Deck 21: Fluid and Electrolyte Alterations

Question 1

Which of the following statements represents a true difference between the fluids and electrolytes of a child compared to those of an adult?

A) Water constitutes a smaller percent of the body weight of children.
B) A smaller percent of the body weight is in the extracellular compartment in children.
C) Infants and children have a relatively greater body surface area than adults.
D) Infants and children have a lower basal metabolic rate than adults.

Answer 1

Infants and children have a relatively greater body surface area than adults.

Question 2

Children reach adult water distribution percentages in the body by the time the child is how old?

A) 1 year
B) 3 years
C) 5 years
D) 8 years

Answer 2

5 years

Question 3

What percentage of an infant's body water is located in extracellular spaces?

A) 20%
B) 30%
C) 40%
D) 50%

Answer 3

40%

Question 4

Which of the following substances is the predominant component of extracellular fluid?

A) saline
B) potassium
C) proteins
D) phosphate

Question 5

Regulation of homeostatic changes associated with fluids and electrolytes in infants and young children is much slower than in adults because of children's:

A) proportionately smaller stomach and intestines
B) immature kidneys and buffering systems
C) differences in the chemical composition of the body
D) immature nervous systems

Question 6

Insensible water loss per unit of body weight is:

A) less in children and infants compared to adults
B) about the same in infants and children compared to adults
C) higher in infants and children
D) significantly higher in infants and children

Question 7

When solutes flow from an area of higher concentration to an area of lower concentration until equilibrium is reached, given that pressures on either side of the membrane are equal, the movement of the solute across the membrane does so by:

A) filtration
B) osmosis
C) diffusion
D) transference

Question 8

Which of the following types of pressure is a force caused by the amount of plasma proteins in the vascular system and which holds the fluids in the capillaries?

A) oncotic
B) osmotic
C) protein
D) filtration

Question 9

Which kind of pressure is a force within the capillary beds that tends to pull water into the capillaries?

A) oncotic
B) osmotic
C) hydrostatic
D) filtration

Question 10

Which of the following is the pressure of blood against the capillary walls generated by the contraction of the heart?

A) oncotic
B) osmotic
C) hydrostatic
D) filtration

Question 11

When the nurse takes a blood pressure reading, the nurse is measuring which of the following kinds of pressure?

A) hydrostatic
B) viscosity
C) velocity
D) osmotic

Question 12

The formula for calculating daily fluid requirements for an infant weighing less than 10 kilograms is:

A) 10 milliliters per kilogram
B) 25 milliliters per kilogram
C) 50 milliliters per kilogram
D) 100 milliliters per kilogram

Question 13

What is the daily fluid requirement for an infant weighing 5 kilograms?

A) 250 milliliters
B) 500 milliliters
C) 1 liter
D) 1-1/2 liters

Question 14

You are the nurse calculating the minimum acceptable urine output per hour for an infant who weighs 5 kilograms (kg). Which of the following amounts in cubic centimeters (cc) would you find to be acceptable?

A) 4-9
B) 10-15
C) 16-22
D) 25-30

Question 15

The normal minimum urine output for older school-aged and adolescent children is how many milliliters per kilogram per hour?

A) 5-10
B) 2-3
C) 1-2
D) 0.5-1

Question 16

Which of the following is the electrolyte responsible for establishing and maintaining the osmolarity and volume of the extracellular fluid?

A) calcium
B) potassium
C) sodium
D) phosphate

Question 17

The nurse coming on duty gets a laboratory report on an assigned child, and the serum sodium level is reported as 133 milliequivalents per liter (mEq/L). The nurse would expect this client with a 133 mEq/L sodium level to:

A) be experiencing headache, muscle weakness, and abdominal cramps
B) have flushed skin, an elevated temperature, and intense thirst
C) have a slow pulse rate, decreased respirations, and elevated blood pressure
D) appear perfectly normal because this is a normal serum sodium level for a child

Question 18

When the nurse finds that a child has a sodium level of more than 145 milliequivalents per liter, the nurse would most expect to see:

A) diarrhea and vomiting
B) dry mucous membranes and thirst
C) moist mucous membranes
D) subnormal temperature

Question 19

The difference between the intracellular and the extracellular level of potassium determines the:

A) pulse pressure of an individual
B) viscosity of the blood
C) excitability of neurons and muscles
D) amount of edema a person has

Question 20

You are the nurse assigned to care for a child on the pediatric unit. The lab calls with a potassium level of slightly over 5 milliequivalents per liter. This report comes just as you note a widened QRS complex on the electrocardiogram (EKG). From this information, you realize this:

A) child has a slightly elevated potassium level and you should leave the pediatrician a note
B) could lead to cardiac arrest if not treated quickly
C) is a normal lab report and a slight deviation from a normal EKG
D) should be called to the attention of the oncoming nurse at the end-of-shift report

Question 21

You would expect to see hypokalemia in which of the following conditions?

