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

Sterile water

Oral electrolyte solution

Half-strength orange juice

Answer and Explanation

The Correct Answer is C

A. Half-strength infant formula: Infant formula, even if diluted, may not be appropriate immediately after a repair of intussusception. It may be too heavy for the infant's digestive system, potentially leading to complications. Clear fluids are usually preferred initially.

B. Sterile water: Sterile water is not typically recommended for oral intake in infants after a repair of intussusception. It lacks essential electrolytes needed to maintain proper hydration and electrolyte balance.

C. Oral electrolyte solution: Oral electrolyte solutions, such as Pedialyte, are often recommended for infants after a repair of intussusception. These solutions contain balanced electrolytes and fluids, which help prevent dehydration and restore electrolyte balance.

D. Half-strength orange juice: Orange juice, even if diluted, is not typically recommended immediately after a repair of intussusception. It may be too acidic and may cause gastrointestinal discomfort or irritation in the infant. Clear fluids are preferred initially to allow the gastrointestinal tract to rest and recover.

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Correct Answer is D

Explanation

A. Skin integrity: Skin integrity can be an indicator of dehydration, as dehydrated skin may appear dry and lack elasticity. However, skin turgor is not the most reliable indicator of fluid loss because it can be influenced by factors such as age and overall health. For example, infants and older adults may have decreased skin turgor due to a loss of skin elasticity, even if they are adequately hydrated.

B. Blood pressure: Blood pressure can decrease with significant fluid loss because there is less fluid volume to fill the arteries, leading to a drop in blood pressure. However, blood pressure is not the most reliable indicator of fluid loss because it can be influenced by many other factors, such as heart function and vascular resistance. Additionally, blood pressure may not change significantly until severe dehydration occurs.

C. Respiratory rate: An increased respiratory rate can be a sign of dehydration because the body may try to compensate for fluid loss by increasing the respiratory rate to deliver more oxygen to the tissues. However, an increased respiratory rate is a nonspecific symptom that can be associated with many other conditions, such as fever, pain, or lung disease. Therefore, it is not the most reliable indicator of fluid loss.

D. Body weight: Body weight is the most reliable indicator of fluid loss. This is because water makes up a significant portion of body weight, so a decrease in body weight is a direct indication of fluid loss. In infants, a rapid change in weight is often the first sign of fluid imbalance because they have a higher percentage of body water and a higher metabolic rate compared to adults. A 5% weight loss is considered mild dehydration, 10% is moderate, and 15% or more is severe. Therefore, regular monitoring of an infant’s weight is crucial when assessing for dehydration.

A. Bleeding B. Pancreatitis C. Dysrhythmias D. Cataracts

Correct Answer is C

Explanation

A. Bleeding: Haloperidol, an antipsychotic medication, is not typically associated with bleeding as an adverse effect. Bleeding is more commonly associated with medications such as anticoagulants or antiplatelet agents.

B. Pancreatitis: While rare, pancreatitis is not a common adverse effect of haloperidol. This condition is more commonly associated with other factors such as gallstones, alcohol consumption, or certain medications.

C. Dysrhythmias: Haloperidol can prolong the QT interval on an electrocardiogram (ECG), which may lead to dysrhythmias, including torsades de pointes. Therefore, it is essential to monitor clients receiving haloperidol for signs and symptoms of dysrhythmias, such as palpitations, syncope, or sudden cardiac arrest.

D. Cataracts: While long-term use of antipsychotic medications like haloperidol may increase the risk of developing cataracts, this adverse effect is not typically observed in clients receiving haloperidol on a PRN basis for agitation.

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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?

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