Nclex Review with Rationales (PEDIATRICS)

Which of the following instructions should the nurse include in her teaching plan for the parents of Liam with otitis media? 1. Placing the child in the supine position to bottle-feed 2. Giving prescribed amoxicillin (Amoxil) on an empty stomach 3. Cleaning the inside of the ear canals with cotton swabs 4. Avoiding contact with people who have upper respiratory tract infections

Answer: D.) Avoiding contact with people who have upper respiratory tract infections RATIONALE: Otitis media is commonly precipitated by an upper respiratory tract infection. Therefore, children prone to otitis should avoid people known to have an upper respiratory tract infection. 1: A bottle-fed child should be fed in an upright position because feeding the child in the supine position may actually precipitate otitis by allowing the formula to pool in the pharyngeal cavity. 2: Amoxicillin, when prescribed, should be given with food to prevent stomach upset. 3: Cotton swabs can cause injuries such as tympanic perforation. They may be used to clean the outer ear, but they should never be inserted into the ear canal.

Which of the following would Nurse Tony suppose to regard as a cardinal manifestation or symptom of digoxin toxicity to his patient Clay diagnosed with heart failure? A. Headache B. Respiratory distress C. Extreme bradycardia D. Constipation

answer: c.) extreme bradycardia rationale: Extreme bradycardia is a cardinal sign of digoxin toxicity

Which of the following is the best method for performing a physical examination on a toddler 1. From head to toe 2. Distally to proximally 3. From abdomen to toes, the to head 4. From least to most intrusive

Answer: 4. From least to most intrusive RATIONALE: When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive.

On physical assessment of the patient with severe anemia the nurse would expect to find? 1. nervousness and agitation 2. fever and tenting of the skin 3. systolic murmur and tachycardia 4. bluish mucous membranes and reddened

answer: 3.) systolic murmors and tachycardia RATIONALE: tachycardia occurs in severe anemia as the body compensates for hypoxemia. The low viscosity of the blood contributes to the development of systolic murmurs and bruits.

Clay is an 8-year-old boy diagnosed with heart failure. Which of the following shows that he is strictly following the directed therapeutic regimen? A. Daily use of an antibiotic B. Pulse rate less than 50 beats/minute C. Normal weight for age D. Elevation in red blood cell (RBC) count

answer: c.) normal weight for age rationale: Adequate weight for height demonstrates adequate nutritional intake and lack of edema.

The nurse is reviewing the laboratory results of an infant suspected of having hypertrophic pyloric stenosis. Which acid-base disorder would the nurse expect to note in the infant? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

ANS: 2 RATIONALE: Laboratory findings in an infant with hypertrophic pyloric stenosis include metabolic alkalosis as a result of the vomiting (depletes acid) that occurs in this disorder. Additional findings include decreased serum potassium and sodium levels, increased pH and bicarbonate, and decreased chloride level.

The nurse is monitoring for fluid volume deficit in an infant who is vomiting and having diarrhea. The nurse weighs the infant's diaper after each voiding and stool and carefully calculates fluid volume based on which knowledge? 1. Each gram of diaper weight is equivalent to 0.5 mL of urine. 2. Each gram of diaper weight is equivalent to 1 mL of urine. 3. Each gram of diaper weight is equivalent to 2 mL of urine. 4. Each gram of diaper weight is equivalent to 2.5 mL of urine.

ANS: 2 Rationale: When monitoring for fluid volume deficit, the nurse should weigh the infant's diaper after each voiding and stool. Each gram of diaper weight is equivalent to 1 mL of urine.

The nurse is assigned to care for a child who is scheduled for an appendectomy. Which prescriptions does the nurse anticipate to be prescribed? (Select all that apply.) 1. Administer a Fleet enema. 2. Initiate an intravenous line. 3. Maintain nothing-by-mouth status. 4. Administer intravenous antibiotics. 5. Administer preoperative medications. 6. Place a heating pad on the abdomen to decrease pain.

ANS: 2, 3, 4, 5 Rationale: During the preoperative period, enemas or laxatives should not be administered. In addition, heat should not be applied to the abdomen. Any of these interventions can cause the rupture of the appendix and resultant peritonitis. Intravenous fluids would be started, and the child should receive nothing by mouth while awaiting surgery. Antibiotics are usually administered because of the risk of perforation. Preoperative medications are administered as prescribed.

