Peds Ch 18

A nurse is planning care for a child with hyponatremia. The nurse, delegating care of this child to a new RN on the pediatric unit, cautions the new nurse to be especially alert for which condition in the child? 1. Seizures 2. Bradycardia 3. Respiratory distress 4. Hyperthermia

Answer: 1 Explanation: 1. A child with hyponatremia is at risk for seizures. Bradycardia, respiratory distress, and hyperthermia are not risks of hyponatremia.

The nurse is assessing an infant brought to the clinic with diarrhea. The infant is alert but has dry mucous membranes. Which other sign indicates the infant is still in the early or mild stage of dehydration? 1. Tachycardia 2. Bradycardia 3. Increased blood pressure 4. Decreased blood pressure

Answer: 1 Explanation: 1. Tachycardia is a sign that indicates mild dehydration. Bradycardia and increased blood pressure are not signs of dehydration. Decreased blood pressure is not a sign of mild dehydration. Decreased blood pressure indicates moderate to severe dehydration.

A child is being treated for dehydration with intravenous fluids. The child currently weighs 13 kg and is estimated to have lost 7 percent of the normal body weight. The nurse is double-checking the IV rate the practitioner has ordered. The formula the practitioner used was for maintenance fluids: 1000 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 body weight × 10 per kg of body weight. According to the calculation for maintenance plus replacement fluid, this child's hourly IV rate for 24 hours should be ________ mL. Round the answer to the nearest whole number.

Answer: 86 Explanation: Maintenance need for 13 kg is 1000 + (50 × 3), or 1150 mL/24 hours. Add to this the replacement-fluid loss = 7 (percent of total body weight lost) × 10 = 70 mL/kg/24 hours (70 × 13 = 910). 1150 + 910 = 2060 for 24 hours. 2060/24 = 86 mL per hour.

A preschool-aged client, diagnosed with croup, has an increased pCO2, a decreased pH, and a normal HCO3 blood-gas value. Which documentation in the medical record is the most appropriate? 1. Uncompensated respiratory acidosis 2. Uncompensated respiratory alkalosis 3. Uncompensated metabolic acidosis 4. Uncompensated metabolic alkalosis

Answer: 1 Explanation: 1. If the pH is decreased and the pCO2 is increased with a normal HCO3, it is uncompensated respiratory acidosis. Also, croup can be a disease process that causes respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased pCO2 and normal HCO3; uncompensated metabolic acidosis has a decreased pH, normal pCO2 and normal HCO3; and uncompensated metabolic alkalosis has an increased pH, normal pCO2, and increased HCO3.

Parents of an infant with slow weight gain ask the nurse if they can feed their baby a highly concentrated formula. Which response by the nurse is the most appropriate? 1. "A higher-concentrated formula could lead to dehydration because of high sodium content; let's discuss other strategies." 2. "An undiluted formula concentrate could be given to help the child gain weight; let's look at brands." 3. "Evaporated milk could be given to the infant instead of the current formula you're using." 4. "A higher-concentrated formula could be given for daytime feedings; let's work on a schedule."

Answer: 1 Explanation: 1. Parents and caregivers of bottle-fed babies should be taught never to give undiluted formula concentrate or evaporated milk due to the high sodium content.

The nurse is planning an in-service for new RNs who will be working on a general pediatric unit. Which statements are appropriate to include when discussing normal acid-base balance? Select all that apply. 1. The lungs are responsible for excreting excess carbonic acid from body. 2. The lungs reabsorb filtered bicarbonate. 3. The kidneys form bicarbonate if needed to restore balance. 4. The liver forms bicarbonate if needed to restore balance. 5. The liver synthesizes proteins needed to maintain osmotic pressure in the fluid compartments.

Answer: 1, 3, 5 Explanation: 1. Statements that the nurse educator will include in the in-service include: the lungs are responsible for excreting excess carbonic acid from body; the kidneys form bicarbonate if needed to restore balance; and the liver synthesizes proteins needed to maintain osmotic pressure in the fluid compartments. The kidneys, not the lungs, reabsorb filtered bicarbonate. The kidneys, not the liver, form bicarbonate to restore balance, if needed.

