Chapter 15: Newborn Nutrition Prep-U Maternal
The nurse is preparing a seminar on breastfeeding for a group of pregnant clients. Which information should the nurse include during this seminar?
Breastfeeding enhances bonding with the infant.
Which type of breast milk is highest in antibodies?
colostrum
A nurse is reading a journal article about recommendations for breastfeeding. The nurse discovers the American Academy of Pediatrics recommends which time period for exclusively breastfeeding an infant?
the first 6 months of age
A newborn infant has loose, yellow stools. Although the infant is healthy, his mother is concerned that this means he is allergic to breast milk. The nurse would explain to her that:
the stools of breastfed infants are normally loose.
A new mother asks the nurse how soon she can breastfeed after delivery. Which of the following would be the nurse's best answer (barring unforeseen complications)?
immediately after birth
Which of the following is an advantage of breastfeeding that directly benefits the mother?
It aids in uterine involution.
Choose the correct statement regarding breast milk production.
Oxytocin is responsible for the let-down reflex, and prolactin stimulates milk production.
A breastfeeding mother asks the nurse how long her baby should breastfeed at each breast after she is home. What would be the nurse's best answer?
The average baby empties a breast in 15 minutes.
A mother has expressed two bottles of breast milk and asks the nurse about how to store it for later use. Which explanation would be accurate?
The breast milk will be good for up to 1 week if refrigerated at 39℉ (4℃) or less.
A G1 P1 mother asks the nurse "Why is my baby losing weight? He dropped 6 oz from yesterday to today. Is my breast milk not good?" Which answer is the best response to this new mother?
"It is normal for breastfed newborns to lose as much as 7% of birth weight the first 3 days after birth."
The nurse asks a new mother how she is planning on feeding her newborn. The mother responds that she is planning on formula feeding her baby. Which of the following is the best response for the nurse to give the mother?
"Have you considered breastfeeding? There are some real benefits that it can offer you and your baby."
A client is 6 weeks' postpartum and has been breastfeeding exclusively. She began pumping 2 days ago in anticipation of going back to work. She notices that her milk is blue-tinged. How should the nurse counsel this client?
"A slightly bluish color is normal."
A nursing instructor is teaching new mothers about nutrition and the actual calories infants need for maintenance and growth. Which of the following statements by one of the mothers indicates a need for further instruction?
"All infants require the same amount of calories."
A new mother asks the nurse, "Are there any medicines that I can or cannot take since I'm breastfeeding?" Which response by the nurse would be best?
"Always check with your provider because almost all drugs are excreted to some extent in breast milk."
The nursing instructor is reviewing with students ways to assess if the infant is getting enough at each feeding. Which of the following statements by a student demonstrates an understanding of these concepts?
"Assess the infant's voiding, growth, and alertness."
A community health nurse completes the home visit. The client is 2 weeks postpartum and is breastfeeding. The nurse asks the client if they have any breastfeeding questions.
"Breastfeeding and formula feedings offer the same benefits.", "I may supplement my breast milk with formula when I am not home.", and "I may use a pacifier while breastfeeding when the infant becomes fussy."
Which statement by the nurse would best support a new mother's choice to feed her baby formula?
"By formula-feeding your newborn, you will know how much the baby takes each feeding and allows others to feed the baby."
The nurse would provide additional teaching if which statement was made by a new mother?
"I will have to buy bottled, 'natural' water for mixing formula."
A new mother wants to prevent her newborn from developing severe jaundice because this happened to her first child. What statement is most accurate for the nurse to say to this mother?
"If possible, feed your baby as frequently as you can to allow the natural laxative in colostrum help pass both meconium and bile."
A client tells you she is unsure whether her baby is getting enough milk when she breastfeeds. The nurse's best response would be:
"If your baby appears content between feedings and is wetting diapers, he/she is getting enough milk."
A client is planning to use formula for the newborn and asks the nurse how to warm the formula. After teaching the client about ways to warm formula, the nurse determines the teaching was successful based on which client statement?
"It's best to put the bottle into a bowl of warm water for several minutes."
A first-time mother learning to breastfeed her newborn is worried her baby is not getting enough milk. Which statement made by the nurse is most appropriate?
