Chapter 18: Newborn Nutrition and Feeding My Nursing Test Banks

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 18: Newborn Nutrition and Feeding

Test Bank 

MULTIPLE CHOICE

1. A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until her infant is crying frantically. On the basis of this information, this woman should feed her infant about every 2 to 3 hours when she:

a. Waves her arms in the air.
b. Makes sucking motions.
c. Has the hiccups.
d. Stretches her legs out straight.

ANS: B

Feedback
A Waving of the arms in the air is not a typical feeding-readiness cue.
B Sucking motions, rooting, mouthing, and hand-to-mouth motions are examples of feeding-readiness cues.
C Hiccups are not a typical feeding-readiness cue.
D Stretching of the legs is not a typical feeding-readiness cue.

DIF:Cognitive Level: ComprehensionREF:538

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

2. A new father is ready to take his wife and newborn son home. He proudly tells the nurse who is discharging them that within the next week he plans to start feeding the infant cereal between breastfeeding sessions. The nurse can explain to him that beginning solid foods before 4 to 6 months may:

a. Decrease the infants intake of sufficient calories.
b. Lead to early cessation of breastfeeding.
c. Help the infant sleep through the night.
d. Limit the infants growth.

ANS: B

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

DIF:Cognitive Level: ApplicationREF:538

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Evaluation

3. A pregnant woman wants to breastfeed her infant; however, her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle-feeding. Which statement is true? Bottle-feeding using commercially prepared infant formulas:

a. Increases the risk that the infant will develop allergies.
b. Helps the infant sleep through the night.
c. Ensures that the infant is getting iron in a form that is easily absorbed.
d. Requires that multivitamin supplements be given to the infant.

ANS: A

Feedback
A Exposure to cows milk poses a risk of developing allergies, eczema, and asthma.
B This is a false statement.
C Iron is better absorbed from breast milk than from formula.
D Commercial formulas are designed to meet the nutritional needs of the infant and resemble breast milk.

DIF:Cognitive Level: ApplicationREF:530

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

4. A postpartum woman telephones about her 4-day-old infant. She is not scheduled for a weight check until the infant is 10 days old, and she is worried about whether breastfeeding is going well. Effective breastfeeding is indicated by the newborn who:

a. Sleeps for 6 hours at a time between feedings.
b. Has at least one breast milk stool every 24 hours.
c. Gains 1 to 2 ounces per week.
d. Has at least six to eight wet diapers per day.

ANS: D

Feedback
A This is not an indication of whether the infant is breastfeeding well. Typically infants sleep 2 to 4 hours between feedings, depending on whether they are being fed on a 2- to 3-hour schedule or cluster fed.
B The infant should have a minimum of three bowel movements in a 24-hour period.
C Breastfed infants typically gain 15 to 30 g/day.
D After day 4, when the mothers milk comes in, the infant should have six to eight wet diapers every 24 hours.

DIF:Cognitive Level: ComprehensionREF:542

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Evaluation

5. A breastfeeding woman develops engorged breasts at 3 days postpartum. What action would help this woman achieve her goal of reducing the engorgement? The woman:

a. Skips feedings to let her sore breasts rest.
b. Avoids using a breast pump.
c. Breastfeeds her infant every 2 hours.
d. Reduces her fluid intake for 24 hours.

ANS: C

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

DIF:Cognitive Level: ComprehensionREF:551

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

6. At a 2-month well-baby examination, it was discovered that a breastfed infant had only gained 10 ounces in the past 4 weeks. The mother and the nurse agree that, to gain weight faster, the infant needs to:

a. Begin solid foods.
b. Have a bottle of formula after every feeding.
c. Add at least one extra breastfeeding session every 24 hours.
d. Start iron supplements.

ANS: C

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

DIF:Cognitive Level: ApplicationREF:545

OBJ:Client Needs: Physiologic Integrity

TOP:Nursing Process: Planning, Implementation

7. A new mother wants to be sure that she is meeting her daughters needs while feeding her commercially prepared infant formula. The nurse should evaluate the mothers knowledge about appropriate infant care. The mother meets her childs needs when she:

a. Adds rice cereal to her formula at 2 weeks of age to ensure adequate nutrition.
b. Warms the bottles using a microwave oven.
c. Burps her infant during and after the feeding as needed.
d. Refrigerates any leftover formula for the next feeding.

