Fluid and Electrolyte Imbalance Flashcards Preview

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Flashcards in Fluid and Electrolyte Imbalance Deck (56)
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1

Nurses should be alert for increased fluid requirements in which circumstance?

a.

Fever

b.

Mechanical ventilation

c.

Congestive heart failure

d.

Increased intracranial pressure

ANS:  A

Fever leads to great insensible fluid loss in young children because of increased body surface area relative to fluid volume. The mechanically ventilated child has decreased fluid requirements. Congestive heart failure is a case of fluid overload in children. Increased intracranial pressure does not lead to increased fluid requirements in children.

1

A toddler sustains a minor burn on the hand from hot coffee. What is the first action in treating this burn?

a.

Apply burn ointment.

b.

Put ice on the burned area.

c.

Cover the hand with gauze dressing.

d.

Hold the hand under cool running water.

ANS:  D

In minor burns, the best method to stop the burning process is to hold the burned area under cool running water. Ointments are not applied to a new burn; the ointment will contribute to the burning. Ice is not recommended. Gauze dressings do not stop the burning process.

1

What is the nursing action related to the applying of biologic or synthetic skin coverings for a child with partial-thickness burns of both legs?

a.

Splint the legs to prevent movement.

b.

Observe wounds for signs of infection.

c.

Monitor closely for manifestations of shock.

d.

Examine dressings for indications of bleeding.

ANS:  B

When applied early to a superficial partial-thickness injury, biologic dressings stimulate epithelial growth and faster wound healing. If the dressing covers areas of heavy microbial contamination, infection occurs beneath the dressing. In the case of partial-thickness burns, such infection may convert the wound to a full-thickness injury. Infection is the primary concern when biologic dressings are used.

 

2

What is a systemic response to severe burns in a child?

a.

Metabolic alkalosis

b.

Decreased metabolic rate

c.

Increased renal plasma flow

d.

Abrupt drop in cardiac output

ANS:  D

The initial physiologic response to a burn injury is a dramatic change in circulation. A precipitous drop in cardiac output precedes any change in circulating blood or plasma volumes. A circulating myocardial depressant factor associated with severe burn injury is thought to be the cause. Metabolic acidosis usually occurs secondary to the disruption of the body’s buffering action resulting from fluid shifting to extravascular space. There is a greatly accelerated metabolic rate in burn patients, supported by protein and lipid breakdown. With the loss of circulating volume, there is decreased renal blood flow and depressed glomerular filtration.

2

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

ANS:  B, C, D

Clinical manifestations of hypotonic dehydration include slightly moist mucous membranes, absent tears, and a very rapid pulse. A thick, doughy feel to the skin and hyperirritability are signs of hypertonic dehydration.

2

The nurse is caring for a child with hypercalcemia. The nurse evaluates the child for which signs and symptoms of hypercalcemia? (Select all that apply.)

a.

Tetany      

b.

Anorexia

c.

Constipation

d.

Laryngospasm

e.

Muscle hypotonicity

ANS:  B, C, E

Signs and symptoms of hypercalcemia are anorexia, constipation, and muscle hypotonicity. Tetany and laryngospasm are signs of hypocalcemia.

3

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

ANS:  A, B, C

The nurse should recognize that conditions such as oliguric renal failure, increased intracranial pressure, and mechanical ventilation can cause an increase or a decrease in fluid requirements. Conditions such as hypotension, tetralogy of Fallot, and diabetes mellitus (type 1) do not cause an alteration in fluid requirements.

 

4

What consideration is important for the nurse when changing dressings and applying topical medication to a child’s abdomen and leg burns?

a.

Apply topical medication with clean hands.

b.

Wash hands and forearms before and after dressing change.

c.

If dressings have adhered to the wound, soak in hot water before removal.

d.

Apply dressing so that movement is limited during the healing process.

ANS:  B

Frequent hand and forearm washing is the single most important element of the infection-control program. Topical medications should be applied with a tongue blade or gloved hand. Dressings that have adhered to the wound can be removed with tepid water or normal saline. Dressings are applied with sufficient tension to remain in place but not so tightly as to impair circulation or limit motion

5

What laboratory finding should the nurse expect in a child with an excess of water?

a.

