RPN - Registered Practical Nurse Maternal and Newborn Care Questions and Answers — Questions and Answers
Question 1: An RPN is assessing a client who is 12 hours postpartum. The RPN palpates the client's fundus and finds it to be boggy, located two fingerbreadths above the umbilicus, and deviated to the right. What is the RPN's priority action?
- Administer a PRN analgesic for afterpains.
- Document the findings and reassess in one hour.
- Assist the client to empty her bladder and then reassess the fundus. (Correct answer)
- Encourage the client to breastfeed to stimulate uterine contractions.
Correct answer: Assist the client to empty her bladder and then reassess the fundus.
A full bladder is a common cause of uterine displacement (often to the right) and uterine atony (a boggy fundus). A boggy uterus cannot contract effectively, which places the client at high risk for postpartum hemorrhage. The priority nursing action is to address the underlying cause by helping the client empty her bladder, then reassessing the fundus.
Question 2: An RPN is preparing to administer routine medications to a healthy term newborn within the first hour of life. Which of the following injections is administered to prevent hemorrhagic disease?
- Hepatitis B vaccine
- Vitamin K (Correct answer)
- Erythromycin
- Rh immune globulin
Correct answer: Vitamin K
Newborns are born with low levels of Vitamin K, which is essential for blood clotting. An injection of Vitamin K is given prophylactically to all newborns to prevent Vitamin K Deficiency Bleeding (VKDB), a potentially life-threatening condition.
Question 3: An RPN is providing discharge teaching to a new mother about lochia. The client is 3 days postpartum. Which statement by the mother indicates an understanding of the normal progression?
- "The flow should change from red to a pinkish-brown colour around this time." (Correct answer)
- "If my discharge becomes pinkish-brown, I should call the clinic immediately."
- "I should expect a heavy, bright red flow for at least the first week."
- "I won't have any more discharge after today."
Correct answer: "The flow should change from red to a pinkish-brown colour around this time."
Normal lochia progresses through three stages. Lochia rubra (red) lasts for about 1-3 days. Lochia serosa (pinkish-brown) occurs from about day 4 to day 10. Lochia alba (yellowish-white) follows and can last for several weeks. A statement indicating the flow will change from red to pinkish-brown around day 3-4 shows correct understanding.
Question 4: An RPN is reinforcing safe sleep education with new parents to reduce the risk of Sudden Infant Death Syndrome (SIDS). Which of the following recommendations is a key component of this teaching?
- Place the infant on their stomach to sleep to prevent choking.
- Ensure the crib is soft with bumpers, blankets, and stuffed animals for comfort.
- Share a bed with the infant to facilitate nighttime feedings.
- Place the infant on their back to sleep on a firm, flat surface. (Correct answer)
Correct answer: Place the infant on their back to sleep on a firm, flat surface.
Current safe sleep guidelines to reduce the risk of SIDS strongly recommend placing infants on their back for every sleep. The sleep surface should be firm and flat, such as in a safety-approved crib, and kept clear of all soft objects like pillows, loose blankets, and bumper pads. Stomach sleeping, soft bedding, and bed sharing are all identified risk factors for SIDS.
Question 5: An RPN is assessing a newborn 2 hours after birth. Which of the following assessment findings requires immediate notification of the Registered Nurse (RN) or physician?
- Respiratory rate of 55 breaths per minute.
- Apical heart rate of 140 beats per minute.
- Presence of nasal flaring and grunting. (Correct answer)
- Axillary temperature of 36.8°C.
Correct answer: Presence of nasal flaring and grunting.
Nasal flaring and grunting are cardinal signs of respiratory distress in a newborn, indicating increased work of breathing. This is an abnormal finding that requires prompt evaluation and intervention. The other options are within normal limits for a term newborn (Normal RR: 30-60 breaths/min; Normal HR: 110-160 bpm; Normal Axillary Temp: 36.5-37.5°C).
Question 6: An RPN is assessing a newborn and observes acrocyanosis. Which of the following best describes this finding?
- A bluish discoloration of the hands and feet. (Correct answer)
- A bluish discoloration of the lips and mucous membranes.
- A fine, downy hair covering the newborn's back and shoulders.
- A yellowish tint to the skin and sclera.
Correct answer: A bluish discoloration of the hands and feet.
Acrocyanosis is a bluish discoloration of the extremities (hands and feet) and is a common, benign finding in the first 24-48 hours after birth due to immature peripheral circulation. It is important to differentiate it from central cyanosis (bluish lips/mucous membranes), which indicates hypoxemia and is a serious concern.
