A nurse is teaching the parent of an infant who has a new diagnosis of heart failure about nutrition. Which of the following instructions should the nurse include in the teaching?
Allow the infant to self soothe by crying prior to feeding
Place the infant in a recumbent position during feeding
Implement a 3 hr feeding schedule.
Allow the infant 45 min for each feeding
The Correct Answer is C
A. Allowing the infant to cry before feeding increases energy expenditure and may worsen fatigue in infants with heart failure.
B. A recumbent position can increase the risk of aspiration; a semi-upright position is preferred.
C. Implementing a 3-hour feeding schedule ensures the infant receives adequate nutrition without excessive fatigue.
D. Feedings should be limited to 30 minutes to prevent excessive energy expenditure.
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Naxlex Comprehensive Predictor Exams
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Correct Answer is D
Explanation
A) Abrasions on the knees could result from normal childhood activities and may not indicate physical abuse.
B) Front deciduous teeth missing could be due to normal tooth loss.
C) Weight in the 45th percentile is within a normal range and does not necessarily indicate physical abuse.
D) Bruising around the wrists is concerning for physical abuse, especially in a pattern consistent with restraining or gripping.
Correct Answer is B
Explanation
A. The nurse should not encourage flexion and extension of the neck, as this could cause further injury or damage to the spinal cord.
B. The nurse should reposition the client using a turning sheet to prevent skin breakdown and maintain alignment of the spine.
C. The nurse should assess the pin sites for infection at least once a day, not every other day.
D. The nurse should not tighten the screws on the halo device, as this could cause pressure ulcers or nerve damage. Only a provider can adjust the screws on the halo device.
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