A
In helping the breastfeeding mother position the baby, nurses should keep in mind that:
a. The cradle position is usually preferred by mother who had a cesarean birth
b. Women with perineal pain and swelling prefer the modified cradle position
c. Whatever the position used, the infant is “skin to skin” with the mother
d. While supporting the head, the mother should push gently on the occiput
c. Whatever the position used, the infant is "skin to skin" with the mother
Rationale: The football position usually is preferred after cesarean birth. Women with perineal pain and swelling prefer the side-lying position because they can rest while breastfeeding. The infant should be placed in a “skin to skin” position facing the mother. The mother should never push on the back of the head. It may cause the baby to bite, hyperextend the neck, or develop an aversion to being brought near the breast.
Which statement regarding infant weaning is correct?
a. Weaning should proceed from breast to bottle to cup
b. The feeding of most interest should be eliminated first
c. Abrupt weaning is easier than gradual weaning
d. Weaning can be mother or infant initiated
d. Weaning can be mother or infant initiated
Rationale: Infants can be weaned directly from the breast to a cup. Bottles are usually offered to infants less than 6 months. If the infant is weaned before 1 year of age, iron-fortified formula rather than cow’s milk should be offered. The feeding of least interest to the baby or the one through which the infant is likely to sleep should be eliminated first. Every few days thereafter the mother drops another feeding. Gradual weaning over a period of weeks or months is easier for both the mother and the infant than an abrupt weaning. Weaning is initiated by the mother or the infant. With infant-led weaning, the infant moves at his or her own pace in omitting feedings, which leads to a gradual decrease in the mother’s milk supply. Mother-led weaning means that the mother decides which feedings to drop.:
With regard to the long-term consequences of infant feeding practices, the nurse should instruct the obese client that the best strategy to decrease the risk for childhood obesity for her infant is:
a. An on-demand feeding schedule
b. Breastfeeding
c. Lower-calorie infant formula
d. Smaller, more frequent feedings
b. Breastfeeding
Rationale: All breastfed infants should be fed on demand. Breastfeeding is the best prevention strategy for decreasing childhood and adolescent obesity. Breastfeeding also assists the woman to return to her prepregnant weight sooner. Lower-calorie formula is an inappropriate strategy that does not meet the infant’s nutritional needs. Breastfeeding is the most appropriate choice for infant feeding. Smaller feedings are not necessary. Infants should continue to be fed every 2 to 3 hours in the newborn period.
The nurse taught new parent the guidelines to follow regarding bottle feeding of their newborn. They will be using formula from a can of concentrate. The parents would demonstrate an understanding of the nurse’s instructions if they:
a. Wash the top of the can and can opener with soap and water before opening the can
b. Adjust the amount of water added according to the weight gain pattern of the newborn
c. Add some honey to sweeten the formula and make it more appealing to a fussy newborn
d. Warm formula in a microwave oven for a couple of minutes before feeding
a. Wash the top of the can and can opener with soap and water before opening the can
Rationale: Washing the top of the can and can opener with soap and water before opening the can of formula is a good habit for a parent to get into to prevent contamination. Directions on the can for dilution should be followed exactly and not adjusted according to weight gain to prevent nutritional and fluid imbalances. Honey is not necessary and could contain botulism spores. The formula should be warmed in a container of hot water since a microwave can easily overheat it.
What is the PRIORITY teaching tip the nurse should provide about bottle feeding?
a. Infants may stool with each feeding in the first weeks
b. Feed newborn at least every 3 to 4 hours
c. Hold infant semi-upright while feeding
d. Some infants take longer to feed than others
c. Hold infant semi-upright while feeding
Rationale: The infant may have a stool with each feeding in the first 2 weeks, although this amount may decrease to one or two stools each day Newborns should be fed at least every 3 to 4 hours and should never go longer than 4 hours without feeding until a satisfactory pattern of weight gain is established. Infants should be held and never left alone while feeding. Never prop the bottle. The infant might inhale formula or choke on any that was spit up. Airway is priority. Taking a few sucks and then pausing briefly before continuing to suck again is normal for infants. Some infants take longer to feed than others. Be patient. Keep the baby awake; encouraging sucking may be necessary. Moving the nipple gently in the infant’s mouth may stimulate sucking.
