A postpartum nurse is giving guidance to a mother whose breast-fed newborn is experiencing hyperbilirubinemia. What are the best instructions for the nurse to give the mother in this case?

Correct Answer: D

Rationale: In the context of pharmacology and nursing care of the newborn, the correct answer is D) The mother should continue to breast-feed the infant every 2 to 3 hours or more frequently as tolerated (every 2 hours if under phototherapy). This guidance is based on the fact that breast milk is crucial for the newborn's health and development. Breast milk helps to promote gut health, immunity, and overall well-being of the infant. Additionally, breast milk helps in the passage of meconium, which aids in the elimination of excess bilirubin, thus helping to reduce hyperbilirubinemia. Option A is incorrect as stopping breast-feeding is not recommended unless there are specific medical reasons to do so. Option B is also incorrect as it suggests switching to bottle-feeding until the bilirubin levels return to normal, which is unnecessary if breastfeeding can continue. Option C, alternating between breast and bottle-feeding, may lead to decreased breast milk supply and confusion for the newborn. Educationally, it is important for nurses to understand the benefits of breastfeeding and how breast milk can help manage conditions like hyperbilirubinemia in newborns. Providing evidence-based guidance to mothers can help optimize the health outcomes for both the baby and the mother.

Correct Answer: C

Rationale: In the context of preventing SIDS (Sudden Infant Death Syndrome), placing the infant on their back to sleep is the correct action for the parent to take. This is in line with the safe sleep guidelines recommended by the American Academy of Pediatrics. Placing the baby on their back reduces the risk of SIDS as it maintains an open airway and prevents suffocation. The other options are incorrect and potentially dangerous. Wrapping the baby in layers of blankets increases the risk of overheating, which is a risk factor for SIDS. Putting stuffed animals in the crib can also pose a suffocation hazard. Additionally, sleeping or bed-sharing with the infant increases the risk of accidental suffocation or overlaying, both of which are associated with an increased risk of SIDS. Educationally, it is crucial for nurses to emphasize safe sleep practices to parents to reduce the risk of SIDS. By providing clear and accurate information on safe sleep guidelines, nurses empower parents to create a safe sleep environment for their newborns, ultimately promoting infant safety and well-being.

Correct Answer: C

Rationale: In the context of nursing care for newborns, ensuring thermoregulation during a bath is crucial. Newborns have limited ability to regulate their body temperature, making them susceptible to hypothermia if exposed to cold water or air during bathing. Maintaining a warm environment and using warm water helps prevent heat loss and supports the newborn's thermoregulatory system. Option A, hyperbilirubinemia, is not a primary concern during a routine newborn bath unless the baby has specific conditions like jaundice that require phototherapy. Hypoglycemia (Option B) is a metabolic concern in newborns, but it is not directly impacted by a routine bath. Contact dermatitis (Option D) can occur if harsh soaps or chemicals are used, but it is a preventable issue through proper selection of bath products and gentle handling. Educationally, understanding the unique vulnerabilities of newborns, such as their impaired thermoregulation, is essential for providing safe and effective care. Nurses and caregivers must be vigilant in maintaining a warm environment during bathing to prevent hypothermia and promote the newborn's overall well-being.

Correct Answer: A

Rationale: The most probable cause of the swelling noted in Edward is a cephalohematoma. A cephalohematoma is a collection of blood between the skull bone and its periosteum, often caused by pressure exerted during delivery. In Edward's case, the sharply demarcated swelling over the parietal bones indicates localized bleeding under the periosteum, which is characteristic of a cephalohematoma. Subgaleal hemorrhage (Option B) involves bleeding into the potential space between the periosteum and the galea aponeurotica and is typically more diffuse, extending beyond suture lines. Caput succedaneum (Option C) is localized soft tissue edema that typically crosses suture lines and usually resolves within a few days. Skull fracture (Option D) would present with other signs such as crepitus, bruising, or depressions on palpation. From an educational perspective, understanding and differentiating these neonatal head conditions are essential for nurses caring for newborns. Recognizing the characteristics of each condition is crucial for accurate diagnosis, appropriate interventions, and monitoring for complications. It also highlights the importance of a thorough neonatal assessment following delivery, especially in cases involving instrumental deliveries like forceps, to identify any potential complications promptly.

Correct Answer: C

Rationale: The best response from the nurse is option C: "Newborns with a cleft lip and palate may be able to breast-feed because latching may fill the gap." This answer is correct because infants with cleft lip and palate may still be able to breastfeed with proper positioning and support. Latching onto the breast can help create a seal and facilitate feeding despite the cleft. Option A is incorrect because it implies that a special nipple and setup are necessary for feeding, which may not always be the case. Option B is incorrect as it states that newborns with cleft lip and palate are unable to breastfeed, which is not always true. Option D is incorrect because it suggests that surgical repair is necessary before breastfeeding can occur, which is not always the case. Educationally, it is important for nurses to understand that with proper guidance and support, many infants with cleft lip and palate can breastfeed successfully. Educating families about techniques such as using different positions, ensuring a proper latch, and possibly using aids like specialty bottles or nipple shields can help support successful breastfeeding for these infants. Providing this information empowers families and promotes positive health outcomes for the newborn.