A newborn with a repaired gastroschisis is transferred to the pediatric unit after several days in the pediatric intensive care unit. The infant is receiving parenteral nutrition and continuous enteral feedings. To maintain normal growth and development of the infant, which action should the nurse include in plan of care?

Ensure placement of the enteral tube with an abdominal x-ray.

Speak to the healthcare provider about instituting physical therapy.

Offer a pacifier for non-nutritive sucking.

Use sterile technique during feedings.

Answer and Explanation

The Correct Answer is C

A. Ensure placement of the enteral tube with an abdominal x-ray: Verifying enteral tube placement is essential for safety, but it is not related to maintaining the newborn's growth and development. Tube placement should already have been verified prior to initiating feedings.

B. Speak to the healthcare provider about instituting physical therapy: Physical therapy may be beneficial for infants with specific motor delays, but it is not a routine intervention for all infants recovering from gastroschisis.

C. Offer a pacifier for non-nutritive sucking: Non-nutritive sucking (e.g., using a pacifier) is crucial for the growth and development of newborns, especially those unable to feed orally. It helps promote oral-motor development, soothes the infant, and lays the foundation for transitioning to oral feeding. This is particularly important for an infant receiving parenteral or enteral nutrition to ensure they develop the skills and comfort needed for future oral feeding.

D. Use sterile technique during feedings: Clean technique is generally sufficient or routine enteral feedings unless there is a specific indication for sterility (e.g., immunocompromised clients). Further, this does not directly support growth and development.

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Correct Answer is B

Explanation

A. Assessing for teeth clenching or grinding is not the most appropriate assessment in this situation. While teeth clenching or grinding may indicate discomfort or anxiety, it may not directly address the specific concern of post-operative bleeding after a tonsillectomy.

B Inspect the posterior oropharynx.

Observing a child who has had a tonsillectomy frequently swallowing may raise concerns about post-operative bleeding. Inspecting the posterior oropharynx is essential to assess for any signs of bleeding, such as fresh blood or bleeding sites.

C. Asking the child to speak to evaluate a change in voice tone is not the primary assessment needed in this scenario. The primary concern is to assess for any signs of bleeding, and this can be done by inspecting the posterior oropharynx.

D. Touching the tonsillar pillars to stimulate the gag reflex is not necessary and may not be well-tolerated by the child who has had a tonsillectomy. It's also not the primary assessment to address the concern of post-operative bleeding.

A. Uses 1 word sentences. B. Speaks in simple sentences with four or more words. C. Recognizes most letters and numbers. D. Uses gestures with 1 to 2 word sentences.

Correct Answer is B

Explanation

A. Using 1-word sentences is more characteristic of a child's speech development at around 12-18 months, and by age 3, children are expected to use more words in their sentences.

B. Speaks in simple sentences with four or more words.

At the age of 3, children typically progress in their speech and language development. Speaking in simple sentences with four or more words is considered a normal developmental milestone at this age. It reflects the child's growing ability to form more complex and coherent sentences.

C. Recognizing most letters and numbers is not typically a developmental milestone for a 3-year-old. This skill often develops later, closer to the preschool and kindergarten years.

D. Using gestures with 1 to 2-word sentences may be seen in younger children, but by age 3, children should be progressing to longer and more complex sentences as part of their language development.

It's important to remember that there can be some individual variation in language development, but by the age of 3, children are generally expected to speak in simple sentences with more words and demonstrate growing language skills.

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Naxlex Comprehensive Predictor Exams

While obtaining the vital signs of a 10-year-old child who had a tonsillectomy this morning, the nurse observes the child swallowing every 2 to 3 minutes. Which assessment should the nurse implement?

Correct Answer is B

Explanation

The nurse is assessing the growth and development of a 3-year-old child. Which speech and language skills should the nurse identify as normal developmental milestones for this child?

Correct Answer is B

Explanation

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