Correct answer: C. Condom with spermicide.

If not contraindicated for moral, cultural, or religious reasons, a condom with spermicide is commonly recommended for contraception after birth until the client’s 6-week postpartal examination. This method has no effect on the neonate who is breast-feeding. Oral contraceptives containing estrogen are not advised for women who are breast-feeding because the hormones decrease the production of breast milk. Women who are not breast-feeding may use oral contraceptive agents. The rhythm method is not effective because the client is unlikely to be able to determine when ovulation has occurred until her menstrual cycle returns. Although breast-feeding is not considered an effective form of contraception, breast-feeding usually delays the return of both ovulation and menstruation. The length of the delay varies with the duration of lactation and the frequency of breast-feeding. While abstinence is one form of birth control and safe while breast-feeding, it may not be acceptable to this couple who is asking about a method that will allow them to resume sexual relations.

Correct answer: C. Medications may be excreted in breast milk to the nursing neonate.

Various medications can be excreted in the breast milk and affect the nursing neonate. The client should avoid all nonprescribed medications (such as acetaminophen) unless approved by the primary care provider. Medications typically do not affect the quality of the mother’s breast milk. Medications usually do not interfere with or diminish the mother’s motivation to breast-feed, nor do they interfere with the mother’s let-down reflex.

Correct answer: B. Immediately after a feeding.

Taking ibuprofen 200 mg orally immediately after breast-feeding helps minimize the neonate’s exposure to the drug because drugs are most highly concentrated in the body soon after they are taken. Most mothers breast-feed on demand or every 2 to 3 hours, so the effects of the ibuprofen should be decreased by the next breast-feeding session. Taking the medication before going to bed is inappropriate because, although the mother may go to bed at a certain time, the neonate may wish to breast-feed soon after the mother goes to bed. If the mother takes the medication midway between feedings, then its peak action may occur midway between feedings. Breast milk is sufficient for the neonate’s nutritional needs. Most breast-feeding mothers should not be encouraged to provide supplemental feedings to the infant because this may result in nipple confusion.

Correct answer: B. Release of oxytocin during the breast-feeding session.

Breast-feeding stimulates oxytocin secretion, which causes the uterine muscles to contract. These contractions account for the discomfort associated with afterpains. Flatulence may occur after a cesarean birth. However, the mother typically would have abdominal distention and a bloating feeling, not a "cramplike" feeling. Stretching of the tissues or healing may cause slight tenderness or itching, not cramping feelings of discomfort. Medications such as mild analgesics or stool softeners, commonly administered postpartum, typically do not cause cramping.

Correct answer: C. "I should drink at least five glasses of fluid daily."

For the breast-feeding client, drinking at least 8 to 10 glasses of fluid a day is recommended. Breast-feeding women need an increased intake of vitamin D for calcium absorption. A breast-feeding woman requires an extra 500 cal/day above the recommended nonpregnancy intake to produce quality breast milk. Breast-feeding women need adequate calcium for blood clotting and strong bones and teeth.

Correct answer: C. Fat.

Breast milk has a higher fat content than cow’s milk. Thirty to fifty-five percent of the calories in breast milk are from fat. Breast milk contains less iron than cow’s milk does. However, the iron absorption from breast milk is greater in the neonate than with cow’s milk. Breast milk contains less sodium and calcium than cow’s milk.

Correct answer: B. Brush the neonate’s lips lightly with the nipple.

Lightly brushing the neonate’s lips with the nipple causes the neonate to open the mouth and begin sucking. The neonate should be taught to open the mouth and grasp the nipple on his or her own. The neonate should not be forced to nurse.

Correct answer: B. Placing as much of the areola as possible into the baby’s mouth.

Several methods can be used to prevent nipple soreness. Placing as much of the areola as possible into the neonate’s mouth is one method. This action prevents compression of the nipple between the neonate’s gums, which can cause nipple soreness. Other methods include changing position with each feeding, avoiding breast engorgement, nursing more frequently, and feeding on demand. Plastic liners are not helpful because they prevent air circulation, thus promoting nipple soreness. Instead, air drying is recommended. Pulling the baby’s mouth out smoothly after only 10 minutes may prevent the baby from getting the entire feeding and increases nipple soreness. Any breast milk remaining on the nipples should not be wiped off, because the milk has healing properties.

Correct answer: A. "When I switch to the other breast, I’ll burp the baby."

Breast-fed neonates do not swallow as much air as bottle-fed neonates, but they still need to be burped. Good times to burp the neonate are when the mother switches from one breast to the other and at the end of the breast-feeding session. Neonates do not eat more if they are burped frequently. Breast-feeding mothers are advised not to supplement the feedings with formula because this may cause nipple confusion and decrease milk production. If supplements are given, the baby still needs to be burped. Neonates who are fed every 3 hours still need to be burped.

Correct answer: A. "I can safely store the milk for 3 days in the refrigerator."

Stored breast milk can be safely kept in the refrigerator for up to 7 days or in a deep freeze at 0�F (?18�C) for 12 months. Breast milk should be stored in glass containers because immunoglobulin tends to stick to plastic bottles. Breast milk can remain without refrigeration or loss of nutrients for up to 10 hours. The containers should be labeled with date, time, and amount to prevent inadvertent administration of spoiled milk. Frozen breast milk should be thawed in the refrigerator for a few hours, placed under warm tap water, and then shaken.

Correct answer: B. Oxytocin.

Oxytocin stimulates the let-down reflex when milk is carried to the nipples. A lactating mother can experience the let-down reflex suddenly when she hears her baby cry or when she anticipates a feeding. Some mothers have reported feeling the let-down reflex just by thinking about the baby. Adrenalin may increase if the mother is excited, but this hormone has no direct influence on breast-feeding. Estrogen influences development of female secondary sex characteristics and controls menstruation. Prolactin stimulates milk production.

Correct answer: B. Express a small amount of breast milk.

Expressing a little milk before nursing, massaging the breasts gently, or taking a warm shower before feeding also may help to improve milk flow. Although various measures such as ice, heat, and massage may be tried to relieve breast engorgement, prevention of breast engorgement by frequent feedings is the method of choice. Applying ice to the nipples does not relieve breast engorgement. However, it may temporarily relieve the discomfort associated with breast engorgement. Using lanolin on the nipples does not relieve breast engorgement and is unnecessary. Use of lanolin may cause sensitivity and irritation. Having frequent breast-feeding sessions, rather than offering the neonate a small amount of formula, is the method of choice for preventing and relieving breast engorgement. In addition, offering the neonate small amounts of formula may result in nipple confusion.

