Which finding in a 5-year-old child diagnosed with hemolytic uremic syndrome would require the nurse to take immediate action?
BUN 14 mg/dL.
Serum Creatinine 0.4 mg/dL.
Urine output 76 mL/24 hours.
Hbg 12 g/dL.
The Correct Answer is C
Urine output 76 mL/24 hours.
Choice A rationale:
BUN (Blood Urea Nitrogen) of 14 mg/dL falls within the normal range (7-20 mg/dL) and is not an immediate concern.
Choice B rationale:
Serum Creatinine of 0.4 mg/dL is also within the normal range (0.2-0.5 mg/dL) and does not warrant immediate action.
Choice C rationale:
Urine output of 76 mL/24 hours is significantly decreased from the expected normal range (1-2 mL/kg/hour), indicating potential kidney dysfunction or dehydration. This requires immediate action to assess the child's hydration status and kidney function.
Choice D rationale:
Hb (Hemoglobin) of 12 g/dL is within the normal range for a 5-year-old child (11.5-15.5 g/dL) and does not necessitate urgent intervention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Replacing the dressing if bleeding is noted is appropriate as it helps maintain a clean and sterile site post-catheterization.
Choice B rationale:
Positioning the child in a flat-lying position immediately after cardiac catheterization is incorrect. The child should be placed in a specific position, such as semi-Fowler's, to avoid complications and promote comfort.
Choice C rationale:
Monitoring the pulses distal to the site is essential to assess circulation and potential complications after the procedure.
Choice D rationale:
Checking the vital signs every 15 minutes is appropriate post-catheterization to detect any hemodynamic changes or complications.
Correct Answer is A
Explanation
Dust the child's room with a damp cloth every week.
Choice A rationale:
Dusting the child's room with a damp cloth weekly is the most appropriate strategy. This minimizes allergen exposure by capturing and removing dust particles instead of dispersing them, as dry dusting might. Consistent, thorough cleaning can help prevent exacerbations.
Choice B rationale:
Providing down pillows might aggravate allergies due to their potential to harbor dust mites and allergens, worsening the child's asthma symptoms.
Choice C rationale:
Using a warm mist humidifier could promote mold growth and allergen accumulation in the room, potentially worsening asthma symptoms rather than alleviating them.
Choice D rationale:
Encouraging the child to go outside in cold air during an asthma attack is not recommended. Cold air can trigger bronchospasms and worsen asthma symptoms, making this strategy potentially harmful.
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