Chapter 18: Maternal Physiologic Changes Examination Study Guide 2023 Latest Updated versi, Exams of Nursing

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Chapter 18: Maternal Physiologic Changes

1. A woman gave birth to an infant boy 10 hour*s ago. Where would the nurse expect to locate this woman’s fundus?

a. (^) One centimeter above the umbilicus

ANS: A Within 12 hours after delivery fundus-approximately 1 cm above umbilicus. fundus descends about 1-2 cm every 24 hours. By 6th postpartum week-fundus normally halfway between symphysis pubis and umbilicus.

2. Which woman is most likely to experience strong afterpains?

b. (^) A woman who is a gravida 4, para 4-0-0-

ANS: B Afterpains-more common in multiparous,with births in which uterus was greatly distended,in woman who experienced polyhydramnios or delivered large infant. Breastfeeding may cause afterpains to intensify.

3. A woman gave birth to a healthy infant boy 5 days ago. What type of lochia would the nurse expect to find when assessing this woman?

d. (^) Lochia serosa

ANS: D Lochia serosa-blood, serum, leukocytes,tissue debris,around day 3 or 4 after childbirth. Lochia rubra-blood,decidual,trophoblastic debris;3 to 4 days and pales, becoming pink or brown.Lochia alba-after day 10,continue up to 6 wks

4. Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman?

c. (^) Prolactin

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ANS: C Prolactin-increase progressively throughout pregnancy. In breastfeed-remain elevated into 6th week after birth. Estrogen,progesterone -decrease markedly after expulsion of placenta,reach their lowest levels 1 week into postpartum period. Human placental lactogen levels decrease dramatically after expulsion of placenta.

5. Two days ago a woman gave birth to a full-term infant. Last night she awakened several times to urinate and noted that her gown and bedding were wet from profuse diaphoresis. One mechanism for the diaphoresis and diuresis that this woman is experiencing during the early postpartum period is:

c. (^) Loss of increased blood volume associated with pregnancy.

ANS: C Within 12 hours of birth women begin to lose excess tissue fluid.1st mechanism for reducing retained fluids-profuse diaphoresis-often occurs, especially at night, for 1st 2-3 days after childbirth. Postpartal diuresis -mechanism by which body rids itself of excess fluid. Diaphoresis,diuresis-referred to as reversal of water metabolism of pregnancy.Postpartal diuresis may be caused by removal of increased venous pressure in lower extremities.

6. A woman gave birth to a 7-pound, 3-ounce infant boy 2 hours ago. The nurse determines that the woman’s bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is:

b. (^) Excessive uterine bleeding.

ANS: B Excessive bleeding-occur immediately after birth if bladder becomes distended because it pushes uterus up,to side,prevents it from contracting firmly.UTI- may result from overdistention of bladder,not most serious consequence.ruptured bladder may result from severely overdistended bladder.vaginal bleeding most likely would occur before bladder reaches this level of overdistention.Bladder distention may result from bladder wall atony.

7. The nurse caring for the postpartum woman understands that breast engorgement is caused by:

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d. (^) Congestion of veins and lymphatics.

ANS: D

8. A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal, and the estimated blood loss (EBL) was approximately 1500 mL. When assessing the woman’s vital signs, the nurse would be concerned to see:

a. (^) Temperature 37.9° C, heart rate 120, respirations 20, blood pressure (BP) 90/50.

ANS: A EBL=1500 mL with tachycardia,hypotension suggests hypovolemia- excessive blood loss. Increased respiratory rate of 36 may be 2ry to pain from birth. Temperature may increase to 38° C during 1st 24 hrs-result of dehydrating effects of labor.BP140/90-slightly elevated-may be caused by use of oxytocic medications.

9. Which statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth?

b. (^) “My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles.”

ANS: B

10. The interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state is called the:

d. (^) Puerperium, or fourth trimester of pregnancy.