Correct answer: A. Six to eight wet diapers by the fifth day.

The nurse should instruct the client that the baby is getting enough to eat when there are six to eight wet diapers by the fifth day of age. Other signs include good suckling sounds during feeding, dripping breast milk at the mouth, and quiet rest or sleep after the feeding. By the fourth day of age, the infant should have soft yellow stools, not transitional (greenish) stools. Falling asleep easily after feeding on the first day is not a good indicator because most infants are sleepy during the first 24 hours. Most infants regain their lost birth weight in 7 to 10 days after birth. An infant who has gained weight during the first well-baby checkup (usually at 2 weeks) is getting sufficient breast milk at feedings.

Correct answer: A. The neonate’s temporary growth spurt, which requires more feedings.

Neonates normally increase breast-feeding during periods of rapid growth (growth spurts). These can be expected at age 10 to 14 days, 5 to 6 weeks, 2.5 to 3 months, and 4.5 to 6 months. Each growth spurt is usually followed by a regular feeding pattern. Lack of adequate intake to meet maternal nutritional needs is not associated with the neonate’s desire for more frequent breast-feeding sessions. However, an intake of adequate calories is necessary to produce quality breast milk. The mother’s fears about weight gain and preventing the neonate from sucking long enough are not associated with the desire for more frequent breast-feeding sessions.

Correct answer: C. Position the baby with the entire areola in the baby’s mouth.

Even if the nipples are sore and cracked, the mother should position the baby with the entire areola in the baby’s mouth so that the nipple is not compressed between the baby’s gums during feeding. The best method is to prevent cracked nipples before they occur. This can be done by feeding frequently and using proper positioning. Warm, moist tea bags can soothe cracked nipples because of tannic acid in the tea. Creams on the nipples should be avoided; wiping off any lanolin creams from the nipple before each feeding can cause further soreness. Feeding the baby less often for the next few days will cause engorgement (and possible neonatal weight loss), leading to additional problems. Soap use while in the shower should be avoided to prevent drying and removal of protective oils.

Correct answer: A. Holding, talking to, and playing with the infant will facilitate bonding between baby and Dad.

Time for bonding with their newborns is a frequent concern for fathers of breastfed babies. It is common for fathers to express concern about having less intimate contact time. These feelings are normal, but they do not go away in a few days. The father of the baby has to dedicate time to spend with the infant where he can talk to, hold, cuddle, and/or play with the infant. These strategies provide the infant with the contact and stimulation to establish a close bond between them. Bonding occurs from the moment of birth and continues in various ways between mother, father, and infant. Infants recognize and respond to touch, light, and voice immediately after birth. Bonding between both parents is equally important and one does not take priority over the other.

Correct answer: C. Soft seedy unformed stools with each feeding are normal for this age infant and will continue through breast-feeding.

A soft seedy unformed stool is the norm for a 4-day-old infant. It may surprise the mother as it is a change from the meconium the infant had since birth. This stool is not diarrhea even though it has no form. There is no need for the infant to be seen for this. As long as the infant is breast-feeding, the stools will remain of this color and consistency. Brown and formed stool is common for an infant who is bottle-fed or after the breast-feeding infant has begun eating food.

Correct answer: B. Firm fundus at the symphysis.

By 4 to 6 weeks postpartum, the fundus should be deep in the pelvis and the size of a nonpregnant uterus. Subinvolution, caused by infection or retained placental fragments, is a problem associated with a uterus that is larger than expected at this time. Normal expectations include a white, thick vaginal discharge, striae that are beginning to fade to silver, and breasts that are soft without evidence of milk production (in a bottle-feeding mother).

Correct answer: B. "I will use a breast pump to remove any milk that may appear."

The use of a breast pump to remove milk is contraindicated in bottle-feeding mothers. Nipple and breast stimulation and emptying of the breasts produce milk, rather than eliminate milk production. The bottle-feeding client is discouraged from stimulating the breasts in any way. A sports bra that is well fitting provides support and decreases stimulation. (Binders are not suggested.) Having the water in a shower land on the shoulders of the mother rather than the breasts also decreases stimulation. Only water is necessary to clean nipples when breast or bottle-feeding

Correct answer: A. An immature cardiac sphincter.

Initial regurgitation in the neonate during the first 12 to 24 hours may be caused by excessive mucus and gastric irritation from foreign substances in the stomach. After the first 24 hours, regurgitation is thought to be caused by the neonate’s immature cardiac sphincter. It represents an overflow of stomach contents and is probably a result of feeding the neonate too fast or too much. A defect in the gastrointestinal system usually results in more severe symptoms. A small amount of regurgitation is normal, but vomiting or forceful fluid expulsion is not. Burping the infant often during a feeding can decrease the amount of air in the stomach from swallowing. However, burping too often can lead the neonate to become tired or fussy. Moving the infant usually does not result in regurgitation.

Correct answer: A. Supine position.

To aid digestion, the neonate should be placed in a supine position. Placing infants on their side or prone in a crib after a feeding is no longer recommended due to the increased risk of sudden infant death syndrome (SIDS). Although the mother may desire to hold the infant in her lap after feeding, this is not necessary for the neonate’s digestion unless the infant has reflux.

Correct answer: D. 6 months.

Pediatricians recommend that infants be given either breast milk or formula until at least 6 months of age because of the neonate’s difficulty digesting solid foods. Giving solid foods too early can lead to food allergies. Because chewing movements do not begin until 7 to 9 months of age, foods requiring chewing should be delayed until this time.

Correct answer: B. "I’ll burp him after 15 minutes of feeding him formula."

The client needs further instruction when she says burping should be done after 15 minutes of formula feeding. The entire feeding should take only 15 to 20 minutes, and the neonate should be burped before that time. During initial feedings, the burping should be done after each half-ounce of formula with the neonate in an upright position, patting the neonate gently on the back

Correct answer: B. 8 to 10 months.

Most babies are developmentally ready to drink independently from a cup by the age of 8 to 10 months. If the child has not mastered drinking from a cup by this time, there may be a problem with motor development that requires further investigation.

Correct answer: C. Aspiration of the formula.

Bottle "propping" is not recommended because it can lead to aspiration, delayed bonding, feelings of mistrust (Erikson), and possible otitis media. The neonate will not be overfed during bottle propping but may suck too quickly, possibly resulting in aspiration of the formula. Putting the neonate to bed with a bottle can lead to tooth decay later in the formative years, but an infant cannot hold the bottle. The cause of SIDS has not been determined. However, it is associated with placing the infant in a prone position after eating.

