HESI - OB, Breastfeeding Education
A first-time mother summons the nurse, distraught because the newborn had a black stool after the third breastfeeding session. The birth was 8 hours ago. What should the nurse tell the mother? A. "This black stool is normal in the first day or two; frequent breastfeeding helps your baby pass it." B. "At 8 hours old, your baby should have yellow, seedy stool, we'll have to test this stool for blood." C. "This type of stool from the baby indicates that you need to increase your caloric intake." D. "This type of dark, sticky stool is normal for about the first 3 to 5 days in breastfed babies."
A. "This black stool is normal in the first day or two; frequent breastfeeding helps your baby pass it." Rationale: Early and frequent breastfeeding during the first 24 to 48 hours will help the newborn pass the normal black, tarlike stools, called meconium. After 48 hours, the newborn's stools will change from a greenish transitional stool to a yellow, seedy stool, which is perfectly normal for a breastfed newborn. The presence of meconium does not indicate that the mother needs to ingest more calories; caloric intake has no direct bearing on the presence of meconium. Meconium stools only occur in the first day or two and are not specific to breastfed newborns.
The nurse is instructing a new mother on how to breastfeed. The mother is extremely anxious about breastfeeding and complains of tingling and tenderness in the nipples. Which nursing intervention is most appropriate? A. Educate the mother about the letdown reflex and continue encouragement through the breastfeeding process. B. Stop the breastfeeding session and ask the practitioner to prescribe antibiotics for the mother's mastitis. C. Stop the breastfeeding session and instruct the mother to avoid the use of soaps and harsh washing of the breasts. D. Educate the mother that these sensations are normal and will continue until the mother ceases to breastfeed the newborn.
A. Educate the mother about the letdown reflex and continue encouragement through the breastfeeding process. Rationale: Some nipple tenderness is normal during the breastfeeding learning period. Tingling of the breasts and dripping of milk are signs of the letdown reflex. The tingling and tenderness described most likely do not signal mastitis; instead, they are probably signs of the letdown reflex and the normal tenderness that occurs during the learning period. If mastitis is identified, it should be treated with antibiotics, but the mother can continue breastfeeding. Harsh washing and soaps can cause extreme dryness and cracking of the nipple and areola but not tingling and tenderness. Tingling and breast tenderness are not long-term expected experiences when breastfeeding
A new mother is concerned about the newborn getting enough nutrition. The mother reports to the nurse that the newborn is always fussy and will not stop crying despite breastfeeding every hour. The newborn's diaper has not needed changing for several hours. For what should the nurse assess? A. Proper latch B. Breast infection C. Mastitis D. Breast size
A. Proper latch Rationale: A newborn who is fussy and has not had a wet diaper in several hours may not have achieved adequate latch and may not have obtained sufficient milk from the breast. The newborn is getting adequate nutrition if feedings occur every 2 or 3 hours, has an appropriate number of wet diapers and bowel movements per day, and is gaining weight appropriately after the initial weight loss. In this scenario, the mother is not displaying any signs or symptoms of a breast infection. Mastitis can make breastfeeding uncomfortable but has no effect on the volume of milk available. Breast size does not affect the volume of milk produced.
A new mother begins to cry because the newborn will not burp despite multiple attempts, and the mother worries that the burping technique is a failure. What should the nurse teach the mother about newborns who are breastfed? A. They may not need to burp as often because they swallow less air than bottle-fed newborns. B. They must be burped after feeding at the first breast and before nursing at the second breast. C. They do not need to burp until the end of every breastfeeding session. D. They do not need burping at all because they do not swallow any air.
A. They may not need to burp as often because they swallow less air than bottle-fed newborns. Rationale: Burping helps the newborn release swallowed air; because breastfed newborns do not swallow as much air as bottle-fed newborns do, not every breastfed newborn needs to burp with each feeding. Breastfeeding should not be delayed if the newborn does not burp during the breast switch because the newborn may not have swallowed any air before or during the breastfeeding session
A new mother reports extreme pain and tenderness of the nipples. During the initial nipple assessment, the nurse discovers dried, cracked, and bleeding nipples and suspects nipple trauma related to removal of the newborn from the breast. The nurse asks for a breastfeeding demonstration to assess how the mother is removing the newborn from the breast. The teaching plan for this breastfeeding mother should include which instruction? A. Do nothing; a newborn will instinctively remove himself or herself from the breast. B. Break suction by inserting a finger into the side of the newborn's mouth. C. Roll, twist, or pull on the nipple to break the suction. D. Break suction by gently compressing both of the newborn's cheeks.
