Chapter 12: The Postpartum Woman
There are reasons why formula feeding may be necessary. What is one reason? A. If mother is taking a medication that can harm the newborn. B. If increased immunologic coverage is needed. C. If the infant has multiple episode of otitis media D. If cost is not an issue.
A
While assessing the breastfeeding of a new mother and her infant, you notice that she is dimpling her breast near the newborn's mouth and nose. What would be the most important reason for you to teach the new mother not to do this? A. It can put pressure on the milk ducts and decrease the flow of milk to the infant B. It can lead to sore nipples C. It doesn't make it easier for the infant to breathe. D. It can make it more difficult for the infant to nurse.
A. It can put pressure on the milk ducts and decrease the flow of milk to the infant. When the newborn is latched onto the breast, make sure the woman does not dimple the breast near the newborn's mouth and nose. Many women do this because they thing they are providing breathing space for the newborn. However, this action can interfere with breast-feeding in several ways. It can cause the nipple to be pulled out of the mouth completely. It can cause the nipple to be pulled to the front of the mouth and lead to sore nipples. It can put pressure on the milk ducts, thereby reducing the flow of milk to the newborn and preventing the breast from emptying completely.
One thing a new mother does is to adapt to the new baby psychologically. The woman takes on her new role as mother by going through a series of four developmental stages. What is one of them? A. Achieving a maternal identity B. Finding a way to get the new baby to conform to existing family interrelationships. C. Physical restoration and learning to get help in caring for the infant. D. Preparing for the infant before she conceives.
A. Achieving a maternal identity. The woman adapts to her new role as mother through a series of four developmental stages: 1. Beginning attachment and preparation for the infant during pregnancy. 2. Increasing attachment, learning to care for the infant, and physical restoration during the early postpartum period. 3. Moving toward a new normal in the first four months. 4. Achieving a maternal identity around four months.
The night shift nurse is checking on a woman who had a cesarean delivery with a spinal Duramorph anesthesia early that morning. The nurse counts a respiratory rate of eight per minute. What should the nurse do first? A. Administer naloxone (Narcan), per the preprinted orders B. Awaken the woman and instruct her to breathe more rapidly C. Call the anesthesiologist from the room for orders D. Perform bag-to-mouth rescue breathing at a rate of 12 per minute.
A. Administer naloxone (Narcan), per the preprinted orders. Have naloxone (Narcan) readily available. The anesthesiologist orders naloxone administration if the respiratory rate falls below 10 to 12 per minute.
It is important to assess the breast feeding mother and her infant during a feeding session. What assessment has priority during the feeding session? A. Assess the position, latching on, and sucking of the newborn. B. Assess the woman's visitors and their opinions regarding breastfeeding C. Check the woman's perineal pad for increased lochia flow D. Determine if the woman needs a visit from the lactation consultat.
A. Assess the position, latching on and sucking of the newborn. Correct positioning and latching on of the newborn will help avoid nipple tissue trauma and sore nipples. Once the newborn is nursing, evaluate the effectiveness of the latch and sucking.
You are providing car for a 10 lb 2 oz newborn who is 3 hours old. The infant begins to display signs of hypoglycemia. You do a heel stick to obtain the infant's blood glucose level. At what blood glucose level would you treat the infant for neonatal hypoglycemia. A. Blood glucose of 50 mg/dL B. Blood glucose of 55 mg/dL C. Blood glucose of 60 mg/dL D. Blood glucose of 65 mg/dL
A. Blood glucose of 50 mg/dL If a heel stick specimen reveals a glucose level of less than 50 mg/dL, draw a venous blood sample and send it to the laboratory for confirmation, because it is common for bedside glucose analyzers to underread glucose results. It is critical; however, that you immediately initiate treatment. Follow institutional policy for frequency of testing asymptomatic newborns at risk for hypoglycemia.
Neonatal hypoglycemia is a risk of newborns with diabetic mothers. What laboratory value would be classified as neonatal hypoglycemia? A. Blood glucose of 50 mg/dL B. Blood glucose of 55 mg/dL C. Blood glucose of 60 mg/dL D. Blood glucose of 65 mg/dL
A. Blood glucose of 50 mg/dL Neonatal hypoglycemia occurs when blood glucose levels drop to 50 mg/dL or lower.
Discharge teaching is an important part of the labor and delivery room nurse's position. New parents need to know the basics of baby care, like how to monitor fluid volume and when to call the physician. What are the parameters for calling the physician in regard to infants' temperature? A. Less than 97.7 or greater than 100 B. Less than 97 or greater than 100.5 C. Less than 96.7 or greater than 99.5 D. Less than 96 or greater than 101
A. Less than 97.7 or greater than 100 Temperatures less than 97.7 or greater than 100 should be reported to the physician.
