Chapter 35 Home Care of the Postpartum Family My Nursing Test Banks

Olds Maternal-Newborn Nursing and Womens Health, 10e (Davidson)

Chapter 35 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?

1. As of 1998, theres a law that requires insurance to pay for a 48-hour stay after an uncomplicated birth.

2. The length of stay was shortened by insurance companies to decrease healthcare costs.

3. Early discharge became more popular in the 1980s as an alternative to having a home birth.

4. With current length-of-stay laws, newborns have no problems at home, and get recommended follow-up care.

Answer: 4

Explanation: 4. Even with the current length-of-stay laws, many newborns do not always receive the recommended follow-up care when they go home early. The health and stability of the mother and baby, the mothers ability and confidence regarding self and newborn care, support systems available, and access to follow-up care should form the basis of the decision.

Page Ref: 914

Cognitive Level: Applying

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

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1 Explain the history of the controversy surrounding length of stay (LOS).

MNL LO: 5.4.1 Develop a discharge teaching plan for the postpartum patient.

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2) A nurse is performing a postpartum assessment during the first home visit to a client 3 days postdelivery. Which actions will the nurse perform?

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

Select all that apply.

1. Palpate the breasts.

2. Auscultate the carotid.

3. Check vaginal discharge.

4. Assess the extremities.

5. Inspect the perineum.

Answer: 1, 3, 4, 5

Explanation: 1. The nurse needs to assess for fullness and engorgement.

3. The nurse should check vaginal discharge for amount and color.

4. The extremities should be checked for any redness, edema, and tenderness.

5. The perineum needs to be checked for healing.

Page Ref: 929

Cognitive Level: Analyzing

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

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN 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. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2 Discuss the components of postpartum home care.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

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3) A mother and her newborn have been discharged after a hospital stay of less than 48 hours. What are essential components the nurse must include in the first postpartum home visit?

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

Select all that apply.

1. Assessment of color

2. Measurement of weight

3. Measurement of height

4. Assessment of mother-newborn interaction

5. Reinforcement of information about feeding and sleep patterns

Answer: 1, 2, 4, 5

Explanation: 1. The nurse should assess the newborns general health, hydration, and degree of jaundice.

2. The nurse should weigh the infant.

4. This is an opportune time to assess the quality of mother-newborn interaction and details of newborn behavior.

5. Parents frequently need further clarification and reinforcement of maternal or family education in neonatal care, particularly feeding and sleep position.

Page Ref: 915

Cognitive Level: Applying

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

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN 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. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Discuss the components of postpartum home care.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

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4) A new mother is concerned about spoiling her newborn. The home care nurse teaches the mother which of the following?

1. Newborns can be manipulative, so caution is advised.

2. Meeting the infants needs develops a trusting relationship.

3. An infant who is rocked to sleep every night is being spoiled.

4. Crying is good for babies, and letting them cry it out is advised.

Answer: 2

Explanation: 2. Picking babies up when they cry teaches them that adults are responsive to their needs. This helps build a sense of trust and security.

Page Ref: 927

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Coping Mechanisms

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6 Describe assessment, care of the newborn, and reinforcement of parent teaching in the home.

MNL LO: 5.4.4 Recognize the assessment, care, and teaching required for the postpartum woman during a home visit.

5) The homecare nurse is visiting a newborn-and-mother couplet. Which nursing action has the highest priority?

1. Establish rapport with the family members.

2. Review the hospital medical records.

3. Determine the newborns sleeping arrangements.

4. Examine the umbilical cord stump.

Answer: 1

Explanation: 1. It is critical to establish rapport with family members prior to beginning any assessments. The nurse can rely on the same characteristics of a caring relationship that have been integral to hospital-based practiceregard for patients, genuineness, empathy, and establishment of trust and rapport.

Page Ref: 916

Cognitive Level: Applying

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

Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN 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. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5 Delineate aspects of fostering a caring relationship in the home.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

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6) 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 babys 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.

Answer: 3, 4, 5

Explanation: 3. Teaching of family members might occur, but the main purpose of the visit is to assess the infants physiologic stability.

4. Safety when the infant crawls should be assessed later.

5. Not all home visits require blood samples. If there were no pregnancy or birth complications, there may not be the need to draw blood from either the mother or the child.

