A nurse is planning care for multiple children on a pediatric unit who have gastroesophageal reflux. Which of the following children requires a revision to their plan of care?

A 14-year-old child who eats small but frequent meals throughout the day

A 16-year-old child who takes their proton pump inhibitor 30 min before meals

A 6-year-old child who underwent a Nissen fundoplication and is tolerating a full liquid diet

A 4-month-old child who is experiencing weight loss

Answer and Explanation

The Correct Answer is D

A. A 14-year-old child who eats small but frequent meals throughout the day: This is an appropriate intervention for gastroesophageal reflux, as smaller, more frequent meals reduce gastric distention and minimize reflux episodes. No revision to the plan of care is needed for this child.

B. A 16-year-old child who takes their proton pump inhibitor 30 min before meals: Administering proton pump inhibitors before meals is correct because these medications are most effective when taken prior to food intake, allowing for optimal acid suppression. The current plan aligns with best practice.

C. A 6-year-old child who underwent a Nissen fundoplication and is tolerating a full liquid diet: Progressing to a full liquid diet after Nissen fundoplication is appropriate and indicates the child is tolerating postoperative dietary advancement. The plan of care is appropriate and requires no changes.

D. A 4-month-old child who is experiencing weight loss: Weight loss in an infant with gastroesophageal reflux is concerning and indicates inadequate nutrition or complications. The plan of care should be revised to address feeding adequacy, possible medical interventions, and close monitoring of growth and hydration status.

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Correct Answer is D

Explanation

A. "I feel emotionally numb and no longer leave the house.": This statement reflects complicated or prolonged grief, characterized by social withdrawal, emotional numbness, and difficulty functioning. It may indicate the need for additional support or referral to mental health services rather than a typical grief response.

B. "I think a part of me died with them. I feel empty inside.": While feelings of emptiness are common in grief, expressing a sense of self-loss that is pervasive and debilitating can suggest a more complicated grief process. It requires careful assessment and monitoring rather than being considered a fully appropriate grief response.

C. "I lost trust in health care professionals since they died.": This statement indicates anger, mistrust, or possible blame associated with grief. While emotional reactions vary, a persistent sense of mistrust can interfere with adaptive coping and may require guidance and support to process feelings constructively.

D. "I am sad but recognize that this was a blessing for them.": This statement demonstrates an adaptive grief response, acknowledging sadness while also finding meaning or acceptance in the situation. It reflects the ability to process loss realistically, maintain perspective, and integrate the experience into ongoing life.

A. "The item serving size is consistent from one manufacturer to the next." B. “The daily values relate to a 1,500-calorie diet." C. "Food manufacturers provide nutrition information voluntarily." D. "The ingredient with the greatest weight appears first."

Correct Answer is D

Explanation

A. "The item serving size is consistent from one manufacturer to the next.": Serving sizes can vary between different manufacturers and products. Clients should read the label carefully for the specific serving size of each item, as it is not standardized across brands.

B. “The daily values relate to a 1,500-calorie diet.": Daily values on nutrition labels are based on a 2,000-calorie diet, not 1,500 calories. Understanding this helps clients interpret percentages correctly in the context of their individual dietary needs.

C. "Food manufacturers provide nutrition information voluntarily.": Nutrition labeling is required by law for most packaged foods. It is not voluntary, and clients should understand that these labels are standardized and regulated.

D. "The ingredient with the greatest weight appears first.": Ingredients on nutrition labels are listed in descending order by weight. The first ingredient is present in the largest amount, which helps clients make informed choices about food composition.

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A nurse is planning care for multiple children on a pediatric unit who have gastroesophageal reflux. Which of the following children requires a revision to their plan of care?

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