Maternal Child Nursing in Canada

A patient gave birth to a healthy 3750 g infant. The nurse suggests that the patient place the infant to their breast within 15 minutes after birth. The nurse knows that breastfeeding is effective during the first 30 minutes after birth because this is the
a. transition period.
b. first period of reactivity.
c. organizational stage.
d. second period of reactivity.

B: First period of reactivity

Part of the health assessment of a newborn is observing the infant's breathing pattern. What is a full-term newborn's predominant breathing pattern?
a.
Abdominal with synchronous chest movements
b.
Chest breathing with nasal flaring
c.
Diaphragmatic with chest retraction
d.
Deep with a regular rhythm

A) Abdominal with synchronous chest movements

While assessing the newborn, the nurse should be aware that which is the average range of expected apical pulse findings of a full-term, quiet, alert newborn?
a.
80 to 100 beats/min
b.
100 to 120 beats/min
c.
110 to 160 beats/min
d.
150 to 180 beats/min

C) 110 to 160 beats/min

A newborn is placed skin-to-skin with a parent, and a nurse evaluates the infant's body temperature frequently. Maintaining the newborn's body temperature is important to prevent which event from happening?
a.
Respiratory depression
b.
Cold stress
c.
Tachycardia
d.
Vasoconstriction

B) Cold Stress

A Canadian patient of African ancestry notices some bruises on their newborn's buttocks. They ask the nurse who spanked their newborn. The nurse explains that these marks are referred to as what?
a.
Lanugo
b.
Vascular nevi
c.
Nevus flammeus
d.
Congenital dermal melanocytosis

D) Congenital dermal melanocytosis

While examining a newborn, a nurse practitioner notes uneven skin folds on the buttocks and a click when performing the Ortolani manoeuvre. The nurse practitioner recognize these findings as an indication of what?
a.
Polydactyly
b.
Clubfoot
c.
Hip dysplasia
d.
Webbing

C) Hip dysplasia

A new mother states that their infant must be cold because the baby's hands and feet are blue. The nurse explains that this is a common and temporary condition called
a.
acrocyanosis.
b.
erythema neonatorum.
c.
harlequin colour.
d.
vernix caseosa.

A) Acrocyanosis

A nurse assessing a newborn knows that the most critical physiological change required of the newborn is
a.
closure of fetal shunts in the circulatory system.
b.
full function of the immune defense system at birth.
c.
maintenance of a stable temperature.
d.
initiation and maintenance of respirations.

D) Initiation and maintenance of respirations

The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. What is the basis for the nurses' response?
a.
Infants can see very little until about 3 months of age.
b.
Infants can track their parent's eyes and distinguish patterns; they prefer complex patterns.
c.
The infant's eyes must be protected. Infants enjoy looking at brightly coloured stripes.
d.
It's important to shield the newborn's eyes. Overhead lights help them see better.

B) Infants can track their parent's eyes and distinguish patterns; they prefer complex patterns.

Newborns in whom cephalhematomas develop are at increased risk for
a.
infection.
b.
jaundice.
c.
caput succedaneum.
d.
erythema toxicum.

B) Jaundice

While assessing the integument of a 24-hour-old newborn, the nurse notes a pink, papular rash with vesicles superimposed on the thorax, back, and abdomen. What should the nurse do?
a.
Notify the pediatric health care provider immediately.
b.
Move the newborn to an isolation nursery.
c.
Document the finding as erythema toxicum.
d.
Take the newborn's temperature and obtain a culture of one of the vesicles.

C) Document the finding as erythema toxicum

A patient is warm and asks for a fan in their room for comfort. The nurse enters the room to assess the mother and their infant and finds the infant unwrapped in the crib with the fan blowing over them on "high." The nurse teaches the mother that the fan should not be directed toward the newborn and the newborn should be wrapped in a blanket. The mother asks why. What is the basis of the nurse's response?
a.
The baby may lose heat by convection, which means that they will lose heat from their body to the cooler ambient air.
b.
The baby may lose heat by conduction, which means that they will lose heat from their body to the cooler ambient air.
c.
The baby may lose heat by evaporation, which means that they will lose heat from their body to the cooler ambient air.
d.
The baby will get cold stressed easily and needs to be bundled up at all times.

A) The baby may lose heat by convection, which means that they will lose heat from their body to the cooler ambient air.

A first-time father is changing the diaper of his 1-day-old newborn. He asks the nurse, "What is this black, sticky stuff in the diaper?" What is the basis for the nurse's response?

b.
It is a transitional stool.
c.
It is a sign of internal bleeding.
d.
Tell the parent not to worry about the colour of the stool.

A) It is meconium and is a baby's first stool.

