chapter 23: Transition to parenthood

Question 1

1. The nurse observes several interactions between a postpartum patient and their newborn. What behaviour, if exhibited by this patient, would the nurse identify as a possible maladaptive behaviour regarding parent–infant attachment?
   a. They talk and coos to their newborn.
   b. They seldom make eye contact with their newborn.
   c. They cuddle their newborn close to them.
   d. They tell visitors how well their newborn is feeding.

Answer 1

ANS: B
The patient should be encouraged to hold their infant in the en face position and make eye contact with the infant. Normal infant– parent interactions include talking and cooing to the newborn, cuddling the newborn close to them, and telling visitors howwell their newborn is feeding.

Question 2

2. The nurse observes that a 15-year-old mother seems to ignore their newborn. What is a strategy that the nurse can use to facilitate mother–infant attachment in this mother?
   a. Tell the mother they must pay attention to their infant.
   b. Show the mother how the infant initiates interaction and pays attention to them.
   c. Demonstrate for the mother different positions for holding the infant while feeding.
   d. Arrange for the mother to watch a video on parent–infant interaction.

Answer 2

ANS: B
Pointing out the responsiveness of the infant is a positive strategy for facilitating parent–infant attachment. Telling the mother that they must pay attention to their infant may be perceived as derogatory and is not appropriate. Educating the young mother in infant care is important but pointing out the responsiveness of their 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.

Question 3

3. The nurse hears a primiparous patient talking to their newborn and telling them that their chin is just like their dad’s chin. What does this patient’s statement reflect?
   a. Mutuality
   b. Synchrony
   c. Claiming
   d. Reciprocity

Answer 3

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 behaviours and characteristics call forth a corresponding set of maternal behaviours and characteristics. Synchrony refers to the “fit” between the infant’s cues and the parent’s responses. Reciprocity is a type of body movement or behaviour that provides the observer with cues.

Question 4

4. New parents express concern that, because of the mother’s emergency Caesarean birth under general anaesthesia, they did not have the opportunity to hold and bond with their newborn immediately after the birth. What should the nurse’s response convey to the parents?
   a. Attachment is a process that occurs over time and does not require early contact.
   b. The time immediately after birth is a critical period for people.
   c. Early contact is essential for optimum parent–infant relationships.
   d. They should just be happy that the infant is healthy.

Answer 4

ANS: A
Attachment 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 inappropriate because it is derogatory and belittling.

Question 5

5. During a phone follow-up conversation with a patient who is 4 days postpartum, the patient tells the nurse, “Everyone loves my baby! I have a routine that I am settling into and I feel physically well.” Which phase would the nurse assess that this patient is experiencing?
   a. Taking-in
   b. Taking-hold
   c. Postpartum blues
   d. Letting-go

Answer 5

ANS: B
The taking-hold phase starts the second or third day and lasts 10 days to several weeks. During this phase the mothers’ focus is on the baby and competent mothering. Indicating acceptance of the baby by others, a routine, and feeling physical well are all characteristics of the taking-hold phase. The taking-in phase is the period after birth when the mother focuses on her own psychological needs. Typically, this period lasts 24 hours. PP depression is an intense, pervasive sadness marked by severe, labile mood swings; it is more serious and persistent than the PP blues. The letting-go phase has a focus on forward movement of the family as a unit with interacting members.

Question 6

6. Which can the nurse do to help a father in his transition to parenthood?
   a. Point out that the infant turned at the sound of his voice.
   b. Encourage him to go home to get some sleep.
   c. Tell him to tape the infant’s diaper a different way.
   d. Suggest that he let the infant sleep in the bassinet.

Answer 6

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, but the manner in which a diaper is taped is not relevant and does not enhance parent–infant interactions. Parent–infant attachment involves touching, holding, and cuddling. It is appropriate for a father to want to hold the infant as the baby sleeps.

Question 7

7. The nurse notes that an Asian patient does not cuddle or interact with their newborn other than to feed him, change his diapers or soiled clothes, and put him to bed. Which does he nurse understand with regard to evaluating the patient’s behaviour with their infant?
   a. What appears to be a lack of interest in the newborn is in fact a cultural practice.
   b. The patient is inexperienced in caring for newborns.
   c. The patient needs a referral to a social worker for further evaluation of her
   parenting behaviours.
   d. Extra time needs to be planned for assisting the patient in bonding with her
   newborn.

