Chapter 5: Psycho-Social-Cultural Aspects of the Antepartum Period Nursing School Test Banks

Chapter 5: Psycho-Social-Cultural Aspects of the Antepartum Period

Multiple Choice

1. Sally is in her third trimester and has begun to sing and talk to the fetus. Sally is probably exhibiting signs of:a. Mental illnessb. Delusionsc. Attachmentd. Crisis

ANS: c
Feedback
a. This is normal maternalfetal adaptation.
b. Delusions are not real, and the fetus is real.
c. Correct, because talking to the fetus is a sign of positive maternal adaptation. All other answers indicate pathology.
d. Interacting with the fetus in utero represents normal development of attachment to the fetus.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Moderate
2. What is the most common expected emotional reaction of a woman to the news that she is pregnant? a. Jealousyb. Acceptancec. Ambivalenced. Depression

ANS: c
Feedback
a. Others in the family may be jealous of the fetus, but that is not a common maternal response.
b. Acceptance of the pregnancy typically occurs later in the pregnancy.
c. Ambivalence is a normal expected reaction to the news of pregnancy, whether or not the pregnancy is planned or wanted.
d. This would represent an abnormal emotional response to pregnancy.

KEY: Integrated Process: Teaching and Learning | Nursing Process: Analysis | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Easy

3. Which of the following information regarding sexual activity would the nurse give a pregnant woman who is 35 weeks gestation? a. Sexual activity should be avoided from now until 6 weeks postpartum.b. Sexual desire may be affected by nausea and fatigue. c. Sexual desire may be increased due to increased pelvic congestion.d. Sexual activity may require different positions to accommodate the womans comfort.

ANS: d
Feedback
a. There are no contraindications to sexual activity during this time for a normally progressing pregnancy.
b. Nausea and fatigue affect sexual desire during the first trimester, not the third.
c. Increased sexual desire r/t increased pelvic congestion is a characteristic of the second trimester, not the third.
d. Correct. An enlarging abdomen creates feelings of awkwardness and bulkiness and may require couples to modify intercourse positions for the pregnant womans comfort.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate
4. Which statement best exemplifies adaptation to pregnancy in relation to the adolescent?a. Adolescents adapt to motherhood in a similar way to other childbearing women.b. Social support has very little effect on adolescent adaptation to pregnancy. c. The pregnant adolescent faces the challenge of multiple developmental tasks.d. Pregnant adolescents of all ages can be capable and active participants in health-care decisions.

ANS: c
Feedback
a. Adolescents must cope with the conflicting developmental tasks of pregnancy and adolescence at the same time.
b. Social support has been associated with a more positive adaptation to mothering for adolescents.
c. Correct. Pregnant adolescents face conflicting and multiple developmental tasks of pregnancy and adolescence at the same time.
d. By late adolescence (ages 17 to 20) this can occur, but early adolescents are oriented toward the present and are self-centered, and often pregnancy at this age is a result of abuse or coercion.

KEY: Integrated Process: Communication and Documentation | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Difficult
5. Janes husband Brian has begun to put on weight. What is this a possible sign of? a. Culturalism syndromeb. Couvade syndromec. Moratorium phased. Attachment

ANS: b
Feedback
a. This is not related to culture.
b. Correct. Couvade syndrome has symptoms that mimic changes of pregnancy.
c. Moratorium phase represents one of the phases of the fathers responses to pregnancy.
d. Attachment is reflected in behaviors.
KEY: Integrated Process: Caring | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Easy
6. Cathy is pregnant for the second time. Her son, Steven, has just turned 2 years old. She asks you what she should do to help him get ready for the expected birth. What is the nurses most appropriate response?a. Steven will probably not understand any explanations about the arrival of the new baby, so Cathy should do nothing.b. If Stevens sleeping arrangements need to be changed, it should be done well in advance of the birth.c. Steven should come to the next prenatal visit and listen to the fetal heartbeat to encourage sibling attachment. d. Steven should be encouraged to plan an elaborate welcome for the newborn.

