Postpartum,

The nurse is concerned that a bottle-fed baby may become obese because of which activity by the mother? 1. She encourages the baby to finish the bottle at each feed. 2. She feeds the baby every 3 to 4 hours. 3. She feeds the baby a soy-based formula. 4. She burps the baby every 1 /2 to 1 ounce

1

The nurse is assessing a newborn on admission to the newborn nursery. Which of the following findings should the nurse report to the neonatologist? 1. Intracostal retractions. 2. Caput succedaneum. 3. Epstein's pearls. 4. Harlequin sign.

1 1. Intracostal retractions are a sign of respiratory distress. 2. Caput succedaneum is a normal finding in a neonate. 3. Epstein's pearls are often seen in the mouths of neonates. 4. Harlequin sign, although odd-appearing, is a normal finding in a neonate.

A 2-day-old baby's blood values are: Blood type, O- (negative). Direct Coombs, negative. Hematocrit, 50%. Bilirubin, 1.5 mg/dL. The mother's blood type is A+. What should the nurse do at this time? 1. Do nothing because the results are within normal limits. 2. Assess the baby for opisthotonic posturing. 3. Administer RhoGAM to the mother per doctor's order. 4. Call the doctor for an order to place the baby under bili-lights

1 1. These findings are all within normal limits. 2. There is no indication that this child has developed any signs of kernicterus, which is associated with opisthotonic posturing. 3. The mother is Rh-positive. Only mothers who are Rh-negative and who deliver babies who are Rh-positive receive RhoGAM. 4. The bilirubin level is very low. There is no indication that phototherapy is needed.

A nurse is providing anticipatory guidance to a couple regarding the baby's immunization schedule. Which of the following statements by the parents shows that the teaching by the nurse was successful? Select all that apply. 1. The first hepatitis B injection is given by 1 month of age. 2. The first polio injection will be given at 2 months of age. 3. The MMR (measles, mumps, and rubella) immunization should be administered before the first birthday. 4. Three DTaP (diphtheria, tetanus, and acellular pertussis) shots will be given during the first year of life. 5. The Varivax (varicella) immunization will be administered after the baby turns one year of age.

1, 2, 4, and 5 are correct.

A 4-day-old breastfeeding neonate whose birth weight was 2,678 grams has lost 100 grams since the cesarean birth. Which of the following actions should the nurse take? 1. Nothing because this is an acceptable weight loss. 2. Advise the mother to supplement feedings with formula. 3. Notify the neonatologist of the excessive weight loss. 4. Give the baby dextrose water between breast feedings

1. This baby has lost only 3.7% of his or her birth weight—100/2,678 × 100% = 3.7%. This is below the accepted weight loss of 5% to 10%.

A nurse must give vitamin K 0.5 mg IM to a newly born baby. Which of the following needles could the nurse safely choose for the injection? 1. 5⁄ 8 inch, 18 gauge. 2. 5⁄ 8 inch, 25 gauge. 3. 1 inch, 18 gauge. 4. 1 inch, 25 gauge

2 1. An 18-gauge needle is too thick to be used. 2. A 5⁄8-inch, 25-gauge needle is an appropriate needle for a neonatal IM injection. 3. A 1-inch needle is too long and the gauge is too thick. 4. Although the gauge is appropriate, a 1-inch needle is too long

Four babies have just been admitted into the neonatal nursery. Which of the babies should the nurse assess first? 1. Baby with respirations 42, oxygen saturation 96%. 2. Baby with Apgar 9/9, weight 4,660 grams. 3. Baby with temperature 98.0°F, length 21 inches. 4. Baby with glucose 55 mg/dL, heart rate 121.

2 1. Respiratory rate between 30 and 60 and oxygen saturation above 95% are normal findings. 2. Although the Apgar score—9—is excellent, the baby's weight—4,660 grams— is well above the average of 2,500 to 4,000 grams. Babies who are large for gestational age are at high risk for hypoglycemia. 3. Temperature 97.7° to 99°F and length 18 to 22 inches are normal findings. 4. Blood glucose 40 to 60 mg/dL and heart rate 120 to 160 bpm are normal findings.

