Nokea
Following delivery of the newborn which nursing intervention should be carried out immediately?
- A. Weigh the infant.
- B. Warm the infant.
- C. Bathe the infant.
- D. Inoculate the infant.
Correct Answer: B
Rationale: Maintenance of body temperature is the primary concern when caring for the newborn. The infant will also be weighed, bathed, and inoculated, but those measures are not the primary concern.
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What is the name of the vaginal discharge that occurs immediately following delivery?
- A. Lochia serosa
- B. Lochia rubra
- C. Lochia palatine
- D. Lochia alba
Correct Answer: B
Rationale: The vaginal discharge that occurs immediately following discharge is known as lochia rubra and is made up mostly of blood. As the placenta heals, the draining turns pink to dark brown in color and is known as lochia serosa. After about 7 days, the discharge turns slight yellow to white and is called lochia alba.
The nurse is observing a new mother interact with her infant. Which observation would indicate that bonding is occurring?
- A. The mother is making eye contact with the infant.
- B. The mother is sending the infant to the nursery for feedings.
- C. The mother is cuddling with the infant and napping.
- D. The mother is requesting that the mother-in-law change all diapers.
- E. The mother states that her favorite thing to do with her baby is to breastfeed.
Correct Answer: A,C,E
Rationale: Eye contact, cuddling, and enjoying infant feeding are all signs of positive parent-infant attachment (bonding). Sending the infant to the nursery for feedings and having someone else change all diapers could indicate difficulty with bonding.
The new mother has decided not to breastfeed the baby. How should the nurse correctly instruct the mother to suppress her milk supply?
- A. Pump the breasts to remove milk
- B. Apply warm moist compresses
- C. Restrict oral fluids
- D. Apply a firm bra and ice packs
Correct Answer: D
Rationale: If a patient is not breastfeeding, compress the breasts with a firm bra and wrapped ice packs to suppress the milk supply. Pumping the breasts and applying warm, moist compresses are instructions for the breast-feeding mother to deal with the painful symptoms of engorgement.
The nurse is giving a bath demonstration for a group of new mothers. What should be included in the demonstration?
- A. Apply baby powder generously to keep baby dry.
- B. Cleanse perineum from front to back.
- C. Use scented soap to make baby smell good.
- D. Partially submerge head in water when shampooing.
Correct Answer: B
Rationale: The perineum should be cleansed by wiping from the anterior to the posterior. Excessive use of powders and scented soaps can irritate the skin. The head should not be submerged in water.
A mother delivered her baby at midnight and it is now 9 a.m. She wants to sleep and asks the nurse to take care of the baby. What is this considered?
- A. Fatigue from labor
- B. Normal "taking in" response
- C. Abnormal "taking in" response
- D. Risk for altered maternal-infant bonding
Correct Answer: B
Rationale: Her primary focus will be on her own needs such as sleep ("taking in" stage).