Match the types of dehydration with their description. A. Isotonic dehydration B. Hypotonic dehydration C. Hypertonic dehydration 1. Occurs when fluid loss is characterized by a proportionately greater loss of sodium than water. 2. Occurs when fluid loss is characterized by a proportionately greater loss of water than sodium. 3. Occurs when fluid loss is not balanced by intake, and the loss of water and sodium are in proportion.

Answer: 1/B, 2/C, 3/A 1. Hypotonic dehydration 2. Hypertonic dehydration 3. Isotonic dehydration Explanation: Isotonic dehydration: occurs when fluid loss is not balanced by intake, and the loss of water and sodium are in proportion. Hypotonic dehydration: occurs when fluid loss is characterized by a proportionately greater loss of sodium than water. Hypertonic dehydration: occurs when fluid loss is characterized by a proportionately greater loss of water than sodium.

The school-age child is admitted to the hospital with dehydration. The child weighs 30 pounds. The physician orders: 50 mL/kg 0.9 percent NSS with 5 percent dextrose IV over 4 hours. Calculate the IV pump to infuse 50 mL/kg/4hrs. Supply on hand: 1000 mL 0.9 percent NSS/2.5 percent dextrose

Answer: 170.4 mL/hr Explanation: Infuse 170.4 mL/hr

The nurse is expecting the admission of a child with severe isotonic dehydration. Which intravenous fluid should the nurse anticipate the practitioner to order initially to replace fluids? 1. D5W 2. 0.9 percent Normal Saline (NS) 3. Albumin 4. D5 0.2 percent (1/4) Normal Saline

Answer: 2 Explanation: 1. 0.9 percent Normal Saline (NS) maintains Na and chloride at present levels. D5W can lower sodium levels so would not be used to initially replace fluids in severe isotonic dehydration. Albumin is used to restore plasma proteins. D5 0.2 percent (1/4) Normal Saline would not be used initially but later, as maintenance fluids.

A nurse is planning care for a child with hyperkalemia. Which clinical manifestation will the nurse plan to assessment this child for based on the diagnosis? 1. Seizures 2. Bradycardia 3. Respiratory distress 4. Hyperthermia

Answer: 2 Explanation: 1. A child with hyperkalemia is at risk for cardiac issues. Seizures, respiratory distress, and hyperthermia are not risks of hyperkalemia.

In the morning, a nurse receives a report on four pediatric clients who have some form of fluid-volume excess. Which client should the nurse assess first? 1. A client with periorbital edema, normal respiratory rate 2. A client with tachypnea and pulmonary congestion 3. A client with dependent and sacral edema, regular pulse 4. A client with hepatomegaly, normal respiratory rate

Answer: 2 Explanation: 1. A child with respiratory distress should be the first client the nurse checks after receiving report. The child with periorbital edema and normal respiratory rate, the child with dependent and sacral edema and regular pulse, and the child with hepatomegaly and normal respiratory rate are all more stable than the child with tachypnea and pulmonary congestion.

A nurse is taking care of four different pediatric clients. Which client poses the great risk for dehydration? 1. A 15-year-old working out in a weight room for an hour before football practice 2. A 10-year-old playing baseball outdoors in 85-degree heat 3. A 5-year-old refusing to eat because of a virus 4. A newborn under a radiant warmer for an hour after the first bath

Answer: 2 Explanation: 1. A condition that increases the risk of insensible fluid loss places the child at risk for dehydration. Any of these situations can place the child at risk for dehydration but the child at greatest risk is the child playing baseball in direct heat, which will increase utilization of extracellular fluids more rapidly than the other situations.

A school-age client is hypokalemic. The nurse is helping the client complete her menu. Which food selection will the nurse encourage for this client? 1. A hamburger with French fries 2. Pizza with a fruit plate 3. Chicken strips with chips 4. A fajita with rice

Answer: 2 Explanation: 1. Pizza with the fruit plate should be encouraged because fruits (bananas, apricots, cantaloupe, cherries, peaches, and strawberries) have high amounts of potassium, and a child is likely to eat this combination.