Decreased hematocrit

b.

High serum osmolality

c.

High urine specific gravity

d.

Increased blood urea nitrogen

ANS:  A

The excess water in the circulatory system results in hemodilution. The laboratory results show a falsely decreased hematocrit. Laboratory analysis of blood that is hemodiluted reveals decreased serum osmolality and blood urea nitrogen. The urine specific gravity is variable relative to the child’s ability to correct the fluid imbalance.

5

What organism is a parasite that causes acute diarrhea?

a.

Shigella organisms

b.

Salmonella organisms

c.

Giardia lamblia

d.

Escherichia coli

ANS:  C

G. lamblia is a parasite that represents 10% of nondysenteric illness in the United States. Shigella, Salmonella, and E. coli are bacterial pathogens

5

Prevention of burn injury is important anticipatory guidance. In the infant and toddler period, which mode is the most common cause of burn?

a.

Matches

b.

Electrical cords

c.

Hot liquids in the kitchen

d.

Microwave-heated foods

ANS:  C

Infants and toddlers are most commonly injured by hot liquids in the kitchen and bathroom. This often occurs as a result of inadequate supervision of this curious and energetic age group. Matches and lighters are seen as toys by young children and should be kept out of reach. Older toddlers and preschool children are at risk of chewing on electrical cords and placing objects in outlets. Microwave-heated fluids and foods can become superheated, resulting in oral burns.

6

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.

 

 

ANS:  B

Weighing diapers will provide an estimate of urinary output. Each 1 g of weight is equivalent to 1 ml of urine. Having parents estimate output would be inaccurate. It is difficult to estimate how much fluid is in a diaper. The urine collection device would irritate the child’s skin. It would be difficult for a toddler who is not toilet trained to sit on a potty chair 30 minutes after eating.

7

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

ANS:  C

The infant’s kidneys are functionally immature at birth and are inefficient in excreting waste products of metabolism. Infants have a relatively high body surface area (BSA) compared with adults. This allows a higher loss of fluid to the environment. A higher metabolic rate is present as a result of the higher BSA in relation to active metabolic tissue. The higher metabolic rate increases heat production, which results in greater insensible water loss. Infants have a greater exchange of extracellular fluid, leaving them with a reduced fluid reserve in conditions of dehydration.

7

Hydrotherapy is required to treat a child with extensive partial-thickness burn wounds. What is the purpose of hydrotherapy?

a.

Provide pain relief

b.

Débride the wounds

c.

Destroy bacteria on the skin

d.

Increase peripheral blood flow

ANS:  B

Soaking in a tub or showering once or twice a day acts to loosen and remove sloughing tissue, exudate, and topical medications. The hydrotherapy cleanses the wound and the entire body and helps maintain range of motion. Appropriate pain medications are necessary. Dressing changes are extremely painful. The total bacterial count of the skin is reduced by the hydrotherapy, but this is not the primary goal. There may be an increase in peripheral blood flow, but the primary purpose is for wound débridement.

8

The nurse is caring for a child with hypernatremia. The nurse evaluates the child for which signs and symptoms of hypernatremia? (Select all that apply.)

a.

Apathy

b.

Lethargy

c.

Oliguria

d.

Intense thirst

e.

Dry, sticky mucos

ANS:  B, C, E

Signs and symptoms of hypernatremia are nausea; oliguria; and dry, sticky mucos. Apathy and lethargy are signs of hyponatremia.

10

What amount of fluid loss occurs with moderate dehydration?

a.

b.

50 to 90 ml/kg

c.

d.

>15% total body weight

ANS:  B

Moderate dehydration is defined as a fluid loss of between 50 and 90 ml/kg. Mild dehydration is defined as a fluid loss of less than 50 ml/kg. Weight loss up to 5% is considered mild dehydration. Weight loss over 15% is severe dehydration.

11

What type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy?

a.

Neurogenic shock

b.

Cardiogenic shock

c.

Hypovolemic shock

d.

