A nurse is caring for a 6-month-old infant who has a prescription for clear liquids by mouth after a repair of an intussusception. Which of the following fluids should the nurse select for the infant?
Half-strength infant formula
Sterile water
Oral electrolyte solution
Half-strength orange juice
The Correct Answer is C
A. Half-strength infant formula: Infant formula, even if diluted, may not be appropriate immediately after a repair of intussusception. It may be too heavy for the infant's digestive system, potentially leading to complications. Clear fluids are usually preferred initially.
B. Sterile water: Sterile water is not typically recommended for oral intake in infants after a repair of intussusception. It lacks essential electrolytes needed to maintain proper hydration and electrolyte balance.
C. Oral electrolyte solution: Oral electrolyte solutions, such as Pedialyte, are often recommended for infants after a repair of intussusception. These solutions contain balanced electrolytes and fluids, which help prevent dehydration and restore electrolyte balance.
D. Half-strength orange juice: Orange juice, even if diluted, is not typically recommended immediately after a repair of intussusception. It may be too acidic and may cause gastrointestinal discomfort or irritation in the infant. Clear fluids are preferred initially to allow the gastrointestinal tract to rest and recover.
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Related Questions
Correct Answer is D
Explanation
A. Place the infant in an infant seat for 2 hours following the procedure. There is no specific need to place the infant in an infant seat for 2 hours following a lumbar puncture. After the procedure, the infant should be positioned comfortably and safely, but there is no requirement for a specific duration in an infant seat.
B. Hold the infant's chin to his chest and knees to his abdomen during the procedure. This positioning is not appropriate for a lumbar puncture. The correct positioning for a lumbar puncture involves having the infant in a lateral recumbent (side-lying) position with knees flexed up toward the chest, allowing the spine to be flexed and creating space between the vertebrae for the needle insertion.
C. Keep the infant NPO for 6 hours prior to the procedure. Keeping the infant NPO (nothing by mouth) for 6 hours prior to the procedure is not necessary for a lumbar puncture. Infants can continue breastfeeding or formula feeding as usual before the procedure. However, if sedation or anesthesia is planned for the procedure, specific fasting guidelines may apply depending on institutional protocols and the infant's age and health status.
D. Apply a eutectic mixture of lidocaine and prilocaine cream topically 15 minutes prior to the procedure. This is the correct choice. Applying a eutectic mixture of lidocaine and prilocaine cream topically before the procedure helps to numb the skin and reduce pain at the site of the lumbar puncture. It is a standard practice to minimize discomfort for the infant during the procedure.
Correct Answer is C
Explanation
A. "You are being unreasonable, and I will not call your doctor at this hour."
This response may escalate the situation by invalidating the client's feelings and refusing to address their request. It fails to recognize the client's distress and could lead to increased agitation or frustration.
B. "I can't call a doctor in the middle of the night unless it's an emergency."
While it's true that non-urgent matters may be deferred until regular hours, this response comes across as dismissive and may exacerbate the client's distress. It does not validate the client's feelings or offer support.
C. "You must be very upset about something."
This response acknowledges the client's emotions and shows empathy. It opens the door for the client to express their concerns, allowing the nurse to assess the situation further and address any immediate needs. It also avoids dismissing the client's request outright and maintains a therapeutic relationship.
D. "Go back to your room, and I'll try to get in touch with your doctor."
This response instructs the client to return to their room without addressing their emotional state or concerns. It lacks empathy and fails to engage with the client's needs effectively.
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