CPNRE - Canadian Practical Nurse Registration Examination Maternal and Newborn Care Questions and Answers 1 — Questions and Answers
Question 1: A practical nurse is assessing a newborn who is 12 hours old. Which of the following findings requires immediate intervention?
- Acrocyanosis of the hands and feet
- Respiratory rate of 50 breaths per minute
- Nasal flaring and sternal retractions (Correct answer)
- Passage of a dark, tarry meconium stool
Correct answer: Nasal flaring and sternal retractions
Nasal flaring and sternal retractions are signs of respiratory distress in a newborn and require immediate notification of the registered nurse or primary care provider. Acrocyanosis is common in the first 24-48 hours. A respiratory rate of 30-60 breaths per minute is normal. Passing meconium is an expected finding.
Question 2: A new mother who is 2 days postpartum tells the practical nurse she is concerned because her breasts have become hard, warm, and tender. Which of the following is the most appropriate response by the nurse?
- "This is a sign of a breast infection; you should stop breastfeeding immediately."
- "This is likely breast engorgement, which is common. Applying cold packs after feeding can help." (Correct answer)
- "You should limit how often you feed the baby to allow your breasts to rest."
- "This means your milk supply is low; you should consider formula supplementation."
Correct answer: "This is likely breast engorgement, which is common. Applying cold packs after feeding can help."
The symptoms described are characteristic of primary breast engorgement, which occurs as the milk comes in around day 2-5 postpartum. Management includes frequent breastfeeding, ensuring proper latch, applying cold compresses between feedings to reduce swelling, and warm compresses before feeding to facilitate milk flow. Stopping breastfeeding or limiting feedings would worsen the condition. Engorgement indicates a robust milk supply, not a low one.
Question 3: The practical nurse is reinforcing teaching with a new mother about umbilical cord care. Which statement by the mother indicates a need for further education?
- "I will clean the base of the cord with a cotton swab and water if it gets soiled."
- "The cord stump should fall off on its own in about one to two weeks."
- "I should cover the cord with the diaper to keep it protected." (Correct answer)
- "I need to call the doctor if I see any redness or pus around the cord."
Correct answer: "I should cover the cord with the diaper to keep it protected."
To promote drying and prevent infection, the diaper should be folded down, below the umbilical cord stump, to keep it exposed to air and free from urine contamination. Cleaning with water if soiled, expecting it to fall off in 1-2 weeks, and monitoring for signs of infection are all correct practices.
Question 4: A practical nurse is performing a postpartum assessment on a client who delivered vaginally 8 hours ago. The fundus is firm, located 2 cm above the umbilicus, and deviated to the right. What is the priority nursing action?
- Document the finding as normal.
- Massage the fundus vigorously.
- Administer a prescribed analgesic.
- Assist the client to empty her bladder. (Correct answer)
Correct answer: Assist the client to empty her bladder.
A fundus that is deviated to the side (usually the right) and positioned above the umbilicus is most often indicative of a full bladder. A full bladder can impede uterine contraction and increase the risk of postpartum hemorrhage. The priority action is to assist the client to void. The fundus is already firm, so vigorous massage is not the priority. While the finding needs documentation, it requires an intervention first.
Question 5: Which of the following is a key component of family-centred maternity care in Canada?
- Restricting visitors to allow for maternal rest.
- Making all healthcare decisions on behalf of the family.
- Involving the family in decision-making and respecting their choices. (Correct answer)
- Discouraging the father's presence during the birth.
Correct answer: Involving the family in decision-making and respecting their choices.
Family-centred care, a guiding principle in Canada, emphasizes a collaborative approach where the woman and her family are integral to the decision-making process. It respects their values and choices and encourages participation in care. Restricting visitors or making decisions for the family contradicts this philosophy.
Question 6: A practical nurse is caring for a newborn diagnosed with physiological jaundice. What is the primary rationale for initiating phototherapy?
- To increase the baby's appetite and milk intake.
- To convert unconjugated bilirubin into a form that can be excreted. (Correct answer)
- To prevent hypothermia by keeping the baby warm.
- To stimulate the production of new red blood cells.
Correct answer: To convert unconjugated bilirubin into a form that can be excreted.
Phototherapy works by using light to change the chemical structure of unconjugated bilirubin in the skin into a water-soluble form (isomer) called lumirubin. This allows the bilirubin to be excreted in the urine and stool, bypassing the need for conjugation by the immature liver, thus lowering the overall bilirubin level.
CPNRE - Canadian Practical Nurse Registration Examination Maternal and Newborn Care Questions and Answers 1
A practical nurse is assessing a newborn who is 12 hours old.
Which of the following findings requires immediate intervention?