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 C
Explanation
Rationale:
A. "I will give him his ADHD medication with his meals": Stimulant medications for ADHD can sometimes cause gastrointestinal upset, and giving them with food may help minimize this side effect.
B. "I will take my child to the physician every three months for a weight and height check.": Regular monitoring of growth is essential because stimulant medications can decrease appetite and potentially slow growth. A three-month interval is an appropriate follow-up.
C. "I will let him do his homework while he is watching his favorite television show.": Children with ADHD are easily distracted, and doing homework while watching television can make it harder to focus and complete tasks. A quiet, structured environment without competing stimuli supports better concentration and academic performance.
D. "I will stick to the same routine each day after school.": Consistent daily routines help children with ADHD feel secure and maintain focus. Predictable schedules reduce anxiety and behavioral outbursts, while also helping the child manage transitions more effectively.
Correct Answer is A
Explanation
Rationale:
A. Bounding pulses, heart failure within weeks, activity intolerance: Truncus arteriosus involves a single large vessel overriding both ventricles. This results in increased pulmonary blood flow, leading to early-onset heart failure. Bounding pulses occur from wide pulse pressure, and activity intolerance is related to poor oxygen delivery to tissues during exertion.
B. Cracked lips, joint pain, thrombocytosis: These symptoms are more consistent with Kawasaki disease, rather than a congenital heart defect like truncus arteriosus. Kawasaki disease often presents with mucocutaneous changes, arthritis, and elevated platelet counts.
C. High upper extremity blood pressure (BP), weak distal pulses: This is more indicative of coarctation of the aorta, where narrowing of the aorta leads to hypertension in the upper extremities and diminished pulses in the lower extremities. It is not characteristic of truncus arteriosus.
D. Squatting, irritability, peri-oral cyanosis: These symptoms are typical of Tetralogy of Fallot. Squatting helps increase systemic vascular resistance to reduce right-to-left shunting, and peri-oral cyanosis results from chronic hypoxemia, which is not the hallmark of truncus arteriosus.
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