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

Chapter 34 Home Care of the Postpartum Family

1. The nurse is speaking to a community group about the controversy regarding the length of the hospital stay for postpartum clients. Which statement indicates that a participant needs additional information?
2. "As of 1998, there's a law that requires insurance to pay for a 48-hour stay after an uncomplicated birth."
3. "The length of stay was shortened by insurance companies to decrease healthcare costs."
4. "Early discharge became more popular in the 1980s as an alternative to having a home birth."
5. "With current length-of-stay laws, newborns have no problems at home, and get recommended follow-up care."

Page Ref: 915

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of 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: 2 Identify the main purposes of home visits during the postpartum period.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. A new mother is concerned about spoiling her newborn. The home care nurse teaches the mother which of the following?
2. Newborns can be manipulative, so caution is advised.
3. Meeting the infant's needs develops a trusting relationship.
4. An infant who is rocked to sleep every night is being spoiled.
5. Crying is good for babies, and letting them cry it out is advised.

Page Ref: 928

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Coping Mechanisms

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: 5 Describe assessment, care of the newborn, and reinforcement of parent teaching in the home.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The home care nurse is visiting a newborn-and-mother couplet. Which nursing action has the highest priority?
2. Establish rapport with the family members.
3. Review the hospital medical records.
4. Determine the newborn's sleeping arrangements.
5. Examine the umbilical cord stump.

Page Ref: 917

Cognitive Level: Applying

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: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Delineate aspects of fostering a caring relationship in the home.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The nurse is meeting with a new mother for the first time during a home visit. The client delivered her first child 3 days ago. She had a normal pregnancy and a vaginal delivery. The infant is breastfeeding. Which statements by the mother indicate that she needs more information about the home visit?

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

Select all that apply.

1. "You are going to check my baby's weight."
2. "You are going to watch me nurse the baby and give me tips."
3. "You are going to teach my mother about the baby."
4. "You are checking for safety issues when my son starts crawling."
5. "You are going to take blood samples from me and my son."

Page Ref: 918

Cognitive Level: Analyzing

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: 1 Discuss the components of postpartum home care.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The nurse is at the home of a postpartum client for an initial assessment. The client gave birth by cesarean section 1 week earlier. Which statements should the nurse include?

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

Select all that apply.

1. "Because you had a cesarean, I'd like to assess your incision."
2. "You aren't having any problems nursing, right?"
3. "How rested do you feel since you came home?"
4. "Because you are bottle-feeding, I won't assess your breasts."
5. "You should remain at home for the first 3 weeks after delivery."

Page Ref: 932

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Management of 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: 1 Discuss the components of postpartum home care.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. Late preterm infants have higher infant morbidity and mortality rates than term infants. Which of the following complications can they experience?
2. Hyperglycemia
3. Jaundice
4. Motor difficulties
5. Sensory complications

Page Ref: 919

Cognitive Level: Applying

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

Standards: Q S E N Competencies: Ⅰ. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | 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: Planning.

Learning Outcome: 1 Discuss the components of postpartum home care.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The nurse is teaching experienced postpartum nurses about home care visits. Which statements indicate that teaching was effective?

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

Select all that apply.

1. "I should tell the family to put any guns or knives away."
2. "It is best to blend in with the community and not bring attention to myself on visits."
3. "If I encounter a crime in progress, I should leave the area."
4. "Wearing jewelry is a good way to demonstrate my professionalism."
5. "Ignoring my 'gut' feelings might lead to an unsafe situation."

Page Ref: 918

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of 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: 3 Summarize actions the nurse should take to ensure personal safety during a home visit.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The nurse is planning a home care visit to a mother who just recently delivered. The neighborhood is known to have a significant crime rate. What should the nurse do when planning this visit to facilitate personal safety?
2. Be friendly to all pets encountered on the visit to build client rapport.
3. Wait to find the exact location until arrival in the neighborhood.
4. Put personal possessions in the trunk when leaving the office.
5. Wear flashy jewelry to garner respect.

Page Ref: 918

Cognitive Level: Analyzing

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

Standards: Q S E N Competencies: Ⅴ. C. 5. Value relationship between national safety campaigns and implementation in local practices and practice settings. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Commit to a generative safety culture. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 3 Summarize actions the nurse should take to ensure personal safety during a home visit.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The postpartum home care client asks the nurse why the visit is taking place. Which response is best?
2. "We make home care visits to reinforce any teaching that you didn't quite grasp in the hospital."
3. "We make home care visits to verify that both you and the baby are safe and doing well."
4. "We make home care visits to ensure you are breastfeeding correctly."
5. "We make home care visits to thoroughly assess your baby to make sure he is growing."