The transition period between intrauterine and extrauterine existence for the newborn
a.
consists of four phases, two reactive and two of decreased responses.
b.
is referred to as the newborn period and lasts from birth to day 28 of life.
c.
applies to full-term births only.
d.
varies by socioeconomic status and the mother's age.

B) is referred to as the newborn period and lasts from birth to day 28 of life.

Which statement is an inaccurate description of the first phase of the transition period?
a.
It lasts no longer than 30 minutes.
b.
It is marked by spontaneous tremors, crying, and head movements.
c.
It often includes the passage of meconium.
d.
It may involve the infant suddenly sleeping briefly.

D) It may involve the infant suddenly sleeping briefly

What should the nurse be aware of with regard to the respiratory development of the newborn?
a.
The positive pressure created by crying aids in keeping the alveoli open.
b.
Newborns must expel the fluid from the respiratory system within a few minutes of birth.
c.
Newborns are instinctive mouth breathers.
d.
Seesaw respirations are no cause for concern in the first hour after birth.

A) The positive pressure created by crying aids in keeping the alveoli open

1What should the nurse be aware of with regard to the newborn's developing cardiovascular system?
a.
The heart rate of a crying infant may rise to 120 beats/min.
b.
Heart murmurs heard after the first few hours are cause for concern.
c.
The point of maximal impulse (PMI) often is visible on the chest wall.
d.
Persistent bradycardia may indicate respiratory distress syndrome (RDS).

C) The point of maximal impulse (PMI) often is visible on the chest wall

What should the nurse know about variations in infants' blood count to explain to new parents?
a.
A somewhat lower than expected red blood cell (RBC) count could be the result of delay in clamping the umbilical cord.
b.
The early high white blood cell (WBC) count is normal at birth and should decrease rapidly.
c.
Platelet counts are higher than in adults for a few months.
d.
Even a modest vitamin K deficiency means a problem with the ability of the blood to clot properly.

B) The early high white blood cell (WBC) count is normal at birth and should decrease rapidly

What infant response to cool environmental conditions is protective?
a.
Dilation of peripheral blood vessels
b.
Shivering
c.
Decreased respiratory rates
d.
Flexed position

A) Dilation of peripheral blood vessels

What would the nurse be aware of with regard to the functioning of the renal system in newborns?
a.
The pediatric health care provider should be notified if the newborn has not voided in 24 hours.
b.
Breastfed infants likely will void more often during the first days after birth.
c.
"Brick dust" or blood on a diaper is always cause to notify the pediatric health care provider.
d.
Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days.

A) The pediatric health care provider should be notified if the newborn has not voided in 24 hours

What should the nurse be aware of with regard to the gastrointestinal (GI) system of the newborn?
a.
The newborn's cheeks are full because of normal fluid retention.
b.
The nipple of the bottle or breast must be placed well inside the baby's mouth because teeth have been developing in utero, and one or more may even be through.
c.
An active rectal "wink" reflex is a sign of good sphincter control.
d.
Bacteria are already present in the infant's GI tract at birth, because they travelled through the placenta.

C) an active rectal "wink" reflex is a sign of good sphincter control

Which statement is true about jaundice?
a.
Neonatal jaundice is not common, but kernicterus occurs frequently.
b.
The appearance of jaundice during the first 24 hours indicates a pathological process.
c.
Jaundice will most likely appear before discharge.
d.
Breastfed babies have a lower incidence of jaundice.

B) The appearance of jaundice during the first 24 hours indicates a pathological process

What is the term given to the cheeselike, whitish substance that fuses with the epidermis and serves as a protective coating for the fetus?
a.
Vernix caseosa
b.
Surfactant
c.
Caput succedaneum
d.
Acrocyanosis

A) Vernix caseosa

What marks on a baby's skin may indicate an underlying problem that requires notification of a pediatric health care provider?
a.
Congenital dermal melanocytosis spots on the back
b.
Telangiectatic nevi on the nose or nape of the neck
c.
Petechiae scattered over the infant's body
d.
Erythema toxicum anywhere on the body

C) Petechiae scattered over the infant's body

What should a nurse practitioner do upon assessing unequal movement and uneven gluteal skin folds during the Ortolani manoeuvre?
a.
Tell the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking.
b.
Determine that the infant may have hip dysplasia.
c.
Inform the parents that moulding has not taken place.
d.
Suggest that, if the condition does not change, surgery to correct vision problems might be needed.

B) Tell the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking

Why is the brain vulnerable to nutritional deficiencies and trauma in early infancy?
a.
The infant has an incompletely developed neuromuscular system.
b.
The infant has a primitive reflex system.
c.
The infant experiences the presence of various sleep-wake states.
d.
The infant experiences a cerebellum growth spurt.

