A nurse is preparing to measure an infant's vital signs. The nurse should use which of the following sites to assess a heart rate?
Brachial artery
Radial artery
Apex of the heart
Carotid artery
The Correct Answer is A
Rationale:
A. The brachial artery is commonly used to assess the heart rate in infants due to its accessibility and the ease of palpation in smaller limbs.
B. The radial artery is not typically used in infants because it is less accessible and not as easily palpated in this age group.
C. While the apex of the heart is where heart sounds are best auscultated, it is not used to palpate the pulse in infants.
D. The carotid artery is not typically used for assessing the heart rate in infants due to the risk of applying excessive pressure.
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Correct Answer is B
Explanation
Rationale:
A. Nausea and vomiting are more commonly associated with hyperglycemia, not hypoglycemia.
B. Shakiness is a common symptom of hypoglycemia, indicating that the parents understand the signs of low blood glucose levels.
C. The onset of hypoglycemia is typically rapid, not slow, which is why quick intervention is necessary.
D. Sweating is a common symptom of hypoglycemia, not hyperglycemia.
Correct Answer is B
Explanation
Rationale:
A. Obtaining a blood culture is important but is not the immediate priority when a transfusion reaction is occurring.
B. Stopping the transfusion is the first step in managing a transfusion reaction to prevent further exposure to the allergen or irritant causing the symptoms.
C. Slowing the transfusion rate might not be sufficient if a reaction is occurring; stopping it is crucial.
D. Providing a diuretic is not relevant to the management of an acute transfusion reaction.