OB FINAL STACK 12

_ 12. The nurse is teaching newborn care to an adolescent mother. When the nurse attempts to teach how to swaddle the newborn, the mother states, "What's the big deal about how to wrap up a baby?" The nurse needs to convey which reason as being most important for proper swaddling? 1. Improper swaddling can cause hip dysplasia. 2. Correct swaddling will increase the neonate's comfort. 3. Neonates are swaddled only until they can turn from front to back. 4. Two to three fingers need to fit between the infant's chest and the swaddle

1 This is correct. Improper swaddling can cause hip dysplasia. It is especially important to allow the hips to spread apart and bend up. In the womb, the legs are in a fetal position with the legs bent up across each other. Sudden straightening of the legs to a standing position can loosen the joints and damage the soft cartilage of the socket. This is the most important information for the nurse to convey.

5. How many kilocalories per kilogram (kcal/kg) of body weight does a full-term formula-fed infant need each day? a. 50 to 75 b. 100 to 110 c. 120 to 140 d. 150 to 200

ANS: B The term newborn being fed with formula requires 100 to 110 kcal/kg to meet nutritional needs each day. 50 to 75 kcal/kg is too little and 120 to 140 kcal/kg and 150 to 200 kcal/kg are too much. Requirements for breastfed infants are different.

6. Which hormone is essential for milk production? a. Estrogen b. Prolactin c. Progesterone d. Lactogen

ANS: B 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

4. Which type of formula should not be diluted before being administered to an infant? a. Powdered b. Concentrated c. Ready to use d. Modified cow's milk

ANS: C Ready to use formula can be poured directly from the can into the baby's bottle and is ideal (although expensive) when a proper water supply is not available. Formula should be well mixed to dissolve the powder and make it uniform. 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.

13. The nurse is preparing to teach a class on the benefits of breastfeeding for infants. Which benefits will the nurse include in the presentation? Select all that apply. 1. Decreased incidence of SIDS 2. Fewer cases of necrotizing enterocolitis 3. Less likely to become obese adults 4. Decreased risk for developing otitis media 5. Immunity to respiratory syncytial virus

13. ANS: 1, 2, 4 1 This is correct. There is a decreased incidence of SIDS in infants who are breastfed. 2 This is correct. Breastfed infants have fewer cases of necrotizing enterocolitis. 4 This is correct. Breastfed infants have a decreased risk for developing otitis media.

9. The parents of a newborn male are concerned about providing care for the baby's new circumcision performed with a Plastibell. Which information will the nurse include in the teaching plan for the parents? 1. Apply lubricants to the penis to keep the diaper from sticking. 2. Report if penis is red, warm, and swollen and/or there is surgical site drainage. 3. Remove the plastic ring gently on the fifth day after surgery. 4. Contact the health care provider if newborn does not void for 36 hours.

2 This is correct. The nurse will include information to the parents that if the entire penis is red, warm, and swollen and/or there is drainage from the surgical site (signs of infection), it should be reported immediately to the health care provider.

_ 10. The postnatal nurse is making a newborn visit to the parents who are from a different country. The nurse finds the newborn swaddled in a heavy blanket and wearing a knitted cap. The newborn has wet hair and is restless with rapid breathing. Which initial comment from the nurse is appropriate? 1. "Your baby is exhibiting some concerning symptoms." 2. "Share with me how babies are cared for in your country." 3. "I would like to explain how to dress your baby correctly." 4. "Let me explain the baby's symptoms of being overheated."

2 This is correct. When the nurse asks the parents to share how babies are cared for in their country, the nurse is showing interest and respect to the parents' culture. The nurse needs to understand the motivation behind dressing the baby in the current manner.

8. Which information is important for the nurse to provide to mothers of infants of 3 months of age regardless of the method of infant feeding? 1. Why breastfeeding delays the need for solid foods 2. When and what order solid foods are introduced 3. When growth spurts and dietary increases are expected 4. Why the babies are most likely to prefer food over milk

3 This is correct. Mothers need to be aware of probable growth spurts regardless of the method of feeding. Infants experience growth spurts at 3 to 5 days, 1 week, 6 weeks, 3 months, and 6 months and require more frequent feedings during these time periods.

