ATI Testbank Questions- OB Exam #2 Part IV

Which principle is important in providing and teaching cord care? a. Cord care is done only to control bleeding. b. Alcohol is the only agent used for cord care. c. It takes a minimum of 24 days for the cord to separate. d. Keeping the cord dry will decrease bacterial growth.

d. Keeping the cord dry will decrease bacterial growth. Bacterial growth increases in a moist environment, so keeping the umbilical cord dry impedes bacterial growth. Cord care is done to prevent infection and aid in the drying of the cord. No agents are necessary to facilitate drying of the cord. The cord will fall off within 10 to 14 days.

Which anticipatory guidance action by the nurse makes role transition to parenthood easier? a. Helps the new parents identify resources b. Recommends employing babysitters frequently c. Tells the parents about the realities of parenthood d. Offers a home phone number and tells parents to call if they have a question

a. Helps the new parents identify resources Available resources within the community can assist the parents in role transition. Some parents may not be able to afford babysitters. Also, this removes them from the parenthood role. Each adult sees parenthood in a different light. They cannot be compared. Searching out resources for the parents is an important task. However, the nurse should not give her personal number to clients.

Which client is most likely to have the least stress adjusting to her role as a mother? a. A 26-year-old woman who is returning to work in 10 weeks b. A 35-year-old anxious mother who has had no contact with babies or children c. A 16-year-old teenager who lives with her parents and has a strained relationship with her mother d. A 25-year-old woman who knew at 16 weeks of gestation that she was pregnant with twins, who were delivered by cesarean birth

a. A 26-year-old woman who is returning to work in 10 weeks The woman who has the least amount of stress in her life will adjust more quickly to her role as a mother. The anxious mother with no real experience with babies may have a difficult time adjusting to motherhood. The teenager has a significant amount of stress in her life, which could make adjusting to her role as a mother more difficult. The 25-year-old mother has the added stress of twins, which may make motherhood adjustment more difficult.

Which woman is most likely to continue breastfeeding beyond 6 months? a. A woman who avoids using bottles b. A woman who uses formula for every other feeding c. A woman who offers water or formula after breastfeeding d. A woman whose infant is satisfied for 4 hours after the feeding

a. A woman who avoids using bottles Women who avoid using bottles and formula are more likely to continue breastfeeding. Use of formula decreases breastfeeding time and decreases the production of prolactin and, ultimately, the milk supply. Overfeeding after breastfeeding causes a sense of fullness in the infant, so the infant will not be hungry in 2 to 3 hours. Formula takes longer to digest. The new breastfeeding mother needs to nurse often to stimulate milk production.

The nurse is assessing a newborns circumcision 30 minutes after the procedure. The nurse notes excessive bleeding coming from the circumcised area. Which priority intervention should the nurse implement? a. Apply pressure to the site. b. Continue to observe for another 30 minutes. c. Apply the diaper tightly over the circumcised area. d. Apply petroleum jelly to the site with a small piece of gauze.

a. Apply pressure to the site. If excessive bleeding occurs after a circumcision, pressure is applied to the site. The nurse notifies the physician, who may apply Gelfoam or epinephrine or suture the small blood vessels. A small amount of blood loss may be significant in an infant, who has a small total blood volume. Continuing to observe could mean additional blood loss. Applying the diaper tightly will not stop the bleeding. Petroleum jelly is applied to keep the diaper from sticking to the circumcised area. It will not stop the bleeding.

Which is the first step in assisting the breastfeeding mother? a. Assess the womans knowledge of breastfeeding. b. Provide instruction on the composition of breast milk. c. Discuss the hormonal changes that trigger the milk ejection reflex. d. Help her obtain a comfortable position and place the infant to the breast.

a. Assess the womans knowledge of breastfeeding. The nurse should first assess the womans knowledge and skill in breastfeeding to determine her teaching needs. Assessment should occur before instruction. Discussing the hormonal changes and helping her obtain a comfortable position may be part of the instructional plan, but assessment should occur first to determine what instruction is needed.

Which is the hormone necessary for milk production? a. Estrogen b. Prolactin c. Progesterone d. Lactogen

b. Prolactin Prolactin, secreted by the anterior pituitary, is a hormone that causes the breasts to produce milk. Estrogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced. Progesterone decreases the effectiveness of prolactin and prevents mature breast milk from being produced. Human placental lactogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced.

The breastfeeding client should be taught a safe method to remove her breast from the babys mouth. Which suggestion by the nurse is most appropriate? a. Break the suction by inserting your finger into the corner of the infants mouth. b. A popping sound occurs when the breast is correctly removed from the infants mouth. c. Slowly remove the breast from the babys mouth when the infant has fallen asleep and the jaws are relaxed. d. Elicit the Moro reflex in the baby to wake the baby up, and remove the breast when the baby cries.

a. Break the suction by inserting your finger into the corner of the infants mouth. Inserting a finger into the corner of the babys mouth between the gums to break the suction avoids trauma to the breast. A popping sound indicates improper removal of the breast from the babys mouth and may cause cracks or fissures in the breast. The infant who is sleeping may lose grasp on the nipple and areola, resulting in chewing on the nipple, making it sore. Most mothers prefer the infant to continue to sleep after the feeding. Gentle wake-up techniques are recommended.

Which are the reasons for having auditory screening on all newborns in the first month of life? (Select all that apply.) a. Early identification and treatment b. Reassurance for concerned new parents c. To prevent or reduce developmental delay d. To achieve one of the Healthy People 2020 goals

a. Early identification and treatment c. To prevent or reduce developmental delay d. To achieve one of the Healthy People 2020 goals Newborn auditory screening is done to identify hearing loss and begin treatment. Treatment can help to reduce developmental delay. Newborn auditory screening is a Healthy People 2020 goal. New parents are often anxious regarding this test and the impending results; however, it is not a reason for the screening to be performed.

Late in pregnancy, the clients breasts should be assessed by the nurse to identify any potential concerns related to breastfeeding. Which of the following nipple conditions make it necessary to intervene before birth. (Select all that apply.) a. Flat nipples b. Cracked nipples c. Everted nipples d. Inverted nipples e. Nipples that contract when compressed

a. Flat nipples d. Inverted nipples e. Nipples that contract when compressed Flat nipples appear soft, like the areola, and do not stand erect unless stimulated by rolling them between the fingers. Inverted nipples are retracted into the breast tissue. These nipples appear normal; however, they will draw inward when the areola is compressed by the infants mouth. Dome-shaped devices known as breast shells can be worn during the last weeks of pregnancy and between feedings after birth. The shells are placed inside the bra, with the opening over the nipple. The shells exert slight pressure against the areola to help the nipples protrude. The helpfulness of breast shells has been debated. A breast pump can be used to draw the nipples out before feedings after birth. Everted nipples protrude and are normal. No intervention will be required. Cracked, blistered, and bleeding nipples occur after breastfeeding has been initiated and are the result of improper latching on. The infant should be repositioned during feeding. The application of colostrum and breast milk after feedings will aid in healing.

A newborn infant weighs 7 pounds, 2 ounces, on the fifth day of life. How much water should be given to the newborn based on required fluid needs? a. Fluid replacement should be based on weight and calculated in the range of 60 to 100 mL/kg. b. Offer additional water to tolerance in between infant feedings to maintain hydration. c. Give 12 ounces of fluid per feeding. d. No water is needed because formula and breast milk are adequate to maintain hydration.

a. Fluid replacement should be based on weight and calculated in the range of 60 to 100 mL/kg. There is an expected weight loss of up to 10% postdelivery, so fluid replacement should be calculated to improve health outcomes and maintain adequate hydration.12 ounces of fluid per feeding is excessive and may cause overdistention. Offering water between feedings to tolerance may not provide enough fluid replacement. Newborn infants require additional water to supplement feedings and support hydration.

