Chapter 27
1) The nurse is teaching an early-parenting class to families expecting their first child soon. A
patient asks the nurse if breast milk is really better than formula. The best response by the
nurse is:
1. “Breast milk is the perfect food for human babies.
2. “Formula attempts to imitate the composition of breast milk. “
3. “Breastfed babies grow faster because of breast milk.”
4. “Formula is harder to digest than is breast milk.”
Answer: 2
Rationale 1:
Although this statement is true, it is somewhat vague because it does not describe the
nutritional composition of breast milk. In addition, this response is emotionally laden and
judgmental of the use of formula, and therefore not therapeutic.
Rationale 2:
This statement best answers the question about whether breast milk or formula is best. Breast
milk is the “gold standard” on which formula is based. Formula attempts to provide nutrition
that is similar to breast milk; however, breast milk composition is different in many ways.
Rationale 3:
Although exclusively breastfed infants have the same or slightly higher weight gain than their
formula-fed and mixed-fed peers in the first 3–4 months, the patient’s question is not about
growth; it is about whether breast milk or formula is better.
Rationale 4:
The patient’s question is not about digestion of formula and breast milk; the question is about
which is better. It is best to answer a patient’s question directly.
2) 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? “In the first 3–4 months:
1. “Breastfed babies gain weight faster.”
2. “There is no difference in weight gain.”
3. “Bottle-fed babies grow faster.”
4. “Growth isn’t as important as your comfort with the method.”
Answer: 1
Rationale 1:
Once feeding is established, breastfed babies tend to gain weight faster than do bottle-fed
babies and have a leaner body at the end of the first year.
Rationale 2:
Breastfed babies have a leaner body at the end of the first year.
Rationale 3:
Breastfed babies tend to gain weight faster than do bottle-fed babies.
Rationale 4:
Although comfort with the feeding method is important, the question is specifically about
growth and weight gain; it is not therapeutic to change the topic and not answer the question.
3) 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?
1. “I should only use soy-based formula for the first year.”
2. “I follow the instructions for mixing the powdered formula exactly.”
3. “I can reuse one bottle for several feedings.”
4. “The mixed formula can be left on the counter for a day.”
Answer: 2
Rationale 1:
Soy-based formulas are more expensive than whey-based formulas, and they are only needed
by infants with milk allergies. No information is provided about milk allergy symptoms.
Powdered formula is the cheapest, followed by concentrated formula; ready-to-feed formula
is the most expensive.
Rationale 2:
Powdered and concentrated formula must be mixed according to manufacturer’s guidelines.
Formula that is too concentrated can lead to excess sodium intake, which creates increased
thirst and overfeeding.
Rationale 3:
Each bottle should contain only enough formula for one feeding, and any formula left after
the feeding should be discarded to prevent bacterial growth.
Rationale 4:
Once formula is mixed, it must be used within two hours or refrigerated.
4) Which statements by a breastfeeding class participant indicate that teaching was effective?
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.”
Answer: 1,2,5
Rationale 1:
This is a true statement.
Rationale 2:
Every time an infant suckles, the prolactin level doubles; prolactin creates feelings of
euphoria and relaxation.
Rationale 3:
Although there is skill involved in getting a baby to nurse successfully and coordinating the
infant’s efforts with the maternal efforts, breastfeeding is not perceived as difficult by the
majority of women who attempt to do so.
Rationale 4:
Breastfeeding actually costs substantially less than formula feeding, even considering the
need for increased calcium and protein intake during lactation.
Rationale 5:
This is a true statement. Reduced infections are due to immunologic properties in breast milk
and to the fact that breastfed infants are not put to bed with a bottle, a practice known to
increase ear infections.
5) The patient 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 patient indicate
that the teaching was successful?
1. “Formula-feeding gives the baby protection from infections.”
2. “Breast milk cannot be stored; it has to be thrown away after pumping.”
3. “Breastfeeding is more expensive than formula-feeding.”
4. “My baby has a lower risk of food allergies if I breastfeed.”
Answer: 4
Rationale 1:
Formula does not provide the baby with protection from infections like breast milk does.
Rationale 2:
Breast milk can be refrigerated or frozen after pumping.
Rationale 3:
Formula must be purchased, and therefore it is expensive.
Rationale 4:
Breast milk provides newborns with immunoglobulins and reduces the risk of food allergies
in children.
6) The nurse is working with a new mother who delivered yesterday. The patient has chosen
to breastfeed her infant. Which demonstration of skill is the best indicator that the patient
understands breastfeeding?
1. The patient puts the infant to breast when he is asleep to help wake him up.
2. The patient takes off her gown to achieve skin-to-skin contact.
3. The infant is held so that he turns his head to access the nipple.
4. The infant is crying when he is brought to the breast.
Answer: 2
Rationale 1:
Breastfeeding is more successful if the infant is in the alert-awake state when put to breast.
