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 A
Explanation
Choice A reason: Warming the formula to room temperature can help reduce the osmotic load and prevent diarrhea in clients receiving enteral nutrition. Cold formula can also cause abdominal cramping and discomfort.
Choice B reason: Increasing the rate of infusion can worsen diarrhea by increasing the osmotic load and the risk of bacterial overgrowth. The rate of infusion should be adjusted based on the client's tolerance and nutritional needs.
Choice C reason: Changing to a low-calorie formula is not indicated for diarrhea. Low-calorie formulas are usually high in osmolality and can cause more water to be drawn into the intestinal lumen, leading to diarrhea. A low-residue or isotonic formula may be more appropriate.
Choice D reason: Replacing the extension tubing every 48 hr is not enough to prevent diarrhea. The extension tubing should be replaced every 24 hr or with each new container of formula to reduce the risk of bacterial contamination and infection.
Correct Answer is ["A","B","C"]
Explanation
Choice A reason: Sipping fluids slowly throughout the day can help prevent dehydration and electrolyte imbalance, which can worsen nausea and vomiting. Fluids also help flush out the toxins from the chemotherapy and reduce the risk of kidney damage¹².
Choice B reason: Consuming foods that are served cold can help reduce the stimulation of the chemoreceptor trigger zone (CTZ), which is responsible for triggering nausea and vomiting. Cold foods also have less odor and taste, which can be unpleasant for some clients with CINV³⁴.
Choice C reason: Sitting up for 1 hr after eating meals can help prevent reflux and aspiration, which can cause more nausea and vomiting. Sitting up can also promote gastric emptying and digestion.
Choice D reason: Limiting the use of antiemetics until after the first emesis is not a recommended practice, as it can make nausea and vomiting more difficult to control. Antiemetics should be given before, during, and after chemotherapy, according to the emetogenic potential of the agents and the client's individual response.
Choice E reason: Eating foods low in carbohydrates is not a helpful strategy for CINV, as carbohydrates can provide energy and prevent hypoglycemia, which can also cause nausea and vomiting. Carbohydrates can also help settle the stomach and reduce acid production.
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