The mother of a 4-year-old child tells a nurse that her child is reluctant to go to bed at night.
Which of the following responses should the nurse make?
Allow your child an additional 30 minutes of play time before bed.
Let your child sleep in your bed with you.
Keep a night light on in your child's room.
Stay with your child until he is asleep if he begins to cry.
The Correct Answer is C
Choice A rationale
Allowing an additional 30 minutes of play before bedtime can lead to overstimulation and delay the child's ability to settle down for sleep. Consistent bedtime routines are crucial for
establishing healthy sleep patterns in children.
Choice B rationale
Letting the child sleep in the parent's bed can create dependency and difficulty in establishing the child's own sleep routine and space. This practice can disrupt both the parent's and
child's sleep in the long term.
Choice C rationale
Keeping a night light on provides a sense of security and comfort for a child who may be afraid of the dark. This helps the child feel safe and can ease the transition to bedtime.
Choice D rationale
Staying with the child until they fall asleep, especially if crying, can reinforce the behavior and make it harder for the child to develop self-soothing skills. It can lead to increased
dependency on the parent's presence to fall asleep.
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Correct Answer is C
Explanation
Choice A rationale
Performing ROM exercises can cause stress on the infant's developing bones and muscles and is not the priority for spina bifida.
Choice B rationale
Feeding through an NG tube is not necessary unless the infant has feeding difficulties related to spina bifida.
Choice C rationale
Placing the infant in a prone position prevents pressure on the lesion, reducing the risk of injury and infection.
Choice D rationale
Covering the lesion with a dry cloth can cause the area to dry out and is not recommended; sterile, moist dressings are preferred.
Correct Answer is A
Explanation
Choice A rationale
Applying a sterile, moist dressing on the sac helps prevent infection and keeps the tissue moist, promoting healing.
Choice B rationale
Monitoring the infant's temperature rectally can increase the risk of infection and is not recommended.
Choice C rationale
Encouraging the guardian to cuddle with the infant is important for bonding but doesn't directly address the care of myelomeningocele.
Choice D rationale
Maintaining the infant in a supine position can put pressure on the sac, increasing the risk of rupture and infection.