An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period?

Test the urine for protein

Reposition the infant frequently.

Assess blood pressure every 15 minutes

Provide a stimulating environment

Answer and Explanation

The Correct Answer is B

A. Test the urine for protein.
Explanation: Testing urine for protein is not a priority nursing intervention in the preoperative period for an infant with hydrocephalus. The focus is on preventing complications related to immobility and positioning.
B. Reposition the infant frequently.
Explanation:
Repositioning the infant frequently is a crucial intervention to prevent complications such as pressure ulcers (bedsores). Infants with hydrocephalus may be at an increased risk of skin breakdown due to prolonged immobility and pressure on specific areas. Repositioning helps distribute pressure, improves circulation, and reduces the risk of skin breakdown.
C. Assess blood pressure every 15 minutes.
Explanation: While monitoring blood pressure is important in certain situations, it is not typically the priority for an infant with hydrocephalus in the preoperative period. The focus is on preventing skin breakdown through repositioning.
D. Provide a stimulating environment.
Explanation: While providing a stimulating environment can be beneficial for infant development, it is not the priority in the preoperative period for an infant with hydrocephalus. The primary concern is addressing potential complications related to immobility, such as skin breakdown.

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Correct Answer is D

Explanation

A. When a parent is holding the infant
Explanation: Being held by a parent is generally a comforting and calming experience for an infant, and it is unlikely to significantly increase oxygen demand. In fact, the presence of a familiar caregiver may help reduce stress.
B. During sleep
Explanation: During sleep, an infant's oxygen demand may decrease, and oxygen supplementation may not be necessary unless there are specific indications or concerns about oxygen saturation levels.
C. When changing the infant's diapers
Explanation: Changing a diaper is a routine care activity that is not likely to significantly increase oxygen demand. It is not typically associated with stress or increased metabolic activity that would necessitate additional oxygen.
D. When drawing blood for electrolyte level testing
Explanation:
Drawing blood for electrolyte level testing is a potentially stressful procedure that may cause distress and anxiety in the infant. Stress and anxiety can increase the metabolic rate and oxygen demand. In a situation where an infant is already prescribed oxygen as needed for heart failure, additional stressors like blood drawing may necessitate the administration of oxygen to ensure an adequate oxygen supply

A. Rye toast B. Rice C. wheat bread D. Oatmeal

Correct Answer is B

Explanation

A. Rye toast
Explanation: Rye contains gluten, so it is not appropriate for individuals with celiac disease. Rye, like wheat and barley, should be avoided.
B. Rice
Explanation:
Celiac disease is a condition characterized by an immune reaction to gluten, a protein found in wheat, barley, and rye. Therefore, individuals with celiac disease need to avoid gluten-containing foods. Rice is naturally gluten-free, making it a suitable and safe option for individuals with celiac disease.
C. Wheat bread
Explanation: Wheat contains gluten, and products made from wheat, including wheat bread, should be strictly avoided by individuals with celiac disease.
D. Oatmeal
Explanation: Oats themselves are gluten-free, but they are often contaminated with gluten during processing. Some individuals with celiac disease can tolerate pure, uncontaminated oats, while others may need to avoid oats altogether. It is important to choose certified gluten-free oats if including them in the diet.

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An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period?

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