D) The infant experiences a cerebellum growth spurt

The nurse caring for the newborn should be aware that which sensory system is least mature at the time of birth?
a.
Vision
b.
Hearing
c.
Smell
d.
Taste

A) Vision

During life in utero, oxygenation of the fetus occurs through transplacental gas exchange. When birth occurs, four factors combine to stimulate the respiratory centre in the medulla. The initiation of respiration then follows. Which contributes to the dynamic sequence of events that occur with the infants' first breath?
a.
Warm air temperature
b.
Oxygen pressure increases
c.
Carbon dioxide pressure decreases
d.
Arterial pH decreases

D) Arterial pH decreases

A collection of blood between the skull bone and its periosteum is known as a cephalhematoma. What should the nurse be aware of with regard to cephalhematoma in order to reassure the new parents whose infant develops such a soft bulge?

a.

It may occur with spontaneous vaginal birth.

b.

It only happens as the result of a forceps or vacuum birth.

c.

It is present immediately after birth.

d.

It will gradually absorb over the first few months of life.

A) It may occur with spontaneous vaginal birth

A nursing student is helping the postpartum unit nurse with morning vital signs. A baby born 10 hours ago by Caesarean section is found to have moist lung sounds. What is the best interpretation of these data?
a.
The nurse should notify the pediatric health care provider stat for this emergency situation.
b.
The newborn must have aspirated surfactant.
c.
If this baby was born vaginally, it could indicate a pneumothorax.
d.
The lungs of a baby born by Caesarean section may sound moist for 24 hours after birth.

D) The lungs of a baby born by Caesarean section may sound moist for 24 hours after birth

Nurses can prevent evaporative heat loss in the newborn by
a.
drying the baby after birth and wrapping the baby in a dry blanket.
b.
keeping the baby out of drafts and away from air conditioners.
c.
placing the baby away from the outside wall and the windows.
d.
warming the stethoscope and the nurse's hands before touching the baby.

A) Drying the baby after birth and wrapping the baby in a dry blanket

A first-time parent is concerned that their 3-day-old daughter's skin looks "yellow." In the nurse's explanation of physiological jaundice, what fact should be included?
a.
Physiological jaundice occurs during the first 24 hours of life.
b.
Physiological jaundice is caused by blood incompatibilities between the mother and infant blood types.
c.
The bilirubin levels of physiological jaundice peak between 60 to 72 hours of life.
d.
This condition is also known as "breast milk jaundice."

C) The bilirubin levels of physiological jaundice peak between 60 to 72 hours of life

Cardiovascular changes that cause the foramen ovale to close at birth are a direct result of
a.
increased pressure in the right atrium.
b.
increased pressure in the left atrium.
c.
decreased blood flow to the left ventricle.
d.
changes in the hepatic blood flow.

B) Increased pressure in the left atrium

A nurse should immediately alert the pediatric health care provider when
a.
the newborn is dusky and turns cyanotic when crying.
b.
acrocyanosis is present at age 1 hour.
c.
the newborn's blood glucose level is 2.8 mmol/L.
d.
the newborn goes into a deep sleep at age 1 hour.

A) The newborn is dusky and turns cyanotic when crying

In administering vitamin K to the infant shortly after birth, a nurse understands that vitamin K is
a.
important in the production of red blood cells.
b.
necessary in the production of platelets.
c.
not initially synthesized because of a sterile bowel at birth.
d.
responsible for the breakdown of bilirubin and prevention of jaundice.

C) Not initially synthesized because of a sterile bowel at birth

A meconium stool can be differentiated from a transitional stool in the newborn because the meconium stool is
a.
seen at age 3 days.
b.
the residue of a milk curd.
c.
passed in the first 12 hours of life.
d.
lighter in colour and looser in consistency.

C) Passed in the first 12 hours of life

What are modes of heat loss in the newborn? (Select all that apply.)

a.

Perspiration

b.

Convection

c.

Radiation

d.

Conduction

e.

Urination

B) Convection
C) Radiation
D) Conduction

The process in which bilirubin is changed from a fat-soluble product to a water-soluble product is known as unconjugation of bilirubin.
True or False

False

An infant was born just a few minutes ago and the nurse is assessing the Apgar score. When is the Apgar score performed?
a.
It is performed only if the newborn is in obvious distress.
b.
It is performed once by the primary health care provider, just after the birth.
c.
It is performed at least twice, 1 minute and 5 minutes after birth.
d.
It is performed every 15 minutes during the newborn's first hour after birth.

C) It is performed at least twice, 1 minute and 5 minutes after birth

A new parent wants to know what medication was put into their infant’s eyes and why it is needed. What does the nurse explain to the parent about the purpose of the erythromycin ophthalmic ointment?

a.

