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A nurse is caring for a newborn who has myelomeningocele. Which of the following nursing goals has the priority in the care of this infant?

A.

Promote maternal-infant bonding.

B.

Maintain the integrity of the sac.

C.

Provide age-appropriate stimulation.

D.

Educate the parents about the defect.

Answer and Explanation

The Correct Answer is B

Rationale:

 

A. Promoting maternal-infant bonding is important but is secondary to addressing immediate physical concerns.

 

B. Maintaining the integrity of the sac is the priority in managing myelomeningocele. The sac should be protected from rupture or infection to prevent damage to the spinal cord and nerves.

 

C. Providing age-appropriate stimulation is important for development but is not as urgent as protecting the physical integrity of the sac.

 

D. Educating the parents about the defect is crucial for long-term care but does not take precedence over immediate physical needs.


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View Related questions

Correct Answer is C

Explanation

Rationale:

A. This statement is incorrect; effective asthma management should help the child attend school regularly rather than miss fewer days.

B. Coughing and shortness of breath in the morning usually indicate poor asthma control, not good control.

C. Eliminating allergens that irritate the lungs is an effective strategy for asthma management and prevention of attacks.

D. Proper asthma management should allow participation in physical activities, not exclude the child from them.

Correct Answer is D

Explanation

Rationale:

A. Temper tantrums are not classified as a learning disability; they are a normal part of toddler development.

B. A psychological consult is not necessary unless tantrums are severe or persistent and interfere significantly with the child's functioning or development.

C. Leaving the room during a tantrum may not be advisable; it is better to stay calm and ensure the child's safety while they express their frustration.

D. Temper tantrums are a normal developmental phase where toddlers express frustration and attempt to gain control of their environment. Understanding this helps parents manage tantrums effectively and respond appropriately.

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