ANS: D Puerperium -4th trimester or postpartum period of pregnancy, lasts about 3- weeks. Involution marks end of puerperium, or 4th trimester of pregnancy. Lochia refers to the various vaginal discharges during puerperium

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11. The self-destruction of excess hypertrophied tissue in the uterus is called:

a. (^) Autolysis.

ANS: A Autolysis -caused by decrease in hormone levels. Subinvolution- failure of uterus to return to nonpregnant state. Afterpain -caused by uterine cramps 2-3 days after birth. Diastasis -separation of muscles.

12. With regard to the postpartum uterus, nurses should be aware that:

b. (^) After 2 weeks postpartum it should not be palpable abdominally.

ANS: B After 2 wks postpartum-uterus should not be palpable abdominally; it has not yet returned to original size.At end of 3rd stage of labor,uterus weighs approximately 1000 g. It takes 6 full weeks for uterus to return to its original size.After 2 weeks postpartum uterus weighs about 350 g, not original size.Normal self-destruction of excess hypertrophied tissue accounts for slight increase in uterine size after each pregnancy.

13. With regard to afterbirth pains, nurses should be aware that these pains are:

c. (^) More noticeable in births in which the uterus was overdistended.

ANS:C large baby or multiple babies overdistend uterus.cramping that causes after birth pains arises from periodic, vigorous contractions,relaxations, which persist through 1st part of postpartum period. Afterbirth pains-more common in multiparous women because 1st-time mothers have better uterine tone. Breastfeeding intensifies afterbirth pain because it stimulates contractions.

14. Postbirth uterine/vaginal discharge, called lochia:

d. (^) Should smell like normal menstrual flow unless an infection is present.

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ANS: D Offensive odor-indicates infection. Lochia flow should approximate heavy menstrual period for 1st 2 hrs,then steadily decrease. Less lochia-seen after cesarean births,increases with ambulation and breastfeeding.

15. Which description of postpartum restoration or healing times is accurate?

b. (^) Vaginal rugae reappear by 3 weeks postpartum.

ANS: B Vaginal rugae reappear by 3 weeks postpartum;never as prominent as in nulliparous women.Cervix regains-form within days;cervical os may take longer.Most episiotomies take 2-3 weeks to heal. Hemorrhoids can take 6 wks to decrease in size.

16. With regard to postpartum ovarian function, nurses should be aware that:

d. (^) The first menstrual flow after childbirth usually is heavier than normal.

ANS: D 1 st flow-heavier,within 3 or 4 cycles-back to normal.Ovulation can occur within 1st mth, but for 70% of nonlactating women,returns within 12 wks after birth.Breastfeeding take longer to resume ovulation.many women ovulate before1st postpartum menstrual period, contraceptive needed discussed early in puerperium.

17. As relates to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that:

c. (^) Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium.

ANS: C Excess fluid loss through other means occurs.Kidney function usually returns to normal in about 1mth.Diastasis recti abdominis-separation of muscles in abdominal wall; no effect on voiding reflex. Bladder tone-restored 5-7 days after childbirth.

18. Knowing that the condition of the new mother’s breasts will be affected by whether she is breastfeeding, nurses should be able to tell their clients all the following statements except:

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a. (^) Breast tenderness is likely to persist for about a week after the start of lactation.

ANS: A Breast tenderness- 24-48 hours after lactation begins. movable, noncancerous mass-filled milk sac.Colostrum-present for few days whether mother breastfeeds or not.mother who does not want to breastfeed should also avoid stimulating her nipples.

19. With regard to the postpartum changes and developments in a woman’s cardiovascular system, nurses should be aware that:

b. (^) Respiratory function returns to nonpregnant levels by 6 to 8 weeks after birth.

ANS: B Respirations-decrease to within normal prepregnancy range by 6- 8 weeks after birth.Stroke volume increases,cardiac output remains high for couple of days.heart rate,BP-return to normal quickly.Leukocytosis increases 10-12 days after childbirth,can obscure diagnosis of acute infections(false-negative results).hypercoagulable state increases risk of thromboembolism-after cesarean birth.

