A 6-month-old infant is brought to the emergency room with signs of dehydration, sunken fontanelles, and decreased urine output. What is the priority nursing intervention?
Offering oral rehydration solution (ORS)
Administering intravenous fluids
Monitoring the infant's vital signs
Obtaining a urine sample for analysis
The Correct Answer is B
A. Offering oral rehydration solution (ORS) may not be effective for severe dehydration in an infant who is unable to drink or tolerate oral fluids.
B. Administering intravenous fluids is the priority intervention for a severely dehydrated infant to restore fluid balance and prevent complications.
C. Monitoring vital signs is important but does not address the immediate need for fluid replacement in severe dehydration.
D. Obtaining a urine sample is not the priority; intravenous fluids should be initiated promptly in a severely dehydrated infant.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Administering a bronchodilator inhaler, such as albuterol, is the priority intervention for a child with asthma experiencing difficulty breathing, wheezing, and coughing.
B. Antihistamines are not the primary treatment for acute asthma exacerbations.
C. Mucolytic medications can help thin mucus but are not the first-line treatment for acute asthma symptoms.
D. Cough suppressants are not recommended for children with asthma as they can worsen respiratory distress.
Correct Answer is B
Explanation
A. Administering ipecac syrup to induce vomiting is no longer recommended as a first-aid measure for poisoning. The Poison Control Center should be consulted first for guidance.
B. Calling the Poison Control Center is the first action to take in case of suspected poisoning. They provide expert guidance on managing poisoning cases.
C. Administering activated charcoal can be done under the guidance of the Poison Control Center, but it is not the first action to take.
D. Performing abdominal thrusts is used for foreign body airway obstruction, not poisoning.
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