OB ch21 care of new born ch 22:breastfeeding

The nurse is teaching a new mother breastfeeding techniques. The mother asks how she will be able to tell if the infant is suckling properly. What does the nurse tell her? 1 "Listen for a soft 'ka' or 'ah' sound." 2 "Listen for swallowing after each suck." 3 "There shouldn't be any pauses in feeding." 4 "Look for a fluttery movement of your infant's jaw."

1 A soft "ka" or "ah" sound indicates the infant is swallowing colostrum or milk. The infant may swallow after each suck or may suck several times before swallowing. Short pauses are normal during breastfeeding. A fluttery or choppy motion of the jaw not accompanied by the sound of swallowing indicates nonnutritive sucking.

The nurse is using the LATCH Scoring Tool to assess a mother and her infant during breastfeeding. The nurse observes that the infant is reluctant to latch and once he or she does latch, it is not easily sustained. The infant then only produces a few audible swallows with stimulation. The mother's nipples are flat, and her breasts have a few small blisters on them. During the assessment, another nurse held the infant and then the mother took over. Which area of assessment will the nurse assign a score of 0? 1 Latch 2 Audible swallowing 3 Type of nipple 4 Hold

1 Because the infant is reluctant to latch and the latch is not sustained, the nurse will assign a score of 0 for latch. The score for audible swallowing will be 1. The score for type of nipple will be 1, and the score for hold will be 1.

Which nipple condition is most conducive to breastfeeding? 1 Flat nipples 2 Everted nipples 3 Inverted nipples 4 Nipples that retract when compressed

2 Everted nipples are nipples that protrude normally; this condition is most conducive to breastfeeding. Flat nipples, inverted nipples, and nipples that retract when compressed may cause difficulty breastfeeding.

Under what conditions in the mother should the nurse advise that breastfeeding is contraindicated? Select all that apply. 1 Hepatitis C 2 Galactosemia 3 Herpes simplex 4 Cigarette smoking 5 Active untreated tuberculosis 6 Taking methadone for opiate addiction

2, 5 Mothers with galactosemia and active untreated tuberculosis are advised against breastfeeding, as the risks of these conditions outweigh the benefits of breastfeeding. Mothers with hepatitis C may safely breastfeed. Herpes simplex does not preclude breastfeeding if the mother does not have a lesion on her breast and uses thorough handwashing. Women who smoke can breastfeed but should stop smoking if possible or not smoke around the infant. Women who take methadone or buprenorphine for opiate addiction are allowed to breastfeed because only minimal amounts of the drugs pass to breast milk.

Why is Vitamin K given to the newborn? 1 To reduce bilirubin levels 2 To increase the production of red blood cells 3 To enhance the ability of blood to clot 4 To stimulate the formation of surfactant

3 Newborns have a deficiency of vitamin K until intestinal bacteria that produce vitamin K are formed. Vitamin K is required for the production of certain clotting factors. Vitamin K does not reduce bilirubin levels. Vitamin K does not increase the production of red blood cells or stimulate the formation of surfactant.

The primary health care provider instructs the nurse to give a hepatitis B (HepB) vaccine to a newborn. How should the nurse administer the vaccine? Select all that apply. 1 Through the deltoid muscle 2 Via the dorsogluteal muscle 3 Using the vastuslateralis muscle 4 By inserting the needle at a 60-degree angle 5 By inserting the needle at a 90-degree angle

3,4 The preferred injection site for a newborn is the vastuslateralis muscle in the thigh at a 90-degree angle. This is the best choice because this muscle has an adequate amount of muscle mass and fat. Administration of the HepB vaccine through the deltoid muscle is not recommended in infants, because this muscle has an inadequate amount of muscle for intramuscular administration. The dorsogluteal muscle is very small, poorly developed, and dangerously close to the sciatic nerve, which occupies a proportionately larger area in infants than in older children. Therefore it is not recommended as an injection site in newborns. The administration of the HepB vaccine is done by inserting the needle at a 90-degree angle, not at a 60-degree angle.

The home health nurse is evaluating how the parents of a newborn place the baby to sleep. Which action by the parents does the nurse correct? 1 Placing the newborn prone 2 Allowing the newborn to have a pacifier 3 Placing the infant on a firm sleep surface 4 Dressing the infant in a sac sleeper for sleep

1 Newborns should be placed on the back to sleep to decrease the incidence of sudden infant death syndrome. Pacifiers are encouraged for sleep but may be delayed if the infant is establishing breastfeeding routine. A firm surface should be used without bumper pads or loose articles. Sac sleepers allow the removal of loose bedding.

The nurse notes tenting of the skin upon assessment of an infant. Which condition does this indicate? 1 Weight loss 2 Dehydration 3 Hyperbilirubinemia 4 Poor thermoregulation

2 Tenting of the skin is an assessment finding typical of dehydration. Weight loss is assessed by obtaining a weight. Hyperbilirubinemia is assessed with skin color and bilirubin level. Thermoregulation is assessed with temperature and the presence of shivering.

The nurse is preparing a family for discharge with a newly circumcised infant using the Gomco clamp. Which statement by the family indicates the need for further learning? 1 "We will apply petroleum jelly to the site for a week." 2 "We will wash the site gently and remove the scab each time it forms." 3 "We will notify the physician if we notice pus or a foul smell indicating infection." 4 "We will call the doctor's office if there are more than a few drops of blood in the diaper."

2 The penis should be washed, but the scab should be left intact. Applying petroleum jelly is appropriate if a PlastiBell ring was not used. Signs of infection and bleeding should be reported immediately to the physician.

The nurse is assessing a postpartum patient who is breastfeeding her infant. Which sign indicates that the infant is latched on to the mother's breast and is receiving the mother's milk? 1 The infant's cheeks are dimpled during sucking. 2 The infant's sucking is not audible. 3 The patient feels strong tugging on the nipple. 4 The patient feels pinching and pain in the nipple.

3 A strong tugging sensation on the nipple is a sign that the infant is latching and feeding well. During sucking, the infant's cheeks should be rounded. Dimpled cheeks indicate improper latching. Audible sucking indicates that the infant is swallowing milk properly. If the infant has latched well, the patient should not feel pain or pinching in nipple during breastfeeding.

The nurse is preparing to deliver vitamin K to the neonate. Which site does the nurse prepare for injection? 1 Groin 2 Buttocks 3 Upper arm 4 Middle outer thigh

4 The nurse injects vitamin K into the middle outer thigh to deliver the injection into the vastus lateralis muscle. The groin does not contain muscle and could involve injury of nerves and blood vessels if accessed. The buttocks and upper arm are not ideal in muscle development or ease of access for intramuscular injection.