Page Ref: 915

Cognitive Level: Analyzing

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

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2 Discuss the components of postpartum home care.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

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7) 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, Id like to assess your incision.

2. You arent having any problems nursing, right?

3. How rested do you feel since you came home?

4. Because you are bottle-feeding, I wont assess your breasts.

5. You should remain at home for the first 3 weeks after delivery.

Answer: 1, 3

Explanation: 1. The nurse should assess the cesarean incision.

3. The nurse should talk with the mother about her fatigue level and ability to rest and sleep.

Page Ref: 929, 931

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Management of Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Discuss the components of postpartum home care.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

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8) The nurse is planning a home visit for a new mother and newborn who were discharged prior to 48 hours after delivery. In preparation for the home visit, what should the nurse do?

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

Select all that apply.

1. Review the clients records.

2. Gather materials and equipment that might be needed.

3. Make a pre-visit telephone call to determine time and day of visit.

4. Contact the healthcare provider about any special concerns.

5. Schedule additional home visits or follow-up contacts with community agencies.

Answer: 1, 2, 3, 4

Explanation: 1. Communication with the primary healthcare provider(s) and a thorough review of inpatient records give the nurse an understanding of current needs and any special concerns for each individual mother-baby couplet.

2. Before the home visit, the nurse prepares by identifying the purpose of the visit and gathering anticipated materials and equipment.

3. The nurse should make a previsit telephone call to arrange the appointment with the woman and her family.

4. Communication with the primary healthcare provider(s) and a thorough review of inpatient records give the nurse an understanding of current needs and any special concerns for each individual mother-baby couplet.

Page Ref: 916

Cognitive Level: Applying

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

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN 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. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Discuss the components of postpartum home care.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

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9) Late preterm infants have higher infant morbidity and mortality rates than term infants. Which of the following complications can they experience?

1. Hyperglycemia

2. Jaundice

3. Motor difficulties

4. Sensory complications

Answer: 2

Explanation: 2. Late preterm infants can experience jaundice.

Page Ref: 918

Cognitive Level: Applying

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

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN 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. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Discuss the components of postpartum home care.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

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10) The nurse is teaching experienced postpartum nurses about homecare 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.

Answer: 3, 5

Explanation: 3. Nurses should avoid entering areas where violence is in progress. In such cases, they should return to the car and contact the appropriate authorities by calling 911.

5. The nurse should terminate the visit if a situation arises that feels unsafe or if the previous requests are not honored.

Page Ref: 917

Cognitive Level: Applying

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

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4 Summarize actions the nurse should take to ensure personal safety during a home visit.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

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11) The nurse is planning a homecare 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?

1. Be friendly to all pets encountered on the visit to build client rapport.

2. Wait to find the exact location until arrival in the neighborhood.

3. Put personal possessions in the trunk when leaving the office.

4. Wear flashy jewelry to garner respect.

Answer: 3

Explanation: 3. The nurse should lock personal belongings in the trunk of the car, out of sight, before starting out or before arriving at the home.

Page Ref: 917

Cognitive Level: Analyzing

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

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

Learning Outcome: 4 Summarize actions the nurse should take to ensure personal safety during a home visit.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

12) The nurse is conducting several home visits over the course of a week. Which action is appropriate to maintain safety?

1. Provide a daily schedule of visits to supervisors, including client addresses and phone numbers.

2. Maintain distance from threatening pets but do not insist that they be kept out of the room.

3. If an unsafe situation arises, discuss safety concerns with the client before continuing with the visit.

4. Lock personal belongings in the car trunk prior to entering the clients home.

Answer: 1

Explanation: 1. The nurse should notify the supervisor when leaving for a visit, and should check in as soon as the visit is completed.

Page Ref: 917

Cognitive Level: Applying

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

Standards: QSEN Competencies: V. B. 8. Use national patient safety resources for own professional development and to focus attention on safety in care settings. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Commit to a generative safety culture. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Summarize actions the nurse should take to ensure personal safety during a home visit.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

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13) The postpartum homecare client asks the nurse why the visit is taking place. Which response is best?

