Chapter 25

Question 1

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 the baby is frantically crying. Which feeding cue would indicate that the baby is ready to eat?
   a. Waves her arms in the air
   b. Makes sucking motions
   c. Has the hiccups
   d. Stretches out her legs straight

Answer 1

ANS: B
Sucking motions, rooting, mouthing, and hand-to-mouth motions are examples of feeding readiness cues. Waving her arms in the air, having the hiccups, and stretching out her extremities are not typical feeding readiness cues.

Question 2

2. 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 regarding bottle feeding using commercially prepared infant formulas might influence their choice?
   a. Bottle feeding using a commercially prepared formula increases the risk that the infant will develop allergies.
   b. Bottle feeding helps the infant sleep through the night.
   c. Commercially prepared formula ensures that the infant is getting iron in a form that is easily absorbed.
   d. Bottle feeding requires that multivitamin supplements be given to the infant.

Answer 2

ANS: A
Exposure to cow’s milk poses a risk of developing allergies, eczema, and asthma. Newborns should be fed during the night, regardless of the 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.

Question 3

3. A postpartum woman telephones the provider regarding her 5-day-old infant. The client is not scheduled for another weight check until the infant is 14 days old. The new mother is worried about whether breastfeeding is going well. Which statement indicates that breastfeeding is effective for meeting the infant’s nutritional needs?
   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

Answer 3

ANS: D
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’s sleep pattern is not an indication whether the infant is breastfeeding well. The infant should have a minimum of three bowel movements in a 24-hour period. Breastfed infants typically gain 15 to 30 g/day.

Question 4

4. A primiparous woman is delighted with her newborn son and wants to begin breastfeeding as soon as possible. How should the client be instructed to position the infant to facilitate correct latch-on?
   a. The infant should be positioned with his or her arms folded together over the chest.
   b. The infant should be curled up in a fetal position.
   c. The woman should cup the infant’s head in her hand.
   d. The infant’s head and body should be in alignment with the mother.

Answer 4

ANS: D
The infant’s head and body should be in correct alignment with the mother and the breast during latch-on and feeding. The infant should be facing the mother with his arms hugging the breast. The baby’s body should be held in correct alignment (i.e., ears, shoulder, and hips in a straight line) during feedings. The mother should support the baby’s neck and shoulders with her hand and not push on the occiput.

Question 5

5. A breastfeeding woman develops engorged breasts at 3 days postpartum. What action will help this client achieve her goal of reducing the engorgement?
   a. Skip feedings to enable her sore breasts to rest.
   b. Avoid using a breast pump.
   c. Breastfeed her infant every 2 hours.
   d. Reduce her fluid intake for 24 hours.

Answer 5

ANS: C
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. If the infant does not adequately feed and empty the breast, then the mother may pump to extract the milk and relieve some of the discomfort. Dehydration further irritates swollen breast tissue.

Question 6

6. At a 2-month well-baby examination, it was discovered that an exclusively breastfed infant had only gained 10 ounces in the past 4 weeks. The mother and the nurse develop a feeding plan for the infant to increase his weight gain. Which change in dietary management will assist the client in meeting this goal?
   a. Begin solid foods.
   b. Have a bottle of formula after every feeding.
   c. Have one extra breastfeeding session every 24 hours.
   d. Start iron supplements.

Answer 6

ANS: C
Usually the solution to slow weight gain is to improve the feeding technique. Position and the latch-on technique are evaluated, and adjustments are made. Adding a feeding or two within a 24-hour period might help. Solid foods should not be introduced to an infant for at least 4 to 6 months. Bottle feeding may cause nipple confusion and may limit the supply of milk. Iron supplements have no bearing on weight gain.

Question 7

7. 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 regarding pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement is valid?
   a. Premature infants more easily digest breast milk than formula.
   b. A glass of wine just before pumping will help reduce stress and anxiety.
   c. The mother should only pump as much milk as the infant can drink.
   d. The mother should pump every 2 to 3 hours, including during the night.