The postpartum nurse is reviewing dietary practices for an Asian client. Which should the nurse expect to observe as a dietary practice for this culture? a. Food brought from home b. Preference for fresh fruits c. Preference for cold foods d. Request for ice water instead of hot water

a. Food brought from home Food brought from home is a welcome sign of caring in many cultures. Some Asians believe that after childbirth the woman should eat only hot foods such as chicken, meat, and fish. Fresh fruit would be considered a cold food. Although ice water is commonly given to hospital clients, it is not acceptable to many Asians. For example, Southeast Asian women may refuse cold or ice water and prefer hot water or other warm beverages to keep warm.

During which stage of role attainment do the parents become acquainted with their baby and combine parenting activities with cues from the infant? a. Formal b. Informal c. Personal d. Anticipatory

a. Formal A major task of the formal stage of role attainment is getting acquainted with the infant. The informal stage begins once the parents have learned appropriate responses to their infants cues. The personal stage is attained when parents feel a sense of harmony in their role. The anticipatory stage begins during the pregnancy when the parents choose a physician and attend childbirth classes.

Which newborn assessment finding requires the nurse to take an action? a. Glucose level of 40 mg/dL b. Axillary temperature of 37 C (98.6 F) c. Mild yellow tinge to skin at 32 hours of age d. Mild inflammation of conjunctiva after eye prophylaxis

a. Glucose level of 40 mg/dL A glucose level of 40 mg/dL requires an action. Follow agency policy and health care provider orders regarding feeding infants with low glucose levels. A common practice is to feed the newborn if the glucose screening shows a level of 40 to 45 mg/dL or less to prevent further depletion of glucose. Infants with severe hypoglycemia may need intravenous feedings to provide glucose rapidly. A normal temperature for a newborn is 36.5 to 37.5 C (97.7 to 99.5 F). Mild jaundice at 32 hours of age is physiologic jaundice and does not need an action by the nurse, just further monitoring. Some infants develop a mild inflammation a few hours after prophylactic eye treatment.

The nurse observes a client on her first postpartum day sitting in bed while her newborn lies awake in the bassinet. Which appropriate action should the nurse take? a. Hand the baby to the woman. b. Explain taking-in to the woman. c. Offer to hand the baby to the woman. d. No action, because this situation is perfectly acceptable.

a. Hand the baby to the woman. During the taking-in phase of maternal adaptation, in which the mother may be passive and dependent, the nurse should encourage bonding when the infant is in the quiet alert stage. This is done best by simply giving the baby to the mother. She learns best during the taking-hold phase. The woman is dependent and passive at this stage and may have difficulty making a decision. This is expected behavior during the taking-in phase. However, interventions can facilitate infant bonding.

A new mother is preparing for discharge. She plans on bottle feeding her baby. Which statement indicates to the nurse that the mom needs more information about bottle feeding? a. I should encourage my baby to consume the entire amount of formula prepared for each feeding. b. I can make up a 24-hour supply of formula and refrigerate the bottles so I am ready to feed my baby. c. I will hold my baby in a cradle hold and alternate sides from left to right when I feed my baby. d. I will generally feed my baby every 3 to 4 hours or more as signs of hunger are displayed.

a. I should encourage my baby to consume the entire amount of formula prepared for each feeding. Infants will stop suckling when they are full. Encouraging them to overeat may lead to problems with regurgitation and possible aspiration. The mother can prepare a single bottle or a 24-hour supply if adequate refrigeration is available. Show the parents how to position the infant in a semi-upright position, such as the cradle hold. This allows them to hold the infant close in a face-to-face position. The bottle is held with the nipple kept full of formula to prevent excessive swallowing of air. Placing the infant in the opposite arm for each feeding provides varied visual stimulation during feedings. Feed the infant every 3 to 4 hours but avoid rigid scheduling and take cues from the infant.

A new father states, I know nothing about babies, but he seems to be interested in learning. The nurse should take which action? a. Include him in teaching sessions. b. Tell him when he does something wrong. c. Show no concern because he will learn on his own. d. Continue to observe his interaction with the newborn.

a. Include him in teaching sessions. The nurse must be sensitive to the fathers needs and include him whenever possible. He should be encouraged by pointing out the correct procedures he does. By criticizing, he will be discouraged. Showing no concern is not a nursing role. Nurses need to be sensitive to clients needs. It is important to note the bonding process of the mother and the father, but that does not satisfy the expressed needs of the father.

During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and accept the real baby? a. Letting-go b. Taking-in c. Taking-on d. Taking-hold

a. Letting-go Accepting the real infant and relinquishing the fantasy infant occurs during the letting-go phase of maternal adjustment. In the taking-in phase, the mother is primarily focused on her own needs. There is no taking-on phase of maternal adjustment. During the taking-hold phase, the mother assumes responsibility for her own care and shifts her attention to the infant.

Which strategies should the nurse suggest to a postpartum client to promote stress reduction during the first weeks at home? (Select all that apply.) a. Limiting coffee, tea, cola, and any caffeinated beverages b. Maintaining a rigid schedule c. Sleeping when the infant sleeps d. Inviting visitors and friends to stop by frequently e. Using learned breathing techniques from childbirth classes for relaxation

a. Limiting coffee, tea, cola, and any caffeinated beverages c. Sleeping when the infant sleeps e. Using learned breathing techniques from childbirth classes for relaxation To promote stress reduction during the first weeks at home, the nurse can suggest that parents limit coffee, tea, colas, and chocolate, because they contain caffeine and will interfere with rest. Recommend that the mother sleep when the infant sleeps and conserve her energy for care of the baby. Suggest breathing exercises and progressive relaxation to reduce stress and increase her energy level, especially when a nap is not possible. The schedule should be flexible; a rigid schedule or meticulous environment increases tension within the family. The parents should let friends and relatives know sleep and nap times and request that they limit visits or telephone before visiting.

The postpartum client who continually repeats the story of her labor, birth, and recovery experiences is doing which? a. Making the birth experience real b. Accepting her response to labor and birth c. Providing others with her knowledge of events d. Taking hold of the events leading to her labor and birth

a. Making the birth experience real Reliving the birth experience makes the event real and helps the mother realize that the pregnancy is over and that the infant is born and is now a separate individual. She is in the taking-in phase, trying to make the birth experience seem real. This is to satisfy her needs, not the needs of others. She is trying to make the event real and is trying to separate the infant from herself.

A mother conveys concern over the fact that she is not sure if her newborn child is getting enough nutrients from breastfeeding. This is the babys first clinic visit after birth. What information can you provide that will help alleviate her fears about nutrient status for her newborn? a. Monitor the infants output; as long as at least six or more diapers are changed in a 24-hour period, that should be sufficient. b. Tell the mother that if a baby is satisfied with feeding, she or he will be content and not fussy. c. Tell the mother that breast milk contains everything required for the infant and not to worry about nutrition. d. Provide nutrition information in the form of pamphlets for the mother to take home with her so that she uses them as a point of reference.

a. Monitor the infants output; as long as at least six or more diapers are changed in a 24-hour period, that should be sufficient. The presence of wet diapers confirms that the infant is receiving enough milk. Recording weight and seeing an increase in weight is also an objective finding that can be used to note nutritional status. Newborns may be fussy and still be receiving adequate nutrition. Although breast milk is potentially the perfect food for the newborn, not everyone's breast milk has nutrient quality, so recording of weight gain and output measurements (wet diapers and stool production) confirm nutritional status. Providing the mother with educational pamphlets may be advisable but does not address the immediate problem.