You are assisting with the admission of a newborn boy to the nursery. The mother's history states that she is of Hispanic descent. You note what appears to be bruising on the left upper outer thigh. How would you document this? A. Mongolian spot noted on left upper outer thigh. B. Harlequin sign noted on the left upper outer thigh C. Mottling noted on the left upper outer thigh D. Birth trauma noted on left upper outer thigh.
A. Mongolian spot noted on left upper outer thigh A Mongolian spot is bluish black areas of discoloration on the back and buttocks or extremities of dark-skinned newborns.
Healthy bonding behaviors are important to note when you are assessing the new family. What would you consider a warning sign that the mother and infant may not be bonding as they should? A. Mother states she wanted a boy this time, not another girl. B. Mother cries and says "I have no family nearby and my mother-in-law doesn't like me." C. Mother wants you in the room while she breastfeeds as she is afraid she isn't doing it right. D. Mother states she is concerned about one of her other children not liking the baby.
A. Mother states she wanted a boy this time, not another girl. It is important to differentiate between a new parent who is nervous and anxious about her new role and one who is rejecting her parenting role. Warning signals of poor attachment include turning away from the newborn, refusing or neglecting to provide care, and disengagement from the newborn.
During pregnancy a woman's cardiovascular system expands to care for the growing fetus. After delivery during the early postpartum period, the woman eliminates the additional fluid volume she has been carrying. In what way does the woman get rid of this fluid? A. Urinary elimination B. Elimination of solid wastes C. Being too tired to eat D. Breathing off fluid vapor
A. Urinary elimination In the early postpartum period, the woman eliminates the additional fluid volume that is present during the pregnancy via the skin and urinary tract and through blood loss.
You are the home health nurse making an initial call on a new mother who delivered her third baby five days ago. The woman says to you "I just feel so down this time. Not at all like when I had my other babies. And this one just doesn't sleep. I feel so inadequate." What is the best response to this new mother? A. "Every baby is different with their own temperament. Maybe this one just isn't ready to sleep when you want him to." B. "It sounds like you have the 'baby blues.' They are common after having a baby. They will most likely go away in a day or two but tell your doctor if it lasts more than several days." C. "It sounds like you need to make an appointment with a counselor. You may have postpartum depression." D. "Tell me, are you seeing things that aren't there, or hearing voices?'"
B. "It sounds like you have baby blues..." A combination of factors likely contributes to the baby blues. Psychological adjustment along with a physiologic decrease in estrogen and progesterone appear to be the greatest contributors. Additional contributing factors include too much activity, fatigue, disturbed sleep patterns, and discomfort.
Neonatal screening is done before the infant leaves the hospital. Blood is drawn through a heel stick and tested for several disorders that can cause lifelong disabilities. When is the ideal time to collect this specimen. A. When the infant is 48 hours old. B. 24 hours after the newborn's first protein feeding. C. 36 hours before the infant is discharged home with its parents. D. Just before discharge home.
B. 24 hours after the newborn's first protein feeding. The laws in most states require this initial screening, which is done within 72 hours of birth. The ideal time to collect the specimen is after the newborn is 26 hours old and 24 hours after he has his first protein feeding.
Baby boy Alvarez is 5 minutes old. The nurse performs a quick assessment and determines that the newborn has a heart rate of 110 bpm, a weak cry, and acrocyanosis. His extremities are help in partial flexion, and he grimaces when a catheter is placed in his nose. What Apgar score does the nurse record, and what does this score mean? A. 5-- The newborn is having extreme difficulty transitioning B. 5-- The newborn is having moderate difficulty transitioning C. 6--The newborn is having moderate difficulty transitioning D. 6--The newborn is vigorous and transitioning with minimal effort.
B. 5--The newborn is having moderate difficulty transitioning Scores between 4 and 6 at five minutes mean that the newborn is having moderate difficulty transitioning to extrauterine life.
