Deck 45: The Child With 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 doctor to order initially to replace fluids?

A)0.9% normal saline (NS)
B)D5 0.2% (¼) normal saline
C)D5W
D)Albumin

Answer 1

0.9% normal saline (NS)

Question 2

The nurse has just finished a parent teaching session on preventing heat-related illnesses for children who exercise. Which statement by a parent indicates understanding of preventive techniques taught?

A)Wearing dark clothing during exercise is recommended
B)Water is the drink of choice to replenish fluids.
C)During activity, stop for fluids every 15 to 20 minutes.
D)Hydration should occur at the end of an exercise session.

Answer 2

During activity, stop for fluids every 15 to 20 minutes.

Question 3

A four-year-old child is admitted to the hospital secondary to dehydration. Lab tests indicate a high hemoglobin and hematocrit, and the serum sodium is below normal levels. This fluid loss is indicative of which condition?

A)Hypernatremia
B)Metabolic acidosis
C)Hypotonic dehydration
D)Isotonic dehydration

Answer 3

Hypotonic dehydration

Question 4

A child is being treated for dehydration with intravenous fluids. The child currently weighs 13 kg and is estimated to have lost 7% of his normal body weight. The nurse is double-checking the IV rate the physician has ordered. The formula the physician used was for maintenance fluids: 1,000 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 bodyweight × 10 per kg of body weight. According to the calculation for maintenance plus replacement fluid, what should this child's hourly IV rate for 24 hours be?

A)88
B)86
C)81
D)83

Question 5

A nurse is taking care of four different pediatric clients. Which of the following children is at greatest risk for dehydration?

A)Seven-year-old child with migraine headaches
B)Four-year-old child with a broken arm
C)Two-year-old child with cellulitis of the left leg
D)18-month-old child with tachypnea

Question 6

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 nursing diagnosis would take priority?

A)Risk for impaired skin integrity
B)Risk for altered body image
C)Risk for imbalanced nutrition: less than body requirements
D)Risk for activity intolerance

Question 7

In the morning, a nurse receives a report on four pediatric clients, each of whom has some form of fluid-volume excess. Which of the children should the nurse see first?

A)The child with tachypnea and pulmonary congestion
B)The child with hepatomegaly and normal respiratory rate
C)The child with dependent and sacral edema and regular pulse
D)The child with periorbital edema and normal respiratory rate

Question 8

A six-year-old child is hypokalemic. The nurse is helping the child complete the menu. The nurse would encourage this child to select which menu items?

A)Pizza with a fruit plate
B)Chicken strips with chips
C)Fajita with rice
D)A hamburger with French fries

Question 9

A child is admitted to the hospital for hypercalcemia and is placed on diuretic therapy. Which diuretic would the nurse expect to give?

A)Furosemide (Lasix)
B)Hydrochlorothiazide (Aquazide)
C)Spironolactone (Aldactone)
D)Mannitol (Osmitrol)

Question 10

A nurse is planning care for a child with hyponatremia. The nurse, delegating care of this child to a licensed vocational nurse (LVN), cautions the LVN to watch for which clinical manifestation?

A)Seizures
B)Respiratory distress
C)Hyperthermia
D)Bradycardia

Question 11

A nine-month-old infant is hospitalized with vomiting and diarrhea. The mother questions why her child needed hospitalization since her school-age nephew had the same symptoms and was treated at home. The nurse would explain that an infant is more at risk for dehydration than a school-age child because:

A)Infants have a lower proportion of their body weight as water.
B)The percentage of extra-cellular fluid is higher in the infant than the school-age child.
C)School-age children have a larger body surface area.
D)The school-age child's kidneys are more mature and better able to conserve water.
E)The metabolic rate of the school-age child is higher.

Question 12

As a result of opioid administration, a child's respirations are slow and shallow. The nurse would expect that lab changes that might be noted in response to the changes in the child's uncompensated respiratory pattern would include:

A)Increased PCO₂ and respiratory acidosis.
B)Decreased PCO₂ and respiratory alkalosis.
C)Low pH and low PCO_2.
D)High pH and high PCO_2.

Question 13

The nurse is assessing an infant brought to the clinic because of diarrhea. The infant is alert but has dry mucous membranes. Which other sign indicates the infant is still in the early to moderate stage of dehydration?

A)Bradycardia
B)Tachycardia
C)Increased blood pressure
D)Normal fontanels

Question 14

A nurse is planning care for a child with hyperkalemia. The nurse explains to the parents that an adverse outcome of hyperkalemia is:

A)Hyperthermia
B)Respiratory distress
C)Seizures
D)Cardiac arrhythmias

Question 15

The nurse is evaluating an infant for dehydration. Which assessment provides the most accurate information on dehydration?

A)Urine output
B)Urine specific gravity
C)The infant's vital signs
D)Weight loss

Question 16

A child with croup has an increased pCO₂, a decreased pH, and a normal HCO₃ blood gas value. The nurse interprets this as uncompensated:

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