You are managing a 10-month-old infant who has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. You have initiated supplemental oxygen therapy and elevated the lower extremities. En route to the hospital, you note that the child's work of breathing has increased. What must you do first?

Correct Answer: A

Rationale: In this scenario, the infant is showing signs of shock with increased work of breathing. Lowering the extremities helps improve venous return to the heart, cardiac output, and oxygenation by reducing the pressure on the diaphragm. This action can alleviate the respiratory distress and is a critical step to take in a child with signs of shock. Beginning positive pressure ventilations (Choice B) should be considered if the infant's respiratory distress worsens despite lowering the extremities. Placing a nasopharyngeal airway and increasing oxygen flow (Choice C) may not directly address the increased work of breathing or the underlying shock condition. Listening to the lungs with a stethoscope (Choice D) may provide information on lung sounds but does not address the immediate need to improve breathing in a child with signs of shock.

Correct Answer: D

Rationale: The correct answer is D. Infants have a higher extracellular fluid requirement per unit of body weight, making them more susceptible to dehydration and electrolyte imbalances during illnesses such as diarrhea. Choice A is incorrect as cellular metabolism instability does not directly relate to the infant's condition described. Choice B is inaccurate as the proportion of water in the body is not the primary issue causing the infant's symptoms. Choice C is incorrect as renal function being immature does not explain the sudden change in the infant's health status; it is more related to fluid balance and dehydration.

Correct Answer: B

Rationale: The correct initial action during a tonic-clonic seizure is to place the child on the floor to prevent injury. This action helps protect the child from falling off the chair and provides a safer environment for the seizure to occur. Attempting to open the jaw can cause harm or injury. Calling out for assistance is important but should follow the immediate action of moving the child to the floor. Placing a pillow under the child's head is not recommended as it may lead to airway obstruction or further injury during the seizure.

Correct Answer: A

Rationale: Tachypnea, which refers to rapid breathing, is an early sign of congestive heart failure. In heart failure, the heart's inability to pump efficiently can lead to fluid accumulation in the lungs, causing the child to breathe faster to try to compensate for the decreased oxygen exchange. Bradycardia (slow heart rate) is not typically associated with congestive heart failure; instead, it may indicate a different issue. Inability to sweat is not a common early sign of congestive heart failure. Increased urinary output is not a typical early sign of congestive heart failure; instead, it may be a sign of other conditions like diabetes or kidney issues.

Correct Answer: A

Rationale: Abdominal swelling is frequently the initial assessment finding associated with a Wilms tumor. This swelling is caused by the tumor's mass in the kidney, leading to abdominal distension. Weight gain (Choice B) is less likely as a primary finding, as it may occur later due to tumor growth or fluid retention. Hypotension (Choice C) is not typically associated with Wilms tumor unless severe complications like hemorrhage develop. Increased urinary output (Choice D) is not a common initial finding; instead, hematuria or other urinary changes may be observed later in the disease process.