Putting a newborn to breast is not likely to wake him up to feed.
Rationale 2:
Skin-to-skin contact creates tactile sensations that increase the sucking of newborns.
Rationale 3:
The infant should be held in a “tummy-to-tummy” position so that the head does not have to
turn to find the nipple and access the breast.
Rationale 4:
Crying is a late cue of hunger. Newborns should be put to breast when they begin rooting,
lip-smacking, or tongue-thrusting behaviors.
7) A newborn appears pale and weak, and laboratory tests reveal the infant has iron
deficiency anemia. The mother asks the nurse if it would better to breastfeed her infant or
feed him a formula high in iron. What should the nurse’s response be?
1. Breastfeed, because breast milk has higher levels of iron compared to formula
2. Breastfeed, because although breast milk has lower levels of iron compared to formula, it
is more easily absorbed by the infant
3. Formula-feed, because formula has higher levels of iron compared to breast milk
4. Formula-feed, because although formula has lower levels of iron compared to breast milk,
it is more easily absorbed by the infant
Answer: 2
Rationale 1:
Breast milk actually contains lower levels of iron compared to formula. While breast milk is
nutritionally complete and suitable for most infants, it may not provide sufficient iron for a
newborn with iron deficiency anemia.
Rationale 2:
Breastfeeding is recommended because although breast milk contains less iron than formula,
it is more easily absorbed by the infant's body. The iron in breast milk is in a form that is
highly bioavailable, promoting better absorption and utilization by the infant.
Rationale 3:
This option is incorrect. While formula may indeed contain higher levels of iron compared to
breast milk, it is not necessarily the better choice in this scenario. The bioavailability of iron
in formula may not be as high as in breast milk, potentially leading to less effective iron
absorption by the infant.
Rationale 4:
Formula may have higher levels of iron compared to breast milk, but it is not necessarily the
preferred option in this situation. Breast milk offers advantages beyond just iron content,
including easier absorption of nutrients, fewer digestive issues, and benefits for the motherinfant bond. Therefore, despite the lower iron content, breastfeeding is still recommended for
infants with iron deficiency anemia.
8) Infants receive approximately 50% of their calories from ____________, even though
breast milk contains more ________________ by weight.
Answer: fat
Rationale:
Infants receive approximately 50% of their calories from fat.
9) A nurse is assisting a new mother to breastfeed. Put the following steps for breastfeeding
in a logical sequence.
Choice 1. Tickle the newborn’s lips with the nipple.
Choice 2. Bring the newborn to breast.
Choice 3. The newborn opens mouth wide.
Choice 4. Have the newborn face the mother tummy-to-tummy.
Choice 5. Position the newborn so the newborn’s nose is at level of the nipple.
Answer: 3,5,4,2,1
Rationale 1:
The step where the newborn opens their mouth wide (Choice 3) should come first in the
sequence because it indicates readiness to latch onto the breast. This action is crucial for
successful breastfeeding as it ensures the baby can take in a sufficient amount of breast tissue
to effectively nurse.
Rationale 2:
Positioning the newborn so their nose is at the level of the nipple (Choice 5) is the next
logical step after the baby opens their mouth wide. This positioning helps ensure a good latch
by aligning the baby's mouth properly with the breast, making it easier for them to latch on
and nurse effectively.
Rationale 3:
Having the newborn face the mother tummy-to-tummy (Choice 4) follows after positioning
the baby correctly. This position promotes skin-to-skin contact, helps the baby feel secure,
and allows for better access to the breast for nursing.
Rationale 4:
Bringing the newborn to the breast (Choice 2) is the subsequent step after ensuring proper
positioning. This involves guiding the baby's mouth to the breast in a way that allows for a
comfortable and effective latch.
Rationale 5:
Tickling the newborn's lips with the nipple (Choice 1) is the final step in the sequence. This
action encourages the baby to open their mouth wide, facilitating a deep latch and successful
breastfeeding. It helps initiate the breastfeeding process by stimulating the baby's sucking
reflex.
10) 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:
1. Offer a pacifier.
2. Burp the newborn.
3. Unwrap the newborn.
4. Stoke the newborn’s spine and feet.
Answer: 2
Rationale 1:
The newborn’s cries are indicative of an issue; a pacifier would not solve the problem.
Rationale 2:
If a newborn has been crying prior to feeding, air might have been swallowed; therefore, the
newborn should be burped before feeding. Time should be taken to calm the newborn prior to
feeding.
Rationale 3:
Unwrapping the newborn stimulates the newborn.
Rationale 4:
Stroking the spine and feet stimulate the newborn.
