Chapter 24 - Newborn Nutrition & Feeding (Maternity) EAQ's

The nurse is caring for a postpartum patient who has been advised to give expressed breast milk to the newborn. What should the nurse tell the patient about the use and storage of expressed milk? Select all that apply. 1 "Never refreeze thawed breast milk." 2 "Always heat frozen milk in the microwave." 3 "Never store breast milk with other food items." 4 "Wash your hands before pumping breast milk." 5 "Store breast milk in serving sizes of 2 to 4 ounces."

1 - "Never refreeze thawed breast milk." 4 - "Wash your hands before pumping breast milk." 5 - "Store breast milk in serving sizes of 2 to 4 ounces." pg 622 - Thawed breast milk should never be refrozen, because thawing and refreezing results in a loss of antibacterial properties in the milk, which promotes bacterial growth. The mother should wash her hands before pumping breast milk to avoid contamination. Breast milk should be stored in serving sizes of 2 to 4 ounces to prevent waste. Frozen milk should never be heated in the microwave because it destroys the immunologic properties of the breast milk. Breast milk can be stored with other food items in the freezer or refrigerator. This does not cause contamination.

A mother reports to the nurse, "My baby cries incessantly after waking up and does not focus on feeding." What suggestions should the nurse give to calm the fussy infant? Select all that apply. 1 "Place the baby close to the skin." 2 "Gently massage the baby's chest." 3 "Allow the baby to suck your finger." 4 "Hold the baby in an upright position." 5 "Swaddle the baby and talk soothingly."

1 - "Place the baby close to the skin." 3 - "Allow the baby to suck your finger." 5 - "Swaddle the baby and talk soothingly." pg 619 - Fussiness in infants usually results from cramping or gas pains. Therefore allowing the infant to suck on a finger until calm will help the infant latch onto the breast. Swaddling the baby, talking soothingly, and placing the baby close to the skin provide comfort and calm the baby. Holding the baby in an upright position and gently massaging the baby's chest are done to awaken the baby for feeding.

While caring for a postpartum patient, the nurse finds that she is unable to feed her newborn on time because the baby spends most of the time sleeping. What should the nurse suggest to the patient in this situation? 1 "You can wake the baby up by gently massaging his back." 2 "Do not allow the baby to suck his thumb because it promotes sleep." 3 "Avoid swaddling the baby with a blanket because it prevents deep sleep in the baby." 4 "Store the expressed breast milk in a bottle and feed the baby when he wakes up."

1 - "You can wake the baby up by gently massaging his back." pg 619 - Feeding the baby on time is difficult if the baby spends most of the time sleeping. The mother can wake the baby by gently massaging the back. Preventing thumb sucking will not help wake the baby. The baby should be properly covered with a blanket to prevent cold stress. The nurse should encourage the patient to feed the baby on time because it helps promote growth and development in the newborn. Therefore the nurse should not advise the patient to give stored milk to the baby.

With regard to the long-term consequences of infant feeding practices, the nurse should instruct the obese woman that the best strategy to decrease the risk for childhood obesity for her infant is what? 1 Breastfeeding 2 Lower-calorie infant formula 3 An on-demand feeding schedule 4 Smaller, more frequent feedings

1 - Breastfeeding pg 606 - 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.

Which statement indicates the effect of breastfeeding on the family or society at large? Select all that apply. 1 Breastfeeding saves families money. 2 Breastfeeding benefits the environment. 3 Breastfeeding results in reduced annual health care costs. 4 Breastfeeding costs employers in terms of time lost from work. 5 Breastfeeding requires fewer supplies and less cumbersome equipment.

1 - Breastfeeding saves families money. 2 - Breastfeeding benefits the environment. 3 - Breastfeeding results in reduced annual health care costs. 5 - Breastfeeding requires fewer supplies and less cumbersome equipment. pg 606 - 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.

What is the priority teaching tip the nurse should provide about bottle-feeding? 1 Hold infant semi-upright while feeding 2 Feed newborn at least every 3 to 4 hours 3 Some infants take longer to feed than others 4 Infants may stool with each feeding in the first weeks

1 - Hold infant semi-upright while feeding pg 630 - 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. Taking a few sucks and then pausing briefly before continuing to suck again is normal for infants. 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. 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 nurse tells a new mother, "Feeding in the first 3 days after childbirth is very important." What are the reasons behind this statement? Select all that apply. 1 It facilitates passing of meconium. 2 It promotes growth spurts in babies. 3 It helps establish flora in the intestine. 4 The milk during the first 3 days contains rich antibodies. 5 The milk during the first 3 days contains rich proteins and fats.

1 - It facilitates passing of meconium. 3 - It helps establish flora in the intestine. 4 - The milk during the first 3 days contains rich antibodies. pg 611 - Colostrum is produced in the first 3 days after childbirth. Colostrum promotes the early passage of meconium (earliest stool of the infant), which consists of the material ingested when the baby is in the uterus. Colostrum contains high amounts of antibodies, which help develop immunity in infants. Colostrum is useful in establishing flora in the digestive tract of an infant and stimulates the immune system. Occurrence of growth spurts is not related to feeding of colostrum. Growth in infants may occur as long as breastfeeding is adequate. Colostrum is rich in proteins but low in fats.

Which action of a breastfeeding mother indicates the need for further instruction? 1 Leans forward to bring breast toward the baby 2 Puts her finger into newborn's mouth before removing breast 3 Holds breast with four fingers along bottom and thumb at top 4 Stimulates the rooting reflex and then inserts nipple and areola into newborn's open mouth

1 - Leans forward to bring breast toward the baby pg 613 - 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.

