A nurse in the delivery room is planning to promote maternal-infant bonding for a client who just delivered. What is the priority action by the nurse?

Limit noise and interruption in the delivery room.

Encourage the parents to touch and explore the neonate’s features.

Place the neonate skin-to-skin on the client’s chest.

Place the neonate at the client’s breast.

Answer and Explanation

The Correct Answer is C

Choice A rationale
Limiting noise and interruption in the delivery room can help create a calm environment, which can be beneficial for both the mother and the newborn. However, this is not the priority action for promoting maternal-infant bonding.
Choice B rationale
Encouraging parents to touch and explore the neonate’s features can help foster a connection between the parents and the newborn. This tactile stimulation can also be comforting for the newborn. However, this is not the most immediate action to promote maternal-infant bonding.
Choice C rationale
Placing the neonate skin-to-skin on the client’s chest is the priority action. Skin-to-skin contact immediately after birth helps regulate the newborn’s temperature, heart rate, and breathing. It also promotes breastfeeding and bonding.
Choice D rationale
Placing the neonate at the client’s breast can promote breastfeeding, which can enhance maternal-infant bonding. However, this is not the first action to take. The priority is to establish skin-to-skin contact.

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Correct Answer is A

Explanation

Choice A rationale
The nurse should reassure the patient by informing her about the hospital’s capabilities to handle such situations. The neonatal unit in the hospital is equipped to handle emergencies and care for preterm babies. This response is factual and directly addresses the patient’s concern about the baby’s well-being.
Choice B rationale
While it’s true that everyone worries about their baby when they’re in labor, this response doesn’t directly address the patient’s concern about the baby’s health and well-being. It’s more of a general statement and doesn’t provide the reassurance the patient is seeking.
Choice C rationale
This response acknowledges the patient’s feelings, which is an important aspect of patient care. However, it doesn’t provide any information or reassurance about the baby’s health. The patient is specifically asking about the baby’s well-being, so the response should focus on that.
Choice D rationale
This response could be misleading. While it’s true that the chances of survival for preterm babies improve with each passing week, it’s not guaranteed that a baby born at 32 weeks will be fine. It’s important to provide accurate information and not give false reassurances.

A. Decreased muscle tone B. Sleeps for 2 hours after feeding C. Continuous high-pitched cry D. Mild tremors when disturbed

Correct Answer is C

Explanation

Choice A rationale
Decreased muscle tone is not typically associated with neonatal abstinence syndrome (NAS). NAS is a condition that affects newborns who have been exposed to addictive opiate drugs while in the mother’s womb.
Choice B rationale
Sleeping for 2 hours after feeding is not a specific symptom of NAS. While changes in sleep patterns can occur in NAS, they are not definitive indicators of the condition.
Choice C rationale
A continuous high-pitched cry is a common symptom of NAS123. This is because the baby is going through withdrawal from the drugs they were exposed to in the womb.
Choice D rationale
Mild tremors when disturbed are indeed a symptom of NAS123. However, this symptom alone is not enough to diagnose NAS as it can be seen in other conditions as well.

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A nurse in the delivery room is planning to promote maternal-infant bonding for a client who just delivered. What is the priority action by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is attending to a patient who is in preterm labor at 32 weeks of gestation. The patient asks the nurse, “Will my baby be okay?” What should the nurse respond?

Correct Answer is A

Explanation

A nurse is providing care for a newborn suspected of having neonatal abstinence syndrome. Which symptom would support this diagnosis?

Correct Answer is C

Explanation

A nurse is providing care for a client who is in preterm labor at 32 weeks of gestation. Which medication should the nurse expect the provider to prescribe to accelerate fetal lung maturity?

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