Chapter 44

Question 1

A 4-year-old child is admitted to the hospital secondary to dehydration. Laboratory tests indicate a high hemoglobin and hematocrit, and the serum sodium is below normal levels. Which condition does the nurse suspect based on the current data?

1. Hypernatremia
2. Metabolic acidosis
3. Hypotonic dehydration
4. Isotonic dehydration

Answer 1

3

Question 2

A nurse is taking care of four different pediatric clients. Which child is at greatest risk for dehydration?

1. 7-year-old child with migraine headaches
2. 4-year-old child with a broken arm
3. 2-year-old child with cellulitis of the left leg
4. 18-month-old child with tachypnea

Answer 2

4

Question 3

Which parental statement indicates correct understanding of preventive techniques for heat-related illnesses when children exercise?

1. “Wearing dark clothing during exercise is recommended.”
2. “Water is the fluid of choice to replenish fluids.”
3. “During activity, stop for fluids every 15 to 20 minutes.”
4. “Hydration should occur at the end of an exercise session.”

Answer 3

3

Question 4

The nurse is assessing an infant brought to the clinic because of diarrhea. The infant is alert but has dry mucous membranes. Which additional assessment data indicates to the nurse that the infant is experiencing an early to moderate stage of dehydration?

1. Bradycardia
2. Tachycardia
3. Increased blood pressure
4. Normal fontanels

Answer 4

2

Question 5

In the morning, a nurse receives change-of-shift report on four pediatric clients, each of whom has some form of fluid-volume excess. Which of the children should the nurse see first?

1. The child with tachypnea and pulmonary congestion
2. The child with hepatomegaly and normal respiratory rate
3. The child with dependent and sacral edema and regular pulse
4. The child with periorbital edema and normal respiratory rate

Answer 5

1

Question 6

The nurse is caring for a child on bed rest who has severe edema in a left lower extremity due to blocked lymphatic drainage. Which nursing diagnosis would take priority?

1. Risk for Impaired Skin Integrity
2. Risk for Altered Body Image
3. Risk for Imbalanced Nutrition: Less Than Body Requirements
4. Risk for Activity Intolerance

Answer 6

1

Question 7

A nurse is planning care for a child with hyponatremia. The nurse, delegating care of this child to a licensed vocational nurse (LVN), cautions the LVN to immediately report which clinical manifestation?

1. Seizures
2. Respiratory distress
3. Hyperthermia
4. Bradycardia

Answer 7

1

Question 8

A nurse is planning care for a child with hyperkalemia. Which manifestation associated with the documented hyperkalemia requires immediate intervention by the nurse?

1. Hyperthermia
2. Respiratory distress
3. Seizures
4. Cardiac arrhythmias

Answer 8

4

Question 9

A child with croup has an increased PCO2, a decreased pH, and a normal HCO3 blood gas value. Which does the nurse report to the healthcare provider based on these data?

1. Uncompensated metabolic alkalosis
2. Uncompensated metabolic acidosis
3. Uncompensated respiratory acidosis
4. Uncompensated respiratory alkalosis

Answer 9

3

Question 10

The nurse is expecting the admission of a child with severe isotonic dehydration. Which intravenous fluid prescription does the nurse anticipate for this child?

1. 0.9% normal saline (NS)
2. D5 0.2% (¼) normal saline
3. D5W
4. Albumin

Answer 10

1

Question 11

A 6-year-old child is hypokalemic. Which menu choice should the nurse encourage for this child?

1. Pizza with a fruit plate
2. Chicken strips with chips
3. Fajita with rice
4. A hamburger with French fries

Answer 11

1

Question 12

A child is admitted to the hospital for hypercalcemia and is placed on diuretic therapy. Which diuretic would the nurse expect to give?

1. Furosemide (Lasix)
2. Hydrochlorothiazide (Aquazide)
3. Spironolactone (Aldactone)
4. Mannitol (Osmitrol)

Answer 12

1

Question 13

A child is being treated for dehydration with intravenous fluids. The child currently weighs 13 kg and is estimated to have lost 7% of his normal body weight. The nurse is double-checking the IV rate the healthcare provider prescribed. The formula the healthcare provider used was for maintenance fluids: 1000 mL for 10 kg of body weight plus 50 mL for every kilogram 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, which hourly IV rate will the nurse implement for 24 hours?

1. 88 mL/hr
2. 86 mL/hr
3. 81 mL/hr
4. 83 mL/hr

Answer 13

2

Question 14

A 9-month-old infant is hospitalized with vomiting and diarrhea. The mother questions why her child needed hospitalization since her school-age nephew had the same symptoms and was treated at home. Which should the nurse include in the explanation to the infant’s mother? Select all that apply.

1. Infants have a lower proportion of their body weight as water.
2. The percentage of extracellular fluid is higher in the infant than the school-age child.
3. School-age children have a larger body surface area.
4. The school-age child’s kidneys are more mature and better able to conserve water.
5. The metabolic rate of the school-age child is higher.

Answer 14

2,4

Question 15

As a result of opioid administration, a child’s respirations are slow and shallow. Which should the nurse anticipate when assessing the child’s arterial blood gas?

1. Increased PCO2 and respiratory acidosis
2. Decreased PCO2 and respiratory alkalosis
3. Low pH and low PCO2
4. High pH and high PCO2

Answer 15

1

Question 16

Which rationale will the seasoned nurse share with the novice nurse regarding why the specific gravity for infants is lower than for older children?

1. The infant has a greater body surface area.
2. The infant has a higher basal metabolic rate.
3. The infant has a greater percentage of body weight that is water.
4. The infant’s kidneys are less able to concentrate urine.

Answer 16

4

Question 17

Which is the priority nursing assessment when providing care for an infant at risk for dehydration?

1. Urine output
2. Urine specific gravity
3. Vital signs
4. Daily weight

Answer 17

4

Question 18

Which pediatric client diagnoses necessitate close monitoring for respiratory acidosis? Select all that apply.

1. Aspiration
2. Epiglottitis
3. Sepsis
4. Meningitis
5. Cystic fibrosis

Answer 18

1,2,5

Question 19

Which pediatric client diagnoses necessitate close monitoring for respiratory alkalosis? Select all that apply.

1. Aspiration
2. Epiglottitis
3. Sepsis
4. Meningitis
5. Cystic fibrosis

Answer 19

3,4

Question 20

The nurse is assessing a pediatric client who is experiencing metabolic acidosis. Which assessment questions should the nurse include when interviewing the child’s parents? Select all that apply.

1. “Has your child consumed any aspirin?”
2. “Has your child consumed any boric acid?”
3. “Has your child consumed any antifreeze?”
4. “Has your child consumed any baking soda?”
5. “Has your child consumed any antacids?”

Answer 20

1,2,3

Question 21

The nurse is assessing a pediatric client who is experiencing metabolic alkalosis. Which assessment questions should the nurse include when interviewing the child’s parents? Select all that apply.

1. “Has your child consumed any aspirin?”
2. “Has your child consumed any boric acid?”
3. “Has your child consumed any antifreeze?”
4. “Has your child consumed any baking soda?”
5. “Has your child consumed any antacids?”

Answer 21

4,5

Question 22

Which age-appropriate techniques should the nurse implement in order to encourage a young child to participate in deep breathing exercises? Select all that apply.

1. Showing the child how to use the “blow bottle”
2. Using a pinwheel that the child plays with and asking the child to blow until it turns
3. Asking the child to blow bubbles in a glass of water using a straw
4. Having the child blow scraps of paper across the bedside table with a straw
5. Telling the child that a “shot” will be needed if the child does not follow the nurse’s directions

Answer 22

2,3,4