A 4-month-old infant has gastroesophageal reflux (GER) with bouts of crying and distress but is thriving without other complications. Which should the nurse suggest to minimize reflux?

Place in Trendelenburg position after eating

Thicken formula with rice cereal

Give continuous nasogastric tube feedings

Give larger, less frequent feedings

Answer and Explanation

The Correct Answer is B

Choice A reason: Placing the infant in Trendelenburg position (head lower than feet) after eating is not a good suggestion to minimize reflux. This position may increase the abdominal pressure and the risk of aspiration. The infant should be placed in an upright or semi-upright position (30 to 45 degrees) for at least 30 minutes after feeding to reduce reflux and prevent regurgitation¹.

Choice B reason: Thickening the formula with rice cereal is a common and effective suggestion to minimize reflux. The rice cereal increases the viscosity and weight of the formula, making it less likely to flow back into the esophagus. The amount of rice cereal added should be about 1 teaspoon per ounce of formula, unless otherwise instructed by the health care provider².

Choice C reason: Giving continuous nasogastric tube feedings is not a necessary or desirable suggestion to minimize reflux. Nasogastric tube feedings are used for infants who have severe reflux and cannot tolerate oral feedings, or who have other medical conditions that require tube feeding. Nasogastric tube feedings may have complications such as infection, irritation, displacement, or obstruction of the tube. They may also interfere with the infant's oral development and bonding with the caregiver³.

Choice D reason: Giving larger, less frequent feedings is not a helpful suggestion to minimize reflux. Larger feedings may overfill the stomach and increase the pressure on the lower esophageal sphincter, which is the muscle that prevents reflux. Less frequent feedings may also make the infant more hungry and irritable, and cause more crying and swallowing of air. The infant should be given smaller, more frequent feedings to reduce reflux and promote digestion.

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Correct Answer is A

Explanation

Choice A reason: This is the correct statement, as the knee-chest position can help reduce the cyanosis and hypoxia in infants with tetralogy of Fallot. This position increases the systemic vascular resistance and decreases the right-to-left shunting of blood, improving the pulmonary blood flow and oxygenation¹².

Choice B reason: This is not a correct statement, as the Trendelenburg position can worsen the cyanosis and hypoxia in infants with tetralogy of Fallot. This position decreases the systemic vascular resistance and increases the right-to-left shunting of blood, reducing the pulmonary blood flow and oxygenation¹².

Choice C reason: This is not a correct statement, as feeding the infant every 2 hours around the clock can cause overfeeding and fatigue in infants with tetralogy of Fallot. These infants may have poor appetite and weight gain due to their cardiac condition, and they may need frequent rest periods during feeding. Feeding the infant on demand or every 3 to 4 hours may be more appropriate¹³.

Choice D reason: This is not a correct statement, as adding rice cereal to the formula can increase the risk of aspiration and choking in infants with tetralogy of Fallot. These infants may have difficulty swallowing and coordinating their breathing, and they may need a thin and easily digestible formula. Adding rice cereal to the formula may also increase the caloric density and volume, which can cause overfeeding and fatigue¹³.

A. Applying oil to the scalp for the next ten days. B. Throwing away all stuffed animals. C. Thorough cleaning of brushes, hats, and linens and staying home until there are no more nits. D. Applying a pediculicide and thoroughly combing the nits out of the hair.

Correct Answer is D

Explanation

Choice A reason: This is not a correct recommendation, as oil may not be effective in killing lice or nits. Oil may also make the hair greasy and difficult to comb.

Choice B reason: This is not a necessary recommendation, as throwing away all stuffed animals may be wasteful and upsetting for the child. Stuffed animals can be treated by sealing them in plastic bags for two weeks or by putting them in a dryer on high heat for 20 minutes¹.

Choice C reason: This is a good recommendation, as thorough cleaning of brushes, hats, and linens can help prevent the spread of lice to other people or items. However, staying home until there are no more nits is not required, as nits are not contagious and do not pose a health risk².

Choice D reason: This is the best recommendation, as applying a pediculicide and thoroughly combing the nits out of the hair can effectively treat lice infestation. Pediculicides are medicated shampoos or lotions that kill lice and some nits. Combing the nits out of the hair can remove any remaining eggs and prevent reinfestation¹².

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A 4-month-old infant has gastroesophageal reflux (GER) with bouts of crying and distress but is thriving without other complications. Which should the nurse suggest to minimize reflux?

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Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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