Answer 7

ANS: A
Human milk is the ideal food for preterm infants, with benefits that are unique, in addition to those benefits received by full-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. To establish an optimal milk supply, the most appropriate instruction for the mother should be to pump 8 to 10 times a day for 10 to 15 minutes on each breast.

Question 8

8. A new mother wants to be sure that she is meeting her daughter’s needs while feeding the baby commercially prepared infant formula. The nurse should evaluate the mother’s knowledge about appropriate infant feeding techniques. Which statement by the client reassures the nurse that correct learning has taken place?
   a. “Since reaching 2 weeks of age, I add rice cereal to my daughter’s formula to ensure adequate nutrition.”
   b. “I warm the bottle in my microwave oven.”
   c. “I burp my daughter during and after the feeding as needed.”
   d. “I refrigerate any leftover formula for the next feeding.”

Answer 8

ANS: C
Most infants swallow air when fed from a bottle and should be given a chance to burp several times during 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.

Question 9

9. A nurse is discussing the storage of breast milk with a mother whose infant is preterm and in the special care nursery. Which statement indicates that the mother requires additional teaching?
   a. “I can store my breast milk in the refrigerator for 3 months.”
   b. “I can store my breast milk in the freezer for 3 months.”
   c. “I can store my breast milk at room temperature for 4 hours.”
   d. “I can store my breast milk in the refrigerator for 3 to 5 days.”

Answer 9

ANS: A
Breast milk for the hospitalized infant can be stored in the refrigerator for only 8 days, not for 3 months. Breast milk can be stored in the freezer for 3 months, in a deep freezer for 6 months, or at room temperature for 4 hours. Human milk for the healthy or preterm hospitalized infant can be kept in the refrigerator for up to 8 days or in the freezer for up to 3 months, but only for 4 hours or less at room temperature.

Question 10

10. A new mother asks the nurse what the “experts say” about the best way to feed her infant. Which recommendation of the American Academy of Pediatrics (AAP) regarding infant nutrition should be shared with this client?
    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, then they should receive cow’s milk, not formula.
    d. After 6 months, mothers should shift from breast milk to cow’s milk.

Answer 10

ANS: A
Breastfeeding and human milk should also be the sole source of milk for the first 12 months, not for only the first 6 months. Infants should be started 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, then they should receive iron-fortified formula, not cow’s milk.

Question 11

11. Which statement is the best rationale for recommending formula over breastfeeding?
    a. Mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk.
    b. Mother lacks confidence in her ability to breastfeed.
    c. Other family members or care providers also need to feed the baby.
    d. Mother sees bottle feeding as more convenient.

Answer 11

ANS: A
Breastfeeding is contraindicated when mothers have certain viruses, tuberculosis, are undergoing chemotherapy, or are using or 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 during the 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. Although modesty issues related to feeding the infant in public may exist, these concerns are not legitimate reasons to formula-feed an infant. Often, the decision to formula feed rather than breastfeed is made without complete information regarding the benefits of breastfeeding.

Question 12

12. Which statement regarding the nutrient needs of breastfed infants is correct?
    a. Breastfed infants need extra water in hot climates.
    b. During the first 3 months, breastfed infants consume more energy than formula-fed infants.
    c. Breastfeeding infants should receive oral vitamin D drops daily during at least the first 2 months.
    d. Vitamin K injections at birth are not necessary for breastfed infants.

Answer 12

ANS: C
Human milk contains only small amounts of vitamin D. All infants who are breastfed should receive 400 International Units of vitamin D each day. Neither breastfed nor formula-fed infants need to be fed water, not even in very hot climates. During the first 3 months, formula-fed infants consume more energy than breastfed infants and therefore tend to grow more rapidly. Vitamin K shots are required for all infants because the bacteria that produce it are absent from the baby’s stomach at birth.