Page Ref: 917

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: 2 Identify the main purposes of home visits during the postpartum period.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. During a postpartum home visit, which step should the nurse take to establish a caring relationship?
2. Ask family members how they want to be addressed.
3. Do a portion of what the nurse agrees to do for the family, to avoid overwhelming them.
4. Speak directly to the father when asking questions.
5. Present information to the family instead of asking questions.

Page Ref: 917

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Therapeutic Communication

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 Delineate aspects of fostering a caring relationship in the home.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The nurse is making a postpartum home visit in the summer. The new father asks about taking the baby to a family outing this weekend. The nurse should encourage the father to do which of the following?
2. Cover the infant with dark blankets to block the sun.
3. Keep the infant in the shade.
4. Uncover the infant's head to prevent hyperthermia.
5. Avoid taking the infant outdoors for 6 months.

Page Ref: 923

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: 5 Describe assessment, care of the newborn, and reinforcement of parent teaching in the home.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The home care nurse is examining a newborn who is sleeping on a pillow in a basket, covered with a fluffy blanket. There is also a stuffed animal in the basket. The most important nursing action to do is which of the following?
2. Remove the stuffed animal from the basket and place it on the floor.
3. Teach the parents the risk of S I D S from soft items in the infant's bed.
4. Make certain that the blanket is firmly tucked under the baby.
5. Ask whether the color of the blanket has cultural significance.

Page Ref: 926

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of 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. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Summarize actions the nurse should take to ensure personal safety during a home visit.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. Babies should sleep in what position every time they are put down for sleep?
2. On their backs
3. On their stomachs
4. On their left sides
5. On their right sides

Page Ref: 926

Cognitive Level: Understanding

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

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. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Summarize actions the nurse should take to ensure personal safety during a home visit.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The nurse is performing a postpartum home care visit. Which teaching has the highest priority?
2. Teaching or reviewing how to bathe the baby
3. Teaching how to thoroughly childproof the house
4. How many wet diapers the baby should have daily
5. Prevention of plagiocephaly

Page Ref: 920

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. 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: 5 Describe assessment, care of the newborn, and reinforcement of parent teaching in the home.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. To prevent sudden infant death syndrome (S I D S), the nurse encourages the parents of a term infant to place the infant in which position when the infant is sleeping?
2. On the parents' waterbed
3. Swaddled in the infant swing
4. On the back
5. On the sides

Page Ref: 926

Cognitive Level: Understanding

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. 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: 3 Summarize actions the nurse should take to ensure personal safety during a home visit.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The postpartum home care nurse is assessing a new mother, and finds her temperature to be 101.6°F. What is the most important nursing action?
2. Ask the mother how often and how well the baby is nursing.
3. Determine the frequency of the mother's voiding and stooling.
4. Verify how many hours of sleep she is getting per day.
5. Assess the odor and color of the lochia and perineum.

Page Ref: 931

Cognitive Level: Applying

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. 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: Implementation.

Learning Outcome: 1 Discuss the components of postpartum home care.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The nurse should explain to new parents that their infant's position should be changed periodically during the early months of life to prevent which of the following?
2. Muscle contractures
3. Respiratory distress
4. Permanently flattened areas of the skull
5. Esophageal reflux

Page Ref: 926

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of 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: 5 Describe assessment, care of the newborn, and reinforcement of parent teaching in the home.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. Nurses should educate parents about which of the following A A P recommendations to promote a safe sleep environment and decrease the risk of S I D S and S U I D in infants less than 12 months of age?
2. Babies should not be offered a pacifier while falling asleep.
3. Babies should be bottle-fed unless contraindicated.
4. Babies should be under many covers when sleeping to keep them warm.
5. Babies should have "tummy time" when they are awake.

Page Ref: 926

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. 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: 3 Summarize actions the nurse should take to ensure personal safety during a home visit.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The nurse is assessing a new mother 2 days after a normal vaginal delivery. The mother has chosen not to breastfeed. What would an abnormal finding be?
2. Weight loss of 3 pounds
3. Small amount of breast milk expressed
4. Pink striae on the abdomen
5. Lochia serosa

Page Ref: 932

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. 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: Planning.

Learning Outcome: 6 Discuss maternal and family assessment and anticipated progress after birth.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The home care nurse is seeing a client at 6 weeks postpartum. Which statement by the client indicates the need for immediate intervention?
2. "The baby sleeps 7 hours each night now."
3. "My flow is red, and I need to wear a pad."
4. "My breasts no longer leak between feedings."
5. "I started back on the pill 2 weeks ago."

Page Ref: 933

Cognitive Level: Analyzing

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: Assessment.