11) The nurse is completing the discharge teaching of a young first-time mother. Which
statement requires immediate intervention?
1. “I will put my baby to bed with his bottle so he doesn’t get hungry during the night.”
2. “My baby will probably have a bowel movement each breastfeeding and will wet often.”
3. “Nursing every 1½–2 hours is normal, for a total of 8–12 feedings every day.”
4. “I will drink yarrow tea from my grandmother to prevent my milk from coming in.”
Answer: 1
Rationale 1:
Putting a baby to bed with a propped bottle is a choking hazard and should never be done.
Rationale 2:
Breastfed infants have more frequent bowel movements than do bottle-fed infants. Both
should have at least five wet diapers per day.
Rationale 3:
This is a true statement. Breast milk is easier to digest than formula; therefore, infants eat
more frequently.
Rationale 4:
Yarrow is one of the anti-galactogogues (herbs that decrease lactation) and is used by
formula-feeding women to decrease milk supply.
12) A nurse conducts an infant assessment on the second day after birth. A physical
assessment of the newborn reveals the infant has dry lips and a dry oral cavity and has had
only one wet diaper rather than the expected two. What is the primary nursing diagnosis for
this infant?
1. Risk for Imbalanced Nutrition: Less than body requirements related to mother’s increased
caloric need
2. Ineffective breastfeeding related to mother’s lack of knowledge about breastfeeding
techniques
3. Risk for infection related to impaired skin integrity
4. Imbalanced Nutrition: Less than body requirements related to dehydration as evidenced by
dry mucus membranes and decreased urine output
Answer: 4
Rationale 1:
The infant has progressed beyond a risk diagnosis as evidenced by the signs of dehydration.
Instead, this infant should receive the actual diagnosis of imbalanced nutrition.
Rationale 2:
Although dehydration is often caused by ineffective breastfeeding, there is no evidence that
this is related to the mother’s lack of knowledge about breastfeeding techniques. A maternal
assessment would be needed to make this diagnosis.
Rationale 3:
Dry lips and mouth may lead to impaired skin integrity, but this is not the primary nursing
diagnosis that needs immediate intervention.
Rationale 4:
The infant is displaying signs of dehydration, which most often occurs when the infant is not
receiving enough fluids through breastfeeding or bottle-feeding. Newborns require 140-160
ml/kg/day of fluids to prevent dehydration because the newborn has a decreased ability to
concentrate urine and their overall metabolic rate is high.
13) 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 breast milk can be adversely affected by this aspect of the mother’s
nutrition. Which of the following strategies should be recommended to the mother?
1. Stop breastfeeding.
2. Provide newborn supplements to the newborn.
3. Offer whole milk.
4. Supplement with skim milk.
Answer: 2
Rationale 1:
The mother may continue to breastfeed, but the caregiver may choose to prescribe additional
vitamins for the newborn.
Rationale 2:
The mother may continue to breastfeed, but the caregiver may choose to prescribe additional
vitamins for the newborn.
Rationale 3:
Whole milk and skim milk are not recommended during the first year of life.
Rationale 4:
Whole milk and skim milk are not recommended during the first year of life.
14) A nurse is conducting a breastfeeding assessment for a primipara mother. The infant has
not yet learned how to latch on strongly, and the mother begins to get frustrated. In addition,
the infant seems unsettled and uninterested in eating. The mother comments that she thinks
her frustration is causing her milk to spoil. How should the nurse handle this statement?
1. Agree with the mother’s statement and teach her relaxation techniques to reduce her
frustration.
2. Assure the mother that there is no evidence that milk composition changes based on the
mother’s emotional state. The infant is fussy because he can sense the mother’s frustration.
3. Tell the mother that the delayed let-down resulting from her frustration is causing the
infant to suck in air rather than milk.
4. Remind the mother that spoiled milk will cause cramping in the infant’s stomach,
contributing to his fussy demeanor.
Answer: 2
Rationale 1:
Although teaching the mother relaxation techniques is an appropriate response, there is no
evidence that milk composition changes based on the mother’s emotional state. Therefore, the
nurse should not agree with this statement.
Rationale 2:
Infants can sense the mother’s emotions, so the mother should be taught relaxation techniques
to reduce her frustration and enhance the feeding experience.
Rationale 3:
A delayed let-down response will not cause the infant to suck air instead of milk through the
nipple.
Rationale 4:
There is no evidence that milk composition changes based on the mother’s emotional state, so
the infant will not be consuming spoiled milk. If the infant has stomach cramping, it will be
for another reason that will need to be investigated more thoroughly.
Test Bank for Contemporary Maternal-Newborn Nursing
Patricia W Ladewig, Marcia L London, Michele Davidson
9780133429862, 9780134257020
