In kangaroo mother care, the baby is placed:

Upright between the mother's breasts, skin-to-skin

Supine across the mother's abdomen, clothed

Prone on the mother's lap, wrapped in a warm blanket

Side-lying next to the mother on her bed

On day 3 after delivery, both of a mother's breasts are hard, warm and tender, and her temperature is 37.6°C. Her baby cannot latch on well. Which advice is most appropriate?

Express a little milk to soften the areola, then feed often

Bind the breasts firmly and cut down on fluids taken

Give formula feeds and rest both breasts for a full day

Stop breastfeeding until the swelling has settled

On the morning after a normal delivery, a mother's uterus is firm but 2 cm above the umbilicus and deviated to the right. Lochia is moderate rubra. What should the nurse do first?

Help the mother empty her bladder

Start an oxytocin infusion at once

A 5-day-old exclusively breastfed baby weighed 3.0 kg at birth and now weighs 2.82 kg. The baby passes urine 7 times a day and has yellow stools. The mother fears her milk is not enough. What is the nurse's best response?

Reassure her that this loss is normal; continue breastfeeding

Advise formula top-ups after each feed to regain the weight

Advise giving boiled water between feeds for hydration

Refer the baby urgently to rule out dehydration

Puerperium, lactation and immediate newborn care

18 AIIMS NORCET (Nursing Officer) practice questions on Puerperium, lactation and immediate newborn care, part of Obstetric and Gynaecological Nursing. The first 18 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
In kangaroo mother care, the baby is placed:
1. ASupine across the mother's abdomen, clothed
2. BProne on the mother's lap, wrapped in a warm blanket
3. CSide-lying next to the mother on her bed
4. DUpright between the mother's breasts, skin-to-skin
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Answer: D · Upright between the mother's breasts, skin-to-skin
Kangaroo mother care keeps a small baby in continuous skin-to-skin contact, upright on the mother's chest between her breasts, with the head turned to one side and the hips flexed in a frog position. The baby wears only a cap, socks and a nappy, and the mother's clothing holds the baby in place. This keeps the baby warm, supports breastfeeding and lowers infection and death in low-birth-weight babies.
- A: A clothed baby lying supine misses the chest-to-chest contact KMC needs.
- B: A baby wrapped in a blanket on the lap has no skin-to-skin contact.
- C: Lying beside the mother is rooming-in, not kangaroo care.
Question 2 · Medium
On day 3 after delivery, both of a mother's breasts are hard, warm and tender, and her temperature is 37.6°C. Her baby cannot latch on well. Which advice is most appropriate?
1. ABind the breasts firmly and cut down on fluids taken
2. BExpress a little milk to soften the areola, then feed often
3. CGive formula feeds and rest both breasts for a full day
4. DStop breastfeeding until the swelling has settled
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Answer: B · Express a little milk to soften the areola, then feed often
This is breast engorgement, which usually appears on day 2-4 when milk comes in and the breasts are not emptied often. Expressing a little milk softens the areola so the baby can latch, and frequent, unrestricted feeding relieves the fullness. A warm compress before feeds, cold packs after, a supportive bra and simple analgesics help. Stopping feeds makes engorgement worse and can lead to mastitis.
- A: Binding and fluid restriction are for suppressing lactation, not for engorgement.
- C: Resting the breasts and giving formula leaves them full and harms breastfeeding.
- D: Stopping feeds leaves milk in the breast and worsens engorgement.
Question 3 · Medium
On the morning after a normal delivery, a mother's uterus is firm but 2 cm above the umbilicus and deviated to the right. Lochia is moderate rubra. What should the nurse do first?
1. AHelp the mother empty her bladder
2. BStart an oxytocin infusion at once
3. CMassage the fundus vigorously
4. DRecord it as normal involution
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Answer: A · Help the mother empty her bladder
A full bladder lifts the uterus and pushes it to one side, usually the right. Because the uterus is firm and the lochia is normal, the first step is to help the mother void, then reassess the fundus. A full bladder also hinders contraction and can lead to bleeding if it is ignored. If she cannot void, catheterisation may be needed.
- B: Oxytocin is not the first step for a firm uterus displaced by the bladder.
- C: Massage is for a soft, boggy uterus; this uterus is already firm.
- D: A displaced fundus above the umbilicus on day 1 is not normal.
Question 4 · Easy
Lochia that is yellowish-white, made up mainly of leucocytes, mucus and epithelial cells, and seen from about the tenth day after delivery is called:
1. ALochia purulenta
2. BLochia alba
3. CLochia rubra
4. DLochia serosa
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Answer: B · Lochia alba
Lochia changes colour as the placental site heals. Rubra (red, blood and decidua) is seen in the first 3-4 days, serosa (pinkish-brown) from about day 5 to 9, and alba (yellowish-white) from about day 10 to 15. A return to red lochia or a foul smell after this stage must be reported, as it suggests retained products or infection.
- A: Purulent, foul lochia is a sign of infection, not a normal stage.
- C: Lochia rubra is the red discharge of the first 3-4 days, rich in blood.
- D: Lochia serosa is pinkish-brown and seen from about day 5 to 9.
Question 5 · Hard
A 5-day-old exclusively breastfed baby weighed 3.0 kg at birth and now weighs 2.82 kg. The baby passes urine 7 times a day and has yellow stools. The mother fears her milk is not enough. What is the nurse's best response?
