25

Chapter 25: Newborn Nutrition and Feeding
Lowdermilk: Maternity & Women’s Health Care, 11th Edition
MULTIPLE CHOICE
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
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.
DIF: Cognitive Level: Understand REF: p. 609 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
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.
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.
DIF: Cognitive Level: Apply REF: p. 602 TOP: Nursing Process: Diagnosis
MSC: Client Needs: Physiologic Integrity, Basic Care and Comfort
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
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.
DIF: Cognitive Level: Understand REF: pp. 613-614 TOP: Nursing Process: Evaluation
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.
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.
DIF: Cognitive Level: Apply REF: p. 610

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
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.
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.
DIF: Cognitive Level: Understand REF: p. 623

TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
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.
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.

TOP: Nursing Process: Planning | Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
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.
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.
DIF: Cognitive Level: Analyze REF: p. 616 TOP: Nursing Process: Evaluation
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.”
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.
DIF: Cognitive Level: Understand REF: p. 626 TOP: Nursing Process: Evaluation
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.”
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.
DIF: Cognitive Level: Analyze REF: p. 618 TOP: Nursing Process: Evaluation
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.
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.
DIF: Cognitive Level: Apply REF: p. 601 TOP: Nursing Process: Planning
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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).
DIF: Cognitive Level: Apply REF: p. 622 TOP: Nursing Process: Planning
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.”
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.
DIF: Cognitive Level: Apply REF: p. 629 TOP: Nursing Process: Evaluation
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
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.
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
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.
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.
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.
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.
DIF: Cognitive Level: Understand REF: p. 602 TOP: Nursing Process: Evaluation
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.
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.

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.”
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.
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.
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.

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
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.
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
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
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.
DIF: Cognitive Level: Remember REF: p. 604

TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
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
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.

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
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.

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.
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.

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.
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.
DIF: Cognitive Level: Remember REF: p. 607

MULTIPLE RESPONSE
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
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.

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
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.
DIF: Cognitive Level: Analyze REF: p. 625 TOP: Nursing Process: Planning
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.
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.

TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment
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.
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.
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.
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.
DIF: Cognitive Level: Analyze REF: pp. 619-620


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Chapter 25: Newborn Nutrition and Feeding

Lowdermilk: Maternity & Women’s Health Care, 11th Edition

DIF: Cognitive Level: Apply REF: p. 610

DIF: Cognitive Level: Understand REF: p. 623

6. At a 2-month well-baby examination, it was discovered that an exclusively breastfed infant

DIF: Cognitive Level: Apply REF: p. 615

DIF: Cognitive Level: Apply REF: p. 610

DIF: Cognitive Level: Apply REF: p. 611

DIF: Cognitive Level: Remember REF: p. 604

DIF: Cognitive Level: Understand REF: p. 607

DIF: Cognitive Level: Apply REF: p. 607

DIF: Cognitive Level: Apply REF: p. 624

DIF: Cognitive Level: Remember REF: p. 607

DIF: Cognitive Level: Apply REF: p. 615

DIF: Cognitive Level: Apply REF: p. 608

DIF: Cognitive Level: Analyze REF: pp. 619-620

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