Correct answer: D. Ambulate the client from the bed to the hallway and back.

The client should have more active bowel sounds by this time postpartum. Ambulation will encourage passing flatus and begin peristaltic action in the gastrointestinal track. Medicating the client should be evaluated prior to ambulating but it is probably too soon because the last dose was 3 hours ago and her pain assessment rating is fairly low. Pain medications should not have codeine as a component as it decreases peristaltic activity. Incentive spirometry or asking the client to turn, cough, and deep breathe are appropriate to encourage good oxygen exchange in the lungs prior to ambulation, and walking can be used concurrently with these interventions. Participating in infant care is another way to encourage the mother to move about but the primary goal would be to have her walk on the unit, a more purposeful activity.

Correct answer: A. Nausea and diarrhea.

Hemabate is an oxytocic prostaglandin that causes uterine contraction in women who are bleeding heavily. Nausea, vomiting, diarrhea, and fever are common adverse effects of prostaglandin administration. Vertigo and confusion are not associated with this drug. Vaginal bleeding may occur with inadequate amounts of Hemabate if the client continues to bleed. Restlessness may result if inadequate amounts of Hemabate are used and the woman continues to bleed and goes into shock. If too large a dose is given, the client may experience headache and hypertension because Hemabate does contract smooth muscles.

Correct answer: A. Contact the client’s physician for further prescriptions.

Slightly red-tinged urine may indicate that the bladder was accidentally cut during the cesarean birth. The nurse should notify the physician as soon as possible about the urine color. Continuing to monitor the client’s input and output should be done after the physician is contacted. Palpating the fundus every 15 minutes is not necessary unless the client’s fundus becomes soft or "boggy." Assessment of the Foley catheter is a normal part of the elimination assessment by the nurse, but displacement is not the cause of the red-tinged urine.

Correct answer: C. "Sometimes baby girls have this from hormones received from the mother."

The most appropriate response would be to explain that the vaginal spotting in female neonates is associated with hormones received from the mother. Estrogen is believed to cause slight vaginal bleeding or spotting in the female neonate. The condition disappears spontaneously, so there is no need for concern. Telling the mother that it is of no concern does not allay the mother’s worry. The vaginal spotting is related to hormones received from the mother, not to swallowing blood during the birth or hemorrhagic disease of the neonate. Anemia is associated with hemorrhagic disease.

Correct answer: A. VBAC may be possible if the client has not had a classic uterine incision.

VBAC can be attempted if the client has not had a classic uterine incision. This type of incision carries a danger of uterine rupture. A physician must be available, and a cesarean birth must be possible within 30 minutes. A history of rapid labor is not a criterion for VBAC. A low transverse incision is not a contraindication for VBAC. A classic (vertical) incision is a contraindication because the client has a greater possibility for uterine rupture. Estimated fetal weight greater than 4,000 g by itself is not a contraindication if the mother is not diabetic.

Correct answer: C. 72 hours.

For maximum effectiveness, RhoGAM should be administered within 72 hours postpartum. Most Rh-negative clients also receive RhoGAM during the prenatal period at 28 weeks’ gestation and then again after birth. The drug is given to Rh-negative mothers who have a negative Coombs test and give birth to Rh-positive neonates. If there is doubt about the fetus’s blood type after pregnancy is terminated, the mother should receive the medication

Correct answer: C. Football hold.

After a cesarean birth, most mothers have the greatest comfort when the neonate is positioned in the football hold with the mother in semi-Fowler’s position, supporting the neonate’s head in her hand and resting the neonate’s body on pillows alongside her hip. This position prevents pressure on the uterine incision yet allows the neonate easy access to the mother’s breast. The scissors hold, where the mother places her hand well back on the breast to prevent touching the areola and interfering with the neonate’s mouth placement, is used by the mother to hold the breast and support it during breast-feeding. The cross-cradle hold is done when the mother holds the neonate’s head in the hand opposite from the breast on which the neonate will feed and the mother’s arm supports the neonate’s body across her lap. This position can be uncomfortable because of the pressure placed on the client’s incision line. For the cradle hold, the mother cradles the infant alongside the arm at the breast on which the neonate will feed. This position also can be uncomfortable because of the pressure placed on the incision line.

Correct answer: D. Fundus and lochia.

A client who is pale and shaking could be experiencing hypovolemic shock likely caused by blood loss. A primary cause of blood loss after the birth of an infant is uterine atony. Therefore, the priority assessments should be the fundus of the uterus for firmness and location. In addition, the amount of vaginal bleeding (lochia) should also be assessed. An immediate intervention for uterine atony is fundal massage that will help the uterus to contract and therefore stop additional bleeding. Assessing the client’s level of consciousness does not require additional time and can be done by the nurse while the fundus and lochia are assessed. Obtaining vital signs, blood glucose, and temperature are important but should be done either after the fundus has been assessed and massaged or should be obtained by a second responder. Assessing for uterine infection and pain should be done after treatment for hypovolemic shock has been initiated.

Correct answer: B. Assessing the perineum.

Pain after childbirth is generally well managed with pain control medications; since they did not help this woman, further assessment is necessary. The first nursing action would be to assess the source of the pain; the woman may have sustained a laceration or a hematoma as a result of childbirth. Assessing the perineum may help the nurse to determine the source of the pain and may require follow-up by the primary health care provider. Subsequent nursing interventions may include pain medication, sitz bath, or education regarding the healing process.

Correct answer: C. Notify the client’s physician immediately.

A positive Homan sign, discomfort behind the knee or in the upper calf area on dorsiflexion of the foot, may be indicative of thrombophlebitis. Other signs include edema and redness at the site and may be more reliable as an indicator of thrombophlebitis. The nurse should notify the physician immediately and ask the client to remain in bed to minimize the risk for pulmonary embolus, a serious consequence of thrombophlebitis should a clot dislodge. The Homan sign is observed on the client’s legs, so placing an ice pack on the perineal area is inappropriate. However, ice to the perineum would be useful for episiotomy pain and swelling. The client does not need to be positioned in semi-Fowler’s position but should remain on bed rest to prevent dislodgement of a potential clot.

Correct answer: B. To prevent further blood clot formation

Heparin therapy is prescribed to prevent further clot formation by inhibiting further thrombus and clot formation. Heparin, an anticoagulant, does not make blood clots thinner. An adverse effect of heparin therapy during the puerperium is increased lochia flow, so the nurse must be observant for symptoms of hemorrhage, such as heavy lochial flow. Heparin does not increase diaphoresis, which is normal for the postpartum client.

Correct answer: B. Dyspnea.