Question 13

13. The nurse should be cognizant of which statement regarding the unique qualities of human breast milk?
    a. Frequent feedings during predictable growth spurts stimulate increased milk production.
    b. Milk of preterm mothers is the same as the milk of mothers who gave birth at term.
    c. Milk at the beginning of the feeding is the same as the milk at the end of the feeding.
    d. Colostrum is an early, less concentrated, less rich version of mature milk.

Answer 13

ANS:	A
Growth spurts (at 10 days, 3 weeks, 6 weeks, and 3 months) usually last 24 to 48 hours, after which the 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. Milk changes composition during feeding. The fat content of the milk increases as the infant feeds. Colostrum precedes mature milk and is more concentrated and richer in proteins and minerals (but not fat).

Question 14

14. A nurse providing couplet care should understand the issue of nipple confusion. In which situation might this condition occur?
    a. Breastfeeding babies receive supplementary bottle feedings.
    b. Baby is too abruptly weaned.
    c. Pacifiers are used before breastfeeding is established.
    d. Twins are breastfed together.

Answer 14

ANS: A
Nipple confusion can result when babies go back and forth between bottles and breasts, especially before breastfeeding is established in 3 to 4 weeks; bottle feeding and breastfeeding require different skills. Abrupt weaning can be distressing to the mother and/or baby but should not lead to nipple confusion. Pacifiers used before breastfeeding is established can be disruptive but do not lead to nipple confusion. Breastfeeding twins require some logistical adaptations but should not lead to nipple confusion.

Question 15

15. Which information should the nurse provide to a breastfeeding mother regarding optimal self-care?
    a. She will need an extra 1000 calories a day to maintain energy and produce milk.
    b. She can return to prepregnancy consumption patterns of any drinks as long as she gets enough calcium.
    c. She should avoid trying to lose large amounts of weight.
    d. She must avoid exercising because it is too fatiguing.

Answer 15

ANS: C
Large weight loss releases fat-stored contaminants into her breast milk, and it also involves eating too little and/or exercising too much. A breastfeeding mother needs to add only 200 to 500 extra calories to her diet to provide the extra nutrients for her infant. However, this is true only if she does not drink alcohol, limits coffee to no more than two cups (including caffeine in chocolate, tea, and some sodas, too), and carefully reads the herbal tea ingredients. Although she needs her rest, moderate exercise is healthy.

Question 16

16. A newly delivered mother who intends to breastfeed tells her nurse, “I am so relieved that this pregnancy is over so that I can start smoking again.” The nurse encourages the client to refrain from smoking. However, this new mother is insistent that she will resume smoking. How will the nurse adapt her health teaching with this new information?
    a. Smoking has little-to-no effect on milk production.
    b. No relationship exists between smoking and the time of feedings.
    c. The effects of secondhand smoke on infants are less significant than for adults.
    d. The mother should always smoke in another room.

Answer 16

ANS: D
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. Tobacco also results in a reduction of the antiinfective properties of breast milk. Research supports the conclusion that mothers should not smoke within 2 hours before a feeding (AAP Committee on Drugs, 2001). The effects of secondhand smoke on infants include excessive crying, colic, upper respiratory infections, and an increased risk of sudden infant death syndrome (SIDS).

Question 17

17. 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. Which information should the nurse provide regarding this feeding plan?
    a. “Feeding solid foods before your son is 4 to 6 months old may decrease your son’s intake of sufficient calories.”
    b. “Feeding solid foods between breastfeeding sessions before your son is 4 to 6 months old will lead to an early cessation of breastfeeding.”
    c. “Your feeding plan will help your son sleep through the night.”
    d. “Feeding solid foods before your son is 4 to 6 months old will limit his growth.”

Answer 17

ANS: B
The introduction of solid foods before the infant is 4 to 6 months of age may result in overfeeding and decreased intake of breast milk. The belief that feeding solid foods helps infants sleep through the night is untrue. The proper balance of carbohydrate, protein, and fat for an infant to grow properly is in the breast milk or formula.

