Which three (3) assessment findings indicate that the breastfeeding client has achieved a proper latch?
Rhythmic suckling
A slurping sound as the infant sucks
Tongue down with lips flanged
Dimpling of the infant's cheeks while sucking
Audible swallowing
Correct Answer : A,C,E
A. Rhythmic suckling. Indicates the infant is effectively extracting milk.
B. A slurping sound as the infant sucks. This suggests poor latch and possible ingestion of air.
C. Tongue down with lips flanged. Shows that the infant's tongue is extended over the lower gum and lips are flared outward, creating a seal.
D. Dimpling of the infant's cheeks while sucking. Indicates improper latch and poor seal around the breast.
E. Audible swallowing. Indicates milk transfer is occurring as the infant swallows.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Keep the newborn in a well-lit nursery: A well-lit nursery can overstimulate a preterm newborn. Preterm infants benefit more from a dim, quiet environment that mimics the womb.
B. Cluster the newborn's care activities: This helps minimize disruptions to the newborn’s rest periods, which is crucial for their growth and neurodevelopment. Clustering care reduces stress and promotes better sleep cycles.
C. Position the newborn to promote extension of muscles: Preterm infants generally benefit from a flexed position, which is more comforting and developmentally appropriate, rather than promoting muscle extension.
D. Use fingertips when calming the newborn: Using fingertips might be too stimulating for a preterm newborn. Instead, a gentle, whole-hand touch is often more comforting and less likely to cause overstimulation.
Correct Answer is ["6"]
Explanation
Heart rate (110/min): 2 points
Respiratory effort (slow, weak cry): 1 point
Muscle tone (some flexion of extremities): 1 point
Reflex irritability (grimace): 1 point
Color (body pink, blue extremities): 1 point
APGAR-6
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