A nurse is preparing to perform a heel stick on an infant. Which of the following actions should the nurse take?
Use an automated lancet device to puncture the heel.
Apply limb restraints to the infant.
Puncture the heel at the inner aspect of the heel.
Cleanse the area with povidone iodine.
The Correct Answer is A
Rationale:
A) Using an automated lancet device provides a controlled and consistent depth of puncture for the heel stick, minimizing discomfort and risk of injury.
B) Applying limb restraints is unnecessary and could cause distress to the infant.
C) Puncturing the heel at the inner aspect may not be the appropriate site for the heel stick.
D) Cleansing the area with povidone iodine is not necessary for a routine heel stick procedure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A) Increasing carbohydrate intake when sick can disrupt blood sugar control and should be done cautiously under the guidance of a healthcare provider.
B) Omitting the bedtime snack can lead to overnight hypoglycemia, especially in children with diabetes who are at risk for low blood sugar during the night.
C) While proteins are part of a balanced diet, the main focus of a child's meal plan with diabetes should be on balancing carbohydrates with proteins and fats for better blood sugar control.
D) Including a snack before physical activity helps prevent hypoglycemia during exercise by providing additional carbohydrates to fuel the activity.
Correct Answer is A
Explanation
Rationale:
A) Offering a pacifier can help soothe a fussy baby with colic.
B) Offering water in between feedings is not recommended for infants, especially at 1 month old, as it can interfere with proper feeding and increase the risk of water intoxication.
C) Placing a warm heating pad on the baby's abdomen is not recommended without specific guidance from a healthcare provider and can pose a risk of burns.
D) Allowing the baby to cry for 5 minutes before responding is not recommended for infants, as it can lead to increased stress and distress.
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