Ch 28: The Normal Newborn: Needs and Care

8) A nurse is instructing nursing students about the procedure for vitamin K administration. What information should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Gently massage the site after injection. B) Use a 22-gauge, 1-inch needle. C) Inject in the vastus lateralis muscle. D) Cleanse the site with alcohol prior to injection. E) Inject at a 45-degree angle.

Answer: A, C, D Explanation: A) The nurse would remove the needle and massage the site with an alcohol swab. B) Vitamin K is given IM using a 25-gauge, 5/8-inch needle. C) Vitamin K is given intramuscularly in the vastus lateralis muscle. D) Before injecting, the nurse must thoroughly clean the newborn's skin site for the injection with a small alcohol swab. E) Vitamin K is given IM at a 90-degree angle. Page Ref: 703

7) The nurse assesses the newborn and notes the following behaviors: nasal flaring, facial grimacing, and excessive mucus. What is the nurse most concerned about? A) Neonatal jaundice B) Neonatal hypothermia C) Neonatal hyperthermia D) Respiratory distress

Answer: D Explanation: A) A high bilirubin level would be an indication of jaundice. B) Temperature instability would indicate either hyperthermia or hypothermia. C) A high temperature would indicate hyperthermia. D) Nasal flaring and facial grimacing are signs of respiratory distress. Page Ref: 704

34) The nurse is preparing to provide a newborn with an injection of vitamin K. In which order should the nurse complete the following steps? 1. Cleanse skin with alcohol and allow to dry 2. Aspirate and then inject the medication slowly 3. Insert a 25-gauge 5/8 inch needle at a 90 degree angle 4. Remove the needle and massage with an alcohol swab 5. Bunch skin over mid-anterior lateral aspect of the thigh

Answer: 1, 5, 3, 2, 4 Explanation: Procedure for vitamin K injection. Cleanse area thoroughly with alcohol swab and allow skin to dry. Bunch the tissue of the mid-anterior lateral aspect of the thigh (vastus lateralis muscle) and quickly insert a 25-gauge 5/8-inch needle at a 90-degree angle to the thigh. Aspirate, and then slowly inject the solution to distribute the medication evenly and minimize the baby's discomfort. Remove the needle and massage the site with an alcohol swab. Page Ref: 702

35) The nurse is preparing to instruct the parents of a newborn on the care of the umbilical cord. In which order should the nurse provide these instructions? 1. Check the cord for color 2. Wash hands with soap and water 3. Fold diaper below umbilical cord 4. Clean cord and base of cord with cotton swab 5. Check the cord for odor or oozing of green material

Answer: 2, 4, 1, 5, 3 Explanation: Wash hands with clean water and soap before and after care. Clean cord and skin around base with a cotton swab or cotton ball. Clean 2 to 3 times a day, or with each diaper change. Cord should look dark and dry up before falling off. Check cord each day for any odor, oozing of greenish yellow material, or reddened areas around the cord. Fold diapers below umbilical cord to air-dry the cord. Page Ref: 715

36) The mother of a ne wly circumcised infant is concerned about caring for the infant at home. What should the nurse instruct the mother about the infant's care? Place the following actions in the order that should be instructed to the mother. 1. Pat dry 2. Rinse area with warm water 3. Fasten diaper snuggly over the penis 4. Apply small amount of petroleum jelly 5. Squeeze water over the circumcision site

Answer: 5, 2, 1, 4, 3 Explanation: Squeeze water over circumcision site once a day. Rinse area off with warm water and pat dry. Apply small amount of petroleum jelly. Fasten diaper over penis snugly enough so that it does not move and rub the tender glans. Page Ref: 715

3) The nurse is caring for four newborns who have recently been admitted to the newborn nursery. Which labor event puts the newborn at risk for an alteration of health? A) The infant's mother has group B streptococcal (GBS) disease. B) The infant's mother had an IV of lactated Ringer's solution. C) The infant's mother had a labor that lasted 12 hours. D) The infant's mother had a cesarean birth with her last child.

Answer: A Explanation: A) A common cause of neonatal distress is early-onset group B streptococcal (GBS) disease. Infected mothers transmit GBS infection to their infants during labor and birth. All infants of mothers identified as at risk should be assessed and observed for signs and symptoms of sepsis. B) An IV of lactated Ringer's solution will not affect the newborn's blood sugar. C) A 12-hour labor is normal. D) Having had a cesarean with her last child poses risk factors for the mother during labor, but does not affect this newborn. Page Ref: 704

12) A newborn delivered at term is being discharged. The parents ask the nurse how to keep their baby warm. The nurse knows additional teaching is necessary if a parent states which of the following? A) "A quick cool bath will help wake up my son for feedings." B) "I can check my son's temperature under his arm." C) "My baby should be dressed warmly, with a hat." D) "Cuddling my son will help to keep him warm."

