Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 28 The Normal Newborn: Needs and Care

1. The parents of a newborn male ask the nurse whether they should circumcise their son. What is the best response by the nurse?
2. "Circumcision should be undertaken to prevent problems in the future."
3. "Circumcision might decrease the child's risk of developing a urinary tract infection."
4. "Circumcision can sometimes cause complications. What questions do you have?"
5. "Circumcision is painful, and should be avoided unless you are Jewish."

Page Ref: 707

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Discuss the common concerns of families regarding their newborns.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse tells a mother that the doctor is preparing to circumcise her newborn. The mother expresses concern that the infant will be uncomfortable during the procedure. The nurse explains that the physician will numb the area before the procedure. Additional methods of comfort often used during the procedure include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Providing a pacifier
2. Stroking the head
3. Restraining both arms and legs
4. Talking to the infant
5. Giving the infant a sedative before the procedure

Page Ref: 708

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Discuss the common concerns of families regarding their newborns.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is caring for four newborns who have recently been admitted to the newborn nursery. Which labor event puts the newborn at risk for an alteration of health?
2. The infant's mother has group B streptococcal (G B S) disease.
3. The infant's mother had an I V of lactated Ringer's solution.
4. The infant's mother had a labor that lasted 12 hours.
5. The infant's mother had a cesarean birth with her last child.

Page Ref: 704

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Summarize the essential areas of information to be obtained about a newborn's birth experience and immediate postnatal period.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse initiates newborn admission procedures and evaluates the newborn's need to remain under observation by assessing which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Respiratory rate
2. Skin texture
3. Airway clearance
4. Ability to feed
5. Head weight

Page Ref: 699

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Summarize the essential areas of information to be obtained about a newborn's birth experience and immediate postnatal period.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse has just assisted the father in bathing the newborn 2 hours after birth. The nurse explains that the newborn must remain in the radiant warmer. This is based on which assessment data?
2. Heart rate 120
3. Temperature 96.8°F
4. Respiratory rate 50
5. Temperature 99.6°F

Page Ref: 701

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 2 Explain how the physiologic and behavioral responses of a newborn during the first 4 hours after birth (admission and transitional period) determine the newborn's nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. In planning care for a new family immediately after birth, which procedure would the nurse most likely withhold for 1 hour to allow time for the family to bond with the newborn?
2. Eye prophylaxis medication
3. Drying the newborn
4. Vital signs
5. Vitamin K injection

Page Ref: 704

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Explain how the physiologic and behavioral responses of a newborn during the first 4 hours after birth (admission and transitional period) determine the newborn's nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse assesses the newborn and notes the following behaviors: nasal flaring, facial grimacing, and excessive mucus. What is the nurse most concerned about?
2. Neonatal jaundice
3. Neonatal hypothermia
4. Neonatal hyperthermia
5. Respiratory distress

Page Ref: 704

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Explain how the physiologic and behavioral responses of a newborn during the first 4 hours after birth (admission and transitional period) determine the newborn's nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. A nurse is instructing nursing students about the procedure for vitamin K administration. What information should be included?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Gently massage the site after injection.
2. Use a 22-gauge, 1-inch needle.
3. Inject in the vastus lateralis muscle.
4. Cleanse the site with alcohol prior to injection.
5. Inject at a 45-degree angle.

Page Ref: 703

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 1 Summarize the essential areas of information to be obtained about a newborn's birth experience and immediate postnatal period.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. To maintain a healthy temperature in the newborn, which of the following actions should be taken?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Keep the newborn's clothing and bedding dry.
2. Reduce the newborn's exposure to drafts.
3. Do not use the radiant warmer during procedures.
4. Do not wrap the newborn.
5. Encourage the mother to snuggle with the newborn under blankets.

