NUR 412: Nursing Concepts for Pediatric Patients Exam 2

What is the volume of rapid replacement fluids given IV to a child weighing 12.6 kg?

252 mL

The nurse is caring for a 22 kg child. The nurse would expect a minimum of ___ mL of urine over 12 hours.

264 mL

What is the volume of oral replacement fluids given to an infant with mild dehydration weighing 6.2 kg?

310 mL

What is the expected urine output calculation for adolescents?

40 mL/hour

A parent calls a triage nurse and discusses with the nurse about her child being dehydrated. Which oral fluids would the nurse recommend if oral replacement fluid is not available? A. Orange juice B. Chicken broth C. Clear white soda, such as 7-Up D. Half-strength athletic drink, which has no caffeine

D. Half-strength athletic drink, which has no caffeine

In which of the following conditions is the fluid requirement for children decreased? A. Burns B. Fever C. Vomiting D. Increased intracranial pressure

D. Increased intracranial pressure

What assessment provides the best indication of hydration status? A. Intake & output B. Blood pressure C. Skin turgor D. Weight E. Level of consciousness

D. Weight

Immaturity of the renal tubular system in children under 2 years of age results in what four characteristics?

-Poor regulation of acid-base balance -Less efficient electrolyte regulation -Decreased ability to adapt to changes in fluid volume -Inability to concentrate urine

What is the expected urine output calculation for children?

1 mL/kg/hour

Glomerular filtration rate (GFR) is decreased at birth with a marked increase in the first month of life. When does GFR reach adult levels?

1 to 2 years of age

A nurse is trying to figure out if the child has had adequate urine output for the shift. If the child weights 24 kg, how much urine output would you anticipate for a 12-hour shift? A. 24 mL B. 28 mL C. 288 mL D. 576 mL

C. 288 mL

It is generally recommended that a child with acute streptococcal pharyngitis can return to school: A. When sore throat is better. B. If no complications develop. C. After taking antibiotics for 24 hours. D. 3 days after initial throat cultures.

C. After taking antibiotics for 24 hours.

Which of the following is a measure of chest wall and lung distensibility? A. Resistance B. Ventilation C. Compliance D. Alveolar surface tension

C. Compliance

In acute glomerulonephritis, the nurse is aware that an early warning sign of encephalopathy is which of the following? A. Seizures B. Psychosis C. Dizziness D. Transient loss of vision

C. Dizziness

Renal blood flow of the newborn is ___% to ___% of the adult renal blood flow due to decreased cardiac output and increased renal vascular resistance.

15% - 20%

Determine the maintenance IV fluid total per day and hourly rate for a child weighing 52 pounds.

1572 mL/day 65.6 mL/hour

Determine the initial hour IV rate for a child weighing 16.5 kg who is 8% dehydrated with a sodium level of 128.

165.3 mL/hour

The nurse is caring for a 32-pound child. The nurse would expect a minimum urine output of ___ mL over 12 hours.

174 mL

What is the volume of maintenance fluids given to a child weighing 32 kg?

1740 mL/day

Nursing considerations related to the administration of oxygen in an infant include which of the following? A. Discontinue during feedings so child can be held. B. Assess infant to determine how much oxygen should be given. C. Ensure uninterrupted delivery of the appropriate oxygen concentration. D. Direct oxygen flow so that it blows directly into the infant's face in a hood.

C. Ensure uninterrupted delivery of the appropriate oxygen concentration.

What is the expected urine output calculation for infants?

2 mL/kg/hour

The renal tubular system matures primarily in the first ___ years of life and then gradually reaches full size and capacity by adolescence.

2 years

What is the volume of fluids given in the first hour to an infant with 7% hypertonic dehydration weighing 7.8 kg?

43.9 mL/hour

The nurse is caring for a 16-year-old who weighs 115 pounds. The nurse would expect minimum of ___ mL of urine over 12 hours.

480 mL

What is the minimum urine output for a 52 kg adolescent over 12 hours?

480 mL

What is the volume of fluids given in the first hour to an infant with 8% isotonic dehydration weighing 4.5 kg?

50.6 mL/hour

The nurse is caring for a 7-pound infant. The nurse would expect a minimum of ___ mL of urine over 8 hours.

51 mL

Determine the maintenance IV fluid total per day and hourly rate for a child weighing 15 pounds.

680 mL/day 28.3 mL/hour

What is the volume of maintenance fluids given to an infant weighing 7.3 kg?

730 mL/day

What is the minimum urine output for a 5 kg infant over 8 hours?

80 mL

Determine the initial hour IV rate for a child weighing 8.3 kg who is 6% dehydrated with an unknown sodium level.

83 mL/hour

What is the hourly IV rate for a child weighing 22 pounds? A. 46 mL/hour B. 42 mL/hour C. 64 mL/hour D. 21 mL/hour

B. 42 mL/hour

What is the daily maintenance fluids for an infant weighing 4.5 kg? A. 225 mL/day B. 450 mL/day C. 90 mL/day D. 204 mL/day

B. 450 mL/day

The nurse is caring for a child who is awaiting surgery. How fast would the nurse anticipate the IV to run at if the child weighs 24.7 kg? A. 63 mL/hour B. 66 mL/hour C. 83 mL/hour D. 100 mL/hour

B. 66 mL/hour

A parent brings in a 14-month-old child who was vomiting last night, has had no urine output for the past 24 hours, and appears tired. Current weight is 9.5 kg. The physician has determined that the child is 6% dehydrated. What action would you anticipate? A. 475 mL oral replacement fluids B. 950 mL oral replacement fluids C. 190 mL IV normal saline D. 570 mL IV D5 ¼ NS

B. 950 mL oral replacement fluids

Which of the following best describes the cause of most cases of acute glomerulonephritis? A. Renal vascular anomalies B. Antecedent streptococcal infection C. Results from a urinary tract infection D. Structural anomalies of genitourinary tract

B. Antecedent streptococcal infection

Asthma is now classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include all of the following except: A. Lung function. B. Associated allergies. C. Frequency of symptoms. D. Frequency and severity of exacerbations.

B. Associated allergies.

Which of the following urine tests of renal function is used to estimate glomerular filtration? A. pH B. Creatinine C. Osmolality D. Protein level

B. Creatinine

Which of the following types of croup is always considered a medical emergency? A. Laryngitis B. Epiglottitis C. Spasmodic croup D. Laryngotracheobronchitis

B. Epiglottitis

What type of dehydration is defined as "dehydration that occurs in conditions in which the electrolyte deficit exceeds the water deficit?" A. Isotonic dehydration B. Hypotonic dehydration C. Hypertonic dehydration D. All types of dehydration in infants and small children

B. Hypotonic dehydration

Rapid replacement of fluid is essential in the treatment of which of the following types of dehydration? A. Isotonic, osmotic B. Hypotonic, isotonic C. Osmotic, hypertonic D. Hypertonic, hypotonic

B. Hypotonic, isotonic

The nurse is caring for a 6-month-old infant in the ED with a history of diarrhea for 24 hours. How would this patient be initially treated if 10% dehydrated? A. Oral re-hydration B. IV re-hydration with 20 mL/kg normal saline C. IV re-hydration over 24 hours D. IV re-hydration over 48 hours

B. IV re-hydration with 20 mL/kg normal saline

Which of the following is NOT a developmental difference in infants and children that affects fluid regulation? A. Immature GI system B. Lower metabolic rate C. Greater body surface area D. Higher percentage of ECF

B. Lower metabolic rate

An appropriate nursing intervention when caring for a child with pneumonia is which of the following? A. Avoid placing child on affected side. B. Monitor respiratory status frequently. C. Place in Trendelenburg position. D. Administer antitussive agents around the clock.

B. Monitor respiratory status frequently.

The nurse is caring for a 6-month-old infant in the ED with a history of diarrhea for 24 hours. What is the definitive assessment to determine the type of dehydration? A. Weight B. Serum sodium level C. Skin color, feel, and turgor D. Behavior

B. Serum sodium level

A young child is diagnosed with vesicoureteral reflux. The nurse should know that this usually results in: A. Incontinence. B. Urinary obstruction. C. Recurrent urinary tract infections. D. Infarction of renal vessels.