Answer: A Explanation: A) Cool baths will chill a newborn, and should not be given. Bathing under warm water is ideal. B) The axilla is the preferred site for checking a newborn's temperature. C) Adequate clothing is needed to keep an infant warm. A snug cap placed on the infant's head reduces heat loss further. D) Encourage the mother to snuggle with the newborn under blankets to keep him or her warm. Page Ref: 701

6) In planning care for a new family immediately after birth, which procedure would the nurse most likely withhold for 1 hour to allow time for the family to bond with the newborn? A) Eye prophylaxis medication B) Drying the newborn C) Vital signs D) Vitamin K injection

Answer: A Explanation: A) Eye prophylaxis medication instillation may be delayed up to 1 hour after birth to allow eye contact during parent-newborn bonding. B) Drying the newborn after birth is an essential nursing intervention, and should not be withheld. C) Taking vital signs is an essential nursing intervention, and should not be withheld. D) Vitamin K usually is given within 1 hour following birth, but does not interfere with eye contact and bonding between parent and newborn. Page Ref: 704

26) A postpartum client calls the nursery to report that her newborn's umbilical cord stump is draining, and has a foul odor. What is the nurse's best response? A) "Take your newborn to the pediatrician." B) "Cover the cord stump with gauze." C) "Apply Betadine around the cord stump." D) "This is normal during healing."

Answer: A Explanation: A) Parents should check each day for any odor, oozing of greenish yellow material, or reddened areas around the cord. They should report to the healthcare provider any signs of infection. B) Parents should fold diapers below the umbilical cord to air-dry the cord. Contact with wet or soiled diapers slows the drying process and increases the possibility of infection. C) Betadine is not used on the cord stump. D) These symptoms are not normal. Page Ref: 715

22) The nurse is instructing parents of a newborn about voiding and stool characteristics. Which of the following would be considered an abnormal pattern? A) Large amounts of uric acid crystals in the first days of life B) At least 6 to 10 wet diapers a day after the first few days of life C) 1 to 2 stools a day for a formula-fed baby D) Urine that is straw to amber color without foul smell

Answer: A Explanation: A) Small, not large, amounts of uric acid crystals are normal in the first days of life. B) 6 to 10 wet diapers a day after the first few days of life is normal. C) 1 to 2 stools a day for a formula-fed baby is normal. D) Urine that is straw to amber color without foul smell is normal. Page Ref: 715

2) The nurse tells a mother that the doctor is preparing to circumcise her newborn. The mother expresses concern that the infant will be uncomfortable during the procedure. The nurse explains that the physician will numb the area before the procedure. Additional methods of comfort often used during the procedure include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Providing a pacifier B) Stroking the head C) Restraining both arms and legs D) Talking to the infant E) Giving the infant a sedative before the procedure

Answer: A, B, D Explanation: A) Providing a pacifier is an accepted method of soothing during the circumcision. B) Stroking the head is an accepted method of soothing during the circumcision. C) Only the legs are restrained during circumcision. D) Talking to the infant is an accepted method of soothing during the circumcision. E) The infant is never given a sedative. Page Ref: 708

13) The nurse is administering erythromycin (Ilotycin) ointment to a newborn. What factors are associated with administration of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) The medication should be instilled in the lower conjunctival sac of each eye. B) The eyelids should be massaged gently to distribute the ointment. C) The medication must be given immediately after delivery. D) The medication does not cause any discomfort to the infant. E) The medication can interfere with the baby's ability to focus.

Answer: A, B, E Explanation: A) Successful eye prophylaxis requires that the medication be instilled in the lower conjunctival sac of each eye. B) After administration, the nurse massages the eyelid gently to distribute the ointment. C) Instillation may be delayed up to 1 hour after birth to allow eye contact during parent-newborn bonding. D) Eye prophylaxis medication can cause chemical conjunctivitis, which gives the newborn some discomfort and may interfere with the baby's ability to focus on the parents' faces and can result in edema, inflammation, and discharge. E) Eye prophylaxis medication can cause chemical conjunctivitis, which gives the newborn some discomfort and can interfere with the baby's ability to focus on the parents' faces. Page Ref: 703

9) To maintain a healthy temperature in the newborn, which of the following actions should be taken? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Keep the newborn's clothing and bedding dry. B) Reduce the newborn's exposure to drafts. C) Do not use the radiant warmer during procedures. D) Do not wrap the newborn. E) Encourage the mother to snuggle with the newborn under blankets.

