A nurse is preparing to administer a fluid bolus to a child in septic shock.
What type of fluid and over what duration should the nurse expect the provider to order?
20 mL/kg of hypotonic saline over 10 minutes.
5 mL/kg of Ringer's lactate (LR) over 30 minutes.
10 mL/kg of D5W over 1 hour.
20 mL/kg of 0.9% NaCl (normal saline) over 5-30 minutes.
The Correct Answer is D
Choice A rationale
Hypotonic saline is not the fluid of choice for septic shock because it lowers serum osmolality and can shift fluid into the cells, worsening intravascular volume depletion and hypotension. A 20 mL/kg bolus is the correct volume, but the fluid type and 10 minutes duration are inappropriate for initial resuscitation.
Choice B rationale
The volume of 5 mL/kg is insufficient for the initial resuscitation of a child in septic shock, where the goal is rapid, aggressive replacement of intravascular volume lost due to capillary leak and vasodilation. A 20 mL/kg bolus is the standard. Ringer's lactate is an acceptable crystalloid, but the volume is wrong.
Choice C rationale
𝐃5𝐖 (5.
Choice D rationale
0.9% 𝐍𝐚𝐂𝐥 (𝐧𝐨𝐫𝐦𝐚𝐥 𝐬𝐚𝐥𝐢𝐧𝐞) is an isotonic crystalloid and is the preferred initial fluid choice to expand the intravascular volume rapidly without risk of electrolyte shift. The dose of 20 mL/kg is standard and must be administered rapidly, typically over 5-30 minutes, to correct hypovolemia and improve cardiac output.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Weight gain of 1 kg suggests fluid retention, which is contrary to the expected diuretic effect of furosemide. Furosemide, a loop diuretic, acts by inhibiting the Na+-K+-2Cl- cotransporter in the thick ascending limb of the loop of Henle, increasing water and electrolyte excretion. A decrease in body weight due to diuresis is the primary indicator of effectiveness in reducing fluid overload associated with CHF.
Choice B rationale
Decreased urine output indicates a diminished response to the diuretic, suggesting ineffectiveness or potential complications like dehydration or pre-renal injury. Effective diuresis should significantly increase the urine output, facilitating the removal of excess interstitial and intravascular fluid volume to alleviate the symptoms of pulmonary and systemic congestion in CHF. Normal urine output for children is typically 1 to 2 mL/kg/hr.
Choice C rationale
Increased crackles, also known as rales, are adventitious lung sounds that signify the presence of fluid in the alveoli and small airways, characteristic of pulmonary edema in CHF. Furosemide aims to decrease this fluid, improving oxygenation and reducing the audible crackles, making an increase an indicator of worsening condition or ineffective treatment.
Choice D rationale
Decreased respiratory rate often accompanies improved oxygenation and reduced work of breathing, secondary to the resolution of pulmonary congestion and edema. Furosemide's action reduces the fluid burden on the lungs, lowering the hydrostatic pressure and facilitating gas exchange, which in turn reduces the tachypnea and respiratory distress common in pediatric CHF.
Correct Answer is D
Explanation
Choice A rationale
An oxygen saturation of 88.
Choice B rationale
Bounding peripheral pulses are a classic finding in Patent Ductus Arteriosus (PDA) due to the wide pulse pressure, which results from the run-off of blood from the aorta back into the pulmonary artery during diastole. This finding supports the diagnosis but is not typically the most concerning indicator of impending decompensation.
Choice C rationale
The machinery-like murmur is the pathognomonic sign of a Patent Ductus Arteriosus, caused by continuous blood flow from the high-pressure aorta to the low-pressure pulmonary artery. This is an expected diagnostic finding for PDA, confirming the presence of the defect, but it is not an indicator of acute distress.
Choice D rationale
A respiratory rate of 60 breaths per minute in a 2-month-old infant is a significant indicator of tachypnea and potential respiratory distress, likely due to pulmonary overcirculation and the resulting congestive heart failure (CHF) caused by the PDA. This elevated rate signals a critical effort to compensate for decreased pulmonary compliance and is the most immediate concern.
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