Chapter 23: Newborn Feeding McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition

The breastfeeding mother should be taught a safe method to remove the breast from

the baby's mouth. Which suggestion by the nurse is most appropriate?

a. Slowly remove the breast from the baby's mouth when the infant has fallen

asleep and the jaws are relaxed.

b. c. Break the suction by inserting your finger into the corner of the infant's mouth.

A popping sound occurs when the breast is correctly removed from the infant's

mouth.

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

ANS: B. Break the suction by inserting your finger into the corner of the infant's mouth

Inserting a finger into the corner of the baby's mouth between the gums to break the

suction avoids trauma to the breast. The infant who is sleeping may lose grasp on the nipple

and areola, resulting in "chewing" on the nipple, making it sore. A popping sound indicates

improper removal of the breast from the baby's mouth and may cause cracks or fissures in

the breast. Most mothers prefer the infant to continue to sleep after the feeding. Gentle

wake-up techniques are recommended.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding

REF: p. 488 OBJ: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance

A pregnant woman wants to breastfeed her infant; however, her husband is not convinced

that there are any scientific reasons to do so. Which statement by the nurse 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. increases the risk that the infant will develop allergies

Breastfeeding is less likely to cause allergies. Newborns should be fed through 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.

PTS:

REF:

MSC:

1 DIF: Cognitive Level: Comprehension/Understanding

p. 482 | Box 23.2 OBJ: Integrated Process: Teaching-Learning

Client Needs: Physiologic Integrity; Basic Care and Comfort

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

A. Suggest that she switch to bottled formula just for today.

B. Assist her in removing her bra, making her more comfortable.

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

before feedings.

d. Instruct and assist the mother to massage her breasts

ANS: D. Instruct and assist the mother to massage her breasts

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

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

fitting bra should be worn both day and night to support the breasts. Cold applications are

used between feedings to reduce edema and pain. Heat is applied just before feedings to

increase vasodilation.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding

REF: p. 492 OBJ: Nursing Process: Implementation

MSC: Client Needs: Physiologic Integrity

A new mother recalls that she should feed her newborn 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 when she

a. waves her arms in the air.

b. makes sucking motions.

c. has hiccups.

d. stretches out her legs straight.

ANS: B. makes sucking motions.

Sucking motions, rooting, mouthing, and hand- to-mouth motions are examples

of feeding-readiness cues. The other observations are not feeding cues.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding

REF: p. 485 | Box 23.3 OBJ: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

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

a. Powdered

b. Concentrated

c. Ready-to-use

d. Modified cow's milk

ANS: C. Ready-to-use

Ready-to-use formula can be poured directly from the can into baby's bottle and is good

(but expensive) when a proper water supply is not available. Powdered and concentrated

formulas should be well mixed to dissolve the powder and make it uniform. Cow's milk is

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

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 496 OBJ: Nursing Process: Implementation

The student nurse learns that the hormone necessary for milk production is

a. estrogen.

b. prolactin.

c. progesterone.

d. lactogen

ANS: B. Prolactin

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

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

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

mature breast milk from being produced. Human placental lactogen decreases the

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

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 484 OBJ: Integrated Process: Teaching-Learning

MSC: Client Needs: Physiologic Inte

To initiate the milk ejection reflex, the mother should

a. wear a firm-fitting bra.

b. drink plenty of fluids.

c. place the infant to the breast

d. apply cool packs to her breast.

ANS: C. place the infant to the breast

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

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

reflex. Drinking plenty of fluids is necessary for adequate milk production but will not

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

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 484 OBJ: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance

What is the first step in assisting the breastfeeding mother?

A. Provide instruction on the composition of breast milk.

B. Discuss the hormonal changes that trigger the milk ejection reflex.

C. Assess the woman's knowledge of and feelings toward breastfeeding.

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

ANS: C. Assess the woman's knowledge of and feelings toward breastfeeding.

The nurse should first assess the woman's knowledge and feedings toward breastfeeding

to determine her teaching needs. Assessment should occur before instruction on positions

and placing the infant to the breast. Education on hormonal changes and composition of

breast milk also comes after assessment.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 483 OBJ: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

A primiparous woman wants to begin breastfeeding as soon as possible. The nurse can

facilitate the infant's 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. with his head and body in alignment

The infant's head and body should be in correct alignment with the mother and the

breast during latch-on and feeding. The other positions do not facilitate nursing.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 486 OBJ: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance

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. has at least six to eight wet diapers per day.

