A 4-month-old is brought to the emergency department with severe dehydration. The heart rate is 198, and the blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which action would the nurse expect to do immediately?
Administer a bolus of D10W.
Offer the child a bottle of an oral rehydration solution such as Pedialyte.
Administer a bolus of hypertonic saline.
Administer a bolus of normal saline.
The Correct Answer is D
Choice A reason: Administering a bolus of D10W is not the first-line treatment for severe dehydration and may not address the immediate fluid needs of the infant.
Choice B reason: Offering an oral rehydration solution is not appropriate for an infant with severe dehydration and a compromised ability to hold down fluids.
Choice C reason: Administering a bolus of hypertonic saline is not typically the initial treatment for dehydration and could potentially worsen the infant's condition.
Choice D reason: This is the correct choice. Administering a bolus of normal saline is the immediate action to treat severe dehydration and restore circulatory volume.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Meningitis is an infection of the protective membranes covering the brain and spinal cord and is not typically listed as a risk factor for ADD/ADHD.
Choice B reason: A family history of ADD/ADHD is a known risk factor, as the disorder can have a genetic component.
Choice C reason: Exposure to environmental toxins, such as lead, is associated with an increased risk of developing ADD/ADHD.
Choice D reason: While maternal health issues like gestational diabetes can impact a child's development, they are not directly linked to ADD/ADHD as a risk factor in the same way as genetic or environmental factors. However, this choice is less incorrect than Choice A, as there is some evidence suggesting a potential association between gestational diabetes and developmental disorders.
Correct Answer is C
Explanation
Choice A reason: Fracturing a bone through the epiphyseal plate does not put a child at risk for developing Rheumatoid Arthritis, which is an autoimmune condition unrelated to such injuries.
Choice B reason: Permanent nerve damage is not a typical consequence of fracturing the epiphyseal plate, as this injury primarily affects bone growth.
Choice C reason: The epiphyseal plate, or growth plate, is responsible for the longitudinal growth of bones in children and adolescents. Damage to this area can disrupt normal bone growth.
Choice D reason: While severe damage to the epiphyseal plate can potentially halt growth in that bone, it is more common for the growth to be disrupted rather than completely prevented. The extent of the impact depends on the severity of the injury.
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