KO is admitted with severe dehydration and electrolyte unbalances. What assessment findings are you most likely to ﬁnd initially before ﬂuid balance reaches homeostasis?

Crackles to Bilateral lobes

Tenting skin and wet mucous membranes

C Tachycardia and hypotension

+4 edema to bilateral lower extremities and confusion

Answer and Explanation

The Correct Answer is C

Dehydration can cause a decrease in blood volume, leading to a drop in blood pressure (hypotension) and an increase in heart rate (tachycardia) as the body tries to compensate. Tenting skin and dry mucous membranes are also signs of dehydration, but wet mucous membranes are not. Crackles in the lungs, edema, and confusion can occur with ﬂuid overload, but not with dehydration.

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Correct Answer is D

Explanation

Explanation: The normal range of sodium (Na+) in the blood is 135-145 mEq/L. The patient's sodium level of 121 mEq/L is below the normal range, indicating a low sodium level, which is called hyponatremia.

Hyponatremia is a common electrolyte imbalance that can be caused by a variety of factors, including excessive sweating, vomiting, diarrhea, certain medications, kidney disease, and hormonal imbalances. It can cause symptoms such as nausea, headache, confusion, seizures, and coma, and it can be a medical emergency if the sodium level drops rapidly or severely.

A. What do you think that the child might have ingested?’ B. ’At what time did the child ingest the substance?' C. ‘Induce vomiting while you wait for emergency personnel to arrive.' D. ‘Check breathing and heart rate.’

Correct Answer is A

Explanation

In case of suspected ingestion of a poisonous substance, the priority response of the poison control nurse should be to assess the child's vital signs, especially breathing and heart rate, to determine if the child is experiencing any immediate life-threatening symptoms. This information will help the nurse determine the appropriate course of action, such as whether to instruct the caregiver to perform CPR or to immediately call for emergency medical assistance.

Asking about the substance ingested and the time of ingestion are also important pieces of information to gather, but they should not take priority over assessing the child's vital signs. Inducing vomiting is generally not recommended unless instructed to do so by a medical professional, as it can cause further harm if the substance ingested is corrosive or caustic.

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KO is admitted with severe dehydration and electrolyte unbalances. What assessment findings are you most likely to ﬁnd initially before ﬂuid balance reaches homeostasis?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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