A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until her infant is crying frantically. On the basis of this information, this woman should feed her infant about every 2.5 to 3 hours when she:
Makes sucking motions.
Sucking motions, rooting, mouthing, and hand-to-mouth motions are examples of feeding-readiness cues.
A new father is ready to take his wife and newborn son home. He proudly tells the nurse who is discharging them that within the next week he plans to start feeding the infant cereal between breastfeeding sessions. The nurse can explain to him that beginning solid foods before 4 to 6 months may:
Lead to early cessation of breastfeeding.
Introduction of solid foods before the infant is 4 to 6 months of age may result in overfeeding and decreased intake of breast milk.
A pregnant woman wants to breastfeed her infant; however, her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle-feeding. Which statement is most accurate? Bottle-feeding using commercially prepared infant formulas:
Increases the risk that the infant will develop allergies.
Exposure to cow's milk poses a risk of developing allergies, eczema, and asthma.
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:
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.
A primiparous woman is delighted with her newborn son and 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
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.
A breastfeeding woman develops engorged breasts at 3 days' postpartum. What action would help this woman achieve her goal of reducing the engorgement? The woman:
Breastfeeds her infant every 2 hours.
The mother should be instructed to attempt feeding her infant every 2 hours while massaging the breasts as the infant is feeding. Skipping feedings may cause further swelling and discomfort.
At a 2-month well-baby examination, it was discovered that a breastfed infant had only gained 10 ounces in the past 4 weeks. The mother and the nurse agree that, to gain weight faster, the infant needs to:
Add at least one extra breastfeeding session every 24 hours.
Usually the solution to slow weight gain is to improve the feeding technique. Position and latch-on are evaluated, and adjustments are made. It may help to add a feeding or two in a 24-hour period.
A new mother wants to be sure that she is meeting her daughter's needs while feeding her commercially prepared infant formula. The nurse should evaluate the mother's knowledge about appropriate infant care. The mother meets her child's needs when she
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.
The nurse is discussing storage of breast milk with a mother whose infant is preterm and in the special care unit. What statement would indicate that the mother needs additional teaching?
"I can store my breast milk in the refrigerator for 3 months."
If the mother states that she can store her breast milk in the refrigerator for 3 months, she needs additional teaching about safe storage. Breast milk can be stored at room temperature for 8 hours, in the refrigerator for 3 to 5 days, in the freezer for 3 months, or in a deep freezer for 6 to 12 months.
According to the recommendations of the American Academy of Pediatrics on infant nutrition:
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.
According to demographic research, the woman least likely to breastfeed and therefore most likely to need education regarding the benefits and proper techniques of breastfeeding would be:
A woman who is younger than 25 years of age, African-American, and employed full time outside the home.
Women least likely to breastfeed typically are younger than 25 years of age, have a lower income, are less educated, are employed full time outside the home, and are African-American.
Which statement concerning the benefits or limitations of breastfeeding is inaccurate?
Breastfeeding increases the risk of childhood obesity.
Breastfeeding actually decreases the risk of childhood obesity. There are multiple benefits of breastfeeding. Breast milk changes over time to meet changing needs as infants grow.
The nurse is explaining the benefits associated with breastfeeding to a new mother. Which statement by the nurse would be inaccurate and provide conflicting information to the patient?
Breastfeeding is an effective method of birth control.
Women who breastfeed have a decreased risk of breast cancer, an increase in bone density, and a possibility of quicker postpartum weight loss. Breastfeeding delays the return of fertility; however, it is not an effective birth control method.
While discussing the societal impacts of breastfeeding, the nurse should be cognizant of the benefits and educate the patient accordingly. Which statement as part of this discussion would be incorrect
Breastfeeding costs employers in terms of time lost from work.
Actually less time is lost to work by breastfeeding mothers, in part because infants are healthier. Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment. It saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother.
The best reason for recommending formula over breastfeeding is that:
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 illicit drugs.
With regard to the nutrient needs of breastfed and formula-fed infants, nurses should be understand that:
Breastfeeding infants should receive oral vitamin D drops daily at least during the first 2 months.
Human milk contains only small amounts of vitamin D. Neither breastfed nor formula-fed infants need to be given water, even in very hot climates. During the first 3 months formula-fed infants consume more energy than do breastfed infants and therefore tend to grow more rapidly.
Nurses providing nutritional instruction should be cognizant of the uniqueness of human milk. Which statement is correct?
Frequent feedings during predictable growth spurts stimulate increased milk production.
These growth spurts (10 days, 3 weeks, 6 weeks, 3 months) usually last 24 to 48 hours, after which infants resume normal feeding. The milk of mothers of preterm infants is different from that of mothers of full-term infants to meet the needs of these newborns
In assisting the breastfeeding mother position the baby, nurses should keep in mind that:
Whatever the position used, the infant is "belly to belly" with the mother.
The infant inevitably faces the mother, belly to belly. 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.
Nurses should be able to teach breastfeeding mothers the signs that the infant has latched on correctly. Which statement indicates a poor latch?
