Pediatrics: Metabolic/Endocrine ( Complete Questions)

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." Rationale: A1c reflects the average blood glucose levels during the previous 3 to 4 months. It assesses glucose control in the client with diabetes mellitus. Glucose molecules attach to the hemoglobin A molecules found in red blood cells (RBCs) and remain there for the lifetime of the RBCs, approximately 120 days. Hint: Review: Purpose for the A1C test.

The clinic nurse is reinforcing instructions to an adolescent with type 1 diabetes about administration of insulin. Which statements by the adolescent indicate the need for further teaching? Select all that apply.

"I should give my injections only in my thighs." "I should place any unopened insulin vials in the freezer." Rationale: Insulin can be injected into any area in which there is adipose (fat) tissue over muscle. The arms, thighs, hips, and abdomen are usual injection sites for insulin. Freezing renders insulin inactive. Insulin bottles that have been "opened" (i.e., the stopper has been punctured) should be stored at room temperature or refrigerated for up to 28 to 30 days. Diabetic supplies should not be left in a hot environment. The insulin injection is injected subcutaneously, typically at a 90-degree angle. Hint: Note the strategic words, need for further teaching. Recognize that this question is a negative event query asking you to select the options that indicate the client has not understood the teaching about insulin injections. Eliminate true statements about insulin injections: insulin vials, once opened, are good for 30 days; insulin supplies should not be kept in a hot environment; and insulin injections should be given subcutaneously at a 90-degree angle Review: Technique of giving insulin injections.

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.

"The onset of diabetes is sudden with type 1." "Type 2 diabetes can often be managed with diet only." "Three symptoms of type 1 diabetes are polyuria, polydipsia and polyphagia." Rationale: Type 1 diabetes is sudden and can only be managed by insulin; it is characterized by polyuria, polydipsia, and polyphagia. Type 2 diabetes has a gradual onset, can often be managed with diet only, and is characterized by weight gain not weight loss. Hint: Focus on the subject, differences between type 1 and type 2 diabetes. It is necessary to recall the difference between the two. Review: The characteristics of type 1 and type 2 diabetes mellitus.

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.

"Which manifestations of this condition do you find most troublesome?" "The signs/symptoms are lessened by taking the prednisone every other day instead of daily." "The cushingoid appearance will gradually disappear once the steroids are tapered and discontinued." Rationale: The nurse should use therapeutic communication to help the client cope with these feelings. Using questioning and providing accurate information will reassure the client about the cushingoid appearance. Hint: Focus on the data in the question and use therapeutic communication techniques of questioning and providing accurate information. Recall that failing to acknowledge feelings and giving advice blocks communication and should be avoided. Review: Therapeutic communication techniques.

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. Rationale: Rehydration is the initial step in resolving DKA. 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 levels reach an acceptable level. IV potassium may be required depending on the potassium level, but it would not be part of the initial treatment. Hint: Focus on the subject, correct IV fluid administration for a child with diabetic ketoacidosis.

The nurse is planning care for a hospitalized child with syndrome of inappropriate antidiuretic hormone (SIADH). The primary health care provider has prescribed that the 24-hour fluid maintenance for the child weighing 12 kg be at ¾ of the maintenance. Using the formula shown (refer to figure), which volume of fluid should the nurse plan as the 24-hour maintenance for this child?

825 mL. Rationale: Using the formula 10 to 20 kg: 1000 mL + 50 mL/kg for each additional kilogram between 10 and 20 kg, calculate that for 12 kg it would be 1100 mL for full 24-hour maintenance. Take 1100 × 0.75 to calculate ¾ maintenance to get 825 mL. Hint: Focus on the subject, fluid maintenance for a child with SIADH. Focus on the data in the question and use the maintenance fluid requirement and minimum urine output formula to answer correctly. Calculate for full fluid maintenance, and then calculate what ¾ maintenance would be.Review:Fluid maintenance for a child.

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. Rationale: 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. A slight elevation in temperature would be expected in a child with dehydration. A weight increase of 0.5 kg is relatively insignificant. A BP that is unchanged is a positive indicator unless the baseline was abnormal. However, there is no information in the question to support such data. Review: Review: Intravenous potassium and the associated nursing responsibilities.

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. Rationale: Diagnostic findings in primary hypothyroidism include a low T4 level and a high TSH level. Hint: Review:Laboratory findings associated with hypothyroidism in infants. Focus on the subject, an infant with hypothyroidism. Use knowledge regarding the laboratory findings in primary hypothyroidism to answer this question. Remember that diagnostic findings in primary hypothyroidism include a low T4 level and a high thyroid-stimulating hormone level.

A nursing student is asked to administer a tepid bath to a child with a fever. The student should avoid which action when performing this procedure?

Applies alcohol-soaked cloths over the child's body. Rationale: Alcohol should never be used for bathing the child with a fever because it can cause rapid cooling, peripheral vasoconstriction, and chilling, thus elevating the temperature further. Washcloths can be used to squeeze water over the child's body. Towels are used to dry the child. Toys, especially water toys, can be used to provide distraction during the bath. Lightweight clothing should be placed on the child after the child is dried. Hint: Review- The procedure for administering a tepid bath. Select Option 1 because of the harmful effects of alcohol and the effect of potentially elevating the temperature.

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.

Atenolol Propranolol Methimazole Rationale: 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. Levothyroxine is a synthetic thyroid replacement medication, which would not be given when the thyroid level is too high. Hint: Focus on the subject, planning care for a client experiencing a thyroid storm. Recall that too much thyroid hormone is released, so choose the medications that will counteract this effect: propranolol, atenolol and methimazole. Eliminate the medications that would be contraindicated in a thyroid storm: tramadol and levothyroxine.Review:The care of a client during a thyroid storm.

