NR-327 Maternal-Child Nursing - Set 5 - Part 1

Correct Answer: They have little brown fat and thin skin

Preterm infants store almost no brown fat, have thin permeable skin, lie in an extended posture and carry a large surface area, so body heat drains away within minutes. Option b is incorrect because preterm skin is gelatinous and thin rather than thick. Water evaporates straight through it, which strips heat away and also makes the skin fragile to handle. Option c is incorrect because newborns of any gestation do not shiver at all. Heat is generated by metabolizing brown fat instead, and the preterm infant simply has very little of it. Option d is incorrect because fat is laid down mostly during the last weeks of pregnancy. An infant born ten weeks early misses that deposition and looks wasted rather than well padded.

Correct Answer: Propping risks choking, ear infection and tooth decay

An unattended bottle lets milk pool in the nasopharynx, where it can be aspirated and where it tracks up the short eustachian tube. Prolonged contact with the teeth also causes early childhood caries. Option a is incorrect because duration is not the issue that makes this practice dangerous. A propped bottle usually empties faster than a paced feeding, and the newborn often takes more volume than he wanted. Option b is incorrect because formula does not curdle from sitting in a propped bottle. The spoilage concern is bacterial growth over time, which is why a bottle in progress is finished within an hour. Option d is incorrect because swallowed air is handled by burping, not by how the bottle is held up. Propping actually worsens air intake once the nipple empties, and no one is there to notice.

Correct Answer: A shrill cry, tremors and frantic sucking

Withdrawal drives the nervous system into overdrive, producing a high pitched inconsolable cry, tremors, stiff tone, sleeplessness and frantic ineffective sucking, along with sneezing, sweating, yawning and loose stools. Option b is incorrect because limpness and heavy sleep suggest depression of the nervous system rather than excitation. That picture would raise concern for sepsis, low glucose or bilirubin injury. Option c is incorrect because a rough cry with a slow pulse and chilly skin fits hypothyroidism or cold stress. Withdrawing infants usually run warm, sweaty and tachypneic instead. Option d is incorrect because being settled and easily comforted describes an infant who is not withdrawing. Difficulty consoling is one of the three questions the eat, sleep, console approach asks.

Correct Answer: Offer a progestin only method or an intrauterine device

Estrogen is unacceptable in the first three weeks after birth because clotting risk peaks then, and it may reduce milk supply, so a progestin only method or either intrauterine device is offered instead. Option a is incorrect because handing over estrogen at this point ignores the highest venous thromboembolism risk of the whole year. Correct pill technique matters little if the method itself is unsafe today. Option b is incorrect because postponing everything leaves her unprotected at the very point when intercourse often resumes. Progestin methods and both devices are suitable now and do not interfere with milk production. Option c is incorrect because the three conditions that make lactational amenorrhea reliable can fail without warning, and one bottle or one bleed ends the protection. She asked for a method, and an effective one is available today.

Correct Answer: Dry the newborn and remove the damp linen

Evaporation of amniotic fluid from wet skin is the largest source of heat loss in the delivery room, so drying the newborn thoroughly and taking away the damp linen comes before every other measure. Option b is incorrect because a cap conserves heat from the large head surface, yet it does nothing for the moisture already sitting on the skin. Warmth is lost through vapor until the infant is dried. Option c is incorrect because weighing belongs to the routine measurements that follow stabilization. Placing a still wet infant on a scale adds a second route of loss through contact with a cool surface. Option d is incorrect because eye prophylaxis guards against gonococcal infection and may wait up to two hours. Delaying it costs nothing, while leaving the skin wet drives the temperature down within minutes.

Correct Answer: Hand express to soften the areola before latching

Softening the areola by hand expression or reverse pressure lets the newborn take a deep latch, and frequent effective removal is what resolves engorgement. Cold packs between feeds ease the swelling and throbbing. Option a is incorrect because leaving milk in the breast is what produced this problem. Stasis worsens the interstitial swelling, invites a plugged duct or mastitis, and tells the lactocytes to cut back production. Option b is incorrect because prolonged heat increases blood flow into tissue that is already congested. Brief warmth just before a feeding helps let down, but cold is the right choice for the interval between feeds. Option d is incorrect because binding belongs to the mother who has chosen not to nurse. For a woman who is breastfeeding, compression plus skipped feedings guarantees more stasis and sets her up for mastitis.

Correct Answer: Report the asymmetric response to the provider

A Moro that appears on one side only suggests a fractured clavicle, brachial plexus injury, or hemiparesis. Asymmetry is the most significant abnormal reflex finding and belongs in the provider's hands. Option a is incorrect because a normal Moro is symmetric, with both arms extending and then embracing together. Charting a one sided response as expected buries a finding that needs evaluation today. Option b is incorrect because repeating the test later will not change an arm that cannot move. Feeding has no bearing on the reflex, and the delay postpones imaging of the clavicle. Option c is incorrect because primitive reflexes are present at birth in a term infant rather than developing gradually. False reassurance here leaves a possible nerve injury unexamined during the days it matters most.

