TOPMARKSOLUTIONS
In the past few decades the number of grandparents providing permanent care to their
d.
grandchildren has been declining.
ANS: B
Preparing older siblings and grandparents helps everyone to adapt. Sibling rivalry should be
expected initially, but the negative behaviors associated with it have been overemphasized
and stop in a comparatively short time. In the United States, in contrast to other cultures,
The number of grandparents providing permanent child care has been on the increase.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 525
18. Nursing activities that promote parent-infant attachment are many and varied. One
a. The baby is able to return to the nursery at night so that the new mother can sleep.
ANS: D
Care providers need to knock before gaining entry. Nursing care activities should be grouped.
Once the baby has demonstrated adjustment to extrauterine life (either in the mother’s room
or the transitional nursery), all care should be provided in one location. This important
opportunity to learn about their infant 24 hours a day. One nurse should provide care to both
2023
TOPMARKSOLUTIONS
mother and baby in this couplet care or rooming-in model. It is not necessary for the baby to
return to the nursery at night. In fact, the mother will sleep better with the infant close by.
Care should be individualized to meet the parents’ needs, not the routines of the staff.
Teaching goals should be developed in collaboration with the parents. The father or other
significant other should be permitted to sleep in the room with the mother. The maternity unit
should develop policies that allow for the presence of significant others as much as the new
mother desires.
PTS: 1 DIF: Cognitive Level: Application REF: 528
OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
19. The early postpartum period is a time of emotional and physical vulnerability. Many
mothers can easily become psychologically overwhelmed by the reality of their new
parentalresponsibilities. Fatigue compounds these issues. Although the baby blues are a
common occurrence in the postpartum period, about one-half million women in America
statement regarding PPD is essential for the nurse to be aware of when attempting to
d. Only mental health professionals should teach new parents about this condition.
ANS: C
PPD can go undetected because parents do not voluntarily admit to this type of emotional
distress out of embarrassment, fear, or guilt. PPD symptoms range from mild to severe, with
women having both good and bad days. Both mothers and fathers should be screened. PPD
2023
TOPMARKSOLUTIONS
may also affect new fathers. The nurse should include information on PPD and how to
differentiate this from the baby blues for all clients on discharge. Nurses also can urge new
parents to report symptoms and seek follow-up care promptly if symptoms occur.
PTS: 1 DIF: Cognitive Level: Synthesis REF: 517
20. The mother-baby nurse is able to recognize reciprocal attachment behavior. This refers to:
a. The positive feedback an infant exhibits toward parents during the attachment process.
b. Behavior during the sensitive period when the infant is in the quiet alert stage.
c. Unidirectional behavior exhibited by the infant, initiated and enhanced by eye contact.
Behavior by the infant during the sensitive period to elicit feelings of “falling in love”
d.
from the parents.
ANS: A
In this definition, “reciprocal” refers to the feedback from the infant during the attachment
process. This is a good time for bonding; however, it does not define reciprocal attachment.
OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
21. The postpartum woman who continually repeats the story of her labor, delivery,
2023
TOPMARKSOLUTIONS
ANS: B
Reliving the birth experience makes the event real and helps the mother realize that the
pregnancy is over and that the infant is born and is now a separate individual. The retelling of
the story is to satisfy her needs, not the needs of others. This new mother is in the taking-in
phase, trying to make the birth experience seem real and separate the infant from herself.
PTS: 1 DIF: Cognitive Level: Knowledge REF: 516
22. On observing a woman on her first postpartum day sitting in bed while her newborn
ANS: C
During the “taking-in” phase of maternal adaptation (the mother may be passive and
dependent), the nurse should encourage bonding when the infant is in the quiet alert stage.
This is done best by simply giving the baby to the mother. The patient is exhibiting expected
behavior during the taking-in phase; however, interventions by the nurse can facilitate infant
bonding. The patient will learn best during the taking-hold phase.
PTS: 1 DIF: Cognitive Level: Application REF: 516
2023
TOPMARKSOLUTIONS
23. A nurse is observing a family. The mother is holding the baby she delivered less
than 24 hours ago. Her husband is watching his wife and asking questions about newborn
care. The4-year-old brother is punching his mother on the back. The nurse should:
c. Report to oncoming staff that the mother is probably not a good disciplinarian.
ANS: D
The observed behaviors are normal variations of families adjusting to change. There is no
need to report this one incident. Giving advice at this point would make the parents feel
inadequate.