You are admitting a newborn to the nursery. You know that it is always important to monitor for signs of distress during the transition period. How long is considered to be the most critical transition period? A. 18-24 hours B. 6-12 hours C. 3-5 hours D. 1-2 hours
B. 6-12 hours. The first 6 to 12 hours after birth is considered the most critical time of transition for a newborn.
You are caring for an infant with a birth weight of 8 lb 5 oz. What would be an acceptable discharge weight for this infant. A. 7 lb 3 oz B. 7 lb 5 oz C. 7 lb 12 oz D. 7 lb 15 oz
B. 7 lb 5 oz Monitor the newborn's weight daily during the hospital stay.The breastfeeding newborn should lose no more than 10% of his or her birth weight and should return to birth weight by 7-14 days of age.
You are doing discharge teaching with the parents of baby who is their second child. You explain about sibling regression and you offer ways to deal with regressive behavior. What is this called? A. Reinforcement B. Anticipatory Guidance C. Preparatory Instructions D. Parenting suggestions
B. Anticipatory Guidance Anticipatory guidance is helpful when siblings are involved. Explain to the parents that it is normal for the older sibling to regress in the first few days after the birth of the baby. Tell them it helps if they do not focus undue attention on regressive behaviors, such as a return to bedwetting, sucking the thumb, or clinging to a favorite toy or blanket. It is particularly important for the parents not to criticize or belittle the older child for regressive behaviors.
A woman is bottlefeeding her baby. When the nurse comes into the room the woman says that her breasts are painful and engorged. Which nursing intervention is appropriate? A. Assist the woman into the shower and have her run cold water over her breasts B. Assist the woman in placing ice packs on her breasts C. Explain to the woman that she should breastfeed because she is producing so much milk D. Ask if she wants a breast pump to empty her breasts
B. Assist the woman in placing ice packs on her breasts If the breasts are engorged and the woman in bottlefeeding her newborn, instruct her to keep a support bra on 24 hours per day. Cool compresses or an ice pack wrapped in a towel will usually be soothing and help to suppress milk production.
You are called into the room of one of your clients where the grandparents are visiting with the new parents. The grandmother is visibly upset. She says, "Just look at my grandson! His head is all soft here and it shouldn't be. The doctor injured him when he was born and now he will be retarded." You assess the newborn and find an area of swelling about the size of a half-dollar on the scalp that crosses the suture line. What is this swelling called? A. Cephalohematoma B. Caput succedaneum C. Molding D. Harlequin sign
B. Caput succedaneum Caput succedaneum is swelling of the soft tissue of the scalp caused by pressure of the presenting part on a partially dilated cervix or trauma from a vacuum-assisted delivery.
A new mother calls the clinic and tells you that her breasts are very full and that they hurt. After assessing that there are no overt signs of inflammation present, you suggest that her breasts are engorged. What is the best intervention you could suggest to relieve this woman's discomfort? A. Placing cabbage leaves into your bra. B. Cold packs C. Taking Advil as recommended D. Taking a cold shower several times a day
B. Engorgement of the breasts is a temporary condition that can be uncomfortable for the new mother. Treatments to alleviate discomfort include cold packs to the breast and taking mild analgesic such as ibuprofen (Motrin, Advil) or acetaminophen (Tylenol).
At birth changes from fetal to newborn circulation must occur. What change causes the ductus arteriosus to close? A. Drop in pressure in the neonate's chest B. Higher oxygen content of the circulating blood C. Higher oxygen levels at the respiratory centers of the brain. D. Increase in pressure in the left atrium of the heart.
B. Higher oxygen content of the circulating blood. The first few breaths greatly increase the oxygen content of circulating blood. This chemical change (i.e., higher oxygen content of the blood) contributes to the closing of the ductus arteriosus, which eventually becomes a ligament.
You are doing discharge teaching with the parents of a newborn baby girl. You know that it is important to teach them about diarrhea and dehydration. When should the parents notify the physician about diarrhea in the newborn? A. If the infant has more than one episode of diarrhea in one day. B. If the infant has more than two episodes of diarrhea in one day. C. If the infant has more than three episodes of diarrhea in one day D. If the infant has more than four episodes of diarrhea in one day.
B. If the infant has more than two episodes of diarrhea in one day. Diarrhea is defined as frequent stools with high water content. Because newborns dehydrate quickly, it is important for parents to notify the physician if the newborn has more than two episodes of diarrhea in one day.
