Chapter 30 Newborn Nutrition My Nursing Test Banks

Olds Maternal-Newborn Nursing and Womens Health, 10e (Davidson)

Chapter 30 Newborn Nutrition

1) A nurse is evaluating the diet plan of a breastfeeding mother. Which beverage is most likely to cause intolerance in the infant?

1. Orange juice

2. Milk

3. Decaffeinated tea

4. Water

Answer: 2

Explanation: 2. Often fussy breastfeeding or cows milk-based formula-fed infants are switched to a lactose-free formula because of concerns about lactose intolerance.

Page Ref: 730

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.1 Recognize maternal and newborn factors when assisting parents in choosing an infant feeding method.

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2) The nurse is caring for a premature infant in the NICU, and is going to attempt a bottle feeding with thawed breast milk. How long can thawed breast milk be stored in the refrigerator before the nurse must discard it?

1. 4 hours

2. 8 hours

3. 12 hours

4. 24 hours

Answer: 4

Explanation: 4. Previously frozen thawed breast milk is good in the refrigerator for 24 hours only.

Page Ref: 747

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

3) The nurse is teaching a prenatal class about feeding methods. A father-to-be asks the nurse which method, breast or formula, leads to the fastest infant growth and weight gain. Which response by the nurse is best?

1. In the first 3 to 4 months breastfed babies tend to gain weight faster.

2. In the first 3 to 4 months there is no difference in weight gain.

3. In the first 3 to 4 months bottle-fed babies grow faster.

4. In the first 3 to 4 months growth isnt as important as your comfort with the method.

Answer: 1

Explanation: 1. Exclusively breastfed infants have the same or slightly higher weight gain than their formula-fed and combination-fed peers in the first 3 to 4 months.

Page Ref: 727, 728

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.1 Recognize maternal and newborn factors when assisting parents in choosing an infant

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feeding method.

4) The community nurse is working with poor women who are formula-feeding their infants. Which statement indicates that the nurses education session was effective?

1. I should use only soy-based formula for the first year.

2. I follow the instructions for mixing the powdered formula exactly.

3. It is okay to add more water to the formula to make it last longer.

4. The mixed formula can be left on the counter for a day.

Answer: 2

Explanation: 2. Powdered formula is the least expensive type of formula. Parents will need to be briefed on safety precautions during formula preparation and they should be instructed to follow the directions on the formula package label precisely as written.

Page Ref: 750

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.2 Examine the considerations of formula feeding when caring for the family with a newborn.

5) What is the primary carbohydrate in mammalian milk that plays a crucial role in the nourishment of the newborn?

1. Colostrum

2. Lactose

3. Lactoferrin

4. Secretory IgA

Answer: 2

Explanation: 2. Lactose is the primary carbohydrate in mammalian milk.

Page Ref: 729

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Compare the nutritional value and composition of human milk and formula preparations in relation to the nutritional needs of the newborn.

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MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

6) When teaching the new mother about the composition of breast milk, the nurse explains that the fat content can range from 30 to 50 grams/liter. Which factors affect the fat content of breast milk?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Maternal parity

2. Duration of pregnancy

3. Stage of lactation

4. Time of day

5. Vitamin C intake

Answer: 1, 2, 3, 4

Explanation: 1. Multiparous mothers produce milk with a lower content of fatty acids than primigravidas.

2. The milk of a mother who delivers a preterm infant has a greater concentration of DHA and ARA than does the milk of a mother who gives birth to a full-term infant.

3. Phospholipids and cholesterol levels are higher in colostrum than in mature milk, although overall fat content is higher in mature breast milk than in colostrum.

4. Fat content is generally higher in the evening and lower in the early morning.

Page Ref: 728

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1 Compare the nutritional value and composition of human milk and formula preparations in relation to the nutritional needs of the newborn.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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7) The nurse knows that in some cases, breastfeeding is not advisable. Which mother should be counseled against breastfeeding?

1. A mother with a poorly balanced diet

2. A mother who is overweight

3. A mother who is HIV positive

4. A mother who has twins

Answer: 3

Explanation: 3. Women with HIV or AIDS are counseled against breastfeeding.

Page Ref: 736

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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8) Which statements by a breastfeeding class participant indicate that teaching by the nurse was effective?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Breastfed infants get more skin-to-skin contact and sleep better.

