NCLEX-Style Review Questions - Chapter 24 (exam 3)

The birth weight of a breastfed newborn was 8 lb, 4 oz. On the third day the newborn's weight was 7 lb, 12 oz. On the basis of this finding, the nurse should ____.

encourage the mother to continue breastfeeding since it is effective in meeting the newborn's nutrient and fluid needs.

suggest that the mother switch to bottle-feeding since the breastfeeding is ineffective in meeting newborn needs for fluid and nutrients.

notify the physician since the newborn is being poorly nourished.

refer the mother to a lactation consultant to improve her breastfeeding technique.

encourage the mother to continue breastfeeding since it is effective in meeting the newborn's nutrient and fluid needs.

Weight loss of 8 oz falls within the 5% to 10% expected weight loss from birth weight during the first few days of life, which for this newborn would be 6.6 to 13.2 oz. Breastfeeding is effective at this time. Breastfeeding is effective, and bottle-feeding does not need to be initiated at this time. The infant is not undernourished, and the physician does not need to be notified. The weight loss is within normal limits; breastfeeding is effective.

Which action of a breastfeeding mother indicates the need for further instruction?

Holds breast with four fingers along bottom and thumb at top.

Leans forward to bring breast toward the baby.

Stimulates the rooting reflex and then inserts nipple and areola into newborn's open mouth.

Puts her finger into newborn's mouth before removing breast.

Leans forward to bring breast toward the baby.

Holding the breast with four fingers along the bottom and the thumb at top is a correct technique. To maintain a comfortable, relaxed position, the mother should bring the baby to the breast, not the breast to the baby. The mother would need further demonstration and teaching to correct the ineffective action. Stimulating the rooting reflex is correct. Placing the finger in the mouth to remove the baby from the breast is correct.

The nurse taught new parents the guidelines to follow regarding bottle-feeding of their newborn. They will be using formula from a can of concentrate. The parents would demonstrate an understanding of the nurse's instructions if they ____.

wash the top of the can and can opener with soap and water before opening the can.

adjust the amount of water added according to the weight gain pattern of the newborn.

add some honey to sweeten the formula and make it more appealing to a fussy newborn.

warm formula in a microwave oven for a couple of minutes before feeding.

wash the top of the can and can opener with soap and water before opening the can.

Washing the top of the can and can opener with soap and water before opening the can of formula is a good habit for a parent to get into to prevent contamination. Directions on the can for dilution should be followed exactly and not adjusted according to weight gain to prevent nutritional and fluid imbalances. Honey is not necessary and could contain botulism spores. The formula should be warmed in a container of hot water since a microwave can easily overheat it.

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

the cradle position is usually preferred by mothers who had a cesarean birth.

women with perineal pain and swelling prefer the modified cradle position.

whatever the position used, the infant is "skin to skin" with the mother.

while supporting the head, the mother should push gently on the occiput.

whatever the position used, the infant is "skin to skin" with the mother.

The football position usually is preferred after cesarean birth. Women with perineal pain and swelling prefer the side-lying position because they can rest while breastfeeding. The infant should be placed in a "skin to skin" position facing the mother. The mother should never push on the back of the head. It may cause the baby to bite, hyperextend the neck, or develop an aversion to being brought near the breast.

A maternity nurse is preparing a teaching class for a group of new parents on infant feeding practices. The maternity nurse wants to include content that is relative to cultural diversity. Which statement related to cultural practices influencing infant feeding practice is correct?

A common practice among Mexican women is known as las dos cosas.

Muslim cultures do not encourage breastfeeding due to modesty concerns.

Latino women born in the United States are more likely to breastfeed.

East Indian and Arab women believe that cold foods are best for a new mother.

A common practice among Mexican women is known as las dos cosas.

A common practice among Mexican women is las dos cosas. This refers to combining breastfeeding and commercial infant formula. It is based on the belief that by combining the two feeding methods, the mother and infant receive the benefits of breastfeeding along with the additional vitamins from formula. Among the Muslim culture, breastfeeding for 24 months is customary. Muslim women may choose to bottle-feed formula or expressed breast milk while in the hospital. Latino women born in the United States are less likely to breastfeed. East Indian and Arab women believe that hot foods, such as chicken and broccoli, are best for the new mother. The descriptor hot has nothing to do with the temperature or spiciness of the food.

Which statement regarding infant weaning is correct?

Weaning should proceed from breast to bottle to cup.

