Ch 19: Nutritional Needs of a Newborn

a) Help expel air ingested during feeding Pg. 483 The nurse should encourage the client to induce burps in the infant because this helps expel the air ingested during feeding or crying. Burps are not an indication for assessing if proper digestion has occurred. Burps do not reduce respiratory-related disorders or gastrointestinal infection.

1. A nurse is caring for a client who is breastfeeding her newborn. The nurse encourages the client to induce burps in her infant to: a) Help expel air ingested during feeding b) Reduce respiratory-related disorders c) Ensure proper digestion of food d) Reduce gastrointestinal infection

d) Go approximately 3 hours between feedings Pg. 464 Formula is harder than breast milk to digest. Therefore, breastfed babies typically feed more frequently than formula-fed babies (i.e., every 3 hours instead of every 4 hours).

10. When asked by a parent to compare the feeding habits of formula-fed and breastfed infants, what is the correct response from the nurse about breastfed infants? a) experience longer periods between feeds b) Digest their milk more slowly c) Usually feed every 4 hours d) Go approximately 3 hours between feedings

a) Crying Pg. 480 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.

11. 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) Crying b) Tense body posture c) Restlessness d) Smacking lips

b) Properties of immunoglobulin A (IgA) Pg. 470 Breast milk contains secretory immunoglobulin A (IgA), which binds large molecules of foreign proteins, including viruses and bacteria, thus keeping them from being absorbed from the gastrointestinal tract. Neither the spleen nor the lymphatic system play a role in protecting the infant from illness. White cells rather than red blood cells have a role in protecting the body from illness.

16. A student nurse asks the preceptor how breastfeeding protects the infant from getting ill due to viruses and bacteria. Which physiologic concept will the nurse discuss with this student? a) Purpose of the spleen b) Properties of immunoglobulin A (IgA) c) How the lymphatic system works d) Function of the various types of red blood cells

a) Allowing the nipples to dry after each feeding Pg. 479 Allowing the nipples to dry after each feeding is actually a way to prevent and heal sore or cracked nipples. All the other answers will contribute to sore nipples.

17. While breastfeeding, all of the following can contribute to sore nipples except: a) Allowing the nipples to dry after each feeding b) Allowing the newborn to suck too long c) Improper newborn latch d) Forceful detachment of the newborn from the breast

b) Pillow supports designed with wider sides to allow the twins to feed at the same time Pg. 477 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.

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

c) "By formula-feeding your newborn, you will know how much the baby takes each feeding and allows others to feed the baby" Pg. 482 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 breastfeeding, but it is her choice how she feeds her baby. Telling her that breastfeeding 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.

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

a) 7 lb 12 oz Pg. 464 Monitor the newborn's weight daily during the hospital stay. The breastfeeding newborn should lose no more than 10 percent of his or her birth weight and should return to birth weight by 7 to 14 days of age.

8. You are caring for an infant with a birth weight of 8 lb, 5 oz. What would be an acceptable discharge weight for this infant? a) 7 lb 12 oz b) 7 lb 3 oz c) 7 lb 5 oz d) 7 lb 1 oz

c) Condoms Pg. 465 The breastfeeding client needs to avoid use of any type of hormonal birth control or her milk supply could be changed. The most appropriate choice is the condom. Tubal ligation is a surgical procedure that prevents the egg and the sperm from meeting. It is a method of birth control for people who do not want any more children.

3. The nurse is teaching young parents discharge instructions. Which form of birth control should the nurse point out will be the best option for the breastfeeding mom who hopes to have more children later? a) Estrogen-based pill b) Tubal ligation c) Condoms d) Combination hormonal birth control pill

20 calories Pg. 482 On average, breast milk supplies the newborn with 20 calories per ounce.

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

b) "Assess the infant's voiding, growth, and alertness" Pg. 464 The best confirmation of whether an infant is receiving adequate nutrition is to assess whether the newborn is voiding, growing, and alert.

4. 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? a) "Assess how long the infant breastfeeds at a time" b) "Assess the infant's voiding, growth, and alertness" c) "Assess how much formula is taken each time" d) "Assess how long the infant sleeps after each feeding"

d) Engorgement Pg. 478 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.

9. 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) Mastitis c) Nipple thrush d) Engorgement

b) Colostrum Pg. 469 Colostrum is the first milk that is expressed postpartum. It is thick, yellow milk and is higher in antibodies than any other type of milk.

