OB 16 Discharge Planning and Teaching during the Neonatal Period

A nurse is assessing a newborn one day after a circumcision with a plastibell. The nurse observes the mother placing lubricant on the circumcision during the diaper change. How should the nurse respond? "Lubricant can cause displacement of the plastibell." "Do not use lubricant during the diaper change." "Lubrication is an excellent technique in caring for the circumcision." "It is always important to lubricate to prevent the diaper from sticking."

"Lubricant can cause displacement of the plastibell."

The Baby-Friendly hospital initiative started in 1991. The nurse understands that which is the goal of this program? To force new mothers to breastfeed, as the hospitals will not carry formula To improve breastfeeding rates and maternal-newborn bonding To eliminate the use of hospital nursery to care for infants outside of the mother's room To eliminate the use of pacifiers

To improve breastfeeding rates and maternal-newborn bonding

The triage nurse receives a phone call from the parent of a 3-week old male infant. The parent states that the infant has had a pink tinge in their diaper for the last two days. How should the nurse respond? "A pink tinge can be a normal finding in the diaper." "A pink color may indicate dehydration." "You may need to change the diaper more frequently." "No worries. Keep your scheduled appointment next month."

"A pink color may indicate dehydration."

A breastfeeding mother is planning to return to work and asks the nurse how to store her breastmilk. What is the best response by the nurse? "Keep the milk warm in a thermos at your desk." "You can store breastmilk for 6 to 8 hours at room temperature." "Expressed milk can remain in the refrigerator for a month." "Do not store breastmilk in a freezer as it damages the milk proteins."

"You can store breastmilk for 6 to 8 hours at room temperature."

A postpartum woman calls the clinic about her 4-day-old infant. The baby is not scheduled for a well-baby visit for another 10 days. The mother states, "I am worried that my baby is not getting enough to eat at the breast." Which response by the nurse about effective breastfeeding would be appropriate? "As long as your baby gains its birth weight back by one month, breastfeeding is effective." "It is normal for your nipples to be sore after breastfeeding." "It is important that you take the baby off the breast after 15 minutes of breastfeeding." "You should anticipate your baby to void 8 times per day."

"You should anticipate your baby to void 8 times per day."

A nurse is working in the emergency department when a family member brings in a 4-month-old infant. Upon assessment, the nurse suspects the infant has pediatric abusive head trauma (PAHT). Which assessment findings are consistent with a PAHT diagnosis? Select all that apply. Breathing Problems Convulsions Crying for 30 minutes Lethargy Vomiting

1,2,4,5

The nurse educates a new mother about infant hunger cues. What cues indicate that an infant is ready to feed? Select all that apply.'= Rooting Hand-to-mouth movements Hiccups Sucking on fingers Quiet-alert behavior state

1,2,4,5

A nurse enters the room of a new mother and newborn. The mother is sleeping in the bed and the infant is lying in the bassinet. The nurse notices the baby showing early signs of hunger and wakes the mother to breastfeed. What did the nurse notice? Select all that apply. The newborn was placing a hand near the mouth. The newborn was in a deep sleep state. The newborn was sucking on their hand. The newborn was crying loudly. The newborn was in need of a diaper change.

1,3

A client states that breastfeeding is very painful. The nurse observes redness and cracking on both nipples. What actions by the nurse would be appropriate? Select all that apply. Assess the infant's latch position. Instruct the client to apply ice to her breasts before feeding. Notify the health care provider to monitor for infection. Instruct the client to express colostrum and rub it on her nipple. Teach the client to wash breasts with water only.

1,3,4,5

The nurse educator is creating an informational brochure on Sudden Infant Death Syndrome (SIDS) prevention to be given to new parents. Which information would the nurse include in the pamphlet? Select all that apply. The infant should sleep in a crib in their own room starting at 6 weeks of age. No loose bedding, pillows, or stuffed toys should be in the crib with the infant. Pacifiers should be used during naps and overnight for all infants. Avoid all secondhand smoke exposure for the infant. Infants should always be placed back on their backs if they have rolled onto their stomachs.