"Look at the number of wet and diapers with stool plus how many times the baby is feeding in a 24 hour period."
A new mother who is about to be discharged expresses concern about how to know her baby is getting enough breast milk. Which response should the nurse prioritize?
"Observe if your baby is eating 8-12 times a day."
The nurse is teaching a parenting class at the local high school for pregnant teenagers. She asks each student to indicate what type of contraception she plans to use after her baby is born. One of the teens states, "I don't need to use any contraception because I plan on breastfeeding my baby. I am not going to use any formula at all." What would be the nurse's best response?
"Ovulation can occur even in the absence of menstruation, and you could become pregnant again."
A mother asks you how she can judge that her infant is receiving sufficient breast milk. What would be the most appropriate response?
"The infant should gain weight and have six wet diapers daily."
Parents ask the nurse why they are not supposed to throw a bottle of milk into the microwave to warm it. Which response is most accurate?
"The microwave causes the milk in the center of the bottle to become hotter than near the sides."
A new mother gave birth yesterday is breastfeeding and informs the nurse that something must be wrong with her milk, because it is a dark yellow color. How will the nurse respond?
"This is normal for the first 3 to 4 days of breastfeeding and is called colostrum."
Which statement from the parents of a 20-week-old infant will require further teaching related to supplying protein needed by a newborn?
"We have a milk cow, so we never have to worry about running out of milk for this baby."
Parents of a 3-month-old infant have questions about supplying breast milk to a day care facility. Which statement(s) made by the parents indicates to the nurse that further education is needed? Select all that apply.
"We will tell the day care to open a can of liquid formula if they run out of breast milk." "During feeding, we will tell the workers to place a soft, rubbery nipple on the bottle." "We will only supply bottles that contain polycarbonate written on the bottle label." "We will have the workers discard the nipple if milk is dripping at a rapid rate."
The nurse is teaching a class called "Care for the Breastfeeding Mother" to a class of nursing students. The nurse knows that the students need further teaching when they state:
"When caring for the client with plugged milk ducts, advise the client to take a warm shower, wear a support bra, take acetaminophen, massage the site, and take antibiotics."
On admission to the labor and delivery unit for a scheduled elective induction, a 21-year-old P1001 expresses to the nurse her desire to bottle-feed. What is the best response from the nurse?
"Would you like any information on breastfeeding?"
The nurse is teaching a breastfeeding class. Which statement made by a mother indicates comprehension of the composition of breast milk. "I will completely empty one breast before starting on the other because my baby needs the:
"fat in the hindmilk."
A mother who is breastfeeding asks the nurse when she should start weaning her infant. Which time factor should the nurse point out is the recommended time?
1 year
The mother of a newborn is concerned her newborn is not getting enough calories. When answering this woman's questions, the nurse should point out it is recommended the newborn should receive how many calories per day?
110 kcal/kg to 120 kcal/kg
A newborn who is receiving formula feedings weighs 6.8 lbs (3.08 kg). The nurse determines that the newborn's daily water intake is sufficient based on an intake of how much formula?
19 oz
How many calories does an ounce of breast milk contain on average?
20
The nurse is teachinga new mother about the nutritional value of breast milk. What information should the nurse include about the number of calories in a fluid ounce?
20
A newborn is being breastfed. To evaluate nutritional adequacy, you should be aware that breast milk contains an average of how many calories?
20 calories per ounce
The nurse is teaching new parents how to calculate the amount of formula to feed their newborn each day. The baby weighs 8 lb. How much formula should the nurse teach the parents to provide each day?
20 to 24 oz
When teaching a woman about ingesting drugs while breastfeeding, which statement is most accurate?
Almost all drugs are excreted to some extent in breast milk.
What will the nurse recommend to a breastfeeding client experiencing sore nipples?
Apply a few drops of breast milk to the nipples after feeding and gently massage it into the areola.
Which of the following is an advantage of breastfeeding for the infant?
Breast milk contains antibodies and thus decreases the possibility of gastrointestinal illnesses.
Which of the following statements is true about breastfeeding?
Breastfeeding offers a good chance for bonding with the infant.
When counseling a mother about the benefits of breastfeeding, all of the following statements should be made except which one?
