Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 29 Newborn Nutrition

1. A nurse is evaluating the diet plan of a breastfeeding mother. Which beverage is most likely to cause intolerance in the infant?
2. Orange juice
3. Milk
4. Decaffeinated tea
5. Water

Page Ref: 723

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is caring for a premature infant in the N I C U, and is going to attempt a bottle feeding with thawed breast milk. How long can thawed breast milk be stored in the refrigerator before the nurse must discard it?
2. 4 hours
3. 8 hours
4. 12 hours
5. 24 hours

Page Ref: 740

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is teaching a prenatal class about feeding methods. A father-to-be asks the nurse which method, breast or formula, leads to the fastest infant growth and weight gain. Which response by the nurse is best?
2. "In the first 3 to 4 months breastfed babies tend to gain weight faster."
3. "In the first 3 to 4 months there is no difference in weight gain."
4. "In the first 3 to 4 months bottle-fed babies grow faster."
5. "In the first 3 to 4 months growth isn't as important as your comfort with the method."

Page Ref: 720

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The community nurse is working with poor women who are formula-feeding their infants. Which statement indicates that the nurse's education session was effective?
2. "I should use only soy-based formula for the first year."
3. "I should follow the instructions for mixing the powdered formula exactly."
4. "It is okay to add more water to the formula to make it last longer."
5. "The mixed formula can be left on the counter for a day."

Page Ref: 744

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. What is the primary carbohydrate in mammalian milk that plays a crucial role in the nourishment of the newborn?
2. Colostrum
3. Lactose
4. Lactoferrin
5. Secretory I g A

Page Ref: 726

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 1 Compare the nutritional value and composition of human milk and formula preparations in relation to the nutritional needs of the newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse knows that in some cases, breastfeeding is not advisable. Which mother should be counseled against breastfeeding?
2. A mother with a poorly balanced diet
3. A mother who is overweight
4. A mother who is H I V positive
5. A mother who has twins

Page Ref: 730

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. Which statements by a breastfeeding class participant indicate that teaching by the nurse was effective?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "Breastfed infants get more skin-to-skin contact and sleep better."
2. "Breastfeeding raises the level of a hormone that makes me feel good."
3. "Breastfeeding is complex and difficult, and I probably won't succeed."
4. "Breastfeeding is worthwhile, even if it costs more overall."
5. "Breastfed infants have fewer digestive and respiratory illnesses."

Page Ref: 740

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. A client at 20 weeks' gestation has not decided on a feeding method for her infant. She asks the nurse for advice. The nurse presents information about the advantages and disadvantages of formula-feeding and breastfeeding. Which statements by the client indicate that the teaching was successful?
2. "Formula-feeding gives the baby protection from infections."
3. "Breast milk cannot be stored; it has to be thrown away after pumping."
4. "Breastfeeding is more expensive than formula-feeding."
5. "My baby will have a lower risk of food allergies if I breastfeed."

Page Ref: 726

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. Which of the following are potential disadvantages to breastfeeding?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Pain with breastfeeding
2. Leaking milk
3. Equal feeding responsibilities with fathers
4. Vaginal wetness
5. Embarrassment

Page Ref: 728

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. What should the healthcare provider consider when prescribing a medication to a woman who is breastfeeding?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Drug's potential effect on hormone production
2. Amount of drug excreted into the mother's blood
3. Drug's potential adverse effects to the infant
4. Infant's age and health
5. Mother's need for the medication

Page Ref: 730

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is teaching a new mother how to encourage a sleepy baby to breastfeed. Which of the following instructions would not be included in that teaching?
2. Providing skin-to-skin contact
3. Swaddling the newborn in a blanket
4. Unwrapping the newborn
5. Allowing the newborn to feel and smell the mother's breast

Page Ref: 742

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. A mother states that her breasts leak between feedings. Which of the following can contribute to the letdown reflex in breastfeeding mothers?
2. Pain with breastfeeding
3. Number of hours passed since last feeding
4. The newborn's cry
5. Maternal fluid intake

Page Ref: 728

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. When a breastfeeding mother complains that her breasts are leaking milk, the nurse can offer which effective intervention?
2. Decrease the number of minutes the newborn is at the breast per feeding.
3. Decrease the mother's fluid intake.
4. Place absorbent pads in the bra.
5. Administer oxytocin.

Page Ref: 728

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅳ. 9. Apply patient-care technologies as appropriate to address the needs of a diverse patient population. | N L N Competencies: Knowledge and Science: Value evidence-based approaches to yield best practices for nursing. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. When is breastfeeding contraindicated?
2. Infant has hypertension
3. Mother has a history of treated tuberculosis
4. Mother is H I V positive or has A I D S
5. Mother has a history of treated herpes

Page Ref: 730

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. Which of the following functions primarily to provide low-income women and children who are at risk for medical or nutritional problems with nutritious foods to supplement their diets, nutrition education and counseling, and screening and referrals to other health, welfare, and social programs?
2. A B M
3. W I C
4. I L C A
5. L L L I

Page Ref: 747

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is performing an assessment on an infant whose mother states that she feeds the infant in a supine position by propping the bottle. Based on this information, what would the nurse include in the assessment?
2. Otoscopic exam of the eardrum
3. Bowel sounds
4. Vital signs
5. Skin assessment

Page Ref: 745

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is working with a new mother who delivered yesterday. The mother has chosen to breastfeed her infant. Which demonstration of skill is the best indicator that the client understands breastfeeding?
2. She puts the infant to breast when he is asleep to help wake him up.
3. She takes off her gown to achieve skin-to-skin contact.
4. She leans toward the infant so that he turns his head to access the nipple.
5. The infant is crying when he is brought to the breast.

