Chapter 40 The Child with a Fluid and Electrolyte Alteration

Chapter 40  The Child with a Fluid and Electrolyte Alteration

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. 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?
a. The respiratory, renal, and chemical-buffering systems
b. The kidneys balance acid; the lungs balance base.
c. The cardiovascular and integumentary systems
d. The skin, kidney, and endocrine systems

ANS: 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. Both the
kidneys and the lungs, along with the buffering system, contribute to acid-base balance.
Neither system regulates acid or base balances exclusively. The cardiovascular and
integumentary systems are not part of acid-base regulation in the body. Chemical buffers,
the lungs, and the kidneys work together to keep the blood pH within normal range.

PTS: 1 DIF: Cognitive Level: Application REF: p. 888
OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

2. A child has a 2-day history of vomiting and diarrhea. He has hypoactive bowel sounds and

an irregular pulse. Electrolyte values are sodium, 139 mEq/L; potassium, 3.3 mEq/L; and
calcium, 9.5 mg/dL. This child is likely to have which of the following electrolyte
imbalances?
a. Hyponatremia
b. Hypocalcemia
c. Hyperkalemia
d. Hypokalemia

ANS: D
A serum potassium level less than 3.5 mEq/L is considered hypokalemia. Clinical
manifestations of hypokalemia include muscle weakness, decreased bowel sounds, cardiac
irregularities, hypotension, and fatigue. The normal serum sodium level is 135 to 145
mEq/L. A level of 139 mEq/L is within normal limits. A serum calcium level less than 8.5
mg/dL is considered hypocalcemia. A serum potassium level greater than 5 mEq/L is
considered hyperkalemia.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 889
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

3. Which statement best describes why infants are at greater risk for dehydration than older

children?
a. Infants have an increased ability to concentrate urine.
b. Infants have a greater volume of intracellular fluid.
c. Infants have a smaller body surface area.

d. Infants have an increased extracellular fluid volume.

ANS: D
The larger ratio of extracellular fluid to intracellular fluid predisposes the infant to
dehydration. Because the kidneys are immature in early infancy, there is a decreased ability
to concentrate the urine. Infants have a larger proportion of fluid in the extracellular space.
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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 887
OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

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

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

ANS: C
Changes in heart rate, sensorium, and skin color are early indicators of impending shock in
the child. 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. Respiratory assessments will not provide data about
impending hypovolemic shock. Diet tolerance, bowel function, and abdominal girth are not
as important indicators of shock as heart rate, sensorium, and skin color.

PTS: 1 DIF: Cognitive Level: Analysis
REF: p. 893 | Safety Alert Box OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity

5. What is the most important factor in determining the rate of fluid replacement in the

dehydrated child?
a. The child’s weight
b. The type of dehydration
c. Urine output
d. Serum potassium level

ANS: B
Isonatremic and hyponatremic dehydration resuscitation involves fluid replacement over 24
hours. Hypernatremic dehydration involves a slower replacement rate to prevent a sudden
decrease in the sodium level. The child’s weight determines the amount of fluid needed, not
the rate of fluid replacement. One milliliter of body fluid is equal to 1 g of body weight;
therefore a loss of 1 kg (2.2 lb) is equal to 1 L of fluid. Urine output is not a consideration
for determining the rate of administration of replacement fluids. Potassium level is not as
significant in determining the rate of fluid replacement as the type of dehydration.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 895
OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity