the nurse is caring for a child with acute renal failure what laboratory findings should the nurse expect to find select all that apply

ATI RN

RN Nursing Care of Children 2019 With NGN

1. The nurse is caring for a child with acute renal failure. What laboratory findings should the nurse expect to find? (Select all that apply.)

A. Hyponatremia
B. Hyperkalemia
C. All are applicable
D. Elevated blood urea nitrogen level

Correct answer: C

Rationale: In acute renal failure, laboratory findings typically include hyperkalemia, hyponatremia, and elevated blood urea nitrogen (BUN) levels due to the kidneys' inability to excrete waste and balance electrolytes. Metabolic alkalosis is less common, with metabolic acidosis being more typical.

2. What is an appropriate screening test for hearing that the nurse can administer to a 5-year-old child?

A. Rinne test
B. Weber test
C. Pure tone audiometry
D. Eliciting the startle reflex

Correct answer: C

Rationale: Pure tone audiometry is an appropriate and effective screening test for hearing in a 5-year-old child, helping to assess the ability to hear various frequencies and volumes.

3. Which is the most frequently used test for measuring visual acuity?

A. Snellen letter chart
B. Ishihara vision test
C. Allen picture card test
D. Denver eye screening test

Correct answer: A

Rationale: The Snellen letter chart is the most commonly used test for measuring visual acuity, particularly in school-age children and adults.

4. A 12-month-old infant has been diagnosed with failure to thrive (FTT). Which assessment findings does the nurse expect to be documented with this infant?

A. Fear of strangers
B. Minimal smiling
C. Avoidance of eye contact
D. All of the above

Correct answer: D

Rationale: These behaviors are consistent with FTT and indicate social withdrawal, which is often observed in infants who are not thriving. A wide-eyed gaze and avoidance of eye contact can also indicate developmental delays or emotional disturbances.

5. What is the most consistent and commonly used indicator of pain in infants?

A. Increased respirations
B. Increased heart rate
C. Thrashing of arms and legs
D. Facial expression of discomfort

Correct answer: D

Rationale: Facial expression has consistently been validated as an indicator of pain in infants. Behavioral pain measures are most reliable for sharp procedural pain in infants. Increased heart rate and respirations are indicative of a generalized and complex response to stress, not specific for pain in infants. Thrashing of arms and legs is a reliable indicator in young children, not specifically in infants.