# Situation: A nurse at a lying-in clinic prepares mothers and their healthy term newborns for discharge and follows them up by telephone and home visits during the first weeks after birth. The mother of a 3-week-old girl who receives only breast milk says, "It is very hot these days, so I want to give her something to drink between feeds." The baby has 7 wet diapers a day with pale yellow urine and is active. Which response by the nurse is BEST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629630  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse at a lying-in clinic prepares mothers and their healthy term newborns for discharge and follows them up by telephone and home visits during the first weeks after birth.

The mother of a 3-week-old girl who receives only breast milk says, "It is very hot these days, so I want to give her something to drink between feeds." The baby has 7 wet diapers a day with pale yellow urine and is active. Which response by the nurse is BEST?

## 보기

1. "Give her a little boiled water, but only after she finishes each feed."
2. "On the hottest days, give oral rehydration solution instead of water."
3. "Express some of your milk and give it to her by cup between her feeds."
4. "Her wet diapers show she has enough fluid; nurse her when she wants." **✔ 정답**

**정답: 4**

## 해설

Exclusive breastfeeding for the first 6 months means no water, formula, or other drinks, and breast milk meets fluid needs even in hot weather. Her 7 wet diapers with pale urine show that she is well hydrated, so the best response uses these findings to reassure the mother and supports feeding on demand. Expressed milk by cup is safe but unnecessary for a baby who breastfeeds well, and it adds work and a risk of contamination.

## 심화 해설

Core concept: exclusive breastfeeding and hydration assessment

The question tests whether you can apply the exclusive breastfeeding recommendation for the first 6 months and use objective hydration findings to guide parent education. For a healthy term infant receiving only breast milk, no supplemental water, oral rehydration solution, or other liquids are needed, even when the environmental temperature rises [1].

Breast milk alone provides sufficient free water to maintain hydration in hot weather because its composition adjusts to the infant’s needs and feeding frequency increases with demand. The infant’s 7 wet diapers per day with pale yellow urine are strong clinical indicators of adequate fluid intake and normal renal concentrating ability. This objective evidence should anchor the nurse’s response.

| Response option | Clinical reasoning | Appropriateness |
| --- | --- | --- |
| 1. Boiled water after feeds | Introduces unnecessary fluid that can displace breast milk, reduce suckling stimulation, and lower milk supply; also carries contamination risk if preparation is imperfect | Incorrect |
| 2. Oral rehydration solution on hot days | ORS is for managing dehydration or diarrheal losses, not for routine supplementation in a well-hydrated breastfed infant | Incorrect |
| 3. Expressed breast milk by cup between feeds | Safe in principle, but unnecessary when the infant breastfeeds effectively; adds maternal workload and introduces a potential route for microbial contamination | Incorrect |
| 4. Reassure using wet diaper evidence and support cue-based feeding | Aligns with exclusive breastfeeding guidance and uses the infant’s own output to confirm hydration; promotes demand feeding that protects milk supply | Correct |

Key point! Hydration in a breastfed infant is assessed primarily through urine output, not through thirst or ambient temperature. Frequent, effective milk removal from the breast is the physiologic driver of a robust milk supply, so any unnecessary supplementation threatens lactogenesis. The guideline emphasizes that nurses in primary care must understand lactation physiology and support effective milk removal during early well-child encounters [1].

Watch out! A common distractor is offering expressed milk by cup because it seems “safe.” However, for an infant who is already breastfeeding well and showing normal urine output, adding cup feeds between breastfeeds can reduce direct suckling time and undermine the very mechanism that maintains milk production [1]. The best nursing action is not to add a task, but to reassure the mother using the infant’s own clinical signs and to encourage feeding whenever the infant shows hunger cues.References (research sources)

- [1]Guidelines for Primary Pediatric Care Professionals to Help Patients Establish and Protect Milk Supply.GuidelineSlater CN, Spatz DL. (2025) · DOI: 10.1097/nmc.0000000000001107

## 임상 시나리오

Exclusive Breastfeeding and Hydration AssessmentReassuring parents using objective wet diaper evidence
For the first 6 months, exclusive breastfeeding means no water, formula, or other liquids, even in hot weather. Breast milk composition adjusts to meet the infant's fluid needs, and increased feeding frequency compensates for heat.

A healthy term infant with 7 wet diapers per day and pale yellow urine is well hydrated. These objective findings should be used to reassure the mother and support feeding on demand.

CautionSupplemental water or oral rehydration solution can displace breast milk, reduce suckling stimulation, and lower milk supply. Expressed milk by cup is unnecessary when breastfeeding is effective and adds contamination risk.

## 핵심 개념

- **Exclusive breastfeeding** — Feeding an infant only breast milk for the first 6 months, with no water, formula, or other liquids, even in hot weather.
- **Hydration indicators** — Clinical signs of adequate fluid intake in infants, including 6-8 wet diapers per day with pale yellow urine.
- **Feeding on demand** — Breastfeeding whenever the infant shows hunger cues, which supports adequate milk production and hydration.
- **Oral rehydration solution** — A fluid containing electrolytes and glucose used to treat dehydration from diarrhea or other fluid losses, not for routine supplementation.

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