The nurse is caring for a child who is scheduled for an appendectomy. When the nurse reviews the health care provider's preoperative prescriptions, which should be questioned? . 1. Administer a Fleet enema. 2. Maintain nothing per mouth (NPO) status. 3. Maintain intravenous (IV) fluids as prescribed. 4. Administer preoperative medication on call to the operating room.

ANSWER: 1.) ADMINISTER A FLEET ENEMA Rationale: In the preoperative period, enemas or laxatives should not be administered. No heat should be applied to the abdomen because this may increase the chance of perforation secondary to vasodilation. IV fluids would be started and the child would be NPO. Prescribed preoperative medications most likely would be administered on call to the operating room.

A nurse is planning care for a client who has a Hgb of 7.5 and a Hct of 21.5. Which of the following should the nurse include in the plan of care? (select all that apply) 1. provide assistance with ambulation 2. monitor oxygen saturation 3. weigh client weekly 4. obtain stool specimen for occult blood 5. schedule daily rest periods

Answer: 1, 2, 4, 5 Rationale: A client with anemia may be dizzy and should be assisted to prevent falls. Oxygen should be monitored due to decreased O2 carrying capacity in the blood. They should be weight DAILY not weekly. Stool testing is performed to identify the cause of anemia due to GI bleeding. A client may experience fatigue so rest period should be planned to conserve energy.

You are assigned to care for a neonate who has a very low-birth-weight. You carefully monitor inspiratory pressure and oxygen (O2) concentration to prevent which of the following? 1. Meconium aspiration syndrome 2. Bronchopulmonary dysplasia (BPD) 3. Respiratory syncytial virus (RSV) 4. Respiratory distress syndrome (RDS)

Answer: 2.) Bronchopulmonary dysplasia (BPD) RATIONALE: Close monitoring of inspiratory pressure and O2 concentration is necessary to prevent BPD, which is related to the use of high inspiratory pressures and O2 concentrations especially in very low-birth-weight and extremely low-birth-weight neonates with lung disorders. 1: Meconium aspiration syndrome is a respiratory disorder created by the aspiration of meconium in perinatal period. 3: RSV is a group of viruses that cause respiratory tract infections, such as bronchiolitis and pneumonia. 4: RDS, a disorder caused by lack of surfactant, usually is found in premature neonates.

A nurse is completing an integumentary assessment of a client who has anemia. Which of the following is an expected finding? 1. Absent turgor 2. Spoon-shaped nails 3. Shiny, hairless legs 4. Yellow mucous membranes

Answer: 2.) Spoon-shaped nails RATIONALE: Deformities of the nails, such as being spoon-shaped, are a finding in a client who has anemia.

Fred is a 12-year-old boy diagnosed with pneumococcal pneumonia. Which of the following would you expect to assess? A. Mild cough B. Slight fever C. Chest pain D. Bulging fontanel

Answer: 3.) Chest pain Rationale: Older children with pneumococcal pneumonia may complain of chest pain. 1,2: A mild cough and slight fever are commonly assessed with viral pneumonia. 4: A bulging fontanel may be seen in infants with meningitis or increased intracranial pressure.

The nurse assists with admitting a child with a diagnosis of acute-stage Kawasaki disease. When obtaining the child's medical history, which manifestation is likely to be noted? 1. Cracked lips 2. A normal appearance 3. Conjunctival hyperemia 4. Desquamation of the skin

Answer: 3.) conjunctival hyperemia Rationale: During the acute stage of Kawasaki disease, the child presents with fever, conjunctival hyperemia, a red throat, swollen hands, a rash, and enlargement of the cervical lymph nodes. During the subacute stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac manifestations, and thrombocytosis occur. During the convalescent stage, the child appears normal, but signs of inflammation may be present.

A mother arrives at the emergency department with her child and a diagnosis of epiglottitis is documented. Which of the health care provider's prescription should the nurse question? 1. Obtain a throat culture. 2. Obtain axillary temperatures. 3. Administer humidified oxygen. 4.Administer antipyretics for fever.

answer: 1 The throat of a child with suspected epiglottitis should not be examined or cultured because any stimulation with a tongue depressor or culture swab could cause laryngospasm and complete airway obstruction. Humidified oxygen and antipyretics are components of the treatment. Axillary rather than oral temperatures should be taken.

