Newborn Nutrition AQ
A registered nurse teaches a nursing student about steps to take to minimize the hazardous effects of maternal drugs on infants during breast-feeding. Which statement of the nursing student indicates the need for additional teaching? "Avoid drugs that have a long half-life in the mother." "Administer sustained-release formulations to the mother." "Use the lowest effective dosage for the shortest possible time." "The mother should be dosed immediately after breast-feeding."
"Administer sustained-release formulations to the mother." (Sustained-release formulation may have long-term effects on the infant through breast milk. Therefore these drug formulations should be avoided in a mother who is breastfeeding. Drugs that have a long half-life should not be administered to a breast-feeding mother to reduce the toxic effect of the drug on the infant. The lowest effective dosage should be used for the shortest possible time in the mother to reduce the toxic effects to the infant. Drug dosing should be immediately given to the mother after breast-feeding to minimize the drug concentration in the milk at the next feeding.)
A new mother who is learning about infant feedings asks the nurse how anyone who is breast-feeding gets anything done with a baby feeding on demand. What is the best response by the nurse? "Most mothers find that feeding whenever the baby cries works out fine." "Perhaps a schedule would be better because the baby is already accustomed to the hospital routine." "Babies on demand feedings eventually set a schedule, so there should be time for you to do other things." "Most breast-feeding mothers find that their babies do better on demand because the amount of milk ingested varies from feeding to feeding."
"Babies on demand feedings eventually set a schedule, so there should be time for you to do other things." (Most average-sized infants regulate themselves to an approximate 3- to 4-hour schedule, but wide variations do exist. Some episodes of crying do not indicate that the infant is hungry; the mother will learn the difference. It is best to allow the infant to set the schedule. Although it is true that most mothers find that their babies do better with a demand-feeding system, this response does not answer the mother's question about when she will have free time.)
The nurse is teaching participants in a prenatal class regarding breastfeeding versus formula feeding. A client asks, "What is the primary advantage of breastfeeding?" Which response is most appropriate? "Breastfed infants have fewer infections." "Breastfeeding inhibits ovulation in the mother." "Breastfed infants adhere more easily to a feeding schedule." "Breastfeeding provides more protein than cow's milk formula does."
"Breastfed infants have fewer infections." (Maternal antibodies are transferred from the mother in breast milk, providing protection for a longer time than do antibodies transferred to the fetus by way of the placenta. The neonate is protected by the antibodies. The fetus' own antibody system is immature at birth. Lactating mothers rarely ovulate for the first 9 postpartum weeks; however, they may ovulate at any time after that period; although a breastfed infant adhering more easily to a feeding schedule may be considered an advantage, it is not a primary advantage. Because of the higher carbohydrate content of breast milk, which is digested rapidly, breastfed infants wake more frequently than formula-fed infants. Their feeding demands take more time to regulate than do the formula-fed infant's. Breast milk has 1.1 g protein/100 mL; cow's milk has 3.5 g/100 mL. Whole cow's milk is unsuitable for infants.)
A nurse is teaching breast-feeding to a newly delivered client. Which statement by the client indicates the need for further instruction? "I'll try to empty my breasts at each feeding." "I'll alternate between breasts to start feedings." "I need to wash my breasts with soapy water before I breast-feed." "I need to stroke my baby's cheek gently when I'm ready to breast-feed."
"I need to wash my breasts with soapy water before I breast-feed." (Soap irritates, cracks, and dries breasts and nipples, making it painful for the mother when the baby sucks; it also increases the risk for mastitis. The client should empty the breasts at each feeding to keep milk flowing. Alternating between breasts to start feedings is a permissible and often-used technique of breast-feeding. Gently stroking the baby's cheek elicits the rooting reflex; the infant's head turns toward and touches the mother's breast.)
