A nurse is teaching the guardian of a newborn about formula feeding. Which of the following instructions should the nurse include?
Boil bottle rings and nipples for 10 min to ensure sanitization.
Keep the newborn on a strict 3 hr feeding schedule.
Use bottles of refrigerated formula within 48 hr.
Place the newborn on their abdomen for 30 min following each feeding.
The Correct Answer is C
A. Boil bottle rings and nipples for 10 min to ensure sanitization. Boiling for 10 minutes is excessive and can damage bottle parts. A boil time of 5 minutes is typically sufficient for sanitizing feeding equipment before first use.
B. Keep the newborn on a strict 3 hr feeding schedule. Newborns should be fed on demand, which may be more or less frequently than every 3 hours. Hunger cues should guide feeding to promote healthy growth and bonding.
C. Use bottles of refrigerated formula within 48 hr. Prepared formula should be refrigerated and used within 48 hours to ensure safety and prevent bacterial growth. This is a safe practice when storing formula that has not been fed to the infant.
D. Place the newborn on their abdomen for 30 min following each feeding. Placing a newborn on the abdomen increases the risk of sudden infant death syndrome (SIDS). Infants should always be placed on their backs to sleep.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Decrease the maintenance infusion rate of IV fluid. Epidural anesthesia can cause hypotension, so IV fluids are often used to help maintain blood pressure. Reducing the fluid rate may increase the risk of hypotensive episodes.
B. Have protamine sulfate available at the bedside. Protamine sulfate is the antidote for heparin, not relevant to epidural anesthesia. It is not required in the management of epidural-related side effects.
C. Reposition the client side-to-side each hour. Frequent repositioning helps prevent pressure injuries, promotes fetal oxygenation, and encourages effective labor progression. It also aids in the distribution of the anesthetic agent.
D. Monitor the client for hypertension. Hypotension, not hypertension, is a common adverse effect of epidural anesthesia due to vasodilation and decreased peripheral resistance. Blood pressure should be monitored closely for drops.
Correct Answer is C
Explanation
A. Apply the largest cuff available. Using a cuff that is too large can result in falsely low readings. Cuff size should match the client’s arm circumference to ensure accuracy, but simply switching to the largest cuff does not resolve difficulty in auscultation.
B. Deflate the cuff quickly. Rapid deflation can cause the nurse to miss the systolic and diastolic sounds, making it harder to obtain an accurate reading. The cuff should be deflated at a steady rate of 2–3 mmHg per second.
C. Use the palpatory method to determine blood pressure. When sounds are difficult to auscultate, the palpatory method is a reliable alternative. This involves palpating the radial pulse while inflating the cuff to estimate systolic pressure, which helps guide a more accurate auscultatory attempt.
D. Place the arm above the level of the client's heart. Elevating the arm above heart level can lower the pressure artificially, resulting in an inaccurate measurement. For correct results, the arm should be supported at heart level.
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