Chapter 16: Discharge Planning and Teaching

14. The nurse is advising parents of a full-term neonate being discharged from the hospital regarding car seat safety. Which of the following should be included in the teaching plan? a. Put the car seat facing forward only after the baby reaches 20 pounds. b. The infant car seat should be placed facing the rear seat in the front seat of the car. c. A fist should fit between the straps of the seat and the baby's body. d. Seat belt adjusters should always be used to support infant car seats.

ANS: a a. It is unsafe for infants to be facing forward until they have reached 20 pounds, even if they are over 1 year of age. b. The baby should be facing the rear of the back seat and not the front seat. c. The straps of the car seat should fit snugly, allowing only two fingers to be inserted between them and the baby. d. Seat belt adjusters that are being sold as adding to a car seat have not been shown to be safe.

7. A mother of a 10-day-old infant calls the clinic and reports that her baby is having loose, green stools. The mother is breastfeeding her infant. Which of the following is the best nursing action? a. Instruct the woman to bring her infant to the clinic. b. Instruct the woman to decrease the amount of feeding for 24 hours and to call if the stools continue to be loose. c. Explain that this is a normal stool pattern. d. Instruct the woman to eat a bland diet for the next 24 hours and call back if the stools continue to be loose and green.

ANS: a a. The loose, green stools indicate that the baby is having diarrhea. The infant needs to be evaluated by the primary health provider, because prolonged diarrhea can lead to dehydration and electrolyte imbalance. b. The baby is having diarrhea. Decreasing the amount of feeding can further dehydrate the baby. c. This is not a normal stool pattern; the baby is having diarrhea. d. This neonate needs to be evaluated first, before determining a treatment plan.

13. The nurse is teaching the parents of a female baby how to change a baby's diapers. Which of the following should be included in the teaching? a. Always wipe the perineum from front to back. b. Remove any vernix caseosa from the labia folds. c. Put powder on the buttocks every time the baby stools. d. Weigh every diaper in order to assess for hydration.

ANS: a a. To decrease risk of infection from bacteria from the rectum, the perineum of female babies should always be cleansed from front to back. b. Vernix is a natural lanolin that will be absorbed over time. Actively removing the vernix can irritate the baby's skin. c. Powder is not recommended for use on babies. When mixed with urine, powders can produce an irritating paste. d. The number of wet diapers per day should be counted to assess hydration, but weighing diapers of full-term, healthy neonates is not necessary.

4. Painful nipples are a major reason why women stop breastfeeding. A primary intervention to decrease nipple irritation is: a. Teaching proper techniques for latching-on and releasing of suction b. Applying hot compresses to breast prior to feeding c. Instructing woman to express colostrum or milk at the end of the feeding session and rub it on her nipples d. Air drying nipples for 10 minutes at the end of the feeding session

ANS: a Feedback a. Correct. All of the answers are correct, but problems with latching-on are a primary cause of nipple irritation. b. All of the answers are correct, but problems with latching-on are a primary cause of nipple irritation. c. All of the answers are correct, but problems with latching-on are a primary cause of nipple irritation. d. All of the answers are correct, but problems with latching-on are a primary cause of nipple irritation.

10. A neonatal nurse caring for newborns knows that the best time for a mother to first attempt breastfeeding is during which one of the following stages of activity? a. First period of reactivity b. First period of inactivity and sleep c. Second period of reactivity d. Second period of inactivity and sleep

ANS: a The best stage for initiating breastfeeding is the first period of active, alert wakefulness that the infant displays immediately after birth, which may last from 30 minutes to 2 hours.

19. The clinic nurse teaches expectant mothers about the differences between breast milk and commercially prepared infant formulas. When compared to commercially prepared formulas, breast milk has (select all that apply): a. More carbohydrates b. Less protein c. Fewer nutrients d. Less cholesterol

ANS: a, b Human breast milk contains more carbohydrates, less protein, and more cholesterol than cow's milk or infant formulas. Commercially prepared infant formulas use vegetable oils which are void of cholesterol

21. The perinatal nurse describes infant feeding cues to a new mother. These feeding cues include (select all that apply): a. Vocalizations b. Mouth movements c. Moving the hand to the mouth d. Yawning

ANS: a, b, c The infant demonstrates readiness for feeding when he or she begins to stir, bobs the head against the mattress or mother's neck or shoulder, makes hand-to-mouth or hand-to-hand movements, exhibits sucking or licking, exhibits rooting, and demonstrates increased activity with the arms and legs flexed and the hands in a fist.

