210 OB Unit 2

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: spina bifida. intrauterine growth restriction. diabetes mellitus. Down syndrome.

intrauterine growth restriction. (Spina bifida is not associated with inadequate maternal weight gain. An adequate amount of folic acid has been shown to reduce the incidence of this condition. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Diabetes mellitus is not related to inadequate weight gain. A gestational diabetic mother is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of a trisomy 21, not inadequate maternal weight gain.)

The nurse is discussing storage of breast milk with a mother whose infant is preterm and in the special care unit. What statement would indicate that the mother needs additional teaching? "I can store my breast milk in the refrigerator for 3 months." "I can store my breast milk in the freezer for 3 months." "I can store my breast milk at room temperature for 8 hours." "I can store my breast milk in the refrigerator for 3 to 5 days."

"I can store my breast milk in the refrigerator for 3 months." (If the mother states that she can store her breast milk in the refrigerator for 3 months, she needs additional teaching about safe storage. Breast milk can be stored at room temperature for 8 hours, in the refrigerator for 3 to 5 days, in the freezer for 3 months, or in a deep freezer for 6 to 12 months. It is accurate and does not require additional teaching if the mother states that she can store her breast milk in the freezer for 3 months, at room temperature for 8 hours, and in the refrigerator for 3 to 5 days.)

Which statement made by a lactating woman would lead the nurse to believe that the woman might have lactose intolerance? "I always have heartburn after I drink milk." "If I drink more than a cup of milk, I usually have abdominal cramps and bloating." "Drinking milk usually makes me break out in hives." "Sometimes I notice that I have bad breath after I drink a cup of milk."

"If I drink more than a cup of milk, I usually have abdominal cramps and bloating." (Abdominal cramps and bloating are consistent with lactose intolerance. One problem that can interfere with milk consumption is lactose intolerance, which is the inability to digest milk sugar because of a lack of the enzyme lactose in the small intestine. Milk consumption may cause abdominal cramping, bloating, and diarrhea people who are lactose intolerant, although many affected individuals can tolerate small amounts of milk without symptoms.)

A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant in 3 months. She can expect the following advice: "Discontinue all contraception now." "Lose weight so that you can gain more during pregnancy." "You may take any medications you have been taking regularly." "Make sure that you include adequate folic acid in your diet."

"Make sure that you include adequate folic acid in your diet." (A healthy diet before conception is the best way to ensure that adequate nutrients are available for the developing fetus. A woman's folate or folic acid intake is of particular concern in the periconception period. Neural tube defects are more common in infants of women with a poor folic acid intake. Depending on the type of contraception used, discontinuing all contraception may not be appropriate advice. Losing weight is not appropriate advice. Depending on the type of medication the woman is taking, continuing its use may not be appropriate.)

After you complete your nutritional counseling for a pregnant woman, you ask her to repeat your instructions so you can assess her understanding of the instructions given. Which statement indicates that she understands the role of protein in her pregnancy? "Protein will help my baby grow." "Eating protein will prevent me from becoming anemic." "Eating protein will make my baby have strong teeth after he is born." "Eating protein will prevent me from being diabetic."

"Protein will help my baby grow." (Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of amniotic fluid. Iron intake prevents anemia. Calcium intake is needed for fetal bone and tooth development. Glycemic control is needed in diabetics; protein is one nutritional factor to consider, but this is not the primary role of protein intake.)

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

(Wash hands before expressing breast milk. Milk thawed in the refrigerator can be stored for 24 hours.) Breast milk storage guidelines for home use for full-term infants are: Before expressing or pumping breast milk, wash your hands.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 (Write the date of expression on container before storing milk. A waterproof label is best.Store milk in serving sizes of 2 to 4 ounces to prevent waste.Storing breast milk in the refrigerator or freezer with other food items is acceptable.When storing milk in a refrigerator or freezer, place containers in the middle or back of the freezer, not on the door.When filling a storage container that will be frozen, fill only three quarters full, allowing space at the top of the container for expansion.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.Milk thawed in the refrigerator can be stored for 24 hours.Thawed breast milk should never be refrozen.Shake milk container before feeding baby and test the temperature of the milk on the inner aspect of your wrist.Any unused milk left in the bottle after feeding is discarded.)

A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 18.0. The nurse knows that this woman's total recommended weight gain during pregnancy should be at least: 20 kg (44 lb). 16 kg (35 lb). 12.5 kg (27.5 lb). 10 kg (22 lb).

12.5 kg (27.5 lb). (This woman has a normal BMI and should gain 11.5 to 16 kg during pregnancy. A weight gain of 20 kg would be unhealthy for most women. A weight gain 35 lb is the high end of the range of weight this woman should gain in her pregnancy. A weight gain of 22 lb would be appropriate for an obese woman.)

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's BEST response would be to tell the woman that her pattern of weight gain should be approximately: a pound a week throughout pregnancy. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. a pound a week during the first two trimesters, then 2 lbs per week during the third trimester. a total of 25 to 35 lbs.

2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. (A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb/week during the second and third trimesters. A total of 25 to 35 lbs is correct, but the pattern needs to be explained.)

If a patient's normal prepregnancy diet contains 45 g of protein daily, how many more grams of protein should she consume per day during pregnancy? 5 10 25 30

25 (The recommended intake of protein for the pregnant woman is 70 g. Intakes of 5, 10, or 15 g would be inadequate to meet protein needs during pregnancy. A protein intake of 30 g is more than is necessary and would add extra calories.)

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned if this woman consumes which food during and after tennis matches? 64 ounces of fluid Extra protein sources, such as peanut butter Salty foods to replace lost sodium Easily digested sources of carbohydrate

64 ounces of fluid (If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise because dehydration can trigger premature labor. The woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.)

How many kilocalories per kilogram (kcal/kg) of body weight does a breastfed term infant require each day? 50 to 65 75 to 90 95 to 110 150 to 200

95 to 110 (For the first 3 months the infant needs 110 kcal/kg/day. At ages 3 to 6 months the requirement is 100 kcal/kg/day. This level decreases slightly to 95 kcal/kg/day from 6 to 9 months and increases again to 100 kcal/kg/day until the baby reaches 12 months.)

A maternity nurse is preparing a teaching class for a group of new parents on infant feeding practices. The maternity nurse wants to include content that is relative to cultural diversity. Which statement related to cultural practices influencing infant feeding practice is correct? A common practice among Mexican women is known as las dos cosas. Muslim cultures do not encourage breastfeeding due to modesty concerns. Latino women born in the United States are more likely to breastfeed. East Indian and Arab women believe that cold foods are best for a new mother.

A common practice among Mexican women is known as las dos cosas. (A common practice among Mexican women is las do coasas. This refers to combining breastfeeding and commercial infant formula. It is based on the belief that by combining the two feeding methods, the mother and infant receive the benefits of breastfeeding along with the additional vitamins from formula. Among the Muslim culture, breastfeeding for 24 months is customary. Muslim women may choose to bottle-feed formula or expressed breast milk while in the hospital. Latino women born in the United States are less likely to breastfeed. East Indian and Arab women believe that hot foods, such as chicken and broccoli, are best for the new mother. The descriptor hot has nothing to do with the temperature or spiciness of the food.)

Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them about pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement is valid? A premature infant more easily digests breast milk than formula. A glass of wine just before pumping will help reduce stress and anxiety. The mother should pump only as much as the infant can drink. The mother should pump every 2 to 3 hours, including during the night.

A premature infant more easily digests breast milk than formula. (Human milk is the ideal food for preterm infants, with benefits that are unique in addition to those received by term, healthy infants. Greater physiologic stability occurs with breastfeeding compared with formula feeding. Consumption of alcohol during lactation is approached with caution. Excessive amounts can have serious effects on the infant and can adversely affect the mother's milk ejection reflex. To establish an optimal milk supply, the mother should be instructed to pump 8 to 10 times a day for 10 to 15 minutes on each breast.)

According to demographic research, the woman least likely to breastfeed and therefore most likely to need education regarding the benefits and proper techniques of breastfeeding would be: A woman who is 30 to 35 years of age, Caucasian, and employed part time outside the home. A woman who is younger than 25 years of age, Hispanic, and unemployed. A woman who is younger than 25 years of age, African-American, and employed full time outside the home. A woman who is 35 years of age or older, Caucasian, and employed full time at home.

A woman who is younger than 25 years of age, African-American, and employed full time outside the home. (Women least likely to breastfeed typically are younger than 25 years of age, have a lower income, are less educated, are employed full time outside the home, and are African-American.)

Which nutritional recommendation about fluids is accurate? A woman's daily intake should be eight to ten glasses (2.3L) of water, milk, or juice. Coffee should be limited to no more than two cups, but tea and cocoa can be consumed without worry. Of the artificial sweeteners, only aspartame has not been associated with any maternity health concerns. Water with fluoride is especially encouraged because it reduces the child's risk of tooth decay.