The nurse is teaching a new mother about breastfeeding. What infant assessment should the nurse ask the mother to perform to find out whether the infant's milk intake is adequate? 1 Urine output 2 Growth pattern 3 Sleeping cycles 4 Frequency of crying

1 - Urine output pg 616 - The infant's urine output is directly related to milk intake. Therefore, if breastfeeding is adequate, the infant's urine frequency will increase. In addition, urine is less concentrated and light yellow in color. Sleeping cycles in infants are unrelated to feeding. Long-term growth patterns may be related to the nutritional composition of the milk but may not be related to the quantity of milk intake. Not all infants cry for hunger.

Which statement regarding infant weaning is correct? 1 Weaning can be mother- or infant-initiated. 2 Abrupt weaning is easier than gradual weaning. 3 Weaning should proceed from breast to bottle to cup. 4 The feeding of most interest should be eliminated first.

1 - Weaning can be mother- or infant-initiated. pg 623 - 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.

The maternity nurse must be aware that cultural practices influence infant feeding choices, and that there are diverse ethnic cultures within the United States. Although nurses should not assume that generalized observations of any cultural group are true for all its members, transcultural researchers have identified common characteristics among specific cultural groups for the purpose of improving nursing care for these clients. Which statement related to cultural research observations that influence infant feeding practice is correct? 1 Latinas who are acculturated to the United States are more likely to breastfeed. 2 A common infant feeding practice among Mexican women is known as las dos cosas. 3 Muslim cultures do not encourage breastfeeding due to modesty concerns. 4 Southeast Asian women believe that cold foods are best for new breastfeeding mothers.

2 - A common infant feeding practice among Mexican women is known as las dos cosas. pg 608 - A common infant feeding practice observed among Mexican women by transcultural researchers is called las dos cosas. This refers to combining breastfeeding and commercial infant formula and is based on the belief that the mother and infant receive the benefits of breastfeeding along with the additional vitamins from formula by combining the two feeding methods. Transcultural investigators of Muslim cultural practices have shown that breastfeeding for 24 months is customary and that Muslim women may choose to bottle-feed using formula or expressed breast milk while in the hospital. Cultural researchers have also observed that Latinas who are acculturated to the United States are less and not more likely to breastfeed after childbirth. Transcultural researchers have also learned that Southeast Asian women believe that hot foods are best for the new breastfeeding mother in order to restore the balance of hot and cold forces (like yin and yang) during postpartum and has nothing to do with the temperature or spiciness of the food.

The nurse is caring for a new mother and baby. What are the most suitable nursing interventions for the welfare of the mother and the child? Select all that apply. 1 Showing only the mother how to breastfeed 2 Educating about the importance of breastfeeding 3 Observing at least one feeding every shift each day 4 Teaching about proper latching and suitable positions 5 Documenting the frequency of feedings only during the day

2 - Educating about the importance of breastfeeding 3 - Observing at least one feeding every shift each day 4 - Teaching about proper latching and suitable positions pg 615/617 - The nurse should observe at least one feeding every shift each day while the mother and newborn are in the hospital. This helps the nurse educate the new mother about the correct method of breastfeeding. The nurse should teach the patient about proper latching and suggest suitable positions. The nurse should provide counseling to highlight the importance of breastfeeding, teach the breastfeeding techniques, and support the mother during breastfeeding. The nurse should teach and demonstrate breastfeeding techniques not only to the mother but also to her family because the family can help the mother during breastfeeding. The nurse should note the frequency of feedings not only during the day but also at night to ensure that the baby is feeding well and gaining weight appropriately.

A postpartum patient is worried that she cannot feed her child effectively. What are the most suitable nursing interventions for decreasing the patient's anxiety? Select all that apply. 1 Modifying the infant's feeding methods 2 Providing education about breastfeeding 3 Providing information for lactation support 4 Monitoring the neonate's weight, intake, and output 5 Monitoring the position of infant's mouth on the areola

2 - Providing education about breastfeeding 3 - Providing information for lactation support 4 - Monitoring the neonate's weight, intake, and output pg 618 - Providing education about breastfeeding increases the patient's knowledge about breastfeeding. Providing information for lactation support decreases anxiety during breastfeeding. Monitoring the neonate's weight, intake, and output provides the mother with information about the adequacy of feeding. Modifying the infant's feeding methods helps meet the infant's hydration and nutritional needs. Monitoring the position of the infant's mouth on the areola gives a positive reinforcement for the infant's latch position.

The nurse is providing postpartum care to a new mother who just gave birth. The new mother reports having a hard time getting her infant to "latch on" while breastfeeding. She expresses frustration with the process and asks the nurse whether breastfeeding has any real benefits. What can the nurse identify as benefits of breastfeeding? Select all that apply. 1 Increases time between feedings 2 Reduces the risk of the child having asthma 3 Reduces the risk of hypertension in the mother 4 Reduces the risk of the child getting type 1 diabetes 5 Increases bonding experience between mother and child

2 - Reduces the risk of the child having asthma 3 - Reduces the risk of hypertension in the mother 5 - Increases bonding experience between mother and child pg 606 - Breastfeeding has multiple benefits for the infant and the mother, including reducing the risk of the child having asthma, reducing the risk of hypertension in the mother, and increasing the bonding experience between the mother and child. Breastfeeding does not increase the time between feedings. Breastfeeding reduces the risk of the child getting type 2 diabetes, not type 1 diabetes.

