The nurse would assess respirations in a 9-month-old infant when the client is:
Playing in the playroom.
Crying.
Sleeping.
Laughing.
The Correct Answer is C
Choice A rationale
Playing might cause irregular breathing patterns due to excitement or activity, making it hard to get an accurate respiratory rate.
Choice B rationale
Crying can alter the normal breathing rate and pattern, resulting in an inaccurate assessment of respirations.
Choice C rationale
Sleeping provides the most accurate assessment of respirations, as the infant’s breathing will be at its natural, resting rate.
Choice D rationale
Laughing, similar to crying, causes irregular breathing patterns due to physical exertion and emotions, affecting accuracy.
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Correct Answer is C
Explanation
Choice A rationale
While knowing the adverse effects of medication is important, understanding why the child is taking the medication is crucial for ensuring adherence and proper administration.
Choice B rationale
Stopping medication when the child feels better can lead to incomplete treatment and antibiotic resistance. This is incorrect advice to give to parents.
Choice C rationale
Knowing the reason for taking the medication ensures that parents understand its importance, which promotes adherence to the prescribed regimen.
Choice D rationale
Using a kitchen spoon to administer medication can lead to inaccurate dosing. A proper measuring device, such as an oral syringe, should be used.
Correct Answer is D
Explanation
Choice A rationale
Administering vitamin K is important but not the immediate priority right after birth.
Choice B rationale
Administering eye prophylaxis is also necessary but comes after ensuring the newborn is dry to prevent heat loss.
Choice C rationale
Placing an identification bracelet is crucial but not as immediate as drying the skin to regulate the baby's temperature.
Choice D rationale
Drying the skin is the priority to prevent hypothermia by reducing evaporative heat loss right after birth