TEST BANK For Wong's Nursing Care of Infants and Children,
12th Edition (Hockenberry, 2024), Verified Chapters 1 - 34,
Complete Newest Version
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) - ANSWER: 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.
Nurses should be alert for increased fluid requirements in which circumstance?
a. Fever
b. Mechanical ventilation
c. Congestive heart failure
d. Increased intracranial pressure - ANSWER: 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.
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 - ANSWER: 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.
What is the required number of milliliters of fluid needed per day for a 14-kg child?
a. 800
,b. 1000
c. 1200
d. 1400 - ANSWER: ANS: C
For the first 10 kg of body weight, a child requires 100 ml/kg. For each additional
kilogram of body weight, an extra 50 ml is needed.
10 kg 100 ml/kg/day = 1000 ml
4 kg 50 ml/kg/day = 200 ml
1000 ml + 200 ml = 1200 ml/day
Eight hundred to 1000 ml is too little; 1400 ml is too much.
An infant is brought to the emergency department with the following clinical
manifestations: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea.
This is suggestive of which situation?
a. Water excess
b. Sodium excess
c. Water depletion
d. Potassium excess - ANSWER: ANS: C
These clinical manifestations indicate water depletion or dehydration. Edema and
weight gain occur with water excess or overhydration. Sodium or potassium excess
would not cause these symptoms.
Clinical manifestations of sodium excess (hypernatremia) include which signs or
symptoms?
a. Hyperreflexia
b. Abdominal cramps
c. Cardiac dysrhythmias
d. Dry, sticky mucous membranes - ANSWER: ANS: D
Dry, sticky mucous membranes are associated with hypernatremia. Hyperreflexia is
associated with hyperkalemia. Abdominal cramps, weakness, dizziness, nausea, and
apprehension are associated hyponatremia. Cardiac dysrhythmias are associated
with hypokalemia.
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 - ANSWER: 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.
What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)?
a. Nausea, vomiting
b. Weakness, fatigue
c. Muscle hypotonicity
d. Neuromuscular irritability - ANSWER: ANS: D
, Neuromuscular irritability is a clinical manifestation of hypocalcemia. Nausea and
vomiting occur with hypercalcemia and hypernatremia. Weakness, fatigue, and
muscle hypotonicity are clinical manifestations of hypercalcemia.
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 - ANSWER: 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.
What amount of fluid loss occurs with moderate dehydration?
a. <50 ml/kg
b. 50 to 90 ml/kg
c. <5% total body weight
d. >15% total body weight - ANSWER: 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.
Physiologically, the child compensates for fluid volume losses by which mechanism?
a. Inhibition of aldosterone secretion
b. Hemoconcentration to reduce cardiac workload
c. Fluid shift from interstitial space to intravascular space
d. Vasodilation of peripheral arterioles to increase perfusion - ANSWER: ANS: C
Compensatory mechanisms attempt to maintain fluid volume. Initially, interstitial
fluid moves into the intravascular compartment to maintain blood volume.
Aldosterone is released to promote sodium retention and conserve water in the
kidneys. Hemoconcentration results from the fluid volume loss. With less circulating
volume, tachycardia results. Vasoconstriction of peripheral arterioles occurs to help
maintain blood pressure.
Ongoing fluid losses can overwhelm the child's ability to compensate, resulting in
shock. What early clinical sign precedes shock?
a. Tachycardia
b. Slow respirations
c. Warm, flushed skin
d. Decreased blood pressure - ANSWER: ANS: A
Shock is preceded by tachycardia and signs of poor tissue perfusion and decreased
pulse oximetry values. Respirations are increased as the child attempts to
12th Edition (Hockenberry, 2024), Verified Chapters 1 - 34,
Complete Newest Version
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) - ANSWER: 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.
Nurses should be alert for increased fluid requirements in which circumstance?
a. Fever
b. Mechanical ventilation
c. Congestive heart failure
d. Increased intracranial pressure - ANSWER: 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.
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 - ANSWER: 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.
What is the required number of milliliters of fluid needed per day for a 14-kg child?
a. 800
,b. 1000
c. 1200
d. 1400 - ANSWER: ANS: C
For the first 10 kg of body weight, a child requires 100 ml/kg. For each additional
kilogram of body weight, an extra 50 ml is needed.
10 kg 100 ml/kg/day = 1000 ml
4 kg 50 ml/kg/day = 200 ml
1000 ml + 200 ml = 1200 ml/day
Eight hundred to 1000 ml is too little; 1400 ml is too much.
An infant is brought to the emergency department with the following clinical
manifestations: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea.
This is suggestive of which situation?
a. Water excess
b. Sodium excess
c. Water depletion
d. Potassium excess - ANSWER: ANS: C
These clinical manifestations indicate water depletion or dehydration. Edema and
weight gain occur with water excess or overhydration. Sodium or potassium excess
would not cause these symptoms.
Clinical manifestations of sodium excess (hypernatremia) include which signs or
symptoms?
a. Hyperreflexia
b. Abdominal cramps
c. Cardiac dysrhythmias
d. Dry, sticky mucous membranes - ANSWER: ANS: D
Dry, sticky mucous membranes are associated with hypernatremia. Hyperreflexia is
associated with hyperkalemia. Abdominal cramps, weakness, dizziness, nausea, and
apprehension are associated hyponatremia. Cardiac dysrhythmias are associated
with hypokalemia.
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 - ANSWER: 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.
What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)?
a. Nausea, vomiting
b. Weakness, fatigue
c. Muscle hypotonicity
d. Neuromuscular irritability - ANSWER: ANS: D
, Neuromuscular irritability is a clinical manifestation of hypocalcemia. Nausea and
vomiting occur with hypercalcemia and hypernatremia. Weakness, fatigue, and
muscle hypotonicity are clinical manifestations of hypercalcemia.
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 - ANSWER: 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.
What amount of fluid loss occurs with moderate dehydration?
a. <50 ml/kg
b. 50 to 90 ml/kg
c. <5% total body weight
d. >15% total body weight - ANSWER: 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.
Physiologically, the child compensates for fluid volume losses by which mechanism?
a. Inhibition of aldosterone secretion
b. Hemoconcentration to reduce cardiac workload
c. Fluid shift from interstitial space to intravascular space
d. Vasodilation of peripheral arterioles to increase perfusion - ANSWER: ANS: C
Compensatory mechanisms attempt to maintain fluid volume. Initially, interstitial
fluid moves into the intravascular compartment to maintain blood volume.
Aldosterone is released to promote sodium retention and conserve water in the
kidneys. Hemoconcentration results from the fluid volume loss. With less circulating
volume, tachycardia results. Vasoconstriction of peripheral arterioles occurs to help
maintain blood pressure.
Ongoing fluid losses can overwhelm the child's ability to compensate, resulting in
shock. What early clinical sign precedes shock?
a. Tachycardia
b. Slow respirations
c. Warm, flushed skin
d. Decreased blood pressure - ANSWER: ANS: A
Shock is preceded by tachycardia and signs of poor tissue perfusion and decreased
pulse oximetry values. Respirations are increased as the child attempts to
