Nokea
A home care nurse is visiting a breastfeeding client who is 2 weeks postdelivery of a 7-lb baby girl over a midline episiotomy. Which of the following findings should take priority?
- A. Lochia is serosa.
- B. Client cries throughout the visit.
- C. Nipples are cracked.
- D. Client yells at the baby for crying.
Correct Answer: D
Rationale: Yelling at the baby raises concerns about bonding.
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The postpartum nurse has completed discharge teaching for a patient being discharged after an uncomplicated vaginal birth. Which statement by the patient indicates that further teaching is necessary?
- A. “I may not have a bowel movement until the 2nd postpartum day.”
- B. “If I breastfeed and supplemUenSt wiNth fTormula,O I won’t need any birth control.”
- C. “I know my normal pattern of bowel elimination won’t return until about 8 to 10 days.”
- D. “If I am not breastfeeding, I should use birth control when I resume sexual
Correct Answer: B
Rationale: The correct answer is B because the patient's statement about not needing birth control if breastfeeding and supplementing with formula is incorrect. Breastfeeding is not a reliable form of birth control and additional contraception is necessary to prevent unintended pregnancy.
Explanation:
1. Breastfeeding alone is not a foolproof method of contraception.
2. The combination of breastfeeding and formula feeding does not guarantee contraception.
3. Lactational amenorrhea method (LAM) is only effective if specific criteria are met.
4. The patient's misconception about not needing birth control while breastfeeding and supplementing with formula puts her at risk of unintended pregnancy.
Summary:
A: Correct statement about the timing of bowel movements postpartum.
C: Incorrect statement about the normal pattern of bowel elimination postpartum.
D: Correct statement about the need for birth control if not breastfeeding.
What percentage of weight loss did the baby experience? Calculate to the nearest hundredth.
- A. 5.55%
- B. 7.20%
- C. 6.85%
- D. 6.90%
Correct Answer: B
Rationale: Calculation: (3,278 - 3,042) / 3,278 * 100 = 7.20%
Which short-term goal is appropriate for a full-term, breastfeeding neonate?
- A. The baby will regain birth weight by 4 weeks of age.
- B. The baby will sleep through the night by 4 weeks of age.
- C. The baby will stool every 2 to 3 hours by 1 week of age.
- D. The baby will urinate 6 to 10 times per day by 1 week of age.
Correct Answer: D
Rationale: Frequent urination indicates adequate hydration.
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?
- A. If the baby feeds 8 to 12 times each day.
- B. If the baby urinates 6 to 10 times each day.
- C. If the baby has stools that are watery and bright yellow.
- D. If the baby has eyes and skin that are tinged yellow.
Correct Answer: D
Rationale: Jaundice may indicate hyperbilirubinemia.
Which action should the nurse take in order to provide support and encouragement to the new postpartum patient?
- A. Recount how she solved her own problems.
- B. Correct the new mother at every opportunity.
- C. Praise the mother’s early attempts at infant car
- D. Explain to the new mother that everything will be fine
Correct Answer: C
Rationale: The correct answer is C: Praise the mother’s early attempts at infant care. This choice focuses on positive reinforcement, which can boost the new mother's confidence and encourage her in her new role. By acknowledging and praising her efforts, the nurse can help build the mother's self-esteem and foster a supportive environment.
Choices A and D do not directly provide support and encouragement to the new mother. Recounting how the nurse solved her own problems (Choice A) may come off as self-centered and not helpful to the new mother's situation. Explaining that everything will be fine (Choice D) may minimize the new mother's feelings and concerns.
Choice B, correcting the new mother at every opportunity, is not supportive or encouraging. It can undermine the mother's confidence and create a negative dynamic. It is important for the nurse to focus on positive reinforcement and support to help the new mother navigate the challenges of postpartum care.