A nurse is providing discharge teaching to a client who has a gastrectomy for stomach cancer. Which of the following information should be included in the teaching? (select all that apply) 1. you will need a monthly injection of vitamin b12 for the rest of your life 2. using nasal spray of vitamin b12 may be an option daily 3. an oral supplement of vitamin b12 may be taken as an option daily 4. u should increase animal proteins, legumes, dairy to increase vitamin b12 5. add soy milk with vitamin b12 to your diet to decrease risk of pernicious anemia

answer: 1 & 2 RATIONALE: A client with gastrectomy will require monthly injections of vitamin b12 for the rest of his life. Cyanocobalamin nasal spray is an option for a client with gastrectomy. The rest will not be absorbed due to lack of intrinsic factor produced by stomach.

The nurse is working with a woman who is pregnant and her husband. The husband asks the nurse why his wife has a folic acid deficiency when she eats healthy meals. The nurse best responds with which of the following? 1.Pregnancy increases metabolic requirements for folic acid. 2.There is inadequate dietary intake of folic acid. 3.Pregnancy causes malabsorption of folic acid. 4.The client has some form of impaired metabolism

answer: 1.) Pregnancy increases metabolic requirements for folic acid. Rationale: Pregnancy increases the metabolic requirements for folic acid. Since the husband states that they eat healthy meals, inadequate intake of folic acid is a less likely cause of the deficiency. Malabsorption and impaired metabolism are causes of folic acid deficiency that are not associated with pregnancy.

A patient has a folic acid deficiency related to chronic alcohol abuse. The nurse would expect a complete blood cell count (CBC) to reveal 1. macrocytic, normochromic RBC 2. normocytic, normochromic RBC 3. microcytic, hypochromic RBC 4. microcytic, normochromic RBC

answer: 1.) macrocytic, normochromic rbc RATIONALE: With folic acid deficiency, the cells are larger than normal, but the iron levels are normal or elevated, leading to findings of a macrocytic, normochromic anemia. NOTE: (macrocytes = enlarged RBCs) *Macrocytosis can be attributed to alcoholism whether or not there is liver disease present. In alcoholics, macrocytosis is often indicative of poor absorption of B12 or folic acid. *Normocytic anemia means you have normal-sized red blood cells, but you have a low number of them.

A mother of a child with cystic fibrosis asks the nurse when the postural drainage should be performed. The mother states that the child eats meals at 8:00 am, 12 noon, and at 6:00 pm. What times should the nurse tell the mother to perform postural drainage?

answer: 10:00 am, 2:00 pm, 8:00 pm rationale: Respiratory treatments should be performed at least 1 hour before meals or 2 hours after meals to prevent vomiting. In some children with cystic fibrosis, treatments are prescribed every 2 hours, particularly if infection is present. It is also important to perform these treatments before bedtime to clear airways and facilitate rest.

A nurse who is working in the emergency department is caring for a child who has been diagnosed with epiglottitis. Indications that the child may be experiencing airway obstruction include which of the following? 1. Nasal flaring and bradycardia 2. The child thrusts the chin forward and opens the mouth 3. A low-grade fever and complaints of a sore throat 4. The child leans backward, supporting himself or herself with the hands and arms

answer: 2 Rationale: Clinical manifestations that are suggestive of airway obstruction include tripod positioning (leaning forward supported by the hands and arms with the chin thrust out and the mouth open), nasal flaring, TACHYCARDIA, a high fever, and a sore throat.

A patient with thrombocytopenia with active bleeding has 2 units of platelets prescribed. To administer the platelets the nurse: 1. checks for ABO compatibility 2. agitates the bag periodically during the transfusion 3. takes vital signs q15 minutes during the procedure 4. refrigerates the second unit until the first unit has transfused

answer: 2.) agitates the bag periodically during the transfusion RATIONALE: Platelets adhere to plastic bags and should be gently agitated throughout the transfusion. Platelets do not have A, B or Rh antibodies (ABO compatibility is not a consideration). Baseline vital signs should be taken before the transfusion is started and the nurse should stay with patient during the first 15 minutes. Platelets are stored at room temperature and should NOT be refrigerated

