A nurse is caring for a toddler who has been vomiting for the past 8 hr. Which of the following findings indicates to the nurse that the child is dehydrated?

Increased blood pressure

Distended jugular veins

Flat anterior fontanel

Increased pulse

Answer and Explanation

The Correct Answer is D

A. Increased blood pressure is typically not associated with dehydration. In fact, dehydration often causes hypotension or low blood pressure, especially in severe cases.

B. Distended jugular veins are usually a sign of fluid overload or heart failure, not dehydration. In dehydration, the veins may appear flat due to decreased fluid volume.

C. A flat anterior fontanel is generally expected in a well-hydrated child. A sunken fontanel would indicate dehydration in infants and young toddlers.

D. Increased pulse (tachycardia) is a common sign of dehydration. As the body loses fluid, the heart compensates by increasing the heart rate to maintain adequate perfusion of organs.

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Correct Answer is "{\"xRanges\":[93.828125,113.828125],\"yRanges\":[223,243]}"

Explanation

A. Lateral aspect: The preferred location for performing a heel stick on a neonate is the lateral (outer) aspect of the heel, avoiding the central area and the arch of the foot. This area contains fewer nerve endings and less tissue, making it safer and less painful for the infant. It also minimizes the risk of injury to the underlying bones, blood vessels, and nerves.

B. Heel: The heel is not recommended as a puncture site because it contains fat, bone, and nerves, and puncturing the heel could cause injury or complications such as osteochondritis (bone infection). This site also carries a higher risk of injury to blood vessels and tendons.

C. Medial aspect: The medial (inner) aspect of the heel is also not recommended because it is near the medial plantar artery and nerves. Puncturing this area could result in damage to these structures, leading to complications. The lateral aspect is a safer, preferred location.

A. Facial edema B. Increased temperature C. Moist mucus membranes D. Muscle twitching

Correct Answer is B

Explanation

A. Facial edema is not typically associated with a urinary tract infection (UTI). Edema may be seen in other conditions, such as nephrotic syndrome.

B. An increased temperature (fever) is a common manifestation of a UTI. The body responds to the infection with an elevated temperature as part of the immune response.

C. Moist mucus membranes are a sign of adequate hydration and are not specifically related to a UTI.

D. Muscle twitching is not a common sign of a UTI. It could be related to electrolyte imbalances or neurological issues, but it is not typical for UTIs.

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A nurse is caring for a toddler who has been vomiting for the past 8 hr. Which of the following findings indicates to the nurse that the child is dehydrated?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is "{\"xRanges\":[93.828125,113.828125],\"yRanges\":[223,243]}"

Explanation

. A nurse in an urgent care clinic is collecting data from a preschooler who reports painful urination. Which of the following findings should the nurse identify as a possible manifestation of a urinary tract infection?

Correct Answer is B

Explanation

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