C. Recurrent urinary tract infections.

A child is developing respiratory failure. Signs that the hypoxia is becoming severe include: A. Tachypnea. B. Tachycardia. C. Somnolence. D. Restlessness.

C. Somnolence.

The nurse is caring for a 20-month-old child with 12% dehydration weighing 10.8 kg. Heart rate is 152, RR 36, BP 92/58, skin dry & warm, color dusky, lethargic, last void unknown. How much fluid will the nurse initially administer? A. 20 mL B. 108 mL C. 216 mL D. 1040 mL

C. 216 mL

What are some potential causes of isotonic dehydration?

Vomiting/diarrhea Decreased oral intake Sunstroke (hiking in desert, etc.) Diuretics

What are the 7 developmental differences in infants and children that affect fluid regulation?

↑ percentage total body fluid ↑ percentage ECF ↑ body surface area ↑ metabolic rate Immature kidney Immature GI system Inability to communicate thirst

Why is renal blood flow in a newborn less than that of an adult?

↓ cardiac output ↑ renal vascular resistance

What is the minimum urine output for a 20 kg child over 6 hours?

120 mL

Determine the maintenance IV fluid total per day and hourly rate for a child weighing 32 pounds.

1225 mL/day 51 mL/hour

Determine the initial hour IV rate for a child weighing 29 kg who is 10% dehydrated with a sodium level of 152.

130.4 mL/hour

What is the volume of maintenance fluids given to a child weighing 17.5 kg?

1375 mL/day

The nurse is caring for an infant who is NPO and weighs 8.6 kg. How fast would the nurse anticipate the IV fluids to run? A. 36 mL/hour B. 63 mL/hour C. 76 mL/hour D. 860 mL/hour

A. 36 mL/hour

How much IV replacement fluid would an infant who is 5 kg and 12% dehydrated need? A. 600 mL B. 120 mL C. 50 mL D. 60 mL

A. 600 mL

The nurse is caring for a 2-year-old child admitted with severe dehydration (10%). The child weighs 14.5 kg. Following administration of the IV bolus fluid, the nurse notes that the child's heart rate is 165 beats per minute, respiratory rate 46 breaths per minute, and blood pressure is 105/78. The child's serum sodium level is 154 mmol/L. What rate would you expect to start the child's IV at? A. 81 mL/hour B. 167 mL/hour C. 244 mL/hour D. 84 mL/hour

A. 81 mL/hour

An infant in the emergency room is admitted for moderate dehydration (8%) who weighs 5.6 kg. The parents inform the nurse that the last wet diaper was 8 hours ago and that the child had been vomiting but has had no emesis for the past 8 hours. The infant has refused to drink anything while in the emergency room. The nurse notes on the child's assessment that the infant's heart rate is 154 beats per minute, respirtory rate is 56 breaths per minute, blood pressure is 92/65, capillary refill is 3 seconds, skin is cool and dry, skin turgor is poor, fontanel is sunken, mucous membranes are dry, and the infant is quiet and does not seem to engage in the environment with either nurse or parents. What would the nurse expect for the initial intervention for this child? A. Administer 112 ml NS IV over 20 minutes B. Give 560 ml of oral replacement fluids over 4-6 hours C. Administer 112 ml NS IV as quickly as possible D. Start IV fluids D5 1/2 NS at 63 ml/hr for 8 hours

A. Administer 112 ml NS IV over 20 minutes

An 11-month-old infant has been admitted to the emergency room with a 4 day history of diarrhea and severe dehydration (10%). The child weighs 8.8 kg. The parents inform the nurse that the last wet diaper was more than 24 hours ago and that the child has refused all foods but has been taking a bottle of tap water about every 4 hours. The nurse notes on the child's assessment that the heart rate is 182 beats per minute, respiratory rate is 56 breaths per minute, blood pressure is 62/40, capillary refill is greater than 4 seconds, skin is cool and clammy, skin turgor is poor, fontanel is sunken, and the child is difficult to arouse or keep awake. What would the nurse expect for the initial intervention for this child? A. Administer 176 mL NS as quickly as possible. B. Administer 176 mL NS over 20 minutes. C. Start IV fluids of D5 NS at 55 mL/hour for 48 hours. D. Start IV fluids of D5 NS at 110 mL/hour for 8 hours.

