A nurse in an emergency department is caring for an infant who has a 2-day history of vomiting and an elevated temperature. Which of the following should the nurse recognize as the most reliable indicator of fluid loss?
Skin integrity
Respiratory rate
Body weight
Blood pressure
The Correct Answer is C
In an infant with a history of vomiting and fever, body weight is the most reliable indicator of fluid loss. Monitoring the infant's weight over time can help assess the degree of dehydration and guide the appropriate fluid replacement therapy. A significant decrease in body weight suggests significant fluid loss.
Option A: Skin integrity is important to assess for signs of dehydration, but it is not as reliable as body weight in determining the extent of fluid loss.
Option B: Respiratory rate can be affected by various factors and is not a direct indicator of fluid loss.
Option D: Blood pressure is not the most reliable indicator of fluid loss in an infant with dehydration. In severe cases of dehydration, blood pressure can drop, but it is not as sensitive as body weight in assessing the extent of fluid loss.
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Correct Answer is C
Explanation
In an infant with a history of vomiting and fever, body weight is the most reliable indicator of fluid loss. Monitoring the infant's weight over time can help assess the degree of dehydration and guide the appropriate fluid replacement therapy. A significant decrease in body weight suggests significant fluid loss.
Option A: Skin integrity is important to assess for signs of dehydration, but it is not as reliable as body weight in determining the extent of fluid loss.
Option B: Respiratory rate can be affected by various factors and is not a direct indicator of fluid loss.
Option D: Blood pressure is not the most reliable indicator of fluid loss in an infant with dehydration. In severe cases of dehydration, blood pressure can drop, but it is not as sensitive as body weight in assessing the extent of fluid loss.
Correct Answer is B
Explanation
When providing teaching to a parent of a child with celiac disease, the nurse should recommend food choices that are gluten-free. Celiac disease is an autoimmune disorder triggered by the ingestion of gluten, which is a protein found in wheat, barley, rye, and their derivatives. Gluten damages the small intestine lining in individuals with celiac disease, leading to various gastrointestinal and nutritional issues.
The correct food choice for a child with celiac disease is B. Rice. Rice is naturally gluten-free and can be a safe and nutritious option for individuals with celiac disease. Other gluten-free options include corn, quinoa, oats (certified gluten-free oats), potatoes, and many fruits and vegetables.
A. Barley: Barley contains gluten, which is harmful to individuals with celiac disease. It should be avoided in the child's diet.
C. Rye: Rye also contains gluten and should be avoided in the child's diet. It can cause damage to the small intestine in individuals with celiac disease.
D. Wheat: Wheat is a primary source of gluten and is strictly off-limits for individuals with celiac disease. It is essential to avoid all wheat-containing products, including bread, pasta, and baked goods.
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