The parent of a 7-month-old infant visits the clinic due to the infant’s diaper area being red and raw, but without any blisters or bleeding.
The parent reports no signs of watery stools.
What nursing intervention should the nurse implement?
Advise the parent to reduce the infant’s fruit intake for 24 hours.
Recommend the parent to clean with soap and water at each diaper change.
Instruct the parent to change the child’s diaper more frequently.
Encourage the parent to apply lotion with each diaper change.
The Correct Answer is C
Choice A rationale
Reducing the infant’s fruit intake for 24 hours is not the best approach in this situation. While certain fruits can cause diarrhea, the parent reports no signs of watery stools. Therefore, this intervention may not address the issue of the red and raw diaper area.
Choice B rationale
Cleaning with soap and water at each diaper change can actually worsen the condition. Soap can dry out the skin and disrupt the skin’s natural barrier, potentially leading to more irritation. It’s generally recommended to use water and a soft cloth, or a gentle non-soap cleanser, to clean the diaper area.
Choice C rationale
Changing the child’s diaper more frequently is the most appropriate intervention. A wet or dirty diaper can irritate the skin, leading to diaper rash. By changing the diaper more often, the skin is kept clean and dry, which can help the rash heal.
Choice D rationale
Applying lotion with each diaper change is not typically recommended for diaper rash. Some lotions can contain fragrances or other ingredients that can further irritate the rash. Instead, a barrier cream or ointment, such as one containing zinc oxide, is often recommended.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Roast pork is a protein source and does not contribute to fiber content. However, fresh strawberries are high in fiber and may not be suitable for a low-fiber diet.
Choice B rationale
Roasted turkey is a good source of protein and does not contribute to fiber content. Canned vegetables are typically lower in fiber than their fresh or frozen counterparts because the canning process tends to degrade some of the fiber. Therefore, this food selection indicates that the patient understands the prescribed low-fiber diet.
Choice C rationale
Both baked potatoes with skin and raw carrots are high in fiber. The skin of the potato and raw carrots contain insoluble fiber, which may not be suitable for a patient with ulcerative colitis on a low-fiber diet.
Choice D rationale
Pancakes made from refined flour can be part of a low-fiber diet. However, whole-grain cereals are high in fiber and may not be suitable for a patient with ulcerative colitis on a low-fiber diet.
Correct Answer is C
Explanation
Choice A rationale
While understanding risk factors for osteoporosis is important, it is not the highest priority for an older adult client diagnosed with osteoporosis. The highest priority is ensuring the client’s safety to prevent falls and fractures.
Choice B rationale
While constipation due to immobility can be a concern for clients with osteoporosis, it is not the highest priority for an older adult client diagnosed with osteoporosis. The highest priority is ensuring the client’s safety to prevent falls and fractures.
Choice C rationale
Identifying home safety hazards to be resolved immediately is the highest priority for an older adult client diagnosed with osteoporosis. Osteoporosis increases the risk of fractures, and falls are a common cause of fractures in older adults. Therefore, ensuring a safe environment is crucial.
Choice D rationale
While adding calcium-rich foods to the daily diet can help manage osteoporosis, it is not the highest priority for an older adult client diagnosed with osteoporosis. The highest priority is ensuring the client’s safety to prevent falls and fractures.
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