1. AReassure her that this loss is normal; continue breastfeeding
2. BAdvise formula top-ups after each feed to regain the weight
3. CAdvise giving boiled water between feeds for hydration
4. DRefer the baby urgently to rule out dehydration
Show answerHide answer
Answer: A · Reassure her that this loss is normal; continue breastfeeding
The loss is 0.18 kg out of 3.0 kg, which is 6%. Term babies may lose up to about 10% of birth weight in the first week and regain it by about 10-14 days. Six or more wet nappies a day and yellow stools show good milk intake. The nurse reassures the mother, checks attachment and encourages frequent exclusive breastfeeding.
- B: Formula is not needed when weight loss and output are normal, and it lowers supply.
- C: Water is not needed by a breastfed baby and reduces milk intake.
- D: Seven wet nappies a day and 6% loss do not suggest dehydration.
Question 6 · Easy
Colostrum is especially rich in which immunoglobulin, which protects the newborn's gut lining?
1. ASecretory IgA
2. BIgM
3. CIgG
4. DIgE
Answer and explanation in LearnFree account
Question 7 · Medium
A para 4 mother complains of cramping lower abdominal pain each time she breastfeeds on the day after delivery. Her fundus is firm at the umbilicus and lochia is normal. What is the best response?
1. AAdvise her to delay breastfeeding until the pain settles
2. BTell her the pain points to retained placental tissue
3. CReport a suspected concealed postpartum haemorrhage
4. DExplain these are afterpains from uterine contractions
Answer and explanation in LearnFree account
Question 8 · Hard
A term baby is born, cries at once and has good tone. Which sequence of essential newborn care is correct?
1. ASuction mouth and nose, clamp cord at once, weigh, then bathe
2. BDry, bathe in warm water, dress, then start breastfeeding at 6 hours
3. CClamp cord at once, weigh, give vitamin K, then hand to mother
4. DDry, skin-to-skin, clamp cord at 1-3 min, breastfeed within 1 hour
Answer and explanation in LearnFree account
Question 9 · Medium
In India, the vitamin K dose given at birth to a term baby weighing 2.8 kg is:
1. A1 mg intramuscularly in the anterolateral thigh
2. B5 mg by mouth, given with the first breastfeed
3. C0.5 mg intramuscularly into the deltoid muscle
4. D1 mg intravenously through the umbilical vein
Answer and explanation in LearnFree account
Question 10 · Easy
The most common cause of secondary postpartum haemorrhage, which occurs after the first 24 hours, is:
1. AA cervical tear made at delivery
2. BRetained bits of placenta or membranes
3. CAn episiotomy wound that was not sutured
4. DAtony of the uterus in the third stage
Answer and explanation in LearnFree account
Question 11 · Medium
On the fourth day after delivery, a mother is tearful and anxious and says she feels low, but she sleeps when the baby sleeps, feeds well and cares for her baby. What is the most likely explanation?
1. APuerperal psychosis
2. BPuerperal sepsis
3. CPostpartum depression
4. DPostpartum blues
Answer and explanation in LearnFree account
Question 12 · Hard
Two weeks after delivery, a mother has a red, tender, wedge-shaped area on the right breast, with fever of 38.5°C and aches. There is no fluctuant swelling. Cloxacillin has been prescribed. Which advice should the nurse give about feeding?
1. AFeed from the left breast and discard right-side milk
2. BStop breastfeeding until the antibiotic course ends
3. CKeep breastfeeding often from both breasts
4. DWean the baby and take a drug to stop lactation
Answer and explanation in LearnFree account
Question 13 · Hard
Day 2 checks after a normal delivery show: temperature 37.2°C, pulse 108/min (it was 78/min yesterday), BP 118/76 mmHg, fundus firm two finger-breadths below the umbilicus, moderate red lochia without clots, and soft breasts. Which finding should the nurse report?
1. AThe temperature of 37.2°C
2. BThe pulse of 108/min
3. CThe red lochia
4. DThe fundal height
Answer and explanation in LearnFree account
Question 14 · Easy
Immediately after delivery the uterus weighs about 1000 g. By the end of the puerperium, at six weeks, it weighs about:
1. A150 g
2. B60 g
3. C500 g
4. D300 g
Answer and explanation in LearnFree account
Question 15 · Medium
For a term baby who breathes well at birth and does not need resuscitation, WHO recommends that the umbilical cord be clamped:
1. AAfter the first breastfeed is complete
2. BWithin 15 seconds of the birth
3. CNot earlier than one minute after birth
4. DOnly after the placenta has been delivered
Answer and explanation in LearnFree account
Question 16 · Medium
As defined in Dutta's textbook, puerperal pyrexia is an oral temperature of 38°C (100.4°F) or more:
1. AOn any single reading taken within the first 24 hours after delivery
2. BOn two occasions 24 hours apart within the first 10 days, excluding the first 24 hours
3. COn two readings four hours apart within the first 48 hours after delivery
4. DPersisting for seven days at any time during the six weeks after delivery
Answer and explanation in LearnFree account
Question 17 · Easy
In the APGAR score, a newborn with a heart rate of 80 beats per minute scores how many points for heart rate?
1. A3
2. B2
3. C1
4. D0
Answer and explanation in LearnFree account
Question 18 · Hard
On day 4 after a prolonged labour with many vaginal examinations and manual removal of the placenta, a mother has temperature 38.6°C, pulse 112/min, a tender uterus that is larger than expected, and foul-smelling lochia. Her breasts are soft, her urine is clear with no dysuria, and her calves are not tender. What is the most likely cause of the fever?
1. ADeep vein thrombosis of the leg
2. BBreast engorgement with so-called milk fever
3. CInfection of the placental site (endometritis)
4. DAcute urinary tract infection
Answer and explanation in LearnFree account