A woman's daily intake should be eight to ten glasses (2.3L) of water, milk, or juice. (Eight to ten glasses is the standard for fluids; however, they should be the right fluids. All beverages containing caffeine, including tea, cocoa, and some soft drinks, should be avoided or drunk only in limited amounts. Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus; however, mothers with phenylketonuria should avoid aspartame. No evidence indicates that prenatal fluoride consumption reduces childhood tooth decay.)

A nurse monitors all newborns in the NICU for hypoglycemia. Which manifestations could indicate hypoglycemia in one of the babies? (Select all that apply.) A. Apneic episodes B. None (asymptomatic) C. Eye rolling D. Lethargy E. Palmar sweating

A. Apneic episodes B. None (asymptomatic) C. Eye rolling D. Lethargy (Apneic episodes, eye rolling, and lethargy are among the manifestations of hypoglycemia. Hypoglycemic infants can also be asymptomatic. Palmar sweating is indicative of pain.)

A baby was born 4 days ago at 34 weeks' gestation and is receiving phototherapy for neonatal jaundice. The baby has symptoms of temperature instability, dry skin, poor feeding, lethargy, and irritability. What are the nurse's priority nursing interventions? (Select all that apply.) A. Assess the baby's temperature to check for hypothermia. B. Check to make sure the infant's face mask stays in place. C. Educate the mother to feed the child every 2 hours. D. Verify laboratory results to check for hypoglycemia. E. Verify laboratory results to check for hypomagnesemia.

A. Assess the baby's temperature to check for hypothermia. D. Verify laboratory results to check for hypoglycemia. (Priority nursing actions for the baby undergoing phototherapy include keeping the baby warm, as hypothermia can occur due to exposure, and ensuring the baby receives adequate nutrition. Bilirubin is excreted in the stool. Proper nutrition will also help maintain fluid status. Keeping the baby's mask in place is an important safety action to prevent eye damage, but is not related to this baby's signs. Hypoglycemia can occur with poor nutrition. Magnesium levels are not affected by jaundice.)

A nurse is preparing an infant for circumcision. The parents ask about pain control. The nurse should inform the parents about what options? (Select all that apply.) A. Concentrated oral glucose solution B. Nonnutritive sucking C. Oral liquid aspirin products D. Swaddling and containment E. Topical anesthetics or anesthetic blocks

A. Concentrated oral glucose solution B. Nonnutritive sucking D. Swaddling and containment E. Topical anesthetics or anesthetic blocks (Pharmacological pain management during circumcision includes topical anesthetics, ring blocks, and nerve blocks. Oral acetaminophen (Tylenol) is also an option. Nonpharmacological pain management includes providing concentrated glucose solutions, nonnutritive sucking opportunities, swaddling and containment, and therapeutic touch.)

A student nurse is caring for an infant who was just circumcised. What assessment finding should the student report to the registered nurse? A. No voiding for 8 hours B. Slight blood on the diaper C. Swelling on the glans penis D. Wishes to be held continuously

A. No voiding for 8 hours (The nurse should assess for the first voiding after a circumcision to evaluate for urinary obstruction related to injury or swelling. Slight blood on the diaper would be expected. Some swelling may occur and does not cause concern unless it blocks the urethra. After a procedure, it is normal for an infant to wish to be held and comforted.)

At a 2-month well-baby examination, it was discovered that a breastfed infant had only gained 10 ounces in the past 4 weeks. The mother and the nurse agree that, to gain weight faster, the infant needs to: Begin solid foods. Have a bottle of formula after every feeding. Add at least one extra breastfeeding session every 24 hours. Start iron supplements.

Add at least one extra breastfeeding session every 24 hours. (Usually the solution to slow weight gain is to improve the feeding technique. Position and latch-on are evaluated, and adjustments are made. It may help to add a feeding or two in a 24-hour period. Solid foods should not be introduced to an infant for at least 4 to 6 months. Bottle-feeding may cause nipple confusion and limit the supply of milk. Iron supplements have no bearing on weight gain.)

The nurse is developing a dietary teaching plan for a patient on a vegetarian diet. The nurse should provide the patient with which examples of protein containing foods? Select all that apply. Dried beans Seeds Peanut butter Bagel Eggs

Dried beans Seeds Peanut butter Eggs (All of the foods listed except a bagel provide protein. A bagel is an example of a whole grain food, not protein.)

To prevent gastrointestinal upset, clients should be instructed to take iron supplements: On a full stomach. After eating a meal. At bedtime. With milk.

At bedtime. (Clients should be instructed to take iron supplements at bedtime. Iron supplements are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may reduce absorption. Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals.)

The breastfeeding mother should be taught a safe method to remove the breast from the baby's mouth. Which suggestion by the nurse is most appropriate? Slowly remove the breast from the baby's mouth when the infant has fallen asleep and the jaws are relaxed. Break the suction by inserting your finger into the corner of the infant's mouth. A popping sound occurs when the breast is correctly removed from the infant's mouth. Elicit the Moro reflex to wake the baby and remove the breast when the baby cries.

Break the suction by inserting your finger into the corner of the infant's mouth. (Inserting a finger into the corner of the baby's mouth between the gums to break the suction avoids trauma to the breast. The infant who is sleeping may lose grasp on the nipple and areola, resulting in "chewing" on the nipple that makes it sore. A popping sound indicates improper removal of the breast from the baby's mouth and may cause cracks or fissures in the breast. Most mothers prefer the infant to continue to sleep after the feeding. Gentle wake-up techniques are recommended.)

Three servings of milk, yogurt, or cheese plus two servings of meat, poultry, or fish adequately supply the recommended amount of protein for a pregnant woman. Many patients are concerned about the increased levels of mercury in fish and may be afraid to include this source of nutrients in their diet. Sound advice by the nurse to assist the client in determining which fish is safe to consume would include: Canned white tuna is a preferred choice. Avoid shark, swordfish, and mackerel. Fish caught in local waterways are the safest. Salmon and shrimp contain high levels of mercury.

Avoid shark, swordfish, and mackerel. (As a precaution, the pregnant patient should avoid eating all of these and the less common tilefish. High levels of mercury can harm the developing nervous system of the fetus. It is essential for the nurse to assist the client in understanding the differences between numerous sources of this product. A pregnant client can 12 ounces a week of canned light tuna; however, canned white, albacore, or tuna steaks contain higher levels of mercury and should be limited to no more than 6 ounces per week. It is a common misconception that fish caught in local waterways are the safest. Pregnant women and mothers of young children should check with local advisories about the safety of fish caught by families and friends in nearby bodies of water. If no information is available, these fish sources should be avoided, limited to less than 6 ounces, or the only fish consumed that week. Commercially caught fish that are low in mercury include salmon, shrimp, pollock, or catfish.)

A nurse has given a premature hypoglycemic infant an IV glucose solution. How would the nurse best determine if the goals for this treatment have been met? A. Blood glucose is 42 mg/dL. B. Blood glucose is 58 mg/dL. C. The baby has a normal-sounding cry. D. The baby is sucking vigorously.

B. Blood glucose is 58 mg/dL. (Many nurseries consider a high-risk newborn hypoglycemic when blood glucose readings are below 50-60 mg/dL. For this premature infant, a glucose of 58 mg/dL indicates that treatment has been effective. A blood glucose of 42 mg/dL would be acceptable for a healthy newborn. One sign of hypoglycemia is a high-pitched or weak cry, so this might be an assessment finding associated with euglycemia; however, it is not as specific as a laboratory test. Vigorous sucking is not related.)

A nurse is assessing a newborn who is jittery, diaphoretic, and hypothermic, and has poor feeding. What laboratory value would the nurse correlate with this condition? A. Bilirubin: 5 mg/dL B. Blood glucose: 32 mg/dL C. Hematocrit: 50% D. White blood cell count: 25,000/mm3

B. Blood glucose: 32 mg/dL (This infant has signs of hypoglycemia, confirmed with a blood glucose level below 40 mg/dL (normal is 40-60 mg/dl). The other laboratory values are normal for a neonate.)

Which meal would provide the most absorbable iron? Toasted cheese sandwich, celery sticks, tomato slices, and a grape drink Oatmeal, whole wheat toast, jelly, and low-fat milk Black bean soup, wheat crackers, orange sections, and prunes Red beans and rice, cornbread, mixed greens, and decaffeinated tea

Black bean soup, wheat crackers, orange sections, and prunes (Food sources that are rich in iron include liver, meats, whole grain or enriched breads and cereals, deep green leafy vegetables, legumes, and dried fruits. In addition, the vitamin C in orange sections aids absorption. Dairy products and tea are not sources of iron.)