While assessing breastfeeding in a postpartum patient, the nurse finds that the baby does not feed properly even when hungry. What is the best nursing intervention? 1 Advising the patient to feed the baby from a bottle 2 Teaching about effective latching of the baby onto the breast 3 Teaching the patient to feed the baby in the hunched position 4 Advising the patient to continue breastfeeding the same way

2 - Teaching about effective latching of the baby onto the breast pg 613 - Latching is the sufficient grip of the infant's mouth over the mother's breast for effective breastfeeding. If the baby is hungry even after breastfeeding, it implies that the baby is not latching properly, resulting in inadequate feeding. Therefore the nurse should help the baby latch properly. Bottle-feeding is not advised until breastfeeding has been well established. Feeding in the hunched position would not help in latching, resulting in inadequate feeding of the infant. If the patient continues breastfeeding in the same way, the baby may remain hungry and may not be well fed.

The nurse advises a postpartum patient not to give any water to her 1-month-old infant after breastfeeding. What is the reason for this advice? 1 The infant does not have any fluctuations in fluid balance. 2 The breast milk contains enough water to hydrate the child. 3 The infant's calorie consumption is increased by excess water. 4 The infant has sufficient fluid reserves, which prevent dehydration.

2 - The breast milk contains enough water to hydrate the child. pg 608 - Breast milk is the best source of fluid for the infant because it contains 87% water. Breast milk meets the infant's fluid needs. Neonates have fluid reserves during birth, which get depleted in a few days. Infants do have fluctuations in fluid balance, which are to be monitored regularly by the nurse. Taking additional water decreases the infant's caloric consumption.

The nurse tells the mother of a full-term infant to start giving iron supplements to the child only after 4 months of age. Why does the nurse recommend this? 1 The iron needs of the infant before 4 months are minimal. 2 The mother's milk is sufficient to meet the iron demands of the child. 3 Enzymes present in the infant's gastrointestinal tract produce ferric ions. 4 Gastrointestinal absorption of iron is impaired in full-term children before 4 months.

2 - The mother's milk is sufficient to meet the iron demands of the child. pg 609 - Breastfed infants do not need supplemental iron before 4 months of age because their iron needs are met by breast milk. Infants need enough iron for formation of hemoglobin. There are no enzymes that produce ferric ions in infants or adults. Iron should be acquired from dietary sources. Iron absorption is well developed in infants. They are able to absorb the iron present in breast milk.

Which instructions should the nurse include when teaching a mother about the storage of breast milk? Select all that apply. 1 Store milk in 8 to 12 oz containers. 2 Wash hands before expressing breast milk. 3 Store refrigerated milk in the door of the refrigerator. 4 Milk thawed in the refrigerator can be stored for 24 hours. 5 Place frozen milk in the microwave for only a few seconds to thaw.

2 - Wash hands before expressing breast milk. 4 - Milk thawed in the refrigerator can be stored for 24 hours. pg 622 - Breast milk storage guidelines for home use for full-term infants are: (1) Before expressing or pumping breast milk, wash your hands. (2) 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 (less than 72 hours). (3) Write the date of expression on container before storing milk. A waterproof label is best. (4) Store milk in serving sizes of 2 to 4 ounces to prevent waste. (5) Storing breast milk in the refrigerator or freezer with other food items is acceptable. (6) When storing milk in a refrigerator or freezer, place containers in the middle or back of the freezer, not on the door. (7) When filling a storage container that will be frozen, fill only three quarters full, allowing space at the top of the container for expansion. (8) 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. (9) Milk thawed in the refrigerator can be stored for 24 hours. (10) Thawed breast milk should never be refrozen. (11) Shake milk container before feeding baby and test the temperature of the milk on the inner aspect of your wrist. (12) Any unused milk left in the bottle after feeding is discarded.

The nurse taught new parents the guidelines to follow regarding the 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 do what? 1 Warm formula in a microwave oven for a couple of minutes before feeding 2 Wash the top of the can and can opener with soap and water before opening the can 3 Adjust the amount of water added according to the weight gain pattern of the newborn 4 Add some honey to sweeten the formula and make it more appealing to a fussy newborn

2 - Wash the top of the can and can opener with soap and water before opening the can pg 631 - 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 because a microwave can easily overheat it.

The nurse advises the patient to use a hospital-grade electric pump for effective feeding of a preterm infant. What does the nurse tell the patient about using this pump? 1 "Honey should be added to the milk obtained by pumping." 2 "Milk obtained by pumping should be microwaved immediately." 3 "Hospital-grade electric pumps can be used once a day after childbirth." 4 "Pumping should be done 8 to 10 times a day to maintain milk supply."

4 - "Pumping should be done 8 to 10 times a day to maintain milk supply." pg 620 - Pumping by a hospital-grade electric pump is recommended 8 to 10 times a day to maintain milk supply. A lower rate of pumping will not maintain an adequate quantity of breast milk. Hospital-grade electric pumps should be used as soon as the baby is born to obtain the colostrum, which is important for growth. Milk obtained by pumping should be refrigerated immediately. Heating the milk may decrease its nutritional value. Breast milk is the best food for a preterm infant. It contains all necessary nutrients for the infant, so the patient should not add anything to the breast milk. Moreover, honey is known to cause botulism in infants and therefore should be avoided.

While explaining the advantages of breastfeeding, the nurse informs the mother that breastfeeding reduces the risk of having respiratory syncytial virus (RSV) infection. How does breastfeeding reduce the risk of this condition? 1 Breast milk regulates blood pressure. 2 Breast milk promotes optimal weight gain. 3 Breast milk fulfills the infant's nutritional needs. 4 Breast milk serves as protection against infections.

4 - Breast milk serves as protection against infections. pg 606 - The vulnerability of infants to common mucosal pathogens such as RSV may be reduced by passive transfer of maternal immunity in the colostrum and breast milk. Breast milk reduces the risk of infection. Breastfeeding also regulates blood pressure and maintains optimal weight gain, which reduces the risk of type 2 diabetes in infants. Breast milk has a high nutritional value, which promotes organ development.

