A nurse is collecting data from a newborn who is receiving phototherapy. Which of the following findings is an indication of dehydration?
Bulging anterior fontanel
Decreased urine specific gravity
Bounding pulses
Decreased skin turgor
The Correct Answer is D
A. A bulging anterior fontanel suggests increased intracranial pressure, not dehydration.
B. Decreased urine specific gravity can occur with hydration or dilute urine, and it is not specific to dehydration.
C. Bounding pulses may be present in various conditions but are not a direct sign of dehydration.
D. Decreased skin turgor is a classic sign of dehydration in both infants and adults. It indicates a deficit of body fluids.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Applying an antiseptic after the puncture can be done to prevent infection, but it is not the initial step.
B. Warming the newborn's heel helps to increase blood flow, making the collection process more effective and less painful.
C. The puncture should be made on the outer aspect of the newborn's heel, where there is a good blood supply.
D. After the puncture, it is important to apply pressure to the site to stop bleeding, typically using a gauze pad or cotton ball.
Correct Answer is B
Explanation
A. Decreased muscle tone is not typically associated with neonatal abstinence syndrome.
B. Exaggerated Moro reflex, which is a startle response that causes the baby to fling their arms and legs out and then curl them in, is a common signof neonatal abstinence
C. Consoling easily is not a characteristic feature of neonatal abstinence syndrome; these infants are often difficult to console.
D. A high pitched cry is a common symptom of neonatal abstinence syndrome. A weak cry is not anticipated.
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