After day 4, when the mother's 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. The infant should

have a minimum of three bowel movements in a 24-hour period. The mother will not know

what her child weighs until the appointment and so the nurse needs to provide her with

other indicators of successful breastfeeding.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding

REF: p. 489 OBJ: Integrated Process: Teaching-Learning

MSC: Client Needs: Health Promotion and Maintenance

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

A. apply cold packs to the breast before feeding.

B. breastfeed frequently and for adequate lengths of time.

C. limit her intake of fluids for the first few days.

D. feed her infant no more than every 4 hours.

ANS: B. breastfeed frequently and for adequate lengths of time.

Engorgement occurs when the breasts are not adequately emptied at each feeding or if

feedings are not frequent enough. Warm packs should be applied to the breast before

feedings. Fluid intake should not be limited with a breastfeeding mother; that will decrease

the amount of breast milk produced. Breast milk moves through the stomach within 1.5 to

2 hours, so waiting 4 hours to feed is too long. Frequent feedings are important to empty

the breast and to establish lactation.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 491 OBJ: Nursing Process: Implementation

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

A. aseptic method does not require boiling of the bottles.

B. terminal method requires boiling water to be added to the formula.

C. aseptic method requires a longer preparation time.

d. terminal method sterilizes the prepared formula at the same time it sterilizes the equipment.

ANS: D. terminal method sterilizes the prepared formula at the same time it sterilizes the equipment.

In the terminal sterilization method, the formula is prepared in the bottles, which are

loosely capped, and then the bottles are placed in the sterilizer, where they are boiled for 25

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

process takes about 5 minutes.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 496 OBJ: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment

How many ounces will a formula-fed infant who is on a 4-hour feeding schedule need

to consume at each feeding to meet daily caloric needs?

a. 0.5 to 1

b. 1 to 2

c. 2 to 3

d. 4

ANS: C. 2 to 3

The newborn requires approximately 2 to 3 ounces per feeding within 1 week after birth.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 496 OBJ: Nursing Process: Implementation

MSC: Client Needs: Physiologic Integrity

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

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

B. infant's stomach capacity is small at birth but will expand within a few days.

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

D. infant is probably having difficulty adjusting to the formula.

ANS: B. infant's stomach capacity is small at birth but will expand within a few days.

The infant's stomach capacity at birth is 10 to 20 mL and increases to 60 to 90 mL by the

end of the first week. One ounce is 30 mL. The infant's requirements are the same, but the

stomach capacity needs to increase before taking in adequate amounts. The infant's sleep

patterns do change, but the infant should be awake enough to feed. There are other

symptoms that occur if there is a formula intolerance.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding

REF: p. 488 OBJ: Nursing Process: Implementation

MSC: Client Needs: Physiologic Integrity

As the nurse assists a new mother with breastfeeding, she asks, "If formula is prepared to

meet the nutritional needs of the newborn, what is in breast milk that makes it better?" The

nurse's best response is that it contains

a. more calories.

b. essential amino acids.

c. important immunoglobulins.

d. more calcium.

ANS: C. important immunoglobulins.

Breast milk contains immunoglobulins that protect the newborn against infection. The

calorie count of formula and breast milk is about the same. All of the essential amino acids

are in both formula and breast milk. The concentrations may differ. Calcium levels are

higher in formula than breast milk. This higher level can cause an excessively high renal

solute load if the formula is not diluted properly.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 480 OBJ: Integrated Process: Teaching-Learning

MSC: Client Needs: Physiologic Inte

When responding to the question "Will I produce enough milk for my baby as she grows

and needs more milk at each feeding?" the nurse should explain that

A. the breast milk will gradually become richer to supply additional calories.

B. as the infant requires more milk, feedings can be supplemented with cow's milk.

C. early addition of baby food will meet the infant's needs.

D. the mother's milk supply will increase as the infant demands more at each feeding

ANS: D. the mother's milk supply will increase as the infant demands more at each feeding

The amount of milk produced depends on the amount of stimulation of the breast. Increased

demand with more frequent and longer breastfeeding sessions results in more milk available

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

feeds for longer times. Supplementation will decrease the amount of stimulation of the

breast and decrease the milk production. Solids should not be added until about 4 to 6

months, when the infant's immune system is more mature. This will decrease the chance of

allergy formations.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding

REF: p. 484 OBJ: Integrated Process: Teaching-Learning

MSC: Client Needs: Physiologic Integrity

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

A. limit the feeding time to less than 5 minutes.

B. position the infant so the nipple is far back in the mouth.

C. assess the nipples before each feeding.

D. wash the nipples daily with mild soap and water.

ANS: B. position the infant so the nipple is far back in the mouth.

