A nurse is reinforcing discharge instructions about breastfeeding with a client.Which of the following statements should the nurse make?
You should feed your baby six times a day.
You should recognize that your baby sucking on his hands is a hunger cue.
You should feed your baby for 10 minutes on each breast.
You should wake your baby at least every 6 hours at night for feedings.
The Correct Answer is B
Choice A rationale
Feeding the baby six times a day is not sufficient. Newborns typically need to be fed 8-12 times in 24 hours to ensure they receive adequate nutrition and to establish a good milk supply.
Choice B rationale
Recognizing that the baby sucking on his hands is a hunger cue is correct. This is an early sign of hunger, and responding to these cues helps ensure the baby is fed before becoming too upset.
Choice C rationale
Feeding the baby for 10 minutes on each breast may not be adequate. The duration of feeding can vary, and it is important to allow the baby to feed until they are satisfied, which may take longer than 10 minutes.
Choice D rationale
Waking the baby at least every 6 hours at night for feedings is not recommended. Newborns should be fed more frequently, typically every 2-3 hours, including during the night, to ensure they receive enough nutrition.
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Correct Answer is A
Explanation
Choice A rationale
A positive Babinski reflex is characterized by the fanning out of the toes and the upward movement of the big toe when the sole of the foot is stroked. This reflex is normal in infants up to 2 years old and indicates an immature central nervous system. The presence of this reflex in older children or adults can indicate neurological issues.
Choice B rationale
Curling in of the toes when the sole of the foot is stroked is indicative of the plantar grasp reflex, not the Babinski reflex. The plantar grasp reflex is a different neurological response and does not indicate the same neurological development as the Babinski reflex.
Choice C rationale
No response when the sole of the foot is stroked could indicate a lack of neurological response or an issue with the sensory or motor pathways. This is not characteristic of a positive Babinski reflex and could be a sign of neurological impairment.
Choice D rationale
The big toe bending down when the sole of the foot is stroked is a normal response in older children and adults, known as the plantar reflex. This response indicates a mature central nervous system and is not characteristic of a positive Babinski reflex in infants.
Correct Answer is B
Explanation
Choice A rationale
Limiting the client’s daily fluid intake is not recommended. Adequate hydration is important for clients with mastitis to help clear the infection and maintain milk supply.
Choice B rationale
Encouraging the client to continue to breastfeed is recommended. Breastfeeding helps to empty the breasts and reduce milk stasis, which can alleviate symptoms of mastitis.
Choice C rationale
Preparing the client for an abdominal sonogram is not relevant to the management of mastitis. Mastitis is typically diagnosed based on clinical symptoms and physical examination.
Choice D rationale
Encouraging the client to wear a bra that is loose fitting is not recommended. A well-fitting, supportive bra can help to reduce discomfort and support the breasts during mastitis.