20. Which condition, not uncommon in pregnancy, is likely to require careful medical assessment during the puerperium?

d. (^) Headaches

ANS: D Headaches -have number of causes, some of which deserve medical attention.Total or nearly total regression of varicosities-expected.Carpal tunnel syndrome-relieved ,when compression on median nerve lessened. Periodic numbness of fingers usually disappears after birth unless carrying baby aggravates condition.

21. Several changes in the integumentary system that appear during pregnancy disappear after birth, although not always completely. What change is almost certain to be completely reversed?

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a. (^) Nail brittleness

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ANS: A nails return to prepregnancy consistency,strength. Some women have permanent darker pigmentation of areolae,linea nigra.Striae gravidarum (stretch marks)-not completely disappear. For some women spider nevi persist indefinitely.

22. Childbirth may result in injuries to the vagina and uterus. Pelvic floor exercises also known as Kegel exercises will help to strengthen the perineal muscles and encourage healing. The nurse knows that the client understands the correct process for completing these conditioning exercises when she reports:

d. (^) “I pretend that I am trying to stop the flow of urine midstream.”

ANS: D Pretend attempting to stop passing of gas or flow of urine midstream-will replicate sensation of muscles drawing upward,inward.Each contraction-as intense as possible without contracting abdomen,buttocks,thighs.Guidelines-exercises should be done 24-100xday.Positive results- min of 24-45 repetitions/day. Best position to learn Kegel exercises-lie supine with knees bent;2nd position-on hands and knees.

23. Which maternal event is abnormal in the early postpartum period?

d. (^) Lochial color changes from rubra to alba

ANS: D 1 st 3 days lochia- rubra. Lochia serosa follows,then at about 11 days,discharge becomes clear, colorless, or white. Diuresis,diaphoresis-methods by which body rids itself of increased plasma volume. Urine output-3000 mL/day=1st few days,facilitated by hormonal changes.Bowel tone remains sluggish for days. Many women anticipate pain during defecation,unwilling to exert pressure on perineum. new mother hungry because of energy used in labor,thirsty because of fluid restrictions during labor.

24. Which finding 12 hours after birth requires further assessment?

a. (^) The fundus is palpable two fingerbreadths above the umbilicus.

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ANS: A fundus rises to umbilicus after delivery,remains for about 24 rs.fundus-above umbilicus-indicate uterine atony,urinary retention.fundus palpable at or below level of umbilicus-normal for patient 12 hrs postpartum.Palpation of fundus 2 fingerbreadths below umbilicus-unusual finding for 12 hours postpartum;still appropriate.

25. If the patient’s white blood cell (WBC) count is 25,000/mm on her second postpartum day, the nurse should:

c. (^) Recognize that this is an acceptable range at this point postpartum.

ANS: C 10-12 days after childbirth, WBC 20,000 and 25,000/mm are common.

26. A postpartum patient asks, “Will these stretch marks go away?” The nurse’s best response is:

d. (^) “They will fade to silvery lines but won`t disappear completely.”

ANS: D

27. Which documentation on a woman’s chart on postpartum day 14 indicates a normal involution process?

c. (^) Fundus below the symphysis and not palpable

ANS: C fundus descends 1 cm/day,by postpartum day 14-no longer palpable.lochia should be changed by this day to serosa.Breasts-not part of involution.episiotomy should not be red or puffy at this stage.

28. Changes in blood volume after childbirth depend on several factors such as blood loss during childbirth and the amount of extravascular water (physiologic edema) mobilized and excreted. A postpartum nurse anticipates blood loss of (Select all that apply) :

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c. (^) 300 to 500 mL

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d. (^) 500 to 1000 mL

ANS: C, D average blood loss vaginal birth of single fetus from 300-500 mL (10% of blood volume).cesarean -500-1000 mL(15% to 30% of blood volume). During 1st few days after birth plasma volume decreases further as result diuresis.Pregnancy-induced hypervolemia (increase in blood volume of at least 35%) allows most women to tolerate considerable blood loss during childbirth.