Answer 7

ANS: A
With an Asian mother, the nurse may observe them giving minimal care to their infant and refusing to cuddle or interact with the newborn. The apparent lack of interest in the newborn may be the norm for this cultural group. It is important to educate the patient in infant care, but it is equally important to acknowledge her cultural beliefs and practices.

Question 8

8. Many first-time parents do not plan on their parents’ help immediately after the newborn arrives. What is most important when counselling new parents about the involvement of grandparents?
   a. Parents should be encouraged to inform grandparents to give them some space
   immediately after birth.
   b. Grandparents can help nurture parenting skills and preserving family traditions.
   c. Grandparent involvement can be very disruptive to the family.
   d. As they are old, parents should let grandparents be involved while they can.

Answer 8

ANS: B
Grandparents can help new families with parenting skills and also help preserve family traditions. While intergenerational help may be perceived as interference, a statement of this sort is not therapeutic to the adaptation of the family. That grandparent involvement can be very disruptive to the family is not true. Regardless of age, grandparents can help with parenting skills and preserve family traditions. Talking about the age of the grandparents is not an appropriate statement, and it does not demonstrate sensitivity on the part of the nurse. The nurse cannot assume that the grandparents are old.

Question 9

9. What is the term used when the infant’s behaviours and characteristics call forth a corresponding set of maternal behaviours and characteristics?
   a. Mutuality
   b. Bonding
   c. Claiming
   d. Acquaintance

Answer 9

ANS: A
Mutuality extends the concept of attachment to include this shared set of behaviours. Bonding is the process over time of parents forming an emotional attachment to their infant; mutuality involves a shared set of behaviours that is a part of the bonding process. 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 period through eye contact, touching, and talking.

Question 10

10. In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviours that can either facilitate or inhibit attachment. What is a facilitating behaviour?
    a. The parents have difficulty naming the infant.
    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.

Answer 10

ANS: B
Hovering over the infant and obviously paying attention to the baby are facilitating behaviours. Inhibiting behaviours 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.

Question 11

11. What should nurses be aware of with regard to parents’ early and extended contact with their infant?
    a. Immediate contact is essential for the parent–child relationship.
    b. Skin-to-skin contact is similar to having the body totally wrapped in a blanket.
    c. Extended contact is especially important for adolescents and low-income parents
    because they are at risk for parenting inadequacies.
    d. Mothers need to take precedence over their partners and other family matters.

Answer 11

ANS: C
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, although skin-to-skin contact is the preferred method. Mothers and their partners are considered equally important.

Question 12

12. Other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that, despite what folk wisdom may say
    a. high-pitched voices irritate newborns.
    b. infants can learn to distinguish their mother’s voice from others soon after birth.
    c. all babies in the hospital smell alike.
    d. a mother’s breast milk has no distinctive odour.

Answer 12

ANS: B
Infants know the sound of their mother’s voice early. Infants respond positively to high-pitched voices. Each infant has a unique odour. Infants quickly learn to distinguish the odour of their mother’s breast milk.

Question 13

13. After birth a crying infant may be soothed by being held in a position in which the newborn can hear the mother’s heartbeat. What is this phenomenon known as?
    a. Entrainment
    b. Reciprocity
    c. Synchrony
    d. Biorhythmicity

Answer 13

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 behaviour that gives cues to the person’s desires. These take several weeks to develop with a new baby. Synchrony is the fit between the infant’s behavioural cues and the parent’s responses.

Question 14

14. What should the nurse be aware of with regard to the adaptation of other family members, mainly siblings and grandparents, to the newborn?
    a. Sibling rivalry cannot be dismissed as overblown psychobabble; negative feelings and behaviours can take a long time to blow over.
    b. Participation in preparation classes helps both siblings and grandparents.
    c. In Canada, paternal and maternal grandparents consider themselves of equal
    importance and status.
    d. There is a decrease in the number of grandparents providing permanent care to
    their grandchildren over the last 10 years.

Answer 14

ANS: B
Preparing older siblings and grandparents helps everyone to adapt. Sibling rivalry should be expected initially, but the negative behaviours associated with it have been overemphasized and stop in a comparatively short time. In Canada, in contrast to other cultures, paternal grandparents frequently consider themselves secondary to maternal grandparents. The number of grandparents providing permanent child care has been rising.

Question 15

15. Which should the nurse ensure while providing routine mother–baby care with regard to the management of the environment?
    a. The baby is able to return to the nursery at night so that the new mother can sleep.
    b. Routine times for care are established to reassure the parents.
    c. The father should be encouraged to go home at night to prepare for mother–baby
    discharge.
    d. An environment that fosters as much privacy as possible should be created.