4. A mother who is 2 weeks postpartum asks the nurse lactation specialist how she knows if her baby is hungry. Which hunger indicator does the nurse discuss? 1. Crying when all other physical needs are met 2. If 2 to 3 hours have passed since feeding 3. When the mother experiences a let-down sensation 4. Opening the mouth in response to tactile stimulation

4 This is correct. Opening the mouth in response to tactile stimulation is the best way to determine if a baby is hungry; the rooting reflex is not solicited in a baby who is not hungry

19. The nurse is collecting information from a parent whose infant has frequent diaper dermatitis. Which comment by the parent indicates a possible cause of the condition? Select all that apply. 1. "I use disposable wipes to clean the diaper area." 2. "I buy an antibiotic ointment specified for skin rashes." 3. "I leave the diaper off while the baby is sleeping." 4. "I treat any sign of a rash immediately with zinc oxide." 5. "I even get up and change the baby's diaper during the night."

19. ANS: 2 2 This is correct. When an infant has diaper dermatitis, the use of antibiotic ointments, which can increase the risk of allergic skin reactions, should be avoided. This statement alerts the nurse to a possible cause of the infant's diaper dermatitis

15. A breastfeeding patient who was discharged yesterday calls to ask about a tender hard area on her right breast. What should the nurse's first response be? a. "This is a normal response in breastfeeding mothers." b. "Notify your doctor so he can start you on antibiotics." c. "Stop breastfeeding because you probably have an infection." d. "Try massaging the area and apply heat; it is probably a plugged duct."

ANS: D A plugged lactiferous duct results in localized edema, tenderness, and a palpable hard area. Massage of the area followed by heat will cause the duct to open. This is a normal deviation but requires intervention to prevent further complications. Tender hard areas are not the signs of an infection, so antibiotics are not indicated. Fatigue, aching muscles, fever, chills, malaise, and headache ar

1. A patient in the second trimester of pregnancy is discussing breastfeeding and other options with the nurse. Which question is most important for the nurses to ask? 1. "How does your partner feel about you breastfeeding?" 2. "Do you have family members who have breastfed their babies?" 3. "What are the reasons why you are considering breastfeeding?" 4. "At what point after childbirth do you plan to return to work?"

1 This is correct. The woman's partner plays a significant role in her choice to breastfeed and to continue breastfeeding. Her feelings about and success at breastfeeding are enhanced by her partner's support

5. A mother who is breastfeeding expresses concern about whether her infant is getting enough milk. Which concrete indicator does the nurse provide to the mother? 1. There are at least eight wet diapers and several stools per day. 2. The mother is physically and emotionally comfortable during feedings. 3. The newborn suckles and the mother can hear and/or see swallowing. 4. The newborn spontaneously releases the grip on the breast when satiated.

1 This is correct. The most concrete indicator that the breastfeeding baby is receiving enough milk is at least eight wet diapers and several stools per day.

14. The postpartum nurse-manager wants the unit to become active as a supporter of the Baby-Friendly Hospital Initiative. Which nursing actions will be initiated? Select all that apply. 1. Give pacifiers to infants on demand. 2. Help mothers initiate breastfeeding within 1 hour of birth. 3. Teach breastfeeding and promote lactation to mothers separated from infants. 4. Refer mothers to support group resources on discharge. 5. Provide infants with water until a milk supply is established.

14. ANS: 2, 3, 4 2 This is correct. Initiating breastfeeding early is helpful in establishing breastfeeding. The ideal time line is to initiate breastfeeding within the first hour after birth. 3 This is correct. Even if separated from their infants for a period of time, mothers are offered information about breastfeeding and maintaining lactation. If the separation is related to a medical condition, the mother can pump and supply her infant with breastmilk unless it is medically contraindicated. 4 This is correct. For continuing care, breastfeeding mothers need to be offered the support of other breastfeeding mothers

15. The postpartum nurse is preparing to present infant care information to a couple who expresses concern about when to bathe their newborn. Which behaviors will the nurse present as general guidelines? Select all that apply. 1. Bathing is best after a feeding when newborn is relaxed. 2. Daily bathing with soap is not necessary for the newborn. 3. Use a mild preservative-free soap with a neutral pH. 4. Avoid the use of soap on the face of the newborn. 5. Genital and rectal areas should be cleaned at each diaper change.