A maternity nurse is preparing a teaching class of a group of new parents on infant feeding practices. The maternity nurse ants to include content that is relative to cultural diversity. Which statement related to cultural practices influencing infant feeding practice correct?
a. A common practice among Mexican women is known as las dos cosas
b. Muslim cultures do not encourage breastfeeding due to modesty concerns
c. Latino women born in the united states are more likely to breastfeed
d. East Indian and arab women believe that cold foods are best for a new mother
a. A common practice among Mexican women is known as las dos cosas
Rationale: A common practice among Mexican women is las do coasas. This refers to combining breastfeeding and commercial infant formula. It is based on the belief that by combining the two feeding methods, the mother and infant receive the benefits of breastfeeding along with the additional vitamins from formula. Among the Muslim culture, breastfeeding for 24 months is customary. Muslim women may choose to bottle-feed formula or expressed breast milk while in the hospital. Latino women born in the United States are less likely to breastfeed. East Indian and Arab women believe that hot foods, such as chicken and broccoli, are best for the new mother. The descriptor hot has nothing to do with the temperature or spiciness of the food.
Which action of a breastfeeding mother indicates the need for further instruction?
a. Holds breast with four fingers along bottom and thumb at top
b. Leans forward to bring breast toward the baby
c. Stimulates the rooting reflex and then inserts nipple and areola into newborn’s open mouth
d. Puts her finger into newborn’s mouth before removing breast
b. Leans forward to bring breast toward the baby
Rationale: Holding the breast with four fingers along the bottom and the thumb at top is a correct technique. To maintain a comfortable, relaxed position, the mother should bring the baby to the breast, not the breast to the baby. The mother would need further demonstration and teaching to correct the ineffective action. Stimulating the rooting reflex is correct. Placing the finger in the mouth to remove the baby from the breast is correct.
Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them about pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement is valid?
a. A premature infant more easily digests breast milk than formula.
b. A glass of wine just before pumping will help reduce stress and anxiety.
c. The mother should pump only as much as the infant can drink.
d. The mother should pump every 2 to 3 hours, including during the night.
a. A premature infant more easily digests breast milk than formula
Rationale: Human milk is the ideal food for preterm infants, with benefits that are unique in addition to those received by term, healthy infants. Greater physiologic stability occurs with breastfeeding compared with formula feeding. Consumption of alcohol during lactation is approached with caution. Excessive amounts can have serious effects on the infant and can adversely affect the mother's milk ejection reflex. To establish an optimal milk supply, the mother should be instructed to pump 8 to 10 times a day for 10 to 15 minutes on each breast.
To prevent nipple trauma, the nurse should instruct the new mother to:
a. limit the feeding time to less than 5 minutes.
b. position the infant so the nipple is far back in the mouth.
c. assess the nipples before each feeding.
d. wash the nipples daily with mild soap and water.
b. position the infant so the nipple is far back in the mouth
Rationale: If the infant's mouth does not cover as much of the areola as possible, the pressure during sucking will be applied to the nipple, thus causing trauma to the area. Stimulating the breast for less than 5 minutes will not produce the extra milk the infant may need. This will also limit access to the higher-fat "hindmilk." Assessing the nipples for trauma is important; however, this action alone will not prevent sore nipples. Soap can be drying to the nipples and should be avoided during breastfeeding.
As the nurse assists a new mother with breastfeeding, the patient asks, "If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better?" The nurse's best response is that it contains:
a. more calories.
b. essential amino acids.
c. important immunoglobulins.
d. more calcium.
c. Important immunoglobulins
Rationale: Breast milk contains immunoglobulins that protect the newborn against infection. The calorie count of formula and breast milk is about the same. All the essential amino acids are in both formula and breast milk; however, the concentrations may differ. Calcium levels are higher in formula than in breast milk. This higher level can cause an excessively high renal solute load if the formula is not diluted properly.
The birth weight of a breastfed newborn was 8 lbs, 4 oz. On the third day the newborn’s weight was 7 lbs, 12 oz. On the basis of this finding, the nurse should:
a. Encourage the mother to continue breastfeeding since it is effective in meeting the newborn’s nutrient and fluid needs
b. Suggest that the mother switch to bottle feeding since the breastfeeding is ineffective in meeting newborn needs for fluid and nutrients
c. Notify the physician since the newborn is being poorly nourished
d. Refer the mother to a lactation consultant to improve her breastfeeding technique
a. Encourage the mother to continue breastfeeding since it is effective in meeting the newborn's nutrient and fluid needs
Rationale: Weight loss of 8 oz falls within the 5% to 10% expected weight loss from birth weight during the first few days of life, which for this newborn would be 6.6 to 13.2 oz. Breastfeeding is effective at this time. Breastfeeding is effective, and bottle-feeding does not need to be initiated at this time. The infant is not undernourished, and the physician does not need to be notified. The weight loss is within normal limits; breastfeeding is effective.
When responding to the question "Will I produce enough milk for my baby as she grows and needs more milk at each feeding?" the nurse should explain that:
a. the breast milk will gradually become richer to supply additional calories.
b. as the infant requires more milk, feedings can be supplemented with cow's milk.
c. early addition of baby food will meet the infant's needs.
d. the mother's milk supply will increase as the infant demands more at each feeding.
d. The mother's milk supply will increase as the infant demands more at each feeding
Rationale: The amount of milk produced depends on the amount of stimulation of the breast. Increased demand with more frequent and longer breastfeeding sessions results in more milk available for the infant. Mature breast milk will stay the same. The amounts will increase as the infant feeds for longer times. Supplementation will decrease the amount of stimulation of the breast and decrease the milk production. Solids should not be added until about 4 to 6 months, when the infant's immune system is more mature. This will decrease the chance of allergy formations
To initiate the milk ejection reflex (MER), the mother should be advised to:
a. wear a firm-fitting bra.
b. drink plenty of fluids.
c. place the infant to the breast.
d. apply cool packs to her breast.
c. Place the infant to the breast
Rationale: Oxytocin, which causes the MER reflex, increases in response to nipple stimulation. A firm bra is important to support the breast; however, will not initiate the MER reflex. Drinking plenty of fluids is necessary for adequate milk production, but this alone will not initiate the MER reflex. Cool packs to the breast will decrease the MER reflex.
The best reason for recommending formula over breastfeeding is that:
a. the mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk.
b. the mother lacks confidence in her ability to breastfeed.
c. other family members or care providers also need to feed the baby.
d. the mother sees bottle-feeding as more convenient.
a. the mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk
Rationale: Breastfeeding is contraindicated when mothers have certain viruses, are undergoing chemotherapy, or are using/abusing illicit drugs. A lack of confidence, the need for others to feed the baby, and the convenience of bottle-feeding are all honest reasons for not breastfeeding, although further education concerning the ease of breastfeeding and its convenience, benefits, and adaptability (expressing milk into bottles) could change some minds. In any case the nurse must provide information in a nonjudgmental manner and respect the mother's decision. Nonetheless, breastfeeding is definitely contraindicated when the mother has medical or drug issues of her own.
While discussing the societal impacts of breastfeeding, the nurse should be cognizant of the benefits and educate the patient accordingly. Which statement as part of this discussion would be incorrect?
a. Breastfeeding requires fewer supplies and less cumbersome equipment.
b. Breastfeeding saves families money.
c. Breastfeeding costs employers in terms of time lost from work.
d. Breastfeeding benefits the environment.
c. Breastfeeding costs employers in terms of time lost from work
Rationale: Actually less time is lost to work by breastfeeding mothers, in part because infants are healthier. Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment. It saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. Breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal.
A new mother asks whether she should feed her newborn colostrum, because it is not "real milk." The nurse's most appropriate answer is:
a. colostrum is high in antibodies, protein, vitamins, and minerals.
b. colostrum is lower in calories than milk and should be supplemented by formula.
c. giving colostrum is important in helping the mother learn how to breastfeed before she goes home.
d. colostrum is unnecessary for newborns.
a. Colostrum is high in antibodies, protein, vitamins, and minerals
Rationale: Colostrum is important because it has high levels of the nutrients needed by the neonate and helps protect against infection. Supplementation is not necessary; it will decrease stimulation to the breast and decrease the production of milk. It is important for the mother to feel comfortable in this role before discharge; however, the importance of the colostrum to the infant is the top priority. Colostrum provides immunities and enzymes necessary to cleanse the gastrointestinal system, among other things.
