Lowdermilk: Maternity Nursing, 8th Edition

Chapter 18: Newborn Nutrition and Feeding Test ank M!LT"#LE C$%"CE 1. A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until her infant is crying frantically. On the basis of this information, this woman should feed her infant about every 2 to 3 hours when she a !aves her arms in the air. . b "a#es suc#ing motions. . c $as the hiccups. . d %tretches her legs out straight. . A&% ' Feedba&k ' !aving of the arms in the air is not a typical feeding(readiness cue. %uc#ing motions, rooting, mouthing, and hand(to(mouth motions are examples of feeding(readiness cues. C $iccups are not a typical feeding(readiness cue. ( %tretching of the legs is not a typical feeding(readiness cue. )*+ ,ognitive -evel ,omprehension ./+ 031 O'2 ,lient &eeds $ealth 3romotion and "aintenance 3lanning 4O3 &ursing 3rocess

2. A new father is ready to ta#e his wife and newborn son home. $e proudly tells the nurse who is discharging them that within the next wee# he plans to start feeding the infant cereal between breastfeeding sessions. 4he nurse can explain to him that beginning solid foods before 5 to 6 months may a )ecrease the infant7s inta#e of sufficient calories. . b -ead to early cessation of breastfeeding. . c $elp the infant sleep through the night. . d -imit the infant7s growth. . A&% '
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Feedba&k ' *ntroduction of solid foods before the infant is 5 to 6 months of age may result in overfeeding and decreased inta#e of breast mil#. *ntroduction of solid foods before the infant is 5 to 6 months of age may result in overfeeding and decreased inta#e of breast mil#. C *t is not true that feeding of solids helps infants sleep through the night. ( *ntroduction of solid foods before the infant is 5 to 6 months of age may result in overfeeding. 4he proper balance of carbohydrate, protein, and fat for an infant to grow properly is in the breast mil# or formula. )*+ ,ognitive -evel Application ./+ 031 O'2 ,lient &eeds $ealth 3romotion and "aintenance /valuation 4O3 &ursing 3rocess

3. A pregnant woman wants to breastfeed her infant: however, her husband is not convinced that there are any scientific reasons to do so. 4he nurse can give the couple printed information comparing breastfeeding and bottle(feeding. !hich statement is true; 'ottle( feeding using commercially prepared infant formulas a *ncreases the ris# that the infant will develop allergies. . b $elps the infant sleep through the night. . c /nsures that the infant is getting iron in a form that is easily absorbed. . d .e<uires that multivitamin supplements be given to the infant. . A&% A Feedba&k ' /xposure to cow7s mil# poses a ris# of developing allergies, ec=ema, and asthma. 4his is a false statement. C *ron is better absorbed from breast mil# than from formula. ( ,ommercial formulas are designed to meet the nutritional needs of the infant and resemble breast mil#. )*+ ,ognitive -evel Application ./+ 039 O'2 ,lient &eeds 3hysiologic *ntegrity )iagnosis 4O3 &ursing 3rocess

5. A postpartum woman telephones about her 5(day(old infant. %he is not scheduled for a weight chec# until the infant is 19 days old, and she is worried about whether breastfeeding is going well. /ffective breastfeeding is indicated by the newborn who a %leeps for 6 hours at a time between feedings.
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4est 'an# . b $as at least one breast mil# stool every 25 hours. . c >ains 1 to 2 ounces per wee#. . d $as at least six to eight wet diapers per day. . A&% ) Feedba&k ' 4his is not an indication of whether the infant is breastfeeding well. 4ypically infants sleep 2 to 5 hours between feedings, depending on whether they are being fed on a 2( to 3(hour schedule or cluster fed. 4he infant should have a minimum of three bowel movements in a 25(hour period. C 'reastfed infants typically gain 10 to 39 g?day. ( After day 5, when the mother7s mil# comes in, the infant should have six to eight wet diapers every 25 hours. )*+ ,ognitive -evel ,omprehension ./+ 052 O'2 ,lient &eeds $ealth 3romotion and "aintenance /valuation 4O3 &ursing 3rocess