MATCHING : The physiologic changes that occur during the reversal of the processes of pregnancy are distinctive; however, they are normal. To provide care during this recovery period the nurse must synthesize knowledge regarding anticipated maternal changes and deviations from normal. Please match the vital signs finding that the postpartum nurse may encounter with the probable cause:

29. Puerperal sepsis - Elevated temperature at 36 hours postpartum (C)
30. Unusually high epidural or spinal block - Hypoventilation (E)
31. Dehydrating effects of labor - Elevated temperature within the first 24 hours (A)
32. Hypovolemia resulting from hemorrhage - Rapid pulse (B)
33. Excessive use of oxytocin- Hypertension (D)

Chapter 19: Nursing Care of the Family during the Postpartum Period

1. A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-pound, 7-ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, “I’m bleeding a lot.” The most likely cause of postpartum hemorrhage in this woman is:

c. (^) Uterine atony.

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ANS: C woman gave birthto macrosomic boy after Pitocin augmentation- uterine atony. Although retained placental fragments may cause postpartum hemorrhage, this typically would be detected in 1st hour after delivery of placenta,not most likely cause of hemorrhage.unrepaired vaginal lacerations may cause bleeding, they typically would occur in period immediately after birth.Puerperal infection can cause subinvolution,subsequent bleeding;would be detected 24 hours after delivery.

2. On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse’s first action is to:

d. (^) Massage the woman’s fundus.

ANS: D nurse should assess uterus for atony.Uterine tone must be established to prevent excessive blood loss.nurse may begin IV infusion to restore circulatory volume, but this would not 1st action.Blood pressure-not reliable indicator of impending shock from impending hemorrhage; assessing vital signs should not be 1st action.physician would be notified after nurse completes assessment of woman.

3. A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely correlated with these orders?

d. (^) The woman has an episiotomy.

ANS: D These orders-typical interventions for woman who has had pisiotomy, lacerations, hemorrhoids. A multiparous classification is not an indication for these orders. vacuum-assisted birth may be used in conjunction with episiotomy, which would indicate these interventions.

4. The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (EIA 0.8); hematocrit, 30%. How would the nurse best interpret these data?

a. (^) Rubella vaccine should be given.

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ANS: A rubella titer indicates-not immune,needs to receive a vaccine.

5. A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle- feed. During your assessment you notice that both of her breasts are swollen, warm, and tender on palpation. The woman should be advised that this condition can best be treated by:

b. (^) Applying ice to the breasts for comfort.

ANS: B Applying ice(cabbage leaves)to breasts for comfort treating engorgement in mother who is bottle-feeding, avoid any breast stimulation, including pumping or expressing milk;should wear well-fitted support bra or breast binder continuously for at least 1st 72 hours after giving birth.

6. A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. The nurse’s most appropriate response is to ask the woman:

d. (^) “I’ll warm the soup in the microwave for you.”

ANS: D

7. A primiparous woman is to be discharged from the hospital tomorrow with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged?

a. (^) The woman leaves the infant on her bed while she takes a shower.

ANS: A Leaving infant on bed unattended-never acceptable.Holding,cuddling after feeding,reading magazine while infant sleeps-appropriate.

8. In many hospitals new mothers are routinely presented with gift bags containing samples of infant formula. This practice:

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a. Is inconsistent with the Baby Friendly Hospital Initiative.

ANS: A

9. A postpartum woman overhears the nurse tell the obstetrics clinician that she has a positive Homans sign and asks what it means. The nurse’s best response is:

c. (^) “You have calf pain when the nurse flexes your foot.”

ANS: C Discomfort in calf with sharp dorsiflexion of foot may indicate deep vein thrombosis. Deep tendon reflexes should be 1+ to 2+.

