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 B
Explanation
Choice A rationale
Keeping the head of bed (HOB) flat is contraindicated; the HOB should be elevated to 30 degrees to promote venous return from the head via the jugular veins. This elevation is critical for lowering intracranial pressure (ICP) and improving cerebral perfusion after a traumatic brain injury.
Choice B rationale
Avoiding sedation is critical for maintaining an accurate and reliable neurological assessment, which includes the Glasgow Coma Scale (GCS). Sedative medications can mask changes in the level of consciousness, pupil reaction, and motor response, thereby delaying the detection of worsening intracranial pathology.
Choice C rationale
Maintaining SpO_2 (oxygen saturation) between 95-99% is crucial to prevent hypoxia, which causes cerebral vasodilation and dangerously increases intracranial pressure (ICP), thereby worsening the secondary brain injury. However, SpO_2 is typically maintained at ≥ 94% in general trauma.
Choice D rationale
Hypotonic fluids, such as 0.45% normal saline, are contraindicated after a traumatic brain injury as they can shift fluid into the cerebral cells. This can exacerbate cerebral edema and dangerously increase intracranial pressure (ICP), thereby worsening the patient's neurological status.
Correct Answer is ["A","B","D","E"]
Explanation
Choice A rationale
Post-ictal confusion, characterized by a period of disorientation, drowsiness, and potential headache, is a universal feature of the post-seizure state following a generalized tonic-clonic event. This transient neurological deficit reflects the exhaustion and metabolic changes within the cerebral cortex after widespread neuronal depolarization.
Choice B rationale
Sudden loss of consciousness occurs at the onset of a generalized tonic-clonic seizure due to the abrupt, widespread, and bilateral electrical discharge throughout the cortex. This loss of awareness defines the generalized nature of the seizure, distinguishing it from focal seizures where consciousness may be preserved.
Choice C rationale
Rhythmic twitching of one extremity while remaining awake and aware describes a focal motor seizure (simple partial), which involves abnormal electrical activity localized to a specific area of one cerebral hemisphere. A generalized tonic-clonic seizure involves both hemispheres and global loss of consciousness.
Choice D rationale
Urinary incontinence is common during the tonic phase of the seizure due to the intense, generalized muscular contraction, including the pelvic floor muscles. The massive autonomic surge and muscular rigidity overwhelm the sphincter control, leading to involuntary voiding.
Choice E rationale
Rhythmic muscle twitching, known as the clonic phase, consists of alternating periods of muscular contraction and relaxation. This phase follows the rigid, sustained contraction of the tonic phase and is a defining characteristic of a generalized tonic-clonic seizure.
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