Maternity & Women’s Health Care 10th Edition by Kathryn Rhodes – ‎ Deitra Leonard Lowdermilk – Test Bank

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Lowdermilk: Maternity & Women’s Health Care, 10th Edition

 

Chapter 05: Violence Against Women

 

Test Bank

 

MULTIPLE CHOICE

 

1. The justification for the victimization of women very early in history was that:

a.	Women were regarded as possessions
b.	Women were the “weaker sex”
c.	Control of women was necessary for protection
d.	Women were created subordinate to men

 

ANS: A

Misogyny, patriarchy, devaluation of women, power imbalance, a view of women as property, gender-role stereotyping, and acceptance of aggressive male behaviors as appropriate contributed and continue to contribute to the subordinate status of women in many of the world’s societies.

Viewing women as the “weaker sex” is a cultural and modern stereotype that contributes to the victimization of women.

Control of women in order to protect them is another cultural and modern stereotype that contributes to the victimization of women.

Women having been created as subordinate to men is yet another example of a cultural stereotype that contributes to the victimization of women.

 

DIF:   Cognitive Level: Knowledge        REF:  “95, 96”

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Assessment

 

2. The primary theme of the feminist perspective on violence against women recognizes the:

a.	Role of testosterone as the underlying cause of men’s violent behavior
b.	Basic human instinctual drive toward aggression
c.	Dominance and coercive control over women by men
d.	Cultural norm of violence in Western society

 

ANS: C

The contemporary social view of violence is derived from the feminist theory. With the primary theme of male dominance and coercive control, this view enhances our understanding of all forms of violence against women, including wife battering, stranger and acquaintance rape, incest, and sexual harassment in the workplace.

The role of testosterone as an underlying cause of men’s violent behavior is not associated with the feminist perspective of violence against women.

The basic human instinctual drive toward aggression is not associated with the feminist perspective.

The cultural norm of violence in Western society is not associated with the feminist perspective regarding violence against women.

 

DIF:   Cognitive Level: Knowledge        REF:  98

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Assessment

 

3. The nurse suspects that a client who comes to the maternity clinic for a pregnancy test is in an abusive relationship. The nurse includes the abuse assessment screen as part of the assessment. Although the woman was very emotional and hesitant in responding to the questions, verbally she denied abuse as being a problem. While waiting for the results of the pregnancy test, the nurse decides to teach the client about partner abuse anyway. The rationale for the nurse’s decision is that all women should be informed about:

a.	The nurse’s ethical responsibility to protect clients
b.	The cycle of violence, which continues and escalates over time once it begins
c.	Women’s legal right not to be controlled by men
d.	The masochistic nature of women who stay in abusive relationships

 

ANS: B

Because of the cycle of violence and the loving respite phase, denial is a coping mechanism often used by battered women. During pregnancy the nurse should assess for abuse at each prenatal visit and on admission to labor.

Although the nurse may feel an ethical responsibility to protect the client, it is not the best rationale for the nurse’s behavior.

Although women have a right not to be controlled by men, it is not the reason the nurse should continue the teaching with this client.

The belief that women are masochistic is simply a myth.

 

DIF:   Cognitive Level: Analysis             REF:  97

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Implementation

 

4. The primary responsibility of the nurse who suspects or confirms any type of violence against a woman is:

a.	Report the incident to legal authorities
b.	Provide information to social services
c.	Call a client advocate who can assist in the client’s decision making about what action to take
d.	Document the incident (or findings) accurately and concisely in the client’s record

 

ANS: D

Documentation can be useful to women later in court if they choose to press charges.

Although many states have mandatory reporting laws, the primary responsibility of the nurse is to document the incident and findings.

Social services is called only if a child also is a victim of violence or had witnessed the violence.

A client advocate usually is notified when legal action is to be taken or if the woman is seeking shelter. The nurse may assist in this endeavor, but it is not the first action to be taken.

