NCLEX-RN Growth, Development and Childbearing Care Summary

Newborns are born with low vitamin K, and their gut does not yet have the bacteria that make it. Vitamin K is needed for blood to clot. One injection soon after birth prevents vitamin K deficiency bleeding, a rare but serious bleeding problem that can affect the brain.

Wrong choices

• "It protects your baby's eyes from infection" describes the eye ointment (erythromycin), not vitamin K.
• "It helps lower the chance of newborn jaundice" is not correct. Jaundice is managed with feeding and, if needed, light therapy.
• "It protects your baby from hepatitis B" describes the hepatitis B vaccine, a different injection.

A severe headache with blurred vision or other vision changes in the second half of pregnancy can be a sign of preeclampsia with severe features (high blood pressure that affects organs). This can lead to seizures (eclampsia), stroke, or problems with the placenta. The client needs to be seen right away for a blood pressure check and further testing.

Wrong choices

• "Mild swelling of both ankles at the end of the day" is common in late pregnancy, especially after standing. Sudden swelling of the face or hands would need follow-up.
• "Heartburn after large meals" is common because hormones relax the stomach valve and the uterus presses on the stomach.
• "Needing to urinate more often" is common late in pregnancy as the baby presses on the bladder. Burning or pain would need follow-up.

Late decelerations mean the baby is not getting enough oxygen from the placenta during contractions. Oxytocin makes contractions stronger and more frequent, which further reduces blood flow to the placenta. The first step is to stop the oxytocin. Then the nurse turns the client onto her side, gives IV fluids and oxygen if ordered, and notifies the provider.

Wrong choices

• "Document the finding and keep watching the monitor" delays care. Late decelerations need action now.
• "Increase the oxytocin rate to speed up the birth" would make contractions stronger and make the baby's oxygen problem worse.
• "Tell the client to push with the next contraction" is not right unless the cervix is fully dilated, and it does not fix the cause.

Soaking a full perineal pad in 15 minutes or less is a sign of heavy bleeding (postpartum hemorrhage). The nurse should check the fundus, massage it if it is soft, check vital signs, and get help. The other findings are normal on the first day after birth.

Wrong choices

• "Dark red vaginal flow with a few small clots" is normal lochia rubra in the first days after birth. Large clots would need follow-up.
• "Firm uterus 1 cm below the belly button" is expected. The uterus shrinks about 1 cm each day after birth.
• "Cramping pain during breastfeeding" (afterpains) is normal. Breastfeeding releases oxytocin, which makes the uterus contract.

Most infants can sit steadily without support by about 6 to 8 months, so a 9-month-old is expected to do this. Checking milestones at each visit helps find delays early so the child can get help sooner.

Wrong choices

• "Walks alone without holding on" usually happens around 12 months, so it is not expected yet at 9 months.
• "Builds a tower of six blocks" is a toddler skill seen around 2 years.
• "Speaks in two-word phrases" usually appears around 2 years. A 9-month-old babbles and may say "mama" or "dada" without meaning.

After birth, the top of the uterus (fundus) should be firm and near the belly button, in the middle. When it is firm but higher than expected and pushed to one side, the most common cause is a full bladder. A full bladder pushes the uterus up and keeps it from contracting well, which can lead to heavy bleeding. The first action is to help the client void (or use a catheter if she cannot), then check the fundus again.

Wrong choices

• "Massage the uterus firmly" is used when the uterus is soft (boggy). This uterus is already firm.
• "Notify the health care provider right away" is not needed first. This is a common finding the nurse can fix by helping the client empty her bladder.
• "Encourage the client to breastfeed" can help the uterus contract, but it does not fix the full bladder that is pushing the uterus out of place.

Confusion and trouble paying attention that start suddenly (over hours to days) are not normal aging. This is a warning sign of delirium, which is often caused by infection, dehydration, medicines, low oxygen, or other illness. Delirium needs quick follow-up to find and treat the cause.

Wrong choices

• "Needing reading glasses to see small print" is presbyopia, a normal age change in the eye lens.
• "Drier, thinner skin that bruises more easily" is a normal change because the skin loses fat, oil, and elasticity with age.
• "Waking up more often during the night" is common with aging, as sleep becomes lighter.