A nurse on a pediatric intensive care unit is caring for a toddler who weighs 12 kg (26.5 lb) and is postoperative following open heart surgery. Which of the following findings should the nurse report to the provider?
Drainage from the chest tube of 22 mL in the last hour
Urine output of 15 mL in the last 2 hr
Skin temperature 36° C (96.8° F)
Pedal and posterior tibial pulses of 2+
The Correct Answer is B
Rationale:
A. This amount of drainage may be expected postoperatively, and it is not indicative of a significant issue.
B. This is a concerning finding indicating possible inadequate renal perfusion, especially considering the postoperative status of the toddler.
C. While slightly lower than the typical body temperature, it is not necessarily abnormal, particularly in a postoperative setting.
D. Pulses of 2+ indicate adequate perfusion and are not concerning.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["0.6"]
Explanation
Rationale:
First, we need to convert the child's weight from pounds to kilograms. We can do this by dividing 55 by 2.2, which gives us 25 kg.
Next, we need to multiply the dose of diphenhydramine by the child's weight to get the total amount of medication needed. We can do this by multiplying 1.25 mg/kg by 25 kg, which gives us 31.25 mg.
Finally, we need to divide the total amount of medication by the concentration of the solution to get the volume to be administered. We can do this by dividing 31.25 mg by 50 mg/mL, which gives us 0.625 mL.
To round the answer to the nearest tenth, we look at the hundredths place and see that it is 5 or more, so we round up the tenths place by one. Therefore, the nurse should administer 0.6 mL of diphenhydramine IV to the child.
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Correct Answer is D
Explanation
Rationale:
A. Sweating is more commonly associated with hypoglycemia (low blood sugar) rather than hyperglycemia (high blood sugar).
B. Tremors are more commonly associated with hypoglycemia.
C. Pallor is not typically associated with hyperglycemia.
D. Thirst (polydipsia) is a classic symptom of hyperglycemia in diabetes mellitus, as the body tries to dilute the excess sugar in the bloodstream by increasing fluid intake.
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