Nokea
The school nurse practitioner is consulted by a fifth-grade teacher about a student who has become increasingly inattentive and hyperactive in the classroom. The nurse notes that the childs weight has changed from the 50th percentile to the 30th percentile. The nurse is concerned about possible hyperthyroidism. What additional sign or symptom should the nurse anticipate?
- A. Skin that is cool and dry
- B. Blurred vision and loss of acuity
- C. Running and being active during recess
- D. Decreased appetite and food intake
Correct Answer: B
Rationale: Blurred vision and loss of acuity are early signs of hyperthyroidism, alongside hyperactivity and weight loss. Skin is typically warm and moist, activity during recess is expected, and appetite increases despite weight loss in hyperthyroidism.
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The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI). What intervention should be included?
- A. Encourage the child to wear medical identification.
- B. Discuss with the child and family ways to limit fluid intake.
- C. Teach the child and family how to do required urine testing.
- D. Reassure the child and family that this is usually not a chronic or life-threatening illness.
Correct Answer: A
Rationale: Medical identification is critical for DI, a potentially life-threatening condition requiring free access to fluids. Fluid restriction worsens dehydration, urine testing isn?t routine, and DI is chronic, requiring lifelong vasopressin.
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.
What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency?
- A. Type 1 diabetes
- B. Type 2 diabetes
- C. Gestational diabetes
- D. Maturity-onset diabetes of the young (MODY)
Correct Answer: A
Rationale: Type 1 diabetes results from autoimmune destruction of pancreatic beta cells, causing absolute insulin deficiency. Type 2 involves insulin resistance, gestational diabetes is temporary, and MODY is a genetic defect in beta cell function without destruction.
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.
A child with hyperthyroidism (Graves disease) is receiving propylthiouracil. The parents and child should be taught to recognize and report which sign or symptom immediately?
- A. Fatigue
- B. Weight loss
- C. Fever, sore throat
- D. Upper respiratory tract infection
Correct Answer: C
Rationale: Fever and sore throat may indicate leukopenia, a serious side effect of propylthiouracil, requiring immediate reporting. Fatigue and weight loss are symptoms of hyperthyroidism, not drug complications, and upper respiratory infections are typically viral, not urgent.