A nurse is teaching breast care to a client who is breastfeeding. Which statement by the client indicates that the teaching has been effective? "I should air-dry my nipples after each feeding." "I should use a mild soap when I wash my breasts." "I'll have to line my breast pads with plastic shields." "I need to take off my bra before I go to bed at night."
"I should air-dry my nipples after each feeding." (Air-drying nipples after feedings limits irritation and disruption of skin integrity. The application of soap to breast tissue may result in drying and cracking. Plastic liners trap moisture against tissue and may cause skin breakdown. Wearing a brassiere continuously, except while bathing, is recommended for 2 to 3 weeks after delivery to provide support to breast tissue structures.)
What statement by a breast-feeding mother indicates that the nurse's teaching regarding stimulating the let-down reflex has been successful? "I will take a cool shower before each feeding." "I will drink a couple of quarts of fat-free milk a day." "I will wear a snug-fitting breast binder day and night." "I will apply warm packs and massage my breasts before each feeding."
"I will apply warm packs and massage my breasts before each feeding." (Applying warm packs and massaging the breasts before each feeding help dilate milk ducts, promote emptying of the breasts, and stimulate further lactation. Taking a cool shower before each feeding will contract the milk ducts and interfere with the let-down reflex. Heavy consumption of milk products is not required to stimulate the production of milk. Breast binders may inhibit lactation by fooling the body into thinking that milk secretion is no longer needed.)
A new mother who has begun breastfeeding asks for assistance removing the baby from her breast. Which instruction is most appropriate for the nurse to provide? "Pinch the baby's nostrils gently to help release the nipple." "Let the baby nurse as long as desired without interruption." "Pull your nipple out of the baby's mouth when the baby falls asleep." "Insert your finger in the corner of the baby's mouth to break the suction."
"Insert your finger in the corner of the baby's mouth to break the suction." (Inserting a finger into the corner of the baby's mouth is painless and will help prevent damage to the mother's nipple. Pinching the baby's nostrils is somewhat cruel; breaking suction with a finger is less traumatic. The mother may need to remove the baby from the breast before the baby is ready to let go, and the mother should be taught how to do this. Pulling without first breaking the suction may inflict trauma on the nipple.)
On the third postpartum day a nurse is preparing a breastfeeding mother of twins for discharge. Which statement by the client indicates a potential problem? "I've been urinating large amounts ever since I gave birth." "My flow is bright red with small brown clots the size of my thumb." "My breasts feel full, heavy, and tingly before I breastfeed the babies." "I hope I'll stop being so hungry, because I don't want to gain weight."
"My flow is bright red with small brown clots the size of my thumb." (Bright-red lochia with thumb-sized brown clots indicates subinvolution and requires further assessment. Urination of large amounts is the expected postpartum diuresis. Breasts that feel full, heavy, and tingly before breastfeeding reflect the influence of the posterior pituitary hormone, oxytocin, that causes the let-down reflex, which is expected before each feeding. An increased appetite is expected with breastfeeding, especially of twins.)
Before discharge, a breastfeeding postpartum client and the nurse discuss methods of birth control. The client asks the nurse, "When will I begin to ovulate again?" How should the nurse respond? "You should discuss this at your first clinic visit." "Ovulation will occur after you stop breastfeeding." "Ovulation may occur before you begin to menstruate." "I really can't tell you, because everyone is so different."
"Ovulation may occur before you begin to menstruate." (If the client is breastfeeding, ovulation and fertility may occur before menstruation resumes. It is the nurse's responsibility to answer the client's questions rather than putting the client off. Ovulation may occur while a woman is breastfeeding because the process of follicular maturation begins when the prolactin level decreases. Declining to answer by claiming that every woman is different evades the question; there are general guidelines that the nurse can share with the client.)
A client who just gave birth has three young children at home. She comments to the nursery nurse that she must prop the baby during feedings when she returns home because she has too much to do. What is the nurse's most appropriate response? "You seem concerned about managing your time. Let's talk about it." "That's up to you; you have to do what works for you." "Holding the baby when feeding is important for development." "It's not safe to prop a bottle. The baby could aspirate the fluid."