ANS: b
Feedback
a. This applies to very young children under the age of 2.
b. Children still sleeping in a crib should be moved to a bed at least 2 months before the baby is due, as this age group is particularly sensitive to disruptions of the physical environment.
c. This is not appropriate for a 2-year-old but may be appropriate for older age groups.
d. This is not appropriate for a 2-year-old but may be appropriate for older age groups.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Difficult
7. The nurse is interviewing a pregnant client who states she plans to drink chamomile tea to ensure an effective labor. The nurse knows that this is an example of:a. Cultural prescriptionb. Cultural tabooc. Cultural restrictiond. Cultural demonstration

ANS: a
Feedback
a. Correct. Cultural prescription is an expected behavior of the pregnant woman during the childbearing period.
b. Taboos are cultural restrictions believed to have serious supernatural consequences. Drinking chamomile tea would not be in this category.
c. Restrictions are activities during the childbearing period which are limited for the pregnant woman. Drinking chamomile tea would not be in this category.
d. Demonstration is not a term that is used in relation to cultural behaviors.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Basic Care and Comfort | Difficulty Level: Easy

8. Which of the following would be a priority for the nurse when caring for a pregnant woman who has recently emigrated from another country?a. Help her develop a realistic, detailed birth plan.b. Identify her support system.c. Teach her about expected emotional changes of pregnancy.d. Refer her to a doula for labor support.

ANS: b
Feedback
a. A detailed birth plan may not be culturally appropriate and is not first priority.
b. Correct, because lack of social support has been correlated with an increased risk of pregnancy complications and difficult adaptation to pregnancy. Pregnant women who are recent immigrants face many challenges in obtaining needed social support, and the nurse should first identify her support system to plan further interventions and referrals.
c. There may be cultural variations in emotional changes of pregnancy.
d. The nurse should first identify her support system before planning further interventions and referrals.
KEY: Integrated Process: Caring | Cognitive Level: Application | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Moderate
9. A pregnant client at 20 weeks gestation comes to the clinic for her prenatal visit. Which of the following client statements would indicate a need for further assessment? a. I hate it when the baby moves.b. Ive started calling my mom every day.c. My partner and I cant stop talking about the baby.d. I still dont know much time Im going to take off work after the baby comes.

ANS: a
Feedback
a. Experiencing quickening as unpleasant may be a sign of maladaptation to pregnancy and needs further assessment by the nurse.
b. This is an expected finding in maternal adaptation and development of the maternal role.
c. This is an expected finding in maternal adaptation and development of the maternal role.
d. At 20 weeks gestation, the client still has plenty of time to process this decision.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Moderate
10. A pregnant client asks the nurse why she should attend childbirth classes. The nurses response would be based on which of the following information? a. Attending childbirth class is a good way to make new friends.b. Childbirth classes will help new families develop skills to meet the challenges of childbirth and parenting.c. Attending childbirth classes will help a pregnant woman have a shorter labor.d. Childbirth classes will help a pregnant woman decrease her chance of having a cesarean delivery.

ANS: b
Feedback
a. There may be a beneficial effect of childbirth classes, but this is not the primary goal of childbirth education.
b. Correct. These are the stated goals of childbirth education (ICEA, Lamaze).
c. Evidence remains inconclusive regarding linking attendance at childbirth classes with a decreased incidence of cesarean section and shorter labors.
d. Evidence remains inconclusive regarding linking attendance at childbirth classes with a decreased incidence of cesarean section and shorter labors.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Easy
11. A woman presents for prenatal care at 6 weeks gestation by LMP. Which of the following findings would the nurse expect to see?
a. Multiple pillow orthopnea
b. Maternal ambivalence
c. Fundus at the umbilicus
d. Pedal and ankle edema

ANS: b
Feedback
a. Orthopnea is a common complaint of women during the third trimester.
b. Ambivalence is a common feeling of women during the first trimester.
c. The fundus should be at the umbilicus at 20 weeks gestation.
d. Dependent edema is a common complaint of women during the third trimester.

KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Comprehension | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

12. A first-time father is experiencing couvade syndrome. He is likely to exhibit which of the following symptoms or behaviors?
a. Urinary frequency
b. Hypotension
c. Bradycardia
d. Prostatic hypertrophy

ANS: a
Feedback
a. Urinary frequency is a common symptom of couvade.
b. The fathers blood pressure is not usually affected.
c. The fathers heart rate is not usually affected.
d. Prostatic changes are not related to couvade.

KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Comprehension | Content Area: Family Dynamics | Client Need: Psychosocial Integrity | Difficulty Level: Moderate

13. When providing a psychosocial assessment on a pregnant woman at 21 weeks gestation, the nurse would expect to observe which of the following signs?
a. Ambivalence
b. Depression
c. Anxiety
d. Happiness

ANS: d
Feedback
a. Ambivalence is often seen during the first trimester.
b. The nurse would not expect to see depression at any time during the pregnancy.
c. The patient may express some anxiety near the time of delivery.
d. The nurse would expect the patient to exhibit signs of happiness at this time.

KEY: Integrated Process: Communication and Documentation; Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

14. An example of a cultural prescriptive belief during pregnancy is:
a. Remain active during pregnancy
b. Coldness in any form should be avoided
c. Do not have your picture taken
d. Avoid sexual intercourse during the third trimester

ANS: a
The belief that the patient should remain active during pregnancy is the only example of a cultural prescriptive belief. All of the other answers are examples of cultural restrictive beliefs.

KEY: Integrated Process: Knowledge | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Cultural Respect | Difficulty Level: Easy

15. Taboos are cultural restrictions that:
a. Have serious supernatural consequences
b. Have serious clinical consequences
c. Have superstitious consequences
d. Are functional and neutral practices

ANS: a
Taboos are believed to have serious supernatural consequences. Taboos are not known to have clinical or superstitious consequences and are not functional or neutral practices.

KEY: Integrated Process: Knowledge | Cognitive Level: Comprehension | Content Area: Cultural Competence | Client Need: Cultural Respect | Difficulty Level: Moderate

16. Jenny, a 21-year-old single woman, comes for her first prenatal appointment at 31 weeks gestation with her first pregnancy. The clinic nurses most appropriate statement is:
a. Jenny, it is late in your pregnancy to be having your first appointment, but it is nice to meet you and I will try to help you get caught up in your care.
b. Jenny, have you had care in another clinic? I cant believe this is your first appointment!
c. Jenny, by the date of your last menstrual period, you are 31 weeks and now that you are finally here, we need you to come monthly for the next two visits and then weekly.
d. Jenny, by your information, you are 31 weeks gestation in this pregnancy. Do you have questions for me before I begin your prenatal history and information sharing?
ANS: d
Feedback
a. The initial interview time with the patient should be used to build a positive, nonthreatening relationship and to gain her confidence by respecting her choices and advocating for continued prenatal care that is woman centered.
b. The initial interview time with the patient should be used to build a positive, nonthreatening relationship and to gain her confidence by respecting her choices and advocating for continued prenatal care and not making assumptions about prior care. The prenatal nurses objective is to provide a user-friendly service that is efficient, effective, caring, and patient centered.
c. The initial interview time with the patient should be used to build a positive, nonthreatening, and nonjudgmental relationship and to gain her confidence by respecting her choices and advocating for continued prenatal care.
d. The initial interview time with the patient should be used to build a positive, nonthreatening relationship and to gain her confidence by respecting her choices and advocating for continued prenatal care. The prenatal nurses objective is to provide a user-friendly service that is efficient, effective, caring, and patient centered.

KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

17. The clinic nurse visits with Wayne, a 32-year-old man whose partner is pregnant for the first time and is at 12 weeks. Wayne describes nausea and vomiting, fatigue, and weight gain. His symptoms are best described as:
a. Influenza
b. Couvade syndrome
c. Acid reflux
d. Cholelithiasis

ANS: b
Feedback
a. This cluster of symptoms is indicative of couvade syndrome, the experience of maternal signs and symptoms of pregnancy.
b. In preparation for parenthood, the male partner moves through a series of developmental tasks. During the first trimester, the father begins to deal with the reality of the pregnancy and may worry about financial strain and his ability to be a good father. Feelings of confusion and guilt often surface with the recognition that he is not as excited about the pregnancy as his partner, and couvade syndrome, the experience of maternal signs and symptoms, may develop.
c. This cluster of symptoms is indicative of couvade syndrome, the experience of maternal signs and symptoms of pregnancy.
d. This cluster of symptoms is indicative of couvade syndrome, the experience of maternal signs and symptoms of pregnancy.

KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

Multiple Response

18. The clinic nurse encourages paternal attachment during pregnancy by including the father in (select all that apply):
a. Prenatal visits
b. Ultrasound appointments
c. Prenatal class information
d. History taking and obtaining prenatal screening information

ANS: b, c, d
Pregnancy is psychologically stressful for men; some enjoy the role of nurturer, but others feel alienated and begin to stray from the relationship. The nurse can be instrumental in promoting early paternal attachment. Involvement of the father during examinations and tests and prenatal classes, along with thorough explanations of the need for them, can minimize the fathers feelings of being left out. A history and prenatal screening should be conducted at the first prenatal visit with the woman alone to ensure confidentiality and an open discussion of any problems or concerns she may have. The history should include information about the current pregnancy; the obstetric and gynecologic history; and a cultural assessment, and a medical, nutritional, social, and family (including the fathers) medical history.

KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

19. The perinatal nurse screens all pregnant women early in pregnancy for maternal attachment risk factors, which include (select all that apply):
a. Adolescence
b. Low educational level
c. History of depression
d. A strong support system for the pregnancy

ANS: a, b, c
Maternal attachment to the fetus is an important area to assess and can be useful in identifying families at risk for maladaptive behaviors. The nurse should assess for indicators such as unintended pregnancy, domestic violence, difficulties in the partner relationship, sexually transmitted infections, limited financial resources, substance use, adolescence, poor social support systems, low educational level, the presence of mental conditions, or adolescence that might interfere with the patients ability to bond with and care for the infant. A strong support system can facilitate the patients ability to bond with and care for the infant.

KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

20. Strategies for culturally responsive care include (select all that apply):
a. Practicing ethnocentrism
b. Applying stereotyping
c. Examining ones own biases
d. Learning another language

ANS: c, d
The only actions among the choices that are culturally responsive are examining ones own biases and learning another language. Ethnocentrism and stereotyping are not culturally responsive actions.

KEY: Integrated Process: Safe and Effective Care Environment | Cognitive Level: Application | Content Area: Cultural Competence | Client Need: Cultural Respect | Difficulty Level: Moderate

Fill-in-the-Blank

21. The clinic nurse talks with Becky, a 16-year-old woman who is now 28 weeks gestation. Todays visit is only the second prenatal appointment that Becky has kept. The nurse wonders if Beckys failure to come for routine prenatal checks is, in part, related to an adolescents orientation to the __________, rather than to the __________.

ANS: present; future
The adolescent may not seek prenatal care unless pressured by authority figures or peers to do so. By nature, adolescents are not future oriented. Hence, the pregnant adolescent may not be able to readily accept the reality of the unborn child.

KEY: Integrated Process: Teaching/Learning | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Difficult

22. According to Rubin, the mother-to-be needs to accept the pregnancy and incorporate it into her own reality and __________. This process is known as __________.

ANS: self-concept; binding in
The mother-to-be needs to accept the pregnancy and incorporate it into her own reality and self-concept. This process is known as binding in. Acceptance of the child is critical to a successful adjustment to the pregnancy. Acceptance must come from the expectant woman as well as from others.

KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Knowledge Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

23. The clinic nurse asks pregnant women about their acceptance and planning for this pregnancy as a component of domestic violence screening. The nurse is aware that a(n) __________ pregnancy __________ the risk for domestic violence.

ANS: unplanned; increases
Intimate partner violence (IPV) may occur for the first time during pregnancy, or the nurse may identify evidence during the physical examination that is suspicious of ongoing physical abuse. Acceptance of pregnancy may be delayed if it was unplanned or unwanted. As a womens advocate, nurses have a duty to be observant, to actively listen, and to use communication skills to gain clarification and understanding.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

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