Nokea
A mother brings her 4-week-old newborn into the clinic for a well-child check. She reports to the nurse that the newborn developed small white marks on her nose. What are these small white marks commonly called?
- A. Milia
- B. Mongolian spots
- C. Erythema toxicum
- D. Port-wine stain
Correct Answer: A
Rationale: The correct answer is A: Milia. Milia are tiny, white, pearly bumps that commonly appear on a newborn's face, including the nose, due to blocked oil glands. They are harmless and typically disappear on their own.
Explanation:
1. Milia are common in newborns, appearing as small white bumps on the nose and face.
2. They result from blocked oil glands and are not harmful.
3. Mongolian spots are bluish-gray birthmarks usually on the lower back or buttocks.
4. Erythema toxicum presents as red blotches on the skin shortly after birth.
5. Port-wine stain is a vascular birthmark that appears as a pink or red mark on the skin.
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The postpartum nurse is caring for a client who gave birth to full-term twins earlier today. The nurse will know to assess for symptoms of which of the following?
- A. Postpartum infection
- B. Increased blood pressure
- C. Postpartum hemorrhage
- D. Hypoglycemia
Correct Answer: C
Rationale: Delivering twins increases the risk of postpartum hemorrhage due to larger placental sites and potential uterine overdistension.
A woman who has just delivered has decided to bottle feed her full term infant. Which of the following should be included in the patient teaching?
- A. It is best to heat the baby’s bottle in the microwave before feeding.
- B. You should prepare enough bottles for 24 hours of feedings.
- C. The bottle nipples should be enlarged to ease the baby’s sucking.
- D. The baby’s stools will appear bright yellow and will have a smell similar to sour milk.
Correct Answer: B
Rationale: Preparing enough bottles for 24 hours ensures convenience and hygiene. Microwaving can create hot spots, and enlarged nipples are unnecessary.
A postpartum nurse is giving guidance to a mother whose breast-fed newborn is experiencing hyperbilirubinemia. What are the best instructions for the nurse to give the mother in this case?
- A. It is best for the infant if she stops breast-feeding and switches to bottle-feeding permanently.
- B. The mother should switch to bottle-feeding until the baby’s bilirubin returns to normal range.
- C. The mother should alternate breast-feeding and bottle-feeding to ensure adequate fluid intake, until the baby’s bilirubin returns to normal range.
- D. The mother should continue to breast-feed the infant every 2 to 3 hours or more frequently as tolerated (every 2 hours if under phototherapy).
Correct Answer: D
Rationale: Continued frequent breastfeeding helps reduce bilirubin levels effectively.
The most effective time to initiate breast-feeding is in which stage of reactivity for the neonate?
- A. period of decreased reactivity
- B. first period of reactivity
- C. second period of reactivity
- D. after the end of the second period of reactivity
Correct Answer: B
Rationale: The correct answer is B: first period of reactivity. During this stage, the infant is alert and eager to suckle, making it an optimal time to initiate breastfeeding. The infant's sucking reflex is strong, and they are more likely to latch on successfully. The other choices are incorrect because during the period of decreased reactivity (A), the infant is often drowsy and less interested in feeding. The second period of reactivity (C) may involve increased activity and may not be the best time to introduce breastfeeding. After the end of the second period of reactivity (D), the infant may be more settled and not as ready to breastfeed as during the first period of reactivity.
The nurse is receiving shift report on her mother-baby couplet assignment. Which infant should the nurse evaluate first?
- A. 38-weeks' gestation female newborn with a blood sugar level of 60 mg/dL
- B. Term male newborn with a noted axillary temperature of 37.2°C (99°F)
- C. 40-weeks' gestation female newborn with reported poor feed at last attempt
- D. 39-weeks' gestation male newborn who has been crying prior to initial bath
Correct Answer: C
Rationale: The correct answer is C, to evaluate the 40-weeks' gestation female newborn with reported poor feed at the last attempt first. This choice should be prioritized as poor feeding in a newborn can be a sign of potential serious issues such as inadequate nutrition, dehydration, or underlying medical conditions. Addressing this concern promptly is crucial for the infant's well-being.
Option A can be considered as the blood sugar level of 60 mg/dL in the 38-weeks' gestation female newborn is slightly low, but it is not an immediate priority compared to poor feeding. Option B's axillary temperature of 37.2°C is within the normal range for a newborn, so it can be assessed after addressing the concern of poor feeding. Option D, a 39-weeks' gestation male newborn crying prior to the initial bath, can also be evaluated after addressing the more urgent issue of poor feed.