Deck 24: The Child with Fluid and Electrolyte Imbalance

Question 1

Nurses should be alert for increased fluid requirements in which circumstance?

A) Fever
B) Mechanical ventilation
C) Congestive heart failure
D) Increased intracranial pressure

Answer 1

Fever

Question 2

The nurse determines that a child's intravenous infusion has infiltrated. The infused solution is a vesicant. What is the most appropriate nursing action?

A) Stop the infusion and apply ice.
B) End the infusion and notify the practitioner.
C) Slow the infusion rate and notify the practitioner.
D) Discontinue the infusion and apply warm compresses.

Answer 2

End the infusion and notify the practitioner.

Question 3

Ongoing fluid losses can overwhelm the child's ability to compensate, resulting in shock. What early clinical sign precedes shock?

A) Tachycardia
B) Slow respirations
C) Warm, flushed skin
D) Decreased blood pressure

Answer 3

Tachycardia

Question 4

What is an approximate method of estimating output for a child who is not toilet trained?

A) Have parents estimate output.
B) Weigh diapers after each void.
C) Place a urine collection device on the child.
D) Have the child sit on a potty chair 30 minutes after eating.

Question 5

What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)?

A) Nausea, vomiting
B) Weakness, fatigue
C) Muscle hypotonicity
D) Neuromuscular irritability

Question 6

The nurse suspects fluid overload in an infant receiving intravenous fluids. What clinical manifestation is suggestive of water intoxication?

A) Oliguria
B) Weight loss
C) Irritability and seizures
D) Muscle weakness and cardiac dysrhythmias

Question 7

What physiologic state(s) produces the clinical manifestations of nervous system stimulation and excitement, such as overexcitability, nervousness, and tetany?

A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic and respiratory acidosis
D) Metabolic and respiratory alkalosis

Question 8

What is the required number of milliliters of fluid needed per day for a 14-kg child?

A) 800
B) 1000
C) 1200
D) 1400

Question 9

Several types of long-term central venous access devices are used. What is a benefit of using an implanted port (e.g., Port-a-Cath)?

A) You do not need to pierce the skin for access.
B) It is easy to use for self-administered infusions.
C) The patient does not need to limit regular physical activity, including swimming.
D) The catheter cannot dislodge from the port even if the child "plays" with the port site.

Question 10

An infant is brought to the emergency department with the following clinical manifestations: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea. This is suggestive of which situation?

A) Water excess
B) Sodium excess
C) Water depletion
D) Potassium excess

Question 11

Physiologically, the child compensates for fluid volume losses by which mechanism?

A) Inhibition of aldosterone secretion
B) Hemoconcentration to reduce cardiac workload
C) Fluid shift from interstitial space to intravascular space
D) Vasodilation of peripheral arterioles to increase perfusion

Question 12

The nurse is selecting a site to begin an intravenous infusion on a 2-year-old child. The superficial veins on his hand and arm are not readily visible. What intervention should increase the visibility of these veins?

A) Gently tap over the site.
B) Apply a cold compress to the site.
C) Raise the extremity above the level of the body.
D) Use a rubber band as a tourniquet for 5 minutes.

Question 13

Clinical manifestations of sodium excess (hypernatremia) include which signs or symptoms?

A) Hyperreflexia
B) Abdominal cramps
C) Cardiac dysrhythmias
D) Dry, sticky mucous membranes

Question 14

What laboratory finding should the nurse expect in a child with an excess of water?

A) Decreased hematocrit
B) High serum osmolality
C) High urine specific gravity
D) Increased blood urea nitrogen

Question 15

What factor predisposes an infant to fluid imbalances?

A) Decreased surface area
B) Lower metabolic rate
C) Immature kidney functioning
D) Decreased daily exchange of extracellular fluid

Question 16

What type of dehydration occurs when the electrolyte deficit exceeds the water deficit?

A) Isotonic dehydration
B) Hypotonic dehydration
C) Hypertonic dehydration
D) Hyperosmotic dehydration

Question 17

When caring for a child with an intravenous (IV) infusion, what is an appropriate nursing action?

