A nurse is caring for an infant who is being treated for dehydration. Which of the following findings indicates the treatment is effective?

Flat anterior fontanel

Oliguria

Oral intake of 4 oz every 3 hr

Capillary refill 4 seconds

Answer and Explanation

The Correct Answer is C

A. A flat anterior fontanel can indicate dehydration in infants, so this finding does not indicate effective treatment.

B. Oliguria, or decreased urine output, is a sign of dehydration and would not indicate effective treatment.

C. Oral intake of 4 oz every 3 hours indicates that the infant is able to drink fluids and is likely rehydrated, indicating effective treatment.

D. A capillary refill of 4 seconds is prolonged and can indicate poor perfusion, which is not indicative of effective treatment for dehydration.

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Free Nursing Study Resources

Correct Answer is C

Explanation

A. "Rub your child's gums with an aspirin tablet before bedtime." - Aspirin is not recommended for children due to the risk of Reye's syndrome, a potentially fatal condition.

B. "Place an amber teething necklace on your child before bedtime." - Amber teething necklaces pose a choking hazard and are not recommended for infants.

C. "Administer acetaminophen drops to your child before bedtime." - Acetaminophen is a safe and effective pain reliever for infants and can help alleviate discomfort associated with teething, which may improve sleep.

D. "Apply a teething product containing benzocaine to your child's gums before bedtime." -

Benzocaine-containing products are not recommended for infants due to the risk of methemoglobinemia, a potentially life-threatening condition.

A. Encourage client fluid intake of 2,500 mL daily. B. Moisturize dry skin areas on the client every other day. C. Place a dehumidifier in the client's room. D. Apply a donut ring pillow under the client's sacral area.

Correct Answer is A

Explanation

A. Adequate hydration helps maintain skin integrity and reduces the risk of pressure injuries by keeping the skin hydrated and resilient.

B. Moisturizing dry skin is important for overall skin health but may not directly prevent pressure injuries.

C. While maintaining a comfortable room environment is important for the client's overall well- being, a dehumidifier specifically may not directly prevent pressure injuries.

D. Donut ring pillows are not recommended for pressure injury prevention as they can actually increase pressure on vulnerable areas of the skin, leading to tissue damage.

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A nurse is caring for an infant who is being treated for dehydration. Which of the following findings indicates the treatment is effective?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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