A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. What signs and symptoms should the nurse include in her discussion? (Select all that apply) Breast tenderness Warmth in the breast An area of redness on the breast often resembling the shape of a pie wedge A small white blister on the tip of the nipple Fever and flulike symptoms

Breast tenderness Warmth in the breast An area of redness on the breast often resembling the shape of a pie wedge Fever and flulike symptoms (Breast tenderness, breast warmth, breast redness, and fever and flulike symptoms are commonly associated with mastitis and should be included in the nurse's discussion of mastitis. A small white blister on the tip of the nipple generally is not associated with mastitis. It is commonly seen in women who have a plugged milk duct.)

Which statement describing physiologic jaundice is incorrect? Neonatal jaundice is common, but kernicterus is rare. The appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process. Because jaundice may not appear before discharge, parents need instruction on how to assess it and when to call for medical help. Breastfed babies have a lower incidence of jaundice.

Breastfed babies have a lower incidence of jaundice. (Breastfeeding is associated with an increased incidence of jaundice. Neonatal jaundice occurs in 60% of newborns; the complication called kernicterus is rare. Jaundice in the first 24 hours or that persists past day 7 is cause for medical concern. Parents need to know how to assess for jaundice in their newborn.)

The nurse providing couplet care should understand that nipple confusion results when: Breastfeeding babies receive supplementary bottle feedings. The baby is weaned too abruptly. Pacifiers are used before breastfeeding is established. Twins are breastfed together.

Breastfeeding babies receive supplementary bottle feedings. (Nipple confusion can result when babies go back and forth between bottles and breasts, especially before breastfeeding is established in 3 to 4 weeks, because the two require different skills. Abrupt weaning can be distressing to mother and/or baby but should not lead to nipple confusion. Pacifiers used before breastfeeding is established can be disruptive, but this does not lead to nipple confusion. Breastfeeding twins requires some logistical adaptations, but this should not lead to nipple confusion.)

While discussing the societal impacts of breastfeeding, the nurse should be cognizant of the benefits and educate the patient accordingly. Which statement as part of this discussion would be incorrect? Breastfeeding requires fewer supplies and less cumbersome equipment. Breastfeeding saves families money. Breastfeeding costs employers in terms of time lost from work. Breastfeeding benefits the environment.

Breastfeeding costs employers in terms of time lost from work. (Actually less time is lost to work by breastfeeding mothers, in part because infants are healthier. Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment. It saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. Breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal.)

Which statement concerning the benefits or limitations of breastfeeding is inaccurate? Breast milk changes over time to meet changing needs as infants grow. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. Breast milk/breastfeeding may enhance cognitive development. Breastfeeding increases the risk of childhood obesity.

Breastfeeding increases the risk of childhood obesity. (Breastfeeding actually decreases the risk of childhood obesity. There are multiple benefits of breastfeeding. Breast milk changes over time to meet changing needs as infants grow. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. Breast milk/breastfeeding may enhance cognitive development.)

With regard to the nutrient needs of breastfed and formula-fed infants, nurses should be understand that: Breastfed infants need extra water in hot climates. During the first 3 months breastfed infants consume more energy than do formula-fed infants. Breastfeeding infants should receive oral vitamin D drops daily at least during the first 2 months. Vitamin K injections at birth are not needed for infants fed on specially enriched formula.

Breastfeeding infants should receive oral vitamin D drops daily at least during the first 2 months. (Human milk contains only small amounts of vitamin D. Neither breastfed nor formula-fed infants need to be given water, even in very hot climates. During the first 3 months formula-fed infants consume more energy than do breastfed infants and therefore tend to grow more rapidly. Vitamin K shots are required for all infants because the bacteria that produce it are absent from the baby's stomach at birth.)

The nurse is explaining the benefits associated with breastfeeding to a new mother. Which statement by the nurse would be inaccurate and provide conflicting information to the patient? Women who breastfeed have a decreased risk of breast cancer. Breastfeeding is an effective method of birth control. Breastfeeding increases bone density. Breastfeeding may enhance postpartum weight loss.

Breastfeeding is an effective method of birth control. (Women who breastfeed have a decreased risk of breast cancer, an increase in bone density, and a possibility of quicker postpartum weight loss. Breastfeeding delays the return of fertility; however, it is not an effective birth control method.)

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

Breastfeeding requires fewer supplies and less cumbersome equipment. Breastfeeding saves families money. Breastfeeding benefits the environment. Breastfeeding results in reduced annual health care costs. (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.)

A breastfeeding woman develops engorged breasts at 3 days' postpartum. What action would help this woman achieve her goal of reducing the engorgement? The woman: Skips feedings to let her sore breasts rest. Avoids using a breast pump. Breastfeeds her infant every 2 hours. Reduces her fluid intake for 24 hours.

Breastfeeds her infant every 2 hours. (The mother should be instructed to attempt feeding her infant every 2 hours while massaging the breasts as the infant is feeding. Skipping feedings may cause further swelling and discomfort. If the infant does not feed adequately and empty the breast, the mother may pump to extract the milk and relieve some of the discomfort. Dehydration further irritates swollen breast tissue.)

A new mother wants to be sure that she is meeting her daughter's needs while feeding her commercially prepared infant formula. The nurse should evaluate the mother's knowledge about appropriate infant care. The mother meets her child's needs when she: Adds rice cereal to her formula at 2 weeks of age to ensure adequate nutrition. Warms the bottles using a microwave oven. Burps her infant during and after the feeding as needed. Refrigerates any leftover formula for the next feeding.

Burps her infant during and after the feeding as needed. (Most infants swallow air when fed from a bottle and should be given a chance to burp several times during a feeding and after the feeding. Solid food should not be introduced to the infant for at least 4 to 6 months after birth. A microwave should never be used to warm any food to be given to an infant. The heat is not distributed evenly, and this may pose a risk of burning the infant. Any formula left in the bottle after the feeding should be discarded because the infant's saliva has mixed with it.)

A pregnant woman's diet history indicates that she likes the following foods. The nurse would encourage this woman to consume more of which food to increase her calcium intake? Fresh apricots Spaghetti with meat sauce Canned clams Canned sardines

Canned sardines (Sardines are rich in calcium. Fresh apricots, canned clams, and spaghetti with meat sauce are not high in calcium.)

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? Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change. (Cleansing the penis gently with water and putting petroleum jelly around the glans after each diaper change are appropriate when caring for an infant who has had a circumcision. 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. Yellow exudates cover the glans penis in 24 hours after the circumcision. This is part of normal healing and not an infective process. The exudates should not be removed.)

A new mother asks whether she should feed her newborn colostrum, because it is not "real milk." The nurse's most appropriate answer is: Colostrum is high in antibodies, protein, vitamins, and minerals. Colostrum is lower in calories than milk and should be supplemented by formula. Giving colostrum is important in helping the mother learn how to breastfeed before she goes home. Colostrum is unnecessary for newborns.

Colostrum is high in antibodies, protein, vitamins, and minerals. (Colostrum is important because it has high levels of the nutrients needed by the neonate and helps protect against infection. Supplementation is not necessary; it will decrease stimulation to the breast and decrease the production of milk. It is important for the mother to feel comfortable in this role before discharge; however, the importance of the colostrum to the infant is the top priority. Colostrum provides immunities and enzymes necessary to cleanse the gastrointestinal system, among other things.)

The major source of nutrients in the diet of a pregnant woman should be composed of: Simple sugars Fiber Fats Complex carbohydrates

Complex carbohydrates (Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients. Fats provide 9 kcal in each gram, in contrast to carbohydrates and proteins, which provide only 4 kcal in each gram. Fiber is supplied primarily by complex carbohydrates.)

A term infant is 22 hours old, has a total serum bilirubin level of 13 mg/dL, and has visible jaundice. What action by the nurse is most appropriate? A. Assure the parents that this is temporary. B. Document the findings in the infant's chart. C. Have the mother switch to bottle feeding. D. Review the chart for history of a traumatic birth.

D. Review the chart for history of a traumatic birth. (Jaundice that appears within the first 24 hours of life is considered pathological. Causes can include events that lead to excessive breakdown of RBCs, leading to increased bilirubin levels, such as polycythemia, traumatic birth, infection, metabolic disorders, and Rh incompatibility. The diagnosis is made when total serum bilirubin levels rise higher than 12.9 mg/dL in term infants and 15 mg/dL in preterm infants. The nurse should review the chart for evidence of a traumatic birth. The other actions are not warranted.)

In teaching the pregnant adolescent about nutrition, the nurse should: Emphasize the need to eliminate common teen snack foods because they are too high in fat and sodium. Determine the weight gain needed to meet adolescent growth and add 35 lb. Suggest that she not eat at fast-food restaurants to avoid foods of poor nutritional value. Realize that most adolescents are unwilling to make dietary changes during pregnancy.

Determine the weight gain needed to meet adolescent growth and add 35 lb. (Adolescents should gain in the upper range of the recommended weight gain. They also need to gain weight that would be expected for their own normal growth. Changes in the diet should be kept at a minimum. Snack foods can be included in moderation, and other foods can be added to make up for the lost nutrients. Eliminating fast foods would make the adolescent appear different to her peers. The patient should be taught to choose foods that add needed nutrients. Adolescents are willing to make changes; however, they still have the need to be similar to their peers.)

