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Chapter 40 The Child with a Fluid and Electrolyte Alteration
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Chapter 40 The Child with a Fluid and Electrolyte Alteration
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Chapter 40: The Child with a Fluid and Electrolyte AlterationTest Bank
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
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.
PTS: 1 DIF: Cognitive Level: Application REF: p. 991
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
Feedback
A The normal serum sodium level is 135 to 145 mEq/L. A level of 139 mEq/L is
within normal limits.
B A serum calcium level less than 8.5 mg/dL is considered hypocalcemia.
C A serum potassium level greater than 5 mEq/L is considered hyperkalemia.
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.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 991
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
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.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 990
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
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.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 995
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
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