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 practice2. A 10-year-old playing baseball outdoors in 85-degree heat3. A 5-year-old refusing to eat because of a virus4. A newborn under a radiant warmer for an hour after the first bath
Answer: 2Explanation: 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.
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. Tachycardia2. Bradycardia3. Increased blood pressure4. Decreased blood pressure
Answer: 1Explanation: 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 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 dry2. Low specific gravity of urine; skin color pale3. Fontanels depressed; capillary refill greater than three seconds4. High specific gravity of urine; moist mucous membranes
Answer: 3Explanation: 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 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. D5W2. 0.9 percent Normal Saline (NS)3. Albumin4. D5 0.2 percent (1/4) Normal Saline
Answer: 2Explanation: 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.
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: 1Explanation: 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 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: 4Explanation: 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.
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: 86Explanation: 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.
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 rate2. A client with tachypnea and pulmonary congestion3. A client with dependent and sacral edema, regular pulse4. A client with hepatomegaly, normal respiratory rate
Answer: 2Explanation: 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.
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 Requirements2. Risk for Impaired Skin Integrity3. Risk for Altered Body Image4. Risk for Activity Intolerance
Answer: 2Explanation: 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.
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. Seizures2. Bradycardia3. Respiratory distress4. Hyperthermia
Answer: 1Explanation: 1. A child with hyponatremia is at risk for seizures. Bradycardia, respiratory distress, and hyperthermia are not risks of hyponatremia.
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. Seizures2. Bradycardia3. Respiratory distress4. Hyperthermia
Answer: 2Explanation: 1. A child with hyperkalemia is at risk for cardiac issues. Seizures, respiratory distress, and hyperthermia are not risks of hyperkalemia.
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 fries2. Pizza with a fruit plate3. Chicken strips with chips4. A fajita with rice
Answer: 2Explanation: 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 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 Pedialyte1/2 of an 8-oz cup of clear orange Jell-O2 graham crackers200 mL of D 5-1/2 sodium chloride IVOutput:345 mL of urine50 mL of loose stoolThe nurse documents the client's intake as ________ milliliters.Round the answer to the nearest whole number.
Answer: 440Explanation: 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.
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, 5Explanation: 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.
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, 5Explanation: 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.
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/hrExplanation: Infuse 170.4 mL/hr
Match the types of dehydration with their description.A. Isotonic dehydrationB. Hypotonic dehydrationC. Hypertonic dehydration1. 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/A1. Hypotonic dehydration2. Hypertonic dehydration3. Isotonic dehydrationExplanation: 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.
A child is prescribed hemodialysis for the treatment of kidney failure. When providing care for this child, what will the nurse monitor for during the assessment? Select all that apply.1. Shock2. Hypotension3. Infections4. Migraines5. Fluid overload
Answer: 1, 2, 3Explanation: 1. Rapid changes in fluid and electrolyte balance during hemodialysis may lead to shock and hypotension. Other complications to watch for are thromboses and infection. Migraines and fluid overload are not clinical manifestations associated with hemodialysis.
A 10-year-old diagnosed with chronic renal failure is seen at the dialysis center for dialysis treatment three times a week. The child weighs 35 pounds after dialysis.Physician's order: Epogen 50 U/kg three times weekly after dialysis.Medication on hand: Epogen 2000 U/mLCalculate how many ml of Epogen the child should receive three times a week.
Answer: 0.38 mLExplanation: 0.38 mL
A child with severe gastroenteritis is admitted to a semiprivate room on the pediatric unit. The charge nurse should place this client with which roommate?1. An infant with meningitis2. A child with fever and neutropenia3. Another child with gastroenteritis4. A child recovering from an appendectomy
Answer: 3Explanation: 1. Gastroenteritis may be viral or bacterial and can be infectious. It is best to cohort children with this infectious process. Good handwashing is essential to prevent the spread. An infant with meningitis, a child with fever and neutropenia, and a child recovering from an appendectomy should not be placed with another child with an infectious process.
The nurse educator is preparing an in-service on the basic functions of the gastrointestinal (GI) system. Which statements will the nurse educator include in the in-service?Select all that apply.1. "The GI system is responsible for the ingestion of fluids and nutrients."2. "The GI system is responsible for the excretion of fluids and nutrients."3. "The GI system is responsible for the metabolism of nutrients."4. "As infants grow, their stomach capacity increases, decreasing the frequency with which they need to be fed."5. "By the second year of life, digestive processes are still developing.
