Chapter 23: Newborn Feeding My Nursing Test Banks

Chapter 23: Newborn Feeding

Test Bank

MULTIPLE CHOICE

1. The breastfeeding mother should be taught a safe method to remove the breast from the babys mouth. Which suggestion by the nurse is most appropriate?

a.

Slowly remove the breast from the babys mouth when the infant has fallen asleep and the jaws are relaxed.

b.

Break the suction by inserting your finger into the corner of the infants mouth.

c.

A popping sound occurs when the breast is correctly removed from the infants mouth.

d.

Elicit the Moro reflex to wake the baby and remove the breast when the baby cries.

ANS: B

Feedback

A

The infant who is sleeping may lose grasp on the nipple and areola, resulting in chewing on the nipple, making it sore.

B

Inserting a finger into the corner of the babys mouth between the gums to break the suction avoids trauma to the breast.

C

A popping sound indicates improper removal of the breast from the babys mouth and may cause cracks or fissures in the breast.

D

Most mothers prefer the infant to continue to sleep after the feeding. Gentle wake-up techniques are recommended.

PTS: 1 DIF: Cognitive Level: Application REF: p. 537

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

2. 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. Newborns should be fed during the night regardless of feeding method.

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 to resemble breast milk. No supplements are necessary.

PTS: 1 DIF: Cognitive Level: Application REF: p. 531 | Box 23-2

OBJ: Nursing Process: Diagnosis

MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort

3. How can the nurse help the mother who is breastfeeding and has engorged breasts?

a.

Suggest that she switch to bottled formula just for today.

b.

Assist her into removing her bra, making her more comfortable.

c.

Apply heat to her breasts between feeding and cold to the breasts just before feedings.

d.

Instruct and assist the mother to massage her breasts.

ANS: D

Feedback

A

Engorgement is more likely to increase if breastfeeding is delayed or infrequent.

B

A well-fitting bra should be worn both day and night to support the breasts.

C

Cold applications are used between feedings to reduce edema and pain. Heat is applied just before feedings to increase vasodilation.

D

Massage of the breasts causes release of oxytocin and increases the speed of milk release.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 542

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

4. 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. Based on this information, this woman should feed her infant about every 2.5 to 3 hours when she

a.

Waves her arms in the air

b.

Makes sucking motions

c.

Has hiccups

d.

Stretches out her legs straight

ANS: B

Feedback

A

Waving about her arms in the air is not a 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 out her extremities is not a typical feeding-readiness cue.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 534 | Box 23-3

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

5. Which type of formula is not diluted before being administered to an infant?

a.

Powdered

b.

Concentrated

c.

Ready-to-use

d.

Modified cows milk

ANS: C

Feedback

A

Formula should be well mixed to dissolve the powder and make it uniform.

B

Improper dilution of concentrated formula may cause malnutrition or sodium imbalances.

C

Ready-to-use formula can be poured directly from the can into babys bottle and is good (but expensive) when a proper water supply is not available.

D

Cows milk is more difficult for the infant to digest and is not recommended, even if it is diluted.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 546

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

6. How many kilocalories per kilogram (kcal/kg) of body weight does a breastfed term infant require each day?

a.

50 to 75

b.

85 to 100

c.

100 to 110

d.

150 to 200

ANS: B

Feedback

A

This amount is too little and does not provide adequate nutrition.

B

The term breastfed infant requires 85 to 100 kcal/kg per day.

C

The term newborn requires 100 to 110 kcal/kg to meet nutritional needs each day.

D

This amount may be too large and would lead to overfeeding.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 528

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

7. The hormone necessary for milk production is

a.

Estrogen

b.

Prolactin

c.

Progesterone

d.

Lactogen

ANS: B

Feedback

A

Estrogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced.

B

Prolactin, secreted by the anterior pituitary, is a hormone that causes the breasts to produce milk.

C

Progesterone decreases the effectiveness of prolactin and prevents mature breast milk from being produced.

D

Human placental lactogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 533

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

8. To initiate the milk ejection reflex, the mother should

a.

Wear a firm-fitting bra.

b.

Drink plenty of fluids.

c.

Place the infant to the breast

d.

Apply cool packs to her breast.