"You seem concerned about managing your time. Let's talk about it." (Asking the client to discuss her concerns about time opens up an area of communication to determine what really is troubling the mother about feeding her baby. The nurse is aware that this is not the best method when using a bottle to feed an infant; the problem of time should be explored with the mother. Holding may be accomplished at times other than feeding periods; telling the client that holding the baby during feedings is important does not explore the client's feelings. Although it is true that it is not safe to prop a baby because of the risk of aspiration, the mother should not be challenged so directly; a gentler explanation should be offered.)
A client asks the nurse at the family planning clinic whether contraception is needed while she is breastfeeding. How should the nurse reply? "As long as you aren't having periods, you won't need a contraceptive." "It would be best to delay sexual relations until you have your first period." "You should use contraceptives, because ovulation may occur at any time without a period." "Breastfeeding suppresses ovulation, so you don't need to worry about pregnancy."
"You should use contraceptives, because ovulation may occur at any time without a period." (Anovulation occurs in nursing mothers for varying periods of time; breastfeeding is not a reliable method of birth control. Periods may not occur for several months; sexual relations need not be delayed until the first period. Ovulation can occur without menstruation. Lactation may delay menses, but does not reliably suppress ovulation.)
After giving birth to a 7-lb 2-oz (3232 g) baby, a client decides that she will breastfeed. What information should the nurse provide to the client regarding breastfeeding? An increase in lochial flow is expected. Weight loss will occur rapidly. Involution of the uterus will be delayed. Application of heat to the breasts is contraindicated.
An increase in lochial flow is expected. (Breastfeeding stimulates oxytocin release and uterine contractions, resulting in increased lochial flow. Weight loss may occur slowly for the breastfeeding mother because of her increased nutritional and caloric needs. The increased levels of oxytocin and subsequent uterine contractions will enhance involution. Heat is not contraindicated, and the client may take warm showers. Warm compresses can be used if the mother experiences problems such as engorgement or sore nipples in order to provide relief.)
A client who is formula feeding her infant complains of discomfort from engorged breasts. What should the nurse recommend that the client do? Use warm, moist towels as compresses. Express milk from each breast manually. Apply cold packs and a snugly fitting bra. Restrict oral fluid intake to less than a quart a day.
Apply cold packs and a snugly fitting bra. (Application of cold relieves discomfort, and a snug bra provides support and aids in pressure atrophy of acini cells so that milk production is suppressed. Warm, moist compresses are suitable for the breastfeeding mother experiencing discomfort from engorgement because it promotes comfort and stimulates milk production. Expressing milk manually is suitable for the breastfeeding mother who is experiencing engorgement, not one who is formula feeding, because it promotes comfort and stimulates milk production. Restriction of fluids will not prevent engorgement and may cause dehydration.)
What should a nurse teach a nonbreastfeeding mother to help relieve the discomfort of engorgement? Empty the breasts manually once a day. Apply cold packs to the breasts frequently. Ask the practitioner to prescribe a medication for pain. Loosen the brassiere until the breast swelling has subsided.
Apply cold packs to the breasts frequently. (Application of cold constricts the vessels and numbs the pain caused by the distention of the vessels with lymph and blood. Emptying the breasts manually once a day is contraindicated because the client is not breastfeeding; this action will stimulate the flow of milk. If the discomfort persists even when the client wears a tight brassiere and applies cold packs, an over-the-counter analgesic should be sufficient for relief. A tight brassiere maintains alignment of blood and lymph vessels and prevents further engorgement.)
A client who has just begun breastfeeding complains that her nipples feel very sore. What should the nurse encourage this new mother to do? Select all that apply. Apply cool packs to her breasts to reduce the discomfort. Take the analgesic medication prescribed to limit the discomfort. Remove the infant from the breast for a few days to rest the nipples. Never expose the nipples to air; only wear a tight-fitting brassiere. Assume a different position when breastfeeding to adjust the infant's sucking.
