Which of the following parameters would Nurse Max monitor to evaluate the effectiveness of thickened feedings for an infant with gastroesophageL REFLUX (GER)?

Correct Answer: C

Rationale: Nurse Max would monitor the infant's weight to evaluate the effectiveness of thickened feedings for gastroesophageal reflux (GER). Weight monitoring is crucial because it can indicate if the infant is gaining, maintaining, or losing weight, which can be reflective of how well they are tolerating the thickened feedings. An increase in weight would suggest that the infant is receiving adequate nutrition and that the thickened feedings are effective in managing GER symptoms. Monitoring weight can also help assess if the infant's overall growth and development are progressing appropriately in the context of their GER condition.

Correct Answer: D

Rationale: At this age, building a tower involves fine motor skills and symbolic thinking.

Correct Answer: B

Rationale: An adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa is likely to exhibit tachycardia (rapid heart rate) and tachypnea (rapid breathing). These symptoms are common manifestations of the body's response to malnutrition and starvation. Tachycardia occurs as a compensatory mechanism to maintain an adequate supply of oxygen to vital organs, while tachypnea helps to eliminate excess carbon dioxide due to metabolic imbalances. It is essential for the nurse to recognize these signs during the physical assessment as they indicate the severity of the condition and the need for immediate intervention to prevent further complications. Dysmenorrhea and oliguria, heat intolerance and increased blood pressure, and lowered body temperature and brittle nails are not typically associated with the physical manifestations of anorexia nervosa.

Correct Answer: A

Rationale: Primary hyperaldosteronism is a condition characterized by excessive production of aldosterone by the adrenal cortex. Aldosterone is a hormone produced by the adrenal glands that plays a key role in regulating blood pressure and electrolyte balance in the body. When there is an overproduction of aldosterone, it can lead to increased sodium retention and potassium excretion, resulting in hypertension. Therefore, in this case, the client's hypertension is caused by excessive hormone secretion from the adrenal cortex, making option A the correct answer.

Correct Answer: B

Rationale: Meningocele is a type of neural tube defect in which there is herniation of the meninges (protective membranes surrounding the brain and spinal cord) through a defect in the spinal column. This results in the formation of a sac-like protrusion that contains the meninges and cerebrospinal fluid but does not involve the spinal cord itself. In meningocele, the spinal cord remains in its normal position within the spinal canal. This condition is typically associated with spina bifida, a neural tube defect that occurs during early embryological development. Unlike myelomeningocele, which involves both the spinal cord and meninges protruding through the spinal column, meningocele specifically refers to the presence of a sac containing the meninges and spinal fluid without direct involvement of the spinal cord.