Newborn Nutrition
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 how long the infant breastfeeds at a time." -"Assess the infant's voiding, growth, and alertness." -"Assess how much formula is taken each time." -"Assess how long the infant sleeps after each feeding."
"Assess the infant's voiding, growth, and alertness." Explanation: The best confirmation of whether an infant is receiving adequate nutrition is to assess whether the newborn is voiding, growing, and alert.
A nurse is caring for a pregnant client who inquires about the benefits of breast feeding. The nurse explains that secretory immunoglobulin A found in breast milk helps the infant by: -Protecting the gastrointestinal tract from foreign proteins -Providing protection against otitis media -Lowering rates of asthma during childhood -Overcoming family history of allergies
-Protecting the gastrointestinal tract from foreign proteins Explanation: Secretory immunoglobulin A found in breast milk specifically protects the infant's gastrointestinal tract from foreign proteins. Overall, infants who are breast fed up to 6 months are protected from otitis media, have lowered rates of asthma during childhood, and are capable of overcoming family history of allergies.
The nurse would provide additional teaching if which statement was made by a new mother? -"I drank fluoridated water during pregnancy." -"While lactating, I should drink fluoridated water." -"I should prepare the baby's formula with fluoridated water." -"I will have to buy bottled, 'natural' water for mixing formula."
"I will have to buy bottled, 'natural' water for mixing formula." Explanation: A mother may think she is helping her child by using bottled, "natural" water in formula rather than chlorinated (and fluoridated) water from a tap. Fluoride is essential for building sound teeth and for preventing tooth decay. Because teeth are already set in their primary form during pregnancy, it is important for women to drink fluoridated water during pregnancy. A lactating mother should continue drinking fluoridated water (although only a small amount of fluoride passes into breast milk), and formulas should be prepared with fluoridated water.
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? -"You know that breast is best, right?" - "What type of formula do you plan on using?" -"Would you like any information on breastfeeding?" -"Did you have a problem breastfeeding your last baby?"
"Would you like any information on breastfeeding?" Explanation: The nurse should respect and support a woman's decision about how to feed her baby without imposing personal views on the patient. A nurse may know that the breast is best; therefore, asking the patient if she would like information about breastfeeding is both nonthreatening and informative. The nurse should not assume that the patient had difficulties with her previous baby.
The nursing director of a busy postpartum unit has arranged for the lactating consultant to provide some education about ways to create an atmosphere conducive to breastfeeding success. Which topics should be emphasized? Select all that apply. -Talk with all mothers, even those who have chosen to bottle-feed, about the benefits of breastfeeding. -If feasible, help women initiate breastfeeding within 30 minutes of birth. -Assist all mothers who are separated from their infant in the NICU to breastfeed and maintain lactation. -Use of pacifiers will help the infant develop a stronger sucking ability. -In between feedings, mothers should start giving juice to the baby as early as 2 months of age.
-If feasible, help women initiate breastfeeding within 30 minutes of birth. -Assist all mothers who are separated from their infant in the NICU to breastfeed and maintain lactation. Explanation: The following can help create an atmosphere conducive to breastfeeding success: if feasible, the nurse should help women initiate breastfeeding within 30 minutes of birth and assist all mothers who are separated from their infant in the NICU to breastfeed and maintain lactation. The mother should not give newborns pacifiers to quiet them as this can reduce the sucking initiative. Mothers should not give newborns food or drink other than breast milk unless medically indicated, so they are hungry to breastfeed. The nurse should also advise women they need not introduce solid food until at least 4 months.
The nurse is educating daycare workers on breast milk and supplemental feedings for newborns. What information will the nurse include? Select all that apply. -Warm bottles in a microwave oven and then shake them prior to feeding. -It is acceptable to wash bottles and nipples in a dishwasher. -If you pump milk, it must be used within a 24-hour time frame. -Breast milk stays good for up to 12 hours on a kitchen counter. -Supplemental feeding bottles should be plastic and marked "safe for infant feeding."
-It is acceptable to wash bottles and nipples in a dishwasher. -Supplemental feeding bottles should be plastic and marked "safe for infant feeding." Explanation: Bottles and nipples should be washed using normal dishwashing practice. An easy way to recall breast milk storage is 4 hours at room temperature, 4 days in the refrigerator, and 4 months in the freezer. The bottle used should be plastic and marked "safe for infant feeding"; otherwise, it may contain substances that can leech into stored milk and which may be associated with chromosomal aberrations. It is not recommended to warm bottles in a microwave oven because the milk in the center of the bottle can become hotter than that near the sides.
The nurse takes a newborn to the mother's room for a formula feeding. What education would the nurse provide this mother to aid in feeding the newborn? Select all that apply. -Warm the bottle up before giving it to the newborn. - Gently shake the bottle prior to feeding to ensure that the formula is well mixed. -Keep an overhead light on so the mother can observe the newborn feeding. -If the mother is tired, she can prop the bottle and baby up in her bed. -Feed the newborn 3 to 4 oz, burping after every ounce.