A) tissue necrosis
B) renal failure
C) rapid infusion of IV potassium
D) loss of gastric or intestinal fluids

Question 22

In which of the following ways does the concentration of hydrogen ions affect the movement of potassium ions into or out of cells, if at all?

A) Hydrogen ions have no effect on the movement of potassium ions.
B) Decreased hydrogen concentration will move potassium out of the bloodstream into the cells.
C) Decreased hydrogen concentration will move potassium from the cells into the bloodstream.
D) Increased hydrogen concentration will move potassium from the bloodstream into the cells.

Question 23

The nurse assesses a child and finds the child to have hypotonic muscles, decreased respirations, and to be irritable. Looking at the lab work, the nurse will likely find:

A) hypernatremia and hypochloremia
B) hypercalcemia and hyperchloremia
C) hypocalcemia and hypernatremia
D) hyponatremia and hypochloremia

Question 24

Acid-base metabolism of the body is controlled by the:

A) respiratory system retaining or releasing carbon dioxide
B) electrolytes at a cellular membrane level
C) digestive system and the release or retention of stomach acid
D) circulatory system through osmotic and oncotic pressure

Question 25

When there are pH changes caused by respiratory problems or a buildup of metabolic acids, compensation will take place by what method?

A) the kidneys controlling hydrogen ion and bicarbonate levels in the blood
B) the baroreceptors in the aortic arch of the heart regulating electrolytes
C) the hormone negative feedback system of the hypothalamic-pituitary-adrenal system
D) regulation of hydrogen and bicarbonate by neurotransmitters in the limbic system

Question 26

The nurse is working with a child who has a drug overdose. Respirations are decreased and shallow. Arterial blood gases show the child's pH is decreased and the pCO₂ is elevated. The nurse realizes that this child is in:

A) respiratory alkalosis
B) respiratory acidosis
C) metabolic alkalosis
D) metabolic acidosis

Question 27

The nurse is assigned to an adolescent who is admitted with out-of-control diabetes. There are high levels of ketones in the urine. The child has Kussmaul's respirations and is confused and somewhat lethargic. The nurse knows that this child is in:

A) respiratory alkalosis
B) respiratory acidosis
C) metabolic acidosis
D) metabolic alkalosis

Question 28

A child is more susceptible to dehydration states than adults because children:

A) forget to drink enough water unless their parents remind them
B) have diarrhea and vomiting more often than adults
C) have a larger portion of the total body fluid in extracellular spaces
D) don't regulate their intake of salt and potassium as well as adults do

Question 29

One type of dehydration in children is isotonic dehydration, which occurs then:

A) the loss of sodium exceeds water loss and serum sodium levels are low
B) extracellular sodium is at the same level as intracellular sodium
C) the muscle tone and skin tone remain stable while the child is dehydrated
D) the loss of sodium and water are equal and the serum sodium level remains normal

Question 30

The nurse is working with a child who has a diagnosis of gastroenteritis. The child becomes dehydrated, has serum sodium of 125 milliequivalents per liter, and goes into shock. After corrective measures to restore the child's electrolyte balance and hydration status, the nurse realizes that this child had which of the following types of dehydration?

A) isotonic
B) hypotonic
C) hypertonic
D) idiopathic

Question 31

Hypertonic dehydration occurs in which of the following conditions?

A) the vascular space loses fluid and particles in equal proportions
B) with vomiting and diarrhea or in severe blood loss
C) then the vascular space loses more fluid than particles
D) then the vascular space loses a greater portion of particles than fluid

Question 32

Which of the following methods is the most reliable method of diagnosing dehydration in children?

A) specific gravity of urine
B) blood pressure changes
C) skin turgor
D) weight loss

Question 33

Classical symptoms of impending shock in a child who is dehydrated are:

A) decreased skin elasticity, flat fontanel, decreased urine output
B) azotemia, rapid thready pulse, mottled skin, low blood pressure
C) dusky and grayish skin color, increased weak pulse, depressed fontanel
D) decreased tears, oliguria, depressed fontanel, slightly increased pulse

Question 34

The nurse is working with a child who is dehydrated. When the nurse weighs the child and compares the weight obtained with the child's weight prior to the illness, there has been an 8% weight loss. This weight loss means that this child's dehydration is:

A) mild
B) moderate
C) severe
D) life-threatening

Question 35

Children with an internal hemorrhage such as bleeding into the thoracic or peritoneal cavity will have the same signs and symptoms of hypovolemic shock as a child with an external hemorrhage, except for one difference, which is:

A) weight loss with external hemorrhage and no weight loss with internal hemorrhage
B) decreased urine loss with external hemorrhage and no decreased urine loss with internal hemorrhage
C) bradycardia with external hemorrhage and tachycardia with internal hemorrhage
D) decreased blood pressure with external hemorrhage and no decrease with internal hemorrhage

Question 36

The nurse is working as a volunteer on a health care team serving in a clinic in a village in a third world country. Several children come to the clinic in a mild or moderate state of dehydration. Which of the following solutions or liquids would be best for rehydrating the dehydrated children?

