Durham - Ch 16 Discharge Planning and Teaching

A mother who is breastfeeding expresses concern about whether her infant is getting enough milk. Which concrete indicator does the nurse provide to the mother? 1. There are at least eight wet diapers and several stools per day. 2. The mother is physically and emotionally comfortable during feedings. 3. The newborn suckles and the mother can hear and/or see swallowing. 4. The newborn spontaneously releases the grip on the breast when satiated.

ANS: 1 Feedback 1 This is correct. The most concrete indicator that the breastfeeding baby is receiving enough milk is at least eight wet diapers and several stools per day. 2 This is incorrect. The mother being physically and emotionally comfortable during feedings is a subjective determination of successful breastfeeding. 3 This is incorrect. When the newborn suckles and the mother can hear and/or see swallowing, the mother knows there is a transfer of milk; however, the amount is still unknown. 4 This is incorrect. The newborn spontaneously releases the grip on the breast when satiated; however, this does not specifically indicate the amount of milk is adequate.

A patient in the second trimester of pregnancy is discussing breastfeeding and other options with the nurse. Which question is most important for the nurses to ask? 1. "How does your partner feel about you breastfeeding?" 2. "Do you have family members who have breastfed their babies?" 3. "What are the reasons why you are considering breastfeeding?" 4. "At what point after childbirth do you plan to return to work?"

ANS: 1 Feedback 1 This is correct. The woman's partner plays a significant role in her choice to breastfeed and to continue breastfeeding. Her feelings about and success at breastfeeding are enhanced by her partner's support. 2 This is incorrect. Family members, especially those who have breastfed, can be a good source of support; however, the woman's partner is a more significant source of support. 3 This is incorrect. It is important for the nurse to understand the woman's reasons for breastfeeding; however, this is not the most important question to ask. 4 This is incorrect. A woman's career plans and/or the time line for returning to work are important for the nurse to ask about; however, this is not the most important question

18. The nurse is concerned about the number of infants in the community who die from SIDS even with teaching about "back to sleep" being provided. On which additional preventive measures will the nurse focus? Select all that apply. 1. During pregnancy, women should not smoke, drink alcohol, or use illegal drugs. 2. Infants need to be dressed to prevent infants from overheating during sleep. 3. Mothers need to be informed that breastfeeding reduces the risk for SIDS. 4. Parents should not smoke or allow smoking around their baby. 5. Parents need to avoid products that claim to reduce the risk of SIDS.

ANS: 1, 2, 3, 4, 5 Feedback 1 This is correct. The National Institute of Child Health and Human Development (2017) and American Academy of Pediatrics (2016c) recommend that during pregnancy, women should not smoke, drink alcohol, or use illegal drugs. 2 This is correct. The National Institute of Child Health and Human Development (2017) and American Academy of Pediatrics (2016c) recommend that infants need to be dressed to prevent infants from overheating during sleep. 3 This is correct. The National Institute of Child Health and Human Development (2017) and American Academy of Pediatrics (2016c) recommend that mothers need to be informed that breastfeeding reduces the risk for SIDS. 4 This is correct. The National Institute of Child Health and Human Development (2017) and American Academy of Pediatrics (2016c) recommend that parents should not smoke or allow smoking around their baby. 5 This is correct. The National Institute of Child Health and Human Development (2017) and American Academy of Pediatrics (2016c) recommend that parents need to avoid products that claim to reduce the risk of SIDS

The nurse is preparing to teach a class on the benefits of breastfeeding for infants. Which benefits will the nurse include in the presentation? Select all that apply. 1. Decreased incidence of SIDS 2. Fewer cases of necrotizing enterocolitis 3. Less likely to become obese adults 4. Decreased risk for developing otitis media 5. Immunity to respiratory syncytial virus

ANS: 1, 2, 4 Feedback 1 This is correct. There is a decreased incidence of SIDS in infants who are breastfed. 2 This is correct. Breastfed infants have fewer cases of necrotizing enterocolitis. 3 This is incorrect. There is no reported information that indicates that breastfed infants are less likely to become obese adults. 4 This is correct. Breastfed infants have a decreased risk for developing otitis media. 5 This is incorrect. Infants who are breastfed have a decreased risk for being hospitalized for respiratory syncytial virus but are not immune to the condition from breastfeeding.