Page Ref: 702

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Explain how the physiologic and behavioral responses of a newborn during the first 4 hours after birth (admission and transitional period) determine the newborn's nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse has received the shift change report on infants born within the previous 4 hours. Which newborn should the nurse see first?
2. 37-week male, respiratory rate 45
3. 8 pound 1 ounce female, pulse 150
4. Term male, nasal flaring
5. 4-hour-old female who has not voided

Page Ref: 704

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Explain how the physiologic and behavioral responses of a newborn during the first 4 hours after birth (admission and transitional period) determine the newborn's nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse assesses a sleeping 1-hour-old, 39-weeks'-gestation newborn. The assessment data that would be of greatest concern would be which of the following?
2. Temperature 97.9°F
3. Respirations 68 breaths/minute
4. Stable vital signs 45 minutes ago
5. Heart rate 156 beats/min

Page Ref: 700

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Explain how the physiologic and behavioral responses of a newborn during the first 4 hours after birth (admission and transitional period) determine the newborn's nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. A newborn delivered at term is being discharged. The parents ask the nurse how to keep their baby warm. The nurse knows additional teaching is necessary if a parent states which of the following?
2. "A quick cool bath will help wake up my son for feedings."
3. "I can check my son's temperature under his arm."
4. "My baby should be dressed warmly, with a hat."
5. "Cuddling my son will help to keep him warm."

Page Ref: 701

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 4 Discuss the common concerns of families regarding their newborns.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is administering erythromycin (Ilotycin) ointment to a newborn. What factors are associated with administration of this medication?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. The medication should be instilled in the lower conjunctival sac of each eye.
2. The eyelids should be massaged gently to distribute the ointment.
3. The medication must be given immediately after delivery.
4. The medication does not cause any discomfort to the infant.
5. The medication can interfere with the baby's ability to focus.

Page Ref: 703

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Stay current in professional healthcare knowledge. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Explain how the physiologic and behavioral responses of a newborn during the first 4 hours after birth (admission and transitional period) determine the newborn's nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is caring for a newborn who was recently circumcised. Which nursing intervention is appropriate following the procedure?
2. Keep the infant N P O for 4 hours following the procedure.
3. Observe for urine output.
4. Wrap dry gauze tightly around the penis.
5. Clean with cool water with each diaper change.

Page Ref: 708

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Stay current in professional healthcare knowledge. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Explain how the physiologic and behavioral responses of a newborn during the first 4 hours after birth (admission and transitional period) determine the newborn's nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. A postpartum mother is concerned that her newborn has not had a stool since birth. The newborn is 18 hours old. What is the nurse's best response?
2. "I will call your pediatrician immediately."
3. "Passage of the first stool within 48 hours is normal."
4. "Your newborn might not have a stool until the third day."
5. "Your newborn must be dehydrated."

Page Ref: 705

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Discuss the common concerns of families regarding their newborns.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. At birth, an infant weighed 8 pounds 4 ounces. Three days later, the newborn is being discharged. The parents note that the baby now weighs 7 pounds 15 ounces. The nurse explains that the change in the newborn's weight is which of the following?
2. Excessive
3. Within normal limits
4. Less than expected
5. Unusual

Page Ref: 705

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Discuss the common concerns of families regarding their newborns.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse teaches the parents of an infant who was recently circumcised to observe for bleeding. What should the parents be taught to do if bleeding does occur?
2. Wrap the diaper tightly.
3. Clean with warm water with each diaper change.
4. Apply gentle pressure to the site with gauze.
5. Apply a new petroleum ointment gauze dressing.

Page Ref: 709

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. To promote infant security in the hospital, the nurse instructs the parents of a newborn to do which of the following?
2. Keep the baby in the room at all times.
3. Check the identification of all personnel who transport the newborn.
4. Place a "No Visitors" sign on the door.
5. Keep the baby in the nursery at all times.