2. Which type of breast milk is highest in antibodies? a) Hind milk b) Colostrum c) Transitional milk d) Foremilk

b) "By formula-feeding your newborn, you will know how much the baby takes each feeding and allows others to feed the baby" Pg. 482 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 breastfeeding, but it is her choice how she feeds her baby. Telling her that breastfeeding 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.

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

d) Feed the infant a lactose-free formula Pg. 482 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 infant formula with amino acids is not contraindicated.

13. Which instruction should a nurse give to a client whose infant has galactosemia? a) Ensure that formula does not contain amino acids b) Breastfeed the infant, but avoid consuming milk products c) Breastfeed after the infant is 2 weeks old d) Feed the infant a lactose-free formula

c) One year Pg. 481 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.

22. 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? a) Two years b) 6 months c) One year d) 4 months

d) "It's best to put the bottle into a bowl of warm water for several minutes" Pg. Warming formula is a parental preference. The best method to warm formula is to stand the bottle in a bowl of warm water or hold it under a faucet of running hot water (not tepid) for a few minutes. Using a pan on the stove to warm formula is not recommended, as the bottle may be damaged. Warming bottles in a microwave is never recommended because the milk can heat unevenly.

30. A client is planning to use formula for the newborn and asks the nurse how to warm the formula. After teaching the client about ways to warm formula, the nurse determines the teaching was successful based on which client statement? a) "I can put the bottle in a pot of water on the stove to warm it" b) "I'll place the bottle in the microwave for about 30 seconds" c) "It's okay to run the bottle under tepid water from the faucet" d) "It's best to put the bottle into a bowl of warm water for several minutes"

b) How long the baby nurses Pg. 484 Once infant feeding begins, assess whether the parents know how to gauge the adequacy of the amount their infant is receiving - not by how long the newborn breastfeeds at one feeding or by how much formula is taken at a feeding, but by a larger measure, such as whether the newborn is voiding, growing, and alert.

33. A new mother is concerned about how she will know whether her newborn is receiving enough breast milk. The nurse should explain that which factor is the least accurate measure of how much nutrition the baby is receiving? a) Whether the baby is voiding b) How long the baby nurses c) Whether the baby is alert d) Change in the baby's body weight

b) "Would you like any information on breastfeeding?" Pg. 465 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.

38. 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) "You know that breast is best, right?" b) "Would you like any information on breastfeeding?" c) "Did you have a problem breastfeeding your last baby?" d) "What type of formula do you plan on using?"

a) "Cow's milk should not be used with infants younger than 9 months" Pg. 467 The quality and quantity of nutrients in cow's milk differ greatly from those of formula. Cow's milk contains more protein and minerals than formula but less iron, which is poorly absorbed. To lower the risk of iron-deficiency anemia, cow's milk is not recommended for infants younger than 9 months.

14. During a postpartum parenting class, a client reports that she has switched her 6-month-old from formula to cow's milk to save money. Which of the following responses from the nurse would be most appropriate? a) "Cow's milk should not be used with infants younger than 9 months" b) "Cow's milk has less protein than formula, so your infant will take longer to recover from illness" c) "Cow's milk has more iron than formula, so the child may experience constipation" d) "Cow's milk should not be used with infants younger than 6 months"

a) "We have a milk cow, so we never have to worry about running out of milk for this baby" Pg. 467 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 (i.e., 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. The alternative to cow's milk is either breast milk or formula for a baby this young.

37. Which statement from the parents of a 20-week-old infant will require further teaching related to supplying protein needed by a newborn? a) "We have a milk cow, so we never have to worry about running out of milk for this baby" b) "I read on the formula package that all the amino acids this baby needs are already added" c) "We are feeding just breast milk to the infant so far" d) "In addition to feeding the baby breast milk, we are giving the daily vitamins as well"

d) Drink a lot of fluids Pg. 480 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.

39. The nurse is preparing discharge instructions for a new mother who has been learning to breastfeed. Which response should the nurse prioritize when the mother questions her ability to produce enough milk for her infant? a) Drink a lot of milk b) Consume a minimum of 3000 calories per day c) Take a daily multivitamin d) Drink a lot of fluids

d) The immunologic properties in breast milk cannot be duplicated in formula Pg. 482 Breast milk is a unique substance that commercial formulas have been unable to duplicate, especially with regard to the immunologic factors in breast milk.