The nurse is teaching a new mother breastfeeding techniques. The mother delivered by cesarean birth and has heavy breasts. Which breastfeeding technique is most appropriate for this new mother? 1 Cradle hold 2 Football hold 3 Side-lying hold 4 Cross-cradle hold

1 The football or clutch hold is especially helpful for mothers with heavy breasts. This hold also avoids pressure against an abdominal incision. The cradle hold does not avoid such pressure. The side-lying hold helps avoid pressure against an abdominal incision but is not as comfortable for women with heavy breasts as the football hold. The cross-cradle hold is helpful for infants who are preterm or have a fractured clavicle.

The nurse is checking in on a patient who has recently given birth. The patient appears anxious, and when questioned she says, "I really wanted to breastfeed my baby, but it hurts and I'm afraid I'm doing it wrong. Maybe I should just use formula." What is the most appropriate initial response by the nurse? 1 "You sound disappointed." 2 "Don't worry, you'll get the hang of it." 3 "I can help you find a comfortable latch." 4 "All new mothers are nervous about breastfeeding."

1 By allowing the patient to express her feelings of disappointment before beginning to teach, the nurse will be able to learn how important breastfeeding is to her and how best to go about teaching her. Reflecting the patient's feelings helps her feel accepted. This is the most appropriate initial response. Saying "Don't worry, you'll get the hang of it" is dismissive of the patient's feelings and does not facilitate patient teaching. While the nurse will likely go on to help the patient find a comfortable latch, offering this as an initial response is premature. The nurse should first offer the patient the chance to express her feelings and have them validated. Stating that all new mothers are nervous about breastfeeding does not address this particular patient's concerns or feelings.

On reviewing the laboratory reports of a newborn, the nurse finds that the infant has galactosemia. What does the nurse advise the parents to ensure safety? 1 Avoid breastfeeding the infant. 2 Feed the infant with expressed human milk. 3 Avoid giving soy-rich formula to the infant. 4 Start giving fruit juice to the infant.

1 Consumption of human milk is contraindicated in infants with galactosemia. Therefore, a newborn with galactosemia should not be breastfed. Any type of human milk is contraindicated in infants with galactosemia. Expressed milk refers to breast milk that is stored in bottles. Therefore, the infant should not be fed with expressed milk, either. The infant can be given soy-rich formula, because it does not affect metabolism and is not contraindicated in infants with galactosemia. Fruit juice is not given to infants until 6 months of age.

While caring for a postpartum patient, the nurse finds that she is unable to feed her newborn as often as she needs to because the baby spends most of the time sleeping. What should the nurse suggest to the patient in this situation? 1 "You can wake the baby up by gently massaging his back." 2 "Do not allow the baby to suck his thumb because it promotes sleep." 3 "Avoid swaddling the baby with a blanket because it prevents deep sleep in the baby." 4 "Store the expressed breast milk in a bottle and feed the baby when it wakes up."

1 Feeding the baby as often as the mother needs to is difficult if the baby spends most of the time sleeping. The mother can wake the baby by gently massaging the back. Preventing thumb sucking will not help wake the baby. The baby should be properly covered with a blanket to prevent cold stress. The nurse should encourage the patient to feed the baby on time because it helps promote growth and development in the newborn. Therefore, the nurse should not advise the patient to give stored milk to the baby.

The nurse is reviewing a draft of a new protocol for infant screenings to be performed before discharge. Which piece of the protocol needs review for correction? 1 Perform the test within 12 hours of birth. 2 Schedule follow-up for any abnormal results. 3 Obtain the blood sample from the infant's heel. 4 Provide education to the parents on the testing.

1 Infant screening tests should be done 24 to 48 hours after birth to be the most accurate. Abnormal results require retesting and follow up. The blood sample is obtained from the heel. Parents can receive education by handout about the different tests contained in screening.

The labor and delivery nurse is on a committee to review and update practices for the prevention of infant abduction. Which practice needs to be changed to better support protection of the infant? 1 Transporting infants by carrying them 2 Positioning cribs away from doorways 3 Requiring infant-adult match verification 4 Teaching parents to look for proper identification on hospital staff

1 Infants should be transported in cribs only, not carried. Anyone carrying an infant outside of the room should be questioned. Positioning cribs away from doorways, requiring an infant-adult match for identification, and teaching parents to identify hospital staff identification are all ways to support safety and reduce opportunity for infant abduction.

The nurse is educating an expectant mother about breastfeeding. What practice does the nurse encourage to prepare for breastfeeding and decrease irritation and pain? 1 Avoiding using soap on the nipples 2 Using unscented cream on the nipples 3 Rolling the nipples to "toughen" them 4 Rubbing the nipples to increase blood flow

1 Little preparation is needed during pregnancy for breastfeeding. The mother should avoid applying soap on her nipples because it removes the natural protective oils secreted by the Montgomery tubercles of the breasts. The use of creams and nipple rolling, pulling, and rubbing to "toughen" nipples does not decrease nipple pain after birth and may cause irritation or uterine contractions from release of oxytocin. It is not necessary to rub the nipples to increase blood flow.

The mother of a newborn infant is considering supplementing breastfeeding with formula because she worries she is not producing enough milk. The nurse confirms the infant is at a healthy weight. Why does the nurse suggest the mother put the infant to the breast more often before supplementing with formula? 1 To encourage suckling to stimulate prolactin 2 To provide skin-to-skin contact to stimulate oxytocin 3 To hasten the shift from colostrum to transitional milk 4 To allow the infant to consume the varied milk composition at different times of day

1 Prolactin activates milk production. The tactile stimulation of suckling and the removal of colostrum or milk cause continued increased levels of prolactin. Prolactin is secreted at the highest levels with suckling and during the night. Increased demand with more frequent and longer breastfeeding results in more milk being available. Skin-to-skin contact stimulates oxytocin, which stimulates the milk ejection reflex, but not the amount of milk available. Hastening the shift from colostrum to transitional milk is not necessarily preferred over allowing the different stages of lactogenesis to occur in due time. Milk composition does change throughout the day, but this does not address the mother's concern in this scenario.

The nurse obtains a heel stick blood glucose on a newborn. The result is 38 mg/dL. Which action does the nurse take? 1 Having the infant feed immediately 2 Administering oral glucose to the infant 3 Initiating intravenous hydration and glucose 4 Waiting for the mother to wake up before feeding the infant

1 The action for a low glucose on an infant is to feed the infant immediately. Oral glucose may temporarily raise the glucose, but the subsequent insulin release will bring the level back down. Intravenous intervention requires orders from the health care provider. Waiting for the infant to feed with the mother would not be appropriate when the infant is hypoglycemic.