In which position should the parents be instructed to place their newborn for sleep? a. On the back b. On the left side c. On the right side d. On the abdomen

a. On the back The American Academy of Pediatrics (AAP) in 2011 recommended that mothers and fathers be taught to place infants on the back for sleep, because this position is associated with the lowest rate of SIDS. The side-lying position is not advised because of the possibility that the infant might roll to the prone position. The newborn should not be placed on the abdomen.

The nurse is preparing a newborn for a circumcision. Which prescribed interventions should the nurse implement to alleviate pain? (Select all that apply.) a. Oral sucrose during the procedure b. Bright lights after the procedure c. Adequate stimulation before and after the procedure d. Acetaminophen (Tylenol) postprocedure, as needed e. EMLA cream (eutectic mixture of local anesthetics) before the procedure

a. Oral sucrose during the procedure d. Acetaminophen (Tylenol) postprocedure, as needed e. EMLA cream (eutectic mixture of local anesthetics) before the procedure Nonpharmacologic pain relief methods during and after the circumcision include pacifiers, oral sucrose, soothing music, recordings of intrauterine sounds, decreased lights, and talking softly to the infant. Acetaminophen may be given throughout the first day for postprocedure pain. EMLA cream (eutectic mixture of local anesthetics) may be applied to anesthetize the skin before the procedure. Bright lights and stimulation would not be methods to reduce circumcision pain.

Which is an important consideration in positioning a newborn for breastfeeding? a. Placing the infant at nipple level facing the breast b. Keeping the infants head slightly lower than the body c. Using the forefinger and middle finger to support the breast d. Limiting the amount of areola the infant takes into the mouth

a. Placing the infant at nipple level facing the breast Positioning the infant at nipple level will prevent downward pulling of the nipple and subsequent nipple trauma. Keeping the infants head slightly lower will pull the nipple down and cause trauma. The forefinger and middle finger can be used to support the breast, but this is not an important consideration in positioning the newborn. The infant should take in as much areola as possible to prevent trauma to the nipples.

Which are nursing measures that can promote parent-infant bonding and attachment? (Select all that apply.) a. Provide comfort and ample time for rest. b. Keep the baby wrapped to avoid cold stress. c. Position the infant face to face with the mother. d. Point out the characteristics of the infant in a positive way. e. Limit the amount of modeling so the mother doesnt feel insecure.

a. Provide comfort and ample time for rest. c. Position the infant face to face with the mother. d. Point out the characteristics of the infant in a positive way. Provide comfort and ample time for rest, because the mother must replenish her energy and be relatively free of discomfort before she can progress to initiating care of the infant. Position the infant in an en face position and discuss the infants ability to see the parents face. Face to face and eye to eye contact is a first step in establishing mutual interaction between the infant and parent. Point out the characteristics of the infant in a positive way: She has such pretty little hands and beautiful eyes. The baby should be kept warm, but parents should be assisted to unwrap the baby (keeping or rewrapping the body part not being inspected) to inspect the toes, fingers, and body. The nurse should model behaviors by holding the infant close, making eye contact with the infant, and speaking in high-pitched, soothing tones.

Which newborn testing must be performed prior to discharge from the hospital? (Select all that apply.) a. Pulse oximetry b. Hearing c. Guthrie d. Hypothyroidism e. Galactosemia

a. Pulse oximetry c. Guthrie d. Hypothyroidism e. Galactosemia The pulse oximetry test is used to identify potential cardiac anomalies, so it must be done prior to infant discharge. The Guthrie test is another name for the metabolic screening panel test that is done to identify a group of metabolic diseases that would have a significant impact on newborn infants. Included in this test are observations related to thyroid activity, PKU, and galactosemia. A hearing screening test is recommended during the first month of life.

A husband calls the nurses station stating that his wife, who delivered last week, is happy one minute and crying the next. He says, She was never like this before the baby was born. Which should be the nurses initial response? a. Reassure him that this behavior is normal. b. Advise him to get immediate psychological help for her. c. Tell him to ignore the mood swings because they will go away. d. Instruct him in the signs, symptoms, and duration of postpartum blues.

a. Reassure him that this behavior is normal. Before providing further instructions, inform family members of the fact that postpartum blues are a normal process to allay anxieties and increase receptiveness to learning. Postpartum blues are a normal process that is short-lived; no medical intervention is needed. Telling him to ignore the moods blocks communication and may belittle the husbands concerns. Client teaching is important; however, his anxieties need to be allayed before he will be receptive to teaching.

A yellow crust has formed over the circumcision site. The mother calls the hotline at the local hospital 5 days after her son was circumcised. She is very concerned. On which rationale should the nurse base a reply? a. The yellow crust should not be removed. b. This yellow crust is an early sign of infection. c. Discontinue the use of petroleum jelly to the tip of the penis. d. After circumcision, the diaper should be changed frequently and fastened snugly.

a. The yellow crust should not be removed. Crust is a normal part of healing. The normal yellowish exudate that forms over the site should be differentiated from the purulent drainage of infection. The only contraindication for petroleum jelly is the use of a PlastiBell. The diaper should be fastened loosely to prevent rubbing or pressure on the incision site.

The client should be taught that when her infant falls asleep after feeding for only a few minutes, she should do which of the following? a. Unwrap and gently arouse the infant. b. Wait an hour and attempt to feed again. c. Try offering a bottle at the next feeding. d. Put the infant in the crib and try again later.

a. Unwrap and gently arouse the infant. The infant who falls asleep during feeding may not have fed adequately and should be gently aroused to continue the feeding. Breastfeeding should continue. By offering a bottle, breast milk production will decrease. The infant should be aroused and feeding continued.

How many kilocalories per kilogram (kcal/kg) of body weight does a full-term formula-fed infant need each day? a. 50 to 75 b. 100 to 110 c. 120 to 140 d. 150 to 200

b. 100 to 110 The term newborn being fed with formula requires 100 to 110 kcal/kg to meet nutritional needs each day. 50 to 75 kcal/kg is too little and 120 to 140 kcal/kg and 150 to 200 kcal/kg are too much.

A mother is attempting to breastfeed her infant in the hospital setting. The infant is sleepy and displays some audible swallowing, the maternal nipples are flat, and the breasts are soft. The nurse has attempted to teach the mother positioning on one side, and now the mother wants to place the infant to the breast on the other side. Based on LATCH scores, the nurse would designate a score of: a. 10 and document findings in the chart. b. 6 and further teach and assist the mother in feeding activities. c. 5 and tell the mother to discontinue feeding attempts at this time because the infant is too sleepy. d. 8 and no further assistance is needed for feeding.

b. 6 and further teach and assist the mother in feeding activities. The LATCH assessment tool is used to identify whether mothers need additional instruction in the area of breastfeeding. The LATCH categories are latch, audible communication/swallowing, type of nipple, comfort of breasts, and holding position of infant. The assessment data reveal a score of 6 (0 + 2 + 1 + 2 + 1) so the mother needs additional assistance during breastfeeding at this time.

A 25-year-old gravida 1, para 1, who had an emergency cesarean birth 3 days ago is scheduled for discharge. As you prepare her for discharge, she begins to cry. Which should be your initial action? a. Assess her for pain. b. Allow her time to express her feelings. c. Point out how lucky she is to have a healthy baby. d. Explain that she is experiencing postpartum blues.

b. Allow her time to express her feelings. Although many women experience transient postpartum blues, they need assistance in expressing their feelings. Assessing her for pain assumes that she is in pain. Pointing out how lucky she is to have a healthy baby is blocking communication. She needs the opportunity to express her feelings first. Later, client teaching can occur.