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0. A breastfeeding woman develops engorged breasts at 3 days7 postpartum. !hat action would help this woman achieve her goal of reducing the engorgement; 4he woman a %#ips feedings to let her sore breasts rest. . b Avoids using a breast pump. . c 'reastfeeds her infant every 2 hours. . d .educes her fluid inta#e for 25 hours. . A&% , Feedba&k ' 4he mother should be instructed to attempt to feed her infant every 2 hours while massaging the breasts as the infant is feeding. %#ipping feedings may cause further swelling and discomfort. *f the infant does not feed ade<uately and empty the breast, the mother may pump to extract the mil# and relieve some of the discomfort. C 4he mother should be instructed to attempt feeding her infant every 2 hours while massaging the breasts as the infant is feeding. ( )ehydration further irritates swollen breast tissue.
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)*+ ,ognitive -evel ,omprehension ./+ 001 O'2 ,lient &eeds 3hysiologic *ntegrity 4O3 &ursing 3rocess *mplementation 6. At a 2(month well(baby examination, it was discovered that a breastfed infant had only gained 19 ounces in the past 5 wee#s. 4he mother and the nurse agree that, to gain weight faster, the infant needs to a 'egin solid foods. . b $ave a bottle of formula after every feeding. . c Add at least one extra breastfeeding session every 25 hours. . d %tart iron supplements. . A&% , Feedba&k ' %olid foods should not be introduced to an infant for at least 5 to 6 months. 'ottle(feeding may cause nipple confusion and limit the supply of mil#. C @sually the solution to slow weight gain is to improve the feeding techni<ue. 3osition and latch(on are evaluated, and adAustments are made. *t may help to add a feeding or two in a 25(hour period. ( *ron supplements have no bearing on weight gain. )*+ ,ognitive -evel Application ./+ 050 O'2 ,lient &eeds 3hysiologic *ntegrity 4O3 &ursing 3rocess 3lanning, *mplementation B. A new mother wants to be sure that she is meeting her daughter7s needs while feeding her commercially prepared infant formula. 4he nurse should evaluate the mother7s #nowledge about appropriate infant care. 4he mother meets her child7s needs when she a Adds rice cereal to her formula at 2 wee#s of age to ensure ade<uate nutrition. . b !arms the bottles using a microwave oven. . c 'urps her infant during and after the feeding as needed. . d .efrigerates any leftover formula for the next feeding. . A&% ,

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4est 'an# Feedba&k ' %olid food should not be introduced to the infant for at least 5 to 6 months after birth. A microwave should never be used to warm any food to be given to an infant. 4he heat is not distributed evenly, which may pose a ris# of burning the infant. C "ost 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. ( Any formula left in the bottle after the feeding should be discarded because the infant7s saliva has mixed with it. )*+ ,ognitive -evel ,omprehension ./+ 00B O'2 ,lient &eeds $ealth 3romotion and "aintenance /valuation 4O3 &ursing 3rocess

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1. 4he nurse is discussing storage of breast mil# with a mother whose infant is preterm and in the special care unit. !hich statement would indicate that the mother needs additional teaching; a C* can store my breast mil# in the refrigerator for 3 months.D . b C* can store my breast mil# in the free=er for 3 months.D . c C* can store my breast mil# at room temperature for 1 hours.D . d C* can store my breast mil# in the refrigerator for 3 to 0 days.D . A&% A Feedba&k ' 4his statement would indicate that the mother needs additional information regarding safe storage of breast mil#. 'reast mil# can be stored at room temperature for 1 hours, in the refrigerator for 3 to 0 days, in the free=er for 3 months, or in a deep free=er for 6 to 12 months. 4his statement is accurate and does not indicate that the mother needs additional teaching. C 4his statement is accurate and does not indicate that the mother needs additional teaching. ( 4his statement is accurate and does not indicate that the mother needs additional teaching. )*+ ,ognitive -evel Analysis ./+ 051 O'2 ,lient &eeds $ealth 3romotion and "aintenance /valuation 4O3 &ursing 3rocess

E. According to the recommendations of the American Academy of 3ediatrics on infant nutrition a *nfants should be given only human mil# for the first 6 months of life.
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4est 'an# . b . c . d .

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*nfants fed on formula should be started on solid food sooner than breastfed infants. *f infants are weaned from breast mil# before 12 months, they should receive cow7s mil#, not formula. After 6 months, mothers should shift from breast mil# to cow7s mil#.