A) Gatorade
B) fruit juices
C) Pedialyte
D) athletic drinks

Question 37

The nurse will read the label to determine the contents of any solution before using it for rehydration because solutions must contain which of the following substances in order for the intestines to absorb sodium chloride?

A) carbohydrate
B) glucose
C) phosphate
D) aluminum

Question 38

The nurse is assessing a 5-year-old child. In checking the heart rate, the nurse finds an increase of 25 beats then the child changes from a lying to a standing position. This increase in heart rate is indicative of:

A) hypovolemia
B) hypervolemia
C) normal findings
D) left-sided heart failure

Question 39

The nurse is assessing a child who is dehydrated. The child begins to cry, but there are no tears. The nurse knows that the loss of the ability to produce tears indicates a fluid loss of at least what percent of the child's body weight?

A) 1%
B) 5%
C) 8%
D) 10%

Question 40

The nurse is preparing to administer intravenous fluids containing potassium for a child who is dehydrated. Which of the following is the most important thing for the nurse to check before administering the potassium?

A) Respirations are over 14.
B) The child does not have a low-grade fever.
C) There is no nausea present; give medication if nausea is present.
D) The child is able to void at least 1 to 2 milliliters per kilogram per hour.

Question 41

The nurse has instructed caregivers on how to care for a dehydrated child at home. The nurse has included instructions on how to decide then the child is doing well and then the caregivers should contact a health professional. The nurse would instruct the family to contact a health professional then which of the following occurs?

A) The child's urine output decreases.
B) The child is more mentally alert.
C) The child complains of nausea.
D) There is any pain.

Question 42

The majority of cases of acute gastroenteritis in children under 2 years old in the United States are caused by:

A) Shigella
B) rotavirus
C) Salmonella
D) Giardia

Question 43

The causes of acute gastroenteritis include viruses, bacteria, and parasites. Which of the following is a parasitic cause of gastroenteritis?

A) Shigella
B) Escherichia coli
C) Yersinia
D) Giardia lamblia

Question 44

When the family of a child with acute gastroenteritis asks about giving their child a diet of bananas, rice, applesauce, and toast or tea, the best response by the nurse would be:

A) "This would be a good diet because it is easily digested; however, the toast needs to be soaked in tea to soften it."
B) "This diet needs to be modified slightly to include either the applesauce or the bananas but not both."
C) "Do not use this diet, because it is low in energy, protein, and fat."
D) "Avoid this diet, because it is low in glucose, sodium, and potassium."

Question 45

The care plan for a baby with gastroenteritis includes a nursing diagnosis of "Impaired skin integrity related to irritation from frequent stools." Which of the following interventions by the nurse would be the best intervention?

A) Clean the diaper area with commercial baby wipes after each stool.
B) Keep the diaper area covered and avoid airing the diaper area.
C) Clean the diaper area with water and mild soap after each stool.
D) Do not use any diaper cream to coat the skin.

Question 46

The nurse is assessing a child who is on bed rest to see if the child has edema. If the child has edema, there is the nurse most likely to find it upon assessment?

A) ankles
B) sacral areas
C) periorbital areas
D) hands

Question 47

When the nurse is trying to treat a child's edema that is due to an allergic reaction, the nurse can reduce blood hydrostatic pressure by decreasing capillary blood flow with which of the following interventions?

A) warm compresses
B) cold compresses
C) restriction of fluid
D) restriction of sodium

Question 48

The nurse is caring for a child who is receiving a diuretic for edema. Which of the following interventions is the most important intervention by the nurse?

A) Monitor blood electrolytes for potassium depletion.
B) Elevate the limbs on pillows to facilitate reabsorption.
C) Elevate the head of the bed.
D) Measure the abdomen daily.

Question 49

The nurse is assessing a child who has significant edema. The nurse finds an increasing respiratory rate and some rales. Which of the following nursing interventions would be best?

A) Place the child in a semi-Fowler's position.
B) Elevate the head of the bed.
C) Place shock blocks under the foot of the bed.
D) Elevate the child's legs on pillows.

Question 50

Which type of burn is most common in children?

A) electrical
B) chemical
C) radiation
D) thermal

Question 51

Which of the following statements best describes full thickness burns?

A) They usually heal within 5 to 10 days without scarring.
B) They are essentially the same as a first-degree burn and are very painful.
C) They involve the epidermis, dermis, and extend into subcutaneous tissues.
D) The skin is moist, bright red, painful, and extremely sensitive to cold air.

