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The nurse would assess respirations in a 9-month-old infant when the client is:

A.

Playing in the playroom.

B.

Crying.

C.

Sleeping.

D.

Laughing.

Answer and Explanation

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

Encouraging play exercises in the evening can lead to overstimulation, which can make it harder for the toddler to fall asleep. Physical activity should generally be done earlier in the day to help with sleep later on.

Choice B rationale

Turning off the room light can create a dark environment conducive to sleep, but it doesn’t address the need for a calming routine, which is essential for young children’s sleep. Some children also feel safer with a nightlight.

Choice C rationale

Providing bedtime rituals can help signal to the toddler that it is time to wind down and sleep. Consistent rituals, such as reading a story or singing a lullaby, provide a sense of security and comfort.

Choice D rationale

Explaining the source of the toddler’s fears may be beyond the cognitive ability of a toddler and does not directly promote sleep. It’s better to provide comfort and reassurance through routine.

Correct Answer is A

Explanation

Choice A rationale

Preterm newborns have underdeveloped mechanisms for thermoregulation, making it difficult for them to maintain stable body temperatures without external assistance.

Choice B rationale

Preterm newborns do not sweat significantly because their sweat glands are not fully developed; thus, this rationale is incorrect.

Choice C rationale

Preterm newborns actually have a larger body surface area relative to their weight, contributing to their difficulty in maintaining body temperature.

Choice D rationale

Preterm newborns have insufficient brown fat, not an excess, which impairs their ability to generate heat effectively.

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