A nurse is caring for a 4-year-old who was admitted with acute diarrhea and dehydration. Which finding indicates that oral rehydration therapy has been effective?
Capillary refill greater than 3 seconds
Respiratory rate 24/min
Urine specific gravity 1.015 (nl. 1.005-1.030)
Heart rate 130/bpm
The Correct Answer is C
A. A capillary refill greater than 3 seconds suggests ongoing dehydration and poor perfusion, indicating that oral rehydration has not been fully effective.
B. A respiratory rate of 24/min is within normal limits for a 4-year-old but is not a direct indicator of hydration status.
C. A urine specific gravity of 1.015 is within the normal range, indicating adequate hydration and that oral rehydration therapy has been effective.
D. A heart rate of 130 bpm, while potentially normal for a 4-year-old, does not specifically indicate the effectiveness of rehydration therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. If NSAIDs (nonsteroidal anti-inflammatory drugs) are ineffective in managing symptoms of JIA, the healthcare provider needs to be notified as other treatments, such as disease-modifying antirheumatic drugs (DMARDs) or biologics, may be necessary.
B. Warm compresses, rather than cool compresses, are typically recommended to relieve joint pain and stiffness in JIA.
C. While rest is important, excessive napping can lead to stiffness and decreased mobility. Regular, gentle activity is encouraged to maintain joint function.
D. High-impact exercises like running may be too strenuous for children with JIA and can exacerbate joint pain. Low-impact activities such as swimming or cycling are generally recommended to promote range of motion without putting undue stress on the joints.
Correct Answer is D
Explanation
A. Oral penicillin is not a primary treatment for nephrotic syndrome. Antibiotics may be used if there is an associated infection, but they are not central to the management of nephrotic syndrome itself.
B. Labetalol is a medication used for hypertension and would not be specifically indicated for nephrotic syndrome unless hypertension is present.
C. Aggressive intravenous fluid resuscitation is not typically used in nephrotic syndrome; instead, fluid management focuses on balancing fluid intake and output carefully.
D. Prednisone, a corticosteroid, is commonly used to reduce inflammation and proteinuria in nephrotic syndrome. It helps to manage the condition effectively by addressing the underlying inflammation.
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