A nurse is providing care for a 3-month-old infant diagnosed with RSV bronchiolitis. The infant is tachypneic, rubbing his eyes, and appears sleepy.
The mother places the infant flat, but the baby becomes more short of breath and irritable. Which of the following is the best advice for the nurse to give?

Choice A rationale

Dehydration in infants can be a serious medical concern if not addressed quickly. It can be caused by various factors such as vomiting or diarrhea, or if the baby is not nursing well. The most common signs of dehydration in babies include concentrated urine that looks very dark yellow or orange, constipation, dry lips, dry mouth, dry mucous membranes, excessive sleepiness, irritability, less than six wet diapers in a 24-hour period, no interest in taking a bottle or breastfeeding, no tears when crying, paleness, sunken fontanelle (soft spot) on their head, and wrinkled skin. If the nurse observes these signs and symptoms in the infant, along with the intake and output record from the previous 8 hours, the nurse might determine that the patient is dehydrated during the shift.

Choice B rationale

If the infant shows signs of improvement such as increased urine output, normal skin turgor, moist mucous membranes, and the infant is alert and active, then the nurse might determine that the patient is improving as anticipated. However, without specific details about the infant’s condition, it’s difficult to definitively say that this is the case.

Choice C rationale

Fluid volume excess, also known as fluid overload, occurs when the body has too much water and electrolytes. Symptoms can include swelling in the hands, feet, ankles, or abdomen, weight gain, high blood pressure, and shortness of breath. If the nurse observes these symptoms in the infant, along with the intake and output record from the previous 8 hours, the nurse might

determine that the patient has fluid volume excess. However, given the information provided, this does not seem to be the most likely scenario.

Choice D rationale

If the infant’s vital signs are stable, the infant is alert and active, and there are no significant changes in the infant’s condition, the nurse might determine that the patient’s condition is stable. However, without specific details about the infant’s condition, it’s difficult to definitively say that this is the case.

Choice A rationale

Supervising the child in outdoor, fenced play areas is a key safety measure for toddlers. At this age, children are exploring their environment and may not be aware of potential dangers.

Fenced play areas provide a safe space for the child to play while still being under the watchful eye of the parents. This demonstrates an understanding of the child’s safety needs.

Choice B rationale

Allowing a toddler to cross the street with a 6-year-old sibling is not a safe practice. Children at this age do not have the cognitive ability to understand the dangers of traffic and cannot make safe decisions about when to cross the street. Therefore, this action does not demonstrate an understanding of the child’s safety needs.

Choice C rationale

Using an automobile booster seat with a lap belt is not appropriate for an 18-month-old toddler. According to safety guidelines, children under the age of 2 should be in a rear-facing car seat, and children between the ages of 2 and 4 should be in a forward-facing car seat with a harness. Booster seats are typically used for older children who have outgrown their forward- facing car seats. Therefore, this action does not demonstrate an understanding of the child’s safety needs.

Choice D rationale

Teaching a toddler about swimming and water safety is important, but it is not enough to ensure the child’s safety. Toddlers should always be supervised around water, even if they have had swimming lessons. Drowning is a leading cause of death in toddlers, and it can happen quickly and silently. Therefore, while teaching water safety is a good step, it needs to be combined with other safety measures.