23. General skin care for full-term infants includes which of the following? (Select all that apply.) a. Avoid daily bathing with soap. b. Use a cleanser with an alkaline pH. c. Avoid fragrant soaps. d. Apply petrolatum-based ointments sparingly to dry skin, but avoid head and face.

ANS: a, c, d It is not necessary to bathe an infant daily. Daily bathing with soap can cause dry skin in the infant. The cleanser should be of neutral pH and free of additives such as fragrances that could be irritants.

8. The perinatal nurse is teaching her new mother about breastfeeding and explains that the most appropriate time to breastfeed is: a. 3 to 4 hours after the last feeding b. When her infant is in a quiet alert state c. When her infant is in an active alert state d. When her infant exhibits hunger-related crying

ANS: b The optimal time to breastfeed is when the baby is in a quiet alert state. Crying is usually a late sign of hunger, and achieving satisfactory latch-on at this time is difficult. Latch-on is proper attachment of the infant to the breast for feeding. The neonate is most alert during the first 1 to 2 hours after an unmedicated birth, and this is the ideal time to put the infant to the breast.

5. The nurse is developing a discharge teaching plan for a 21-year-old first-time mom. This was an unplanned pregnancy. She had a prolonged labor and an early postpartum hemorrhage. The woman plans to breastfeed her baby. She plans to return to work when her baby is 3 months old. Based on this information, the three primary learning needs of this woman are: a. Breastfeeding, bathing of the newborn, and infant safety b. Breastfeeding, storage of milk, and nutrition c. Breastfeeding, contraception, infant safety d. Breastfeeding, storage of milk, and rest

ANS: b a. These are important learning needs but do not reflect an understanding of learning needs based on early postpartum hemorrhage and returning to work in 3 months. b. Because this is the woman's first time breastfeeding and she plans to return to work, it is important that she feels comfortable with her understanding of breastfeeding and knows how to store her milk when she returns to work. Because she had a postpartum hemorrhage, she needs to learn what foods are high in iron. c. These are important learning needs but do not reflect an understanding of learning needs based on early postpartum hemorrhage and returning to work in 3 months. d. These are important learning needs but do not reflect an understanding of learning needs based on early postpartum hemorrhage.

24. A nurse is going to teach her postpartum patient about newborn bathing, diapering, and swaddling. Which of the following indicates that the nurse incorporated teaching/learning principles in her teaching plans? (Select all that apply.) a. Asked family members to leave b. Turned off TV c. Closed the door of the room d. Administered analgesics a few hours before teaching session

ANS: b, c, d a. It is often helpful to have family members present, with the woman's permission, so they can also learn about caring for the newborn. b. Turning off the TV decreases the amount of distractions and allows the woman to focus on learning about infant care. c. Closing the door decreases the amount of distractions and allows the woman to focus on learning about infant care. d. Administering analgesia prior to the teaching session will enhance the woman's comfort and facilitate her ability to focus on the teaching session.

17. The let-down reflex occurs in response to the release of oxytocin. Which of the following can stimulate the release of oxytocin? (Select all that apply.) a. Prolactin release b. Infant suckling c. Infant crying d. Sexual activity

ANS: b, c, d a. Prolactin stimulates milk production but does not have a direct effect on the release of oxytocin. b. Infant suckling can cause the release of oxytocin. c. Hearing an infant cry can cause the release of oxytocin. d. An orgasm triggers the release of oxytocin.

20. The perinatal nurse is teaching the new mother who has chosen to formula feed her infant. Appropriate instructions to be given to this mother include (select all that apply): a. Mix the formula with hot water only. b. Periodically check the nipple for slow flow. c. Prepare only enough formula to last for 24 hours. d. Discard any unused formula that remains in a bottle following use.

ANS: b, c, d Parents should be advised to read and follow the manufacturer's instructions explicitly when preparing the formula, because some require no water and some need to be diluted with water. Cold water should be used to mix the powder, only the amount to be used for each feeding should be prepared, and any unused formula should be discarded. The nipples should be checked periodically during feedings for correct flow and should be replaced regularly

22. Typical signs of abusive head trauma (Shaken Baby Syndrome) include which of the following? (Select all that apply.) a. Broken clavicle b. Poor feeding c. Vomiting d. Breathing problems

ANS: b, c, d Symptoms of abusive head trauma are extreme irritability, breathing problems, convulsions, vomiting, and pale or bluish skin.

