Phase 1
A 5 year old is brought to her pediatrician for an annual routine checkup. Her grandparents, who are also the legal guardians, are with her. The child has not seen her pediatrician in a year. The child recently had a visit to the urgent care center and was treated for strep throat. The grandparents are concerned about the child’s weight gain. They state no matter how much she eats she cannot gain weight and is hungry all of the time.
Highlight the conditions requiring immediate follow-up in the “follow-up” category.
Assessment:
Weight:15.9 kg
Height: 41 in
Heart rate: 122 beats per minute
Blood pressure: 96/44
Child is anxious, looks thin, and has dry lips and dry mucous membranes. Upon neck palpation the child has several enlarged cervical lymph nodes and has a “sweet odor to her breath, The remainder of the examination is within normal limits.
Weight:15.9 kg
Height: 41 in
Blood pressure: 96/44
anxious
looks thin
has dry lips and dry mucous membranes
Heart rate: 122 beats per minute
several enlarged cervical lymph nodes
sweet odor to her breath
The Correct Answer is ["A","C","D","E","F","H","I"]
Dry lips and mucous membranes can indicate dehydration, which is common in children with diabetes mellitus type 1 (DM1) due to hyperglycemia. Dehydration in DM1 often results from osmotic diuresis, where excess glucose in the urine draws water out of the body, causing significant fluid loss. Immediate follow-up is needed to assess hydration status and possible management of the child's glucose levels and fluid intake.
The presence of enlarged lymph nodes can suggest an underlying infection or immune response. Although lymphadenopathy is commonly associated with infections, it is also important to investigate whether this could be related to diabetic ketoacidosis (DKA), as children with untreated or poorly controlled diabetes can be more prone to infections. This warrants follow-up for possible infection or other causes of lymphadenopathy.
Unexplained weight loss and an appearance of being thin, despite increased appetite (polyphagia), can be an early sign of diabetes type 1. The body begins breaking down fat and muscle tissue for energy when it cannot use glucose properly due to a lack of insulin. Immediate follow-up is necessary to assess blood glucose levels and determine if the child has undiagnosed diabetes.
A fruity or "sweet" odor on the breath, often described as similar to acetone, is a hallmark sign of diabetic ketoacidosis (DKA), a serious and potentially life-threatening complication of uncontrolled diabetes. This requires immediate follow-up as it indicates that the body is burning fat for fuel due to a lack of insulin, resulting in the production of ketones, which are excreted through the breath.
Anxiety can be associated with an underlying medical condition such as diabetes mellitus. Children with uncontrolled diabetes may feel anxious due to fluctuations in blood glucose levels or the physical symptoms associated with hyperglycemia or DKA. It’s important to address the cause of anxiety to ensure the child is receiving the appropriate treatment and emotional support.
A blood pressure of 96/44 mm Hg is on the lower side, and in the context of a child with suspected diabetes, this could suggest a state of dehydration or possible shock, especially if DKA is developing. Blood pressure changes must be followed up immediately to ensure appropriate treatment of dehydration or any circulatory compromise.
Weight: 15.9 kg: The child's weight (15.9 kg) in combination with the other symptoms (e.g., being thin, increased appetite) could indicate that the child is not gaining weight as expected, possibly due to undiagnosed type 1 diabetes. Immediate follow-up is required to assess growth patterns and consider possible conditions like diabetes that could affect normal weight gain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Skipping blood sugar checks could lead to undetected hypo- or hyperglycemia, so regular checks are essential.
B. Illness typically requires more insulin, not less, as the body is under stress.
C. Irritability, sweating, and shakiness are more likely signs of hypoglycemia, not hyperglycemia.
D. Thirst and stomach aches are common symptoms of hyperglycemia, so the child should check blood sugar when experiencing these signs.
Correct Answer is ["A","B","C","D","E","F","G"]
Explanation
Inability to stay latched to the breast is concerning because it reflects increased work of breathing or fatigue. Infants often show feeding difficulties as an early sign of respiratory compromise, and in this case, poor feeding may also contribute to dehydration and hypoglycemia.
Capillary refill greater than 4 seconds suggests delayed peripheral perfusion, which can indicate dehydration or early shock. This is a red flag in infants and requires prompt assessment of circulatory status.
Intermittent wheezing in both lungs is an abnormal breath sound typically associated with airway narrowing or obstruction, as seen in bronchiolitis or reactive airway disease. It requires close monitoring for worsening respiratory effort or decreased air exchange.
Heart rate of 178 beats per minute is elevated for a 10-week-old infant (normal is generally 100–160 bpm). This tachycardia may be a response to fever, hypoxia, respiratory distress, or dehydration, and should be evaluated in the context of other clinical signs.
Oxygen saturation of 92% on room air is below the expected range for a healthy infant (typically ≥95%). This indicates hypoxemia, and supplemental oxygen and further respiratory support may be necessary.
Respiratory rate of 65 breaths per minute exceeds the normal range for this age (30–60 breaths/min). Tachypnea can reflect respiratory distress and is especially concerning when paired with other abnormal findings.
Mild intercostal retractions are a sign that the infant is using accessory muscles to breathe, which indicates increased work of breathing. Even mild retractions in a young infant warrant close observation.
Restlessness and head bobbing are signs of significant respiratory distress. Head bobbing is particularly concerning as it indicates fatigue and the use of neck muscles to assist with breathing, which can precede respiratory failure.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.