She hears a clicking or smacking sound.
The clicking or smacking sound may indicate that the baby is having difficulty keeping the tongue out over the lower gum ridge. The mother should hope to hear the sound of swallowing. The tugging sensation without pinching is a good sign. Rounded cheeks are a positive indicator of a good latch. A smoothly gliding jaw is a good sign.
The process whereby parents awaken the infant to feed every 3 hours during the day and at least every 4 hours at night is:
Necessary during the first 24 to 48 hours after birth.
The parents do this to make sure that the infant has at least eight feedings in 24 hours. Demand feeding is when the infant determines the frequency of feedings; this is appropriate once the infant is feeding well and gaining weight. The supply-meets-demand system is a milk production system that occurs naturally.
The nurse providing couplet care should understand that nipple confusion results when:
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.
With regard to basic care of the breastfeeding mother, nurses should be able to advise her that she:
Should avoid trying to lose large amounts of weight.
Large weight loss would release fat-stored contaminants into her breast milk. It would also likely involve eating too little and/or exercising too much. A breastfeeding mother need add only 200 to 500 extra calories to her diet to provide extra nutrients for the infant.
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?
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.
A newly delivered mother who intends to breastfeed tells her nurse, "I am so relieved that this pregnancy is over so I can start smoking again." The nurse encourages the client to refrain from smoking. However, this new mother insists that she will resume smoking. The nurse will need to adapt her health teaching to ensure that the client is aware that:
The mother should always smoke in another room.
The new mother should be encouraged not to smoke. If she continues to smoke, she should be encouraged to always smoke in another room removed from the baby. Smoking may impair milk production. When the products of tobacco are broken down, they cross over into the breast milk
Which type of formula is not diluted before being administered to an infant?
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. Formula should be well mixed to dissolve the powder and make it uniform in consistency. Improper dilution of concentrated formula may cause malnutrition or sodium imbalances.
How many kilocalories per kilogram (kcal/kg) of body weight does a breastfed term infant require each day?
95 to 110
For the first 3 months the infant needs 110 kcal/kg/day. At ages 3 to 6 months the requirement is 100 kcal/kg/day. This level decreases slightly to 95 kcal/kg/day from 6 to 9 months and increases again to 100 kcal/kg/day until the baby reaches 12 months.
The hormone necessary for milk production is:
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.
To initiate the milk ejection reflex (MER), the mother should be advised to:
Place the infant to the breast.
Oxytocin, which causes the MER reflex, increases in response to nipple stimulation.
As the nurse assists a new mother with breastfeeding, the client 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:
Important immunoglobulins.
Breast milk contains immunoglobulins that protect the newborn against infection. The calorie count of formula and breast milk is about the same.
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:
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.
To prevent nipple trauma, the nurse should instruct the new mother to:
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, thus causing trauma to the area. Stimulating the breast for less than 5 minutes will not produce the extra milk the infant may need.
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. Which statement is valid?
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.
A new mother asks whether she should feed her newborn colostrum, because it is not "real milk." The nurse's most appropriate answer is:
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.
All parents are entitled to a birthing environment in which breastfeeding is promoted and supported. The Baby Friendly Hospital Initiative endorsed by WHO and UNICEF was founded to encourage institutions to offer optimal levels of care for lactating mothers. Which instruction is not included in the "Ten Steps to Successful Breastfeeding for Hospitals"?
Give artificial teats or pacifiers as necessary.
No artificial teats or pacifiers (also called dummies or soothers) should be given to breastfeeding infants.
Examples of appropriate techniques to wake a sleepy infant for breastfeeding include (Select all that apply):
- Unwrapping
the infant
- Changing the diaper
- Talking to the infant
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)?
- Breast tenderness
- Warmth in the breast
- An area of redness on the breast resembling the shape of a pie wedge
- Fever and flulike symptoms
Late in pregnancy, the woman's breasts should be assessed by the nurse to identify any potential concerns related to breastfeeding. Some nipple conditions make it necessary to provide intervention before birth. These include(Select all that apply):
- Flat nipples
- Inverted nipples
- Nipples that contract when compressed
In helping the breastfeeding mother position the baby, nurses should keep in mind that:
whatever the position used, the infant is "belly to belly" with the mother.
The infant inevitably faces the mother, belly to belly.
Which of these statements indicate the effect of breastfeeding on the family or society at large.
- Breastfeeding requires fewer supplies and less cumbersome equipment
- Breastfeeding saves families
money
- Breastfeeding benefits the environment
- Breastfeeding results in reduced annual health care costs
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:
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.
Which action of a breastfeeding mother indicates the need for further instruction?
Leans forward to bring breast toward the baby.
To maintain a comfortable, relaxed position, the mother should bring the baby to the breast, not the breast to the baby
The nurse should include which instructions when teaching a mother about the storage of breast milk?
- Wash hands before expressing breast milk
- Milk thawed in the refrigerator can be stored for 24 hours
The birth weight of a breastfed newborn was 8 lbs, 4 oz. On the third day the newborn's weight was 7 lbs, 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
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.