A nurse is providing discharge teaching to a new guardian about car seat safety.
Which of the following statements by the guardian indicates an understanding of the teaching?
I should place the harness snugly in a slot above my baby's shoulders.
I should position the retainer clip at the top of my baby's abdomen.
I should position my baby's car seat at a 45-degree angle in the car.
I should place the car seat rear-facing until my baby is 12 months old.
The Correct Answer is C
Choice A rationale
The car seat harness straps should be positioned at or slightly below the baby's shoulders when the car seat is installed rear-facing. Positioning the straps above the shoulders could allow the baby to slide up and out of the harness in a crash due to the forces involved, compromising the restraint system's effectiveness and increasing injury risk.
Choice B rationale
The retainer clip, also called the chest clip, must be positioned at the level of the armpits across the center of the chest or sternum, not the abdomen. This critical placement ensures that the harness straps are kept correctly positioned over the baby's shoulders, preventing the straps from slipping off during a collision and maintaining optimal force distribution across the torso.
Choice C rationale
A 45-degree recline angle for a rear-facing car seat is generally recommended to prevent the infant's head from falling forward, which can compromise the airway, particularly in newborns or infants with poor head control. This specific angle is crucial for maintaining a safe and open airway and is often achieved using built-in level indicators on the car seat base.
Choice D rationale
Current safety recommendations advise keeping a child in a rear-facing car seat as long as possible, typically until they reach the maximum weight or height limit allowed by the car seat manufacturer, which often extends well beyond 12 months of age, frequently up to 2 to 4 years of age, for maximum spinal protection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","E"]
Explanation
Choice A rationale
The Diphtheria-tetanus-acellular pertussis (Tdap) vaccine is recommended during each pregnancy, ideally between 27 and 36 weeks of gestation. This timing is crucial because it allows for the maternal production and optimal transplacental transfer of pertussis antibodies to the fetus. These antibodies provide crucial passive immunity to the newborn against pertussis (whooping cough), which is a severe and potentially fatal disease in infants before they can be directly immunized.
Choice B rationale
The Human papillomavirus (HPV) vaccine is not recommended during pregnancy because there is limited safety data regarding its use in pregnant women. While it is not known to cause adverse fetal effects, it is a recombinant vaccine and, as a precautionary measure, it should be delayed until the postpartum period. Routine HPV vaccination is typically administered to adolescents and young adults up to age 26.
Choice C rationale
The Varicella vaccine is a live attenuated virus vaccine and is contraindicated in pregnancy due to the theoretical risk of transmission of the live virus to the fetus, which could potentially cause congenital varicella syndrome. Women who are non-immune to varicella should receive this vaccine postpartum, before being discharged from the hospital, to protect future pregnancies.
Choice D rationale
The Measles, mumps, and rubella (MMR) vaccine is a live attenuated virus vaccine and is contraindicated in pregnancy due to the theoretical risk of fetal infection and subsequent congenital abnormalities, particularly from the rubella component. Women who are not immune to rubella should be vaccinated postpartum and advised to avoid conception for about one month following vaccination.
Choice E rationale
The inactivated influenza (flu shot) vaccine is recommended for all women who are pregnant during the flu season, regardless of their stage of gestation, including at 30 weeks. This is a killed virus vaccine and is considered safe in pregnancy. It protects the mother from severe influenza illness and also provides the newborn with passive immunity in the initial months of life.
Correct Answer is ["A","B","E"]
Explanation
Choice A rationale
Body tremors are a key indicator of central nervous system (CNS) hyperirritability, which is a major component of neonatal abstinence syndrome (NAS) following in utero exposure to opioids like heroin. The newborn's immature CNS struggles to adapt after the abrupt cessation of the drug, leading to uncoordinated, jerky movements, exaggerated reflexes, and generalized irritability.
Choice B rationale
Tachypneic respirations (respiratory rate greater than 60 breaths/min) are a common sign of NAS. This occurs due to the dysregulation of the autonomic nervous system and increased metabolic rate associated with the hyperirritable state. Other respiratory signs include flaring, retractions, and frequent yawning or sneezing, reflecting CNS overstimulation.
Choice C rationale
The hyperirritability of the CNS in NAS typically leads to increased and exaggerated reflexes (hyperreflexia), such as a hyperactive Moro reflex, not decreased reflexes. Decreased reflexes would suggest CNS depression, which is characteristic of acute opioid intoxication, not the withdrawal state of NAS.
Choice D rationale
Newborns experiencing NAS are characterized by CNS hyperstimulation, leading to excessive wakefulness, irritability, and an inability to be consoled, often referred to as hyperactivity or agitation. Extreme lethargy and hypoactivity are signs of CNS depression or severe illness, which is contrary to the expected presentation of NAS.
Choice E rationale
The hyper-responsiveness of the newborn's CNS in NAS causes a characteristic high-pitched, non-stop, inconsolable crying. This shrill, distressed cry is due to the sustained state of irritability and neurological overstimulation, representing a significant manifestation of withdrawal symptoms that is distressing to both the newborn and the caregivers.
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