It destroys an infectious exudate caused by Staphylococcus that could make the infant blind.

b.

It prevents gonorrheal and chlamydial infection of the infant’s eyes that is potentially acquired from the birth canal.

c.

It prevents potentially harmful exudate from invading the tear ducts of the infant’s eyes, leading to dry eyes.

d.

It prevents the infant’s eyelids from sticking together and helps the infant see.

B) It prevents gonorrheal and chlamydial infection of the infant's eyes that is potentially acquired from the birth canal

The nurse is using the Ballard scale to determine the gestational age of a newborn. Which is consistent with a gestational age of 40 weeks?
a.
Flexed posture
b.
Abundant lanugo
c.
Smooth, pink skin with visible veins
d.
Faint red marks on the soles of the feet

A) Flexed posture

A 3800 g infant was born vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth, the infant had petechiae over the face and upper back. Which information would be accurate to be given to the infant's parents about petechiae?
a.
They are benign if they disappear within 48 hours of birth.
b.
They result from increased blood volume.
c.
They should always be further investigated.
d.
They usually occur with forceps assisted birth.

A) They are benign if they disappear within 48 hours of birth

What is the most important appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy via ultraviolet lights?
a.
Ensure the newborn is removed from phototherapy during feeding.
b.
Limit the newborn's intake of milk to prevent nausea, vomiting, and diarrhea.
c.
Place eye shields over the newborn's closed eyes.
d.
Change the newborn's position every 2 hours.

C) Place eye shields over the newborn's closed eyes

Early this morning, an infant boy was circumcised using the PlastiBell method. When should the nurse tell the mother that she and their infant can be discharged?
a.
The bleeding stops completely.
b.
Yellow exudate forms over the glans.
c.
The PlastiBell rim falls off.
d.
The infant voids.

D) The infant voids

A mother expresses fear about changing their infant's diaper after he is circumcised with a Gomco clamp. What does the patient need to be taught, in order to take care of the infant when they go home?
a.
Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours.
b.
Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs.
c.
Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change.
d.
Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

C) Cleanse the penis gently with water and put petroleum jelly around the glams after each diaper change

What should the nurse be aware of when preparing to administer a hepatitis B vaccine to a newborn?
a.
Obtain a syringe with a 25-gauge, 16-mm (5/8-inch) needle.
b.
Confirm that the newborn's mother has been infected with the hepatitis B virus.
c.
Assess the dorsogluteal muscle as the preferred site for injection.
d.
Confirm that the newborn is at least 24 hours old.

A) Obtain a syringe with a 25-gauge, 16mm (5/8-inch) needle

Which range, in g/L, represents the normal hemoglobin of a healthy full-term infant?
a.
50 to 95
b.
120 to 150
c.
140 to 240
d.
160 to 260

C) 140 to 240

What is the main reason that nurses wear gloves when handling the newborn at birth?
a.
To protect the baby from infection
b.
It is part of the Apgar protocol
c.
To protect the nurse from contamination by the newborn
d.
Because the nurse has primary responsibility for the baby during the first 2 hours

C) To protect the nurse from contamination by the newborn

While evaluating the reflexes of a newborn, the nurse notes that with a loud noise the newborn symmetrically abducts and extends their arms, their fingers fan out and form a C with the thumb and forefinger, and they have a slight tremor. How would the nurse document this positive finding?
a.
Tonic neck reflex
b.
Glabellar (Myerson) reflex
c.
Babinski reflex
d.
Moro reflex

D) Moro Reflex

What would an Apgar score of 10 at 1 minute after birth indicate?
a.
The infant is having no difficulty adjusting to extrauterine life and needs no further testing.
b.
The infant is in severe distress and needs resuscitation.
c.
The score predicts a future free of neurological problems.
d.
The infant will have no difficulty adjusting to extrauterine life, but should be assessed again at 5 minutes after birth.

D) The infant will have no difficulty adjusting to extrauterine life, but should be assessed again at 5 minutes after birth

What should the nurse be aware of with regard to umbilical cord care?
a.
The stump can easily become infected.
b.
A nurse noting bleeding from the vessels of the cord should immediately call for assistance.
c.
The cord clamp is removed at cord separation.
d.
The average cord separation time is 5 to 7 days.

A) The stump can easily become infected

In the classification of newborns by gestational age and birth weight, which is the appropriate for gestational age (AGA) weight?
a.
It falls between the twenty-fifth and seventy-fifth percentiles for the infant's age.
b.
It depends on the infant's length and the size of the head.
c.
It falls between the tenth and ninetieth percentiles for the infant's age.
d.
It should be modified to consider intrauterine growth restriction (IUGR).

