OB Chapter 19

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

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

Breastfeeding is generally encouraged except under certain conditions. Which conditions contraindicate breastfeeding? Select all that apply. when the mother has lactose intolerance when the mother takes certain medications, such as antineoplastics when the mother has active tuberculosis for multiple births when the mother is diagnosed with breast cancer

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

A nursing instructor is teaching new mothers about nutrition and the actual calories infants need for maintenance and growth. Which of the following statements by one of the mothers indicates a need for further instruction? "An adult requires fewer calories per kg than an infant." "Growth in the neonatal period is very rapid." "After 2 months, the amount needed in calories declines." "All infants require the same amount of calories."

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

A woman who has made the decision to bottle-feed expresses to the nurse her concerns about the cost of formula. What is the best response from the nurse? "I'll give you some free samples to take home with you." "You really should breastfeed your baby. It is what is best and it costs less than formula." "Let's see about getting you signed up for the Women, Infants, and Children's Program (WIC)." "The powder formula is the least expensive, and you can adjust the amount that you add to make it last longer."

"Let's see about getting you signed up for the Women, Infants, and Children's Program (WIC)." Telling the woman that she should breastfeed instead of formula-feed may make her feel guilty and is nontherapeutic. Formula must be mixed exactly how it states on the label to prevent malnutrition. Although free samples may make her feel better initially, the BEST response is to connect the woman with resources in her area, such as WIC, that can help her in the long term.

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

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

A mother who is breastfeeding asks the nurse when she should start weaning her infant. Which time factor should the nurse point out is the recommended time? 2 years 6 months 3 months 1 year

1 year The AAP (2018) recommends infants be exclusively breastfed for the first 6 months and breastfed with complementary foods for the first year of life. However, it is ultimately the woman's decision as to how long she will breastfeed. If she chooses to stop breastfeeding at 3 or 6 months, she will need to initiate formula feeding to ensure the infant receives adequate nutrition. The World Health Organization recommends exclusive breastfeeding up to 6 months and continuation up to 2 years.

The nurse is teaching young parents discharge instructions. Which form of birth control should the nurse point out will be the best option for the breastfeeding mom who hopes to have more children later? estrogen-based pill tubal ligation condoms combination hormonal birth control pill

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

All of the following are maternal benefits of breastfeeding except: weight loss. decreased risk of adult-onset asthma. uterine involution. decreased incidence of breast and ovarian cancer.

decreased risk of adult-onset asthma. A decreased incidence of asthma is seen in the newborn, not the mother. Uterine involution, weight loss, and decreased risk of ovarian and breast cancer are all maternal benefits of breastfeeding.

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

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

Parents of a 3-month-old infant have questions about supplying breast milk to a day care facility. Which statement(s) made by the parents indicates to the nurse that further education is needed? Select all that apply. "During feeding, we will tell the workers to place a soft, rubbery nipple on the bottle." "We will tell the day care to open a can of liquid formula if they run out of breast milk." "We will have the workers discard the nipple if milk is dripping at a rapid rate." "We will only supply bottles that contain polycarbonate written on the bottle label." "We will make sure the day care keeps all formula covered and refrigerated throughout the day."

"During feeding, we will tell the workers to place a soft, rubbery nipple on the bottle." "We will tell the day care to open a can of liquid formula if they run out of breast milk." "We will have the workers discard the nipple if milk is dripping at a rapid rate." "We will only supply bottles that contain polycarbonate written on the bottle label." The nurse should caution parents to keep opened cans of liquid formula covered and refrigerated, discarding any unused formula within 24 hours. They should use glass or plastic bottles that are noted to not contain polycarbonate (bisphenol A). Nipples for bottles should be firm enough so an infant sucks vigorously. A soft, flabby nipple allows a baby to suck in milk so rapidly the need for sucking may not be satisfied. A way to judge a nipple's adequacy is to hold a bottle of milk with the nipple attached upside down. The milk should drip from it at a rate of about one drop per second.

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

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

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

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

A woman on the postpartum unit with her 1-day-old infant is asking when her milk will "come in." The nurse should point out this normally occurs at which time after delivery? 6 to 9 days 2 weeks 1 to 2 days 3 to 5 days

3 to 5 days The breast has colostrum during the first few days after delivery. The breast begins to make milk between days 3 and 5 after delivery. At day 6 and beyond, the mother should be producing milk and will gradually increase the amount as she continues to breastfeed her infant.

