Final Exam: Fluid & Electrolyte Imbalance

a

A 7-year-old child with acute diarrhea has been rehydrated with oral rehydration solution (ORS). The nurse should recommend that the childs 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

c

A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solutions (ORS). The childs 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.

d

A school-age child with diarrhea has been rehydrated. The nurse is discussing the childs 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

c

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

An infant with moderate dehydration has what clinical signs? a. mottled skin color, decreased pulse and respirations b. decreased urinary output, tachycardia, and fever c. tachycardia, oliguria, capillary refilling within 2-4 seconds d. tachycardia, bulging fontanel, decreased blood pressure

d

Clinical manifestations of sodium excess (hypernatremia) include which signs or symptoms? a. Hyperreflexia b. Abdominal cramps c. Cardiac dysrhythmias d. Dry, sticky mucous membranes

Stimuli Turgor Capillary

Degree of Dehydration Other determinants of dehydration include altered response to __________, decreased skin elasticity and ________, prolonged __________ refill, increased heart rate, and sunken eyes and fontanels

Weight

Degree of Dehydration This is the most important determinant of the percent of total body fluid loss in infants and younger children

Hypoxia

Degree of Dehydration When fluid losses exceed the body's ability to sustain blood volume and blood pressure, circulation is seriously compromised and the blood pressure falls. This results in tissue ___________

Vomiting Diarrhea

Dehydration Although dehydration can result from lack of oral intake, more often it is a result of abnormal losses, such as those that occur in ____________ or ____________, when oral intake only partially compensates for the abnormal losses

Emesis

Dehydration The child may not be thirsty enough even though dehydrated and may refuse oral fluids initially for fear of continued _________ or because of decreased strength, oral stomatitis, or thrush

Oral

Dehydration When the child is alert, awake, and not in danger, correction of dehydration may be attempted with ________ fluid administration

Sodium Proteins Permeability

Edema The formation of edema can occur from anything that alters the retention of ___________, affects the formation or destruction of plasma ___________, or alters membrane ____________

Ascites

Edema _________ is the accumulation of fluid in the abdominal cavity

Peripheral

Edema __________ edema is localized or generalized palpable swelling of the interstitial space

Generalized

Edema ________________ edema is manifested by swelling in the extremities, face, perineum, and torso. Loss of normal skin creases may be assessed as well

Intraosseous

IV Infusion An _____________ infusion is an IV infusion into the bone

Infiltration

IV Infusion When checking IVs every hour, monitor for signs of ___________, leaks, edema, cold extremities, and redness

Potassium

IV Infusion When starting an IV in a child, do not infuse ___________ until the child voids. If you don't, the child can suffer nephron damage

a b c

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

c

Karen Lumia, age 13 months, is being admitted for parenteral fluid therapy because of excessive vomiting. The nurse would recognize which one of the following as most essential in implementing care for Karen? a. give Karen oral fluids until the parenteral fluid therapy can be established b. question the physician's order for parenteral fluid therapy of 0.9% sodium chloride c. withhold the ordered potassium additive until Karen's renal function has been verified d. replace half of Karen's estimated fluid deficit over the first 24 hours of parenteral fluid therapy

a

Nurses should be alert for increased fluid requirements in which circumstance? a. Fever b. Mechanical ventilation c. Congestive heart failure d. Increased intracranial pressure

c

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

b

Rapid replacement of fluid is essential in the treatment of what types of dehydration? a. Isotonic, osmotic b. Hypotonic, isotonic c. Osmotic, hypertonic d. Hypertonic, hypotonic

b

The greatest threat to life as a result of dehydration in children is a. oliguria b. shock c. arrhythmia d. hypotension

a

The nurse is assessing an infant brought to the clinic with diarrhea. He is lethargic and has dry mucous membranes. What would 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

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.

c

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

d

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

a

To obtain relevant information from the parents of a child with fluid and electrolyte disturbances, the nurse should question the parents about a. the type and amount of the child's intake and output b. the child's general appearance c. the child's weight over the past month d. whether they have taken the child's temperature within the past 24 hours

d

What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)? a. Nausea, vomiting b. Weakness, fatigue c. Muscle hypotonicity d. Neuromuscular irritability

b c d

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

d

What conditions would cause a decrease of fluid requirements for children? a. Burns b. Fever c. Vomiting d. Increased intracranial pressure

c

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

What is a major complication of total parenteral nutrition in children? a. Anemia b. Asthma c. Liver disease d. Renal impairment

c

What is an appropriate nursing action when caring for a child with an intravenous infusion? a. Change the insertion site every 24 hr. 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.

b

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.

a

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

b

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.

c

Which finding would most likely alert the nurse to the possibility that a preschooler is experiencing moderate dehydration? a. deep, rapid respirations b. diaphoresis c. absence of tear formation d. decreased urine specific gravity

d

Which of the following instructions for treating the child with moderate dehydration is not correct? a. administer 2-5 ml of oral rehydration solution (ORS) by syringe or small medicine cup every 2-3 minutes b. oral administration of Zofran to the child with acute gastroenteritis and vomiting may prevent the needs for IV therapy c. ORS management consists of replacement of fluid loss over 4-6 hours d. ORS should not be started until after all vomiting has stopped

a b d

Which signs or symptoms suggest than an infant with diarrhea is dehydrated? Select all that apply a. tacky mucous membranes b. sunken anterior fontanel c. salty saliva d. restlessness e. increased urine output

Sodium

___________ if the chief solute in ECF and the primary determinant of ECF volume