what is the most appropriate nursing action when intermittently gavage feeding a preterm infant
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Nursing Elites

ATI RN

RN Nursing Care of Children 2019 With NGN

1. What is the most appropriate nursing action when intermittently gavage feeding a preterm infant?

Correct answer: A

Rationale: The correct action when intermittently gavage feeding a preterm infant is to allow the formula to flow by gravity. This method helps prevent overfeeding and aspiration, which can occur if the formula is delivered too quickly under pressure. Choice B is incorrect as sucking on the tube can cause complications. Choice C is incorrect as the tube is typically inserted through the mouth. Choice D is incorrect as steady pressure can lead to rapid delivery of the formula, increasing the risk of complications.

2. The nurse is planning care for a patient with a different ethnic background. Which should be an appropriate goal?

Correct answer: A

Rationale: Adapting ethnic practices to health needs respects the patient's cultural background while ensuring that care is effective and culturally sensitive.

3. Nurses should be alert for increased fluid requirements in which circumstance?

Correct answer: A

Rationale: Fever increases metabolic rate, leading to insensible water loss, thus requiring increased fluid intake. Mechanical ventilation, CHF, and increased intracranial pressure generally require fluid restriction rather than increased fluid intake.

4. If the needs of the infant are met in a loving, consistent manner, the infant will develop a sense of:

Correct answer: A

Rationale: The correct answer is A: Trust. According to Erikson's psychosocial development theory, when infants receive consistent and loving care, they develop trust. This trust forms the basis of the first stage of psychosocial development, known as Trust vs. Mistrust. Trust is essential for healthy social and emotional development. Choice B, Love, is incorrect as it is more of an emotion than a developmental stage. Choice C, Independence, typically occurs later in development during Erikson's Autonomy vs. Shame and Doubt stage. Choice D, Responsibility, is also not the correct answer as it relates more to later stages of development where individuals develop a sense of duty and obligation.

5. The nurse is taking a health history of an adolescent. Which best describes how the chief complaint should be determined?

Correct answer: B

Rationale: Asking the adolescent directly about the reason for their visit encourages open communication and helps the nurse understand the primary concern from the patient's perspective.

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