A 26-year-old new mother says to her nurse, "I am so disappointed. I gained 25 lb with my baby. Just what the doctor said I should gain. But after I had my baby I only lost 12 lb." What is the best response by the nurse. A. "I see that you are bottle-feeding your baby. You would lose your weight faster if you were breast-feeding." B. It is normal to lose between 12 and 14 lb after the baby delivers. You should be back to your prepregnancy weight by the time the baby is about 6 months old." C. "I know you are anxious to lose all your 'baby fat.' Get yourself on a good diet and you will be down to your original weight in no time." D. "Remember, it took nine months for you to gain all this weight. It won't disappear in just a couple of days."
B. It is normal to lose bewtween 12 and 14 lb... Immediately after delivery, approximately 12 to 14 lb are lost with the expulsion of the fetus, placenta, and amniotic fluid.
You are assessing a newborn girl, 4 hours old, weighing 9 lb 2 oz. While doing the initial assessment the nurse noted that the mothers' history showed her to be morbidly obese. The nurse would know to observe frequently for signs/symptoms of hypoglycemia. What would be early signs of hypoglycemia in this newborn? A. Low temperature and hypertonia B. Jitteriness and irritability C. Hypotonia and fever D. Frequent activity and jitteriness
B. Jitteriness and irritability Early signs of hypoglycemia in the newborn include jitteriness, poor feeding, listlessness, irritability, low temperature, weak or high-pitched cry and hypotonia.
A premature infant often needs a special formula. What formula is specific for a premature infant? A. Alimentum B. Neosure C. Portagen D. Good Start
B. Neosure Neosure is a formula specific to a premature infant. Alimentum is for protein sensitivity, Portagen for impaired fat absorption, and Good Start is for full-term infants.
You are used to working on the postpartum floor taking care of women who have had normal vaginal deliveries. Today; however, you have been assigned to help care for women who are less that 24 hours post scheduled cesarean delivery. You know that in making your assessments you will have to change some things that you would not normally assess. What would you leave out of your patient assessments? A. Breasts B. Perineum C. Lower extremities D. Respiratory Status
B. Perineum Usually a woman who experiences cesarean birth does not have an episiotomy, although rarely this may be the case.
You are doing discharge teaching with a group of new parents before they are discharged home with their infant. One set of parents inquire as to why they need to place their new baby on its back to sleep. What is your best response? A. It really isn't important how you place your baby for it to sleep as long as it is comfortable. B. Research has shown that placing an infant on their back to sleep reduces the risk for SIDS C. Research has found that sleeping on their back reduces the infacts' risk of esophageal reflux D. Sleeping on their stomach is fine, too.
B. Research has shown that placing an infant on their back to sleep reduces the risk for SIDS. Newborns should always be placed on their backs to sleep to reduce the risk for SIDS (AAP Task Force on SIDS 2011).
An antibiotic ointment must be placed in the newborn's eyes to prevent opthalmia neonatroum, a sever eye infection contracted in the birth canal of a woman with gonorrhea or chlamydia. How soon after birth must the antibiotic ointment be applied? A. Within 30 minutes B. Within an hour C. Within an hour and a half D. Within two hours.
B. Within an hour. Within the first hour after birth, an antibiotic ointment must be placed in the newborn's eyes to prevent opthamia neonatorum, a severe eye infection contracted in the birth canal of a woman with gonorrhea or chlamydia.
Feeding rates differ by age, amount of education, and socioeconomic status. Which of the following reflects an accurate statement? A. Women who live in poverty choose to breast-feed B. Women older than 30 years of age choose to breastfeed C. One third of women younger than 20 years of age bottle feed D. Higher education levels correlate with bottlefeeding
B. Women older than 30 years of age choose to breast-feed. Women older than 30 years of age choose to breast-feed.
A newborn has unique nutritional needs. The healthy newborn needs how many calories to meet their energy needs? A. 80 to 100 mL/kg/day B. 100 to 115 mL/kg/day C. 100 to 115 kcal/kg/day D. 80 to 100 kcal/kg/day
C. 100 to 115 kcal/kg/day To meet energy requirements, the newborn needs 100 to 115 kcal/kg/day (Colson, Chapman, & Held, 2012).
One assessment parameter that the nurse is responsible for is fluid volume loss. It would be important to assess the umbilical cord for any sign of bleeding. What would be important to assess for if the infant has an unusually large cord? A. Disintegrating vessels B. A large amount of Wharton jelly C. A loose clamp D. A dry cord.
