53.
4. Depo-Provera is a progestin contracep- tive that can reduce the initial production of breast milk. It is given to a breast-feeding woman when she returns for the 6-week postpartum check up. By this time, the milk supply is well established and will remain at that level. Depo-Provera is effec- tive as a contraceptive for 90 days. Clients who are bottle-feeding may be given Depo-Provera prior to discharge from the hospital.CN: Pharmacological and parenteral therapies; CL: Evaluate
54.
3. As much of the mother’s nipple and areola need to be in the infant’s mouth in order to establish a latch that does not cause nipple cracks or fi ssures.Having the nipple and the areola deep in the infant’s mouth decreases the stress on the end of the nipple, therefore decreasing pain, cracking and fi ssures.
Breast milk has been found to heal nipples when placed on the nipple at the completion of a feeding.
The length of time the baby feeds on each nipple is not a factor as long as the nipple is correctly placed in the infant’s mouth.
CN: Health promotion and maintenance;
CL: Evaluate
55.
1. New mothers usually begin to produce milk at about the third day postpartum and colos- trum is produced until that time. For clients who have breast-fed another infant during pregnancy, having milk shortly after delivery is not unusual.Diaphoresis and diuresis are considered normal during this time as the body excretes the additional fl uids that are no longer needed after the pregnancy.
Constipation may continue for several days as a result of progesterone remaining in the system, the consummation of iron, and trauma to the perineum.
CN: Physiological adaptation;
CL: Analyze
49.
1. The client will need a 4 to 6 week postpar- tum checkup to assure that she has returned to a pre-pregnancy state rather than 1 week postpartum.A sports bra will provide support to the breasts and decrease the chance that her milk will come in, or will provide support if she is breast-feeding. Some postpartum clients ovulate shortly after delivery and can become pregnant before having a fi rst period. Postpartum blues occurs within the fi rst 4 to 5 days postpartum and usually improves within 10 days postpartum, but the nurse should instruct the client to report any signs of feeling depressed to her health care provider.
CN: Health promotion and maintenance;
CL: Evaluate
50.
4. It is believed that the process of attachment is structured so that the parents become attached to only one infant at a time. Therefore, the nurse should encourage the parents to relate to each twin individu- ally, rather than as a unit, to enhance the attachment process. Mothers of twins are usually able to breast- feed successfully because the milk supply increases on demand. However, possible fatigue and exhaus- tion require that the mother rest whenever possible.It would be highly unlikely and unrealistic that each parent would be able to spend equal amounts of time with both twins. Other responsibilities, such as employment, may prevent this. The parents should try to engage assistance from family and friends, because caring for twins or other multiple births (e.g., triplets) can be exhausting for the family.
CN: Psychosocial adaptation;
CL: Synthesize
51.
3. At 12 hours postpartum, the fundus nor- mally should be in the midline and at the level of the umbilicus. When the fundus is fi rm yet above the umbilicus, and deviated to the right rather than in the midline, the client’s bladder is most likely distended. The client should be encouraged to ambulate to the bathroom and attempt to void, because a full bladder can prevent normal involu- tion. A fi rm but deviated fundus above the level of the umbilicus is not a normal fi nding and if voiding does not return it to midline, it should be reported to the physician. Methylergonovine (Methergine) is used to treat uterine atony. This client’s fundus is fi rm, not boggy or soft, which would suggest atony.Gentle massage is not necessary because there is no evidence of atony or clots.
CN: Reduction of risk potential;
CL: Synthesize
52.
2, 3, 5, 6. The nurse is responsible for provid- ing discharge instructions that include signs and symptoms that need to be reported to the physician as well as resources and follow-up for home careBillings_Part 2_Chap 1_Test 4.indd 140
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perineal circulation. Increased fl uid (and fi ber) intake promotes bowel elimination, thus prevent- ing constipation, which can increase the client’s discomfort.
CN: Health promotion and maintenance;
CL: Evaluate
60.