A) Change the insertion site every 24 hours.
B) Check the insertion site frequently for signs of infiltration.
C) Use a macrodropper to facilitate reaching the prescribed flow rate.
D) Avoid restraining the child to prevent undue emotional stress.

Question 18

What substance is released from the posterior pituitary gland and promotes water retention in the renal system?

A) Renin
B) Aldosterone
C) Angiotensin
D) Antidiuretic hormone (ADH)

Question 19

The presence of which pair of factors is a good predictor of a fluid deficit of at least 5% in an infant?

A) Weight loss and decreased heart rate
B) Capillary refill of less than 2 seconds and no tears
C) Increased skin elasticity and sunken anterior fontanel
D) Dry mucous membranes and generally ill appearance

Question 20

What amount of fluid loss occurs with moderate dehydration?

A) <50 ml/kg
B) 50 to 90 ml/kg
C) <5% total body weight
D) >15% total body weight

Question 21

What explains physiologically the edema formation that occurs with burns?

A) Vasoconstriction
B) Reduced capillary permeability
C) Increased capillary permeability
D) Diminished hydrostatic pressure within capillaries

Question 22

The nurse is teaching the family of a child with a long-term central venous access device about signs and symptoms of bacteremia. What finding indicates the presence of bacteremia?

A) Hypertension
B) Pain at the entry site
C) Fever and general malaise
D) Redness and swelling at the entry site

Question 23

A child is admitted with extensive burns. The nurse notes burns on the child's lips and singed nasal hairs. The nurse should suspect what condition in the child?

A) A chemical burn
B) A hot-water scald
C) An electrical burn
D) An inhalation injury

Question 24

What type of diarrhea is associated with an inflammation of the mucosa and submucosa in the ileum and colon caused by infectious agents?

A) Osmotic
B) Secretory
C) Cytotoxic
D) Dysenteric

Question 25

A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solutions (ORS). The child's mother calls the clinic nurse because he is also occasionally vomiting. The nurse should recommend which intervention?

A) Bring the child to the hospital for intravenous fluids.
B) Alternate giving ORS and carbonated drinks.
C) Continue to give ORS frequently in small amounts.
D) Keep child NPO (nothing by mouth) for 8 hours and resume ORS if vomiting has subsided.

Question 26

A toddler sustains a minor burn on the hand from hot coffee. What is the first action in treating this burn?

A) Apply burn ointment.
B) Put ice on the burned area.
C) Cover the hand with gauze dressing.
D) Hold the hand under cool running water.

Question 27

A 7-year-old child with acute diarrhea has been rehydrated with oral rehydration solution (ORS). The nurse should recommend that the child's diet be advanced to what kind of diet?

A) Regular diet
B) Clear liquids
C) High carbohydrate diet
D) BRAT (bananas, rice, applesauce, and toast or tea) diet

Question 28

The nurse suspects shock in a child 1 day after surgery. What should be the initial nursing action?

A) Place the child on a cardiac monitor.
B) Obtain arterial blood gases.
C) Provide supplemental oxygen.
D) Put the child in the Trendelenburg position.

Question 29

What is the most immediate threat to life in children with thermal injuries?

A) Shock
B) Anemia
C) Local infection
D) Systemic sepsis

Question 30

What flush solution is recommended for intravenous catheters larger than 24 gauge?

A) Saline
B) Heparin
C) Alteplase
D) Heparin and saline combination

Question 31

What is a systemic response to severe burns in a child?

A) Metabolic alkalosis
B) Decreased metabolic rate
C) Increased renal plasma flow
D) Abrupt drop in cardiac output

Question 32

What sign is one of the first to indicate overwhelming sepsis in a child with burn injuries?

A) Seizures
B) Bradycardia
C) Disorientation
D) Decreased blood pressure

Question 33

After the acute stage and during the healing process, what is the primary complication from burn injury?

A) Shock
B) Asphyxia
C) Infection
D) Renal shutdown

Question 34

What condition is often associated with severe diarrhea?

A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis

Question 35

What is the most frequent cause of hypovolemic shock in children?

A) Sepsis
B) Blood loss
C) Anaphylaxis
D) Heart failure

Question 36

A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. What food or beverage should be tolerated best?

