A nurse is providing teaching to the parent of a newborn who has gastroesophageal reflux. Which of the following instructions should the nurse include?

"Provide a small feeding just before bedtime."

"Dilute formula with 1 tablespoon of water."

"Position the newborn at a 20-degree angle after feeding."

"Place the newborn in a side-lying position if vomiting."

Answer and Explanation

The Correct Answer is C

Gastroesophageal reflux (GER) is a common condition in infants where the contents of the stomach flow back into the esophagus. It often resolves on its own as the infant grows, but management strategies can help alleviate symptoms. Positioning the newborn upright or at a slight angle after feeding is a key recommendation to reduce reflux episodes.

Now, let's review the rationales for each option:

A) "Provide a small feeding just before bedtime." - Feeding a newborn just before bedtime can exacerbate reflux symptoms as lying down can increase the likelihood of stomach contents refluxing into the esophagus. Therefore, this instruction is not recommended as it may worsen GER symptoms.

B) "Dilute formula with 1 tablespoon of water." - Diluting formula with water can disrupt the balance of nutrients and calories in the formula, potentially affecting the infant's growth and nutritional status. Additionally, diluting formula does not address the underlying cause of GER and is not a recommended practice.

C) "Position the newborn at a 20-degree angle after feeding." - This instruction is correct. Placing the newborn at a 20-degree angle or slightly upright after feeding can help reduce the occurrence of reflux episodes by allowing gravity to assist in keeping stomach contents down. This position helps prevent the backflow of gastric contents into the esophagus and reduces discomfort for the infant.

D) "Place the newborn in a side-lying position if vomiting." - Placing the newborn in a side-lying position after vomiting may increase the risk of aspiration, especially in young infants. It is safer to position the infant upright or at a slight angle to minimize reflux and reduce the risk of aspiration.

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Correct Answer is A

Explanation

A) Canned pears are a suitable choice for a mechanical soft diet because they are soft and easy to chew. Canned fruits, including pears, are often soft in texture, makiIg them approprIate for individuals with difficulty chewing. Additionally, canned pears are typically served in a syrup or juice, further softening their texture.

B) Cashews are not typically included in a mechanical soft diet because they are hard and crunchy, which can pose challenges for individuals with difficulty chewing. Nuts, including cashews, require significant chewing and may not be suitable for clients with chewing difficulties.

C) Peas are not commonly included in a mechanical soft diet because they are small, round, and firm, which can make them difficult to chew for individuals with chewing difficulties. Peas require significant mastication, and their small size may increase the risk of choking or aspiration in clients with swallowing issues.

D) Dried apricots are typically not included in a mechanical soft diet because they are tough and chewy, which can be challenging for individuals with difficulty chewing. Dried fruits, including apricots, have a dense texture and may require extensive chewing, making them unsuitable for clients with chewing difficulties.

A. "Consume foods that are high in calcium." B. "Increase intake of refined carbohydrates." C. "Consume ten percent of total calories from saturated fat." D. "Limit sodium intake to 3,200 milligrams per day."

Correct Answer is A

Explanation

Answer: A

Rationale:

A. Consume foods that are high in calcium: The DASH diet emphasizes the consumption of foods rich in calcium, as well as potassium and magnesium. Adequate calcium intake is important for managing hypertension, making this a key component of the diet.

B. Increase intake of refined carbohydrates: The DASH diet recommends reducing refined carbohydrates and focusing on whole grains. Refined carbohydrates can contribute to weight gain and adversely affect blood pressure, so increasing their intake is not advised.

C. Consume ten percent of total calories from saturated fat: The DASH diet suggests limiting saturated fat to less than 6-7% of total daily calories. Consuming ten percent of total calories from saturated fat exceeds the recommended amount and is not consistent with DASH guidelines.

D. Limit sodium intake to 3,200 milligrams per day: The DASH diet recommends limiting sodium intake to 1,500 milligrams per day, not 3,200 milligrams. Reducing sodium intake is crucial for controlling blood pressure and aligning with DASH diet principles.

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