On the first postpartum day, the nurse examines a new mother’s breasts.
What condition is the nurse most likely to find?

Soft, with no change from before delivery.

Filling and secreting colostrum.

Slightly firm with an immediate let-down response.

Firm, larger, and very tender to touch.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Immediately after delivery, the breasts of a new mother are not likely to remain the same as before delivery. Hormonal changes during pregnancy prepare the breasts for lactation, and these changes do not typically revert immediately after delivery.

Choice B rationale

On the first postpartum day, the breasts of a new mother are most likely to be filling and secreting colostrum. Colostrum is the first form of milk produced by the mammary glands, and it usually starts to be produced during pregnancy and continues during the early days of breastfeeding.

Choice C rationale

An immediate let-down response is not typically observed on the first postpartum day. The letdown reflex, which releases milk from the breast, usually becomes more pronounced after the first few days of breastfeeding.

Choice D rationale

While the breasts may become larger due to milk production, they are not typically very tender to touch on the first postpartum day. Tenderness may occur later, especially if complications like engorgement or mastitis develop.

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Correct Answer is B

Explanation

The correct answer is choice B: Thick, muffled voice.

Choice B rationale: A thick, muffled voice is a characteristic symptom of epiglottitis. The inflammation and swelling of the epiglottis cause an obstruction in the airway, leading to changes in the child's voice quality.

Choice A rationale: High-pitched wheezing is typically associated with conditions affecting the lower airways, such as asthma or bronchiolitis. Epiglottitis primarily affects the upper airway, causing stridor (a high-pitched, harsh sound during inhalation) rather than wheezing.

Choice C rationale: Purulent nasal discharge is not a typical symptom of epiglottitis. Epiglottitis usually presents with minimal or no secretions, while purulent discharge is more commonly seen in bacterial infections like sinusitis or pneumonia.

Choice D rationale: A productive cough is not a common symptom of epiglottitis. Coughing is associated with conditions affecting the lower respiratory tract, such as bronchitis or pneumonia. Epiglottitis primarily affects the upper airway, causing difficulty breathing and a characteristic "thick, muffled voice."

A. Draw the antibiotic trough level within 3 days. B. Administer antipyretic medication continuously. C. Continue strict monitoring of daily wet diapers for 1 week. D. Monitor the infant for response to auditory stimuli.

Correct Answer is D

Explanation

The correct answer is **d. Monitor the infant for response to auditory stimuli**.

Choice A rationale:

Drawing an antibiotic trough level within 3 days is not a necessary action after a 14-day antibiotic treatment for bacterial meningitis in an infant. Trough levels are typically monitored during the course of treatment to ensure appropriate dosing, not after completion of therapy.

Choice B rationale:

Administering antipyretic medication continuously is not recommended after the completion of antibiotic treatment for bacterial meningitis. Fever is a common symptom during the acute phase of the illness, and the need for antipyretics should decrease as the infection is resolved.

Choice C rationale:

Continuing strict monitoring of daily wet diapers for 1 week is not a necessary action after the completion of antibiotic treatment for bacterial meningitis. Monitoring fluid intake and output is important during the acute phase of the illness, but not necessarily after the infant has completed the full course of antibiotics.

Choice D rationale:

Monitoring the infant for response to auditory stimuli is an important action to include when preparing the family for discharge after a 14-day antibiotic treatment for bacterial meningitis. Hearing loss is a potential complication of bacterial meningitis, and the infant should be evaluated for any hearing impairment before being discharged from the hospital.

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On the first postpartum day, the nurse examines a new mother’s breasts. What condition is the nurse most likely to find?

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A 3-year-old male was brought into the emergency room this morning with a sudden onset of “fast and noisy breathing”. What other symptoms is the nurse likely to note in a child diagnosed with epiglottitis?

Correct Answer is B

Explanation

After a 14-day antibiotic treatment for bacterial meningitis in an infant, the nurse is preparing the family for discharge. Monitor the infant for response to auditory stimuli.

Correct Answer is D

Explanation

The nurse is evaluating the growth and development of a 3-year-old child. Which speech and language skills should the nurse identify as normal developmental milestones for this child?

What other symptoms is the nurse likely to note in a child diagnosed with epiglottitis?

The nurse receives 2 newborns within the first minutes after a vaginal delivery and intervenes to establish adequate respirations. What is the priority issue that the nurse should address to ensure the newborn’s survival?

The nurse is instructing the parents of a child who underwent a surgical repair of a myelomeningocele on how to change an occlusive dressing on the child’s back. Which parental statement indicates understanding of the procedure?

A client’s maternal serum alpha-fetoprotein level is elevated at 17 weeks. What condition should the nurse identify as the likely cause of this increase?

On the first postpartum day, the nurse examines a new mother’s breasts.
What condition is the nurse most likely to find?