A 3-month-old is admitted with severe diarrhea. Yesterday, the infant weighed 11 pounds (5 kg). Today, this infant weighs 9 pounds, 8 ounces (4.3 kg). Based on this information the nurse documents that the infant has:
Severe dehydration.
Risk for fluid volume deficit.
Failure to thrive.
Malabsorption syndrome
The Correct Answer is A
A. A weight loss of 10% or more in infants within a short period is indicative of severe dehydration. The significant weight loss from 5 kg to 4.3 kg confirms this diagnosis.
B. The risk for fluid volume deficit would be noted if there were signs of potential dehydration, but in this case, the infant has already lost a significant amount of weight, confirming severe dehydration.
C. Failure to thrive is a diagnosis related to insufficient weight gain over time, rather than acute weight loss due to dehydration.
D. Malabsorption syndrome could contribute to chronic weight loss, but the acute loss in this case is more likely due to dehydration from diarrhea.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Insulin should not be stored in the freezer, as freezing it can cause it to lose potency. Unopened insulin should be stored in the refrigerator.
B. The target blood glucose for a school-age child with type 1 diabetes is typically between 90 and 130 mg/dL, but this answer does not directly relate to management practices.
C. Insulin requirements may actually increase during illness, and skipping insulin can lead to dangerous hyperglycemia or diabetic ketoacidosis.
D. Eating a snack before physical activity is crucial to prevent hypoglycemia, especially in a child with type 1 diabetes. This response shows an understanding of managing blood glucose during exercise.
Correct Answer is A
Explanation
A. Projectile vomiting is a classic sign of pyloric stenosis due to the obstruction of the pylorus, which prevents normal stomach emptying.
B. A ridged abdomen is not specific to pyloric stenosis; it may indicate other abdominal issues.
C. Red currant jelly stools are associated with intussusception, not pyloric stenosis.
D. Distended neck veins are typically associated with right-sided heart failure or fluid overload, not pyloric stenosis.
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