Page Ref: 706

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network. | N L N Competencies: Quality and Safety: Promote communication and open reporting as a priority in healthcare. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse has instructed a new mother on quieting activities for her newborn. The nurse knows that the mother understands when she overhears the mother telling the father to do what?
2. Hold the newborn in an upright position.
3. Massage the hands and feet.
4. Swaddle the newborn in a blanket.
5. Make eye contact while talking to the newborn.

Page Ref: 710

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. Before the newborn and mother are discharged from the birthing unit, the nurse teaches the parents about newborn screening tests that includes which of the following?
2. Preeclampsia screening
3. Congenital kidney disease screening
4. Visual screening
5. Hearing screening

Page Ref: 713

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. Placing the baby at mother's breast facilitates early latch and promotes successful breastfeeding. When should breastfeeding be initiated?
2. 6 to 12 hours after birth
3. Within 1 hour of birth
4. 24 hours after birth
5. 48 hours after birth

Page Ref: 704

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 6. Describe strategies to empower patients or families in all aspects of the healthcare process. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Stay current in professional healthcare knowledge. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Explain how the physiologic and behavioral responses of a newborn during the first 4 hours after birth (admission and transitional period) determine the newborn's nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is instructing parents of a newborn about voiding and stool characteristics. Which of the following would be considered an abnormal pattern?
2. Large amounts of uric acid crystals in the first days of life
3. At least 6 to 10 wet diapers a day after the first few days of life
4. 1 to 2 stools a day for a formula-fed baby
5. Urine that is straw to amber color without foul smell

Page Ref: 715

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse should inform the parents of a newborn that they should call their healthcare provider when which of the following occurs?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Continual rise in temperature
2. Decreased frequency of stools
3. Absence of breathing longer than 20 seconds
4. Lethargy
5. Refusal of two feedings in a row

Page Ref: 716

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is instructing a new mother on circumcision care with a Plastibell. The nurse knows the mother understands when she states that the Plastibell should fall off within how long?
2. 2 days
3. 10 days
4. 8 days
5. 14 days

Page Ref: 716

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. New parents decide not to have their newborn circumcised. What should the nurse teach regarding care for the uncircumcised infant?
2. The foreskin will be retractable at 2 months.
3. Retract the foreskin and clean thoroughly.
4. Avoid retracting the foreskin.
5. Use soap and Betadine to cleanse the penis daily.

Page Ref: 716

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. A postpartum client calls the nursery to report that her newborn's umbilical cord stump is draining, and has a foul odor. What is the nurse's best response?
2. "Take your newborn to the pediatrician."
3. "Cover the cord stump with gauze."
4. "Apply Betadine around the cord stump."
5. "This is normal during healing."

Page Ref: 715

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Encourage patients and families to communicate their observations and concerns regarding safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Discuss the common concerns of families regarding their newborns.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is analyzing various strategies for teaching new mothers about newborn care. To enhance learning, which teaching method should the nurse implement?
2. Select videos on various topics of newborn care.
3. Organize a class that includes first-time mothers only.
4. Have mothers return in 1 week, when they feel more rested.
5. Schedule time for one-to-one teaching in the mother's room.

Page Ref: 711

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is discussing parent-infant attachment with a prenatal class. Which statement indicates that teaching was successful?
2. "I should avoid looking directly into the baby's eyes to prevent frightening the baby."
3. "My baby will be very sleepy immediately after birth and should go to the nursery."
4. "Newborns cannot focus their eyes, so it doesn't matter how I hold my new baby."
5. "Giving my baby his first bath can really give me a chance to get to know him."

Page Ref: 705

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is working with new parents who have recently immigrated to the United States. The nurse is not familiar with the family's cultural background. Which approach is most appropriate when discussing the newborn?
2. "You appear to be Muslim. Do you want your son circumcised?"
3. "Let me explain newborn care here in the United States."
4. "Your baby is a United States citizen. You must be very happy about that."
5. "Could you explain your preferences regarding childrearing?"