What is the most serious consequence of propping an infants bottle? a. Colic b. Aspiration c. Dental caries d. Ear infections

b. Aspiration Propping the bottle increases the likelihood of choking and aspiration if regurgitation occurs. Colic can occur but is not the most serious consequence. Dental caries becomes a problem when milk stays on the gums for a long period of time. This may cause a buildup of bacteria that will alter the growing teeth buds. However, this is not the most serious consequence. Ear infections can occur when the warm formula runs into the ear and bacterial growth occurs. However, this is not the most serious consequence.

A new mother asks why she has to open a new bottle of formula for each feeding. What is the nurses best response? a. Formula may turn sour after it is opened. b. Bacteria can grow rapidly in warm milk. c. Formula loses some nutritional value once it is opened. d. This makes it easier to keep track of how much the baby is taking.

b. Bacteria can grow rapidly in warm milk. Formula should not be saved from one feeding to the next because of the danger of rapid growth of bacteria in warm milk. Formula will have bacterial growth before turning sour. This will cause problems in a newborn with an immature immune system. The loss of some nutritional value after the formula is opened is not the reason for using fresh bottles with each feeding. The danger of bacterial growth is the main concern.

Which interventions may relieve symptoms of colic in the infant? (Select all that apply.) a. Increased stimulation of infant to provide distraction b. Burping infant frequently during feedings c. Feeding infant placed in an upright position d. Providing chamomile tea to infant e. Feeding infant on an on demand schedule

b. Burping infant frequently during feedings c. Feeding infant placed in an upright position d. Providing chamomile tea to infant The presence of colic is a self-limiting temporary condition seen in infants during the first few months of life. Although there are many theories about its cause, none has been determined to show direct causation. Providing a quiet environment and a consistent feeding schedule, positioning the infant in an upright position during feeding, burping the infant frequently, and using supplements or medications that have antispasmodic properties may be recommended. Chamomile tea is reported to have antispasmodic effects. Feeding the infant on an on demand schedule may exacerbate the condition as a result of overfeeding.

A new mother asks whether she should feed her newborn colostrum because it is not real milk. The nurses best answer includes which information? a. Colostrum is unnecessary for newborns. b. Colostrum is high in antibodies, protein, vitamins, and minerals. c. Colostrum is lower in calories than milk and should be supplemented by formula. d. Giving colostrum is important in helping the mother learn how to breast-feed before she goes home.

b. Colostrum is high in antibodies, protein, vitamins, and minerals. Colostrum is important because it has high levels of the nutrients needed by the neonate and helps protect against infection. Colostrum provides immunity and enzymes necessary to clean the gastrointestinal system, among other things. Supplementation is not necessary. It will decrease stimulation to the breast and decrease the production of milk. It is important for the mother to feel comfortable in this role before discharge, but the importance of the colostrum to the infant is top priority.

For which infant should the nurse anticipate the use of soy formula? (Select all that apply.) a. Preterm infant b. Infant with galactosemia c. Infant with phenylketonuria d. Infant with lactase deficiency e. Infant with a malabsorption disorder

b. Infant with galactosemia d. Infant with lactase deficiency e. Infant with a malabsorption disorder Soy formula may be given to infants with galactosemia or lactase deficiency or those whose families are vegetarians. Soy milk is derived from the protein of soybeans and supplemented with amino acids. The formulas are also used for infants with malabsorption disorders. The preterm infant may require a more concentrated formula, with more calories in less liquid. Modifications of other nutrients are also made. Human milk fortifiers can be added to breast milk to adapt it for preterm infants. Low-phenylalanine formulas are needed for infants with phenylketonuria, a deficiency in the enzyme to digest phenylalanine found in standard formulas.

The term reciprocal attachment behavior refers to which of the following? a. Behavior during the sensitive period when the infant is in the quiet alert stage b. Positive feedback an infant exhibits toward parents during the attachment process c. Unidirectional behavior exhibited by the infant, initiated and enhanced by eye contact d. Behavior by the infant during the sensitive period to elicit feelings of falling in love from the parents

b. Positive feedback an infant exhibits toward parents during the attachment process In this definition, reciprocal refers to the feedback from the infant during the attachment process. The quiet alert state is a good time for bonding but does not define reciprocal attachment. Reciprocal attachment deals with feedback behavior and is not unidirectional.

Which should the nurse implement to prevent the kidnapping of a newborn from the hospital? a. Restricting the amount of time infants are out of the nursery b. Questioning anyone who is seen walking in the hallways carrying an infant c. Allowing no visitors in the maternity area except those who have identification bracelets d. Instructing the parents to not give the baby to anyone except the nurse assigned that day

b. Questioning anyone who is seen walking in the hallways carrying an infant Infants should be transported in the hallways only in their cribs. Restricting the amount of time infants are out of the nursery will be difficult to monitor and will limit the mothers support system from visiting. Infants need to spend time with the parents to facilitate the bonding process. It is impossible for one nurse to be on call for one mother and baby for the entire shift, so the parents need to be able to identify the nurses who are working on the unit.

In reviewing safety concerns for the newborn nursery, an ad hoc committee has been organized to discuss methods to prevent infant abduction. Which option can be used to facilitate improved outcomes related to this potential problem? a. Allow only immediate adult family members to visitor the newborn nursery during unrestricted visiting hours. b. Require identification with picture ID confirmation of all family members and/or staff who want to have contact with the newborn. c. Make sure that all emergency exits are accessible to staff and clients on the unit. d. Limit the number of visitors to two per client who can be on the unit during visiting hours to maintain security.

b. Require identification with picture ID confirmation of all family members and/or staff who want to have contact with the newborn. Requiring appropriate identification is the best method of preventing possible infant abduction. Evidenced-based practice has indicated that potentially family and/or staff or someone representing themselves as such is more likely to attempt an infant abduction. The unit should be a closed or locked unit and require admittance to maintain security. Limiting the visitors to two per client may cause increased stress to the new family because they want to share this experience. Preventing siblings from visiting by only allowing immediate adult family members may prevent beginning sibling attachment and cause separation and stress anxiety to the mother and children.

A new mother asks the nurse, How will I know early signs of hunger in my baby? The nurses best response is which of the following? (Select all that apply.) a. Crying b. Rooting c. Lip smacking d. Decrease in activity e. Sucking on the hands

b. Rooting c. Lip smacking e. Sucking on the hands Early signs of hunger in a baby are rooting, lip smacking, and sucking on the hands. Crying is a late sign, and the baby's activity will increase, not decrease.

The postpartum nurse is reviewing oral-nasal bulb suctioning with a first-time mom. Which statement will the nurse need to correct? a. Depress the bulb prior to inserting the tip. b. Suction the nose first and then the mouth. c. Keep a bulb syringe in the bassinet at all times. d. Gradually release the pressure on the bulb while withdrawing it.

b. Suction the nose first and then the mouth. The mouth should be suctioned first because the infant may gasp when the nose is suctioned, causing aspiration of mucus or fluid in the mouth. Then the nose is suctioned gently and only if necessary. Suctioning is traumatic to the delicate tissues and may cause edema of the nasal passages. The remaining statements are correct.

