A nurse is providing teaching to the parent of a newborn who has gastroesophageal reflux. Which of the following instructions should the nurse include?
Position the newborn at a 20-degree angle after feeding.
Dilute formula with 1 tablespoon of water.
Place the newborn in a side-lying position if vomiting.
Provide a small feeding just before bedtime.
The Correct Answer is A
Choice A reason: Positioning the newborn at a 20-degree angle after feeding can help prevent the reflux of gastric contents into the esophagus. This position allows gravity to keep the food in the stomach and reduces the pressure on the lower esophageal sphincter. The nurse should instruct the parent to keep the newborn in this position for at least 30 minutes after each feeding.
Choice B reason: Diluting formula with 1 tablespoon of water is not recommended, as it can cause water intoxication, electrolyte imbalance, and malnutrition in the newborn. Water intoxication can lead to seizures, coma, and death. The nurse should advise the parent to follow the manufacturer's instructions for preparing the formula and not to add extra water.
Choice C reason: Placing the newborn in a side-lying position if vomiting is not a safe practice, as it can increase the risk of aspiration and sudden infant death syndrome (SIDS). Aspiration is when food or liquid enters the lungs and causes pneumonia or respiratory distress. SIDS is when a healthy baby dies suddenly and unexpectedly during sleep. The nurse should instruct the parent to place the newborn on the back for sleeping and to avoid soft bedding, pillows, and stuffed animals.
Choice D reason: Providing a small feeding just before bedtime is not a good idea, as it can worsen the gastroesophageal reflux and disrupt the newborn's sleep. The nurse should suggest the parent to feed the newborn smaller and more frequent meals throughout the day and to avoid feeding the newborn within 2 to 3 hours of bedtime.
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Related Questions
Correct Answer is C
Explanation
Choice A reason: Formula should not be changed to whole milk until the infant is 12 months old, as whole milk does not provide enough iron and other nutrients for the infant's growth and development. Whole milk can also cause intestinal bleeding and increase the risk of allergies in infants younger than 12 months.
Choice B reason: Formula that remains in the bottle should not be used for another feeding, as it can harbor bacteria and cause infection. Any formula that is not consumed within one hour of preparation or feeding should be discarded.
Choice C reason: If the infant turns away after taking most of the feeding, it is a sign that the infant is full and satisfied. The nurse should instruct the parents to stop the feeding and burp the infant. Forcing the infant to finish the bottle can cause overfeeding and vomiting.
Choice D reason: If the infant is gaining weight too rapidly, diluting the formula is not a safe or effective solution. Diluting the formula can cause water intoxication, electrolyte imbalance, and malnutrition in the infant. The nurse should advise the parents to consult with the infant's doctor about the appropriate amount and type of formula for the infant.
Correct Answer is B
Explanation
Choice A reason: Bran cereal is high in phosphorus, containing about 34% of the DV per cup (118 g) ( 1 ). Phosphorus is a mineral that helps build strong bones and teeth, but too much of it can cause problems for people with kidney disease. The kidneys normally filter out excess phosphorus from the blood, but when they are damaged, phosphorus can build up and cause bone loss, itching, and calcification of blood vessels and organs ( 2 ).
Choice B reason: A medium apple is low in phosphorus, containing only 3% of the DV per 182 g ( 3 ). Apples are also a good source of fiber, vitamin C, and antioxidants. They can help lower blood pressure, cholesterol, and blood sugar levels, which are beneficial for people with kidney disease ( 4 ).
Choice C reason: Scrambled eggs are moderate in phosphorus, containing about 12% of the DV per large egg (50 g) ( 5 ). Eggs are also high in protein, which can increase the workload of the kidneys and worsen kidney function. People with kidney disease should limit their protein intake to 0.8 g per kg of body weight per day, unless advised otherwise by their doctor ( 6 ).
Choice D reason: Ground turkey is high in phosphorus, containing about 16% of the DV per 3 oz (85 g) ( 7 ). Ground turkey is also high in protein, which can have the same negative effects as eggs on kidney function. People with kidney disease should choose lean meats and poultry, and eat them in moderation.
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