15. ANS: 2, 3, 4, 5 2 This is correct. Daily bathing of a newborn with soap is not necessary and can contribute to skin irritation. Between baths with soap, the newborn can be cleaned with clear water. 3 This is correct. When bathing with soap, a mild preservative-free soap with a neutral pH is used to prevent skin irritation. 4 This is correct. The use of soap on the face is not recommended. The face and neck areas should be cleaned after feedings with plain water. 5 This is correct. Genital and rectal areas should be cleaned at each diaper change with water or diaper wipes.

____ 16. A new mother expresses severe frustration with an infant that is exhibiting symptoms of colic. Which suggestions from the nurse are aimed at infant safety? Select all that apply. 1. Hold the infant and sway from side to side or walk around with the infant. 2. Place the infant in a car seat and take him or her for a ride in the car. 3. Place the baby in a safe place and allow the baby to cry for 10 to 15 minutes. 4. Do simple household chores, such as vacuuming or washing the dishes. 5. Place the infant (abdomen down) over the knees and gently rub or pat the back

16. ANS: 3, 4 3 This is correct. When a mother expresses severe frustration with a colicky baby, she needs to place the baby in a safe place and allow the baby to cry for 10 to 15 minutes. The mother can check on the baby when she has calmed down. 4 This is correct. A mother who expresses severe frustration with a colicky baby needs to find a distraction. Doing simple household chores, such as vacuuming or washing the dishes can be effective and allow the mother time to calm down.

17. The nurse is teaching new parents about the Period of PURPLE Crying Program aimed at the prevention of shaken baby syndrome. At the end of the program, the nurse evaluates the program successful if parents select which fact? Select all that apply. 1. Your baby may not stop crying no matter what you do. 2. Your baby may cry more in the late afternoon and evening. 3. A serious condition exists if crying last 5 hours a day or more. 4. Your baby will cry less each week, the least during the first 2 months. 5. A crying baby may look to be in pain, even when he or she is not.

17. ANS: 1, 2, 5 1 This is correct. Parents who understand the baby may not stop crying no matter what they do indicates a successful program 2 This is correct. Parents who understand the baby may cry more in the late afternoon and evening is an indication of a successful program 5 This is correct. Parents who understand the baby may look to be in pain, even when he or she is not, indicates a successful program.

18. The nurse is concerned about the number of infants in the community who die from SIDS even with teaching about "back to sleep" being provided. On which additional preventive measures will the nurse focus? Select all that apply. 1. During pregnancy, women should not smoke, drink alcohol, or use illegal drugs. 2. Infants need to be dressed to prevent infants from overheating during sleep. 3. Mothers need to be informed that breastfeeding reduces the risk for SIDS. 4. Parents should not smoke or allow smoking around their baby. 5. Parents need to avoid products that claim to reduce the risk of SIDS.

18. ANS: 1, 2, 3, 4, 5 1 This is correct. The National Institute of Child Health and Human Development (2017) and American Academy of Pediatrics (2016c) recommend that during pregnancy, women should not smoke, drink alcohol, or use illegal drugs. 2 This is correct. The National Institute of Child Health and Human Development (2017) and American Academy of Pediatrics (2016c) recommend that infants need to be dressed to prevent infants from overheating during sleep. 3 This is correct. The National Institute of Child Health and Human Development (2017) and American Academy of Pediatrics (2016c) recommend that mothers need to be informed that breastfeeding reduces the risk for SIDS. 4 This is correct. The National Institute of Child Health and Human Development (2017) and American Academy of Pediatrics (2016c) recommend that parents should not smoke or allow smoking around their baby. 5 This is correct. The National Institute of Child Health and Human Development (2017) and American Academy of Pediatrics (2016c) recommend that parents need to avoid products that claim to reduce the risk of SIDS

11. The nurse is teaching the mother of a neonate the benefits of kangaroo care. Which action is explained to the mother regarding the procedure? 1. The neonate is tucked into the front of a parent's shirt. 2. A bare-chested neonate is held against a bare-chested parent. 3. A pouch is formed from a blanket for carrying the neonate. 4. The neonate is placed in a sling and placed on a parent's side.

2 This is correct. When the nurse teaches a mother the benefit of initiating kangaroo care, a bare-chested neonate is held against a bare-chested parent and both the neonate and parent are covered with a warm blanket.

