The nurse recognizes that a 4-year-old hospitalized child is exhibiting which characteristic of cognitive development, when the child tells the nurse it’s sad to be at home alone?

Choice A rationale

While positioning to prevent fluid accumulation in the middle ear is important in the care of a newborn with a cleft lip and palate, it is not the first priority. Middle ear infections are common in children with cleft palate because the muscles that open the eustachian tubes (which drain fluid from the middle ear) may not work well. However, this is typically addressed after feeding issues are managed.

Choice B rationale

Facilitating immediate repair of the cleft palate to ease feeding difficulties is important, but it is not the first priority. Surgery to repair cleft palate is usually done when the child is older,

between 6 and 12 months of age. The timing of surgery depends on the child’s overall health and the type and severity of the cleft.

Choice C rationale

Assisting the mother to bond with the baby by providing emotional support is an important aspect of care. However, it is not the first priority. The initial focus is on addressing the baby’s immediate physical needs, such as feeding and breathing.

Choice D rationale

Establishing adequate feeding and sucking is the first priority when caring for a newborn with a cleft lip and palate. Babies with a cleft palate may have difficulty creating enough suction to breastfeed or bottle-feed effectively. Special feeding techniques and equipment may be needed to help these babies get enough nutrition.

Choice A rationale

A 6-month-old who has a high fever, dysphagia, stridor, and a muffled cry. This child is showing signs of epiglottitis, a severe and life-threatening condition that requires immediate medical attention. Epiglottitis is characterized by inflammation and swelling of the epiglottis, the flap at the base of the tongue that keeps food from going into the windpipe. Symptoms include high fever, difficulty swallowing (dysphagia), stridor (a high-pitched wheezing sound caused by disrupted airflow), and a muffled or hoarse voice. In severe cases, it can lead to complete blockage of the airway, which is a medical emergency.

Choice B rationale

A 13-year-old who has a high fever, stridor, and purulent secretions. While these symptoms are concerning and require medical attention, they are not as immediately life-threatening as the symptoms presented in Choice A. The presence of purulent secretions suggests a bacterial infection, which while serious, can typically be treated with antibiotics.

Choice C rationale

A 2-year-old who has a barky cough, is afebrile, and has mild intercostal retractions. These symptoms suggest croup, a common childhood condition that causes a barky cough and mild breathing difficulties. While croup can be distressing, it is usually not life-threatening and can often be managed at home with supportive care.

Choice D rationale

A 5-year-old who has an abrupt onset of moderate respiratory distress, a mild fever, and a barky cough. These symptoms also suggest croup. While this child is experiencing moderate respiratory distress, which requires medical attention, it is not as immediately life-threatening as the symptoms presented in Choice A2.