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

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

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

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

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

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

The nurse will assess the newborn for which potential cause of excess sleepiness? Select all that apply. Research type of pain medication mother is taking. Draw a hemoglobin level for possible anemia. Review bilirubin level for elevation Check glucose level for possible hypoglycemia Draw a toxicology screen for illicit drugs.

Review bilirubin level for elevation Check glucose level for possible hypoglycemia Often, a newborn being breastfed becomes sleepy at the breast, especially in the first 24 hours of life. Jaundice and hypoglycemia are also causes of sleepiness at the breast. Anemia is rare in newborns. After assessing the infant for jaundice and hypoglycemia, the nurse should consider substances that may be in the mother's milk, such as opioids or illicit drugs.

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

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

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

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

A new mother asks when she can give her infant fruit juice. The nurse would most likely instruct the mother to wait until the infant is how old? 12 months old 5 months old 3 months old 8 months old

8 months old Fruit juice is not recommended for infants younger than 6 months because it supplies no protein and, if not pasteurized, can carry infectious organisms. The amount should be limited to 3 to 4 ounces.

The postpartum nurse is teaching a nutrition class for a group of new breastfeeding mothers. Which topics should be included in this presentation? Select all that apply. If any of the mothers are smoking, they should try to stop with the help of smoking cessation class. Caffeine intake can affect the newborn while breastfeeding, so mothers should try to limit consumption if possible. Recommend the mothers increase their water intake to at least four to six 8-oz glasses/day. Recommend an increase in caloric intake of at least 1,000 calories/24 hour period. Social drinking of alcohol is permitted during breastfeeding as long as the mother consumes three or less drinks per day.

Caffeine intake can affect the newborn while breastfeeding, so mothers should try to limit consumption if possible. Recommend the mothers increase their water intake to at least four to six 8-oz glasses/day. The nurse should remind women a good intake of water is necessary to maintain an adequate milk supply and should also recommend they drink at least four 8-oz glasses of water a day; many may need to drink six glasses. They also need to increase their calorie intake by about 500 calories per day. Alcohol and caffeine can affect the newborn and should be avoided by the breastfeeding mother. Cigarette smoking is not a contraindication to breastfeeding, but women should be aware some nicotine is carried in breast milk.

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

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

The nurse is assisting a primigravida woman make decisions and prepare for her baby. The nurse should point out that breastfeeding is not an option for this client based on which assessment finding? breast implants HIV infection galactosemia need to return to work quickly

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

A client in the early stage of labor informs the nurse that she is planning to breastfeed. She tells the nurse that this is her first baby and wants to begin breastfeeding as soon as possible. When should the nurse tell the mother she will be able to start breastfeeding? immediately after birth 6 to 8 hours after birth the very next day after the birth 2 to 4 hours after birth

immediately after birth Most hospitals begin breastfeeding immediately after birth.

The nurse is conducting a prenatal class on breastfeeding. The nurse determines the class is successful when the young parents correctly choose which time frame is recommended for breastfeeding the infant? 6 months one year 4 months two years

one year It is recommended that the infant be fed exclusively by breastfeeding for the first six months and then continued with supplemental breastfeeding until the infant is 1 year old. However, when the mother stops breastfeeding is a personal choice as some will continue breastfeeding until the infant is 2 years old.

A student nurse asks the preceptor how breastfeeding protects the infant from getting ill due to viruses and bacteria. Which physiologic concept will the nurse discuss with this student? how the lymphatic system works function of the various types of red blood cells purpose of the spleen properties of immunoglobulin A (IgA)

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

Which factors affect a woman's decision to breastfeed? Select all that apply. work status socioeconomic family past experience culture

work status socioeconomic family past experience culture The decision to breastfeed is multifaceted. Several factors can influence a woman's decision regarding whether to breastfeed. These include family influences, peer influences, socioeconomic factors, culture, past experiences, whether the mother intends to return to work, and more.

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

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

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

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

Which instruction should a nurse give to a lactating client about how to break suction during a feeding? Shift the infant to the football hold from the cross-cradle hold. Insert a finger into the corner of the baby's mouth between the gums. Instruct the mother to tug at the nipple gently but insistently. Instruct the mother to press both cheeks of the infant simultaneously.

