A nurse is caring for an infant who has spina bifida.
Which of the following actions should the nurse take?
Feed the infant through an NG tube.
Place the infant in a prone position.
Cover the infant’s lesion with a dry cloth.
Perform range-of-motion (ROM) exercises to the infant’s hips.
The Correct Answer is B
Choice A rationale
Feeding an infant with spina bifida through an NG tube may not be necessary unless the child has specific feeding difficulties or other health issues. Spina bifida does not typically affect a child’s ability to eat or swallow.
Choice B rationale
Placing an infant with spina bifida in a prone position can help protect and care for the lesion on their back. It can also help prevent pressure sores and promote comfort.
Choice C rationale
Covering the infant’s lesion with a dry cloth is not typically recommended. The lesion should be kept clean and moist to promote healing and prevent infection.
Choice D rationale
While physical therapy and exercises can be beneficial for children with spina bifida, performing range-of-motion exercises to the infant’s hips may not be necessary unless specifically recommended by a healthcare provider.
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Related Questions
Correct Answer is D
Explanation
Choice A rationale
Understanding the cause of illness is a complex cognitive task that typically develops later in childhood. Preschool-aged children are still developing their understanding of cause and effect, and their thinking is often more concrete than abstract.
Choice B rationale
Describing manifestations of illness is also a complex task that requires a certain level of cognitive and language development. While preschool-aged children are developing their language skills rapidly, their ability to describe complex phenomena such as the manifestations of illness is still developing.
Choice C rationale
Awareness of body functioning is a concept that typically develops later in childhood. Preschool-aged children are still learning about their bodies and how they work. Their understanding of body functioning is often concrete and based on what they can see and feel.
Choice D rationale
Relating fears to magical thinking is a characteristic of preschool-aged children’s cognitive development. At this age, children’s thinking is often dominated by fantasy and magic. They may attribute events or experiences to magical causes, and their fears may be related to these magical beliefs.
Correct Answer is ["B","C","D","E"]
Explanation
Choice A rationale
Pursed lips are not typically a sign of pain in an infant.
Choice B rationale
Pushing away stimuli can be a sign that an infant is in pain.
Choice C rationale
A loud cry can be a sign of pain in an infant.
Choice D rationale
A rigid body can be a sign of pain in an infant.
Choice E rationale
Furrowed eyebrows can be a sign of pain in an infant.
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