A newly delivered mother who intends to breastfeed tells her nurse, "I am so relieved that this pregnancy is over so I can start smoking again." The nurse encourages the patient to refrain from smoking. However, this new mother insists that she will resume smoking. The nurse will need to adapt her health teaching to ensure that the patient is aware that:
a. smoking has little or no effect on milk production.
b. there is no relation between smoking and the time of feedings.
c. the effects of secondhand smoke on infants are less significant than for adults.
d. the mother should always smoke in another room.
d. the mother should always smoke in another room
Rationale: The new mother should be encouraged not to smoke. If she continues to smoke, she should be encouraged to always smoke in another room removed from the baby. Smoking may impair milk production. When the products of tobacco are broken down, they cross over into the breast milk. Tobacco also results in a reduction of the immunologic properties of breast milk. Research supports that mothers should not smoke within 2 hours before a feeding. The effects of secondhand smoke on infants include sudden infant death syndrome.
The breastfeeding mother should be taught a safe method to remove the breast from the baby's mouth. Which suggestion by the nurse is most appropriate?
a. Slowly remove the breast from the baby's mouth when the infant has fallen asleep and the jaws are relaxed.
b. Break the suction by inserting your finger into the corner of the infant's mouth.
c. A popping sound occurs when the breast is correctly removed from the infant's mouth.
d. Elicit the Moro reflex to wake the baby and remove the breast when the baby cries.
b. break the suction by inserting your finger into corner of the infant's mouth
Rationale: Inserting a finger into the corner of the baby's mouth between the gums to break the suction avoids trauma to the breast. The infant who is sleeping may lose grasp on the nipple and areola, resulting in "chewing" on the nipple that makes it sore. A popping sound indicates improper removal of the breast from the baby's mouth and may cause cracks or fissures in the breast. Most mothers prefer the infant to continue to sleep after the feeding. Gentle wake-up techniques are recommended.
Nurses providing nutritional instruction should be cognizant of the uniqueness of human milk. Which statement is correct?
a. Frequent feedings during predictable growth spurts stimulate increased milk production.
b. The milk of preterm mothers is the same as the milk of mothers who gave birth at term.
c. The milk at the beginning of the feeding is the same as the milk at the end of the feeding.
d. Colostrum is an early, less concentrated, less rich version of mature milk.
a. Frequent feedings during predictable growth spurts stimulate increased milk production
Rationale: These growth spurts (10 days, 3 weeks, 6 weeks, 3 months) usually last 24 to 48 hours, after which infants resume normal feeding. The milk of mothers of preterm infants is different from that of mothers of full-term infants to meet the needs of these newborns. Milk changes composition during feeding. The fat content of the milk increases as the infant feeds. Colostrum precedes mature milk and is more concentrated and richer in proteins and minerals (but not fat).
With regard to the nutrient needs of breastfed and formula-fed infants, nurses should understand that:
a. breastfed infants need extra water in hot climates.
b. during the first 3 months breastfed infants consume more energy than do formula-fed infants.
c. breastfeeding infants should receive oral vitamin D drops daily at least during the first 2 months.
d. vitamin K injections at birth are not needed for infants fed on specially enriched formula.
c. Breastfeeding infants should receive oral vitamin D drops daily at least during the first 2 months
Rationale: Human milk contains only small amounts of vitamin D. Neither breastfed nor formula-fed infants need to be given water, even in very hot climates. During the first 3 months formula-fed infants consume more energy than do breastfed infants and therefore tend to grow more rapidly. Vitamin K shots are required for all infants because the bacteria that produce it are absent from the baby's stomach at birth.
The nurse should include which instructions when teaching a mother about the shortage of breast milk? (Select all that apply.)
