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A nurse in an emergency department is caring for an infant who has a 2-day history of vomiting and an elevated temperature. Which of the following should the nurse recognize as the most reliable indicator of fluid loss?

A.

Blood pressure.

B.

Respiratory rate.

C.

Body weight.

D.

Skin integrity.

Answer and Explanation

The Correct Answer is C

Choice A rationale

 

Blood pressure is not the most reliable indicator of fluid loss in infants. Blood pressure can remain normal until dehydration is severe.

 

Choice B rationale

 

Respiratory rate can be affected by many factors and is not the most reliable indicator of fluid loss.

 

Choice C rationale

 

Body weight is the most reliable indicator of fluid loss in infants. A significant decrease in body weight indicates significant fluid loss and helps guide appropriate fluid replacement therapy.

 

Choice D rationale

 

Skin integrity can be affected by many factors and is not the most reliable indicator of fluid loss.


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View Related questions

Correct Answer is ["A","D","E"]

Explanation

Choice A rationale

The Measles, Mumps, and Rubella (MMR) vaccine is recommended for children at 12-15 months of age. This vaccine protects against three serious diseases: measles, mumps, and rubella. Measles can cause severe respiratory illness and encephalitis, mumps can lead to meningitis and hearing loss, and rubella can cause congenital rubella syndrome in unborn babies if a pregnant woman is infected.

Choice B rationale

The Rotavirus (RV) vaccine is typically given to infants at 2, 4, and sometimes 6 months of age. It is not recommended for children older than 8 months.

Choice C rationale

The Human Papillomavirus (HPV) vaccine is recommended for preteens starting at age 11 or 12. It is not given to 1-year-old children.

Choice D rationale

The Varicella (VAR) vaccine is recommended for children at 12-15 months of age to protect against chickenpox, which can cause severe skin infections, pneumonia, and encephalitis.

Choice E rationale

The Diphtheria, Tetanus, and Acellular Pertussis (DTaP) vaccine is part of the routine immunization schedule for children, with doses given at 2, 4, 6, and 15-18 months of age. This vaccine protects against three serious diseases: diphtheria, which can cause breathing problems and heart failure; tetanus, which can cause muscle stiffness and lockjaw; and pertussis (whooping cough), which can cause severe coughing spells and pneumonia.

Correct Answer is D

Explanation

ChoiceA rationale

Hypotensionisnotacommonmanifestationofhypoxemiaduringanasthmaattack.

ChoiceB rationale

Dysphagiaisnotacommonmanifestationofhypoxemiaduringanasthmaattack.

ChoiceCrationale

Nauseaisnotacommonmanifestationofhypoxemiaduring anasthmaattack.

ChoiceD rationale

Agitationisacommonmanifestationofhypoxemiaduringanasthmaattack.Hypoxemiacancauserestlessnessandagitationduetothelackof oxygenin thebody.

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