Correct Answer: Metabolism of brown fat stores

Newborns cannot shiver, so they rely on non shivering thermogenesis. Norepinephrine triggers lipolysis in brown adipose tissue at the neck, scapulae, and around the kidneys, releasing heat that warms the blood flowing past. Option b is incorrect because the muscle activity of shivering is not available to a newborn. That reflex matures later in infancy, leaving brown fat metabolism as the only heat producing option now. Option c is incorrect because vasoconstriction only limits how fast warmth escapes from the skin surface. Conserving heat is not the same as making it, and the infant still needs an active source. Option d is incorrect because flexion and squirming contribute very little warmth. Posture is the newborn's single behavioral defense against cold, and it cannot replace the chemical heat produced inside brown adipose tissue.

Correct Answer: "His wet diapers should increase each day during the first week."

Wet diapers roughly track the day of life during the first week, reaching six or more by about the fifth day. Rising output together with yellow seedy stools tells the mother transfer is adequate. Option a is incorrect because breasts normally stop feeling tight once production matches what the infant takes. That change happens around the third or fourth week and reflects calibration, not loss of milk. Option b is incorrect because swallowing should be heard at every feeding once let down occurs. Its absence, not its presence, is the warning sign, so limiting the expectation to one feeding misses the point entirely. Option c is incorrect because a newborn is not expected back at birth weight for ten to fourteen days. Losing up to a tenth of that weight in the first days is ordinary and stops by the fifth day.

Correct Answer: "I will scrub my nipples with soap before every feeding."

Soap strips the natural lubricant that Montgomery tubercles secrete and worsens cracking. Plain water during the daily shower is all the cleansing needed, so this statement shows the mother missed a key point. Option a is incorrect because starting on the less sore breast is sound advice. Let down happens in both breasts at once, so the tender side then receives a gentler, less vigorous suck. Option b is incorrect because expressed milk left to air dry on the nipple is a recommended remedy. Human milk has antibacterial properties and promotes healing, making this statement evidence that the teaching landed. Option d is incorrect because releasing the seal first is precisely what protects an injured nipple. A finger slipped between the gums ends the vacuum, and pulling a latched newborn off is what causes tears.

Correct Answer: Position side lying and bulb suction the mouth

The second period of reactivity brings a surge of oral mucus with gagging and choking. Turning the infant to the side and suctioning the mouth before the nose clears the airway promptly. Option a is incorrect because an infant who clears the mucus and pinks up does not need an emergency team. Escalation is reserved for a newborn who fails to recover after suctioning and repositioning. Option c is incorrect because feeding an infant whose mouth is full of secretions invites aspiration. The airway must be cleared first, and only then is this window a good time to nurse. Option d is incorrect because warmth addresses temperature, not a blocked airway. Nothing in this picture suggests cold, and moving the newborn under the warmer would delay the suctioning that solves the problem.

Correct Answer: Applying baby lotion to the dry skin

Lotions, oils, powders and ointments absorb light energy and cause burns on skin under the lights, so the nurse stops the student immediately and keeps the skin bare and dry. Option a is incorrect because turning the infant regularly exposes every skin surface to the blue light. Rotation is part of the standard protocol and needs no correction from the nurse. Option b is incorrect because temperature checks catch both overheating under the lamps and chilling in an uncovered infant. Watching thermal status closely is exactly what this treatment demands. Option d is incorrect because frequent feeding replaces the water lost through skin and loose stools. Extra milk also speeds gut transit, which carries more bilirubin out of the body.

Correct Answer: The newborn is latched too shallowly onto the nipple

A nipple that comes out creased, wedged or lipstick shaped, together with pain lasting the whole feeding, means the infant has only the nipple and too little areola. The latch must be corrected. Option b is incorrect because mastitis announces itself with fever near one hundred one degrees, chills and body aching, plus a red wedge on one breast. Nothing in this picture matches that. Option c is incorrect because suck strength does not deform a nipple when the mouth is positioned well. A deeply attached newborn draws tissue far back past the gums, and the nipple emerges round and elongated. Option d is incorrect because shortening feeds treats the symptom and starves the newborn. Duration is led by the infant, and cutting time at the breast lowers intake and supply while leaving the faulty attachment untouched.

