Which Interventions Should the Nurse Include in Care Giver Education for Feeding an Infant with Cleft Lip and Palate

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Sample questions from Which Interventions Should the Nurse Include in Care Giver Education for Feeding an Infant with Cleft Lip and Palate

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 2-day-old newborn with an unrepaired cleft palate is being discharged from the maternity unit. The infant is alert, temperature is 36.8 C, and oxygen saturation is 99% on room air; the caregiver says feeding takes nearly an hour. Which instruction should the nurse emphasize?

   • A.Use a specialty feeding system and aim to complete each feeding within about 20 to 30 minutes.
   • B.Continue feeding until the infant finishes the bottle, even if the feeding takes longer than an hour.
   • C.Use a standard nipple and enlarge its hole to increase the milk flow.
   • D.Feed the infant only when the infant is crying vigorously.

   Rationale: A specialty system can help compensate for the infant's inability to create suction, and limiting feeds to about 20 to 30 minutes helps reduce fatigue and excessive energy expenditure. Continuing for an hour increases fatigue, enlarging a nipple hole can cause uncontrolled flow, and waiting for vigorous crying can make coordinated feeding harder. The takeaway is to use the prescribed feeding equipment and monitor feeding duration and tolerance.

2. 2.A 1-week-old infant with a cleft lip and palate is seen at a pediatric clinic. Temperature is 37.0 C, heart rate is 142/min, and the caregiver reports milk coming from the infant's nose during feeds. Which teaching should the nurse provide?

   • A.Stop all oral feedings until the infant has surgery.
   • B.Expect some nasal regurgitation and use an upright position with paced feeding.
   • C.Lay the infant flat so milk does not enter the nasal passages.
   • D.Increase the nipple flow so the infant can finish before milk reaches the nose.

   Rationale: Nasal regurgitation can occur with a cleft palate, and upright positioning with pacing can improve control while the caregiver watches for distress. Stopping oral feeds is not routinely indicated, a flat position can increase aspiration risk, and faster flow can overwhelm the infant. The exam takeaway is to adapt the feeding technique while promptly reporting respiratory symptoms or poor intake.

3. 3.A 3-day-old newborn with an isolated cleft lip is breastfeeding in the hospital. The infant has a temperature of 36.9 C and oxygen saturation of 98%; the caregiver asks whether breastfeeding must stop. Which response is best?

   • A.Breastfeeding is never possible when an infant has a cleft lip.
   • B.Breastfeeding may be possible; help the infant achieve a good seal and assess milk transfer.
   • C.Switch to a bottle immediately because all infants with cleft lip aspirate at the breast.
   • D.Feed only from the breast on the side opposite the cleft and do not assess swallowing.

   Rationale: Many infants with an isolated cleft lip can breastfeed, although latch and milk transfer should be assessed and positioning support may be needed. A universal ban on breastfeeding is unjustified, aspiration is not inevitable, and choosing a side without assessing the infant does not ensure effective feeding. The takeaway is to individualize feeding support according to the cleft and the infant's observed function.

4. 4.A 5-day-old infant with a cleft palate is assessed at home by a visiting nurse. Temperature is 36.8 C, respiratory rate is 42/min, and the caregiver asks how to hold the infant during feeds. Which position is most appropriate?

   • A.Flat on the back with the bottle propped.
   • B.Upright or semi-upright with the head supported and aligned.
   • C.Head lower than the stomach to encourage milk to flow into the mouth.
   • D.Side-lying without head support so the infant can turn away from the bottle.

   Answer and rationale are in the full material.

5. 5.A 2-week-old infant with cleft palate is feeding in a pediatric clinic. The infant's temperature is 37.1 C and oxygen saturation is 97%; the caregiver reports the infant gulps and coughs with a standard bottle. Which intervention should the nurse recommend?

   • A.Use a specialty feeder selected with the cleft team and pace the flow to the infant's cues.
   • B.Squeeze a standard bottle continuously so milk reaches the infant faster.
   • C.Increase the bottle flow until the infant stops sucking.
   • D.Place the nipple deeply in the infant's mouth and keep it there despite coughing.

   Answer and rationale are in the full material.