Nokea
What finding should the nurse report to the physician immediately?
- A. Respiratory rate of 60 breaths/minute
- B. Pulse rate of 100 beats/minute
- C. Minimal verbalization
- D. Fussy behavior
Correct Answer: A
Rationale: A respiratory rate of 60 breaths/minute is above the normal range of 20 to 40 for a 1-year-old and indicates potential distress.
You may also like to solve these questions
What is the most appropriate recommendation to help this parent?
- A. Play the radio or TV while you feed the infant.
- B. Put the infant in a room with sunlight.
- C. Wrap the infant snugly when you hold them.
- D. Change the infant's position quickly.
Correct Answer: C
Rationale: Swaddling the infant snugly with extremities flexed and hands near the face helps soothe an irritable premature infant.
What statement made by a parent indicates correct understanding of infant feeding?
- A. I've been mixing rice cereal and formula in the baby's bottle.'
- B. I switched the baby to low-fat milk at 9 months.'
- C. The baby really likes little pieces of chocolate.'
- D. I give the baby new foods before he takes his bottle.'
Correct Answer: D
Rationale: Offering new solid foods before formula or breast milk encourages the infant to try new foods, promoting dietary variety.
Which statement made by the mother would indicate an unsafe behavior?
- A. I put covers on all of the electrical outlets.'
- B. In the car, she rides in a front-facing car seat.'
- C. There are locks on all of the cabinets in the house.'
- D. I have a gate at the top and bottom of the stairs.'
Correct Answer: B
Rationale: Infants younger than 1 year should use a rear-facing car seat for safety, making a front-facing car seat an unsafe choice.
What will the nurse advise a parent to do when introducing solid foods?
- A. Begin with one tablespoon of food.
- B. Mix foods together.
- C. Eliminate a refused food from the diet.
- D. Introduce each new food 4 to 7 days apart.
Correct Answer: D
Rationale: Introducing one new food every 4 to 7 days allows time to monitor for tolerance and potential allergies.
How might the nurse demonstrate the parachute reflex with an infant?
- A. Lifting the infant high in the air above her head
- B. Holding the infant in a football hold, cradling the head
- C. Seating the infant in a stroller in an upright position
- D. Placing the infant downward into the crib
Correct Answer: D
Rationale: The parachute reflex is demonstrated by placing the infant downward in a prone position, prompting protective arm extension.