A male infant with a 2-day history of fever and diarrhea is brought to the clinic by his mother who tells the nurse that the child refuses to drink anything. The nurse determines that the child has a weak cry with no tears. Which prescription is most important for the nurse to implement?
Infuse normal saline intravenously.
Apply external cooling blanket.
Provide a bottle of electrolyte solution.
Administer an antipyretic rectally.
The Correct Answer is A
A. Infusing normal saline intravenously is crucial as the infant shows signs of dehydration (weak cry, no tears), and intravenous fluids are necessary to restore hydration and electrolyte balance.
B. Applying an external cooling blanket may be necessary to manage fever but does not address the dehydration issue.
C. Providing an electrolyte solution is helpful, but given the infant’s refusal to drink, IV fluids are more immediate and effective.
D. Administering an antipyretic rectally might help manage fever but does not address the dehydration or fluid needs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Osteoarthritis is primarily caused by the destruction of joint cartilage, which leads to pain, stiffness, and decreased mobility in the affected joints. This degenerative process is the hallmark of the condition.
B. Loss of bone mineral density is associated with osteoporosis, not osteoarthritis. While both conditions can cause joint pain, they have different underlying pathologies.
C. An infectious process in the synovial fluid would indicate septic arthritis, which is an acute and severe condition requiring different management.
D. A systemic inflammatory response is more characteristic of rheumatoid arthritis, an autoimmune condition, rather than osteoarthritis, which is a degenerative joint disease.
Correct Answer is A
Explanation
A. Checking the femoral site for hematoma formation is crucial as the client’s pain at the groin insertion site could indicate bleeding or hematoma formation, which requires immediate attention.
B. Evaluating the IV insertion site is important but does not directly address the pain at the groin site.
C. Stimulating the client to take deep breaths helps with respiratory function but does not address the potential complications at the groin site.
D. Assessing distal lower extremity capillary refill is useful for overall circulation but is not the immediate concern in this situation.
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