Page Ref: 710

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Therapeutic Communication

Standards: Q S E N Competencies: Ⅰ. C. 6. Willingly support patient-centered care for individuals and groups whose values differ from own. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Describe the influence of cultural values on newborn care.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is working with an adolescent mother who tells the nurse, "I'm really scared that I won't take care of my baby correctly. My mother says I'll probably hurt the baby because I'm too young to be a mother." What is the best response by the nurse?
2. "You are very young, and parenting will be a challenge for you."
3. "Your mother was probably right. Be very careful with your baby."
4. "Mothers have instincts that kick in when they get their babies home."
5. "We can give the baby a bath together. I'll help you learn how to do it."

Page Ref: 701

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 7 Discuss safety needs of the newborn that would ensure integration into the family unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is planning visits to the homes of new parents and their newborns. Which client should the nurse see first?
2. 3-day-old male who received hepatitis B vaccine prior to discharge
3. 4-day-old female whose parents are both hearing-impaired
4. 5-day-old male with light, sticky, yellow drainage on the circumcision site
5. 6-day-old female with greenish discharge from the umbilical cord site

Page Ref: 715

Cognitive Level: Analyzing

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Discuss the common concerns of families regarding their newborns.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is instructing the parents of a newborn about car seat safety. Which statement indicates that the parents need additional information?
2. "The baby should be in the back seat."
3. "Newborns must be in rear-facing car seats."
4. "We need instruction on how to use the car seat before installing it."
5. "We can bring the baby home from the hospital without a car seat, as it is only a short drive."

Page Ref: 713

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is discharging a 15-year-old first-time mother. Which statement should the nurse include in the discharge teaching?
2. "Call your pediatrician if the baby's temperature is below 98.6°F axillary."
3. "Your baby's stools will change to a greenish color when your milk comes in."
4. "You can wipe away any eye drainage that might form."
5. "Your infant should wet a diaper at least 6 times per day."

Page Ref: 716

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is preparing to provide a newborn with an injection of vitamin K. In which order should the nurse complete the following steps?
2. Cleanse skin with alcohol and allow to dry
3. Aspirate and then inject the medication slowly
4. Insert a 25-gauge 5/8 inch needle at a 90 degree angle
5. Remove the needle and massage with an alcohol swab
6. Bunch skin over mid-anterior lateral aspect of the thigh

Page Ref: 702

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation; Nursing Process.

Learning Outcome: 1 Summarize the essential areas of information to be obtained about a newborn's birth experience and immediate postnatal period.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is preparing to provide a newborn with a prescribed intramuscular injection. Which area should the nurse use for this injection?

1. A
2. B
3. C
4. D

Page Ref: 703

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 1 Summarize the essential areas of information to be obtained about a newborn's birth experience and immediate postnatal period.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse obtains the following device to be used on a newborn. For which procedure is the nurse preparing this infant?

1. Hearing test
2. Circumcision
3. Neurological exam
4. Assess for umbilical hernia

Page Ref: 708

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Nursing Process.

Learning Outcome: 4 Discuss the common concerns of families regarding their newborns.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The nurse is preparing to instruct the parents of a newborn on the care of the umbilical cord. In which order should the nurse provide these instructions?
2. Check the cord for color
3. Wash hands with soap and water
4. Fold diaper below umbilical cord
5. Clean cord and base of cord with cotton swab
6. Check the cord for odor or oozing of green material

Page Ref: 715

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.

1. The mother of a ne wly circumcised infant is concerned about caring for the infant at home. What should the nurse instruct the mother about the infant's care? Place the following actions in the order that should be instructed to the mother.
2. Pat dry
3. Rinse area with warm water
4. Fasten diaper snuggly over the penis
5. Apply small amount of petroleum jelly
6. Squeeze water over the circumcision site

Page Ref: 715

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 6 Identify opportunities to individualize parent teaching and enhance parent's abilities and confidence while providing newborn care in the birthing unit.

M N L L O: Demonstrate use of the nursing process in the care of the normal newborn.