1. If not contraindicated for moral, cultural, or religious reasons, a condom with spermicide is commonly recommended for contraception after delivery until the client’s 6-week postpartal exami- nation. This method has no effect on the neonate who is breast-feeding. Oral contraceptives contain- ing estrogen are not advised for women who are breast-feeding because the hormones decrease the production of breast milk. Women who are not breast-feeding may use oral contraceptive agents.The rhythm method is not effective because the client is unlikely to be able to determine when ovulation has occurred until her menstrual cycle returns. Although breast-feeding is not considered an effective form of contraception, breast-feeding usually delays the return of both ovulation and menstruation. The length of the delay varies with the duration of lactation and the frequency of breast-feeding. While abstinence is one form of birth control and safe while breast-feeding, it may not be acceptable to this couple who is asking about a method that will allow them to resume sexual relations.
CN: Health promotion and maintenance;
CL: Synthesize
61.
4. Colostrum is a thin, watery, yellow fl uid composed of protein, sugar, fat, water, minerals, vitamins, and maternal antibodies (e.g., immuno- globulin A). It is important for the neonate to receive colostrum for passive immunity. Colostrum is lower in fat and lactose than mature breast milk. Colos- trum does not contain vitamin K. The neonate will produce vitamin K once a feeding pattern is estab- lished. Colostrum may speed, rather than delay, the passage of meconium.CN: Health promotion and maintenance;
CL: Apply
62.
3. Various medications can be excreted in the breast milk and affect the nursing neonate. The client should avoid all nonprescribed medications (such as acetaminophen) unless approved by the physician. Medications typically do not affect the quality of the mother’s breast milk. Medications usu- ally do not interfere with or diminish the mother’s motivation to breast-feed, nor do they interfere with the mother’s let-down refl ex.CN: Health promotion and maintenance;
CL: Apply
56.
2. The major reasons for afterbirth pains are breast-feeding, high parity, overdistended uterus during pregnancy, and a uterus fi lled with blood clots. Physiologically, afterbirth pains are caused by intermittent contraction and relaxation of the uterus.These contractions are stronger in multigravidas in order to maintain a contracted uterus. The release of oxytocin when breast-feeding also stimulates uterine contractions. There is no data to suggest any of these clients has had an overdistended uterus or currently has clots within the uterus. The G 3, P 3 client who is breast-feeding has the highest parity of the clients listed, which—in addition to breast-feeding—places her most at risk for afterbirth pains. The G 2, P 2 postcesarean client may have cramping but it should be less than the G 3, P 3 client. The G 3, P 3 client who is bottle-feeding would be at risk for afterbirth pains because she has delivered several children, but her choice to bottle-feed reduces her risk of pain.
CN: Physiological adaptation;
CL: Evaluate
57.
2. The client is exhibiting signs and symptoms of a breast infection (mastitis). The nurse should instruct her to contact her health care provider, who will likely order a prescription for antibiotics. She should continue to breast-feed the infant from both breasts. Frequent breast-feeding is encouraged rather than discontinuing the process for anyone having a breast infection. Applying warm compresses may relieve pain. However, the underlying infection indicated by the elevated temperature indicates that additional treatment with antibiotics will be needed.CN: Management of care; CL: Synthesize
58.
4. Breast-feeding consumes maternal calories and requires energy which increases the maternal basal metabolic rate and assists in lowering the mater- nal blood glucose level. Insulin is not transferred to the infant through breast milk. Breast-feeding is recommended for diabetic mothers because it does lower blood glucose levels. The number of antibodies in breast milk is not altered by maternal diabetes.CN: Physiological adaptation;
CL: Evaluate
59.
4. Postpartum clients who are breast-feeding need to be cautioned about taking various medica- tions, many of which can be passed to the infant via breast milk. Aspirin and codeine products should be avoided because the drug can increase bleeding or cause sleepiness in the infant. Medi- cations such as ibuprofen or acetaminophen can be used to help to relieve the discomfort without causing any apparent harm to the neonate. Warm sitz baths three to four times a day for 20 minutes can be helpful in relieving the client’s discomfort.Application of moist heat is soothing and increases
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the recommended nonpregnancy intake to produce quality breast milk. Breast-feeding women need adequate calcium for blood clotting and strong bones and teeth.
CN: Basic care and comfort; CL: Evaluate
67.
2, 3, 4, 5, 6. To maintain adequate milk supply, lactating women need to increase their calories by 500. They also need to increase protein (to 7 serv- ings daily), fl uid (4 to 5 glasses of milk plus 2 addi- tional glasses), fat (from sparing use prepregnancy to 5 daily servings), and calcium intake (1,000 to 1,200 mg daily).CN: Health promotion and maintenance;
CL: Evaluate
68.