Breastfeeding prevents the transmission of group B streptococcus (GBS) skin infections.
Which instruction should a nurse give to a client whose infant has galactosemia?
Feed the infant a lactose-free formula.
A new mother calls for the nurse to come to her room while she is breastfeeding her newborn. She reports that the baby will not wake up and latch on. What can the nurse do to assist this mother in getting her newborn to nurse?
Change the diaper and gently rub the newborn's back
A nurse is giving a new mother some tips regarding breastfeeding. Which of the following should the nurse mention?
Empty one breast completely before feeding the baby from the other breast.
Dietary needs change from pregnancy to lactation. What should breastfeeding mothers be advised?
Even if a mother has adequate fat stores, calorie intake should increase.
A woman who began breastfeeding develops sore nipples. The nurse bases her response on which of the following?
Exposing her nipples to air after each feeding should help.
The nurse is teaching a new father how to bottle-feed a baby. What is the correct sequence of the steps?
Hold the infant during feedings. Be sure the tongue is under the nipple. Hold the bottle at a 45-degree angle. Watch for bubbles rising in the bottle during the feeding. Burp the infant to avoid vomiting.
The lactation nurse is working with a woman who is experiencing some difficulties getting her newborn to "latch on" to her breast. They are trying various positions to see which is best for this infant. The nurse will document which nursing problem related to this teaching session?
Imbalanced nutrition, less than body requirements related to poor latch
Which is true regarding mineral requirements in the newborn?
Infants who are formula-fed should drink an iron-enriched formula for at least 12 months.
Which instruction should a nurse give to a lactating client about how to break suction during a feeding?
Insert a finger into the corner of the baby's mouth between the gums.
The nurse is conducting a prenatal class on the pros and cons of breastfeeding versus formula feeding. Which deciding factor should the nurse prioritize when assisting these parents to make their decision?
It is based on their personal preference and situation.
While assessing a new mother breastfeeding, the nurse notices that she is dimpling her breast. Which nursing teaching should the nurse prioritize?
It puts pressure on the milk ducts and decreases the flow of milk.
The nurse is evaluating a new mother's ability to breastfeed her infant. Which criteria indicate that the mother is able to breastfeed independently? Select all that apply.
Nipples are everted. Breasts are soft and nontender. Baby swallows spontaneously and frequently.
The nurse is assisting a new mother to begin breastfeeding her newborn. Which action should the nurse prioritize?
Position the infant in her arms, across her abdomen, stroking the infant's cheek with her nipple.
A new mother is ambivalent about breastfeeding and agrees to do it for at least 3 months. What response should the nurse provide to the client at this time that would support the 2030 National Health Goals?
Six months to 1 year of age is the best time frame to support the baby's growth needs.
Which of the following is true regarding storing breast milk?
Thawed breast milk must be used within 24 hours.
The nurse is conducting prenatal counseling with pregnant women in the community. An 18-year-old G1P0 in her 36th week states, "I don't know if I should breastfeed or not. Isn't formula just as good for the baby?" What is the nurse's best response?
The immunologic properties in breast milk cannot be duplicated in formula.
A breastfeeding mother calls the clinic asking how much water she should be giving her 2-month-old infant. What would the nurse recommend to this mother?
The infant does not need any water supplement if nursing well.
A mother delivers her newborn and has chosen to formula-feed her baby. She asks the nurse how to keep her breasts from making milk. How would the nurse respond to the mother's question?
The mother needs to understand that she will produce some milk, but wearing a constrictive bra will help dry up the milk supply.
Annie, a new mother, is talking with the nurse about breastfeeding. She asks, "How does lactation work?" The best answer by the nurse is:
The newborn sucking on the breast stimulates the pituitary gland causing the release of prolactin and oxytocin. Prolactin causes synthesis and release of breast milk and oxytocin causes contraction of the smooth muscle around the alveoli of the breast.
A client opts to feed formula to her newborn baby. Which instruction should the nurse give to the client regarding the proper procedure for bottle-feeding?
Tilt the bottle while feeding.
