Ch. 19

Nurses know that which factor most influences whether women decide to initiate breastfeeding? A. prenatal education B. ease of learning to breastfeed C. economic savings with breastfeeding D. convenience with breastfeeding

A. prenatal education Rationale: Research has shown that when health care providers discuss breastfeeding within prenatal education, they can influence women to breastfeed following their infants' births. The other factors are important but not as influential as prenatal education.

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: A. "Prolactin in the let-down." B. "Fat in the hindmilk." C. "Protein in the colostrum." D. "Water in the foremilk."

B. "Fat in the hindmilk." Rationale: Hindmilk contains a higher quantity of fat and more calories than foremilk. The hindmilk satiates the infant between feedings. Incorrect: A,C,D: the foremilk is watery but is high in protein and low in fat; it is not prolactin in the letdown, but oxytocin; colostrum not only has protein but also fat soluble vitamins, minerals, fat and lactose.

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? A. "What type of formula do you plan on using?" B. "Would you like any information on breastfeeding?" C. "You know that breast is best, right?" D. "Did you have a problem breastfeeding your last baby?"

B. "Would you like any information on breastfeeding?" Rationale: The nurse should respect and support a woman's decision about how to feed her baby without imposing personal views on the client. A nurse may know that the breast is best; therefore, asking the client if she would like information about breastfeeding is both nonthreatening and informative. The nurse should not assume that the client had difficulties with her previous baby.

A nurse is teaching a new mother the benefits and protective effects of breastfeeding. The nurse should point out breastfeeding is known to provide protection against which disorder? A. Edema B. Diarrhea C. Cholera D. Typhoid

B. Diarrhea Rationale: Breastfeeding an infant for up to 6 months helps to prevent diarrhea in the infant. In addition, breastfeeding also protects the infant from otitis media, colds, wheezing, and asthma during childhood. Typhoid, edema, or cholera are not prevented by breastfeeding in infants.

The new mother is determined to breast-feed her baby exclusively for 6 months but will need to return to work before then. The nurse should encourage the mother to wait until the baby is what age before using expressed milk? A. 2 weeks B. 6 weeks C. 4 weeks D. 8 weeks

B. 6 weeks Rationale: It is recommended to breast-feed for six weeks prior to introduction of bottles and pumping to establish a solid breast-feeding relationship. If bottles are introduced at much less than 6 weeks, the establishment of a solid breast-feeding relationship may be impaired. Waiting 8 weeks to introduce bottles of breast milk into the baby's routine is not necessary and should not be suggested by the nurse.

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? A. Anxiety related to not being able to communicate with infant about how best to position during feedings B. Imbalanced nutrition, less than body requirements related to poor latch C. Risk for ineffective breastfeeding resulting in switching to a bottle D. Risk for impaired parenting due to mother's stress of possible breastfeeding failure

B. Imbalanced nutrition, less than body requirements related to poor latch Rationale: The nursing problem related to difficulty in getting the newborn to latch on to the breast would be: Imbalanced nutrition, less than body requirements, related to poor newborn response, poor latch, or ineffective transfer of milk. There is no indication that the mother wants to switch to bottle-feeding or that she feels like a failure, resulting in anxiety or impaired parenting.

The nurse is preparing a care plan for a new mother who desires to breast-feed. Which action should the nurse prioritize if the mother has a history of breast implants? A. Seek approval from health care provider for breast-feeding. D. Encourage the mother to use formula. C. Consult a lactation specialist for assistance. D. Give the mother a trial of breast-feeding.

C. Consult a lactation specialist for assistance. Rationale: Any woman with a history of breast surgery or abnormal nipples may need additional assistance with breast-feeding by a lactation consultant. This consultant will know the best plan of action to assist this mother in breast-feeding. The health care provider's permission is not required. The nurse should not advise the mother to just try breastfeeding to see if it works or to encourage formula feeding, but instead should provide the mother with the proper support.