C. A loose clamp. One potential source of hemorrhage is the clamped umbilical cord. An unusually large cord may have large amounts of Wharton jelly, which may disintegrate faster than the cord vessels and cause the clamp to become loose. This situation could lead to blood loss from the cord.
One of the infants you are caring for is scheduled for a circumcision later this afternoon. The physician has ordered EMLA cream to be applied prior to the procedure. When would you apply the EMLA? A. Fifteen minute prior to the procedure B. Thirty minutes prior to the procedure C. An hour prior to the procedure D. An hour and a half prior to the procedure
C. An hour prior to the procedure If an anesthetic cream, such as EMLA, is to be used for the procedure, it must be applied approximately one hour before the procedure to adequately numb the area.
You are the senior LVN/LPN in the newborn nursery and you are orienting a new graduate LVN/LPN. One of the subjects you want to cover today is hepatic adaptation of the normal newborn. What would you know to talk about? A. Ductus arteriosus B. Umbilical veins C. AquaMEPHYTON D. Pathologic jaundice
C. AquaMEPHYTON The newborn cannot produce vitamin K, which in turn causes the liver to be unable to produce some clotting factors. This situation could lead to bleeding problems, so newborns receive vitamin K (AquaMEPHYTON) intramuscularly shortly after birth to prevent hemorrhage.
You are the oncoming nursery nurse in a normal newborn nursery. You receive report on four infants. Baby A is reported as being 16 hours old, vital signs within normal limits (WNL), bilirubin 3.5 mg/dL, rooming in with mother; Baby B is 8 hours old, vital signs WNL, bilirubin 3 mg/dL, returning to nursery for night; Baby C is 19 hours old, vital signs WNL, bilirubin 4 mg/dL, rooming in with mother; Baby D is 4 hours old, vital signs WNL, bilirubin 2 mg/dL, returning to nursery for night. Which baby would you assess first? A. Baby A B. Baby B C. Baby C D. Baby D
C. Baby C. Hyperbilirubinemia, high levels of unconjugated bilirubin in the bloodstream (serum levels of 4 to 6 mg/dL and greater), can lead to jaundice, a yellow staining of the skin.
A woman comes to the nursery and states "Mrs. Smith is ready for her baby. I will be glad to take the baby to her." The woman is dressed in hospital scrub attire but has no name badge showing. What is the best response by the nurse caring for the baby? A. "I don't know you. Are you trying to take a baby?" B. "Leave immediately! I'm calling security." C. Do you have an ID band? I will walk with you to the parent's room." D. "You must be Mrs. Smith's sister. She said her sister is a nurse."
C. Do you have an ID band? I will walk with you to the parent's room." Each member of the hospital staff should have an identification badge clearly displayed. The nurse in the nursery is appropriate in asking to see the identification of the woman who is offering to take Mrs. Smith's baby to her. Educatio and watchful vigilance are keys to preventing infant abductions. Each facility that cares for newborns should have specific policies and procedures in place that address this problem. Review these policies and know the protocols for the facility in which you will be working.
You are the oncoming nursery nurse caring for a 3-hour-old newborn boy. You make your initial assessment and find the following: Respiratory rate 30 bpm, B/P 60/40 mm/Hg, heart rate 155, temperature (axillary) 36.8 C. You assess that the newborn is in a state of quiet alert. What would you do? A. Inform the charge nurse B. Call the physician C. Document the data D. Stimulate the newborn
C. Document the data. The normal respiratory rate is 30-60 breaths per minute and should be counted for a full minute when the infant is quiet. A newborn starts with a low blood pressure (60/40 mm/Hg) and a high pulse (120 to 160 bpm). Normal temperature range is between 97.7 F (36.5 C) and 99.5 F (37.5 C).
The newborn has been placed in skin-to-skin contact with his mother. A blanket covers all of his body except his head. His hair is skill wet with amniotic fluid, and so on. What is the most likely type of heat loss this baby may experience. A. Conductive B. Convective C. Evaporative D. Radiating
C. Evaporative Evaporative heat loss occurs with the evaporation of fluid from the infant.
As the nurse caring for postpartum patients, what laboratory study would you expect to have ordered by the birth attendant the morning after delivery of the baby? A. Blood type B. CBC C. H&H D. Iron level
C. H&H Monitor the hemoglobin and hematocrit (H&H). Note the H&H before delivery. Most practicioners order a postpartum H&H on the morning after delivery. If the values drop significantly, the woman may have experienced postpartum hemorrhage. Note the blood type and Rh. If the woman is Rh-negative, she will a RhoGAM workup. Determine the woman's rubella status. If she is nonimmune, she will need a rubella immunization before she is discharged home.
