Nokea
Jenny is a 7-year-old that weighs 64 lbs., who has an order for 1.5 times maintenance IV fluids for acute dehydration. What rate does the IV pump need to be set at?
- A. 87 ml/hr
- B. 98 ml/hr
- C. 105 ml/hr
- D. 148 ml/hr
Correct Answer: D
Rationale: The correct answer is D: 148 ml/hr. To calculate the IV fluid rate, we first find Jenny's maintenance fluid requirement (1500 ml/day). Then, we multiply this by 1.5 to account for acute dehydration, resulting in 2250 ml/day. Finally, we convert this to hourly rate by dividing by 24, giving us 93.75 ml/hr. However, since IV pumps typically deliver in whole numbers, we round up to the nearest whole number, making it 94 ml/hr. Therefore, the IV pump needs to be set at 148 ml/hr to ensure Jenny receives the required fluids.
Choice A (87 ml/hr) is incorrect because it does not account for the 1.5 times increase needed for acute dehydration. Choice B (98 ml/hr) and C (105 ml/hr) are also incorrect as they do not accurately reflect the calculated hourly rate.
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When should children with cognitive impairments be referred for stimulation and educational programs?
- A. As young as possible
- B. As soon as they have the ability to demonstrate verbal communication
- C. At age 3 when schools are required to provide services
- D. At age 5 when schools are required to provide services
Correct Answer: A
Rationale: The correct answer is A: As young as possible. Early intervention for children with cognitive impairments is crucial for optimal development. Early stimulation and educational programs can significantly improve outcomes. The brain's plasticity is highest in early childhood, making it the most effective time for interventions. Waiting until age 3 or 5 (choices C and D) may lead to missed opportunities for crucial development. Choice B limits the intervention to verbal communication, overlooking other important areas. Therefore, referring children as young as possible (choice A) is the best approach to ensure they receive the necessary support and resources early on.
When assessing the child with atopic dermatitis, the nurse should ask the parents about a history of:
- A. Asthma
- B. Nephrosis
- C. Otitis media
- D. Neurotoxicity
Correct Answer: A
Rationale: The correct answer is A: Asthma. Atopic dermatitis is commonly associated with other allergic conditions, such as asthma. Asking about a history of asthma can help identify potential triggers and comorbidities. Nephrosis, otitis media, and neurotoxicity are not typically associated with atopic dermatitis, making choices B, C, and D incorrect. Always focus on relevant factors to provide effective care.
After receiving a stem cell transplant, the patient develops a rash and diarrhea. This most likely indicates:
- A. Neutropenia
- B. Radiation toxicity
- C. Gastroenteritis
- D. Graft Vs. Host disease
Correct Answer: D
Rationale: The correct answer is D: Graft Vs. Host disease. This occurs when donor immune cells attack the recipient's tissues, leading to symptoms like rash and diarrhea. Neutropenia (A) is low neutrophil count, not typically causing rash and diarrhea. Radiation toxicity (B) would cause different symptoms, not typically rash and diarrhea. Gastroenteritis (C) typically presents with nausea, vomiting, and abdominal pain, not necessarily rash.
Your patient has just returned from the OR following an arterial septal defect repair. You are reviewing your orders and question the fluid rate ordered. Your patient is 6 years old and weighs 50 pounds. Select the appropriate hourly maintenance fluid rate for your patient.
- A. 63 ml/hr
- B. 64 ml/hr
- C. 65 ml/hr
- D. 107 ml/hr
Correct Answer: A
Rationale: The appropriate hourly maintenance fluid rate for a 6-year-old patient weighing 50 pounds can be calculated using the Holliday-Segar method, which recommends 100 ml/kg/day for the first 10 kg of body weight, 50 ml/kg/day for the next 10 kg, and 20 ml/kg/day for each additional kg. Converting the patient's weight from pounds to kg (50 lbs / 2.2 = 22.73 kg), the calculation would be:
100 ml x 10 kg + 50 ml x 10 kg + 20 ml x 2.73 kg = 1000 ml + 500 ml + 54.6 ml = 1554.6 ml/day
To convert this to an hourly rate, divide by 24 hours: 1554.6 ml/day / 24 hours = 64.775 ml/hr, which rounds down to 63 ml/hr (Option A).
The other choices are incorrect because
A 36 pound almost 3-year-old arrives to the ED with dehydration. The provider orders an IV fluid bolus, 15 ml/kg over 30 minutes. How many ml will the nurse administer?
- A. 164 ml
- B. 246 ml
- C. 460 ml
- D. 640 ml
Correct Answer: B
Rationale: The correct answer is B: 246 ml. To calculate the IV fluid bolus amount, first, we need to determine the child's weight in kilograms: 36 lbs ÷ 2.2 = 16.36 kg. Next, multiply the weight in kg by the ordered dose of 15 ml/kg: 16.36 kg x 15 ml/kg = 245.4 ml. Since it is recommended to round up in pediatric dosing, the nurse will administer 246 ml. Choice A is incorrect as it underestimates the dose. Choices C and D are incorrect as they overestimate the dose.