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? A. a plugged duct B. nipple thrush C. mastitis D. engorgement

D. engorgement Rationale: Because you know that this client had a cesarean and is being discharged today, she is most likely on postpartum day 3 or 4, when engorgement is most common. Although mastitis, nipple thrush, or a plugged duct may happen during this time, they more commonly occur after 2 weeks postpartum. Also, mastitis, thrush, and a plugged duct are usually unilateral, and this client's symptoms are bilateral. Hard, warm, and tender breasts on the third or fourth day with normal vital signs are most likely the result of engorgement.

Which feeding position should the nurse recommend for a woman who has just had a cesarean birth? A. side-lying B. across the lap C. football hold D. cradle hold

C. football hold Rationale: The best choice would be a football hold. This allows the mother to avoid maneuvering to a side-lying position and sitting up for across the lap and cradle hold positions. It also keeps the infant—and thus pressure—off her abdomen, where she is likely to be experiencing some degree of pain.

The nurse is reviewing discharge instructions with a young couple. The nurse determines they understand how to properly use prepared formula and will discard any leftover refrigerated formula after which time frame? A. 24 hours B. 12 hours C. 48 hours D. 36 hours

A. 24 hours Rationale: Once formula is mixed it should be stored in the refrigerator until ready to use. Once a bottle is warmed and the infant has drank from it, any leftover contents need to be discarded. Any pre-prepared formula not used in a 24-hour period should be discarded as well.

How many calories does an ounce of breast milk contain on average?

20 Rationale: On average, breast milk supplies the newborn with 20 calories per ounce.

The nurse is teaching a breast-feeding class for nursing students. Teaching has been effective when the student can cite which of the following maternal conditions in which breast-feeding is contraindicated? Select all that apply. A. Active untreated tuberculosis B. Illegal drug use C. HIV D. Chemotherapy E. Chlamydia

A. Active untreated tuberculosis B. Illegal drug use C. HIV D. Chemotherapy Rationale: There are certain maternal conditions or situations in which breastfeeding is contraindicated. Examples are illegal drug use, active untreated tuberculosis, HIV, chemotherapy, and herpetic lesions on the breast. Chlamydia is not a contraindication to breastfeeding.

The nurse is reviewing discharge instructions with a young couple. The nurse determines they understand how to properly use prepared formula and will discard any leftover refrigerated formula after which time frame? A. 48 hours B. 24 hours C. 36 hours D. 12 hours

B. 24 hours Rationale: Once formula is mixed it should be stored in the refrigerator until ready to use. Once a bottle is warmed and the infant has drank from it, any leftover contents need to be discarded. Any pre-prepared formula not used in a 24-hour period should be discarded as well.

A nurse is working with four new mothers and assessing their ability to breastfeed. For which mother would breastfeeding be appropriate and safe? A. a mother who smokes cigarettes B. a mother who is receiving chemotherapy C. a mother with an infant with galactosemia D. a mother with herpes lesions on her nipples

A. a mother who smokes cigarettes Rationale: Cigarette smoking is not a contraindication to breastfeeding but women should be aware some nicotine is carried in breast milk. The milk of mothers who smoke also tends to be lower in protein and may be less in amount. Breastfeeding is contraindicated in all of the other situations listed.

A nurse is caring for a pregnant client who inquires about the benefits of breastfeeding. The nurse explains that secretory immunoglobulin A found in breast milk helps the infant by: A. protecting the gastrointestinal tract from foreign proteins. B. providing protection against otitis media. C. lowering rates of asthma during childhood. D. overcoming a family history of allergies.

A. protecting the gastrointestinal tract from foreign proteins. Rationale: Secretory immunoglobulin A found in breast milk specifically protects the infant's gastrointestinal tract from foreign proteins. Overall, infants who are breastfed up to 6 months are protected from otitis media, have lower rates of asthma during childhood, and are capable of overcoming a family history of allergies.

The new mother has decided to formula-feed her infant and is unsure when to introduce soft foods. Which age should the nurse point out will be appropriate to introduce her infant to mashed fruit and vegetables? A. 8 to 10 months B. 6 to 8 months C. after 12 months D. 4 to 6 months

B. 6 to 8 months Rationale: The AAP has recommended the introduction of solids at the age of 6 to 8 months. Starting before 6 months would be too early. Waiting until after 8 months may lead to malnutrition issues for the infant, as an infant's requirement for increased vitamins and minerals starts to increase and are not always met by formulas.