 

DIF:   Cognitive Level: Comprehension            REF:  107

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Implementation

 

5. Intimate partner violence (IPV) is seen in all races, ethnicities, religions, and socioeconomic backgrounds. Which statement is most accurate regarding the reporting of IPV in the United States?

a.	Asian women report more IPV than do other minority groups.
b.	Caucasian women report less IPV than do non-Caucasians.
c.	Native-American women report IPV at a rate similar to other groups.
d.	African-American women are less likely to report IPV than Caucasian women.

 

ANS: B

Caucasian women report less IPV than other ethnic groups.

Asian women report significantly less IPV than do other racial groups.

Native-American and Alaska Native women report significantly more IPV than do women of any other racial background.

African-American women tend to report violence at a slightly higher rate than Caucasian women.

 

DIF:   Cognitive Level: Comprehension            REF:  101

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Assessment

 

6. Intervention for the sexual abuse survivor often is not attempted by maternity and women’s health nurses because of the concern about increasing the distress of the woman and the lack of expertise in counseling. What initial intervention is appropriate and most important in facilitating the woman’s care?

a.	Initiating a referral to an expert counselor
b.	Setting limits on what the client discloses
c.	Listening and encouraging therapeutic communication skills
d.	Acknowledging the nurse’s discomfort to the client as an expression of empathy

 

ANS: C

The survivor needs support on many different levels, and a women’s health nurse may be the first person to whom she relates her story. Therapeutic communication skills and listening are initial interventions.

Referring this client to a counselor is an appropriate measure but not the most important initial intervention.

A client should be allowed to disclose any information she feels the need to discuss. As a nurse you should provide a safe environment in which she can do so.

Either verbal or nonverbal shock and horror reactions from the nurse are particularly devastating. Professional demeanor and professional empathy are essential.

 

DIF:   Cognitive Level: Analysis             REF:  105

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Implementation

 

7. A young woman arrives at the emergency department and states that she thinks she has been raped. She is sobbing and expresses disbelief that this could happen because the man was her best friend. In an effort to calm the client in order to perform a thorough assessment and physical examination, the nurse acknowledges the client’s fear and anxiety and tells her:

a.	“Rape is not limited to strangers and frequently occurs by someone who is known to the victim.”
b.	“I would be very upset if my best friend did that to me; that is very unusual.”
c.	“You must feel very betrayed. In what way do you think you might have led him on?”
d.	“This does not sound like rape. Didn’t you just change your mind about having sex after the fact?”

 

ANS: A

Acquaintance rape involves individuals who know one another. Sexual assault occurs when the trust of a relationship is violated. Victims may be less prone to recognize what is happening to them because the dynamics are different from those of stranger rape.

It is not at all unusual for the victim to know and trust the perpetrator.

Stating that the woman might have led the man to attack her indicates that the sexual assault was somehow the victim’s fault. This type of mentality is not constructive. Nurses must first reflect on their own feelings and learn to be unbiased when dealing with victims. A statement of this type can be very psychologically damaging to the victim.

Nurses must display compassion by first believing what the victim states. The nurse is not responsible for deciphering the facts involving the victim’s claim.

 

DIF:   Cognitive Level: Application        REF:  109

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Assessment

 

8. The nurse’s best measure of evaluating care of a rape victim is that:

a.	All legal evidence is preserved during the physical examination
b.	The victim appreciates the legal information but decides not to pursue legal proceedings
c.	The victim states that she is going to advocate against sexual violence
d.	The victim leaves the health care facility without feeling revictimized

 

ANS: D

Nurses can assist clients through an examination that is as nontraumatic as possible with kindness, skill, and empathy. The initial care of the victim affects her recovery and decision to receive follow-up care.

Preservation of all legal evidence is very important; however, this may not be the best measure in terms of evaluating care of a rape victim.

Offering legal information is not the best measure of evaluating the care that this victim received. The victim may well decide not to pursue legal proceedings.

Advocating against sexual violence may be extremely therapeutic for the client after her initial recovery. This is not a measure of evaluating her care.

