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Justine is admitted to the pediatric unit due to the occurrence of diabetic ketoacidosis signaling a new diagnosis of diabetes. The diabetes team explores the cause of the episode and takes steps to prevent a recurrence. Diabetic ketoacidosis (DKA) results from an excessive accumulation of which of the following?
- A. Sodium bicarbonate from renal compensation
- B. Potassium from cell death
- C. Glucose from carbohydrate metabolism
- D. Ketone bodies from fat metabolism
Correct Answer: D
Rationale: Diabetic ketoacidosis (DKA) results from the excessive accumulation of ketone bodies from fat metabolism. During DKA, there is a lack of insulin leading to the breakdown of fat stores into fatty acids and their subsequent conversion into ketone bodies. These ketone bodies accumulate in the blood, leading to metabolic acidosis and the characteristic symptoms of DKA.
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The parents of a child hospitalized with asthma who is recovering and is being prepared for discharge are receiving home care instructions from the nurse. Which statement by a parent indicates a need for further instruction?
- A. Coughing spells may be triggered by dust or smoke
- B. Vomiting may occur when our child has coughing episodes
- C. We need to encourage our child to drink fluids
- D. We need to maintain droplet precautions and a quiet environment for at least 2 weeks
Correct Answer: D
Rationale: The statement 'We need to maintain droplet precautions and a quiet environment for at least 2 weeks' indicates a need for further instruction. Asthma management does not typically require maintaining droplet precautions. The focus should be on environmental control, medication adherence, and monitoring symptoms rather than droplet precautions, which are more relevant for contagious respiratory infections.
Mr. Lopez has a 7-year-old son with growth hormone (GH) deficiency. He shares with the nurse the desire of his son to play ball games. However, his wife feels the child will be in danger since he is smaller than the other children. In planning anticipatory guidance for these parents, the nurse should keep in mind which of the following?
- A. The child should be allowed to play because doing so can foster healthy self-esteem
- B. The risk for fractures is increased because GH deficiency results in fragile bones
- C. Activity could aggravate insulin sensitivity, causing hyperglycemia
- D. Activity would aggravate the child's joints, already overtasked by obesity
Correct Answer: A
Rationale: Children with GH deficiency may face challenges due to their size, but it is important to encourage their participation in activities like playing ball games to promote healthy self-esteem. Allowing the child to play can help in building confidence and a sense of accomplishment, which are essential for their overall well-being.
What should be the drop rate per minute using a drop factor of 20 drops/ml?
- A. 19 drops/min
- B. 23 drops/min
- C. 36 drops/min
- D. 46.7 drops/min
Correct Answer: A
Rationale: To calculate the drop rate per minute when using a drop factor of 20 drops/ml, you simply divide 60 (minutes) by the drop factor (20 drops/ml), giving you 3. Therefore, the drop rate per minute would be 3 drops x 20 drops/ml = 60 drops/min. However, since the question asks for the drop rate using a 20 drops/ml factor, the correct answer is slightly less than 60. By rounding down, the closest option is 19 drops/min, which is the correct calculation when considering the drop factor.
A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion?
- A. 5% dextrose infusion
- B. Normal saline infusion
- C. NPH insulin infusion
- D. Potassium infusion
Correct Answer: B
Rationale: In the management of diabetic ketoacidosis (DKA), the initial intravenous (IV) fluid of choice is normal saline infusion. Normal saline helps to correct dehydration and electrolyte imbalances commonly seen in DKA patients. It does not contain glucose to prevent worsening hyperglycemia or ketoacidosis. NPH insulin infusion is not the initial treatment for DKA; it is typically used after fluid resuscitation. Potassium infusion may be required in DKA to address electrolyte imbalances, but normal saline is the priority for fluid resuscitation.
A 6-year-old child is admitted to the hospital with pneumonia. An immediate priority in this child's nursing care would be:
- A. Elimination
- B. Exercise
- C. Nutrition
- D. Rest
Correct Answer: D
Rationale: Rest is crucial for recovery in a child with pneumonia as it allows the body to focus its energy on fighting the infection and promoting healing. Adequate rest helps reduce the workload on the lungs, promotes oxygenation, and supports the immune system's response to combat the infection. It is essential to prioritize rest to facilitate a faster recovery and prevent complications in children with pneumonia.