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? A. "Growth in the neonatal period is very rapid." B. "All infants require the same amount of calories." C. "After 2 months, the amount needed in calories declines." D. "An adult requires fewer calories per kg than an infant."

B. "All infants require the same amount of calories." Rationale: The actual calorie requirement depends on an infant's individual activity level and growth rate. For example, an active infant needs more calories than one who is more passive and content to spend long hours playing quietly.

The nurse is meeting with a group of expectant parents to discuss the feeding options available for their soon-to-be infant. The nurse predicts which factor will exert the strongest influence on their choice? A.Exposure to breast-feeding B. Sociodemographics C. Cost D. Culture

D. Culture Rationale: A woman's culture often strongly influences newborn feeding choice. If the woman feels it is culturally acceptable to breast-feed, she is more likely to breast-feed her infant. Sociodemographics are characteristics of a person or a group of people; the mother's exposure to breast-feeding and the cost of bottle-feeding all can influence the mother's decision to breast-feed. However, they will not have the strongest influence on the mother's choice of feeding her infant.

The nurse is preparing discharge instructions for a new mother who has been learning to breast-feed. Which response should the nurse prioritize when the mother questions her ability to produce enough milk for her infant? A. Consume a minimum of 3000 calories per day. B. Drink a lot of milk. C. Drink a lot of fluids. D. Take a daily multivitamin.

C. Drink a lot of fluids. Rationale: The mother needs to be sure to drink enough fluids, especially water, to handle her thirst. She only needs an additional 500 calories per day over her normal diet. Too much milk may cause gas and if her diet is appropriate she would not need a multivitamin.

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. A. Keep an overhead light on so the mother can observe the newborn feeding. B. If the mother is tired, she can prop the bottle and baby up in her bed. C. Warm the bottle up before giving it to the newborn. D. Gently shake the bottle prior to feeding to ensure that the formula is well mixed. E. Feed the newborn 3 to 4 oz, burping after every ounce.

A. Keep an overhead light on so the mother can observe the newborn feeding. D. Gently shake the bottle prior to feeding to ensure that the formula is well mixed. E. Feed the newborn 3 to 4 oz, burping after every ounce. Rationale: 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.

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. a mold that only exposes the breasts so the mother can feed on her stomach side by side B. pillow supports designed with wider sides to allow the twins to feed at the same time C. an extra-wide heating pad on both breasts, which will help stimulate milk production for both infants D. an extra-wide chair to allow the mother to use the football hold on both sides without fear of dropping an infant

B. pillow supports designed with wider sides to allow the twins to feed at the same time Rationale: 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.

The nurse is leading a group discussion of new mothers about breast-feeding. Which instruction should the nurse prioritize as the best method to increase their milk supply? A. Double pump when away from the baby. B. Only direct breast-feed. C. Empty the breast as completely as possible. D. Massage breast while pumping or breast feeding.

C. Empty the breast as completely as possible. Rationale: Milk production is based on supply and demand. To maintain or increase breast milk supply, the mother should empty her breast as often and as completely as possible. Massaging the breast, double-pumping, and only direct breast-feeding are not ways to increase the mother's milk supply.

What will the nurse recommend to a breastfeeding client experiencing sore nipples? A. Wear a nipple shield 24 hours/day to protect the nipple from rubbing against fabrics. B. Keep the nipple clean by applying rubbing alcohol after each feeding. C. Supplement breastfeeding with bottle feeding until the nipple is healed and no longer sore. D. Apply a few drops of breast milk to the nipples after feeding and gently massage it into the areola.