1. We make homecare visits to reinforce any teaching that you didnt quite grasp in the hospital.

2. We make homecare visits to verify that both you and the baby are safe and doing well.

3. We make homecare visits to ensure you are breastfeeding correctly.

4. We make homecare visits to thoroughly assess your baby to make sure he is growing.

Answer: 2

Explanation: 2. Family well-being should be determined through a comprehensive assessment that includes physical, emotional, and social functioning.

Page Ref: 915

Cognitive Level: Applying

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

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Identify the main purposes of home visits during the postpartum period.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

14) During a postpartum home visit, which step should the nurse take to establish a caring relationship?

1. Ask family members how they want to be addressed.

2. Do a portion of what the nurse agrees to do for the family, to avoid overwhelming them.

3. Speak directly to the father when asking questions.

4. Present information to the family instead of asking questions.

Answer: 1

Explanation: 1. Establishing a caring relationship starts with introducing yourself to the family and by calling the family members by their surnames until you have been invited to use the given or a less formal name.

Page Ref: 916

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Therapeutic Communication

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Delineate aspects of fostering a caring relationship in the home.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

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15) 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?

1. Cover the infant with dark blankets to block the sun.

2. Keep the infant in the shade.

3. Uncover the infants head to prevent hyperthermia.

4. Avoid taking the infant outdoors for 6 months.

Answer: 2

Explanation: 2. To prevent sunburn, the newborn should remain shaded, wear a light layer of clothing, or be protected with sunscreen specifically formulated for infants.

Page Ref: 922

Cognitive Level: Applying

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

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6 Describe assessment, care of the newborn, and reinforcement of parent teaching in the home.

MNL LO: 5.4.3 Recognize the assessment, care, and parental teaching required for the newborn during a home visit.

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16) Characteristics of a caring relationship that the nurse cultivates when interacting with the client in the home 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. Regard for the client

2. Genuineness

3. Empathy

4. Rapport

5. Attachment

Answer: 1, 2, 3, 4

Explanation: 1. Showing regard to the client by introducing oneself and calling the client by name helps demonstrate a positive regard for the client.

2. The nurse displays genuineness by meaning what he says, conveying verbal and nonverbal messages that are congruent, and being nonjudgmental.

3. The nurse needs to listen to the client without judgment and to try to view events from the clients point of view.

4. Trust and rapport is established by doing what you say will you do, being prepared for the visit and being on time, and following up on any areas that are needed.

Page Ref: 916

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Therapeutic Communication

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Delineate aspects of fostering a caring relationship in the home.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

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17) The homecare 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 is to do which of the following?

1. Remove the stuffed animal from the basket and place it on the floor.

2. Teach the parents the risk of SIDS from soft items in the infants bed.

3. Make certain that the blanket is firmly tucked under the baby.

4. Ask whether the color of the blanket has cultural significance.

Answer: 2

Explanation: 2. Teaching the parents about the risk of sudden infant death syndrome (SIDS) is the highest priority.

Page Ref: 925

Cognitive Level: Applying

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

Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Summarize actions the nurse should take to ensure personal safety during a home visit.

MNL LO: 5.4.3 Recognize the assessment, care, and parental teaching required for the newborn during a home visit.

18) Babies should sleep in what position every time they are put down for sleep?

1. On their backs

2. On their stomachs

3. On their left sides

4. On their right sides

Answer: 1

Explanation: 1. Babies should sleep on their backs every time they are put down for sleep.

Page Ref: 925

Cognitive Level: Understanding

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

Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Summarize actions the nurse should take to ensure personal safety during a home visit.

MNL LO: 5.4.3 Recognize the assessment, care, and parental teaching required for the newborn during a home visit.

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19) The nurse is performing a postpartum homecare visit. Which teaching has the highest priority?

1. Teaching or reviewing how to bathe the baby

2. Teaching how to thoroughly childproof the house

3. How many wet diapers the baby should have daily

4. Prevention of plagiocephaly

Answer: 3

Explanation: 3. Assessment of intake, output, weight, and hydration status is imperative. The baby should have at least six diapers that are saturated with clear urine each day by 1 week of age. Wet diapers are an indication of hydration of the newborn. This is the highest priority.

Page Ref: 933

Cognitive Level: Applying

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

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6 Describe assessment, care of the newborn, and reinforcement of parent teaching in the home.