2. Breastfeeding raises the level of a hormone that makes me feel good.

3. Breastfeeding is complex and difficult, and I probably wont succeed.

4. Breastfeeding is worthwhile, even if it costs more overall.

5. Breastfed infants have fewer digestive and respiratory illnesses.

Answer: 1, 2, 5

Explanation: 1. Skin-to-skin contact after birth helps the baby maintain his or her body temperature, helps with self-regulation, increases maternal oxytocin levels, helps the mother to notice subtle feeding cues, and promotes bonding.

2. Hormones of lactation promote maternal feelings and sense of well-being.

5. This is a true statement. The immunologic advantages of human milk include varying degrees of protection from respiratory tract and gastrointestinal tract infections.

Page Ref: 735, 737

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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9) A client at 20 weeks gestation has not decided on a feeding method for her infant. She asks the nurse for advice. The nurse presents information about the advantages and disadvantages of formula-feeding and breastfeeding. Which statements by the client indicate that the teaching was successful?

1. Formula-feeding gives the baby protection from infections.

2. Breast milk cannot be stored; it has to be thrown away after pumping.

3. Breastfeeding is more expensive than formula-feeding.

4. My baby will have a lower risk of food allergies if I breastfeed.

Answer: 4

Explanation: 4. Secretory IgA, an immunoglobulin present in colostrum and mature breast milk, has antiviral, antibacterial, and antigenic-inhibiting properties and plays a role in decreasing the permeability of the small intestine to help prevent large protein molecules from triggering an allergic response.

Page Ref: 734

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.4 Implement strategies to provide parental support and address concerns related to infant feeding.

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10) A new mother is questioning the nurse about the advantages of breastfeeding her newborn. Which information should the nurse include in the teaching session?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Breast milk has immunological advantages, including varying degrees of protection from bacterial and viral infections.

2. Breastfeeding has been shown to increase maternal-infant attachment.

3. Breastfeeding can be initially supplemented with bottle feedings so that the father does not feel left out of the infants care.

4. Breastfeeding often causes nipple tenderness, and may be discouraged until healing occurs.

5. Breastfeeding provides a psychologic advantage to the mother, who derives satisfaction knowing that she is providing her infant with the optimal nutritional start in life.

Answer: 1, 2, 5

Explanation: 1. Secretory IgA, an immunoglobulin present in colostrum and mature breast milk, has antiviral, antibacterial, and antigenic-inhibiting properties.

2. Early breastfeeding can enhance maternal-infant bonding.

5. The mothers sense of accomplishment in being able to satisfy her babys needs for nourishment and comfort can be a tremendous source of personal satisfaction.

Page Ref: 734, 737

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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11) What are some of the advantages and disadvantages of formula-feeding that a nurse should discuss with new parents?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. The nutritional value of formula depends on the proper preparation/dilution.

2. There is a potential for bacterial contamination during preparation and storage.

3. Both parents can participate in positive parent-infant interaction during feeding.

4. Refrigeration is not necessary if preparing more than one bottle at a time.

5. Formula has higher levels of essential fatty acids, lactose, cystine, and cholesterol than does breast milk.

Answer: 1, 2, 3

Explanation: 1. Formula composition does not vary unless the instructions for preparation and dilution are not followed.

2. Bacteria can be introduced if bottles and nipples are not properly cleaned.

3. If a mother has chosen not to breastfeed, then the father can be involved with bottle feedings from the start.

Page Ref: 735

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.2 Examine the considerations of formula feeding when caring for the family with a newborn.

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12) What interventions would the nurse apply to support the breastfeeding mother?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Assist the mother to begin breastfeeding within the first hour after birth.

2. Have the baby returned to the nursery after feeding so that the mother can get adequate rest.

3. Teach the mother to recognize and respond to early infant feeding cues.

4. Inform the mother about community resources that support breastfeeding.

5. Instruct the mother to avoid eating foods that might upset the newborns stomach

Answer: 1, 3, 4

Explanation: 1. Throughout the first 2 hours after birth, but especially during the first hour of life, most infants are usually alert and ready to breastfeed.

3. The new mother should be taught to recognize and respond to early infant feeding cues. The timing of newborn feedings is ideally determined by physiologic and behavioral cues rather than a set schedule.