D. Apply a few drops of breast milk to the nipples after feeding and gently massage it into the areola. Rationale: Appropriate nipple care is important to prevent skin breakdown of the nipples. The nurse can also recommend applying a few drops of breast milk to the nipples after feeding and gently massaging it into the areola. The components of breast milk have healing properties. Alcohol is very harsh and drying to the nipple. Sore nipples are not a contraindication to breastfeeding as long as a proper latch is obtained. A nipple shield, worn while breastfeeding, can protect the nipple while the reasons for poor latch are determined. A nipple shell, not a shield, is worn over the nipple in between feedings to promote healing and protect the nipple from irritation.

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 of an infant? A. The first 2 months of age B. The first 3 months of age C. The first 12 months of age D. The first 6 months of age

D. The first 6 months of age Rationale: The American Academy of Pediatrics recommends an infant be fed exclusively by breastfeeding for the first 6 months and continuation of breastfeeding for at least 12 months, with the mother deciding how long to continue after that.

A new mother who does not want to breastfeed but who finds formula to be too expensive, asks the nurse why she can't just give her baby cow's milk. Which information would the nurse integrate into the response? Select all that apply. A. Cow's milk contains twice as much protein as needed and can overwhelm the baby's kidneys. B. Cow's milk contains half as much protein as needed and will leave the baby malnourished. C. Cow's milk contains casein and therefore the curd is large, tough, and difficult to digest. D. Cow's milk can cause microscopic bleeding of the gastrointestinal tract, leading to blood loss and anemia.

A. Cow's milk contains twice as much protein as needed and can overwhelm the baby's kidneys. C. Cow's milk contains casein and therefore the curd is large, tough, and difficult to digest. D. Cow's milk can cause microscopic bleeding of the gastrointestinal tract, leading to blood loss and anemia. Rationale: Unaltered cow's milk is not recommended for newborns, because it contains about 16% of its calories as protein, whereas human milk contains about 8%. This means cow's milk can create such a rich solute load (the amount of urea and electrolytes that must be excreted in the urine) that a newborn's kidneys could be overwhelmed. In addition, cow's milk can cause microscopic bleeding of the gastrointestinal tract leading to blood loss and anemia. These problems occur because the protein in cow's milk, casein, differs from that in human milk, lactalbumin, both in composition and in amount. This is important because the amount of casein present in milk determines its curd tension. Because of the increased amount of casein in cow's milk, the curd is large, tough, and difficult to digest, whereas in human milk the curd is softer and is digested more easily.

The nurse is assisting a new mother to begin breastfeeding her newborn. Which action should the nurse prioritize? A. Caution her not to allow the infant to grasp the areola of her breast to prevent soreness B. Position the infant in her arms, across her abdomen, stroking the infant's cheek with her nipple C. Encourage her to lie on her side with the infant, gently stroking the infant's cheek with her finger D. Encourage her to do what feels the most natural to her while gently stroking the infant's face.

B. Position the infant in her arms, across her abdomen, stroking the infant's cheek with her nipple Rationale: For the initial feedings, it is best for the mother to assume a sitting position, hold the infant in a tummy-to-tummy position and gently stroke the infant's cheek with the nipple to stimulate the rooting reflex. The infant should take the entire nipple and areola in it's mouth to properly stimulate and drain the breast as well as prevent nipple soreness. The lying position is not recommended for initial feedings as it requires the infant to latch more independently. This position will be more appropriate after the infant has learned the technique. It will also assist with the bonding if the mother cuddle's the infant while initially feeding the newborn. Each new mother may need some guidance and instruction as they start breastfeeding their newborn.

When working with a new mom sharing information as to when the newborn is getting hungry, the nurse should include which manifestations? Select all that apply. A. drooling B. fussiness leading to crying C. mouth movements D. kicking legs E. increase in restlessness

B. fussiness leading to crying C. mouth movements E. Part of a feeding assessment includes recognizing signs of hunger in the newborn. The nurse should ask parents if they can identify restlessness, tense body posture, and mouth movements as signs of hunger in their infant. Otherwise, they may wait for their infant to cry, and this is actually a late sign of newborn hunger. There are many causes of kicking in a newborn, and kicking is not specific to hunger. Drooling is not specific to hunger and can be related to such things as teething or chewing on a toy.

