A nurse is caring for an infant who weighs 7.8 kg (17.2 lb) and was admitted yesterday for treatment of moderate dehydration. Which of the following findings indicates to the nurse that the infant's condition is improving?
Respiratory rate 70/min
Capillary refill is greater than 3 seconds.
Dry mucous membranes
Fontanelle is level and soft.
The Correct Answer is D
A. Respiratory rate 70/min: A respiratory rate of 70/min is high for an infant and may indicate ongoing respiratory distress or other issues. Normal respiratory rates for infants are generally 30-60 breaths per minute. This does not indicate improvement.
B. Capillary refill is greater than 3 seconds. Capillary refill time greater than 3 seconds indicates poor perfusion, which can be a sign of continued dehydration or shock. This does not indicate improvement.
C. Dry mucous membranes: Dry mucous membranes are a sign of dehydration. For an infant's condition to be improving, mucous membranes should be moist.
D. Fontanelle is level and soft. A level and soft fontanelle indicates that the infant is likely well-hydrated. Sunken fontanelles are a sign of dehydration, so this finding suggests improvement in the infant’s hydration status.
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Related Questions
Correct Answer is C
Explanation
A. Stevens-Johnson syndrome. Incorrect. While Stevens-Johnson syndrome is a severe adverse effect of some medications, it is not commonly associated with morphine.
B. Prolonged wound healing. Incorrect. Morphine does not typically affect wound healing.
C. Nausea. Correct. Nausea is a common side effect of opioids like morphine.
D. Renal failure. Incorrect. While morphine can have some effects on renal function, it is not commonly associated with causing renal failure directly.
Correct Answer is A
Explanation
A. "Your baby's crying is a way to communicate with you." Correct. This response validates the parent's concern and provides an understanding that crying is a normal behaviour for infants as a form of communication.
B. "Why do you feel like your baby cries a lot?" This question might make the parent feel defensive and does not provide reassurance or helpful information about infant behaviour.
C. "Is it possible that you have spoiled your baby?" This response is inappropriate and can make the parent feel judged or blamed. It also suggests a misunderstanding of infant development, as infants cannot be spoiled by responding to their needs.
D. "Letting your baby cry will teach them how to self-soothe." This advice is not suitable for a 1-month-old infant, as they are too young to self-soothe and need their caregivers to respond to their needs for comfort and care.
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