Maternal / Newborn Question #50

Question

The nurse is assisting the health care provider with a spinal tap procedure on an 8-month old infant. Which actions by the nurse will provide the best assistance during the procedure?

Answers

  1. Nurse should maintain the infant in a side-lying position.
    • Rationale:
  2. Nurse should raise the head of the crib during the procedure.
    • Rationale:
  3. Nurse should teach parents the procedure.
    • Rationale:
  4. Nurse should open all equipment at least an hour prior to the procedure.
    • Rationale:

Overview

Explanation

The correct answer is A since the infant must be held in a position for the procedure. This may require firm holding in a side-lying position. The position holding may be difficult if the head of the crib is elevated (selection B). Selection C is incorrect, and while it is important, but does not support the intent of the question since the nurse actions are selected as best during the procedure, not prior to or after (for teaching). Selection D is incorrect since sterile items should not be exposed and open to air for long periods of time.

Learning Outcomes

Test Taking Tip

Video Rationale