In caring for the premature infant, the nurse must continually assess hydration status. Parameters to assess would include all of the following except:
Select one:

Daily weight.

Consistency of stool.

Volume of urine output.

Blood pH.

Answer and Explanation

The Correct Answer is D

Choice A Reason: Daily weight. This is an incorrect answer that indicates a valid parameter to assess hydration status. Daily weight is a measure of the body mass that can reﬂect changes in ﬂuid balance. Daily weight can help detect ﬂuid loss or gain in premature infants, who are more prone to dehydration or overhydration due to immature renal function and high insensible water loss.

Choice B Reason: Consistency of stool. This is an incorrect answer that indicates a valid parameter to assess hydration status. Consistency of stool is a measure of the texture and form of feces that can reﬂect changes in ﬂuid intake and absorption. Consistency of stool can help identify diarrhea or constipation in premature infants, who are more susceptible to gastrointestinal problems such as necrotizing enterocolitis or feeding intolerance.

Choice C Reason: Volume of urine output. This is an incorrect answer that indicates a valid parameter to assess hydration status. Volume of urine output is a measure of the amount of urine produced and excreted by the kidneys that can reﬂect changes in ﬂuid balance and renal function. Volume of urine output can help monitor hydration status and kidney function in premature infants, who are more vulnerable to ﬂuid overload or deficit and renal impairment.

Choice D Reason: Blood pH. This is because blood pH is a measure of the acidity or alkalinity of the blood, which reﬂects the balance between carbon dioxide and bicarbonate in the body. Blood pH is not a direct indicator of hydration status, which refers to the amount of water and electrolytes in the body. Hydration status can aﬀect blood pH, but blood pH can also be inﬂuenced by other factors such as respiratory or metabolic disorders.

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Correct Answer is D

Explanation

Choice A Reason: Apical pulse of 148 beats per minute. This is not a finding that would support a diagnosis of RDS, but rather a normal finding for a newborn. A normal apical pulse for a newborn ranges from 120 to 160 beats per minute. A high pulse rate may indicate fever, infection, anemia, or dehydration. A low pulse rate may indicate hypothermia, hypoxia, or heart block.

Choice B Reason: Respiratory rate of 40 during sleep. This is not a finding that would support a diagnosis of RDS, but rather a normal finding for a newborn. A normal respiratory rate for a newborn ranges from 40 to 60 breaths per minute. A high respiratory rate may indicate respiratory distress, infection, or metabolic acidosis. A low respiratory rate may indicate respiratory depression, hypothermia, or narcotic exposure.

Choice C Reason: Skin color jaundiced. This is not a finding that would support a diagnosis of RDS, but rather a diﬀerent condition called jaundice. Jaundice is a yellowish discoloration of the skin and mucous membranes caused by elevated levels of bilirubin in the blood. Bilirubin is a breakdown product of hemoglobin that is normally excreted by the liver and kidneys. Jaundice can occur in newborns due to immature liver function, increased red blood cell breakdown, or blood group incompatibility. Jaundice does not aﬀect lung function or oxygenation.

Choice D Reason: Chest retractions. This is because chest retractions are a sign of respiratory distress that indicate increased work of breathing and reduced lung compliance. Chest retractions occur when the chest wall sinks in between the ribs or below the sternum during inhalation, creating a negative pressure that helps draw air into the lungs. RDS is a serious condition where the newborn's lungs are immature and lack sufficient surfactant, which is a substance that reduces surface tension and prevents alveolar collapse. RDS can cause respiratory distress, hypoxia, acidosis, and organ failure. It is more common in preterm infants, especially those born before 37 weeks' gestation.

A. Two arteries, one vein. B. Two veins, one artery. C. Two veins, two arteries. D. One artery, one vein.

Correct Answer is A

Explanation

Choice A Reason: Two arteries, one vein. This is because two arteries and one vein are the normal components of the umbilical cord, which is a structure that connects the fetus to the placenta and provides blood circulation between them. The umbilical cord carries oxygenated blood from the placenta to the fetus through the umbilical vein, and deoxygenated blood from the fetus to the placenta through the umbilical arteries.

Choice B Reason: Two veins, one artery. This is an incorrect answer that indicates an abnormal anatomy of the umbilical cord, which is known as single umbilical artery (SUA). SUA is a condition where there is only one umbilical artery instead of two, which can reduce blood ﬂow and oxygen delivery to the fetus. SUA can be associated with congenital anomalies or growth restriction in some cases.

Choice C Reason: Two veins, two arteries. This is an incorrect answer that indicates an abnormal anatomy of the umbilical cord, which is known as double umbilical vein (DUV). DUV is a condition where there are two umbilical veins instead of one, which can increase blood ﬂow and oxygen delivery to the fetus. DUV can be associated with fetal overgrowth or polycythemia in some cases.

Choice D Reason: One artery, one vein. This is an incorrect answer that indicates an abnormal anatomy of the umbilical cord, which is also known as single umbilical artery (SUA). SUA is a condition where there is only one umbilical artery instead of two, which can reduce blood ﬂow and oxygen delivery to the fetus. SUA can be associated with congenital anomalies or growth restriction in some cases.

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In caring for the premature infant, the nurse must continually assess hydration status. Parameters to assess would include all of the following except: Select one:

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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Select one: