Ch 29: Newborn Nutrition
35) A premature newborn is unable to suck at the breast. The nurse plans care for the mother, who is going to hand-express milk. Arrange the steps for milk expression in the correct order. 1. Roll the thumb and fingers simultaneously forward. 2. Position the thumb at 12:00 and the forefinger and middle finger at 6:00 around the areola. 3. Repeat the sequence multiple times to completely drain the breasts. 4. Stretch the areola back toward the chest wall without lifting the fingers off the breast.
Answer: 2, 4, 1, 3 Explanation: Positioning the thumb at 12:00 and the forefinger and middle finger at 6:00 around the areola is the beginning position for manually expressing milk. Next the mother should stretch the areola back as far as possible. Then roll the thumb and fingers forward to stimulate the breast to empty. The sequence is repeated as necessary until the desired amount of milk has been expressed. Page Ref: 739
32) The nurse is reviewing the process of pumping the breasts with a new mother. In which order should the nurse provide this information? 1. Fill glass or bottles 3/4 full 2. Massage the breasts and relax 3. Sit up straight or lean forward 4. Wash hands with soap and water 5. Pump each breast for 10 to 20 minutes
Answer: 4, 2, 3, 5, 1 Explanation: Wash hands well with soap and water before preparing to pump. Take a few minutes to massage the breasts and relax. Sit up straight or lean slightly forward. Pump each breast for 10 to 20 minutes. Pump the expressed milk preferably into glass or plastic bottles. Do not fill milk storage containers more than 3/4 full, because milk expands during freezing. Page Ref: 739
30) A newborn weighs 7 lbs. 10 ounces at birth. What is the maximum number of calories that the nurse should instruct the mother that the baby needs to consume each day? (Calculate to the nearest whole number.)
Answer: 400 calories Explanation: Caloric intake for a newborn is 45.5 to 52.5 kcal/lb/day or 100 to 115 kcal/kg/day. The nurse needs to convert the baby's weight in ounces to pounds by dividing 10 ounces/16 ounces or 10/16 or 0.625. Since the baby weighs 7.625 lbs., the nurse should multiply 52.5 × 7.625 = 400.3125 calories. When rounded to a whole number the infant needs a maximum of 400 calories per day. Page Ref: 720
31) During an educational session the nurse learns that legislation was written to support breastfeeding mothers. In which order did the titles of this legislation occur? 1. Establish standards for safe and effective breast pumps 2. Include breastfeeding equipment as medical care for taxes 3. Require businesses with 50 or more employees to give lactating women breaks 4. Give tax incentives to businesses that establish a private place for breastfeeding 5. Protect lactating women from being fired or discriminated against in the workplace
Answer: 5, 4, 1, 2, 3 Explanation: The Breastfeeding Promotion Act of 2009 was enacted into law on March 23, 2010 and acts to protect breastfeeding in the workplace through five provisions. These include the following: Title Ⅰ: Amending the Civil Rights Act of 1964 to protect lactating women from being fired or discriminated against in the workplace. Title Ⅱ: Giving tax incentives to businesses that establish a private space in the workplace for their employees to breastfeed or express their milk. Employers can also receive tax credits for supplying breastfeeding equipment and providing lactation consultation services for their employees. Title Ⅲ: Establishing set standards for breast pumps to ensure that they are safe and effective. Title Ⅳ: Expanding the Internal Revenue Code definition of "medical care" to include breastfeeding equipment and lactation services as tax-deductible for families. Title Ⅴ: Requiring employers with 50 or more employees to provide lactating employees break time and a private area to express their milk. Page Ref: 729
34) The nurse is demonstrating to a patient the proper steps for breastfeeding a newborn. Put these steps in the logical order that would assist the patient in placing the newborn to her breast. 1. Tickle the newborn's lips with the nipple. 2. Allow the newborn to latch on to the nipple. 3. The newborn opens her mouth wide. 4. Have the newborn face the mother tummy to tummy. 5. Position the newborn so the nose is at the level of the nipple.
Answer: 5, 4, 1, 3, 2 Explanation: Positioning the baby's nose at nipple level enhances latching on. The baby needs to face the mother. Tickling the newborn's lips provides stimulation, and the baby can smell the milk. If hungry, the newborn opens her mouth. The mother holds the baby to the breast for feeding. Page Ref: 736
33) The nurse is reviewing the contents of breastmilk with a new mother. What amount of water should the nurse explain is in 8 ounces of breastmilk? Record your answer rounding to the nearest whole number.
Answer: 7 ounces Explanation: Breastmilk contains 87% water. The nurse should multiply 8 ounces by 87% to determine that 6.96 ounces out of 8 ounces of breast milk is water. With rounding, the volume of water in 8 ounces of breastmilk is 7 ounces. Page Ref: 725
25) The nurse is preparing a class on breastfeeding for pregnant women in their first trimester. The women are from a variety of cultural backgrounds, and all speak English well. Which statement should the nurse include in this presentation? A) "Although some cultures believe colostrum is not good for the baby, it provides protection from infections and helps the digestive system to function." B) "Some women are uncomfortable with exposing their breasts to nurse their infant, but it really isn't a big deal. You will get used to it." C) "No religion prescribes a feeding method, so you all can choose whatever method makes the most sense to you." D) "In most cultures, it is culturally acceptable to speak about intimate matters in front of their families."
Answer: A Explanation: A) Although it is true that some cultures believe colostrum to be unhealthy, colostrum helps to protect the infant from disease and illness. B) It is not therapeutic to downplay a woman's concern by stating, "It's no big deal"; this type of statement should be avoided. C) Muslim women generally breastfeed until their children are 2 years of age. This is encouraged in the Koran. D) For Muslim women, it is culturally unacceptable for them to speak about intimate matters in front of their families. The nurse should be aware that it would be inappropriate to ask the new mother's husband or her children to be her interpreter. Page Ref: 731
3) The nurse is teaching a prenatal class about feeding methods. A father-to-be asks the nurse which method, breast or formula, leads to the fastest infant growth and weight gain. Which response by the nurse is best? A) "In the first 3 to 4 months breastfed babies tend to gain weight faster." B) "In the first 3 to 4 months there is no difference in weight gain." C) "In the first 3 to 4 months bottle-fed babies grow faster." D) "In the first 3 to 4 months growth isn't as important as your comfort with the method."
Answer: A Explanation: A) Exclusively breastfed infants have the same or slightly higher weight gain than their formula-fed and combination-fed peers in the first 3 to 4 months. B) Once feedings are established, growth rates for breastfed and formula-fed infants vary. C) Bottle-fed babies do not gain weight faster. D) Although comfort with the feeding method is important, the question is specifically about growth and weight gain; it is not therapeutic to change the topic and not answer the question. Page Ref: 720
16) The nurse is performing an assessment on an infant whose mother states that she feeds the infant in a supine position by propping the bottle. Based on this information, what would the nurse include in the assessment? A) Otoscopic exam of the eardrum B) Bowel sounds C) Vital signs D) Skin assessment
Answer: A Explanation: A) Infants who bottle feed in a supine position have an increased risk of otitis media and dental caries in the older infant. B) Bowel sounds are not affected by the position of the feeding. C) Vital signs are not affected by the position of the feeding. D) The skin is not affected by the position of the feeding. Page Ref: 745
26) The nurse has completed a community education session on growth patterns of infants. Which statement by a participant indicates that additional teaching is needed? A) "Newborns should regain their birth weight by 1 week of age." B) "Breastfed and formula-fed babies have different growth rates." C) "Formula-fed infants regain their birth weight earlier than breastfed infants." D) "Healthcare providers consider breastfeeding to be the 'gold standard' for neonatal nutrition."
Answer: A Explanation: A) Newborns should gain at least 10 g/kg/day and be back to birth weight no later than day 14 of life. B) Breastfed and formula-fed babies have different growth rates because the compositions of human milk and formula are different. C) Formula-fed infants tend to regain their birth weight earlier than breastfed infants because of consistent fluid intake in the first few days of life, whereas the breastfed infant's fluid intake depends on the mother's milk supply and breastfeeding efficiency. D) Most healthcare providers (as well as representatives of formula companies) consider breastfeeding to be the "gold standard" for neonatal nutrition, and the outcomes associated with its use are the norm to which other forms of nutrition should be compared. Page Ref: 749
29) The nurse is completing the discharge teaching of a young first-time mother. Which statement by the mother requires immediate intervention? A) "I will put my baby to bed with his bottle so he doesn't get hungry during the night." B) "My baby will probably have a bowel movement each breastfeeding, and will wet often." C) "Nursing every 2 to 3 hours is normal, for a total of 8 to 12 feedings every day." D) "I will drink fenugreek tea from my grandmother to prevent my milk from coming in."
Answer: A Explanation: A) Putting a baby to bed with a propped bottle is a choking hazard, and should never be done. B) Breastfed infants have more frequent bowel movements than do bottle-fed infants. The infant will have 4 wet diapers, 3 to 4 bowel movements on day 4; 5 wet diapers, 3 to 4 bowel movements on day 5; and 6 to 8 wet diapers, 3 to 4 bowel movements every day thereafter during the first month of life. C) Breast milk is easier to digest than formula, therefore infants eat more frequently. Infants will arouse to feed at least every 3 hours and will stay awake until the end of each feeding. The infant will breastfeed 8 to 12 times per day. D) Herbal galactogogues can be consumed as a tea or can be taken as capsules or as a tincture added to liquid to drink. Fenugreek is probably the most well-known herbal galactogogue among lactation consultants in the United States. Page Ref: 745
9) Which of the following are potential disadvantages to breastfeeding? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Pain with breastfeeding B) Leaking milk C) Equal feeding responsibilities with fathers D) Vaginal wetness E) Embarrassment
Answer: A, B, E Explanation: A) Nipple tenderness is the most common source of discomfort and is usually related to improper positioning and/or not obtaining a proper attachment of the infant on the breast. Pain can also be related to engorgement or infection. B) Some women will leak milk when their breasts are full and it is nearly time to breastfeed again or whenever they experience let-down. Mothers should be given reassurance that this problem diminishes over time. C) There are unequal feeding responsibilities and fathers are left out in the first 3 to 4 weeks. The parents should be informed that it is advisable for the father to wait to bottle feed the baby with expressed breast milk until after the milk supply and breastfeeding are established. D) Vaginal dryness is associated with breastfeeding. Some mothers experience vaginal dryness related to a low level of estrogen while lactating. This is only a temporary side effect. E) Some mothers feel uncomfortable about breastfeeding because they are modest or may feel embarrassed because our society views breasts as sexual objects and/or an unfriendly social environment makes it difficult to breastfeed in public. This is not an easy issue to overcome. Page Ref: 728
7) Which statements by a breastfeeding class participant indicate that teaching by the nurse was effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "Breastfed infants get more skin-to-skin contact and sleep better." B) "Breastfeeding raises the level of a hormone that makes me feel good." C) "Breastfeeding is complex and difficult, and I probably won't succeed." D) "Breastfeeding is worthwhile, even if it costs more overall." E) "Breastfed infants have fewer digestive and respiratory illnesses."
Answer: A, B, E Explanation: A) Skin-to-skin contact after birth helps the baby maintain his or her body temperature, helps with self-regulation, increases maternal oxytocin levels, helps the mother to notice subtle feeding cues, and promotes bonding. B) Hormones of lactation promote maternal feelings and sense of well-being. C) Breastfeeding is a natural process but requires a certain knowledge base. Breastfeeding with proper technique should not hurt and these mothers should be encouraged to seek assistance from a knowledgeable person skilled in lactation. D) Breastfeeding actually costs less than formula-feeding. E) This is a true statement. The immunologic advantages of human milk include varying degrees of protection from respiratory tract and gastrointestinal tract infections. Page Ref: 740
28) The nurse encourages a new mother to feed the newborn as soon as the newborn shows interest. The nurse bases this recommendation on which benefits of early feedings? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Early feedings stimulate peristalsis. B) Colostrum is thinner than mature milk. C) Early feedings enhance maternal-infant bonding. D) Early feedings promote the passage of meconium. E) Colostrum contains a high number of calories.
Answer: A, C, D Explanation: A) Early breastfeeding stimulates the newborn's peristalsis. B) Colostrum is a thick, creamy, yellowish fluid with concentrated amounts of protein, fat-soluble vitamins, and minerals. C) Early breastfeeding enhances maternal-infant bonding. D) Early breastfeeding promotes the passage of meconium. E) Colostrum contains fewer calories than mature milk does. Page Ref: 740
22) The nurse is caring for a new breastfeeding mother who is from Pakistan. The nurse plans her care so that the newborn is offered the breast on which of the following? A) Day of birth B) First day after birth C) Second day after birth D) Third to fourth day after birth
Answer: D D) Among some traditional cultures around the world, it is believed that colostrum is "unclean" or even harmful to a newborn. Because of this ancient belief, mothers living the Middle East and parts of Asia even today discard their colostrum or wait 2 to 4 days to begin breastfeeding, when their "true milk" arrives. This mother would begin breastfeeding on the third or fourth day after the birth. Page Ref: 731
11) The nurse is teaching a new mother how to encourage a sleepy baby to breastfeed. Which of the following instructions would not be included in that teaching? A) Providing skin-to-skin contact B) Swaddling the newborn in a blanket C) Unwrapping the newborn D) Allowing the newborn to feel and smell the mother's breast
Answer: B Explanation: A) Activities that encourage a sleepy newborn to breastfeed include providing skin-to-skin contact, which enhances bonding. B) Remove the baby's blanket and clothing so that the infant is wearing only a diaper and T-shirt. Babies feed better when they are not bundled, and they can achieve better attachment without the bulk of extra clothing and blankets. Swaddling the newborn has the opposite effect. C) Remove the baby's blanket and clothing so that the infant is wearing only a diaper and T-shirt. Babies feed better when they are not bundled, and they can achieve better attachment without the bulk of extra clothing and blankets. D) If the newborn falls asleep after the first few suckles, encourage the mother to use tactile stimulation while the newborn is still attached to the breast. The mother can also be encouraged to use breast compression or breast massage while the infant is breastfeeding. Page Ref: 742
5) What is the primary carbohydrate in mammalian milk that plays a crucial role in the nourishment of the newborn? A) Colostrum B) Lactose C) Lactoferrin D) Secretory IgA
Answer: B Explanation: A) Another term for human milk is colostrum. B) Lactose is the primary carbohydrate in mammalian milk. C) Lactoferrin is an iron-binding protein found only in breast milk. D) Secretory IgA is an immunoglobulin present in colostrum and mature breast milk. Page Ref: 726
18) A new mother who is breastfeeding tells the nurse that her infant is spitting up frequently, has very loose stools and copious gas, and feeds for only short periods of time. The nurse suspects a feeding intolerance and, after questioning the mother about her diet, suggests that she do which of the following? A) Stop breastfeeding and switch to formula. B) Eliminate dairy products from her diet. C) Supplement breastfeeding with a soy-based formula. D) Offer the baby water between feedings.
Answer: B Explanation: A) At this point, there is no reason to stop breastfeeding. B) Breastfeeding babies may not be allergic to the mother's milk but rather to the cow's milk protein (an antigen) in the mother's milk. By eliminating the culprit (e.g., the bovine protein) from the mother's diet and therefore from the breast milk, the mother can continue to breastfeed, providing optimal nutrition and immune factors to her infant. C) Soy-protein-based formula is not the first choice for term infants unless they have special nutritional needs. D) Increased water can cause hyponatremia and, in excessive amounts, can cause seizures. Page Ref: 723
1) A nurse is evaluating the diet plan of a breastfeeding mother. Which beverage is most likely to cause intolerance in the infant? A) Orange juice B) Milk C) Decaffeinated tea D) Water
Answer: B Explanation: A) Orange juice does not usually pose a problem for the infant. B) Often fussy breastfeeding or cow's milk-based formula-fed infants are switched to a lactose-free formula because of concerns about lactose intolerance. C) Decaffeinated tea does not usually present a problem for the infant. D) Water should not be a problem at any time. Page Ref: 723
17) The nurse is working with a new mother who delivered yesterday. The mother has chosen to breastfeed her infant. Which demonstration of skill is the best indicator that the client understands breastfeeding? A) She puts the infant to breast when he is asleep to help wake him up. B) She takes off her gown to achieve skin-to-skin contact. C) She leans toward the infant so that he turns his head to access the nipple. D) The infant is crying when he is brought to the breast.