Question 18

18. According to demographic research, which woman is least likely to breastfeed and therefore most likely to need education regarding the benefits and proper techniques of breastfeeding?
    a. Between 30 and 35 years of age, Caucasian, and employed part time outside the home
    b. Younger than 25 years of age, Hispanic, and unemployed
    c. Younger than 25 years of age, African-American, and employed full time outside the home
    d. 35 years of age or older, Caucasian, and employed full time at home

Answer 18

ANS: C
Women least likely to breastfeed are typically younger than 25 years of age, have a lower income, are less educated, are employed full time outside the home, and are African-American.

Question 19

19. The nurse is explaining the benefits associated with breastfeeding to a new mother. Which statement by the nurse would provide conflicting information to the client?
    a. Women who breastfeed have a decreased risk of breast cancer.
    b. Breastfeeding is an effective method of birth control.
    c. Breastfeeding increases bone density.
    d. Breastfeeding may enhance postpartum weight loss.

Answer 19

ANS: B
Although breastfeeding delays the return of fertility, it is not an effective birth control method. Women who breastfeed have a decreased risk of breast cancer, an increase in bone density, and a possibility of faster postpartum weight loss.

Question 20

20. While discussing the societal impacts of breastfeeding, the nurse should be cognizant of the benefits and educate the client accordingly. Which statement as part of this discussion would be incorrect?
    a. Breastfeeding requires fewer supplies and less cumbersome equipment.
    b. Breastfeeding saves families money.
    c. Breastfeeding costs employers in terms of time lost from work.
    d. Breastfeeding benefits the environment.

Answer 20

ANS: C
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. Breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal.

Question 21

21. In assisting the breastfeeding mother to position the baby, which information regarding positioning is important for the nurse to keep in mind?
    a. The cradle position is usually preferred by mothers who had a cesarean birth.
    b. Women with perineal pain and swelling prefer the modified cradle position.
    c. Whatever the position used, the infant is “belly to belly” with the mother.
    d. While supporting the head, the mother should push gently on the occiput.

Answer 21

ANS: C
The infant naturally faces the mother, belly to belly. The football position is usually preferred after a cesarean birth. Women with perineal pain and swelling prefer the side-lying position because they can rest while breastfeeding. 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.

Question 22

22. Nurses should be able to teach breastfeeding mothers the signs that the infant has correctly latched on. Which client statement indicates a poor latch?
    a. “I feel a firm tugging sensation on my nipples but not pinching or pain.”
    b. “My baby sucks with cheeks rounded, not dimpled.”
    c. “My baby’s jaw glides smoothly with sucking.”
    d. “I hear a clicking or smacking sound.”

Answer 22

ANS: D
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 also is a good sign.

Question 23

23. 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. Break the suction by inserting your finger into the corner of the infant’s mouth.
    c. 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.

Answer 23

ANS: B
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 that makes 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.

Question 24

24. Which type of formula is not diluted with water, before being administered to an infant?
    a. Powdered
    b. Concentrated
    c. Ready-to-use
    d. Modified cow’s milk

Answer 24

ANS: C
Ready-to-use formula can be poured directly from the can into the 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. Cow’s milk is more difficult for the infant to digest and is not recommended, even if it is diluted.

Question 25

25. How many kilocalories per kilogram (kcal/kg) of body weight does a breastfed term infant require each day?
    a. 50 to 65
    b. 75 to 90
    c. 95 to 110
    d. 150 to 200

Answer 25

ANS: C
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.

Question 26

26. Which action by the mother will initiate the milk ejection reflex (MER)?
    a. Wearing a firm-fitting bra
    b. Drinking plenty of fluids
    c. Placing the infant to the breast
    d. Applying cool packs to her breast

Answer 26

ANS: C
Oxytocin, which causes the MER reflex, increases in response to nipple stimulation. A firm bra is important to support the breast; however, it will not initiate the MER reflex. Drinking plenty of fluids is necessary for adequate milk production, but adequate intake of water alone will not initiate the MER reflex. Cool packs to the breast will decrease the MER reflex.