 

DIF:   Cognitive Level: Comprehension            REF:  115

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Evaluation

 

9. Proper documentation of the abuse as reported by the victim is a crucial role of the nurse. Evaluate the following data, which include information from the victim, and choose the best documentation by the nurse.

 

A 34-year-old Caucasian arrives at the emergency department with a black right eye; she also is bleeding from the left side of her head. She reports that her boyfriend has been abusing her physically. The nurse performs a history and physical examination and documents her findings.

a.	“Client alleges that her boyfriend beat her up.”
b.	“Client reports that her boyfriend hit her in the eye and head.”
c.	“Client is a 34-year-old Caucasian female. Presents with periorbital ecchymosis on right side. Laceration of left parietal area, 3 cm long with tissue bridging. Approximately 1 cm deep. Client states that her boyfriend ‘threw a brick from 10 feet away, aiming at my head. The corner of the brick hit the left side of my head.’ She reports that he also ‘hit me in the eye.’ Client indicates that the hit was with her boyfriend’s closed left fist.”
d.	“Client presents with a black eye and a cut on the left side of her head. Reports being abused.”

 

ANS: C

It is important to list the name of the abuser, if possible, because a defense strategy is to portray the victim as having more than one partner. Listing the name eliminates any confusion as to who the abuser was. In addition, using accurate medical terminology is crucial. If you are unsure of the proper descriptive terms to use in documentation, simply describe what you see without labeling the injury. Photographs should be taken.

Documenting only that the client states that her boyfriend beat her lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victim’s case if she were to pursue legal recourse against the abuser.

Documenting only that the client states that her boyfriend hit her in the eye and head lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victim’s case if she were to pursue legal recourse against the abuser.

Documenting only that the client reports being abused lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victim’s case if she were to pursue legal recourse against the abuser.

 

DIF:   Cognitive Level: Evaluation          REF:  107

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Implementation

 

10. With regard to violence against women, intimate partner violence (IPV) nurses should be aware that:

a.	Relationship violence usually consists of a single episode that the couple can put behind them
b.	Violence often declines or ends with pregnancy
c.	Economic coercion is considered part of IPV
d.	Battered women generally are poorly educated and come from a deprived social background

 

ANS: C

Economic coercion accompanies physical assault and psychologic attacks.

IPV almost always follows an escalating pattern. It rarely ends with a single episode of violence.

IPV often begins with and escalates during pregnancy. It may include both psychologic attacks and economic coercion.

Race, religion, social background, age, and education level are not significant factors in differentiating women at risk.

 

DIF:   Cognitive Level: Comprehension  REF:  96

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Assessment

 

11. In 1979, Lenore Walker pioneered the cause of women as victims of violence when she published her book The Battered Woman. While Walker conducted her research she found a similar pattern of abuse among many of the women. This concept is now referred to as the Cycle of Violence. Which phase does not belong in this three-cycle pattern of violence?

a.	Tension-building state
b.	Frustration followed by violence
c.	Acute battering incident
d.	Kindness and contrite, loving behavior

 

ANS: B

Frustration followed by violence is not part of the Cycle of Violence.

Tension-building state is also known as phase I of the cycle. The batterer expresses dissatisfaction and hostility with violent outbursts. The woman senses anger and anxiously tries to placate him.

Acute battering incident is phase II of the cycle. It results in the man’s uncontrollable discharge of tension toward the woman. Outbursts can last from several hours to several days and may involve kicking, punching, slapping, choking, burns, broken bones, and the use of weapons.

Sometimes referred to as the honeymoon, kindness and contrite, loving behavior is the third phase of the cycle. The batterer feels remorseful and apologizes profusely. He tries to help the woman and often showers her with gifts.