1. Breast milk has a higher fat content than cow’s milk. Thirty percent to fi fty fi ve percent of the calories in breast milk are from fat. Breast milk contains less iron than cow’s milk does. However, the iron absorption from breast milk is greater in the neonate than with cow’s milk. Breast milk contains less sodium and calcium than cow’s milk.CN: Basic care and comfort; CL: Apply
69.
4. Lightly brushing the neonate’s lips with the nipple causes the neonate to open the mouth and begin sucking. The neonate should be taught to open the mouth and grasp the nipple on his or her own. The neonate should not be forced to nurse.CN: Health promotion and maintenance;
CL: Apply
70.
2. Several methods can be used to prevent nipple soreness. Placing as much of the areola as possible into the neonate’s mouth is one method.This action prevents compression of the nipple between the neonate’s gums, which can cause nipple soreness. Other methods include changing position with each feeding, avoiding breast engorge- ment, nursing more frequently, and feeding on demand. Plastic liners are not helpful because they prevent air circulation, thus promoting nipple sore- ness. Instead, air drying is recommended. Pulling the baby’s mouth out smoothly after only 10 min- utes may prevent the baby from getting the entire feeding and increases nipple soreness. Any breast milk remaining on the nipples should not be wiped off, because the milk has healing properties.
CN: Health promotion and maintenance;
CL: Synthesize
71.
4. Breast-fed neonates do not swallow as much air as bottle-fed neonates, but they still need to be burped. Good times to burp the neonate are when the mother switches from one breast to the other and at the end of the breast-feeding ses- sion. Neonates do not eat more if they are burped63.
3. Taking ibuprofen 200 mg orally immedi- ately after breast-feeding helps minimize the neo- nate’s exposure to the drug because drugs are most highly concentrated in the body soon after they are taken. Most mothers breast-feed on demand or every 2 to 3 hours, so the effects of the ibuprofen should be decreased by the next breast-feeding ses- sion. Taking the medication before going to bed is inappropriate because, although the mother may go to bed at a certain time, the neonate may wish to breast-feed soon after the mother goes to bed. If the mother takes the medication midway between feedings, then its peak action may occur midway between feedings. Breast milk is suffi cient for the neonate’s nutritional needs. Most breast-feeding mothers should not be encouraged to provide supplemental feedings to the infant because this may result in nipple confusion.CN: Pharmacological and parenteral therapies; CL: Apply
64.
3. During the fi rst few days postpartum, the mother should be encouraged to nurse frequently.Breast-feeding for at least 10 minutes per side is rec- ommended for the let-down refl ex to begin. Feeding the infant whenever the infant cries is not appropri- ate and can lead to maternal exhaustion. Feeding for 1 to 2 minutes per side is insuffi cient for the let- down refl ex. Also, this short period of time prevents the neonate from latching on and obtaining the needed nutrition. Initially, feeding for 10 minutes per side is suffi cient until the infant becomes more comfortable with breast-feeding. Then the mother can increase the breast-feeding time gradually to 20 to 30 minutes.
CN: Health promotion and maintenance;
CL: Apply
65.
4. Breast-feeding stimulates oxytocin secre- tion, which causes the uterine muscles to contract.These contractions account for the discomfort associated with afterpains. Flatulence may occur after a cesarean delivery. However, the mother typically would complain of abdominal distention and a bloating feeling, not a “cramplike” feeling.
Stretching of the tissues or healing may cause slight t enderness or itching, not cramping feelings of discomfort. Medications such as mild analgesics or stool softeners, commonly administered postpartum, typically do not cause cramping.
CN: Health promotion and maintenance;
CL: Apply
66.
2. For the breast-feeding client, drinking at least 8 to 10 glasses of fl uid a day is recommended.Breast-feeding women need an increased intake of vitamin D for calcium absorption. A breast-feeding woman requires an extra 500 calories per day above
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75.
