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 []
Explanation
A. Offer the infant a pacifier during feedings.
B. Check for residual volumes by aspirating stomach contents.
D. Instill the formula over a period of 30 to 45 min.
Offering the infant a pacifier during feedings can help promote non-nutritive sucking and provide comfort to the infant.
Checking for residual volumes by aspirating stomach contents can help monitor gastric emptying and tolerance to enteral feeding.
Instilling the formula over a period of 30 to 45 min can help prevent overfeeding and reduce the risk of aspiration.
Choice C is wrong because placing the infant in a supine position during feedings increases the risk of aspiration.
The infant should be placed in an upright or semi-upright position during feedings.
Choice E is wrong because heating the formula to 39° C (102° F) prior to administration is not necessary and may even be harmful if the formula is overheated.
Correct Answer is C
Explanation
During menstruation, girls lose some iron and should try to replace it by including iron-rich foods in their diet.
Choice A is wrong because the American Heart Association recommends limiting sodium intake to 1,500 milligrams per day.
Choice B is wrong because caloric needs vary depending on age, sex, height, weight, and level of physical activity.
Choice D is wrong because vitamin D is important for bone health and adolescents should not decrease their intake.
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