nagelhout chapter 53 practice questions

What is the NPO deficit in mL for a 70 Kg patient who has been NPO for 8 hours but has had an IV of lactated ringer's solution running at 100 mL/hour for 4.5 hours? (Calculate your answer as a whole number with no decimals)

430 Remember that for a patient that weighs more than 20 Kg, you may simply add 40 to their weight to arrive at their hourly fluid requirement. For a 70 Kg patient, the hourly fluid requirement is 110 mL. Over 8 hours, the total NPO deficit would be 880 mL. However, because the patient has had an IV running at 100 mL/hour for 4.5 hours, they have already received 450 mL of their fluid requirement, leaving a deficit of 880-450, or 430 mL.

What is the hourly intravenous fluid maintenance rate in mL/hour for a 12 kilogram infant? (Calculate answer to a whole number with no decimals)

44 The hourly intravenous fluid maintenance rate for patients of all ages is calculated as 4 mL/kg for the first ten kilograms, 2 ml/kg for the second ten kilograms, and 1 mL/kg for each kilogram thereafter. In this instance, the patient weighs 12 kilograms, so we have 40 mL/hour for the first ten kilograms of weight. We then add 2 mL/kg for each kilogram in the second ten kilograms of weight. Since there are only two kilograms left, we only need to add 4mL to the 40 mL we have already calculated, leaving an answer of 44 mL/hour.

What is the hourly maintenance fluid requirement for a 13 Kg child? (enter a whole number)

46 The hourly fluid maintenance rate is calculated as 4 mL/kg/hour for the first 10 kg, 2 mL/kg/hour for the second 10 kilograms, and 1 mL/kg/hour thereafter. In this instance, the child weighs 13 Kg which you can think of as 10 kg + 3 Kg. The first 10 kilograms warrant 40 mL/hour and the remaining 3 kilograms warrant 6 additional mL/hour for a total of 46 mL/hour.

What is the hourly intravenous fluid maintenance rate in mL/hour for a 15 kilogram infant? (Calculate answer to a whole number with no decimals)

50 The hourly intravenous fluid maintenance rate for patients of all ages is calculated as 4 mL/kg for the first ten kilograms, 2 ml/kg for the second ten kilograms, and 1 mL/kg for each kilogram thereafter. In this instance, the patient weighs 15 kilograms, so we have 40 mL/hour for the first ten kilograms of weight. We then add 2 mL/kg for each kilogram in the second ten kilograms of weight. Since there are only five kilograms left, we only need to add 10 mL to the 40 mL we have already calculated, leaving an answer of 50 mL/hour.

Your pediatric patient weighs 35.2 lbs. What is the appropriate hourly fluid maintenance for this patient? Provide your answer in mL/hour and round to the nearest whole number using no decimals.

52 The patient weighs 16 kg (35.2 divided by 2.2). Using the 4-2-1 rule, the hourly maintenance rate is 52 ml/hr.

At what age is the MAC for sevoflurane the highest? A. 3 months old B. 1 year old C. 2 years old D. 4 years old

A MAC is higher in pediatric patients. For sevoflurane, it is approximately 3.3% in neonates and 3.2% in infants 1-6 months of age. For children 6-12 months of age it is constant at 2.4%. The MAC for isoflurane in both infants and children is 1.6%.

A pediatric patient has undergone a prolonged propofol infusion in the ICU and now exhibits lactic acidosis, rhabdomyolysis, and bradydysrhythmias. This may be the result of A. propofol infusion syndrome B. epilepsy C. adrenocortical supression D. sepsis

A Propofol infusion syndrome is associated with prolonged propofol infusions over several days and may appear as lactic acidosis, fever, hepatomegaly, dysrhythmias, hypertriglyceridemia, rhabdomyolysis, and cardiac failure. It is more likely to occur in children with mitochondrial disease and is believed to be the result of impaired mitochondrial function and subsequent uncoupling of oxidative phosphorylation.

What would be an appropriate preoperative intranasal dose of midazolam for a 10 kilogram pediatric patient? A. 1 mg B. 5 mg C. 10 mg D. 20 mg

A The pediatric dose of intranasal midazolam is 0.1-0.2 mg/kg. For this patient, the range would be 1-2 mg.

Which of the following would be an appropriate dose of intranasal midazolam in a 20 kg pediatric patient? A. 2 mg B. 7.5 mg C. 10 mg D. 15 mg

A The pediatric dose of intranasal midazolam is 0.1-0.2 mg/kg. For this patient, the range would be 2-4 mg.

Which of the following agents and doses would be appropriate for the reversal of neuromuscular blockade of rocuronium in an infant? A. Neostigmine 50 mcg/kg B. Pyridostigmine 1 mg/kg C. Edrophonium 50 mcg/kg D. Physostigmine 1 mg/kg

A Traditional doses of neostigmine (50-60 mcg/kg) or edrophonium (500-1000 mcg/kg) combined with glycopyrrolate 0.2 mg per 1 mg of neostigmine are appropriate for reversing neuromuscular blockade in infants. Physostigmine and pyridostigmine are not traditionally used for reversal of neuromuscular blockade.

What is the fluid deficit for a 60 Kg, 42 year-old woman who has been NPO for 12 hours? A. 600 mL B. 900 mL C. 1.2 L D. 1.8 L

C Maintenance fluid requirements are calculated as 4 mL/Kg/hour for the first 10 kilograms, 2 mL/Kg/hour for the second 10 kilograms, and 1 mL/Kg/hour thereafter. For a 60 Kg patient, this would equal 40 + 20 + 40 or 100 mL/hour. Over a period of 12 hours, the NPO deficit is 1.2 liters.

A pediatric patient with which condition is more likely to develop propofol infusion syndrome? A. Polycythemia B. Gastroschisis C. Mitochondrial disease D. Sickle cell disease

C Propofol infusion syndrome is associated with prolonged propofol infusions over several days and may appear as lactic acidosis, fever, hepatomegaly, dysrhythmias, hypertriglyceridemia, rhabdomyolysis, and cardiac failure. It is more likely to occur in children with mitochondrial disease and is believed to be the result of impaired mitchondrial function and subsequent uncoupling of oxidative phosphorylation.

Which of the following anesthetic breathing systems does not have a gas reservoir bag? A. Mapleson A B. Bain C. Mapleson E D. Jackson-Rees

C The Bain circuit and all of the Mapleson circuits except for the Mapleson E have a gas reservoir bag. The Jackson-Rees system is another name for the Mapleson F circuit.

Which of the following explains why children have a faster uptake and more rapid increase in alveolar levels of inhaled anesthetic? (select two) A. Decreased serum albumin levels B. Decreased heart rate C. Increased cardiac output D. Increased minute ventilation

C, D Children have a tidal volume that is equivalent to that of adults (5-7 mL/kg), but they have a much higher relative minute ventilation and a higher ratio of tidal volume to FRC. They also have a higher relative cardiac output. Because of the increased cardiac output and increased minute ventilation, they exhibit a faster uptake as well as more rapid alveolar concentration of anesthetic.

What is the estimated hourly maintenance fluid rate for a 4 Kg infant? (Calculate your answer to the nearest whole milliliter).

Using the 4-2-1 rule, you administer 4 mL/hour for each of the first 10 kilograms, 2 mL/hour for each of the next 10 kilograms, and 1 additional mL/kg for each kilogram after that. In a 4 kilogram patient, the hourly maintenance fluid rate would be 16 mL/hour.