4. It is important that parents receive verbal and written instructions and community resource information to which they can later refer.

Page Ref: 737, 753

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their infants successfully in hospital and community-based settings.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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13) Which of the following are potential disadvantages to breastfeeding?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Pain with breastfeeding

2. Leaking milk

3. Equal feeding responsibilities with fathers

4. Vaginal wetness

5. Embarrassment

Answer: 1, 2, 5

Explanation: 1. Nipple tenderness is the most common source of discomfort and is usually related to improper positioning and/or not obtaining a proper attachment of the infant on the breast. Pain can also be related to engorgement or infection.

2. Some women will leak milk when their breasts are full and it is nearly time to breastfeed again or whenever they experience let-down. Mothers should be given reassurance that this problem diminishes over time.

5. Some mothers feel uncomfortable about breastfeeding because they are modest or may feel embarrassed because our society views breasts as sexual objects and/or an unfriendly social environment makes it difficult to breastfeed in public. This is not an easy issue to overcome.

Page Ref: 734

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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14) What should the healthcare provider consider when prescribing a medication to a woman who is breastfeeding?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Drugs potential effect on hormone production

2. Amount of drug excreted into the mothers blood

3. Drugs potential adverse effects to the infant

4. Infants age and health

5. Mothers need for the medication

Answer: 3, 4, 5

Explanation: 3. The healthcare provider should consider the drugs potential adverse effects to the infant.

4. The healthcare provider should consider the infants age and health.

5. The healthcare provider should consider the mothers need for the medication.

Page Ref: 736

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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15) The nurse is teaching a new mother how to encourage a sleepy baby to breastfeed. Which of the following instructions would not be included in that teaching?

1. Providing skin-to-skin contact

2. Swaddling the newborn in a blanket

3. Unwrapping the newborn

4. Allowing the newborn to feel and smell the mothers breast

Answer: 2

Explanation: 2. Remove the babys blanket and clothing so that the infant is wearing only a diaper and T-shirt. Babies feed better when they are not bundled, and they can achieve better attachment without the bulk of extra clothing and blankets. Swaddling the newborn has the opposite effect.

Page Ref: 738

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their infants successfully in hospital and community-based settings.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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16) A mother states that her breasts leak between feedings. Which of the following can contribute to the letdown reflex in breastfeeding mothers?

1. Pain with breastfeeding

2. Number of hours passed since last feeding

3. The newborns cry

4. Maternal fluid intake

Answer: 3

Explanation: 3. Some women will leak milk when their breasts are full and it is nearly time to breastfeed again or whenever they experience letdown, which can be triggered by hearing, seeing, or even thinking of their baby.

Page Ref: 734

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

17) When a breastfeeding mother complains that her breasts are leaking milk, the nurse can offer which effective intervention?

1. Decrease the number of minutes the newborn is at the breast per feeding.

2. Decrease the mothers fluid intake.

3. Place absorbent pads in the bra.

4. Administer oxytocin.

Answer: 3

Explanation: 3. The mother can wear nursing pads inside her bra with instructions to change wet pads frequently.

Page Ref: 734

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IV. 9. Apply patient-care technologies as appropriate to address the needs of a diverse patient population. | NLN Competencies: Knowledge and Science: Value evidence-based approaches to yield best practices for nursing. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their infants successfully in hospital and community-based settings.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a

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newborn.

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18) When is breastfeeding contraindicated?

1. Infant has hypertension

2. Mother has a history of treated tuberculosis

3. Mother is HIV positive or has AIDS

4. Mother has a history of treated herpes

Answer: 3

Explanation: 3. Breastfeeding is contraindicated when the mother is HIV positive or has AIDS and is counseled against breastfeeding.

Page Ref: 736

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

19) Which of the following functions primarily to provide low-income women and children who are at risk for medical or nutritional problems with nutritious foods to supplement their diets, nutrition education and counseling, and screening and referrals to other health, welfare, and social programs?

1. ABM

2. WIC

3. ILCA

4. LLLI

Answer: 2

Explanation: 2. The Supplemental Nutrition Program for Women, Infants, and Children (WIC) functions primarily to provide low-income women and children who are at risk for medical or nutritional problems with nutritious foods to supplement their diets, nutrition education and counseling, and screening and referrals to other health, welfare, and social programs.