-Warm the bottle up before giving it to the newborn. -Gently shake the bottle prior to feeding to ensure that the formula is well mixed. -Keep an overhead light on so the mother can observe the newborn feeding. Explanation: It is recommended that the caregiver gently shake the bottle prior to feeding the newborn because some settling of contents may occur. Warming the bottle is a personal preference (with no data supporting warming/not warming the formula prior to feeding). The only warning is to not microwave the formula to heat it up. The newborn should be fed 1 to 2 ounces, being burped after every ½ ounce of formula. It is recommended that the mother feed the newborn with the light on so as to be able to see if the newborn begins to choke. Bottle propping is never recommended.
Which clients need to be assessed by a lactation consultant? Select all that apply. -an infant who is sleepy and needs stimulation to wake up and feed every 3 hours -a woman who is stating that her breasts are very painful throughout the entire feed -a large for gestational age infant who wants to breastfeed every 2 hours -a newborn infant who has only had 3 wet diapers in the past 24-hour period -an infant who was born at 34 weeks' gestation weighing only 3 pounds 4 oz (1.4 kg 113 g)
-a woman who is stating that her breasts are very painful throughout the entire feed -a newborn infant who has only had 3 wet diapers in the past 24-hour period -an infant who was born at 34 weeks' gestation weighing only 3 pounds 4 oz (1.4 kg 113 g) Explanation: Mothers may need to see a lactation consultant for breast pain throughout the feed. Infants may need to be assessed if there is inadequate urine output; a late preterm small for gestational age infant may also need to be assessed. It is not unusual for an infant to be sleepy after birth and need stimulation to wake up and feed. It is not uncommon for large for gestational age infants to feed every 2 hours.
Which feeding position shoud the nurse suggest as most beneficial for the mother who had a cesarean birth? -supine in bed with the newborn lying across the mother's chest and abdomen -side-lying position with newborn near the mother's armpit so the mother can rest while the newborn feeds -newborn in a sling draped over the mother's shoulder so the breast is near the newborn's face -sitting in a chair using a football hold with the newborn on a pillow on the mother's lap
-sitting in a chair using a football hold with the newborn on a pillow on the mother's lap Explanation: Using a football hold with the newborn supported on a pillow may be helpful, especially if a mother had a cesarean birth. This position is also helpful if the baby is having difficulty latching due to large breasts that obstruct the mother's view. The other positions are also acceptable for the woman to try until she and her infant find the position that works best for them.
Evidence-based practice research has discovered that which women are most likely to breastfeed exclusively for the first 6 months? Select all that apply. -young women experiencing financial concerns -women who did not smoke during pregnancy -older women with a higher income -women who had in vitro fertilization before becoming pregnant -women who gave birth to twins
-women who did not smoke during pregnancy -older women with a higher income Explanation: To discover the characteristics of women who were exclusively breastfeeding at the time of hospital discharge, researchers studied all term hospital births in one hospital for a year. From this pool of over 90,000 infants, 56,865 were identified as still being exclusively breastfed at discharge. Characteristics of women who were exclusively breastfeeding were older age, nonsmoking, higher income, and no pregnancy complications or reproductive assistance. They also had a single rather than twin infants and had attended prenatal classes.
A new mother is concerned that the baby is not going to receive enough calories from breast milk to grow. What should the nurse instruct the mother as the daily caloric requirements per pound of weight for a newborn? -50 to 55 -100 to 120 -150 to 170 -200 to 225
50 to 55 Explanation: An infant up to 2 months of age requires 110 to 120 calories per kilogram of body weight or 50 to 55 kcal/lb every 24 hours to provide an adequate amount for maintenance and growth.
When counseling a mother about the benefits of breastfeeding, all of the following should be stated except: -Reduces the incidence of colic in a newborn -Promotes better tooth and jaw development -Provides protection against food allergies -Prevents the transmission of group beta streptococcus skin infections
Prevents the transmission of group beta streptococcus skin infections Explanation: A group beta streptococcus skin infection is one that the fetus would contract in utero from bacteria colonizing in the mother's vaginal vault. Breastfeeding would not prevent colonization on the skin.
Which of the following instructions should a nurse give to a client whose infant has galactosemia? -Breastfeed the infant, but avoid consuming milk products -Feed the infant a lactose-free formula -Breastfeed after the infant is 2 weeks old -Ensure that formula does not contain amino acids
Feed the infant a lactose-free formula Explanation: The nurse should instruct the client to feed the infant a lactose-free formula, because the infant is lactose intolerant. The client should avoid breastfeeding even as she avoids consuming milk products or after the infant is two weeks old. The infant does not have tyrosinemia, thus, formula with amino acids is not contraindicated.