Page Ref: 740

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. A new mother who is breastfeeding tells the nurse that her infant is spitting up frequently, has very loose stools and copious gas, and feeds for only short periods of time. The nurse suspects a feeding intolerance and, after questioning the mother about her diet, suggests that she do which of the following?
2. Stop breastfeeding and switch to formula.
3. Eliminate dairy products from her diet.
4. Supplement breastfeeding with a soy-based formula.
5. Offer the baby water between feedings.

Page Ref: 723

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. Which of the following is a sign of dehydration in the newborn?
2. Slow, weak pulse
3. Soft, loose stools
4. Light colored, concentrated urine
5. Depressed fontanelles

Page Ref: 721

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is assisting a mother to bottle-feed her newborn, who has been crying. The nurse suggests that prior to feeding, the mother should do which of the following?
2. Offer a pacifier
3. Burp the newborn
4. Unwrap the newborn
5. Stroke the newborn's spine and feet

Page Ref: 745

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is explaining the nutritional differences between breast milk and formula to an expectant couple. The mother-to-be asks whether breast milk is nutritionally superior to formula. What should the nurse reply?
2. The vitamins and minerals in formula are more bioavailable to the infant.
3. There is no cholesterol in breast milk.
4. The only carbohydrate in breast milk is lactose.
5. The ratio of whey to casein proteins in breast milk changes to meet the nutritional needs of the growing infant.

Page Ref: 722

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Compare the nutritional value and composition of human milk and formula preparations in relation to the nutritional needs of the newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is caring for a new breastfeeding mother who is from Pakistan. The nurse plans her care so that the newborn is offered the breast on which of the following?
2. Day of birth
3. First day after birth
4. Second day after birth
5. Third to fourth day after birth

Page Ref: 731

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Therapeutic Environment

Standards: Q S E N Competencies: Ⅰ. C. 6. Willingly support patient-centered care for individuals and groups whose values differ from own. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Explain the influence of cultural values on newborn/infant feeding practices.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is working with a client from Southeast Asia. The client tells the nurse that she should not put the baby to breast until her milk comes in and her breasts are warm, because "cold milk" (colostrum) is bad for the baby. After the nurse explains the benefits of colostrum, the client still insists that "cold milk" is bad. Which response by the nurse is best?
2. "What kind of formula would you like to use?"
3. "That idea is folklore. Colostrum is good for the baby."
4. "Now that you are here, you need to feed your baby the right way."
5. "Let's give the baby formula after you breastfeed."

Page Ref: 731

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. C. 13. Acknowledge the tension that may exist between patient rights and the organizational responsibility for professional, ethical care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Be open to others' ideas; show humility, mutual trust, empathy, support, and a capacity for grace. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Explain the influence of cultural values on newborn/infant feeding practices.

M N L L O: Demonstrate understanding of newborn nutrition.

1. A client from Mexico has just delivered a son, and the nurse offers to assist in putting the baby to breast. Although the client indicated before the birth that she wanted to breastfeed, she is very hesitant, and says she would like to bottle-feed for the first few days. After talking to her, the nurse understands that her primary reason for wanting to delay breastfeeding is based on what cultural belief?
2. Breast milk causes skin rashes.
3. It is harmful to breastfeed immediately.
4. Colostrum is bad for the baby.
5. Thin milk causes diarrhea.

Page Ref: 731

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. C. 4. Seek learning opportunities with patients who represent all aspects of human diversity. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Be open to others' ideas; show humility, mutual trust, empathy, support, and a capacity for grace. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Explain the influence of cultural values on newborn/infant feeding practices.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is preparing a class on breastfeeding for pregnant women in their first trimester. The women are from a variety of cultural backgrounds, and all speak English well. Which statement should the nurse include in this presentation?
2. "Although some cultures believe colostrum is not good for the baby, it provides protection from infections and helps the digestive system to function."
3. "Some women are uncomfortable with exposing their breasts to nurse their infant, but it really isn't a big deal. You will get used to it."
4. "No religion prescribes a feeding method, so you all can choose whatever method makes the most sense to you."
5. "In most cultures, it is culturally acceptable to speak about intimate matters in front of their families."

Page Ref: 731

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. C. 4. Seek learning opportunities with patients who represent all aspects of human diversity. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Explain the influence of cultural values on newborn/infant feeding practices.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse has completed a community education session on growth patterns of infants. Which statement by a participant indicates that additional teaching is needed?
2. "Newborns should regain their birth weight by 1 week of age."
3. "Breastfed and formula-fed babies have different growth rates."
4. "Formula-fed infants regain their birth weight earlier than breastfed infants."
5. "Healthcare providers consider breastfeeding to be the 'gold standard' for neonatal nutrition."