A woman in week 34 of pregnancy reports that she is very uncomfortable because of heartburn. The nurse would suggest that the woman: Substitute other calcium sources for milk in her diet. Lie down after each meal. Reduce the amount of fiber she consumes. Eat five small meals daily.

Eat five small meals daily. (Eating small, frequent meals may help with heartburn, nausea, and vomiting. Substituting other calcium sources for milk, lying down after eating, and reducing fiber intake are inappropriate dietary suggestions for all pregnant women and do not alleviate heartburn.)

Nutrition is one of the most significant factors influencing the outcome of a pregnancy. It is an alterable and important preventive measure for various potential problems, such as low birth weight and prematurity. While completing the physical assessment of the pregnant client, the nurse can evaluate the client's nutritional status by observing a number of physical signs. Which sign would indicate that the client has unmet nutritional needs? Normal heart rate, rhythm, and blood pressure Bright, clear, shiny eyes Alert, responsive, and good endurance Edema, tender calves, and tingling

Edema, tender calves, and tingling (The physiologic changes of pregnancy may complicate the interpretation of physical findings. Lower extremity edema often occurs when caloric and protein deficiencies are present; however, it may also be a common physical finding during the third trimester. It is essential that the nurse complete a thorough health history and physical assessment and request further laboratory testing if indicated. A malnourished pregnant patient may display rapid heart rate, abnormal rhythm, enlarged heart, and elevated blood pressure. A patient receiving adequate nutrition has bright, shiny eyes with no sores and moist, pink membranes. Pale or red membranes, dryness, infection, dull appearance of the cornea, or blue sclerae all are signs of poor nutrition. This client is well nourished. Cachexia, listlessness, and tiring easily would be indications of poor nutritional status.)

Which nutrient's recommended dietary allowance (RDA) is higher during lactation than during pregnancy? Energy (kcal) Vitamin A Iron Folic acid

Energy (kcal) (Needs for energy, protein, calcium, iodine, zinc, the B vitamins, and vitamin C remain greater than nonpregnant needs.)

Late in pregnancy, the woman's breasts should be assessed by the nurse to identify any potential concerns related to breastfeeding. Some nipple conditions make it necessary to provide intervention before birth. These include: (Select all that apply) Everted nipples Flat nipples Inverted nipples Nipples that contract when compressed Cracked nipples

Flat nipples Inverted nipples Nipples that contract when compressed (Flat nipples appear soft, like the areola, and do not stand erect unless stimulated by rolling them between the fingers. Inverted nipples are retracted into the breast tissue. These nipples appear normal; however, they will draw inward when the areola is compressed by the infant's mouth. Dome-shaped devices known as breast shells can be worn during the last weeks of pregnancy and between feedings after birth. The shells are placed inside the bra with the opening over the nipple. The shells exert slight pressure against the areola to help the nipples protrude. The helpfulness of breast shells is debated. A breast pump can be used to draw the nipples out before feedings after delivery.)

Nurses providing nutritional instruction should be cognizant of the uniqueness of human milk. Which statement is correct? Frequent feedings during predictable growth spurts stimulate increased milk production. The milk of preterm mothers is the same as the milk of mothers who gave birth at term. The milk at the beginning of the feeding is the same as the milk at the end of the feeding. Colostrum is an early, less concentrated, less rich version of mature milk.

Frequent feedings during predictable growth spurts stimulate increased milk production. (These growth spurts (10 days, 3 weeks, 6 weeks, 3 months) usually last 24 to 48 hours, after which infants resume normal feeding. The milk of mothers of preterm infants is different from that of mothers of full-term infants to meet the needs of these newborns. Milk changes composition during feeding. The fat content of the milk increases as the infant feeds. Colostrum precedes mature milk and is more concentrated and richer in proteins and minerals (but not fat).)

Identify a goal of a patient with the following nursing diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to diet choices inadequate to meet nutrient requirements of pregnancy. Gain a total of 30 lb. Take daily supplements consistently. Decrease intake of snack foods. Increase intake of complex carbohydrates.

Gain a total of 30 lb. (A weight gain of 30 lb is one indication that the patient has gained a sufficient amount for the nutritional needs of pregnancy. A daily supplement is not the best goal for this patient. It does not meet the basic need of proper nutrition during pregnancy. Decreasing snack foods may be a problem and should be assessed; however, assessing weight gain is the best method of monitoring nutritional intake for this pregnant patient. Increasing the intake of complex carbohydrates is important for this patient, but monitoring the weight gain should be the end goal.)

All parents are entitled to a birthing environment in which breastfeeding is promoted and supported. The Baby Friendly Hospital Initiative endorsed by WHO and UNICEF was founded to encourage institutions to offer optimal levels of care for lactating mothers. Which instruction is not included in the "Ten Steps to Successful Breastfeeding for Hospitals"? Give newborns no food or drink other than breast milk. Have a written breastfeeding policy that is communicated to all staff. Help mothers initiate breastfeeding within one half hour of birth. Give artificial teats or pacifiers as necessary.

Give artificial teats or pacifiers as necessary. (No artificial teats or pacifiers (also called dummies or soothers) should be given to breastfeeding infants. No other food or drink should be given to the newborn unless medically indicated. The breastfeeding policy should be routinely communicated to all health care staff. All staff should be trained in the skills necessary to maintain this policy. Breastfeeding should be initiated within one half hour of birth, and all mothers need to be shown how to maintain lactation even if they are separated from their babies.

A pregnant woman's diet may not meet her need for folates. A good source of this nutrient is: Chicken Potatoes Cheese Green leafy vegetables

Green leafy vegetables (Sources of folates include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken and cheese are excellent sources of protein but are poor in folates. Potatoes contain carbohydrates and vitamins and minerals but are poor in folates.)

A postpartum woman telephones about her 4-day-old infant. She is not scheduled for a weight check until the infant is 10 days old, and she is worried about whether breastfeeding is going well. Effective breastfeeding is indicated by the newborn who: Sleeps for 6 hours at a time between feedings. Has at least one breast milk stool every 24 hours. Gains 1 to 2 ounces per week. Has at least six to eight wet diapers per day.

Has at least six to eight wet diapers per day. (After day 4, when the mother's milk comes in, the infant should have six to eight wet diapers every 24 hours. Sleeping for 6 hours between feedings is not an indication of whether the infant is breastfeeding well. Typically infants sleep 2 to 4 hours between feedings, depending on whether they are being fed on a 2- to 3-hour schedule or cluster fed. The infant should have a minimum of three bowel movements in a 24-hour period.)

The most common cause of pathologic hyperbilirubinemia is: Hepatic disease. Postmaturity. Hemolytic disorders in the newborn. Congenital heart defect.

Hemolytic disorders in the newborn. (Hemolytic disorders in the newborn are the most common cause of pathologic jaundice. Hepatic damage may be a cause of pathologic hyperbilirubinemia, but it is not the most common cause. Prematurity would be a potential cause of pathologic hyperbilirubinemia in neonates, but it is not the most common cause. Congenital heart defect is not a common cause of pathologic hyperbilirubinemia in neonates.)

What is the PRIORITY teaching tip the nurse should provide about bottle-feeding? Infants may stool with each feeding in the first weeks. Feed newborn at least every 3 to 4 hours. Hold infant semiupright while feeding. Some infants take longer to feed than others.

Hold infant semiupright while feeding. (Infants should be held and never left alone while feeding. Never prop the bottle. The infant might inhale formula or choke on any that was spit up. Airway is priority. The infant may have a stool with each feeding in the first 2 weeks, although this amount may decrease to one or two stools each day Newborns should be fed at least every 3 to 4 hours and should never go longer than 4 hours without feeding until a satisfactory pattern of weight gain is established. Taking a few sucks and then pausing briefly before continuing to suck again is normal for infants. Some infants take longer to feed than others. Be patient. Keep the baby awake; encouraging sucking may be necessary. Moving the nipple gently in the infant's mouth may stimulate sucking.)

The most important reason for evaluating the pattern of weight gain in pregnancy is to: Prevent excessive adipose tissue deposits Identify potential nutritional problems or complications of pregnancy Assess the need to limit caloric intake in obese women Determine cultural influences on the woman's diet

Identify potential nutritional problems or complications of pregnancy (Maternal and fetal risks in pregnancy are increased when the mother is significantly overweight. Excessive adipose tissue may occur with excess weight gain; however, this is not the reason for monitoring the weight gain pattern. It is important to monitor the pattern of weight gain to identify complications. The pattern of weight gain is not influenced by cultural influences.)

To determine the cultural influence on a patient's diet, the nurse should first: Evaluate the patient's weight gain during pregnancy Assess the socioeconomic status of the patient Discuss the four food groups with the patient Identify the food preferences and methods of food preparation common to that culture

Identify the food preferences and methods of food preparation common to that culture (Understanding the patient's food preferences and how she prepares food will assist the nurse in determining whether the patient's culture is adversely affecting her nutritional intake. Evaluation of a patient's weight gain during pregnancy should be included for all patients, not just for patients who are culturally different. The socioeconomic status of the patient may alter the nutritional intake but not the cultural influence. Teaching the food groups to the patient should come after assessing food preferences.)

As the nurse assists a new mother with breastfeeding, the client asks, "If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better?" The nurse's best response is that it contains: More calories. Important immunoglobulins. Essential amino acids. More calcium.

Important immunoglobulins. (Breast milk contains immunoglobulins that protect the newborn against infection. The calorie count of formula and breast milk is about the same. All the essential amino acids are in both formula and breast milk; however, the concentrations may differ. Calcium levels are higher in formula than in breast milk. This higher level can cause an excessively high renal solute load if the formula is not diluted properly.)

A pregnant woman wants to breastfeed her infant; however, her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle-feeding. Which statement is most accurate? Bottle-feeding using commercially prepared infant formulas: Increases the risk that the infant will develop allergies. Helps the infant sleep through the night. Ensures that the infant is getting iron in a form that is easily absorbed. Requires that multivitamin supplements be given to the infant.

Increases the risk that the infant will develop allergies. (Exposure to cow's milk poses a risk of developing allergies, eczema, and asthma. "Bottle-feeding using commercially prepared infant formulas helps the infant sleep through the night" is a false statement. Iron is better absorbed from breast milk than from formula. Commercial formulas are designed to meet the nutritional needs of the infant and resemble breast milk.)

According to the recommendations of the American Academy of Pediatrics on infant nutrition: Infants should be given only human milk for the first 6 months of life. Infants fed on formula should be started on solid food sooner than breastfed infants. If infants are weaned from breast milk before 12 months, they should receive cow's milk, not formula. After 6 months mothers should shift from breast milk to cow's milk.

Infants should be given only human milk for the first 6 months of life. (Breastfeeding/human milk should also be the sole source of milk for the second 6 months. Infants start on solids when they are ready, usually at 6 months, whether they start on formula or breast milk. If infants are weaned from breast milk before 12 months, they should receive iron-fortified formula, not cow's milk.)

When providing care to the prenatal patient, the nurse understands that pica is defined as: Intolerance of milk products Ingestion of nonfood substances Iron deficiency anemia Episodes of anorexia and vomiting

Ingestion of nonfood substances (The practice of eating substances not normally thought of as food is called pica. Clay or dirt and solid laundry starch are the substances most commonly ingested. Intolerance of milk products is referred to as lactose intolerance. Pica may produce iron deficiency anemia if proper nutrition is decreased. Pica is not related to anorexia and vomiting.)

Which minerals and vitamins usually are recommended as a supplement a pregnant woman's diet? Fat-soluble vitamins A and D Water-soluble vitamins C and B₆ Iron and folate Calcium and zinc

Iron and folate (Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B₆ is prescribed only if the woman has a very poor diet. Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Zinc sometimes is supplemented. Most women get enough calcium.)

Maternal nutritional status is an especially significant factor of the many factors that influence the outcome of pregnancy because: It is very difficult to adjust because of people's ingrained eating habits. It is an important preventive measure for a variety of problems. Women love obsessing about their weight and diets. A woman's preconception weight becomes irrelevant.

It is an important preventive measure for a variety of problems. (Nutritional status draws so much attention not only for its effect on a healthy pregnancy and birth but also because significant changes are within relatively easy reach.)

A new father is ready to take his wife and newborn son home. He proudly tells the nurse who is discharging them that within the next week he plans to start feeding the infant cereal between breastfeeding sessions. The nurse can explain to him that beginning solid foods before 4 to 6 months may: Decrease the infant's intake of sufficient calories. Lead to early cessation of breastfeeding. Help the infant sleep through the night. Limit the infant's growth.

Lead to early cessation of breastfeeding. (Introduction of solid foods before the infant is 4 to 6 months of age may result in overfeeding and decreased intake of breast milk. It is not true that feeding of solids helps infants sleep through the night. The proper balance of carbohydrate, protein, and fat for an infant to grow properly is in the breast milk or formula.)

Which action of a breastfeeding mother indicates the need for further instruction? Holds breast with four fingers along bottom and thumb at top. Leans forward to bring breast toward the baby. Stimulates the rooting reflex and then inserts nipple and areola into newborn's open mouth. Puts her finger into newborn's mouth before removing breast.

Leans forward to bring breast toward the baby. (Holding the breast with four fingers along the bottom and the thumb at top is a correct technique. 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. Stimulating the rooting reflex is correct. Placing the finger in the mouth to remove the baby from the breast is correct.)

A pregnant patient would like to know a good food source of calcium other than dairy products. Your best answer is: Legumes Lean meat Yellow vegetables Whole grains

Legumes (Although dairy products contain the greatest amount of calcium, it also is found in legumes, nuts, dried fruits, and some dark green leafy vegetables. Yellow vegetables are rich in vitamin A. Lean meats are rich in protein and phosphorus. Whole grains are rich in zinc and magnesium.)

Pregnant adolescents are at high risk for _____ because of lower body mass indices (BMIs) and "fad" dieting. Obesity Diabetes Low-birth-weight babies High-birth-weight babies

Low-birth-weight babies (Adolescents tend to have lower BMIs because they are still developing and may follow unsafe nutritional practices. In addition, the fetus and still-growing mother appear to compete for nutrients. These factors, along with inadequate weight gain, lend themselves to a higher incidence of low-birth-weight babies. Obesity, diabetes, and high-birth-weight babies are conditions associated with higher BMIs.)

A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until her infant is crying frantically. On the basis of this information, this woman should feed her infant about every 2.5 to 3 hours when she: Waves her arms in the air. Has hiccups. Makes sucking motions. Stretches her legs out straight.

Makes sucking motions. (Sucking motions, rooting, mouthing, and hand-to-mouth motions are examples of feeding-readiness cues. Waving the arms in the air, hiccupping, and stretching the legs out straight are not typical feeding-readiness cues.)

The process whereby parents awaken the infant to feed every 3 hours during the day and at least every 4 hours at night is: Known as demand feeding. Necessary during the first 24 to 48 hours after birth. Used to set up the supply-meets-demand system. A way to control cluster feeding.

Necessary during the first 24 to 48 hours after birth. (The parents do this to make sure that the infant has at least eight feedings in 24 hours. Demand feeding is when the infant determines the frequency of feedings; this is appropriate once the infant is feeding well and gaining weight. The supply-meets-demand system is a milk production system that occurs naturally. Cluster feeding is not a problem if the baby has eight feedings in 24 hours.)

Nurses should be able to teach breastfeeding mothers the signs that the infant has latched on correctly. Which statement indicates a poor latch? She feels a firm tugging sensation on her nipples but not pinching or pain. The baby sucks with cheeks rounded, not dimpled. The baby's jaw glides smoothly with sucking. She hears a clicking or smacking sound.

She hears a clicking or smacking sound. (The clicking or smacking sound may indicate that the baby is having difficulty keeping the tongue out over the lower gum ridge. The mother should hope to hear the sound of swallowing. The tugging sensation without pinching is a good sign. Rounded cheeks are a positive indicator of a good latch. A smoothly gliding jaw is a good sign.)

Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? Select all that apply. Underweight women should gain 12.5 to 18 kg. Obese women should gain at least 7 to 11.5 kg. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled. Normal weight women should gain 11.5 to 16 kg.

Obese women should gain at least 7 to 11.5 kg. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. Normal weight women should gain 11.5 to 16 kg. (Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore, their bodies naturally compete for nutrients with the fetus. Women bearing twins need to gain more weight (usually 16 to 20 kg) but not necessarily twice as much. Normal weight women should gain 11.5 to 16 kg. Underweight women need to gain the most.)

While taking a diet history, the nurse might be told that the expectant mother has cravings for ice chips, cornstarch, and baking soda. This represents a nutritional problem known as: Preeclampsia. Pica. Pyrosis. Purging.

Pica. (The consumption of foods low in nutritional value or of nonfood substances (e.g., dirt, laundry starch) is called pica.)

A newborn is jaundiced and receiving phototherapy via ultraviolet bank lights. An appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy by this method would be to: Apply an oil-based lotion to the newborn's skin to prevent dying and cracking. Limit the newborn's intake of milk to prevent nausea, vomiting, and diarrhea. Place eye shields over the newborn's closed eyes. Change the newborn's position every 4 hours.

Place eye shields over the newborn's closed eyes. (The infant's eyes must be protected by an opaque mask to prevent overexposure to the light. Eye shields should cover the eyes completely but not occlude the nares. Lotions and ointments should not be applied to the infant because they absorb heat, and this can cause burns. The lights increase insensible water loss, placing the infant at risk for fluid loss and dehydration. Therefore, it is important that the infant be adequately hydrated. The infant should be turned every 2 hours to expose all body surfaces to the light.)