Correct Answer: Explain that output and weight show supply is adequate

Eight wet diapers and steady weight gain are the objective evidence that transfer is fine. Breasts soften once production calibrates, and a pump never draws as well as an infant, so neither worry reflects real shortage. Option a is incorrect because every bottle removes a feeding from the breast. Milk that stays in the alveoli builds feedback inhibitor of lactation, production falls, and the mother's fear turns into an actual shortage. Option b is incorrect because drugs to boost milk are not first line, and this mother has no deficit to treat. Evidence for them is thin, and none of them work without more frequent removal anyway. Option c is incorrect because pump yield is a poor gauge of what the breast makes. Measuring it would reinforce the very misconception driving her anxiety, since an efficient infant empties far more than any device.

Correct Answer: Explain that partners often grieve through activity

Many partners grieve instrumentally, through work and activity rather than tears, and the nurse explains that a different style is not a measure of love, since mismatched grieving is a common source of conflict. Option b is incorrect because silence at home is what most damages couples after a loss. Both parents need permission to speak about the baby, and shutting down the subject deepens the distance she already feels. Option c is incorrect because busy activity three weeks after a stillbirth is a recognized grief style, not a diagnosis. Referral would be considered if he became unable to function or spoke of harming himself. Option d is incorrect because more separation answers the wrong problem. She is describing a gap between them, and leaving him alone would confirm her belief that he stopped caring about their baby.

Correct Answer: The lips are flanged out and swallowing is audible

Flanged lips seal the breast, and audible swallowing proves milk is actually transferring. Together with a chin pressed into the breast and rounded cheeks, these confirm the newborn has taken enough areola. Option a is incorrect because inturned lips break the seal the infant needs. Curled under lips chafe the nipple and let milk stay behind in the breast, so the mother should ease them outward. Option c is incorrect because dimpling signals lost suction rather than good attachment. Cheeks that pull inward usually accompany clicking sounds and mean the tongue is not cupping the breast tissue properly. Option d is incorrect because nipple only feeding compresses tissue never meant to bear it. The infant must take a large mouthful of areola to reach the ducts, so the mother stays sore and transfer suffers.

Correct Answer: Swaddle the infant and reduce light and noise

A quiet dim space, snug swaddling with hands to midline, gentle rocking and clustered care calm an overloaded nervous system, and this comes before any consideration of medication for this infant. Option a is incorrect because bright light adds to the sensory load that is already overwhelming this infant. Dimming the room and covering the crib are standard parts of withdrawal care. Option b is incorrect because repeated stimulation triggers more tremors and crying in a withdrawing newborn. Care is clustered so the infant gets long stretches of undisturbed rest between contacts. Option d is incorrect because these infants suck frantically, vomit and pass loose stools, so small feedings offered often work better. Large widely spaced volumes worsen regurgitation and weight loss.

Correct Answer: Left atrial pressure now exceeds right atrial pressure

Lung expansion drops pulmonary vascular resistance and sends more blood back to the left atrium, while removal of the placenta lowers right sided pressure. The higher left pressure presses the flap shut. Option a is incorrect because rising arterial oxygen is what constricts the ductus arteriosus, a different fetal channel. The atrial flap answers to chamber pressures rather than to the oxygen content of blood. Option b is incorrect because falling prostaglandin after placental separation also acts on the ductus arteriosus. Naming that hormone here confuses the vessel between the pulmonary artery and aorta with the atrial opening. Option c is incorrect because clamping the cord shuts down the ductus venosus, the shortcut past the liver. It changes atrial pressures indirectly, yet it is not the event that closes the flap.

Correct Answer: Start emergency contraception as soon as possible

Emergency contraception works by delaying ovulation, so effectiveness falls with every hour of delay, and the client is told to take it as soon as she can rather than wait for anything. Option a is incorrect because waiting throws away the only window in which the ovum can still be stopped from being released. By the time a period is missed, implantation has already occurred. Option b is incorrect because a test performed now would reflect an earlier cycle, not last night. Screening first delays the dose without adding information, which is why testing is never required beforehand. Option d is incorrect because an appointment weeks later addresses nothing about this exposure. Emergency methods carry a strict limit of a few days, and copper device placement or an oral dose must happen inside it.

Correct Answer: Observe a full feeding and assess the latch

Sore nipples almost always come from a shallow latch or poor positioning, so watching an entire feeding is the assessment that identifies the cause. Correcting attachment relieves pain and protects the mother's supply. Option a is incorrect because cutting feeds short trades one problem for another. The newborn loses the fatty hindmilk that drives weight gain, the breast is left full, and the shallow attachment that caused the pain persists. Option b is incorrect because alcohol dries and cracks skin that is already injured. Montgomery glands supply their own protective lubricant, and plain water in the shower is all the cleansing a nipple ever needs. Option c is incorrect because bottles given for a fixable problem start a downward spiral in production. Milk left in the breast signals the cells to slow, and the mother is likelier to wean before she intended.