Which action should the nurse perform before the infant is breastfed for the first time after birth? 1 Weigh the infant for documentation 2 Provide eye prophylaxis to the infant 3 Inject the infant with a vitamin K supplement 4 Ensure skin-to-skin contact between the mother and infant

4 - Ensure skin-to-skin contact between the mother and infant pg 613 - Skin-to-skin contact of an infant with the mother is associated with an increased rate and duration of breastfeeding. Therefore the nurse should ensure that skin-to-skin contact is maintained between the infant and mother. Other actions such as weighing the infant for documentation, providing eye prophylaxis, and injecting vitamin K should be delayed until the infant is breastfed for the first time.

What complementary feedings does the nurse recommend for a 6-month-old infant in addition to breast milk and formula? 1 Low-fat foods 2 Low-starch food 3 High-protein food 4 Single-grain cereals

4 - Single-grain cereals pg 633/634 - In infants, amylase is produced by the salivary glands at 3 months and by the pancreas at 6 months. Therefore, as a part of complementary feeding, single-grain cereals are recommended because they contain large amounts of starch, which is broken down by amylase. Lipase acts on fats and is produced by the pancreas at 6 months of age; therefore the infant can have foods that have high fat content. The infant's protein needs are met by breast milk. Therefore the infant does not need a high-protein diet. The child needs starch-rich food such as single-grain cereals, so low-starch food will not help meet the child's carbohydrate needs.

What does the nurse instruct a postpartum patient to do before initiating breastfeeding? 1 "Spread a few drops of milk on the nipple." 2 "Insert only the nipple into the infant's mouth." 3 "First give milk in the feeding bottle to the infant." 4 "Do not give any additional support to your breasts."

1 - "Spread a few drops of milk on the nipple." pg 613 - Spreading a few drops of expressed milk on the nipple facilitates lubrication and enables the baby to open his or her mouth easily. The nurse should instruct the patient to insert the nipple and areola of the breast into the baby's mouth. This practice ensures good latching and less pain and discomfort in the mother. The mother need not start giving bottle milk until breastfeeding is established. The breasts should be supported sufficiently to promote effective latching and positioning of the infant.

In helping the breastfeeding mother position the baby, what should nurses keep in mind? 1 Whatever the position used, the infant is "belly to belly" with the mother. 2 While supporting the head, the mother should push gently on the occiput. 3 Women with perineal pain and swelling prefer the modified cradle position. 4 The cradle position is usually preferred by mothers who had a cesarean birth.

1 - Whatever the position used, the infant is "belly to belly" with the mother. pg 613 - The infant inevitably faces the mother, belly to belly. 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 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.

The nurse finds that an infant's weight gain pattern is delayed. Which additive to cow's milk given to the baby is responsible for this condition? 1 Casein 2 Glucose 3 Corn oil 4 Cholesterol

2 - Glucose pg 609 - If cow's milk without added glucose is fed to infants, it results in fecal loss of fat. This happens because the milk passes through the infant's intestines too quickly, before adequate absorption takes place. This ultimately leads to poor weight gain. Casein is a protein that inhibits the absorption of iron in the body. However, its deficiency does not cause poor weight gain. Corn oil is easily digestible and absorbable. Therefore it is used as a substitute for milk fat in formula. Cholesterol is important for the infant's brain growth, neurologic development, and visual function. Cholesterol is not helpful in ensuring proper weight gain in the baby.

The nurse works in a neonatal care unit. Which infant does the nurse expect to need fewer calories for growth? 1 A 2-month-old infant 2 A 4-month-old infant 3 An 8-month-old infant 4 A 10-month-old infant

3 - An 8-month-old infant pg 608 - An infant between 6 and 9 months of age needs 95 kcal/kg/day. This is less than the energy needs of infants of other ages. An infant who is 1 to 3 months old is the early stage of growth and development and therefore needs a caloric intake of 110 kcal/kg/day in order to obtain energy for growth. An infant 3 to 6 months of age needs a lower caloric intake of approximately 100 kcal/kg/day. An infant 9 to 12 months of age needs 100 kcal/kg/day of caloric intake.

While teaching breastfeeding techniques to a postpartum patient, the nurse advises the patient to check whether the infant's cheeks are rounded or dimpled during feeding. What is the reason for giving such advice to the patient? 1 It prevents nipple trauma. 2 It helps the infant latch onto the nipples. 3 It indicates the effectiveness of breastfeeding. 4 It may help prevent trauma to the infant's jaws.

3 - It indicates the effectiveness of breastfeeding. pg 614 - Usually during sucking, the infant's cheeks become rounded and are not dimpled, so the shape of the baby's cheeks indicates the effectiveness of feeding. Nipple trauma can be prevented by inserting a finger in the side of baby's mouth to break the suction. Trauma to the infant's jaw is not associated with rounded cheeks. Placing the nipple on the infant's lips helps the infant latch.

The nurse observes that a patient tickles her baby's lips with her nipple while breastfeeding. Why does the patient do this? 1 To prevent nipple trauma 2 To reduce the pain while feeding the infant 3 To help stimulate mouth opening by her baby 4 As a way to encourage the baby to swallow the milk

3 - To help stimulate mouth opening by her baby pg 613 - While breastfeeding, the patient tickles the baby's lips with her nipple to stimulate wide opening of her baby's mouth so that the baby can easily latch on. Inserting a finger at the side of the baby's mouth helps break the suction and prevents nipple trauma. Tickling the lips does not encourage the infant to swallow the milk. If breastfeeding is painful, then the nurse should help the patient evaluate the feeding position and the latch.

