A nurse is caring for a 3-year-old toddler who has dehydration. Which of the following findings should the nurse report to the provider?
Heart rate 148/min
Potassium 3.9 mEq/L
Respiratory rate 22/min
Sodium 142 mEq/L
The Correct Answer is A
A. Heart rate 148/min – Correct. A heart rate of 148/min in a 3-year-old is elevated (tachycardia) and may indicate worsening dehydration or shock.
B. Potassium 3.9 mEq/L – Incorrect. This potassium level is within the normal range (3.5–5.0 mEq/L).
C. Respiratory rate 22/min – Incorrect. This is within the expected range for a 3-year-old.
D. Sodium 142 mEq/L – Incorrect. This sodium level is within the normal range (135–145 mEq/L).
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Acetaminophen does not affect kidney function or contrast dye metabolism.
B. Metformin should be withheld 24-48 hours before and after contrast dye administration to reduce the risk of lactic acidosis, especially in clients with impaired renal function.
C. Atenolol, a beta-blocker, does not interfere with contrast dye.
D. Prednisone is not contraindicated in contrast studies unless the client has an allergy to the dye.
Correct Answer is D
Explanation
A. Place the client in Trendelenburg position during the procedure – Incorrect, as amniocentesis is typically performed with the client in a supine position.
B. Instruct the client to maintain a full bladder for the procedure – This is required for an early pregnancy amniocentesis (before 20 weeks), but for later procedures, the bladder should be empty.
C. Administer a tocolytic 30 min before the procedure – Not routinely necessary unless the client is at risk for preterm labor.
D. Monitor the fetal heart rate throughout the procedure – Correct, as amniocentesis carries a risk of fetal distress, and continuous monitoring ensures immediate detection of complications.
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