A. Administer 176 mL NS as quickly as possible.

Therapeutic management of nephrotic syndrome includes which of the following? A. Corticosteroids B. Long-term diuretics C. Antihypertensive agents D. Fluid and salt restrictions

A. Corticosteroids

Which of the following helps nurses understand how the respiratory tract in children is different from that in adults? A. Infants rely almost entirely on diaphragmatic-abdominal breathing. B. Smooth muscle development in the airways increases until about age 12 years. C. The configuration of the chest at birth is not as round as it becomes by adulthood. D. With age there is a decrease in both number of alveoli and branching of terminal bronchioles.

A. Infants rely almost entirely on diaphragmatic-abdominal breathing.

What type of dehydration is defined as "dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportion"? A. Isotonic dehydration B. Hypotonic dehydration C. Hypertonic dehydration D. All types of dehydration in infants and small children

A. Isotonic dehydration

The most profound complication of prolonged middle ear disorders is: A. Loss of hearing. B. Failure to thrive. C. Visual impairment. D. Tympanic membrane rupture.

A. Loss of hearing.

Which of the following is the primary clinical manifestation of acute renal failure? A. Oliguria B. Hematuria C. Proteinuria D. Bacteriuria

A. Oliguria

Which of the following blood oxygenation tests is the photometric measurement of oxygen saturation? A. Oximetry B. Capnography C. Arterial puncture D. Transcutaneous oxygen and carbon dioxide monitoring

A. Oximetry

The nurse is assessing an infant brought to the clinic with diarrhea. He is lethargic and has dry mucous membranes. Which of the following should the nurse recognize as an early sign of dehydration? A. Tachycardia B. Bulging, tense fontanel C. Decreased blood pressure D. Capillary refill of less than 3 seconds

A. Tachycardia

A child is on the pediatric floor with hypotonic dehydration (9%) being treated with IV fluids. The child weighs 29.6 kg. The initial 8 hours of fluids have been administrated. What rate of IV fluids will the nurse expect to change the pump to starting on the 9th hour? A. 71 mL/hour B. 136 mL/hour C. 272 mL/hour D. 126 mL/hour

B. 136 mL/hour

What is the daily maintenance fluids for a child weighing 18.2 kg? A. 910 mL/day B. 1410 mL/day C. 1910 mL/day D. 1820 mL/day

B. 1410 mL/day

An infant on the pediatric floor is in with hypertonic dehydration (8%). The infant weighs 2.8 kg. The IV fluids have been infusing for 8 hours. What rate would the nurse expect the IV fluids to be running on the 9th hour? A. 11 mL/hour B. 16 mL/hour C. 9 mL/hour D. 31 mL/hour

B. 16 mL/hour

What is the daily maintenance fluids for a child weighing 57 pounds? A. 2240 mL/day B. 1618 mL/day C. 2590 mL/day D. 2018 mL/day

B. 1618 mL/day

Which of the following blood oxygenation tests measures carbon dioxide during inhalation and exhalation? A. Oximetry B. Capnography C. Arterial puncture D. Transcutaneous oxygen and carbon dioxide monitoring

B. Capnography

In providing nourishment for a child with cystic fibrosis (CF), which of the following factors should the nurse keep in mind? A. Fats and proteins must be greatly curtailed. B. Diet should be high in calories and protein. C. Most fruits and vegetables are not well tolerated. D. Diet should be high in easily digested carbohydrates and fats.

B. Diet should be high in calories and protein.

When planning care for a 4-month-old child admitted with respiratory distress caused by respiratory syncytial virus (RSV) and bronchiolitis, it is essential to include which of the following? A. Give antibiotics. B. Ensure adequate hydration. C. Administer cough syrup. D. Feed 4 oz of formula every 4 hours.