A major complication of deep vein thrombosis is pulmonary embolism. Signs and symptoms, which may occur suddenly and require immediate treatment, include dyspnea, severe chest pain, apprehension, cough (possibly accompanied by hemoptysis), tachycardia, fever, hypotension, diaphoresis, pallor, shortness of breath, and friction rub. Pain in the calf is common with a diagnosis of deep vein thrombosis. Hypotension, not hypertension, would suggest a possible pulmonary embolism. It also could suggest possible hemorrhage secondary to intravenous heparin therapy. Bradycardia for the first 7 days in the postpartum period is normal.

Correct answer: A. Slow pulse.

A slow pulse (bradycardia) is normal for the first 7 days postpartum as the body begins to adjust to the decrease in blood volume and return to the prepregnant state. Adverse effects of heparin therapy suggesting prolonged bleeding include hematuria, epistaxis, increased lochial flow, and bleeding gums. Typically, tachycardia, not bradycardia, would be associated with hemorrhage. Petechiae indicate bleeding under the skin or in subcutaneous tissue.

Correct answer: A. "I should use a soft toothbrush to brush my teeth."

Successful teaching is demonstrated when the client says, "I should use a soft toothbrush to brush my teeth." Heparin therapy can cause the gums to bleed, so a soft toothbrush should be used to minimize this adverse effect. Use of aspirin and other nonsteroidal anti-inflammatory medications should be avoided because of the increased risk for possible hemorrhage. Protamine sulfate is the antidote for heparin therapy. Vitamin K is the antidote for warfarin excess. Alcohol can inhibit the metabolism of oral anticoagulants and should be avoided.

Correct answer: B. "I must practice frequent handwashing."

Frequent handwashing is the most important aspect of infection control. The nurse can emphasize, monitor, and ensure this strategy for all who come in contact with this client. The use of gowns and gloves is appropriate when there is blood and stool. Barrier isolation and individual client care equipment are not needed in this situation.

Correct answer: B. Ask the client if she has any drug allergies.

Before administering ampicillin intravenously, the nurse must ask the client if she has any drug allergies, especially to penicillin. Antibiotic therapy can cause adverse effects, such as rash or even anaphylaxis. If the client is allergic to penicillin, the physician should be notified and ampicillin should not be given. Checking the client’s pulse rate or placing her in a side-lying position are not necessary. Assessing the amount of lochia by checking the perineal pad is important for all postpartum clients but is not necessary before antibiotic therapy.

Correct answer: A. Emptying the bladder every 2 to 4 hours while awake.

The client diagnosed with cystitis needs to void every 2 to 4 hours while awake to keep her bladder empty. In addition, she should maintain adequate fluid intake; 3,000 mL/day is recommended. Intake of acidic fruit juices (eg, cranberry, apricot) is recommended because of their association with reducing the risk for infection. The client should wear cotton underwear and avoid tight-fitting slacks. She does not need to wash with povidone iodine after voiding. Plain warm water is sufficient to keep the perineal area clean.

Correct answer: B. "You can continue to breast-feed as long as you want to do so."

The client can continue to breast-feed as often as she desires. Continuation of breast-feeding is limited only by the client’s discomfort or malaise. Antibiotics for treatment are chosen carefully so that they avoid affecting the neonate through breast milk. Drugs such as sulfonamides, nitrofurantoin, and cephalosporins usually are not prescribed for breast-feeding mothers. Manual pumping of the breasts is not necessary.

Correct answer: A. "This medication may cause nausea and vomiting."

Carboprost tromethamine (Hemabate) may cause hypertension, not hypotension. More commonly carboprost tromethamine, a synthetic progastgladin, causes nausea, vomiting, diarrhea, and fever. Gastrointestinal symptoms are so common that antiemetic and antidiarreal medications are often given as a pretreatment or immediately following carboprost.

Correct answer: B. Overdistention of the uterus from hydramnios.

The most likely cause of this client’s uterine atony is overdistention of the uterus caused by the hydramnios. As a result, the stretched uterine musculature contracts less vigorously. Besides hydramnios, a large infant, bleeding from abruptio placentae or placenta previa, and rapid labor and birth can also contribute to uterine atony during the postpartum period. Trauma during labor and birth is not a likely cause. In addition, no evidence of excessive trauma was described in the scenario. Moderate fundal massage helps to contract the uterus, not contribute to uterine atony. Although a lengthy or prolonged labor can contribute to uterine atony, this client had a cesarean birth for breech presentation. Therefore, it is unlikely that she had a long labor.

Correct answer: A. Retained placental fragments.

The most likely cause of delayed postpartum hemorrhage is retained placental fragments. The client may be scheduled for a dilatation and curettage to remove remaining placental fragments. Uterine atony, cervical lacerations, and vaginal lacerations are commonly associated with early, not late, postpartum hemorrhage.

Correct answer: C. "You can continue to breast-feed, feeding your baby more frequently."

The client being treated for infectious mastitis should continue to breast-feed often, or at least every 2 to 3 hours. Treatment also includes bed rest, increased fluid intake, local heat application, analgesics, and antibiotic therapy. Continually emptying the breasts decreases the risk of engorgement or breast abscess. The client should not discontinue breast-feeding unless she chooses to do so. The client may continue breast-feeding while receiving antibiotic therapy. Generally, the breast milk is not contaminated by the offending organism and is safe for the neonate.

Correct answer: B. "I’ll bring the baby to you for feeding."

After birth, the client should make the decision about how much she would like to participate in the neonate’s care. Seeing and caring for the neonate commonly facilitates the grief process. The nurse should be nonjudgmental and should allow the client any opportunity to see, hold, and care for the neonate. The physician does not need to be contacted about the client’s desire to see the baby, which is a normal reaction. The social worker and the adoptive parents do not need to give the client permission to feed the baby.

Correct answer: A. "I should begin breast-feeding on the right side to decrease the pain."

The client needs further instruction when she says that she should begin feeding on the right (painful) breast to decrease the pain. Starting the feeding on the unaffected (left) breast can stimulate the milk ejection reflex in the right breast and thereby decrease the pain. Frequent nursing or pumping is recommended to empty the breast. For some mothers, mastitis is so painful that they choose to discontinue breast-feeding, so these mothers need a great deal of support. Applying heat to the infected area before starting to feed is appropriate because heat stimulates circulation and promotes comfort. Increasing fluid intake is advised to ensure adequate hydration. Antibiotics need to be taken until all medication has been used, usually 7 to 10 days to ensure eradication of the infection.