ANS: C

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

DIF:Cognitive Level: ComprehensionREF:557

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Evaluation

8. The nurse is discussing storage of breast milk with a mother whose infant is preterm and in the special care unit. Which statement would indicate that the mother needs additional teaching?

a. I can store my breast milk in the refrigerator for 3 months.
b. I can store my breast milk in the freezer for 3 months.
c. I can store my breast milk at room temperature for 8 hours.
d. I can store my breast milk in the refrigerator for 3 to 5 days.

ANS: A

Feedback
A This statement would indicate that the mother needs additional information regarding safe storage of breast milk. Breast milk can be stored at room temperature for 8 hours, in the refrigerator for 3 to 5 days, in the freezer for 3 months, or in a deep freezer for 6 to 12 months.
B This statement is accurate and does not indicate that the mother needs additional teaching.
C This statement is accurate and does not indicate that the mother needs additional teaching.
D This statement is accurate and does not indicate that the mother needs additional teaching.

DIF:Cognitive Level: AnalysisREF:548

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Evaluation

9. According to the recommendations of the American Academy of Pediatrics on infant nutrition:

a. Infants should be given only human milk for the first 6 months of life.
b. Infants fed on formula should be started on solid food sooner than breastfed infants.
c. If infants are weaned from breast milk before 12 months, they should receive cows milk, not formula.
d. After 6 months, mothers should shift from breast milk to cows milk.

ANS: A

Feedback
A Breastfeeding/human milk should also be the sole source of milk for the second 6 months.
B Infants start on solids when they are ready, usually at 6 months, whether they start on formula or breast milk.
C If infants are weaned from breast milk before 12 months, they should receive iron-fortified formula, not cows milk.
D Breastfeeding/human milk should also be the sole source of milk for the second 6 months.

DIF:Cognitive Level: KnowledgeREF:529

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

10. Which statement concerning the benefits or limitations of breastfeeding is NOT accurate?

a. Breast milk changes over time to meet changing needs as infants grow.
b. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned.
c. Breast milk/breastfeeding may enhance cognitive development.
d. Breastfeeding increases the risk of childhood obesity.

ANS: D

Feedback
A This is a known benefit of breastfeeding.
B The benefits of breastfeeding continue long after weaning and have implications for the future health of the child.
C Research has shown that breastfeeding enhances cognitive development.
D Breastfeeding actually decreases the risk of childhood obesity.

DIF:Cognitive Level: ComprehensionREF:530

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

11. The best reason for recommending formula over breastfeeding is that:

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

ANS: A

Feedback
A Breastfeeding is contraindicated when mothers have certain viruses, are undergoing chemotherapy, or are using/abusing drugs.
B This may be an honest reason for not breastfeeding, although further education concerning the ease of breastfeeding and its convenience, benefits, and adaptability (expressing milk into bottles) might change some minds. In any case, the nurse must provide information in a nonjudgmental manner and respect the mothers decision.
C This may be a reason for not breastfeeding, although further education concerning the ease of breastfeeding and its convenience, benefits, and adaptability (expressing milk into bottles) might change some minds. In any case, the nurse must provide information in a nonjudgmental manner and respect the mothers decision.
D For the first-time mother, breastfeeding may initially appear to be more difficult. With appropriate education regarding convenience and cost advantages of breastfeeding, some may change their minds. In any case, the nurse should provide this information in a nonjudgmental manner and respect the mothers decision.

DIF:Cognitive Level: ComprehensionREF:530, 531

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

12. With regard to the nutrient needs of breastfed and formula-fed infants, nurses should be aware that:

a. Breastfed infants need extra water in hot climates.
b. During the first 3 months, breastfed infants consume more energy than formula-fed infants.
c. Breastfeeding infants should receive oral vitamin D drops daily at least during the first 2 months.
d. Vitamin K injections at birth are not needed for infants fed on specially enriched formula.

ANS: C

Feedback
A Neither breastfed nor formula-fed infants need to be given water, not even in very hot climates.
B During the first 3 months, formula-fed infants consume more energy than breastfed infants and therefore tend to grow more rapidly.
C Human milk contains only small amounts of vitamin D.
D Vitamin K shots are required for all infants because the bacteria that produce it are absent from the babys stomach at birth.