1. The nurse should instruct the client that the baby is getting enough to eat when there are six to eight wet diapers by the fi fth day of age. Other signs include good suckling sounds during feeding, dripping breast milk at the mouth, and quiet rest or sleep after the feeding. By the fourth day of age, the infant should have soft yellow stools, not transitional (greenish) stools. Falling asleep easily after feeding on the fi rst day is not a good indicator because most infants are sleepy during the fi rst 24 hours. Most infants regain their lost birth weight in 7 to 10 days after birth. An infant who has gained weight during the fi rst well-baby checkup (usually at 2 weeks) is getting suffi cient breast milk at feedings.CN: Health promotion and maintenance;
CL: Apply
76.
4. The client should wean the infant gradu- ally, eliminating one feeding at a time. The baby can be weaned to a bottle (formula) anytime the mother desires; she does not have to breast-feed for 4 months. Most infants (and mothers) develop a “favorite feeding time,” so this feeding session should be eliminated last. The client may wish to begin weaning with daytime feedings when the infant is busy.CN: Health promotion and maintenance;
CL: Create
77.
4. Neonates normally increase breast-feeding during periods of rapid growth (growth spurts).These can be expected at age 10 to 14 days, 5 to 6 weeks, 2.5 to 3 months, and 4.5 to 6 months. Each growth spurt is usually followed by a regular feeding pattern. Lack of adequate intake to meet maternal nutritional needs is not associated with the neonate’s desire for more frequent breast-feeding sessions.
However, an intake of adequate calories is necessary to produce quality breast milk. The mother’s fears about weight gain and preventing the neonate from sucking long enough are not associated with the desire for more frequent breast-feeding sessions.
CN: Health promotion and maintenance;
CL: Analyze
78.
2. Even if the nipples are sore and cracked, the mother should position the baby with the entire areola in the baby’s mouth so that the nipple is not compressed between the baby’s gums during feeding.The best method is to prevent cracked nipples before they occur. This can be done by feeding frequently and using proper positioning. Warm, moist tea bags can soothe cracked nipples because of tannic acid in the tea. Creams on the nipples should be avoided;
wiping off any lanolin creams from the nipple before each feeding can cause further soreness. Feeding the baby less often for the next few days will cause engorgement (and possible neonatal weight loss), frequently. Breast-feeding mothers are advised not
to supplement the feedings with formula because this may cause nipple confusion and decrease milk production. If supplements are given, the baby still needs to be burped. Neonates who are fed every 3 hours still need to be burped.
CN: Health promotion and maintenance;
CL: Evaluate
72.
3. Stored breast milk can be safely kept in the refrigerator for up to 7 days or in a deep-freeze at 0° F (–18° C) for 12 months. Breast milk should be stored in glass containers because immunoglobu- lin tends to stick to plastic bottles. Breast milk can remain without refrigeration or loss of nutrients for up to 10 hours. The containers should be labeled with date, time, and amount to prevent inadvertent administration of spoiled milk. Frozen breast milk should be thawed in the refrigerator for a few hours, placed under warm tap water, then shaken.CN: Health promotion and maintenance;
CL: Evaluate
73.
4. Oxytocin stimulates the let-down refl ex when milk is carried to the nipples. A lactating mother can experience the let-down refl ex suddenly when she hears her baby cry or when she antici- pates a feeding. Some mothers have reported feeling the let-down refl ex just by thinking about the baby.Adrenalin may increase if the mother is excited, but this hormone has no direct infl uence on breast- feeding. Estrogen infl uences development of female secondary sex characteristics and controls menstrua- tion. Prolactin stimulates milk production.
CN: Health promotion and maintenance;
CL: Apply
74.
3. Expressing a little milk before nursing, massaging the breasts gently, or taking a warm shower before feeding also may help to improve milk fl ow. Although various measures such as ice, heat, and massage may be tried to relieve breast engorgement, prevention of breast engorgement by frequent feedings is the method of choice. Applying ice to the nipples does not relieve breast engorge- ment. However, it may temporarily relieve the discomfort associated with breast engorgement.Using lanolin on the nipples does not relieve breast engorgement and is unnecessary. Use of lanolin may cause sensitivity and irritation. Having fre- quent breast-feeding sessions, rather than offer- ing the neonate a small amount of formula, is the method of choice for preventing and relieving breast engorgement. In addition, offering the neonate small amounts of formula may result in nipple confusion.
CN: Health promotion and maintenance;
CL: Apply
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