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Which finding in a 5-year-old child diagnosed with hemolytic uremic syndrome would require the nurse to take immediate action?

BUN 14 mg/dL.

Serum Creatinine 0.4 mg/dL.

Urine output 76 mL/24 hours.

Hbg 12 g/dL.

Answer and Explanation

The Correct Answer is C

Urine output 76 mL/24 hours.

Choice A rationale:

BUN (Blood Urea Nitrogen) of 14 mg/dL falls within the normal range (7-20 mg/dL) and is not an immediate concern.

Choice B rationale:

Serum Creatinine of 0.4 mg/dL is also within the normal range (0.2-0.5 mg/dL) and does not warrant immediate action.

Choice C rationale:

Urine output of 76 mL/24 hours is significantly decreased from the expected normal range (1-2 mL/kg/hour), indicating potential kidney dysfunction or dehydration. This requires immediate action to assess the child's hydration status and kidney function.

Choice D rationale:

Hb (Hemoglobin) of 12 g/dL is within the normal range for a 5-year-old child (11.5-15.5 g/dL) and does not necessitate urgent intervention.

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Correct Answer is C

Explanation

Choice A rationale:

Allowing a pacifier is appropriate and unrelated to the procedure.

Choice B rationale:

Feeding before the procedure helps prevent dehydration and maintains the infant's well-being.

Choice C rationale:

Bathing immediately after the procedure can introduce infection risk through the catheterization site. Waiting a day is advisable.

Choice D rationale:

Counting wet diapers helps monitor hydration post-procedure; it's a valid concern. In each case, the correct choices were determined by logical reasoning and adherence to medical guidelines. It's important for healthcare providers to educate patients and caregivers to ensure the best outcomes for patients' health and well-being.

A. Wait to discuss the surgery with until the child asks specific questions. B. Set aside an hour a day to talk about the child's feelings concerning the surgery. C. Read the child a story about children of similar age who go to the hospital for surgery. D. Have the child visit a family whose preschool child has just been discharged from the hospital.

Correct Answer is C

Explanation

Choice A rationale:

Waiting to discuss the surgery until the child asks specific questions might lead to increased anxiety as the child may be apprehensive about the surgery but unable to express their concerns.

Choice B rationale:

Setting aside an hour a day to talk about the child's feelings concerning the surgery can be overwhelming for a 5-year-old, potentially increasing anxiety and making the procedure seem more daunting.

Choice C rationale:

Reading the child a story about children of similar age who go to the hospital for surgery provides a developmentally appropriate approach. It helps the child understand the process through relatable characters, reducing fear and uncertainty about the upcoming experience.

Choice D rationale:

Having the child visit a family whose preschool child has just been discharged from the hospital might expose the child to unfamiliar situations, possibly leading to more confusion and anxiety.

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Which finding in a 5-year-old child diagnosed with hemolytic uremic syndrome would require the nurse to take immediate action?

Nursing Test Bank

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