a. Wash hands before expressing breast milk
b. Store milk in 8 to 12 oz containers
c. Store refrigerated milk in the door of the refrigerator
d. Place frozen milk in the microwave for only a few seconds to thaw
e. Milk thawed in the refrigerator can be stored for 24 hours
a. Wash hands before expressing breast milk
e. Milk thawed in the refrigerator can be stored for 24 hours
Rationale: Breast milk storage guidelines for home use for full-term infants are: Before expressing or pumping breast milk, wash your hands. Containers for storing milk should be washed in hot, soapy water, and rinsed thoroughly; they can also be washed in a dishwasher. If the water supply may not be clean, boil containers after washing. Plastic bags designed specifically for breast milk storage can be used for short-term storage (Write the date of expression on container before storing milk. A waterproof label is best. Store milk in serving sizes of 2 to 4 ounces to prevent waste. Storing breast milk in the refrigerator or freezer with other food items is acceptable. When storing milk in a refrigerator or freezer, place containers in the middle or back of the freezer, not on the door. When filling a storage container that will be frozen, fill only three quarters full, allowing space at the top of the container for expansion. To thaw frozen breast milk, place container in the refrigerator for gradual thawing or under warm, running water for quicker thawing. Never boil or microwave. Milk thawed in the refrigerator can be stored for 24 hours. Thawed breast milk should never be refrozen. Shake milk container before feeding baby and test the temperature of the milk on the inner aspect of your wrist. Any unused milk left in the bottle after feeding is discarded.
Which of these statements indicate the effect of breastfeeding on the family or society at large? (select all that apply.)
a. Breastfeeding requires fewer supplies and less cumbersome equipment
b. Breastfeeding saves families money
c. Breastfeeding costs employers in terms of time lost from work
d. Breastfeeding benefits the environment
e. Breastfeeding results in reduced annual health care costs
b. Breastfeeding saves families money
d. Breastfeeding benefits the environment
e. Breastfeeding results in reduced annual health care costs
Rationale: Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment. Breastfeeding saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. Less time is lost from work by breastfeeding mothers, in part because infants are healthier. Breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal. Breastfeeding results in reduced annual health care costs.
Late in pregnancy, the woman's breasts should be assessed by the nurse to identify any potential concerns related to breastfeeding. Some nipple conditions make it necessary to provide intervention before birth. These include: (Select all that apply.)
a. everted nipples.
b. flat nipples.
c. inverted nipples.
d. nipples that contract when compressed.
e. cracked nipples.
b. flat nipples
c. inverted nipples
d. nipples that contract when compressed
Rationale: Flat nipples appear soft, like the areola, and do not stand erect unless stimulated by rolling them between the fingers. Inverted nipples are retracted into the breast tissue. These nipples appear normal; however, they will draw inward when the areola is compressed by the infant's mouth. Dome-shaped devices known as breast shells can be worn during the last weeks of pregnancy and between feedings after birth. The shells are placed inside the bra with the opening over the nipple. The shells exert slight pressure against the areola to help the nipples protrude. The helpfulness of breast shells is debated. A breast pump can be used to draw the nipples out before feedings after delivery. Everted nipples protrude and are normal. No intervention will be required. Cracked, blistered, and bleeding nipples occur after breastfeeding has been initiated and are the result of improper latch. The infant should be repositioned during feeding. Application of colostrum and breast milk after feedings will aid in healing.
A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. What signs and symptoms should the nurse include in her discussion? (Select all that apply.)
a. Breast tenderness
b. Warmth in the breast
c. An area of redness on the breast often resembling the shape of a pie wedge
d. A small white blister on the tip of the nipple
e. Fever and flu-like symptoms
a. breast tenderness
b. warmth in the breast
c. an area of redness on the breast often resembling the shape of a pie wedge
e. fever and flu-like symptoms
Rationale: Breast tenderness, breast warmth, breast redness, and fever and flu-like symptoms are commonly associated with mastitis and should be included in the nurse's discussion of mastitis. A small white blister on the tip of the nipple generally is not associated with mastitis. It is commonly seen in women who have a plugged milk duct.
Examples of appropriate techniques to wake a sleepy infant for breastfeeding include: (Select all that apply.)
a. unwrapping the infant.
b. changing the diaper.
c. talking to the infant.
d. slapping the infant's hands and feet.
e. applying a cold towel to the infant's abdomen.
a. unwrapping the infant
b. changing the diaper
c. talking to the infant
Rationale: Unwrapping the infant, changing the diaper, and talking to the infant are appropriate techniques to use when trying to wake a sleepy infant. Slapping the infant's hand and feet and applying a cold towel to the infant's abdomen are not appropriate. The parent can rub the infant's hands or feet to wake the infant. Applying a cold towel to the infant's abdomen may lead to cold stress in the infant. The parent may want to apply a cool cloth to the infant's face to wake the infant.