6. A breastfeeding mother is planning to return to work 3 months after her baby is born. The mother is planning to use an electric breast pump and freeze some breast milk for use later. Which information does the nurse need to provide? 1. Frozen breast milk can be defrosted in a microwave. 2. Breast milk can be kept in a deep freezer for 6 to 12 months 3. The freezer door shelf decreases the chance of milk contamination. 4. Breast milk can only be frozen in special plastic freezer bags

2 This is correct. Breast milk can be safely kept in a deep freezer for 6 to 12 months; in a freezer attached to a refrigerator, it can be safely stored for 3 to 6 months.

_ 2. The lactation nurse visits the room of a patient who is postpartum and being prepared for discharge. The nurse plans to provide breastfeeding information aimed at assisting the patient to continue breastfeeding her newborn. Which observation by the nurse indicates a possible disruption to the planned teaching? 1. The patient is currently breastfeeding her baby. 2. The patient is excited about taking her baby home. 3. The patient's partner is in the patient's room. 4. The patient states she has no questions or concerns.

2 This is correct. When the patient is distracted by feelings and/or activities, there is the possibility for disruption of the nurse's teaching. The right time for teaching is imperative

3. A patient in the first stage of pregnancy is discussing the options for feeding her infant, and asks the nurse, "Which is the most important reason I should consider breastfeeding my baby?" Which is the most significant reason the nurse presents? 1. Human milk proteins are easier to digest than protein in prepared formula. 2. The amount of cholesterol in human milk is essential for the baby. 3. Human milk contains multiple antibodies, enzymes, and immune factors. 4. Vitamins and minerals are transferred to human milk from the mother

3 This is correct. Human milk contains multiple antibodies, enzymes, and immune factors that help protect the infant from common infections. It also stimulates the growth of healthy bacteria in the intestinal system, which inhibits growth of bacteria that can cause diseases. The factors are not found in formula, and this is the most significant reason for the nurse to recommend breastfeeding.

7. The nurse is collecting information from a new mother who is bottle-feeding her infant. Which comment, if made by the mother, requires the nurse to provide patient teaching? 1. "I wish that I had tried breastfeeding because formula is expensive." 2. "At least I get a break every evening when my spouse feeds the baby." 3. "Sometimes I will add a little water to the formula if I am running low." 4. "I get frustrated if the last bottle is fed to the baby late at night."

3 This is correct. If the mother states a practice of diluting the baby's formula if her supply is low, the nurse needs to provide teaching. Prolonged over-dilution of formulas can cause water intoxication, as well as decrease the caloric intake by the baby

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

ANS: A Inserting a finger into the corner of the baby's mouth between the gums to break the suction avoids trauma to the breast. A popping sound indicates improper removal of the breast from the baby's mouth and may cause cracks or fissures in the breast. The infant who is sleeping may lose grasp on the nipple and areola, resulting in chewing on the nipple, making it sore. Most mothers prefer the infant t

10. The patient should be taught that when her infant falls asleep after feeding for only a few minutes, she should do which of the following? a. Unwrap and gently arouse the infant. b. Wait an hour and attempt to feed again. c. Try offering a bottle at the next feeding. d. Put the infant in the crib and try again later.

ANS: A The infant who falls asleep during feeding may not have fed adequately and should be gently aroused to continue the feeding. Breastfeeding should continue. By offering a bottle, breast milk production will decrease. The infant should be aroused and feeding continued.

22. A mother conveys concern over the fact that she is not certain if her newborn is receiving enough nutrients from breastfeeding. This is the baby's first clinic visit after birth. What information can you provide that will help alleviate her fears regarding nutrient status for her newborn? a. Monitor the infant's output; as long as at least six or more diapers are changed in a 24-hour period, the baby is receiving sufficient intake. b. Tell the mother that if a baby is satisfied with feeding, she or he will be content and not fussy. c. Tell the mother that breast milk contains everything required for the infant and not to worry about nutrition. d. Provide nutrition information in the form of pamphlets for the mother to take home with her so that she uses them as a point of reference.

ANS: A The presence of wet diapers confirms that the infant is receiving enough milk. Recording weight and seeing an increase in weight is also an objective finding that can be used to note nutritional status. Newborns may be fussy and still be receiving adequate nutrition. Although breast milk is potentially the perfect food for the newborn, not everyone's breast milk has the same nutrient quality, therefore recording of weight gain and output measurements (wet diapers and stool production) confirm nutritional status. Providing the mother with educational pamphlets may be advisable; however, does not address the immediate problem.

