Ati Rn Paediatrics 2023 Proctored Exam
A nurse on a pediatric intensive care unit is caring for a toddler who weighs 12 kg (26.5 lb) and is postoperative following open-heart surgery. Which of the following findings should the nurse report to the provider?
Explanation & Rationale
A. Urine output of 15 mL in the last 2 hr: Urine output is a critical indicator of kidney function. For a toddler weighing 12 kg, an output of less than 1 ml/kg/hr (in this case, 12 mL/hr) is concerning and might suggest dehydration or kidney dysfunction.B. Pedal and posterior tibial pulses of 2+ are considered normal for pulses in the lower extremities.C. A skin temperature of 36°C (96.8°F) is slightly on the low side but not a critical finding in isolation.D. Drainage from the chest tube is expected after open heart surgery. The amount (22 mL in an hour) might need monitoring depending on the specifics of the surgery, but it's not necessarily a red flag on its own.
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