A nurse is caring for a pediatric patient with suspected dehydration.
The child presents with diarrhea and vomiting.
What clinical manifestations would the nurse expect to observe in this patient?
Thirst and dry mouth.
Rapid heart rate and low blood pressure.
Sunken eyes and fontanelle in infants.
Lethargy and irritability.
The Correct Answer is C
Choice A rationale:
Thirst and dry mouth are common signs of dehydration in adults, but in pediatric patients, especially infants, the signs are different.
Children may not be able to communicate their thirst effectively, and dry mouth might not be as noticeable as other signs.
Choice B rationale:
Rapid heart rate and low blood pressure are symptoms of shock, which can occur in severe dehydration.
However, these symptoms are not specific to dehydration and can be present in other conditions.
Sunken eyes and fontanelle in infants are more specific indicators of dehydration in pediatric patients.
Sunken eyes occur due to loss of tissue turgor, and a sunken fontanelle (the soft spot on an infant's head) is a late sign of dehydration.
Choice D rationale:
Lethargy and irritability can be signs of dehydration, but they are nonspecific and can occur in various pediatric conditions.
Sunken eyes and fontanelle, on the other hand, are more specific to dehydration, especially in infants.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","E"]
Explanation
Choice A rationale:
Administering oral rehydration solution (ORS) is a crucial nursing intervention for a dehydrated child.
ORS helps replenish the lost fluids and electrolytes, making it an effective treatment for dehydration.
Choice B rationale:
Keeping the child in a cold environment is not an appropriate intervention for a dehydrated child.
Dehydration is not related to room temperature, and maintaining a comfortable environment is important, but extreme cold could cause discomfort to the child.
Choice C rationale:
Monitoring the child's vital signs is an essential nursing intervention when caring for a dehydrated child.
Vital signs, including heart rate, respiratory rate, blood pressure, and temperature, can provide important information about the child's condition and hydration status.
Regular monitoring helps in assessing the child's progress and identifying any worsening symptoms.
Choice D rationale:
Providing heavy meals at regular intervals is not an appropriate intervention for a dehydrated child.
As mentioned earlier, heavy meals can be difficult to digest and may worsen dehydration.
It is more important to focus on rehydration with fluids like ORS.
Choice E rationale:
Educating the child and caregivers about dehydration is an important nursing intervention.
Teaching them about the signs and symptoms of dehydration, the importance of ORS, and how to prevent it in the future is essential for the child's well-being and for preventing future episodes of dehydration.
Correct Answer is D
Explanation
Choice A rationale:
Ensure appropriate fluid intake based on age and weight.
Rationale: This is an essential piece of advice to prevent dehydration in children.
Proper fluid intake based on age and weight helps maintain hydration.
However, it's not the only advice that should be given.
Choice B rationale:
Monitor for signs of dehydration such as dry mucous membranes and decreased urine output.
Rationale: Monitoring for signs of dehydration is crucial, but it's not the only preventive measure.
Detecting dehydration early is important for timely intervention, but proactive prevention is also necessary.
Choice C rationale:
Encourage consumption of electrolyte solutions during periods of illness.
Rationale: Encouraging the consumption of electrolyte solutions during illness is a valuable piece of advice, especially when children may lose fluids due to vomiting or diarrhea.
However, it's not the only preventive measure.
Choice D rationale:
All these measures are necessary to prevent dehydration in children.
Rationale: This is The correct answer.
Preventing dehydration in children involves a combination of measures, including ensuring appropriate fluid intake, monitoring for signs of dehydration, and encouraging electrolyte solutions during illness.
All these measures work together to keep a child well-hydrated and prevent dehydration.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.