The nurse is seeing an 5 year-old patient referred to the ED by the pediatrician. The patient presents with 3 weeks of polyuria, polydipsia, and polyphagia and 2 months of weight loss. The patient is currently awake and oriented with vital signs WNL The patient is complaining of 4/10 abdominal pain but asks the nurse if he can have a snack and something to drink
The Correct Answer is []
Rationale for Correct Choices:
• Administer ordered NS bolus: Children with suspected new-onset diabetes mellitus and possible diabetic ketoacidosis require isotonic fluid resuscitation to restore intravascular volume and improve tissue perfusion. Early fluid replacement helps correct dehydration and supports renal clearance of glucose and ketones.
• Obtain a POC glucose: Rapid bedside glucose testing confirms hyperglycemia, guiding immediate treatment decisions and helping distinguish diabetes mellitus from other conditions with similar symptoms.
• Diabetes Mellitus: The classic presentation of polyuria, polydipsia, polyphagia, and weight loss in a child strongly suggests new-onset type 1 diabetes mellitus, likely progressing toward DKA if untreated.
• Blood glucose: Frequent blood glucose monitoring is essential to assess severity, guide insulin therapy, and prevent hypoglycemia during treatment.
• Ketones: Monitoring ketones in urine or blood identifies ketoacidosis, a potentially life-threatening complication of untreated diabetes mellitus that requires urgent management.
Rationale for Incorrect Choices:
• Administer potassium : Potassium is not given before confirming the serum potassium level and ensuring adequate urine output. Giving potassium without lab verification can cause dangerous hyperkalemia, especially if renal function is impaired.
• Order the patient lunch from the cafeteria: Food intake is not prioritized before diagnosis and stabilization, as carbohydrate ingestion could worsen hyperglycemia and acidosis until insulin therapy is initiated.
• Hyperthyroidism : Although hyperthyroidism can cause weight loss and increased appetite, it typically does not cause polyuria or polydipsia, making it less likely in this presentation.
• Diabetes Insipidus: This condition causes polyuria and polydipsia due to ADH deficiency or resistance but is not associated with polyphagia or weight loss from catabolism.
• Anorexiav: Anorexia nervosa involves reduced food intake and weight loss but does not cause the triad of polyuria, polydipsia, and polyphagia, which are hallmarks of hyperglycemia.
• Hemoglobin A1C: While useful for assessing long-term glucose control, A1C is not a priority in the acute setting when rapid stabilization is needed.
• Check the patient’s weight Q12: Frequent weight monitoring is more relevant for long-term nutritional assessment rather than immediate stabilization in acute hyperglycemia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. Folic acid: Adequate folic acid intake before conception and during early pregnancy significantly reduces the risk of neural tube defects such as spina bifida and anencephaly. The recommended daily intake for women of childbearing age is generally 400–800 mcg, starting at least one month before pregnancy and continuing through the first trimester.
B. Vitamin D: Vitamin D is important for fetal skeletal development and maternal bone health, but it does not have a direct role in preventing neural tube defects. Deficiency may cause rickets in infants, but it is not associated with closure of the neural tube.
C. Iron: Iron supplementation is essential to prevent maternal anemia and to support fetal growth and development. However, iron does not influence the formation of the neural tube and thus does not reduce the risk of defects like spina bifida.
D. Calcium: Calcium supports fetal bone and teeth development and helps maintain maternal bone stores. While it is important in pregnancy, it is not connected to prevention of neural tube defects.
Correct Answer is A
Explanation
Rationale:
A. Acute Lymphoblastic Leukemia (ALL): ALL is the most common pediatric cancer, typically affecting children between the ages of 2 and 5. Clinical signs include pallor, fatigue, petechiae, recurrent fevers, and bone marrow suppression. A CBC often shows elevated WBCs with a predominance of immature lymphoblasts on a peripheral smear.
B. Hodgkin's Lymphoma: This cancer usually presents in older children and adolescents, often with painless cervical lymphadenopathy, night sweats, fever, and weight loss. It does not typically present with massive lymphoblast proliferation in peripheral blood, as seen in this case.
C. Acute Myelogenous Leukemia (AML): AML is more common in adults but can occur in children. It presents with similar symptoms of bone marrow failure but is characterized by myeloblasts rather than lymphoblasts on the blood smear.
D. Non-Hodgkin's Lymphoma: Pediatric non-Hodgkin's lymphoma often presents with rapidly enlarging lymph nodes, mediastinal mass, or abdominal symptoms. It is not primarily a bone marrow disease and would not typically show high lymphoblast counts in the peripheral blood.
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