2. A postpartum woman, who gave birth 12 hours ago, is breastfeeding her baby. She tells her nurse that she is concerned that her baby is not getting enough food since her milk has not come in. The best response for this patient is: a. "I understand your concern, but your baby will be okay until your milk comes in." b. "Your baby seems content, so you should not worry about him getting enough to eat." c. "Milk normally comes in around the third day. Prior to that, he is getting colostrum which is high in protein and immunoglobulins which are important for your baby's health." d. "You can bottle feed until your milk comes in."

ANS: c a. Incorrect because it does not inform the woman of what to expect with the stages of milk. b. This conveys a message that the woman's concern is not important. c. This response provides information on the stages of milk production to help the woman understand her newborn's nutritional needs. d. Incorrect response. It is important to avoid bottles until breastfeeding has been well established.

16. Which of the following statements indicates that a new mother needs additional teaching? a. "I need to supervise my cat when she is in the same room as my baby." b. "I will place my baby on her back when she is sleeping." c. "I will not leave my baby on an elevated flat surface after she is able to turn over on her own." d. "I have asked my husband to install safety latches on the lower cabinets."

ANS: c a. Pets should always be supervised when in the same room as the infant, because they can intentionally and unintentionally harm the infant. b. True statement. c. Newborns/infants should never be left on an elevated flat surface because they may roll or wiggle and fall off. d. True statement.

11. A nurse is providing discharge teaching to the parents of a 2-day-old neonate. Which of the following information should be included in the discharge teaching on umbilical cord care? a. Cleanse the cord twice a day with hydrogen peroxide. b. Remove the cord with sterile tweezers if the cord does not fall off by 10 days of age. c. Call the doctor if greenish discharge appears. d. Cover the cord with sterile dressing until it falls off.

ANS: c a. There is a controversy in the literature regarding what should be used to clean the cord, but hydrogen peroxide is not one of the recommended agents. b. The cord should be allowed to fall off on its own. c. The green drainage may be a sign of infection. d. There is no need to cover the cord.

12. The nurse is teaching the parents of a 1-day-old baby how to give their baby a bath. Which of the following actions should be included? a. Clean the eye from the outer canthus to the inner canthus. b. Keep the door of the room open to allow for ventilation. c. Gather all supplies before beginning the bath. d. Check the temperature of the water with your fingertip

ANS: c a. To decrease the risk of infection, the eyes should be cleaned from the inner to the outer canthus. b. Keeping doors open can cause a drop in baby's temperature by convection. c. If items must be obtained while the bath is being given, the baby may become hypothermic from evaporation resulting from exposure to the air when wet. d. The safest way to check the temperature is with a thermometer or, if none, with the elbow or forearm.

1. A nurse is making a home visit on the seventh postpartum day to assess a 23-year-old primipara woman and her full-term, healthy baby. Breastfeeding is the method of infant nutrition. The woman tells the nurse that she does not think her milk is good because it looks very watery when she expresses a little before each feeding. The nurse's best response is: a. "This is normal. You only have to be concerned when your baby does not gain weight." b. "What types of foods are you eating? A lack of protein in the diet can cause watery looking breast milk." c. "How much fluid are you drinking while you are nursing your baby? Too much fluid during the feeding session can dilute the breast milk." d. "This is normal and is referred to as foremilk which is higher in water content. Later in the feeding the fat content increases and the milk becomes richer in appearance."

ANS: d a. Correct information but does not provide information for the woman to understand the different types of milk. b. Incorrect information. c. Incorrect information. d. Correct. This provides an explanation for the consistency of the milk and reassures the woman that the appearance of the milk is normal.

6. Instructions to a mother of an uncircumcised male infant should include which of the following? a. Instruct her to use a cotton swab to clean under the foreskin. b. Instruct her to clean the penis by retracting the foreskin. c. Instruct her to clean the penis with alcohol. d. Instruct her not to retract the foreskin.

ANS: d a. Use of cotton swabs or retracting the foreskin can damage the inner layer of the foreskin and cause adhesions. b. Retracting the foreskin can damage the inner layer of the foreskin and cause adhesions. c. Use of alcohol is irritating and painful. d. Parents should not retract the foreskin. The foreskin will fully retract on its own around 5 years of age.

15. The nurse is teaching the parents of a healthy newborn about infant safety. Which of the following should be included in the teaching plan? a. Water temperature for the infant's bath should be 39°C. b. Crib slates should be a maximum of 3 inches apart. c. Cover electrical outlets once the infant is crawling. d. Remove strings from infant sleepwear.

