Ati nur223g paediatrics sect 2 final proctored exam
A nurse is admitting an infant who has severe dehydration from acute gastroenteritis. Which of the following findings should the nurse expect?
Explanation & Rationale
A. A bulging fontanel indicates increased intracranial pressure or fluid overload, not dehydration. With dehydration, you expect a sunken fontanel. B. Bradypnea (slow breathing) is not typically associated with dehydration and may indicate other issues. C. A capillary refill time of 3 seconds suggests delayed perfusion, but it is not as indicative of severe dehydration as other signs. D. Severity of dehydration is classified by percentage of body weight lost: Severe: ≥10% loss, moderate: 6–9% loss, mild: 3–5% loss. A 13% loss = severe dehydration, which matches the scenario.
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