Page Ref: 753

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers

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to feed their infants successfully in hospital and community-based settings.

MNL LO: 4.4.4 Implement strategies to provide parental support and address concerns related to infant feeding.

20) The nurse is performing an assessment on an infant whose mother states that she feeds the infant in a supine position by propping the bottle. Based on this information, what would the nurse include in the assessment?

1. Otoscopic exam of the eardrum

2. Bowel sounds

3. Vital signs

4. Skin assessment

Answer: 1

Explanation: 1. Infants who bottle feed in a supine position have an increased risk of otitis media and dental caries in the older infant.

Page Ref: 750

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their infants successfully in hospital and community-based settings.

MNL LO: 4.4.4 Implement strategies to provide parental support and address concerns related to infant feeding.

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21) The nurse is working with a new mother who delivered yesterday. The mother has chosen to breastfeed her infant. Which demonstration of skill is the best indicator that the client understands breastfeeding?

1. She puts the infant to breast when he is asleep to help wake him up.

2. She takes off her gown to achieve skin-to-skin contact.

3. She leans toward the infant so that he turns his head to access the nipple.

4. The infant is crying when he is brought to the breast.

Answer: 2

Explanation: 2. Skin-to-skin contact after birth helps the baby maintain his or her body temperature, helps with self-regulation, increases maternal oxytocin levels, helps the mother to notice subtle feeding cues, and promotes bonding.

Page Ref: 737

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their infants successfully in hospital and community-based settings.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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22) A new mother who is breastfeeding tells the nurse that her infant is spitting up frequently, has very loose stools and copious gas, and feeds for only short periods of time. The nurse suspects a feeding intolerance and, after questioning the mother about her diet, suggests that she do which of the following?

1. Stop breastfeeding and switch to formula.

2. Eliminate dairy products from her diet.

3. Supplement breastfeeding with a soy-based formula.

4. Offer the baby water between feedings.

Answer: 2

Explanation: 2. Breastfeeding babies may not be allergic to the mothers milk but rather to the cows milk protein (an antigen) in the mothers milk. By eliminating the culprit (e.g., the bovine protein) from the mothers diet and therefore from the breast milk, the mother can continue to breastfeed, providing optimal nutrition and immune factors to her infant.

Page Ref: 730

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their infants successfully in hospital and community-based settings.

MNL LO: 4.4.4 Implement strategies to provide parental support and address concerns related to infant feeding.

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23) Which of the following is a sign of dehydration in the newborn?

1. Slow, weak pulse

2. Soft, loose stools

3. Light colored, concentrated urine

4. Depressed fontanelles

Answer: 4

Explanation: 4. Depressed fontanelles are a sign of dehydration in the newborn.

Page Ref: 728

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their infants successfully in hospital and community-based settings.

MNL LO: 4.4.4 Implement strategies to provide parental support and address concerns related to infant feeding.

24) The nurse is assisting a mother to bottle-feed her newborn, who has been crying. The nurse suggests that prior to feeding, the mother should do which of the following?

1. Offer a pacifier

2. Burp the newborn

3. Unwrap the newborn

4. Stroke the newborns spine and feet

Answer: 2

Explanation: 2. Crying results in increased ingestion of air even before the infant has started feeding. Infants who are very hungry also gulp more air. For these situations, instruct the parents to burp their infant frequently.

Page Ref: 751

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their infants successfully in hospital and community-based settings.

MNL LO: 4.4.4 Implement strategies to provide parental support and address concerns related to infant feeding.

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25) The nurse is explaining the nutritional differences between breast milk and formula to an expectant couple. The mother-to-be asks whether breast milk is nutritionally superior to formula. What should the nurse reply?

1. The vitamins and minerals in formula are more bioavailable to the infant.

2. There is no cholesterol in breast milk.

3. The only carbohydrate in breast milk is lactose.

4. The ratio of whey to casein proteins in breast milk changes to meet the nutritional needs of the growing infant.

Answer: 4

Explanation: 4. The ratio of whey to casein proteins in breast milk, unlike that in formula, is not static. It changes to meet the nutritional needs of the growing infant.

Page Ref: 729

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1 Compare the nutritional value and composition of human milk and formula preparations in relation to the nutritional needs of the newborn.