A mother and her 2-day-old baby are preparing for discharge. Which of the following situations would require the baby's discharge to be cancelled? 1. The parents own a car seat that only faces the rear of the car. 2. The baby's bilirubin is 19 mg/dL. 3. The baby's blood glucose is 59 mg/dL. 4. There is a large bluish spot on the left buttock of the baby

2 1. The neonate should be placed in a rear facing car seat. 2. A bilirubin of 19 mg/dL is above the expected level. Therapeutic intervention is needed. 3. A blood glucose level of 59 mg/dL is within normal levels for a neonate. 4. Mongolian spots are normal variations seen on the neonatal skin.

A baby has just been admitted into the neonatal nursery. Before taking the newborn's vital signs, the nurse should warm his or her hands and the stethoscope to prevent heat loss resulting from which of the following? 1. Evaporation. 2. Conduction. 3. Radiation. 4. Convection

2 Heat loss resulting from conduction occurs when the baby comes in contact with cold objects (hands or stethoscope).

On admission to the maternity unit, it is learned that a mother has smoked 2 packs of cigarettes per day and expects to continue to smoke after discharge. The mother also states that she expects to breastfeed her baby. The nurse's response should be based on which of the following? 1. Breastfeeding is contraindicated if the mother smokes cigarettes. 2. Breastfeeding is protective for the baby and should be encouraged. 3. A 2-pack-a-day smoker should be reported to child protective services for child abuse. 4. A mother who admits to smoking cigarettes may also be abusing illicit substances

2 This is true. Breastfeeding is protective of the baby and should be encouraged.

A mother is attempting to latch her newborn baby to the breast. Which of the following actions are important for the mother to perform to achieve effective breastfeeding? Select all that apply. 1. Place the baby on his or her back in the mother's lap. 2. Wait until the baby opens his or her mouth wide. 3. Hold the baby at the level of the mother's breasts. 4. Point the baby's nose to the mother's nipple. 5. Wait until the baby's tongue is pointed toward the roof of his or her mouth

2, 3, and 4 are correct. 1. The baby should be placed "tummy to tummy" with the mother. Babies cannot swallow when their heads are turned. They must face the breast for effective feeding. 2. To achieve an effective latch of both the nipple and the areolar tissue, the baby must have a wide-open mouth. 3. Because the neonate's mouth muscles are relatively weak, it is important for the baby to be placed at the level of the breast. If the baby is placed lower, he or she is likely to "slip to the tip" of the nipple and cause nipple abrasions. 4. Babies latch best when they are positioned at the breast, in preparation to opening their mouths, with their noses pointed toward their mothers' nipples

A woman who is 3 hours postpartum has had difficulty urinating. She finally urinates 100 mL. The initial nursing action is to: a. insert an indwelling catheter. b. have her drink additional fluids. c. assess the height of her fundus. d. chart the urination amount.

C

A neonate has an elevated bilirubin and is slightly jaundiced on day 3 of life. What is the probable reason for these changes? 1. Hemolysis of neonatal red blood cells by the maternal antibodies. 2. Physiological destruction of fetal red blood cells during the extrauterine period. 3. Pathological liver function resulting from hypoxemia during the birthing process. 4. Delayed meconium excretion resulting in the production of direct bilirubin.

2. 1.This is a description of pathological jaundice resulting from maternal-fetal blood incompatibilities. 2. With lung oxygenation, the neonate no longer needs large numbers of red blood cells. As a result, excess red blood cells are destroyed. Jaundice often results on days 2 to 4. 3. There is nothing in the scenario to suggest that this was a traumatic delivery. 4. There is nothing in the scenario to suggest that meconium excretion was delayed.