If the infant's mouth does not cover as much of the areola as possible, the pressure during

sucking will be applied to the nipple, causing trauma to the area. Stimulating the breast

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

nipples for trauma is important, but it will not prevent sore nipples. Soap can be drying to

the nipples and should be avoided during breastfeeding.

PTS: 1 DIF: Cognitive Level: Application REF: p. 487

OBJ: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenan

A breastfeeding mother who was discharged yesterday calls to ask about a tender, hard area

on her right breast. The nurse's first response should be

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

B. "Stop breastfeeding because you probably have an infection."

C. "Notify your doctor so he can start you on antibiotics."

D. "This is a normal response in breastfeeding mothers."

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

A plugged lactiferous duct results in localized edema, tenderness, and a palpable hard area.

Massage of the area followed by heat will cause the duct to open. This does not indicate an

infection or a need for antibiotics. This is a normal deviation but requires intervention to

prevent further complications.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding

REF: p. 493 OBJ: Integrated Process: Teaching-Learning

MSC: Client Needs: Physiologic Integri

An important aspect about storage of breast milk is that it

A. can be frozen for up to 2 months.

B. should be stored only in glass bottles.

C. can be thawed and refrozen.

D. can be kept refrigerated for 48 hours.

ANS: D. can be kept refrigerated for 48 hours.

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

nutritional value.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 496

OBJ: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment

The nurse should explain to new parents that the most serious consequence of propping

an infant's bottle is

a. dental caries.

b. aspiration.

c. ear infections.

d. colic.

ANS: B. aspiration.

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

occurs. Dental caries become a problem when milk stays on the gums for a long period of

time. This may cause a buildup of bacteria that will alter the growing teeth buds. However,

this is not the most serious consequence. Ear infections can occur when the warm formula

runs into the ear and bacterial growth occurs. However, this is not the most serious

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

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding

REF: p. 497 OBJ: Integrated Process: Teaching-Learning

MSC: Client Needs: Physiologic Integrity

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. b. c. d. A premature infant more easily digests breast milk than formula.

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

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

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

ANS: A. A premature infant more easily digests breast milk than formula.

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 mother's milk ejection reflex. It is generally taught that lactating

mothers avoid it. 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. The mother should be

instructed to pump 8 to 10 times a day for 10 to 15 minutes on each breast.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 480 OBJ: Integrated Process: Teaching-Lea

A new mother asks if she should feed her newborn colostrum, because it is not "real milk."

The nurse's best answer is that

A. colostrum is high in antibodies, protein, vitamins, and minerals.

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

C. giving colostrum helps the mother learn how to breastfeed.

D. colostrum is unnecessary for newborns.

ANS: A. colostrum is high in antibodies, protein, vitamins, and minerals.

Colostrum is important because it has high levels of the nutrients needed by the neonate

and helps protect against infection. Supplementation is not necessary. It will decrease

stimulation to the breast and decrease the production of milk. It is important for the mother

to feel comfortable in this role before discharge, but the importance of the colostrum to the

infant is top priority. Colostrum provides immunities and enzymes necessary to clean the

gastrointestinal system, among other things.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 480 OBJ: Nursing Process: Assessm

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

a. Start iron supplementation shortly after birth if the infant is

breastfeeding exclusively.

B. Iron-fortified formula will meet the infant's iron requirements.

C. Iron supplements must be given when the infant begins teething.

D. Infants need a multivitamin with iron every day

ANS: B. Iron-fortified formula will meet the infant's iron requirements.

Iron-fortified formula will meet the infant's initial iron requirements. Solid foods added to

the diet maintain iron needs as formula intake decreases. Term infants who are exclusively

breastfed have adequate iron stored until they are age 6 months. Iron supplements are not

necessary for adequate teething. Vitamins and minerals are added to processed formulas and

cereals. It should not be necessary for the child to receive a multivitamin with iron unless

the infant is at risk for undernutrition.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 481 OBJ: Integrated Process: Teaching-Learning

MSC: Client Needs: Health Promotion and Maintenance

A new mother wants to be sure that she is meeting her daughter's needs while feeding her

commercially prepared infant formula. The nurse determines that the mother meets her

child's 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. burps her infant during and after the feeding as needed.

