A nurse is assessing an infant who has severe dehydration due to gastroenteritis.
Which of the following findings should the nurse expect?
Hypertension.
Increased urine output.
Capillary refill of 2 seconds.
Increased respiratory rate.
Increased respiratory rate.
The Correct Answer is D
An increased respiratory rate is a sign of severe dehydration in infants.
Dehydration occurs when an infant loses so much body fluid that they are not able to maintain ordinary function.
Choice A is wrong because hypertension is not a sign of severe dehydration in infants.
Choice B is wrong because increased urine output is not a sign of severe dehydration in infants.
In fact, decreased urine output is a sign of dehydration 2.
Choice C is wrong because a capillary refill of 2 seconds is normal and not a sign of severe dehydration in infants.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Pad the side rails of the crib.
Padding the side rails of the crib can help prevent injury if the infant experiences seizures, which can be a symptom of bacterial meningitis.
Choice A is wrong because infants with bacterial meningitis may be sensitive to noise and light, so keeping the television on may not be appropriate.
Choice B is wrong because range of motion exercises to the neck and shoulders may not be appropriate for an infant with bacterial meningitis.
Choice D is wrong because placing the infant in a semiprivate room may increase the risk of infection 1.
Correct Answer is A
Explanation
A 24-gauge catheter is the smallest-gauge catheter and is appropriate for administering IV fluids and medications to an infant.
Choice B is wrong because an opaque dressing would prevent the nurse from visualizing the insertion site.
Choice C is wrong because starting an IV in an infant’s foot can be painful and difficult to secure.
Choice D is wrong because IV sites should be changed every 72-96 hours or according to facility policy.
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