17. The nurse is teaching new parents about the Period of PURPLE Crying Program aimed at the prevention of shaken baby syndrome. At the end of the program, the nurse evaluates the program successful if parents select which fact? Select all that apply. 1. Your baby may not stop crying no matter what you do. 2. Your baby may cry more in the late afternoon and evening. 3. A serious condition exists if crying last 5 hours a day or more. 4. Your baby will cry less each week, the least during the first 2 months. 5. A crying baby may look to be in pain, even when he or she is not.

ANS: 1, 2, 5 Feedback 1 This is correct. Parents who understand the baby may not stop crying no matter what they do indicates a successful program. 2 This is correct. Parents who understand the baby may cry more in the late afternoon and evening is an indication of a successful program. 3 This is incorrect. Parents who think a serious condition exists if crying lasts 5 hours a day or more are indicative of an unsuccessful program. 4 This is incorrect. Parents who think the baby will cry less each week, the least during the first 2 months, is an indication of an unsuccessful program. A baby may cry more each week, the most at 2 months, the least in 3 to 5 months. 5 This is correct. Parents who understand the baby may look to be in pain, even when he or she is not, indicates a successful program.

A breastfeeding mother is planning to return to work 3 months after her baby is born. The mother is planning to use an electric breast pump and freeze some breast milk for use later. Which information does the nurse need to provide? 1. Frozen breast milk can be defrosted in a microwave. 2. Breast milk can be kept in a deep freezer for 6 to 12 months. 3. The freezer door shelf decreases the chance of milk contamination. 4. Breast milk can only be frozen in special plastic freezer bags.

ANS: 2 Feedback 1 This is incorrect. Breast milk in any form cannot be either thawed or warmed in a microwave. The microwave can cause uneven heating or overheating. Overheating by either microwave or stovetop can destroy antibodies within the breast milk. 2 This is correct. Breast milk can be safely kept in a deep freezer for 6 to 12 months; in a freezer attached to a refrigerator, it can be safely stored for 3 to 6 months. 3 This is incorrect. Freezer door storage causes a fluctuation of temperature every time the freezer is opened. The milk needs to be stored far back in the freezer/compartment. 4 This is incorrect. Breast milk can be stored in plastic bags, in glass bottles, or in hard BPA-free plastic containers.

10. The postnatal nurse is making a newborn visit to the parents who are from a different country. The nurse finds the newborn swaddled in a heavy blanket and wearing a knitted cap. The newborn has wet hair and is restless with rapid breathing. Which initial comment from the nurse is appropriate? 1. "Your baby is exhibiting some concerning symptoms." 2. "Share with me how babies are cared for in your country." 3. "I would like to explain how to dress your baby correctly." 4. "Let me explain the baby's symptoms of being overheated."

ANS: 2 Feedback 1 This is incorrect. If the nurse's initial comment expresses concern over the baby's well-being, the nurse may be interfering with open sharing and conversation with the parents. The baby is not in a life-threatening situation. 2 This is correct. When the nurse asks the parents to share how babies are cared for in their country, the nurse is showing interest and respect to the parents' culture. The nurse needs to understand the motivation behind dressing the baby in the current manner. 3 This is incorrect. When the nurse expresses a desire to explain how to correctly dress the baby, the nurse is suggesting the parents are lacking knowledge. The nurse needs to gain information and understanding about cultural differences. 4 This is incorrect. Explaining the symptoms that indicate the baby is over-dressed may be appropriate later in the conversation; however, the nurse's initial comment is aimed at achieving cultural understanding.

The lactation nurse visits the room of a patient who is postpartum and being prepared for discharge. The nurse plans to provide breastfeeding information aimed at assisting the patient to continue breastfeeding her newborn. Which observation by the nurse indicates a possible disruption to the planned teaching? 1. The patient is currently breastfeeding her baby. 2. The patient is excited about taking her baby home. 3. The patient's partner is in the patient's room. 4. The patient states she has no questions or concerns.

ANS: 2 Feedback 1 This is incorrect. The fact that the patient is currently breastfeeding her baby will not present a disruption in the nurse performing teaching. 2 This is correct. When the patient is distracted by feelings and/or activities, there is the possibility for disruption of the nurse's teaching. The right time for teaching is imperative. 3 This is incorrect. The presence of the patient's partner will not disrupt the nurse's teaching plan. The partner can be included in the goals of the teaching. 4 This is incorrect. If the patient has no questions or concerns, the nurse may or may not decide to continue with the teaching plan. The nurse can share the teaching plan topics to elicit patient interest

19. The nurse is collecting information from a parent whose infant has frequent diaper dermatitis. Which comment by the parent indicates a possible cause of the condition? Select all that apply. 1. "I use disposable wipes to clean the diaper area." 2. "I buy an antibiotic ointment specified for skin rashes." 3. "I leave the diaper off while the baby is sleeping." 4. "I treat any sign of a rash immediately with zinc oxide." 5. "I even get up and change the baby's diaper during the night."