A new mother is concerned about providing enough milk for her newborn. What does the nurse tell her? 1 "If you breastfeed your baby frequently for longer periods of time, your body will make milk to keep up with that demand." 2 "Your body will produce a steady supply of milk for about a year, and then the rate of production will slowly decrease." 3 "Try not to feed your baby too many times during the day. The longer you go between feedings, the more milk your body will make." 4 "If you are mindful of how much breast milk you allow your baby to have during each feeding, you will have enough to last through infancy."

1 There is a "supply and demand" effect in the production of breast milk. Early and frequent suckling may increase prolactin receptors in the breast and therefore increase the milk-making capacity of the breasts. Therefore, increased demand with more frequent and longer breastfeeding results in more milk being available. The mother's body will not supply a steady supply of milk; the milk supply will depend on the demand. The nurse should encourage the mother to feed the infant more frequently, not less frequently, to encourage production of breast milk. Similarly, the nurse should encourage the mother to feed for longer periods of time, not less, to encourage milk production.

The nurse on a labor and delivery unit is caring for several newborns. Which newborn will the nurse assess for feeding problems? 1 The 4-day-old infant who has lost weight in the past 24 hours 2 The 3-day-old infant who has lost weight in the past 24 hours 3 The 2-day-old infant who has lost 6% of his or her birth weight 4 The 3-day-old infant who has lost 7% of his or her birth weight

1 Infants should be evaluated for feeding problems if weight loss exceeds 7% of birth weight, if weight loss continues beyond 3 days of age, or if the birth weight is not regained by 10 days of age in the term infant. Because the 4-day-old infant has lost weight past 3 days of age, the nurse will assess him or her for feeding problems. The 3-day-old infant who has lost weight in the past 24 hours is still within the range of normal weight loss. The 2-day-old and 3-day-old infants who have lost 6% and 7% of body weight, respectively, are within the expected range.

The birth weight of a breastfed newborn was 8 lb, 4 oz. On the third day the newborn's weight was 7 lb, 12 oz. On the basis of this finding, the nurse should do what? 1 Encourage the mother to continue breastfeeding because it is effective in meeting the newborn's nutrient and fluid needs. 2 Suggest that the mother switch to bottle feeding because breastfeeding is ineffective in meeting newborn needs for fluid and nutrients. 3 Notify the physician because the newborn is being poorly nourished. 4 Refer the mother to a lactation consultant to improve her breastfeeding technique.

1 Weight loss of 8 oz falls within the 5% to 10% expected weight loss from birth weight during the first few days of life, which for this newborn would be 6.6 to 13.2 oz. Breastfeeding is effective, and bottle feeding does not need to be initiated at this time. The infant is not undernourished, and the physician does not need to be notified.

The nurse is using the LATCH Scoring Tool to assess a mother and her infant during breastfeeding. The nurse notes the following: The infant is able to sustain latch and suck after repeated attempts and the mother is holding her nipple, which is everted, in the infant's mouth. The infant is exhibiting spontaneous and frequent audible swallowing. The mother is supported by pillows during the feeding, and her breasts are soft and nontender. The nurse assigns the following scores: L, 0; A, 1; T, 2; C, 2; H, 1. Which scores need to be corrected? Select all that apply. 1 Latch 2 Audible swallowing 3 Type of nipple 4 Comfort 5 Hold

1,2 The repeated attempts and subsequent sustained latching and suckling and the mother's need to hold her nipple in the infant's mouth are indicative of a score of 1 for latch. Spontaneous and frequent audible swallows are indicative of a score of 2 for audible swallowing. The nurse's scores for type of nipple, comfort, and hold are correct.

Which are effective techniques to relieve crying in infants? Select all that apply. 1 Bathing 2 Massage 3 Pacifiers 4 Loud music 5 Cool air from a fan

1,2,3 Bathing, massage, and pacifiers are soothing and sleep-inducing. Soft music or white noise, not loud music, helps relieving crying. Heat, not cool air, is soothing and can relieve crying.

Which techniques does the nurse include when teaching care of the infant? Select all that apply. 1 Providing handouts 2 Practicing return demonstration 3 Including the mother and partner 4 Reviewing reliable internet resources for information 5 Planning all information to be delivered in a single session

1,2,3,4 Handouts reinforce verbal teaching and provide reference for later use. Return demonstration allows for the practice of skills. Both the mother and partner should be involved in the education. Reviewing reliable internet sources supports obtaining well-researched information. Education is done as the opportunity arises and over many small sessions.

The nurse is helping to soothe a crying baby using the 5Ss. Which interventions does the nurse include? Select all that apply. 1 Swing the baby. 2 Swaddle the infant. 3 Make shushing sounds. 4 Have the baby suck on a pacifier. 5 Place the infant in a side-lying position. 6 Remove clothing for skin-to-skin contact.

1,2,3,4,5 Swinging, swaddling, shushing, sucking, and side-lying are the components of the 5S technique. Skin-to-skin contact may help to soothe crying but is not part of the 5Ss.

The nurse is assessing breastfeeding in a new mother and infant using the LATCH scoring tool. Which components does the nurse assess? Select all that apply. 1 Hold 2 Latch 3 Comfort 4 Type of nipple 5 Amount of milk 6 Audible swallowing

1,2,3,4,6 The LATCH scoring tool includes assessment of hold, latch, comfort, type of nipple, and audible swallowing. Amount of milk is not a component of the LATCH scoring tool.

What methods are used to prevent and treat diaper rash? Select all that apply. 1 Applying zinc oxide as a barrier 2 Washing the skin with mild soap 3 Changing diapers as soon as they are wet 4 Using diaper wipes with alcohol to promote drying 5 Understanding rashes occur more frequently as the child sleeps for longer periods

1,2,3,5 Zinc oxide and petroleum-based creams will help form a barrier against wetness. Mild soap and warm water should be used to cleanse the skin. Diapers should be changed as soon as they are wet or soiled. Rashes will increase as the time between changes increases. Alcohol-free wipes should be used.

What are risks to the infant of choosing formula feeding over breastfeeding? Select all that apply. 1 Diarrhea is more common. 2 The risk of infections is higher. 3 Formula is more likely to be underfed. 4 Formula can be improperly diluted. 5 Allergies are more likely to develop.

2,4,5 Formula-fed infants are at a higher risk of infections, consuming formula that has been improperly and potentially dangerously diluted, and developing allergies. Constipation, not diarrhea, is more common in formula-fed infants. Formula is more likely to be overfed.