Which of the following instructions should a nurse give to a client whose infant has galactosemia? =Breastfeed the infant, but avoid consuming milk products -Feed the infant a lactose-free formula -Breastfeed after the infant is 2 weeks old -Ensure that formula does not contain amino acids
Feed the infant a lactose-free formula Explanation: The nurse should instruct the client to feed the infant a lactose-free formula, because the infant is lactose intolerant. The client should avoid breastfeeding even as she avoids consuming milk products or after the infant is two weeks old. The infant does not have tyrosinemia, thus, formula with amino acids is not contraindicated.
When asked by a father to compare the feeding habits of formula-fed and breastfed infants, what is the correct response from the nurse about breastfed infants? -Experience longer periods between feeds. -Digest their milk more slowly. -Go approximately 3 hours between feedings. -Usually feed every 4 hours.
Go approximately 3 hours between feedings. Explanation: Formula is harder than breast milk to digest. Therefore, breastfed babies typically feed more frequently than formula-fed babies (ie, every 3 hours instead of every 4 hours).
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? -4 months -6 months -One year -Two years
One year Explanation: It is recommended that the infant be fed exclusively by breastfeeding for the first six months and then continued with supplemental breastfeeding until the infant is 1 year old. However, when the mother stops breastfeeding is a personal choice as some will continue breastfeeding until the infant is 2 years old.
A mother has opted to formula feed her 2-month-old baby. She proudly announces to the nurse during an office visit that she uses only the best bottled spring water to prepare the formula. How should the nurse respond? -She should tell the mother to switch to using fluoridated water from the tap -She should support the mother's choice to formula feed and congratulate her on using such pure water -She should tell her that it is fine to use bottled water as long as she brushes the baby's gums with a fluoride toothpaste -She should tell the mother that it is fine to use bottled water as long as she begins giving the baby a fluoride supplement immediately
She should tell the mother to switch to using fluoridated water from the tap Explanation: Fluoride is essential for building sound teeth and for preventing tooth decay. A lactating mother should continue drinking fluoridated water (although only a small amount of fluoride passes into breast milk), and formulas should be prepared with fluoridated water. This is an essential point to remember, because a mother may think she is helping her child by using bottled, "natural" water in formula rather than chlorinated (and fluoridated) water from a tap. Fluoride toothpaste should not be used with children under 2 years of age as they tend to swallow toothpaste, and too much fluoride can be detrimental. A fluoride supplement, 0.25 mg daily, may be given to the infant beginning at 6 months of age, but not earlier (this child is only 2 months old).
The nurse is conducting prenatal counseling with pregnant women in the community. An 18-year-old G1 P0 in her 36th week states, "I don't know if I should breast-feed or not. Isn't formula just as good for the baby?" What is the nurse's best response? -The benefits of breast-feeding are equal to those of formula feeding. -It is ultimately the woman's choice whether she wants to breast-feed or not. -The immunologic properties in breast milk cannot be duplicated in formula. -The economic status of the woman is an important breast-feeding consideration.
The immunologic properties in breast milk cannot be duplicated in formula. Explanation: Breast milk is a unique substance that commercial formulas have been unable to duplicate, especially with regard to the immunologic factors in breast milk.
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? -"You know that breast is best, right?" -"What type of formula do you plan on using?" -"Would you like any information on breastfeeding?" -"Did you have a problem breastfeeding your last baby?"
When counseling a mother about the benefits of breastfeeding, all of the following should be stated Explantion Reduces the incidence of colic in a newborn Promotes better tooth and jaw development Provides protection against food allergies Prevents the transmission of group beta streptococcus skin infections
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? -a mold that only exposes the breasts so the mother can feed on her stomach side by side -pillow supports designed with wider sides to allow the twins to feed at the same time -an extra-wide chair to allow the mother to use the football hold on both sides without fear of dropping an infant -an extra-wide heating pad on both breasts, which will help stimulate milk production for both infants
pillow supports designed with wider sides to allow the twins to feed at the same time Explanation: Nurses can recommend pillow supports designed to allow twins to feed simultaneously. These pillows are similar to the pillows used to support one baby, but they are wider on the sides to support two babies for simultaneous feedings. The other equipment items are not needed to breastfeed twins.
A nurse is teaching about bottle-feeding and breastfeeding. The nurse states that because commercial formulas have higher concentrations of fatty acids, the infant should be assessed for which possible complication? -cardiac murmurs -hyperglycemia -tetany -enlarged liver
tetany Explanation: An advantage of breastfeeding is that breastfed newborns appear to be able to regulate their calcium/phosphorus levels better than infants who are formula fed. Decreased calcium levels in a newborn can lead to tetany (muscle spasm). The increased concentration of fatty acid in commercial formulas may bind calcium in the gastrointestinal tract, also increasing the danger of tetany. Heart murmurs caused by congenital defects should be assessed in newborns; however, they are not caused by increased fatty acid intake. Hyperglycemia is monitored in newborns, especially if their mother is diabetic. Fatty acids do not cause liver engorgement.