MNL LO: 4.4.1 Recognize maternal and newborn factors when assisting parents in choosing an infant feeding method.

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26) The nurse is caring for a new breastfeeding mother who is from Pakistan. The nurse plans her care so that the newborn is offered the breast on which of the following?

1. Day of birth

2. First day after birth

3. Second day after birth

4. Third to fourth day after birth

Answer: 4

Explanation: 4. Among some traditional cultures around the world, it is believed that colostrum is unclean or even harmful to a newborn. Because of this ancient belief, mothers living the Middle East and parts of Asia even today discard their colostrum or wait 2 to 4 days to begin breastfeeding, when their true milk arrives. This mother would begin breastfeeding the third or fourth day after the birth.

Page Ref: 739

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Therapeutic Environment

Standards: QSEN Competencies: I. C. 6. Willingly support patient-centered care for individuals and groups whose values differ from own. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Explain the influence of cultural values on infant feeding practices.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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27) The nurse is working with a client from Southeast Asia. The client tells the nurse that she should not put the baby to breast until her milk comes in and her breasts are warm, because cold milk (colostrum) is bad for the baby. After the nurse explains the benefits of colostrum, the client still insists that cold milk is bad. Which response by the nurse is best?

1. What kind of formula would you like to use?

2. That idea is folklore. Colostrum is good for the baby.

3. Now that you are here, you need to feed your baby the right way.

4. Lets give the baby formula after you breastfeed.

Answer: 4

Explanation: 4. This response attempts to provide a compromise between acknowledging the clients desire to give formula and getting the baby to breast to get colostrum. Nurses should be aware that some immigrant mothers may have this misconception about their colostrum.

Page Ref: 739

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. C. 13. Acknowledge the tension that may exist between patient rights and the organizational responsibility for professional, ethical care. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Relationship-Centered Care: Be open to others ideas; show humility, mutual trust, empathy, support, and a capacity for grace. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Explain the influence of cultural values on infant feeding practices.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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28) A client from Mexico has just delivered a son, and the nurse offers to assist in putting the baby to breast. Although the client indicated before the birth that she wanted to breastfeed, she is very hesitant, and says she would like to bottle-feed for the first few days. After talking to her, the nurse understands that her primary reason for wanting to delay breastfeeding is based on what cultural belief?

1. Breast milk causes skin rashes.

2. It is harmful to breastfeed immediately.

3. Colostrum is bad for the baby.

4. Thin milk causes diarrhea.

Answer: 3

Explanation: 3. Some Hispanics may delay breastfeeding because they believe colostrum is bad.

Page Ref: 739, 740

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. C. 4. Seek learning opportunities with patients who represent all aspects of human diversity. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Be open to others ideas; show humility, mutual trust, empathy, support, and a capacity for grace. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Explain the influence of cultural values on infant feeding practices.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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29) The nurse is preparing a class on breastfeeding for pregnant women in their first trimester. The women are from a variety of cultural backgrounds, and all speak English well. Which statement should the nurse include in this presentation?

1. Although some cultures believe colostrum is not good for the baby, it provides protection from infections and helps the digestive system to function.

2. Some women are uncomfortable with exposing their breasts to nurse their infant, but it really isnt a big deal. You will get used to it.

3. No religion prescribes a feeding method, so you all can choose whatever method makes the most sense to you.

4. In most cultures, it is culturally acceptable to speak about intimate matters in front of their families.

Answer: 1

Explanation: 1. Although it is true that some cultures believe colostrum to be unhealthy, colostrum helps to protect the infant from disease and illness.

Page Ref: 733

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. C. 4. Seek learning opportunities with patients who represent all aspects of human diversity. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Explain the influence of cultural values on infant feeding practices.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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30) The nurse has completed a community education session on growth patterns of infants. Which statement by a participant indicates that additional teaching is needed?

1. Newborns should regain their birth weight by 1 week of age.

2. Breastfed and formula-fed babies have different growth rates.

3. Formula-fed infants regain their birth weight earlier than breastfed infant.

4. Healthcare providers consider breastfeeding to be the gold standard for neonatal nutrition.

Answer: 1

Explanation: 1. Newborns should gain at least 10 g/kg/day and be back to birth weight no later than day 14 of life.