You have just received a newborn male into the nursery with the report that he has a hypospadias. What does this mean? A. He has normal male genitalia B. His testicles have not descended into the scrotal sac C. His urinary meatus is located on the under surface of the glans D. He has fluid in the scrotal sac
C. His urinary meatus is located on the under surface of the glans. The term hypospadias refers to the urinary meatus being abnormally located on the ventral (under) surface of the glans.
The nurse assessing a 1-day-old newborn and notices a small amount of white drainage and redness at the base of the umbilical cord. What is the best response by the nurse. A. Call the doctor immediately to ask for IV antibiotics B. Carefully clean the area with a damp washcloth and cover it with an absorbent dressing C. Notify the charge nurse, because this finding represents a possible complication D. Show the mother how to clean the area with soap and water
C. Notify the charge nurse, because this finding represents a possible complication, and document the finding. A normal umbilical cord is well formed and has three vessels. The base of the cord should be dried without redness or drainage, and the umbilical clamp should be fastened securely.
You are assisting with the circumcision of a 16-hour-old male infant. If ordered, what kind of dressing would you apply to the surgical area immediately after the procedure. A. Steri strips B. Small pressure dressing C. Petrolatum gauze dressing D. Sterile 2 x 2s and paper tape
C. Petrolatum gauze dressing Immediately after the procedure, place a petrolatum gauze dressing, as ordered by the physician.
A 20-year-old primipara is getting ready to go home. She had a second-degree episiotomy with repair. She confides in the nurse that she is afraid to go to her postpartum checkup because she is afraid to have the stitches removed. Which reply by the nurse is best? A. "It doesn't hurt when the midwife takes out the stitches. You will only feel a little tugging and pulling sensation." B. "It is very important for you to go to your checkup visit. Besides, the stitches do not have to be removed." C. "The stitches do not need to be removed because the suture will be gradually absorbed." D. "Oh, you mustn't miss your follow-up appointment. Don't worry. Your midwife will be very gently."
C. The stitches do not need to be removed. The episiotomy is approximated and repaired using suture that is gradually absorbed by the body.
When positioning the newborn for breastfeeding the mother tells you that she prefers the cradle hold position. How does this mean the infant is lying? A. On its back with its head turned toward its mother B. Lying on its side facing its mother C. Tummy-to-tummy with its mother D. On a pillow slightly on its side.
C. Tummy to tummy with its mother In the cradle hold, the newborn's abdomen is facing and touching the woman's abdomen. Make sure the newborn is not lying on his back and turning his head toward his shoulder to reach the breast. The newborn should be on his side and tummy-to-tummy with the woman.
You are a graduate nurse seeing your first cesarean delivery. Why is assessment of the respiratory status especially important with this type of delivery? A. "There is more fluid present in the lungs at birth after a cesarean delivery than after a vaginal delivery." B. "Surfactant may be missing from the lungs depending on the newborn's gestational age." C. "The respiratory centers in the brain have not been stimulated when a newborn is delivered by a cesarean delivery." D. "A newborn delivered by cesarean has less sensory stimulation to breathe."
D. "A newborn delivered by cesarean has less sensory stimulation to breathe." The process of labor stimulates surfactant productions, and much of the fetal lung fluid is squeezed out as the fetus moves down the birth canal. This so-called vaginal squeeze is an important way nature helps to clear the airway in preparation for the first breath. The vaginal squeeze also plays a role in stimulating lung expansion. The pressure of the birth canal on the fetal chest releases immediately when the infant is born. The lowered pressure from chest expansion draws air into the lungs.
Your patient is very conscious of the weight she gained during her pregnancy. She has decided to breastfeed her baby and asks you how many calories a day extra she should be eating so that she and her baby are healthy. She states she does not want to gain any extra weight from over-eating. What would be your best response? A. "You are eating for two now. Besides, you are breastfeeding and you will lose your pregnancy weight very quickly.' B. "You need to keep eating just like when you were pregnant. That gives you about 300 kcal extra everyday." C. You have a nice slender body type. Just eat what you want and you will do fine. D. "You should be eating an extra 200 kcal over what you were eating while you were pregnany."