Question 27

27. 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?” What is the nurse’s best response?
    a. More calories
    b. Essential amino acids
    c. Important immunoglobulins
    d. More calcium

Answer 27

ANS: C
Breast milk contains immunoglobulins that protect the newborn against infection. The calorie count of formula and breast milk is approximately the same. All the essential amino acids are in both formula and breast milk; however, the concentrations may differ. Calcium levels are higher in formula than in breast milk, which can cause an excessively high renal solute load if the formula is not properly diluted.

Question 28

28. Which instruction should the nurse provide to reduce the risk of nipple trauma?
    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.

Answer 28

ANS: B
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 and will also limit access to the higher-fat hindmilk. Assessing the nipples for trauma is important; however, this action alone will not prevent sore nipples. Soap can be drying to the nipples and should be avoided during breastfeeding.

Question 29

29. A new mother asks whether she should feed her newborn colostrum, because it is not “real milk.” What is the nurse’s most appropriate answer?
    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 is important in helping the mother learn how to breastfeed before she goes home.
    d. Colostrum is unnecessary for newborns.

Answer 29

ANS: A
Colostrum is important because it has high levels of the nutrients needed by the neonate and helps protect against infection. Supplementation is not necessary and 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; however, the importance of the colostrum to the infant is the top priority. Colostrum provides immunities and enzymes necessary to cleanse the gastrointestinal system, among other things.

Question 30

1. Which actions are examples of appropriate techniques to wake a sleepy infant for breastfeeding? (Select all that apply.)
   a. Unwrapping the infant
   b. Changing the diaper
   c. Talking to the infant
   d. Slapping the infant’s hands and feet
   e. Applying a cold towel to the infant’s abdomen

Answer 30

ANS: A, B, C
Unwrapping the infant, changing the diaper, and talking to the infant are appropriate techniques to use when trying to wake a sleepy infant. The parent can rub, never slap, the infant’s hands or feet to wake the infant. Applying a cold towel to the infant’s abdomen may lead to cold stress in the infant. The parent may want to apply a cool cloth to the infant’s face to wake the infant.

Question 31

2. A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. Which findings should the nurse include in the discussion? (Select all that apply.)
   a. Breast tenderness
   b. Warmth in the breast
   c. Area of redness on the breast often resembling the shape of a pie wedge
   d. Small white blister on the tip of the nipple
   e. Fever and flulike symptoms

Answer 31

ANS: A, B, C, E
Breast tenderness, warmth in the breast, redness on the breast, and fever and flulike symptoms are commonly associated with mastitis and should be included in the nurse’s discussion of mastitis. A small white blister on the tip of the nipple generally is not associated with mastitis but is commonly seen in women who have a plugged milk duct.

Question 32

3. The Baby Friendly Hospital Initiative endorsed by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) was founded to encourage institutions to offer optimal levels of care for lactating mothers. Which actions are included in the “Ten Steps to Successful Breastfeeding for Hospitals”? (Select all that apply.)
   a. Give newborns no food or drink other than breast milk.
   b. Have a written breastfeeding policy that is communicated to all staff members.
   c. Help mothers initiate breastfeeding within hour of childbirth.
   d. Give artificial teats or pacifiers as necessary.
   e. Return infants to the nursery at night.

Answer 32

ANS: A, B, C
No artificial teats or pacifiers (also called dummies or soothers) should be given to breastfeeding infants. Although pacifiers have been linked to a reduction in SIDs, they should not be introduced until the infant is 3 to 4 weeks old and breastfeeding is well established. No other food or drink should be given to the newborn unless medically indicated. The breastfeeding policy should be routinely communicated to all health care staff members. All staff should be trained in the skills necessary to maintain this policy. Breastfeeding should be initiated within hour of childbirth, and all mothers need to be shown how to maintain lactation even if separated from their babies. The facility should practice rooming in and keep mothers and babies together 24 hours a day.