B. Ensure adequate hydration.

Which of the following factors predisposes the urinary tract to infection? A. Increased fluid intake B. Short urethra in girls C. Ingestion of highly acidic juices D. Frequent emptying of the bladder

B. Short urethra in girls

A 13-year-old child has been admitted to the emergency room after collapsing during football practice with moderate dehydration (8%). The child weighs 45 kg. The coach informs the nurse that they had been practicing all afternoon in the heat and that the only water available was inside the school which had been locked up for the past 4 hours. The nurse notes on the child's assessment that the heart rate is 132 beats per minute, respiratory rate is 26 breaths per minute, blood pressure is 112/78, capillary refill is 3 seconds, skin is dry, and mucous membranes are very dry. The child is very lethargic, irritable flailing his arms and legs when stimulated, and unable to follow commands. Labs were drawn and the sodium level is 149 mmol/L. What would the nurse expect for the initial intervention for this child? A. Give 4500 ml oral replacement fluids over 4-6 hours B. Start IV fluids D5 1/4 NS at 158 ml/hr for 48 hours C. Start IV fluids D5 1/4 NS at 350 ml/hr for 8 hours D. Administer 900 ml NS over 20 minutes

B. Start IV fluids D5 1/4 NS at 158 ml/hr for 48 hours

A 21-month-old child has been admitted to the emergency room with moderate dehydration (7%). The child weighs 11.7 kg. The parents inform the nurse that they have been out hiking in the desert for the past 6 hours. The last wet diaper was about 4 hours ago and the child last had something to drink about 4 hours ago. The nurse notes on the child's assessment that the heart rate is 142 beats per minute, respiratory rate is 38 breaths per minute, Blood pressure is 102/76, capillary refill is less than 3 seconds, skin is cool and dry, skin turgor is poor, and the child is irritable but consolable. What would the nurse expect for the initial intervention for this child? A. Administer 234 ml NS over 20 minutes B. Start IV fluids D5 1/2 NS at 119 ml/hr for 8 hours C. Give 1170 ml of oral replacement fluids over 4-6 hours D. Start IV fluids D5 1/2 NS at 62 ml/hr for 48 hours

C. Give 1170 ml of oral replacement fluids over 4-6 hours

Which of the following is a developmental difference in infants and children that affects fluid regulation? A. Lower percentage of total body fluid B. Lower percentage of ECF C. Greater body surface area D. Lower metabolic rate

C. Greater body surface area

The nurse is caring for a 20-month-old child with 12% dehydration weighing 10.8 kg. Heart rate is 152, RR 36, BP 92/58, skin warm and dry, color dusky, lethargic, last void unknown, serum Na+ 149 mmol/L. What type of dehydration does this child have? A. Isotonic dehydration B. Hypotonic dehydration C. Hypertonic dehydration

C. Hypertonic dehydration

What type of dehydration is defined as "dehydration that occurs in conditions in which water loss is in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes?" A. Isotonic dehydration B. Hypotonic dehydration C. Hypertonic dehydration D. All types of dehydration in infants and small children

C. Hypertonic dehydration

Which statement accurately expresses the genetic implications of cystic fibrosis (CF)? A. It is inherited as an autosomal dominant trait. B. It is a genetic defect found primarily in non-Caucasian population groups. C. If it is present in a child, both parents are carriers of this defective gene. D. There is a 50% chance that siblings of an affected child will also be affected.

C. If it is present in a child, both parents are carriers of this defective gene.

Which of the following is a major complication of total parenteral nutrition in children? A. Anemia B. Asthma C. Liver disease D. Renal impairment

C. Liver disease

Depression of the central nervous system, manifested by lethargy, delirium, stupor, and coma, is observed in which of the following? A. Metabolic acidosis B. Respiratory alkalosis C. Metabolic and respiratory acidosis D. Metabolic and respiratory alkalosis

C. Metabolic and respiratory acidosis

When caring for a child with an intravenous infusion, the nurse should do which of the following? A. Change the insertion site every 24 hours. B. Use a macrodropper to facilitate the prescribed flow rate. C. Observe the insertion site frequently for signs of infiltration. D. Avoid restraining the child to prevent undue emotional stress.