To initiate the milk ejection reflex (MER), the mother should be advised to: Wear a firm-fitting bra. Place the infant to the breast. Drink plenty of fluids. Apply cool packs to her breast.

Place the infant to the breast. (Oxytocin, which causes the MER reflex, increases in response to nipple stimulation. A firm bra is important to support the breast; however, will not initiate the MER reflex. Drinking plenty of fluids is necessary for adequate milk production, but this alone will not initiate the MER reflex. Cool packs to the breast will decrease the MER reflex.)

To prevent nipple trauma, the nurse should instruct the new mother to: Limit the feeding time to less than 5 minutes. Position the infant so the nipple is far back in the mouth. Assess the nipples before each feeding. Wash the nipples daily with mild soap and water.

Position the infant so the nipple is far back in the mouth. (If the infant's mouth does not cover as much of the areola as possible, the pressure during sucking will be applied to the nipple, thus causing trauma to the area. Stimulating the breast for less than 5 minutes will not produce the extra milk the infant may need. This will also limit access to the higher-fat "hindmilk." Assessing the nipples for trauma is important; however, this action alone will not prevent sore nipples. Soap can be drying to the nipples and should be avoided during breastfeeding.)

Most women with uncomplicated pregnancies can use the nurse as their primary source for nutritional information. The nurse or midwife should refer a client to a registered dietitian for in-depth nutritional counseling in the following situations (Select all that apply). Preexisting or gestational illness such as diabetes Ethnic or cultural food patterns Obesity Vegetarian diet Allergy to tree nuts

Preexisting or gestational illness such as diabetes Ethnic or cultural food patterns Obesity Vegetarian diet (The nurse should be especially aware that conditions such as diabetes can require in-depth dietary planning and evaluation. To prevent issues with hypoglycemia and hyperglycemia and an increased risk for perinatal morbidity and mortality, this patient would benefit from a referral to a dietitian. Consultation with a dietitian may ensure that cultural food beliefs are congruent with modern knowledge of fetal development and that adjustments can be made to ensure that all nutritional needs are met. The obese pregnant patient may be under the misapprehension that because of her excess weight little or no weight gain is necessary. According to the Institute of Medicine, a client with a body mass index in the obese range should gain at least 7 kg to ensure a healthy outcome. This patient may require in-depth counseling on optimal food choices. The vegetarian client needs to have her dietary intake carefully assessed to ensure that the optimal combination of amino acids and protein intake is achieved. Very strict vegetarians (vegans) who consume only plant products may also require vitamin B and mineral supplementation. A patient with a food allergy would not alter that component of her diet during pregnancy; therefore, no additional consultation is necessary.)

The hormone necessary for milk production is: Estrogen. Progesterone. Prolactin. Lactogen.

Prolactin. (Prolactin, secreted by the anterior pituitary, is a hormone that causes the breasts to produce milk. Estrogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced. Progesterone decreases the effectiveness of prolactin and prevents mature breast milk from being produced. Human placental lactogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced.)

Which type of formula is not diluted before being administered to an infant? Powdered Ready-to-use Concentrated Modified cow's milk

Ready-to-use (Ready-to-use formula can be poured directly from the can into baby's bottle and is good (but expensive) when a proper water supply is not available. Formula should be well mixed to dissolve the powder and make it uniform in consistency. Improper dilution of concentrated formula may cause malnutrition or sodium imbalances. Cow's milk is more difficult for the infant to digest and is not recommended, even if it is diluted.)

With regard to basic care of the breastfeeding mother, nurses should be able to advise her that she: Will need an extra 1000 calories a day to maintain energy and produce milk. Can go back to prepregnancy consumption patterns of any drinks, as long as she ingests enough calcium. Should avoid trying to lose large amounts of weight. Must avoid exercising because it is too fatiguing.

Should avoid trying to lose large amounts of weight. (Large weight loss would release fat-stored contaminants into her breast milk. It would also likely involve eating too little and/or exercising too much. A breastfeeding mother need add only 200 to 500 extra calories to her diet to provide extra nutrients for the infant. The mother can go back to her consumption patterns of any drinks as long as she ingests enough calcium, only if she does not drink alcohol, limits coffee to no more than two cups (caffeine in chocolate, tea, and some sodas), and reads the herbal tea ingredients carefully. The mother needs her rest, but moderate exercise is healthy.)

The labor and delivery nurse is preparing a bariatric patient for an elective cesarean birth. Which piece of "specialized" equipment is unnecessary when providing care for this pregnant woman. Extra long surgical instruments Wide surgical table Temporal thermometer Increased diameter blood pressure cuff

Temporal thermometer (Obstetricians today are seeing more morbidly obese pregnant women weighing 400, 500, and 600 pounds. To manage their conditions and to meet their logistical needs, a new medical subspecialty "bariatric obstetrics" has arisen. Extra-wide blood pressure cuffs, scales that can accommodate up to 880 pounds, and extra-wide surgical tables designed to hold the weight of these women are used. Special techniques for ultrasound examination and longer surgical instruments for cesarean birth are also required. A temporal thermometer can be used for a pregnant patient of any size.)

A first-time dad is concerned that his 3-day-old daughter's skin looks "yellow." In the nurse's explanation of physiologic jaundice, what fact should be included? Physiologic jaundice occurs during the first 24 hours of life. Physiologic jaundice is caused by blood incompatibilities between the mother and infant blood types. The bilirubin levels of physiologic jaundice peak between the second and fourth days of life. This condition is also known as "breast milk jaundice."

The bilirubin levels of physiologic jaundice peak between the second and fourth days of life. (Physiologic jaundice becomes visible when the serum bilirubin reaches a level of 5 mg/dL or greater, which occurs when the baby is approximately 3 days old. This finding is within normal limits for the newborn. Pathologic jaundice occurs during the first 24 hours of life. Pathologic jaundice is caused by blood incompatibilities, causing excessive destruction of erythrocytes, and must be investigated. Breast milk jaundice occurs in one third of breastfed infants at 2 weeks and is caused by an insufficient intake of fluids.)

With regard to hemolytic diseases of the newborn, nurses should be aware that: Rh incompatibility matters only when an Rh-negative child is born to an Rh-positive mother. ABO incompatibility is more likely than Rh incompatibility to precipitate significant anemia. Exchange transfusions frequently are required in the treatment of hemolytic disorders. The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth.

The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth. (An indirect Coombs' test may be performed on the mother a few times during pregnancy. Only the Rh-positive child of an Rh-negative mother is at risk. ABO incompatibility is more common than Rh incompatibility but causes less severe problems; significant anemia, for instance, is rare with ABO. Exchange transfers are needed infrequently because of the decrease in the incidence of severe hemolytic disease in newborns from Rh incompatibility.)

The best reason for recommending formula over breastfeeding is that: The mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk. The mother lacks confidence in her ability to breastfeed. Other family members or care providers also need to feed the baby. The mother sees bottle-feeding as more convenient.

The mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk. (Breastfeeding is contraindicated when mothers have certain viruses, are undergoing chemotherapy, or are using/abusing illicit drugs. A lack of confidence, the need for others to feed the baby, and the convenience of bottle-feeding are all honest reasons for not breastfeeding, although further education concerning the ease of breastfeeding and its convenience, benefits, and adaptability (expressing milk into bottles) could change some minds. In any case the nurse must provide information in a nonjudgmental manner and respect the mother's decision. Nonetheless, breastfeeding is definitely contraindicated when the mother has medical or drug issues of her own.)

A newly delivered mother who intends to breastfeed tells her nurse, "I am so relieved that this pregnancy is over so I can start smoking again." The nurse encourages the client to refrain from smoking. However, this new mother insists that she will resume smoking. The nurse will need to adapt her health teaching to ensure that the client is aware that: Smoking has little or no effect on milk production. There is no relation between smoking and the time of feedings. The effects of secondhand smoke on infants are less significant than for adults. The mother should always smoke in another room.

The mother should always smoke in another room. (The new mother should be encouraged not to smoke. If she continues to smoke, she should be encouraged to always smoke in another room removed from the baby. Smoking may impair milk production. When the products of tobacco are broken down, they cross over into the breast milk. Tobacco also results in a reduction of the immunologic properties of breast milk. Research supports that mothers should not smoke within 2 hours before a feeding. The effects of secondhand smoke on infants include sudden infant death syndrome.)

When responding to the question "Will I produce enough milk for my baby as she grows and needs more milk at each feeding?" the nurse should explain that: The breast milk will gradually become richer to supply additional calories. As the infant requires more milk, feedings can be supplemented with cow's milk. Early addition of baby food will meet the infant's needs. The mother's milk supply will increase as the infant demands more at each feeding.

