An infant who has clinical manifestation of acute otitis media is brought to the emergency room by their parent. The nurse recognizes which of the following factors places the child at increased risk for otitis media? (Select the 3 that apply)

Exclusive breastfeeding

Recent upper respiratory infection

Immature sinuses and eustachian tube anatomy

Limited vaccination

Smoke-free house hold

Answer and Explanation

Correct Answer : B,C,D

Rationale:

A. Exclusive breastfeeding: Exclusive breastfeeding is actually protective against otitis media because it provides antibodies that help prevent infections, reducing the risk rather than increasing it.

B. Recent upper respiratory infection: Upper respiratory infections can cause inflammation and blockage of the eustachian tubes, which increases the risk for fluid buildup and subsequent middle ear infections like otitis media.

C. Immature sinuses and eustachian tube anatomy: Infants have shorter, more horizontal eustachian tubes that drain poorly, making them more prone to infections like otitis media due to fluid accumulation and bacterial growth.

D. Limited vaccination: Incomplete immunization, especially against pathogens like Streptococcus pneumoniae and Haemophilus influenzae, increases susceptibility to infections including otitis media.

E. Smoke-free household: A smoke-free environment reduces the risk of respiratory infections and otitis media; exposure to secondhand smoke increases the risk of ear infections in children.

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Correct Answer is A

Explanation

Rationale:

A. Folic acid: Adequate folic acid intake before conception and during early pregnancy significantly reduces the risk of neural tube defects such as spina bifida and anencephaly. The recommended daily intake for women of childbearing age is generally 400–800 mcg, starting at least one month before pregnancy and continuing through the first trimester.

B. Vitamin D: Vitamin D is important for fetal skeletal development and maternal bone health, but it does not have a direct role in preventing neural tube defects. Deficiency may cause rickets in infants, but it is not associated with closure of the neural tube.

C. Iron: Iron supplementation is essential to prevent maternal anemia and to support fetal growth and development. However, iron does not influence the formation of the neural tube and thus does not reduce the risk of defects like spina bifida.

D. Calcium: Calcium supports fetal bone and teeth development and helps maintain maternal bone stores. While it is important in pregnancy, it is not connected to prevention of neural tube defects.

A. Flutter valve device B. Peak Flow Meter C. Nebulizer D. Metered-dose inhaler

Correct Answer is A

Explanation

Rationale:

A. Flutter valve device: The flutter valve device helps loosen and clear thick mucus from the lungs, which is a primary concern in cystic fibrosis. Teaching parents how to properly use this device is essential to maintain airway clearance and reduce respiratory infections.

B. Peak Flow Meter: While useful for monitoring lung function in asthma, the peak flow meter is less critical in cystic fibrosis management. It does not directly assist in clearing mucus or delivering medication.

C. Nebulizer: Nebulizers are important for delivering inhaled medications and airway clearance therapies, but initial priority is often given to devices that facilitate mucus clearance like the flutter valve.

D. Metered-dose inhaler: Metered-dose inhalers deliver bronchodilators or steroids but require coordination and proper technique, which can be challenging for some children. Education on this device is important but secondary to airway clearance tools in CF care.

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An infant who has clinical manifestation of acute otitis media is brought to the emergency room by their parent. The nurse recognizes which of the following factors places the child at increased risk for otitis media? (Select the 3 that apply)

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