A&% A Feedba&k ' 'reastfeeding?human mil# should also be the sole source of mil# for the second 6 months. *nfants start on solids when they are ready, usually at 6 months, whether they start on formula or breast mil#. C *f infants are weaned from breast mil# before 12 months, they should receive iron(fortified formula, not cow7s mil#. ( 'reastfeeding?human mil# should also be the sole source of mil# for the second 6 months. )*+ ,ognitive -evel Fnowledge ./+ 02E O'2 ,lient &eeds 3hysiologic *ntegrity 3lanning 4O3 &ursing 3rocess

19. !hich statement concerning the benefits or limitations of breastfeeding is &O4 accurate; a 'reast mil# changes over time to meet changing needs as infants grow. . b -ong(term studies have shown that the benefits of breast mil# continue after the . infant is weaned. c 'reast mil#?breastfeeding may enhance cognitive development. . d 'reastfeeding increases the ris# of childhood obesity. . A&% ) Feedba&k ' 4his is a #nown benefit of breastfeeding. 4he benefits of breastfeeding continue long after weaning and have implications for the future health of the child. C .esearch has shown that breastfeeding enhances cognitive development. ( 'reastfeeding actually decreases the ris# of childhood obesity. )*+ ,ognitive -evel ,omprehension ./+ 039 O'2 ,lient &eeds $ealth 3romotion and "aintenance 3lanning 4O3 &ursing 3rocess

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11. 4he best reason for recommending formula over breastfeeding is that a 4he mother has a medical condition or is ta#ing drugs that could be passed along . to the infant via breast mil#. b 4he mother lac#s confidence in her ability to breastfeed. . c Other family members or care providers also need to feed the baby. . d 4he mother sees bottle(feeding as more convenient. . A&% A Feedba&k ' 'reastfeeding is contraindicated when mothers have certain viruses, are undergoing chemotherapy, or are using?abusing drugs. 4his may be an honest reason for not breastfeeding, although further education concerning the ease of breastfeeding and its convenience, benefits, and adaptability Gexpressing mil# into bottlesH might change some minds. *n any case, the nurse must provide information in a nonAudgmental manner and respect the mother7s decision. C 4his may be a reason for not breastfeeding, although further education concerning the ease of breastfeeding and its convenience, benefits, and adaptability Gexpressing mil# into bottlesH might change some minds. *n any case, the nurse must provide information in a nonAudgmental manner and respect the mother7s decision. ( +or the first(time mother, breastfeeding may initially appear to be more difficult. !ith appropriate education regarding convenience and cost advantages of breastfeeding, some may change their minds. *n any case, the nurse should provide this information in a nonAudgmental manner and respect the mother7s decision. )*+ ,ognitive -evel ,omprehension ./+ 039, 031 O'2 ,lient &eeds 3hysiologic *ntegrity 3lanning 4O3 &ursing 3rocess

12. !ith regard to the nutrient needs of breastfed and formula(fed infants, nurses should be aware that a 'reastfed infants need extra water in hot climates. . b )uring the first 3 months, breastfed infants consume more energy than formula( . fed infants. c 'reastfeeding infants should receive oral vitamin ) drops daily at least during the . first 2 months. d Iitamin F inAections at birth are not needed for infants fed on specially enriched . formula.

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A&% , Feedba&k ' &either breastfed nor formula(fed infants need to be given water, not even in very hot climates. )uring the first 3 months, formula(fed infants consume more energy than breastfed infants and therefore tend to grow more rapidly. C $uman mil# contains only small amounts of vitamin ). ( Iitamin F shots are re<uired for all infants because the bacteria that produce it are absent from the baby7s stomach at birth. )*+ ,ognitive -evel ,omprehension ./+ 035 O'2 ,lient &eeds 3hysiologic *ntegrity 3lanning 4O3 &ursing 3rocess

13. *n helping the breastfeeding mother position the baby, nurses should #eep in mind that a 4he cradle position usually is preferred by mothers who had a cesarean birth. . b !omen with perineal pain and swelling prefer the modified cradle position. . c !hatever the position used, the infant is Cbelly to bellyD with the mother. . d !hile supporting the head, the mother should push gently on the occiput. . A&% , Feedba&k ' 4he football position usually is preferred after cesarean birth. !omen with perineal pain and swelling prefer the side(lying position because they can rest while breastfeeding. C 4he infant inevitably faces the mother, belly to belly. ( 4he mother should never push on the bac# of the head. *t may cause the baby to bite, hyperextend the nec#, or develop an aversion to being brought near the breast. )*+ ,ognitive -evel ,omprehension ./+ 03E O'2 ,lient &eeds 3hysiologic *ntegrity 4O3 &ursing 3rocess *mplementation 15. 4he process whereby parents awa#en the infant to feed every 3 hours during the day and at least every 5 hours at night is a Fnown as demand feeding. . b &ecessary during the first 25 to 51 hours after birth.
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4est 'an# . c @sed to set up the supply(meets(demand system. . d A way to control cluster feeding. . A&% ' Feedba&k ' )emand feeding is when the infant determines the fre<uency of feedings: this is appropriate once the infant is feeding well and gaining weight. 4he parents do this to ma#e sure that the infant gets at least eight feedings in 25 hours. C 4he supply(meets(demand system is a mil# production system that occurs naturally. ( ,luster feeding is not a problem if the baby gets eight feedings in 25 hours. )*+ ,ognitive -evel ,omprehension ./+ 051, 052 O'2 ,lient &eeds $ealth 3romotion and "aintenance )iagnosis 4O3 &ursing 3rocess

