A nurse is preparing to calculate fluid replacement for a dehydrated child.
Which of the following steps should the nurse take? (Select all that apply).
Assess the degree of dehydration based on clinical signs and symptoms.
Calculate the fluid deficit based on the degree of dehydration.
Administer electrolyte solutions or supplements as necessary.
Monitor the child’s response to treatment and adjust the plan accordingly.
Communicate with physicians, nutritionists, and other healthcare professionals to ensure comprehensive care.
Correct Answer : A,B,D,E
Choice A rationale:
Assessing the degree of dehydration based on clinical signs and symptoms is a fundamental step in managing a dehydrated child.
This assessment guides the choice of appropriate treatment and fluid replacement.
Choice B rationale:
Calculating the fluid deficit based on the degree of dehydration is crucial in determining the amount of fluid that needs to be replaced accurately.
This calculation helps prevent under or overhydration.
Choice D rationale:
Monitoring the child's response to treatment and adjusting the plan accordingly is essential.
Dehydration management is an ongoing process, and adjustments may be necessary based on how the child is progressing.
Choice E rationale:
Communication with physicians, nutritionists, and other healthcare professionals is vital for comprehensive care.
Dehydration management often involves a multidisciplinary approach to address the child's overall health and nutritional needs.
Selecting all of these options (A, B, D, and E) ensures a comprehensive approach to managing dehydration in a child.
It involves assessment, calculation, monitoring, and collaboration with healthcare professionals for the best outcome.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
“This fluid will help to increase your sodium levels which are currently too low.”.
The nurse should explain to the client that they are receiving Normal Saline (0.9% NaCl) to increase their sodium levels.
This is The correct choice because Normal Saline is a hypertonic solution containing 154 mEq/L of sodium and 154 mEq/L of chloride.
It is used in cases of hyponatremia to raise sodium levels.
Sodium is an essential electrolyte, and low levels can lead to symptoms such as weakness, confusion, and muscle cramps.
Choice B rationale:
“This fluid will help to decrease your sodium levels which are currently too high.”.
Normal Saline is a hypertonic solution that would not be used to lower sodium levels, as it would have the opposite effect and further elevate sodium levels.
Choice C rationale:
“This fluid will help to increase your potassium levels which are currently too low.”.
It is not used to increase potassium levels, and potassium replacement would require a different solution, such as potassium chloride.
Choice D rationale:
“This fluid will help to decrease your potassium levels which are currently too high.”.
Normal Saline does not address high potassium levels; it is used to address hyponatremia and dehydration by increasing sodium levels.
Correct Answer is ["A","B","C"]
Explanation
Choice A rationale:
Gastrointestinal illnesses, including diarrhea and vomiting, lead to fluid loss, significantly contributing to dehydration in children.
Diarrhea increases water and electrolyte loss from the body, while vomiting leads to rapid fluid depletion.
These conditions can be severe, especially in infants and young children, making them prone to dehydration.
Choice B rationale:
Excessive sweating during physical activity or in hot weather can result in significant fluid loss.
Children, especially when engaged in vigorous activities, can sweat profusely, leading to dehydration, especially if fluid intake does not match the loss.
Monitoring fluid balance is crucial during such situations to prevent dehydration-related complications.
Choice C rationale:
Insufficient fluid intake due to poor feeding or decreased thirst perception can lead to dehydration, especially in infants and young children who rely heavily on fluid intake for their hydration needs.
Children may not recognize their thirst or may refuse to drink due to illness, leading to decreased fluid intake.
This can result in dehydration, emphasizing the importance of assessing feeding habits and fluid intake patterns.
Choice D rationale:
Sunken eyes and fontanelle in infants are physical signs of dehydration, not etiological factors.
Sunken eyes are due to decreased tissue turgor, indicating dehydration.
Fontanelle, the soft spot on an infant's head, can appear sunken in dehydration.
These signs are crucial in assessing the severity of dehydration during physical examination but do not contribute to the causes of dehydration.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.