 

DIF:   Cognitive Level: Analysis             REF:  97

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Diagnosis

 

12. Nurses must remember that pregnancy is a time of risk for all women. Which condition is likely the biggest risk for the pregnant client?

a.	Preeclampsia
b.	Intimate partner violence (IPV)
c.	Diabetes
d.	Abnormal Pap test

 

ANS: B

The prevalence of IPV during pregnancy is estimated at 4% to 8% of all pregnant women. The risk for IPV and even IPV-related homicide is more common than all of the other pregnancy-related conditions.

Although preeclampsia poses a risk to the health of the pregnant client, it is less common than IPV.

Gestational diabetes continues to be a complication of pregnancy; however, it is less common than IPV during pregnancy.

Some women are at risk for an abnormal Pap screening during pregnancy. This finding is not as common as IPV.

 

DIF:   Cognitive Level: Comprehension            REF:  103

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Diagnosis

 

 

 

 

 

 

 

 

 

MULTIPLE RESPONSE

 

1. The nurse who is evaluating the client for potential abuse should be aware that intimate partner violence includes (choose all that apply):

a.	Physical abuse
b.	Sexual abuse
c.	Emotional abuse
d.	Psychologic abuse
e.	Economic abuse

 

ANS: A, B, C, D, E

Physical, sexual, emotional, psychologic, and economic abuse can be factors in intimate partner violence.

 

DIF:   Cognitive Level: Comprehension            REF:  115

OBJ:  Client Needs: Psychosocial and Physiologic Integrity

TOP:  Nursing Process: Assessment

 

2. Common characteristics of a potential batterer include (choose all that apply):

a.	High level of self-esteem
b.	High frustration tolerance
c.	Substance abuse problems
d.	Excellent verbal skills
e.	Personality disorders

 

ANS: C, E

Substance abuse and personality disorders are often seen in batterers.

Typically the batterer has low self-esteem. Batterers usually have a low frustration level (i.e., they lose their temper easily). Batterers characteristically have poor verbal skills and especially can have difficulty expressing their feelings.

 

DIF:   Cognitive Level: Comprehension            REF:  98

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Diagnosis

 

3. Which nursing diagnosis would be most applicable for battered women? Choose all that apply.

a.	Loss of trust
b.	Ineffective family coping
c.	Situational low self-esteem
d.	Risk for self-directed violence
e.	Enhanced communication

 

ANS: A, B, C, D

Loss of trust, ineffective family coping, situational low self-esteem, and risk for self-directed violence are potential nursing diagnoses associated with battered women.

A more appropriate nursing diagnosis for this client would be impaired communication.

 

DIF:   Cognitive Level: Evaluation          REF:  106

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Diagnosis

 

4. A thorough abuse assessment screen should be done on all clients. This screen includes (choose all that apply):

a.	Asking the client if she has ever been slapped, kicked, punched, or physically hurt by her partner
b.	Asking the client if she is afraid of her partner
c.	Asking the client if she has been forced to perform sexual acts
d.	Diagramming the client’s current injuries on a body map
e.	Asking the client what she did wrong to elicit the abuse

 

ANS: A, B, C, D

Asking the client if she has been slapped, kicked, punched, or physically hurt by her partner, if she is afraid of her partner, or if she has been forced to perform sexual acts are questions that should be posed to all clients. If any physical injuries are present, they should be marked on a form that indicates their location on the body.

Implying that a client did something wrong can be very emotionally damaging. Many victims of violence are not aware that they are in an abusive relationship. They may not respond to questions about abuse. It is best to use general descriptive words, such as “slap,” “kick,” or “punch” to elicit information.

 

DIF:   Cognitive Level: Analysis             REF:  104

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  Nursing Process: Assessment

 

COMPLETION

 

1. Nurses who are part of a collaborative team that cares for victims of sexual assault and who have special education and training in forensic nursing are called ______________.