Anaphylactic shock

ANS:  D

Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Neurogenic shock results from loss of neuronal control, such as the interruption of neuronal transmission after a spinal cord injury. Cardiogenic shock is decreased cardiac output. Hypovolemic shock is a reduction in the size of the vascular compartment, decreasing blood pressure, and low central venous pressure.

11

What clinical manifestation(s) should the nurse expect to see as shock progresses in a child and becomes decompensated shock?

a.

Thirst

b.

Irritability

c.

Apprehension

d.

Confusion and somnolence

ANS:  D

Confusion and somnolence are beginning signs of decompensated shock. Thirst, irritability, and apprehension are signs of compensated shock

11

The nurse is caring for an 18-month-old child with rotavirus. What clinical manifestations should the nurse expect to observe?

a.

Severe abdominal cramping and bloody diarrhea

b.

Mild fever and vomiting followed by onset of watery stools

c.

Colicky abdominal pain and vomiting

d.

High fever, diarrhea, and lethargy

 

ANS:  B

Rotavirus is one of the most common pathogens that cause gastroenteritis in children younger than the age of 2 years. Clinical manifestations include mild to moderate fever and vomiting followed by the onset of watery stools. The fever and vomiting usually abate in 1 or 2 days, but the diarrhea persists for 5 to 7 days. Severe abdominal cramping and bloody diarrhea are seen with Escherichia coli infection; colicky abdominal pain and vomiting are seen with salmonella infection; and high fever, diarrhea, and lethargy are seen with infection by Salmonella typhi.

12

What flush solution is recommended for intravenous catheters larger than 24 gauge?

a.

Saline

b.

Heparin

c.

Alteplase

d.

Heparin and saline combination

ANS:  A

The recommended solution for flushing venous access devices is saline. The turbulent flow flush with saline is effective for catheters larger than 24 gauge. The use of heparin does not increase the longevity of the venous access device. In 24-gauge catheters, heparin may offer an advantage. Alteplase is used for treating catheter-related occlusions in children. The heparin and saline combination does not offer any advantage over saline or heparin individually.

13

The nurse is teaching a group of female adolescents about toxic shock syndrome and the use of tampons. What statement by a participant indicates a need for additional teaching?

a.

“I can alternate using a tampon and a sanitary napkin.”

b.

“I should wash my hands before inserting a tampon.”

c.

“I can use a superabsorbent tampon for more than 6 hours.”

d.

“I should call my health care provider if I suddenly develop a rash that looks like sunburn.”

ANS:  C

Teaching female adolescents about the association between toxic shock syndrome and the use of tampons is important. The teaching should include not using superabsorbent tampons; not leaving the tampon in for longer than 4 to 6 hours; alternating the use of tampons with sanitary napkins; washing hands before inserting a tampon to decrease the chance of introducing pathogens; and informing a health care provider if a sudden high fever, vomiting, muscle pain, dizziness, or a rash that looks like a sunburn appears.

 

14

The nurse is teaching a parent of a 10-year-old child who will be discharged with a venous access device (VAD). What statement by the parent indicates a correct understanding of the teaching?

a.

“I should have my child wear a protective vest when my child wants to participate in contact sports.”

b.

“I should apply pressure to the entry site to the vein, not the exit site, if the VAD is accidentally removed.”

c.

“I can expect my child to have feelings of general malaise for 1 week after the VAD is inserted.”

d.

“I should give my child a sponge bath for the first 2 weeks after the VAD is inserted; then I can allow my child to take a bath.”

ANS:  B

The parents of a child with a VAD should be taught to apply pressure to the entry site to the vein, not the exit site, if the VAD is accidentally removed. The child should not participate in contact sports, even with a protective vest, to prevent the VAD from becoming dislodged. General malaise is a sign of an infection, not an expected finding after insertion of the VAD. The child can shower or take a bath after insertion of the VAD; the child does not need a sponge bath for any length of time.

14

What is the most frequent cause of hypovolemic shock in children?

a.

Sepsis

b.

Blood loss

c.

Anaphylaxis

d.

Heart failure

ANS:  B

Blood loss is the most frequent cause of hypovolemic shock in children. Sepsis causes septic shock, which is overwhelming sepsis and circulating bacterial toxins. Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Heart failure contributes to hypervolemia, not hypovolemia.

