Maternal and Newborn Care Flashcards

A primigravida at 39 weeks gestation is in active labour. Her contractions are every 2–3 minutes and her cervix is 7 cm dilated. The fetal monitor shows a Category II tracing with variable decelerations that recover within 30 seconds, accompanied by moderate variability. She suddenly reports intense rectal pressure and an urge to push. What is the PN's priority action?

Answer: Notify the RN or midwife immediately and prepare for a possible precipitous delivery

Sudden intense rectal pressure and urge to push — even when the last documented dilation was 7 cm — signals rapid cervical change or imminent delivery. The PN's priority is to notify the responsible RN/midwife immediately and prepare for delivery. Performing an independent vaginal examination in response to an urgent change exceeds PN scope without RN direction in most jurisdictions, and encouraging pushing without confirming full dilation risks cervical laceration. Oxygen is not the priority action here.

A breastfeeding mother on postpartum day 2 reports bilateral breast engorgement with nipple flattening that is making latch difficult. Her infant's weight is 8% below birth weight. Which intervention should the PN prioritize FIRST?

Answer: Teach the mother reverse pressure softening of the areola immediately before each feed

Reverse pressure softening (RPS) temporarily moves fluid centrally away from the areola, restoring nipple protractility so the infant can achieve a deep latch — directly addressing both problems (engorgement-related flattening and poor latch). Fully emptying the breast by pump before feeding can over-stimulate supply and worsen engorgement. Formula supplementation is not indicated for an 8% weight loss on day 2 (threshold is typically ≥10% with clinical concern). Prolonged heat before feeds increases milk flow and can worsen engorgement.

A PN is caring for a neonate born at 37 weeks gestation via vacuum-assisted delivery. On assessment at 6 hours of life, the PN notes a firm, well-demarcated swelling over the right parietal bone that does not cross the suture lines, and the neonate is irritable with a high-pitched cry. Which action is most appropriate?

Answer: Report findings to the RN immediately, as the high-pitched cry warrants further neurological evaluation

A cephalohematoma (confined by suture lines) is a common, usually benign birth trauma finding. However, a high-pitched, inconsolable cry in a neonate — especially after vacuum-assisted delivery — is a red flag for intracranial hemorrhage or elevated intracranial pressure, independent of the cephalohematoma. This combination requires immediate escalation to the RN for neurological evaluation. Documenting without escalation misses a potentially life-threatening finding. Cephalohematomas should never be drained or dressed. Reabsorption typically takes weeks to months, not days.

A client is 12 hours post-cesarean section. During assessment, the PN notes the uterine fundus is firm, at the level of the umbilicus, and displaced to the right of midline. Lochia is rubra with a moderate flow. The client last voided 4 hours ago and reports lower abdominal discomfort. Which condition does this presentation most likely indicate?

Answer: Urinary retention causing bladder distension that is displacing the uterus

Uterine displacement to one side of midline (classically to the right) with lower abdominal discomfort and the last void 4 hours ago is the hallmark presentation of a distended bladder displacing the uterus post-cesarean. Post-surgical urinary retention is common due to epidural/spinal anesthesia and indwelling catheter removal. A firm fundus at the umbilicus rules out atony. Subinvolution presents later (beyond 24 hours) with a soft, high fundus. The immediate action is bladder assessment and catheterization if needed.

A PN is providing teaching to a client who is Rh-negative and delivered an Rh-positive neonate 18 hours ago. The client is breastfeeding and asks whether the Rh immunoglobulin (RhIg) injection will harm her infant through breast milk. The client also mentions she received RhIg at 28 weeks gestation. Which response by the PN is most accurate?

Answer: RhIg is safe during breastfeeding; the postpartum dose is still required even after the antenatal dose at 28 weeks

Postpartum RhIg is required within 72 hours of delivery even when an antenatal dose was given at 28 weeks — the antenatal dose addresses the risk of sensitization during pregnancy, while the postpartum dose addresses fetal red blood cells that entered maternal circulation during delivery. RhIg is classified as safe during breastfeeding (IgG antibodies are largely destroyed in the infant's GI tract and not systemically absorbed). While answer C is partially true, it is not the complete or priority teaching point. Delaying the postpartum dose is never appropriate.

On postpartum day 4, a breastfeeding client calls the clinic reporting a sudden onset of flu-like symptoms, a temperature of 38.9°C, and a painful, red, wedge-shaped area on her left breast. She says her infant has been feeding less frequently over the past 24 hours due to the infant's sleepiness. Which instruction by the PN reflects current evidence-based practice?

Answer: Instruct the client to continue frequent breastfeeding or pumping from the affected breast as the first-line management, and seek medical evaluation for possible antibiotic therapy

The presentation is consistent with lactational mastitis. Current evidence-based guidelines (WHO, ABM Protocol #4) recommend continued and frequent breastfeeding or pumping from the affected breast as the primary management — milk removal reduces ductal stasis, which is the underlying driver. Stopping breastfeeding increases the risk of abscess formation. The client should also be assessed by a provider for antibiotic therapy (typically dicloxacillin or cephalexin). The wedge-shaped erythema, systemic flu-like symptoms, and fever distinguish this from simple engorgement. Cold compresses may provide comfort but are not a first-line management strategy.