The mother's milk supply will increase as the infant demands more at each feeding. (The amount of milk produced depends on the amount of stimulation of the breast. Increased demand with more frequent and longer breastfeeding sessions results in more milk available for the infant. Mature breast milk will stay the same. The amounts will increase as the infant feeds for longer times. Supplementation will decrease the amount of stimulation of the breast and decrease the milk production. Solids should not be added until about 4 to 6 months, when the infant's immune system is more mature. This will decrease the chance of allergy formations.)

A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lbs) since conception. How would the nurse interpret this? This weight gain indicates possible gestational hypertension. This weight gain indicates that the woman's infant is at risk for intrauterine growth restriction (IUGR). This weight gain cannot be evaluated until the woman has been observed for several more weeks. The woman's weight gain is appropriate for this stage of pregnancy.

The woman's weight gain is appropriate for this stage of pregnancy. (This woman's BMI is within the normal range. During the first trimester, the average total weight gain is only 1 to 2.5 kg. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman's height. A commonly used method of evaluating the appropriateness of weight for height is body mass index (BMI). This woman has gained the appropriate amount of weight for her size at this point in her pregnancy. Weight gain should take place throughout the pregnancy. The optimal rate of weight gain depends on the stage of the pregnancy.)

To help a woman reduce the severity of nausea caused by morning sickness, the nurse might suggest that she: Try a tart food or drink such as lemonade or salty foods such as potato chips. Drink plenty of fluids early in the day. Brush her teeth immediately after eating. Never snack before bedtime.

Try a tart food or drink such as lemonade or salty foods such as potato chips. (Some women can tolerate tart or salty foods when they are nauseous. The woman should avoid drinking too much when nausea is most likely, but she should make up the fluid levels later in the day when she feels better. The woman should avoid brushing her teeth immediately after eating. A small snack of cereal and milk or yogurt before bedtime may help the stomach in the morning.)

Examples of appropriate techniques to wake a sleepy infant for breastfeeding include (Select all that apply): Unwrapping the infant. Changing the diaper. Talking to the infant. Slapping the infant's hands and feet. Applying a cold towel to the infant's abdomen.

Unwrapping the infant. Changing the diaper. Talking to the infant. (Unwrapping the infant, changing the diaper, and talking to the infant are appropriate techniques to use when trying to wake a sleepy infant. Slapping the infant's hand and feet and applying a cold towel to the infant's abdomen are not appropriate. The parent can rub the infant's hands or feet to wake the infant. Applying a cold towel to the infant's abdomen may lead to cold stress in the infant. The parent may want to apply a cool cloth to the infant's face to wake the infant.)

Which vitamins or minerals can lead to congenital malformations of the fetus if taken in excess by the mother? Zinc Folic acid Vitamin D Vitamin A

Vitamin A (Zinc, vitamin D, and folic acid are vital to good maternal and fetal health and are highly unlikely to be consumed in excess. Vitamin A taken in excess causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy.)

A pregnant woman's diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. The nurse would be most concerned about this woman's intake of: Calcium. Vitamin B₁₂. Protein. Folic acid.

Vitamin B₁₂. (This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B₁₂ is found in foods of animal origin, this diet is deficient in vitamin B₁₂.)

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

Weaning can be mother or infant initiated. (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. If the infant is weaned before 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.)

A primiparous woman is delighted with her newborn son and wants to begin breastfeeding as soon as possible. The nurse can facilitate the infant's correct latch-on by helping the woman hold the infant: With his arms folded together over his chest. Curled up in a fetal position. With his head cupped in her hand. With his head and body in alignment.

With his head and body in alignment. (The infant's head and body should be in correct alignment with the mother and the breast during latch-on and feeding. Holding the infant with his arms folded together over his chest, curled up in a fetal position, or with his head cupped in her hand are not ideal positions to facilitate latch-on.)

Which pregnant woman should restrict her weight gain during pregnancy? Woman pregnant with twins Woman in early adolescence Woman shorter than 62 inches or 157 cm Woman who was 20 pounds overweight before pregnancy

Woman who was 20 pounds overweight before pregnancy (A weight gain of 5 to 9 kg will provide sufficient nutrients for the fetus. Overweight and obese women should be advised to lose weight before conception to achieve the best pregnancy outcomes. A higher weight gain in twin gestations may help prevent low birth weights. Adolescents need to gain weight toward the higher acceptable range, which provides for their own growth as well as for fetal growth. In the past, women of short stature were advised to restrict their weight gain; however, evidence to support these guidelines has not been found.)

The newborn with severe jaundice is at risk for developing which of the following? a. Encephalopathy b. Bullous impetigo c. Respiratory distress d. Blood incompatibility

a. Encephalopathy (Unconjugated bilirubin, which can cross the blood-brain barrier, is highly toxic to neurons. An infant with severe jaundice is at risk for developing kernicterus or bilirubin encephalopathy.)

A healthy, full-term baby is scheduled for a circumcision. Nursing actions prior to the procedure include which of the following? (Select all that apply.) a. Obtain written consent from the mother. b. Administer acetaminophen PO 1 hour before procedure per MD order. c. Feed the neonate glucose water 30 minutes before the procedure. d. Obtain the neonate's protime.

a. Obtain written consent from the mother. b. Administer acetaminophen PO 1 hour before procedure per MD order. c. Feed the neonate glucose water 30 minutes before the procedure. (Circumcision is a surgical procedure and requires written consent signed by the parent. Administration of acetaminophen is a method of pain management for the newborn. Glucose water is a method of pain management for the newborn. It is not a standard protocol to obtain a protime prior to circumcision.)

Hemolytic disease is suspected in a mother's second newborn. Which factor is important in understanding how this could develop? a. The mother's first child was Rh positive. b. The mother is Rh positive. c. Both parents have type O blood. d. RhIG (RhoGAM) was given to the mother during her first pregnancy.

a. The mother's first child was Rh positive. (Hemolytic disease of the newborn results from an abnormally rapid rate of red blood cell (RBC) destruction. The major causes of this are Rh and maternal-fetal ABO incompatibility. If an Rh-negative mother has previously been exposed to Rh-positive blood through pregnancy or blood transfusion, antibodies to this blood group antigen may develop so that she is isoimmunized. With further exposure to Rh, the maternal antibodies will agglutinate with the red cells of the fetus who has the antigen and destroy the cells. Hemolytic disease is also caused by ABO incompatibilities. Blood type is the important consideration. If both parents are type O blood, ABO incompatibility would not be a possibility. The mother should have received Rho(D) immune globulin to prevent antibody development after the first pregnancy.)

Which interventions would be included in the nursing care of the newly circumcised infant? (Select all that apply.) a. Wash penis with warm water. b. Wipe with alcohol swab. c. Gently remove the yellow crust formation. d. Apply diaper loosely. e. Dress with simple bandage.

a. Wash penis with warm water. d. Apply diaper loosely. (Postcircumcision care includes washing with warm water, avoiding alcohol wipes, leaving the yellow crust in place, and diapering loosely.)

The parents of a newborn plan to have him circumcised. They ask the nurse about pain associated with this procedure. The nurse's response should be based on the knowledge that newborns: a. experience pain with circumcision. b. do not experience pain with circumcision. c. quickly forget about the pain of circumcision. d. are too young for anesthesia or analgesia.

a. experience pain with circumcision. (Circumcision is a surgical procedure. The American Academy of Pediatrics has recommended that, when circumcision is performed, procedural analgesia be provided.)

Early this morning, a baby boy was circumcised by using the Plastibell method. The nurse should tell the mother that the baby can be discharged after: a. the infant voids. b. receiving vitamin K. c. yellow exudate forms over glans. d. the Plastibell rim falls off.

a. the infant voids. (The circumcision site is evaluated for excessive bleeding every 30 minutes for at least 2 hours. After these observations and voiding, the infant can be discharged. The infant should have received vitamin K soon after delivery. This normal yellow exudate will usually form on the second day after the circumcision. Discharge can occur earlier. The Plastibell rim will separate and fall off within 5 to 8 days. The infant should be discharged before this.)

When should the nurse expect jaundice to be present in a newborn with hemolytic disease? a. At birth b. During first 24 hours after birth c. 24 to 48 hours after birth d. 48 to 72 hours after birth

b. During first 24 hours after birth (In hemolytic disease of the newborn, jaundice is usually evident within the first 24 hours of life.)

Which of the following is the primary treatment for hypoglycemia in neonates? a. Oral glucose feedings b. Intravenous (IV) infusion of glucose c. Short-term insulin therapy d. Feedings (formula or breast milk) at least every 2 hours

b. Intravenous (IV) infusion of glucose (IV infusions of glucose are indicated when the glucose level is very low and when feedings are not tolerated.)

With regard to the long-term consequences of infant feeding practices, the nurse should instruct the obese client that the best strategy to decrease the risk for childhood obesity for her infant is: an on-demand feeding schedule. breastfeeding. lower-calorie infant formula. smaller, more frequent feedings.

breastfeeding. (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.)