ANS: C

Feedback

A

A firm bra is important to support the breast, but will not initiate the let-down reflex.

B

Drinking plenty of fluids is necessary for adequate milk production, but will not initiate the let-down reflex.

C

Oxytocin, which causes the milk let-down reflex, increases in response to nipple stimulation.

D

Cool packs to the breast will decrease the let-down reflex.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 533

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

9. What is the first step in assisting the breastfeeding mother?

a.

Provide instruction on the composition of breast milk.

b.

Discuss the hormonal changes that trigger the milk ejection reflex.

c.

Assess the womans knowledge of breastfeeding.

d.

Help her obtain a comfortable position and place the infant to the breast.

ANS: C

Feedback

A

Assessment should occur before instruction.

B

This may be part of the instructional plan, but assessment should occur first to determine what instruction is needed.

C

The nurse should first assess the womans knowledge and skill in breastfeeding to determine her teaching needs.

D

This may be part of the instructional plan, but assessment should occur first to determine what instruction is needed.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 532

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

10. A primiparous woman is delighted with her newborn son and wants to begin breastfeeding as soon as possible. The nurse can facilitate the infants correct latch-on by helping the woman hold the infant

a.

With his arms folded together over his chest

b.

Curled up in a fetal position

c.

With his head cupped in her hand

d.

With his head and body in alignment

ANS: D

Feedback

A

The infant should be facing the mother with his arms hugging the breast.

B

The babys body should be held in correct alignment (ears, shoulder, hips in a straight line) during feedings.

C

The mother should support the babys neck and shoulders with her hand and not push on the occiput.

D

The infants head and body should be in correct alignment with the mother and the breast during latch-on and feeding.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 535

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

11. 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 539

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

12. To prevent breast engorgement, the new breastfeeding mother should be instructed to

a.

Apply cold packs to the breast before feeding.

b.

Breastfeed frequently and for adequate lengths of time.

c.

Limit her intake of fluids for the first few days.

d.

Feed her infant no more than every 4 hours.

ANS: B

Feedback

A

Warm packs should be applied to the breast before feedings.

B

Engorgement occurs when the breasts are not adequately emptied at each feeding or if feedings are not frequent enough.

C

Fluid intake should not be limited with a breastfeeding mother; that will decrease the amount of breast milk produced.

D

Breast milk moves through the stomach within 1.5 to 2 hours, so waiting 4 hours to feed is too long. Frequent feedings are important to empty the breast and to establish lactation.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 541

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

13. The difference between the aseptic and terminal methods of sterilization is that the

a.

Aseptic method does not require boiling of the bottles.

b.

Terminal method requires boiling water to be added to the formula.

c.

Aseptic method requires a longer preparation time.

d.

Terminal method sterilizes the prepared formula at the same time it sterilizes the equipment.

ANS: D

Feedback

A

With the aseptic method, the bottles are boiled separate from the formula.

B

With the terminal method, the formula is prepared, placed in bottles, and everything is boiled at one time.

C

The terminal method takes 25 minutes to boil; the aseptic method takes 5 minutes to boil.

D

In the terminal sterilization method, the formula is prepared in the bottles, which are loosely capped, and then the bottles are placed in the sterilizer, where they are boiled for 25 minutes.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 546

OBJ: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment

14. How many ounces will a formula fed infant who is on a 4-hour feeding schedule need to consume at each feeding to meet daily caloric needs?

a.

0.5 to 1

b.

1 to 2

c.

2 to 3

d.

4

ANS: C

Feedback

A

The infant takes 0.5 to 1 ounce per feeding during the first day of life.

B

This is too small an amount to meet calorie needs.

C

The newborn requires approximately 2 to 3 ounces per feeding within one week after birth.

D

Four ounces with every feeding would be overfeeding the infant.

PTS: 1 DIF: Cognitive Level: Application REF: p. 547

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

15. A new mother is concerned because her 1-day-old newborn is taking only 1 ounce at each feeding. The nurse should explain that the

a.

Infant does not require as much formula in the first few days of life.

b.

Infants stomach capacity is small at birth but will expand within a few days.

c.

Infant tires easily during the first few days but will gradually take more formula.

d.

