FLUIDS & ELECTROLYTES

How much wt loss indicates a moderate dehydration? 1. < 5% loss of body wt 2. 5-10% loss of body wt 3. > 10% loss of body wt 4. > 15% loss of body wt

2

A client who is at 12 weeks' gestation tells the nurse at the prenatal clinic that she is experiencing severe nausea and frequent vomiting. The nurse suspects that the client has hyperemesis gravidarum. Which factor is frequently associated with this disorder? 1. Hx of cholecystitis 2. Large amt of amniotic fluid 3. High level of chorionic gonadotropin 4. Decreased secretion of HCL

3

Where on a child's body does edema present first?

Periorbital

A nurse is caring for a 7-month-old infant admitted to the pediatric unit with a diagnosis of severe dehydration from persistent vomiting. The infant's admission weight is down 10 % from their previous weight obtained at a well-child visit. What other signs and symptoms would the nurse expect to see during their assessment? Select all that apply. 1. Parched mucous membranes 2. Normal BP 3. Sunken anterior fontanel 4. HR 164 bpm 5. Capillary refill time of 2 seconds

1, 3, 4

After tolerating an oral rehydration solution (Pedialyte) being given because of dehydration resulting from diarrhea, a 20-month-old toddler's condition improves and a regular diet is started. What foods should the nurse suggest that the parents offer their child? Select all that apply. 1. Poached eggs 2. Creamed soup 3. Strained carrots 4. Vanilla pudding 5. Animal crackers

1, 3, 5 Rationale: - Poached eggs are nutritious and are easily digested. Carrots help replace the sodium lost in diarrhea. Animal crackers are not irritating to the gastrointestinal tract. Creamed foods and puddings contain milk, which may irritate the gastrointestinal tract in some children.

A nurse is conducting an assessment of a young infant who is dehydrated. Which clinical sign is the most important indication of the degree of dehydration? 1. Dry skin 2. Wt loss 3. Sunken fontanel 4. Decreased urine output

2 Rationale: - Loss of fluid as a result of dehydration is most objectively assessed by weighing the infants daily because total body water accounts for approximately 75% of an infant's body weight. One liter of fluid weighs approximately 2.2 lb (1 kg). - Dry skin may be indicative of conditions other than dehydration. - A sunken fontanel is a clinical sign of dehydration, but is not an accurate measurement of dehydration. - Decreased urine output cannot always be measured accurately in infants and children who are not toilet trained.

An infant has been admitted for dehydration as a result of acute gastroenteritis and vomiting, and the nurse administers lactated Ringer solution intravenously. The nurse concludes that the treatment has been effective after noting what? 1. Tenting turgor 2. Pink mucous membranes 3. Three wet diapers in 24 hours 4. Capillary refill longer than 2 seconds

3 Rationale: - Three or more wet diapers in 24 hours indicates that fluid balance is improving and that the kidneys are functioning. - Tenting turgor, fewer than three wet diapers in a day, and capillary refill of more than 2 seconds are all signs of dehydration, not of improvement.

Findings on a client's cardiac monitor indicate a need for an intravenous infusion that contains potassium for a client with hypokalemia. The nurse concludes that what finding on the monitor indicated a need for potassium replacement? 1. Lowering of T wave 2. Elevation of the ST segment 3. Shortening of the QRS complex 4. Increased deflection of the Q wave

1 Rationale: - Hypokalemia causes a flattening of the T wave on an electrocardiogram, as observed on the monitor, because of its effect on muscle function. - Hypokalemia causes a depression of the ST segment. - Hypokalemia causes a widening of the QRS complex. - Hypokalemia does not cause a deflection of the Q wave.

A toddler is admitted to the pediatric unit with diarrhea and severe dehydration. After several days of treatment, the child is evaluated. What clinical findings indicate that the child is rehydrated? Select all that apply. 1. Decreased hematocrit 2. Increased in daily wt 3. Negative blood culture 4. Increased sedimentation rate 5. Decreased blood urea nitrogen level

1, 2, 5 Rationale: - A decrease in the hematocrit level indicates that the blood has become less concentrated as hydration improves. The daily weight reading increases with rehydration as water is retained. One liter of fluid weighs 2.2 lb (1 kilogram). The blood urea nitrogen level will decrease as blood volume increases because the components of the blood are in a more dilute solution. - A blood culture will not provide information about hydration. An increased sedimentation rate indicates an inflammatory process, not the state of hydration.