Answer: A, B, E Explanation: A) To maintain a healthy temperature in the newborn, keep the newborn's clothing and bedding dry. B) To maintain a healthy temperature in the newborn, reduce the newborn's exposure to drafts. C) To maintain a healthy temperature in the newborn, use the radiant warmer during procedures. D) To maintain a healthy temperature in the newborn, double-wrap the newborn. E) To maintain a healthy temperature in the newborn, encourage the mother to snuggle with the newborn under blankets. Page Ref: 702

4) The nurse initiates newborn admission procedures and evaluates the newborn's need to remain under observation by assessing which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Respiratory rate B) Skin texture C) Airway clearance D) Ability to feed E) Head weight

Answer: A, C, D Explanation: A) The nurse initiates newborn admission procedures and evaluates the newborn's need to remain under observation by assessing vital signs (body temperature, heart rate, respiratory rate). B) The nurse initiates newborn admission procedures and evaluates the newborn's need to remain under observation by assessing skin color, not skin texture. C) The nurse initiates newborn admission procedures and evaluates the newborn's need to remain under observation by assessing airway clearance. D) The nurse initiates newborn admission procedures and evaluates the newborn's need to remain under observation by assessing ability to feed. E) The nurse initiates newborn admission procedures and evaluates the newborn's need to remain under observation by assessing circumference and body weight, not head weight. Page Ref: 699

23) The nurse should inform the parents of a newborn that they should call their healthcare provider when which of the following occurs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Continual rise in temperature B) Decreased frequency of stools C) Absence of breathing longer than 20 seconds D) Lethargy E) Refusal of two feedings in a row

Answer: A, C, D, E Explanation: A) Parents should call their healthcare provider due to a continual rise in temperature. B) Parents should call their healthcare provider when there are two consecutive green watery or black stools or increased frequency of stools. C) Parents should call their healthcare provider in the absence of breathing longer than 20 seconds. D) Parents should call their healthcare provider if the newborn exhibits lethargy and listlessness. E) Parents should call their healthcare provider if the newborn has refused two feedings in a row. Page Ref: 716

11) The nurse assesses a sleeping 1-hour-old, 39-weeks'-gestation newborn. The assessment data that would be of greatest concern would be which of the following? A) Temperature 97.9°F B) Respirations 68 breaths/minute C) Stable vital signs 45 minutes ago D) Heart rate 156 beats/min

Answer: B Explanation: A) 97.9°F is within the normal temperature range of 97.5-99°F. B) The normal respiratory rate is 30-60 breaths/min; 68 breaths/min could represent a less-than-ideal transition. C) The vital signs for a healthy term newborn should be monitored at least every 30 minutes until the newborn's condition has remained stable for 2 hours. D) This heart rate is within the normal range of 110-160 beats/min. Page Ref: 700

21) Placing the baby at mother's breast facilitates early latch and promotes successful breastfeeding. When should breastfeeding be initiated? A) 6 to 12 hours after birth B) Within 1 hour of birth C) 24 hours after birth D) 48 hours after birth

Answer: B Explanation: A) Breastfeeding should be initiated within the first hour of life, not 6 to 12 hours after birth. B) Breastfeeding should be initiated within the first hour of life unless medically contraindicated. C) Breastfeeding should be initiated within the first hour of life, not 24 hours after birth. D) Breastfeeding should be initiated within the first hour of life, not 48 hours after birth. Page Ref: 704

18) To promote infant security in the hospital, the nurse instructs the parents of a newborn to do which of the following? A) Keep the baby in the room at all times. B) Check the identification of all personnel who transport the newborn. C) Place a "No Visitors" sign on the door. D) Keep the baby in the nursery at all times.