Infant is probably having difficulty adjusting to the formula.

ANS: B

Feedback

A

The infants requirements are the same, but the stomach capacity needs to increase before taking in adequate amounts.

B

The infants stomach capacity at birth is 10 to 20 mL and increases to 60 to 90 mL by the end of the first week.

C

The infants sleep patterns do change, but the infant should be awake enough to feed.

D

There are other symptoms that occur if there is a formula intolerance.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 528

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

16. As the nurse assists a new mother with breastfeeding, she asks, If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better? The nurses best response is that it contains

a.

More calories

b.

Essential amino acids

c.

Important immunoglobulins

d.

More calcium

ANS: C

Feedback

A

The calorie count of formula and breast milk is about the same.

B

All of the essential amino acids are in both formula and breast milk. The concentrations may differ.

C

Breast milk contains immunoglobulins that protect the newborn against infection.

D

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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 529

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

17. When responding to the question Will I produce enough milk for my baby as she grows and needs more milk at each feeding? the nurse should explain that

a.

The breast milk will gradually become richer to supply additional calories.

b.

As the infant requires more milk, feedings can be supplemented with cows milk.

c.

Early addition of baby food will meet the infants needs.

d.

The mothers milk supply will increase as the infant demands more at each feeding.

ANS: D

Feedback

A

Mature breast milk will stay the same. The amounts will increase as the infant feeds for longer times.

B

Supplementation will decrease the amount of stimulation of the breast and decrease the milk production.

C

Solids should not be added until about 4 to 6 months, when the infants immune system is more mature. This will decrease the chance of allergy formations.

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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 533

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

18. In order to prevent nipple trauma, the nurse should teach the new mother to

a.

Limit the feeding time to less than 5 minutes.

b.

Position the infant so the nipple is far back in the mouth.

c.

Assess the nipples before each feeding.

d.

Wash the nipples daily with mild soap and water.

ANS: B

Feedback

A

Stimulating the breast for less than 5 minutes will not produce the extra milk the infant may need.

B

If the infants 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.

C

Assessing the nipples for trauma is important, but it will not prevent sore nipples.

D

Soap can be drying to the nipples and should be avoided during breastfeeding.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 536-537

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

19. A breastfeeding mother who was discharged yesterday calls to ask about a tender, hard area on her right breast. The nurses first response should be

a.

Try massaging the area and apply heat, as this is probably a plugged duct.

b.

Stop breastfeeding because you probably have an infection.

c.

Notify your doctor so he can start you on antibiotics.

d.

This is a normal response in breastfeeding mothers.

ANS: A

Feedback

A

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.

B

Fatigue, aching muscles, fever, chills, malaise, and headache are signs of mastitis. She may have a localized area of redness and inflammation.

C

These are not the signs of an infection, so antibiotics are not indicated.

D

This is a normal deviation but requires intervention to prevent further complications.

PTS: 1 DIF: Cognitive Level: Application REF: p. 541

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

20. An important aspect about storage of breast milk is that it

a.

Can be frozen for up to 2 months

b.

Should be stored only in glass bottles

c.

Can be thawed and refrozen

d.

Can be kept refrigerated for 48 hours

ANS: D

Feedback

A

Frozen milk should be kept for 1 month only.

B

Antibodies in the milk will adhere to glass bottles. Only rigid polypropylene plastic containers should be used.

C

It should not be refrozen.

D

If used within 48 hours after being refrigerated, breast milk will maintain its full nutritional value.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 545

OBJ: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment

21. The nurse should explain to new parents that the most serious consequence of propping an infants bottle is

a.

Dental caries

b.

Aspiration

c.

Ear infections

d.

Colic

ANS: B

Feedback

A

Dental caries become 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.

B

Propping the bottle increases the likelihood of choking and aspiration if regurgitation occurs.

C

Ear infections can occur when the warm formula runs into the ear and bacterial growth occurs. However, this is not the most serious consequence.

D

Colic can occur, but it is not the most serious consequence.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 547

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

22. Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them about pumping, storing, and transporting the milk needs to assess their knowledge of lactation. What statement is valid?

a.

A premature infant more easily digests breast milk than formula.

b.

