A nurse is collecting data from a 4-month-old infant who has meningitis. Which of the following manifestations should the nurse expect?
Constipation
Depressed anterior fontanel
Presence of the rooting reflex
High-pitched cry
The Correct Answer is D
D. A high-pitched cry, often described as a "crying in pain" or "irritable cry," can be a characteristic sign of meningitis in infants. The cry may sound different from the infant's usual cry and may be associated with irritability, discomfort, or pain. It can be indicative of increased intracranial pressure and neurological irritation caused by the inflammation of the meninges.
A. Constipation is not typically associated with meningitis in infants. Meningitis is an inflammation of the membranes surrounding the brain and spinal cord, which can cause symptoms such as fever, irritability, poor feeding, vomiting, and lethargy.
B. A depressed anterior fontanel (sunken soft spot on the baby's head) is not a typical manifestation of meningitis. Meningitis may cause signs of increased intracranial pressure, such as a bulging fontanel, rather than a depressed fontanel.
C. he presence of the rooting reflex is not specific to meningitis. The rooting reflex is a normal reflex present in infants, where they turn their head toward a stimulus (such as stroking the cheek or corner of the mouth) in search of nourishment (typically the breast or bottle).
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
C. Clubbing, characterized by bulbous enlargement of the fingertips and nail bed, is a result of chronic hypoxia in tetralogy of Fallot. In tetralogy of Fallot, there is a right-to-left shunting of blood due to the presence of a ventricular septal defect, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. This leads to reduced oxygenation of blood and chronic hypoxia, which can result in clubbing of the fingertips over time.

A This option is not the primary explanation for clubbing in tetralogy of Fallot. While decreased cardiac output may contribute to some manifestations of the condition, clubbing specifically results from chronic hypoxia rather than decreased cardiac output alone.
B Clubbing is not directly caused by a left-to-right shunting of blood. Instead, it is associated with chronic hypoxia, which can occur due to right-to-left shunting of blood in tetralogy of Fallot.
D Congestive heart failure may occur in individuals with tetralogy of Fallot but it is not the primary cause of clubbing. Clubbing in tetralogy of Fallot is primarily attributed to chronic hypoxia rather than heart failure alone.
Correct Answer is A
Explanation
A. This statement indicates that the mother understands the purpose of giving pancreatic enzymes to her child with cystic fibrosis. Cystic fibrosis can cause pancreatic insufficiency, leading to difficulty digesting fats and other nutrients. Pancreatic enzymes help to supplement the deficient digestive enzymes, aiding in the digestion of fats and improving nutrient absorption.
B. Pancreatic enzyme capsules are typically meant to be swallowed whole, not chewed. Chewing the capsules could affect their effectiveness by prematurely releasing the enzymes in the mouth rather than in the stomach where they are needed for digestion.
C. While pancreatic enzymes can help with digestion and may indirectly reduce symptoms like nausea by improving nutrient absorption, their primary purpose is not to prevent nausea.
D. Pancreatic enzymes are usually taken with meals or snacks to aid in the digestion of food. The timing of pancreatic enzyme administration may vary depending on the child's eating schedule and the specific instructions provided by the healthcare provider, but taking them 2 hours before meals would not typically be recommended.
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