Prior to discharge, a new mother who is breastfeeding wonders the best way to know her newborn is getting enough milk.
Which information should the practical nurse (PN) provide?
Use an on-demand feeding schedule.
Count the number of wet diapers per day.
Initiate feeding on the same breast each time.
Supplement with formula between feedings.
The Correct Answer is B
Choice A rationale
Using an on-demand feeding schedule allows the newborn to feed when hungry, which is important for establishing milk supply and meeting the infant's needs. However, it does not directly provide a quantitative measure of milk intake, as duration and frequency can vary.
Choice B rationale
Counting the number of wet diapers per day is an objective and reliable indicator of adequate hydration and milk intake in a breastfed newborn. Typically, a newborn should have at least 6-8 wet diapers per 24 hours by the end of the first week of life, indicating sufficient milk consumption.
Choice C rationale
Initiating feeding on the same breast each time is incorrect. It is generally recommended to alternate breasts with each feeding or offer both breasts at each feeding to ensure equal stimulation and drainage, which helps maintain milk supply in both breasts and prevents engorgement.
Choice D rationale
Supplementing with formula between feedings is not recommended as a primary method to assess milk intake and can interfere with the establishment of a robust breastfeeding relationship. It can decrease the infant's demand for breast milk, potentially reducing the mother's milk supply and introducing allergens.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
A soft, spongy fundus, often described as boggy, indicates uterine atony. This condition means the uterine muscles are not contracting effectively, which is abnormal postpartum and significantly increases the risk of postpartum hemorrhage due to inadequate compression of uterine blood vessels.
Choice B rationale
Unilateral lower leg pain, especially accompanied by warmth, redness, or swelling, is an abnormal finding and can be indicative of a deep vein thrombosis (DVT). Postpartum women are at an increased risk for DVT due to hypercoagulability and venous stasis, making this a critical assessment requiring immediate attention.
Choice C rationale
Saturating two perineal pads per hour is an excessive amount of lochia and suggests postpartum hemorrhage. Normal lochia flow should not saturate more than one pad per hour in the immediate postpartum period, indicating that the uterus is not contracting adequately to control bleeding.
Choice D rationale
A heart rate of 56 beats/minute, also known as puerperal bradycardia, is considered a normal physiological finding for a primigravida client 12 hours postpartum. This transient bradycardia often occurs due to the increased stroke volume and cardiac output that result from the significant decrease in uterine blood flow after delivery.
Correct Answer is D
Explanation
Choice A rationale
Administering oxygen and suctioning are appropriate for respiratory distress, but turning the newborn from supine to prone every 2 hours does not prevent aspiration in tracheoesophageal fistula and may increase the risk of aspiration or worsen respiratory compromise by allowing refluxed gastric contents to enter the airway.
Choice B rationale
Offering sterile water per nipple is contraindicated in suspected tracheoesophageal fistula because it poses a significant aspiration risk, as the water will likely enter the trachea. Placing the infant in a prone position does not mitigate this aspiration risk during feeding.
Choice C rationale
Inserting an orogastric tube is appropriate, but giving feedings via gavage before confirmation is dangerous due to the risk of aspiration into the lungs if a fistula is present. Confirmation via x-ray is crucial to ensure the tube is correctly placed and feeding is safe.
Choice D rationale
Keeping the infant NPO (nothing by mouth) prevents aspiration of fluids or food into the respiratory tract, which is a major complication of tracheoesophageal fistula. Elevating the head of the crib to 30 degrees uses gravity to minimize gastroesophageal reflux and further reduce the risk of aspiration.
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