a nurse is caring for an 8 month old infant who screams when the parent leaves the room the parent begins to cry and says i dont understand why my chi
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Nursing Elites

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1. A nurse is caring for an 8-month-old infant who screams when the parent leaves the room. The parent begins to cry and says, 'I don't understand why my child is so upset. I've never seen my child act this way around others before.' Which of the following statements should the nurse make?

Correct answer: A

Rationale: The correct answer is 'This is a normal, expected reaction for a child of this age.' Separation anxiety typically peaks around 8-10 months of age, leading to distress when separated from caregivers. Choice B is incorrect because the infant's behavior is more likely due to separation anxiety rather than overstimulation. Choice C is incorrect as the infant's behavior is not related to overexposure to caregivers but rather a natural developmental stage. Choice D is incorrect as the infant's behavior is not indicative of illness but rather a normal emotional response.

2. Are the following statements both true: 'Most excess energy intake, whether from protein, carbohydrate, alcohol, or fat, is stored in the liver' and 'Fat is a good source of energy, but the preferred fuel is protein'?

Correct answer: B

Rationale: Both of the given statements are false. The first statement is inaccurate because the primary location for excess energy storage is not the liver, but rather adipose tissue where it is stored as fat. While the liver does have a role in energy storage and metabolism, it is not the main storage site for excess intake. The second statement is also incorrect. Although fat and protein can be used as sources of energy, the body's preferred source of energy is carbohydrates. They break down more efficiently and are easier for the body to use. The body prefers to conserve protein for other essential functions, such as tissue repair and the production of enzymes. Therefore, protein is not the preferred fuel source.

3. Each is a physiologic role of vitamin D, except one. Which is the exception?

Correct answer: A

Rationale: The correct answer is A, Hematopoiesis. Vitamin D plays a crucial role in regulating serum calcium levels, which is essential for maintaining cardiac and neuromuscular function. Additionally, vitamin D is involved in modulating immune responses. However, hematopoiesis, the formation of red blood cells, is not a direct physiologic role of vitamin D. Therefore, hematopoiesis is the exception among the listed functions of vitamin D.

4. A nurse is planning care for a toddler who has burns over 50% total body surface area. Which of the following actions should the nurse include in the plan of care?

Correct answer: A

Rationale: Administering enteral feedings is crucial for ensuring adequate nutrition and supporting healing in toddlers with extensive burns. Burns over 50% total body surface area can lead to increased metabolic demands, making it essential to provide nutrition through enteral feedings to meet the child's needs for healing and recovery. Limiting intake of vitamin C or dietary protein would be detrimental in this scenario as the child requires increased amounts of nutrients to support healing. Administering insulin prior to meals is not indicated in this case as the priority is to provide adequate nutrition to promote healing.

5. A client with gastroesophageal reflux disease is being taught by a nurse about managing the illness. Which of the following recommendations should the nurse include in the teaching?

Correct answer: C

Rationale: The correct recommendation for managing gastroesophageal reflux disease is to avoid eating within 3 hours of bedtime. This helps prevent acid reflux by allowing food to digest before lying down. Choices A, B, and D are incorrect. Limiting fluid intake not related to meals is not a standard recommendation for managing GERD. Chewing on mint leaves may worsen symptoms as mint can relax the lower esophageal sphincter, allowing stomach acid to flow back up. Seasoning foods with black pepper does not specifically help manage GERD.

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