Answer: 1, 3, 4Explanation: 1. The GI system is responsible for the ingestion of fluids and nutrients as well as the metabolism of nutrients. As infants grow, their stomach capacity increases, which does decrease the frequency with which they need to be fed. The GI system is responsible for the excretion of waste products. By the second year of life, digestive processes are fairly complete.
A pediatric client is admitted to the hospital unconscious. The client has a history of type 1 diabetes, and according to the client's mother, has been to two birthday parties in the last few days and has resisted taking the prescribed insulin. At school the client had two more pieces of birthday cake and some ice cream at a class birthday party. What is the likely reason for this client's unconscious state?1. Metabolic alkalosis2. Metabolic ketoacidosis3. Insulin shock4. Insulin reaction
Answer: 2Explanation: 1. Metabolic acidosis or ketoacidosis could have occurred because of the excessive intake of sugar with no additional insulin. The body burns fat and protein stores for energy when no insulin is available to metabolize glucose. Altered consciousness occurs as symptoms progress. Metabolic alkalosis, insulin shock, or insulin reaction would not be happening in this case.
A pediatric client is diagnosed with type 1 diabetes. The nurse teaches the client the difference between insulin shock and diabetic hyperglycemia. The nurse evaluates that the client understands the teaching when the client states which characteristics of diabetic hyperglycemia?1. Tremors and lethargy2. Hunger and hypertension3. Thirst and flushed skin4. Shakiness and pallor
Answer: 3Explanation: 1. Thirst and flushed skin are characteristic of diabetic hyperglycemia. Tremors, lethargy, hunger, shakiness, and pallor are characteristic of hypoglycemia. Hypertension is not a sign associated with hyperglycemia or hypoglycemia.
The nurse is providing education to a pediatric client diagnosed with diabetes. The client will be playing soccer over the summer. Which change in the client's management will the nurse explore during this education session?1. Increased food intake2. Decreased food intake3. Increased need for insulin4. Decreased risk of insulin reaction
Answer: 1Explanation: 1. Increased physical activity requires adequate caloric intake to prevent hypoglycemia, so food intake should be increased. Increased activity would not require decreased food intake, and it would not result in a decreased risk of insulin reaction. Exercise causes the insulin to be used more efficiently, so increased insulin would not be needed.
The nurse is teaching the parent of a type 1 diabetic preschool-age client about management of the disease. Which teaching point is appropriate for the nurse to include in this session?1. Allowing the client to administer all the insulin injections2. Allowing the client to choose which finger to stick for glucose testing3. Allowing the client to draw up the insulin dose4. Allowing the client to test blood glucose
Answer: 2Explanation: 1. The preschool-age client's need for autonomy and control can be met by allowing the client to pick which finger to stick for glucose testing. Administering the insulin, drawing up the dose, and testing blood glucose should not be done by the client until he or she is middle-school age or older.
A pediatric client is seen in the clinic with a possible diagnosis of type 2 diabetes. The mother asks what the healthcare provider uses to make the diagnosis. The nurse explains that type 2 diabetes is suspected if the child has obesity, acanthosis nigricans, and two non-fasting blood-glucose levels above which level?1. 1202. 803. 2004. 50
Answer: 3Explanation: 1. Blood-glucose levels at or above 200 mg/dL without fasting is diagnostic of type 2 diabetes.
An adolescent is admitted to the intensive care unit (ICU) with diabetic ketoacidosis. The client weighs 115 pounds.The healthcare provider orders: Regular insulin 0.15 units/kg bolus via IVF, then regular insulin 0.1 units/kg/hr in 0.9 percent NSSMedication on hand: 250 mL 0.9 percent NSS with 250 units of regular insulin.Calculate the mL/hr for the continuous infusion of regular insulin at 0.1 unit/kg/hr in 0.9 percent NSS.
Answer: 7.4 mL/hrExplanation: 7.4 mL/hr
A child diagnosed with a Wilms tumor is prescribed chemotherapy. Which laboratory test will the nurse monitor prior to administering the chemotherapy to determine the child's infection-fighting capability?1. Hemoglobin2. RBC count3. Absolute neutrophil count (ANC)4. Platelets
Answer: 3Explanation: 1. The absolute neutrophil count uses both the segmented (mature) and bands (immature) neutrophils as a measure of the body's infection-fighting capability. RBC count, hemoglobin, and platelets cannot determine infection-fighting capabilities.