Apply cool packs to her breasts to reduce the discomfort. Take the analgesic medication prescribed to limit the discomfort. Assume a different position when breastfeeding to adjust the infant's sucking. (Applying cool packs to the breasts to reduce the discomfort may provide relief after a feeding. Analgesics may eventually be necessary. Altering the breastfeeding position may ensure that the entire nipple and as much of the areola as possible are in the infant's mouth. When the infant is latched on the nipple correctly and a finger is used to release suction at the end of a feeding, trauma to the nipple is reduced. Soreness is common; it usually occurs at the beginning of a feeding and is temporary, lasting until the nipples become accustomed to the infant's sucking. Nursing mothers should be encouraged to expose their nipples to air several times a day. Discontinuing feeding for several days will result in engorgement, which will increase the discomfort.)
On the second postpartum day a client mentions that her nipples are becoming sore from breastfeeding. What is the nurse's initial action in response to this information? Assess her breastfeeding techniques to identify possible causes. Provide a nipple shield to keep the infant's mouth off the nipples. Instruct her to apply warm compresses 10 minutes before she begins to breastfeed. Explain that she should limit breastfeeding to 5 minutes per side until the soreness subsides.
Assess her breastfeeding techniques to identify possible causes. (The nurse must first assess the client's breastfeeding practices; nipple soreness may occur when the newborn's mouth is not covering the entire areola; also, nipples must toughen in response to suckling. Providing a nipple shield, having the client apply warm compresses before the feeding, or limiting the time spent at breastfeeding is premature; the cause of the soreness must be determined first and will dictate the choice of intervention.)
A client who has been breastfeeding her newborn every 3 hours experiences sore nipples. What should the nurse teach her about easing nipple soreness? Use nipple shields at each feeding. Wash with mild soap when cleansing the nipples. Change the baby's breastfeeding position for each feeding. Allow just the edge of the nipple to be placed in the baby's mouth.
Change the baby's breastfeeding position for each feeding. (If the infant's position is changed for each feeding, the infant will exert pressure on different areas of the nipples while suckling, thereby decreasing the possibility of soreness from constant pressure on one site. Persistent use of nipple shields does not foster effective breastfeeding; the rubber nipple of the shield may cause infant "nipple confusion." The nipples should not be washed with soap, which can cause further irritation. The entire nipple and surrounding areolar tissue should be in the infant's mouth.)
Which statement related to breast-feeding is correct? Protein soluble drugs can enter breast milk. Drugs with a long half-life should be avoided. Mothers should take drugs prior to breast-feeding. Drug usage during lactation is safe because the drugs will not harm the baby.
Drugs with a long half-life should be avoided. (Drugs with a longer half-life stay in the body for a longer time and may enter the breast milk, which can produce unwanted pharmacologic effects in the child. Therefore drugs with a longer half-life should be avoided. Lipid soluble drugs can enter the breast milk. Mothers should take drugs immediately after breast-feeding to reduce the possibility of drugs entering the breast milk. Although the concentration of drugs entering breast milk is very low, drug usage should be minimized during lactation to prevent any unknown harmful effects on the newborn.)
A breastfeeding mother asks the nurse how human milk compares with cow's milk. How should the nurse respond? Lactose content is higher in cow's milk than in human milk. Protein content in human milk is higher than in cow's milk. Fat in human milk is easier to digest and absorb than the fat in cow's milk. Immunologic and antiallergenic factors found in human milk are now added to cow's milk.
Fat in human milk is easier to digest and absorb than the fat in cow's milk. (Fat in human milk is easier to digest because of the arrangement of fatty acids on the glycerol molecule. Also, human milk is not heat treated, as is cow's milk when it is pasteurized. The lactose content is higher in human milk. There is less protein in human milk than in cow's milk; however, it is easier for human beings to digest. Human immunologic and antiallergenic factors are found only in human milk, not in cow's milk.)
