While caring for four different pediatric clients, which child is at the highest risk for dehydration?

Correct Answer: D

Rationale: In this scenario, the 18-month-old child with tachypnea (rapid breathing) is at the highest risk for dehydration. Tachypnea can lead to increased respiratory rate, which can result in excessive loss of fluids through respiration, potentially causing dehydration. Option A, a 7-year-old child with migraine headaches, is less likely to be at high risk for dehydration unless vomiting is a significant symptom. Option B, a 4-year-old child with a broken arm, is not directly related to dehydration risk unless there are complicating factors like prolonged immobilization. Option C, a 2-year-old child with cellulitis of the left leg, might have localized infection but not necessarily higher dehydration risk unless it leads to systemic symptoms like fever and poor intake. In a pediatric nursing context, understanding the signs and symptoms of dehydration in children is crucial for appropriate assessment and intervention. It is essential to recognize high-risk factors like tachypnea in infants and young children, as they are more vulnerable to fluid imbalances due to their smaller body size and higher metabolic rate. Early identification and management of dehydration are vital in pediatric care to prevent complications and promote optimal health outcomes.

Correct Answer: A

Rationale: Furosemide (Lasix) is a loop diuretic that acts on the ascending loop of Henle in the kidney to increase calcium excretion. In the setting of hypercalcemia, where there is an elevated level of calcium in the blood, Furosemide can help promote the elimination of excess calcium through the urine, thereby aiding in the management of hypercalcemia.

Correct Answer: D

Rationale: In pediatric nursing, assessing infants at risk for dehydration requires a comprehensive approach to prioritize care effectively. The correct answer, D) Daily weight, is crucial because infants are more vulnerable to fluid imbalances due to their small size and rapid metabolic rate. Daily weight monitoring in infants can provide early indications of fluid loss or gain, helping to guide timely interventions. Option A) Urine output is important in assessing hydration status, but in infants, it can be variable and may not provide a reliable indicator of dehydration, especially in cases of insensible water loss. Urine specific gravity, option B), is also a useful indicator but may not be as practical or sensitive in infants compared to adults. While vital signs, option C), are important in assessing overall health, they may not be as specific indicators of dehydration in infants as changes can be subtle and easily missed. Daily weight monitoring is a more direct and reliable method to detect changes in fluid status in infants. In an educational context, understanding the rationale behind prioritizing daily weight assessment in dehydrated infants is crucial for pediatric nurses to provide safe and effective care. By emphasizing the significance of daily weight monitoring, nurses can proactively identify and manage dehydration in infants, ultimately improving patient outcomes and safety.

Correct Answer: B

Rationale: Angiotensin II is the most potent compound in the renin-angiotensin-aldosterone system for raising blood pressure. It acts as a powerful vasoconstrictor, leading to increased systemic vascular resistance. Angiotensin II is formed from angiotensin I through the action of the angiotensin-converting enzyme. While renin initiates the cascade by converting angiotensinogen to angiotensin I, it is angiotensin II that exerts the strongest pressor effect.

Correct Answer: C

Rationale: In the management of heart failure, the preferred diuretic due to its demonstrated significant mortality reduction in patients with heart failure is Spironolactone (Aldactone). Spironolactone is a potassium-sparing diuretic that not only helps in reducing fluid overload but also exerts additional benefits through its aldosterone antagonistic effects. By blocking aldosterone receptors, Spironolactone helps in reducing myocardial fibrosis and remodeling, leading to improved outcomes in heart failure patients. The other options listed are not preferred for significant mortality reduction in heart failure: A) Furosemide (Lasix): While Furosemide is commonly used to manage fluid overload in heart failure, it does not offer the same mortality benefits as Spironolactone. B) Hydrochlorothiazide (HydroDIURIL): Hydrochlorothiazide is a thiazide diuretic that is not typically used for the management of heart failure. It is more commonly used for hypertension and edema due to other causes. D) Mannitol (Osmitrol): Mannitol is an osmotic diuretic that is not commonly used in the management of heart failure. It is more often used for conditions such as cerebral edema or acute kidney injury. In pediatric nursing practice, understanding the rationale behind choosing specific medications for conditions like heart failure is crucial for providing safe and effective care to pediatric patients. It is essential to be aware of the pharmacological properties of diuretics and their impact on pediatric patients with heart failure to optimize treatment outcomes and minimize adverse effects.