Insert a finger into the corner of the baby's mouth between the gums. The nurse should instruct the client to insert her finger into the corner of the baby's mouth between the gums to break the suction. The mother should not tug at the nipple, as this might damage the infant's unexposed teeth. Pressing both the cheeks of the infant simultaneously or shifting the infant to the football hold from the cross-cradle hold will not help break the suction.

Breast milk contains all of the following except: lactoferrin Listeria lysozyme immunoglobulins

Listeria Breast milk contains immunoglobulins (antibodies), lactoferrin (an iron-binding protein), and the enzyme lysozyme. Listeria is a bacterium that is not found in breast milk.

The nurse is monitoring a breastfeeding session and determines the infant is nursing well. Which assessment finding is the nurse using to make this determination? The mother has difficulty rousing the newborn for a feeding. The mother is experiencing uterine contractions. The newborn has a dry mouth after feedings. The mother is free of painful engorgement.

The mother is experiencing uterine contractions. When the infant is latched on and breastfeeding well, the body will release oxytocin and the result is uterine contractions. This is a good sign that the infant has a good latch. A lack of painful engorgement does not mean that the infant is getting an adequate supply of milk. The mucous membranes of an infant's mouth should be moist and pink. Being able to rouse an infant for feeding or having a difficult time rousing the infant are not indicators that the breastfeeding is going well. Indications that breastfeeding is going well include the following: a newborn that is correctly latched onto the breast will resist being pulled off of the breast; audible swallowing and rhythmic jaw gliding; leaking from the opposite breast or a let-down reflex.

The nursing instructor is conducting a teaching session illustrating the basics of feeding newborns. The instructor determines the class is successful after the students correctly choose which disorder as a contraindication to breastfeeding? hypothyroidism phenylketonuria (PKU) hypertension galactosemia

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

When asked by a parent to compare the feeding habits of formula-fed and breastfed infants, what is the correct response from the nurse about breastfed infants? usually feed every 4 hours digest their milk more slowly experience longer periods between feeds go approximately 3 hours between feedings

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

When using the LATCH assessment tool, the nurse will evaluate breastfeeding using which factors? latch, jaw thrusting, areola, maternal comfort level, and hold/positioning latch, audible swallowing, type of nipple, nipple comfort, and hold/positioning latch, audible swallowing, type of areola, pain in the infant and mother, and hold/positioning latch, jaw movements, type of nipple, pain in the infant and mother, and hold/positioning

latch, audible swallowing, type of nipple, nipple comfort, and hold/positioning The LATCH assessment tool is used to help the nurse evaluate a newborn's breastfeeding effectiveness. The nurse would evaluate the mother and newborn on latch, the presence of audible swallowing, the shape and size of the nipple, any level of discomfort in the nipple, and hold/positioning of the baby.

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

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

A client is 6 weeks' postpartum and has been breastfeeding exclusively. She began pumping 2 days ago in anticipation of going back to work. She notices that her milk is blue-tinged. How should the nurse counsel this client? "A slightly bluish color is normal." "This is a sign of too much fluoride in the milk. You should stop your supplements." "This is an indication that you are lacking iron in your diet. You will need to start iron supplementation." "This is a sign of mastitis. You will need to take an antibiotic."

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

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

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

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

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

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

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

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

Feed the infant a lactose-free formula. The nurse should instruct the client to feed the infant a lactose-free formula, because the infant is lactose intolerant. The client should avoid breastfeeding even as she avoids consuming milk products or after the infant is two weeks old. The infant does not have tyrosinemia, thus infant formula with amino acids is not contraindicated.

The nurse is conducting a prenatal class on the pros and cons of breastfeeding versus formula feeding. Which deciding factor should the nurse prioritize when assisting these parents to make their decision? Strongly encourage only breastfeeding to all parents. It depends on how the newborn responds to the feeding. Stress the disadvantages to formula feeding. It is based on their personal preference and situation.