2,3,4

The nurse is preparing discharge instructions for the parents of a newborn. When developing the teaching plan, the nurse must include which rights for teaching? Select all that apply. Right day Right context Right content Right goal Right method

2,3,4,5

The nurse is teaching a client about breastmilk storage. The client is concerned with how long breastmilk can safely be stored in the refrigerator or freezer. Which statement would the nurse include in the education? Select all that apply. "Breastmilk can be stored in the refrigerator for 7 to 10 days." "Breastmilk can be stored in a freezer attached to a refrigerator for 3 to 6 months." "Breastmilk can be stored in a deep freezer for 6 to 12 months." "Breastmilk can be stored at room temperature for up to 24 hours." "Breastmilk in the freezer should be stored towards the back and not near the door."

2,3,5

The nurse is discussing newborn care with a client as part of the discharge teaching. In regard to bathing, what statement by the client indicates an understanding of the teaching? Select all that apply. "I should wash my baby daily with soap and water." "Bathing baby after a feeding will ensure that the baby is relaxed." "I will use a mild soap to prevent skin irritation." "After feeding, I will clean the baby's face and neck with water." "I will make sure the water temperature is between 90 to 100 degrees F"

3,4,5

A new mother is reporting significant incision pain after a cesarean section. The nurse is at the bedside to assist the mother into position for breastfeeding. Which position would be optimal for breastfeeding, considering the mother's incisional pain? Select all that apply. Cradle position Cross-cradle position Crown position Football hold position Lying down position

4,5

Human breastmilk is composed of proteins, carbohydrates, and fats. What is the correct composition for proteins, carbohydrates, and fat in human breastmilk? 52%, 42%, 6% 42%, 6%, 52% 6%, 42%, 52% 6%, 52%, 42%

6%, 42%, 52%

Some medications are not compatible with breastfeeding. Which client is most likely to be taking a contraindicated medication? A client with high cholesterol A client with hypothyroidism A client with hypertension A client with asthma

A client with high cholesterol

A pregnant client presents to the labor and delivery unit in active labor with a history of no prenatal care. Initial lab work indicates a positive HIV status. What should the nurse advise the client to do? Complete a living will. Do not breastfeed the infant. Do not tell the family about the result. Consider placing the baby up for adoption.

Do not breastfeed the infant.

In order to prevent Shaken Baby Syndrome, a national prevention program has been instituted to educate parents on normal infant behavior. Place the educational considerations in the correct order for the acronym of the shaken baby campaign. Resists soothing Unexpected Pain-like face Peak of Crying Evening Long-Lasting

P U R P L E

A student nurse is giving a bath to a newborn infant. The preceptor should explain the following steps of bathing in what order? Wash the eyes from the inside out. Cleanse the genital area. Wash the upper body. Wash the hair and scalp. Clean the neck folds.

eyes, hair, neck, upper, genital

The nurse is observing a new mother bathe her newborn female. The nurse knows teaching has been effective when the mother completes the bathing steps in which order? Clean genitals by washing front to back. Clean the lower body. Cleanse the eyes from inner to outer corner. Wash hair and massage scalp. Clean the upper body.

please, wash, upper, lower, genitals

The nurse is teaching a new mother on how to swaddle her newborn for comfort. Place the steps in order of the correct steps for swaddling. Other corner fold First corner fold Bottom fold Top fold

top, first, bottom, other

Place the stages of breast milk in the correct chronological order. Mature Milk Transitional Milk Colostrum

C, T, M

A client asks the nurse how she knows if the baby is getting enough to eat. What is the best response by the nurse? "The baby's suckle should be strong enough to cause mild discomfort." "The infant will feed for at least 20 minutes per side." "Your breasts will feel full and firm which indicates adequate milk supply." "The baby will be drowsy and relaxed after feeding."

"The baby will be drowsy and relaxed after feeding."

A new mother calls the provider's office, concerned about her toddler's behavior toward the family's newborn. Which statement by the mother would require further assessment by the nurse? "Even though my toddler is fully potty-trained, they have begun wetting their pants again." "My toddler has insisted on using a bottle at mealtimes." "I caught my toddler hitting the baby when I was not in the room." "My toddler said they 'hated' the baby and has started to throw tantrums."