The pediatrician writes the following order for a term newborn: Vitamin K 1 mg IM. Which of the following responses provides a rationale for this order? 1. During the neonatal period, babies absorb fat-soluble vitamins poorly. 2. Breast milk and formula contain insufficient quantities of vitamin K. 3. The neonatal gut is sterile. 4. Vitamin K prevents hemolytic jaundice

3

A 2-day-old, exclusively breastfed baby is to be discharged home. Under what conditions should the nurse teach the parents to call the pediatrician? 1. If the baby feeds 8 to 12 times each day. 2. If the baby urinates 6 to 10 times each day. 3. If the baby has stools that are watery and bright yellow. 4. If the baby has eyes and skin that are tinged yellow

4

To check for the presence of Epstein's pearls, the nurse should assess which part of the neonate's body? 1. Feet. 2. Hands. 3. Back. 4. Mouth

4

A mucousy baby is being left with the parents for the first time after delivery. Which of the following should the nurse teach the parents regarding use of the bulb syringe? 1. Suction the nostrils before suctioning the mouth. 2. Make sure to suction the back of the throat. 3. Insert the syringe before compressing the bulb. 4. Dispose of the drainage in a tissue or a cloth

4 1. The mouth should be suctioned before the nose. 2. If the back of the throat is suctioned, it will stimulate the gag reflex. 3. The bulb should be compressed before it is inserted into the baby's mouth. 4. The drainage should be evaluated by the nurse. The drainage, therefore, should be disposed of in a tissue or cloth.

The mother notes that her baby has a "bulge" on the back of one side of the head. She calls the nurse into the room to ask what the bulge is. The nurse notes that the bulge covers the right parietal bone but does not cross the suture lines. The nurse explains to the mother that the bulge results from which of the following? 1. Molding of the baby's skull so that the baby could fit through her pelvis. 2. Swelling of the tissues of the baby's head from the pressure of her pushing. 3. The position that the baby took in her pelvis during the last trimester of her pregnancy. 4. Small blood vessels that broke under the baby's scalp during birth.

4. Cephalhematomas are subcutaneous swellings of accumulated blood from the trauma of delivery. The bulges may be one-sided or bilateral and the swellings do not cross suture lines. *REMEMBER, CAPUTS ARE AT THE SUTURE LINE*

A breastfeeding woman develops mastitis. She tells the nurse that she will just feed her baby formula instead of breastfeeding. The best nursing response is that: a. emptying the breast is important to prevent an abscess. b. a tight breast binder or bra will help reduce engorgement. c. she should continue to drink extra fluids while weaning. d. breastfeeding can continue when her temperature is normal.

A

A woman who is 4 hours postpartum ambulates to the bathroom and suddenly has a large gush of lochia rubra. The nurse's first action should be to: a. determine whether the bleeding slows to normal or remains heavy. b. observe the vital signs for signs of hypovolemic shock. c. check to see what her previous lochia flow has been. d. identify the type of pain relief that was given when she was in labor.

A

Becoming cold can lead to respiratory distress, primarily because the infant: a. needs more oxygen than he or she can supply to generate heat. b. breathes more slowly and shallowly when hypothermic. c. reopens fetal shunts when the body temperature reaches 36.1°C (97°F). d. cannot supply enough glucose to provide fuel for respiration

A

Choose the nursing assessment that most clearly suggests hypovolemia. a. A urine output of 20 to 25 mL/hr b. Fetal heart rate of 155 to 165 bpm c. Blood pressure of 108/84 mm Hg d. Maternal heart rate of 90 to 100 bpm

A

Choose the nursing observation that is most important if the nurse notes a two-vessel umbilical cord. a. Urine output b. Onset of jaundice c. Respiratory rate d. Heart rhythm

A

The woman has an 8-pound 9-ounce baby after an 18-hour labor that required a low-forceps delivery. Her membranes were ruptured for 15 hours. Based on these facts, patient teaching should emphasize: a. reporting foul-smelling lochia. b. delaying intercourse for at least 6 weeks. c. eating a diet that is high in iron. d. losing weight over at least a 6-month period.

A

Choose the best independent nursing action to aid episiotomy healing in a woman who is 24 hours postpartum. a. Antibiotic cream application to the area b. Warm sitz baths taken four times per day c. Maintaining cold packs to the area at all times d. Checking the leukocyte level

B

The nurse can help prevent many cases of jaundice in the breastfed infant by: a. encouraging extra water intake between each nursing session. b. teaching the mother how to encourage regular and adequate breastfeeding. c. placing the infants under phototherapy prophylactically. d. advising mothers of suitable formulas to use if jaundice occurs.