B. Break suction by inserting a finger into the side of the newborn's mouth. Rationale: The mother should be instructed to ensure the proper release of the newborn from the breast to prevent trauma to the nipple and areola by inserting a finger into the side of the newborn's mouth or by gently pressing the pad of a finger into the breast near the newborn's mouth to break the suction. The newborn does not instinctively remove himself or herself without causing trauma to the nipple and areola. Rolling, twisting, or pulling on the nipple is not recommended because these actions may cause nipple trauma; trauma to the nipple and areola can lead to further nipple soreness, making breastfeeding uncomfortable or painful. It can also lead to breaks in the skin of the nipple and areola. Gentle compression of the newborn's cheeks is insufficient to break the suction.
Which is a contraindication to breastfeeding a newborn? A. The mother has inverted nipples. B. The newborn has galactosemia. C. The mother has a fever. D. The mother is seropositive for CMV.
B. The newborn has galactosemia. Rationale: Breastfeeding is contraindicated when the newborn has galactosemia and must be fed lactose-free formula. If the mother has inverted nipples, a nipple shield can be worn during feedings to provide a larger area for the newborn to latch. Breast shells can be worn between feedings to help draw out the nipples. The maternal conditions of fever and seropositive carrier of CMV are not contraindications to breastfeeding.
The nurse is teaching a new mother about breastfeeding. Which instruction should be included so that the mother is able to monitor the newborn for adequate milk intake? A. The newborn should have at least two wet diapers per day by day 3 to 5 of life. B. The newborn should have four to six wet diapers per day by day 7 of life. C. The newborn will have greenish stool turning yellow by day 7 of life. D. The newborn will fall asleep quickly after breastfeeding.
B. The newborn should have four to six wet diapers per day by day 7 of life. Rationale: The newborn should have four to six wet diapers per day by day 7 of life and three to five wet diapers per day by day 3 to 5 of life, not two wet diapers. The newborn's normal stool will transition from black, tarlike stools during the first few days to a greenish stool, then to yellow, seedy stools by the end of the first week of life. This does not indicate adequate milk intake. The newborn falling to sleep after breastfeeding is not an indication of adequate milk intake.
A new mother asks to breastfeed the newborn immediately after delivery. The mother had a negative drug screen upon admission; however, the nurse is aware that the mother has a recent history of IV drug use and is infected with HBV. How should the nurse advise the mother? A. There is no concern for the newborn, and breastfeeding may be started if the mother is taking medications to treat the HBV. B. The session must be canceled because breastfeeding by a mother with HBV is always unsafe for the newborn, and the mother must use prepared infant formula. C. The mother can breastfeed now, but the newborn should receive hepatitis B immune globulin and a first dose of hepatitis B vaccine within 12 hours. D. The breastfeeding session must be deferred until the newborn is treated with immunoglobulin and vaccinated
C. The mother can breastfeed now, but the newborn should receive hepatitis B immune globulin and a first dose of hepatitis B vaccine within 12 hours. Rationale: A mother infected with HBV can safely breastfeed the newborn if the newborn receives hepatitis B immune globulin and the first dose of hepatitis B vaccine within 12 hours of birth. Transmission of HBV through breastfeeding has not been reported. The mother does not have to be taking medication to treat HBV to safely breastfeed. In fact, certain medications are contraindicated in breastfeeding women. The newborn should be treated with immunoglobulin and vaccination within 12 hours but can breastfeed immediately after delivery.
Which is an advantage to the mother to breastfeed? A. Prevents pregnancy. B. Decreases the risk of uterine cancer. C. Improves maternal renal function. D. Enables an earlier return to prepregnancy weight.
D. Enables an earlier return to prepregnancy weight. Rationale: One advantage of breastfeeding to the mother is an earlier return to prepregnancy weight. Breastfeeding does not prevent pregnancy but may decrease the risk. Breastfeeding decreases the mother's risk for breast and ovarian cancer but does not decrease the risk of uterine cancer. Breastfeeding has no effect on maternal renal function.
A new mother reports breast engorgement and nipple pain on day 2 after the delivery of a healthy newborn. The mother tells the nurse, "I'm not sure that breastfeeding the baby is for me." What should the nurse advise the mother to do to help relieve discomfort and encourage persevering with breastfeeding? A. Explain that plugged milk ducts are probably causing the pain and swelling. B. Advise the mother to limit the duration of breastfeeding to 5 minutes on each side. C. Advise the mother to offer the newborn just one breast at each feeding session and to alternate with each feeding. D. Inform the mother that breastfeeding the newborn more frequently will help treat these symptoms.
D. Inform the mother that breastfeeding the newborn more frequently will help treat these symptoms. Rationale: In many cases, breasts become swollen and painful 2 or 3 days after a woman gives birth; the best way to decrease the pain and swelling is to breastfeed the newborn more frequently. The nurse should assist the mother with offering both breasts at every feeding and should avoid setting time limits on the duration of feeding. A plugged duct generally causes pain in the area and may cause redness, hardness, or lumpiness; however, this mother's breast discomfort is more likely the normal pain and swelling that occur 2 or 3 days after birth.