The nurse is explaining circumcision to new parents, and informed consent must be obtained. However, the parents are reluctant to proceed with the procedure. What justification could warrant the parents' rejection of circumcision? Select all that apply. 1 They believe the pain and risks outweigh the benefits. 2 The procedure is culturally inappropriate for their family. 3 They have heard there is an increased risk for penile cancer. 4 They consider the procedure cosmetic and therefore unnecessary. 5 They believe the foreskin serves to protect the penis and can result in an infection if removed.

1,2,4 Many parents feel the benefits to circumcision do not outweigh the risks and pain involved with the procedure. Many cultures do not believe in circumcision or choose not to have the procedure for many reasons, including altering the body and protection of the penis. Parents may feel as if the purpose of the procedure is more cosmetic than medical and is unnecessary. Circumcision lowers the risk of penile cancer and infection, and the parents' misconceptions should be addressed in order for consent to be fully informed.

Which statement indicates the effect of breastfeeding on the family or society at large? Select all that apply. 1 Breastfeeding requires fewer supplies and less cumbersome equipment. 2 Breastfeeding saves families money. 3 Breastfeeding costs employers in terms of time lost from work. 4 Breastfeeding benefits the environment. 5 Breastfeeding results in reduced annual health care costs.

1,2,4,5 Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment. Breastfeeding saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. Less time is lost from work by breastfeeding mothers, in part because infants are healthier. Breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal. Breastfeeding results in reduced annual health care costs.

The mother of an infant states the infant seems to cry often. Which interventions does the nurse suggest? Select all that apply. 1 Burp the infant. 2 Rock the infant. 3 Allow the infant to cry. 4 Try an automated swing. 5 Check clothing for tightness and warmth.

1,2,4,5 Burping the infant may release an uncomfortable air bubble. Rocking the infant and an automated swing may provide soothing motion for the infant. Clothing that is too tight or too warm may cause discomfort for the infant. The infant's needs should be met to build trust, which is not supported by letting the infant cry.

Which interventions does the nurse suggest to promote sleep for a 12-week-old infant? Select all that apply. 1 Use soft lighting. 2 Try patting the baby back to sleep. 3 Incorporate playtime into night feeding. 4 Perform night feeding in the infant's room. 5 Allow crying for a few minutes in case the infant returns to sleep.

1,2,4,5 Soft, low lighting promotes sleep. Patting the back may allow the infant to fall back asleep at this age. Night feeding in the bedroom with immediate return to bed promotes sleep. Crying may subside if the infant returns back to sleep without needing to feed. Playtime or any other stimulation should not be incorporated to night feeding.

The nurse is assessing the cord of a 3-day-old infant. Which assessment findings may indicate infection? Select all that apply. 1 Edema 2 Redness 3 Black color 4 Brown color 5 Purulent drainage

1,2,5 Edema, redness, and purulent draining at the site of the umbilical cord are all indications of infection. Black and brown are expected colors as the cord dries.

The nurse is caring for a patient who had a normal vaginal birth. The patient is concerned about the shape of the infant's head. What does the nurse tell the patient? Select all that apply. 1 "The bones of the skull continue to grow after birth." 2 "The shape of the head undergoes molding during labor." 3 "The head assumes its normal shape within a month." 4 "The skull bones of an infant are generally firmly united." 5 "The sutures and fontanels make the skull flexible."

1,2,5 The bones of the skull continue to grow for some time after birth to accommodate the infant's brain. During labor, the shape of the head gets molded as the bones undergo a slight overlapping. The sutures and fontanels are membranous structures that unite the skull bones and make the skull flexible. Molding can be extensive, but the heads of most newborns assume their normal shape within 3 days after birth. The skull bones are held together by sutures and fontanels and are not firmly united in an infant.

The nurse is teaching the parents about ensuring safety for a sleeping infant. Identify appropriate teachings by the nurse. Select all that apply. 1 Place the infant's crib in the parent's room. 2 Provide comforters and soft toys in the crib. 3 Place the infant in the supine position while sleeping. 4 Have a firm mattress with a fitted sheet in the crib. 5 Share the parent's bed with the infant while sleeping.

1,3,4 The parents can share the room with the infant to facilitate better observation and care. The infant must always be placed in the supine position while sleeping during the first year to prevent sudden infant death syndrome (SIDS). The crib must have a firm mattress with a fitted sheet. Parents must avoid the use of comforters or soft toys in the crib to prevent incidents of suffocation or SIDS. Parents must not share the bed with the infant while sleeping to reduce the risk of fall. The infant may be brought to the bed for feeding and placed back in the crib before the parents fall asleep.

Parents of a newborn male ask the nurse about the benefits of circumcision. Which benefits does the nurse include in responding? Select all that apply. 1 Reduces risk of penile cancer 2 Reduces irritation of the glans 3 Reduces risk of contracting human immunodeficiency virus (HIV) 4 Reduces urinary tract infections the first year 5 Reduces transmission of sexually transmitted disease

1,3,4,5 Circumcision removes the foreskin of the penis and reduces the risk of penile cancer, contracting HIV, urinary tract infections, and the transmission of other sexually transmitted diseases. Circumcision removes the skin covering the glans, making the glans more prone to irritation.

The nurse is teaching the parents of a newborn about care. Which intervention does the nurse stress as the most important in preventing infection in the newborn? 1 Promote rest. 2 Wash hands frequently. 3 Keep the head covered with a cap. 4 Place the infant on the back to sleep.

2 All those in contact with the infant should wash their hands frequently to prevent the transmission of infection to the infant. Rest promotes health but is not the most important intervention for infection prevention. Keeping the head covered will promote thermoregulation. Placing the infant on his or her back to sleep reduces the risk of sudden infant death syndrome.

Which action of a breastfeeding mother indicates understanding of instructions about breastfeeding? Select all that apply. 1 Holds breast with four fingers along bottom and thumb at top 2 Leans forward to bring breast toward the baby 3 Stimulates the rooting reflex and then inserts nipple and areola into newborn's open mouth 4 Puts her finger into newborn's mouth before removing breast 5 Holds the baby close to the breast with the infant's mouth directly in front of the nipple

1,3,4,5 Holding the breast with four fingers along the bottom and the thumb at top is a correct technique. The mother has understood instructions when she holds the baby close to the breast with the infant's mouth directly in front of the nipple. Stimulating the rooting reflex is correct. Placing the finger in the mouth to remove the baby from the breast is correct. To maintain a comfortable, relaxed position, the mother should bring the baby to the breast, not the breast to the baby. The mother would need further demonstration and teaching to correct the ineffective action.