What instruction should the nurse give the mother of a neonate while preparing for a latch? 1 "Spread the colostrum over the infant's lips." 2 "Spread the colostrum over a spoon and feed." 3 "Spread the colostrum over the infant's tongue." 4 "Spread the colostrum over the mother's nipple."

4 - "Spread the colostrum over the mother's nipple." pg 613 - The nurse instructs the patient to manually express the colostrum and spread it on her nipple in the early feeding days. This action lubricates the nipple and entices the baby to open the mouth as he or she tastes the milk. The colostrum is not placed on the infant's lips or tongue. A spoon is not used in the early feeding stages.

On interacting with a lactating patient, the nurse finds that the patient consumes alcohol. Which advice should the nurse give in order to prevent potential risks to the infant? 1 "Avoid consuming grape juice while breastfeeding." 2 "Feed the infant cow's milk rather than breast milk." 3 "Pump and discard the first 10 drops of breast milk." 4 "Avoid breastfeeding for 2 hours after consuming alcohol."

4 - "Avoid breastfeeding for 2 hours after consuming alcohol." pg 626 - If a breastfeeding mother consumes alcohol, she is advised to avoid breastfeeding for at least 2 hours after doing so. This will avoid potential risks to the infant. Consuming grape juice is beneficial during breastfeeding, but it does not reduce risks in the infant. Pumping and discarding the first 10 drops of milk is not sufficient to remove alcohol. Breast milk is nutritionally superior to cow's milk. Therefore the nurse should advise the patient to feed the infant breast milk rather than cow's milk.

The nurse is discussing the importance of breastfeeding and the risks associated with cow's milk with a new mother. What condition is associated with feeding cow's milk to the infant? 1 Hypocalcemia 2 Hypercalcemia 3 Hypophosphatemia 4 Hyperphosphatemia

1 - Hypocalcemia pg 609 - Human milk contains calcium and phosphorus at a ratio of 2:1. This is an optimal proportion for bone mineralization. In cow's milk the calcium level is very high and the phosphorus level is very low. This results in decreased calcium absorption. This condition is called hypocalcemia. Calcium levels are high, but the overall absorption and availability are very low, so it does not cause hypercalcemia. Hypophosphatemia and hyperphosphatemia are not associated with feeding cow's milk.

After assessing the stools of a newborn, the nurse plans to evaluate the infant's breastfeeding effectiveness. Which possible finding in the stools prompted such an evaluation? 1 Greenish yellow, loose stools on the third day 2 Yellow, soft, and seedy stools on the seventh day 3 Greener, thinner, and less sticky stools on the second day 4 Greenish black, thick, and sticky meconium stools on the fourth day

4 - Greenish black, thick, and sticky meconium stools on the fourth day pg 618 - Breastfeeding effectiveness and milk transfer should be assessed if the infant passes greenish black, thick, and sticky meconium stools on third or fourth day. Greenish yellow, loose stools are usually observed in a 3-day-old newborn. Yellow, soft, and seedy stools are usually observed in a week-old newborn. Green, thin, and less sticky stools are the usual stool patterns of 2-day-old infant. Therefore the nurse would not evaluate breastfeeding effectiveness with these usual stool patterns.

The nurse should instruct the patient who has lost 3 kg of weight after giving birth to take an adequate amount of what? 1 Calcium 2 Vitamin K 3 Fluids and sterols 4 Polyunsaturated fatty acids

4 - Polyunsaturated fatty acids pg 624 - A weight loss of ½ kg in postpartum patient is safe, but if the loss exceeds 2 kg, the nurse instructs the patient to consume an adequate amount of polyunsaturated fatty acids. Calcium is not recommended because it does not prevent weight loss. Vitamin K alone is not recommended; however, a multivitamin is recommended along with omega fatty acids. Fluids are recommended but sterols are not specified.

The nurse is planning the diet plan for a Korean postpartum patient. What food should the nurse include in the patient's diet plan to increase the production of breast milk? 1 Corn syrup 2 Clarified butter 3 Boiled chicken 4 Seaweed soup

4 - Seaweed soup pg 608 - Seaweed soup is preferred by Korean patients after delivery to increase milk production. Some cultures believe that clarified butter will clear out meconium. Corn syrup solids are added to infant formula to increase carbohydrate levels. Hmong patients prefer boiled chicken as the part of their diet in the first month after birth.

The nurse is assessing a postpartum patient who is breastfeeding her infant. Which sign indicates that the infant is latched onto the mother's breast and is receiving the mother's milk? 1 The infant's sucking is not audible. 2 The patient feels strong tugging on the nipple. 3 The infant's cheeks are dimpled during sucking. 4 The patient feels pinching and pain in the nipple.

2 - The patient feels strong tugging on the nipple. pg 614 - A strong tugging sensation on the nipple is a sign that the infant is latching and feeding well. During sucking, the infant's cheeks should be rounded. Dimpled cheeks indicate improper latching. Audible sucking indicates that the infant is swallowing milk properly. If the infant has latched well, the patient should not feel pain or pinching in the nipple during breastfeeding.

A nurse educator is teaching a group of nursing students about oligosaccharides in breast milk. Which statement by the nursing educator best describes the role of oligosaccharides in the development of an infant? 1 Oligosaccharides develop microflora in the intestinal tract. 2 Oligosaccharides prevent growth of gram-positive bacteria. 3 Oligosaccharides maintain the basic environment in the stomach. 4 Oligosaccharides increase the absorption of iron in the stomach.