The nurse is teaching a breastfeeding class for nursing students. Teaching has been effective when the student can cite which maternal conditions in which breastfeeding is contraindicated? Select all that apply.
active untreated tuberculosis chemotherapy illegal drug use HIV
The nurse will educate the breastfeeding client to burp her infant at which time? Select all that apply.
after feeding from the first breast at the end of the total feeding
While breastfeeding, all of the following can contribute to sore nipples except:
allowing the nipples to dry after each feeding.
On the first day postpartum, a new mother is concerned that her milk has not yet "come in." The nurse would explain to her that:
breast milk normally comes in on the third or fourth postpartum day.
A new mother calls the clinic and tells the nurse that her breasts are very full and that they hurt. After assessing that there are no overt signs of inflammation present, the nurse suggests that her breasts are engorged. What is the best intervention the nurse could suggest to relieve this woman's discomfort?
cold packs
All of the following are maternal benefits of breastfeeding except:
decreased risk of adult-onset asthma.
On the fourth day postpartum, a woman develops breast engorgement. Which measure would be best to recommend to her as a means of alleviating this problem?
encouraging her to continue regular breastfeeding
During a home visit, the nurse learns that a new mother is experiencing breast engorgement. What should the nurse recommend to help alleviate this problem?
encouraging her to wear a firm-fitting bra
A woman who had a cesarean is getting ready to be discharged from the hospital. Before she leaves, she asks you to assess her breasts because she has pain on both sides. The nurse notices that both breasts are hard, warm, and tender to the touch. Her vital signs are normal. What does the nurse suspect?
engorgement
The nurse takes a newborn into the mother's room for feeding following a cesarean delivery. The nurse notes that the mother has large breasts when assisting her to feed the newborn. Which position would the nurse recommend to this mother?
football hold
The nursing instructor is conducting a teaching session illustrating the basics of feeding newborns. The instructor determines the class is successful after the students correctly choose which disorder as a contraindication to breastfeeding?
galactosemia
A client in the early stage of labor informs the nurse that she is planning to breastfeed. She tells the nurse that this is her first baby and wants to begin breastfeeding as soon as possible. When should the nurse tell the mother she will be able to start breastfeeding?
immediately after birth
When asked by a parent to compare the feeding habits of formula-fed and breastfed infants, what is the correct response from the nurse about breastfed infants?
go approximately 3 hours between feedings
A nurse is caring for a client who is breastfeeding her newborn. The nurse encourages the client to induce burps in her infant to:
help expel air ingested during feeding.
A G1P1 new mother asks what position she should place the newborn in while feeding formula? Which response by the nurse is best?
holding infant with head slightly elevated
A new mother is concerned about how she will know whether her newborn is receiving enough breast milk. The nurse should explain that which factor is the least accurate measure of how much nutrition the baby is receiving?
how long the baby nurses
The nurse is teaching a class for expectant parents at the community center. One woman asks about the benefits of breastfeeding. What benefits to the baby would the nurse identify? Select all that apply.
improved gastrointestinal function reduced susceptibility to respiratory infection for the first year improved immunity to disease reduced incidence of childhood obesity
Breastfeeding is contraindicated in all of the following conditions in the mother except:
mastitis.
The nurse is conducting a prenatal class on breastfeeding. The nurse determines the class is successful when the young parents correctly choose which time frame is recommended for breastfeeding the infant?
one year
A new mother of twins asks the nurse if there is any way she can feed them both at the same time. Which piece of equipment would the nurse recommend for this situation?
pillow supports designed with wider sides to allow the twins to feed at the same time
Nurses know that which factor most influences whether women decide to initiate breastfeeding?
prenatal education
A pregnant client had decided to breastfeed the infant but, after delivery, tells the nurse that formula feeding would be the best choice for her now. What nursing diagnosis should the nurse use to plan this client's care?
risk for impaired parenting
Which feeding position should the nurse suggest as most beneficial for the mother who had a cesarean birth?
sitting in a chair using a football hold with the newborn on a pillow on the mother's lap
Breastfeeding is generally encouraged except under certain conditions. Which conditions contraindicate breastfeeding? Select all that apply.
when the mother takes certain medications, such as antineoplastics when the mother has active tuberculosis when the mother is diagnosed with breast cancer
