A nurse is assessing an infant who has water intoxication. Which of the following findings should the nurse expect?
Generalized edema
Elevated urine specific gravity
Thready pulse
Increased hematocrit
The Correct Answer is C
A. Water intoxication can lead to dilutional hyponatremia, which may result in fluid shifting into cells, causing cellular swelling and potentially cerebral edema, but generalized edema is not typically associated with water intoxication.
B. Water intoxication leads to dilution of electrolytes, including sodium, which results in decreased urine specific gravity rather than elevated.
C. Thready pulse is a common finding in water intoxication due to electrolyte imbalances and hemodilution.
D. Increased hematocrit is not typically associated with water intoxication; rather, it may indicate dehydration or hemoconcentration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Detaching the needle from the syringe before discarding it increases the risk of needlestick injuries and is not recommended.
B. Placing broken glass in a wastebasket increases the risk of injury to housekeeping staff; it should be disposed of in a puncture-proof container.
C. Recapping needles increases the risk of needlestick injuries and is not recommended unless there are no alternatives available.
D. Placing lancets in a puncture-proof container is the correct procedure for preventing puncture injuries, as it safely contains sharp objects and reduces the risk of accidental needlesticks.
Correct Answer is B
Explanation
A. Apply oxygen at 3 L/min per nasal cannula: While oxygenation is important, there is no
indication in the scenario that the client requires oxygen supplementation at this time. Checking oxygen saturation would be more relevant if there were respiratory concerns.
B. Review the chest x-ray report: This is the most appropriate action before initiating the IV
infusion to ensure proper placement of the central venous catheter and absence of complications such as pneumothorax or malposition.
C. Flush the catheter with sterile water: Flushing the catheter with sterile water is not necessary before starting the infusion, especially without confirming proper catheter placement through chest x-ray.
D. Obtain a peripheral blood glucose level: While monitoring blood glucose levels may be
important in certain clinical situations, it is not directly relevant to initiating an IV infusion of Ringer's lactate via a central venous catheter.
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