Answer: B Explanation: A) Parents can be taught techniques to wake their sleepy baby, as breastfeeding is more successful if the infant is awake. With a little help, the baby may be gently roused to breastfeed. B) Skin-to-skin contact after birth helps the baby maintain his or her body temperature, helps with self-regulation, increases maternal oxytocin levels, helps the mother to notice subtle feeding cues, and promotes bonding. C) The mother should bring the baby to her breast, rather than leaning forward to the baby. D) Crying is a late cue of hunger. Newborns should be put to breast when they begin rooting, lip-smacking, or fussing behaviors. Page Ref: 740
4) The community nurse is working with poor women who are formula-feeding their infants. Which statement indicates that the nurse's education session was effective? A) "I should use only soy-based formula for the first year." B) "I should follow the instructions for mixing the powdered formula exactly." C) "It is okay to add more water to the formula to make it last longer." D) "The mixed formula can be left on the counter for a day."
Answer: B Explanation: A) Soy protein-based formula is not intended as a first-choice formula except for infants with primary lactase deficiency or galactosemia, for term infants of formula-feeding vegan parents, and for infants who develop secondary (transient) lactase deficiency following an acute bout with diarrhea. B) Powdered formula is the least expensive type of formula. Parents will need to be briefed on safety precautions during formula preparation, and they should be instructed to follow the directions on the formula package label precisely as written. C) Parents should know that adding too much water during preparation dilutes the nutrients and caloric density and may contribute to undernourishment, insufficient weight gain, and possibly water intoxication leading to hyponatremia and seizures. Not adding enough water concentrates nutrients and calories and can damage an infant's immature kidneys and digestive system, as well as cause dehydration. D) Allow freshly prepared (unused) formula to sit out at room temperature for no longer than 2 hours. Milk left over in the bottle after a feeding should be discarded. Page Ref: 744
15) Which of the following functions primarily to provide low-income women and children who are at risk for medical or nutritional problems with nutritious foods to supplement their diets, nutrition education and counseling, and screening and referrals to other health, welfare, and social programs? A) ABM B) WIC C) ILCA D) LLLI
Answer: B Explanation: A) The Academy of Breastfeeding Medicine (ABM) provides many research-based breastfeeding protocols. B) The Supplemental Nutrition Program for Women, Infants, and Children (WIC) functions primarily to provide low-income women and children who are at risk for medical or nutritional problems with nutritious foods to supplement their diets, nutrition education and counseling, and screening and referrals to other health, welfare, and social programs. C) International Lactation Consultant Association (ILCA) has listings of lactation consultants in specific geographic areas. D) La Leche League International (LLLI) is the first (not-for-profit international educational and service organization) mother-to-mother breastfeeding support group formally recognized in the United States. Page Ref: 747
27) A nurse is evaluating the diet plan of a breastfeeding mother, and determines that her intake of fruits and vegetables is inadequate. The nurse explains that the nutritional composition of the mother's breast milk can be adversely affected by this nutritional inadequacy. Which strategy should the nurse recommend to the mother? A) Stop breastfeeding B) Provide newborn supplements to the newborn C) Offer whole milk D) Supplement with skim milk
Answer: B Explanation: A) The mother may continue to breastfeed. B) The mother may continue to breastfeed, but the caregiver may choose to prescribe additional vitamins for the newborn. Vitamins in human milk are influenced by the mother's vitamin intake, general nutritional status, and genetic differences. C) Cow's milk should not be given to infants before 1 year of age. The use of skim milk or low-fat cow's milk is not recommended for children under 2 years old. D) Cow's milk should not be given to infants before 1 year of age. The use of skim milk or low-fat cow's milk is not recommended for children under 2 years old. Page Ref: 722
20) The nurse is assisting a mother to bottle-feed her newborn, who has been crying. The nurse suggests that prior to feeding, the mother should do which of the following? A) Offer a pacifier B) Burp the newborn C) Unwrap the newborn D) Stroke the newborn's spine and feet
Answer: B Explanation: A) The newborn's cries are indicative of an issue; a pacifier would not solve the problem. B) Crying results in increased ingestion of air even before the infant has started feeding. Infants who are very hungry also gulp more air. For these situations, instruct the parents to burp their infant frequently. C) Unwrapping stimulates the newborn. D) Stroking the spine and feet stimulates the newborn. Page Ref: 745
6) The nurse knows that in some cases, breastfeeding is not advisable. Which mother should be counseled against breastfeeding? A) A mother with a poorly balanced diet B) A mother who is overweight C) A mother who is HIV positive D) A mother who has twins
