A nurse is creating a plan of care for a fetus who has been diagnosed with clubfoot via ultrasound. Which of the following procedures should the nurse expect to include in the plan of care?
A series of casts will be made for the infant soon after birth.
Monitor the infant and perform physical therapy if needed to help with mobility.
Surgery will be performed in utero to correct the deformity.
An orthotic brace will be made when the infant is 6 months of age.
The Correct Answer is A
Choice A reason: Clubfoot, or talipes equinovarus, is treated with serial casting (Ponseti method) soon after birth to gradually correct foot deformities caused by shortened tendons. Weekly casts realign the foot, promoting normal bone and joint development, preventing long-term mobility issues, and avoiding invasive surgery in most cases.
Choice B reason: Monitoring and physical therapy alone are insufficient for clubfoot correction. While therapy supports mobility post-casting, the primary treatment involves serial casting to address tendon contractures. Delaying active intervention risks permanent deformity, as passive monitoring does not correct the structural abnormality.
Choice C reason: In utero surgery for clubfoot is not a standard treatment, as the condition is effectively managed postnatally with casting. Fetal surgery is reserved for severe conditions like spina bifida, not clubfoot, which involves soft tissue contractures correctable after birth, making this inappropriate.
Choice D reason: An orthotic brace at 6 months is part of maintenance after casting, not the primary treatment. Serial casting begins shortly after birth to correct clubfoot, with bracing later to maintain alignment, making this a secondary step, not the initial plan of care.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Congenital immunodeficiency is a contraindication for the MMR vaccine, a live attenuated vaccine, as it risks causing severe infection in immunocompromised children. Weakened immune systems cannot control live viruses, potentially leading to disseminated disease, making this a critical safety concern.
Choice B reason: A fever of 38.3°C (101°F) after prior immunizations is a common, transient reaction, not a contraindication for MMR. It indicates an immune response, not an ongoing condition preventing vaccination, allowing safe administration in healthy children without active severe illness.
Choice C reason: A mild cough and temperature of 37.7°C (99.9°F) are not contraindications for MMR. Minor respiratory symptoms do not impair immune response to the vaccine, and delaying immunization risks leaving the child unprotected against measles, mumps, and rubella.
Choice D reason: Antibiotics for otitis media are not a contraindication for MMR. Antibiotics treat bacterial infections, not affecting the immune response to a viral vaccine. Administering MMR during antibiotic therapy is safe, ensuring timely protection against these contagious diseases.
Correct Answer is C
Explanation
Choice A reason: A 109 ml/hour rate is excessive for a 13.5 kg child. Using the 4-2-1 rule (4 ml/kg/hour for the first 10 kg, 2 ml/kg/hour for the next 3.5 kg), the total is 47 ml/hour, not 109, which could cause fluid overload and cardiovascular strain.
Choice B reason: A 79 ml/hour rate overestimates maintenance fluids for a 13.5 kg child. The 4-2-1 rule yields 47 ml/hour (40 ml for 10 kg + 7 ml for 3.5 kg). Higher rates risk hypervolemia, potentially causing pulmonary edema or electrolyte imbalances in a child.
Choice C reason: For a 13.5 kg child, the 4-2-1 rule calculates maintenance fluids as 40 ml/hour (10 kg × 4 ml) + 7 ml/hour (3.5 kg × 2 ml) = 47 ml/hour, closest to 49 ml/hour. This rate maintains hydration without risking fluid overload, supporting renal and cardiovascular function.
Choice D reason: A 200 ml/hour rate is far too high for a 13.5 kg child, risking fluid overload, heart failure, or pulmonary edema. The correct maintenance rate, per the 4-2-1 rule, is approximately 47 ml/hour, making this choice dangerously excessive for pediatric fluid needs.
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