A breastfeeding mother who is 2 weeks postpartum is informed by her pediatrician that her 4-year-old has chickenpox (varicella). The mother calls the nursery nurse because she is concerned about having the baby in contact with the sick sibling. The mother had chickenpox as a child. Which of the following responses by the nurse is appropriate?

Correct Answer: A

Rationale: The correct answer is A) The baby received passive immunity through the placenta. This is the appropriate response by the nurse because infants born to mothers who had chickenpox in the past have passive immunity through the transfer of maternal antibodies across the placenta. This immunity provides protection to the newborn for a few months post-birth. Breast milk also contains antibodies that can further protect the baby. Option B is incorrect because while breast milk does provide some protection, the primary source of immunity in this case is through the placenta. Option C is wrong as separating the baby from the family is not necessary if the newborn has passive immunity. Option D is incorrect as handwashing does not prevent the spread of chickenpox, as it is primarily transmitted through respiratory droplets. In an educational context, understanding the concept of passive immunity through placental transfer is crucial for healthcare providers working with postpartum mothers and newborns. It highlights the importance of prenatal care and maternal immunity in protecting infants against certain infections. This knowledge can inform decisions regarding newborn care and potential exposure to infectious diseases within the family.

Correct Answer: D

Rationale: In this scenario, option D is the correct answer because the baby being latched only to the nipple and not to a significant portion of the areola can cause pain during breastfeeding. When a baby latches onto just the nipple, it can lead to improper positioning and shallow latch, resulting in increased friction and pressure on the nipple, causing pain and potential damage. Option A is incorrect because a frenulum attached to the tip of the tongue does not directly cause pain during breastfeeding. Option B is incorrect as the baby forming a trough around the breast is a natural breastfeeding behavior and not a cause of pain. Option C is also incorrect as frequent and long feedings are expected in the early postpartum period to establish milk supply and support the baby's nutritional needs. Educationally, it is important for caregivers and healthcare professionals to understand the significance of proper latch and positioning during breastfeeding to prevent pain and ensure successful breastfeeding outcomes. Teaching mothers about correct latch techniques, positioning, and signs of a good latch can help prevent issues such as pain and nipple damage, ultimately supporting a positive breastfeeding experience for both the mother and baby.

Correct Answer: B

Rationale: In this scenario, the correct action for the nurse to take is option B, which is to call the doctor and question the order. This is the best course of action because it is crucial to ensure the safety and well-being of both the mother and the baby, especially considering the impact of medications on breastfeeding. Calling the doctor allows the nurse to seek clarification on the physician's rationale for requesting bottle feeding during the mother's medication course. It also presents an opportunity to discuss alternative antibiotics that are safe for breastfeeding mothers, as well as strategies to continue breastfeeding while on medication if possible. Option A is incorrect because blindly following the order without questioning could potentially compromise the health of the baby and disrupt the breastfeeding relationship. Option C is not advisable as it disregards the physician's instruction regarding bottle feeding, which may have important implications related to the medication's effects on the infant. Option D, while seeking information from a reference source is valuable, the immediate concern of ensuring the safety of the mother and baby warrants direct communication with the prescribing physician. In an educational context, this scenario highlights the importance of advocating for the patient's well-being, effective communication among healthcare team members, and the need to critically evaluate orders that may have significant implications for vulnerable populations like breastfeeding mothers and their infants. It underscores the significance of evidence-based practice and interprofessional collaboration in delivering safe and patient-centered care.

Correct Answer: C

Rationale: The correct answer is C: The mother can consume a variety of good calcium sources like broccoli and fish with bones as well as dairy products. Educational Rationale: Breast milk production is not solely dependent on the mother's consumption of milk. While dairy products are good sources of calcium, it is essential for the nurse to educate the mother that a variety of calcium sources can support adequate breast milk production. By emphasizing the inclusion of foods like broccoli and fish with bones, the nurse promotes a well-rounded diet that meets the mother's nutritional needs. Why the other options are incorrect: A) Option A is incorrect because there is no specific requirement for a mother to drink a set number of glasses of milk per day to produce quality breast milk. B) Option B is also incorrect as it limits the mother's dietary choices by focusing primarily on milk consumption rather than a diverse range of calcium-rich foods. D) Option D is misleading as it shifts the focus to protein intake, which although important, is not directly related to the mother's ability to produce high-quality breast milk. Educational Context: In a postpartum setting, it is crucial for healthcare providers to offer evidence-based information to support new mothers in making informed decisions regarding breastfeeding. By providing accurate information on nutrition and breastfeeding, nurses can empower mothers to make choices that support both their own health and the health of their baby. Encouraging a balanced diet rich in various nutrients, including calcium from a variety of sources, can contribute to successful breastfeeding outcomes.