Chapter 24

7. 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

A. Decreased hematocrit

2. Nurses should be alert for increased fluid requirements in which circumstance? A. Fever B. Mechanical ventilation C. Congestive heart failure D. Increased intracranial pressure

A. Fever

17. 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.

A. Gently tap over the site.

46. 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.

A. Involve the child and give choices as feasible.

25. What condition is often associated with severe diarrhea? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A. Metabolic acidosis

2. 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

A. Oliguric renal failure B. Increased intracranial pressure C. Mechanical ventilation

29. 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

A. Regular diet

22. What flush solution is recommended for intravenous catheters larger than 24 gauge? A. Saline B. Heparin C. Alteplase D. Heparin and saline combination

A. Saline

37. What is the most immediate threat to life in children with thermal injuries? A. Shock B. Anemia C. Local infection D. Systemic sepsis

A. Shock

12. 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

A. Tachycardia

1. 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

A. Tachypnea B. Oliguria C. Confusion D. Pale extremities

45. 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.

B. Observe wounds for signs of infection

43. 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

B. Provide pain relief

3. 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

B. Slightly moist mucous membranes C. Absent tears D. Very rapid pulse

47. 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.

B. Wash hands and forearms before and after dressing change.

16. 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.

B. Weigh diapers after each void.

5. 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

C. Water depletion

35. 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

D. Abrupt drop in cardiac output

36. 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

D. An inhalation injury

31. 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

D. Anaphylactic shock

1. 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)

D. Antidiuretic Hormone (ADH)

32. 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

D. Confusion and somnolence

13. 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

D. Dry mucous membranes and generally ill appearance.

6. Clinical manifestations of sodium excess (hypernatremia) include which signs or symptoms? A. Hyperreflexia B. Abdominal cramps C. Cardiac dysrhythmias D. Dry, sticky mucous membranes

D. Dry, sticky mucous membranes

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

D. Dysenteric

27. 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

D. Easily digested foods

40. 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.

D. Hold the hand under cool running water.

15. 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

D. Metabolic and respiratory alkalosis

8. What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)? A. Nausea, vomiting B. Weakness, fatigue C. Muscle hypotonicity D. Neuromuscular irritability

D. Neuromuscular irritability

41. 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

D. Urinary output of 1 to 2 ml/kg of body weight/hr

51. 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

B. Mild fever and vomiting followed by onset of watery stools.

10. 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

B. 50 to 90 ml/kg

5. 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

B. Anorexia C. Constipation E. Muscle hypotonicity

30. What is the most frequent cause of hypovolemic shock in children? A. Sepsis B. Blood loss C. Anaphylaxis D. Heart failure

B. Blood loss

18. 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.

B. Check the insertion site frequently for signs of infiltration.

44. 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

B. Debride the wounds.

19. 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.

B. End the infusion and notify the practitioner.

4. 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

B. Hypotension D. Muscle Weakness E. Cardiac arrhythmias

9. 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

B. Hypotonic dehydration

23. 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."

B. I should apply pressure to the entry site to the vein, not the exit site, if the VAD is accidentally removed.

20. 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.

B. It is easy to use for self-administered infusions.

6.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

B. Lethargy C. Oliguria E. Dry, stick mucous membranes

33. 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.

C. Provide supplemental oxygen.

50. 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 super absorbent tampon for more than 6 hours." D. "I should call my health care provider if I suddenly develop a rash that looks like sunburn."

C. "I can use a super absorbent tampon for more than 6 hours."

4. 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

C. 1200

28. 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.

C. Continue to give ORS frequently in small amounts

39. 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

C. Disorientation

21. 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

C. Fever and general malaise

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

C. Fluid shift from interstitial space to intravascular space.

26. What organism is a parasite that causes acute diarrhea? A. Shigella organisms B. Salmonella organisms C. Giardia lamblia D. Escherichia coli

C. Giardia lamblia

49. 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

C. Hot liquids in the kitchen

3. 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

C. Immature kidney functioning

34. 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

C. Increased capillary permeability

38. 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

C. Infection

14. 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

C. Irritability and seizures

48. 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

C. Limitation of period without pressure

42. 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

C. Minimize protein breakdown