Postpartum Mood Disorders Practice Exam

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1. When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically:

  1. express a strong need to review events and her behavior during the process of labor and birth.
  2. exhibit a reduced attention span, limiting readiness to learn.
  3.  vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn.
  4. have reestablished her role as a spouse/partner.

2. Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should:

  1. tell the woman she can rest after she feeds her baby.
  2. recognize this as a behavior of the taking-hold stage.
  3. record the behavior as ineffective maternal-newborn attachment.
  4. take the baby back to the nursery, reassuring the woman that her rest is a priority at this time.

3. Parents can facilitate the adjustment of their other children to a new baby by:

  1. having the children choose or make a gift to give to the new baby on its arrival home.
  2. emphasizing activities that keep the new baby and other children together.
  3. having the mother carry the new baby into the home so she can show him or her to the other children.
  4. reducing stress on other children by limiting their involvement in the care of the new baby.

4. 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:

  1. foster an active role in the baby’s care.
  2. provide time for the mother to reflect on the events of and her behavior during childbirth.
  3. 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.
  4. promote maternal independence by encouraging her to meet her own hygiene and comfort needs.

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

  1. Talks and coos to her son
  2. Seldom makes eye contact with her son
  3. Cuddles her son close to her
  4. Tells visitors how well her son is feeding

6. 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. What is a facilitating behavior?

  1. The parents have difficulty naming the infant.
  2. The parents hover around the infant, directing attention to and pointing at the infant.
  3. The parents make no effort to interpret the actions or needs of the infant.
  4. The parents do not move from fingertip touch to palmar contact and holding.

7. Which statement regarding postpartum depression (PPD) is essential for the nurse to be aware of when attempting to formulate a plan of care?

  1. PPD symptoms are consistently severe.
  2. This syndrome affects only new mothers.
  3. PPD can easily go undetected.
  4. Only mental health professionals should teach new parents about this condition.

8. When working with parents who have some form of sensory impairment, nurses should consider which information when writing a plan of care?

  1. One of the major difficulties visually impaired parents experience is the skepticism of health care professionals
  2. Visually impaired mothers cannot overcome the infant’s need for eye-to-eye contact
  3. The best approach for the nurse is to assess the parents’ capabilities rather than focusing on their disabilities
  4. Technologic advances, including the Internet, can provide deaf parents with a full range of parenting activities and information
  5. Childbirth education and other materials are available in Braille.

9. The maternity nurse promoting parental-infant attachment should incorporate which appropriate cultural beliefs into the plan of care? (Select all that apply.)

  1. Asian mothers are encouraged to return to work as soon as possible.
  2. Jordanian mothers have a 40-day lying-in after birth.
  3. Japanese mothers rest for the first 2 months after childbirth.
  4. Encourage Hispanics to eat plenty of fish and pork to increase vitamin intake.
  5. Encourage Vietnamese mothers to cuddle with the newborn.

10. When helping a woman cope with postpartum blues, the nurse should offer what appropriate suggestions? (Select all that apply.)

  1. The father should take over care of the baby, because postpartum blues are exclusively a female problem.
  2. Get plenty of rest.
  3. Plan to get out of the house occasionally.
  4. Asking for help will not foster independence.
  5. Use La Leche League or community mental health centers.

11. Mothers that have experienced postpartum depression in the past have a decreased risk for postpartum depression in the future.

  1. True
  2. False

12. Postpartum depression symptoms are similar to ________ symptoms.

  1. Bipolar Disorder
  2. Depression unrelated to childbirth
  3. Anorexia Nervosa
  4. Borderline Personality

13.  Symptoms of postpartum depression include: (choose all that apply)

  1. Euphoria
  2. Tiredness
  3. Changes in Diet
  4. Issues with sleep
  5. None of these apply

14. Many nurses find it easy to speak with patients regarding postpartum depression.

  1. True
  2. False

15. Why is postpartum depression commonly a missed or under diagnosed problem?

  1. Women do not report symptoms
  2. Providers do not take reports from patients seriously
  3. Symptoms are masked by common experiences of new mothers (lack of sleep, etc)
  4. All of the above
  5. A,B
  6. A,C
  7. B,C
  8. None of the above

16. What best describe Baby Blues?

  1. Feelings of sadness during the first two weeks postpartum
  2. More serious problem requiring followup and treatment from provider
  3. Symptoms requiring immediate treatment

17. Which best describe Postpartum Depression?

  1. Feelings of sadness during the first two weeks postpartum
  2. More serious problem requiring followup and treatment from provider
  3. Symptoms requiring immediate treatment

18. Including the support person in postpartum depression education creates a barrier to recognizing postpartum depression.