Correct answer: C. "It’s not unusual for some mothers to feel depressed after the birth of a baby. I think I should contact your doctor."

The client is probably experiencing postpartum depression, and the doctor should be contacted. Postpartum depression is usually treated with psychotherapy, social support groups, and antidepressant medications. Contributing factors include hormonal fluctuations, a history of depression, and environmental factors (eg, job loss). An estimated 50% to 70% of women experience some degree of postpartum "blues," but these feelings of sadness disappear within 1 to 2 weeks after birth. However, the client is voicing more than just sadness. Telling her that she is overreacting is not helpful and may make her feel even less worthy. She is not exhibiting symptoms of a serious mental illness (loss of contact with reality) and does not need hospitalization.

Correct answer: A. "If I’m feeling guilty or not capable of caring for the baby and am not sleeping or eating well, I need to contact the office."

Feelings of guilt combined with a lack of self-care (not eating or sleeping enough) can predispose a new mother to postpartum depression, especially one who has had previous episodes of depression. Sleep is essential to both the mother and baby, but sleeping through the night does not usually occur in the first few weeks after birth. While breast-feeding mothers do need good nutrition, eating as much as you want after childbirth may inhibit the return to a normal weight and could create depression in a new mother, especially a vulnerable one. Attempting to care for an infant with no help from others is likely to cause stress that could lead to depression, especially in an adolescent.

Correct answer: D. Eggs.

One of the microcytic, hypochromic anemias is iron deficiency anemia. A rich source of iron is needed in the diet, and eggs are high in iron. Other foods high in iron include organ and muscle (dark) meats; shellfish, shrimp, and tuna; enriched, whole-grain, and fortified cereals and breads; legumes, nuts, dried fruits, and beans; oatmeal; and sweet potatoes. Dark green, leafy vegetables and citrus fruits are good sources of vitamin C. Cheese is a good source of calcium.

Correct answer: C. Observe individuals in the area for large bags or oversized coats.

process for infant abduction in a hospital system focuses on utilizing all health care workers to observe for anyone who may possibly be concealing an infant in a large bag or under an oversized coat and is attempting to leave the building. Moving to the entrances and exits and checking each individual would be a responsibility of the doorman or security staff within the hospital system. Going to the obstetrics unit to determine if they need help would not be advised as the doors to the unit will be locked and access will not be available. Calling the nursery to ask about a missing baby wastes time, and the nursery staff should not reveal such information.

Correct answer: C. Go to the obstetrics unit to determine if they need help with the situation.

The client who is a G4 P4 can be cared for by the CNA II. There are no indications that there are any problems with this couplet and the assessments have been completed by the RN. The client with gestational diabetes will need specific assessments, medications, and potentially other actions based on recent birth. Her infant is within the first 24 hours of birth when infants of women with gestational diabetes often drop their blood glucose levels and this will require frequent assessment and possible interventions. The client who is G3 P3 postpartum and receiving magnesium sulfate must be cared for by a registered nurse. The respiratory rate of this client’s infant is borderline low and often is related to the administration of magnesium sulfate and should receive a higher level of nursing care. The client who is a G2 P2, with an infant with documented low blood sugars, will require assessment and potential intervention if the blood sugar levels change; only registered nurses can safely manage this care.

Correct answer: A. Complete an incident report.

Patient safety is the highest priority and a nursing error has occurred. If the day nurse decides to tell the night nurse, the timing of the notification will be up to the nurse initiating the incident report. The nurse should confer with the charge nurse concerning the incident but completion of the report is required. Waiting for several hours to initiate the report based on changes in patient data and assessment is not an ethical or professional decision and should not be considered; again, patient safety is the highest priority.

Correct answer: C. All of the above

The use of recycling bins on the unit does not impact patient safety or contribute to the quality of care. The infant identification system is a patient safety practice. Nursing influences the type of system used and how monitoring and identification occur, which improves the quality of patient care. The sibling and family visitation policy can be an excellent project. Sibling policies regarding visitation can influence patient safety (safety of mother and infant by keeping children with colds/flus, infections away from the obstetrics unit). Nursing influences development of the policy utilized and implemented on a daily basis. Postpartum instructions represent an area where the skill level, quality, and quantity of instruction represent nursing contributions to patient care. The ability for a family to remain together during a hospital stay is important to families. The quality of the obstetrical experience can be enhanced or determined to be negative by this particular policy, one that is often looked at by these committees.

Correct answer: C. All of the above

The safety of clients on an obstetrical unit does include prevention of infant abduction. Safe medication administration guidelines apply in obstetrics as well as all units in the hospital system. Adequate nourishment on the unit is essential for promotion of breast-feeding and for those patients who want to eat shortly after birth but is not a safety concern. Adequate restraints as used during circumcisions are a safety concern. An infant always needs proper identification when admitted, discharged, and taken to or away from parents, and this is also a great safety issue

Correct answer: C. All of the above

Specific safety concerns on an obstetrical unit include a very specific "hand-off report" after birth and recovery has been completed and the couplet is transitioned to mother-baby care. In any invasive procedure including tubal ligations and circumcisions, preprocedure verification is a standard procedure. Client education concerning the potential for infection in obstetrics is essential for any incision areas. Infant abduction is an ever-present concern for those working in a mother-baby unit. Car seat instructions for new parents involve the infant being in the back seat of a car facing backward-not in the front seat. Education for the family includes this important area.

Correct answer: C. Breast-feeding.

Breast-fed infants should eat within the first hour of life and approximately every 2 to 3 hours. Successful breast-feeding will likely require sustained support, encouragement, and instruction from the nurse. Information on SIDS, infant bathing, and sleep-wake cycles are also important topics for the new parent, but can be done at any time prior to discharge.

Correct answer: C. Keep the neonate away from air conditioning vents.

The neonate should be kept away from drafts, such as from air conditioning vents, which may cause heat loss by convection. Evaporation is one of the most common mechanisms by which the neonate will lose heat, such as when the moisture on the newly born neonate’s body is converted to vapor. Radiation is heat loss between solid objects that are not in contact with one another such as walls and windows. Conduction is when heat is transferred between solid objects in contact with one another, such as when a neonate comes in contact with a cold mattress or scale.

Correct answer: B. Use of humidity in the incubator.

Adding humidity to the incubator adds moisture to the ambient air, which helps to decrease the insensible water loss. Bathing and the use of eye patches has no impact on insensible water loss. The use of a radiant warmer will increase the insensible water loss by drawing moisture out of the skin.

Correct answer: B. Continue feeding every 3 to 4 hours since the weight loss is normal.