Answer: B Explanation: A) Newborns need to return to the nursery at times. B) Parents should be instructed to allow only people with proper birthing unit identification to remove the baby from the room. If parents do not know the staff person, they should call the nurse for assistance. C) A "No Visitors" sign would not ensure safety. D) Newborns will need to return to the nursery at times, but the newborn is not required to be there at all times. Page Ref: 706

5) The nurse has just assisted the father in bathing the newborn 2 hours after birth. The nurse explains that the newborn must remain in the radiant warmer. This is based on which assessment data? A) Heart rate 120 B) Temperature 96.8°F C) Respiratory rate 50 D) Temperature 99.6°F

Answer: B Explanation: A) The heart rate is within normal limits for a newborn 2 hours old. B) The nurse rechecks the temperature after the bath and, if it is stable, dresses the newborn in a shirt, diaper, and cap; wraps the baby; and places the baby in an open crib at room temperature. If the baby's axillary temperature is below 36.5°C (97.7°F), the nurse returns the baby to the radiant warmer. The rewarming process should be gradual to prevent the possibility of hyperthermia. C) The respiratory rate is within normal limits for a newborn 2 hours old. D) This temperature (99.6°F) does not warrant placing the infant back in the radiant warmer. Page Ref: 701

14) The nurse is caring for a newborn who was recently circumcised. Which nursing intervention is appropriate following the procedure? A) Keep the infant NPO for 4 hours following the procedure. B) Observe for urine output. C) Wrap dry gauze tightly around the penis. D) Clean with cool water with each diaper change.

Answer: B Explanation: A) The newborn does not need to be NPO. B) It is important to observe for the first voiding after a circumcision to evaluate for urinary obstruction related to penile injury and/or edema. C) Gauze should not be wrapped tightly around the penis. Only if bleeding occurs should the nurse apply light pressure with a sterile gauze pad to stop the bleeding within a short time. D) The newborn should be cleaned with warm water with each diaper change. Page Ref: 708

15) A postpartum mother is concerned that her newborn has not had a stool since birth. The newborn is 18 hours old. What is the nurse's best response? A) "I will call your pediatrician immediately." B) "Passage of the first stool within 48 hours is normal." C) "Your newborn might not have a stool until the third day." D) "Your newborn must be dehydrated."

Answer: B Explanation: A) This is not an emergency situation. B) The first voiding should occur within 24 hours and first passage of stool within 48 hours. C) The passage of the first stool should occur sooner. D) Decreased urinary output and depressed fontanelles indicate dehydration. Page Ref: 705

16) At birth, an infant weighed 8 pounds 4 ounces. Three days later, the newborn is being discharged. The parents note that the baby now weighs 7 pounds 15 ounces. The nurse explains that the change in the newborn's weight is which of the following? A) Excessive B) Within normal limits C) Less than expected D) Unusual

Answer: B Explanation: A) This is not an excessive weight loss. B) This newborn's weight loss is within normal limits. A weight loss of up to 10% for term newborns is considered within normal limits during the first week of life. C) This is not a less-than-expected amount of weight loss. D) This weight loss is not unusual. Page Ref: 705

10) The nurse has received the shift change report on infants born within the previous 4 hours. Which newborn should the nurse see first? A) 37-week male, respiratory rate 45 B) 8 pound 1 ounce female, pulse 150 C) Term male, nasal flaring D) 4-hour-old female who has not voided

Answer: C Explanation: A) A normal respiratory rate is 30 to 60 breaths/min. This infant has no unexpected findings. B) A normal pulse is 110 to 160 beats/min. This infant has no unexpected findings. C) Nasal flaring is an indication of respiratory distress. The nurse must be immediately available to provide appropriate interventions for a newborn in distress. D) The first voiding should occur within 24 hours and first passage of stool within 48 hours. This is not a life-threatening condition. Page Ref: 704

1) The parents of a newborn male ask the nurse whether they should circumcise their son. What is the best response by the nurse? A) "Circumcision should be undertaken to prevent problems in the future." B) "Circumcision might decrease the child's risk of developing a urinary tract infection." C) "Circumcision can sometimes cause complications. What questions do you have?" D) "Circumcision is painful, and should be avoided unless you are Jewish."

Answer: C Explanation: A) Although this is a common reason parents give for requesting circumcision, it is still an opinion not based in medical fact. B) Although circumcision permits exposure of the glans for easier cleaning, getting more information from the parents about their questions or concerns would be better. C) Asking this question allows the nurse to determine what the parents' concerns are, then address them specifically. D) Although circumcision can be painful, most providers administer a penile nerve root block to prevent or minimize procedural pain. Circumcision is practiced in many religions and traditions. Page Ref: 707

19) The nurse has instructed a new mother on quieting activities for her newborn. The nurse knows that the mother understands when she overhears the mother telling the father to do what? A) Hold the newborn in an upright position. B) Massage the hands and feet. C) Swaddle the newborn in a blanket. D) Make eye contact while talking to the newborn.

