A nurse is caring for a 3-year-old child who has had 160 mL of urine output over the past 8-hour period.
The child weighs 33 lb.
Which of the following actions should the nurse take?
Notify the provider.
Continue to monitor the client.
Perform a bladder scan at the bedside.
Provide oral rehydration fluids.
The Correct Answer is B
Normal urine output for a child is 1-2 ml/kg/hr.
The child weighs 33 lb (15 kg), so their expected urine output over an 8-hour period would be between 120 mL and 240 mL.
The child’s urine output of 160 mL falls within this range.
Choice A, Notifying the provider, is not necessary because the child’s urine output
is within the normal range.
Choice C, Perform a bladder scan at the bedside, is not necessary because there is no indication of urinary retention.
Choice D, Providing oral rehydration fluids, is not necessary because the child’s urine output is within the normal range.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
This is the recommended technique for chest compressions on an infant, as it provides adequate blood flow without causing injury12.
Choice A.
Deliver compressions just above the nipple line is incorrect, as this is not the correct location for chest compressions on an infant.
The correct location is below the nipple line, at the center of the chest.
Choice B.
Deliver compressions with the heel of one hand is incorrect, as this is the technique for chest compressions on a child, not an infant. For an infant, two fingers are used instead of one hand13.
Choice C.
Deliver compressions at a depth of 5 cm (2 in) is incorrect, as this is too deep for an infant’s chest.
The correct depth for an infant is about 4 cm (1.5 in) or 1/3 the depth of the
chest12.
Therefore, choice D is the best answer.
Correct Answer is A
Explanation
Head lice are spread most commonly by direct head-to-head (hair-to-hair) contact.
However, much less frequently they are spread by sharing clothing or belongings onto which lice have crawled or nits attached to shed hairs may have fallen.
Choice B is not correct because lice cannot jump from one child to another. Choice C is not correct because live lice survive less than 1-2 days if they fall off a
person and cannot feed.
Choice D is not correct because washing your child’s hair daily will not prevent lice.
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