The parents of a 2-day-old girl are concerned because her feet and hands are slightly blue. How should the nurse respond?

“This is a vasomotor response caused by cooling or warming."

“This is normal her circulatory system will take a few days to adjust.”

"Let's watch her carefully to make sure she does not have a circulatory problem."

"Your daughter has acrocyanosis; this is causing her blue hands and feet.”

Answer and Explanation

The Correct Answer is D

A. “This is a vasomotor response caused by cooling or warming": While vasomotor responses can cause changes in skin color due to temperature changes, acrocyanosis specifically refers to blue discoloration of the hands and feet due to reduced peripheral circulation, not necessarily due to temperature changes.

B. “This is normal her circulatory system will take a few days to adjust”: While it's true that newborns may have transient circulatory changes as their circulatory system adapts after birth, acrocyanosis specifically refers to a benign condition characterized by persistent blue discoloration of the extremities unrelated to circulatory adjustments.

C. "Let's watch her carefully to make sure she does not have a circulatory problem": While it's important to monitor infants for any signs of circulatory problems, acrocyanosis is typically a

benign and self-limiting condition that does not require intervention unless accompanied by other concerning symptoms.

D. "Your daughter has acrocyanosis; this is causing her blue hands and feet.”: This response provides an accurate explanation for the blue discoloration of the infant's hands and feet. Acrocyanosis is a common and benign condition in newborns characterized by blue discoloration of the extremities due to peripheral vasoconstriction, which gradually resolves over the first few days to weeks of life.

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Correct Answer is C

Explanation

A. Transduction - Transduction refers to the process of reasoning from one specific instance to another without necessarily understanding the broader concept. The girl's statement about the sky and her throat does not demonstrate this mental process.

B. Centration - Centration involves focusing on only one aspect of a situation while ignoring others. The girl's statement may involve a degree of focus, but it's more indicative of a broader imaginative process.

C. Magical thinking - Magical thinking involves attributing human emotions or characteristics to inanimate objects or natural phenomena. The girl's belief that the sky is crying because it's sad about her throat hurting reflects this type of thinking.

D. Animism - Animism is a belief system that attributes life or consciousness to natural objects or phenomena. While the girl's statement involves anthropomorphizing the sky, it specifically

involves emotions rather than attributing life itself to the sky. Therefore, magical thinking is a more accurate description.

A. "I will give him a pacifier during feeding time." B. "We need to make sure he doesn't lose the desire to eat by mouth." C. "We need to keep feeding time very quiet." D. "Sucking produces saliva, which aids in digestion."

Correct Answer is A

Explanation

A. "I will give him a pacifier during feeding time.": Giving a pacifier during feeding time may interfere with the infant's ability to coordinate sucking, swallowing, and breathing, especially if

they are receiving nutrition through a nasogastric tube. This response indicates a need for further teaching because pacifiers during feeding time could potentially disrupt the infant's feeding

pattern and may not be appropriate in this situation.

B. "We need to make sure he doesn't lose the desire to eat by mouth.": This response

demonstrates an understanding of the importance of maintaining the infant's oral feeding skills and indicates appropriate knowledge about promoting oral feeding while using a nasogastric

tube.

C. "We need to keep feeding time very quiet.": Keeping feeding time quiet can help reduce distractions and promote a calm environment, which may enhance feeding tolerance for the infant. This response reflects an understanding of strategies to facilitate feeding.

D. "Sucking produces saliva, which aids in digestion.": This response demonstrates knowledge about the benefits of sucking and saliva production during feeding, indicating an understanding of the infant's physiological needs during feeding.

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The parents of a 2-day-old girl are concerned because her feet and hands are slightly blue. How should the nurse respond?

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a 5-year-old girl post-tonsillectomy. The girl looks out the window and tells the nurse that it is raining and says. The sky is crying because it is sad that my throat hurts." The nurse understands that the girl is demonstrating which mental process?

Correct Answer is C

Explanation

The nurse is providing teaching for the mother of an infant who receives all of his nutrition through a nasogastric feeding tube. The nurse is reviewing interventions to promote growth and development. Which response from the mother indicates a need for further teaching?

Correct Answer is A

Explanation

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