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 D
Explanation
A. Seizures are not a typical complication of polycythemia, though they may occur if the condition progresses to severe levels of blood viscosity.
B. Yellowing of the skin (jaundice) is not associated with polycythemia but with liver conditions.
C. While activity is important, preventing dehydration is more critical in managing polycythemia because dehydration increases blood viscosity, exacerbating the condition.
D. Preventing dehydration is essential as it helps maintain adequate blood flow and reduces the risk of thrombotic events in a child with polycythemia.
Correct Answer is A
Explanation
A. Recording an upper extremity blood pressure (in the arms) compared to a lower extremity blood pressure (in the legs) can help reveal coarctation of the aorta, as the condition often results in higher blood pressure in the upper body and lower pressure in the lower body.
B. Assessing for femoral pulses is important but may not reveal coarctation of the aorta unless there is significant obstruction.
C. Excessive crying is not a specific indicator of coarctation of the aorta.
D. While a cardiac murmur can be associated with various heart conditions, it is not the most definitive assessment for coarctation of the aorta.
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