Which interventions will the nurse implement to help an infant maintain an axillary temperature within the normal range of 97.7°F to 99.5°F? Select all that apply. 1 Dry the infant quickly with warm towels. 2 Place the bassinet by the window for warmth from the sun. 3 Prepare a radiant warmer to be used during initial assessment. 4 Cover the infant's head with a warm hat, and place under the warmer. 5 Check the infant frequently to ensure temperature is rising as expected and is being maintained. 6 Place the infant on the mother's chest or abdomen immediately after birth for skin-to-skin contact.

1,3,5,6 To meet the goal of maintaining body temperature, the nurse will dry the infant quickly with warm towels; use a warmer as needed when assessing, cleaning, and changing the infant; monitor the infant frequently to ensure the temperature is increasing as expected; and place the infant on the mother's skin to allow body heat to help regulate the infant's temperature. It is not necessary and not always possible to place an infant in the window for warmth from the sun. The nurse does not need to cover the newborn's head with a heated hat while under the warmer.

Which instructions should the nurse include when teaching a mother about the storage of breast milk? Select all that apply. 1 Wash hands before expressing breast milk. 2 Store milk in 8- to 12-oz containers. 3 Store refrigerated milk in the door of the refrigerator. 4 Place frozen milk in the microwave for only a few seconds to thaw. 5 Milk thawed in the refrigerator can be stored for 24 hours.

1,5 Breast milk storage guidelines for home use for full-term infants are: (1) Before expressing or pumping breast milk, wash your hands. (2) Containers for storing milk should be washed in hot, soapy water and rinsed thoroughly; they can also be washed in a dishwasher. If the water supply may not be clean, boil containers after washing. Plastic bags designed specifically for breast milk storage can be used for short-term storage (less than 72 hours). (3) Write the date of expression on container before storing milk. A waterproof label is best. (4) Store milk in serving sizes of 2 to 4 ounces to prevent waste. (5) Storing breast milk in the refrigerator or freezer with other food items is acceptable. (6) When storing milk in a refrigerator or freezer, place containers in the middle or back of the freezer, not on the door. (7) When filling a storage container that will be frozen, fill only three quarters full, allowing space at the top of the container for expansion. (8) To thaw frozen breast milk, place container in the refrigerator for gradual thawing or under warm, running water for quicker thawing. Never boil or microwave. (9) Milk thawed in the refrigerator can be stored for 24 hours. (10) Thawed breast milk should never be refrozen. (11) Shake the milk container before feeding the baby and test the temperature of the milk on the inner aspect of your wrist. (12) Any unused milk left in the bottle after feeding is discarded.

What is the rationale behind encouraging postpartum patients to nurse when they are producing colostrum? 1 Colostrum is rich in immunoglobulin G (IgG). 2 Colostrum is rich in immunoglobulin A (IgA). 3 Colostrum is rich in immunoglobulin D (IgD). 4 Colostrum is rich in immunoglobulin M (IgM).

2 A newborn baby does not have any IgA. However, colostrum, which is the precursor to breast milk, is rich in IgA. This substance provides passive immunity to the neonate. The antibody cannot pass placental barriers, and therefore the fetus lacks this immunoglobulin. IgG provides passive acquired immunity against bacterial toxins and can cross placental barriers. IgD is produced in very low amounts and is seen in blood serum. IgD is not present in breast milk and passes through placental barriers. IgM can pass through the maternal placenta and reach the fetus. This antibody aids in response to the blood group antigens.

The nurse is discussing coping with colic with the mother of an infant. Which statement by the mother alerts the nurse to intervene and discuss abusive head trauma? 1 "I am afraid of spoiling the baby with so much holding and rocking." 2 "I've tried everything, and this crying is starting to make me so angry." 3 "I don't seem to get anything done in the evening because of the crying." 4 "I am tracking my intake to see if there are trigger foods for the colic in the breast milk."

2 Abusive head trauma is most often done in the case of an inconsolable infant. Stating defeat and anger are signals for the need for therapeutic coping mechanisms. The nurse would work with the mother to discuss safe, effective interventions. The infant is not spoiled through attention to crying. The inconsolable infant can be time-consuming. Triggers in the diet may be linked to colic and should then be avoided.

The nurse advises the postpartum patient to breastfeed regularly to lower the risk of postpartum hemorrhage. The reason behind this suggestion is to increase what? 1 Lactose production 2 Oxytocin production 3 Estrogen production 4 Progesterone production

2 Breast milk production follows the supply-meets-demand system. The more the patient breastfeeds the infant, the greater the demand for production. This in turn increases the production of oxytocin. Oxytocin is the hormone that helps in uterine contraction and involution and decreases the risk of postpartum hemorrhage. Other hormones are present at the appropriate levels but are not related to postpartum hemorrhage.

With regard to the long-term consequences of infant feeding practices, the nurse should instruct the obese patient that the best strategy to decrease the risk for childhood obesity for her infant is what? 1 An on-demand feeding schedule 2 Breastfeeding 3 Lower-calorie infant formula 4 Smaller, more frequent feedings

2 Breastfeeding is the best prevention strategy for decreasing childhood and adolescent obesity. Breastfeeding also assists the woman to return to her prepregnant weight sooner. All breastfed infants should be fed on demand. Lower-calorie formula is an inappropriate strategy that does not meet the infant's nutritional needs. Breastfeeding is the most appropriate choice for infant feeding. Smaller feedings are not necessary. Infants should continue to be fed every 2 to 3 hours in the newborn period.

The nurse is teaching a new mother breastfeeding techniques. The mother expresses concern that her infant will not be able to breathe while feeding. What education does the nurse provide? 1 "Holding your hand in a 'C' position will help avoid breathing difficulty." 2 "Holding your infant's hips closer to your body will help avoid breathing difficulty." 3 "Indenting the breast tissue near your infant's mouth will help avoid breathing difficulty." 4 "Holding your infant's body in a more vertical position will help avoid breathing difficulty."

2 Bringing the infant's hips closer to the mother and lifting the body to a more horizontal position are usually sufficient if there is concern about the infant's ability to breathe while breastfeeding. The mother's hand should be in a "C" or "U" position in general for breastfeeding. This does not address concerns about breathing. Indenting the breast tissue near the infant's nostrils is unnecessary. This might cause improper positioning of the nipple in the infant's mouth, interfere with the grasp of the nipple, or interfere with milk flow. The infant's body should be held in a more horizontal, not vertical, position.

The nurse has assisted with a vaginal delivery. Which action does the nurse take to promote infant thermoregulation? 1 Allowing the infant to air-dry 2 Placing the infant skin-to-skin with the mother 3 Applying a hat to the infant's head under the warmer 4 Setting the radiant warmer temperature to 36˚C

2 Evidence supports that placing the infant skin-to-skin with the mother promotes thermoregulation. The infant is dried with blankets, not by air, which would remove heat through evaporation. Hats are not worn under the warmer, as they would obstruct the warmer reaching the skin of the head. The radiant warmer temperature would be set to 36.5˚C to maintain the heat level of the skin at normal.