Answer: C Explanation: A) Holding the newborn upright is a waking activity. B) Increasing skin contact and gently rubbing hands and feet is a waking activity. C) Swaddling or bundling the baby increases the sense of security and is a quieting activity. D) Talking to the newborn while making eye contact is a waking activity. Page Ref: 710

24) The nurse is instructing a new mother on circumcision care with a Plastibell. The nurse knows the mother understands when she states that the Plastibell should fall off within how long? A) 2 days B) 10 days C) 8 days D) 14 days

Answer: C Explanation: A) The Plastibell does not fall off in 2 days. B) The Plastibell should fall off before 10 days. C) The Plastibell should fall off within 8 days. If it remains on after 8 days, the parents should consult with the newborn's physician. D) The Plastibell should fall off before 14 days. Page Ref: 716

25) New parents decide not to have their newborn circumcised. What should the nurse teach regarding care for the uncircumcised infant? A) The foreskin will be retractable at 2 months. B) Retract the foreskin and clean thoroughly. C) Avoid retracting the foreskin. D) Use soap and Betadine to cleanse the penis daily.

Answer: C Explanation: A) The foreskin is not fully retractable at 2 months. B) The foreskin is not fully retractable in a newborn, and should not be forced back over the penis. C) The foreskin will retract normally over time, and may take 3 to 5 years. D) If retraction has occurred, daily gentle washing of the glans with soap and water is sufficient to maintain adequate cleanliness. Page Ref: 716

17) The nurse teaches the parents of an infant who was recently circumcised to observe for bleeding. What should the parents be taught to do if bleeding does occur? A) Wrap the diaper tightly. B) Clean with warm water with each diaper change. C) Apply gentle pressure to the site with gauze. D) Apply a new petroleum ointment gauze dressing.

Answer: C Explanation: A) When diapering, ensure that the diaper is neither too loose, which can cause rubbing with movement, nor too tight, which can cause pain. B) Cleaning the newborn with warm water with each diaper change is part of the care plan, but it does not prevent bleeding. C) If bleeding does occur, apply light pressure with a sterile gauze pad to stop the bleeding within a short time. If this is not effective, contact the physician immediately or take the newborn to the healthcare provider. D) Continued application of a petroleum ointment can help protect the granulation tissue that forms as the glans heals, but does not stop any bleeding. Page Ref: 709

30) The nurse is working with an adolescent mother who tells the nurse, "I'm really scared that I won't take care of my baby correctly. My mother says I'll probably hurt the baby because I'm too young to be a mother." What is the best response by the nurse? A) "You are very young, and parenting will be a challenge for you." B) "Your mother was probably right. Be very careful with your baby." C) "Mothers have instincts that kick in when they get their babies home." D) "We can give the baby a bath together. I'll help you learn how to do it."

Answer: D Explanation: A) Although this statement is true, it does not teach the client anything, or increase her confidence in being able to care for her infant. B) This statement is very judgmental, and does not teach the client anything, or increase her confidence in being able to care for her infant. C) Maternal instincts might indeed exist, but this client has expressed a specific fear about being a safe mother. It is best to work with her to teach her skills and increase her confidence. D) This response is best because bathing the newborn offers an excellent opportunity for teaching and welcoming parent involvement in the care of their baby. Page Ref: 701

28) The nurse is discussing parent-infant attachment with a prenatal class. Which statement indicates that teaching was successful? A) "I should avoid looking directly into the baby's eyes to prevent frightening the baby." B) "My baby will be very sleepy immediately after birth and should go to the nursery." C) "Newborns cannot focus their eyes, so it doesn't matter how I hold my new baby." D) "Giving my baby his first bath can really give me a chance to get to know him."

