Which of the following statements should a nurse make when providing discharge teaching to a new parent about breastfeeding her infant?
Supplement breastfeedings with water every 12 hours.
Offer your infant the breast when he shows signs of hunger.
Limit the time your infant feeds to 10 minutes on each breast.
Begin each feeding using the same breast.
None
None
The Correct Answer is B
Choice A reason: Supplementing breastfeedings with water every 12 hours is not advised for newborns, as breast milk provides complete hydration and nutrition. Water can reduce milk intake, decreasing supply due to reduced demand. It risks electrolyte imbalances, like hyponatremia, in infants with immature kidneys. Exclusive breastfeeding for six months supports optimal growth, immune function, and maternal-infant bonding, making this recommendation inappropriate.
Choice B reason: Offering the breast at hunger cues, such as rooting or hand-sucking, supports demand-driven breastfeeding, which stimulates prolactin and oxytocin for milk production. This ensures adequate supply, promotes healthy weight gain, and aligns with the infant’s natural feeding rhythm. It prevents over- or under-feeding, fostering neonatal development and strengthening the maternal-infant bond, making this the correct advice.
Choice C reason: Limiting feeding to 10 minutes per breast can prevent adequate hindmilk transfer, which is high in fat and calories, essential for growth. Short sessions may reduce milk supply due to insufficient stimulation. Infants need variable feeding times to meet nutritional needs. This restriction risks poor weight gain and inadequate nutrition, indicating it’s not a suitable recommendation.
Choice D reason: Starting each feeding with the same breast can cause imbalanced milk production, as one breast may be understimulated, reducing overall supply. Alternating breasts ensures both are drained, supporting balanced lactation and preventing engorgement or mastitis. This practice maintains milk supply via prolactin release, making this advice incorrect for optimal breastfeeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Referring to a mental health clinic addresses potential emotional distress but not the adolescent’s primary concern of affordability. Pregnancy increases psychological stress, but financial barriers to prenatal care are critical. This action fails to ensure access to medical resources, essential for maternal and fetal health in adolescent pregnancy.
Choice B reason: Contacting the adolescent’s parent risks breaching confidentiality, depending on legal guidelines, and does not address financial concerns directly. Family dynamics may complicate support, and without consent, this action could increase stress, failing to provide immediate healthcare access critical for a healthy pregnancy outcome.
Choice C reason: Assisting with Medicaid application directly addresses financial concerns, ensuring access to prenatal care, delivery, and postpartum support. Medicaid reduces risks like preterm birth by covering medical and nutritional needs, critical for adolescent mothers with limited resources, aligning with public health goals for maternal-fetal well-being.
Choice D reason: Advising adoption is premature and overlooks the adolescent’s autonomy. Adoption requires extensive counseling, not immediate recommendation. It fails to address healthcare access, critical for a healthy pregnancy. This approach dismisses financial solutions, potentially increasing stress and undermining informed decision-making in pregnancy.
Correct Answer is ["A","D"]
Explanation
Choice A reason: Explaining the implications of a Do Not Resuscitate (DNR) status ensures the client understands that no CPR or intubation will occur if their condition deteriorates. This supports informed consent and autonomy, clarifying the scope of DNR to prevent misunderstandings. It respects the client’s decision-making capacity, ensuring their wishes align with end-of-life care preferences.
Choice B reason: Placing a “Do Not Resuscitate” sign outside the room breaches confidentiality under HIPAA, risking unauthorized disclosure of sensitive information. DNR status is communicated via medical records or wristbands. This action is inappropriate, as it does not contribute to implementing the client’s wishes and violates privacy standards, making it an incorrect response.
Choice C reason: Obtaining family consent is unnecessary for a competent client’s DNR request, as autonomy rests with the client. If decisionally capable, their wishes override family input. The nurse’s role is to support the client’s decision, not seek family approval, unless the client is incapacitated, which is not indicated, making this action inappropriate.
Choice D reason: Documenting the DNR request in the medical record ensures the care team follows the client’s wishes, preventing unwanted interventions. Accurate documentation communicates code status, supports legal and ethical standards, and ensures continuity of care. This is critical for aligning treatment with the client’s end-of-life preferences, making it a necessary action.
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