Question 33

4. Which statements concerning the benefits or limitations of breastfeeding are accurate? (Select all that apply.)
   a. Breast milk changes over time to meet the changing needs as infants grow.
   b. Breastfeeding increases the risk of childhood obesity.
   c. Breast milk and breastfeeding may enhance cognitive development.
   d. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned.
   e. Benefits to the infant include a reduced incidence of SIDS.

Answer 33

ANS: A, C, D, E
Breastfeeding actually decreases the risk of childhood obesity. Human milk is the perfect food for human infants. Breast milk changes over time to meet the demands of the growing infant. Scientific evidence is clear that human milk provides the best nutrients for infants with continued benefits long after weaning. Fatty acids in breast milk promote brain growth and development and may lead to enhanced cognition. Infants who are breastfed experience a reduced incidence of SIDS.

Question 34

5. The AAP recommends pasteurized donor milk for preterm infants if the mother’s own milk in not available. Which statements regarding donor milk and milk banking are important for the nurse to understand and communicate to her client? (Select all that apply.)
   a. All milk bank donors are screened for communicable diseases.
   b. Internet milk sharing is an acceptable source for donor milk.
   c. Donor milk may be given to transplant clients.
   d. Donor milk is used in neonatal intensive care units (NICUs) for severely low-birth-weight infants only.
   e. Donor milk may be used for children with immunoglobulin A (IgA) deficiencies.

Answer 34

ANS: A, C, E
Because of the antiinfective and growth promotion properties for donor milk, donor milk is highly recommended for preterm and sick infants, as well as for term newborns. Human donor milk has also been used for older children with short gut syndrome, immunodeficiencies, metabolic disorders, or congenital anomalies. Human donor milk has also been used in the adult population—posttransplant clients and for those with colitis, ulcers, or cirrhosis of the liver. Some mothers acquire milk through Internet-based or community-based milk sharing. The U.S. Food and Drug Administration (FDA) has issued a warning regarding this practice. Samples of milk from these sources are higher in contaminants and infectious disease. A milk bank that belongs to the Human Milk Banking Association of North America should always be used for donor milk. All donors are scrupulously screened, and the milk is tested to determine its safety for use.

Question 35

Which statement is not accurate regarding the effect of breastfeeding on the family or society at large?

a. Breastfeeding requires fewer supplies and less cumbersome equipment.
b. Breastfeeding saves families money.
c. Breastfeeding costs employers in terms of time lost from work.
d. Breastfeeding benefits the environment.

Answer 35

Ans: C
Less time is lost from work by breastfeeding mothers, in part because infants are healthier than bottle-fed infants. Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment, and it saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. Also, breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal.

Question 36

In helping the breastfeeding mother position the baby, the nurse should keep in mind that:

a. The cradle position is usually preferred by mothers who had a cesarean birth.
b. Women with perineal pain and swelling prefer the modified cradle position.
c. Whatever the position used, the infant is “belly to belly” with the mother.
d. While supporting the head, the mother should push gently on the occiput.

Answer 36

Ans: C
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. The mother should never push on the back of the head, because doing so might cause the baby to bite, hyperextend the neck, or develop an aversion to being brought near the breast.

Question 37

The maternity nurse must be cognizant that cultural practices have significant influence on infant feeding methods. Many regional and ethnic cultures can be found within the United States. One cannot assume that generalized observations about any cultural group will hold for all members of the group. Which statement related to cultural practices influencing infant feeding practice is correct?

a. A common practice among Mexican women is known as las dos cosas.
b. Muslim cultures do not encourage breastfeeding because of modesty concerns.
c. Latino women born in the United States are more likely to breastfeed.
d. East Indian and Arab women believe that cold foods are best for a new mother.

Answer 37

Ans: A
Las dos cosas refers to combining breastfeeding and commercial infant formula. It is based on the belief that combining the two feeding methods gives the mother and infant the benefits of breastfeeding along with the additional vitamins from formula. In the Muslim culture, breastfeeding for 24 months is customary; Muslim women may, however, 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 cultural descriptor hot has nothing to do with the temperature or spiciness of the food.