MNL LO: 5.4.3 Recognize the assessment, care, and parental teaching required for the newborn during a home visit.

20) To prevent sudden infant death syndrome (SIDS), the nurse encourages the parents of a term infant to place the infant in which position when the infant is sleeping?

1. On the parents waterbed

2. Swaddled in the infant swing

3. On the back

4. On the sides

Answer: 3

Explanation: 3. Babies should sleep on their backs every time they are put down for sleep.

Page Ref: 925

Cognitive Level: Understanding

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

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Summarize actions the nurse should take to ensure personal safety during a home visit.

MNL LO: 5.4.3 Recognize the assessment, care, and parental teaching required for the newborn durin

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g a home visit.

21) The postpartum homecare nurse is assessing a new mother, and finds her temperature to be 101.6F. What is the most important nursing action?

1. Ask the mother how often and how well the baby is nursing.

2. Determine the frequency of the mothers voiding and stooling.

3. Verify how many hours of sleep she is getting per day.

4. Assess the odor and color of the lochia and perineum.

Answer: 4

Explanation: 4. If the lochia is malodorous, or if the perineum is reddened or malodorous, an infection is present that could be causing the fever.

Page Ref: 929

Cognitive Level: Applying

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

Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN 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. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Discuss the components of postpartum home care.

MNL LO: 5.4.2 Explain the purpose and components of the postpartum home visit.

22) The nurse should explain to new parents that their infants position should be changed periodically during the early months of life to prevent which of the following?

1. Muscle contractures

2. Respiratory distress

3. Permanently flattened areas of the skull

4. Esophageal reflux

Answer: 3

Explanation: 3. The nurse can describe plagiocephaly as a flattened area on the head and can recommend that parents alternate their infants head position between the right and the left side when placing the infant supine for sleep. Placing the infants head at alternate ends of the crib every few days is helpful as well.

Page Ref: 926

Cognitive Level: Applying

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

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

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Learning Outcome: 6 Describe assessment, care of the newborn, and reinforcement of parent teaching in the home.

MNL LO: 5.4.3 Recognize the assessment, care, and parental teaching required for the newborn during a home visit.

23) What assessments of the newborn should be completed during the initial home visit?

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

Select all that apply.

1. Sleep-wake cycles

2. Parent-infant interaction

3. Fontanelles

4. Umbilical cord status

5. Breast engorgement

Answer: 1, 2, 3, 4

Explanation: 1. The infants sleep-wake cycles need to be assessed.

2. It is important to assess whether the parent is beginning to attach and bond to the infant.

3. The infants fontanelles should be assessed.

4. The umbilical cord stump should show no signs of infection.

Page Ref: 918

Cognitive Level: Applying

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

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN 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. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6 Describe assessment, care of the newborn, and reinforcement of parent teaching in the home.

MNL LO: 5.4.3 Recognize the assessment, care, and parental teaching required for the newborn during a home visit.

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24) Nurses should educate parents about which of the following AAP recommendations to promote a safe sleep environment and decrease the risk of SIDS and SUID in infants less than 12 months of age?

1. Babies should not be offered a pacifier while falling asleep.

2. Babies should be bottlefed unless contraindicated.

3. Babies should be under many covers when sleeping to keep them warm.

4. Babies should have tummy time when they are awake.

Answer: 4

Explanation: 4. Babies should have tummy time when they are awake and observed by an adult to prevent positional plagiocephaly and to promote motor development.

Page Ref: 926

Cognitive Level: Applying

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

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN 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. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Summarize actions the nurse should take to ensure personal safety during a home visit.

MNL LO: 5.4.3 Recognize the assessment, care, and parental teaching required for the newborn during a home visit.

25) 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?

1. Weight loss of 3 pounds

2. Small amount of breast milk expressed

3. Pink striae on the abdomen

4. Lochia serosa

Answer: 1

Explanation: 1. Normal weight loss postpartum is in the range of 12 to 20-plus pounds.

Page Ref: 930

Cognitive Level: Applying

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

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN 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. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 7 Discuss maternal and family assessment and anticipated progress after birth.

MNL LO: 5.4.4 Recognize the assessment, care, and teaching required for the postpartum woman during a home visit.