Question 52

The extent of burns in children are normally assessed and expressed in:

A) percentages of total body surface area (TBSA)
B) terms of how deep the deepest burns are
C) the severity of the burns on a 1 to 5 burn scale
D) the amount of body surface that is unburned

Question 53

If burns are severe enough, the child will require fluid replacement. Which of the following fluids is most often used as replacement?

A) dextrose 5% in water
B) one-half strength normal saline
C) normal saline solution
D) lactated Ringer's solution

Question 54

Fluid resuscitation for burn victims is based on formulas; however, the adequacy of the amount is based on:

A) skin turgor of the unburned area of skin and how normal or abnormal it is
B) thirst levels of the victims by self-assessment
C) urine output of 1-2 milliliters per kilogram per hour, stable vital signs, alertness, and orientation
D) amount of weeping taking place in the area of the burns

Question 55

Nurses have been found to have a tendency to undermedicate children with severe burns due to:

A) a fear of hurting the children with a needle
B) a fear of causing the children to be addicted
C) an unrealistic fear of causing respiratory depression
D) a perception that pain is experienced to a lesser extent than actually exists

Question 56

The nurse working with children with severe burns who are in pain and anxious will best help the child by:

A) touching the child even if this hurts
B) holding the hands 2-5 inches from the client's body
C) taking as much time as necessary then having to touch the child
D) not touching the child and staying at least 2 feet away then possible

Question 57

For hydrotherapy and debridement of a child's burn wound, the nurse will most help the child by:

A) medicating the child first
B) moving swiftly and getting it done
C) asking the parents to leave
D) explaining the procedure fully

Question 58

Hydrotherapy before the debridement of a wound is done to soften tissue and to:

A) get rid of dead skin so debridement will be faster
B) make the area sterile
C) soothe the nerves in the area
D) improve circulation to the wound

Question 59

Skin grafts made from cadaver skin are called:

A) homografts
B) heterografts
C) c-grafts
D) humano grafts

Question 60

The nurse caring for clients with severe burns that have required grafts will expect which of the following types of grafts to be more likely to be replaced every day or every other day?

A) cadaver skin
B) pig skin
C) nylon
D) nonnylon synthetics

Question 61

The parents of a child who has suffered serious burns and is scheduled for temporary grafts asks the nurse to explain why the child needs temporary grafts instead of permanent ones. Which of the following is the nurse's best answer?

A) "The temporary graft gives the tissue area time to rest and recover from the burn before the work of accepting a permanent graft."
B) "The temporary graft allows for a quick skin cover while the surgeon studies just what type of permanent graft to use."
C) "Temporary grafts provide an educated guess as to how difficult it will be to get the permanent graft to 'take.'"
D) "Temporary grafts promote formation of granulation tissue, which has to be present before a person can be permanently grafted."

Question 62

Cultured epithelial autografts are used only in children with more than which of the following percent of total body surface area burned?

A) 25%
B) 40%
C) 60%
D) 80%

Question 63

The nurse is working with a child who has had skin grafts that are now healed. The nurse realizes that for several months the child will need which of the following to prevent complications?

A) antibiotics
B) hydrotherapy
C) skin stimulation
D) pressure dressings

Question 64

When the nurse develops a care plan for a child with severe burns, the nurse will most likely include which of the following interventions?

A) Perform active range-of-motion exercises using familiar toys or objects and passive range- of-motion exercises at least three times a day.
B) Encourage bed rest without any more movement than is absolutely necessary.
C) Allow the child to choose the amount of movement he or she is comfortable with, and do not push the child to perform exercises.
D) Maintain joints in a position that is somewhat flexed.

Question 65

The nurse working with a child with severe burns instructs the family about the dietary needs of the child explaining that the child needs a diet:

A) high in carbohydrates and fat
B) high in calories, protein, vitamin A, and vitamin C
C) that consists of strained baby foods
D) high in bulk, fruit, and vegetables

Question 66

The nurse is working with a child with severe burns who is not eating much. What strategy will the nurse most likely use to get the child to eat more?

A) Explain how eating more helps a person get well quicker.
B) Offer rewards for eating more.
C) Serve food more often.
D) Have other children or family members eat with this child.

Question 67

Which of the following is most important in doing discharge teaching to prepare the family to care for the child who is recovering from severe burns?

A) Procedures must be done even when painful, because the burns won't heal properly if the procedures are not done.
B) Wait until the child is pain free before doing any painful procedures, even if you have to postpone procedures for a day.
C) Measure and record the child's weight at the same time each day for several months.
D) Prepare and feed the child food that is on the list of suggested dietary meals, and don't deviate from this list.

Question 68

Which of the following intravenous fluids would be considered isotonic solutions? Select all that apply.

A) dextrose 5% in 0.45% normal saline
B) normal saline
C) Ringer's lactate
D) dextrose 5% in water