A glass of wine just before pumping will help reduce stress and anxiety.

c.

The mother should only pump as much as the infant can drink.

d.

The mother should pump every 2 to 3 hours, including during the night.

ANS: A

Feedback

A

Human milk is the ideal food for preterm infants, with benefits that are unique in addition to those received by term, healthy infants. Greater physiologic stability occurs with breastfeeding compared with formula feeding.

B

Consumption of alcohol during lactation is approached with caution. Excessive amounts can have serious effects on the infant and can adversely affect the mothers milk ejection reflex.

C

To establish an optimal milk supply, the mother should be instructed to pump eight to 10 times a day for 10 to 15 minutes on each breast.

D

The mother should be instructed to pump eight to 10 times a day for 10 to 15 minutes on each breast.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 540

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

23. A new mother asks if she should feed her newborn colostrum, because it is not real milk. The nurses best answer is that

a.

Colostrum is high in antibodies, protein, vitamins, and minerals.

b.

Colostrum is lower in calories than milk and should be supplemented by formula.

c.

Giving colostrum is important in helping the mother learn how to breastfeed before she goes home.

d.

Colostrum is unnecessary for newborns.

ANS: A

Feedback

A

Colostrum is important because it has high levels of the nutrients needed by the neonate and helps protect against infection.

B

Supplementation is not necessary. It will decrease stimulation to the breast and decrease the production of milk.

C

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.

D

Colostrum provides immunities and enzymes necessary to clean the gastrointestinal system, among other things.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 529

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

24. What information about iron supplementation should the nurse teach a new mother?

a.

Start iron supplementation shortly after birth if the infant is breastfeeding exclusively.

b.

Iron-fortified formula will meet the infants iron requirements.

c.

Iron supplements must be given when the infant begins teething.

d.

Infants need a multivitamin with iron every day.

ANS: B

Feedback

A

Term infants who are exclusively breastfed have adequate iron stored until they are age 6 months.

B

Iron-fortified formula will meet the infants initial iron requirements. Solid foods added to the diet maintain iron needs as formula intake decreases.

C

Iron supplements are not necessary for adequate teething.

D

Vitamins and minerals are added to processed formulas and cereals. It should not be necessary for the child to receive a multivitamin with iron unless the infant is at risk for undernutrition.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 530

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

25. 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 546

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

26. According to the recommendations of the American Academy of Pediatrics (AAP) 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.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 530

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

27. All parents are entitled to a birthing environment in which breastfeeding is promoted and supported. The Baby Friendly Hospital Initiative endorsed by WHO and Unicef was founded to encourage institutions to offer optimal levels of care for lactating mothers. Which is not one of the Ten Steps to Successful Breastfeeding for Hospitals?

a.

Give newborns no food or drink other than breast milk.

b.

Have a written breastfeeding policy that is communicated to all staff.

c.

Help mothers initiate breastfeeding within one half hour of birth.

d.

Give artificial teats or pacifiers as necessary.

ANS: D

Feedback

A

No other food or drink should be given to the newborn unless medically indicated.

B

The breastfeeding policy should be routinely communicated to all health care staff. All staff should be trained in the skills necessary to maintain this policy.

C

Breastfeeding should be initiated within one half hour of birth and all mothers need to be shown how to maintain lactation even if separated from their babies.

D

No artificial teats or pacifiers (also called dummies or soothers) should be given to breastfeeding infants.

PTS: 1 DIF: Cognitive Level: Application REF: p. 531

OBJ: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment

28. 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

Some women lack confidence in their ability to produce breast milk of adequate quantity or quality. The key to encouraging these mothers to breastfeed is anticipatory guidance beginning as early as possible in pregnancy.

C

A major barrier for many women is the influence of family and friends. She may view formula feeding as a way to ensure that the father and other family members can participate. Each encounter with the family is an opportunity for the nurse to educate, dispel myths and clarify information regarding the benefits of breastfeeding.

