A child is hospitalized after a serious motor vehicle crash and has developed increased urination. What action by the nurse takes priority?
Restrict dietary sodium intake.
Assess the daily serum sodium level.
Weigh the child daily.
Monitor the child's intake and output.
The Correct Answer is D
In this scenario, the child's increased urination after a serious motor vehicle crash may
indicate a potential issue with fluid balance. Monitoring the child's intake and output is the
priority action for the nurse. This involves accurately measuring and recording the fluids the
child consumes (intake) and the fluids the child eliminates through urine, sweat, and other
sources (output). By closely monitoring the child's intake and output, the nurse can assess the
child's fluid status and identify any abnormalities or imbalances that may require further
intervention.
Restrict dietary sodium intake in (option A) is incorrect because restricting dietary sodium
intake, may be necessary in certain situations, such as if the child has a known sodium
imbalance or hypertension. However, it is not the priority action in this scenario.
Assess the daily serum sodium level in (option B) is incorrect because assessing the daily
serum sodium level, is important to evaluate the child's electrolyte balance. However, it is not
the priority action compared to monitoring the child's intake and output.
Weigh the child daily in (option C) is incorrect because weighing the child daily, is a useful
measure to assess changes in fluid balance. However, it is not the priority action in this
scenario compared to monitoring the child's intake and output, which provides real-time
information on fluid balance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Upper extremity fractures in children commonly occur as a result of falls. Children are more prone to falls due to their developing motor skills, balance, and coordination. They may fall from playground equipment, bicycles, or simply while running or playing.
While sports injuries (Option A) can also lead to upper extremity fractures, falls are generally the most common cause in children.
Physical abuse (Option B) is an unfortunate possibility in some cases, but it is important to approach the assessment without assuming abuse as the cause without appropriate evidence or disclosure.
Upper extremity fractures resulting from automobile crashes (Option D) are less common in children compared to falls or sports injuries, although they can occur in severe accidents.
It is always important for the nurse to assess the child's history, obtain a detailed account of the injury, and consider any additional signs or indications that may suggest non-accidental trauma if appropriate.
Correct Answer is A
Explanation
The statement that accurately describes the difference between the central nervous system (CNS) of a child and an adult is option A. The brain of a term infant weighs less than half of the weight of the adult brain. The brain undergoes significant growth and development during childhood and continues to develop until early adulthood. At birth, the brain is only a fraction of its adult weight, and it continues to grow and mature over time.
infant has 150 mL of cerebrospinal fluid (CSF) compared with 50 mL in the adult in (option B), is incorrect. The volume of CSF in the CNS is not a significant difference between children and adults.
coordination and fine motor skills develop as myelination of peripheral nerves progresses in (option C), is an incorrect statement. Myelination is an ongoing process that occurs throughout childhood and contributes to the development of coordination and fine motor skills.
papilledema is a common manifestation of increased intracranial pressure (ICP) in the very young child in (option D), is not correct. Papilledema refers to swelling of the optic disc and is not commonly seen in very young children. Signs of increased ICP in young children may present differently compared to adults and can include altered mental status, irritability, vomiting, and changes in vital signs.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.