A nurse is assessing an infant who has hydrocephalus and is 6 hr postoperative following placement of a ventriculoperitoneal (VP) shunt. Which of the following findings should the nurse report to the provider?

Irritability when being held

Heart rate 122/min

Hypoactive bowel sounds

Urine specific gravity 1.018

Answer and Explanation

The Correct Answer is A

A. Irritability when being held may indicate increased intracranial pressure or complications related to the VP shunt placement and should be reported to the provider.

B. A heart rate of 122/min is within the normal range for an infant and does not require reporting.

C. Hypoactive bowel sounds may occur postoperatively, especially if the infant has not been fed or has been under anesthesia, and is not an immediate concern.

D. A urine specific gravity of 1.018 is within normal limits for infants and does not indicate a need for reporting.

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Correct Answer is C

Explanation

A. Compensated metabolic acidosis would show a normal pH with a decrease in HCO3- and a decrease in PaCO2.

B. Compensated respiratory acidosis would show a normal pH with an elevated PaCO2 and a compensatory increase in HCO3-.

C. The low pH indicates acidosis, and the elevated PaCO2 suggests that it is respiratory in origin, with the HCO3- remaining normal, indicating no compensation has occurred yet.

D. Uncompensated metabolic acidosis would present with a low pH, low HCO3-, and normal PaCO2.

A. "I am concerned about my child's future participation in team sports." B. "My child doesn't like to sit still for nebulizer treatments." C. "My child has only a small amount of mucus after percussion therapy." D. "I think that my child has been running a fever over the last couple of days."

Correct Answer is C

Explanation

A. Concerns about participation in team sports are important, but they do not directly warrant a request for a high-frequency chest compression vest.

B. Discomfort with nebulizer treatments suggests the need for alternate therapies but does not specifically indicate a need for the vest.

C. A statement regarding a small amount of mucus after percussion therapy suggests that traditional methods of airway clearance may not be effective enough, indicating a need for a high-frequency chest compression vest to help mobilize mucus.

D. A fever may indicate an infection or exacerbation but does not directly relate to the need for a high-frequency chest compression vest.

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A nurse is assessing an infant who has hydrocephalus and is 6 hr postoperative following placement of a ventriculoperitoneal (VP) shunt. Which of the following findings should the nurse report to the provider?

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Naxlex Comprehensive Predictor Exams

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Explanation

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