Author Question: The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's ... (Read 64 times)

Ebrown · **on:** Jun 28, 2018

The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant's postoperative care include:

a. Arm restraints, postural drainage, and mouth irrigations.
b. Cleansing of suture line, supine and side-lying positions, and arm restraints.
c. Mouth irrigations, prone position, and cleansing of suture line.
d. Supine and side-lying positions, postural drainage, and arm restraints.

Question 2

The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis?

a. Abdominal rigidity and pain on palpation
b. Rounded abdomen and hypoactive bowel sounds
c. Visible peristalsis and weight loss
d. Distention of lower abdomen and constipation

nguyenhoanhat · **Reply #1 on:** Jun 28, 2018

Answer to Question 1

ANS: B
The suture line should be cleansed gently after feeding. The child should be positioned on back or side or in an infant seat. Elbows are restrained to prevent the child from accessing the operative site. Postural drainage is not indicated. This would increase the pressure on the operative site when the child is placed in different positions. Mouth irrigations would not be indicated.

Answer to Question 2

ANS: C
Visible gastric peristaltic waves that move from left to right across the epigastrium are observed in pyloric stenosis, as is weight loss. Abdominal rigidity and pain on palpation, and rounded abdomen and hypoactive bowel sounds, are usually not present. The upper abdomen is distended, not the lower abdomen.