What instructions should the nurse provide to a new mother regarding postpartum care and monitoring the newborn’s health?

You will need to set up an appointment with your obstetrician in 8 weeks.

You will need to abstain from sexual activities until you see your obstetrician.

Contact the pediatrician if the baby is not breastfeeding well or has fewer wet diapers and stools.

The lactation nurse will be coming by to work with you and your baby.

Answer and Explanation

The Correct Answer is C

Choice A rationale

The obstetrician follow-up appointment is typically scheduled at 6 weeks postpartum, not 8 weeks. Accurate timing of follow-up visits is crucial for monitoring the mother's health and recovery.

Choice B rationale

While abstaining from sexual activities postpartum is generally advised, it is usually recommended until the 6-week follow-up appointment, not specified by the obstetrician's discretion.

Choice C rationale

Contacting the pediatrician if the baby is not breastfeeding well or has fewer wet diapers and stools is critical for early detection of feeding issues, dehydration, or other health concerns.

Choice D rationale

A lactation nurse visit is beneficial for breastfeeding support but does not cover the broader scope of postpartum care and monitoring the newborn's health. Comprehensive instructions are essential for new mothers.

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Correct Answer is D

Explanation

Choice A rationale

Assessing pain intensity with contraction is not the priority when preeclampsia is suspected. The client's headache, hypertension, and edema indicate a need to evaluate for more specific signs of preeclampsia.

Choice B rationale

Fetal heart rate assessment is important, but evaluating maternal status is more urgent when preeclampsia symptoms are present. Monitoring maternal indicators helps determine the severity of preeclampsia.

Choice C rationale

Checking temperature, pulse, and respirations is part of routine assessment, but it does not provide specific information related to preeclampsia. Other assessments are more relevant for the client's condition.

Choice D rationale

Assessing deep tendon reflexes and clonus helps identify severe preeclampsia and potential for eclampsia. Hyperreflexia and clonus are signs of central nervous system irritability, requiring immediate attention and intervention.

A. Obtain a heel stick blood glucose level. B. Document the findings in the record. C. Swaddle the infant in a warm blanket. D. Place a pulse oximeter on the heel.

Correct Answer is A

Explanation

Choice A rationale

A heel stick blood glucose test is crucial for an infant showing jitteriness, hypotonicity, and weak cry as these symptoms suggest hypoglycemia which requires immediate confirmation and treatment.

Choice B rationale

Documenting findings is essential but does not address the immediate need to rule out and treat hypoglycemia in the symptomatic newborn.

Choice C rationale

Swaddling the infant provides comfort and warmth but does not address potential hypoglycemia, which is the priority in this case.

Choice D rationale

Placing a pulse oximeter monitors oxygenation but does not directly address the underlying cause of jitteriness and hypotonia, which could be hypoglycemia.

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What instructions should the nurse provide to a new mother regarding postpartum care and monitoring the newborn’s health?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A primigravida client who is at 33 weeks gestation presents to the labor and delivery unit troubled with a headache. The initial assessment findings include a blood pressure of 144/96 mm Hg, facial edema, and 3+ pitting edema in lower extremities. Which assessment should the nurse perform next?

Correct Answer is D

Explanation

Assessment findings of a 4-hour-old newborn include murmur, irregular respiratory rate at 64 breaths/min, heart rate of 150 beats/min with soft murmur, jitteriness, hypotonic, and weak cry. Based on these findings, which action should the nurse implement?

Correct Answer is A

Explanation

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