D. "You should be eating an extra 200 kcal over what you were eating while you were pregnant." Instruct the woman who is not breast-feeding to decrease her caloric intake by approximately 300 kcal per day (i.e., she should reduce her intake to prepregnancy levels). The lactating woman will need to tadd an additional 200 kcal above the pregnancy requirement of 300 kcal per day, for a total of 500 kcal above prepregnancy requirements.
A newborn's axillary temperature is 97.5 F. He has a cap on his head. His T-shirt is damp with spit-up milk. His blanket is laid over him, and several children are in the room running around his bassinet. The room is comfortably warm, and the bassinet is beside the mother's bed away from the window and doors. What are the most likely mechanisms of heat loss for this newborn? A. Conduction and Evaporation B. Conduction and Radiation C. Convection and Radiation D. Convection and Evaporation
D. Convection and evaporation Conductive heat loss occurs when the newborn's skin touches a cold surface, causing body heat to transfer to the colder object. Heat loss by convection happens when air currents blow over the newborn's body. Evaporate heat loss happens when the newborn's skin is wet. As the moisture evaporates from the body surface, the newborn looses body heal along with the moisture. Heat loss also occurs by radiation to a cold object that is close to, but not touching, the newborn.
What sign would indicate an infant was tolerating formula? A. Transitional stools B. Ineffective sucking C. Pasty yellow stools D. Emesis
D. Emesis An infant who is not tolerating formula will often have emesis of old curdled formula. Transitional stools and pasty yellow stools are normal stools that follow meconium. Ineffective sucking does not indicate intolerance to formula but a feeding technique difficulty.
While assessing a newborn you elicit a rooting reflex. How do you do this? A. Putting a nipple into the newborn's mouth B. Stroking the lips of the newborn C. Cuddling the newborn close to your chest D. Gently stroking the cheek of the newborn
D. Gently stroking the cheek of the newborn. Rooting, sucking, and swallowing reflexes are all important to the newborn's nutritional intake. Gently stroking the newborn's cheek brings out the rooting reflex. The newborn demonstrates this reflex by turning toward the touch with an open mouth.
You are the senior nurse on the unit and you are orienting a new graduate LVN/LPN. One of the subjects you want to cover today is a postpartum assessment for a vaginal delivery. What would you need to know to cover during this assessment? A. Nagele sign B. Hegar sign C. Chadwick sign D. Homans sign
D. Homans sign Inspect the extremities for edema, equality of pulses, and capillary refill. Check for Homans sign. Feel along the calf area for any warmth or redness. The calves should be of equal size and warmth bilaterally. There should be no reddened, painful areas, and there should be no pain in the calves when feet are dorsiflexed (negative Homans sign), or when the woman is walking.
The parents of a newborn boy ask you about circumcising their son. They are undecided as to what to do. Which response by the nurse is best? A. Cicumcision is best in order to protect the baby from diseases like cancer. B. If you do not circumcise your baby, he will always have difficulty maintaining adequate hygiene. C. It is best not to circumcise your baby because the procedure is very painful. D. Let me ask the pediatrician to come and talk to you about the procedure.
D. Let me ask the pediatrition to come and talk to you about the procedure. If the parents decide to have their male newborn circumcised, informed consent is necessary. It is the physician's responsibility to obtain informed consent, although you may be responsible for witnessing the parent's signatures to a written documentation of that consent. If the parents have unanswered questions, notify the physician before the procedure is done.
To prevent misidentification of a newborn, identification bands are placed on the newborn and on the parents before the newborn is separated from the parents. What information is on all the bands? A. Hospital number, attending physician, and father's name B. Father's name and date and time of birth C. Mother's name and date and time of her birth D. Newborn's sex and date and time of birth.
D. Newborn's sex and date and time of birth Information included on the bands is the mother's name, hospital number, and physician, and newborn's sex, and date and time of birth.
In the United States, the highest rate of breastfeeding initiation is among which group of women? A. Hispanic B. Caucasian C. Asian D. Non-Hispanic African American
The breastfeeding initiation rate for Asian women is 83%, for Hispanic women 81% for Caucasian women 72% and for non-hispanic African America women 59% (CDC, 2012).