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 infant's saliva has mixed with it.

PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating

REF: p. 496 OBJ: Nursing Process: Evaluation

MSC: Client Needs: Health Promotion and Maintenance

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 cow's milk, not formula.

d. After 6 months, mothers should shift from breast milk to cow's milk.

ANS: A. Infants should be given only human milk for the first 6 months of life.

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 cow's milk. Breastfeeding/human milk should also

be the sole source of milk for the second 6 months.

PTS:

REF:

1 DIF:

p. 482 | Box 23.2

Cognitive Level: Knowledge/Remembering

OBJ: Nursing Process: Planning

The Baby Friendly Hospital Initiative was founded to encourage institutions to offer

optimal levels of care for lactating mothers. Which is of the following is inconsistent with

the nurse's knowledge about the "Ten Steps to Successful Breastfeeding for Hospitals"?

a. b. c. d. Give newborns no food or drink other than breast milk.

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

Help mothers initiate breastfeeding within one half-hour of birth.

Give artificial pacifiers as necessary.

ANS: D. Give artificial pacifiers as necessary.

No artificial pacifiers should be given to breastfeeding infants. The other statements

are consistent with the "Ten Steps to Successful Breastfeeding for Hospitals."

PTS: 1 REF: p. 482 | Box 23.2 MSC: Client Needs: Physiologic Integrity

The best reason for recommending formula over breastfeeding is that

a. the mother has a medical condition or is taking drugs that could be passed along

to the infant via breast milk.

B. the mother lacks confidence in her ability to breastfeed.

C. other family members or care providers also need to feed the baby.

D. the mother sees bottle-feeding as more convenient.

ANS: A. the mother has a medical condition or is taking drugs that could be passed along

to the infant via breast milk.

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.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 492 OBJ: Nursing Process: Planning

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

A. breastfeeding babies receive supplementary bottle feedings.

B. the baby is weaned too abruptly.

C. pacifiers are used before breastfeeding is established.

d. twins are breastfed together

ANS: A. breastfeeding babies receive supplementary bottle feedings.

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 logistic

adaptations, but this should not lead to nipple confusion.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding

REF: p. 490 OBJ: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenanc

The mother who is pumping for an occasional bottle would be most suited for which type

of breast pump?

a. Manual or hand pump

b. Hospital-grade pump

c. Electric self-cycling double pumps

d. Smaller electric or battery-operated pump

ANS: A. Manual or hand pump

These are the least expensive and can be the most appropriate choice for mothers

pumping for the occasional bottle. Full-service electric or hospital-grade pumps most

closely duplicate the sucking action of the breastfeeding infant. These are used when

mother and baby (preterm or sick) are separated for long periods. Self-cycling pumps are

easy to use, efficient, and designed for working mothers. Smaller pumps operated with a

battery are typically used when pumping occasionally.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 495 OBJ: Nursing Process: Implementation

The nurse notes a new mother is waiting until her newborn begins crying prior

to breastfeeding her. What response by the nurse is best?

A. Praise the mother for her efforts to nurse.

B. Teach the mother signs of hunger in the newborn.

C. Inform the mother she is inhibiting bonding.

D. Demonstrate calming methods prior to feeding

ANS: B. Teach the mother signs of hunger in the newborn.

Crying is a late sign of hunger in the newborn. The nurse should teach the mother other

signs of hunger so the baby will be more ready to eat when the mother attempts to feed the

baby. Of course the nurse should praise all attempts at breastfeeding, but this is not the best

response. Telling the mother she is inhibiting bonding will discourage her. The nurse should

also demonstrate calming methods, but the goal is to feed the infant when he or she

displays early signs of hunger.

PTS:

REF:

MSC:

1 DIF: Cognitive Level: Application/Applying

p. 483 | Box 23.3 OBJ: Nursing Process: Implementation

Client Needs: Health Promotion and Maintenance

A woman wants to breastfeed, but her nipples are inverted and she is concerned it won't be

possible. What does the nurse teach the woman about this condition?

A. A woman with inverted nipples rarely is successful at breastfeeding.

B. You can use a breast pump just prior to feeding to evert the nipples.

C. Massage the breasts prior to feeding to allow milk let-down.

D. Try changing the infant's position during feedings.

ANS: B. You can use a breast pump just prior to feeding to evert the nipples.

A breast pump can be used just prior to feeding. As soon as the suction everts the nipple, the

woman needs to place the baby to the breast. Women with inverted nipples can breastfeed.