"I caught my toddler hitting the baby when I was not in the room."

The nurse is teaching a community education course that includes discussion of current recommendations for infant feeding. Which statement by a participant would indicate that further teaching is required? "Well water should not be used for formula preparation." "Parents need to discard any unused formula after each feeding." "Solid foods should be introduced after 6 months to reduce allergy risks." "Cereal should be added to bottles as a fortifier to increase caloric intake."

"Cereal should be added to bottles as a fortifier to increase caloric intake."

A 2-day postpartum client states, "My baby nurses all the time. I don't think I have enough milk." What education should the nurse provide to the client? "Colostrum is thick and small in volume. Babies must nurse frequently to get the nutrients they need." "Transitional milk is lower in calories than colostrum. Babies must nurse often to gain weight." "You need to begin pumping to increase your milk supply." "Hindmilk has higher fat, so you need to ensure your baby nurses for at least 20 minutes per breast."

"Colostrum is thick and small in volume. Babies must nurse frequently to get the nutrients they need."

A client is breastfeeding her full-term newborn for the first time. She reports to the nurse that her nipples are sore. What suggestion can the nurse provide to the client after observing the feeding? "Bring your breast to the baby, as this will help the baby latch." "Get all of the nipple and as much areola as you can in the baby's mouth." "Let the baby suck only on the tip of the nipple." "Use a pacifier as a tool to get the baby to suck appropriately."

"Get all of the nipple and as much areola as you can in the baby's mouth."

The nurse is instructing a new parent on appropriate circumcision care to his newborn son. Which statement by the parent demonstrates effective teaching regarding circumcision care? "I can expect the circumcision to be fully healed within 3 to 5 days." "I will apply a lubricant over the circumcision site with each diaper change." "I will need to remove the plastibell in 7 to 10 days." "It is not uncommon for circumcised babies to void 36 to 42 hours after the procedure."

"I will apply a lubricant over the circumcision site with each diaper change."

The nurse overhears a client and spouse discussing the needs for the newborn to have daily baths to maintain cleanliness. What is the appropriate response from the nurse?'= "Babies smell so good right after a bath." "Nobody bathes infants daily anymore." "Daily baths with soap are important for newborns." "Tell me more about what you know about bathing newborns."

"Tell me more about what you know about bathing newborns."

The nurse is entering a client's room and overhears the grandmother telling the client to put rice cereal in the infant's bottle to help with sleep. The nurse shares with the client the signs to watch for that the infant is ready for solid foods, and to wait until these are present to start cereal. What signs does the nurse include? Select all that apply. The infant is sitting with support. The infant refuses food by turning head away. The infant opens mouth to indicate hunger. The infant cries and appears hungry frequently. The infant sucks on the spoon like a nipple.

1,2,3

A nurse is creating an educational pamphlet for women who are interested in breastfeeding. This pamphlet will be provided at prenatal appointments. What statements are appropriate to include in the educational pamphlet? Select all that apply. Breastfeeding has psychological benefits that include a decreased risk of postpartum depression. Breastfeeding your infant can lead to a decreased risk of otitis media. Breastfeeding can lead to decreased risk of colon cancer for mothers. Breastfeeding mothers lose more weight after three months compared to those who did not breastfeed. Breastfeeding can lower your infant's risk of inflammatory bowel disease.

1,2,4,5

When planning for a childbirth education class for pregnant clients, the nurse knows to include benefits of breastfeeding for infants. What will the nurse include in the education session? Select all that apply. Gastroenteritis Childhood Chronic Constipation Obesity Asthma Respiratory Distress Syndrome

1,3,4

For some women, breastfeeding is contraindicated. Which client should not breastfeed her infant? A woman who smokes half a pack of cigarettes per day A woman with mastitis A woman with genital herpes simplex lesions A woman whose infant has galactosemia

A woman whose infant has galactosemia

Which statement should the nurse include in an education program for parents regarding Sudden Infant Death Syndrome (SIDS)? Babies need to be placed in the supine position for sleeping. Babies should be swaddled from birth until one year old. Babies should be placed in the prone position for naps to prevent abnormal head shape. Pacifiers should not be offered to babies who established effective breastfeeding.