PTS: 1 DIF: Cognitive Level: Analysis REF: 518
24. The best way for the nurse to promote and support the maternal-infant bonding
process isto:
a. Help the mother identify her positive feelings toward the newborn.
2023
TOPMARKSOLUTIONS
ANS: C
Close and frequent interaction between mother and infant, which is facilitated by rooming-in,
is important in the bonding process. This is often referred to as the mother-baby care or
couplet care. Having the mother express her feelings is important; however, it is not the best
way to promote bonding. The mother needs time to rest and recuperate; she should not be
expected to do all of the care. The patient needs to observe the infant during all stages so she
25. During which phase of maternal adjustment will the mother relinquish the baby of
a. Letting go c. Taking in
ANS: A
Accepting the real infant and relinquishing the fantasy infant occurs during the letting-go
phase of maternal adjustment. During the taking-hold phase the mother assumes
responsibility for her own care and shifts her attention to the infant. In the taking-in phase the
mother is primarily focused on her own needs. There is no taking-on phase of maternal
adjustment.
PTS: 1 DIF: Cognitive Level: Knowledge REF: 516
26. A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago
is scheduled for discharge. As you prepare her for discharge, she begins to cry. Your
initialaction should be to
2023
TOPMARKSOLUTIONS
ANS: D
Although many women experience transient postpartum blues, they need assistance in
expressing their feelings. This condition affects 50% to 80% of new mothers. There should be
no assumption that the patient is in pain, when in fact she may have no pain whatsoever. This
is “blocking” communication and inappropriate in this situation. The patient needs the
opportunity to express her feelings first; patient teaching can occur later.
PTS: 1 DIF: Cognitive Level: Application REF: 517
27. A man calls the nurse’s station and states that his wife, who delivered 2 days ago, is
happyone minute and crying the next. The man says, “She was never like this before the
ANS: B
Before providing further instructions, inform family members of the fact that postpartum
blues are a normal process. Telling her partner to “ignore the mood swings” does not
2023
TOPMARKSOLUTIONS
encourage further communication and may belittle the husband’s concerns. Postpartum blues
however, the new father’s anxieties need to be allayed before he will be receptive to teaching.
PTS: 1 DIF: Cognitive Level: Application REF: 517
28. To promote bonding and attachment immediately after delivery, the most
ANS: B
Assisting the mother in assuming an en face position with her newborn will support the
bonding process. The mother should be given as much privacy as possible; however, nursing
assessments must still be continued during this critical time. The mother has just delivered
and is more focused on the infant; she will not be receptive to teaching at this time. This is a
good time to initiate breastfeeding; however, the mother first needs time to explore the new
OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
29. A new father states, “I know nothing about babies,” but he seems to be
2023
TOPMARKSOLUTIONS
ANS: D
The nurse must be sensitive to the father’s needs and include him whenever possible. As
fathers take on their new role, the nurse should praise every attempt, even if his early care is
awkward. It is important to note the bonding process of the mother and the father; however,
that does not satisfy the expressed needs of the father. The new father should be encouraged
in caring for his baby by pointing out the things that he does right. Criticizing him will
discourage him.
PTS: 1 DIF: Cognitive Level: Application REF: 521
OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance
MULTIPLE RESPONSE
30. Which concerns about parenthood are often expressed by visually impaired mothers
a. Infant safety
b. Transportation
e. Needing extra time for parenting activities to accommodate the visual limitations
2023
TOPMARKSOLUTIONS
ANS: A, B, D, E
Concerns expressed by visually impaired mothers include infant safety, extra time needed for
discipline, and missing out visually. Blind people sense reluctance on the part of others to
acknowledge that they have a right to be parents; however, blind parents are fully capable of
OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance
31. A parent who has a hearing impairment is presented with a number of challenges in
parenting. Which nursing approaches are appropriate for working with hearing-impaired
ANS: A, D, E
Section 504 of the Rehabilitation Act of 1973 requires that hospitals use various
communication techniques and resources with the deaf and hard of hearing patient. This
includes devices such as door alarms, cry alarms, and amplifiers. Before initiating
communication, the nurse needs to be aware of the parents’ preferences for communication.
Not all hearing-impaired patients know sign language. Do they wear a hearing aid? Do they
read lips? Do they wish to have a sign language interpreter? If the parent relies on lip reading,
2023
TOPMARKSOLUTIONS
the nurse should sit close enough so that the parent can visualize lip movements. The nurse
should speak clearly in a regular voice volume, in short, simple sentences. Written messages
such as on a black or white erasable board can be useful. Written materials should be
2023