 

ANS:

SANE (nurses)

Sexual assault nurse examiners

 

DIF:   Cognitive Level: Comprehension            REF:  111

OBJ:  Client Needs: Safe and Effective Care Environment

TOP:  “Nursing Process: Assessment, Diagnosis, Planning, Implementation, Evaluation”

 

 

 

Lowdermilk: Maternity & Women’s Health Care, 10th Edition

 

Chapter 22: Transition to Parenthood

 

Test Bank

 

MULTIPLE CHOICE

 

1. After giving birth to a healthy infant boy, a primiparous woman, age 16, is admitted to 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 should be certain to include in the plan of care?

a.	Tell the woman how to feed and bathe her infant.
b.	Give the woman written information on bathing her infant.
c.	Advise the woman that all mothers instinctively know how to care for their infants.
d.	Provide time for the woman 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 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 client education, it is not the most developmentally appropriate teaching for a teenage mother.

Although providing written information is useful, it is not the most developmentally appropriate teaching for a teenage mother.

Advising the woman that all mothers instinctively know how to care for their infants is inappropriate; it is belittling and false.

 

DIF:   Cognitive Level: Application        REF:  513

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  “Nursing Process: Diagnosis, Planning”

 

2. A 30-year-old multiparous woman has a boy who is 2½ years old and now an infant girl. She tells the nurse, “I don’t know how I’ll ever manage both children when I get home.” Which suggestion would best help this woman alleviate sibling rivalry?

a.	Tell the older child that he is a big boy now and should love his new sister.
b.	Let the older child stay with his grandparents for the first 6 weeks to allow him to adjust to the newborn.
c.	Ask friends and relatives not to bring gifts to the older sibling because you do not want to spoil him.
d.	Realize that the regression in habits and behaviors in the older child is a typical reaction and that he needs extra love and attention at this time.

 

ANS: D

The older child may regress in habits or behaviors (e.g., toileting and sleep habits) as a method of seeking attention. Parents need to distribute their attention in an equitable manner.

Telling the older child that he should love his new sister is a negative approach to facilitating sibling acceptance of the new infant.

Reactions of siblings may result from temporary separation from the mother. Removing the older child from the home when the new infant arrives may enhance negative behaviors from the older child caused by separation from the mother.

Providing small gifts from the infant to the older child is a strategy for facilitating sibling acceptance of the new infant.

 

DIF:   Cognitive Level: Analysis             REF:  524

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning

 

3. A nurse observes that a 15-year-old new mother appears to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is:

a.	Tell the mother she must pay attention to her infant
b.	Show the mother how the infant initiates interaction and attends 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, but 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.

 

DIF:   Cognitive Level: Application        REF:  519

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Implementation

 

4. A nurse hears a primiparous woman talking to her son and telling him that his chin is just like his dad’s. 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.

 

DIF:   Cognitive Level: Comprehension            REF:  508

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Evaluation

 

5. 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 humans
c.	Early contact is essential for optimum parent-infant relationships
d.	They should just be happy that the infant is healthy

 

ANS: A

Attachment occurs over time and does not require early contact. Although a delay in contact does not necessarily mean that attachment is inhibited, additional psychologic energy may be necessary to achieve the same effect.

The formerly accepted definition of bonding held that the period immediately after birth was critical 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.

Telling the parents that they should be happy that the infant is healthy is inappropriate because it is derogatory and belittling.

 

DIF:   Cognitive Level: Application        REF:  507

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Implementation

 

6. During a phone follow-up conversation with a woman who is 4 days postpartum, 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 recognizes that the woman is experiencing:

a.	Letting-go
b.	Postpartum depression (PPD)
c.	Postpartum blues
d.	Attachment difficulty

 

ANS: C

During the postpartum blues women are emotionally labile, often crying easily and for no apparent reason. This lability seems to peak around the fifth postpartum day.

The letting-go phase is the period that occurs several weeks postdelivery. During this phase the woman wants to move forward as a family unit with all members interacting appropriate to their new roles.

PPD is an intense, pervasive sadness marked by severe, labile mood swings; it is more serious and persistent than the postpartum blues.

Crying is not a maladaptive attachment response; it indicates postpartum blues.