C) It falls between the tenth and ninetieth percentiles for the infant's age

Which statement applies to a complete physical examination within 24 hours after birth?
a.
The parents are excused to reduce their normal anxiety.
b.
The nurse can gauge the newborn's maturity level by assessing the infant's general appearance.
c.
It is ideally completed immediately after birth.
d.
When the nurse listens to the heart, the S1 and S2 sounds can be heard; the first sound is somewhat higher in pitch and sharper than the second.

B) The nurse can gauge the newborn's maturity level by assessing the infant's general appearance

Which type of blood should be used for genetic screening?
a.
Maternal venous
b.
Maternal cord blood
c.
Fetal cord blood
d.
Infant capillary blood

D) Infant capillary blood

Which should the nurse explain to the parents that will assist them with their decision related to circumcision?
a.
The nurse explains the pros and cons of the procedure during the prenatal period.
b.
The Canadian Paediatric Society (CPS) recommends that all newborn males be routinely circumcised.
c.
Circumcision is rarely painful and any discomfort can be managed without medication.
d.
The infant will likely be alert and hungry shortly after the procedure.

A) The nurse explains the pros and cons of the procedure during the prenatal period

The normal term newborn has little difficulty clearing the airway after birth. Most secretions are brought up to the oropharynx by the cough reflex. However, if the infant has excess secretions, the mouth and nasal passages can be cleared easily with a bulb syringe. When instructing parents on the correct use of this piece of equipment, which is important that the nurse teach them to do?
a.
Avoid suctioning the nares.
b.
Insert the compressed bulb into the centre of the mouth.
c.
Suction the mouth first.
d.
Remove the bulb syringe from the crib when finished.

C) Suction the mouth first

Which principle applies to a newborn bath?
a.
Cleanse eyes from outer canthus to inner.
b.
Complete the bath from clean to dirty.
c.
Finish the bath with fresh water and cleaning the infant's face.
d.
Wash genitals first, then diaper and continue the bath.

B) Complete the bath from clean to dirty

Which newborn reflex is elicited by stroking the lateral sole of the newborn's foot from the heel to the ball of the foot?
a.
Babinski
b.
Tonic neck
c.
Stepping
d.
Plantar grasp

A) Babinski

A nurse is performing a gestational age and physical assessment on the newborn. The newborn appears to have an excessive amount of saliva. The nurse recognizes that this finding
a.
is normal.
b.
indicates that the infant is hungry.
c.
may indicate that the infant has a tracheoesophageal fistula or esophageal atresia.
d.
may indicate that the infant has a diaphragmatic hernia.

C) May indicate that the infant has a tracheoesophageal fistula or esophageal atresia

The nurse's initial action when caring for a newborn with a slightly decreased temperature is to
a.
notify the health care provider immediately.
b.
place a cap on the newborn's head.
c.
take the newborn to the nursery and observe for the next 4 hours.
d.
change the formula because this is a sign of formula intolerance.

B) Place a cap on the newborn's head

As part of their teaching function at discharge, nurses should educate parents regarding safe sleep. Which statement is incorrect?
a.
Prevent exposure to people with upper respiratory tract infections.
b.
Keep the infant away from secondhand smoke.
c.
Avoid loose bedding, water beds, and beanbag chairs.
d.
Place the infant on their abdomen to sleep.

D) Place the infant on their abdomen to sleep

To prevent the abduction of newborns from the hospital, the nurse should
a.
instruct the mother not to give their infant to anyone except the one nurse assigned to her that day.
b.
apply an electronic and identification bracelet to mother and infant.
c.
carry the infant when transporting them in the halls.
d.
restrict the amount of time newborns are out of the nursery

B) Apply an electronic and identification bracelet to mother and infant

A nurse administers vitamin K to the newborn for which reason?
a.
Most mothers have a diet deficient in vitamin K, which results in the infant's being deficient.
b.
Vitamin K prevents the synthesis of prothrombin in the liver and must be given by injection.
c.
Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract.
d.
The supply of vitamin K is inadequate for at least 3 to 4 months, and the newborn must be supplemented.

C) Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract

As part of discharge teaching, which should nurses tell parents about in relation to their baby? (Select all that apply.)

a.

Prevent exposure to people with upper respiratory tract infections.

b.

Keep the infant away from secondhand smoke.

c.

Avoid loose bedding, water beds, and beanbag chairs.

d.

Avoid letting the infant sleep on his or her back.

e.

Do not use a pacifier when the baby is put to sleep.

f.

Ensure the rear-facing car seat is placed in the front seat with the air bag on.

A) Prevent exposure to people with upper respiratory tract infections
B) Keep the infant away from secondhand smoke
C) Avoid loose bedding, water beds, and beanbag chairs

When eliciting newborn reflexes, which is true about the Babinski reflex? (Select all that apply.)

a.

