A nurse is caring for a 3-year-old child who was admitted with acute diarrhea and dehydration. Which of the following findings indicates that oral rehydration therapy has been effective?
Heart rate 130/min
Urine specific gravity 1.015
Respiratory rate 24/min
Capillary refill less than 3 seconds
None
None
The Correct Answer is B
The correct answer is: b.
Choice A: Heart rate 130/min
A heart rate of 130 beats per minute (bpm) is considered high for a 3-year-old child. Normal heart rates for children aged 1-3 years typically range from 80 to 120 bpm. While dehydration can cause tachycardia (increased heart rate), a heart rate of 130 bpm does not necessarily indicate effective rehydration.
Choice B: Urine specific gravity 1.015
Urine specific gravity of 1.015 is within the normal range (1.005–1.030) for a hydrated child. Dehydration increases urine concentration (>1.020), but a normalized value like 1.015 shows that ORT has restored fluid balance. UpToDate and NIH studies (e.g., Binder et al., 2014) highlight urine specific gravity as a precise measure of hydration status, making it the strongest indicator of ORT effectiveness.
Choice C: Respiratory rate 24/min
The normal respiratory rate for a 3-year-old child is between 20 and 30 breaths per minute. A respiratory rate of 24 breaths per minute is within this normal range. While a normal respiratory rate can indicate improved hydration status, it is not the most specific indicator of effective rehydration therapy.
Choice D: Capillary refill less than 3 seconds
Capillary refill time of less than 3 seconds suggests adequate perfusion, as normal is under 2 seconds. Dehydration may prolong this time, but “less than 3 seconds” could include slightly delayed values (e.g., 2.5 seconds). UpToDate and NIH studies (e.g., Doan et al., 2010) note it as useful but less specific than urine specific gravity for confirming ORT effectiveness.
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Related Questions
Correct Answer is B
Explanation
The correct answer is: B. I will add Polycose to each of my baby's bottles.
Choice A reason:
Allowing the baby to take as much time as needed to finish the bottle is not ideal for infants with heart failure. These infants often tire easily and may not consume enough calories if feeding sessions are prolonged. Shorter, more frequent feedings are generally recommended to ensure adequate intake without exhausting the infant.
Choice B reason:
Adding Polycose to each bottle is an effective way to increase the caloric density of the infant's feedings. Infants with heart failure have higher caloric needs due to their increased metabolic demands and may struggle to consume enough calories through regular formula or breast milk alone. Polycose, a carbohydrate supplement, helps meet these increased nutritional needs.
Choice C reason:
Feeding the baby on a schedule every 4 hours may not be sufficient for an infant with heart failure. These infants often require more frequent feedings to meet their caloric needs and to prevent fatigue during feeding. Feeding every 1-3 hours is typically recommended to ensure they receive adequate nutrition.
Choice D reason:
Limiting the baby's crying to 15 minutes prior to each feeding does not directly address the nutritional needs of an infant with heart failure. While managing crying is important to reduce energy expenditure, the focus should be on providing adequate nutrition through frequent, high-calorie feedings.
Correct Answer is B
Explanation
Choice A reason: Wheat is not a suitable food choice for a child who has celiac disease, as it contains gluten, a protein that triggers an immune response and damages the small intestine in people with celiac disease. Wheat is found in many breads, cereals, pastas, and baked goods, and it should be avoided by the child.
Choice B reason: Rice is a suitable food choice for a child who has celiac disease, as it is a gluten-free grain that does not cause any adverse reactions in people with celiac disease. Rice can be eaten plain or cooked with other gluten-free ingredients, such as vegetables, meat, or dairy.
Choice C reason: Barley is not a suitable food choice for a child who has celiac disease, as it contains gluten, a protein that triggers an immune response and damages the small intestine in people with celiac disease. Barley is found in some soups, stews, beers, and malt products, and it should be avoided by the child.
Choice D reason: Rye is not a suitable food choice for a child who has celiac disease, as it contains gluten, a protein that triggers an immune response and damages the small intestine in people with celiac disease. Rye is found in some breads, crackers, cereals, and whiskey, and it should be avoided by the child.
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