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Puerperium, lactation and immediate newborn care

In kangaroo mother care, the baby is placed:

On day 3 after delivery, both of a mother's breasts are hard, warm and tender, and her temperature is 37.6°C. Her baby cannot latch on well. Which advice is most appropriate?

On the morning after a normal delivery, a mother's uterus is firm but 2 cm above the umbilicus and deviated to the right. Lochia is moderate rubra. What should the nurse do first?

Lochia that is yellowish-white, made up mainly of leucocytes, mucus and epithelial cells, and seen from about the tenth day after delivery is called:

A 5-day-old exclusively breastfed baby weighed 3.0 kg at birth and now weighs 2.82 kg. The baby passes urine 7 times a day and has yellow stools. The mother fears her milk is not enough. What is the nurse's best response?

Colostrum is especially rich in which immunoglobulin, which protects the newborn's gut lining?

A para 4 mother complains of cramping lower abdominal pain each time she breastfeeds on the day after delivery. Her fundus is firm at the umbilicus and lochia is normal. What is the best response?

A term baby is born, cries at once and has good tone. Which sequence of essential newborn care is correct?

In India, the vitamin K dose given at birth to a term baby weighing 2.8 kg is:

The most common cause of secondary postpartum haemorrhage, which occurs after the first 24 hours, is:

On the fourth day after delivery, a mother is tearful and anxious and says she feels low, but she sleeps when the baby sleeps, feeds well and cares for her baby. What is the most likely explanation?

Two weeks after delivery, a mother has a red, tender, wedge-shaped area on the right breast, with fever of 38.5°C and aches. There is no fluctuant swelling. Cloxacillin has been prescribed. Which advice should the nurse give about feeding?

Day 2 checks after a normal delivery show: temperature 37.2°C, pulse 108/min (it was 78/min yesterday), BP 118/76 mmHg, fundus firm two finger-breadths below the umbilicus, moderate red lochia without clots, and soft breasts. Which finding should the nurse report?

Immediately after delivery the uterus weighs about 1000 g. By the end of the puerperium, at six weeks, it weighs about:

For a term baby who breathes well at birth and does not need resuscitation, WHO recommends that the umbilical cord be clamped:

As defined in Dutta's textbook, puerperal pyrexia is an oral temperature of 38°C (100.4°F) or more:

In the APGAR score, a newborn with a heart rate of 80 beats per minute scores how many points for heart rate?