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)

Keep the baby on his to back to sleep

Keep the cord as dry as possible until it falls off

Always keep the baby dressed and wrapped in 2 blankets when you go outside

After your milk comes in your baby should have 3-4 wet or dirty diapers a day

Have the bulb syringe near the baby at all times

Answer and Explanation

Correct Answer : A,B,E

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.

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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.

A. A rubella injection is advised B. A blood transfusion is advised C. The nurse should contact the provider for an antibiotic order an D. RhoGAM injection should be administered within 72 hours

Correct Answer is A

Explanation

A) A rubella injection is advised:
Since the rubella titer is non-immune, the woman is not protected against rubella, which is important to address during the postpartum period. The rubella vaccine is typically given to women who are non-immune to rubella after childbirth, but it is contraindicated during pregnancy because it is a live vaccine. The best action in this case would be to administer the rubella vaccine to the postpartum woman before discharge, with instructions to avoid becoming pregnant for at least 28 days after vaccination to prevent harm to a future fetus.

B) A blood transfusion is advised:
The hematocrit of 30% indicates that the woman has mild anemia, but it does not require immediate intervention like a blood transfusion. Normal hematocrit levels for postpartum women typically range between 32% and 42%. A transfusion would be indicated if the hematocrit were much lower (usually below 20-25%) or if there were symptoms of significant blood loss, which are not indicated in this case.

C) The nurse should contact the provider for an antibiotic order:
There is no indication from the provided laboratory results or the scenario that the woman requires antibiotics. Group B Streptococcus (GBS) was negative, which eliminates the need for prophylactic antibiotics. There is no mention of any infection risk requiring an antibiotic prescription, and since her GBS result is negative, antibiotics are not warranted.

D) RhoGAM injection should be administered within 72 hours:
RhoGAM (Rh immunoglobulin) is typically administered to a woman with Rh-negative blood who has given birth to an Rh-positive baby to prevent Rh sensitization in future pregnancies. In this case, the woman has an Rh-positive blood type (A+), so she does not need RhoGAM. RhoGAM would only be necessary if the woman had an Rh-negative blood type, which she does not.

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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)

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Correct Answer is A

Explanation

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Correct Answer is A

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