A nurse is caring for a 6-month-old infant who has a prescription for clear liquids by mouth after a repair of an intussusception. Which of the following fluids should the nurse select for the infant?
Half-strength infant formula
Half-strength orange juice
Sterile water
Oral electrolyte solution
The Correct Answer is D
Choice A reason: Half-strength infant formula is not a clear liquid and should not be given to an infant with intussusception. Infant formula contains proteins, fats, and carbohydrates that can increase the risk of bowel obstruction, infection, and perforation.
Choice B reason: Half-strength orange juice is not a clear liquid and should not be given to an infant with intussusception. Orange juice contains fructose, citric acid, and potassium that can irritate the bowel, cause osmotic diarrhea, and worsen dehydration.
Choice C reason: Sterile water is a clear liquid, but it is not the best choice for an infant with intussusception. Sterile water does not contain any electrolytes or glucose and can dilute the blood sodium level, leading to hyponatremia and seizures.
Choice D reason: Oral electrolyte solution is the best fluid for an infant with intussusception, as it contains the optimal balance of electrolytes and glucose to prevent dehydration and restore fluid balance. Oral electrolyte solution is recommended by the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) for the management of dehydration in children.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: The child has a normal potassium level, as it is within the reference range of 3.5 to 5 mEq/L. Potassium is an electrolyte that helps regulate the fluid balance, nerve impulses, and muscle contractions in the body.
Choice B reason: The child has a low hemoglobin level, as it is below the reference range of 10 to 15.5 g/dL. Hemoglobin is a protein in the red blood cells that carries oxygen to the tissues. Sickle cell anemia is a genetic disorder that causes the red blood cells to have an abnormal shape and become rigid, sticky, and prone to clumping. This can lead to hemolysis, anemia, and reduced oxygen delivery.
Choice C reason: The child has a normal platelet level, as it is within the reference range of 150,000 to 450,000 mm^3^. Platelets are blood cells that help with clotting and prevent bleeding. Sickle cell anemia can cause thrombocytopenia, a low platelet count, due to increased destruction or sequestration of platelets in the spleen.
Choice D reason: The child has a normal blood glucose level, as it is within the reference range of 70 to 110 mg/dL. Blood glucose is the main source of energy for the cells in the body. Sickle cell anemia can cause hypoglycemia, a low blood glucose level, due to impaired glucose metabolism, increased glucose utilization, or decreased glucose production.
Correct Answer is D
Explanation
Choice A reason: Drooling is not a sign of hemorrhage, but rather a sign of difficulty swallowing or breathing. Drooling may occur after a tonsillectomy due to throat pain or swelling, but it does not indicate bleeding.
Choice B reason: Poor fluid intake is not a sign of hemorrhage, but rather a sign of dehydration or nausea. Poor fluid intake may occur after a tonsillectomy due to throat pain or fear of swallowing, but it does not indicate bleeding.
Choice C reason: Increased pain is not a sign of hemorrhage, but rather a sign of inflammation or infection. Increased pain may occur after a tonsillectomy due to tissue damage or healing, but it does not indicate bleeding.
Choice D reason: Frequent swallowing is a sign of hemorrhage, as it indicates that the child is trying to clear blood from the throat. Frequent swallowing may occur after a tonsillectomy due to bleeding from the surgical site or a ruptured blood vessel.
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