Chapter 23 - Transition to Parenthood

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.

b. They seldom make eye contact with their newborn.

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.

b. Show the mother how the infant initiates interaction and pays attention to them.

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

c. Claiming

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.

a. Attachment is a process that occurs over time and does not require early contact.

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

b. Taking-hold

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.

a. Point out that the infant turned at the sound of his voice.

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.

a. What appears to be a lack of interest in the newborn is in fact a cultural practice.

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.

b. Grandparents can help nurture parenting skills and preserving family traditions.

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

a. Mutuality

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.

b. The parents hover around the infant, directing attention to and pointing at the infant.

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.

c. Extended contact is especially important for adolescents and low-income parents because they are at risk for parenting inadequacies

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.

b. infants can learn to distinguish their mother’s voice from others soon after birth.

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

d. Biorhythmicity

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.

b. Participation in preparation classes helps both siblings and grandparents.

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.

d. An environment that fosters as much privacy as possible should be created.

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

a. Skepticism of nurse

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 newborn.

c. Discuss behavioural characteristics with the parent(s).

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.

b. Visually impaired mothers cannot overcome the infant’s need for eye-to-eye contact.

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.

d. Provide time for the patient to bathe their infant after they view an infant bath demonstration.

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.

a. the positive feedback an infant exhibits toward parents during the attachment process.

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.

c. hand the baby to the patient.

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.

d. realize that this is a normal family adjusting to family change.

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.

c. assist the family with rooming-in.

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

a. Letting go

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.

b. assist the mother in assuming an en face position with their newborn.

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.

d. include him in teaching sessions.

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. Encouraging breastfeeding with the baby in the transverse hold

B, C, D

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

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.

A, B, D

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., d. Mothers older than 35 often deal with more stress related to work and career issues and decreasing libido.

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

B, C, F

b. Names the infant, c. Hovers over the infant to maintain proximity, f. Assigns meaning to the infant’s actions

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

A, B, D, E

a. Infant safety, b. Transportation, d. Missing out visually, e. Needing extra time for parenting activities to accommodate the visual limitations

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.

A, D, E

a. Use devices that transform sound into light., d. Ascertain whether the patient can read lips before teaching., e. Written messages aid in communication.