DIF:Cognitive Level: ComprehensionREF:534

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

13. In helping the breastfeeding mother position the baby, nurses should keep in mind that:

a. The cradle position usually is preferred by mothers who had a cesarean birth.
b. Women with perineal pain and swelling prefer the modified cradle position.
c. Whatever the position used, the infant is belly to belly with the mother.
d. While supporting the head, the mother should push gently on the occiput.

ANS: C

Feedback
A The football position usually is preferred after cesarean birth.
B Women with perineal pain and swelling prefer the side-lying position because they can rest while breastfeeding.
C The infant inevitably faces the mother, belly to belly.
D 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.

DIF:Cognitive Level: ComprehensionREF:539

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

14. The process whereby parents awaken the infant to feed every 3 hours during the day and at least every 4 hours at night is:

a. Known as demand feeding.
b. Necessary during the first 24 to 48 hours after birth.
c. Used to set up the supply-meets-demand system.
d. A way to control cluster feeding.

ANS: B

Feedback
A Demand feeding is when the infant determines the frequency of feedings; this is appropriate once the infant is feeding well and gaining weight.
B The parents do this to make sure that the infant gets at least eight feedings in 24 hours.
C The supply-meets-demand system is a milk production system that occurs naturally.
D Cluster feeding is not a problem if the baby gets eight feedings in 24 hours.

DIF:Cognitive Level: ComprehensionREF:541, 542

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

15. The nurse providing couplet care should understand that nipple confusion results when:

a. Breastfeeding babies receive supplementary bottle feedings.
b. The baby is weaned too abruptly.
c. Pacifiers are used before breastfeeding is established.
d. Twins are breastfed together.

ANS: A

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

DIF:Cognitive Level: ComprehensionREF:543

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

16. All of these statements indicate impacts of breastfeeding on the family or society at large except:

a. Breastfeeding requires fewer supplies and less cumbersome equipment.
b. Breastfeeding saves families money.
c. Breastfeeding costs employers in terms of time lost from work.
d. Breastfeeding benefits the environment.

ANS: C

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

DIF:Cognitive Level: ComprehensionREF:530

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Evaluation

17. A newly delivered mother who intends to breastfeed tells her nurse, I am so relieved that this pregnancy is over so I can start smoking again. The nurse encourages the woman to refrain from smoking. However, this new mother insists that she will resume smoking. The nurse will need to adapt her health teaching to ensure that the woman is aware that:

a. Smoking has little or no effect on milk production.
b. There is no relation between smoking and the time of feedings.
c. The effects of secondhand smoke on infants are less significant than for adults.
d. The mother should always smoke in a room away from the baby.

ANS: D

Feedback
A Smoking may impair milk production. When the products of tobacco are broken down, they cross over into the breast milk. Tobacco also results in a reduction of the antiinfective properties of breast milk.
B Research supports that mothers should not smoke within 2 hours before a feeding.
C The effects of secondhand smoke on infants include sudden infant death syndrome.
D For all of the above reasons, the new mother should be encouraged not to smoke. If she continues to smoke, she should be encouraged to always smoke in a room away from the baby.

DIF:Cognitive Level: ApplicationREF:551

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

MULTIPLE RESPONSE

1. A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. What signs and symptoms should the nurse include in her discussion? Choose all that apply.

a. Breast tenderness
b. Warmth in the breast
c. An area of redness on the breast often resembling the shape of a pie wedge
d. A small white blister on the tip of the nipple
e. Fever and flulike symptoms

ANS: A, B, C, E

Feedback
Correct These symptoms are commonly associated with mastitis and should be included in the nurses discussion of mastitis.
Incorrect This symptom generally is not associated with mastitis. It is commonly seen in women who have a plugged milk duct.

DIF:Cognitive Level: AnalysisREF:553

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

TRUE/FALSE

1. A woman who recently arrived from Africa insists upon feeding her infant honey prior to her milk coming in. This statement leads the nurse to believe that the woman should receive further education on infant feeding practices.

ANS: F

For many cultures in Southern Asia, the Pacific Islands, and parts of sub-Saharan Africa, the babies are fed a prelacteal food such as honey or clarified butter. It is the belief that these substances will help clear out the meconium.

DIF:Cognitive Level: KnowledgeREF:532, 533

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Assessment

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