Babies need to be placed in the supine position for sleeping.

During discharge education, the nurse informs the parents of a newborn to anticipate increased fussiness and need for frequent feeds around 2 weeks of age. What does the nurse describe as the contributing factor for these symptoms? Growth spurt Colic Lactose intolerance Constipation

Growth spurt

An emergency room nurses admits a 6-week old infant. During the assessment, the nurse notes the infant to be lethargic. The infant vomits during the assessment and the parent reports that the infant has been eating poorly. Upon visual inspection of the infant, faint bruising is noted on the arms. What will the nurse be most concerned about? Feeding intolerance Clotting disorder Metabolic disorder Head trauma

Head trauma

A breastfeeding mother reports a tingling sensation in her breasts while feeding. What does the nurse explain as the cause of this sensation? It is a release of oxytocin causing milk let-down. It is a release of prolactin causing milk production. This is the initial sign of a clogged milk duct. This is pressure on the breast tissue from engorgement.

It is a release of oxytocin causing milk let-down.

A nurse is creating a pamphlet on breastfeeding for new mothers. The stages of lactogenesis will be included in the information. In which stage will the nurse discuss supply and demand? Lactogenesis I Lactogenesis II Lactogenesis III Lactogenesis IV

Lactogenesis III

The nurse is educating a woman on adequate protein intake to support breastfeeding. What foods should be included in the nutrition plan? Sunflower seeds Swordfish Fortified cereals Cooked greens

Sunflower seeds

The nurse is teaching new parents about ways to comfort a newborn. The education includes the 5 S's to guide the learning. What is the nurse including in the presentation? Swaddling, side lying, singing, swinging, sucking Swaddling, singing, swinging, sucking, swaying Swaddling, side lying, shushing, swaying, sucking Swaddling, side lying, shushing, swinging, sucking

Swaddling, side lying, shushing, swinging, sucking

During a hospital tour, the childbirth educator mentioned that the facility was designated as "baby-friendly." What is an example of baby-friendly care? The nurse assists the mother to breastfeed within 1 hour of delivery. The infant is given a pacifier to facilitate sucking. Breastfeeding on a regular schedule is encouraged. A newborn nursery is provided so mothers may rest at night.

The nurse assists the mother to breastfeed within 1 hour of delivery.

When discussing positioning for breastfeeding, what does the nurse instruct the client to do? Lean forward toward the infant. Place the nipple symmetrically in the infant's mouth. Use pillows to support the newborn. Hold the newborn supine and turn the head toward the breast.

Use pillows to support the newborn.

The postpartum nurse is educating a new mother on ways to prevent contamination of expressed breastmilk. What action should be included in the plan of teaching? Wash nipples with soap and water before pumping. Pump into sterile containers only. Wash hands before touching breasts. Refreeze unused portions of breastmilk within 2 hours.

Wash hands before touching breasts.

While preparing for discharge, the nurse asks the parents about the car seat for the infant. The parents state that they have not yet been able to purchase one, due to financial concerns, and plan to take the infant home without a car seat. What is the best response by the nurse? "We refuse to let you take the infant home like that." "Car seats help to ensure the infant will be safe on the way home." "Let me see if there is an organization that can donate a car seat to you." "The ride home should be okay, but please plan to purchase one soon."

"Let me see if there is an organization that can donate a car seat to you."

A pediatric triage nurse receives a call from a parent of a 3-month old infant. The parent is very frustrated with the colicky symptoms the infant is presenting with and feels out of control. What can the nurse suggest?' "Place the infant in a stroller and go for a walk." "Hold the infant and sway side to side." "Place the baby in the crib and allow yourself 10-15 minutes to calm down." "Place the infant over your knees on their abdomen and pat their back."

"Place the baby in the crib and allow yourself 10-15 minutes to calm down."

