# Situation: A public health nurse makes home visits to mothers and newborns in a farming barangay during the first weeks after birth. The nurse plans a home visit to a mother and her 6-day-old baby, who is exclusively breastfed. Which activities should the plan include? 1. Confirm that the newborn screening sample was collected 2. Observe a breastfeed for latch and position 3. Advise giving water between feeds in hot weather 4. Counsel the mother on family planning methods 5. Check the mother's bleeding and uterine involution

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627160  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: A public health nurse makes home visits to mothers and newborns in a farming barangay during the first weeks after birth.

The nurse plans a home visit to a mother and her 6-day-old baby, who is exclusively breastfed. Which activities should the plan include?
1. Confirm that the newborn screening sample was collected
2. Observe a breastfeed for latch and position
3. Advise giving water between feeds in hot weather
4. Counsel the mother on family planning methods
5. Check the mother's bleeding and uterine involution

## 보기

1. 1, 2 and 5 only
2. 1, 2, 3 and 5
3. 1, 2, 4 and 5 **✔ 정답**
4. 2, 3, 4 and 5

**정답: 3**

## 해설

Early postpartum and newborn visits check the mother's bleeding and uterine involution, support breastfeeding, follow up newborn screening, and include family planning counseling. Giving water to an exclusively breastfed baby is wrong at any temperature: exclusive breastfeeding means no water, formula, or other food for 6 months.

## 심화 해설

Core issue The visit is at 6 days postpartum, so the plan must cover both maternal recovery and newborn safety while protecting exclusive breastfeeding.

Why the correct activities are included

Newborn screening follow-up is a time-sensitive task. The sample is ideally collected after 24 hours of feeding but before the baby is too old, so confirming collection at the first home visit is a standard early postpartum responsibility. If the sample was not obtained in the facility, the nurse must arrange collection promptly.

Direct observation of a breastfeed is the most reliable way to assess latch and positioning. Early postpartum home visits that include hands-on support for breastfeeding reduce common feeding problems. In one study, inappropriate breastfeeding position and attachment were the predominant problems, affecting 12 to 15% of newborns [4]. Observing a feed lets the nurse correct poor attachment before it causes sore nipples, poor milk transfer, or early breastfeeding cessation.

Maternal bleeding and uterine involution are essential assessments in the first week. Postpartum home visits in the weeks after birth help detect maternal complications before they become chronic or severe . Checking lochia and fundal height identifies hemorrhage, retained products, or subinvolution early.

Family planning counseling belongs in the early postpartum plan. Ovulation can return before the first menstrual period, even in exclusively breastfeeding mothers, so contraceptive discussion should begin before six weeks. The visit is an opportunity to provide information, not to pressure a method choice.

Why water between feeds is excluded

Exclusive breastfeeding for the first 6 months means the infant receives only breast milk — no water, formula, or other liquids or foods. Breast milk alone meets the infant’s hydration needs even in hot weather, and giving water can reduce milk intake, increase the risk of infection, and interfere with establishing a full milk supply. Watch out! The option “advise giving water between feeds in hot weather” is incorrect at any temperature and directly violates the definition of exclusive breastfeeding.

How the options separate

| Option set | Includes water advice | Includes family planning | Verdict |
| --- | --- | --- | --- |
| 1, 2, and 5 only | No | No | Incomplete: omits family planning counseling |
| 1, 2, 3, and 5 | Yes | No | Incorrect: adds water, which violates exclusive breastfeeding |
| 1, 2, 4, and 5 | No | Yes | Correct: all four activities are appropriate |
| 2, 3, 4, and 5 | Yes | Yes | Incorrect: adds water and omits newborn screening follow-up |

Key point! The early postpartum home visit is a package of care: maternal recovery, breastfeeding support, newborn screening, and family planning. The only activity that must be rejected is giving water to an exclusively breastfed infant, because exclusive breastfeeding means breast milk only for the first 6 months.
References (research sources)

- [4]Can early postpartum home visits by trained community health workers improve breastfeeding of newborns?Research articleMannan I, Rahman SM, Sania A, Seraji HR, Arifeen SE, Winch PJ (2008) · DOI: 10.1038/jp.2008.64

## 임상 시나리오

6-Day Postpartum Home VisitMaternal recovery and exclusive breastfeeding protection
Confirm that the newborn screening sample was collected after 24 hours of feeding. If not done in the facility, arrange prompt collection during the home visit.

Observe a breastfeed directly to assess latch and positioning. Correct poor attachment early to prevent sore nipples, poor milk transfer, and early breastfeeding cessation.

Check the mother's bleeding and uterine involution by assessing lochia and fundal height. This detects hemorrhage, retained products, or subinvolution in the first week.

Counsel on family planning because ovulation can return before the first menstrual period, even during exclusive breastfeeding.

CautionNever advise giving water between feeds to an exclusively breastfed baby, even in hot weather. Exclusive breastfeeding means no water, formula, or other food for the first 6 months.

## 핵심 개념

- **exclusive breastfeeding** — Feeding only breast milk with no water, formula, or other foods for the first 6 months of life
- **newborn screening** — Time-sensitive testing ideally collected after 24 hours of feeding to detect congenital disorders early
- **uterine involution** — The process of the uterus returning to its prepregnancy size and position after delivery
- **lochia** — Postpartum vaginal discharge composed of blood, mucus, and uterine tissue that changes over the first weeks
- **latch assessment** — Direct observation of how the infant attaches to the breast to correct poor positioning and prevent feeding problems

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