Peds Respiratory NCLEX questions ...

Unit 1 - Fluid and Electrolyte - NCLEX Qs ScienceMedicinePaediatrics Jackie_Baxter5 Save Peds Respiratory NCLEX questions ...31 terms lyndsay_sexton2 Preview GI peds NCLEX questions 15 terms Calipark22Preview Pediatric Neurological Practice Que...28 terms cheyenne_hutcheson Preview Paedia 11 terms mr2 Why are infants at greater risk for fluid and electrolyte imbalances than older children?

• Their metabolic rate is lower
• They have a decreased surface area
• Their kidney functioning is immature
• Their daily exchange of extracellular fluid is decreased

Answer: C. Their kidney functioning is immature

Rationale:

• The infant has a higher metabolic rate.
• The infant has a proportionately greater body surface area, which allows for greater insensible water loss.
• The infant's kidneys are unable to concentrate or dilute urine, conserve or excrete sodium, and acidify urine.
• There is an increased amount of extracellular fluid in the infant. Forty percent of a neonate's body fluid is extracellular fluid, compared with

20% in an adult. Fluid is lost from the extracellular space first.

Which statement best describes why infants are at greater risk for dehydration than older children?

• Infants have an increased ability to concentrate urine.
• Infants have a greater volume of intracellular fluid.
• Infants have a smaller body surface area.
• Infants have an increased extracellular fluid volume.

ANS: d. Infants have an increased extracellular fluid volume.

Feedback A Because the kidneys are immature in early infancy, there is a decreased ability to concentrate the urine.B Infants have a larger proportion of fluid in the extracellular space.C Infants have proportionately greater body surface area in relation to body mass, which creates the potential for greater fluid loss through the skin and gastrointestinal tract.D The larger ratio of extracellular fluid to intracellular fluid predisposes the infant to dehydration.The parents of a child with acid-base imbalance ask the nurse about mechanisms that regulate acid-base balance. Which statement by the nurse accurately explains the mechanisms regulating acid-base balance in children?

• The respiratory, renal, and chemical-buffering systems
• The kidneys balance acid; the lungs balance base
• The cardiovascular and integumentary systems
• The skin, kidney, and endocrine systems

ANS: a. The respiratory, renal, and chemical-buffering systems

Feedback A The acid-base system is regulated by chemical buffering, respiratory control of carbon dioxide, and renal regulation of bicarbonate and secretion of hydrogen ions.B Both the kidneys and the lungs, along with the buffering system, contribute to acid-base balance. Neither system regulates acid or base balances exclusively.C The cardiovascular and integumentary systems are not part of acid-base regulation in the body.D Chemical buffers, the lungs, and the kidneys work together to keep the blood pH within normal range.

A nurse is evaluating an infant brought to the clinic with severe diarrhea. What signs and symptoms indicate that the infant has severe dehydration?

• Tachycardia, decreased tears, 5% weight loss
• Normal pulse and blood pressure, intense thirst
• Irritability, moderate thirst, normal eyes and fontanel
• Tachycardia, capillary refill greater than 3 seconds, sunken eyes and fontanel

Answer: D. Tachycardia, capillary refill greater than 3 seconds, sunken eyes and fontanel

Rationale:

• In severe dehydration, there is a 15% weight loss in infants.
• Tachycardia, orthostatic hypotension and shock, and intense thirst would be expected.
• The infant would be extremely irritable, with sunken eyes and fontanel.
• Tachycardia, capillary refill greater than 3 seconds, and sunken eyes and fontanel are the symptoms of severe dehydration.

A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solutions (ORS). The child's mother calls the clinic nurse to report the child has occasional vomiting. What is the appropriate recommendation by the nurse?

• Bring the child to the hospital for intravenous fluids
• Alternate giving the child ORS and carbonated drinks
• Continue to give the child ORS frequently in small amounts
• Maintain the child on NPO for 8 hours and resume ORS if vomiting subsides

Answer: C. Continue to give the child ORS frequently in small amounts

Rationale:

• A school-age child with mild dehydration can be rehydrated safely at home with oral solutions.
• Carbonated drinks should not be given to the child. They may have a high carbohydrate content and contain caffeine, which is a diuretic.
• Vomiting is not a contraindication to the use of ORS unless it is severe. The mother should continue to give the ORS in small amounts and at

frequent intervals.

• NPO status is not indicated. Frequent intake of ORS in small amounts is recommended.

A 2-month-old breastfed infant is successfully rehydrated with oral rehydration solutions (ORS) for acute diarrhea. What instructions to the mother about breastfeeding should be included by the nurse?

• Continue breastfeeding
• Stop breastfeeding until breast milk is cultured
• Stop breastfeeding until diarrhea is absent for 24 hours
• Express breast milk and dilute with sterile water before feeding

Answer: A. Continue breastfeeding

Rationale:

• Breastfeeding should continue.
• Culturing the breast milk is not necessary.
• Breastfeeding can continue along with ORS to replace the continuing fluid loss from the diarrhea.
• Breast milk should not be diluted.

Which assessment is most relevant to the care of an infant with dehydration?

• Temperature, heart rate, and blood pressure.
• Respiratory rate, oxygen saturation, and lung sounds.
• Heart rate, sensorium, and skin color.
• Diet tolerance, bowel function, and abdominal girth.

ANS: C) Heart rate, sensorium, and skin color.

Feedback A Children can compensate and maintain an adequate cardiac output when they are hypovolemic. Blood pressure is not as reliable an indicator of shock as are changes in heart rate, sensorium, and skin color.B Respiratory assessments will not provide data about impending hypovolemic shock.C Changes in heart rate, sensorium, and skin color are early indicators of impending shock in the child.D Diet tolerance, bowel function, and abdominal girth are not as important indicators of shock as heart rate, sensorium, and skin color.A toddler is hospitalized with severe dehydration. The nurse should assess the child for which possible complication?

• Hypertension
• Hypokalemia
• A rapid, bounding pulse
• Decreased specific gravity

Answer: B. Hypokalemia

Rationale:

• The child needs to be monitored for hypotension.
• Hypokalemia is a concern in severe dehydration.
• A rapid, thready pulse would be seen in severe dehydration.
• The urine would be concentrated, so the specific gravity would increase.