A) Clear fluids
B) Carbonated drinks
C) Applesauce and milk
D) Easily digested foods

Question 37

What clinical manifestation(s) should the nurse expect to see as shock progresses in a child and becomes decompensated shock?

A) Thirst
B) Irritability
C) Apprehension
D) Confusion and somnolence

Question 38

The nurse is teaching a parent of a 10-year-old child who will be discharged with a venous access device (VAD). What statement by the parent indicates a correct understanding of the teaching?

A) "I should have my child wear a protective vest when my child wants to participate in contact sports."
B) "I should apply pressure to the entry site to the vein, not the exit site, if the VAD is accidentally removed."
C) "I can expect my child to have feelings of general malaise for 1 week after the VAD is inserted."
D) "I should give my child a sponge bath for the first 2 weeks after the VAD is inserted; then I can allow my child to take a bath."

Question 39

What type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy?

A) Neurogenic shock
B) Cardiogenic shock
C) Hypovolemic shock
D) Anaphylactic shock

Question 40

What organism is a parasite that causes acute diarrhea?

A) Shigella organisms
B) Salmonella organisms
C) Giardia lamblia
D) Escherichia coli

Question 41

What is the purpose of a high-protein diet for a child with major burns?

A) Promote growth
B) Improve appetite
C) Minimize protein breakdown
D) Diminish risk of stress-induced hyperglycemia

Question 42

What clinical manifestations should be observed in a 2-year-old child with hypotonic dehydration? (Select all that apply.)

A) Thick, doughy feel to the skin
B) Slightly moist mucous membranes
C) Absent tears
D) Very rapid pulse
E) Hyperirritability

Question 43

The nurse is caring for an 18-month-old child with rotavirus. What clinical manifestations should the nurse expect to observe?

A) Severe abdominal cramping and bloody diarrhea
B) Mild fever and vomiting followed by onset of watery stools
C) Colicky abdominal pain and vomiting
D) High fever, diarrhea, and lethargy

Question 44

A health care provider prescribes nitroprusside (Nipride), 1 mcg/kg/min in a continuous intravenous (IV) infusion for a child in shock. The child weighs 20 kg. The medication is available as nitroprusside 50 mg in 250 ml. The nurse prepares to calculate the rate. How many milliliters per hour will the nurse set the IV infusion pump to deliver 1 mcg/kg/min? Fill in the blank. Record your answer in a whole number.
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Question 45

Prevention of burn injury is important anticipatory guidance. In the infant and toddler period, which mode is the most common cause of burn?

A) Matches
B) Electrical cords
C) Hot liquids in the kitchen
D) Microwave-heated foods

Question 46

The nurse is caring for a child with hypernatremia. The nurse evaluates the child for which signs and symptoms of hypernatremia? (Select all that apply.)

A) Apathy
B) Lethargy
C) Oliguria
D) Intense thirst
E) Dry, sticky mucos

Question 47

Fentanyl and midazolam (Versed) are given before débridement of a child's burn wounds. What is the purpose of using these medications?

A) Facilitate healing
B) Provide pain relief
C) Minimize risk of infection
D) Decrease amount of débridement needed

Question 48

What consideration is important for the nurse when changing dressings and applying topical medication to a child's abdomen and leg burns?

A) Apply topical medication with clean hands.
B) Wash hands and forearms before and after dressing change.
C) If dressings have adhered to the wound, soak in hot water before removal.
D) Apply dressing so that movement is limited during the healing process.

Question 49

What is the nursing action related to the applying of biologic or synthetic skin coverings for a child with partial-thickness burns of both legs?

A) Splint the legs to prevent movement.
B) Observe wounds for signs of infection.
C) Monitor closely for manifestations of shock.
D) Examine dressings for indications of bleeding.

Question 50

Hydrotherapy is required to treat a child with extensive partial-thickness burn wounds. What is the purpose of hydrotherapy?

