A nurse is presenting an in-service about the use of postural drainage for infants who have cystic fibrosis. Which of the following positions should the nurse identify as being contraindicated for the infant?
Sitting on a nurse’s lap leaning forward.
Supine.
Sitting on a nurse’s lap leaning backward.
Trendelenburg.
The Correct Answer is D
Choice A rationale
Sitting on a nurse’s lap leaning forward is a position that can be used for postural drainage in infants with cystic fibrosis. This position helps drain secretions from the upper lobes of the lungs.
Choice B rationale
The supine position (lying on the back) is also used for postural drainage to target different areas of the lungs. It is not contraindicated for infants with cystic fibrosis.
Choice C rationale
Sitting on a nurse’s lap leaning backward is another position that can be used for postural drainage. This position helps drain secretions from the lower lobes of the lungs.
Choice D rationale
The Trendelenburg position (lying flat on the back with the feet elevated higher than the head) is contraindicated for infants with cystic fibrosis. This position can increase the risk of gastroesophageal reflux and aspiration, which can worsen respiratory symptoms.
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Correct Answer is A
Explanation
Choice A rationale
Auscultating the rate and characteristics of the child’s heart sounds is the priority assessment. Acute rheumatic fever can lead to carditis, which affects the heart valves and can cause new or changed heart murmurs.
Choice B rationale
Assessing the client’s erythematous rash is important but not the priority. The rash is a common symptom but does not indicate the severity of the condition.
Choice C rationale
Identifying the degree of parental anxiety is important for providing holistic care but is not the immediate priority in assessing the child’s physical condition.
Choice D rationale
Using a pain-rating tool to determine the severity of joint pain is important for managing symptoms but is not the priority assessment upon admission.
Correct Answer is D
Explanation
Choice A rationale
Talking to the baby each day at a special time can help build a bond and promote language development. However, it is not the most important factor in promoting the infant’s development of trust. Consistent and responsive caregiving is more crucial in building trust.
Choice B rationale
Having many caregivers caring for the baby can lead to inconsistency in caregiving. According to Erikson’s theory of psychosocial development, infants need consistent and reliable caregiving to develop a sense of trust. Multiple caregivers can create confusion and insecurity for the baby.
Choice C rationale
Stimulating the baby with many toys can promote cognitive and motor development. However, it is not the most important factor in promoting the infant’s development of trust. Consistent and responsive caregiving is more crucial in building trust.
Choice D rationale
Responding to the baby’s needs consistently is the most important factor in promoting the infant’s development of trust. According to Erikson’s theory, infants develop trust when their caregivers are reliable and responsive to their needs. This consistent caregiving helps the baby feel secure and builds a foundation for healthy emotional development. .