20. The nurse is conducting prenatal counseling with pregnant women in the community. An 18-year-old G1P0 in her 36th week states, "I don't know if I should breastfeed or not. Isn't formula just as good for the baby?" What is the nurse's best response? a) It is ultimately the woman's choice whether she wants to breastfeed or not b) The economic status of the woman is an important breastfeeding consideration c) The benefits of breastfeeding are equal to those of formula feeding d) The immunologic properties in breast milk cannot be duplicated in formula

c) Mastitis Pg. 478 Mastitis is a problem associated with breastfeeding and is an infection of the breast tissue. The woman will need antibiotic therapy to resolve this infection. A plugged milk duct is usually indicated by a sore, reddened, hard lump in one area of her breast. Engorgement is the filling of the breast with milk when the mother's milk comes in. Breast yeast infection is not indicated.

21. A breastfeeding mother, 1-month postpartum, calls the clinic and reports left breast soreness, a temperature of 100.4°F (38°C), and feeling tired all the time. The nurse suspects the mother is experiencing which situation after revealing she is still trying to breastfeed on a regular schedule? a) Breast yeast infection b) Plugged milk duct c) Mastitis d) Engorgement

c) Running it under warm water or in a bottle warmer Pg. 483 Milk and formula do not need to be warmed before they are consumed. Placing the bottle in a pan on the stove or over steam can overheat the milk. The microwave is not recommended because pockets of milk can be extremely hot and may burn the newborn. Running warm water over the bottle or using a bottle warmer is the best way.

15. When educating a woman about newborn feedings, what instruction should the nurse give on the proper way to heat a bottle? a) On the stove in a pan of water b) In the microwave c) Running it under warm water or in a bottle warmer d) Over steam

d) "A slightly bluish color is normal" Pg. 473 Breast milk is thick and white and can have a bluish tinge. This is a normal finding, and this client needs only reassurance.

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

a) Galactosemia Pg. 469 Most infants are able to breastfeed, but infants who have certain metabolic disorders should not be breastfed. Galactosemia is an inborn error of metabolism and requires a specialty formula. Infants with a cleft palate or Down syndrome can be breastfed. An infant who is born preterm may have to take its mother's milk from a bottle but can still have breast milk.

19. The young mother has been breastfeeding her newborn; however, the nurse is concerned the infant is not thriving and may need to be switched to a formula. Which condition is a contraindication for the infant to continue breastfeeding? a) Galactosemia b) Down syndrome c) Preterm delivery d) Cleft palate

a) When the mother has active tuberculosis c) When the mother takes certain medications, such as antineoplastics e) When the mother is diagnosed with breast cancer Pg. 469 Breastfeeding is contraindicated when the mother is being treated with certain medications, when the mother has untreated tuberculosis, and when breast cancer is diagnosed during pregnancy. Other contraindications include when the mother is HIV-positive, and when there is an inborn error of metabolism in the infant.

23. Breastfeeding is generally encouraged except under certain conditions. Which conditions contraindicate breastfeeding? Select all that apply. a) When the mother has active tuberculosis b) For multiple births c) When the mother takes certain medications, such as antineoplastics d) When the mother has lactose intolerance e) When the mother is diagnosed with breast cancer

a) The mother needs to understand that she will produce some milk, but wearing a constrictive bra will help dry up the milk supply Pg. 478 Wearing a tight bra is the best way to support the engorged breasts and aid in drying up the mother's milk supply, because all postpartum women produce milk. Manually expressing milk stimulates milk production. Health care providers no longer prescribe medications to dry up the breast milk because the benefits do not outweigh the associated risks of the medications.

24. A mother delivers her newborn and has chosen to formula-feed her baby. She asks the nurse how to keep her breasts from making milk. How would the nurse respond to the mother's question? a) The mother needs to understand that she will produce some milk, but wearing a constrictive bra will help dry up the milk supply b) When she becomes engorged, it is recommended to not wear a bra to allow the breasts to be more comfortable c) The mother will produce milk after delivery but by manually expressing the milk, she can reduce the discomfort d) The doctor can give her a hormone shot to dry up her breasts

a) Vitamin D at 2 months Pg. 468 According the AAP, all infants should receive vitamin D supplementation to prevent vitamin D deficiency and rickets. The breastfed infant does not need to supplement with iron until 6 months of age, when iron-rich foods can be adequate. Fluoride should be supplemented at 6 months in infants not receiving fluoridated water. Both breast milk and formula are high in calcium.