This 3-day-old neonate’s weight loss falls within a normal range, and therefore no action is needed at this time. Full-term neonates tend to lose 5% to 10% of their birth weight during the first few days after birth, most likely because of minimal nutritional intake. With bottle-feeding, the neonate’s intake varies from one feeding to another. Additionally, the neonate experiences a loss of extracellular fluid. Typically, neonates regain any weight loss by 7 to 10 days of life. If the weight loss continues after that time, the primary health care provider should be called.

Correct answer: B. Placing the infant skin-to-skin on the mother.

Placing an infant on a mother’s bare chest or abdomen facilitates transition to extrauterine life and is the preferred method of thermoregulation for stable infants. A radiant warmer should be used if an infant is unstable and needs medical intervention. Blankets may be placed over a newborn and mom’s chest. A hat may be added to prevent heat loss from the head, but these methods are supplemental to skin-to-skin care.

Correct answer: B. "My baby doesn’t have the normal bacteria in his intestines to produce this vitamin."

For vitamin K synthesis in the intestines to begin, food and normal intestinal flora are needed. However, at birth, the neonate’s intestines are sterile. Therefore, vitamin K is administered via injection to prevent a vitamin K deficiency that may result in a bleeding tendency. When administered, vitamin K promotes formation in the liver of clotting factors II, VII, IX, and X. Neonates are not normally susceptible to clotting disorders, unless they are diagnosed with hemophilia or demonstrate a deficiency of or a problem with clotting factors. Hemolysis of fetal red blood cells does not destroy vitamin K. Hemolysis may be caused by Rh or ABO incompatibility, which leads to anemia and necessitates an exchange transfusion. Vitamin K synthesis occurs in the intestines, not the liver.

Correct answer: A. Stroke the newborn’s cheek with her nipple to direct the baby’s mouth to nipple.

Currently, touch is believed to be the most highly developed sense at birth. It is probably why neonates respond well to touch. Auditory sense typically is relatively immature in the neonate, as evidenced by the neonate’s selective response to the human voice. By 4 months, the neonate should turn his eyes and head toward a sound coming from behind. Visual sense tends to be relatively immature. At birth, visual acuity is estimated at 20/100 to 20/150, but it improves rapidly during infancy and toddlerhood. Taste is well developed, with a preference toward glucose; however, touch is more developed at birth.

Correct answer: A. "We should weigh our baby daily to make sure he is gaining weight."

Healthy infants are weighed during their visits to their primary care provider, so it is not necessary to monitor weights at home. Infants may require 1 to 3 feedings during the night initially. By 3 months, 90% of babies sleep through the night. Projective vomiting may indicate pyloric stenosis and should not be seen in a normal newborn. Bottle-fed infants may stool 1 to 3 times daily.

Correct answer: B. "I did not realize that even children between 1 to 2 years old are safer in rear-facing car seats."

The head and neck are best supported in a rear-facing seat in infants and toddlers, and infants should remain rear facing for as long possible until they outgrow their car seat. In the United States, the American Academy of Pediatrics recommends a rear-facing car seat for children younger than 2?years. The middle of the back seat is safest for a car seat. Because plastic can become brittle over time, car seats have an expiration date that must be checked before use. Ten years would generally be outside of most car seats’ expiration dates.

Correct answer: A. It may cause pneumonia to develop.

The nurse should inform the mother that baby powder can enter the neonate’s lungs and result in pneumonia secondary to aspiration of the particles. The best prevention for diaper rash is frequent diaper changing and keeping the neonate’s skin dry. The new disposable diapers have moisture-collecting materials and generally do not adhere to the skin unless the diaper becomes saturated. Typically, allergies are not associated with the use of baby powder in neonates.

Correct answer: B. "I’ll remove any yellowish crusting gently with water."

The mother needs further instruction when she says that a yellowish crust should be removed with water. The yellowish crust is normal and indicates scar formation at the site. It should not be removed, because to do so might cause increased bleeding. The petroleum gauze prevents the diaper from sticking to the circumcision site, and it may fall off in the diaper. If this occurs, the mother should not attempt to replace it but should simply apply plain petroleum jelly to the site. The gauze should be left in place for 24 hours, and the mother should continue to apply petroleum jelly with each diaper change for 48 hours after the procedure. A few drops of oozing blood is normal, but if the amount is greater than a few drops the mother should apply pressure and contact the primary health care provider. Any bleeding after the first day should be reported.

Correct answer: A. Passage of a liquid stool with a watery ring.

The mother demonstrates understanding of the discharge instructions when she says that she should contact the primary health care provider if the baby has a liquid stool with a watery ring, because this indicates diarrhea. Infants can become dehydrated very quickly, and frequent diarrhea can result in dehydration. Normally, babies fall asleep easily after a feeding because they are satisfied and content. Spitting up a tablespoon of formula is normal. However, projectile or forceful vomiting in larger amounts should be reported. Bottle-fed infants typically pass one to two light brown stools each day.

Correct answer: A. Placing the neonate on his back after the feeding.

Placing the neonate on his back after the feeding is recommended to minimize the risk for sudden infant death syndrome (SIDS). Placing the neonate on the abdomen after feeding has been associated with SIDS. The mother should bubble or burp the baby after � oz (15 mL) of formula has been taken and then again when the baby is finished. Waiting until the baby has eaten 1 oz (30 mL) of formula can lead to regurgitation. The entire nipple should be placed on top of the baby’s tongue and into the mouth to prevent excessive air from being swallowed. The nipple is pointed directly into the mouth, not toward the neonate’s palate, to provide adequate sucking.

Correct answer: C. Antibacterial soap.

Placing the neonate on his back after the feeding is recommended to minimize the risk for sudden infant death syndrome (SIDS). Placing the neonate on the abdomen after feeding has been associated with SIDS. The mother should bubble or burp the baby after � oz (15 mL) of formula has been taken and then again when the baby is finished. Waiting until the baby has eaten 1 oz (30 mL) of formula can lead to regurgitation. The entire nipple should be placed on top of the baby’s tongue and into the mouth to prevent excessive air from being swallowed. The nipple is pointed directly into the mouth, not toward the neonate’s palate, to provide adequate sucking.

Correct answer: B. Identify this reflex as a normal finding.

The Moro reflex is a normal reflex of a neonate and requires no intervention. Calling a code, placing the neonate on seizure precautions, and starting supplemental oxygen are not necessary for a normally occurring reflex.

Correct answer: A. Start positive pressure ventilation.

