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

Answer and Explanation

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.

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Correct Answer is B

Explanation

A. Once I am fitted for the diaphragm it will always be the correct size. Incorrect because weight changes, pregnancy, or pelvic surgery may require refitting.
B. I need to leave the diaphragm in for six hours after the last act of intercourse. This is correct to ensure that all sperm are inactivated.
C. This contraceptive can be used during menstruation. Incorrect because it's generally not recommended to use the diaphragm during menstruation due to increased risk of infection.
D. I can leave the diaphragm in for a day or two. Incorrect because leaving it in for more than 24 hours can increase the risk of infection, including toxic shock syndrome.

A. Establish IV access B. Assess the client's vital signs C. Obtain fetal heart rate D. Perform a sterile vaginal exam

Correct Answer is C

Explanation

A. Establish IV access: Although important for hydration and medication administration, it is not the immediate priority when assessing the fetal condition.
B. Assess the client's vital signs: While important, the immediate assessment of fetal well-being takes precedence to ensure there is no fetal distress.
C. Obtain fetal heart rate: This is crucial to assess the fetus’s condition immediately. Monitoring the fetal heart rate can identify any signs of distress and determine if urgent interventions are necessary.
D. Perform a sterile vaginal exam: This should follow the fetal heart rate assessment to check for labor progress and any complications, but it is not the first priority.

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Which three (3) assessment findings indicate that the breastfeeding client has achieved a proper latch?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After educating a client on use of a diaphragm for contraception, which statement made by the client demonstrates an understanding of the teaching provided?

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