mommabearroar peds metabolic
A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion?
Normal saline infusion Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. Hyperglycemia occurs with diabetic ketoacidosis. Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose level decreases to an acceptable level. Intravenously administered potassium may be required, depending on the potassium level, but would not be part of the initial treatment.
The nurse determines that an adolescent client with diabetes mellitus needs further teaching about A1c levels and their purpose if the client made which statement when told that a level will be drawn?
"I already had a complete blood cell count drawn an hour ago, so this test is not necessary."
The nurse is reinforcing instructions to an adolescent with type 1 diabetes mellitus regarding insulin administration and rotation sites. Which statement made by the adolescent would indicate an understanding of the instructions?
"I need to use one major site for the morning injection and another major site for the evening injection for 2 to 3 weeks before changing major sites."
The nursing instructor asks a nursing student about phenylketonuria (PKU). Which statement made by the student indicates a need for further teaching?
"PKU primarily affects the gastrointestinal system." PKU is a genetic disorder that results in central nervous system (CNS) damage from toxic levels of phenylalanine in the blood, not the gastrointestinal system. PKU is an autosomal-recessive disorder and treatment includes the dietary restriction of phenylalanine intake. All 50 states require screening newborns for PKU.
A child with diabetes mellitus is brought to the emergency department by her mother, who states that her daughter has been complaining of abdominal pain and has a fruity odor on the breath. Diabetic ketoacidosis (DKA) is diagnosed. The nurse assisting with care for the child checks the intravenous (IV) and medication supply area for what?
0.9% normal saline IV infusion
The nurse is reinforcing the teaching of parents of a diabetic child on the differences between type 1 and type 2 diabetes mellitus. Which statements by the parents indicate understanding of the teaching? Select all that apply.
1."The onset of diabetes is sudden with type 1." 3."Type 2 diabetes can often be managed with diet only." 5."Three symptoms of type 1 diabetes are polyuria, polydipsia and polyphagia."
The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL (3.4 mmol/L)? Select all that apply.
1.Give the child a teaspoon of honey. 2.Prepare to administer glucagon subcutaneously if unconsciousness occurs. 1. Hypoglycemia glucose , <70 mg/dL Glucose is administered orally immediately; rapid-releasing glucose followed by a complex carbohydrate and protein, such as a slice of bread or a peanut butter cracker. An extra snack given if next meal not for 30 minutes or if activity is planned. If the child becomes unconscious, cake frosting or glucose paste is squeezed onto the gums, and the blood glucose level is retested in 15 minutes; if the reading remains low, additional glucose is administered. If the child remains unconscious, administration of glucagon may be necessary, and the nurse should be prepared for this intervention.
A 10-year-old child in remission from leukemia is upset over the appearance of cushingoid characteristics from long-term use of corticosteroids that are currently being administered every other day. Which therapeutic statements should the nurse make to the child about the cushingoid appearance? Select all that apply.
2."Which manifestations of this condition do you find most troublesome?" 4."The signs/symptoms are lessened by taking the prednisone every other day instead of daily." 5."The cushingoid appearance will gradually disappear once the steroids are tapered and discontinued."
The nurse is reinforcing the teaching to parents of a diabetic child about the signs/symptoms of hypoglycemia. Which signs/symptoms should the nurse include when reinforcing the teaching? Select all that apply.
2.Sweating 4.Dizziness 5.Trembling Early signs are adrenergic, including sweating and trembling, which help raise the blood glucose level, similar to the reaction when an individual is startled or anxious. The second set of symptoms that follow an untreated adrenergic reaction is neuroglycopenic (also called brain hypoglycemia). These symptoms typically include difficulty with balance, memory, attention, or concentration; dizziness or lightheadedness; and slurred speech. Headache and fatigue are signs of hyperglycemia.
A licensed practical nurse (LPN) is assigned to assist in caring for a hospitalized child who is receiving a continuous infusion of intravenous (IV) potassium for the treatment of dehydration. The LPN monitors the child closely and notifies the registered nurse if which finding is noted?
A decrease in urine output to 0.5 mL/kg/hr The priority assessment is to monitor the status of urine output. Potassium should never be administered in the presence of oliguria or anuria. If urine output is less than 1 to 2 mL/kg/hr, potassium should not be administered.
The nurse is caring for an infant who has been diagnosed with primary hypothyroidism. The nurse is reviewing the results of the laboratory tests and should expect to note which finding?
An elevated thyroid-stimulating hormone (TSH) level Diagnostic findings in primary hypothyroidism include a low T4 level and a high TSH level.
The nurse is collecting data from a child with a diagnosis of diabetes insipidus. Which clinical finding is consistent with this diagnosis?
Urinary output is increased.
A school-age child with type 1 diabetes mellitus has soccer practice three afternoons a week. The nurse reinforces instructions regarding how to prevent hypoglycemia during practice. Which should the nurse tell the child?
Drink a half a cup of orange juice before soccer practice. An extra snack of 10 g to 15 g of carbohydrates eaten before activities and for every 30 to 45 minutes of activity will prevent hypoglycemia. A half cup of orange juice will provide the needed carbohydrates. The child or parents should not be instructed to adjust the amount or time of insulin administration, and meal amounts should not be doubled.
The mother of a 6-year-old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action?
Encourage the child to drink liquids. When the child is sick, the mother should test for urinary ketones with each voiding. If ketones are present, liquids are essential to aid in clearing the ketones. The child should be encouraged to drink liquids. Bringing the child to the clinic immediately is unnecessary. Insulin doses should not be adjusted or changed.
