Exhibit 1. Nurses' Notes.
Today, 1000: Exhibit 2. Infant here at the provider's office for a scheduled visit.
The infant is in their parent's arms, grimacing.
S1 and S2 auscultated, no murmur noted.
Respirations are symmetric and unlabored with abdominal movement.
Abdomen is soft and flat, bowel sounds present.
Current weight is 4.1 kg (9 lb) The parent states they have exclusively breast- and bottle-fed breastmilk to the infant since birth.
The parent states the infant sometimes chokes with bottle feedings.
The parent noticed that the infant recently started "spitting up" during the night and after feeds, and cries excessively.
They state the infant has been vomiting more forcefully and has become disinterested in feeding.
Today, 1010: Exhibit 3. Provider assessed infant and discussed gastroesophageal reflux with parent.
Education provided.
1 month later: Infant here for follow-up visit.
Infant is calm and alert in parent's arms.
Parent states infant is sleeping through the night.
Parent states infant continues to spit up. States they have been thickening bottle feedings and the infant has taken them well.
Current weight is 5 kg (11 lb)
What is the most notable change observed in the infant's condition during the one-month follow-up visit?
Sleeping pattern.
Irritability.
Weight.
Regurgitation.
Heart rate.
Bottle feeding.
Correct Answer : C,D,F
Choice A rationale:
The sleeping pattern is mentioned, but it does not provide relevant information regarding the infant's condition. The fact that the infant is sleeping through the night does not address the concerns related to gastroesophageal reflux.
Choice B rationale:
Irritability is mentioned in the notes, but it is not a parameter that directly reflects the improvement or worsening of the infant's condition. While irritability can be a symptom of discomfort due to reflux, it's not a parameter to monitor progress over time.
Choice C rationale:
Monitoring the infant's weight is crucial in this scenario. Weight gain is a significant indicator of the infant's overall health and nutritional status. A decrease in weight gain could indicate feeding difficulties or other health issues. In this case, the weight has increased, suggesting improvement in the infant's condition.
Choice D rationale:
Regurgitation is one of the main symptoms of gastroesophageal reflux. Monitoring the frequency and severity of regurgitation is essential to assess the effectiveness of interventions, such as thickened feedings. The persistence of regurgitation in this case indicates that the condition has not completely resolved.
Choice E rationale:
Heart rate is not mentioned in the provided information, and it does not provide relevant information about the infant's condition in this context.
Choice F rationale:
Bottle feeding is mentioned, specifically the thickening of feedings. This information is crucial in assessing the effectiveness of interventions for gastroesophageal reflux. Thickened feedings are often recommended to reduce regurgitation, and the fact that the parents have been thickening the feedings suggests an attempt to manage the condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Acute acetylsalicylic acid (aspirin) poisoning can lead to hyperpyrexia, which is an extremely high fever, often above 106°F (41.1°C) This hyperpyrexia occurs due to the toxic effects of salicylates on the hypothalamus, the part of the brain that regulates body temperature. Aspirin poisoning can disrupt the body's ability to regulate temperature, leading to a dangerously high fever.
Choice B rationale:
Neck vein distention is not a common symptom of acute acetylsalicylic acid poisoning. This finding is more indicative of issues related to the cardiovascular system, such as heart failure or fluid overload.
Choice C rationale:
Polyuria (excessive urination) is not a typical symptom of acute aspirin poisoning. Aspirin toxicity is more likely to cause dehydration due to increased respiratory rate and metabolic acidosis.
Choice D rationale:
Jaundice, the yellowing of the skin and eyes, is not a characteristic symptom of acute acetylsalicylic acid poisoning. Jaundice typically occurs in conditions affecting the liver, such as hepatitis or liver failure.
Correct Answer is ["A","D","E"]
Explanation
Choice A rationale: Offering the infant a pacifier during feedings can help with non-nutritive sucking, which is beneficial for the development of oral motor skills. It can also provide comfort and a sense of normalcy for the infant during tube feedings. This practice is encouraged to promote positive feeding experiences and support the infant's overall development.
Choice B rationale: Placing the infant in a supine position during feedings is not recommended due to the increased risk of aspiration. The preferred position is to keep the infant in an upright or semi-upright position to facilitate proper digestion and reduce the risk of gastroesophageal reflux and aspiration. Proper positioning is crucial for the safety and well-being of the infant during enteral feedings.
Choice C rationale: Heating the formula to 39°C (102°F) is not advised as it can be too hot and cause burns or discomfort to the infant. The formula should be administered at room temperature or slightly warmed to body temperature to ensure it is safe and comfortable for the infant. Proper temperature regulation is important to prevent thermal injuries.
Choice D rationale: Checking for residual volumes by aspirating stomach contents is an important step in assessing the infant's tolerance to the feeding. It helps determine if the previous feeding has been adequately digested and can indicate potential issues such as delayed gastric emptying. Regular assessment of residual volumes is a standard practice in managing enteral feedings for infants.
Choice E rationale: Instilling the formula over a period of 30 to 45 minutes is recommended to mimic normal feeding patterns and promote proper digestion. Slow and controlled administration of the feeding reduces the risk of gastrointestinal discomfort and aspiration. It also allows for better tolerance and absorption of the nutrients in the formula.
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