Massage and changing the infant's position will not affect the inverted nipples.

PTS: 1 DIF: Cognitive Level: Application/Applying

REF: p. 485 OBJ: Nursing Process: Implementation

MSC: Client Needs: Physiologic Integrity

The nurse notices an infant has dimpling of the cheeks when breastfeeding. What action

by the nurse is best?

A. Tell the mother this is a sign of adequate feeding.

B. Have the mother remove the baby from the breast and try again.

C. Make a referral for a lactation consultation.

D. Instruct the mother to feed for at least 15 minutes

ANS: B. Have the mother remove the baby from the breast and try again.

Dimpling the cheeks is a sign of an infant- derived problem during breastfeeding. The

nurse should have the mother gently remove the baby from the breast, reposition the infant

if needed, and try to get the baby to latch on correctly so she can try again. The nurse may

need to call for a lactation consultant, but all mother -baby or labor and delivery nurses

should be able to provide basic assistance first. This is not a sign of adequate feeding so the

nurse should not encourage her to keep going for another 15 minutes.

PTS: 1 DIF: Cognitive Level: Application/Applying

REF: p. 490 | Safety Alert Box OBJ: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenan

Some nipple conditions make it necessary to provide intervention before birth in the

mother who plans to breastfeed. These include (Select all that apply.)

a. Everted nipples

b. Flat nipples

c. Inverted nipples

d. Nipples that contract when compressed

e. Cracked nipples

ANS: B, C, D

b. Flat nipples

c. Inverted nipples

d. Nipples that contract when compressed

2. 3. Flat nipples appear soft, like the areola, and do not stand erect unless stimulated by rolling

them between the fingers. Inverted nipples are retracted into the breast tissue. These

nipples appear normal; however, they will draw inward when the areola is compressed by

the infant's mouth. Dome-shaped devices known as breast shells can be worn during the

last weeks of pregnancy and between feedings after birth. The shells are placed inside the

bra with the opening over the nipple. The shells exert slight pressure against the areola to

help the nipples protrude. The helpfulness of breast shells is debated. A breast pump can be

used to draw the nipples out before feedings after delivery. Everted nipples protrude and

are normal. No intervention will be required. Cracked, blistered, and bleeding nipples

occur after breastfeeding has been initiated and are the result of improper latch.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: pp. 484-485 OBJ: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

Which are examples of appropriate techniques to wake a sleepy infant for

breastfeeding? (Select all that apply.)

a. Unwrap the infant.

b. Change the diaper.

c. Talk to the infant.

d. Slap the infant's hands and feet.

e. Apply a cold towel to the infant's abdomen.

ANS: A, B, C

a. Unwrap the infant.

b. Change the diaper.

c. Talk to the infant.

Unwrapping the infant, changing the diaper, or talking to the infant are appropriate ways

of waking the sleeping baby. Slapping the hands and feet and applying cold towels are not

appropriate methods.

PTS: 1 DIF: Cognitive Level: Application/Applying

REF: p. 493 OBJ: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance

A nurse is discussing the signs and symptoms of mastitis with a mother who is

breastfeeding. What signs and symptoms should the nurse include in her discussion?

(Select all that apply.)

a. Breast tenderness

b. Warmth in the breast

c. An area of redness on the breast often resembling the shape of a pie wedge

d. A small white blister on the tip of the nipple

e. Fever and flulike symptoms

ANS: A, B, C, E

a. Breast tenderness

b. Warmth in the breast

c. An area of redness on the breast often resembling the shape of a pie wedge

e. Fever and flulike symptoms

Signs and symptoms of mastitis include breast tenderness and warmth, an area of redness

on the breast, and fever or flulike symptoms. A small white blister on the tip of the nipple is

generally associated with a plugged milk duct.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering

REF: p. 491 OBJ: Integrated Process: Teaching-Learning

MSC: Client Needs: Physiologic Integrity

The student nurse learns that breastfed babies are less likely to develop certain health

conditions as adults. Which conditions does this include? (Select all that apply.)

a. Diabetes

b. Asthma

c. Obesity

d. Kidney failure

e. Some cancers

ANS: A, B, C, E

a. Diabetes

b. Asthma

c. Obesity

e. Some cancers

Breastfed infants are less likely to develop diabetes, asthma, obesity, and some cancers than

bottle-fed infants. No difference is seen in the development of kidney failure.

PTS: 1 REF: p. 482 | Box 23.2 MSC: Client Needs: Physiologic Integrit