Answer: C Explanation: A) A newborn whose mother has a poor diet might need to receive supplements. B) Mothers who are overweight can be encouraged to breastfeed. C) Women with HIV or AIDS are counseled against breastfeeding. D) Mothers who have twins can be encouraged to breastfeed. Page Ref: 730
14) When is breastfeeding contraindicated? A) Infant has hypertension B) Mother has a history of treated tuberculosis C) Mother is HIV positive or has AIDS D) Mother has a history of treated herpes
Answer: C Explanation: A) Breastfeeding is contraindicated when the infant has galactosemia. B) Breastfeeding is contraindicated when the mother has active, untreated tuberculosis. C) Breastfeeding is contraindicated when the mother is HIV positive or has AIDS and is counseled against breastfeeding. D) Breastfeeding is contraindicated when the mother has active herpes on her breast-the infant may still feed on the unaffected side only, until the lesion has healed. Page Ref: 730
13) When a breastfeeding mother complains that her breasts are leaking milk, the nurse can offer which effective intervention? A) Decrease the number of minutes the newborn is at the breast per feeding. B) Decrease the mother's fluid intake. C) Place absorbent pads in the bra. D) Administer oxytocin.
Answer: C Explanation: A) Decreasing the number of minutes the newborn is at the breast would be contraindicated for a breastfeeding client. B) The mother should consume a nutritionally balanced diet with appropriate caloric and fluid intake to support breastfeeding. Decreasing the mother's fluid intake would be contraindicated for a breastfeeding client. C) The mother can wear nursing pads inside her bra with instructions to change wet pads frequently. D) Early breastfeeding can enhance maternal-infant bonding and facilitate release of oxytocin. Administering oxytocin would be contraindicated for a breastfeeding client. Page Ref: 728
24) A client from Mexico has just delivered a son, and the nurse offers to assist in putting the baby to breast. Although the client indicated before the birth that she wanted to breastfeed, she is very hesitant, and says she would like to bottle-feed for the first few days. After talking to her, the nurse understands that her primary reason for wanting to delay breastfeeding is based on what cultural belief? A) Breast milk causes skin rashes. B) It is harmful to breastfeed immediately. C) Colostrum is bad for the baby. D) Thin milk causes diarrhea.
Answer: C Explanation: A) Haitian mothers may believe that "strong emotions" spoil breast milk and that thick breast milk causes skin rashes. B) Believing it is harmful to breastfeed immediately is not a cultural belief of Hispanics. C) Some Hispanics may delay breastfeeding because they believe colostrum is "bad." D) Haitian mothers may believe that "strong emotions" spoil breast milk and that thin milk results in diarrhea. Page Ref: 731
12) A mother states that her breasts leak between feedings. Which of the following can contribute to the letdown reflex in breastfeeding mothers? A) Pain with breastfeeding B) Number of hours passed since last feeding C) The newborn's cry D) Maternal fluid intake
Answer: C Explanation: A) Pain with breastfeeding is associated with improper positioning, and does not stimulate the letdown reflex. B) Allowing too many hours between feedings can affect the milk supply. It does not stimulate the letdown reflex. C) Some women will leak milk when their breasts are full and it is nearly time to breastfeed again or whenever they experience letdown, which can be triggered by hearing, seeing, or even thinking of their baby. D) Maternal fluid intake can affect milk supply. It does not stimulate the letdown reflex. Page Ref: 728
10) What should the healthcare provider consider when prescribing a medication to a woman who is breastfeeding? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Drug's potential effect on hormone production B) Amount of drug excreted into the mother's blood C) Drug's potential adverse effects to the infant D) Infant's age and health E) Mother's need for the medication
Answer: C, D, E Explanation: A) The healthcare provider should consider the drug's potential effect on milk production. B) The healthcare provider should consider the amount of drug excreted into the milk. C) The healthcare provider should consider the drug's potential adverse effects to the infant. D) The healthcare provider should consider the infant's age and health. E) The healthcare provider should consider the mother's need for the medication. Page Ref: 730
19) Which of the following is a sign of dehydration in the newborn? A) Slow, weak pulse B) Soft, loose stools C) Light colored, concentrated urine D) Depressed fontanelles
Answer: D Explanation: A) A rapid, weak pulse is a sign of dehydration in the newborn. B) Dry, hard stools are a sign of dehydration in the newborn. C) Dark, concentrated urine is a sign of dehydration in the newborn. D) Depressed fontanelles are a sign of dehydration in the newborn. Page Ref: 721
8) A client at 20 weeks' gestation has not decided on a feeding method for her infant. She asks the nurse for advice. The nurse presents information about the advantages and disadvantages of formula-feeding and breastfeeding. Which statements by the client indicate that the teaching was successful? A) "Formula-feeding gives the baby protection from infections." B) "Breast milk cannot be stored; it has to be thrown away after pumping." C) "Breastfeeding is more expensive than formula-feeding." D) "My baby will have a lower risk of food allergies if I breastfeed."
