A nurse is assessing a school-age child who has moderate dehydration due to diarrhea and vomiting. Which of the following manifestations should the nurse expect?
Decreased respirations
Polyuria
Bradycardia
Orthostatic hypotension
The Correct Answer is D
A. Decreased respirations: Moderate dehydration typically does not cause respiratory depression. Respiratory changes are more commonly associated with severe acid-base imbalances or advanced dehydration.
B. Polyuria: Dehydration leads to decreased fluid volume, which generally results in oliguria (reduced urine output) rather than polyuria. Increased urination is not an expected finding in moderate dehydration.
C. Bradycardia: Dehydration usually causes a compensatory increase in heart rate (tachycardia) to maintain cardiac output. Bradycardia is not typical unless there is a severe or underlying cardiac issue.
D. Orthostatic hypotension: Loss of fluid volume from diarrhea and vomiting can decrease circulating blood volume, leading to a drop in blood pressure upon standing. This is an expected cardiovascular manifestation of moderate dehydration in school-age children.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Apply lidocaine gel around the incision: Topical lidocaine is generally used for localized superficial pain, not for deep postoperative pain following major joint surgery. Its effectiveness for a knee arthroplasty incision is limited.
B. Attach a transcutaneous electrical nerve stimulation unit around the incision: TENS units can help with some types of pain but are more effective for chronic musculoskeletal pain rather than acute postoperative pain.
C. Place a cold pack over the incision: Cold therapy reduces inflammation, swelling, and pain in the immediate postoperative period. It is a safe and effective nonpharmacological intervention for mild to moderate pain following knee arthroplasty.
D. Assist the client for a walk in the hallway: Early ambulation is important for preventing complications and promoting recovery, but it may initially increase pain when the client is only 4 hours post-surgery. Cold therapy is more appropriate for immediate pain relief.
Correct Answer is B
Explanation
A. Prospective audit: A prospective audit evaluates care before it is provided, focusing on planned interventions rather than outcomes after discharge. It is not used to assess post-care quality.
B. Outcome audit: Outcome audits measure the results of care, such as client recovery, complication rates, or satisfaction, after interventions have been completed. This type of audit is appropriate for gathering information about quality of care following discharge.
C. Structure audit: Structure audits assess the resources, staffing, and organizational infrastructure used to deliver care. They do not measure client outcomes or post-discharge quality.
D. Concurrent audit: Concurrent audits evaluate care while it is being provided, allowing immediate feedback and corrections. They are performed during hospitalization, not after discharge.
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