ANS: 2 Feedback 1 This is incorrect. The use of disposable wipes or clear water to clean an infant's diaper area is not a cause for diaper dermatitis. 2 This is correct. When an infant has diaper dermatitis, the use of antibiotic ointments, which can increase the risk of allergic skin reactions, should be avoided. This statement alerts the nurse to a possible cause of the infant's diaper dermatitis. 3 This is incorrect. Leaving the infant's diaper off during sleeping and exposing the diaper area to air helps to clear or prevent diaper dermatitis. 4 This is incorrect. Prevention and management of diaper dermatitis is most effective if the first signs are treated immediately with zinc oxide or a thin layer of petroleum-based ointment. 5 This is incorrect. The infant's diaper should be changed every 1 to 3 hours during the day. Changing the diaper at least once during the night will also help prevent diaper dermatitis.

11. The nurse is teaching the mother of a neonate the benefits of kangaroo care. Which action is explained to the mother regarding the procedure? 1. The neonate is tucked into the front of a parent's shirt. 2. A bare-chested neonate is held against a bare-chested parent. 3. A pouch is formed from a blanket for carrying the neonate. 4. The neonate is placed in a sling and placed on a parent's side.

ANS: 2 Feedback 1 This is incorrect. When the nurse teaches a mother the benefit of initiating kangaroo care, the neonate is not tucked into the front of a parent's shirt. 2 This is correct. When the nurse teaches a mother the benefit of initiating kangaroo care, a bare-chested neonate is held against a bare-chested parent and both the neonate and parent are covered with a warm blanket. 3 This is incorrect. When the nurse teaches a mother the benefit of initiating kangaroo care, a pouch is not formed from a blanket for carrying the neonate. 4 This is incorrect. When the nurse teaches a mother the benefit of initiating kangaroo care, the neonate is not placed in a sling and placed on a parent's side.

The parents of a newborn male are concerned about providing care for the baby's new circumcision performed with a Plastibell. Which information will the nurse include in the teaching plan for the parents? 1. Apply lubricants to the penis to keep the diaper from sticking. 2. Report if penis is red, warm, and swollen and/or there is surgical site drainage. 3. Remove the plastic ring gently on the fifth day after surgery. 4. Contact the health care provider if newborn does not void for 36 hours.

ANS: 2 Feedback 1 This is incorrect. With a Plastibell, lubricant is not applied to the penis; the Gomco or Mogen clamp needs a protective lubricant over the circumcision site after each diaper change for the first week. 2 This is correct. The nurse will include information to the parents that if the entire penis is red, warm, and swollen and/or there is drainage from the surgical site (signs of infection), it should be reported immediately to the health care provider. 3 This is incorrect. With the Plastibell method, the plastic ring falls off in 7 to 10 days. Parents should not pull it off. 4 This is incorrect. The health care provider should be contacted if the newborn does not void within 24 hours.

14. The postpartum nurse-manager wants the unit to become active as a supporter of the Baby Friendly Hospital Initiative. Which nursing actions will be initiated? Select all that apply. 1. Give pacifiers to infants on demand. 2. Help mothers initiate breastfeeding within 1 hour of birth. 3. Teach breastfeeding and promote lactation to mothers separated from infants. 4. Refer mothers to support group resources on discharge. 5. Provide infants with water until a milk supply is established.

ANS: 2, 3, 4 Feedback 1 This is incorrect. Giving babies nipples and pacifiers causes confusion for breastfed babies and interferes with breastfeeding. 2 This is correct. Initiating breastfeeding early is helpful in establishing breastfeeding. The ideal time line is to initiate breastfeeding within the first hour after birth. 3 This is correct. Even if separated from their infants for a period of time, mothers are offered information about breastfeeding and maintaining lactation. If the separation is related to a medical condition, the mother can pump and supply her infant with breastmilk unless it is medically contraindicated. 4 This is correct. For continuing care, breastfeeding mothers need to be offered the support of other breastfeeding mothers. 5 This is incorrect. While establishing breastfeeding, the infant will not be given supplements of formula or water. This is especially important if the mother plans to exclusively breastfeed for a period of 6 months.

