OB Week 9 and on

Lift her head while she is supine and allow it to fall back 1 in.

A Moro reflex is the single best assessment of neurologic ability in a newborn. Unit protocols should specify what action for eliciting a Moro reflex in Beth?

An assessment of Linda's beliefs and attitudes about breastfeeding

A nursing assessment of Linda Satir's plan for her infant's nutrition should begin with which of the following?

"I'll use this adorable little hat I was given to help him stay warm."

A review of the literature was completed to examine interventions that prevent hypothermia in the premature newborn in the delivery room and that maintain core body temperature. In addition to the use of the standard thermoregulation interventions such as knit hats, the literature showed using respiratory gases during ventilation, the use of gel thermal mattresses, and the use of polyethylene wraps or bags (Fawcett, 2014). Based on the previous study, which response by Mrs. Atkins, whose infant was born prematurely, would alert the nurse she may need further teaching?

Assess her uterus for height and tone.

All postpartum women are at risk for uterine hemorrhage. What assessment data should the nurse first collect when appraising Ms. Cheshire's risk for hemorrhage?

Arranging a blanket Mrs. Atkins has knit into a circle or "nest" for the baby

Baby Atkin's father plays in a garage band for a hobby, and his mother enjoys knitting. The nurse's care team has agreed to design a developmental care environment for Baby Atkins that will both make him feel secure and help his parents interact more with him. The care team determines which action is best?

"Surfactant keeps his tiny lung sacs open and this improves his breathing."

Baby Atkins has surfactant administered at birth. When Mrs. Atkins asks why her baby had to receive surfactant, the nurse determines which response is best?

Gently flick the sole of his foot to stimulate the baby to breathe again.

Baby Atkins is at risk for having apnea and bradycardia. What initial nursing intervention should the nurse initiate during these events to maintain his vital signs in a safe range?

Walking around her room listening to music

Bailey Cheshire develops endometritis. When planning nursing care, which activity would be best to advise for Bailey?

Heart rate, respiratory effort, muscle tone, reflex irritability, and color

Beth Ruiz had Apgar scores of 6 at 1 minute and 8 at 5 minutes after birth. Which of the following are the five areas assessed with Apgar scoring?

"These will disappear on their own, so you don't need to take any action."

Beth Ruiz has milia on her nose. What teaching point would constitute a quality and safety risk?

The nurse place her on a scale that has not been prewarmed.

Beth Ruiz, like all newborns, is in danger of losing body heat by conduction. The nurse is taking action to ensure that Beth's body temperature is maintained to protect her health and comfort. Under which condition is heat loss by conduction most likely to occur?

Help her to give her new baby a bath.

Leana Cooper has expressed that she is excited to "get to know" her new baby. The nurse determines which of the following actions will support Leana's transition into a postpartal taking-hold phase?

It will provide immunity as well as nutrients for her newborn.

Linda asks the nurse why breastfeeding is so beneficial for her newborn. The nurse would want her to know breast milk has which of the following characteristics?

After the baby drinks from a bottle, he should discard any milk still in the bottle.

Linda's husband, Paul, plans to offer their baby bottled breast milk once daily when Linda returns to work. Educational literature available on the unit should include which guideline?

"I know that the baby will sleep just fine because I've read everything I can about the subject."

Many new mothers are not prepared for how much time newborns spend crying (as many as 16 of 24 hours); trying to quiet a newborn can lead to extreme fatigue in a postpartal parent. To investigate the effect of newborn crying on new mothers' ability to rest, researchers conducted a systematic review of studies concerned with newborn crying. Results of the literature review revealed that infant crying during the first 3 months postpartum is responsible for disrupting new mothers' circadian rhythms, reducing opportunities to rest, and exacerbating tiredness. Incremental exhaustion from infant crying diminishes a parent's ability to concentrate, raises the fear of harming the children, triggers depressive symptoms, and burdens parent-child interaction (Nugent, 2013). The Neonatal Behavioral Assessment Scale (NBAS) focuses on the dynamic relationship of a newborn with its parents, rather than a passive state, and that newborns are extremely sensitive to their new surroundings and parents (Nugent, 2013). The NBAS uniquely identifies and assess a newborn's 18 reflex behavioral and social competencies and helps to provide a window into the infant's temperament to aid the parents in their parenting techniques. Based on current research, which comment by Leana would make the nurse worry that she may have a difficult time getting enough sleep after she returns home and understanding her newborn's behavior?

Their stomach is larger than usual due to overgrowth.

Mrs. Atkins asks the nurse why the baby in the incubator next to her baby whose mother has diabetes mellitus was fed so soon after birth. Why is it important for infants of women with diabetes to be fed early?

Days 6 to 10

Mrs. Ruiz is preparing to take her new daughter home and has asked an unlicensed care provider when Beth's dried umbilical cord will fall off. The nurse should confirm that the care provider has stated what time?