It is based on their personal preference and situation. An assessment of newborn nutrition begins during pregnancy with an assessment of the mother's and her partner's attitudes and choices about infant feeding. Breastfeeding is widely accepted as the preferred method of human newborn nutrition and should be recommended but not forced on the parents. If a mother chooses not to breastfeed as a personal preference based on her situation, it is important she not be made to feel guilty for her choice. Most importantly, parents need to feel comfortable with and confident about the feeding method they choose. Feeding should be a pleasurable experience, so both parents should be comfortable with the chosen method. There are a few reasons why an infant should be formula-fed. These include adverse reactions to the mother's milk and allergies. The nurse should ensure the parents are provided information for both forms of feeding so they can make an informed decision and then the nurse should support their decision and assist them as they learn how to care for their infant.

A breastfed infant has been diagnosed with nonphysiologic jaundice. When developing a plan of care, nursing interventions are related to which fact? Intake and output will show an elevated output of urine. Laboratory reports will likely report a blood abnormality. Evaluation will report an impaired liver function. There is an inadequate intake of breast milk.

There is an inadequate intake of breast milk. The nurse must understand that nonphysiologic jaundice in a breastfed infant results from inadequate intake of breast milk. Nursing interventions will include breastfeeding strategies and ways to increase fluid intake. Blood abnormalities and impaired liver function are associated with pathologic jaundice. Elevated urinary output is not associated with nonphysiologic jaundice in infants.

At a follow-up visit to the health care provider's office, a woman who is breastfeeding her newborn is planning to return to work and will be pumping her breasts for feedings while she is away. After teaching the woman about pumping her breasts and storing the expressed breast milk, the nurse determines that the teaching was successful based on which statement by the woman? "I can keep expressed breast milk in the refrigerator for up to 4 days." "If the milk has been more than 2 hours at room temperature, my baby sitter should throw it out." "I can tell my baby sitter to warm the milk in the microwave." "I can refreeze any breast milk that was frozen and then thawed."

"I can keep expressed breast milk in the refrigerator for up to 4 days." Breast milk can be stored in the refrigerator for up to 4 days and at room temperature for up to 4 hours. It should be stored in hard plastic bottles or breast milk bags. The proper way to reheat breast milk is to place the bottle/bag into a pan of hot water. Heating in the microwave kills the antibodies in breast milk. In addition, milk reheated in the microwave may have hot spots that could burn the newborn's mouth and esophagus. Breast milk that has been frozen and thawed should never be refrozen; doing so may introduce further breakdown of nutrients and increase the risk of bacterial growth.

A G1 P1 mother asks the nurse "Why is my baby losing weight? He dropped 6 oz from yesterday to today. Is my breast milk not good?" Which answer is the best response to this new mother? "Don't worry. You baby will have plenty of time to gain weight over the upcoming months." "I will let the health care provider know that you are concerned about your baby's weight dropping." "This is nothing to worry about. He will get a stronger suck reflex which will help increase his intake." "It is normal for breastfed newborns to lose as much as 7% of birth weight the first 3 days after birth."

"It is normal for breastfed newborns to lose as much as 7% of birth weight the first 3 days after birth." Breastfed newborns may lose up to 3% of birthweight on day 1, 5% of birth weight on day 2, and 7% of birthweight on day 3; a breastfed infant regains birth weight at about 14 days. Babies are born with the ability to suck milk from either a breast or a bottle. Deferring to answer the question will make the mother think something is wrong with her infant when, in fact, weight loss is normal. It will take about 2 weeks to regain weight, rather than months.

A new mother who is about to be discharged expresses concern about how to know her baby is getting enough breast milk. Which response should the nurse prioritize? "Make sure the baby stays on the breast for at least 5 minutes each time on each side." "Observe if your baby is eating 8-12 times a day." "Supplementing with one bottle of formula is okay." "If you have nipple pain, that is a sign of inadequate supply."

"Observe if your baby is eating 8-12 times a day." Breastfeeding mothers may fear their newborns are not getting adequate amounts of breast milk at each feeding. This may be especially true when the newborn cries for reasons other than hunger. Mothers cannot measure the amount of breast milk the newborn ingests each feeding. Nurses can reassure mothers by instructing them to look for signs the newborn is voiding and defecating within the acceptable range and waking for feedings 8-12 times in 24 hours. The amount of time at the breast is not a good indication that an infant is getting adequate nutrition. Each infant is different and will receive an adequate amount over varying lengths of time at the breast. Nipple pain can be a sign of an ineffective latch, not of inadequate supply.