A preschool child is seen in the clinic, and the nurse anticipates a diagnosis of leukemia. Which reaction does the nurse anticipate this child will exhibit upon diagnosis?1. Acceptance, especially if able to discuss the disease with children their own age2. Thoughts that they caused their illness and are being punished3. Understanding of what cancer is and how it is treated4. Unawareness of the illness and its severity
Answer: 2Explanation: 1. Preschool-age children may think they caused their illness. Adolescents find contact with others who have gone through their experience helpful. School-age children can understand a diagnosis of cancer. Infants and toddlers are unaware of the severity of the disease.
The antiemetic drug ondansetron (Zofran) is administered to a child receiving chemotherapy. When should the nurse administer this medication?1. Only if the child experiences nausea2. After the chemotherapy has been administered3. Before chemotherapy administration as a prophylactic measure4. Never; this antiemetic is not effective for controlling nausea and vomiting associated with chemotherapy
Answer: 3Explanation: 1. The antiemetic ondansetron (Zofran) should be administered before chemotherapy as a prophylactic measure. Giving it after the child has nausea or at the end of chemotherapy treatment does not help with preventing nausea. It is the drug of choice for controlling nausea caused by chemotherapy agents.
A child is diagnosed with thrombocytopenia secondary to chemotherapy treatments. Which action by the nurse is the most appropriate?1. Refrain from administering any intramuscular injections (IM).2. Perform oral hygiene.3. Monitor intake and output.4. Use palpation as a component of assessment.
Answer: 1Explanation: 1. When the child is thrombocytopenic (decreased platelets) from chemotherapy, the nurse should not administer IM injections because of the risk of bleeding. Oral hygiene care should be done with a soft toothbrush and intake and output monitored for any abnormalities. Gentle palpation should still be included in physical assessments.
A child is diagnosed with a Wilms tumor. Which nursing action is most appropriate prior to surgery?1. Careful bathing and handling2. Monitoring of behavioral status3. Maintenance of strict isolation4. Administration of packed RBCs
Answer: 1Explanation: 1. The tumor should never be palpated; careful bathing and handling are an important nursing consideration. Palpating the tumor can cause a piece of the tumor to dislodge. The child's behavior will not be affected with a Wilms tumor. The tumor does not cause excessive lowering of WBCs or RBCs, so strict isolation or administration of packed RBCs is not usually a nursing intervention.
The pediatric nurse is providing care to a school-age child receiving chemotherapy to treat cancer. Which interventions are appropriate to include in the plan of care in order to monitor for oncologic emergencies?Select all that apply.1. Monitor complete blood count (CBC).2. Document intake and output.3. Observe for behavioral changes.4. Refer for psychosocial support.5. Implement neutropenic precautions.
Answer: 1, 2, 3Explanation: 1. Oncologic emergencies can be organized into three groups: metabolic, hematologic, and those involving space-occupying lesions. Appropriate interventions for the nurse to include in the plan of care to monitor for these emergencies include monitoring the CBC to prevent sepsis and hemorrhage; monitoring intake and output by encouraging hydration to prevent hypercalcemia and observing for signs of water intoxication; and observing for behavioral changes as space-occupying lesions may cause seizures or increased intracranial pressure. Referring for psychosocial support and implementing neutropenia precautions may be appropriate, but these interventions do not address oncologic emergencies.
A seasoned nurse is precepting a novice nurse on a pediatric oncology unit. The seasoned nurse would like to review the ongoing physiologic and psychosocial care of the children who survive cancer. Which topics will the seasoned nurse include in the discussion with the novice nurse?Select all that apply.1. Developing other cancers2. Recommending regular office visits3. Encouraging school-age clients to manage their own care4. Needing weekly laboratory tests5. Providing educational and psychosocial support
Answer: 1, 2, 5Explanation: 1. Appropriate topics include discussing the increased risk for these children to develop other cancers; recommending regular office visits for monitoring purposes; and providing educational and psychosocial support. It would be appropriate to encourage the adolescent and young adult clients to manage their own care, not a school-age child. While these clients need regular laboratory examinations, weekly laboratory tests are not appropriate.