Question 38

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

a. Encourage the mother to continue breastfeeding because it is effective in meeting the newborn’s nutrient and fluid needs.
b. Suggest that the mother switch to bottle feeding because breastfeeding is ineffective in meeting newborn needs for fluid and nutrients.
c. Notify the physician because the newborn is being poorly nourished.
d. Refer the mother to a lactation consultant to improve her breastfeeding technique.

Answer 38

Ans: A
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. The infant is not undernourished, and the physician does not need to be notified. Breastfeeding is effective, and bottle feeding does not need to be initiated at this time.

Question 39

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

a. Holds breast with four fingers along bottom and thumb at top.
b. Leans forward to bring breast toward the baby.
c. Stimulates the rooting reflex and then inserts nipple and areola into newborn’s open mouth.
d. Puts her finger into newborn’s mouth before removing breast.

Answer 39

Ans: B
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. The other actions described are correct.

Question 40

The nurse taught new parents the guidelines to follow regarding the 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:

a. Wash the top of can and can opener with soap and water before opening the can.
b. Adjust the amount of water added according to weight gain pattern of the newborn.
c. Add some honey to sweeten the formula and make it more appealing to a fussy newborn.
d. Warm formula in a microwave oven for a couple of minutes prior to feeding.

Answer 40

Ans: A
Washing the top of the can and can opener with soap and water before opening the can of formula is a good habit for parents 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 because a microwave can easily overheat it.

Question 41

Which statement regarding infant weaning is correct?

a. Weaning should proceed from breast to bottle to cup.
b. The feeding of most interest should be eliminated first.
c. Abrupt weaning is easier than gradual weaning.
d. Weaning can be mother or infant initiated.

Answer 41

Ans: D
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. In mother-led weaning, the mother decides which feedings to drop. Infants can be weaned directly from the breast to a cup. Bottles are usually offered to infants younger than 6 months. If the infant is weaned prior to 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.

Question 42

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:

a. An on-demand feeding schedule.
b. Breastfeeding.
c. Lower-calorie infant formula.
d. Smaller, more frequent feedings.

Answer 42

Ans: B
Breastfeeding is the best prevention strategy for decreasing childhood and adolescent obesity. Breastfeeding also helps the woman return to her prepregnant weight sooner.
All breastfed infants should be fed on demand. Use of 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.

Question 43

The concept of tandem feeding is based on:

a. Adequate nutritional stores for the mother and infant.
b. Using both breasts to nurse the baby.
c. Breastfeeding an infant and an older sibling during the same period.
d. Supplementing breastfeeding with bottle feeding to maintain adequate weight gain.

Answer 43

Ans: C

In tandem feeding, a mother nurses both an infant and an older child during the same period.

Question 44

Following a vaginal delivery, the patient tells the nurse that she intends to breastfeed her infant but she is very concerned about returning to her prepregnancy weight. On the basis of this interaction, the nurse would advise the patient that: (Select all that apply.)

a. She should join Weight Watchers as soon as possible to ensure adequate weight loss.
b. Even though more calories are needed for lactation, typically women who breastfeed lose weight more rapidly than women who bottle feed in the postpartum period.
c. Weight loss diets are not recommended for women who breastfeed.
d. If breastfeeding, she should regulate her fluid consumption in response to her thirst level.
e. If she decreases her calorie intake by 100-200 calories a day she will lose weight more quickly.

Answer 44

Ans: B, C, D
Weight loss diet plans are not recommended for women who are breastfeeding because they can lead to depletion of reserves and nutrient stores and decreased milk production. Breastfeeding mothers need to increase their caloric intake by 400-500 calories/day to ensure adequate nutritional stores and milk production. Breastfeeding women lose weight faster postpartum than women who bottle feed their infants. Regulating fluid consumption in response to her thirst level will ensure that a breastfeeding woman has adequate hydration without overhydration.