Answer: D Explanation: A) Formula does not provide the baby with protection from infections; breast milk does. B) Breast milk can be refrigerated or frozen after pumping. C) Formula must be purchased, and therefore is more expensive. D) Secretory IgA, an immunoglobulin present in colostrum and mature breast milk, has antiviral, antibacterial, and antigenic-inhibiting properties and plays a role in decreasing the permeability of the small intestine to help prevent large protein molecules from triggering an allergic response. Page Ref: 726
2) The nurse is caring for a premature infant in the NICU, and is going to attempt a bottle feeding with thawed breast milk. How long can thawed breast milk be stored in the refrigerator before the nurse must discard it? A) 4 hours B) 8 hours C) 12 hours D) 24 hours
Answer: D Explanation: A) Thawed breast milk can stay refrigerated longer than 4 hours before it should be discarded. B) Thawed breast milk can stay refrigerated longer than 8 hours before it should be discarded. C) Thawed breast milk can stay refrigerated longer than 12 hours before it should be discarded. D) Previously frozen thawed breast milk is good in the refrigerator for 24 hours only. Page Ref: 740
21) The nurse is explaining the nutritional differences between breast milk and formula to an expectant couple. The mother-to-be asks whether breast milk is nutritionally superior to formula. What should the nurse reply? A) The vitamins and minerals in formula are more bioavailable to the infant. B) There is no cholesterol in breast milk. C) The only carbohydrate in breast milk is lactose. D) The ratio of whey to casein proteins in breast milk changes to meet the nutritional needs of the growing infant.
Answer: D Explanation: A) The vitamins and minerals in breast milk have a higher bioavailability. B) Approximately 98% of human milk fat is in the form of triglycerides, and a very small but clinically significant amount is from cholesterol. C) Lactose is the primary carbohydrate in breast milk. Human milk also contains trace amounts of other carbohydrates such as glucosamines and nitrogen-containing oligosaccharides. D) The ratio of whey to casein proteins in breast milk, unlike that in formula, is not static. It changes to meet the nutritional needs of the growing infant. Page Ref: 722
23) The nurse is working with a client from Southeast Asia. The client tells the nurse that she should not put the baby to breast until her milk comes in and her breasts are warm, because "cold milk" (colostrum) is bad for the baby. After the nurse explains the benefits of colostrum, the client still insists that "cold milk" is bad. Which response by the nurse is best? A) "What kind of formula would you like to use?" B) "That idea is folklore. Colostrum is good for the baby." C) "Now that you are here, you need to feed your baby the right way." D) "Let's give the baby formula after you breastfeed."
Answer: D Explanation: A) This statement does not facilitate breastfeeding, and does not support the education provided to the client that colostrum is beneficial. B) Although colostrum is indeed good for newborns, this response is disrespectful. C) This answer is disrespectful and therefore not therapeutic. D) This response attempts to provide a compromise between acknowledging the client's desire to give formula and getting the baby to breast to get colostrum. Nurses should be aware that some immigrant mothers may have this misconception about their colostrum. Page Ref: 731