The nurse is preparing a male infant for circumcision. On review of the chart, the nurse notes that the consent has been signed, vitamin K has been administered, the temperature has been between 36.8 to 37 C (98.2 to 98.6 F), and the heart rate range is 126 to 144 beats per minute (bpm). Which finding, if omitted from the chart, would cause the nurse to have to cancel the circumcision? a. Consent b. Vitamin K c. Heart rate d. Temperature

b. Vitamin K The administration of the vitamin K prevents excessive bleeding. The infant could be at risk for hemorrhage without the vitamin K. Other assessment measures can be used to fulfill the remaining assessments, such as a verbal consent can be obtained, the skin can be palpated to determine temperature, and overall color can give the health care provider information about the infants heart rate. The only replacement for vitamin K is time to allow for the development of vitamin K in the gastrointestinal (GI) system.

Administration of medications after birth is the topic of discussion during a prenatal education class. Which statement indicates to the nurse that the pregnant patient understands the primary indication for the administration of vitamin K? a. The nurse will draw blood to determine if vitamin K is needed. b. Vitamin K prevents the possibility of bleeding problems in my baby. c. My baby will receive a shot when the nurse administers the vitamin K. d. Vitamin K will be administered shortly after birth, generally within the first hour.

b. Vitamin K prevents the possibility of bleeding problems in my baby. This indication is the reason for vitamin K administration. Vitamin K is given to neonates because they cannot synthesize it in the intestines without bacterial flora. This places them at risk for hemorrhagic disease of the newborn (vitamin K deficiency disease). One dose of vitamin K intramuscularly after birth prevents bleeding problems until the infant is able to produce vitamin K in sufficient amounts. Although the injection is usually given within the first hour after birth, it can be delayed until the infant has finished breastfeeding shortly after birth.

Which nursing action is a priority to prevent infection in the newborn? (Select all that apply.) a. Wearing gloves before touching neonates b. Washing hands before and after handling any neonate c. Washing hands and arms thoroughly at the beginning of the day d. Sharing some equipment that will not transmit infection from one neonate to another

b. Washing hands before and after handling any neonate c. Washing hands and arms thoroughly at the beginning of the day At the beginning of their shift, nurses wash their hands and arms thoroughly. Throughout the day, handwashing is important before and after touching any infant. Gloves are not necessary unless personal protective equipment is required because of coming in contact with body fluids. To avoid cross-contamination, each infants supplies are kept separately from those used for other infants. Supplies in drawers or cupboards of each crib unit should be used only for that infant because they are likely to be touched by nurses giving care. Using them for another neonate could result in the transfer of infectious organisms.

The nurse has just completed discharge teaching to parents on newborn bathing. Which statement made by the parents indicates a further need for teaching? (Select all that apply.) a. We will clean the diaper area last. b. We will use cotton-tipped swabs to clean the ears. c. We will use an antibacterial soap during the sponge bath. d. We can submerge the baby in a tub of water after the cord falls off. e. We will shampoo the baby's head using a football hold before unwrapping.

b. We will use cotton-tipped swabs to clean the ears. c. We will use an antibacterial soap during the sponge bath. Soap is not necessary for the young infant but if used, it should be gentle and nonalkaline to protect the natural acids of the infants skin. Do not use cotton-tipped swabs in the infants ears or nose because injury may occur if the baby moves suddenly. Clean the diaper area last. The cord generally falls off in about 10 to 14 days. Some care providers suggest waiting for the cord to fall off before tub bathing. Before fully undressing the baby, use the football position to shampoo the baby's head.

When an infants temperature drops from 98.7 to 97.4 F (37 to 36.3 C), the nurse should: a. instruct parents on cold stress. b. determine time and amount of last feeding. c. increase the temperature in the mothers room. d. evaluate infant for the presence of a blood sugar level higher than 50 mg/dL.

b. determine time and amount of last feeding. Temperature instability in the neonate may be caused by a decrease in blood glucose levels. Infants who do not maintain adequate intake will not have adequate energy to maintain temperature; instructing parents on cold stress and increasing the temperature in the room are interventions to maintain a stable temperature but will not correct the underlying problem. A blood sugar level higher than 50 mg/dL is a normal finding.

An example of binding in during the postpartum period is a: a. new mother telling her friends all about her labor and birth experience. b. father looking at his newborn and stating that he looks like I did when I was a baby. c. mother reporting increasing anxiety during the postpartum period because she feels like she is all alone. d. mother wanting some time alone so that she can catch up on needed sleep.

b. father looking at his newborn and stating that he looks like I did when I was a baby. A new mother telling her friends all about her labor and birth experience is an example of binding in or claiming. A new mother telling her friends all about her labor and birth experience is an example of the taking-in phase of maternal adaptation. A mother who reports increasing anxiety during the postpartum period because she feels like she is all alone may be problematic and indicates that the client is experiencing significant stressors during the postpartum period. A mother wanting some time alone so that she can catch up on needed sleep is a normal reaction to the demands of the newborn and reflects that the client may need additional support during this time.

A mother is breastfeeding her newborn infant but is experiencing signs of her breasts feeling tender and full in between infant feedings. She asks if there are any suggestions that you can provide to help alleviate this physical complaint. The best nursing response would be to: a. tell the client to wear a bra at all times to provide more support to breast tissue. b. have the client put the infant to her breast more frequently. c. place ice packs on breast tissue after infant feeding. d. explain that this is a normal finding and will resolve as her breast tissue becomes more used to nursing.

b. have the client put the infant to her breast more frequently. The client may be experiencing signs of engorgement. Intervention methods such as placing the infant to feed more frequently may help prevent physical complaints of tenderness to milk accumulation. Wearing a bra at all times will not help resolve engorgement issues but can provide comfort. Ice packs provide symptomatic relief but do not resolve engorgement issues. Warm water compresses are more likely to provide comfort. Engorgement is not a normal finding but is a common presentation in nursing mothers. These symptoms will not dissipate with continuation of breastfeeding.

How many ounces will an infant who is on a 4-hour feeding schedule need to consume at each feeding to meet daily caloric needs? a. 1 b. 1.5 c. 3.5 d. 5

c. 3.5 The newborn requires approximately 12 to 24 oz of formula each day (6 feedings/24-hour period). 1 and 1.5 ounces are too small to meet calorie needs; 5 ounces with every feeding would be overfeeding the infant.

How many milliliters per kilogram (mL/kg) of fluids does a newborn need daily for the first 3 to 5 days of life? a. 20 to 30 b. 40 to 60 c. 60 to 100 d. 120 to 150

c. 60 to 100 The newborn needs 60 to 100 mL/kg of fluids daily for the first 3 to 5 days of life. 20 to 30 mL/kg and 40 to 60 mL/kg are too small an amount for the newborn. 120 to 150 mL/kg is too large an amount for the newborn.

The nurse is developing a plan of care for the patients fourth stage of labor. One nursing intervention is to promote bonding. Specifically, which nursing action will facilitate the bonding process? a. Encourage the patient to call the baby by his or her first name. b. Stimulate the grasp reflex by placing the patients finger in the infants palm. c. Ask the patient if she wants her baby placed on her chest immediately after birth. d. Assess for familial characteristics and remark on the resemblance to the patient or the father.

c. Ask the patient if she wants her baby placed on her chest immediately after birth. Bonding refers to the rapid initial attraction felt by parents for their infant. It is unidirectional, from parent to child, and is enhanced when parents and infants are permitted to touch and interact during the first 30 to 60 minutes after birth. During this time, the infant is in a quiet, alert state and seems to gaze directly at the parents. Infants are often placed skin to skin on the mothers chest or abdomen for bonding time immediately after birth. Nurses frequently delay procedures such as measurements and medication administration that would interfere with this time, so that parents can focus on their newborn baby. Attachment follows a progressive or developmental course that changes over time. It is rarely instantaneous. Unlike bonding, attachment is reciprocalit occurs in both directions between parent and infant.

