Chapter 40: The Child with a Fluid and Electrolyte Alteration My Nursing Test Banks

Chapter 40: The Child with a Fluid and Electrolyte Alteration

Test Bank

MULTIPLE CHOICE

1. The parents of a child with acid-base imbalance ask the nurse about mechanisms that regulate acid-base balance. Which statement by the nurse accurately explains the mechanisms regulating acid-base balance in children?

a.

The respiratory, renal, and chemical-buffering systems

b.

The kidneys balance acid; the lungs balance base

c.

The cardiovascular and integumentary systems

d.

The skin, kidney, and endocrine systems

ANS: A

Feedback

A

The acid-base system is regulated by chemical buffering, respiratory control of carbon dioxide, and renal regulation of bicarbonate and secretion of hydrogen ions.

B

Both the kidneys and the lungs, along with the buffering system, contribute to acid-base balance. Neither system regulates acid or base balances exclusively.

C

The cardiovascular and integumentary systems are not part of acid-base regulation in the body.

D

Chemical buffers, the lungs, and the kidneys work together to keep the blood pH within normal range.

PTS: 1 DIF: Cognitive Level: Application REF: p. 991

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

2. A child has a 2-day history of vomiting and diarrhea. He has hypoactive bowel sounds and an irregular pulse. Electrolyte values are sodium, 139 mEq/L; potassium, 3.3 mEq/L; and calcium, 9.5 mg/dL. This child is likely to have which of the following electrolyte imbalances?

a.

Hyponatremia

b.

Hypocalcemia

c.

Hyperkalemia

d.

Hypokalemia

ANS: D

Feedback

A

The normal serum sodium level is 135 to 145 mEq/L. A level of 139 mEq/L is within normal limits.

B

A serum calcium level less than 8.5 mg/dL is considered hypocalcemia.

C

A serum potassium level greater than 5 mEq/L is considered hyperkalemia.

D

A serum potassium level less than 3.5 mEq/L is considered hypokalemia. Clinical manifestations of hypokalemia include muscle weakness, decreased bowel sounds, cardiac irregularities, hypotension, and fatigue.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 991

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

3. Which statement best describes why infants are at greater risk for dehydration than older children?

a.

Infants have an increased ability to concentrate urine.

b.

Infants have a greater volume of intracellular fluid.

c.

Infants have a smaller body surface area.

d.

Infants have an increased extracellular fluid volume.

ANS: D

Feedback

A

Because the kidneys are immature in early infancy, there is a decreased ability to concentrate the urine.

B

Infants have a larger proportion of fluid in the extracellular space.

C

Infants have proportionately greater body surface area in relation to body mass, which creates the potential for greater fluid loss through the skin and gastrointestinal tract.

D

The larger ratio of extracellular fluid to intracellular fluid predisposes the infant to dehydration.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 990

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. Which assessment is most relevant to the care of an infant with dehydration?

a.

Temperature, heart rate, and blood pressure.

b.

Respiratory rate, oxygen saturation, and lung sounds.

c.

Heart rate, sensorium, and skin color.

d.

Diet tolerance, bowel function, and abdominal girth.

ANS: C

Feedback

A

Children can compensate and maintain an adequate cardiac output when they are hypovolemic. Blood pressure is not as reliable an indicator of shock as are changes in heart rate, sensorium, and skin color.

B

Respiratory assessments will not provide data about impending hypovolemic shock.

C

Changes in heart rate, sensorium, and skin color are early indicators of impending shock in the child.

D

Diet tolerance, bowel function, and abdominal girth are not as important indicators of shock as heart rate, sensorium, and skin color.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 995

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

5. What is the most important factor in determining the rate of fluid replacement in the dehydrated child?

a.

The childs weight

b.

The type of dehydration

c.

Urine output

d.

Serum potassium level

ANS: B

Feedback

A

The childs weight determines the amount of fluid needed, not the rate of fluid replacement. One milliliter of body fluid is equal to 1 g of body weight; therefore a loss of 1 kg (2.2 lb) is equal to 1 L of fluid.

B

Isonamtremic and hyponatremic dehydration resuscitation involves fluid replacement over 24 hours.  Hypernatremic dehydration involves a slower replacement rate to prevent a sudden decrease in the sodium level.

C

Urine output is not a consideration for determining the rate of administration of replacement fluids.