A client asks about the difference between cow's milk and breast milk. The nurse should respond that cow's milk differs from human milk in that it contains what? Less protein, less calcium, and more carbohydrates More protein, less calcium, and fewer carbohydrates Less protein, more calcium, and more carbohydrates More protein, more calcium, and fewer carbohydrates
More protein, more calcium, and fewer carbohydrates (Cow's milk contains more protein, more calcium, and fewer carbohydrates. Cow's milk is more difficult to digest because it is meant to meet a calf's, not an infant's, nutritional needs. It is not recommended until after the infant is 1 year old. Formula is preferred if the mother is not breastfeeding.)
A client who has been breastfeeding tells the nurse on the third postpartum day that her breasts are painful and that she is afraid that the baby will hurt her while grasping the nipple and suckling. How should the nurse respond at this time? Offering the client an analgesic before breastfeeding Recommending that the client limit fluids for several days Suggesting that the client formula feed the baby for 2 days Helping the client express some milk manually before feeding
Helping the client express some milk manually before feeding (The pressure and tenderness resulting from accumulated milk can be relieved by manually expressing some of the fluid before feeding. Pain medication may be offered if other measures are unsuccessful; however, medication can be transferred to the infant through breast milk. Also, giving medication is a dependent function of the nurse that requires a prescription. The mother should not limit fluids, especially if she is breastfeeding. Breastfeeding, not formula feeding, should continue as a means of limiting engorgement and aiding milk production.)
A breast-feeding mother experiences redness and pain in the left breast, a temperature of 100.8° F (38.2° C), chills, and malaise. Which condition does the nurse suspect? Mastitis Engorgement Blocked milk duct Inadequate milk production
Mastitis (Because of the presence of generalized symptoms, the nurse should suspect mastitis. Engorgement would involve both breasts, not one. A blocked milk duct is usually marked by swelling and pain in one area of the breast but does not have systemic symptoms. There is no indication of the volume of milk being produced.)
A breastfeeding mother requires treatment for depression. Which drug would be safe to use if the mother wishes to continue breastfeeding the newborn? Fluoxetine Paroxetine Valproic acid Methotrexate
Paroxetine (Paroxetine can be safely given during breastfeeding. Fluoxetine can easily enter breast milk; therefore this drug would only be used when other selective serotonin reuptake inhibitors are ineffective. Valproic acid is an antiepileptic drug that can be given safely to breastfeeding women. Methotrexate is an anticancer drug that cannot be given during breastfeeding because it enters the breast milk and can cause adverse effects in the baby.)
A nurse is teaching a birthing/prenatal class about breast-feeding. Which hormone stimulates the production of milk during lactation? Inhibin Estrogen Prolactin Progesterone
Prolactin (Prolactin is the hormone that initiates and produces milk during lactation. Inhibin prevents the secretions of follicle stimulating hormone and gonadotropin releasing hormone. Estrogen and progesterone are the sex hormones produced by the ovaries.)
A lactating woman who reports a loss of interest in daily activities, loss of appetite, and sleeplessness is diagnosed with depression. What would be the drug of choice for this client if she wishes to continue breast-feeding? Sertraline Fluoxetine Sumatriptan Bromocriptine
Sertraline (Sertraline is the drug of choice for lactating woman with depression because it does not cause any effects on breast-feeding infants. Fluoxetine should be taken with caution because it may cause adverse effects on the infant at high dosages. Sumatriptan is the drug of choice for lactating woman suffering from migraines because it does not adversely affect to the fetus. Bromocriptine is contraindicated in lactating woman.)