Answer: D Explanation: A) Eye-to-eye contact between parents and their newborn is extremely important during the early hours after birth, when the newborn is in the first period of reactivity. B) Newborns are usually alert and responsive in the first few hours after birth. Interacting with the newborn during this first period of reactivity facilitates parent-infant attachment. C) Newborns can have direct eye contact with human faces, with an optimal range for visual acuity of 7 to 8 inches. Eye contact is an important component of the emerging parent-baby bond. D) Another situation that can facilitate attachment is the interactive bath. While bathing their newborn for the first time, parents attend closely to their baby's behavior and the nurse can observe and point out behaviors. Page Ref: 705

20) Before the newborn and mother are discharged from the birthing unit, the nurse teaches the parents about newborn screening tests that includes which of the following? A) Preeclampsia screening B) Congenital kidney disease screening C) Visual screening D) Hearing screening

Answer: D Explanation: A) Preeclampsia is a maternal condition, and not part of the newborn screening tests. B) Congenital heart disease screening, not kidney disease screening, is part of the newborn screening tests. C) Visual screening is not part of newborn screening tests. D) Newborn screening tests include hearing screening tests. Page Ref: 713

27) The nurse is analyzing various strategies for teaching new mothers about newborn care. To enhance learning, which teaching method should the nurse implement? A) Select videos on various topics of newborn care. B) Organize a class that includes first-time mothers only. C) Have mothers return in 1 week, when they feel more rested. D) Schedule time for one-to-one teaching in the mother's room.

Answer: D Explanation: A) Selecting videos on various topics of newborn care would not ensure one-to-one teaching. B) Organizing a class that includes first-time mothers only would not ensure one-to-one teaching. C) It is not appropriate or realistic to expect new mothers to return in 1 week. D) One-to-one teaching while the nurse is in the mother's room is shown to be the most effective educational model. Individual instruction is helpful to answer specific questions. Page Ref: 711

29) The nurse is working with new parents who have recently immigrated to the United States. The nurse is not familiar with the family's cultural background. Which approach is most appropriate when discussing the newborn? A) "You appear to be Muslim. Do you want your son circumcised?" B) "Let me explain newborn care here in the United States." C) "Your baby is a United States citizen. You must be very happy about that." D) "Could you explain your preferences regarding childrearing?"

Answer: D Explanation: A) The nurse should avoid making assumptions about clients based on appearance. B) The nurse should not assume the family doesn't understand the United States healthcare system. C) The nurse should avoid making assumptions regarding family beliefs and values. D) The nurse must be sensitive to the cultural beliefs and values of the family and be aware of cultural variations in newborn care. Page Ref: 710

33) The nurse is discharging a 15-year-old first-time mother. Which statement should the nurse include in the discharge teaching? A) "Call your pediatrician if the baby's temperature is below 98.6°F axillary." B) "Your baby's stools will change to a greenish color when your milk comes in." C) "You can wipe away any eye drainage that might form." D) "Your infant should wet a diaper at least 6 times per day."

Answer: D Explanation: A) The pediatrician should be called if the temperature is lower than 97.8°F axillary. B) Stool color for a breastfed infant is a yellow gold, soft or mushy stools. C) Eye drainage is abnormal, and should be reported to the baby's provider. D) A minimum of 6 to 10 wet diapers per day indicates adequate fluid intake. Page Ref: 716

32) The nurse is instructing the parents of a newborn about car seat safety. Which statement indicates that the parents need additional information? A) "The baby should be in the back seat." B) "Newborns must be in rear-facing car seats." C) "We need instruction on how to use the car seat before installing it." D) "We can bring the baby home from the hospital without a car seat, as it is only a short drive."

Answer: D Explanation: A) The safest spot in any car is the middle of the back seat. The car seat should be positioned to face the rear of the car. B) The safest spot in any car is the middle of the back seat. The car seat should be positioned to face the rear of the car. C) Nurses need to ensure that all parents are knowledgeable about the benefits of child safety seat use and proper installation. Nurses can encourage parents to have their infant safety seats checked by local groups trained specifically for that purpose. D) Newborns must go home from the birthing unit in a car seat adapted to fit newborns. Page Ref: 713

31) The nurse is planning visits to the homes of new parents and their newborns. Which client should the nurse see first? A) 3-day-old male who received hepatitis B vaccine prior to discharge B) 4-day-old female whose parents are both hearing-impaired C) 5-day-old male with light, sticky, yellow drainage on the circumcision site D) 6-day-old female with greenish discharge from the umbilical cord site

Answer: D Explanation: A) This infant has no indications of unexpected findings. Immunization programs against the hepatitis B virus during the newborn period and infancy are in place in many states. B) This infant is not at risk, but the appointment should be scheduled when the sign language interpreter is available. C) This is normal healing and a light, sticky, yellow drainage may form over the head of the penis. D) Oozing greenish yellow material or reddened areas around the cord is not an expected finding. This family should be seen first because the child is experiencing a complication. Page Ref: 715