Place infant prone on a flat surface and run finger down back lateral to the spine to elicit the Babinski reflex.

b.

Absence of Babinski reflex requires neurological evaluation.

c.

Babinski reflex usually disappears by 1 year of age.

d.

Response to Babinski reflex is the trunk flexes and the pelvis swings to the stimulated side.

e.

A positive Babinski is hyperextension of all toes with dorsiflexion of the big toe.

f.

Lower limbs should extend when the Babinski reflex is elicited.

B) Absence of Babinski reflex requires neurological evaluation
C) Babinski reflex usually disappears by 1 year of age
E) A positive Babinski is hyperextension of all toes with dorsiflexion of the big toe

Pain should be assessed regularly in all newborns. If the newborn is displaying physiological or behavioural cues indicating pain, measures should be taken to manage the pain. Examples of nonpharmacological pain management techniques include (Select all that apply.)

a.

swaddling.

b.

nonnutritive sucking.

c.

skin-to-skin contact with the mother.

d.

sucrose.

e.

acetaminophen.

A) Swaddling
B) Non-nutritive sucking
C) Skin-to-skin contact with the mother
D) Sucrose

Hearing loss is one of the genetic disorders that may be screened for in the newborn period. Auditory screening of all newborns within the first month of life is recommended by the Canadian Paediatric Society. Reasons for having this testing performed include (Select all that apply.)

a.

prevention or reduction of developmental delay.

b.

reassurance for concerned new parents.

c.

early identification and treatment.

d.

helping the child communicate better.

e.

mandated by all provinces.

A) Prevention or reduction of developmental delay
C) Early identification and treatment
D) Helping the child communicate better

A new mother recalls from prenatal class that she should try to feed her newborn whenever they exhibit hunger cues, rather than waiting until the infant is crying frantically. Which cue should the nurse alert this patient to regarding feeding their infant?
a.
The newborn is waving their arms in the air.
b.
The newborn is making sucking motions.
c.
The newborn is having hiccups.
d.
The newborn is stretching their legs out straight.

B) The newborn is making sucking motions

A new father is ready to take his partner and newborn home. He proudly tells the nurse who is discharging them that, within the next week, he plans to start feeding the infant cereal between breastfeeding sessions. What does the nurse explain to him about beginning solid foods before 6 months?
a.
It may decrease the infant's intake of sufficient calories.
b.
It may lead to decreased intake of breast milk.
c.
It may help the infant sleep through the night.
d.
It may limit the infant's growth.

B) It may lead to decreased intake of breast milk

A postpartum patient telephones about her 6-day-old newborn. They are not scheduled for a newborn weight check until the infant is 10 days old, and they are worried about whether breastfeeding is going well. What will the nurse teach the patient that indicates effective breastfeeding?
a.
Newborn sleeps for 6 hours at a time between feedings.
b.
Newborn has at least one breast milk stool every 24 hours.
c.
Infant gains 30 to 60 grams per week.
d.
Infant has at least six wet diapers per day.

D) Infant has at least six wet diapers per day

A primiparous patient wants to begin breastfeeding her newborn son as soon as possible. Which position best facilitates the infant's correct latch-on?
a.
With his arms folded together over his chest
b.
Curled up in a fetal position
c.
With his head cupped in her hand
d.
With his head and body in alignment

D) With his head and body in alignment

A breastfeeding patient develops engorged breasts at 3 days postpartum. What action would help this patient achieve their goal of reducing the engorgement?
a.
Skip feedings to let their sore breasts rest.
b.
Avoid using a breast pump.
c.
Breastfeed their infant frequently.
d.
Reduce their fluid intake for 24 hours.

C) Breastfeed their infant frequently

At a 2-month well-baby examination, it was discovered that a breastfed infant had only gained 300 g in the past 4 weeks. Which will best assist the baby to gain weight faster?
a.
Begin solid foods.
b.
Have a bottle of formula after every feeding.
c.
Add at least one extra breastfeeding session every 24 hours.
d.
Add a supplement to the breastmilk to enhance the calorie consumption.

C) Add at least one extra breastfeeding session every 24 hours

A new mother wants to be sure that they are meeting their newborn's needs while feeding them commercially prepared infant formula. The nurse should evaluate the mother's knowledge about appropriate infant care. Which indicates that the mother is meeting her child's needs?
a.
She adds rice cereal to her formula at 2 weeks of age to ensure adequate nutrition.
b.
She warms the bottles using a microwave oven.
c.
She burps her infant during and after the feeding as needed.
d.
She refrigerates any leftover formula for the next feeding.