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26) The homecare nurse is seeing a client at 6 weeks postpartum. Which statement by the client indicates the need for immediate intervention?

1. The baby sleeps 7 hours each night now.

2. My flow is red, and I need to wear a pad.

3. My breasts no longer leak between feedings.

4. I started back on the pill 2 weeks ago.

Answer: 2

Explanation: 2. By 6 weeks postpartum, lochia should be absent or minimal in amount, requiring only a pantiliner. Red, heavy flow is not an expected finding, and requires intervention.

Page Ref: 931

Cognitive Level: Analyzing

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

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7 Discuss maternal and family assessment and anticipated progress after birth.

MNL LO: 5.4.4 Recognize the assessment, care, and teaching required for the postpartum woman during a home visit.

27) 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?

1. The newborns respiratory rate is less than 60/min.

2. Singleton birth at a minimum 35 weeks gestation.

3. The newborn has passed at least three spontaneous stools.

4. The newborn has normal and stable vital signs for 24 hours before discharge.

Answer: 1

Explanation: 1. Minimal criteria include a respiratory rate in the newborn less than 60/min.

Page Ref: 915

Cognitive Level: Applying

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

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Explain the history of the controversy surrounding length of stay (LOS).

MNL LO: 5.4.1 Develop a discharge teaching plan for the postpartum patient.

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28) The postpartum client has chosen to bottle-feed her infant. Nursing actions that aid in lactation suppression include which of the following?

1. Warm showers

2. Pumping milk

3. Ice packs to each breast

4. Avoiding wearing a bra for 5 to 7 days

Answer: 3

Explanation: 3. A nonbreastfeeding mother should use cooling packs for comfort and to decrease the flow of breast milk.

Page Ref: 930

Cognitive Level: Understanding

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

Standards: QSEN Competencies: I. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8 Describe appropriate nursing interventions for women who are experiencing breastfeeding difficulties.

MNL LO: 5.4.4 Recognize the assessment, care, and teaching required for the postpartum woman during a home visit.

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29) The postpartum nurse is performing a homecare 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?

1. I can apply lanolin cream to help with the nipple pain.

2. Watching how much areola is visible will help me see whether my baby has a good mouthful of breast or not.

3. My nipples will heal if I switch to bottle feeding for about 3 days while I pump my breasts.

4. Rotating breastfeeding positions will allow the sore areas of my nipples to have less friction.

Answer: 3

Explanation: 3. For severe cases, in which the mother is unable to tolerate breastfeeding, the mother will need to pump or hand-express the breast milk until the nipple condition improves. Bottle feeding may not be necessary.

Page Ref: 934

Cognitive Level: Applying

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

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN 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. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 8 Describe appropriate nursing interventions for women who are experiencing breastfeeding difficulties.

MNL LO: 5.4.4 Recognize the assessment, care, and teaching required for the postpartum woman during a home visit.

30) The postpartum homecare nurse has performed home visits to four breastfeeding mothers. Which mother is experiencing an expected outcome?

1. Breasts are engorged; placing fresh cabbage leaves inside her bra

2. Sore and cracked nipples; using hydrogel dressings to facilitate healing

3. Breast engorgement; accompanied by erythema

4. Concerns about milk supply; supplementing with formula

Answer: 1

Explanation: 1. A compress of fresh green cabbage leaves helps reduce engorgement.

Page Ref: 935

Cognitive Level: Applying

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

Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN 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. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 8 Describe appropriate nursing interventions for women who are experiencing brea

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stfeeding difficulties.

MNL LO: 5.4.4 Recognize the assessment, care, and teaching required for the postpartum woman during a home visit.

31) A breastfeeding postpartum client reports sore nipples to the nurse during a home visit. What intervention would be the highest priority?

1. Infant positioning

2. Use of the breast shield

3. Use of breast pads

4. Type of soap used

Answer: 1

Explanation: 1. Poor latch and/or suck are the primary causes of nipple soreness and the babys position at the breast is a critical factor in nipple soreness. Encouraging the mother to rotate positions when feeding the infant may decrease nipple soreness. Changing positions alters the focus of greatest stress and promotes more complete breast emptying.