A) Provide pain relief
B) Débride the wounds
C) Destroy bacteria on the skin
D) Increase peripheral blood flow

Question 51

A health care provider prescribes diphenhydramine (Benadryl), 1 mg/kg PO every 4 to 6 hours as needed for pruritus to a child with a mild cutaneous anaphylactic reaction. The child weighs 5 kg. The medication label states: "Diphenhydramine 12.5 mg/5 ml." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.
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Question 52

The nurse is teaching a group of female adolescents about toxic shock syndrome and the use of tampons. What statement by a participant indicates a need for additional teaching?

A) "I can alternate using a tampon and a sanitary napkin."
B) "I should wash my hands before inserting a tampon."
C) "I can use a superabsorbent tampon for more than 6 hours."
D) "I should call my health care provider if I suddenly develop a rash that looks like sunburn."

Question 53

The nurse is caring for a child with hypokalemia. The nurse evaluates the child for which signs and symptoms of hypokalemia? (Select all that apply.)

A) Twitching
B) Hypotension
C) Hyperreflexia
D) Muscle weakness
E) Cardiac arrhythmias

Question 54

What is a strategy used to minimize scarring with burn injury in a child?

A) Applying of drying agents on skin
B) Use of loose-fitting garments over healing areas
C) Limitation of period without pressure to areas of scarring
D) Immobilization of extremities while healing is occurring

Question 55

In what condition should the nurse be alert for altered fluid requirements in children? (Select all that apply.)

A) Oliguric renal failure
B) Increased intracranial pressure
C) Mechanical ventilation
D) Compensated hypotension
E) Tetralogy of Fallot
F) Type 1 diabetes mellitus

Question 56

The nurse is preparing a presentation on compensated, decompensated, and irreversible shock in children. What clinical manifestations related to decompensated shock should the nurse include? (Select all that apply.)

A) Tachypnea
B) Oliguria
C) Confusion
D) Pale extremities
E) Hypotension
F) Thready pulse

Question 57

The nurse is caring for a child with hypercalcemia. The nurse evaluates the child for which signs and symptoms of hypercalcemia? (Select all that apply.)

A) Tetany
B) Anorexia
C) Constipation
D) Laryngospasm
E) Muscle hypotonicity

Question 58

What is an effective strategy to reduce the stress of burn dressing procedures?

A) Involve the child and give choices as feasible.
B) Explain to the child why analgesics cannot be used.
C) Reassure the child that dressing changes are not painful.
D) Encourage the child to master stress with controlled passivity.

Question 59

A health care provider prescribes dopamine (Intropin), 5 mcg/kg/min in a continuous intravenous (IV) infusion for a child in shock. The child weighs 25 kg. The medication is available as dopamine 400 mg in 250 ml. The nurse prepares to calculate the rate. How many milliliters per hour will the nurse set the IV infusion pump to deliver 5 mcg/kg/min? Fill in the blank. Round to one decimal place.
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Question 60

What finding is the most reliable guide to the adequacy of fluid replacement for a small child with burns?

A) Absence of thirst
B) Falling hematocrit
C) Increased seepage from burn wound
D) Urinary output of 1 to 2 ml/kg of body weight/hr

Question 61

MATCHING
Match the type of skin graft to its definition.

Skin that is obtained from members of a different species, primarily pigskin

A)Allografts
B)Xenografts
C)Autografts
D)Isografts

Question 62

MATCHING
Match the type of skin graft to its definition.

Tissue obtained from undamaged areas of the patient's own body

A)Allografts
B)Xenografts
C)Autografts
D)Isografts

Question 63

MATCHING
Match the type of skin graft to its definition.

Histocompatible tissue obtained from genetically identical individuals

A)Allografts
B)Xenografts
C)Autografts
D)Isografts

Question 64

MATCHING
Match the type of skin graft to its definition.

Skin that is obtained from genetically different members of the same species who are free of disease

A)Allografts
B)Xenografts
C)Autografts
D)Isografts

Question 65

A health care provider prescribes midazolam (Versed) syrup 0.5 mg/kg per mouth (PO) 30 minutes before a burn wound dressing change on a child. The medication label states: "Versed 2 mg/1 ml." The child weighs 8 kg. The nurse prepares to administer the dose. How many milliliters will the nurse prepare to administer the dose? Fill in the blank. Record your answer in a whole number.
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