 

DIF:   Cognitive Level: Comprehension            REF:  515

OBJ:  Client Needs: Psychosocial Integrity

TOP:  “Nursing Process: Assessment, Diagnosis”

 

7. A nurse can assist 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, 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.

 

DIF:   Cognitive Level: Application        REF:  516

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Implementation

 

8. A 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.

Inexperience in caring for newborns is not an issue. Cultural beliefs are important determinates of parenting behaviors. The woman’s “lack of interest” is a Vietnamese cultural behavior.

Referring the woman to a social worker is not necessary in this situation. The lack of infant interaction is not a form of infant neglect, but rather a demonstration of love and concern for the infant.

The nurse may observe the woman and may be concerned by the apparent lack of interest in the newborn when in fact this is a cultural display of 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.

 

DIF:   Cognitive Level: Comprehension            REF:  522

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Evaluation

 

9. 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

Telling the parents that grandparents can help with parenting skills and help preserve family traditions is the most appropriate response.

Intergenerational help may be perceived as interference, but telling the parents that their parents should be told to leave them alone is not therapeutic to the adaptation of the family.

Telling the parents that grandparent involvement can be disruptive to the family is an invalid statement and not an appropriate nursing response.

Regardless of age, grandparents can help with parenting skills and preserve family traditions.

 

DIF:   Cognitive Level: Analysis             REF:  525

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Planning

 

 

 

 

10. In follow-up appointments or visits with parents and their new baby, it is useful if the nurse can identify infant behaviors that can either facilitate or inhibit attachment. What is an inhibiting behavior?

a.	The infant cries only when hungry or wet.
b.	The infant’s activity is somewhat predictable.
c.	The infant clings to the parents.
d.	The infant seeks attention from any adult in the room.

 

ANS: D

Parents want to be the focus of the infant’s existence, just as the infant is the focus of their existence. Facilitating and inhibiting behaviors build or discourage bonding (attitudes); they do not reflect any value judgments on what might be healthy or unhealthy. The infant that shows no preference for his or her parents over other adults is exhibiting an inhibiting behavior.

An infant that cries only when hungry or wet is exhibiting a facilitating behavior.

An infant that has a predictable attention span is exhibiting a facilitating behavior.

The infant that clings to his or her parents, enjoys being cuddled and held, and is easily consoled is displaying facilitating behaviors.

 

DIF:   Cognitive Level: Comprehension            REF:  508

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Assessment

 

11. 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.

 

DIF:   Cognitive Level: Comprehension            REF:  510

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Planning

 

 

 

 

 

12. 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

As newborns become functionally able to sustain eye contact with their parents, they spend time in mutual gazing, often in the en face position, a position in which the parent’s and infant’s faces are approximately 20 cm apart and on the same plane. Washing the infant’s or mother’s face is not necessary at this time and would interrupt the process.

Nurses and physicians or midwives can facilitate eye contact immediately after birth by placing the infant on the mother’s abdomen or breasts with the mother’s and the infant’s faces on the same plane.

Dimming the lights encourages the infant’s eyes to stay open.

To promote eye contact, instillation of prophylactic antibiotic ointment into the infant’s eyes can be delayed until after the infant and parents have had some time together in the first hour after birth.

 

DIF:   Cognitive Level: Comprehension            REF:  511

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Implementation

 

13. In addition to eye contact other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that despite what folk wisdom might 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.

 

DIF:   Cognitive Level: Knowledge        REF:  511

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning

 

14. After birth, 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.

 

DIF:   Cognitive Level: Knowledge        REF:  512

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Implementation

 

15. Of the many factors that influence parental responses, nurses should be aware that all of these statements regarding age are true except:

a.	An adolescent mother’s egocentricity and unmet developmental needs 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, as well as decreasing libido

 

ANS: C

Adolescent mothers are more inclined to have a number of parenting difficulties that benefit from counseling, but a higher incidence of child abuse is not one of them.