D

Potassium level is not as significant in determining the rate of fluid replacement as the type of dehydration.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 994

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

6. What is the priority nursing intervention for a 6-month-old infant hospitalized with diarrhea and dehydration?

a.

Estimating insensible fluid loss

b.

Collecting urine for culture and sensitivity

c.

Palpating the posterior fontanel

d.

Measuring the infants weight

ANS: D

Feedback

A

Infants have a greater total body surface area and therefore a greater potential for fluid loss through the skin. It is not possible to measure insensible fluid loss.

B

Urine for culture and sensitivity is not usually part of the treatment plan for the infant who is dehydrated from diarrhea.

C

The posterior fontanel closes by 2 months of age. The anterior fontanel can be palpated during an assessment of an infant with dehydration.

D

Weight is a crucial indicator of fluid status. It is an important criterion for assessing hydration status and response to fluid replacement.

PTS: 1 DIF: Cognitive Level: Application REF: p. 994

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

7. What assessment should the nurse make before initiating an intravenous (IV) infusion of dextrose 5% in 0.9% normal saline solution with 10 mEq of potassium chloride for a child hospitalized with dehydration?

a.

Fluid intake

b.

Number of stools

c.

Urine output

d.

Capillary refill

ANS: C

Feedback

A

Fluid intake does not give information about renal function.

B

Stool count sheds light on intestinal function. Renal function is the concern before potassium chloride is added to an IV solution.

C

Potassium chloride should never be added to an IV solution in the presence of oliguria or anuria (urine output less than 0.5 mL/kg/hr).

D

Assessment of capillary refill does not provide data about renal function.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 990 | Box 40-1

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

8. A nurse is teaching parents about diarrhea. Which statement by the parents indicates understanding of the teaching?

a.

Diarrhea results from a fluid deficit in the small intestine.

b.

Organisms destroy intestinal mucosal cells, resulting in an increased intestinal surface area.

c.

Malabsorption results in metabolic alkalosis.

d.

Increased motility results in impaired absorption of fluid and nutrients.

ANS: D

Feedback

A

Diarrhea results from fluid excess in the small intestine.

B

Destroyed intestinal mucosal cells result in decreased intestinal surface area.

C

Loss of electrolytes in the stool from diarrhea results in metabolic acidosis.

D

Increased motility and rapid emptying of the intestines result in impaired absorption of nutrients and water. Electrolytes are drawn from the extracellular space into stool, and dehydration results.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1000

OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

9. What is the best response by the nurse to a parent asking about antidiarrheal medication for her 18-month-old child?

a.

It is okay to give antidiarrheal medication to a young child as long as you follow the directions on the box for correct dosage.

b.

Antidiarrheal medication is not recommended for young children because it slows the bodys attempt to rid itself of the pathogen.

c.

Im sure your child wont like the taste, so give extra fluids when you give the medication.

d.

Antidiarrheal medication will lessen the frequency of stools, but give your child Gatorade to maintain electrolyte balance.

ANS: B

Feedback

A

Antidiarrheal medications are not recommended for children younger than 2 years old.

B

Antidiarrheal medications may actually prolong diarrhea because the body will retain the organism causing the diarrhea, further increasing fluid and electrolyte losses. The use of these medications is not recommended for children younger than 2 years old because of their binding nature and potential for toxicity.

C

This action is inappropriate because antidiarrheal medications should not be given to a child younger than 2 years old.

D

It is not appropriate to advise a parent to use antidiarrheal medication for a child younger than 2 years old. Education about appropriate oral replacement fluids includes avoidance of sugary drinks, apple juice, sports beverages, and colas.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1001

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

10. Which action is the primary concern in the treatment plan for a child with persistent vomiting?

a.

Detecting the cause of vomiting

b.

Preventing metabolic acidosis

c.

Positioning the child to prevent further vomiting

d.

Recording intake and output

ANS: A

Feedback

A

The primary focus of managing vomiting is detection of the cause and then treatment of the cause.

B

Metabolic alkalosis results from persistent vomiting. Prevention of complications is the secondary focus of treatment.

C

The child with persistent vomiting should be positioned upright or side-lying to prevent aspiration.

D

Recording intake and output is a nursing intervention, but it is not the primary focus of treatment.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1004

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

11. What is the best response for the nurse to give a parent about contacting the physician regarding an infant with diarrhea?

a.