If an infant is not breathing after the initial steps of resuscitation, the next thing the nurse must do is begin positive pressure ventilation. Apgar scores are an evaluation of the neonate’s status at 1 and 5 minutes of life. Waiting to restore respirations until after assigning an Apgar score would be a waste of valuable time. Oxygen alone does little good if the infant is not breathing. Chest compressions must be accompanied by adequate oxygenation.

Correct answer: B. 4

The neonate has a heart rate >100, which earns him 2 points. His respiratory rate of 70 is equivalent to a 2 on the scale. His flaccid muscle tone is equal to 0 on the scale. The lack of response to stimulus also equals 0, as does his overall pale white color. Thus, the total score equals 4.

Correct answer: D. Bradycardia.

As a result of vigorous suctioning the nurse must watch for bradycardia due to potential vagus nerve stimulation. Rapid eye movement is not associated with vagus nerve stimulation. Vagal stimulation will not cause seizures or tachycardia.

Correct answer: D. Caf� au lait spots.

There is a correlation between caf� au lait spots and the development of neurofibromatosis. Acrocyanosis is a normal finding of bluish hands and feet as a result of poor capillary perfusion. Port wine nevus and strawberry hemangiomas are a collection of dilated capillaries and are not associated with any other disease process.

Correct answer: C. All of the above

Holding the neonate steady and in the proper position will help ensure a safe and accurate lumbar puncture. The neonate is usually held in a "C" position to open the spaces between the vertebral column. This position puts the neonate at risk for airway obstruction. Thus, ensuring the patency of the airway is the first priority, and the nurse should observe the neonate for adequate ventilation. Maintaining a sterile field is important to avoid infection in the neonate. It is not necessary to administer antibiotics or obtain a serum glucose level during the procedure.

Correct answer: D. Cardiovascular anomalies.

Normally, the umbilical cord has two umbilical arteries and one vein. When a neonate is born with only one artery and one vein, the nurse should notify the primary health care provider for further evaluation of cardiac anomalies. Other common congenital problems associated with a missing artery include renal anomalies, central nervous system lesions, tracheoesophageal fistulas, trisomy 13, and trisomy 18. Respiratory anomalies are associated with dyspnea and respiratory distress; musculoskeletal anomalies include fractures or dislocated hip; and facial anomalies are associated with fetal alcohol syndrome or Down syndrome, not a missing umbilical artery.

Correct answer: C. Approximately 2 cm larger than the chest.

Normally at birth, the neonate’s head circumference is approximately 2 cm larger than the chest circumference. The average normal head circumference is 13 to 14 inches (33 to 35 cm); average normal chest circumference is 12.5 to 14 inches (31 to 35 cm). A head circumference that is equal to or smaller than the chest circumference may indicate microcephaly; a head that is larger than normal may indicate hydrocephalus. The presence of any of these conditions warrants further evaluation.

Correct answer: A. "Brain damage may occur if the molding doesn’t resolve quickly."

The mother needs further instruction if she says the molding can result in brain damage. Brain damage is highly unlikely. Molding occurs during vaginal birth when the cranial bones tend to override or overlap as the head accommodates to the size of the mother’s birth canal. The amount and duration of pressure on the head influence the degree of molding. Molding usually disappears in a few days without any special attention.

Correct answer: A. Sole creases covering the entire foot.

Sole creases covering the entire foot are indicative of a term neonate. If the neonate’s ear is lying flat against the head, the neonate is most likely preterm. An absence of rugae in the scrotum typically suggests a preterm neonate. A square window sign angle of 0 degrees occurs in neonates of 40 to 42 weeks’ gestation. A 90-degree square window angle suggests an immature neonate of approximately 28 to 30 weeks’ gestation.

Correct answer: B. Expiratory grunt.

An expiratory grunt is significant and should be reported promptly, because it may indicate respiratory distress and the need for further intervention such as oxygen or resuscitation efforts. The presence of a red reflex in the eyes is normal. An absent red reflex may indicate congenital cataracts. A respiratory rate of 45 breaths/min and a prominent xiphoid process are normal findings in a term neonate.

Correct answer: C. Turns head to the left, extends left extremities, and flexes right extremities.

The tonic neck reflex, also called the fencing position, is present when the neonate turns the head to the left side, extends the left extremities, and flexes the right extremities. This reflex disappears in a matter of months as the neonatal nervous system matures. The stepping reflex is demonstrated when the infant is held upright near a hard, firm surface. The prone crawl reflex is demonstrated when the infant pulls both arms but does not move the chin beyond the elbows. When the infant extends and abducts the arms and legs with the toes fanning open, this is a normal Babinski reflex.

Correct answer: B. Neonates commonly lack eye muscle coordination.

Convergent strabismus is common during infancy until about age 6 months because of poor oculomotor coordination. The neonate has peripheral vision and can fixate on close objects for short periods. The neonate can also perceive colors, shapes, and faces. Neonates can focus on light and should blink or close their eyes in response to light. However, this is not associated with strabismus. An absent red reflex or white areas over the pupils, not strabismus, may indicate congenital cataracts. Most neonates cannot focus well or accommodate for distance immediately after birth.

Correct answer: A. Single crease on each of the palms.

A single crease across the palm (simian crease) is most commonly associated with chromosomal abnormalities, notably Down syndrome. Deep creases across the soles of the feet is a normal finding in a term neonate. Frequent sneezing in a term neonate is normal. This occurs because the neonate is a nose breather and sneezing helps to clear the nares. An absence of lanugo on the skin of a term neonate is a normal finding.

Correct answer: A. All of the above

Phenylketonuria, an inherited autosomal recessive disorder, involves the body’s inability to metabolize the amino acid phenylalanine. A diet low in phenylalanine must be followed. Such foods as meats, eggs, and milk are high in phenylalanine. Assistance from a dietitian is commonly necessary to keep phenylalanine levels low and to provide the essential amino acids necessary for cell function and tissue growth. With autosomal recessive disorders, future children will have a 25% chance of having the disease, a 50% chance of carrying the disease, and a 25% chance of being free of the disease. If a diet low in phenylalanine is followed until brain growth is complete (sometime in adolescence), the child should achieve normal intelligence.

Correct answer: D. Respiratory arrest.

Periods of apnea lasting longer than 20 seconds, mild cyanosis, and a heart rate of <100 bpm (bradycardia) are associated with a potentially life-threatening event and subsequent respiratory arrest. The neonate needs further evaluation by the primary health care provider. Pneumonia is associated with tachycardia, anorexia, malaise, cyanosis, diminished breath sounds, and crackles. Intraventricular hemorrhage is associated with prematurity. Assessment findings include bulging fontanels and seizures. Epiglottitis is a bacterial form of croup. Assessment findings include inspiratory stridor, cough, and irritability. It occurs most commonly in children age 3 to 7 years.