A new mother is concerned because her 1-day-old newborn is taking only 1 oz at each feeding. What should the nurse explain? a. The infant is probably having difficulty adjusting to the formula. b. An infant does not require as much formula in the first few days of life. c. The infants stomach capacity is small at birth but will expand within a few days. d. The infant tires easily during the first few days but will gradually take more formula.

c. The infants stomach capacity is small at birth but will expand within a few days. The infants stomach capacity at birth is 10 to 20 mL and increases to 30 to 90 mL by the end of the first week. There are other symptoms if there is a formula intolerance. The infants requirements are the same, but the stomach capacity needs to increase before taking in adequate amounts. The infants sleep patterns do change, but the infant should be awake enough to feed.

A breastfeeding mother asks the postpartum nurse if any supplementation is necessary once her breast milk comes in. What is the nurses best response? a. Are you concerned about your ability to adequately nurse your baby? b. Do you eat a well-balanced diet, high in protein and carbohydrates? c. Breast milk is low in vitamin D and supplementation with 400 IU is recommended. d. Your breast milk has all the vitamins and will adequately meet your baby's needs.

c. Breast milk is low in vitamin D and supplementation with 400 IU is recommended. Generally, nutrients provided in breast milk are present in amounts and proportions needed by the infant. However, recent studies have shown that the vitamin D content of breast milk is low, and daily supplementation with 400 IU of vitamin D is recommended within the first few days of life. Breastfeeding infants who are not exposed to the sun and those with dark skin are particularly at risk for insufficient vitamin D. Formula-fed infants who drink less than 1 quart of vitamin Dfortified milk per day should also be supplemented. Although the fatty acid content of breast milk is influenced by the mothers diet, malnourished mothers milk has about the same proportions of total fat, protein, carbohydrates, and most minerals as milk from those who are well nourished. Levels of water-soluble vitamins in breast milk are affected by the mothers intake and stores. It is important for breastfeeding women to eat a well-balanced diet to maintain their own health and energy levels.

An hour after birth, the nurse assesses a newborns temperature and notes that it is 36.2 C (97.2 F). The next activity planned for the newborn is the bath, and the new mother and father are invited to participate in the procedure. What is the nurses next action? a. Take the infants temperature rectally. b. Ask the father to test the water to determine if it is too hot. c. Delay the bath until the newborns temperature is above 36.7 C (98 F). d. Explain to the new parents that no soap should be used to cleanse the eyes.

c. Delay the bath until the newborns temperature is above 36.7 C (98 F). A temperature of 36.7 C (98 F) or higher is often used to determine when to bathe the infant. The infant can lose heat in the bath through the process of evaporation. Rectal temperatures are avoided because they can traumatize the rectal mucosa. The water temperature should be approximately 38 to 40 C (100.4 to 104 F). The nurse and not the father needs to determine if the bath water is the correct temperature to avoid scalding the newborn. Explain the process of giving a bath during the procedure. Informing the parents before the procedure may result in loss of information.

A nursing student has been caring for a client and her newborn all morning. After taking the newborn to the nursery for tests, the student is returning the newborn to the mother. Which procedure is correct for identifying the newborn? a. Ask the mother to state her name and the name of her infant. b. Call out the mothers full name before leaving the infant with her. c. Have the mother read her printed band number and verify that it matches the infants number. d. Return the infant with no special procedure because the student knows the mother and infant.

c. Have the mother read her printed band number and verify that it matches the infants number. The mother and infant should have identifying arm bands with matching numbers. The other actions do not adequately verify the identities of mother and infant.

In which condition is breastfeeding contraindicated? a. Triplet birth b. Flat or inverted nipples c. Human immunodeficiency virus infection d. Inactive, previously treated tuberculosis

c. Human immunodeficiency virus infection Human immunodeficiency virus is a serious illness that can be transmitted to the infant via body fluids. Because the amount of milk being produced depends on the amount of suckling of the breasts, providing enough milk should not be a problem. Nipple abnormality can begin to be treated during pregnancy but may begin after birth. Many methods help flat or inverted nipples to become more erect. Only active tuberculosis patients would be cautioned not to breastfeed.

A family is concerned about how their 2-year-old son is going to react to the new baby. What intervention would help facilitate sibling attachment? a. Have the mother and father spend individual time with their son to allay potential anxiety over the new baby coming in and displacing his position in the family as the only child. b. Make sure that their son is supervised at all times when the baby is brought home from the hospital and is in his presence. c. Include the son in helping to take care of the baby and reinforce the label of big brother as a special role. d. Observe the sons reaction to the baby and let him decide when he wants to be introduced to his new sibling.

c. Include the son in helping to take care of the baby and reinforce the label of big brother as a special role. Providing the older son with a special role designation and involving him in the care of the baby will facilitate sibling attachment. Spending individual time with the older child is recommended but will not facilitate sibling attachment. Although the older child should be supervised because of his age in terms of infant safety, this level of overprotection may inhibit sibling attachment. Observation of his behavior may be warranted, but the age of the child (2 years) does not warrant this type of control.

A 38 weeks gestation fetus is delivered via cesarean section and transported to the newborn nursery in an isolette. Apgar scores were 8, 9, and 10. At this time, the infant is receiving an initial assessment in the newborn nursery. Which is the priority nursing diagnosis? a. Risk for injury related to potential equipment malfunction of radiant warmer b. Altered tissue perfusion related to use of medications during delivery process c. Ineffective airway clearance due to mode of delivery and use of anesthetics d. Risk for ineffective thermoregulation related to gestational age

c. Ineffective airway clearance due to mode of delivery and use of anesthetics Delivery via cesarean section may affect the newborns ability to remove excess fluid secretions because the infant did not move down the birth canal and thus may be at risk for airway concerns. There is no evidence to support that the equipment is malfunctioning. Although the use of medications may affect the newborn in terms of respiratory, cardiac, and neurologic depression, Apgar scores do not indicate any immediate deficit. The infant is at term based on reported gestational age and therefore is not a risk for ineffective

What should the nurse teach to parents about using a bulb syringe? a. Use it only once a day. b. Suction the back of the throat vigorously. c. Insert the syringe into the sides of the mouth. d. Always suction the mouth before suctioning the nose.

c. Insert the syringe into the sides of the mouth. The syringe should be inserted into the sides of the mouth rather than the back of the throat to avoid a vagal response and bradycardia. Suction can occur as needed. Vigorous suction of the back of the throat may stimulate the vagal nerve and produce bradycardia. The mouth should be suctioned first to prevent aspiration.

A postpartum client who is a gravida 4, para 4, comes to the office for her 6-week postpartum checkup. Her presentation is untidy and unkempt. The client states that she is not sleeping well and relates that she feels overwhelmed at times. According to the client, family members responses have been nonsupportive. What recommendations would you advise to help the client at this time? a. Tell the client that this is a normal reaction to an increase in family size and that listening to music can help relieve anxiety. b. Tell the client to increase her exercise pattern because that will promote a sense of well-being. c. Make appropriate referrals for psychological intervention counseling because the client is exhibiting high-risk symptoms. d. Record the clients vital signs as part of the ongoing assessment and offer relaxation strategies as a method of support.

c. Make appropriate referrals for psychological intervention counseling because the client is exhibiting high-risk symptoms. This client is exhibiting symptoms that are consistent with postpartum depression, so she should be given priority intervention to maintain client safety.