C) She burps her infant during and after the feeding as needed

The nurse is discussing storage of breast milk with a mother whose infant is preterm and in the special care unit. Which information from the mother would indicate that they need additional teaching?
a.
Breastmilk can be stored in the refrigerator for 3 months.
b.
Breastmilk can be frozen in the freezer for 3 months.
c.
Breastmilk can remain at room temperature for 8 hours.
d.
Breastmilk can be in the refrigerator for 3 to 5 days.

A) Breastmilk can be stored in the refrigerator for 3 months

Which is correct regarding recommendations about infant nutrition according to the Canadian Paediatric Society?
a.
Infants should be given only human milk for the first 6 months of life.
b.
Formula-fed infants should be started on solid food sooner than breastfed infants.
c.
If infants are weaned from breast milk before 12 months, they should receive cow's milk, not formula.
d.
After 6 months mothers should shift from breast milk to cow's milk.

A) Infants should be given only human milk for the first 6 months of life

According to demographic research, which patient would be least likely to breastfeed and thus most likely to need education on the benefits and proper techniques of breastfeeding?
a.
A patient who is 30 to 35 years of age, white, and employed part-time outside the home.
b.
A patient who is younger than 25 years of age, has small breasts, and unemployed.
c.
A patient who is in her early 30s and is obese.
d.
A patient who is 35 years of age or older, white, and employed full-time at home.

C) A patient who is in her early 30s and is obese

Which is a late hunger cue in the newborn?
a.
Rooting
b.
Crying
c.
Tongue movements
d.
Hand to mouth movements

B) Crying

What is the best reason for recommending formula over breastfeeding?
a.
The mother has active tuberculosis.
b.
The mother lacks confidence in her ability to breastfeed.
c.
Other family members or care providers also need to feed the baby.
d.
The mother sees bottle-feeding as more convenient.

A) The mother has active tuberculosis

Which should nurses be aware of with regard to the nutrient needs of breastfed and formula-fed infants?
a.
Breastfed infants need extra water in hot climates.
b.
During the first 3 months breastfed infants consume more energy than formula-fed infants.
c.
Breastfeeding infants should receive oral vitamin D drops daily until their diet provides this or they are 1 year of age.
d.
Vitamin K injections at birth are not needed for infants fed on specially enriched formula.

C) Breastfeeding infants should receive oral vitamin D drops daily until their diet provides this or they are 1 year of age

Nurses providing nutritional instruction should be cognizant of the uniqueness of human milk. Which statement is correct?
a.
Frequent feedings during predictable growth spurts stimulate increased milk production.
b.
The milk of preterm mothers is the same as the milk of mothers who gave birth at term.
c.
The milk at the beginning of the feeding is the same as the milk at the end of the feeding.
d.
Colostrum is an early, less concentrated, less rich version of mature milk.

A) Frequent feedings during predictable growth spurts stimulate increased milk production

What should the nurse keep in mind when helping the breastfeeding mother position the baby for nursing?
a.
The cradle position usually is preferred by mothers who had a Caesarean birth.
b.
Patients with perineal pain and swelling prefer the modified cradle position.
c.
Whatever the position used, the infant's body is to be in alignment.
d.
While supporting the head, the mother should push gently on the occiput.

C) Whatever the position used, the infant's body is to be in alignment

The nurse is explaining the benefits associated with breastfeeding to a new mother. Which statement by the nurse would be inaccurate and provide conflicting information to the patient?
a.
Patients who breastfeed have a decreased risk of breast cancer.
b.
Breastfeeding is not an effective method of birth control.
c.
Breastfeeding increases bone density.
d.
Breastfeeding may enhance after birth weight loss.

B) Breastfeeding is not an effective method of birth control

Which can result in the infant experiencing difficulty latching onto the breast?
a.
Breastfeeding babies receive supplementary bottle feedings.
b.
The baby is weaned too abruptly.
c.
Pacifiers are used before breastfeeding is established.
d.
Twins are breastfed together.

A) Breastfeeding babies receive supplementary bottle feedings

What should the nurse advise the breastfeeding patient with regard to basic care?
a.
They will need an extra 1000 calories a day to maintain energy and produce milk.
b.
They can go back to pre-pregnancy fluid consumption as long as they get enough calcium.
c.
They should avoid trying to lose large amounts of weight.
d.
They must avoid exercising because it is too fatiguing.

C) They should avoid trying to lose large amounts of weight

The breastfeeding mother should be taught a safe method to remove the breast from the baby's mouth. Which suggestion by the nurse is most appropriate?
a.
Slowly remove the breast from the baby's mouth when the infant has fallen asleep and the jaws are relaxed.
b.
Break the suction by inserting your finger into the corner of the infant's mouth.
c.
A popping sound occurs when the breast is correctly removed from the infant's mouth.
d.
Elicit the Moro reflex to wake the baby and remove the breast when the baby cries.

