Which is the first step in assisting the breastfeeding mother to nurse her infant?

Correct Answer: A

Rationale: The correct answer is A - Assess the woman's knowledge of breastfeeding. Assessment is the first step in determining the mother's learning needs and readiness to breastfeed. Only after assessing her knowledge can appropriate instruction and support be provided. The other options may be important steps in the process, but assessment comes first.

Correct Answer: D

Rationale: Teaching parents the signs of overstimulation allows them to adjust their care to prevent overstimulation in the preterm infant. This empowers parents to provide appropriate care and create a soothing environment for the infant, ultimately reducing the risk of increased oxygen use due to overstimulation.

Correct Answer: B

Rationale: A large infant born after a traumatic birth is at risk for shoulder dystocia, which may result in clavicle fracture or damage to the brachial plexus. Evaluating the flexion of both upper extremities can provide important information about any potential injuries. Gestational age status or growth chart percentile will not provide data about traumatic birth injuries, and while large infants are at risk for hypoglycemia, evaluating blood sugar alone may not address potential physical injuries.

Correct Answer: C

Rationale: The best confirmation of hyperbilirubinemia in an infant is through assessing the infant's bilirubin level. While the direct and indirect Coombs tests and maternal blood type are important in determining ABO incompatibility, the infant's bilirubin level provides the most definitive evidence of hyperbilirubinemia or pathologic jaundice.

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.