A nurse is caring for an infant who has heart failure and is formula-fed. Which of the following nursing interventions is appropriate to meet the infant's nutritional needs?
Feed the infant at the first sign of hunger.
Use a firm nipple on the bottle when feeding.
Dilute the formula with water to half strength.
Thicken the formula with 1 tsp of rice cereal per ounce.
The Correct Answer is A
A. Infants with HF tire easily; feeding them early, before they are overly fatigued and crying, conserves energy and helps them take in more nutrition. Smaller, more frequent feedings are often recommended.
B. A firm nipple may require more effort to suck, which can be tiring for an infant with heart failure. A softer nipple may be more appropriate.
C. Diluting the formula with water can lead to inadequate caloric intake and nutritional deficiencies. Formula should be prepared according to instructions to ensure proper nutrition.
D. Thickened feeds are sometimes used for reflux, not HF. Adding cereal increases caloric intake but also makes sucking/swallowing more difficult, increasing energy expenditure.
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Related Questions
Correct Answer is C
Explanation
A. Cleansing the surgical site is not typically recommended as it can interfere with healing and cause trauma to the area. The surgical site should be kept clean and dry according to the surgeon's instructions.
B. Placing the infant in a supine position is not recommended as it can increase the risk of aspiration and disrupt the surgical site. Positioning should be done to protect the surgical repair.
C. Applying elbow immobilizers to both arms prevents the infant from touching or putting their hands in their mouth, which helps to protect the surgical site from injury and allows it to heal properly.
D. Offering a pacifier with glucose syrup is not appropriate as sucking on a pacifier can disrupt the surgical site and glucose syrup is not necessary in this situation.
Correct Answer is B
Explanation
A. An oatmeal bath can soothe the skin but is not the immediate first step.
B. Flushing the area with cold, running water helps remove the plant oils that cause the reaction and is the first step in managing poison ivy exposure.
C. Administering an oral corticosteroid may be necessary for severe reactions but is not the first action to take.
D. Calamine lotion can help with itching but should be applied after washing off the plant oils.
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