The mother of a child who had a myringotomy with insertion of tympanostomy tubes calls the nurse and tells the nurse that the "tubes" fell out. The nurse should make which response to the mother? 1."Replace the tubes immediately so that the created opening does not close." 2."Soak the tubes in alcohol for 1 hour before replacing them in the child's ears." 3."This is not an emergency. I will speak to the health care provider and call you right back." 4."This is an emergency and requires immediate intervention. Bring the child to the emergency department."

answer: 3 RATIONALE: The size and appearance of the tympanostomy tubes should be described to the parents following surgery. They should be reassured that if the tubes fall out, it is not an emergency but that the health care provider should be notified. The tubes cannot be replaced without surgical intervention.

During care for patient with thrombocytopenia, the nurse 1. takes frequent temperatures to assess for fever 2. maintains the patient on strict bed rest to prevent injury 3. monitors patient for headaches, vertigo, or confusion 4. removes oral crusting and scabs with firm friction every two hours

answer: 3 Rationale: The major complication of thrombocytopenia is hemorrhage, and it may occur in any area of the body. Cerebral hemorrhage may be fatal and evaluation of mental status for CNS alteration to identify CNS bleeding is very important. Fever is not a common finding in thrombocytopenia. Protection from injury to prevent bleeding is an important nursing intervention, but strict bed rest is not indicated. Oral care is performed very gently with minimum friction and soft swabs

A 10-year-old child with asthma is treated for acute exacerbation. Which finding would indicate that the condition is worsening? 1. Warm, dry skin 2. Increased wheezing 3. Decreased wheezing 4. A pulse rate of 90 beats per minute

answer: 3 rationale: Decreased wheezing in a child who is not improving clinically may be interpreted incorrectly as a positive sign, when in fact it may signal an inability to move air. A "silent chest" is an ominous sign during an asthma episode. With treatment, increased wheezing may actually signal that the child's condition is improving. Warm, dry skin indicates an improvement in the condition because the child is normally diaphoretic during exacerbation. The normal pulse rate in a 10-year-old is 70 to 110 beats per minute.

A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as e precipitating factor, indicates the need for further instructions? 1. infection 2. trauma 3. fluid overload 4. stress

answer: 3) Fluid Overload Rationale: Pain crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1.5-2 times the daily requirement to prevent dehydration.

Sickle cell crisis may be precipitated by dehydration, not fluid overload. Infection, trauma, and stress are all factors that may cause sickle cell crisis. A pregnant woman tells the nurse that there is a history of sickle cell disease in her family and she is afraid that the baby will have the disease. The nurse provides the client with which of the following information? 1. Sickle cell is a male disease and would be passed on by the baby's father. 2. The baby needs only one parent to be a carrier to be affected. 3. Both the mother and father must carry the gene for the baby to be affected. 4. Genetic testing will be needed to determine if the baby is affected.

answer: 3.) Both the mother and father must carry the gene for the baby to be affected. Rationale: Sickle cell is inherited as an AUTOSOMAL RECESSIVE DISORDER. Both parents must carry the gene for the baby to be affected. The other statements are inaccurate.

The nurse following a client after a gastric resection observes carefully for evidence of nutritional deficiency anemia related to malabsorption including which of the following? 1.Bone pain 2.Dark yellow or bronze skin 3.Numbness and tingling of extremities 4. Steatorrhea

answer: 3.) Numbness and tingling of extremities Rationale:The client who has had a gastric resection is at risk for anemia because intrinsic factor may decrease, leading to vitamin B12 deficiency anemia with associated neurologic deficits such as numbness and tingling of extremities. The other symptoms are not related to nutritional deficiency anemia.

Which of the following foods would the nurse encourage the client in sickle cell crisis to eat? 1. Peaches 2. Cottage cheese 3. Popsicle 4. Lima beans

answer: 3.) Popsicle Rationale: Hydration is important in the client with sickle cell disease to prevent thrombus formation. Popsicles, gelatin, juice, and pudding have HIGH FLUID CONTENT.

Which of the following respiratory conditions is always considered a medical emergency? 1. Asthma 2. Cystic fibrosis (CF) 3. Epiglottitis 4. Laryngotracheobronchitis (LTB)

answer: 3.) epiglottitis rationale: epiglottitis is an acute and severe inflammation of the epiglottis, is always considered an acute medical emergency because it can lead to acute, life-threatening airway obstruction.

