Which of the following is not a sign of dehydration in an infant?

Appeared in: NORCET -4 , 2023

Explanation

Perineal excoriation refers to skin breakdown or irritation in the diaper area.
It is a classic sign of diaper dermatitis (diaper rash), which is a localized skin condition.
Dehydration is a systemic condition involving total body fluid loss, and its signs reflect this widespread deficit (e.g., dry mouth, poor skin turgor), not localized skin irritation.

Option B: A delayed skin pinch indicates poor skin turgor, which is a hallmark sign of dehydration due to decreased fluid in the interstitial spaces.
Option C: A dry mouth signifies dry mucous membranes, a direct consequence of systemic fluid loss and a key indicator of dehydration.
Option D: The absence of tears when an infant cries is a reliable and significant sign of moderate to severe dehydration.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of dehydration in infants as background academic context rather than a clinical decision trigger.
Early and accurate assessment of dehydration in infants is critical for nurses, as infants can deteriorate rapidly, leading to complications like hypovolemic shock, electrolyte imbalances, and kidney injury.
Nurses must differentiate between signs of dehydration and other common infant conditions like diaper rash to initiate the correct interventions.
What if? If an infant showed signs of dehydration (like a sunken fontanelle) but also had a bulging fontanelle intermittently, the nurse should consider increased intracranial pressure (e.g., from meningitis) as a possible concurrent issue, which requires immediate medical evaluation.

How to Approach the Question

First, identify that the question is a negative-framing question, asking for what is 'NOT' a sign.
Next, recall the core concept: the clinical manifestations of dehydration in an infant. Think about systemic signs related to fluid loss.
Evaluate each option against this concept.
Option A, 'Perineal excoriation,' relates to a local skin issue in the diaper area.
Options B, C, and D ('Delayed skin pinch,' 'Dry mouth,' 'Drying of tears') are all well-known systemic signs of dehydration.
Conclude that the option that does not fit the pattern of systemic dehydration is the correct answer.

Concept Tested & Keywords

Concept Tested: Clinical signs of dehydration in infants
Stem keywords: dehydration, infant, sign
Lead-in keywords: not
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: Question asks for the option that is NOT a sign.

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 311-313

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 152-154

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 574-576

Practise the full NORCET -4 , 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.