A nurse is providing teaching to the parent of a newborn who has gastroesophageal reflux. Which of the following instructions should the nurse include?
Position the newborn at a 20-degree angle after feeding.
Dilute formula with 1 tablespoon of water.
Place the newborn in a side-lying position if vomiting.
Provide a small feeding just before bedtime.
The Correct Answer is A
Choice A reason: Positioning the newborn at a 20-degree angle after feeding can help prevent the reflux of gastric contents into the esophagus. This position allows gravity to keep the food in the stomach and reduces the pressure on the lower esophageal sphincter. The nurse should instruct the parent to keep the newborn in this position for at least 30 minutes after each feeding.
Choice B reason: Diluting formula with 1 tablespoon of water is not recommended, as it can cause water intoxication, electrolyte imbalance, and malnutrition in the newborn. Water intoxication can lead to seizures, coma, and death. The nurse should advise the parent to follow the manufacturer's instructions for preparing the formula and not to add extra water.
Choice C reason: Placing the newborn in a side-lying position if vomiting is not a safe practice, as it can increase the risk of aspiration and sudden infant death syndrome (SIDS). Aspiration is when food or liquid enters the lungs and causes pneumonia or respiratory distress. SIDS is when a healthy baby dies suddenly and unexpectedly during sleep. The nurse should instruct the parent to place the newborn on the back for sleeping and to avoid soft bedding, pillows, and stuffed animals.
Choice D reason: Providing a small feeding just before bedtime is not a good idea, as it can worsen the gastroesophageal reflux and disrupt the newborn's sleep. The nurse should suggest the parent to feed the newborn smaller and more frequent meals throughout the day and to avoid feeding the newborn within 2 to 3 hours of bedtime.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Weight gain of 0.45 kg (1 lb) per week is not within the expected reference range for a client who is in the second trimester of pregnancy and has a normal BMI. The recommended weight gain for this client is 0.35 to 0.5 kg (0.8 to 1 lb) per week.
Choice B reason: Intake of 200 extra calories per day is within the expected reference range for a client who is in the second trimester of pregnancy and has a normal BMI. The recommended caloric intake for this client is 2200 to 2900 calories per day, which is about 340 to 450 calories more than the pre-pregnancy intake.
Choice C reason: Intake of 100 extra calories per day is not within the expected reference range for a client who is in the second trimester of pregnancy and has a normal BMI. The recommended caloric intake for this client is 2200 to 2900 calories per day, which is about 340 to 450 calories more than the pre-pregnancy intake.
Choice D reason: Weight gain of 0.91 kg (2 lb) per week is not within the expected reference range for a client who is in the second trimester of pregnancy and has a normal BMI. The recommended weight gain for this client is 0.35 to 0.5 kg (0.8 to 1 lb) per week.
Correct Answer is A
Explanation
Choice A reason: Confusion and weakness are signs of dehydration and electrolyte imbalance, which can result from vomiting and diarrhea. These are serious complications that can affect the client's mental status, blood pressure, heart rate, and kidney function. The nurse should report these findings to the provider and monitor the client's vital signs and fluid status.
Choice B reason: Dry oral mucosa and furrowed tongue are also signs of dehydration, but they are less severe than confusion and weakness. The nurse should report these findings to the provider as well, but they are not the most urgent ones.
Choice C reason: A temperature of 37.4° C (99.3° F) is slightly elevated, but not indicative of a fever or infection. The nurse should document this finding, but it does not require immediate follow-up.
Choice D reason: A blood pressure of 90/58 mm Hg is low, but not hypotensive. The nurse should document this finding, but it does not require immediate follow-up.
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