A nurse is contributing to the plan of care for a 12-month-old infant following cleft palate repair. Which of the following actions should the nurse include?
Allow the infant to have soft foods.
Maintain elbow restraints on the infant.
Instruct the parents to feed the infant with a spoon.
Tell the parents to avoid brushing the infant's teeth for two weeks.
The Correct Answer is B
The nurse should include maintaining elbow restraints on the infant in the plan of care following cleft palate repair. This helps to prevent the infant from touching their surgical site and disrupting the healing process.
a) Allowing the infant to have soft foods may be appropriate, but it is not the highest priority. The infant's diet should be determined by the provider and based on the infant's individual needs.
c) Instructing the parents to feed the infant with a spoon may be appropriate, but it is not the highest priority. The infant's feeding method should be determined by the provider and based on the infant's individual needs.
d) Telling the parents to avoid brushing the infant's teeth for two weeks may be appropriate, but it is not the highest priority. The infant's oral care should be determined by the provider and based on the infant's individual needs.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Correct answer: C
A) Start the first patch on the seventh day of the menstrual cycle: The patch is typically applied on the first day of the menstrual cycle or the first Sunday after the menstrual period begins, not on the seventh day. This helps ensure effective contraception from the start of use.
B) The contraceptive effect will continue for 6 months following discontinuation of the medication: The contraceptive effect of the patch does not last for 6 months after discontinuation. Once the patch is removed and not replaced, hormone levels drop, and fertility can return relatively quickly, typically within a few days to weeks.
C) Apply the patch to the lower abdomen: The patch should be applied to clean, dry, and intact skin on areas such as the lower abdomen, upper outer arm, buttock, or upper torso (excluding the breasts). This location allows for consistent hormone absorption.
D) Expect to have a headache during the first month: While some individuals may experience headaches as a side effect of hormonal contraceptives, this is not an expected or guaranteed outcome. Any persistent or severe headache should be reported to the healthcare provider, as it could indicate other concerns.
Correct Answer is D
Explanation
The client's partner assisting them with their meal tray (option d) is not as important as the other information and may not need to be included in the change-of-shift report.
A nurse providing change-of-shift report for a client who has heart failure should include all of the above information in the report.
The client's most recent blood pressure reading,morning laboratory results, and presence of pitting edema in the lower extremities are all important pieces of information that the incoming nurse should be aware of.
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