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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Related Questions
Correct Answer is C
Explanation
A. While heart failure can occur in many congenital heart defects, it is not the most specific condition commonly associated with tetralogy of Fallot.
B. Asthma is not typically associated with tetralogy of Fallot. It is a respiratory condition that does not have a direct link to congenital heart defects.
C. Tetralogy of Fallot is associated with polycythemia due to chronic hypoxemia. The body produces more red blood cells in response to low oxygen levels, leading to an increased hematocrit.
D. While pulmonary hypertension can occur in congenital heart defects, tetralogy of Fallot is more directly associated with polycythemia as a result of the decreased blood flow to the lungs.
Correct Answer is D
Explanation
A. Constipation is not a typical manifestation of a sickle cell crisis.
B. High fever may occur if an infection is present, but it is not a hallmark symptom of a sickle cell crisis.
C. Bradycardia is not expected during a sickle cell crisis; if anything, tachycardia may be seen due to pain or anemia.
D. Pain is the most common and significant symptom of a sickle cell crisis, caused by the obstruction of blood flow by sickled red blood cells, leading to ischemia and severe pain. This requires immediate attention and pain management.
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