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

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

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

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

While breastfeeding, all of the following can contribute to sore nipples except: allowing the newborn to suck too long improper newborn latch. allowing the nipples to dry after each feeding. forceful detachment of the newborn from the breast.

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

The lactation nurse is working with a woman who is experiencing some difficulties getting her newborn to "latch on" to her breast. They are trying various positions to see which is best for this infant. The nurse will document which nursing problem related to this teaching session? Risk for ineffective breastfeeding resulting in switching to a bottle Imbalanced nutrition, less than body requirements related to poor latch Anxiety related to not being able to communicate with infant about how best to position during feedings Risk for impaired parenting due to mother's stress of possible breastfeeding failure

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

Which postpartum client would the nurse advise to pump her breasts to provide breast milk to her newborn? Select all that apply. a woman with genital herpes who is experiencing an outbreak an infant with a latch score of 5 on two different observations an infant with respiratory distress who is in the NICU a newborn who is 24 hours old and has loss 3% of body weight a woman with an inverted nipple using a breast shield to no avail

an infant with a latch score of 5 on two different observations an infant with respiratory distress who is in the NICU a woman with an inverted nipple using a breast shield to no avail Mothers may need to pump to provide breast milk to their newborns in the following circumstances: infants in NICU; infants with weight loss ≥8%, latch scores ≤7x2 and in need of supplementation; and mothers using breast shield. Genital herpes outbreak should not interfere with breastfeeding as long as a good handwashing technique is practiced. It is normal for a newborn to lose 3% of their body weight the first 24 hours.

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

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

A nurse is caring for a pregnant client undergoing chemotherapy treatment. Which instruction will a nurse give to this client regarding the ability to breastfeed the newborn? You will be able feed the newborn expressed breast milk. You will need to avoid breastfeeding. Take the chemotherapeutic medication after breastfeeding. Increase fluids by an additional 8 oz (0.25 L) due to the chemotherapeutic medications.

You will need to avoid breastfeeding. The nurse should instruct a client to avoid breastfeeding while undergoing chemotherapy because antineoplastic agents are toxic to the infant. Taking medications after breastfeeding or feeding the infant expressed milk will not reduce the risk posed by antineoplastic agents in the client's milk. Increasing fluid consumption does not provide the ability to breastfeed.

The new mother is surprised to learn that oxytocin is helping her breastfeed her baby, especially after her health care provider used oxytocin to induce her labor. Which additional function of oxytocin should the nurse point out to the mother?

contracts breast cells to move the milk out of ducts Oxytocin is a muscle stimulant; the role of oxytocin in breastfeeding is to move the milk down the ducts and out of the breast for feeding. Oxytocin does not increase the production of milk; only complete emptying of the breast stimulates an increase in the production of milk. Prolactin is responsible for stimulating the release of milk, which then moves into the ducts. The receptor sites in the breast are responsible for the increased production of milk. Lactogen aids in milk production by stimulating the receptor sites.

The nurse is teaching a class for expectant parents at the community center. One woman asks about the benefits of breastfeeding. What benefits to the mother would the nurse identify? Select all that apply. improved postpartum weight loss lower risk for heart disease reduced rates of breast cancer improved involution of the uterus reduced incidence of infections

improved postpartum weight loss lower risk for heart disease reduced rates of breast cancer improved involution of the uterus Maternal benefits of breastfeeding include improved involution of the uterus, improved postpartum weight loss, reduced rates of breast cancers, and lower risk for heart disease. It does not have an impact on maternal immune status.

A new mother of twins asks the nurse if there is any way she can feed them both at the same time. Which piece of equipment would the nurse recommend for this situation? a mold that only exposes the breasts so the mother can feed on her stomach side by side pillow supports designed with wider sides to allow the twins to feed at the same time an extra-wide heating pad on both breasts, which will help stimulate milk production for both infants an extra-wide chair to allow the mother to use the football hold on both sides without fear of dropping an infant

pillow supports designed with wider sides to allow the twins to feed at the same time Nurses can recommend pillow supports designed to allow twins to feed simultaneously. These pillows are similar to the pillows used to support one baby, but they are wider on the sides to support two babies for simultaneous feedings. The other equipment items are not needed to breastfeed twins.

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

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