1 - Oligosaccharides develop microflora in the intestinal tract. pg 609 - Infants lack bacteria that help in the digestion and maintenance of the acidic pH in the intestine. Oligosaccharides present in the milk play a critical role in the development of microflora in the newborn's intestine. Oligosaccharides prevent the growth of gram-negative bacteria. They are also helpful in maintaining the acidic pH of the intestine. Casein helps in absorption of iron, and oligosaccharides play no role in it.

While giving discharge instructions to a postpartum patient, the nurse tells the patient to add corn syrup to the baby's infant formula. The reason for giving this instruction to the patient is to provide sufficient what? 1 Vitamins to the baby 2 Proteins to the baby 3 Minerals to the baby 4 Carbohydrates to the baby

4 - Carbohydrates to the baby pg 609 - Glucose polymers and corn syrup are added to infant formulas to provide sufficient carbohydrates for the infant. Corn syrup is not rich in vitamins, protein, or minerals. Therefore it does not prevent deficiency of these nutrients in the infant. Moreover, formula provides adequate amounts of vitamins, proteins, and minerals.

During assessment the nurse instructs a postpartum patient to hold her baby across her lap during breastfeeding. What is the most likely reason for such an instruction to the patient? 1 The infant is very small. 2 The patient has perineal pain. 3 The infant easily latches onto the breast. 4 The patient is unable to see her baby's mouth.

1 - The infant is very small. pg 613 - Placing the breastfeeding baby across her lap (cradle hold) is convenient for the patient, especially if the baby is small. Women with perineal pain are advised to use the side position while breastfeeding the infant because it allows the patient to rest. The cradle hold is advised only when the infant easily latches onto the breast. The football position is advised if the patient cannot see her baby's mouth.

The nurse is assessing an infant who is exclusively fed cow's milk. The nurse understands that the infant is at high risk for seizures. What could be the reason behind this risk? 1 The low ratio of lactose to phosphorus in cow's milk 2 The high ratio of lactose to phosphorus in cow's milk 3 The low ratio of calcium to phosphorus in cow's milk 4 The high ratio of calcium to phosphorus in cow's milk

3 - The low ratio of calcium to phosphorus in cow's milk pg 609 - Although cow's milk is rich in calcium, it has a low ratio of calcium to phosphorus, which results in decreased calcium absorption. Decreased calcium levels may result in seizures in infants. Therefore intake of unmodified cow's milk increases the risk of seizures. High and low ratios of lactose and phosphorus do not have any effect on seizures.

The nurse assesses a postpartum patient who gave birth to a newborn at 36 weeks of gestation. In which position will the nurse place the patient during breastfeeding? 1 Cradle position 2 Lying-down position 3 Across-the-lap position 4 Under-the-arm position

4 - Under-the-arm position pg 621 - Infants born at 34 to 36 weeks of gestation are considered late-preterm infants. Because these infants are more prone to positional apnea, the nurse would advise the patient to hold the infant in the under-the-arm position (football or clutch position) while breastfeeding. This position is used to hold the baby while feeding and avoid flexing the head, which impedes breathing. Cradle, lying-down, and across-the-lap positions are not recommended for late-preterm infants. These positions may increase the risk of positional apnea in late-preterm infants.

The nurse is caring for a new mother who reports that her 6-month-old infant has started to wean. Which statement made by the new mother indicates to the nurse that the mother needs additional teaching on the weaning process? 1 "My baby initiated the weaning on his own." 2 "My spouse says that I've been more emotional lately." 3 "I've been giving my baby small amounts of cow's milk." 4 "I am weaning my baby directly from my breast to a cup."

3 - "I've been giving my baby small amounts of cow's milk." pg 623 - When an infant is weaned before one year of age, the infant should be given iron-fortified formula instead of cow's milk. Weaning can be initiated by either the infant or the mother. It is common for mothers to feel emotional and even grieve during weaning, as it signifies the end of an important stage between the mother and the child. Infants can be weaned directly from the breast to the cup.

The nurse advises a postpartum patient to avoid breastfeeding. What could be the possible reason for this suggestion? 1 The newborn has galactosemia. 2 The newborn was a preterm infant. 3 The patient has acute H1N1 infection. 4 The patient has herpes simplex lesions on the breasts.

1 - The newborn has galactosemia. pg 607 - Galactosemia is a condition associated with impaired galactose metabolism. Breastfeeding is contraindicated if the baby is unable to metabolize galactose, which is a principal constituent of breast milk. Mothers of preterm infants are encouraged to breastfeed their babies. A patient with acute H1N1 infection or herpes simplex lesions is temporarily isolated from the newborn to prevent the transfer of infection from the patient to newborn. However, the infant can receive expressed milk from the patient.

The nurse assesses a Mexican patient who gave birth to an infant. What does the nurse expect the patient to do before feeding the infant for the first time? 1 Eat seaweed soup and rice 2 Give both expressed milk and infant formula 3 Restrict breastfeeding for some time after birth 4 Rub a piece of soft date on the newborn's palate

2 - Give both expressed milk and infant formula pg 608 - Mexican mothers believe that infants will receive benefits of breastfeeding and vitamins from infant formula. Therefore the nurse expects the patient to give both expressed milk and infant formula. Eating seaweed soup and rice to improve milk production is practiced by Korean mothers. Restricting breastfeeding for some time after birth is practiced by Southern Asian mothers because of beliefs about the harmful nature or inadequacy of colostrum. Muslim women would rub a small piece of soft date on the newborn's palate as a ritual.

The nurse is caring for a breastfeeding mother who is four weeks postpartum. The new mother asks the nurse about contraception that can be used while she is breastfeeding her infant. What is the nurse's best response? 1 "We recommend taking hormonal contraceptives that contain estrogen." 2 "A progestin-only pill is a good option for you considering the age of your baby." 3 "Using a condom is an effective way to prevent pregnancy while breastfeeding." 4 "You do not have to worry about contraception, because you cannot get pregnant while breastfeeding."

