NCLEX OB Breastfeeding

A mother is told that she should bottle feed her child for medical reasons. Which of the following maternal disease states are consistent with the recommendations? Select all that apply. 1) Untreated, active tuberculosis (TB) 2) Hepatitis B surface antigen positive. 3) Human immunodeficiency virus positive. 4) Chorioamnionitis 5) Mastitis

1 and 3 are correct. 1. A mother with active untreated TB should be separated from her baby until the mother has been on antibi- otic therapy for about 2 weeks. She can, however, pump her breast milk and have it fed to baby through an al- ternate feeding method. 3. Mothers who are HIV positive are ad- vised not to breastfeed because there is an increased risk of transmission of the virus to the infant.

The nurse is developing a teaching plan for parents who are taking home their 2 year old breastfed baby. Which of the following should the nurse include in the plan? 1) Wash hands well before picking up the baby. 2) Refrain from having visitors for the 1st month. 3) Wear a mask to prevent transmission of a cold. 4) Sterilize the breast pump supplies after every use.

1. Although this baby is being breastfed, he or she is still susceptible to illness. The best way to prevent transmission of pathogens is to wash hands care- fully before touching the baby.

It is time for a baby who is in the drowsy behavioral state to breastfeed. Which of the following techniques could the mother use to arouse the baby? Select all that apply. 1) Swaddle or tightly bundle the baby 2) Hand express milk onto the baby's lips. 3) Talk with the baby while making eye contact. 4) Remove the baby's shirt and change the diaper. 5) Play pat-a-cake with the baby.

2 3 4 and 5 are correct 2. The smell and/or the taste of the milk often will arouse a drowsy baby. 3. Drowsy babies will open their eyes when placed in the en face position and are interacted with. 4. Performing manipulations like diaper- ing or playing pat-a-cake often will arouse a drowsy baby. 5. Performing manipulations like diaper- ing or playing pat-a-cake often will arouse a drowsy baby.

A mother is attempting to latch her newborn baby to the breast. Which of the following actions are important for the mother to perform to achieve effective breastfeeding? Select all that apply. 1) Place the baby on his back in the mother's lap. 2) Wait until the baby opens his or her mouth wide. 3) Hold the baby at the level of the mother's breast. 4) Point the baby's nose to the mother's nipple. 5) Wait until the baby's tongue is pointed toward the roof of his or her mouth.

2, 3, and 4 are correct. 2. To achieve an effective latch of both the nipple and the areolar tissue, the baby must have a wide-open mouth. 3. Because the neonate's mouth muscles are relatively weak, it is important for the baby to be placed at the level of the breast. If the baby is placed lower, he or she is likely to "slip to the tip" of the nipple and cause nipple abrasions. 4. Babies latch best when they are posi- tioned at the breast, in preparation to opening their mouths, with their noses pointed toward their mothers' nipples.

A breastfeeding baby is born with a tight frenulum. Which of the following is an important assessment for the nurse to make? 1) Integrity of the baby's uvula. 2) Presence of maternal nipple damage. 3) Presence of neonatal tongue injury 4) The baby's breathing pattern

2. Babies who are tongue-tied—that is have a tight frenulum—have difficulty extending their tongues while breast- feeding. The mothers' nipples often become damaged as a result.

The nurse is evaluating the effectiveness of an intervention when assisting a woman whose baby has been latched to the nipple only rather than to the nipple and the areola. Which response would indicate that further intervention is needed? 1) The client states that the pain has decreased. 2) The nurse hears the baby swallow after each suck. 3) The baby's jaws move up and down once every second. 4) The baby's cheeks move in and out with each suck.

4. Babies whose cheeks move in and out during feeds are attempting to use negative pressure to extract the milk from the breasts. This action is not an indicator of breastfeeding success.

A nurse determines that which of the following is an appropriate short term goal for a full term, breastfeeding neonate? 1) The baby will regain birth weight by 4 weeks of age. 2) The baby will sleep through the night by weeks of age. 3) The baby will stool every 2 to 3 hours by 1 week of age 4) The baby will urinate 6 to 10 times per day by 1 week of age.