10. In the recovery room, if a woman is asked either to raise her legs (knees extended) off the bed or to flex her knees, place her feet flat on the bed, and raise her buttocks well off the bed, most likely she is being tested to see whether she:

a. (^) Has recovered from epidural or spinal anesthesia.

ANS: A

11. Under the Newborns’ and Mothers’ Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of hours after a normal vaginal birth and for hours after a cesarean birth.

c. (^) 48, 96

ANS: C

12. In a variation of rooming-in, called couplet care, the mother and infant share a room, and the mother shares the care of the infant with:

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d. (^) The nurse.

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ANS: D In couplet care mother shares room with newborn,care with nurse educated in maternity and infant care.

13. Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to mother the mother. Specifically this expression refers to:

d. (^) Nurturing the woman by providing encouragement and support as she takes on the many tasks of motherhood.

ANS: D “Mothering the mother” is more process of encouraging,supporting woman in her new role.

14. Excessive blood loss after childbirth can have several causes; the most common is:

c. (^) Failure of the uterine muscle to contract firmly.

ANS: C Uterine atony can best be thwarted by maintaining good uterine tone,preventing bladder distention.vaginal or vulvar hematomas, unpaired lacerations of vagina or cervix,retained placental fragments-possible causes of excessive blood loss,uterine muscle failure (uterine atony)-most common cause.

15. A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. This activity indicates that the nurse is trying to:

a. (^) Improve the accuracy of blood loss estimation, which usually is a subjective assessment.

ANS: A

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16. Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman empty her bladder spontaneously as soon as possible. If all else fails, the last thing the nurse could try is:

d. (^) Inserting a sterile catheter.

ANS: D Invasive procedures usually-last to be tried, especially with so many other simple.easy methods available (water, peppermint vapors, pain medication).

17. If a woman is at risk for thrombus and is not ready to ambulate, nurses may intervene by performing a number of interventions. Which intervention should the nurse avoid?

c. (^) Having the patient sit in a chair.

ANS: C Sitting immobile in chair-not help.Bed exercise,prophylactic footwear may. TED hose,SCD boots-recommended.Bed exercises-flexing, extending,rotating feet, ankles,legs-useful.Positive Homans’ sign(calf muscle pain,warmth, redness,tenderness)-immediate attention.

18. As relates to rubella and Rh issues, nurses should be aware that:

b. (^) Women should be warned that the rubella vaccination is teratogenic, and that they must avoid pregnancy for 1 month after vaccination.

ANS: B contraception for 1 month after vaccinated.live attenuated rubella virus is not communicable in breast milk, breastfeeding mothers can be vaccinated. Rh immune globulin is administered intramuscularly;never be given to infant. Rh immune globulin suppresses immune system,therefore could thwart rubella vaccination.

19. Discharge instruction, or teaching the woman what she needs to know to care for herself and her newborn, officially begins:

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a. (^) At the time of admission to the nurse’s unit.

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ANS: A

20. A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. The nurse should be concerned that psychosocial outcomes are not being met if the woman:

c. (^) Has not given the baby a name.

ANS: C If mother having difficulty naming her new infant, it may be signal that she is not adapting well to parenthood. red flags-refusal to hold or feed baby, lack of interaction with infant,becoming upset when baby vomits or needs diaper change;unwilling to discuss her labor,birth experience; baby unattractive and messy,overly disappointed in baby’s sex;voice concern that baby reminds her of family member whom she does not like nursing diagnosis could be Impaired parenting related to a long, difficult labor or unmet expectations of birth.

21. Which breastfeeding patient is most likely to have severe afterbirth pains and request a narcotic analgesic?

a. (^) Gravida 5, para 5

ANS: A

22. Postpartal overdistention of the bladder and urinary retention can lead to which complications?

c. (^) Postpartum hemorrhage and urinary tract infection

ANS: C

23. Rho immune globulin will be ordered postpartum if which situation occurs?

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a. (^) Mother Rh2-, baby Rh+

ANS: A

24. Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus?

d. (^) Assist the patient in emptying her bladder.

