A nurse is reinforcing teaching about formula feeding with the guardian of a term newborn who was born 2 hr ago.
Which of the following instructions should the nurse include?
You should offer a bottle of formula every 3 to 3 1/2 hours.
You should wake the baby for night feedings for the first few months.
You should add filtered water to dilute ready-to-feed formula.
You can keep prepared bottles in the refrigerator for 72 hours.
The Correct Answer is A
Choice A rationale
The American Academy of Pediatrics recommends that term newborns should be fed on demand or at least every 3 to 4 hours, which provides sufficient caloric intake for growth and prevents hypoglycemia. Formula is digested more slowly than breast milk, so offering a bottle every 3 to 3 1/2 hours is generally appropriate to meet the infant's nutritional needs and satisfy hunger cues. Regular feeding supports adequate weight gain, which is a critical developmental milestone in the neonatal period.
Choice B rationale
For the first few weeks, the nurse should instruct the guardian to wake a sleepy newborn if more than 4 hours have passed since the last feeding to prevent excessive weight loss and hypoglycemia, as their small glycogen stores are rapidly depleted. However, after the initial period and once the infant is feeding well and gaining weight appropriately (usually about 2 weeks old), night waking is typically not necessary.
Choice C rationale
Diluting ready-to-feed formula by adding filtered water is contraindicated because it reduces the caloric and nutrient density below required levels for the newborn's growth. The proper ratio of formula powder or concentrate to water is crucial for providing essential electrolytes, protein, and carbohydrates. Dilution can lead to water intoxication or hyponatremia and cause serious neurological complications due to electrolyte imbalance.
Choice D rationale
Prepared infant formula should be used or discarded within 24 hours if stored in the refrigerator, not 72 hours. Bacteria can rapidly proliferate in prepared formula, even under refrigeration, increasing the risk of gastrointestinal infection for the newborn. Formula ready-to-feed containers, once opened, should also be used within 24 to 48 hours or discarded to maintain optimal safety.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Vesicles on the skin, lips, and around the eyes are characteristic findings for a herpes simplex virus (HSV) infection, which is a significant and potentially life-threatening viral infection in a newborn. Candida albicans, a fungus, typically causes superficial mucocutaneous infections and is not associated with vesicular skin lesions unless disseminated, which is rare.
Choice B rationale
A temperature of 37.5°C (99.5°F) is within the normal thermal range for a newborn; normal rectal temperature is 36.5°C to 37.5°C (97.7°F to 99.5°F). While an infection could cause fever, this specific temperature is not necessarily indicative of a Candida infection and is an expected normal finding.
Choice C rationale
Edematous red conjunctivae are classic signs of conjunctivitis (ophthalmia neonatorum), often caused by bacterial pathogens like Chlamydia trachomatis or Neisseria gonorrhoeae, acquired during passage through the birth canal. Candida albicans rarely causes ocular infection unless in immunocompromised infants.
Choice D rationale
White patches on the tongue that cannot be removed with gentle scraping are the pathognomonic sign of oral candidiasis (thrush). This is caused by an overgrowth of the yeast Candida albicans, forming a superficial pseudomembrane composed of yeast, debris, and inflammatory cells on the buccal mucosa and tongue.
Correct Answer is D
Explanation
Choice A rationale
Normal vaginal fluid is acidic due to the presence of Lactobacillus species, which convert glycogen to lactic acid, maintaining a pH typically between 4.5 and 6.0. Amniotic fluid is alkaline, with a pH usually ranging from 7.0 to 7.5. Therefore, a pH of 5.3 indicates acidic vaginal secretions, suggesting the fluid is likely not amniotic fluid and ruling out premature rupture of membranes (PROM).
Choice B rationale
Nitrazine paper is used to test the pH of vaginal fluid. It is impregnated with a pH-sensitive dye. When the paper comes into contact with acidic fluid (normal vaginal secretions, pH < 6.0), it will remain yellow or turn a yellow-green color. This result indicates an acidic environment, which is inconsistent with the alkaline nature of amniotic fluid (pH≥ 6.5), making PROM unlikely.
Choice C rationale
Ferning refers to the characteristic microscopic crystallization pattern that dried amniotic fluid forms due to its salt and protein content. A negative ferning test means the characteristic pattern is absent. This negative result suggests the fluid is not amniotic fluid, thereby providing evidence against the diagnosis of premature rupture of membranes (PROM).
Choice D rationale
Nitrazine paper turning a dark blue color (or royal blue, deep blue-green, or deep blue) indicates an alkaline pH of 6.5 or greater. Amniotic fluid is alkaline, typically with a pH of 7.0 to 7.5. Therefore, this color change strongly suggests the presence of amniotic fluid, which is the defining diagnostic finding for premature rupture of membranes (PROM).
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