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
The first action the nurse should take is to assess the respiratory status of the infant.
After a head injury, it is important to ensure that the child’s airway is clear and that they are breathing adequately.
This is a crucial step in providing care for a patient with a head injury.
Choice B is wrong because inspecting for fluid leaking from the ears is not the first priority.
Choice C is wrong because examining the scalp for lacerations is not the first priority.
Choice D is wrong because checking pupil reactions is not the first priority.
Correct Answer is B
Explanation
Deep-breathing and counting exercises can help the child relax and cope with anxiety before the procedure.
Choice A is wrong because a 30-minute teaching session may not be necessary or appropriate for a school-age child.
Choice C is wrong because it’s important to use clear and honest language when explaining the procedure to the child.
Choice D is wrong because it’s important to explain the procedure to the child in a calm and quiet environment, not in the playroom.
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