24. A new mother is preparing for discharge. She plans on bottle feeding her baby. Which statement indicates to the nurse that the mom needs more information about bottle feeding? a. "I should encourage my baby to consume the entire amount of formula prepared for each feeding." b. "I can make up a 24-hour supply of formula and refrigerate the bottles so I am ready to feed my baby." c. "I will hold my baby in a cradle hold and alternate sides from left to right when I feed my baby." d. "I will generally feed my baby every 3 to 4 hours or more often as signs of hunger are displayed."

ANS: A Infants will stop suckling when they are full. Encouraging them to overeat may lead to problems with regurgitation and possible aspiration. The mother can prepare a single bottle or a 24-hour supply if adequate refrigeration is available. Show the parents how to position the infant in a semi-upright position, such as the cradle hold. This allows them to hold the infant close in a face-to-face position. The bottle is held with the nipple kept full of formula to prevent excessive swallowing of air. Placing the infant in the opposite arm for each feeding provides varied visual stimulation during feedings. Feed the infant every 3 to 4 hours but avoid rigid scheduling and take cues from the infant.

9. Which of the following is an important consideration in positioning a newborn for breastfeeding? a. Placing the infant at nipple level facing the breast b. Keeping the infant's head slightly lower than the body c. Using the forefinger and middle finger to support the breast d. Limiting the amount of areola the infant takes into the mouth

ANS: A Positioning the infant at nipple level will prevent downward pulling of the nipple and subsequent nipple trauma. Keeping the infant's head slightly lower will pull the nipple down and cause trauma. The forefinger and middle finger can be used to support the breast; however, this is not an important consideration in positioning the newborn. The infant should take in as much areola as possible to prevent trauma to the nipples.

8. Which is the first step in assisting the breastfeeding mother to nurse her infant? a. Assess the woman's knowledge of breastfeeding. b. Provide instruction on the composition of breast milk. c. Discuss the hormonal changes that trigger the milk-ejection reflex. d. Help her obtain a comfortable position and place the infant to the breast.

ANS: A The nurse should first evaluate the woman's knowledge and skill in breastfeeding to determine her learning needs. Assessment should occur prior to instruction. Discussing the hormonal changes and helping her obtain a comfortable position may be part of the instructional plan; however, assessment should occur first to determine what instruction is needed.

2. Which woman is most likely to continue breastfeeding beyond 6 months? a. A woman who avoids using bottles. b. A woman who uses formula for every other feeding. c. A woman who offers water or formula after breastfeeding. d. A woman whose infant is satisfied for 4 hours after the feeding

ANS: A Women who avoid using bottles and formula are more likely to continue breastfeeding. Use of formula decreases breastfeeding time and decreases the production of prolactin and, ultimately, the milk supply. Overfeeding after breastfeeding causes a sense of fullness in the infant, so the infant will not be hungry in 2 to 3 hours. Formula takes longer to digest. The new breastfeeding mother needs to nurse often to stimulate milk production.

1. Late in pregnancy, the patient's breasts should be evaluated by the nurse to identify any potential concerns related to breastfeeding. Which of the following nipple conditions make it necessary to intervene prior to birth. (Select all that apply.) a. Flat nipples b. Cracked nipples c. Everted nipples d. Inverted nipples e. Nipples that contract when compressed

ANS: A, D, E 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 has been debated. A breast pump can be used to draw the nipples out before feedings after birth. Everted nipples protrude and are normal. No intervention will be required. Cracked, blistered, and bleeding nipples occur after breastfeeding has been initiated and are the result of improper latching on. The infant should be repositioned during feeding. The application of colostrum and breast milk after feedings will aid in healing.

17. What is the most serious consequence of propping an infant's bottle? a. Colic b. Aspiration c. Dental caries d. Ear infections

ANS: B Propping the bottle increases the likelihood of choking and aspiration if regurgitation occurs. Colic can occur in any infant. Dental caries becomes a problem when milk stays on the gums for a long period of time. This may cause a buildup of bacteria that will alter the growing teeth buds. However, this is not the most serious consequence. Ear infections can occur when the warm formula runs into the ear and bacterial growth occurs.

18. A new mother asks why she has to open a new bottle of formula for each feeding. What is the nurse's best response? a. "Formula may turn sour after it is opened." b. "Bacteria can grow rapidly in warm milk." c. "Formula loses some nutritional value once it is opened." d. "This makes it easier to keep track of how much the baby is taking."

