A nurse is assessing a child who has acute kidney injury. Which of the following clinical manifestations should the nurse expect?
Decreased respiratory rate
Polyuria
Hyperactivity
Edema
The Correct Answer is D
A. Decreased respiratory rate: AKI typically does not directly affect respiratory rate. Respiratory rate is more closely related to lung function and oxygenation status rather than kidney function.
B. Polyuria: This is an incorrect option. Polyuria, or increased urine output, is not typically seen in acute kidney injury. In fact, oliguria (decreased urine output) or anuria (absence of urine output) are more common in AKI due to decreased kidney function.
C. Hyperactivity: AKI does not typically cause hyperactivity. In fact, children with AKI may appear lethargic or fatigued due to the buildup of waste products in their bodies and electrolyte imbalances.
D. Edema: This is the correct option. Edema, or swelling due to fluid retention, is a common clinical manifestation of AKI. When the kidneys are unable to adequately filter and excrete excess fluid from the body, fluid accumulates in the tissues, leading to edema. Edema may be particularly noticeable in the face, hands, feet, or around the eyes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "I should place the shoulder harness above the level of my baby's shoulders."
This statement is incorrect. Placing the shoulder harness above the baby's shoulders could lead to improper restraint in the event of a crash. The harness should be positioned at or slightly below the level of the baby's shoulders to provide effective protection.
B. "I should place the car seat rear-facing until my baby is 2 years old."
This statement is correct. The American Academy of Pediatrics recommends that infants and toddlers ride in a rear-facing car seat until they are at least 2 years old or until they reach the maximum height and weight limit specified by the car seat manufacturer. This position provides optimal protection for the baby's head, neck, and spine in the event of a crash.
C. "I will place the retainer clip over my baby's abdomen."
This statement is incorrect. The retainer clip, also known as the chest clip, should be positioned at armpit level to secure the harness straps. Placing it over the baby's abdomen could result in serious injuries in the event of a crash.
D. "I should position my baby at a 30-degree angle in the car seat."
This statement is incorrect. Infants should be positioned at a 45-degree angle in their car seats. This angle helps to keep the baby's airway open and prevents the head from flopping forward, which could restrict breathing. Placing the baby at a 30-degree angle may not provide adequate support and protection.
Correct Answer is C
Explanation
A. Increased respiratory rate: An increased respiratory rate may indicate that the child is experiencing respiratory distress or discomfort, which could be a sign that suctioning was not effective or that it was too aggressive. Ideally, after suctioning, the child's respiratory rate should stabilize or decrease as they are able to breathe more comfortably with a clear airway.
B. Decreased oxygen saturation: A decreased oxygen saturation level may indicate that the child is not receiving enough oxygen, which could be a sign of ineffective suctioning or airway obstruction. Effective suctioning should improve oxygenation by removing secretions and allowing for better airflow. A decrease in oxygen saturation would suggest the need for further assessment and intervention.
C. Clear breath sounds: This is the correct option. Clear breath sounds indicate that the airway has been effectively cleared of excess secretions, allowing for clear airflow. After suctioning, the nurse should listen for clear breath sounds without any crackles, wheezes, or other abnormal sounds indicating obstruction or congestion.
D. Increased oral secretions: Increased oral secretions may suggest that suctioning was not effective in clearing secretions from the airway, leading to pooling of secretions in the mouth. Effective suctioning should remove excess secretions from the airway, reducing the need for excessive oral secretions.
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.