Learning Outcome: 6 Discuss maternal and family assessment and anticipated progress after birth.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. A new mother at 36 hours post-delivery has asked to be discharged to home. The nurse explains that criteria for discharge before the newborn is 48 hours old include which of the following?
2. The newborn's respiratory rate is less than 60/min.
3. Singleton birth at a minimum 35 weeks' gestation.
4. The newborn has passed at least three spontaneous stools.
5. The newborn has normal and stable vital signs for 24 hours before discharge.

Page Ref: 916

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. 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 Discuss maternal and family assessment and anticipated progress after birth.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The postpartum client has chosen to bottle-feed her infant. Nursing actions that aid in lactation suppression include which of the following?
2. Warm showers
3. Pumping milk
4. Ice packs to each breast
5. Avoiding wearing a bra for 5 to 7 days

Page Ref: 932

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

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. 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 Describe appropriate nursing interventions for women who are experiencing breastfeeding difficulties.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The postpartum nurse is performing a home care visit to a first-time mother on her third day after delivery. She reports that her nipples are becoming sore. What statement indicates that further teaching is needed?
2. "I can apply lanolin cream to help with the nipple pain."
3. "Watching how much areola is visible will help me see whether my baby has a good mouthful of breast or not."
4. "My nipples will heal if I switch to bottle feeding for about 3 days while I pump my breasts."
5. "Rotating breastfeeding positions will allow the sore areas of my nipples to have less friction."

Page Ref: 937

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of 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: 7 Describe appropriate nursing interventions for women who are experiencing breastfeeding difficulties.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The postpartum home care nurse has performed home visits to four breastfeeding mothers. Which mother is experiencing an expected outcome?
2. Breasts are engorged; placing fresh cabbage leaves inside her bra
3. Sore and cracked nipples; using hydrogel dressings to facilitate healing
4. Breast engorgement; accompanied by erythema
5. Concerns about milk supply; supplementing with formula

Page Ref: 939

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

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: Assessment.

Learning Outcome: 7 Describe appropriate nursing interventions for women who are experiencing breastfeeding difficulties.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. A breastfeeding postpartum client reports sore nipples to the nurse during a home visit. What intervention would be the highest priority?
2. Infant positioning
3. Use of the breast shield
4. Use of breast pads
5. Type of soap used

Page Ref: 937

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

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: Respect the patient's dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 7 Describe appropriate nursing interventions for women who are experiencing breastfeeding difficulties.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The nurse is making an initial visit to a postpartum family's home. The mother states that she is having difficulty with breastfeeding. Which resource should the nurse tell the family about?
2. The lactation consultant at the hospital
3. Free immunizations through the county public health department clinics
4. Sources of free formula at a local food pantry
5. A support group for mothers who are experiencing postpartum depression

Page Ref: 937

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of 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: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan. | N L N Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 8 Identify postpartum resources that are available to new families.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. Before a newborn and mother are discharged from the hospital, the nurse informs the parents about routine screening tests for newborns. What is a good reason for having the screening tests done?
2. The tests prevent infants from developing phenylketonuria.
3. The tests detect such disorders as hypertension and diabetes.
4. The tests detect disorders that cause physical, intellectual, and developmental complications or death if left undiscovered.
5. The tests prevent sickle-cell anemia, galactosemia, and homocystinuria.

Page Ref: 930

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Management of 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: Ⅶ. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan. | N L N Competencies: Context and Environment: health promotion/disease prevention. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Discuss the components of postpartum home care.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The nurse is instructing a new mother on basic infant care. For which activities should the nurse suggest that the mother use the following infant hold?

1. Burping
2. Bottle feeding
3. Shampooing hair
4. Changing a diaper

Page Ref: 920

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: 5 Describe assessment, care of the newborn, and reinforcement of parent teaching in the home.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The nurse is reviewing the process of applying a pre-folded diaper with a new mother. In which order should the nurse provide these instructions?

Page Ref: 924

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: 5 Describe assessment, care of the newborn, and reinforcement of parent teaching in the home.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The nurse is preparing teaching material for a new mother. For which activity should the nurse provide the following diagram?

1. Preparing to feed
2. Wrapping the baby
3. Preparing for a bath
4. Changing the diaper

Page Ref: 924

Cognitive Level: Analyzing

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: 5 Describe assessment, care of the newborn, and reinforcement of parent teaching in the home.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.

1. The nurse is preparing an educational program for new parents. In which order should the nurse provide the Purple Crying information?
2. Unexpected
3. Long lasting
4. Pain-like face
5. Peak of crying
6. Resists soothing
7. Evening and late afternoon

Page Ref: 929

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: 5 Describe assessment, care of the newborn, and reinforcement of parent teaching in the home.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family at home.