ANS: B Formula should not be saved from one feeding to the next because of the danger of rapid growth of bacteria in warm milk. Formula will have bacterial growth before turning sour. This will cause problems in a newborn with an immature immune system. The loss of some nutritional value after the formula is opened is not the reason for using fresh bottles with each feeding. The danger of bacterial growth is the primary concern.

21. A mother is attempting to breastfeed her infant in the hospital setting. The infant is sleepy and displays some audible swallowing, the maternal nipples are flat, and the breasts are soft. The nurse has attempted to teach the mother positioning on one side, and now the mother wants to place the infant to the breast on the other side. Based on LATCH scores, what score would the nurse assign to this feeding session? a. 10 and document findings in the chart. b. 6 and further teach and assist the mother in feeding activities. c. 5 and tell the mother to discontinue feeding attempts at this time because the infant is too sleepy. d. 8 and no further assistance is needed for feeding.

ANS: B The LATCH assessment tool is used to identify whether mothers need additional instruction in the area of breastfeeding. The LATCH categories are latch, audible communication/swallowing, type of nipple, comfort of breasts, and holding position of infant. The assessment data reveal a score of 6 (0 + 2 + 1 + 2 + 1). The mother will need additional assistance during breastfeeding at this time

19. A new mother asks whether she should feed her newborn colostrum because it is not "real milk." The nurse's best answer includes which information? a. Colostrum is unnecessary for newborns. b. Colostrum is high in antibodies, protein, vitamins, and minerals. c. Colostrum is lower in calories than milk and should be supplemented by formula. d. Giving colostrum is important in helping the mother learn how to breast-feed before she goes home.

ANS: B Colostrum is important because it has high levels of the nutrients needed by the neonate and helps protect against infection. Colostrum provides immunity and enzymes necessary to clean the gastrointestinal system, among other things. 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, but the importance of the colostrum to the infant is top priority.

20. A mother is breastfeeding her newborn son and is experiencing signs of her breasts feeling tender and full in between infant feedings. She asks if there are any suggestions that you can provide to help alleviate this physical complaint. The ideal nursing response would be to a. tell the patient to wear a bra at all times to provide more support to breast tissue. b. have the patient put the infant to her breast more frequently. c. place ice packs on breast tissue after infant feeding. d. explain that this is a normal finding and will resolve as her breast tissue becomes more used to nursing

ANS: B The patient may be experiencing the signs of engorgement. Intervention methods such as placing the infant to feed more frequently may help prevent physical complaints of tenderness to milk accumulation. Wearing a bra at all times will not help resolve engorgement issues but can provide comfort. Ice packs provide symptomatic relief but do not resolve engorgement issues. Warm water compresses are more likely to provide comfort. Engorgement is not a normal finding but is a common presentation in nursing mothers. These symptoms will not dissipate with continuation of breastfeeding

3. A new mother asks the nurse, "How will I know early signs of hunger in my baby?" The nurse's best response is which of the following? (Select all that apply.) a. Crying b. Rooting c. Lip smacking d. Decrease in activity e. Sucking on the hands

ANS: B, C, E Early signs of hunger in a baby are rooting, lip smacking, and sucking on the hands. Crying is a late sign, and the baby's activity will increase, not decrease.

2. For which infant should the nurse anticipate the use of soy formula? (Select all that apply.) a. Preterm infant b. Infant with galactosemia c. Infant with phenylketonuria d. Infant with lactase deficiency e. Infant with a malabsorption disorder

ANS: B, D, E Soy formula may be given to infants with galactosemia or lactase deficiency or those whose families are vegetarians. Soy milk is derived from the protein of soybeans and supplemented with amino acids. The formulas are also used for infants with malabsorption disorders. The preterm infant may require a more concentrated formula, with more calories in less liquid. Modifications of other nutrients are also made. Human milk fortifiers can be added to breast milk to adapt it for preterm infants. Low-phenylalanine formulas are needed for infants with phenylketonuria, a deficiency in the enzyme to digest phenylalanine found in standard formulas.

23. A breastfeeding mother asks the postpartum nurse if any supplementation is necessary once her breast milk comes in. What is the nurse's most appropriate response? a. "Are you concerned about your ability to adequately nurse your baby?" b. "Do you eat a well-balanced diet, high in protein and carbohydrates?" c. "Breast milk is low in vitamin D and supplementation with 400 IU is recommended." d. "Your breast milk has all the vitamins and will adequately meet your baby's needs."