D

Many women see bottle-feeding as more convenient and less embarrassing than breastfeeding. They may also see breastfeeding as incompatible with an active social life. There may be modesty issues related to feeding the infant in public. Although concerning, these are not legitimate reasons to formula-feed an infant. Often this decision is made without complete information regarding the benefits of breastfeeding.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 544

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

29. 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 require some logistical adaptations, but this should not lead to nipple confusion.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 539

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

30. Many types of breast pumps are available, varying in price and effectiveness. Before either renting or purchasing a pump, the new mother would benefit from counseling by a nurse or lactation consultant to determine the most appropriate pump to suit her needs. The mother who is pumping for an occasional bottle would be most suited for which type of pump?

a.

Manual or hand pump

b.

Hospital grade pump

c.

Electric self-cycling double pumps

d.

Smaller electric or battery operated pump

ANS: A

Feedback

A

These are the least expensive and can be the most appropriate choice for mothers pumping for the occasional bottle.

B

Full service electric or hospital grade pumps most closely duplicate the sucking action of the breastfeeding infant. These are used when mother and baby (preterm or sick) are separated for long periods.

C

Self-cycling pumps are easy to use, efficient and designed for working mothers.

D

Smaller pumps operated with a battery are typically used when pumping occasionally.

PTS: 1 DIF: Cognitive Level: Application REF: p. 544

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Late in pregnancy, the womans breasts should be assessed by the nurse to identify any potential concerns related to breastfeeding. Some nipple conditions make it necessary to provide intervention before birth. These include (select all that apply)

a.

Everted nipples

b.

Flat nipples

c.

Inverted nipples

d.

Nipples that contract when compressed

e.

Cracked nipples

ANS: B, C, D

Feedback

Correct

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 infants 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 is debated. A breast pump can be used to draw the nipples out before feedings after delivery.

Incorrect

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 latch. The infant should be repositioned during feeding. Application of colostrum and breast milk after feedings will aid in healing.

PTS: 1 DIF: Cognitive Level: Application REF: p. 534

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. Examples of appropriate techniques to wake a sleepy infant for breastfeeding include (select all that apply)

a.

Unwrap the infant.

b.

Change the diaper.

c.

Talk to the infant.

d.

Slap the infants hands and feet.

e.

Apply a cold towel to the infants abdomen.

ANS: A, B, C

Feedback

Correct

These are appropriate techniques to use when trying to wake a sleepy infant.

Incorrect

This is not appropriate. The parent can rub the infants hands or feet to wake the infant. Applying a cold towel to the infants abdomen may lead to cold stress in the infant. The parent may want to apply a cool cloth to the infants face to wake the infant.

PTS: 1 DIF: Cognitive Level: Application REF: p. 539

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

3. 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? Select 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.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 541

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

COMPLETION

1. A newborn weight loss of _____% in a breastfeeding infant during the first 3 days of life should be investigated. Most often, the excessive weight loss is associated with poor breastfeeding techniques.

ANS:

7-8

Health care providers should evaluate and monitor infants who continue to lose weight after 5 days or who do not regain their birth weight by 14 days.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 528

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. Milk that gradually changes from colostrum to mature milk, appears over about 10 days after delivery. This is known as _____________ milk.

ANS:

transitional

The amount of transitional milk increases rapidly as the milk comes in. Immunoglobulins and proteins decrease while lactose, fat, and calories increase.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 529

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

TRUE/FALSE

1. At some hospitals in the United States, new mothers are given formula gift packs at discharge. Having been given the gift pack by hospital staff leads parents to believe that formula will be necessary even for breastfeeding mothers. Is this statement true or false?

ANS: T

This is the goal of the formula manufacturers, and for this reason many hospitals have stopped providing new mothers with formula gift packs. For many parents, having formula available at home may lead them to feel that having to supplement breastfeeding is necessary. Adding formula to the infants diet will lessen breastfeeding success because the introduction of supplemental feedings will reduce the amount of breastfeeding time, which in turn will decrease milk production.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 538

OBJ: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment

2. The cultural group in the United States that is most likely to breastfeed are non-Hispanic black women. Is this statement true or false?

ANS: F

The cultural group with the lowest breastfeeding rates in the U.S. includes women who are non-Hispanic black. Women who are most likely to breastfeed are Asian, Pacific Islanders, or Hispanic. It is essential that the nurse educates this patient population on the benefits of breastfeeding and provides additional support.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 532

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

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