3 - "Using a condom is an effective way to prevent pregnancy while breastfeeding." pg 625 - Condoms and other barrier methods are effective forms of contraception for the breastfeeding mother and are safe to use because they do not impact the infant or affect milk supply. Hormonal contraceptives that contain estrogen are not recommended for breastfeeding women, as they affect milk supply. A progestin-only pill is not a good option since the infant is only 4 weeks old. Progestin-only pills, injections, and implants are not recommended until after six weeks postpartum. It is a myth that women cannot get pregnant while breastfeeding, so this statement is inaccurate.

What type of bottle should the nurse advise the patient to purchase for the baby? 1 Clear plastic bottles 2 PC-printed clear bottles 3 Bisphenol A-free bottles 4 Recycling number 7 bottles

3 - Bisphenol A-free bottles pg 632 - The nurse should instruct the patient to buy feeding bottles that are free of bisphenol A because it can cause life-threatening complications in the baby. The use of clear plastic bottles that are imprinted with recycling number 7 or PC-printed bottles must be avoided because they contain bisphenol A.

The nurse is caring for a postpartum patient who reports severe pain after a cesarean delivery. Which position should the nurse advise the patient to assume during breastfeeding? 1 Cradle hold 2 Side-lying position 3 Clutch hold position 4 Modified cradle hold

3 - Clutch hold position pg 613 - The clutch hold position is suitable for a patient who gave birth by cesarean section. This position prevents pressure on the abdomen and reduces strain on the abdominal sutures. If the patient complains of severe pain after vaginal delivery, she is instructed to breastfeed in the side-lying position. This position enables the patient to rest while feeding. The cradle hold and across-the-lap hold are suitable for the infant who is accustomed to feeding and has effective latching. The modified cradle hold is suitable for neonates and during early feedings.

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, what should the nurse do? 1 Notify the physician because the newborn is being poorly nourished 2 Refer the mother to a lactation consultant to improve her breastfeeding technique 3 Encourage the mother to continue breastfeeding because it is effective in meeting the newborn's nutrient and fluid needs 4 Suggest that the mother switch to bottle-feeding because the breastfeeding is ineffective in meeting newborn needs for fluid and nutrients

3 - Encourage the mother to continue breastfeeding because it is effective in meeting the newborn's nutrient and fluid needs pg 608/615 - Weight loss of 8 ounces 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.

The nurse reports to the primary health care provider that a newborn has hypoglycemia and passes meconium stools until the fifth day. Which intervention does the nurse expect may benefit the newborn? 1 Starting bottle-feeding in the newborn 2 Giving only breast milk to the newborn 3 Giving the newborn expressed breast milk 4 Heating the breast milk in a microwave before feeding

3 - Giving the newborn expressed breast milk pg 618 - Usually supplementary feeding is recommended for a newborn who has very low blood glucose levels (hypoglycemia) and passes meconium stools until the fifth day. Giving expressed breast milk to the infant is the best method. Therefore the nurse would expect the primary health care provider to advise using expressed breast milk to provide supplementary feeding for the infant. Hypoglycemia cannot be treated with breastfeeding alone. Bottle-feeding is avoided in infants until breastfeeding is well established. This will prevent the newborn from getting confused between breasts and bottles. Heating the breast milk in a microwave creates encapsulated boiling bubbles that can cause severe burns in the infant's mouth and throat, so it is never recommended.

The nurse advises a postpartum patient to feed her newborn with expressed milk. While teaching about breast milk storage, which instruction should the nurse include? 1 "The milk can be stored in the refrigerator in plastic bags for 4 days." 2 "Always fill the container to the brim before placing it in the freezer." 3 "Avoid placing the milk container in the middle rack of the refrigerator." 4 "Milk can be stored along with other food in the refrigerator."

4 - "Milk can be stored along with other food in the refrigerator." pg 622 - The breast milk container can be stored along with other food items in the refrigerator without contamination. Breast milk can be stored in plastic bags for up to 3 days; after 3 days it begins to deteriorate. When milk is to be frozen, the container should be only three-quarters full to allow space for expansion. If the container is filled to the brim, the milk will expand and break the container. The milk container should be stored in the middle of the refrigerator rather than in the door. This keeps the milk colder and helps prevent accidental spillage and breakage of the container.

A postpartum patient who is receiving antibiotic therapy has been advised to give formula to the infant. The patient reports that her breasts are firm, hot, and shiny. What treatment does the nurse recommend to reduce the milk supply? 1 Breast massage 2 Cold compression 3 Antiinflammatory drugs 4 Placement of cabbage leaves over the breasts

4 - Placement of cabbage leaves over the breasts pg 623 - When the patient does not breastfeed, milk accumulates and causes breast engorgement, which is characterized by firm, hot, and shiny breasts. The phytoconstituents present in cabbage leaves help dry up the milk supply in the patient who cannot breastfeed. Therefore the nurse should place the crushed cabbage leaves over the patient's breasts. Accumulation of milk in the breasts causes pain and inflammation. Cold compressors are used to treat engorgement. Breast massage will increase milk flow. Antiinflammatory drugs are prescribed to relieve pain and inflammation in the breasts; they do not decrease the milk supply.

The primary health care provider instructs the patient not to alter the concentration of formula while feeding her infant. What could happen to the infant if the formula is concentrated? 1 The kidneys would become functional. 2 Growth would be abnormally increased. 3 Bilirubin levels would become excessive. 4 Proteins in the formula would exceed the infant's excretory ability.

