Chapter 25: Newborn Nutrition and Feeding My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 25: 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. Based on 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 hiccups

d.

Stretches her legs out straight

ANS: B

Sucking motions, rooting, mouthing, and hand-to-mouth motions are examples of feeding readiness cues.

Waving her arms in the air is not a feeding readiness cue.

Hiccups are not a typical feeding readiness cue.

Stretching out her extremities is not a typical feeding readiness cue.

DIF: Cognitive Level: Comprehension REF: 613

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

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

Exposure to cows milk poses a risk of developing allergies, eczema, and asthma.

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

Iron is better absorbed from breast milk than from formula.

Commercial formulas are designed to meet the nutritional needs of the infant and to resemble breast milk. No supplements are necessary.

DIF: Cognitive Level: Application REF: 608

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

TOP: Nursing Process: Diagnosis

3. 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

After day 4, when the mothers milk comes in, the infant should have six to eight wet diapers every 24 hours.

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. This is not an indication if the infant is breastfeeding well.

The infant should have a minimum of three bowel movements in a 24-hour period.

Breastfed infants typically gain 15 to 30 g/day.

DIF: Cognitive Level: Comprehension REF: 617

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

4. 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

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

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

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

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

DIF: Cognitive Level: Comprehension REF: 615

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

5. A breastfeeding woman develops engorged breasts at 3 days postpartum. What action will 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

The mother should be instructed to attempt feeding her infant every 2 hours while massaging the breasts as the infant is feeding.

Skipping feedings may cause further swelling and discomfort.

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.

Dehydration further irritates swollen breast tissue.

DIF: Cognitive Level: Comprehension REF: 627

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 in order 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

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.

Solid foods should not be introduced to an infant for at least 4 to 6 months.

Bottle feeding may cause nipple confusion and may limit the supply of milk.

Iron supplements have no bearing on weight gain.

DIF: Cognitive Level: Application REF: 620

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning, Implementation

7. 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

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.

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.

To establish an optimal milk supply, the mother should be instructed to pump 8 to 10 times a day for 10 to 15 minutes on each breast.

Pumping 8 to 10 times a day for 10 to 15 minutes on each breast is the most appropriate instruction for the parents.

DIF: Cognitive Level: Analysis REF: 621

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

8. 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

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.

Solid food should not be introduced to the infant for at least 4 to 6 months after birth.

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.

Any formula left in the bottle after the feeding should be discarded because the infants saliva has mixed with it.

DIF: Cognitive Level: Comprehension REF: 630

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

9. A nurse is discussing storage of breast milk with a mother whose infant is preterm and in the special care unit. What statement indicates 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 4 hours.

d.

I can store my breast milk in the refrigerator for 3 to 5 days.

ANS: A

Breast milk for the hospitalized infant can be stored at room temperature for 4 hours, in the refrigerator for 8 days, in the freezer for 3 months, or in a deep freezer for 6 months.

Human milk for the preterm hospitalized infant can be kept in the freezer for up to 3 months.

Human milk for the preterm hospitalized infant can be kept at room temperature for 4 hours or less.

Human milk for the healthy or preterm hospitalized infant can be kept in the refrigerator for up to 8 days.

DIF: Cognitive Level: Analysis REF: 624

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

10. 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

Breastfeeding/human milk should also be the sole source of milk for the second 6 months.

Infants start on solids when they are ready, usually at 6 months, whether they start on formula or breast milk.

If infants are weaned from breast milk before 12 months, they should receive iron-fortified formula, not cows milk.

Breastfeeding/human milk should be the sole source of milk for the first 12 months.

DIF: Cognitive Level: Knowledge REF: 607

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

11. All parents are entitled to a birthing environment in which breastfeeding is promoted and supported. The Baby Friendly Hospital Initiative endorsed by the World Health Organization (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

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

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

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.

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.

DIF: Cognitive Level: Application REF: 609

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Implementation

12. What 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

Breastfeeding actually decreases the risk of childhood obesity.

Human milk is the perfect food for human infants. Breast milk changes over time to meet the demands of the growing infant.

Scientific evidence is clear that human milk provides the best nutrients for infants with continued benefits long after weaning.

Fatty acids in breast milk promote brain growth and development and may lead to enhanced cognition.

DIF: Cognitive Level: Comprehension REF: 608

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

13. The best reason for recommending formula over breastfeeding is:

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

Breastfeeding is contraindicated when mothers have certain viruses, are undergoing chemotherapy, or are using/abusing drugs.

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.

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.

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.

DIF: Cognitive Level: Comprehension REF: 608

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

14. 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 during at least the first 2 months

d.

Vitamin K injections at birth are not needed for infants fed on specially enriched formula

ANS: C

Human milk contains only small amounts of vitamin D. All infants who are breastfed should receive 400 International Units of vitamin D each day.

Neither breastfed nor formula-fed infants need to be fed water, not even in very hot climates.

During the first 3 months, formula-fed infants consume more energy than breastfed infants and therefore tend to grow more rapidly.

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: Comprehension REF: 611

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

15. With regard to the special qualities of human breast milk, nurses should be aware that:

a.

Frequent feedings during predictable growth spurts stimulate increased milk production

b.

The milk of preterm mothers is the same as the milk of mothers who gave birth at term

c.