B) Breaks the suction by inserting your finger into the corner of the infant's mouth

A mother who has just given birth and who intends to breastfeed tells their nurse, "I am so relieved that this pregnancy is over so I can start smoking again." The nurse encourages the patient to refrain from smoking. However, this new mother insists that she will resume smoking. How should the nurse adapt her health teaching?
a.
Smoking has little or no effect on milk production.
b.
There is no relation between smoking and the time of feedings.
c.
The effects of secondhand smoke on infants are less significant than for adults.
d.
The mother should not smoke within 2 hours of breastfeeding.

D) The mother should not smoke within 2 hours of breastfeeding

Which statement concerning the benefits or limitations of breastfeeding is inaccurate?
a.
Breast milk changes over time to meet changing needs as infants grow.
b.
Long-term studies have shown that the benefits of breast milk continue after the infant is weaned.
c.
Breastfeeding may enhance cognitive development.
d.
Breastfeeding increases the risk of childhood obesity.

D) Breasting increased the risk of childhood obesity

A pregnant patient wants to breastfeed her infant; however, her partner is not convinced that there are any scientific reasons to do so. The nurse can give the couple teaching comparing breastfeeding and bottle-feeding. Which statement is most accurate? Bottle-feeding using commercially prepared infant formulas
a.
increases the risk that the infant will develop allergies.
b.
helps the infant sleep through the night.
c.
ensures that the infant is getting iron in a form that is easily absorbed.
d.
requires that multivitamin supplements be given to the infant.

A) Increases the risk that the infant will develop allergies

Which type of formula is not diluted before being administered to a newborn?
a.
Powdered
b.
Concentrated
c.
Ready-to-use
d.
Modified cow's milk

C) Ready-to-use

How many kilocalories per kilogram (kcal/kg) of body weight does a breastfed term infant require each day?
a.
50 to 65
b.
75 to 90
c.
85 to 100
d.
150 to 200

C) 85 to 100

What is the hormone necessary for milk production?
a.
Estrogen
b.
Prolactin
c.
Progesterone
d.
Lactogen

B) Prolactin

To initiate the milk ejection reflex (MER), the mother should be advised to
a.
wear a firm-fitting bra.
b.
drink plenty of fluids.
c.
place the infant to the breast.
d.
apply cool packs to her breast

C) Place the infant to the breast

As the nurse assists a new mother with breastfeeding, the patient asks, "If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better?" The nurse's best response is that it contains
a.
more calories.
b.
essential amino acids.
c.
important immunoglobulins.
d.
more calcium.

C) Important immunoglobulins

When responding to the question "Will I produce enough milk for my baby as they grow and needs more milk at each feeding?" the nurse should explain that
a.
the breast milk will gradually become richer to supply additional calories.
b.
as the infant requires more milk, feedings can be supplemented with cow's milk.
c.
early addition of baby food will meet the infant's needs.
d.
the mother's milk supply will increase as the infant demands more at each feeding.

D) The mother's milk supply will increase as the infant demands more at each feeding

To prevent nipple trauma, the nurse should instruct the new mother to
a.
limit the feeding time to less than 5 minutes.
b.
position the infant so the nipple is far back in the mouth.
c.
assess the nipples before each feeding.
d.
wash the nipples daily with mild soap and water.

B) Position the infant so the nipple is far back in the mouth

Parents have been asked by the neonatologist to provide breastmilk for their newborn, who was born prematurely at 32 weeks of gestation. The nurse who instructs them about pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement by the parents is correct?
a.
A premature infant more easily digests breast milk than formula.
b.
A glass of wine just before pumping will help reduce stress and anxiety.
c.
The mother should pump only as much as the infant can drink.
d.
The mother should pump every 2 to 3 hours, including during the night.

A) A premature infant more easily digests breast milk than formula

A new mother asks whether they should feed their newborn colostrum, because it is not "real milk." The nurse's most appropriate answer is
a.
colostrum is high in antibodies, protein, vitamins, and minerals.
b.
colostrum is lower in calories than milk and should be supplemented by formula.
c.
giving colostrum is important in helping the mother learn how to breastfeed before she goes home.
d.
colostrum is unnecessary for newborns.

A) Colostrum is high in antibodies, protein, vitamins and minerals

Which nutrient's recommended dietary allowance (RDA) is higher during lactation than during pregnancy?
a.
Iodine
b.
Iron
c.
Vitamin A
d.
Folic acid

A) Iodine

Which should a nurse be aware of with regard to nutritional needs during lactation?
a.
The mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy.
b.
Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful.
c.
Critical iron and folic acid levels must be maintained.
d.
Lactating women can go back to their pre-pregnant calorie intake.

B) Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful