Which is the priority nursing intervention for a 6-month-old infant hospitalized with diarrhea and dehydration?
a. Estimating insensible fluid loss
b. Collecting urine for culture and sensitivity
c. Palpating the posterior fontanel
d. Measuring the infant's weight
D
Weight is a crucial indicator of fluid status. It is an important criterion for assessing hydration status and response to fluid replacement. Infants have a greater total body surface area and therefore a greater potential for fluid loss through the skin. It is not possible to measure insensible fluid loss. Urine for culture and sensitivity is not usually part of the treatment plan for the infant who is dehydrated from diarrhea. The posterior fontanel closes by 2 months of age. The anterior fontanel can be palpated during an assessment of an infant with dehydration.
You might also like to view...
Telophase is which phase of cell reproduction during mitosis?
a. First phase b. Latent phase c. Final phase d. Spindle phase
You are caring for a patient who speaks a language different from your own. You recognize that special approaches for overcoming the language barrier would include which of the following? Select all that apply
a. Use clichés and jargon for a little humor b. Avoid defensive or offensive body language c. Use a different interpreter for each interaction d. Speak to the interpreter, rather than to the patient e. Provide reading material written in the appropriate language f. Use a culturally sensitive interpreter with fluency in health care terminology
The nurse has completed discharge teaching with a patient who had a valve replacement for infective endocarditis. Which of the following patient statements would indicate an understanding of the instructions?
1. "I will take antibiotics prior to a dental cleaning.". 2. "I will take antibiotics prior to my next electrocardiogram.". 3. "I will take antibiotics prior to going on vacation.". 4. "I will take antibiotics prior to seeing my chiropractor.".
A nursing leader observes conflict in the team. The leader's response to this conflict should be based on which principle?
1. Information and expertise from sources external to the team cause erosion of teamwork. 2. Conflict that is focused on differing personalities is acceptable as long as agreement regarding work issues exists. 3. Total agreement on all matters is not as important as general agreement among members to support decisions of the team. 4. Personal feelings or reactions of members regarding decisions always must be aired immediately.