C. Observe the insertion site frequently for signs of infiltration.

What is the hourly IV rate for a child weighing 7 pounds? A. 29 mL/hour B. 7 mL/hour C. 22 mL/hour D. 13 mL/hour

D. 13 mL/hour

What is the hourly IV rate for a child weighing 17 kg? A. 71 mL/hour B. 35 mL/hour C. 77 mL/hour D. 56 mL/hour

D. 56 mL/hour

What is the hourly IV rate for a child weighing 45 kg? A. 100 mL/hour B. 63 mL/hour C. 115 mL/hour D. 83 mL/hour

D. 83 mL/hour

How much IV replacement fluids will a child who is 8% dehydrated weighing 12 kg need? A. 1100 mL B. 80 mL C. 96 mL D. 960 mL

D. 960 mL

One of the goals for children with asthma is to prevent respiratory tract infection. This is because respiratory tract infection does which of the following? A. Increases sensitivity to allergens B. Causes exercise-induced asthma C. Lessens effectiveness of medications D. Can trigger an episode or aggravate asthmatic state

D. Can trigger an episode or aggravate asthmatic state

The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To perform percussion, the nurse should instruct her to: A. Strike the chest wall with a flat-hand position. B. Percuss before and after positioning for postural drainage. C. Percuss over the entire trunk anteriorly and posteriorly. D. Cover the skin with a shirt or gown before percussing.

D. Cover the skin with a shirt or gown before percussing.

What is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? A. Give tepid water baths to reduce fever. B. Encourage food intake to maintain caloric needs. C. Have child wear heavy clothing to prevent chilling. D. Give small amounts of favorite fluids frequently to prevent dehydration.

D. Give small amounts of favorite fluids frequently to prevent dehydration.

An infant arrives in the ER and his parents claim that he is dehydrated. As the nurse begins to assess the infant, she is aware that the best indicator of dehydration in this patient is: A. Weight B. Blood pressure C. Skin turgor D. Level of consciousness E. Intake & output as indicated by parents

D. Level of consciousness No history of weights, so weight is not the most reliable indicator in this case

Which of the following is NOT a developmental difference in infants and children that affects fluid regulation? A. Higher percentage of ECF B. Immature kidney C. Inability to communicate thirst D. Lower percentage of total body fluid

D. Lower percentage of total body fluid

Skin testing for tuberculosis (TB) is recommended: A. Every year for all children older than 2 years. B. Every year for all children older than 10 years. C. Every 2 years for all children starting at age 1 year. D. Periodically for children who are high-risk populations.

D. Periodically for children who are high-risk populations.

An immediate intervention when an infant chokes on a piece of food would be to do which of the following? A. Administer mouth-to-mouth resuscitation. B. Open infant's mouth and perform blind finger sweep. C. Have infant lie quietly while a call is placed for emergency help. D. Position infant in a head-down, prone position, and administer five quick blows between the shoulder blades.

D. Position infant in a head-down, prone position, and administer five quick blows between the shoulder blades.

The clinical manifestations of nephrotic syndrome include which of the following? A. Hematuria, bacteriuria, weight gain B. Gross hematuria, albuminuria, fever C. Hypertension, weight loss, proteinuria D. Proteinuria, hypoalbuminemia, edema

D. Proteinuria, hypoalbuminemia, edema

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it: A. Liquefies secretions. B. Improves oxygenation. C. Promotes less labored ventilation. D. Soothes inflamed mucous membranes.

D. Soothes inflamed mucous membranes.

The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. Which of the following should be the nurse's next action? A. Notify surgeon. B. Perform oral intubation. C. Try inserting larger tube. D. Try inserting smaller tube.

D. Try inserting smaller tube.

(True/false) A decrease in blood pressure is always an early sign of dehydration.

False - latent sign

For a patient who presents with possible dehydration, in what order is the assessment performed?

LOC Skin color HR Urine output BP