Chapter 40

A 4-year-old has had diarrhea for several days, and her perineum is inflamed and almost excoriated. What nursing actions are indicated? (Select all that apply.) A. Gently wash the perineum with cold water and mild soap after each stool. B. Apply an ointment to the inflamed area to provide a moisture barrier. C. Place the child without underwear for brief periods to allow air to the area. D. Turn the child at least every two hours.

Answer: B, C, D

A 2-month-old breastfed infant is successfully rehydrated with oral rehydration solutions (ORS) for acute diarrhea. What instructions to the mother about breastfeeding should be included by the nurse? A. Continue breastfeeding. B. Stop breastfeeding until breast milk is cultured. C. Stop breastfeeding until diarrhea is absent for 24 hours. D. Express breast milk and dilute with sterile water before feeding.

Answer: A A. Breastfeeding should continue. B. Culturing the breast milk is not necessary. C. Breastfeeding can continue along with ORS to replace the continuing fluid loss from the diarrhea. D. Breast milk should not be diluted.

A preschooler with severe vomiting and diarrhea was admitted to the hospital. The vomiting has stopped and rehydration has begun intravenously. When should the nurse begin feeding the child solid food? A. When the parents give their permission to feed their child. B. After the child has been rehydrated. C. After the diarrhea has stopped for 24 hours. D. When the IV rehydration can be stopped.

Answer: B A. It is not up to the parents to decide when resumption of solid food begins. B. Feeding of solids or formula is started as soon as the child is rehydrated. Children should be encouraged to eat frequently—every 3 to 4 hours. Parents should be instructed that although stool output may increase, feeding will not prolong diarrhea, and the child will be absorbing necessary nutrients and calories. C. Parents should be instructed that although stool output may increase, feeding will not prolong diarrhea, and the child will be absorbing necessary nutrients and calories D. The intravenous solutions may run a little longer to ensure that the child remains hydrated.

A preschooler with vomiting and diarrhea lost 0.5 kg of weight since being weighed in the pediatrician's office prior to admission to the hospital. How much fluid would the nurse calculate that this child has lost? A. 250 mL B. 500 mL C. 750 mL D. 1000 mL

Answer: B. A. One milliliter of body fluid is approximately equal to 1 g of body weight, so a weight loss or gain of 1 kg represents 1 liter or 1000 mL. A half-kilogram loss would be 500 mL. B. One milliliter of body fluid is approximately equal to 1 g of body weight, so a weight loss or gain of 1 kg represents 1 liter or 1000 mL. A half-kilogram loss would be 500 mL. C. One milliliter of body fluid is approximately equal to 1 g of body weight, so a weight loss or gain of 1 kg represents 1 liter or 1000 mL. A half-kilogram loss would be 500 mL. D. One milliliter of body fluid is approximately equal to 1 g of body weight, so a weight loss or gain of 1 kg represents 1 liter or 1000 mL. A half-kilogram loss would be 500 mL.

A toddler is hospitalized with severe dehydration. The nurse should assess the child for which possible complication? A. Hypertension B. Hypokalemia C. A rapid, bounding pulse D. Decreased specific gravity

Answer: B. A. The child needs to be monitored for hypotension. B. Hypokalemia is a concern in severe dehydration. C. A rapid, thready pulse would be seen in severe dehydration. D. The urine would be concentrated, so the specific gravity would increase.

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 to report the child has occasional vomiting. What is the appropriate recommendation by the nurse? A. Bring the child to the hospital for intravenous fluids. B. Alternate giving the child ORS and carbonated drinks. C. Continue to give the child ORS frequently in small amounts. D. Maintain the child on NPO for 8 hours and resume ORS if vomiting subsides.

Answer: C A. A school-age child with mild dehydration can be rehydrated safely at home with oral solutions. B. Carbonated drinks should not be given to the child. They may have a high carbohydrate content and contain caffeine, which is a diuretic. C. Vomiting is not a contraindication to the use of ORS unless it is severe. The mother should continue to give the ORS in small amounts and at frequent intervals. D. NPO status is not indicated. Frequent intake of ORS in small amounts is recommended.

Parents have a 23-month-old daughter who started having vomiting and diarrhea yesterday. When should the pediatrician's office be called to find out what to do? (Select all that apply.) A. If their daughter doesn't urinate for longer than 4 hours B. If their daughter's fontanel appears sunken C. If crying produces no tears D. When the diarrhea has been present for 24 hours E. The toddler has a fever (>39° C [102° F]) F. If severe abdominal cramps occur

Answer: C, D, E, F

Why are infants at greater risk for fluid and electrolyte imbalances than older children? A. Their metabolic rate is lower. B. They have a decreased surface area. C. Their kidney functioning is immature. D. Their daily exchange of extracellular fluid is decreased.

Answer: C. A. The infant has a higher metabolic rate. B. The infant has a proportionately greater body surface area, which allows for greater insensible water loss. C. The infant's kidneys are unable to concentrate or dilute urine, conserve or excrete sodium, and acidify urine. D. There is an increased amount of extracellular fluid in the infant. Forty percent of a neonate's body fluid is extracellular fluid, compared with 20% in an adult. Fluid is lost from the extracellular space first.

A nurse is evaluating an infant brought to the clinic with severe diarrhea. What signs and symptoms indicate that the infant has severe dehydration? A. Tachycardia, decreased tears, 5% weight loss B. Normal pulse and blood pressure, intense thirst C. Irritability, moderate thirst, normal eyes and fontanel D. Tachycardia, capillary refill greater than 3 seconds, sunken eyes and fontanel

Answer: D. A. In severe dehydration, there is a 15% weight loss in infants. B. Tachycardia, orthostatic hypotension and shock, and intense thirst would be expected. C. The infant would be extremely irritable, with sunken eyes and fontanel. D. Tachycardia, capillary refill greater than 3 seconds, and sunken eyes and fontanel are the symptoms of severe dehydration.

The nurse has measured the urinary output for the 12 hour shifted and has 340 mL for a 12 kg toddler. What is the normal range of urinary output for this child for a 12 hour shift so the nurse can evaluate the output obtained? A. 238-366 mL B. 246-398 mL C. 274-416 mL D. 288-432 mL

Answer: D. The normal urinary output for infants and toddlers is greater than 2-3 mL/kg/hr, so the calculation would be: 12 kg × 2 mL/hr and 12 kg × 3 mL/hr → 24-36 mL/hr. Since the output is for twelve hours, 24 mL/hr would be multiplied by 12 hours and 36 mL/hr would also be multiplied by 12 hours. The answer is 288-432 mL for the 12-hour shift. The amount the toddler urinated falls within the range.