When planning care for the infant, the nurse should prepare the infant for a

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and frequently

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.

Choice A rationale

Gastroesophageal reflux (GER) involves the retrograde flow of gastric contents into the esophagus. By thickening the infant's formula with a substance like cereal, the viscosity of the feeding is increased. This higher viscosity makes it more difficult for the stomach contents to flow back up the esophagus, thereby reducing the frequency and severity of regurgitation episodes. The increased density helps the food stay in the stomach.

Choice B rationale

While citrus juices are known to be acidic and may exacerbate symptoms of GER in some individuals by irritating the esophageal mucosa, avoiding them is a management strategy for symptom control rather than a primary action to physically prevent the act of regurgitation itself. The mechanism of regurgitation is mechanical, related to the lower esophageal sphincter, not solely to the pH of the consumed liquid. This choice does not directly prevent the physical reflux.

Choice C rationale

Elevating the infant's head after meals leverages gravity to help keep gastric contents in the stomach and away from the esophagus. A head elevation of at least 30 degrees is often recommended to reduce the pressure on the lower esophageal sphincter (LES), thus decreasing the likelihood of stomach acid and food flowing backward, which is the physiological basis of regurgitation.

Choice D rationale

Placing an infant on a soft pillow while sleeping poses a significant risk of sudden infant death syndrome (SIDS) due to potential suffocation. Soft bedding can obstruct the infant's airway. The American Academy of Pediatrics recommends that infants sleep on a firm surface without any pillows, blankets, or soft toys to minimize these risks, making this a dangerous and contraindicated practice for an infant.

Choice E rationale

Antiemetics are medications used to treat nausea and vomiting by acting on chemoreceptor trigger zones in the brain or other peripheral receptors. They do not prevent the mechanical process of regurgitation in infants with GER. Furthermore, these medications are generally not recommended for routine use in infants with uncomplicated GER due to potential adverse effects and the self-limiting nature of the condition.

Choice A rationale

A green zone reading on a peak expiratory flow meter indicates that the child's asthma is well-controlled and symptoms are absent or minimal. This measurement, typically 80% to 100% of the child's personal best, reflects good airflow through the airways and is not a sign of an asthma exacerbation. The purpose of this device is to monitor pulmonary function and detect early changes.

Choice B rationale

Rhinitis is an inflammation of the nasal mucous membranes, commonly caused by allergic reactions or viral infections. While allergies can be a trigger for asthma, rhinitis itself is not a primary manifestation of an acute asthma exacerbation. An asthma attack is characterized by bronchospasm, airway inflammation, and increased mucus production, leading to respiratory distress, not just nasal symptoms.

Choice C rationale

An axillary temperature of 37.2° C (99° F) is within the normal temperature range for a school-age child. A fever is generally defined as a temperature above 38° C (100.4° F), and while infections can trigger asthma, this specific temperature does not indicate a fever or an acute exacerbation of asthma. A normal temperature range is 36.5° C to 37.5°

Choice D rationale

A hacking nonproductive cough is a classic manifestation of an asthma exacerbation. The cough is a physiological response to the inflammation, bronchoconstriction, and increased mucus production in the airways. The cough is nonproductive because the bronchospasm makes it difficult to clear the thickened mucus, which further contributes to the child's respiratory distress.