A nurse is caring for a 3-month-old infant who has a cleft of the soft palate.
Which of the following actions should the nurse take?
Discontinue feeding if the infant's eyes become watery.
Postpone burping the infant until after completing each feeding.
Elevate the infant's head to a 10° angle during feedings.
Feed the infant 177.4 mL (6 oz) of formula three times each day.
Feed the infant 177.4 mL (6 oz) of formula three times each day.
The Correct Answer is C
The correct answer is choice C. Elevate the infant’s head to a 10° angle during feedings.
This position can help prevent milk from coming out of the infant’s nose and reduce the risk of choking.
Choice A is wrong because watery eyes are not an indication to discontinue feeding.
Choice B is wrong because babies with cleft palate should be burped more frequently, but not so often as to interrupt good feeding behaviors.
Choice D is wrong because the amount of formula an infant needs varies and should be determined by a pediatrician.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
According to the normal pediatric vital signs chart provided by Cleveland Clinic, the normal blood pressure range for a 2-year-old child should be between 90- 105/55-70 mm Hg. The blood pressure of 118/74 mm Hg is higher than the normal range for a 2- year-old child and should be reported to the provider.
Choice B is wrong because a respiratory rate of 26/min falls within the normal range of 20-30 breaths per minute for a child between ages 1 and.
Choice C is wrong because a pulse rate of 98/min falls within the normal range of 80-125 beats per minute for a child between ages 1 and.
Choice D is wrong because a temperature of 37.2° C (99° F) falls within the normal range for children which is around 98.6 degrees.
Correct Answer is B
Explanation
Chest physiotherapy treatments aim to improve ventilation and mucociliary clearance by removing tenacious and obstructing secretions in patients with cystic fibrosis.
Increased expectoration indicates that the therapy has been effective in clearing secretions.
Choice A is wrong because increased urine output is not an indication of the effectiveness of chest physiotherapy.
Choice C is wrong because reduced pain is not a specific indication of the effectiveness of chest physiotherapy.
Choice D is wrong because increased heart rate is not an indication of the effectiveness of chest physiotherapy.
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