ANS: D Urinary retention may cause overdistention of urinary bladder,which lifts,displaces uterus. Nursing actions need to be implemented before notifying physician.important to evaluate blood pressure, pulse,lochia if bleeding continues; focus at this point in time is to assist patient in emptying her bladder.

25. When caring for a newly delivered woman, the nurse is aware that the best measure to prevent abdominal distention after a cesarean birth is:

b. (^) Early and frequent ambulation.

ANS: B Activity will aid movement of accumulated gas in GI tract. Rectal suppositories-helpful after distention occurs;not prevent it.Ambulation-best prevention. Carbonated beverages-increase distention.

26. The nurse caring for the postpartum woman understands that breast engorgement is caused by:

d. (^) Congestion of veins and lymphatics.

ANS: D

27. Nurses play a critical role in educating parents regarding measures to prevent infant abduction. Which instructions contribute to infant safety and security?

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a. (^) The mother should check the photo ID of any person who comes to her room.

d. (^) Parents should use caution when posting photos of their infant on the Internet.

e. (^) The mom should request that a second staff member verify the identity of any questionable person.

ANS: A, D, E

MATCHING : Much of a woman’s behavior during the postpartum period is strongly influenced by her cultural background. Nurses are likely to come into contact with women from many different countries and cultures. All cultures have developed safe and satisfying methods of caring for new mothers and babies. Please match the cultural norm with the nationality of origin_._

28. Muslim countries - Will not eat pork or pork products (D)
29. Korean or other South East Asian countries .- Prefer not to give babies colostrum (A)
30. Chinese- Have an IUD inserted after the first child (E )
31. Haitian- Take the placenta home to bury (C )
32. Mexican- Eat only warm foods and hot drinks (B)

Chapter 20: Transition to Parenthood

1. After giving birth to a healthy infant boy, a primiparous woman, 16 years old, 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 be certain to include in the plan of care?

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d. (^) Provide time for the patient to bathe her infant after she views an infant bath demonstration.

ANS: D

2. The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, would the nurse identify as a possible maladaptive behavior regarding parent-infant attachment?

b. (^) Seldom makes eye contact with her son

ANS: B woman should be encouraged to hold her infant in en face position and make eye contact with infant. Normal infant-parent interactions include talking,cooing to her son, cuddling her son close to her, and telling visitors how well her son is feeding.

3. 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:

b. (^) Show the mother how the infant initiates interaction and pays attention to her.

ANS: B Pointing out responsiveness of infant-positive strategy for facilitating parent- infant attachment.Videos-educational tool that can demonstrate parent-infant attachment.

4. 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:

c. (^) Claiming.

ANS: C Claiming -process by which child identified in terms of likeness to other

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family members. Mutuality - infant’s behaviors,characteristics call 4th corresponding set

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of maternal behaviors,characteristics. Synchrony - “fit” between infant’s cues,parent’s responses. Reciprocity -body movement or behavior provides observer with cues.

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.

ANS: A Attachment, or bonding-process that occurs over time,does not require early contact. Parent-infant attachment involves activities such as touching, holding,gazing; it is not exclusively eye contact.

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 would recognize that the woman is experiencing:

c. (^) Postpartum (PP) blues.

ANS: C During PP blues women-emotionally labile, often crying easily,for no apparent reason;peak around 5th PP day.taking-in phase-period after birth when mother focuses on her own psychologic needs;lasts 24 hours.

7. 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.

ANS: A Infants respond to sound of voices-attachment involves reciprocal interchange, observing interaction between parent and infant very important. Separation of the parent and infant does not encourage parent-infant attachment.

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8. 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.

ANS: A

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?

b. (^) “Grandparents can help you with parenting skills and also help preserve

family traditions.”

ANS: B

10. When the infant’s behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics, this is called:

a. (^) Mutuality.

ANS: A

11. 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?

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