An adolescent client with type 1 diabetes is experiencing high glucose levels upon awakening in the morning. After reviewing the client's chart, the nurse determines that the elevated glucose level in the morning is due to the Somogyi effect. Which finding should lead the nurse to this conclusion?
Glucose level at 2 am of 65 mg/dL
A cooling blanket is prescribed for a child with a fever. The nurse prepares to use the cooling blanket and should avoid which action?
Keeping the child uncovered to assist in reducing the fever
The nurse is caring for a hospitalized child newly diagnosed with type 1 diabetes mellitus. At 11:00 am, the child suddenly complains of weakness, headache, and blurred vision. How should the nurse respond?
Obtain a blood glucose reading.
The nurse is checking a child for dehydration and documents that the child is moderately dehydrated. Which symptoms should be noted in determining this finding? Select all that apply.
Oliguria Slightly sunken fontanels Very dry, mucous membranes
The nursing instructor asks the nursing student to plan and conduct a clinical conference on phenylketonuria (PKU). The student researches the topic and plans to include which information in the conference?
PKU results in central nervous system (CNS) damage. PKU is an autosomal recessive disorder. Treatment includes dietary restriction of phenylalanine intake (not sodium). PKU is a genetic disorder that results in CNS damage from toxic levels of phenylalanine in the blood. All 50 states require routine screening of all newborn infants for PKU.
The nurse has just administered ibuprofen to a child with a temperature of 38.8° C (102° F). The nurse should also take which action
Remove excess clothing and blankets from the child. After administering ibuprofen, excess clothing and blankets should be removed. The child can be sponged with tepid water, but not cold water because the cold water can cause shivering, which increases metabolic requirements above those already caused by the fever. Aspirin is not administered to a child with fever because of the risk of Reye's syndrome. Fluids should be encouraged to prevent dehydration, so oral fluids should not be withheld.
A primary health care provider prescribes intravenous potassium for a child with hypertonic dehydration. The nurse assigned to assist in caring for the child should check which highest priority item before administration of the potassium
Urine output
The nurse determines that a child with type 1 diabetes mellitus is having a hypoglycemic reaction. Which supplement should the nurse give the child to treat the reaction?
½ cup of fruit juice
The nurse is planning care for a child with type 1 diabetes. Which items should the nurse plan to use to treat an early mild hypoglycemic episode? Select all that apply.
1.Candy 4.Orange juice 5.Glucose tablets
An adolescent client with type 1 diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note?
Fruity breath odor and decreasing level of consciousness Hyperglycemia occurs with diabetic ketoacidosis. Signs of hyperglycemia include fruity breath odor and a decreasing level of consciousness. Hunger can be a sign of hypoglycemia or hyperglycemia,
A mother brings her 3-week-old infant to a clinic for a phenylketonuria rescreening blood test. The test indicates a serum phenylalanine level of 0 mg/dL (0 mcmol/L). The nurse reviews this result and makes which interpretation?
It is negative. Phenylketonuria is a genetic (autosomal recessive) disorder that results in central nervous system damage from toxic levels of phenylalanine (an essential amino acid) in the blood. It is characterized by blood phenylalanine levels greater than 20 mg/dL (1210 mcmol/L). The normal level is 0 mg/dL to 2 mg/dL (0-121 mcmol/L). A result of 0 mg/dL is a negative test result.
A health care provider prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription?
Checks the amount of urine output hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment before administering potassium chloride intravenously would be to assess the status of the urine output. Potassium chloride should never be administered in the presence of oliguria or anuria. If the urine output is less than 1 mL/kg/hour to 2 mL/kg/hour, potassium chloride should not be administered. Although options 1, 2, and 3 are appropriate assessments for a child with dehydration, these assessments are not related specifically to the IV administration of potassium chloride.
An adolescent with diabetes mellitus becomes flushed and complains of hunger and dizziness. A blood glucose level is drawn, and the results indicate a glucose level of 60 mg/dL. Which is the appropriate intervention?
Give the child a glass of fruit juice.
A 3-year-old child is brought to the emergency department. The mother states that the child has had flulike symptoms with vomiting and diarrhea for the past 2 days. On data collection the nurse finds that the child's heart rate is slightly elevated and the blood pressure is normal. The child is irritable and crying only a few tears. The mother states that the child's weight before the illness was 33 pounds. The nurse finds the current weight to be 31 pounds. The nurse correctly interprets this as which level of dehydration?
Moderate dehydration Moderate dehydration demonstrates itself with a weight loss in children of 6% to 8% of weight.
A child has fluid volume deficit. The nurse collects data and determines that the child is improving and the deficit is resolving if which finding is noted?
Capillary refill is less than 2 seconds. Indicators that fluid volume deficit is resolving would be capillary refill less than 2 seconds, specific gravity of 1.002 to 1.025, urine output of at least 1 mL/kg/hour, and adequate tear production. A capillary refill time less than 2 seconds is the only indicator that the child is improving. Urine output of less than 1 mL/kg/hour, a specific gravity of 1.030, and no tears would indicate that the deficit is not resolving.
The nurse is planning care for a pediatric client experiencing thyrotoxicosis (thyroid storm). Which prescribed medications should the nurse plan to administer? Select all that apply.
1.Atenolol 3.Propranolol 4.Methimazole Treatment for a thyroid storm includes antithyroid drugs and administration of beta-adrenergic blocking agents, which provide relief from the adrenergic hyperresponsiveness that produces the disturbing side effects of the reaction. Propranolol and atenolol are beta-adrenergic blocking agents. Methimazole is an antithyroid medication and should be expected to be given during a thyroid storm. Tramadol is an analgesic and should not be given to anyone with a metabolic disease.