Answer 15

ANS: D
An environment that fosters privacy should be maintained at all times. Once the baby has demonstrated adjustment to extrauterine life, all care should be provided in one location. This important principle of family-centred maternity care fosters attachment by giving parents the opportunity to learn about their infant 24 hours a day. One nurse should provide care to both 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 partner 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.

Question 16

16. Which concern about parenthood is often expressed by visually impaired mothers?
    a. Skepticism of nurse
    b. Lack of direct eye contact
    c. The ability to care for the infant
    d. Inability to care for themselves postpartally

Answer 16

ANS: A
Concerns expressed by visually impaired mothers include infant safety, extra time needed for parenting activities, transportation, handling other people’s reactions, providing proper 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 caring for their infants.

Question 17

17. What can a nurse do to facilitate parent–infant attachment?
    a. Teach about infant feeding cues.
    b. Prepare parent(s) for expected role changes involved in becoming a parent.
    c. Discuss behavioural characteristics with the parent(s).
    d. Teach parent(s) skills to care for newbor

Answer 17

ANS: C
Discussing infant behavioural characteristics with the parents facilitates the development of an affective, enduring relationship between infant and parent, promoting attachment. Preparing parents for expected role change facilitates growth of the family. Instruction on infant feeding cues assists in the establishment and maintenance of successful feeding. Teaching the parent skills to care for the newborn is facilitating nurturing and physical care.

Question 18

18. When caring for parents who have some form of sensory impairment, nurses should realize that which of the following statements is not true?
    a. One of the major difficulties that visually impaired parents experience is the skepticism of health care providers.
    b. Visually impaired mothers cannot overcome the infant’s need for eye-to-eye contact.
    c. The best approach for the nurse is to assess the parents’ capabilities rather than focusing on their disabilities.
    d. Technological advances, including the Internet, can provide deaf parents with a full range of parenting activities and information

Answer 18

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 providers places an additional and unneeded burden on 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 acquired readily by young children.

Question 19

19. After giving birth to a healthy infant boy, a primiparous 16 years old patient, is admitted to the after-birth unit. In planning for the patient’s discharge, what should a nurse be certain to include in the plan of care?
    a. Instruct the patient how to feed and bathe their infant.
    b. Give the patient written information on bathing their infant.
    c. Advise the patient that all mothers instinctively know how to care for their infants.
    d. Provide time for the patient to bathe their infant after they view an infant bath demonstration.

Answer 19

ANS: D
Having the mother demonstrate infant care is a valuable method of assessing the patient’s understanding of their newly acquired knowledge, especially in this age group, because they may inadvertently neglect their 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 is an inappropriate statement; it is belittling and false.

Question 20

20. The mother-baby nurse is able to recognize reciprocal attachment behaviour. This refers to
    a. the positive feedback an infant exhibits toward parents during the attachment
    process.
    b. behaviour during the sensitive period when the infant is in the quiet alert stage.
    c. unidirectional behaviour exhibited by the infant, initiated and enhanced by eye
    contact.
    d. behaviour by the infant during the sensitive period to elicit feelings of “falling in
    love” from the parents.

Answer 20

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. Reciprocal attachment applies to feedback behavior and is not unidirectional.

Question 21

21. On observing a patient on her first day after giving birth sitting in bed while her newborn lies awake in the bassinet, the nurse should
    a. realize that this situation is perfectly acceptable.
    b. offer to hand the baby to the patient.
    c. hand the baby to the patient.
    d. explain “taking in” to the patient.

Answer 21

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 behaviour during the taking-in phase; however, interventions by the nurse can facilitate infant bonding. The patient will learn best during the taking-hold phase.

Question 22

22. A nurse is observing a postpartum family at 24 hours after the birth. The partner is watching the mother and asking questions about newborn care. The 4-year-old brother is punching their mother on the back. The nurse should
    a. report the incident to the social services department.
    b. advise the parents that the toddler needs to be reprimanded.
    c. report to oncoming staff that the mother is probably not a good disciplinarian.
    d. realize that this is a normal family adjusting to family change.

Answer 22

ANS: D
The observed behaviours 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.

Question 23

23. The best way for the nurse to promote and support the maternal-infant bonding process is to
    a. help the mother identify their positive feelings toward the newborn.
    b. encourage the mother to provide all newborn care.
    c. assist the family with rooming-in.
    d. return the newborn to the nursery during sleep periods.

Answer 23

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 their 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 they will be aware of what to anticipate when they go home.