Which of the following behaviors would be applicable to a nursing diagnosis of risk for impaired parenting? a. En face behavior is observed between father and infant. b. Mother relates that she feels exhilarated postbirth. c. Mother states that she feels excessive fatigue as a result of the childbirth experience. d. Father displays finger tipping behavior toward infant.

c. Mother states that she feels excessive fatigue as a result of the childbirth experience. Fatigue can contribute to altered parenting because it may affect the level of interaction between parent and child. En face behavior acknowledges maternal-paternal attachment. A feeling of exhilaration is normal following a changing life cycle event such as childbirth. Finger tipping behavior conveys a sense of identification or claiming behavior.

A postpartum nurse is observing a client holding the baby she delivered less than 24 hours ago. Her husband is watching his wife and asking questions about newborn care. The 4-year-old big brother is punching his mother on the back. Which action should the nurse should take? a. Report the incident to the social services department. b. Advise the parents that the older son needs to be reprimanded. c. No action; this is a normal family adjusting to family change. d. Report to oncoming staff that the mother is probably not a good disciplinarian.

c. No action; this is a normal family adjusting to family change. The observed behaviors are normal variations of families adjusting to change. There is no need to report this one incident. Giving advice at this point would make the parents feel inadequate as parents. This is normal for an adjusting family.

Which recommendation should the nurse make to a client to initiate the milk ejection reflex? a. Wear a well-fitting firm bra. b. Drink plenty of fluids. c. Place the infant to the breast. d. Apply cool packs to the breast.

c. Place the infant to the breast. Oxytocin, which causes the milk let-down reflex, increases in response to nipple stimulation. A firm bra is important to support the breast but will not initiate the let-down reflex. Drinking plenty of fluids is necessary for adequate milk production but will not initiate the let-down reflex. Cool packs to the breast will decrease the let-down reflex.

Which action should the nurse do to provide support and encouragement to the new postpartum client? a. Recount how she solved her own problems. b. Correct the new mother at every opportunity. c. Praise the mothers early attempts at infant care. d. Explain to the new mother that everything will be fine.

c. Praise the mothers early attempts at infant care. Positive reinforcement of the mothers attempt to provide care to the newborn will promote a healthy self-concept. The mother needs to learn how to solve problems on her own. Each person may use different techniques that work for that person. Correcting her actions would be discouraging to a new mother. She needs encouragement. Saying everything will be fine is blocking communication and further teaching.

Which type of formula should not be diluted before being administered to an infant? a. Powdered b. Concentrated c. Ready to use d. Modified cows milk

c. Ready to use Ready to use formula can be poured directly from the can into the babys bottle and is good (but expensive) when a proper water supply is not available. Formula should be well mixed to dissolve the powder and make it uniform. Improper dilution of concentrated formula may cause malnutrition or sodium imbalances. Cows milk is more difficult for the infant to digest and is not recommended, even if it is diluted.

While the nurse is demonstrating a baby bath, the client states, The other nurse told me to do it a different way. Which response should the nurse make? a. Tell her to do the procedure whichever way works best for her. b. Confront the other nurse about her knowledge of the procedure. c. Reassure her that procedures are based on standard principles and may vary. d. Tell her that the other nurse does not have much experience in caring for newborns.

c. Reassure her that procedures are based on standard principles and may vary. Procedures may vary as long as basic principles are included. There is no evidence that the other nurse gave incorrect information. Telling her whichever way works best or the other nurse does not have much experience do not answer her concerns.

A client who is receiving a pitocin (Oxytocin) infusion for the augmentation of labor is experiencing a contraction pattern of more than eight contractions in a 10-minute period. Which intervention would be a priority? a. Increase the rate of pitocin infusion to help spread out the contraction pattern. b. Place oxygen on the client at 8 to 10 L/min via face mask and turn the client to her left side. c. Stop the pitocin infusion. d. Call the physician to obtain an order for the initiation of magnesium sulfate.

c. Stop the pitocin infusion. The client is exhibiting uterine tachysystole (uterine tetany). The priority intervention is to stop the infusion. The next course of action is to place oxygen on the client and reposition and increase the flow rate of the primary infusion. If the condition does not improve, the physician may be contacted for additional orders.

The nurse is teaching new parents about behavior cues that indicate their infant has had enough stimulation. Which cues should the nurse include in the teaching session? a. The infant kicks his legs. b. The infant is quiet and alert. c. The infant splays his fingers. d. The infant looks at their faces.

c. The infant splays his fingers. Nurses should help parents recognize signals that indicate when their infant has had enough interaction and wants to avoid further stimulation. These avoidance cues, such as looking away, splaying the fingers, arching the back, and fussiness, indicate that the infant needs a quiet time. Kicking legs, being quiet and alert, and looking at faces are not clues the infant is overstimulated.

The nurse is explaining the procedure of newborn screening to parents before discharge. Which statement by the parents indicates a need for further teaching? a. We understand the tests are performed at 24 to 48 hours. b. Were glad all the tests can be done on one blood sample. The nurse is explaining the procedure of newborn screening to parents before discharge. Which statement by the parents indicates a need for further teaching? c. We wish the tests would screen for congenital hypothyroidism. d. We know that if the tests are done before 24 hours, the tests will need to be repeated at 1 to 2 weeks.

c. We wish the tests would screen for congenital hypothyroidism. Common disorders often included in newborn screening are phenylketonuria (PKU), hypothyroidism, galactosemia, hemoglobinopathies such as sickle cell disease and thalassemia, and congenital adrenal hyperplasia. The parents need further teaching if they say that congenital hypothyroidism is not screened. The newborn screening tests are performed at 24 to 48 hours after birth. Newborn screening requires a blood sample taken from the infants heel, and only one blood sample is needed for all tests. Tests performed within the first 24 hours of life are less sensitive than those performed after 24 hours. Infants tested before 12 to 24 hours of age should have repeat tests at 1 to 2 weeks of age so that disorders are not missed because of early testing.

Which should the nurse do to provide support to a new client who must return to full-time employment 6 weeks after a vaginal birth? a. Discuss child care arrangements with her. b. Allow her to solve the problem on her own. c. Reassure her that shell get used to leaving her baby. d. Allow her to express her positive and negative feelings freely.

d. Allow her to express her positive and negative feelings freely. Allowing the client to express feelings will provide positive support in her process of maternal adjustment. Discussing child care arrangements is an important step in anticipatory guidance but is not the best way to offer support. She should be instrumental in solving the problem; however, allowing her time to express her feelings and talk the problem over will assist her in making this decision. Reassuring her that she will get used to leaving the baby blocks communication and belittles the clients feelings.

A postpartum patient calls the clinic and reports to the nurse feelings of fatigue, tearfulness, and anxiety. What is the nurses best response? a. When did these symptoms begin? b. Sounds like normal postpartum depression. c. Are you having trouble getting enough sleep? d. Are you able to get out of bed and provide care for your baby?

d. Are you able to get out of bed and provide care for your baby? Postpartum blues must be distinguished from postpartum depression and postpartum psychosis, which are disabling conditions and require therapeutic management for full recovery. Nurses need to assess the depression to ascertain if she is unable to cope with daily life. Postpartum blues are self-limiting and frequently occur by the fifth postpartum day and resolve in 2 weeks. The response Sounds like postpartum depression does not offer the patient any help or encouragement through this challenging time. Asking if she is getting enough sleep does not add to the assessments already identified in the stem. Enough information exists to determine that she has the signs and symptoms of postpartum blues. The nurse must differentiate between postpartum blues and depression.

To promote bonding and attachment immediately after birth, which action should the nurse take? a. Assist the mother in feeding her baby. b. Allow the mother quiet time with her infant. c. Teach the mother about the concepts of bonding and attachment. d. Assist the mother in assuming an en face position with her newborn.

d. Assist the mother in assuming an en face position with her newborn. Assisting the mother in assuming an en face position with her newborn will support the bonding process. After birth is a good time to initiate breastfeeding, but first the mother needs time to explore the new infant and begin the bonding process. The mother should be given as much privacy as possible; however, nursing assessments must still be continued during this critical time. The mother has just delivered and is more focused on the infant; she will not be receptive to teaching at this time.

