The nurse educates the parents on actions to prevent sudden infant death syndrome.
Which observation indicates the teaching has been effective?
Mother removes pacifier from the newborn's mouth.
The newborn is on an every 2-hour feeding schedule.
Newborn is placed in bassinet on the back.
Newborn is placed in bassinet with a blanket draped over them.
The Correct Answer is C
Choice A rationale
Removing a pacifier does not align with preventing SIDS. Studies suggest pacifier use during sleep reduces the risk of SIDS by maintaining airway patency and ensuring better sleep quality, though it should be used appropriately without attaching strings or clips that may pose risks.
Choice B rationale
Feeding every 2 hours does not directly prevent SIDS but supports adequate nutrition for growth and development. While proper feeding schedules are important, specific sleeping arrangements and environment management play a more significant role in reducing SIDS risk.
Choice C rationale
Placing the newborn on their back to sleep aligns with safe sleep recommendations to prevent SIDS. This position reduces the risk of airway obstruction and promotes proper breathing. The supine sleep position is widely endorsed by health organizations for its protective effect.
Choice D rationale
Draping a blanket over the newborn increases the risk of suffocation and overheating, both of which are associated with SIDS. It is essential to keep sleep environments free of loose items and ensure the baby is dressed appropriately for the room's temperature to reduce these risks.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Decreased urine output is not typically associated with patent ductus arteriosus (PDA). PDA causes an abnormal connection between the aorta and pulmonary artery, leading to left-to-right shunting of blood, which predominantly affects the cardiovascular and pulmonary systems rather than renal output directly.
Choice B rationale
Bradycardia is not a hallmark sign of PDA. Instead, PDA commonly leads to increased cardiac workload and tachycardia. The persistent opening between the aorta and pulmonary artery creates volume overload in the heart, which does not slow heart rate but rather increases it to compensate for the extra demand.
Choice C rationale
Cyanosis of the extremities is more typical in conditions involving right-to-left shunting, which is not characteristic of PDA. In PDA, the blood flow is typically left-to-right, meaning oxygenated blood flows back into the pulmonary circulation, which may lead to pulmonary congestion but not peripheral cyanosis.
Choice D rationale
A continuous "machinery-like" heart murmur is a classic sign of PDA due to the turbulent flow of blood between the high-pressure aorta and low-pressure pulmonary artery during both systole and diastole. This characteristic sound is often used diagnostically to identify PDA in newborns.
Correct Answer is D
Explanation
Choice A rationale
The Oucher scale uses photographic images or numerical scales and is appropriate for older children who can visually correlate their pain level with the provided scale. It is not ideal for younger children or those unable to understand numerical or photographic representations.
Choice B rationale
The Visual Analog Scale requires a more mature understanding of concepts such as gradients and is suitable for older children and adults. It is not an appropriate tool for a 5-year-old as their cognitive development may limit the accurate use of this scale.
Choice C rationale
The FLACC scale assesses pain based on behavioral observations and is ideal for non-verbal or very young children. However, a 5-year-old can generally articulate their pain or utilize pictorial representations, making other scales more suitable.
Choice D rationale
The FACES scale, featuring cartoonish faces representing varying pain levels, is a validated tool for children as young as 3 years old. Its simplicity and visual clarity make it an effective and age-appropriate method for a 5-year-old to communicate their pain level.
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