25. The nurse is providing education to a group of new mothers regarding appropriate supplements needed for both breastfed and formula-fed infants. Using evidence-based practice, which supplement is most important to recommend? a) Vitamin D at 2 months b) Calcium at 9 months c) Iron at 6 months d) Fluoride at 4 months

a) Increase the feeding to on-demand Pg. 466-468 As the infant enters growth spurts, the infant will demand more milk, which in turn increases the milk production, ensuring there will be enough to meet the needs. Nursing the infant on-demand and increasing the frequency of breastfeeding and the duration of the feedings will increase the milk supply. Offering formula in addition to breastfeeding, or offering exclusively formula during the growth spurt, is not recommended. Pumping and offering the breast milk in a bottle is not necessary and is not recommended.

26. A new mother brings her 2-week-old infant to the clinic for a well-baby visit and reports there are days when the baby wants to nurse all the time. Which instruction should the nurse prioritize to this mother? a) Increase the feeding to on-demand b) Pump and offer the breast milk in a bottle c) Offer formula in addition to breastfeeding d) Offer only formula during the growth spurt

d) Check the provider order to confirm the type of formula ordered Pg. 482 The first action by the nurse after receiving the report is to check provider orders and confirm the information passed in the report. It would not be appropriate for the nurse to ask the mother what formula she wants to use or to use the formula that is in the unit's supply room. It is also inappropriate to discuss the mother's choice of feeding in an attempt to sway her decision.

27. The nurse is assigned to care for a new mother and her formula-fed 2-day-old infant. Which action should the nurse prioritize for this mother after receiving the report from the previous shift nurse? a) Use the standard formula in the unit's supply room b) Offer the mother the opportunity to try breastfeeding c) Ask the mother what formula she wants to use d) Check the provider order to confirm the type of formula ordered

d) Even if a mother has adequate fat stores, calorie intake should increase Pg. 480 Women use approximately 500 calories above their normal total daily calorie needs to produce breast milk. Thirst is usually a reliable indicator of need; caffeine should be restricted because it does enter breast milk; and breast milk will not be deficient of calcium even if the woman does not consume enough calcium.

31. Dietary needs change from pregnancy to lactation. What should breastfeeding mothers be advised? a) Thirst is not a reliable indicator of need b) If she does not consume enough calcium, her milk will be calcium deficient c) Because caffeine does not enter breast milk, its intake does not need to be restricted d) Even if a mother has adequate fat stores, calorie intake should increase

d) Assist all mothers who are separated from their infant in the NICU to breastfeed and maintain lactation e) If feasible, help women initiate breastfeeding within 30 minutes of birth Pg. 466 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.

34. 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. a) Use of pacifiers will help the infant develop a stronger sucking ability b) In between feedings, mothers should start giving juice to the baby as early as 2 months of age c) Talk with all mothers, even those who have chosen to bottle-feed, about the benefits of breastfeeding d) Assist all mothers who are separated from their infant in the NICU to breastfeed and maintain lactation e) If feasible, help women initiate breastfeeding within 30 minutes of birth

c) HIV infection Pg. 469 Contraindications for breastfeeding include women who have HIV, use illegal drugs, have active untreated tuberculosis, are receiving chemotherapy, or have herpetic lesions on the breast. Women with active infections can pass these conditions on to their infants while breastfeeding. A woman with breast implants should be referred to a lactation consultant to assist and support this mother. Galactosemia is a newborn disorder in which the infant has an inborn error of metabolism. The mother who needs to return to work should be taught how to pump her milk so that she can still provide breast milk to her infant.

35. The nurse is assisting a primigravida woman make decisions and prepare for her baby. The nurse should point out that breastfeeding is not an option for this client based on which assessment finding? a) Galactosemia b) Breast implants c) HIV infection d) Need to return to work quickly

a) "The recommendation is to use only breast milk for the first 6 months, then add other foods until 12 months" Pg. 481 The AAP (2016) recommends infants be exclusively breastfed for the first 6 months and breastfed with complementary foods for the first year of life. The mother should be encouraged to breastfeed for longer than six weeks to ensure the infant gains all the benefits from proper nutrition provided by breast milk. It is the mother's choice to continue breastfeeding after 12 months, but the child should be weaned at 2 years of age.