To prevent breast engorgement, what should the new breastfeeding mother be instructed to do? a. Feed her infant no more than every 4 hours. b. Limit her intake of fluids for the first few days. c. Apply cold packs to the breast prior to feeding. d. Breast-feed frequently and for adequate lengths of time.

d. Breast-feed frequently and for adequate lengths of time. Engorgement occurs when the breasts are not adequately emptied at each feeding or if feedings are not frequent enough. Breast milk moves through the stomach within 1.5 to 2 hours, so waiting 4 hours to feed is too long. Frequent feedings are important to empty the breast and establish lactation. Fluid intake should not be limited with a breastfeeding mother; that would decrease the amount of breast milk produced. Warm packs should be applied to the breast before feedings.

Which is an important consideration about the storage of breast milk? a. Can be thawed and refrozen b. Can be frozen for up to 2 months c. Should be stored only in glass bottles d. Can be kept refrigerated for 48 hours

d. Can be kept refrigerated for 48 hours If used within 48 hours after being refrigerated, breast milk will maintain its full nutritional value. It should not be refrozen. Frozen milk should be kept for 1 month only. Antibodies in the milk will adhere to glass bottles. Only rigid polypropylene plastic containers should be used.

A new mother states, My mother-in-law will be here from out of town for a few weeks. Im afraid she will take over the care of the baby. Which response should the nurse make? a. Tell the client that everything will be okay. b. Tell the client how lucky she is to have someone to help her. c. Encourage the client to allow her mother-in-law to take care of the newborn. d. Encourage the client to tell her mother-in-law that she (the new mother) wants to care for her infant.

d. Encourage the client to tell her mother-in-law that she (the new mother) wants to care for her infant. Before the mother-in-law has the opportunity to take over, the mother needs to state her own desire to care for the infant. Telling the client everything will be okay or she is lucky does not address the clients concern and are dismissive. The new mother needs to believe that she can care for her baby and should express this to the mother-in-law so she will not feel resentful in the future.

An infants temperature is recorded at 36 C (96.8 F) during the morning assessment in the newborn nursery. Which priority action should the nurse implement? a. Note the findings in the electronic health record (EHR). b. Unwrap the infant and inspect for abnormalities. c. Provide the infant with glucose water. d. Make sure that the infant is wrapped securely with a blanket and recheck temperature in 15 minutes.

d. Make sure that the infant is wrapped securely with a blanket and recheck temperature in 15 minutes. This temperature potentially indicates hypothermia, so the infant should be wrapped securely in a blanket and reassessed after that intervention. Findings should be documented in the EHR, but this is not the priority intervention. Unwrapping the infant would lead to further compromise and additional risk for the core temperature to drop. Feeding the infant with glucose water may eventually be used as an intervention if the infant shows additional signs of hypoglycemia, which may accompany hypothermia.

Which should the nurse recommend to the postpartum client to prevent nipple trauma? a. Assess the nipples before each feeding. b. Limit the feeding time to less than 5 minutes. c. Wash the nipples daily with mild soap and water. d. Position the infant so the nipple is far back in the mouth.

d. Position the infant so the nipple is far back in the mouth. If the infants mouth does not cover as much of the areola as possible, the pressure during sucking will be applied to the nipple, causing trauma to the area. Assessing the nipples for trauma is important, but it will not prevent sore nipples. Stimulating the breast for less than 5 minutes will not produce the extra milk the infant may need. Soap can be drying to the nipples and should be avoided during breastfeeding.

Which is the purpose of state-required newborn screening? a. Keep the state records updated. b. Document the number of births. c. Allow for accurate statistical information. d. Recognize and treat newborn disorders early.

d. Recognize and treat newborn disorders early. Early treatment of disorders will prevent morbidity associated with some common newborn disorders. Keeping state records and documenting the number of births are not the purposes of newborn screening. The number of births is not indicated by the newborn screening test.

What should the nurse explain when responding to the question, Will I produce enough milk for my baby as she grows and needs more milk at each feeding? a. Early addition of baby food will meet the infants needs. b. The breast milk will gradually become richer to supply additional calories. c. As the infant requires more milk, feedings can be supplemented with cows milk. d. The mothers milk supply will increase as the infant demands more at each feeding.

d. The mothers milk supply will increase as the infant demands more at each feeding. The amount of milk produced depends on the amount of stimulation of the breast. Increased demand with more frequent and longer breastfeeding sessions results in more milk available for the infant. Solids should not be added until about 4 to 6 months, when the infants immune system is more mature. This will decrease the chance of allergy formations. Mature breast milk will stay the same. The amounts will increase as the infant feeds for longer times. Supplementation will decrease the amount of stimulation of the breast and decrease the milk production.

What is the difference between the aseptic and terminal methods of sterilization? a. The aseptic method requires a longer preparation time. b. The aseptic method does not require boiling of the bottles. c. The terminal method requires boiling water to be added to the formula. d. The terminal method sterilizes the prepared formula at the same time it sterilizes the equipment.

d. The terminal method sterilizes the prepared formula at the same time it sterilizes the equipment. In the terminal sterilization method, the formula is prepared in the bottles, which are loosely capped, and then the bottles are placed in the sterilizer, where they are boiled for 25 minutes. The terminal method takes 25 minutes to boil; the aseptic method takes 5 minutes to boil. With the aseptic method, the bottles are boiled separate from the formula. With the terminal method, the formula is prepared, placed in bottles, and everything is boiled at one time.

A breastfeeding client who was discharged yesterday calls to ask about a tender hard area on her right breast. What should be the nurses first response? a. This is a normal response in breastfeeding mothers. b. Notify your doctor so he can start you on antibiotics. c. Stop breastfeeding because you probably have an infection. d. Try massaging the area and apply heat; it is probably a plugged duct.

d. Try massaging the area and apply heat; it is probably a plugged duct. A plugged lactiferous duct results in localized edema, tenderness, and a palpable hard area. Massage of the area followed by heat will cause the duct to open. This is a normal deviation but requires intervention to prevent further complications. Tender hard areas are not the signs of an infection, so antibiotics are not indicated. Fatigue, aching muscles, fever, chills, malaise, and headache are signs of mastitis. She may have a localized area of redness and inflammation.

Most newborns receive a prophylactic injection of vitamin K soon after birth. Which site is appropriate for the newborn? a. Deltoid muscle b. Gluteal muscles c. Rectus femoris muscle d. Vastus lateralis muscle

d. Vastus lateralis muscle The vastus lateralis muscle is located away from the sciatic nerve and femoral blood vessels. Gluteal muscles are not used until a child has been walking for at least 1 year to develop these muscles. The rectus femoris is used only if absolutely necessary because this muscle is located closer to the sciatic nerve and blood vessels, which poses a greater danger. The deltoid is not a recommended site for newborn injections.

As the nurse assists a new mother with breastfeeding, the mother asks, If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better? The nurses best response is that it contains: a. more calcium. b. more calories. c. essential amino acids. d. important immunoglobulins.

d. important immunoglobulins. Breast milk contains immunoglobulins that protect the newborn against infection. Calcium levels are higher in formula than breast milk. This higher level can cause an excessively high renal solute load if the formula is not diluted properly. The calorie counts of formula and breast milk are about the same. All the essential amino acids are in formula and breast milk. The concentrations may differ.