Nokea
A 20-kg (44-lb) child in ketoacidosis is admitted to the pediatric intensive care unit. What order should the nurse not implement until clarified with the physician?
- A. Weigh on admission and daily.
- B. Replace fluid volume deficit over 48 hours.
- C. Begin intravenous line with D5 0.45% normal saline with 20 mEq of potassium chloride.
- D. Give intravenous regular insulin 2 units/kg/hr after initial rehydration bolus.
Correct Answer: C
Rationale: D5 0.45% normal saline with potassium should be clarified, as initial rehydration in DKA uses 0.9% saline, and potassium is delayed until renal function is confirmed (urine output ?25 ml/hr). Daily weights, 48-hour fluid replacement, and insulin dosing are appropriate.
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A goiter is an enlargement or hypertrophy of which gland?
- A. Thyroid
- B. Adrenal
- C. Anterior pituitary
- D. Posterior pituitary
Correct Answer: A
Rationale: A goiter is an enlargement of the thyroid gland, often due to iodine deficiency or thyroid dysfunction. It is not associated with adrenal, anterior, or posterior pituitary glands.
What is a common clinical manifestation of juvenile hypothyroidism?
- A. Insomnia
- B. Diarrhea
- C. Dry skin
- D. Rapid growth
Correct Answer: C
Rationale: Dry skin is a hallmark of juvenile hypothyroidism, along with mental decline and myxedema. Hypothyroidism causes sleepiness, constipation, and slowed growth, not insomnia, diarrhea, or rapid growth.
A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered?
- A. At bedtime
- B. After meals
- C. Before meals
- D. After arising in morning
Correct Answer: A
Rationale: Administering GH at bedtime mimics the body?s natural nocturnal GH release, optimizing effectiveness. Timing after meals, before meals, or in the morning does not align with physiologic patterns.
A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention?
- A. Sports drink and fruit
- B. Glucose tabs and protein
- C. Glass of water and crackers
- D. Milk and peanut butter on bread
Correct Answer: D
Rationale: After rapid-releasing sugar for hypoglycemia, milk (with lactose and protein) and peanut butter on bread (complex carbohydrate and protein) provide sustained glucose stabilization. Sports drinks and fruit lack protein, glucose tabs are rapid-acting, and crackers with water lack sufficient protein.
What blood glucose measurement is most likely associated with diabetic ketoacidosis?
- A. 185 mg/dl
- B. 220 mg/dl
- C. 280 mg/dl
- D. 330 mg/dl
Correct Answer: D
Rationale: Diabetic ketoacidosis (DKA) typically involves blood glucose levels ?330 mg/dl, reflecting severe insulin deficiency. Levels of 185, 220, and 280 mg/dl are hyperglycemic but below the threshold commonly associated with DKA.