ANS: C Generally, nutrients provided in breast milk are present in amounts and proportions needed by the infant. However, recent studies have shown that the vitamin D content of breast milk is low, and daily supplementation with 400 IU of vitamin D is recommended within the first few days of life. Breastfeeding infants who are not exposed to the sun and those with dark skin are particularly at risk for insufficient vitamin D. Formula-fed infants who drink less than 1 quart of vitamin D-fortified milk per day should also be supplemented. Although the fatty acid content of breast milk is influenced by the mother's diet, malnourished mothers' milk has about the same proportions of total fat, protein, carbohydrates, and most minerals as milk from those who are well nourished. Levels of water-soluble vitamins in breast milk are determined by the mother's intake. It is important for breastfeeding women to eat a well-balanced diet to maintain their own health and energy levels

7. Which recommendation should the nurse make to a patient to assist in initiating the milk-ejection reflex? a. Wear a well-fitting firm bra. b. Drink plenty of fluids. c. Place the infant to the breast. d. Apply cool packs to the breast.

ANS: C Oxytocin, which causes the milk let-down reflex, increases in response to nipple stimulation. A firm bra is important to support the breast; however, will not initiate the let-down reflex. Drinking plenty of fluids is necessary for adequate milk production; but, will not initiate the let-down reflex. Cool packs to the breast will decrease the let-down reflex. For many mothers simply thinking of her infant will result in the let-down reflex

3. In which condition is breastfeeding contraindicated? a. Triplet birth b. Flat or inverted nipples c. Human immunodeficiency virus infection d. Inactive, previously treated tuberculosis

ANS: C Human immunodeficiency virus is a serious illness that can be transmitted to the infant via body fluids. Because the amount of milk being produced depends on the amount of suckling of the breasts, providing enough milk should not be a problem. Nipple abnormality can begin to be treated during pregnancy but may begin after birth. Many methods help flat or inverted nipples to become more erect. Only active tuberculosis patients would be cautioned not to breastfeed.

14. Which technique should the nurse recommend to the postpartum patient in order to prevent nipple trauma? a. Assess the nipples before each feeding. b. Limit the feeding time to less than 5 minutes. c. Wash the nipples daily with mild soap and water. d. Position the infant so the nipple is far back in the mouth.

ANS: D 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, causing trauma to the area. Assessing the nipples for trauma is important; however, it will not prevent sore nipples. Stimulating the breast for less than 5 minutes will not produce the extra milk the infant may need. Soap can be drying to the nipples and should be avoided during breastfeeding.

12. As the nurse assists a new mother with breastfeeding, the mother 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 a. more calcium. b. more calories. c. essential amino acids. d. important immunoglobulins.

ANS: D Breast milk contains immunoglobulins that protect the newborn against infection. Calcium levels are higher in formula than breast milk. This higher level can cause an excessively high renal solute load if the formula is not diluted properly. The calorie counts of formula and breast milk are about the same. All the essential amino acids are in formula and breast milk. The concentrations may differ.

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

ANS: D 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. 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. 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.

11. To prevent breast engorgement, what should the new breastfeeding mother be instructed to do? a. Feed her infant no more than every 4 hours. b. Limit her intake of fluids for the first few days. c. Apply cold packs to the breast prior to feeding. d. Breast-feed frequently and for adequate lengths of time.

ANS: D Engorgement occurs when the breasts are not adequately emptied at each feeding or if feedings are not frequent enough. Breast milk moves through the stomach within 1.5 to 2 hours, therefore waiting 4 hours to feed is too long. Frequent feedings are important to empty the breast and establish lactation. Fluid intake should not be limited with a breastfeeding mother; that would decrease the amount of breast milk produced. Warm packs should be applied to the breast before feedings.

16. Which is an important consideration regarding the storage of breast milk? a. Can be thawed and refrozen b. Can be frozen for up to 6 months c. Should be stored only in glass bottles d. Can be kept refrigerated for 72 hours

ANS: D If used within 72 hours after being refrigerated, breast milk will maintain its full nutritional value. It should not be refrozen. Ideally frozen milk should be used within 6 months. Frozen milk should be kept at the back of the freezer. Milk can be stored in glass or rigid polypropylene plastic containers with a tight cap. Frozen milk should be thawed in the refrigerator and need used within 48 hours.