Page Ref: 755

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6 Describe ways to educate parents about their infants nutritional needs and normal growth patterns.

MNL LO: 4.4.4 Implement strategies to provide parental support and address concerns related to infant feeding.

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31) A nurse is evaluating the diet plan of a breastfeeding mother, and determines that her intake of fruits and vegetables is inadequate. The nurse explains that the nutritional composition of the mothers breast milk can be adversely affected by this nutritional inadequacy. Which strategy should the nurse recommend to the mother?

1. Stop breastfeeding

2. Provide newborn supplements to the newborn

3. Offer whole milk

4. Supplement with skim milk

Answer: 2

Explanation: 2. The mother may continue to breastfeed, but the caregiver may choose to prescribe additional vitamins for the newborn. Vitamins in human milk are influenced by the mothers vitamin intake, general nutritional status, and genetic differences.

Page Ref: 729

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. C. 14. Appreciate shared decision-making with empowered patients and families, even when conflicts occur. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6 Describe ways to educate parents about their infants nutritional needs and normal growth patterns.

MNL LO: 4.4.4 Implement strategies to provide parental support and address concerns related to infant feeding.

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32) The nurse encourages a new mother to feed the newborn as soon as the newborn shows interest. The nurse bases this recommendation on which benefits of early feedings?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Early feedings stimulate peristalsis.

2. Colostrum is thinner than mature milk.

3. Early feedings enhance maternal-infant bonding.

4. Early feedings promote the passage of meconium.

5. Colostrum contains a high number of calories.

Answer: 1, 3, 4

Explanation: 1. Early breastfeeding stimulates the newborns peristalsis.

3. Early breastfeeding enhances maternal-infant bonding.

4. Early breastfeeding promotes the passage of meconium.

Page Ref: 737

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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33) The nurse is completing the discharge teaching of a young first-time mother. Which statement by the mother requires immediate intervention?

1. I will put my baby to bed with his bottle so he doesnt get hungry during the night.

2. My baby will probably have a bowel movement each breastfeeding, and will wet often.

3. Nursing every 2 to 3 hours is normal, for a total of 8 to 12 feedings every day.

4. I will drink fenugreek tea from my grandmother to prevent my milk from coming in.

Answer: 1

Explanation: 1. Putting a baby to bed with a propped bottle is a choking hazard, and should never be done.

Page Ref: 750

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their infants successfully in hospital and community-based settings.

MNL LO: 4.4.3 Examine the considerations of breastfeeding when caring for the family with a newborn.

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34) What information should the nurse include when teaching a new mother how to successfully bottle-feed her newborn?

1. Proper dilution of powdered formula is essential to provide adequate nutrition.

2. Keep formula at room temperature for at least 4 hours to warm it, instead of microwaving it.

3. Use enough water to dilute the nutrient and calorie density so the infant will drink more formula.

4. Freeze newly prepared formula for up to 3 months.

Answer: 1

Explanation: 1. Parents should be instructed to follow the directions on the formula can label precisely as written.

Page Ref: 750

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their infants successfully in hospital and community-based settings.

MNL LO: 4.4.2 Examine the considerations of formula feeding when caring for the family with a newborn.

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35) What are the nurses responsibilities when teaching the new mother about infant feeding?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. The nurse should be well informed about infant nutrition and feeding methods.

2. The nurse should provide accurate and consistent information.

3. The nurse should use each interaction to support the parents and promote the familys sense of confidence.

4. The nurse should familiarize the mother with information about community resources that might be helpful after discharge.

5. The nurse should aggressively promote breastfeeding, even if the parents have decided to bottle-feed their infant.

Answer: 1, 2, 3, 4

Explanation: 1. The nurse should provide information on maternal and infant nutrition, fluid requirements, and feeding methods.

2. The nurse should provide information that is accurate and consistent. Nurses have a responsibility to educate parents.

3. Every interaction is a chance to educate and support the new parents in learning how to care for the newborn. Nurses have a responsibility to educate parents.

4. It is important that parents receive verbal and written instructions and community resource information to which they can later refer.

Page Ref: 753, 754, 755

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their infants successfully in hospital and community-based settings.

MNL LO: 4.4.4 Implement strategies to provide parental support and address concerns related to infant feeding.

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