Following a splenectomy for treatment of immune thrombocytopenic purpura, the nurse would expect the patients lab results to reveal 1. decreased rbc 2. decreased wbc 3. increased platelets 4. increased immunoglobulins

answer: 3.) increased platelets RATIONALE: Immune Thrombocytopenic Purpura (ITP) is a kind of thrombocytopenia which is characterized by the destruction of the thrombocytes in the spleen. Due to thrombocytopenia, the bleeding time is increased. This results in comparatively larger amount of blood loss and severe hemorrhage in case of major injuries. As a result, the Red Blood Cell (RBC) count decreases. When the spleen is removed by splenectomy, the destruction of the thrombocytes stops and the platelet count comes back to normal. This in turn reduces blood loss and the RBC count consequently increases. Since, destruction of the thrombocytes is reduced after splenectomy and the subsequent blood loss is prevented, the number of thrombocytes and other White Blood Cells (WBCs) increase. Immunoglobulins are synthesized by the B-cells. These B-cells are stored in the spleen for maturation. Therefore, splenectomy decreases the amount of immunoglobulin.

The nurse is assisting with data collection from an infant who has been diagnosed with hydrocephalus. If the infant's level of consciousness diminishes, which is a priority intervention? 1. Taking the apical pulse 2. Taking the blood pressure 3.Testing the urine for protein 4.Palpating the anterior fontanel

answer: 4 A full or bulging anterior fontanel indicates an increase in cerebrospinal fluid collection in the cerebral ventricle. Apical pulse and blood pressure changes and proteinuria are not specifically associated with increasing cerebrospinal fluid in the brain tissue in an infant.

The nurse is teaching breast self-examination (BSE) to a client who has had a hysterectomy. Which time of the month should the nurse tell the client to perform breast self-examination? 1. At ovulation time 2. 7 to 10 days after menses 3. Just before the menses begins 4. On a specific day of the month and on that same day every month thereafter

answer: 4 Rationale: If the client has had a hysterectomy or is no longer menstruating, the BSE should be performed on the same day every month. Options 2 and 3 are inappropriate because the client who had a hysterectomy would not be menstruating. It is best not to perform the BSE at ovulation time because of the hormonal changes that occur.

The nurse receives a call from the mother whose child has a foreign body in the eye. The object is clearly visible and not embedded. When the mother asks for the most effective way to get it out, the nurse should give which response? 1. Irrigate the eye with natural tears. 2. Irrigate the eye with running tap water. 3. Let the object just "work its way out" of the eye. 4. Touch the object gently with a cotton swab, and lift it out.

answer: 4 Rationale: The most effective method that would cause the least amount of trauma would be to lift the foreign body from the eye. It should not be allowed to remain and "work its way out." Irrigating the eye may cause the foreign body to move and cause trauma in another area of the eye.

The nurse prepares to administer an intravenous (IV) medication when the nurse notes that the medication is incompatible with the IV solution. Which is the best intervention for the nurse to implement for safe medication administration? 1. Ask the provider to prescribe a compatible IV solution. 2 Start a new IV catheter for the incompatible medication. 3 Collaborate with the provider for a new administration route. 4 Flush tubing before and after administering the medication with normal saline.

answer: 4.) flush tubing before & after administering the medication with normal saline Rationale: When giving a medication intravenously, if the medication is incompatible with the IV solution, the tubing is flushed before and after the medication with infusions of normal saline to prevent in-line precipitation of the incompatible agents. Starting a new IV, changing the solution, or changing the administration route are unnecessary because a simpler, less risky, viable option exists.

A 5-year-old girl Hannah is recently diagnosed with Kawasaki disease. Apart from the identified symptoms of the disease, she may also likely develop which of the following? A. Sepsis B. Meningitis C. Mitral valve disease D. Aneurysm formation

answer: D.) aneurysm formation RATIONALE: Kawasaki disease is a rare childhood illness that affects the blood vessels. 20% to 25% of children can develop aneurysm formation if not intervened. Treatment depends on the degree of the disease, but is often immediate treatment with IV gamma globulin or aspirin. Corticosteroids can sometimes lessen impending complications. Children who experience the disease usually need lifelong follow-up appointments to keep an eye on heart health.

