Neonatal Period: Discharge Planning and Teaching

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.

4. Football hold position 5. Lying down position

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

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?

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

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?

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

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?

Do not breastfeed the infant.

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?

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

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 color may indicate dehydration."

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?

"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."

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?

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

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?

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

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?

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

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."

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?

"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?

"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?

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

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?

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

A client is preparing to formula-feed her one-day-old newborn with a bottle. The client states, "I cannot remember how much to feed my baby, and this bottle is in milliliters. What is the most I should be feeding my baby with this bottle?" Enter the nurse's answer in numerical value.

0.5 to 1 ounce = 15-30 milliliters

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.

1. Assess the infant's latch position. 3. Notify the health care provider to monitor for infection. 4. Instruct the client to express colostrum and rub it on her nipple. 5. Teach the client to wash breasts with water only.

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.

1. Breastfeeding has psychological benefits that include a decreased risk of postpartum depression. 2. Breastfeeding your infant can lead to a decreased risk of otitis media. 4. Breastfeeding mothers lose more weight after three months compared to those who did not breastfeed. 5. Breastfeeding can lower your infant's risk of inflammatory bowel disease.

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.

1. Breathing Problems 2. Convulsions 4. Lethargy 5. Vomiting

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.

1. Gastroenteritis 3. Obesity 4. Asthma

The nurse educates a new mother about infant hunger cues. What cues indicate that an infant is ready to feed? Select all that apply.

1. Rooting 2. Hand-to-mouth movements 4. Sucking on fingers 5. Quiet-alert behavior state

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.

1. The infant is sitting with support. 2. The infant refuses food by turning head away. 3. The infant opens mouth to indicate hunger.

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.

1. The newborn was placing a hand near the mouth. 3. The newborn was sucking on their hand.

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.

2. "Breastmilk can be stored in a freezer attached to a refrigerator for 3 to 6 months." 3. "Breastmilk can be stored in a deep freezer for 6 to 12 months." 5. "Breastmilk in the freezer should be stored towards the back and not near the door."

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?

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

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.

2. Right context 3. Right content 4. Right goal 5. Right method

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.

3. "I will use a mild soap to prevent skin irritation." 4. "After feeding, I will clean the baby's face and neck with water." 5. "I will make sure the water temperature is between 90 to 100 degrees F"

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

3. 6%, 42%, 52%

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

For some women, breastfeeding is contraindicated. Which client should not breastfeed her infant?

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.

Question 8. 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

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?

Head trauma

Lactogenesis occurs in the breast following delivery of the infant. In which area does milk production occurs in the breast?

In the alveolar glands (Upper Left)

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 III

The nurse understands that which is a primary reason that women stop breastfeeding before the eighth week?

Painful nipples

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?

Prolactin increases

The nurse is educating a woman on adequate protein intake to support breastfeeding. What foods should be included in the nutrition plan?

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, shushing, swinging, sucking

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 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 makes sucking motions.

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 will be drowsy and relaxed after feeding.

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 warm water and places on the outside of the diaper.

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 Baby-Friendly hospital initiative started in 1991. The nurse understands that which is the goal of this program?

To improve breastfeeding rates and maternal-newborn bonding

When discussing positioning for breastfeeding, what does the nurse instruct the client to do?

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 hands before touching breasts.