An 18-month-old is brought to the emergency department with severe dehydration and weight loss secondary to acute diarrhea and vomiting. The nurse knows that therapeutic management of this child will begin with:
Administration of an anti-diarrheal
Clear liquids, 1 to 2 ounces at a time
Oral rehydration solution (ORS)
Intravenous fluids
The Correct Answer is C
Choice A reason: Administration of an anti-diarrheal is not the appropriate management for an 18-month-old with severe dehydration and weight loss secondary to acute diarrhea and vomiting. Anti-diarrheals are not recommended for children under 5 years, as they can have serious side effects, such as paralytic ileus, toxic megacolon, and worsening of dehydration. Anti-diarrheals do not address the underlying cause of diarrhea, and may prolong the duration of infection or toxin exposure.
Choice B reason: Clear liquids, 1 to 2 ounces at a time, are not sufficient to treat an 18-month-old with severe dehydration and weight loss secondary to acute diarrhea and vomiting. Clear liquids, such as water, tea, or broth, do not contain enough electrolytes, such as sodium, potassium, and bicarbonate, to replace the losses from diarrhea and vomiting. Clear liquids may also dilute the blood sodium level and cause hyponatremia, a condition of low sodium in the blood, which can lead to seizures, coma, and death.
Choice C reason: Oral rehydration solution (ORS) is the best management for an 18-month-old with severe dehydration and weight loss secondary to acute diarrhea and vomiting. ORS is a specially formulated solution that contains water, glucose, and electrolytes in the right proportions to replenish the fluid and electrolyte losses from diarrhea and vomiting. ORS can prevent or treat dehydration, and reduce the need for intravenous fluids. ORS can be given by mouth, spoon, cup, or syringe, depending on the child's ability to drink. The amount of ORS to give depends on the degree of dehydration and the weight of the child. The nurse should follow the guidelines from the World Health Organization (WHO) or the local health authority for the appropriate dosage and frequency of ORS administration¹.
Choice D reason: Intravenous fluids are not the first-line management for an 18-month-old with severe dehydration and weight loss secondary to acute diarrhea and vomiting. Intravenous fluids are only indicated for children who have severe dehydration and are unable to drink or tolerate ORS, or who have signs of shock, such as weak pulse, cold extremities, or altered consciousness. Intravenous fluids require hospitalization, skilled personnel, and sterile equipment, and carry the risk of infection, overhydration, or electrolyte imbalance. Intravenous fluids should be given according to the WHO or the local health authority guidelines, and should be switched to ORS as soon as the child is able to drink¹.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Lispro (Humalog) is a type of insulin that is used for mealtime coverage. It is a rapid-acting insulin that starts to work within 15 minutes, peaks in about an hour, and lasts for 2 to 4 hours. It mimics the natural insulin response to food intake, and helps to lower the blood glucose level after meals. The nurse will discuss using lispro for mealtime coverage, and instruct the patient to inject it within 15 minutes before or after eating.
Choice B reason: NPH (Humulin N) is a type of insulin that is not used for mealtime coverage. It is an intermediate-acting insulin that starts to work within 2 to 4 hours, peaks in 4 to 12 hours, and lasts for 12 to 18 hours. It provides a steady background of insulin throughout the day, and helps to control the blood glucose level between meals and overnight. The nurse will discuss using NPH for basal coverage, and instruct the patient to inject it once or twice a day, usually in the morning and/or evening.
Choice C reason: Detemir (Levemir) is a type of insulin that is not used for mealtime coverage. It is a long-acting insulin that starts to work within 1 to 2 hours, has no peak, and lasts for up to 24 hours. It provides a constant level of insulin throughout the day, and helps to maintain the blood glucose level at a stable range. The nurse will discuss using detemir for basal coverage, and instruct the patient to inject it once or twice a day, depending on the individual needs.
Choice D reason: Glargine (Lantus) is a type of insulin that is not used for mealtime coverage. It is a long-acting insulin that starts to work within 1 to 2 hours, has no peak, and lasts for up to 24 hours. It provides a constant level of insulin throughout the day, and helps to maintain the blood glucose level at a stable range. The nurse will discuss using glargine for basal coverage, and instruct the patient to inject it once a day, usually at the same time every day.
Correct Answer is A
Explanation
Choice A reason: This statement is true. Fluid volume deficit, or hypovolemia, is a condition where the body loses more fluid than it gains. It can be caused by fluid loss from vomiting, diarrhea, bleeding, or excessive sweating. Fluid volume deficit can lead to dehydration, hypotension, tachycardia, and shock.
Choice B reason: This statement is false. Sodium imbalance, or dysnatremia, is a condition where the blood sodium level is either too high or too low. It can be caused by fluid imbalance, kidney disease, hormonal disorders, or medications. Sodium imbalance can affect the brain function, causing confusion, seizures, or coma.
Choice C reason: This statement is false. Potassium imbalance, or dyskalemia, is a condition where the blood potassium level is either too high or too low. It can be caused by kidney disease, acid-base disorders, medications, or dietary intake. Potassium imbalance can affect the heart function, causing arrhythmias, cardiac arrest, or death.
Choice D reason: This statement is false. Fluid volume excess, or hypervolemia, is a condition where the body gains more fluid than it loses. It can be caused by fluid overload, heart failure, kidney failure, or liver disease. Fluid volume excess can lead to edema, hypertension, dyspnea, and pulmonary congestion.
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