ANS: d a. Water temperature should be 38°C. b. Crib slates should be no wider than 2 3/8 inches. c. Electrical covers should be covered before the infant begins to crawl, because infants can roll around to move and reach outlets before they crawl. d. Strings should be removed from bedding, sleepwear, pacifiers, and other objects that come in contact with the infant to decrease the risk of strangulation.

9. Felicity Chan, a new mother, is accompanied by her mother during her hospital stay on the postpartum unit. Felicity's mother makes specific, various requests of the nurses including bringing warm tea, a cot to sleep on, and that the baby not be bathed at this time. Felicity's mother is also concerned about the amount of work that Felicity may be doing in the provision of infant care. Felicity asks for help with breastfeeding. After Felicity has finished breastfeeding, her mother asks for a bottle so they can warm it and "feed" the baby. How would the perinatal nurse best respond to Felicity's mother in a culturally sensitive way? a. Ask Felicity's mother to leave for 30 minutes to allow for some private time with Felicity to explore her learning needs privately. b. Ask both Felicity and her mother about the preferred infant feeding method, and assess what they already know. c. Convey to Felicity and her mother an understanding of the concepts of "hot" and "cold" within their belief system. d. Ask Felicity what she knows about breastfeeding, and provide information to both women to support Felicity's decision.

ANS: d In certain multicultural populations such as India, Thailand, and China, the woman's postpartum confinement lasts for 40 days. During this time, prolonged rest with restricted activity is believed to be essential. The postpartum period is an important time for ensuring future good health, and great emphasis is placed on allowing the mother's body to regain balance after the birth of a child. To provide sensitive, appropriate care, nurses need to adopt a flexible approach when caring for women who embrace non-Western health beliefs and practices. The nurse should advocate for the patient by inquiring about her feeding preferences and by providing information to the mother and her family to support her in her decision.

29. The perinatal nurse understands that the hormonal processes involved in breastfeeding include decreased serum __________ and __________ levels immediately following birth which lead to an increased serum __________ level that causes milk production by the fourth to fifth postpartal days.

ANS: progesterone; estrogen; prolactin Circulating levels of estrogen and progesterone decrease dramatically following delivery of the placenta. The decline in these two hormones signals the anterior pituitary gland to produce prolactin in readiness for lactation.

28. The perinatal nurse encourages all mothers to place their infants under 12 months of age in the supine position for sleeping, because a leading cause of death for this age group is __________.

ANS: sudden infant death syndrome Sudden infant death syndrome (SIDS) is a leading cause of death among infants between the ages of 1 and 12 months. Having infants sleep on their backs has decreased the risk of SIDS.

18. Which of the following are disadvantages of bottle feeding? (Select all that apply.) a. Hampers mother-infant attachment b. Increases cost c. Increases risk of infection d. Increases risk of childhood obesity

ANS: b, c, d a. Bottle feeding does not interfere with mother-infant attachment. b. The cost of formula is greater than the cost of eating a well-balanced diet. c. Bottle-fed babies are at higher risk for infection because formulas lack the antibiotics that are found in colostrum and human milk. d. There is a relationship between childhood obesity and bottle feeding.

25. The clinic nurse recognizes that the longer an infant is formula fed, the greater is the immunity and resistance the infant will develop against bacterial and viral infections. (T/F)

ANS: False One of the primary benefits of breastfeeding, not formula feeding, is the decreased incidence of bacterial and viral infections as a result of passive immunity, including the transfer of maternal antibodies.

26. It is a common custom for traditional Chinese women to bottle feed their infants until their milk comes in. (T/F)

ANS: True It is common for traditional Chinese women to bottle feed until their milk comes in.

3. Which of the following positions for breastfeeding is preferred for a 2-day post-cesarean-birth woman? a. Lying down on side b. Sitting c. Cradle d. Cross-cradle

ANS: a a. Having the woman lying on her side to breastfeed prevents pressure on her abdomen and the pain that can result from the pressure. b. In this position, the baby is on the woman's abdomen, and this can be painful for the woman. c. In this position, the baby is on the woman's abdomen, and this can be painful for the woman. d. In this position, the baby is on the woman's abdomen, and this can be painful for the woman.

27. The clinic nurse discusses gradual warming of expressed breast milk or formula and cautions against use of the __________ for heating breast milk or formula.

ANS: microwave oven With regard to infant feeding and safety, parents should be taught to warm bottles slowly, never to use a microwave oven to heat breast milk or formula, and never to prop a bottle in the infant's mouth, as this practice creates a choking hazard