The nurse evaluates a new mother who is breastfeeding. The client asks how to care for her nipples. What should the nurse recommend? Putting lanolin cream on the nipples after breastfeeding Applying vitamin E gel to the nipples before breastfeeding Using soap and water to clean the breasts and nipples at least once a day Spreading breast milk on the nipples after the feeding and allowing them to air dry
Spreading breast milk on the nipples after the feeding and allowing them to air dry (Breast milk is a natural lubricant for the nipples and obviously is not toxic for the infant. Products containing lanolin or vitamin E are not recommended because these may be ingested by the infant. Soap should not be used on the nipples because it has a drying effect, which may precipitate cracking of the nipples.)
A breastfeeding mother asks the nurse what she can do to ease the discomfort caused by a cracked nipple. What should the nurse instruct the client to do? Stop nursing for a few days and allow the nipple to heal. Manually express milk and feed it to the baby in a bottle. Start feedings on the unaffected breast until the affected breast heals. Use a breast shield to keep the baby from making direct contact with the nipple.
Start feedings on the unaffected breast until the affected breast heals. (The most vigorous suckling occurs during the first few minutes of nursing, as the infant suckles on the unaffected breast; suckling on the affected breast later is less traumatic. Stopping nursing for several days is unnecessary and will interfere with lactation. Manual expression may not completely empty the breast, interfering with lactation. A breast shield confuses an infant because it requires a different suckling pattern to obtain milk.)
Before teaching a client about breastfeeding, which information regarding hormonal influences should the nurse fully understand? A high level of progesterone stimulates the secretion of oxytocin. A high level of estrogen stimulates the secretion of lactogenic hormones. Milk secretion is under the control of postpartum hormones starting immediately after birth. Suckling stimulates the pituitary gland to release oxytocin, which initiates the let-down reflex.
Suckling stimulates the pituitary gland to release oxytocin, which initiates the let-down reflex. (Several factors influence the secretion of oxytocin and the let-down reflex; these include suckling; nipple stimulation; sexual activity; and thoughts, sight, and/or odor of the infant. Progesterone does not stimulate the secretion of oxytocin. A high level of estrogen inhibits anterior pituitary gland secretion of lactogenic hormones. Milk secretion is under the control of postpartum hormones, but it starts on the third or fourth day after birth. Colostrum, secreted during the first 2 postpartum days, is under the control of the pregnancy hormones.)
The nurse assures a breast-feeding mother that one way she will know that her infant is getting an adequate supply of breast milk is if the infant gains weight. What behavior does the infant exhibit if an adequate amount of milk is being ingested? Has several firm stools daily Voids six or more times a day Spits out a pacifier when offered Awakens to feed about every 4 hours
Voids six or more times a day (The presence of at least six to eight wet diapers each day indicates sufficient breast milk intake. Several firm stools daily may indicate an inadequate amount of fluid ingestion; the stools of breast-feeding neonates should be soft to loose. Spitting out a pacifier is not an indication of adequate milk consumption; some infants need extra sucking stimulation. Awakening to feed every 4 hours is not a reliable indicator of adequate breast milk intake; sleep patterns vary.)
What client behavior indicates to the nurse that a woman needs further teaching regarding breastfeeding her newborn? When she leans forward to place her breast in the infant's mouth If she holds the infant level with her breast while in a side-lying position If she touches her nipple to the infant's cheek at the beginning of the feeding When she puts her finger in the infant's mouth to break the suction after the feeding
When she leans forward to place her breast in the infant's mouth (When the breast is pushed into the infant's mouth, typically the infant's mouth closes too soon, resulting in inadequate latching on. The infant should be brought to the breast rather than the other way around. Holding the infant level with her breast while in a side-lying position facilitates latching on and maintains the infant's head in correct alignment, which promotes sucking and swallowing. Touching the nipple to the infant's cheek at the beginning of the feeding will stimulate the rooting reflex and promote latching on. Putting her finger in the infant's mouth to break the suction after the feeding prevents trauma to the nipple when the infant is removed from the breast.)