When should the nurse expect breastfeeding-associated jaundice to first appear in a normal newborn? a. 0 to 12 hours b. 12 to 24 hours c. 2 to 4 days d. 4 to 5 days

c. 2 to 4 days (Breastfeeding-associated jaundice is caused by decreased milk intake related to decreased caloric and fluid intake by the infant before the mother's milk is well established. Fasting is associated with decreased hepatic clearance of bilirubin.)

A preterm infant has a yellow skin color and a rising bilirubin level. The nurse knows that this infant is at risk for what? a. Skin breakdown b. Renal failure c. Brain damage d. Heart failure

c. Brain damage (The higher the bilirubin level and the deeper the jaundice, the greater is the risk for neurological damage.)

A newborn infant has developed significant jaundice and has a positive Coombs test result resulting from high levels of bilirubin. What should a nurse be aware that these symptoms may indicate? a. Aplastic anemia b. Hemophilia c. Hemolytic anemia d. Sickle cell anemia

c. Hemolytic anemia (Newborns can develop hemolytic anemias resulting from blood incompatibility to their mother. These are typical signs of hemolytic anemia in the newborn.)

Physiologic jaundice in a neonate can be caused by which of the following? a. Fetal-maternal blood incompatibility b. Destruction of red blood cells as a result of antibody reaction c. Liver's inability to bind bilirubin adequately for excretion d. Immature kidneys' inability to hydrolyze and excrete bilirubin

c. Liver's inability to bind bilirubin adequately for excretion (Physiologic jaundice is caused by the immature hepatic function of the infant's liver coupled with the increased load from red blood cell hemolysis. The excess bilirubin from the destroyed red blood cells cannot be excreted from the body.)

A baby was born 4 days ago at 34 weeks' gestation. She is receiving phototherapy as ordered by the physician for physiological jaundice. She has symptoms of temperature instability, dry skin, poor feeding, lethargy, and irritability. The nurse's priority nursing action(s) is (are) to (select all that apply): a. Verify laboratory results to check for hypomagnesia. b. Verify laboratory results to check for hypoglycemia. c. Monitor the baby's temperature to check for hypothermia. d. Calculate 24-hour intake and output to check for dehydration.

c. Monitor the baby's temperature to check for hypothermia. d. Calculate 24-hour intake and output to check for dehydration. (There are two priority nursing interventions for hyperbilirubinemia. Hydration status is important if the newborn shows signs of dehydration such as dry skin and mucus membranes, poor intake, concentrated urine or limited urine output, and irritability. The newborn should also be kept warm while receiving phototherapy. When an infant is under phototherapy, the temperature needs to be monitored closely because the lights give off extra heat, but if the newborn is in an open crib and undressed, hypothermia may occur. Hypomagnesia and hypoglycemia are not related to phototherapy.)

Which of the following is the most appropriate nursing intervention for the neonate who is jittery and twitching and has a high-pitched cry? a. Monitor blood pressure closely. b. Obtain urine sample to detect glycosuria. c. Obtain serum glucose and serum calcium levels. d. Administer oral glucose or, if infant refuses to suck, IV dextrose.

c. Obtain serum glucose and serum calcium levels. (These are signs and symptoms of hypocalcemia and hypoglycemia. A blood test is useful to determine the treatment.)

Where is the best place to observe for jaundice in dark-skinned infants? a. Buttocks b. Tip of nose and sclera c. Sclera, conjunctiva, and oral mucosa d. Palms of hands and soles of feet

c. Sclera, conjunctiva, and oral mucosa (Assessing for jaundice is part of the routine physical assessment in newborns. In dark-skinned infants, the sclera, conjunctiva, and oral mucosa are the best place to observe jaundice because of the lack of skin pigmentation in these areas.)

With regard to nutritional needs during lactation, a maternity nurse should be aware that: the mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy. caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. critical iron and folic acid levels must be maintained. lactating women can go back to their prepregnant calorie intake.

caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. (Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. A lactating woman needs to avoid consuming too much caffeine. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.)

When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that: milk, coffee, and tea aid iron absorption if consumed at the same time as iron. iron absorption is inhibited by a diet rich in vitamin C. iron supplements are permissible for children in small doses. constipation is common with iron supplements.

constipation is common with iron supplements. (Constipation can be a problem. These beverages inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. Children who ingest iron can get very sick and even die.)

Parents ask the nursery staff what the light does for their jaundiced infant. What is the nurse's best response? a. "The light increases the infant's metabolism." b. "The light stimulates liver function." c. "The light dilates blood vessels." d. "The light breaks down bilirubin."

d. "The light breaks down bilirubin." (Severe jaundice can cause kernicterus, an accumulation of bilirubin in the brain tissue, which can lead to serious brain damage. The light breaks down excess bilirubin so that it can be excreted.)

A pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman: drink warm fluids with each of her meals. eat a high-protein snack before going to bed. keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed. schedule three meals and one midafternoon snack a day.

eat a high-protein snack before going to bed. (A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that would contribute to nausea. Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine. Dry carbohydrates such as plain toast or crackers are recommended before getting out of bed. Eating small, frequent meals (about 5 or 6 each day) with snacks helps to avoid a distended or empty stomach, both of which contribute to the development of nausea and vomiting.)

A pregnant woman experiencing nausea and vomiting should: drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. eat small, frequent meals (every 2 to 3 hours). increase her intake of high-fat foods to keep the stomach full and coated. limit fluid intake throughout the day.

eat small, frequent meals (every 2 to 3 hours). (A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated but should compensate by drinking fluids at other times. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried foods and other fatty foods.)

The birth weight of a breastfed newborn was 8 lbs, 4 oz. On the third day the newborn's weight was 7 lbs, 12 oz. On the basis of this finding, the nurse should: encourage the mother to continue breastfeeding since it is effective in meeting the newborn's nutrient and fluid needs. suggest that the mother switch to bottle-feeding since the breastfeeding is ineffective in meeting newborn needs for fluid and nutrients. notify the physician since the newborn is being poorly nourished. refer the mother to a lactation consultant to improve her breastfeeding technique.

encourage the mother to continue breastfeeding since it is effective in meeting the newborn's nutrient and fluid needs. (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 at this time. 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 weight loss is within normal limits; breastfeeding is effective.)

With regard to protein in the diet of pregnant women, nurses should be aware that: many protein-rich foods are also good sources of calcium, iron, and B vitamins. many women need to increase their protein intake during pregnancy. as with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet. high-protein supplements can be used without risk by women on macrobiotic diets.

many protein-rich foods are also good sources of calcium, iron, and B vitamins. (Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron. Most women already eat a high-protein diet and do not need to increase their intake. Protein is sufficiently important that specific servings of meat and dairy are recommended. High-protein supplements are not recommended because they have been associated with an increased incidence of preterm births.)

When planning a diet with a pregnant woman, the nurse's FIRST action would be to: review the woman's current dietary intake. teach the woman about the food pyramid. caution the woman to avoid large doses of vitamins, especially those that are fat-soluble. instruct the woman to limit the intake of fatty foods.

review the woman's current dietary intake. (Reviewing the women's dietary intake as the first step will help to establish if she has a balanced diet or if changes in the diet are required. These are correct actions on the part of the nurse, but the first action should be to assess the patient's current dietary pattern and practices since instruction should be geared to what she already knows and does.)

The nurse taught new parents the guidelines to follow regarding bottle-feeding of their newborn. They will be using formula from a can of concentrate. The parents would demonstrate an understanding of the nurse's instructions if they: wash the top of the can and can opener with soap and water before opening the can. adjust the amount of water added according to the weight gain pattern of the newborn. add some honey to sweeten the formula and make it more appealing to a fussy newborn. warm formula in a microwave oven for a couple of minutes before feeding.

wash the top of the can and can opener with soap and water before opening the can. (Washing the top of the can and can opener with soap and water before opening the can of formula is a good habit for a parent to get into to prevent contamination. Directions on the can for dilution should be followed exactly and not adjusted according to weight gain to prevent nutritional and fluid imbalances. Honey is not necessary and could contain botulism spores. The formula should be warmed in a container of hot water since a microwave can easily overheat it.)

In helping the breastfeeding mother position the baby, nurses should keep in mind that: the cradle position is usually preferred by mothers who had a cesarean birth. women with perineal pain and swelling prefer the modified cradle position. whatever the position used, the infant is "skin to skin" with the mother. while supporting the head, the mother should push gently on the occiput.

whatever the position used, the infant is "skin to skin" with the mother. (The football position usually is preferred after cesarean birth. Women with perineal pain and swelling prefer the side-lying position because they can rest while breastfeeding. The infant should be placed in a "skin to skin" position facing the mother. The mother should never push on the back of the head. It may cause the baby to bite, hyperextend the neck, or develop an aversion to being brought near the breast.)