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A nurse is caring for a 25-year-old postpartum female client who had a spontaneous vaginal birth at 39 weeks of gestation in the postpartum unit.

Medical History: The client is a Gravida 1, Para 1. She is currently breastfeeding.

Vital Signs:

  • Blood Pressure: 120/80 mmHg
  • Pulse: 80 bpm
  • Respirations: 16/min
  • Temperature: 36.8°C (98.2°F)
  • Pulse Ox: 99%

Nurses Notes: The client reports feeling well overall. She is breastfeeding her newborn and has expressed concerns about her baby’s weight loss. The client’s breasts are full, warm, and slightly tender, indicating that her milk is coming in. She has been educated on breastfeeding and the expected changes in her baby's stool color. The client appears attentive and responsive to her baby’s needs. She is utilizing correct breastfeeding techniques and has been encouraged to continue feeding 8 to 12 times per day and on demand. The client has also been advised on the importance of monitoring her newborn's weight and intake.

Newborn Daily Weights:

  • Birth weight: 3,515 gm (7 lb 12 oz)
  • Weight after 24 hr: 3,410 gm (7 lb 8 oz) (3% weight loss)
  • Weight after 48 hr: 3,345 gm (7 lb 4 oz) (5% weight loss)

Querry: Which of the following statements by the client indicates an understanding of the discharge teaching? Click to highlight the client statements that indicate an understanding of the discharge teaching.

A.

"Because of my baby's weight loss, I need to supplement with formula after breastfeeding."

B.

"I should make sure that my baby feeds 8 to 12 times per day, and on demand."

C.

"I should cover my sore nipples with plastic-lined breast pads after every feeding."

D.

"I can increase my milk supply by drinking more whole milk."

E.

My baby's stools should turn from the dark greenish color meconium to a yellow color within the next day or two.

F.

I should expect my breasts to feel full, warm, and slightly tender when my milk comes in

Question Solution

Correct Answer : B,E,F

Choice A rationale:

The statement suggests supplementing with formula due to the baby’s weight loss. However, a 5% weight loss in the first few days is normal for breastfed infants, and formula

supplementation is not necessary unless recommended by a healthcare provider. Early breastfeeding should be encouraged to increase milk supply and support newborn weight gain.

 

Choice B rationale:

This statement correctly indicates that newborns should feed 8 to 12 times per day and on demand to ensure adequate nutrition and promote milk production. Frequent breastfeeding

helps establish and maintain milk supply.

 

Choice C rationale:

Using plastic-lined breast pads can retain moisture and increase the risk of infection or irritation. Sore nipples can be managed with lanolin creams, air-drying, and proper latching

techniques during breastfeeding.

 

Choice D rationale:

Drinking more whole milk is a common misconception and does not directly increase a mother's milk supply. Milk production is influenced by frequent breastfeeding, proper hydration,

and balanced nutrition, not by specific types of foods or drinks.

 

Choice E rationale:

Newborn stools transition from dark greenish meconium to yellow, seedy stools within the first few days of life as breastfeeding becomes established. This indicates effective feeding

and milk intake.

 

Choice F rationale:

It is normal for a breastfeeding mother’s breasts to feel full, warm, and slightly tender as her milk comes in. This indicates that the milk supply is increasing and the body is responding

to the newborn’s feeding needs.


View Related questions

Correct Answer is A

Explanation

Choice A rationale

A newborn who is 26 hours post-delivery and has had no urine output needs immediate attention. Lack of urine output for over 24 hours may indicate dehydration or renal issues. Immediate medical evaluation is required to identify underlying conditions and prevent complications such as acute kidney injury or sepsis.

Choice B rationale

Acrocyanosis, characterized by blueish discoloration of the extremities, is common in newborns during the first 24-48 hours of life and usually resolves on its own. It occurs due to immature blood circulation and is generally not a cause for concern.

Choice C rationale

Failure to pass meconium within the first 24 hours can be a sign of conditions like Hirschsprung's disease or cystic fibrosis, but it is not as immediately concerning as anuria (no urine output). Monitoring and further evaluation are necessary, but it does not require urgent provider notification.

Choice D rationale

A blood glucose level of 50 mg/dL in a newborn is within the lower limit of normal. While it's important to monitor, it does not necessitate immediate provider notification unless it continues to drop or other symptoms arise.

Correct Answer is C

Explanation

Choice A rationale

Accelerations are increases in the fetal heart rate (FHR) above the baseline, typically in response to fetal movement or uterine contractions. They indicate a healthy, well-oxygenated

fetus and are not consistent with the described pattern of decelerations.

Choice B rationale

Late decelerations are characterized by a gradual decrease in FHR that begins after the contraction has started, with the lowest point of the deceleration (nadir) occurring after the

peak of the contraction. They are associated with uteroplacental insufficiency and fetal hypoxia, which is not described in the scenario.

Choice C rationale

Early decelerations are a gradual decrease in FHR that mirrors the contraction, starting with the contraction and returning to baseline as the contraction ends. The nadir of the

deceleration occurs at the peak of the contraction, which fits the pattern described.

Choice D rationale

Variable decelerations are abrupt decreases in FHR that can occur at any time during the contraction cycle, usually due to umbilical cord compression. They are not uniform in

relation to contractions and can vary in duration, depth, and timing, unlike the described pattern.