Answer to Question 1
Correct Answer: 2
Rationale 1: Soy-based formulas are more expensive than whey-based formulas, and they are only needed by infants with milk allergies. No information is provided about milk allergy symptoms. Powdered formula is the cheapest, followed by concentrated formula; ready-to-feed formula is the most expensive.
Rationale 2: Powdered and concentrated formula must be mixed according to manufacturer's guidelines. Formula that is too concentrated can lead to excess sodium intake, which creates increased thirst and overfeeding.
Rationale 3: Each bottle should contain only enough formula for one feeding, and any formula left after the feeding should be discarded to prevent bacterial growth.
Rationale 4: Once formula is mixed, it must be used within two hours or refrigerated.
Answer to Question 2
Correct Answer: 2
Rationale 1: Although this statement is true, it is somewhat vague because it does not describe the nutritional composition of breast milk. In addition, this response is emotionally laden and judgmental of the use of formula, and therefore not therapeutic.
Rationale 2: This statement best answers the question about whether breast milk or formula is best. Breast milk is the gold standard on which formula is based. Formula attempts to provide nutrition that is similar to breast milk; however, breast milk composition is different in many ways.
Rationale 3: Although exclusively breastfed infants have the same or slightly higher weight gain than their formula-fed and mixed-fed peers in the first 34 months, the patient's question is not about growth; it is about whether breast milk or formula is better.
Rationale 4: The patient's question is not about digestion of formula and breast milk; the question is about which is better. It is best to answer a patient's question directly.