  1. True
  2. False

19. Risk factors for postpartum depression include: (CHOOSE ALL THAT APPLY)

  1. History of abuse
  2. Marriage
  3. History of mental illness
  4. Concurrent life events
  5. Giving birth to a male child
  6. Red hair

20. Removal of the child from the home is a common response to PPD diagnosis.

  1. True
  2. False
Answers and Rationales
  1. C) vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. One week after birth the woman should exhibit behaviors characteristic of the taking-hold stage. This stage lasts for as long as 4 to 5 weeks after birth.
    • Reviewing events and behavior during labor/birth and exhibiting reduced attention span/limited readiness to learn are characteristic of the taking-in stage, which lasts for the first few days after birth.
    • Re-establishing role as spouse/partner reflects the letting-go stage, which indicates that psychosocial recovery is complete.
  2. D) take the baby back to the nursery, reassuring the woman that her rest is a priority at this time. The woman should not be told what to do and needs to care for her own well-being. The taking-hold stage occurs about 1 week after birth. Because the woman needs to rest does not indicate ineffective maternal-newborn attachment. The behavior described is typical of this stage and not a reflection of ineffective attachment unless it persists. Mothers need to reestablish their own well-being to effectively care for their baby.
  3. A) having the children choose or make a gift to give to the new baby on its arrival home. Having the sibling make or choose a gift for the new baby helps to make the child feel a part of the process. Special time should be set aside just for the other children without interruption from the newborn. Someone other than the mother should carry the baby into the home so she can give full attention to greeting her other children. Children should be actively involved in the care of the baby according to their ability without overwhelming them.
  4. B) provide time for the mother to reflect on the events of and her behavior during childbirth. Once the mother’s needs are met, she would be more able to take an active role, not only in her own care but also the care of her newborn. Women express a need to review their childbirth experience and evaluate their performance. Short teaching sessions, using written materials to reinforce the content presented, are a more effective approach. The focus of the taking-in stage is nurturing the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition.
  5. B) Seldom makes eye contact with her son. The woman should be encouraged to hold her infant in the en face position and make eye contact with him. Talking and cooing to her son is a normal infant-parent interaction. Cuddling is a normal infant-parent interaction. Sharing her son’s success at feeding is a normal infant-parent interaction.
  6. B) The parents hover around the infant, directing attention to and pointing at the infant. Hovering over the infant, as well as obviously paying attention to the baby, is a facilitating behavior. Reluctance to name the baby is an inhibiting behavior. Failure to interpret the actions and needs of the infant is an inhibiting behavior. Lack of fingertip, palmar touch, and holding represents an inhibiting behavior.
  7. C) PPD can easily go undetected. PPD symptoms range from mild to severe, with women having good days and bad days. Screening should be done for mothers and fathers. PPD may also occur in new fathers. PPD can go undetected because parents do not voluntarily admit to this type of emotional distress out of embarrassment, fear, or guilt. The nurse should include information on PPD and how to differentiate this from the baby blues for all clients on discharge. Nurses also can urge new parents to report symptoms and seek follow-up care promptly if they occur.
  8. A, C, D, E. The skepticism, open or hidden, of health care professionals throws up an additional and unneeded hurdle for the parents. Other sensory output can be provided by the parent, other people can participate, and other coping devices can be used. After the parents’ capabilities have been assessed (including some the nurse may not have expected), the nurse can help find ways to assist the parents that play to their strengths. The Internet affords an extra teaching tool for the deaf, as do videos with subtitles or nurses signing. A number of electronic devices can turn sound into light flashes to help pick up a child’s cry. Sign language is acquired readily by young children. Childbirth education and other materials are available in Braille.
  9. B,  C. Asian mothers must remain at home with the baby up to 30 days after birth and are not supposed to engage in household chores, including care of the baby. Jordanian mothers have a 40-day lying-in after birth, during which their mothers or sisters care for the baby. Japanese mothers rest for the first 2 months after childbirth. Hispanic practice involves many food restrictions after childbirth, such as avoiding fish, pork, and citrus foods. Vietnamese mothers may give minimal care to their babies and refuse to cuddle or further interact with the baby to ward off “evil” spirits.
  10. B, C, E. Suggestions for coping with postpartum blues include:
    • Remember that the “blues” are normal and that both the mother and the father or partner may experience them.
    • Get plenty of rest; nap when the baby does if possible. Go to bed early, and let friends and family know when to visit and how they can help. (Remember, you are not “Supermom.”)
    • Use relaxation techniques learned in childbirth classes (or ask the nurse to teach you and your partner some techniques).
    • Do something for yourself. Take advantage of the time your partner or family members care for the baby—soak in the tub (a 20-minute soak can be the equivalent of a 2-hour nap), or go for a walk.
    • Plan a day out of the house—go to the mall with the baby, being sure to take a stroller or carriage, or go out to eat with friends without the baby. Many communities have churches or other agencies that provide child care programs such as Mothers’ Morning Out.
    • Talk to your partner about the way you feel—for example, about feeling tied down, how the birth met your expectations, and things that will help you (do not be afraid to ask for specifics).
    • If you are breastfeeding, give yourself and your baby time to learn.
    • Seek out and use community resources such as La Leche League or community mental health centers.
  11. B. False
  12. B. Depression unrelated to childbirth
  13. B,C,D.
  14. B. False
  15. F. A,C.
  16. A. Feelings of sadness during the first two weeks postpartum
  17. B. More serious problem requiring followup and treatment from provider
  18. B. False
  19. A,C,D.
  20. B. False