Page Ref: 934

Cognitive Level: Understanding

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

Standards: QSEN Competencies: I. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Respect the patients 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 Describe appropriate nursing interventions for women who are experiencing breastfeeding difficulties.

MNL LO: 5.4.4 Recognize the assessment, care, and teaching required for the postpartum woman during a home visit.

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32) The nurse is making an initial visit to a postpartum familys home. The mother states that she is having difficulty with breastfeeding. Which resource should the nurse tell the family about?

1. The lactation consultant at the hospital

2. Free immunizations through the county public health department clinics

3. Sources of free formula at a local food pantry

4. A support group for mothers who are experiencing postpartum depression

Answer: 1

Explanation: 1. When the client specifies a problem with breastfeeding, the best resource the nurse should inform the family about is the lactation consultant.

Page Ref: 933

Cognitive Level: Applying

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

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN 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. | NLN Competencies: Relationship-Centered Care: Respect the patients dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9 Identify postpartum resources that are available to new families.

MNL LO: 5.4.4 Recognize the assessment, care, and teaching required for the postpartum woman during a home visit.

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Copyright 2016 Pearson Education, Inc.

33) During a home visit, a new mother who is breastfeeding complains that her nipples are sore and cracked. Which measures should the nurse suggest?

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

Select all that apply.

1. Alternate the babys nursing positions throughout the day.

2. Breastfeed the baby always in a seated position

3. Avoid placing the areola in the babys mouth.

4. Insert a finger between the infants gums to break the latch before removing from the breast.

5. Wash the breasts with warm water, and avoid drying soaps.

Answer: 1, 4, 5

Explanation: 1. Changing positions alters the focus of greatest stress and promotes more complete emptying of the breasts.

4. To prevent trauma, the mother should also be taught to gently insert her finger between the infants gums to break the latch before removing the baby from the breast.

5. The nurse can instruct the mother in a number of measures to promote comfort and healing and to prevent skin breakdown. Washing the breasts with warm water and avoiding drying soaps are recommended. Simply keeping the nipples clean and dry is adequate for many mothers.

Page Ref: 934

Cognitive Level: Applying

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

Standards: QSEN Competencies: I. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Respect the patients 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 Describe appropriate nursing interventions for women who are experiencing breastfeeding difficulties.

MNL LO: 5.4.4 Recognize the assessment, care, and teaching required for the postpartum woman during a home visit.

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Copyright 2016 Pearson Education, Inc.

34) 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?

1. The tests prevent infants from developing phenylketonuria.

2. The tests detect such disorders as hypertension and diabetes.

3. The tests detect disorders that cause physical, intellectual, and developmental complications or death if left undiscovered.

4. The tests prevent sickle-cell anemia, galactosemia, and homocystinuria.

Answer: 3

Explanation: 3. Newborn screening tests use a few drops of the newborns blood to detect disorders that are often asymptomatic at birth but cause irreversible harm if not detected early. Profound physical, intellectual, and developmental complications and even death can result from many of the conditions for which newborns are screened prior to discharge.

Page Ref: 928

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Management of Care

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN 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. | NLN Competencies: Context and Environment: health promotion/disease prevention. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Discuss the components of postpartum home care.

MNL LO: 5.4.1 Develop a discharge teaching plan for the postpartum patient.

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Copyright 2016 Pearson Education, Inc.

35) A new mother inquires about postpartum resources. What resources can the nurse suggest to provide assistance to the new mother?

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

Select all that apply.

1. Breastfeeding support groups

2. Meals on Wheels

3. Lactation consultants

4. Postpartum classes

5. Internet sites

Answer: 1, 3, 4, 5

Explanation: 1. Support groups provide an opportunity for parents to interact with one another and share information.

3. Lactation consultants are helpful for women who are having breastfeeding problems or concerns.

4. Postpartum classes offer chances for the new mother to socialize, share concerns, and receive encouragement.

5. The nurses role is to direct the new mother to reliable web sites.

Page Ref: 938

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Safety and Infection Control

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN 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. | NLN Competencies: Context and Environment: apply health promotion/disease prevention strategies; apply health policy. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9 Identify postpartum resources that are available to new families.

MNL LO: 5.4.4 Recognize the assessment, care, and teaching required for the postpartum woman during a home visit.

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