A nurse is caring for a year old child who has had watery diarrhea for the past 3 days. Which of the following is the most appropriate action for the nurse to take?
Offer the child guitar chicken broth
Initiate oral rehydration therapy
Start hypertonic solution
Keep NPO until the diarrhea subsides
The Correct Answer is B
A. While clear chicken broth can provide some hydration, it does not contain the necessary electrolytes to replace losses effectively.
B. Initiating oral rehydration therapy is critical for managing dehydration due to diarrhea and is the best approach for a child in this situation.
C. Starting a hypertonic solution is inappropriate and could lead to further dehydration or electrolyte imbalances.
D. Keeping the child NPO is not necessary; it is more important to maintain hydration and possibly offer oral rehydration solutions.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Blood pressure can fluctuate and may not accurately reflect fluid loss in an infant, especially in early stages of dehydration.
B. Respiratory rate may increase with distress but is not a direct indicator of fluid loss.
C. Skin integrity can show signs of dehydration, but it is not as definitive as changes in body weight.
D. Body weight is the most reliable indicator of fluid loss, as it reflects changes in fluid status directly and provides a clear measure for assessing hydration.
Correct Answer is B
Explanation
A. Passing flatus every 30 minutes indicates bowel activity and suggests that the child may be able to resume oral intake.
B. Absent bowel sounds indicate a lack of gastrointestinal function, which supports the continuation of NPO status until bowel function returns.
C. An increase in abdominal girth, even by 1 cm, can be concerning postoperatively and may indicate fluid retention or other issues, warranting further assessment.
D. Pain at the operative site is expected post-surgery, but it does not directly relate to the child’s ability to resume oral intake.
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