A nurse is creating a plan of care for an infant who has osteogenesis imperfecta. Which of the following interventions should the nurse include in the plan?
Use pillows to position the infant when changing a diaper.
Instruct the parents to withhold immunizations until 1 year of age.
Obtain the infant's blood pressure with an automatic cuff.
Avoid using splints to support the infant's limbs
The Correct Answer is A
Choice A rationale:
Infants with osteogenesis imperfecta have fragile bones that can fracture easily. Using pillows or other soft support can help prevent accidental fractures during diaper changes.
Choice B rationale:
Immunizations are important for all infants and should not be withheld, even in the presence of osteogenesis imperfecta.
Choice C rationale:
Blood pressure measurement is not a common concern in infants with osteogenesis imperfecta.
Choice D rationale:
Splints may be used to provide support for the infant's limbs to minimize the risk of fractures.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Monitoring the client for a period of time after meals helps prevent behaviors such as purging or excessive exercise, which individuals with anorexia nervosa might engage in to compensate for food intake.
Choice B rationale:
Encouraging a specific weight gain is not the initial priority. Weight restoration should be approached carefully and gradually to avoid refeeding syndrome.
Choice C rationale:
Allowing the client to exercise for less than 1 hr per day is a potential intervention, but the priority is to observe the client after meals to prevent harmful behaviors.
Choice D rationale:
Weighing the client in the morning every other day is an important monitoring step, but it is not the initial intervention during admission.
Correct Answer is C
Explanation
Choice A rationale:
Administering all the missed immunizations in one injection is not recommended and can lead to increased discomfort and potential adverse reactions.
Choice B rationale:
Starting the immunization series over is unnecessary and can delay the child's protection against vaccine-preventable diseases.
Choice C rationale:
The most appropriate action is to administer the immunizations the child missed at the earliest opportunity to catch up on the schedule.
Choice D rationale:
Waiting until 12 months of age is not necessary if the child has already missed scheduled immunizations. The catch-up schedule should be followed based on the child's current age.
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