"I don't like talking to the baby yet. She can't talk back yet."

Postpartal depression affects not only the postpartum woman but also her entire family because partners can become depressed during this time as well. To assess developmental impacts on children, researchers assessed 192 fathers, 54 who met criteria for depression, and their interactions with their infants in a play session. Fathers with depression were more likely to be withdrawn in their behavior with their infants, providing less stimulation for their babies (Sethna, Murray, Netsi, et al., 2015). Based on the given study, which statement by Bailey's boyfriend would concern the nurse he might be as depressed as she seems to be?

Human chorionic gonadotropin hormone

Suppose Bailey Cheshire has a retained placental fragment that is causing extensive postpartal bleeding. Which test prescribed by her primary care provider would best reveal a retained fragment is present?

"I enjoyed going for prenatal visits."

The AAP (Hagan, Shaw, & Duncan, 2017) recommends infants be exclusively breastfed for 6 months. To discover the characteristics of women who were exclusively breastfeeding at the time of hospital discharge, researchers studied all term hospital births in the province of Ontario, Canada, for a year. From this pool of over 90,000 infants, 56,865 were identified as still being exclusively breastfed at discharge. Characteristics of women who were exclusively breastfeeding were older age, nonsmoking, higher income, and no pregnancy complications or reproductive assistance. They also had a single rather than twin infants and had attended prenatal classes. Patients of obstetricians were less likely to exclusively breastfeed than those cared for by midwives or family physicians. Women who had a planned cesarean birth were more apt to breastfeed than those who had an unplanned cesarean birth. Based on the previous findings, which statement by Linda would be the best indicator that she will be successful at exclusive breastfeeding?

"While breastfeeding, I need to drink at least 12 glasses of fluid a day."

The discharge coordinator is discussing some of the statements made by Linda. Which of the following would indicate she needs further teaching about breastfeeding from the nurse?

No longer palpable over the symphysis pubis

The nurse cares for Leana Cooper at a 6-week postpartum visit. The nurse reads in Leana's electronic health record that her fundal height has been progressing in a healthy and predicted manner. What should her fundal height be during this current visit?

Urging all mothers to breastfeed early to promote infants' bowel motility

The nurse is concerned that Baby Atkins will develop hyperbilirubinemia because of his immaturity. Because the prevention of jaundice is one of the NICU's quality indicators, what priority nursing intervention would the nurse initiate to best prevent hyperbilirubinemia in Baby Atkins?

"I'm happy not to have any children."

The nurse is making an effort to address Bailey Cheshire's psychosocial health in addition to her physiologic well-being. Which of Bailey's statements would be most suggestive of possible postpartal psychosis?

Leana's uterus does not become firm when massaged.

The nurse is performing massage of Leana's fundus 2 days postpartum. What assessment finding should prompt the nurse to contact Leana's primary care provider immediately?

She looks directly at her infant's face and talks to him.

The nurse observes Leana Cooper holding her newborn. Which position would best reassure the nurse that interventions aimed at promoting bonding have been successful?

"I know about lochia; I'll use tampons just like I do for my periods."

The nurse wants to prepare Leana to assess her own health after discharge. Which statement by her would make the nurse worry that she needs added information?

a. Breastfeeding exclusively for 6 months can reduce the risk of obesity later in life. b. Maternal benefits of breastfeeding include a decreased risk of breast and ovarian cancer. D. Once breastfeeding is established, pacifier use may help to decrease the risk of sudden infant death syndrome.

When teaching Linda about newborn feeding, the nurse would include which statement(s) to reflect safety and evidence-based practice? Select all that apply.

Ambulate early and consistently to improve circulation.

Ms. Cheshire has a risk for DVT during the postpartal period. What would be the best suggestion the nurse could make to help prevent this?

Discuss the fact that breastfeeding is a new skill, so infants take time to learn this.

Shaken baby syndrome, or abusive head trauma caused by a parent or caregiver shaking an infant in anger or frustration, creates a potentially lethal situation because forceful shaking can lead to subdural bleeding. To investigate whether a nurse-initiated program could reduce the incidence of abusive head trauma by shaking, nurse researchers offered an educational program including a leaflet explaining abusive head trauma, helpful ways to cope safely with an infant's crying, and an 8-minute video on the subject given to all new mothers at their hospital. Results of the study showed a decrease from 2.8 injuries per year (14 cases in 5 years prior to the intervention) to 0.7 injuries per year (2 cases in 3 years) or a 75% reduction in injuries following the intervention (Altman, Canter, Patrick, et al., 2011). The nurse notices Mrs. Ruiz grows irritated with Beth when Beth doesn't suck readily when she begins to breastfeed. Based on the previous study, what is the best action for the nurse to take?