Question 24

24. During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and accept the real baby?
    a. Letting go
    b. Taking hold
    c. Taking in
    d. Taking on

Answer 24

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 their own care and shifts their attention to the infant. In the taking-in phase the mother is primarily focused on their own needs. There is no taking-on phase of maternal adjustment.

Question 25

25. To promote bonding and attachment immediately after birth, the most important nursing intervention is to
    a. allow the mother quiet time with their infant.
    b. assist the mother in assuming an en face position with their newborn.
    c. teach the mother about the concepts of bonding and attachment.
    d. assist the mother in feeding their baby.

Answer 25

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 given birth and is more focused on the infant; they 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 infant and begin the bonding process.

Question 26

26. A new father states, “I know nothing about babies,” but he seems to be interested in learning. This is an ideal opportunity for the nurse to
    a. continue to observe his interaction with the newborn.
    b. tell him when he does something wrong.
    c. show no concern, as he will learn on his own.
    d. include him in teaching sessions.

Answer 26

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.

Question 27

1. The en face position is preferred immediately after birth. Which would facilitate this process? (Select all that apply.)
   a. Washing both the infant’s face and the mother’s face
   b. Placing the infant on the mother’s abdomen with their heads on the same plane
   c. Dimming the lights
   d. Delaying the instillation of prophylactic antibiotic ointment in the infant’s eyes
   e. Ensuring that the infant and parent’s face are 10 cm apart
   f. Encoouraging breastfeeding with the baby in the transverse hold

Answer 27

ANS: B,C,D
Washing the infant’s and mother’s face does not facilitate the en face position. To facilitate the position in which the parent’s and infant’s faces are approximately 20 cm 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 lights so that the infant’s eyes open, and delay putting ointment in the infant’s eyes. Breastfeeding positions that enable the mothers and infants faces to be in the same plane are to be encouraged, i.e., side-lying, football hold.

Question 28

2. Of the many factors that influence parental responses, nurses should be aware that which statements regarding age are true? (Select all that apply.)
   a. An adolescent mother’s egocentricity and unmet developmental needs may
   interfere with her ability to parent effectively.
   b. An adolescent mother is likely to use less verbal instruction, be less responsive,
   and interact less positively than other mothers.
   c. Adolescent mothers have a higher documented incidence of child abuse.
   d. Mothers older than 35 often deal with more stress related to work and career
   issues and decreasing libido.
   e. Adolescent mothers are at decreased risk of postpartum depression.
   f. Adolescent mothers have a high tolerance for frustration.

Answer 28

ANS: A, B, D
Adolescent mothers are more inclined to have a number of parenting difficulties that benefit from counselling, but a higher incidence of child abuse is not one of them. Midlife mothers have many competencies but are more likely to have to deal with career and sexual issues than are younger mothers. Adolescent mothers are at an increased risk of postpartum depression. Adolescent mothers have a low tolerance for frustration that is typical of adolescence.

Question 29

3. Which are facilitating behaviours affecting infant attachment? (Select all that apply.)
   a. Identifies the infant with someone the parent dislikes
   b. Names the infant
   c. Hovers over the infant to maintain proximity
   d. Views infants’ behaviour as deliberately uncooperative
   e. Maintains bland countenance
   f. Assigns meaning to the infant’s actions

Answer 29

ANS: B, C, F
Examples of facilitating parental behaviours affecting infant attachment are naming the infant, hovering over the infant and maintaining proximately, assigning meaning to the infant’s actions, and sensitively interpreting the infant’s needs. Examples of inhibiting parental behaviours affecting infant attachment are identifying the baby with someone that the parents do not like, viewing the infant’s behaviour as exploiting or deliberatively uncooperative, and maintaining a bland countenance or frowning at the infant.

Question 30

4. Which concerns about parenthood are often expressed by visually impaired mothers? (Select all that apply.)
   a. Infant safety
   b. Transportation
   c. The ability to care for the infant
   d. Missing out visually
   e. Needing extra time for parenting activities to accommodate the visual limitations

Answer 30

ANS: A, B, D, E
Concerns expressed by visually impaired mothers include infant safety, extra time needed for parenting activities, transportation, handling other people’s reactions, providing proper 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 caring for their infants.

Question 31

5. 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 new parents? (Select all that apply.)
   a. Use devices that transform sound into light.
   b. Assume that the patient knows sign language.
   c. Speak quickly and loudly.
   d. Ascertain whether the patient can read lips before teaching.
   e. Written messages aid in communication.

Answer 31

ANS: A, D, E
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 lipreading, 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 reviewed with the parents before discharge.