A nurse is assisting with the care of a 2-month-old infant who has a subdural hematoma. Which of the following findings should the nurse expect?
Depressed fontanels
Decreased temperature
Difficult to arouse
Weak cry
The Correct Answer is C
Choice A reason:
A subdural hematoma may not directly affect the fontanels. Depressed fontanels can be a sign of dehydration or other underlying conditions, but they are not specifically associated with a subdural hematoma.
Choice B reason:
A subdural hematoma would not typically cause a decrease in body temperature. This finding may be related to other factors, but it is not a characteristic sign of a subdural hematoma.
Choice C reason:
Correct. A subdural hematoma is a collection of blood between the dura mater and the brain. This can lead to increased intracranial pressure and result in the infant being difficult to arouse.
Choice D reason:
While a weak cry can be an indication of distress or illness in an infant, it is not a specific sign of a subdural hematoma. Other assessments, including neurological signs, are crucial in evaluating the infant's condition.
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Related Questions
Correct Answer is C
Explanation
Choice A reason:
Giving the infant a bottle immediately before bedtime can actually exacerbate gastroesophageal reflux, as lying down right after feeding can increase the likelihood of regurgitation.
Choice B reason:
Switching to a soy-based formula is not the first-line intervention for gastroesophageal reflux. Additionally, soy-based formulas are not recommended for all infants and should be used under specific circumstances.
Choice C reason:
This statement is correct. Keeping the infant at a 30° angle for 1 hour following each feeding can help reduce the likelihood of gastroesophageal reflux. This position helps gravity keep the stomach contents from flowing back up into the esophagus.
Choice D reason:
Limiting formula feedings to every 6 hours may not be appropriate for a 2-month-old infant, as they typically require more frequent feedings for proper growth and development.
Correct Answer is B
Explanation
Choice A reason:
Pneumonia is typically transmitted through respiratory droplets, and standard precautions are sufficient for preventing its spread.
Choice B reason:
Correct. Tuberculosis (TB) is an infectious disease that requires contact precautions. This helps prevent the spread of Mycobacterium tuberculosis, the bacteria that cause TB.
Choice C reason:
Haemophilus influenzae type B disease is primarily transmitted through respiratory droplets, so standard precautions are generally sufficient.
Choice D reason:
Respiratory syncytial virus (RSV) is primarily transmitted through respiratory droplets, so standard precautions are generally sufficient. However, in some cases, droplet precautions may be recommended for infants and young children with severe RSV infections.
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