The feeding of most interest should be eliminated first.

Abrupt weaning is easier than gradual weaning.

Weaning can be mother or infant initiated.

Weaning can be mother or infant initiated.

Infants can be weaned directly from the breast to a cup. Bottles are usually offered to infants less than 6 months. If the infant is weaned before 1 year of age, iron-fortified formula rather than cow's milk should be offered. The feeding of least interest to the baby or the one through which the infant is likely to sleep should be eliminated first. Every few days thereafter the mother drops another feeding. Gradual weaning over a period of weeks or months is easier for both the mother and the infant than an abrupt weaning. Weaning is initiated by the mother or the infant. With infant-led weaning, the infant moves at his or her own pace in omitting feedings, which leads to a gradual decrease in the mother's milk supply. Mother-led weaning means that the mother decides which feedings to drop.

With regard to the long-term consequences of infant feeding practices, the nurse should instruct the obese client that the best strategy to decrease the risk for childhood obesity for her infant is ______.

an on-demand feeding schedule.

breastfeeding.

lower-calorie infant formula.

smaller, more frequent feedings.

breastfeeding.

All breastfed infants should be fed on demand. Breastfeeding is the best prevention strategy for decreasing childhood and adolescent obesity. Breastfeeding also assists the woman to return to her prepregnant weight sooner. Lower-calorie formula is an inappropriate strategy that does not meet the infant's nutritional needs. Breastfeeding is the most appropriate choice for infant feeding. Smaller feedings are not necessary. Infants should continue to be fed every 2 to 3 hours in the newborn period.

What is the PRIORITY teaching tip the nurse should provide about bottle-feeding?

Infants may stool with each feeding in the first weeks.

Feed newborn at least every 3 to 4 hours.

Hold infant semiupright while feeding.

Some infants take longer to feed than others.

Breastfeeding requires fewer supplies and less cumbersome equipment.

Breastfeeding saves families money.

Breastfeeding benefits the environment.

Breastfeeding results in reduced annual health care costs.

Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment. Breastfeeding saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. Less time is lost from work by breastfeeding mothers, in part because infants are healthier. Breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal. Breastfeeding results in reduced annual health care costs.

Which of these statements indicate the effect of breastfeeding on the family or society at large? (Select all that apply.)

Breastfeeding requires fewer supplies and less cumbersome equipment.

Breastfeeding saves families money.

Breastfeeding costs employers in terms of time lost from work.

Breastfeeding benefits the environment.

Breastfeeding results in reduced annual health care costs.

Breastfeeding requires fewer supplies and less cumbersome equipment.

Breastfeeding saves families money.

Breastfeeding benefits the environment.

Breastfeeding results in reduced annual health care costs.

Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment. Breastfeeding saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. Less time is lost from work by breastfeeding mothers, in part because infants are healthier. Breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal. Breastfeeding results in reduced annual health care costs.

The nurse should include which instructions when teaching a mother about the storage of breast milk? (Select all that apply.)

Wash hands before expressing breast milk.

Store milk in 8 to 12 oz containers.

Store refrigerated milk in the door of the refrigerator.

Place frozen milk in the microwave for only a few seconds to thaw.

Milk thawed in the refrigerator can be stored for 24 hours.

Wash hands before expressing breast milk.

Milk thawed in the refrigerator can be stored for 24 hours.

Breast milk storage guidelines for home use for full-term infants are: Before expressing or pumping breast milk, wash your hands. Containers for storing milk should be washed in hot, soapy water, and rinsed thoroughly; they can also be washed in a dishwasher. If the water supply may not be clean, boil containers after washing. Plastic bags designed specifically for breast milk storage can be used for short-term storage. (Write the date of expression on container before storing milk. A waterproof label is best.) Store milk in serving sizes of 2 to 4 ounces to prevent waste. Storing breast milk in the refrigerator or freezer with other food items is acceptable. When storing milk in a refrigerator or freezer, place containers in the middle or back of the freezer, not on the door. When filling a storage container that will be frozen, fill only three quarters full, allowing space at the top of the container for expansion. To thaw frozen breast milk, place container in the refrigerator for gradual thawing or under warm, running water for quicker thawing. Never boil or microwave. Milk thawed in the refrigerator can be stored for 24 hours. Thawed breast milk should never be refrozen. Shake milk container before feeding baby and test the temperature of the milk on the inner aspect of your wrist. Any unused milk left in the bottle after feeding is discarded.