A nurse is teaching a client who is taking a loop diuretic about foods that are high in potassium. Which foods should the nurse emphasize? Select all that apply. 1. Banana 2. Apricots 3. Roasted chicken 4. Macaroni & cheese 5. Baked potatoes with skins

1, 2, 5 Rationale: - Bananas, apricots, and potatoes (with skins) are among the top 10 foods high in potassium. Others include dark leafy greens, white beans, winter squash (e.g., acorn squash), salmon, avocados, and mushrooms. - Both a serving of chicken and a serving of pasta and cheese contain less than 400 mg of potassium.

A 13-month-old with gastroenteritis is being discharged home from the hospital. She has been eating well, appears well hydrated, and has had a significant decrease in stool frequency. What should the nurse include in their discharge teaching? Select all that apply? 1. Washing hands frequently will help prevent spread of this infection 2. Protect diaper area with a barrier cream 3. Give toddler anti-diarrheal meds 4. Clean diaper area with baby wipes 5. Provide the child with nutrient rich foods like yogurt, lean meats, and fresh vegetables

1, 2, 5 Rationale: - Continuing of anti-diarrheal meds is not indicated since the child has recovered - Baby wipes contain alcohol, which will irritate the skin

A client is scheduled to receive an intravenous (IV) infusion of potassium chloride (KCl) 40 mEq in 100 mL of 5% dextrose and water to be infused over 2 hours. Before administering this IV medication, it is a priority for the nurse to assess which of the following? Select all that apply. 1. Urinary output 2. Deep tendon reflexes 3. Latest BM 4. Arterial blood gas results 5. Last serum potassium level 6. Patency of the IV access

1, 5, 6 Rationale: - Before administering IV potassium, the urinary output must be normal. If the urine output is low, a potassium infusion may damage renal cells. The last serum potassium level should also be checked to ensure potassium replacement is appropriate. A patent IV access is essential because potassium is very irritating and painful to subcutaneous tissue. - The infusion of KCL 40 mEq in 100 mL of 5% dextrose and water has no direct effect on deep tendon reflexes, bowel movement patterns, or arterial blood gases. Therefore these items are not required to be assessed before administration of this medication.

A client has been admitted with a diagnosis of intractable vomiting and can only tolerate sips of water. The initial blood work shows a sodium level of 122 mEq/L (122 mmol/L) and a potassium level of 3.6 mEq/L (3.6 mmol/L). Based on the lab results and symptoms, what is the client experiencing? 1. Hypernatremia 2. Hyponatremia 3. Hyperkalemia 4. Hypokalemia

2 Rationale: - The normal range for serum sodium is 135 to 145 mEq/L (135 to 145 mmol/L), and for serum potassium it is 3.5 to 5 mEq/L (3.5 to 5 mmol/L). Vomiting and use of diuretics, such as furosemide (Lasix), deplete the body of sodium. Without intervention, symptoms of hyponatremia may progress to include neurologic symptoms such as confusion, lethargy, seizures, and coma. - Hypernatremia results when serum sodium is greater than 145 mEq/L (145 mmol/L); hyperkalemia results when serum potassium is greater than 5.0 mEq/L (5.0 mmol/L); hypokalemia results when serum potassium is less than 3.5 mEq/L (3.5 mmol/L).

A cachectic adolescent with the diagnoses of anorexia nervosa, dehydration, and electrolyte imbalances is admitted to a mental health facility. The adolescent has been obsessed with weight, has exercised for hours every day, has taken enemas and laxatives several times a week, and has engaged in self-induced vomiting. What outcome is a priority for the nurse planning care for this client? 1. Identify personal strengths 2. Controlling impulsive behaviors 3. Correcting electrolytes imbalances 4. Developing a contract for tx goals

3 Rationale: - Electrolyte imbalances can precipitate life-threatening dysrhythmias. Although clients with the diagnosis of anorexia nervosa have low self-esteem, and identifying and supporting strengths promote the development of a positive self-regard, this is not the priority at this time. Clients with anorexia are perfectionists who usually do not display impulsivity. Developing a contract for treatment outcomes is difficult to accomplish initially, because anorexic clients often deny the illness and evade therapeutic treatment.

An infant is admitted to the pediatric unit with gastroenteritis and dehydration. The nurse determines that the parents understand the teaching about contact precautions when they note that after washing their hands they need to do what? 1. Put on a mask when holding the baby 2. Wt the diaper each time they change the baby 3. Keep the door to the baby's room closed most of the time 4. Change their gloves each time they change the baby's diaper

4 Rationale: - The organisms causing gastroenteritis are eliminated in the feces. The gloves should be removed and the hands washed after giving direct care. New gloves should be donned if the parents are to remain with the child. A mask is required for airborne precautions. Weighing diapers is not a requirement of contact precautions; this technique may be used to measure intake and output. The door to the baby's room should be closed if airborne precautions are necessary.