4. By 1 week of age, breastfed babies should be urinating at least 6 times in every 24-hour period.

The parents and their full term, breastfed neonate were discharged from the hospital. Which behavior 2 days later indicates a positive response by the parents to the nurse's discharge teaching? Select all that apply. 1) The parents count their baby's diapers. 2) The parents measure the baby's intake. 3) The parents give one bottle of formula every day. 4) The parents take the baby to see the pediatrician. 5) The parents time the baby's feedings.

4. The baby should be seen by the pediatrician. 1) The parents count their baby's diapers. 5) The parents time the baby's feedings. ???

A 37 week gravid client states that she noticed a "white liquid" leaking from her breast during a recent shower. Which of the following nursing responses is appropriate at this time? 1) Advise the woman that she may have galactocele. 2) Encourage the woman to pump her breasts to stimulate an adequate milk supply. 3) Assess the liquid because a breast discharge is diagnostic of a mammary infection. 4) Reassure the mother that this is normal in the 3rd semester

It is normal for colostrum to be expressed late in pregnancy

A woman in her 3rd trimester advises the nurse that she wishes to breastfeed her baby, "but I don't think my nipples are right." Upon examination, the nurse notes that the client has inverted nipples. Which of the following actions should the nurse take at this time? 1) Advise the client that it is unlikely that she will be able to breastfeed. 2) Refer to the client to a lactation consultant for advice. 3) Call the labor room and notify them that a client with inverted nipples will be admitted. 4) Teach the woman exercises to evert her nipples.

The client should be referred to a lactation consultant

A nurse has brought a 2 hour old baby to a mother from the nursery. The nurse is going to assist the mother with the first breastfeeding experience. Which of the following actions should the nurse perform first? 1) Compare mother's and baby's identification bracelets. 2) Help the mother into a comfortable position. 3) Teach the mother about proper breast latch. 4) Tickle the baby's lips with the mother's nipple.

1. The first action the nurse should ever perform is to make sure that the cor- rect baby is being given to the correct mother.

The nurse does not hear the baby swallow when suckling even though the baby appears to be latched properly to the breast. Which of the following situations may be the reason for this observation? 1) The mother reports a pain level of 4 on a 5 point scale. 2) The baby has been suckling for over 10 minutes. 3) The mother uses the cross cradle hold while feeding. 4) The baby lies with the chin touching the under part of the breast.

1. When the mother is anxious, overly fatigued, and/or in pain, the secretion of oxytocin is inhibited, and this, in turn, inhibits the milk ejection reflex and insufficient milk may be produced.

The nurse is concerned that a bottle-fed baby may become obese because of which activity by the mother? 1) She encourages the baby to finish the bottle at each feed. 2) She feeds the baby every 3-4 hours. 3) She feeds the baby a soy based formula. 4) She burps the baby every 1/2 to 1 ounce.

1. It has been shown that bottlefed ba- bies are at higher risk for obesity than breastfed babies. One of the reasons is the insistence by some mothers that the baby finish the formula in a bottle even if the baby initially rejects it. The increased calorie intake leads to increased weight gain.

A bottle feeding mother is providing a return demonstration of how to burp the baby. Which of the following would indicate that the teaching was successful? Select all that apply. 1) The woman gently strokes and pats her baby's back. 2) The woman positions the baby in a sitting position on her lap. 3) The woman waits to burp the baby until the baby's feeding is complete. 4) The woman states that a small amount of regurgitated formula is acceptable. 5) The woman remarks that the baby does not need to burp after trying for one full minute.

A, B, D Stroking and patting the baby's back are very effective ways of burping. Babies can be burped in many different positions, including over the shoulder, lying flat across the lap, and in sitting position. When placing the baby in the sitting position, themother should carefully support the baby's chin. Positioning the baby face down on the lap can be very effective and some mothers feel more secure using this position because the baby is unlikely to be dropped from this position. A small amount of "spitup" is within normal limits. Breastfed babies often spit up bits of their feeds.