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 is the priority diagnosis for this child? 1. Risk for Imbalanced Nutrition: Less Than Body Requirements 2. Risk for Impaired Skin Integrity 3. Risk for Altered Body Image 4. Risk for Activity Intolerance

Answer: 2 Explanation: 1. The highest priority problem is skin integrity. Nutrition, body image, and activity intolerance would not take priority over the integrity of the skin for this scenario.

The nurse educator is preparing an in-service for new RNs hired on a general pediatric unit regarding normal fluid and electrolyte status for children at various ages. Which statements will the educator include about normal fluid and electrolyte status of an infant? Select all that apply. 1. The infant has 75 percent total body water. 2. The extracellular fluid accounts for 25 percent of total body water in the infant. 3. A high metabolic rate requires generous fluid intake for the infant. 4. The infant's kidneys are mature and able to conserve water and electrolytes. 5. The infant's high body surface area promotes fluid loss.

Answer: 2, 3, 5 Explanation: 1. The nurse educator would include the following statements in the in-service: the extracellular fluid accounts for 25 percent of total body water in the infant; a high metabolic rate requires generous fluid intake for the infant; and the infant's high body surface area promotes fluid loss. All of these statements are true and accurate. The newborn, not the infant, has 75 percent total body water. All clients under the age of two years have immature kidney and are unable to conserve water and electrolytes.

A child is admitted to the hospital for hypercalcemia and is placed on diuretic therapy. Which diuretic would the nurse expect to give? 1. Hydrochlorothiazide (Aquazide) 2. Spironolactone (Aldactone) 3. Furosemide (Lasix) 4. Mannitol (Osmitrol)

Answer: 3 Explanation: 1. Furosemide (Lasix) is the diuretic used to aid in excretion of calcium. Thiazide diuretics (hydrochlorothiazide) decrease calcium excretion and should not be given to the hypercalcemic client. Mannitol (Osmitrol) is a diuretic used to decrease cerebral edema and is not routinely used to aid in excretion of calcium. Spironolactone (Aldactone) is a potassium-sparing diuretic and would not be effective for excretion of calcium.

A 1-month-old client is admitted to the emergency room with severe diarrhea. Which assessment suggests the client is severely dehydrated? 1. Skin moist and flushed; mucous membranes dry 2. Low specific gravity of urine; skin color pale 3. Fontanels depressed; capillary refill greater than three seconds 4. High specific gravity of urine; moist mucous membranes

Answer: 3 Explanation: 1. Two signs of severe dehydration are depressed fontanels and capillary refill time greater than three seconds. Moist, flushed skin; moist mucous membranes; and low specific gravity of urine are not signs of dehydration. Dry mucous membranes and pale skin color are signs of mild dehydration, not severe.

The nurse finishes a parent-teaching session on preventing heat-related illnesses for children who exercise. Which statement by a parent indicates understanding of preventive techniques taught? 1. Hydration should occur at the end of an exercise session. 2. Water is the drink of choice to replenish fluids. 3. Wearing dark clothing during exercise is recommended. 4. During activity, stop for fluids every 15 to 20 minutes.

Answer: 4 Explanation: 1. During activity, stopping for fluids every 15 to 20 minutes is recommended. Hydration should occur before and during the activity, not just at the end. A combination of water and sports drinks is best to replace fluids during exercise. Light-colored, light clothing is best to wear during exercise activities; wearing of dark colors can increase sweating.

The nurse is completing the intake and output record for a preschool-age client admitted for fluid volume deficit. The client has had the following intake and output during the shift: Intake: 4 oz of Pedialyte 1/2 of an 8-oz cup of clear orange Jell-O 2 graham crackers 200 mL of D 5-1/2 sodium chloride IV Output: 345 mL of urine 50 mL of loose stool The nurse documents the client's intake as ________ milliliters. Round the answer to the nearest whole number.

Answer: 440 Explanation: Pedialyte, Jell-O and IV fluid would be calculated for intake. The child has had 240 mL orally and 200 mL intravenously for a total of 440.