A nurse is assessing a dehydrated child's vital signs.
What parameters should the nurse monitor?
"Height and weight.”..
"Heart rate and blood pressure.”..
"Hair and eye color.”..
"Shoe size and clothing size.”..
The Correct Answer is B
Choice A rationale:
"Height and weight.”.
Rationale: While monitoring height and weight is important for a child's growth and development, these parameters are not the primary vital signs to assess dehydration.
Dehydration assessment focuses on immediate physiological indicators, such as heart rate and blood pressure.
Choice B rationale:
"Heart rate and blood pressure.”.
Rationale: This is The correct answer.
When assessing a dehydrated child, monitoring vital signs such as heart rate and blood pressure is crucial.
Dehydration can lead to an increased heart rate and decreased blood pressure.
These parameters provide valuable information about the child's circulatory status and fluid balance.
Choice C rationale:
"Hair and eye color.”.
Rationale: Hair and eye color are not relevant parameters for assessing dehydration.
They are genetic traits and do not change in response to dehydration.
Choice D rationale:
"Shoe size and clothing size.”.
Rationale: Shoe size and clothing size are not relevant for assessing dehydration.
These measurements are related to a child's growth and body structure but do not provide information about their hydration status.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C"]
Explanation
Choice A rationale:
Gastrointestinal illnesses, including diarrhea and vomiting, lead to fluid loss, significantly contributing to dehydration in children.
Diarrhea increases water and electrolyte loss from the body, while vomiting leads to rapid fluid depletion.
These conditions can be severe, especially in infants and young children, making them prone to dehydration.
Choice B rationale:
Excessive sweating during physical activity or in hot weather can result in significant fluid loss.
Children, especially when engaged in vigorous activities, can sweat profusely, leading to dehydration, especially if fluid intake does not match the loss.
Monitoring fluid balance is crucial during such situations to prevent dehydration-related complications.
Choice C rationale:
Insufficient fluid intake due to poor feeding or decreased thirst perception can lead to dehydration, especially in infants and young children who rely heavily on fluid intake for their hydration needs.
Children may not recognize their thirst or may refuse to drink due to illness, leading to decreased fluid intake.
This can result in dehydration, emphasizing the importance of assessing feeding habits and fluid intake patterns.
Choice D rationale:
Sunken eyes and fontanelle in infants are physical signs of dehydration, not etiological factors.
Sunken eyes are due to decreased tissue turgor, indicating dehydration.
Fontanelle, the soft spot on an infant's head, can appear sunken in dehydration.
These signs are crucial in assessing the severity of dehydration during physical examination but do not contribute to the causes of dehydration.
Correct Answer is C
Explanation
Choice A rationale:
"The child's favorite foods and beverages" are not relevant when assessing dehydration.
While dietary habits are essential for overall health, they do not provide information about the child's hydration status.
Choice B rationale:
"The child's school attendance and activities" are unrelated to the assessment of dehydration.
School attendance and activities are important for a child's social and educational development but do not provide any insight into the child's fluid balance or hydration status.
Choice C rationale:
"The child's skin turgor and mucous membranes" are crucial indicators of dehydration during physical examination.
Poor skin turgor, where the skin tents or remains elevated after being pinched, suggests decreased tissue elasticity due to fluid loss.
Dry mucous membranes, including the mouth, indicate dehydration.
These signs provide immediate visual clues about the child's hydration status and guide further assessment and intervention.
Choice D rationale:
"The child's vaccination history" is not relevant to the assessment of dehydration.
While vaccination history is essential for preventive healthcare, it does not provide any information about the child's current hydration status or fluid balance.
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