36. A young couple are discussing how long the mother should breastfeed and cannot agree on a time frame. What is the best response from the nurse when they question the nurse about it? a) "The recommendation is to use only breast milk for the first 6 months, then add other foods until 12 months" b) "You should work toward a goal of 6 weeks and then you can probably switch to formula" c) "There are no recommended guidelines for breastfeeding" d) "It is recommended to breastfeed until 18 months, and possibly as long as 2 years"

a) Empty one breast completely before feeding the baby from the other breast Pg. 478 An important principle for women to learn is milk forms in response to being used. If breasts are completely emptied, they completely fill again. If half emptied, they only half fill, and, after a time, milk production will become insufficient for proper nourishment. Urge women to always place their infant first at the breast at which the infant fed last in the previous feeding to help ensure each breast is completely emptied at every other feeding. Because it takes less energy for an infant to suck at a bottle, urge parents not to offer bottles of breast milk until 4 to 6 weeks of age, or after the infant is thoroughly accustomed to breastfeeding. Teach women to wash their breasts before beginning with clear water because soap tends to dry and crack nipples. Be certain infants open their mouths wide enough to grasp both the nipple and the areola (the pigmented circle surrounding the nipple) when sucking. This gives them effective sucking action and helps to empty the collecting sinuses completely.

40. A nurse is giving a new mother some tips regarding breastfeeding. Which of the following should the nurse mention? a) Empty one breast completely before feeding the baby from the other breast b) Clean the nipples with soap each time before beginning to breastfeed to prevent infections in the baby c) Be sure the infant grasps only the nipple in his mouth and not the areola when sucking d) Alternate breastfeeding with bottle feeding of expressed breast milk beginning at 1 week of age so that the baby becomes used to both

c) "My husband is bringing bottles of water for our baby" Pg. 468 The mother should not offer her newborn supplemental water. The mother should nurse her infant every 2 to 4 hours. To increase or maintain her milk supply, the mother needs to continuously empty her breast to make more milk. Offering supplementation would be a period where the breast would not be emptied and the production of milk would be decreased at that point. There is no need for the mother to start using a breast pump at this time. The time in which the mother starts breastfeeding after birth is not as important as how well the breasts are emptied to encourage the production of more milk.

5. The nurse is assisting a new mother with breastfeeding her infant, and she is concerned about producing enough milk. The nurse determines the mother needs more teaching when she makes which comment? a) "I should wait to start pumping my breasts for a few weeks" b) "Maybe I should have started breastfeeding sooner" c) "My husband is bringing bottles of water for our baby" d) "My baby needs to feed every 2 hours"

a) "If your baby appears content between feedings and is wetting diapers, he/she is getting enough milk" Pg. 480 The newborn should be satiated between feedings and, after nursing, appear to be drowsy or asleep. By the end of the third day of life, the newborn should have at least six wet diapers and about three bowel movements per day. It is normal for infants to wake at night to feed. Hours between feeding and use of a pacifier are not used to determine the adequacy of intake.

6. A client tells you she is unsure whether her baby is getting enough milk when she breastfeeds. The nurse's best response would be: a) "If your baby appears content between feedings and is wetting diapers, he/she is getting enough milk" b) "If your baby breastfeeds every 2 to 3 hours, he/she is getting enough milk" c) "If your baby is taking a pacifier between feedings, you don't have enough milk" d) "A baby who wakes at night to feed is not getting enough milk"

d) Galactosemia Pg. 469 Galactosemia is an inborn error of metabolism for which a special formula is necessary because the infant lacks the necessary enzymes to break down the sugar in breast milk. Newborns with PKU may supplement with breast milk in small amounts but will require special formula to complete their diet. Hypothyroidism and hypertension are not contraindications for breastfeeding.

7. The nursing instructor is conducting a teaching session illustrating the basics of feeding newborns. The instructor determines the class is successful after the students correctly choose which disorder as a contraindication to breastfeeding? a) Hypothyroidism b) Phenylketonuria (PKU) c) Hypertension d) Galactosemia