As adolescent mothers move through the transition to parenthood, they can feel “different” from their peers, excluded from “fun” activities and prematurely forced to enter the adult role. The conflict between their own desires and the infant’s demands further contribute to the normal psychosocial stress of childbirth and parenting.

Adolescent mothers provide warm and attentive physical care; however, they use less verbal interaction than older parents, and adolescents tend to be less responsive and to interact less positively with their infants then older mothers.

Midlife mothers have many competencies; however, they are more likely to have to deal with career and sexual issues than are younger mothers.

 

DIF:   Cognitive Level: Comprehension            REF:  519

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Evaluation

 

16. With regard to the adaptation of other family members (mainly siblings and grandparents) to the newborn, nurses should be aware that:

a.	Sibling rivalry cannot be dismissed as overblown psychobabble; negative feelings and behaviors can take a long time to blow over
b.	Participation in preparation classes helps both siblings and grandparents
c.	In the United States, paternal and maternal grandparents consider themselves of equal importance and status
d.	Since 1990, the number of grandparents providing permanent care to their grandchildren has been declining

 

ANS: B

Preparing older siblings, as well as grandparents, helps with everyone’s adaptation.

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, paternal grandparents frequently consider themselves secondary to maternal grandparents.

The number of grandparents providing permanent child care has been rising.

 

DIF:   Cognitive Level: Comprehension            REF:  “524, 525”

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Planning

 

17. Nursing activities that promote parent-infant attachment are many and varied. One activity that should not be overlooked is the management of the environment. While providing routine mother-baby care, the nurse should ensure that:

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

 

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 principle of family-centered 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 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.

 

DIF:   Cognitive Level: Application        REF:  509

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Implementation

 

18. 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:

a.	Foster an active role in the baby’s care
b.	Provide time for the mother to reflect on the events of her labor and delivery
c.	Recognize the woman’s limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now
d.	Promote maternal independence by encouraging her to meet her own hygiene and comfort needs

 

ANS: B

During this stage the new mother is excited and talkative. It is important that she be able to fulfill her desire to review her birth experience.

During this stage the new mother still relies upon others to meet her physical needs. Once these are met she will be more able to take an active role, not only in her own care but also in the care of her newborn. This happens during the taking-hold stage.

Short teaching sessions, using written materials to reinforce the content presented, is a more effective approach.

The focus of the taking-in or dependency stage is to nurture the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition.

 

DIF:   Cognitive Level: Comprehension            REF:  514

OBJ:  Client Needs: Psychosocial Integrity

TOP:  “Nursing Process: Planning, Implementation”

 

MULTIPLE RESPONSE

 

1. What concerns about parenthood are often expressed by visually impaired mothers? Choose 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

 

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.

 

DIF:   Cognitive Level: Comprehension            REF:  523

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Evaluation

 

COMPLETION

 

1. ____________________ is the process by which the parent and infant come to love and accept each other.

 

ANS:

Attachment

By using the terms attachment and bonding, Klaus and Kennell originally proposed that the period shortly after birth is important to mother and infant attachment. Attachment is developed and maintained by proximity to and interaction with the infant. It also occurs through a mutually satisfying experience.

 

DIF:   Cognitive Level: Comprehension            REF:  507

OBJ:  Client Needs: Psychosocial Integrity

TOP:  Nursing Process: Evaluation

 

TRUE/FALSE

 

1. Hearing-impaired parents face many challenges related to caregiving and parenting, particularly if their deafness dates back to infancy or early childhood. In order to ensure that the learning needs of these families are met, legislation has been passed that directs hospitals to use various communication techniques and resources with their deaf clients. Is this statement true or false?

 

ANS: T

Section 504 of the Rehabilitation Act of 1973 requires that hospitals or other institutions that receive funding from the U.S. Department of Health and Human Services use a variety of communication techniques and resources with their deaf clients. This includes providing certified interpreters who are proficient in sign language.

 

DIF:   Cognitive Level: Comprehension            REF:  523

OBJ:  Client Needs: Health Promotion and Maintenance

TOP:  Nursing Process: Planning