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10. 4he nurse providing couplet care should understand that nipple confusion results when a 'reastfeeding babies receive supplementary bottle feedings. . b 4he baby is weaned too abruptly. . c 3acifiers are used before breastfeeding is established. . d 4wins are breastfed together. . A&% A Feedba&k ' &ipple confusion can result when babies go bac# and forth between bottles and breasts, especially before breastfeeding is established in 3 to 5 wee#s, because the two re<uire different s#ills. Abrupt weaning can be distressing to mother and?or baby but should not lead to nipple confusion. C 3acifiers used before breastfeeding is established can be disruptive, but this does not lead to nipple confusion. ( 'reastfeeding twins re<uires some logistical adaptations, but this should not lead to nipple confusion. )*+ ,ognitive -evel ,omprehension ./+ 053 O'2 ,lient &eeds $ealth 3romotion and "aintenance 4O3 &ursing 3rocess

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16. All of these statements indicate impacts of breastfeeding on the family or society at large except: a 'reastfeeding re<uires fewer supplies and less cumbersome e<uipment. . b 'reastfeeding saves families money. . c 'reastfeeding costs employers in terms of time lost from wor#. . d 'reastfeeding benefits the environment. . A&% , Feedba&k ' 'reastfeeding is convenient because it does not re<uire cleaning or transporting bottles and other e<uipment. 'reastfeeding saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. C Actually less wor# time is lost by breastfeeding mothers, in part because infants are healthier. ( 'reastfeeding uses a renewable resource: it does not need fossil fuels, advertising, shipping, or disposal. )*+ ,ognitive -evel ,omprehension ./+ 039 O'2 ,lient &eeds $ealth 3romotion and "aintenance /valuation 4O3 &ursing 3rocess

1B. A newly delivered mother who intends to breastfeed tells her nurse, C* am so relieved that this pregnancy is over so * can start smo#ing again.D 4he nurse encourages the woman to refrain from smo#ing. $owever, this new mother insists that she will resume smo#ing. 4he nurse will need to adapt her health teaching to ensure that the woman is aware that a %mo#ing has little or no effect on mil# production. . b 4here is no relation between smo#ing and the time of feedings. . c 4he effects of secondhand smo#e on infants are less significant than for adults. . d 4he mother should always smo#e in a room away from the baby. . A&% ) Feedba&k ' %mo#ing may impair mil# production. !hen the products of tobacco are bro#en

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down, they cross over into the breast mil#. 4obacco also results in a reduction of the antiinfective properties of breast mil#. .esearch supports that mothers should not smo#e within 2 hours before a feeding. C 4he effects of secondhand smo#e on infants include sudden infant death syndrome. ( +or all of the above reasons, the new mother should be encouraged not to smo#e. *f she continues to smo#e, she should be encouraged to always smo#e in a room away from the baby. )*+ ,ognitive -evel Application ./+ 001 O'2 ,lient &eeds 3hysiologic *ntegrity 3lanning M!LT"#LE )E*#%N*E 1. A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. !hat signs and symptoms should the nurse include in her discussion; ,hoose all that apply. a 'reast tenderness . b !armth 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 +ever and fluli#e symptoms . A&% A, ', ,, / Corre&t "n&orre &t Feedba&k 4hese symptoms are commonly associated with mastitis and should be included in the nurse7s discussion of mastitis. 4his symptom generally is not associated with mastitis. *t is commonly seen in women who have a plugged mil# duct. 4O3 &ursing 3rocess 4O3 &ursing 3rocess

)*+ ,ognitive -evel Analysis ./+ 003 O'2 ,lient &eeds 3hysiologic *ntegrity 3lanning T)!E+F'L*E

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1. A woman who recently arrived from Africa insists upon feeding her infant honey prior to her mil# coming in. 4his statement leads the nurse to believe that the woman should receive further education on infant feeding practices. A&% + +or many cultures in %outhern Asia, the 3acific *slands, and parts of sub(%aharan Africa, the babies are fed a prelacteal food such as honey or clarified butter. *t is the belief that these substances will help clear out the meconium. )*+ ,ognitive -evel Fnowledge ./+ 032, 033 O'2 ,lient &eeds 3sychosocial *ntegrity Assessment 4O3 &ursing 3rocess

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