A child with diabetes is brought to the emergency department. He is flushed and drowsy, and his skin is dry. His father states that the child has been feeling progressively worse since the morning. What is this child most likely experiencing?
Ketoacidosis
Somogyi phenomenon
Water intoxication
Dawn phenomenon
The Correct Answer is A
Choice A reason: Diabetic ketoacidosis (DKA) presents with flushing, drowsiness, and dry skin due to severe hyperglycemia, ketosis, and dehydration from osmotic diuresis. In children, insulin deficiency increases glucose and ketone production, causing metabolic acidosis and lethargy. DKA is life-threatening, requiring urgent insulin and fluid therapy to correct metabolic imbalances and prevent coma.
Choice B reason: The Somogyi phenomenon involves rebound hyperglycemia after nocturnal hypoglycemia, typically causing morning symptoms like sweating or shakiness, not flushing or drowsiness. Dry skin and progressive worsening suggest sustained hyperglycemia, as in DKA, not a transient rebound, making this an incorrect diagnosis for the child’s acute presentation.
Choice C reason: Water intoxication results from excessive water intake, causing hyponatremia, seizures, or confusion, not flushing or dry skin. The child’s symptoms indicate hyperglycemia and dehydration, consistent with DKA, not water overload. This condition is unrelated to diabetes pathophysiology, making it an incorrect explanation for the clinical presentation.
Choice D reason: The Dawn phenomenon involves morning hyperglycemia due to nocturnal growth hormone surges, not flushing, drowsiness, or dry skin. These symptoms suggest severe metabolic decompensation, as in DKA, with dehydration and acidosis. The Dawn phenomenon is less acute and does not match the child’s progressive deterioration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["3.8"]
Explanation
Step 1 is to convert pounds to kilograms: (22 ÷ 2.2) = 10 Result = 10 kg
Step 2 is to calculate the total daily dose in mg: 10 × 1.5 = 15 Result = 15 mg/day
Step 3 is to determine the number of doses per day when given every 6 hours: 24 ÷ 6 = 4 Result = 4 doses/day
Step 4 is to divide the total daily dose by number of doses: 15 ÷ 4 = 3.75 Result = 3.75 mg per dose
Step 5 is to calculate volume in mL: (3.75 ÷ 1) = 3.75 Result = 3.75 mL
Step 6 is to round to the nearest tenth: 3.75 rounds to 3.8
Correct Answer is C
Explanation
Choice A reason: Droplet precautions are used for diseases like influenza, spread by large respiratory droplets over short distances. Varicella is transmitted via airborne particles and direct contact, requiring airborne precautions with negative pressure rooms to prevent viral spread, making droplet precautions insufficient for this highly contagious infection.
Choice B reason: Indirect transmission precautions are not a standard category; contact precautions address indirect spread via fomites. Varicella spreads primarily through airborne routes and direct contact, requiring airborne precautions with specialized ventilation. This option is incorrect, as it does not fully address varicella’s transmission modes in a hospital setting.
Choice C reason: Varicella (chickenpox) is highly contagious, spread via airborne viral particles and direct contact. Airborne precautions, including negative pressure rooms and N95 masks, prevent inhalation of infectious aerosols. This is essential in hospitals to protect patients and staff, making it the correct precaution for a child with active varicella.
Choice D reason: Contact precautions address direct or fomite transmission, as in MRSA. Varicella requires airborne precautions due to its primary spread via respiratory aerosols. While contact precautions are relevant, they are insufficient alone, as airborne transmission is the dominant mode, making this an incomplete precaution for varicella.
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