A nurse is assisting with the care of a preschooler who sustained a major burn injury 5 days ago. Which of the following findings should the nurse identify as a manifestation of sepsis?
Polyuria
Disorientation
Hyperactive bowel sounds
Hypoglycemia
The Correct Answer is B
A. Polyuria is not typically associated with sepsis; it may be seen in other conditions such as diabetes. In sepsis, urine output is often decreased due to impaired kidney function and shock.
B. Disorientation is a sign of sepsis, indicating that the infection may have spread to the bloodstream and is affecting the central nervous system. Altered mental status is a critical indicator of severe infection.
C. Hyperactive bowel sounds are not associated with sepsis. In sepsis, bowel sounds may actually be decreased due to decreased perfusion to the gastrointestinal tract.
D. Hypoglycemia can occur in sepsis, but it is not as specific an indicator as disorientation. Monitoring blood glucose levels is important, but disorientation provides a clearer sign of systemic infection.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Meperidine is not recommended for pain management in sickle cell crisis due to the risk of seizures and neurotoxicity. Fever should be managed with antipyretics like acetaminophen.
B. Increasing, not decreasing, daily oral fluid intake is important to help reduce blood viscosity and prevent further sickling of red blood cells.
C. Maintaining bed rest helps to reduce oxygen demand and prevent hypoxemia, which can exacerbate the vaso-occlusive crisis.
D. Applying cold compresses is not recommended as it can cause vasoconstriction and worsen the pain. Warm compresses are more appropriate for managing pain in sickle cell crisis.
Correct Answer is A
Explanation
A. "You should be prepared to answer your child's questions about dying." is appropriate because children at this age may have questions about death and dying. It is important for the guardian to be honest and provide age-appropriate answers to help the child understand and cope with their situation.
B. While younger children often view death as temporary, a 10-year-old child typically has a more developed understanding of the finality of death. This statement might not be accurate for this age group.
C. Hiding grief is not recommended as it can create an atmosphere of secrecy and fear. It is better to model healthy expressions of emotions and provide support for the child's feelings.
D. Limiting visits between siblings may not be necessary and can be detrimental. Sibling support can be very important for both the ill child and the sibling, providing comfort and a sense of normalcy.
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