Lochia progresses in the following order:

Rubra, serosa, alba.

Rubra, alba, serosa.

Serosa, alba, rubra.

Alba, rubra, serosa.

Answer and Explanation

The Correct Answer is A

A) Rubra, serosa, alba:
The normal progression of lochia, the vaginal discharge after childbirth, follows a predictable sequence of stages. Lochia rubra is the initial stage, occurring within the first few days postpartum. It is bright red and consists primarily of blood, tissue, and debris from the placenta. After 3-4 days, the discharge changes to lochia serosa, which is pinkish-brown and contains a mixture of blood, serous fluid, and mucous. After 10-14 days, it progresses to lochia alba, which is white or pale yellow and consists mostly of leukocytes (white blood cells), mucus, and epithelial cells. This is the expected progression, which marks the natural healing process after childbirth.

B) Rubra, alba, serosa:
This order is incorrect because lochia serosa comes before lochia alba in the normal sequence. Lochia alba occurs after lochia serosa, not before. This progression would not accurately reflect the typical stages of lochia.

C) Serosa, alba, rubra:
This sequence is incorrect as lochia rubra is the first stage, not lochia serosa. The initial discharge following childbirth is always red and blood-tinged, which is lochia rubra. Serosa and alba come later in the progression, so this order does not follow the correct timeline.

D) Alba, rubra, serosa:
This order is completely incorrect. Lochia rubra (red blood discharge) is the first stage, not lochia alba (white discharge). After childbirth, rubra occurs first, followed by serosa, and then finally alba. This sequence does not reflect the normal postpartum discharge process.

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Correct Answer is ["A","B","E"]

Explanation

A) Keep the baby on his back to sleep:
Placing babies on their back to sleep is the most effective way to reduce the risk of sudden infant death syndrome (SIDS). The American Academy of Pediatrics (AAP) strongly recommends this practice. Babies should not sleep on their stomach or side because these positions increase the risk of suffocation. This position should be maintained until the baby is at least 1 year old, even though many parents may be encouraged to place babies on their tummies when they start rolling over on their own.

B) Keep the cord as dry as possible until it falls off:
It is important to keep the umbilical cord stump clean and dry until it falls off, which typically happens between 1-3 weeks of life. Moisture can cause infection, so avoiding unnecessary exposure to water and keeping the stump exposed to air is essential for healing. The area should not be submerged in water until the stump falls off, and the diaper should be folded down so it doesn’t rub against it, promoting proper drying and healing.

C) Always keep the baby dressed and wrapped in 2 blankets when you go outside:
This is not an ideal practice. Overheating can be dangerous for newborns, as they have a limited ability to regulate their body temperature. Instead of wrapping the baby in two blankets, the baby should be dressed appropriately for the weather—usually in one extra layer than an adult would wear in the same conditions. This ensures the baby stays warm without the risk of overheating, which is a risk factor for SIDS.

D) After your milk comes in your baby should have 3-4 wet or dirty diapers a day:
This information is inaccurate for a 2-day-old baby. After milk comes in (usually around day 3 or 4 postpartum), the baby should be producing at least 6-8 wet diapers a day and 3-4 dirty diapers by day 4 or 5. Fewer wet diapers or a decrease in bowel movements may indicate that the baby is not feeding effectively, and it is important to monitor this carefully. In the first few days, before the milk comes in, the baby might have fewer wet diapers, but by day 3-4, this is the standard for adequate hydration and nutrition.

E) Have the bulb syringe near the baby at all times:
Having a bulb syringe nearby is a good practice in case of respiratory distress. Newborns often have mucus in their airways, and a bulb syringe can help clear their nasal passages if they are having trouble breathing. While the baby should not be suctioned too frequently or aggressively, keeping a bulb syringe available can help manage mild congestion. Additionally, in the case of sudden breathing difficulties or choking, it’s important to be prepared.

A. The neonate with respirations of 78 and a heart rate of 176 B. The neonate with a temperature of 99.1 F and a weight of 3000 grams C. The neonate with raised white specks on the gums D. The neonate with white spots on the bridge of the nose

Correct Answer is A

Explanation

A) The neonate with respirations of 78 and a heart rate of 176:
This is the most concerning finding and requires immediate evaluation. Normal respiratory rate for a newborn is typically between 30 and 60 breaths per minute, so a rate of 78 breaths per minute is significantly elevated, indicating potential respiratory distress. Additionally, a heart rate of 176 beats per minute, while somewhat elevated, could indicate tachycardia, especially if the baby is experiencing distress or inadequate oxygenation. This combination of abnormal vital signs may point to respiratory or cardiovascular compromise, such as respiratory distress syndrome or other neonatal respiratory issues, which requires immediate evaluation and intervention.

B) The neonate with a temperature of 99.1°F and a weight of 3000 grams:
This neonate’s temperature is within the normal range (97.7°F to 99.5°F), and a weight of 3000 grams is also considered appropriate for a full-term newborn. These findings do not raise any immediate concerns, and no further action is necessary based on these observations alone.

C) The neonate with raised white specks on the gums:
Raised white specks or nodules on the gums are often a normal finding in newborns and are called Epstein pearls. These are benign cystic formations that do not require treatment. They are not a cause for concern and are common in newborns, usually disappearing on their own within a few weeks.

D) The neonate with white spots on the bridge of the nose:
White spots on the nose are likely to be Milia, which are small, benign cysts commonly seen on the face of newborns, particularly on the nose, cheeks, and chin. Milia are harmless and typically resolve without treatment within a few weeks. There is no need for concern in this case.

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Lochia progresses in the following order:

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Naxlex Comprehensive Predictor Exams

Your patient just had her first baby two days ago. The infant is healthy and breastfeeding well. What are important things to teach her about the safety of her baby: (select all that apply)

Correct Answer is ["A","B","E"]

Explanation

Four newborns were admitted into the neonatal nursery 1 hour ago. They are all sleeping in overhead warmers. Which of the babies should the nurse ask the neonatologist to evaluate?

Correct Answer is A

Explanation

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