The nurse is caring for a new breastfeeding mother reporting breast tenderness. The nurse notes localized edema of the breast and a hard area upon palpation. The patient's body temperature is 98.4˚ F. What best describes this condition? 1 Mastitis 2 Plugged duct 3 Engorgement 4 Nipple trauma

2 Localized edema and tenderness are present with a plugged duct, and a hard area may be palpated. A tiny, white area may be present on the nipple. A plugged duct may progress to mastitis if not treated promptly. Mastitis involves localized pain accompanied by fever, generalized aching, and malaise. Engorgement may become a problem if feedings are delayed, too short, or infrequent. Engorged breasts become edematous, hard, and tender, making feeding and even movement painful. Nipple trauma causes more sustained pain. Traumatized nipples appear red, cracked, blistered, or bleeding.

The nurse advises the patient to use a hospital-grade electric pump for effective feeding of a preterm infant. What does the nurse tell the patient about using this pump? 1 Hospital-grade electric pumps can be used at any time after childbirth. 2 Pumping should be done eight to 10 times a day to maintain milk supply. 3 Milk obtained by pumping should be microwaved immediately. 4 Honey should be added to the milk obtained by pumping.

2 Pumping by a hospital-grade electric pump is recommended eight to 10 times a day to maintain milk supply. A lower rate of pumping will not maintain an adequate quantity of breast milk. Hospital-grade electric pumps should be used as soon as the baby is born to obtain the colostrum, which is important for growth. Milk obtained by pumping should be refrigerated immediately. Heating the milk may decrease its nutritional value. Breast milk is the best food for a preterm infant. It contains all necessary nutrients for the infant, so the patient should not add anything to the breast milk. Moreover, honey is known to cause botulism in infants and therefore should be avoided.

A new mother tells the nurse she is concerned her infant is not getting enough milk because her infant tends to fall asleep a few minutes after beginning feeding. What possible solution does the nurse offer? 1 Wrapping the baby in a blanket 2 Rubbing the infant's back gently 3 Avoiding all bottles and pacifiers unless absolutely necessary 4 Wiping the infant's face with a cold washcloth to wake him or her up

2 Rubbing the back stimulates the central nervous system and arouses the baby. Undressing the baby for skin-to-skin contact is a possible solution; wrapping the baby in a blanket prevents skin-to-skin contact and may be detrimental to feeding. Avoiding bottles and pacifiers is a solution for nipple confusion, not for the infant falling asleep during feeding. Wiping the infant's face with a lukewarm washcloth is also a possible solution for the infant falling asleep shortly into feeding.

The nurse is teaching a postpartum patient about formula preparation. Which statement by the patient indicates the need for further teaching? Select all that apply. 1 "Ready-to-feed formula can be used directly by pouring it into the bottle." 2 "Concentrated formula is diluted with twice the amount of water." 3 "Powdered formula is fed to the infant after mixing one scoop with 60 mL of water." 4 "Ready-to-feed formula and concentrated formula can be refrigerated for 48 hours."

2,4, Concentrated formula is diluted with equal parts water to feed the infant. Diluting the formula with double the amount of water would decrease the nutrient and calorie content of the milk. Ready-to-feed formula is expensive and easy to use. The required amount is poured into the bottle and fed directly to the baby. One scoop of powdered formula is mixed with 60 mL of water to provide appropriate nutrition to the infant. Both ready-to-feed formula and concentrated formula can be refrigerated for 48 hours. However, these formulas may not be safe to feed to the infant if refrigerated for more than 48 hours.

The nurse is educating a pregnant patient about breastfeeding. The patient asks if she should avoid particular foods while breastfeeding. What does the nurse tell her? 1 "You should avoid shellfish because this is a common allergen." 2 "You do not need to restrict your diet as you begin breastfeeding your infant." 3 "You should avoid peanuts and tree nuts which can cause allergic reactions." 4 "You should avoid drinking cow's milk because it is hard for your baby to digest."

2 Studies have been unable to determine whether infants whose mothers avoid eating common allergens are less likely to develop food allergies. Therefore, current recommendations are for mothers to eat a regular, unrestricted diet during pregnancy and while breastfeeding. The nurse will tell the patient that she does not need to restrict her diet as she begins breastfeeding. If an allergic reaction is triggered in the infant after breastfeeding, the mother should be educated on identifying and eliminating the offending food. Shellfish, peanuts, and tree nuts are common allergens, but they do not need to be avoided as the mother begins breastfeeding. Cow's milk is difficult for infants to digest; however, the concern is not relevant if the infant is breastfeeding and not directly drinking cow's milk.

The charge nurse is performing rounds on the labor and delivery unit where four births have recently occurred. Which neonate requires immediate attention? 1 The neonate who is crying with a respiratory rate of 58 2 The neonate with a respiratory rate of 72 and retractions 3 The neonate with a respiratory rate of 45 and clear secretions by bulb suction 4 The neonate who is sleeping skin-to-skin with the mother with a respiratory rate of 35

2 The neonate with a respiratory rate of 72 and retractions is tachypneic outside of the normal respiratory rate of 30 to 60 breaths per minute and showing signs of distress with retractions. Crying with a respiratory rate of 58, a respiratory rate of 45 with clear secretions by bulb suction, and sleeping skin-to-skin with a respiratory rate of 35 are all normal, expected findings of the neonate.

After allowing a new mother to bond with her newborn after delivery, the nurse tells the mother, "I need to take the baby now." What is the best explanation for the nurse to provide? 1 "All newborns must get certain medications to keep them healthy, so I'm going to give your baby an injection." 2 "The baby needs a bath and some medication that will help promote health. I will bring your baby back all clean." 3 "The baby needs a bath to remove all the bacteria from the birthing process, and I will return after your baby has been assessed." 4 "Newborns don't have the necessary defense mechanisms yet to ward off bacteria, so I need to take your baby to a controlled environment."

2 The nurse should explain in lay terms that the new mother can understand why the nurse is taking the baby, and what procedures will be done. These include bathing and necessary medications. Reinforcing that the nurse will return the baby as soon as the procedures are complete will help reassure the mother that the baby will be safe. While newborns need certain medications, saying the newborn will receive an injection is an incomplete explanation that can leave the mother concerned. Likewise, telling the mother that the newborn has to have bacteria removed from the birthing process can cause anxiety and stress on the mother. The mother may also feel anxiety and stress if told that the newborn has a lack of defense mechanisms.

The nurse is teaching new parents how to use bulb suction with their new infant. Which action does the nurse correct on return demonstration? 1 Releases the bulb slowly 2 Inserts the tip to the back of the throat 3 Compresses the bulb before entering the mouth 4 Places the infant on the back with the head to the side

2 The nurse would correct inserting the tip to the back of the throat to avoid eliciting a gag reflex and demonstrate placing the tip between the gums and cheek. Releasing the bulb slowly, compressing the bulb before entering the mouth, and placing the infant on the back with the head to the side are all correct form.

The nurse is teaching parents of an uncircumcised male about care of the penis. Which action does the nurse correct when observing a diaper change? 1 The penis is gently cleansed. 2 The foreskin is forcibly retracted. 3 The parents observe for signs of infection. 4 The parents state the penis will be cleaned with each bath.

2 The foreskin will not fully retract on an uncircumcised penis until at least 3 years of age and should not be forced to retract. Care of the infant penis includes gentle cleansing, observing for infection, and daily cleaning outside of diaper changes.

Which statements are most appropriate for the nurse to include when educating a new mother about feeding options for her infant? Select all that apply. 1 "If you breastfeed your infant, you will start ovulating again earlier." 2 "Breastfeeding encourages bonding more than formula feeding does." 3 "You will likely find you get more rest while feeding if you choose to breastfeed." 4 "If you are concerned about the health of your child, you should only consider breastfeeding." 5 "With formula feeding, your uterus will take longer to return to its pre-pregnancy size and shape."

2,3 It is appropriate to tell the patient that breastfeeding encourages bonding more than formula feeding does. Breastfeeding mothers have more skin-to-skin contact with their infants; this promotes bonding. It is true that mothers who breastfeed are better able to rest during feeding than mothers who formula feed. It is also true that uterine involution takes longer with formula feeding. This is because breastfeeding releases oxytocin, which enhances uterine involution. Mothers who formula feed their infants resume ovulation earlier. While breastfeeding has clear benefits over formula feeding, the nurse should be supportive of the mother's informed decision. This can be an emotional decision, and the nurse should take care in avoiding statements that communicate judgment. The nurse should avoid implying that only breastfeeding mothers care about the health of their children.

Which statement provides helpful and accurate nursing advice concerning bathing the newborn? Select all that apply. 1 Newborns should be bathed every day, for the bonding as well as the cleaning. 2 Tub baths may be given before the infant's umbilical cord falls off and the umbilicus is healed. 3 Only plain warm water can be used to preserve the skin's acid mantle. 4 Powders are not recommended because the infant can inhale powder. 5 Bathe immediately after feeding while baby is calm and relaxed.

2,3 Tub baths may be given as soon as an infant's temperature has stabilized. Powder is not recommended because of the risk of inhalation. If a parent chooses to use baby powder, it should never be sprinkled directly onto the baby's skin. The parent can apply a small amount of powder to his or her own hand and then apply to the infant. Newborns do not need a bath every day, even if the parents enjoy it. The diaper area and creases under the arms and neck need more attention. Unscented mild soap is appropriate to use to wash the infant. Do not bathe immediately after a feeding period because the increased handling may cause regurgitation.

The nurse on a labor and delivery unit is caring for a 2-day-old infant who has lost 6% of his or her birth weight. When the mother expresses concern, how does the nurse respond? 1 "We may have to think about switching your baby to formula, as your breast milk may not be providing adequate nutrients." 2 "This is normal in the first few days after birth. Your newborn's weight loss may be due to excreting water and meconium." 3 "This is normal in the first few days after birth. Your body hasn't started producing enough milk yet, but it likely will in the next few days." 4 "Your baby is likely having difficulty feeding. Let's take a look at how your next feeding session goes and discuss breastfeeding techniques."

2. The nurse will assure the patient that this is a normal occurrence and that the newborn is excreting extracellular water and meconium. If the weight loss persists past 3 days or goes above 7% of birth weight, the infant should be evaluated for feeding problems. Given the normalcy of this, there is no evidence that the mother's breast milk is providing inadequate nutrition. There is no evidence that the mother's body is not producing enough milk. The infant will be evaluated for feeding problems if the weight loss persists past 3 days or goes above 7% of birth weight; such an evaluation is not necessary given the current evidence.

The nurse tells a postpartum patient to gently massage her breasts before performing hand expression. Why did the nurse give such an instruction? 1 To prevent nipple trauma 2 To reduce body temperature 3 To stimulate the let-down reflex 4 To reduce pain during expression

3 Gentle massage before hand expression is recommended to stimulate the let-down reflex or milk ejection reflex, which increases milk production. This intervention is not useful to prevent nipple trauma, reduce body temperature, or reduce pain during expression. Nipple trauma can be prevented by placing the finger at the side of the infant's mouth to reduce the suction while separating the lips from the nipples. Body temperature and pain can be reduced by taking antipyretics or analgesics.

The novice nurse is learning about hormonal changes related to birth and breastfeeding. Which statement reflects understanding of these changes? 1 "At birth, placental hormone and prolactin levels drop. This activates milk production." 2 "When levels of oxytocin are high, a new mother may experience slower lactation and difficulty in feeding." 3 "Oxytocin increases in response to nipple stimulation as well as the mother's seeing or thinking about her infant." 4 "Prolactin levels are low in the early months after birth, rise steadily until a year after birth, and then begin to drop."

3 It is correct that oxytocin increases in response to nipple stimulation as well as the mother's seeing or thinking about her infant. At birth, there is a loss of placental hormones and an increase in prolactin levels. This increase activates milk production. When levels of oxytocin are high, a new mother experiences a let-down of milk, not inhibition of lactation. Prolactin is secreted at the highest levels with suckling and during the night. Levels are high during the early months and then gradually decrease until weaning.

The nurse is educating a new mother on safely formula-feeding her infant. Which statement made by the mother indicates a need for further education on formula safety? 1 "I should test the temperature of the formula by tipping a few drops onto my inner arm." 2 "I should avoid propping the bottle while feeding because it could cause my baby to choke." 3 "Heating the formula in the microwave will kill pathogens quickly so my baby doesn't get sick." 4 "If my baby drinks too quickly without stopping to breathe, I will tip her forward to stop the formula from flowing."

3 The mother should not heat formula in a microwave oven because the heating will be uneven. This may result in some parts of the liquid being very hot even when the outside of the bottle feels only warm. The other statements are correct and indicate the mother understands how to use formula safely. Testing the formula temperature on the inner arm is appropriate. Propping should be avoided. The mother can tip the baby forward to stop the flow of formula and allow a break for breathing.