The milk at the beginning of the feeding is the same as the milk at the end of the feeding

d.

Colostrum is an early, less concentrated, less rich version of mature milk

ANS: A

These growth spurts (10 days, 3 weeks, 6 weeks, 3 months) usually last 24 to 48 hours, after which infants resume normal feeding.

The milk of mothers of preterm infants is different from that of mothers of full-term infants to meet the needs of these newborns.

Milk changes composition during feeding. The fat content of the milk increases as the infant feeds.

Colostrum precedes mature milk and is more concentrated and richer in proteins and minerals (but not fat).

DIF: Cognitive Level: Comprehension REF: 613

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

16. Nurses should be able to tell breastfeeding mothers that all of these are signs that the infant has latched on correctly to her breast except:

a.

She feels a firm tugging sensation on her nipples but not pinching or pain

b.

The baby sucks with cheeks rounded, not dimpled

c.

The babys jaw glides smoothly with sucking

d.

The babys nostrils become occluded

ANS: D

If the babys nostrils happen to become occluded by the breast, reflexes will prompt the newborn to move the head and pull back to breathe. If the mother is worried about the babys breathing, she can raise the babys hips slightly to change the angle of the babys head at the breast.

The tugging sensation without pinching is a good sign. The clicking or smacking sound may indicate the baby is having difficulty keeping the tongue out over the lower gum ridge. The mother should hope to hear the sound of swallowing.

Rounded cheeks are a positive sign. The clicking or smacking sound may indicate the baby is having difficulty keeping the tongue out over the lower gum ridge. The mother should hope to hear the sound of swallowing.

A smoothly gliding jaw is a good sign. The clicking or smacking sound may indicate the baby is having difficulty keeping the tongue out over the lower gum ridge. The mother should hope to hear the sound of swallowing.

DIF: Cognitive Level: Comprehension REF: 616

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

17. 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

The parents do this to make sure the infant gets at least eight feedings in 24 hours.

Demand feeding is when the infant determines the frequency of feedings; this is appropriate once the infant is feeding well and gaining weight.

The supply-meets-demand system is a milk production system that occurs naturally.

Cluster feeding is not a problem if the baby gets eight feedings in 24 hours.

DIF: Cognitive Level: Comprehension REF: 616

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

18. A 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

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.

Abrupt weaning can be distressing to mother and/or baby but should not lead to nipple confusion.

Pacifiers used before breastfeeding is established can be disruptive, but this does not lead to nipple confusion.

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

DIF: Cognitive Level: Comprehension REF: 618

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

19. With regard to basic care of the breastfeeding mother, nurses should be able to advise her that she:

a.

Will need an extra 1000 calories a day to maintain energy and produce milk

b.

Can go back to prepregnancy consumption patterns of any drinks as long as she gets enough calcium

c.

Should avoid trying to lose large amounts of weight

d.

Must avoid exercising because it is too fatiguing

ANS: C

Large weight loss releases fat-stored contaminants into her breast milk. It also involves eating too little and/or exercising too much.

A breastfeeding mother need add only 200 to 500 extra calories to her diet to provide extra nutrients for the infant.

This is true only if she doesnt drink alcohol, limits coffee to no more than two cups (caffeine in chocolate, tea, and some sodas, too), and reads the herbal tea ingredients carefully.

She needs her rest; however, moderate exercise is healthy.

DIF: Cognitive Level: Comprehension REF: 625

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

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

a.

Smoking has little to no effect on milk production

b.

There is no relationship 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 another room

ANS: D

The new mother should be encouraged not to smoke. If she continues to smoke, she should be encouraged to always smoke in another room removed from the baby.

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.

Research supports that mothers should not smoke within 2 hours before a feeding (AAP Committee on Drugs, 2001).

The effects of secondhand smoke on infants include excessive crying, colic, upper respiratory infections, and an increased risk of sudden infant death syndrome (SIDS).

DIF: Cognitive Level: Application REF: 626

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

MULTIPLE RESPONSE

1. Examples of appropriate techniques to wake a sleepy infant for breastfeeding include (choose 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

Unwrapping the infant, changing the diaper, and talking to the infant are appropriate techniques to use when trying to wake a sleepy infant.

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.

DIF: Cognitive Level: Application REF: 620

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

2. 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

Breast tenderness, warmth in the breast, redness on the breast, and fever and flulike symptoms are commonly associated with mastitis and should be included in the nurses discussion of mastitis.

A small white blister on the tip of the nipple generally is not associated with mastitis. It is commonly seen in women who have a plugged milk duct.

DIF: Cognitive Level: Analysis REF: 629

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

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%

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.

DIF: Cognitive Level: Comprehension REF: 620

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

TRUE/FALSE

1. The size of the mothers breasts is an accurate indicator of their ability to produce milk. Is this statement true or false?

ANS: F

Size is not an accurate indicator of the breasts ability to produce milk. Although nearly all women lactate, a small number of women have insufficient mammary gland development to breastfeed their infants exclusively.

DIF: Cognitive Level: Knowledge REF: 611

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

2. A woman who recently arrived from Africa insists on 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. Is this statement true or false?

ANS: F

For many cultures in Southeast 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: Knowledge REF: 609

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment

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