15

What type of dehydration occurs when the electrolyte deficit exceeds the water deficit?

a.

Isotonic dehydration

b.

Hypotonic dehydration

c.

Hypertonic dehydration

d.

Hyperosmotic dehydration

ANS:  B

Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit, leaving the serum hypotonic. Isotonic dehydration occurs in conditions in which electrolyte and water deficits are present in balanced proportion. Hypertonic dehydration results from water loss in excess of electrolyte loss. This is the most dangerous type of dehydration. It is caused by feeding children fluids with high amounts of solute. Hyperosmotic dehydration is another term for hypertonic dehydration

17

What substance is released from the posterior pituitary gland and promotes water retention in the renal system?

a.

Renin

b.

Aldosterone

c.

Angiotensin

d.

Antidiuretic hormone (ADH)

ANS:  D

ADH is released in response to increased osmolality and decreased volume of intravascular fluid; it promotes water retention in the renal system by increasing the permeability of renal tubules to water. Renin release is stimulated by diminished blood flow to the kidneys. Aldosterone is secreted by the adrenal cortex. It enhances sodium reabsorption in renal tubules, promoting osmotic reabsorption of water. Renin reacts with a plasma globulin to generate angiotensin, which is a powerful vasoconstrictor. Angiotensin also stimulates the release of aldosterone.

18

The nurse is caring for a child with hypokalemia. The nurse evaluates the child for which signs and symptoms of hypokalemia? (Select all that apply.)

a.

Twitching

b.

Hypotension

c.

Hyperreflexia

d.

Muscle weakness

e.

Cardiac arrhythmias

 

ANS:  B, D, E

Signs and symptoms of hypokalemia are hypotension, muscle weakness, and cardiac arrhythmias. Twitching and hyperreflexia are signs of hyperkalemia.

 

20

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

ANS:  D

Easily digested foods such as cereals, cooked vegetables, and meats should be provided for the child. Early reintroduction of nutrients is desirable. Continued feeding or reintroduction of a regular diet has no adverse effects and actually lessens the severity and duration of the illness. Clear fluids (e.g., fruit juices and gelatin) and carbonated drinks have high carbohydrate content and few electrolytes. Caffeinated beverages should be avoided because caffeine is a mild diuretic. In some children, lactose intolerance will develop with diarrhea, and cow’s milk should be avoided in the recovery stage.

21

What is the purpose of a high-protein diet for a child with major burns?

a.

Promote growth

b.

Improve appetite

c.

Minimize protein breakdown

d.

Diminish risk of stress-induced hyperglycemia

ANS:  C

Initially after major burns, there is a hypometabolic phase, which lasts for 2 or 3 days. A hypermetabolic phase follows, characterized by increased body temperature, oxygen and glucose consumption, carbon dioxide production, glycogenolysis, proteolysis, and lipolysis. This response continues for up to 9 months. A diet high in protein and calories is necessary. Healing, not growth, is the primary consideration. Many children have poor appetites, and supplementation is necessary. Hypoglycemia, not hyperglycemia, can occur from the stress of burn injury because the liver glycogen stores are rapidly depleted.

 

23

The nurse is preparing a presentation on compensated, decompensated, and irreversible shock in children. What clinical manifestations related to decompensated shock should the nurse include? (Select all that apply.)

a.

Tachypnea

b.

Oliguria

c.

Confusion

d.

Pale extremities

e.

Hypotension

f.

Thready pulse

ANS:  A, B, C, D

As shock progresses, perfusion in the microcirculation becomes marginal despite compensatory adjustments, and the signs are more obvious. Signs include tachypnea, oliguria, confusion, and pale extremities, as well as decreased skin turgor and poor capillary filling. Hypotension and a thready pulse are clinical manifestations of irreversible shock

24

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.

ANS:  A

Gently tapping the site can sometimes cause the veins to be more visible. This is done before the skin is prepared. Warm compresses (not cold) may be useful. The extremity is held in a dependent position. A tourniquet may be helpful, but if too tight, it could cause the vein to burst when punctured. Five minutes is too long.