A nurse in an emergency department is caring for an infant who has a 2-day history of vomiting and an elevated temperature.
Which of the following should the nurse recognize as the most reliable indicator of fluid loss?
Blood pressure.
Respiratory rate.
Body weight.
Skin integrity.
The Correct Answer is C
The correct answer is Choice C.
Choice A rationale
Blood pressure is not the most reliable indicator of fluid loss in infants. Blood pressure can remain normal until dehydration is severe.
Choice B rationale
Respiratory rate can be affected by many factors and is not the most reliable indicator of fluid loss.
Choice C rationale
Body weight is the most reliable indicator of fluid loss in infants. A significant decrease in body weight indicates significant fluid loss and helps guide appropriate fluid replacement therapy.
Choice D rationale
Skin integrity can be affected by many factors and is not the most reliable indicator of fluid loss.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","E"]
Explanation
The correct answers are Choices A, C, and E.
Choice A rationale
Daytime symptoms occurring more than twice a week is an expected finding in mild persistent asthma. This indicates that the asthma is not well-controlled and requires regular use of a controller medication.
Choice B rationale
Nighttime symptoms occurring approximately twice a month is more characteristic of intermittent asthma, not mild persistent asthma.
Choice C rationale
Minor limitations with normal activity are expected in mild persistent asthma. This indicates that the asthma is affecting the child’s daily activities to some extent.
Choice D rationale
Symptoms that are continuous throughout the day are indicative of severe persistent asthma, not mild persistent asthma.
Choice E rationale
A peak expiratory flow (PEF) greater than or equal to 80% of the predicted value is an expected finding in mild persistent asthma. This indicates that the child’s lung function is relatively well-preserved. .
Correct Answer is A
Explanation
The correct answer is Choice A.
Choice A rationale
Placing the child in a knee-chest position helps increase systemic vascular resistance, which reduces the right-to-left shunt and improves oxygenation during a cyanotic spell in children with Tetralogy of Fallot.
Choice B rationale
Having the child lie supine with the head turned to one side does not help in managing a cyanotic spell and may not improve oxygenation.
Choice C rationale
Lying prone does not specifically address the cyanotic spell and may not be the most effective position for improving oxygenation.
Choice D rationale
Placing the child in a semi-Fowler’s position in an infant seat does not specifically address the cyanotic spell and may not be the most effective position for improving oxygenation.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.