During a postpartum examination of a client who delivered an 8-pound newborn 6 hours ago, the following assessment findings are noted: fundus firm and at the umbilicus, and moderate lochia rubra with a steady trickle of blood from the vagina. What is the assessment finding that would necessitate follow-up?

Correct Answer: B

Rationale: In this scenario, the assessment finding that necessitates follow-up is option B) Steady trickle of blood. This finding indicates excessive bleeding, which could be a sign of postpartum hemorrhage (PPH), a serious complication that requires immediate medical attention. Option A) Firm fundus is a normal finding indicating uterine contraction, and the fundus being at the umbilical level (Option D) is also normal within the first 6 hours postpartum. Option C) Moderate lochia rubra is expected in the early postpartum period as the uterus sheds the decidua and other tissues. Educationally, it is crucial for nursing students to understand the normal postpartum assessment findings and recognize abnormal signs that require prompt intervention. Recognizing the signs of PPH and understanding the urgency of addressing excessive bleeding is essential for providing safe and effective care to postpartum clients and ensuring positive outcomes for both the mother and newborn.

Correct Answer: B

Rationale: The correct answer is B) The baby’s bilirubin is 19mg/dl. This situation would require the baby’s discharge to be cancelled because a bilirubin level of 19mg/dl in a 2-day-old newborn is significantly elevated and poses a risk for severe jaundice and potential neurotoxicity if not treated promptly. Hyperbilirubinemia in newborns can lead to kernicterus, a condition characterized by bilirubin deposition in the brain, which can cause neurological damage. Option A) The parents own a car seat that only faces the rear of the car is not a reason to cancel discharge. Rear-facing car seats are actually recommended for infants as they provide better protection in the event of a crash. Option C) The baby’s blood glucose is 65 mg/dl may be slightly low, but it is not a critical value that would require cancellation of discharge. It can be managed with feeding and monitoring. Option D) There is a large bluish spot on the left buttock of the baby is likely a common birthmark known as a Mongolian spot and does not typically require cancellation of discharge unless it is accompanied by other concerning symptoms. In the context of nursing care of the newborn and family, it is crucial to prioritize the safety and well-being of the newborn. Understanding the significance of abnormal lab values, such as elevated bilirubin levels, is essential for nurses to provide appropriate care and make informed decisions regarding discharge planning. Hyperbilirubinemia is a common condition in newborns that requires close monitoring and intervention to prevent complications.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) None; it will disappear within about a month. This rash described is likely erythema toxicum neonatorum, a common benign skin condition in newborns that typically resolves on its own without any specific treatment. A) Applying aloe vera lotion (Option A) is unnecessary and may not provide any additional benefit as the rash will naturally disappear. B) Using hormonal skin cream (Option B) is not recommended for newborns as it can be harsh on their delicate skin and may cause harm. D) Vigorously washing and cleansing the baby's skin (Option D) can actually irritate the skin further and disrupt the natural balance, leading to more issues. Educationally, it is important for nurses and parents to be aware of common skin conditions in newborns to provide appropriate care and avoid unnecessary treatments. Understanding the natural course of conditions like erythema toxicum neonatorum helps prevent over-treatment and promotes the overall well-being of the newborn. By choosing the correct answer, the nurse demonstrates knowledge of neonatal skin conditions and promotes evidence-based care.

Correct Answer: D

Rationale: The correct answer is D) Supine, which means placing the infant on their back to sleep. This sleeping position is recommended by the American Academy of Pediatrics (AAP) to reduce the risk of sudden infant death syndrome (SIDS). When infants sleep on their backs, it helps maintain an open airway, reduces the risk of suffocation, and allows for better regulation of body temperature. Option A) Prone (on stomach) is not recommended as it increases the risk of SIDS due to potential airway obstruction. Option B) Side-lying can also pose risks as the infant may roll onto their stomach unintentionally. Option C) Side-lying with a blanket roll behind the infant's back is not advised because the blanket roll can shift, potentially covering the baby's face and increasing the risk of suffocation. As perinatal nurses, it is crucial to educate parents on safe sleep practices to promote infant safety and reduce the risk of SIDS. By emphasizing the importance of placing infants on their backs to sleep, nurses can empower parents to create a safe sleep environment for their newborns. This education is essential in ensuring the well-being of the newborn and promoting healthy sleep habits from an early age.

Correct Answer: C

Rationale: The correct answer is C) Keep the base of the umbilical cord clean and dry. This instruction is crucial for preventing infection in the newborn. The umbilical cord stump is a potential entry point for bacteria, so keeping it clean and dry reduces the risk of infection. This teaching is essential for new parents to ensure the health and well-being of their newborn. Option A) Apply a mild soap and lotion to dry skin is incorrect because newborn skin is delicate and sensitive. Using soap and lotion can irritate the skin and disrupt the natural balance, leading to dryness or rashes. Option B) Change diapers frequently following circumcision is incorrect in the context of preventing complaints related to umbilical cord care. While changing diapers frequently is important for overall hygiene, it is not directly related to caring for the umbilical cord stump. Option D) Take rectal temperatures twice a day for a week is incorrect because it is not a standard recommendation for routine infant care. Rectal temperatures in infants require specific techniques and can be uncomfortable for the newborn. It is not necessary to take rectal temperatures unless advised by a healthcare provider for a specific reason. Educationally, teaching new parents about appropriate infant care is crucial in promoting the health and well-being of newborns. Providing accurate and clear instructions empowers parents to care for their baby effectively and confidently. Understanding the rationale behind each instruction helps parents make informed decisions and ensures the best possible outcomes for their newborn.