A nurse is caring for a 4-month-old infant who is one day postoperative following surgical repair of a cleft lip. Which of the following actions should the nurse take? Select all that apply

Position the infant on their back and upright in Semi-Fowler's

Encourage the parents told the baby

Administer aspirin for pain

Apply elbow restraints as ordered

Maintain IV therapy for nutrition

Answer and Explanation

Correct Answer : A,D,E

A. Positioning the infant on their back and upright in Semi-Fowler's helps prevent aspiration and supports respiratory function after surgery.

B. Encouraging parents to hold the baby is important for bonding, but caution should be taken to avoid placing pressure on the surgical site.

C. Aspirin should not be administered due to the risk of Reye's syndrome; acetaminophen is typically used for pain management in infants.

D. Applying elbow restraints as ordered is necessary to prevent the infant from pulling at the surgical site and to ensure proper healing.

E. Maintaining IV therapy is crucial for nutrition until the infant can take oral feeds safely.

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Correct Answer is A

Explanation

A. Acute glomerulonephritis is characterized by the sudden onset of hematuria (reddish-brown urine), proteinuria (4+ protein), and a recent history of streptococcal infection, making it the most likely diagnosis.

B. Renal agenesis is a congenital condition and would not present suddenly with abdominal pain and hematuria.

C. Nephrotic syndrome typically presents with significant proteinuria, but the acute onset of symptoms and recent strep throat history point more toward glomerulonephritis.

D. Polycystic kidney disease usually presents with abdominal or flank pain, hypertension, and hematuria over a more chronic course, not typically after an acute infection.

A. "Try switching to a different formula.” B. "Bring your baby in to the clinic today.” C. "Give your infant an oral rehydration solution.” D. "Burp your baby more frequently during feedings.”

Correct Answer is B

Explanation

A. Switching to a different formula may not address the underlying issue and could lead to further complications.

B. Bringing the baby to the clinic is essential as projectile vomiting in an infant can indicate a serious condition such as pyloric stenosis that requires evaluation and intervention.

C. Giving oral rehydration solutions is not appropriate before assessing the infant's condition, especially if there’s a possibility of a serious underlying issue.

D. While burping is generally recommended, it is not the solution to the problem of projectile vomiting and does not address the need for urgent assessment.

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A nurse is caring for a 4-month-old infant who is one day postoperative following surgical repair of a cleft lip. Which of the following actions should the nurse take? Select all that apply

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

A parent calls a clinic and reports to a nurse that his 2-month-old infant is hungry more than usual but is having projectile vomiting immediately after eating Which of the following responses should the nurse make?

Correct Answer is B

Explanation

A child is experiencing an acute exacerbation of Crohn disease for which she is prescribed prednisone. The nurse teaches the parents and child about this medication. Which statement by the parents indicates that the teaching was successful?

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A nurse is providing teaching to a 17-year-old female client who has severe acne about the use of isotretinoin. Which of the following adverse effects should the nurse instruct the client is the priority to report immediately to the provider?

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A nurse is caring for a year old child who has had watery diarrhea for the past 3 days. Which of the following is the most appropriate action for the nurse to take?

In caring for a child with nephrotic syndrome, which intervention will be most important to be included in the child's plan of care?

A nurse is caring for a client who will have blood sampling for a serum creatinine level and asks what this test shows. Which of the following responses should the nurse make?