Correct answer: A. 12 to 18 months.

Normally, the anterior fontanel closes between ages 12 and 18 months. Premature closure (craniostenosis or premature synostosis) prevents proper growth and expansion of the brain, resulting in mental retardation. The posterior fontanel typically closes by ages 2 to 3 months.

Correct answer: D. Unequally sized corneas.

Corneas of unequal size should be reported because this may indicate congenital glaucoma. An absence of tears is common because the neonate’s lacrimal glands are not yet functioning. The neonate’s pupils normally constrict when a bright light is focused on them. The finding implies that light perception and visual acuity are present, as they should be after birth. A red circle on the pupils is seen when an ophthalmoscope’s light shines onto the retina and is a normal finding. Called the red reflex, this indicates that the light is shining onto the retina.

Correct answer: A. A state of deep sleep.

At 24 hours of age, the neonate is probably in a state of deep sleep, as evidenced by the closed eyes, lack of eye movements, normal skin color, and normal heart rate and respiratory rate. Jitteriness, a high-pitched cry, and tremors are associated with drug withdrawal. The first period of reactivity occurs in the first 30 minutes after birth, evidenced by alertness, sucking sounds, and rapid heart rate and respiratory rate. There is no evidence to suggest respiratory distress because the neonate’s respiratory rate of 35 breaths/min is normal.

Correct answer: D. Hypospadias.

The condition in which the urinary meatus is located on the ventral surface of the penis, termed hypospadias, occurs in 1 of every 500 male infants. Circumcision is delayed until the condition is corrected surgically, usually between 6 and 12 months of age. Phimosis is an inability to retract the prepuce at an age when it should be retractable or by age 3 years. Phimosis may necessitate circumcision or surgical intervention. Hydrocele is a painless swelling of the scrotum that is common in neonates. It is not a contraindication for circumcision. Epispadias occurs when the urinary meatus is located on the dorsal surface of the penis. It is extremely rare and is commonly associated with bladder extrophy.

Correct answer: A. All of the above

Kangaroo care is skin-to-skin holding of a neonate by one of the parents. Research has shown increased bonding, physiologic stability, decreased length of stay, and improved breast-feeding for neonates who experience this method of holding. Research has not shown an increase in IQ as a developmental outcome. The experience is usually limited to 1 to 2 hours, 2 to 3 times/day.

Correct answer: B. Back, with the neck slightly extended.

When receiving oxygen by mask, the neonate is placed on the back with the neck slightly extended, in the "sniffing" or neutral position. This position optimizes lung expansion and places the upper respiratory tract in the best position for receiving oxygen. Placing a small rolled towel under the neonate’s shoulders helps to extend the neck properly without overextending it. Once stabilized and transferred to an isolette in the intensive care unit, the neonate can be positioned in the prone position, which allows for lung expansion in the oxygenated environment. Placing the neonate on the left side does not allow for maximum lung expansion. Also, slightly flexing the neck interferes with opening the airway. Placing the neonate on the back with the head turned to the left side does not allow for lung expansion. Placing the neonate on the abdomen interferes with proper positioning of the oxygen mask.

Correct answer: B. Maintain a compression to ventilation ratio of 3:1.

Chest compressions should be alternated with ventilation to ensure breathing and circulation. Two fingers or two thumbs encirciling hands, not the palm of the hand, are used to compress a neonate’s sternum. The chest is compressed 100 to 120 times/min. The proper technique recommended by the Neonatal Resuscitation Program is to use enough pressure to depress the sternum to a depth of approximately one-third of the anterior-posterior diameter of the chest.

Correct answer: B. Humidify the air being delivered.

Whenever oxygen is administered, it should be humidified to prevent drying of the nasal passages and mucous membranes. Because the neonate is under a radiant warmer, a stocking cap is not necessary. Temperature, continuously monitored by a skin probe attached to the radiant warmer, is recorded every 30 to 60 minutes initially. Although the oxygen concentration in the hood requires close monitoring and measurement of blood gases, checking the blood glucose level is not necessary.

Correct answer: A. Temperature instability.

The neonate is at high risk for sepsis due to exposure to the mother’s infection. Temperature instability in a neonate at 38 weeks’ gestation is an early sign of sepsis. Other signs include tachycardia, decreased muscle tone, acidosis, apnea, respiratory distress, hypotension, poor feeding behaviors, vomiting, and diarrhea. Late signs of infection include jaundice, seizures, enlarged liver and spleen, respiratory failure, and shock. Alkalosis is not typically seen in neonates who develop sepsis. Acidosis and respiratory distress may develop unless treatment such as antibiotics is started. A positive Babinski reflex is a normal finding and does not need to be reported.

Correct answer: C. Obtain a prescription for a stat chest x-ray.

With an absent apical pulse left of the midclavicular line accompanied by cyanosis, grunting, and diminished breath sounds, the neonate is most likely experiencing pneumothorax. Pneumothorax occurs when alveoli are overdistended and subsequently the lung collapses, compressing the heart and lung and compromising the venous return to the right side of the heart. This condition can be confirmed by x-ray or ultrasound studies. Repositioning the infant may open the airway, administering oxygen will improve oxygen saturation levels, and obtaining blood studies for infection will rule that out, but until pneumothorax is resolved, the other symptoms will continue.

Correct answer: C. Neonate born preterm.

RDS is a developmental condition that primarily affects preterm infants before 35 weeks’ gestation because of inadequate lung development from deficient surfactant production. The development of placenta previa has little correlation with the development of RDS. Although excessive analgesia can depress the neonate’s respiratory condition if it is given shortly before birth, the scenario presents no information that this has occurred. The neonate’s sluggish respiratory activity postpartum is not the likely cause of RDS but may be a sign that the neonate has the condition.

Correct answer: D. "Oxygen is drying to the mucous membranes unless it is humidified."

Oxygen should be humidified before administration to help prevent drying of the mucous membranes in the respiratory tract. Drying impedes the normal functioning of cilia in the respiratory tract and predisposes to mucous membrane irritation. Humidification of oxygen does not promote expansion of the immature lungs. Expansion is promoted by placing the infant in a prone position or providing the preterm infant with surfactant medication. Humidified oxygen does not prevent viral or bacterial pneumonia. In fact, in some nurseries, Staphylococcus aureus has been detected in moist environments and on the hands and nails of staff members, predisposing the neonate to pneumonia. Humidified oxygen does not improve blood circulation in the cardiac system.