NR 328 Exam #2 Practice Questions (latest upgrade 2023)

What factor predisposes an infant to fluid imbalances? a. Immature kidney functioning b. Decreased surface area c. Lower metabolic rate d. Decreased daily exchange of extracellular fluid - Answer Answer: A Rationale: 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. 1200 b. 1100 c. 1300 d. 1400 - Answer Answer: A Rationale: 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 800 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 depletion b. Water excess c. Potassium excess d. Sodium depletion - Answer Answer: A Rationale: These clinical manifestations indicate water depletion or dehydration. Edema and weight gain occur with water excess or over-hydration. Sodium or potassium excess would not cause these symptoms. What explains physiologically the edema formation that occurs with burns? a. Increased capillary permeability b. Decreased capillary permeability c. Vasoconstriction d. Diminished hydrostatic pressure within capillaries - Answer Answer: A Rationale: With a major burn, capillary permeability increases, allowing plasma proteins, fluids, and electrolytes to be lost into the interstitial space, causing edema. Maximum edema in a small wound occurs about 8 to 12 hr after injury. In larger injuries, the maximum edema may not occur until 18 to 24 hr later. Vasodilation occurs, causing an increase in hydrostatic pressure. What is the most immediate threat to life in children with thermal injuries? a. Shock b. Anemia c. Local infection d. Systemic sepsis - Answer Answer: A Rationale: The immediate threat to life in children with thermal injuries is airway compromise and profound shock. Anemia is not of immediate concern. During the healing phase, local infection or sepsis is the primary complication. After the acute stage and during the healing process, what is the primary complication from burn injury? a. Infection b. Shock c. Renal shutdown d. Asphyxia - Answer Answer: A Rationale: During the healing phase, local infection or sepsis is the primary complication. Respiratory problems, primarily airway compromise, and shock are the primary complications during the acute stage of burn injury. Renal shutdown is not a complication of the burn injury but may be a result of the profound shock. What finding is the most reliable guide to the adequacy of fluid replacement for a small child with burns? a. Urinary output of 1 to 2 mL/kg of body weight/hr b. Increased seepage from burn wound c. Falling hematocrit d. Absence of thirst - Answer Answer: A Rationale: Replacement fluid therapy is delivered to provide a urinary output of 30 mL/hr in older children or 1 to 2 mL/kg of body weight/hr for children weighing less than 30 kg (66 pounds). Thirst is the result of a complex set of interactions and is not a reliable indicator of hydration. Thirst occurs late in dehydration. A falling hematocrit would be indicative of hemodilution. This may reflect fluid shifts and may not accurately represent fluid replacement therapy. Increased seepage from a burn wound would be indicative of increased output, not adequate hydration. What intervention is contraindicated in a suspected case of appendicitis? a. Enemas b. Palpating the abdomen c. Administration of antibiotics d. Administration of antipyretics for fever - Answer Answer: A Rationale: In any instance in which severe abdominal pain is observed and appendicitis is suspected, the nurse must be aware of the danger of administering laxatives or enemas. Such measures stimulate bowel motility and increase the risk of perforation. The abdomen is palpated after other assessments are made. Antibiotics should be administered, and antipyretics are not contraindicated. An infant had a gastrostomy tube placed for feedings after a Nissen fundoplication and bolus feedings are initiated. Between feedings while the tube is clamped, the infant becomes irritable, and there is evidence of cramping. What action should the nurse implement? a. Vent the gastrostomy tube. b. Withhold the next feeding. c. Burp the infant. d. Notify the health care provider. - Answer Answer: A Rationale: If bolus feedings are initiated through a gastrostomy after a Nissen fundoplication, the tube may need to remain vented for several days or longer to avoid gastric distention from swallowed air. Edema surrounding the surgical site and a tight gastric wrap may prohibit the infant from expelling air through the esophagus, so burping does not relieve the distention. Some infants benefit from clamping of the tube for increasingly longer intervals until they are able to tolerate continuous clamping between feedings. During this time, if the infant displays increasing irritability and evidence of cramping, some relief may be provided by venting the tube. The next feeding should not be withheld, and calling the health care provider is not necessary. The nurse should instruct parents to administer a daily proton pump inhibitor to their child with gastroesophageal reflux at which time? a. 30 minutes before breakfast b. Midmorning c. Bedtime d. With a meal - Answer Answer: A Rationale: Proton pump inhibitors are most effective when administered 30 minutes before breakfast so that the peak plasma concentrations occur with mealtime. If they are given twice a day, the second best time for administration is 30 minutes before the evening meal. The nurse is assisting a child with celiac disease to select foods from a menu. What foods should the nurse suggest? a. Corn on the cob with butter b. Hamburger on a bun c. Spaghetti with meat sauce d. Peanut butter and crackers - Answer Answer: A Rationale: Treatment of celiac disease consists primarily of dietary management. Although a gluten-free diet is prescribed, it is difficult to remove every source of this protein. Some patients are able to tolerate restricted amounts of gluten. Because gluten occurs mainly in the grains of wheat and rye but also in smaller quantities in barley and oats, these foods are eliminated. Corn, rice, and millet are substitute grain foods. Corn on the cob with butter would be gluten free. An infant is born with a gastroschisis. Care preoperatively should include which priority intervention? a. Covering the defect with a sterile bowel bag b. Monitoring serum laboratory electrolytes c. Sterile water feedings d. Prone position - Answer Answer: A Rationale: Initial management of a gastroschisis involves covering the exposed bowel with a transparent plastic bowel bag or loose, moist dressings. The infant cannot be placed prone, and feedings will be withheld until surgery is performed. Electrolyte laboratory values will be monitored but not before covering the defect with a sterile bowel bag.