15. The postpartum nurse is preparing to present infant care information to a couple who expresses concern about when to bathe their newborn. Which behaviors will the nurse present as general guidelines? Select all that apply. 1. Bathing is best after a feeding when newborn is relaxed. 2. Daily bathing with soap is not necessary for the newborn. 3. Use a mild preservative-free soap with a neutral pH. 4. Avoid the use of soap on the face of the newborn. 5. Genital and rectal areas should be cleaned at each diaper change.

ANS: 2, 3, 4, 5 Feedback 1 This is incorrect. Bathing of a newborn is best performed before a feeding to decrease the risk of emesis related to jostling during bathing. 2 This is correct. Daily bathing of a newborn with soap is not necessary and can contribute to skin irritation. Between baths with soap, the newborn can be cleaned with clear water. 3 This is correct. When bathing with soap, a mild preservative-free soap with a neutral pH is used to prevent skin irritation. 4 This is correct. The use of soap on the face is not recommended. The face and neck areas should be cleaned after feedings with plain water. 5 This is correct. Genital and rectal areas should be cleaned at each diaper change with water or diaper wipes.

Which information is important for the nurse to provide to mothers of infants of 3 months of age regardless of the method of infant feeding? 1. Why breastfeeding delays the need for solid foods 2. When and what order solid foods are introduced 3. When growth spurts and dietary increases are expected 4. Why the babies are most likely to prefer food over milk

ANS: 3 Feedback 1 This is incorrect. At the age of 3 months, the nutritional requirements for infants are ideally met by breast milk. Iron-fortified infant formula is substituted when the woman is not breastfeeding. 2 This is incorrect. The order and types of solid food introduction do not need to be taught to the mothers of 3-month-old infants, regardless of the current methods of feeding. Introduction of semisolid foods is determined by the physician or nurse practitioner in collaboration with parents. The AAP and WHO guidelines recommend waiting to start solids until 6 months of age to reduce allergy risks. 3 This is correct. Mothers need to be aware of probable growth spurts regardless of the method of feeding. Infants experience growth spurts at 3 to 5 days, 1 week, 6 weeks, 3 months, and 6 months and require more frequent feedings during these time periods. 4 This is incorrect. Infants at the age of 3 months are not likely to prefer food over milk. Before 4 to 6 months, the sucking reflex forces semisolid food out of the mouth instead of moving it to the back of the mouth.

A patient in the first stage of pregnancy is discussing the options for feeding her infant, and asks the nurse, "Which is the most important reason I should consider breastfeeding my baby?" Which is the most significant reason the nurse presents? 1. Human milk proteins are easier to digest than protein in prepared formula. 2. The amount of cholesterol in human milk is essential for the baby. 3. Human milk contains multiple antibodies, enzymes, and immune factors. 4. Vitamins and minerals are transferred to human milk from the mother.

ANS: 3 Feedback 1 This is incorrect. Human milk proteins are easier to digest than protein in prepared formula; however, this is not the most significant reason the nurse recommends breastfeeding. 2 This is incorrect. Cholesterol is high in human milk and is essential for brain development; however, this is not the most significant reason the nurse recommends breastfeeding. 3 This is correct. Human milk contains multiple antibodies, enzymes, and immune factors that help protect the infant from common infections. It also stimulates the growth of healthy bacteria in the intestinal system, which inhibits growth of bacteria that can cause diseases. The factors are not found in formula, and this is the most significant reason for the nurse to recommend breastfeeding. 4 This is incorrect. Vitamins and minerals are transferred to the human milk from the maternal plasma; however, this is not the most significant reason for the nurse to recommend breastfeeding.

The nurse is collecting information from a new mother who is bottle-feeding her infant. Which comment, if made by the mother, requires the nurse to provide patient teaching? 1. "I wish that I had tried breastfeeding because formula is expensive." 2. "At least I get a break every evening when my spouse feeds the baby." 3. "Sometimes I will add a little water to the formula if I am running low." 4. "I get frustrated if the last bottle is fed to the baby late at night."

