A nurse is caring for a 3-year-old toddler who has dehydration.
Which of the following findings should the nurse report to the provider?
Sodium 142 mEq/L.
Respiratory rate 22/min.
Potassium 3.9 mEq/L.
Heart rate 148/min.
The Correct Answer is D
Choice A rationale:
Sodium level of 142 mEq/L is within the normal range (135-145 mEq/L) for adults. However, normal ranges for children might vary slightly, but 142 mEq/L is not indicative of dehydration on its own.
Choice B rationale:
Respiratory rate of 22/min is within the normal range for a 3-year-old child (20-30 breaths/min) This rate alone does not provide evidence of dehydration.
Choice C rationale:
Potassium level of 3.9 mEq/L is within the normal range (3.5-5.1 mEq/L) for children. Like sodium, normal ranges for potassium may differ slightly in pediatric patients, but 3.9 mEq/L is not alarming on its own.
Choice D rationale:
Heart rate of 148/min is elevated for a 3-year-old child. Tachycardia is a common sign of dehydration in pediatric patients. This increased heart rate indicates the body's compensatory mechanism to maintain cardiac output in response to decreased blood volume, a typical consequence of dehydration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
- A: Incorrect. Hospital-based hospice care is not a service provided by PACE, which is a program that offers comprehensive medical and social services to eligible older adults who wish to remain in their own homes and communities.
- D: Correct. Adult day care services are part of the PACE program, which helps older adults maintain their independence and quality of life by providing socialization, supervision, and assistance with activities of daily living.
- C: Incorrect. Telehealth for pacemaker diagnostics is not a specific service offered by PACE, which provides primary care, specialty care, prescription drugs, home health care, personal care, transportation, and other services as needed.
- B: Incorrect. Transfer to a skilled care facility is not a goal of PACE, which aims to prevent or delay institutionalization by providing coordinated care and support to older adults with chronic conditions and functional limitations.
Correct Answer is C
Explanation
How does this make you feel?
- A. Saying "I'm sure your family does not want you to die" is not a therapeutic response, as it invalidates the client's feelings and imposes the nurse's assumption on the client. This option is incorrect.
- B. Asking "Why would you believe such things?" is not a therapeutic response, as it sounds judgmental and confrontational, and may make the client feel defensive or ashamed. This option is incorrect.
- C. Asking "How does this make you feel?" is a therapeutic response, as it encourages the client to express their emotions and shows empathy and interest from the nurse. This option is correct.
- D. Saying "You should talk to your family about your feelings" is not a therapeutic response, as it implies that the client is responsible for resolving their family issues and may increase their guilt or anxiety. This option is incorrect.
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