Deck 18: Alterations in Fluid, Electrolyte, and Acid-Base Balance

Question 1

The nurse is expecting the admission of a child with severe isotonic dehydration. Which intravenous fluid should the nurse anticipate the practitioner to order initially to replace fluids?
1) D5W
3) Albumin
4) D5 0.2 percent (1/4) Normal Saline

Answer 1

2

Question 2

A 1-month-old client is admitted to the emergency room with severe diarrhea. Which assessment suggests the client is severely dehydrated?
1) Skin moist and flushed; mucous membranes dry
2) Low specific gravity of urine; skin color pale
3) Fontanels depressed; capillary refill greater than three seconds
4) High specific gravity of urine; moist mucous membranes

Answer 2

3

Question 3

The nurse is planning an in-service for new RNs who will be working on a general pediatric unit. Which statements are appropriate to include when discussing normal acid-base balance? Select all that apply.
1) The lungs are responsible for excreting excess carbonic acid from body.
2) The lungs reabsorb filtered bicarbonate.
3) The kidneys form bicarbonate if needed to restore balance.
4) The liver forms bicarbonate if needed to restore balance.
5) The liver synthesizes proteins needed to maintain osmotic pressure in the fluid compartments.

Answer 3

1, 3, 5

Question 4

The nurse educator is preparing an in-service for new RNs hired on a general pediatric unit regarding normal fluid and electrolyte status for children at various ages. Which statements will the educator include about normal fluid and electrolyte status of an infant? Select all that apply.
1) The infant has 75 percent total body water.
2) The extracellular fluid accounts for 25 percent of total body water in the infant.
3) A high metabolic rate requires generous fluid intake for the infant.
4) The infant's kidneys are mature and able to conserve water and electrolytes.
5) The infant's high body surface area promotes fluid loss.

Question 5

The nurse is assessing an infant brought to the clinic with diarrhea. The infant is alert but has dry mucous membranes. Which other sign indicates the infant is still in the early or mild stage of dehydration?
1) Tachycardia
2) Bradycardia
3) Increased blood pressure
4) Decreased blood pressure

Question 6

In the morning, a nurse receives a report on four pediatric clients who have some form of fluid-volume excess. Which client should the nurse assess first?
1) A client with periorbital edema, normal respiratory rate
2) A client with tachypnea and pulmonary congestion
3) A client with dependent and sacral edema, regular pulse
4) A client with hepatomegaly, normal respiratory rate

Question 7

The nurse is completing the intake and output record for a preschool-age client admitted for fluid volume deficit. The client has had the following intake and output during the shift:
Intake:
4 oz of Pedialyte
1/2 of an 8-oz cup of clear orange Jell-O
2 graham crackers
200 mL of D 5-1/2 sodium chloride IV
Output:
345 mL of urine
50 mL of loose stool
The nurse documents the client's intake as ________ milliliters.
Round the answer to the nearest whole number.

Question 9

A nurse is planning care for a child with hyponatremia. The nurse, delegating care of this child to a new RN on the pediatric unit, cautions the new nurse to be especially alert for which condition in the child?
1) Seizures
2) Bradycardia
3) Respiratory distress
4) Hyperthermia

Question 10

A school-age client is hypokalemic. The nurse is helping the client complete her menu. Which food selection will the nurse encourage for this client?
1) A hamburger with French fries
2) Pizza with a fruit plate
3) Chicken strips with chips
4) A fajita with rice

Question 11

The school-age child is admitted to the hospital with dehydration. The child weighs 30 pounds. The physician orders: 50 mL/kg
0.9 percent NSS with 5 percent dextrose IV over 4 hours. Calculate the IV pump to infuse 50 mL/kg/4hrs. Supply on hand: 1000 mL
0.9 percent NSS/
2.5 percent dextrose

Question 12

A nurse is planning care for a child with hyperkalemia. Which clinical manifestation will the nurse plan to assessment this child for based on the diagnosis?
1) Seizures
2) Bradycardia
3) Respiratory distress
4) Hyperthermia

Question 13

Parents of an infant with slow weight gain ask the nurse if they can feed their baby a highly concentrated formula. Which response by the nurse is the most appropriate?
1) "A higher-concentrated formula could lead to dehydration because of high sodium content; let's discuss other strategies."
2) "An undiluted formula concentrate could be given to help the child gain weight; let's look at brands."
3) "Evaporated milk could be given to the infant instead of the current formula you're using."
4) "A higher-concentrated formula could be given for daytime feedings; let's work on a schedule."

Question 14

A child is admitted to the hospital for hypercalcemia and is placed on diuretic therapy. Which diuretic would the nurse expect to give?
1) Hydrochlorothiazide (Aquazide)
2) Spironolactone (Aldactone)
3) Furosemide (Lasix)
4) Mannitol (Osmitrol)

Question 15

A child is being treated for dehydration with intravenous fluids. The child currently weighs 13 kg and is estimated to have lost 7 percent of the normal body weight. The nurse is double-checking the IV rate the practitioner has ordered. The formula the practitioner used was for maintenance fluids: 1000 mL for 10 kg of body weight plus 50 cc for every kg over 10 for 24 hours. Replacement fluid is the percentage of lost body weight × 10 per kg of body weight. According to the calculation for maintenance plus replacement fluid, this child's hourly IV rate for 24 hours should be ________ mL.
Round the answer to the nearest whole number.

Question 16

The nurse is caring for a child on bed rest who has severe edema in a left lower leg due to blocked lymphatic drainage. Which is the priority diagnosis for this child?
1) Risk for Imbalanced Nutrition: Less Than Body Requirements
2) Risk for Impaired Skin Integrity
3) Risk for Altered Body Image
4) Risk for Activity Intolerance

Question 17

A preschool-aged client, diagnosed with croup, has an increased pCO₂, a decreased pH, and a normal HCO₃ blood-gas value. Which documentation in the medical record is the most appropriate?
1) Uncompensated respiratory acidosis
2) Uncompensated respiratory alkalosis
3) Uncompensated metabolic acidosis
4) Uncompensated metabolic alkalosis

Question 18

The nurse finishes a parent-teaching session on preventing heat-related illnesses for children who exercise. Which statement by a parent indicates understanding of preventive techniques taught?
1) Hydration should occur at the end of an exercise session.
2) Water is the drink of choice to replenish fluids.
3) Wearing dark clothing during exercise is recommended.
4) During activity, stop for fluids every 15 to 20 minutes.

Question 19

A nurse is taking care of four different pediatric clients. Which client poses the great risk for dehydration?
1) A 15-year-old working out in a weight room for an hour before football practice
2) A 10-year-old playing baseball outdoors in 85-degree heat
3) A 5-year-old refusing to eat because of a virus
4) A newborn under a radiant warmer for an hour after the first bath