Call your pediatrician if the infant has not had a wet diaper for 6 hours.

b.

The pediatrician should be contacted if the infant has two loose stools in an 8-hour period.

c.

Call the doctor immediately if the infant has a temperature greater than 100 F.

d.

Notify the pediatrician if the infant naps more than 2 hours.

ANS: A

Feedback

A

No urine output in 6 hours needs to be reported because it indicates dehydration.

B

Two loose stools in 8 hours is not a serious concern. If blood is obvious in the stool or the frequency increases to one bowel movement every hour for more than 8 hours, the physician should be notified.

C

A fever greater than 101 F should be reported to the infants physician.

D

It is normal for the infant who is not ill to nap for 2 hours. The infant who is ill may nap longer than the typical amount.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1003

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

12. Which diet would the nurse recommend to the mother of a child who is having mild diarrhea?

a.

Rice, potatoes, yogurt, cereal, and cooked carrots

b.

Bananas, rice, applesauce, and toast

c.

Apple juice, hamburger, and salad

d.

Whatever the child would like to eat

ANS: A

Feedback

A

Bland but nutritious foods including complex carbohydrates (rice, wheat, potatoes, cereals), yogurt, cooked vegetables, and lean meats are recommended to prevent dehydration and hasten recovery.

B

These foods used to be recommended for diarrhea (BRAT diet). These foods are easily tolerated, but the BRAT diet is low in energy, density, fat, and protein.

C

Fatty foods, spicy foods, and foods high in simple sugars should be avoided.

D

The child should be offered foods he or she likes but should not be encouraged to eat fatty foods, spicy foods, and foods high in simple sugars.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1001

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

MULTIPLE RESPONSE

1. Which assessment findings indicate to the nurse that a child has excess fluid volume? Select all that apply.

a.

Weight gain

b.

Decreased blood pressure

c.

Moist breath sounds

d.

Poor skin turgor

e.

Rapid bounding pulse

ANS: A, C, E

Feedback

Correct

A child with fluid volume excess will have a weight gain, moist breath sounds due to the excess fluid in the pulmonary system, and a rapid bounding pulse. Other signs seen with fluid volume excess are increased blood pressure, edema, and fatigue.

Incorrect

Decreased blood pressure and poor skin turgor are signs of fluid volume deficit.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 992

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

COMPLETION

1. Bodily fluids are composed of two elements; water and _____.

ANS:

solutes

Water is the primary constituent of bodily fluids. An infants weight is approximately 75% water compared to the adults weight, which is 55% to 60% water. Solutes are composed of both electrolytes and nonelectrolytes. The bodys solutes include sodium, potassium, chloride, calcium, and magnesium.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 997 | Table 40-3

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

SHORT ANSWER

1. You are caring for a 44-lb child who is hospitalized with vomiting and severe dehydration. The physician has ordered parenteral rehydration therapy to restore circulation. The order is for sodium chloride (0.9%) solution in a 20 mL/kg bolus. How much will you give?

ANS:

400 mL

The childs weight must first be converted from pounds to kilograms (1 kg = 2.2 lb): 44 lb =20 kg. Next multiply 20 kg 20 mL = 400 mL. The bolus will be 400 mL.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 990

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

TRUE/FALSE

1. The nurse who provides care for young children with fluid and electrolyte imbalance understands that they are more vulnerable to changes in fluid balance than adults. Under normal conditions the amount of fluid ingested during the day should equal the amount of fluid lost. Sensible water loss is that which occurs through the respiratory tract and skin. Is this statement true or false?

ANS: F

Sensible water loss occurs through urine output. Insensible water loss occurs through the skin and respiratory tract. Insensible water loss per unit of body weight is significantly higher in infants and young children due to the faster respiratory rate and higher evaporative water losses.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 989

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. Alterations in acid-base balance can affect cellular metabolism and enzymatic processes. When alterations in pH become too much for buffer systems to handle, compensatory mechanisms are activated. If the pH drops below normal than acidosis will occur. Is this statement true or false?

ANS: T

Acidosis is the result of a drop in blood pH. The respiratory rate and depth will increase, removing carbon dioxide and raising blood pH. Conversely in the presence of alkalosis, respiratory rate and depth decrease, lowering blood pH.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 991

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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