ANS: 3 Feedback 1 This is incorrect. When the mother expresses a reconsideration about breastfeeding, the nurse can only plan teaching if the next pregnancy occurs. 2 This is incorrect. When the mother expresses positive feelings about the ability of her spouse to feed the baby, there is no need for teaching. 3 This is correct. If the mother states a practice of diluting the baby's formula if her supply is low, the nurse needs to provide teaching. Prolonged over-dilution of formulas can cause water intoxication, as well as decrease the caloric intake by the baby. 4 This is incorrect. The nurse may make suggestions about planning specific times for the preparation of formula. However, this is not a statement that requires teaching.

16. A new mother expresses severe frustration with an infant that is exhibiting symptoms of colic. Which suggestions from the nurse are aimed at infant safety? Select all that apply. 1. Hold the infant and sway from side to side or walk around with the infant. 2. Place the infant in a car seat and take him or her for a ride in the car. 3. Place the baby in a safe place and allow the baby to cry for 10 to 15 minutes. 4. Do simple household chores, such as vacuuming or washing the dishes. 5. Place the infant (abdomen down) over the knees and gently rub or pat the back.

ANS: 3, 4 Feedback 1 This is incorrect. Holding the infant and swaying from side to side or walking around with the infant is an appropriate action for calming the infant with colic. However, the nurse is focusing on infant safety; this does not address the concern. 2 This is incorrect. Placing the infant in a car seat and taking him or her for a ride in the car can be very effective in calming an infant with colic. However, the mother who expresses severe frustration with a colicky baby may not be safe driving a car. 3 This is correct. When a mother expresses severe frustration with a colicky baby, she needs to place the baby in a safe place and allow the baby to cry for 10 to 15 minutes. The mother can check on the baby when she has calmed down. 4 This is correct. A mother who expresses severe frustration with a colicky baby needs to find a distraction. Doing simple household chores, such as vacuuming or washing the dishes can be effective and allow the mother time to calm down. 5 This is incorrect. Placing the infant (abdomen down) over the knees and gently rubbing or patting the back can be effective in calming a colicky baby. However, the mother who is extremely frustrated needs to prevent the opportunity to shake, throw, hit, slam, or jerk a child of any age.

A mother who is 2 weeks postpartum asks the nurse lactation specialist how she knows if her baby is hungry. Which hunger indicator does the nurse discuss? 1. Crying when all other physical needs are met 2. If 2 to 3 hours have passed since feeding 3. When the mother experiences a let-down sensation 4. Opening the mouth in response to tactile stimulation

ANS: 4 Feedback 1 This is incorrect. There are signals for hunger that occur without the baby crying, which will reduce the baby's stress and facilitate bonding. 2 This is incorrect. The breastfed baby will not always follow a set feeding schedule. Most mothers are taught to breastfeed on demand, which will keep an adequate milk supply. 3 This is incorrect. The mother may experience a let-down sensation for a variety of reasons, including hearing an infant cry. It can also occur during sexual arousal or activity due to the natural release of oxytocin in response to an orgasm. The let-down reflex can be inhibited by stress, anxiety, pain, and fatigue. 4 This is correct. Opening the mouth in response to tactile stimulation is the best way to determine if a baby is hungry; the rooting reflex is not solicited in a baby who is not hungry.

12. The nurse is teaching newborn care to an adolescent mother. When the nurse attempts to teach how to swaddle the newborn, the mother states, "What's the big deal about how to wrap up a baby?" The nurse needs to convey which reason as being most important for proper swaddling? 1. Improper swaddling can cause hip dysplasia. 2. Correct swaddling will increase the neonate's comfort. 3. Neonates are swaddled only until they can turn from front to back. 4. Two to three fingers need to fit between the infant's chest and the swaddle.

ANS: 1 Feedback 1 This is correct. Improper swaddling can cause hip dysplasia. It is especially important to allow the hips to spread apart and bend up. In the womb, the legs are in a fetal position with the legs bent up across each other. Sudden straightening of the legs to a standing position can loosen the joints and damage the soft cartilage of the socket. This is the most important information for the nurse to convey. 2 This is incorrect. Correct swaddling will increase the neonate's comfort, and provides warmth and a sense of security that can have a calming effect, but another reason is most important. 3 This is incorrect. Infants are actually only swaddled until they can turn from back to front. Infants who are swaddled and roll from back to front while sleeping are at greater risk for SIDS. 4 This is incorrect. Check the tightness of swaddle. The parent should be able to get two to three fingers between the infant's chest and the swaddle, but this I not the most important reason to convey.