While teaching breastfeeding techniques to a postpartum patient, the nurse advises the patient to check whether the infant's cheeks are rounded or dimpled during feeding. What is the reason for giving such advice to the patient? 1 It prevents nipple trauma. 2 It possibly prevents of trauma to the infant's jaws. 3 It indicates the effectiveness of breastfeeding. 4 It helps the infant latch onto the nipples.

3 Usually during sucking, the infant's cheeks become rounded and are not dimpled, so the shape of the baby's cheeks indicates the effectiveness of feeding. Nipple trauma can be prevented by inserting a finger in the side of baby's mouth to break the suction. Trauma to the infant's jaw is not associated with rounded cheeks. Placing the nipple on the infant's lips helps the infant latch.

A mother expresses fear about changing her infant's diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home? 1 Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours. 2 Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs. 3 Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change. 4 Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

3 With each diaper change, the penis should be washed off with warm water to remove any urine or feces. If bleeding occurs, the nurse should apply gentle pressure to the site of the bleeding with a sterile gauze square. This action is appropriate when caring for an infant who has had a circumcision. Yellow exudate covers the glans penis in 24 hours after the circumcision. This is part of normal healing and not an infective process. The exudate should not be removed.

The family of a neonate asks the nurse why ointment is being administered in the eyes. How does the nurse respond? 1 "The ointment protects the eyes from the bright lights." 2 "Tears do not develop yet, so the ointment keeps the eyes moist." 3 "The state requires every child to receive antibiotic ointment to the eyes." 4 "The ointment is administered to prevent bacterial growth in the eyes that could harm vision."

4 Antibiotic ointment is used to prevent growth of Neisseria gonorrhoeae which may have been contracted in the birth canal and can lead to blindness. The ointment does not protect against light nor do the eyes need to be protected in the room. Tears will lubricate the eye after birth. While many states do indeed require the application of the ointment, the most informative answer is to explain the prevention of infection and its complications.

The nurse is educating a new mother about breastfeeding. Which statement made by the mother indicates that she understands infant feeding behaviors? 1 "I should feed my baby as soon as he starts crying to be fed." 2 "I should look for my baby to smack his lips or make fists as hunger cues." 3 "To keep a feeding schedule, I should wake up my baby to feed if he is sleeping." 4 "I should recognize hand-to-mouth movements and increased activity as hunger cues."

4 Hand-to-mouth movements and increased activity are both hunger cues in infants. Crying is a late sign that an infant is hungry; feeding should begin before crying. If the infant is crying, he needs to be comforted before feeding. Lip smacking is a hunger cue, but making fists is not. Trying to feed an infant in a deep sleep period is frustrating to both the mother and the infant and should be avoided.

The mother of an infant comments that the baby suddenly cries often and seems to need to eat frequently. How does the nurse respond? 1 "Continue a strict feeding schedule." 2 "The baby may not be getting enough nutrition." 3 "It is alright to let the baby cry between feedings." 4 "The baby may be experiencing a growth spurt and needs extra feeding."

4 Infants will experience growth spurts and need extra feedings for a day or two to support that growth. A feeding schedule should be followed with allowances for needs like those from a growth spurt. If the baby is growing and gaining weight, nutrition is not a significant concern. When the infant cries, needs should be met to promote trust.

The mother of an infant states that the hands of the infant always seem cool. How does the nurse respond? 1 "Keep the baby indoors only." 2 "More blankets should be added to the infant carrier." 3 "Have the infant evaluated in the health care provider's office." 4 "It is alright for the hands and feet to be cooler than the body as long as they are not blue."

4 It is normal for the hands and feet to be cooler than the body as long as they are not blue or mottled. It is not necessary to keep the infant indoors or add blankets if the abdomen and head are warm. Cool hands and feet are not a condition that requires evaluation in the provider's office.

The novice nurse is learning about the nutritional needs of breastfeeding mothers and babies. Which statement shows an understanding of the education that should be provided to such patients? 1 "New breastfeeding mothers should take supplementary vitamin A." 2 "New breastfeeding mothers should take supplementary vitamin B12." 3 "New breastfeeding mothers should take supplementary vitamin C." 4 "New breastfeeding mothers should take supplementary vitamin D."

4 Levels of vitamins A, E, and C are high in breast milk. The vitamin D content of breast milk is low, and daily supplementation with 400 IU is recommended within the first few days of life. The new breastfeeding mother does not need to supplement with vitamins A or C since their content is high in breast milk. The infant of a vegan mother may need supplementation with vitamin B12, but this is not necessary for all new breastfeeding mothers.

The nurse is triaging health issues in a telephone call center. For which patient would the nurse instruct the caller to hang up and dial 911? 1 An infant with a slight fever 2 A circumcised infant with small dots of blood in the diaper 3 An infant who has not taken a bottle or urinated in the last 8 hours 4 An infant described as floppy and making strange noises with breathing

4 The infant described as floppy and making strange noises with breathing should be seen emergently for possible respiratory issues. The infants with a fever, small dots of blood after circumcision, and poor intake over the last 8 hours should be referred to the health care provider for immediate follow-up, but do not require emergency assistance.

Which statement regarding infant weaning is correct? 1 Weaning should proceed from breast to bottle to cup. 2 The feeding of most interest should be eliminated first. 3 Abrupt weaning is easier than gradual weaning. 4 Weaning can be mother- or infant-initiated.

4 Weaning is initiated by the mother or the infant. With infant-led weaning the infant moves at his or her own pace in omitting feedings, which leads to a gradual decrease in the mother's milk supply. Mother-led weaning means that the mother decides which feedings to drop. Infants can be weaned directly from the breast to a cup. Bottles are usually offered to infants less than 6 months old. If the infant is weaned prior to 1 year of age, iron-fortified formula rather than cow's milk should be offered. The feeding of least interest to the baby or the one through which the infant is likely to sleep should be eliminated first. Every few days thereafter the mother drops another feeding. Gradual weaning over a period of weeks or months is easier for both the mother and the infant than an abrupt weaning.

The nurse is educating a new mother about formula feeding. Which statement made by the new mother indicates she is sufficiently educated on the safe use of powdered formula? 1 "I should not use powdered formula until my infant is at least 3 months old." 2 "I can prepare formula ahead of time and store it in the refrigerator for up to 2 days." 3 "I should mix the powdered formula with boiling water that has cooled for 45 minutes." 4 "I can rapidly cool the mixed formula by placing the bottle under running cold tap water."

A bottle of mixed formula should be rapidly cooled to a temperature safe for feeding by placing the bottle under running cold tap water or placing it in a cup of cold water. The mother can use powdered formula when her child is at least 2 months old. The prepared formula can be stored in the refrigerator for up to 24 hours. Powdered formula should be mixed with boiling water that has not been allowed to cool for more than 30 minutes.