What information would the nurse include in the preoperative plan of care for an infant with myelomeningocele?
Positioning supine with a pillow under the buttocks.
Covering the sac with saline-soaked nonadhesive gauze.
Wrapping the infant snugly in a blanket.
Applying a diaper to prevent fecal soiling of the sac.
The Correct Answer is B
Choice A rationale
Positioning an infant with myelomeningocele in the supine position increases the risk of rupture or damage to the delicate sac, which contains neural tissue and cerebrospinal fluid. Proper positioning requires the infant to be prone or side-lying to prevent pressure on the defect, protecting the integrity of the meningeal sac before surgical repair. A pillow under the buttocks when supine does not eliminate the risk.
Choice B rationale
Covering the sac with a sterile, moist, nonadhesive dressing, such as saline-soaked gauze, is essential preoperative care. This prevents the sac from drying out and maintains the viability of the exposed neural tissues, while the nonadhesive nature minimizes tissue trauma upon removal. Saline is used as an isotonic solution that avoids osmotic shifts in the exposed tissue.
Choice C rationale
Wrapping the infant snugly in a blanket should be avoided because the pressure exerted by the blanket could easily rupture the fragile meningeal sac. The goal is to minimize all external pressure and contact with the defect site to prevent infection and further neurological damage prior to surgical closure.
Choice D rationale
Applying a diaper is contraindicated as the diaper edges would rub against the sac, causing irritation, potential breakdown, and increasing the risk of contamination from urine and feces. The sac must be kept clean and dry from contaminants; therefore, the infant is typically kept in an incubator without a diaper.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Circumcision is a surgical procedure that removes the foreskin of the penis. While it is associated with a lower risk of acquiring some sexually transmitted infections like HIV, it does not prevent all of them, making condom use and safe sexual practices the primary preventive measures. Furthermore, this statement is not a balanced, educational response for undecided parents, who require comprehensive information on risks and benefits.
Choice B rationale
Maintaining adequate hygiene is possible in both circumcised and uncircumcised males. For uncircumcised males, proper hygiene involves gently retracting the foreskin daily after infancy to cleanse the glans, preventing the accumulation of smegma. This statement presents an exaggerated and often incorrect difficulty, failing to provide factual, unbiased information to the parents.
Choice C rationale
While the procedure is associated with pain, standard practice involves administering appropriate pain management, such as a dorsal penile nerve block or topical anesthetic, along with non-pharmacologic measures like sucrose solution and non-nutritive sucking. Therefore, the pain is controllable, and this statement is insufficient to guide a final parental decision.
Choice D rationale
The nurse's role is to provide objective information and support the parents' decision-making process, not to give a personal recommendation or push a specific viewpoint. Recommending a discussion with the healthcare provider ensures the parents receive a detailed, evidence-based review of both the potential medical benefits and risks associated with the procedure.
Correct Answer is ["4.5"]
Explanation
Step 1 is: Calculate the total daily dose in milligrams by multiplying the ordered dose (3 mg/kg/day) by the weight in kilograms (3 kg). 3 mg/kg/day × 3 kg = 9 mg/day.
Step 2 is: Calculate the single dose by dividing the total daily dose (9 mg/day) by the number of doses per day (2 doses). 9 mg/day ÷ 2 doses = 4.5 mg/dose. The final calculated answer is 4.5 mg.
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