A new mother in the postpartum unit calls the nurse to the bedside. The mother states, "I just changed my baby girl's diaper and noticed a small amount of pink discharge in her diaper. Do you think something is wrong with my baby?" Which statement is the nurse's best response to the mother? "I will call the pediatrician with your concern." "Let's go ahead and give the baby some formula in addition to your colostrum." "That is a normal finding as a result of the withdrawal of hormones from pregnancy." "That is nothing to worry about. All babies have pink discharge in the newborn period."

"That is a normal finding as a result of the withdrawal of hormones from pregnancy."

A woman and her partner are discussing plans to breastfeed with the nurse. The partner states, "I know breastfeeding is recommended, but how am I supposed to help?" What is the best response by the nurse? "Many partners feel left out of the breastfeeding process." "You can feed formula while mom is resting." "Are you having second thoughts about the decision to breastfeed?" "You can help mom save energy for breastfeeding by helping with newborn care and household chores."

"You can help mom save energy for breastfeeding by helping with newborn care and household chores."

A nulliparous client expresses a desire to breastfeed. She asks the nurse how she can be successful. How should the nurse respond? "No preparation is required. It's natural and will come easily." "You can start prenatally by attending classes and gathering a support system." "Begin by pumping prenatally and storing your breast milk." "You should seek the advice of friends and family who have breastfed."

"You can start prenatally by attending classes and gathering a support system."

The nurse observes a client breastfeeding a newborn and completes a LATCH assessment of the feeding. The nurse notes the infant needs stimulation to latch, and has some audible swallowing with stimulation and minimal assistance from the nurse for positioning. The client's nipples are everted, and the client denies any pain or discomfort. What score will the nurse document? 7 6 8 9

7

A nurse is teaching a new mother about milk production. The client has questions about the hormones that stimulate milk production. What will the nurse include in the answer? Estrogen increases Oxytocin decreases Progesterone increases Prolactin increases

Prolactin increases

The nurse understands that which is a primary reason that women stop breastfeeding before the eighth week? Engorgement Painful nipples Mastitis Thrush

Painful nipples

The nurse is completing a home visit on a family with a 1-month-old infant. During this visit, the nurse is completing a safety assessment. Which finding by the nurse would require further intervention? The baby sleeps in a crib right next to the parent's bed. The baby was found to be swaddled in a light blanket. The baby was offered a pacifier at naptime. The baby had a strong smell of cigarette smoke.

The baby had a strong smell of cigarette smoke.

A new mother who is breastfeeding is discussing feeding cues with the postpartum nurse. The nurse knows that education has been effective when the mother breastfeeds the baby after the baby displays what behavior? The baby has started to cry. The baby makes sucking motions. The baby stretches the legs out straight. The baby waves the arms in the air after being startled.

The baby makes sucking motions.

A nurse has been working on the mother-baby unit caring for four mother-baby couplets. Throughout the day, all clients have been observed during breastfeeding the infant. Which client would the nurse have been required to intervene? The client places her hand away from the areola and cups the breast. The client places the infant in a cross-cradle hold with a pillow. The client leans forward to guide the nipple to the infant's mouth. The client starts on a different breast with each feeding.

The client leans forward to guide the nipple to the infant's mouth.

A nurse is providing discharge education to a new mother regarding umbilical cord care. Which action by the mother demonstrates effective teaching regarding umbilical cord care? The mother cleans the umbilical cord with an alcohol swab to prevent infection. The mother applies petroleum jelly to the cord to prevent it from sticking to the diaper. The mother places the umbilical cord in the diaper to prevent the cord from rubbing on clothing. The mother cleans the umbilical cord with warm water and places on the outside of the diaper.

The mother cleans the umbilical cord with warm water and places on the outside of the diaper.

The nurse is providing discharge information to parents regarding use of the bulb syringe. The nurse identifies further teaching is needed when the parent demonstrates which behavior? The parent removes drainage from the syringe onto a tissue. The parent cleans the bulb syringe after each use with warm soapy water. The parent uses the bulb syringe in the mouth prior to inserting in the nose. The parent places the bulb syringe straight back in the mouth to elicit a gag reflex.

The parent places the bulb syringe straight back in the mouth to elicit a gag reflex.