B

When performing an admission assessment on a term newborn, the nurse notes that the lung sounds are slightly moist. The skin color is pink except for acrocyanosis. Pulse is 156 beats/min (bpm), and respirations are 55 breaths/min and unlabored. The appropriate nursing action is to: a. notify the pediatrician regarding the abnormal lung sounds. b. continue to observe the infant's respiratory status. c. recheck the high respiratory and pulse rates in 30 minutes. d. keep the infant in the newborn nursery until stable

B

The infant of a diabetic mother is prone to hypoglycemia because: a. liver conversion of glycogen to glucose is sluggish. b. excess subcutaneous fat reduces blood flow to the tissues. c. high insulin production rapidly metabolizes glucose. d. vulnerability to infections increases metabolic stress.

C

A 9-pound 11-ounce infant was vaginally born. The labor nurse reports that there was shoulder dystocia at birth but that Apgar scores were 8 at 1 minute and 9 at 5 minutes. The nurse should do a focused assessment for: a. hip dysplasia. b. head molding. c. clavicle fracture. d. abnormal cord vessels.

C

To help the postpartum woman avoid constipation, the nurse should teach her to: a. avoid the intake of foods such as milk, cheese, or yogurt. b. take a laxative for the first 3 postpartum days. c. drink at least 2500 mL of non-caffeinated fluids daily. d. limit her walking until the episiotomy is fully healed

C

A newborn has a hemoglobin level of 24 and a hematocrit value of 71%. The nurse should anticipate: a. temperature instability. b. high calcium levels. c. delayed breastfeeding. d. greater than normal jaundice.

D

Choose the sign or symptom that a new mother should be taught to report. a. Occasional uterine cramping when the infant nurses b. Oral temperature that is 37.2°C (99°F) in the morning c. Descent of the fundus one fingerbreadth each day d. Reappearance of red lochia after it changes to serous

D

The best location for an infant's glucose determination is the: a. great toe of either foot. b. nondominant heel. c. midline of the heel. d. lateral surface of the heel.

D

The best position for the woman who has postpartum endometritis is: a. left lateral. b. Trendelenburg. c. supine. d. Fowler's

D

The foramen ovale closes because the: a. arterial pressure in the lungs is higher than that in the body. b. the presence of slight hypoxia and acidosis causes constriction. c. blood flow through it is redirected through the liver. d. pressure in the left atrium is higher than that in the right atrium.

D

The nurse notes that the infant's feet are turned inward. The appropriate nursing action is to: a. apply a splint to the feet and lower legs. b. notify the pediatrician or nurse practitioner. c. explain to the parents that this is typical for intrauterine position. d. determine whether the feet can be moved to a normal, straight position.

D

The primary difference between physiologic and pathologic jaundice is the: a. number of fetal erythrocytes that are broken down. b. type of feeding method chosen by the mother. c. location of the yellow areas on the newborn's skin. d. time of onset and rate of increase in bilirubin levels.

D

To prevent breast engorgement, the nurse should teach the non-breastfeeding postpartum woman to: a. maintain loose-fitting clothing over her breasts. b. pump the breasts briefly if they become painful. c. limit fluid intake to suppress milk production. 231 d. constantly wear a well-fitting bra or breast binder

D

What drug should be readily available when the woman is receiving heparin therapy? a. Vitamin K b. Methylergonovine c. Ferrous sulfate d. Protamine sulfate

D

Where is a heel stick done?

Theon one of the lateral aspects of the heel, the safe sites

MATH A newborn was born weighing 3,278 grams. On day 2 of life, the baby weighed 3,042 grams. What percentage of weight loss did the baby experience? Calculate to the nearest hundredth. _______

To determine how many grams the baby has lost, the test taker must subtract the new weight from the birth weight: 3278-3042 =236 grams of weight loss Then, to determine the percentage of weight loss, the test taker must divide the difference by the original weight and multiply by 100%: 236/3278 = 0.0719 0.0719 × 100 = 7.19%