A nurse is assessing a 3-month-old infant who has diarrhea. Which of the following findings should the nurse expect?
Decreased heart rate
Bulging fontanel
Polyuria
Increased hematocrit
The Correct Answer is D
A. Decreased heart rate: Dehydration typically causes an increased heart rate (tachycardia) rather than a decreased heart rate.
B. Bulging fontanelle: A bulging fontanel can indicate increased intracranial pressure or overhydration. Dehydration, which is more common with diarrhea, would more likely cause a sunken fontanel.
C. Polyuria: Polyuria (increased urine output) is not expected with dehydration. Dehydration often results in oliguria (decreased urine output).
D. Increased haematocrit: Correct. Dehydration can cause hemoconcentration, which leads to an increased haematocrit as the blood becomes more concentrated.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Give the child small sips of water. Giving water can be helpful, but frequent throat clearing may indicate bleeding, which should be assessed first.
B. Administer an analgesic. Pain management is important, but the immediate concern should be to rule out postoperative bleeding.
C. Observe the child's throat with a flashlight. Frequent throat clearing can be a sign of bleeding. The nurse should inspect the throat first to check for signs of hemorrhage, which is a serious complication.
D. Offer the child an ice collar. An ice collar can help reduce swelling and pain but should be done after assessing for bleeding.
Correct Answer is D
Explanation
A. Sausage-shaped mass in the upper right abdomen A sausage-shaped mass in the upper right abdomen is indicative of intussusception, not celiac disease.
B. Red-currant, jelly-like stools: Red-currant, jelly-like stools are characteristic of intussusception, not celiac disease.
C. Hematemesis: Hematemesis (vomiting blood) is not a typical symptom of celiac disease. It is more commonly associated with conditions involving gastrointestinal bleeding such as esophageal varices or severe gastritis.
D. Steatorrhea: Steatorrhea (fatty stools) is a common finding in celiac disease due to malabsorption of fats in the intestine. The inability to digest and absorb fat leads to pale, foul-smelling, and bulky stools.
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