Mr. and Mrs. Baker's only daughter is diagnosed with heart failure. Which of the following interventions would be appropriate to promote optimal nutrition for the infant? A. Replacing regular nipples with easy-to-suck ones B. Allowing the infant to feed for at least 1 hour C. Providing large feedings evenly spaced every 4 hours D. Offering formula that is high in sodium and calories

answer: a.) replacing regular nipples with easy-to-suck ones

Bryce is a child diagnosed with coarctation of aorta. While assessing him, Nurse Zach would expect to find which of the following? A. Squatting posture B. Absent or diminished femoral pulses C. Severe cyanosis at birth D. Cyanotic ("tet") episodes

answer: b.) coarctation of aorta rationale: Absent or diminished femoral pulse is a classic characteristic of coarctation of aorta.

_______________ is the presence of cells of an abnormal type within a tissue, which may signify a stage preceding the development of cancer.

dysplasia

The nurse is attempting to ensure the parent is able to safely administer at home the prescribed ear drops to the 2-year-old client. The parent demonstrates understanding of the teaching by listing the steps of the process in which priority order? Arrange the actions in the order that they should be performed. All options must be used. 1. Have the child lie on his or her back with the affected ear facing up. 2. Straighten the ear canal by pulling the pinna of the affected ear down and back. 3. Warm the bottle of ear drops by rolling it in the palms of the hands to help decrease discomfort. 4. Massage the area anterior to the ear to facilitate entry of the drops. 5. Keep the child in the same position for 2 to 3 minutes. 6. Slowly instill the number of drops prescribed by the health care provider into the ear.

1. Warm the bottle of ear drops by rolling it in the palms of the hands to help decrease discomfort. 2. Have the child lie on his or her back with the affected ear facing up. 3. Straighten the ear canal by pulling the pinna of the affected ear down and back. 4. Slowly instill the number of drops prescribed by the health care provider into the ear. 5. Massage the area anterior to the ear to facilitate entry of the drops. 6. Keep the child in the same position for 2 to 3 minutes.

Immunization of children with Haemophilus influenzae type B (Hib) vaccine decreases the incidence of which of the following conditions? 1. Bronchiolitis 2. Laryngotracheobronchitis (LTB) 3. Epiglottitis 4. Pneumonia

Answer: 3.) Epiglottitis RATIONALE: Epiglottitis is a bacterial infection of the epiglottis primarily caused by Hib. Administration of the vaccine has decreased the incidence of epiglottitis. 1: Bronchiolitis is usually caused by Respiratory Syncytial Virus (RSV). 2: Acute LTB is of viral origin. 4: The most common bacterial organisms causing pneumonia in children are pneumococci, streptococci, and staphylococci.

Which of the following disorders leads to cyanosis from deoxygenated blood entering the systemic arterial circulation? A. Aortic stenosis (AS) B. Coarctation of aorta C. Patent ductus arteriosus (PDA) D. Tetralogy of Fallot

answer: d.) tetralogy of fallot

The nurse prepares to administer a pancreatic enzyme powder to the child with cystic fibrosis (CF). Which food item should the nurse mix with the medication? 1. Tapioca 2. Applesauce 3. Hot oatmeal 4. Mashed potatoes

ANSWER: 2.) APPLE SAUCE Rationale: Pancreatic enzyme powders are not to be mixed with hot foods or foods containing tapioca or other starches. Enzyme powder should be mixed with nonfat, nonprotein foods such as applesauce. Pancreatic enzymes are inactivated by heat and are partially degraded by gastric acids.

The nurse provides instructions to the mother of an infant with cleft palate regarding feeding. Which statement by the mother indicates a need for further teaching? 1. "I need to allow my infant time to swallow." 2. "I need to use a nipple with a small hole to prevent choking." 3. "I need to stimulate sucking by rubbing the nipple on the lower lip." 4. "I need to allow my infant to rest frequently to provide time for swallowing what has been placed in the mouth."

ANS: 2 RATIONALE: The mother should be taught the ESSR method of feeding the child with a cleft palate: ENLARGE the nipple by cross-cutting a hole so that food is delivered to the back of the throat without sucking; STIMULATE sucking by rubbing the nipple on the lower lip; SWALLOW; then REST to allow the infant to finish swallowing what has been placed in the mouth.