4 - Proteins in the formula would exceed the infant's excretory ability. pg 633 - An infant's kidneys are too immature to excrete large protein molecules. Concentrated formula may contain large protein molecules that may not be excreted and may impair kidney function. Concentrated formula does not increase growth; in fact, it may stall growth because the infant may not be able to digest it. Bilirubin levels are not affected by the concentration of the infant's formula.

The nurse assesses a postpartum patient who is breastfeeding her infant. The patient states that she does not consume eggs or meat. Which deficiency does the nurse expect the infant to have? 1 Vitamin D deficiency 2 Vitamin E deficiency 3 Vitamin K deficiency 4 Vitamin B12 deficiency

4 - Vitamin B12 deficiency pg 609 - The patient does not consume eggs and meat, which are rich sources of vitamin B12. Therefore the infant should receive supplemental vitamin B12 from birth to decrease the risk associated with vitamin B12 deficiency. Vitamin D is absent in human milk. It is produced in infants when they are exposed to sunlight. Vitamin E deficiency is not observed in patients who do not consume eggs and meat. Deficiency of vitamin K may occur in the infant if the patient does not consume green leafy vegetables.

The nurse is educating first-time mothers on breastfeeding. What are the common reasons for breastfeeding cessation? Select all that apply. 1 The mother may have an insufficient supply of milk. 2 The mother may have painful nipples while feeding. 3 The mother may be embarrassed about breastfeeding. 4 The mother may not get enough sleep during breastfeeding. 5 The mother may have insufficient knowledge about lactation.

1 - The mother may have an insufficient supply of milk. 2 - The mother may have painful nipples while feeding. 4 - The mother may not get enough sleep during breastfeeding. 5 - The mother may have insufficient knowledge about lactation. pg 612 - When the milk supply is not sufficient to feed the baby, the mother may become frustrated and switch to formula-feeding. The mother may stop breastfeeding if there is pain in the nipples during breastfeeding. Some babies may sleep throughout the night, so the mother may stop breastfeeding to prevent the baby from waking up. Therefore early assistance and support from health care professionals is essential to promoting a successful and satisfying breastfeeding experience for mothers and infants. Many women use bottle-feeding because it is more convenient, and they may find it less embarrassing than breastfeeding. However, this is not a common problem. Many women do not have sufficient knowledge on lactation and as such may be more likely to stop breastfeeding because of this fact. Therefore health care professionals should give accurate training to women who lack knowledge about lactation.

The nurse is educating a lactating patient about feeding an infant. Why does the nurse ask the patient to breastfeed the child from either breast for longer durations? 1 To increase the levels of oxytocin 2 To increase the colostrum content 3 To increase the caloric intake from fats 4 To increase the volume of milk produced

3 - To increase the caloric intake from fats pg 611 - The nurse advises the patient to feed the infant from each breast for a longer duration because the foremilk contains less fat compared with the hindmilk. The fat obtained from the hindmilk has high caloric value and is needed for optimal growth. The amount of fat obtained increases with breastfeeding time. Oxytocin is also available in the milk but is proportional to the volume of milk produced. Colostrum is the milk produced within 24 hours of birth. The volume of milk produced is in direct relation to the volume of milk consumed.

The nurse is teaching about breastfeeding to a postpartum patient with a 2-day-old baby. Which statement made by the patient indicates the need for further teaching? 1 "I will feed my baby every 4 hours at night." 2 "I will sleep along with my baby in the same room." 3 "I will feel relaxed and drowsy while feeding the baby." 4 "I will give 10 mL of water to the baby after breastfeeding."

4 - "I will give 10 mL of water to the baby after breastfeeding." pg 608 - Supplemental feedings of water should not be offered to a healthy newborn after breastfeeding because a healthy newborn needs only 60 to 80 mL per kilogram of body weight per day, and this is obtained from the breast milk. Therefore the patient should not give 10 mL of water after feeding the newborn. The patient will feel relaxed or drowsy during the ejection of milk because of the release of hormones. The baby should be fed frequently to provide energy and facilitate proper growth and development. Therefore the patient should feed the baby every 3 hours during the day and every 4 hours at night. The patient and her baby should sleep in the same room but not in the same bed to promote breastfeeding.

The nurse is assessing a postpartum Hmong patient who has come for a follow-up 15 days after childbirth. What diet would the patient follow to increase milk production and nourishment? 1 Seaweed soup and rice 2 Honey and clarified butter 3 Fresh fruits and vegetables 4 Boiled chicken and hot water

4 - Boiled chicken and hot water pg 608 - According to the cultural beliefs of Hmong women, boiled chicken, rice, and hot water provide good nourishment in the first postpartum month. Koreans consider seaweed soup and rice good for postpartum women. Honey and clarified butter are considered to be good for postpartum women in Southern Asia and the Pacific Islands. Lactating mothers belonging to Indian, Chinese, and Arab communities prefer fresh fruits and vegetables in their diet.

A mother has brought her newborn to the health care provider for a well-child visit. During the assessment, the nurse notes the infant is not gaining the expected weight. What feeding schedule does the nurse expect the health care provider to have the patient implement? 1 Feed the infant every 5 hours 2 Feed with formula twice a day 3 Alternate between both breasts in one feeding 4 Have the infant use the same breast for a longer time

4 - Have the infant use the same breast for a longer time pg 616 - The baby should be fed from the same breast until the breast becomes soft. At this stage, the milk is rich in fats, which helps increase the infant's weight. The baby should be fed on demand, as feeding readiness cues occur, rather than every 5 hours. Feeding the baby with formula is not recommended in this scenario because breast milk is more nutritious than formula. Alternating between both breasts during the same feeding may result in loss of the fat-rich hindmilk, so this method should be avoided.