What laboratory finding should the nurse expect in a child with an excess of water?

Correct Answer: A

Rationale: In a child with an excess of water, the nurse should expect a decreased hematocrit. This is because an excess of water dilutes the blood, leading to a lower concentration of red blood cells in the plasma, resulting in a decreased hematocrit level. Option A is correct because excess water intake can lead to hemodilution, causing a decrease in hematocrit levels. This is a direct physiological response to increased water in the body. Option B, high serum osmolality, would be seen in conditions of dehydration or when there is a deficit of water in the body, not in a child with an excess of water. Option C, high urine specific gravity, is also seen in dehydration when the body tries to conserve water. In a child with an excess of water, the urine specific gravity would be low due to the high volume of dilute urine being produced. Option D, increased blood urea nitrogen (BUN), typically indicates dehydration or impaired kidney function, not an excess of water. Understanding these laboratory findings in relation to fluid balance is crucial in pediatric nursing care to assess and manage children's hydration status accurately. Nurses must be able to interpret these results to provide appropriate interventions and ensure optimal patient outcomes.

Correct Answer: B

Rationale: In this question from the ATI RN Nursing Care of Children exam, the correct answer is B) Hypotonic dehydration. Hypotonic dehydration occurs when the electrolyte deficit exceeds the water deficit. In this type of dehydration, there is a greater loss of electrolytes compared to water, leading to an imbalance where the concentration of solutes outside the cell is lower than inside the cell. This can result in cellular swelling and potentially dangerous shifts in fluid balance. Option A) Isotonic dehydration is incorrect because in isotonic dehydration, there is an equal loss of water and electrolytes, maintaining a balance in solute concentration inside and outside the cell. Option C) Hypertonic dehydration is also incorrect as it occurs when there is a greater loss of water compared to electrolytes, leading to an increased concentration of solutes outside the cell, causing cells to shrink. Option D) Hyperosmotic dehydration is not a recognized term in dehydration classification and is not a valid option in this context. Understanding the different types of dehydration is crucial for nurses caring for children, as dehydration is a common issue in pediatric patients, especially in cases of vomiting, diarrhea, or inadequate fluid intake. Recognizing the type of dehydration is essential for providing appropriate treatment and preventing complications. Nurses must be able to assess electrolyte imbalances and fluid status accurately to intervene effectively in pediatric dehydration cases.

Correct Answer: B

Rationale: In pediatric nursing, understanding the amount of fluid loss associated with dehydration is crucial for providing safe and effective care to children. In this case, the correct answer is B) 50 to 90 ml/kg for moderate dehydration. This range is considered appropriate for moderate dehydration because it signifies a more significant fluid deficit than mild dehydration but is not as severe as the fluid loss seen in severe dehydration. Children with moderate dehydration may exhibit symptoms such as decreased urine output, dry mucous membranes, and increased heart rate. Option A) <50 ml/kg is incorrect because this amount would typically indicate mild dehydration, where symptoms are usually less pronounced and the fluid deficit is lower. Option C) <5% total body weight is incorrect because it does not provide a specific measurement in terms of fluid loss, making it less precise and not commonly used in clinical practice to assess dehydration. Option D) >15% total body weight is incorrect as it represents severe dehydration, which is characterized by critical fluid loss and poses immediate life-threatening risks to the child if not promptly addressed. Educationally, understanding the different degrees of dehydration and their corresponding fluid loss amounts is essential for nurses caring for children. This knowledge helps in recognizing and managing dehydration promptly to prevent complications and ensure optimal patient outcomes.

Correct Answer: C

Rationale: In pediatric patients, compensating for fluid volume losses involves shifting fluid from the interstitial space to the intravascular space. This mechanism helps to maintain blood volume and perfusion to vital organs. Option A, inhibition of aldosterone secretion, is incorrect because aldosterone is typically released to retain sodium and water, not to compensate for fluid losses. Option B, hemoconcentration to reduce cardiac workload, is incorrect because hemoconcentration actually occurs as a result of fluid volume depletion, not as a compensatory mechanism. Option D, vasodilation of peripheral arterioles to increase perfusion, is incorrect because vasodilation typically occurs in response to factors like decreased oxygen levels, not specifically to compensate for fluid volume losses. Educationally, understanding how children compensate for fluid volume losses is crucial in pediatric nursing care to assess and manage fluid imbalances effectively. Teaching this concept helps nurses provide optimal care to pediatric patients with fluid volume issues.

Correct Answer: A

Rationale: In pediatric nursing, understanding the early signs of shock is crucial for timely intervention to prevent further deterioration in a child's condition. In this scenario, the correct answer is A) Tachycardia. Tachycardia, or an increased heart rate, is an early compensatory mechanism the body employs to maintain perfusion to vital organs in response to ongoing fluid losses. It is a key indicator that the child's body is attempting to compensate for decreased circulating volume. Option B) Slow respirations are not typically an early sign of shock in children. Respiratory rate may increase as the body tries to compensate for decreased oxygen delivery, rather than slow down. Option C) Warm, flushed skin may be present in early stages of shock due to peripheral vasodilation, but it is not the most sensitive indicator as it can vary depending on the stage of shock and individual responses. Option D) Decreased blood pressure is a late sign of shock in children. By the time blood pressure drops, the child is usually in a more advanced stage of shock, making it a less sensitive indicator compared to tachycardia. Educationally, understanding these nuanced clinical signs of shock in pediatric patients is vital for nurses to recognize early warning signs, initiate appropriate interventions promptly, and prevent progression to severe shock. Regular review and practice of such scenarios help nurses build clinical judgment skills essential for providing safe and effective care to children in various healthcare settings.