A nurse is planning care for a toddler who was admitted for acute diarrhea. Which of the following actions is the nurse's priority?
Initiating IV fluid therapy
Administering a regular diet
Administering IV antibiotics
Initiating oral rehydration therapy
The Correct Answer is D
A. IV fluid therapy may be necessary if the child cannot tolerate oral fluids, but oral rehydration therapy is the first line of treatment for mild to moderate dehydration.
B. Administering a regular diet is important for recovery but is not the priority action when addressing acute dehydration.
C. IV antibiotics are not typically necessary for acute diarrhea unless there is a confirmed bacterial infection.
D. Initiating oral rehydration therapy is the priority to address dehydration and replace lost fluids and electrolytes effectively.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"C"}
Explanation
The nurse should clarify the child's prescription of dextrose 5% in 0.45% sodium chloride with 20 mEq potassium chloride/L at 75 mL/hr because of the child's laboratory values. The elevated potassium level of 6.2 mEq/L, which is above the normal range of 3.4 to 4.7 mEq/L, indicates hyperkalemia. Administering additional potassium could exacerbate this condition, therefore, it is crucial to review the prescription and adjust it accordingly to ensure the safety and well-being of the child.
Correct Answer is C
Explanation
A. Instilling 2 mL of 0.9% sodium chloride is not recommended as it can cause discomfort and does not improve the effectiveness of suctioning.
B. Sterile technique, not clean technique, should be used when suctioning a tracheostomy to prevent infection.
C. Applying suction in 3 to 4 second increments is appropriate to clear the occlusion effectively without causing trauma to the trachea.
D. The catheter should not fit snugly into the tracheostomy tube; it should be small enough to fit comfortably to avoid trauma and ensure effective suctioning.
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