NR 328 Exam #2 Practice Questions and Answers 2022
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NR 328
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: A
Rationale: The infant’s kidneys are functionally immature at birth and are ineffi...
what factor predisposes an infant to fluid imbalances
what is the required number of milliliters of fluid needed per day for a 14 kg child
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NR 328 Exam #2 Practice Questions
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.
,NR 328 Exam #2 Practice Questions
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.
,NR 328 Exam #2 Practice Questions
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
, NR 328 Exam #2 Practice Questions
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.
A 3-day-old infant presents with abdominal distention, is vomiting, and has not passed
any meconium stools. What disease should the nurse suspect?
a. Hirschsprung disease
b. Intussusception
c. Celiac disease
d. Pyloric stenosis - Answer Answer: A
Rationale: The clinical manifestations of Hirschsprung disease in a 3-day-old infant
include abdominal distention, vomiting, and failure to pass meconium stools. Pyloric
stenosis would present with vomiting but not distention or failure to pass meconium
stools. Intussusception presents with abdominal cramping and celiac disease presents
with malabsorption.
The parents of a newborn with an umbilical hernia ask about treatment options. The
nurse's response should be based on which knowledge?
a. The defect usually resolves spontaneously by 3 to 5 years of age.
b. Surgery is recommended as soon as possible.
c. Aggressive treatment is necessary to reduce its high mortality.
d. Taping the abdomen to flatten the protrusion is sometimes helpful. - Answer Answer:
A
Rationale: The umbilical hernia usually resolves by ages 3 to 5 years of age without
intervention. Umbilical hernias rarely become problematic. Incarceration, where the
hernia is constricted and cannot be reduced manually, is rare. Umbilical hernias are not
associated with a high mortality rate. Taping the abdomen flat does not help heal the
hernia; it can cause skin irritation.
A child with pyloric stenosis is having excessive vomiting. The nurse should assess for
what potential complication?
a. Metabolic alkalosis
b. Metabolic acidosis
c. Hyperchloremia
d. Hyperkalemia - Answer Answer: A
Rationale: Infants with excessive vomiting are prone to metabolic alkalosis from the loss
of hydrogen ions. Potassium and chloride ions are lost with vomiting. Metabolic
alkalosis, not acidosis, is likely.
When caring for a child with probable appendicitis, the nurse should be alert to
recognize which sign or symptom as a manifestation of perforation?
a. Sudden relief from pain
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