A nurse is collecting data from a 3-year-old child who has acute diarrhea and dehydration. Which of the following findings indicates that oral rehydration therapy has been effective?
Respiratory rate 24/min>
Urine specific gravity 1.015
Heart rate 130/min
Capillary refill greater than 3 seconds
The Correct Answer is B
A. Respiratory rate 24/min: While a normal respiratory rate is positive, it is not a primary marker of hydration status.
B. Urine specific gravity 1.015: A normal urine specific gravity indicates adequate hydration.
C. Heart rate 130/min: Tachycardia indicates ongoing dehydration or stress.
D. Capillary refill greater than 3 seconds: Prolonged capillary refill suggests inadequate perfusion and continued dehydration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "I am hungry and thirsty.": Hunger and thirst are not concerning and may occur after fasting or due to nausea resolution.
B. "My belly doesn't hurt anymore.": A sudden decrease in abdominal pain may indicate rupture of the appendix, leading to peritonitis—a life-threatening emergency.
C. "I am scared and I want to go home.": This is a common emotional response in children facing surgery and not indicative of a medical emergency.
D. "I'm tired and want to take a nap.": Fatigue could result from illness but is less concerning than the potential for appendiceal rupture.
Correct Answer is C
Explanation
A. Recovery from German measles 2 months ago: German measles (rubella) is not associated with glomerulonephritis.
B. Dysuria: While dysuria is a symptom of urinary tract infections, it does not directly cause glomerulonephritis.
C. A sore throat 2 weeks ago: Acute glomerulonephritis often follows a streptococcal infection, such as strep throat, typically within 1-3 weeks.
D. A history of allergy: Allergies are not a causative factor for glomerulonephritis.
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