Exam 3 - Chapter 22 Flashcards
- After giving birth to a healthy infant boy, a primiparous woman, 16 years old, is admitted to the after birth 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?
a. Instruct the patient how to feed and bathe her infant.
b. Give the patient written information on bathing her infant.
c. Advise the patient that all mothers instinctively know how to care for their infants.
d. Provide time for the patient to bathe her infant after she views an infant bath demonstration.
ANS: D
Having the mother demonstrate infant care is a valuable method of assessing the patient’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 is an inappropriate statement; it is belittling and false.
- The nurse observes several interactions between a after birth woman and her new son. What behavior, if exhibited by this woman, would the nurse identify as a possible maladaptive behavior regarding parent-infant attachment?
a. Talks and coos to her son
b. Seldom makes eye contact with her son
c. Cuddles her son close to her
d. Tells visitors how well her son is feeding
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.
- The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is to:
a. tell the mother she must pay attention to her infant.
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.
d. arrange for the mother to watch a video on parent-infant interaction.
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 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.
- The nurse hears a primiparous woman talking to her son and telling him that his chin is just like his dad’s chin. This woman’s statement reflects:
a. mutuality.
b. synchrony.
c. claiming.
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 or behavior that provides the observer with cues.
- New parents express concern that, because of the mother’s emergency cesarean birth under general 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:
a. attachment, or bonding, 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.
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 inappropriate because it is derogatory and belittling.
- During a phone follow-up conversation with a woman who is 4 days’ after birth, the woman tells the nurse, “I don’t know what’s wrong. I love my son, but I feel so let down. I seem to cry for no reason!” The nurse would recognize that the woman is experiencing:
a. taking-in.
b. postpartum depression (PPD).
c. postpartum (PP) blues.
d. attachment difficulty.
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 response; it indicates PP blues.
- The nurse can help a father in his transition to parenthood by:
a. pointing out that the infant turned at the sound of his voice.
b. encouraging him to go home to get some sleep.
c. telling him to tape the infant’s diaper a different way.
d. suggesting that he let the infant sleep in the bassinet.
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 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.
- 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 evaluating the woman’s behavior with her infant, the nurse realizes that:
a. what appears to be a lack of interest in the newborn is in fact the Vietnamese way of demonstrating intense love by attempting to ward off evil spirits.
b. the woman is inexperienced in caring for newborns.
c. the woman needs a referral to a social worker for further evaluation of her parenting 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 important to acknowledge her cultural beliefs and practices.
- Many first-time parents do not plan on their parents’ help immediately after the newborn arrives. What statement by the nurse is the most appropriate when counseling new parents about the involvement of grandparents?
a. “You should tell your parents to leave you alone.”
b. “Grandparents can help you with parenting skills and also help preserve family traditions.”
c. “Grandparent involvement can be very disruptive to the family.”
d. “They are getting old. You should let them be involved while they can.”
ANS: B
“Grandparents can help you with parenting skills and also help preserve family traditions” is the most appropriate response. Intergenerational help may be perceived as interference; 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.
- When the infant’s behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics, this is called:
a. mutuality.
b. bonding.
c. claiming.
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 refers to a shared set of behaviors 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 after birth period through eye contact, touching, and talking.
- In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. Which one is a facilitating behavior?
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.
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.
- With regard to parents’ early and extended contact with their infant and the relationships built, nurses should be aware that:
a. immediate contact is essential for the parent-child relationship.
b. skin-to-skin contact is preferable to contact with the body totally wrapped in a blanket.
c. extended contact is especially important for adolescents and low-income women because they are at risk for parenting inadequacies.
d. mothers need to take precedence over their partners and other family matters.
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. Mothers and their partners are considered equally important.
- In the United States the en face position is preferred immediately after birth. Nurses can facilitate this process by all of these actions except:
a. washing both the infant’s face and the mother’s face.
b. placing the infant on the mother’s abdomen or breast with their heads on the same plane.
c. dimming the lights.
d. delaying the instillation of prophylactic antibiotic ointment in the infant’s eyes.
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 putting ointment in the infant’s eyes.
- 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 odor.
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 odor of their mother’s breast milk.
- After they are born, a crying infant may be soothed by being held in a position in which the newborn can hear the mother’s heartbeat. This phenomenon is known as:
a. entrainment.
b. reciprocity.
c. synchrony.
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 the infant’s behavioral cues and the parent’s responses.