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. "This is an indication that you are lacking iron in your diet. You will need to start iron supplementation." B. "This is a sign of mastitis. You will need to take an antibiotic." C. "A slightly bluish color is normal." D. "This is a sign of too much fluoride in the milk. You should stop your supplements."

C. "A slightly bluish color is normal." Rationale: Breast milk is thick and white and can have a bluish tinge. This is a normal finding, and this client needs only reassurance.

A nurse is teaching a new mother about dietary needs while breastfeeding. The nurse would instruct the woman to consume a minimum of how much fluid a day to maintain an adequate milk supply? A. 16 ounces (473 mL) B. 48 ounces (1419 mL) C. 32 ounces (946 mL) D. 64 ounces (1893 mL)

C. 32 ounces (946 mL) Rationale: The nurse should remind women that good fluid intake is necessary to maintain an adequate milk supply and should recommend they drink at least four 8-oz (236-mL) glasses of fluid a day. Many may need to drink six glasses.

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? A. Side-lying position B. Abdominal hold C. Football hold D. Cradle hold

C. Football hold Rationale: For mothers who have undergone surgery, have large breasts or have twins, the football hold is the recommended feeding position. Cradle hold would work well for any infant. Side-lying position is recommended for women following surgery and to encourage rest.

Choose the correct statement regarding breast milk production. A. Prolactin is responsible for the let-down reflex, and progesterone stimulates milk production. B. Prolactin is responsible for the let-down reflex, and oxytocin stimulates milk production. C. Oxytocin is responsible for the let-down reflex, and prolactin stimulates milk production. D. Progesterone is responsible for the let-down reflex, and prolactin stimulates milk production.

C. Oxytocin is responsible for the let-down reflex, and prolactin stimulates milk production. Rationale: As the level of progesterone decreases drastically after birth, the anterior pituitary is stimulated to produce prolactin. Prolactin triggers the mammary glands to stimulate the production of milk. Oxytocin, released from the posterior pituitary, causes the mammary glands to contract and triggers the let-down reflex.

Which of the following is true regarding storing breast milk? A. Breast milk can still be used if it sits out overnight. B. Breast milk should never be frozen. C. Thawed breast milk must be used within 24 hours. D. Breast milk must be refrigerated immediately after pumping.

C. Thawed breast milk must be used within 24 hours. Rationale: Breast milk can be frozen for 2 to 6 months depending on the grade of the freezer. It can sit out at room temperature for 2 to 4 hours depending on the outside air temperature. It cannot be used if it sits out at room temperature overnight. Once it is thawed from frozen, it must be used within 24 hours.

Which statement by the nurse would best support a new mother's choice to bottle-feed her baby? A. "You do know that breast-feeding is the recommended method of feeding a newborn, don't you? But formula feedings are good, too." B. "I see from your chart you have chosen to bottle feed your newborn. I suppose you don't have enough support at home to try breast-feeding." C. "Try not to feel guilty by deciding to formula-feed your newborn. Many women make the same choice." D. "By formula-feeding your newborn, you will know how much the baby takes each feeding and allows others to fed the baby."

D. "By formula-feeding your newborn, you will know how much the baby takes each feeding and allows others to fed the baby." Rationale: If a mother chooses to formula-feed her newborn, the nurse needs to support her decision and offer encouragement. The mother needs to be well informed about the advantages of breast-feeding, but it is her choice how she feeds her baby. Telling her that breast-feeding is the recommended method of feeding will only make her feel guilty, as would mentioning that she may feel guilty. Presuming that the reason for the mother's choice is her lack of support at home is an assumption that is not validated and may offend the mother.

A nurse is helping to educate the parent of a newborn about signs of hunger in the newborn. Which of the following should be the last, in terms of time, a sign that a parent should pick up on that indicates hunger in the newborn? A. restlessness B. tense body posture C. smacking lips D. crying

D. crying Rationale: Part of assessment includes recognizing signs of hunger in the newborn. Ask parents if they can identify restlessness, tense body posture, smacking lips, and tongue thrusting as signs of hunger in their infant. Otherwise, they may wait for their infant to cry, and this is actually a late sign of newborn hunger.