Page Ref: 749

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 6 Describe ways to educate parents about their newborn's nutritional needs and normal growth patterns.

M N L L O: Demonstrate understanding of newborn nutrition.

1. A nurse is evaluating the diet plan of a breastfeeding mother, and determines that her intake of fruits and vegetables is inadequate. The nurse explains that the nutritional composition of the mother's breast milk can be adversely affected by this nutritional inadequacy. Which strategy should the nurse recommend to the mother?
2. Stop breastfeeding
3. Provide newborn supplements to the newborn
4. Offer whole milk
5. Supplement with skim milk

Page Ref: 722

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. C. 14. Appreciate shared decision-making with empowered patients and families, even when conflicts occur. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Describe ways to educate parents about their newborn's nutritional needs and normal growth patterns.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse encourages a new mother to feed the newborn as soon as the newborn shows interest. The nurse bases this recommendation on which benefits of early feedings?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Early feedings stimulate peristalsis.
2. Colostrum is thinner than mature milk.
3. Early feedings enhance maternal-infant bonding.
4. Early feedings promote the passage of meconium.
5. Colostrum contains a high number of calories.

Page Ref: 740

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Explain the advantages and disadvantages of breastfeeding and formula-feeding in determining the nursing care of both mother/family and newborn.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is completing the discharge teaching of a young first-time mother. Which statement by the mother requires immediate intervention?
2. "I will put my baby to bed with his bottle so he doesn't get hungry during the night."
3. "My baby will probably have a bowel movement each breastfeeding, and will wet often."
4. "Nursing every 2 to 3 hours is normal, for a total of 8 to 12 feedings every day."
5. "I will drink fenugreek tea from my grandmother to prevent my milk from coming in."

Page Ref: 745

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. A newborn weighs 7 l b s. 10 ounces at birth. What is the maximum number of calories that the nurse should instruct the mother that the baby needs to consume each day? (Calculate to the nearest whole number.)

Page Ref: 720

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 5 Explain the nutritional needs and normal growth patterns of newborns.

M N L L O: Demonstrate understanding of newborn nutrition.

1. During an educational session the nurse learns that legislation was written to support breastfeeding mothers. In which order did the titles of this legislation occur?
2. Establish standards for safe and effective breast pumps
3. Include breastfeeding equipment as medical care for taxes
4. Require businesses with 50 or more employees to give lactating women breaks
5. Give tax incentives to businesses that establish a private place for breastfeeding
6. Protect lactating women from being fired or discriminated against in the workplace

Page Ref: 729

Cognitive Level: Analyzing

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. A. 7. Explore ethical and legal implications of patient-centered care. | A A C N Essentials Competencies: Ⅴ. 4. Examine legislative and regulatory processes relevant to the provision of healthcare. | N L N Competencies: Context and Environment: Ethical Comportment; Act in accordance with legal and regulatory requirements, including H I P A A, for faculty, students, patients, and families. | Nursing/Integrated Concepts: Assessment: Teaching/Learning.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. A new mother asks the nurse about the football hold to use when breastfeeding. Which picture should the nurse use to explain this position to the new mother?

Page Ref: 733

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is instructing a new mother on the type of stool to expect a breast-fed newborn to produce. In which order should the nurse explain the stool changes?

Page Ref: 738

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is reviewing the process of pumping the breasts with a new mother. In which order should the nurse provide this information?
2. Fill glass or bottles 3/4 full
3. Massage the breasts and relax
4. Sit up straight or lean forward
5. Wash hands with soap and water
6. Pump each breast for 10 to 20 minutes

Page Ref: 739

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is reviewing the contents of breastmilk with a new mother. What amount of water should the nurse explain is in 8 ounces of breastmilk? Record your answer rounding to the nearest whole number.

Page Ref: 725

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. The nurse is demonstrating to a patient the proper steps for breastfeeding a newborn. Put these steps in the logical order that would assist the patient in placing the newborn to her breast.
2. Tickle the newborn's lips with the nipple.
3. Allow the newborn to latch on to the nipple.
4. The newborn opens her mouth wide.
5. Have the newborn face the mother tummy to tummy.
6. Position the newborn so the nose is at the level of the nipple.

Page Ref: 736

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.

1. A premature newborn is unable to suck at the breast. The nurse plans care for the mother, who is going to hand-express milk. Arrange the steps for milk expression in the correct order.
2. Roll the thumb and fingers simultaneously forward.
3. Position the thumb at 12:00 and the forefinger and middle finger at 6:00 around the areola.
4. Repeat the sequence multiple times to completely drain the breasts.
5. Stretch the areola back toward the chest wall without lifting the fingers off the breast.

Page Ref: 739

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 3 Formulate guidelines for helping both breastfeeding and formula-feeding mothers to feed their newborns successfully in hospital and community-based settings.

M N L L O: Demonstrate understanding of newborn nutrition.