The nurse is planning care for an infant after a cleft-lip repair. Which of the following is NOT an appropriate nursing intervention for this infant?
Keep suction equipment at bedside.
Position the child upright for feedings.
Feed slowly using specialized feeding bottles.
Explain to the mother that breastfeeding will not be possible until after the repair.
The Correct Answer is D
Choice A reason: Keeping suction equipment at bedside is important to maintain airway patency and prevent aspiration.
Choice B reason: Positioning the child upright for feedings can help prevent aspiration and is a recommended practice.
Choice C reason: Feeding slowly using specialized feeding bottles can help the infant feed effectively and safely.
Choice D reason: This is the correct choice. Breastfeeding is often possible with the use of special techniques and should not be discouraged unless specifically contraindicated.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: A CVA typically does not present with fever and rash.
Choice B reason: This is the correct choice. The symptoms described are classic for meningococcal meningitis, a bacterial infection of the membranes covering the brain and spinal cord.
Choice C reason: Rocky Mountain spotted fever presents with a rash but not typically with nuchal rigidity.
Choice D reason: Intracerebral hemorrhage may cause a severe headache but would not typically present with fever or a petechial rash.
Correct Answer is A
Explanation
Choice A reason: This is the correct choice. If an orogastric tube fails to pass, it may indicate a blockage or abnormal connection, such as a tracheoesophageal fistula.
Choice B reason: Low birth weight can be associated with many conditions and is not specific to TEF.
Choice C reason: TEF is not typically visible without special imaging or procedures; it cannot be visually identified at delivery.
Choice D reason: Dry mouth and nares with little to no oral secretions could indicate other conditions and are not specific to TEF. TEF often presents with excessive oral secretions.
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