Which test would the nurse anticipate for a teenage client who has been treated for vaginal Candida infections repeatedly in the last 6 months to assist in the identification of the underlying chronic pathology?

Blood glucose level. Rationale: A blood glucose level is an indicator of diabetes mellitus. In females, monilial infections of the genitourinary tract are a common symptom of diabetes mellitus. Pap smears are specific for detecting cancer of the cervix. A throat culture may show a candidal infection, but this test is unrelated to an undiagnosed underlying chronic disease. An infection of the blood (diagnosed by a blood culture) is indicative of an acute systemic disease. Hint: Focus on the subject, vaginal Candida and note the words underlying chronic pathology. Review:The relationship between vaginal Candida infections and diabetes mellitus.

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.

Candy Orange juice Glucose tablets Rationale: For a mild hypoglycemic reaction the child should be given 10 to 15 g of a simple, high-carbohydrate substance. Orange juice, glucose tablets, and candy provide 10 to 15 g of a simple high-carbohydrate substance. Low-fat milk and apple slices would not provide enough grams of a simple high-carbohydrate substance. Hint: Note the strategic word, early, and focus on the subject, treating mild hypoglycemic reaction. Eliminate the options that will not provide enough simple high-carbohydrate substances, such as apple slices and low-fat milk Review:The treatment of a mild hypoglycemia reaction.

An adolescent with type 1 diabetes mellitus will become a member of the school's football cheerleader team. The adolescent excitedly reports to the school nurse to obtain information regarding adjustments needed in the treatment plan for the diabetes. The school nurse should instruct the adolescent to take which action?

Eat six graham crackers or drink a cup of orange juice before practice or game time. Rationale: An extra snack of 15 to 30 g of carbohydrate eaten before activities such as cheerleader practice will prevent hypoglycemia. Six graham crackers or a cup of orange juice will provide 15 to 30 g of carbohydrate. The adolescent should not be instructed to adjust the amount or time of insulin administration. Meal amounts should not be decreased. Hint: Focus on the subject, an adolescent with diabetes mellitus type 1. Review:Treatment to prevent hypoglycemia.

An adolescent with diabetes mellitus is attending gym class and suddenly becomes flushed and complains of dizziness and a headache. The gym teacher quickly takes the adolescent to the school nurse's office. The nurse obtains a blood glucose level, and the results indicate a level of 65 mg/dL. Which initial nursing intervention is appropriate?

Give the child 6 oz of a regular cola drink. Rationale: A blood glucose level below 70 mg/dL indicates hypoglycemia. The child is participating in an activity that requires more energy than that of the normal routine at school. Insulin and food requirements change with situations that require more energy. When signs of hypoglycemia occur, the child needs an immediate source of glucose. Hint: The question is requiring you to interpret the situation as a hypoglycemic state and determine the appropriate action. Option 1 is the only action that will address the hypoglycemic state. Review - The findings associated with hypoglycemia and the treatment measures.

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. Rationale: A blood glucose less than 70 mg/dL indicates hypoglycemia. When signs of hypoglycemia occur, the child needs an immediate source of glucose. Hint: Review:Hypoglycemia.

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? Refer to chart.

Glucose level at 2 am of 65 mg/dL. Rationale: The Somogyi effect may occur at any time but often entails an elevated blood glucose level at bedtime and a drop at 2 am with a rebound rise following. A pulse of 76 beats per minute is a normal finding. Glycosylated hemoglobin (hemoglobin A1c) in an adolescent is normal if less than 7.5% (or as determined by the primary health care provider). A new diagnosis of type 1 diabetes is not a cause of the Somogyi effect. Hint: Focus on the subject, Somogyi effect that causes a high blood glucose upon arising in the morning. Recall that both the dawn phenomenon and Somogyi effect present with high glucose levels in the morning, but only the Somogyi effect has a drop in glucose levels around 2 am with a rebound rise in glucose due to counterregulatory hormones. Review: The symptoms of the Somogyi effect.

The nurse is assisting a school-age client with type 1 diabetes to follow an appropriate diet. Which recommendations should the nurse make for this client? Select all that apply.

Limit Concentrated Sweets. Consume snacks between meals and at bedtime. Plan to eat a larger snack during active times of the day. Rationale: Clients with type 1 diabetes need extra food during times of increased activity, so a larger snack should be planned for the active times of the day. In addition to three meals a day, there should be snacks between meals and at bedtime because of the constant release of insulin into the circulation making the child prone to hypoglycemia. Concentrated sweets should be limited. Fat should be reduced to 30% or less of the total caloric requirement, so high-fat snacks should not be encouraged. For growing children, food restriction should never be used for diabetes control and an 1800 kcal should not be encouraged. Hint: Focus on the subject, meal planning for a school-age client with type 1 diabetes. Think about the pathophysiology and treatment plan for the child with type 1 diabetes mellitus. Choose the correct options of limiting concentrated sweets, increasing snacks during active times, and planning snacks between meals and at bedtime. Review: Meal planning for a client with type 1 diabetes mellitus.

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. Rationale: Moderate dehydration demonstrates itself with a weight loss in children of 6% to 8% of weight. Mild dehydration would not present with these symptoms. In severe dehydration, additional findings would include lethargy and listlessness. The symptoms listed are all characteristics of moderate dehydration. Very mild dehydration is not a term used to describe dehydration. Hint: Review:The symptoms of each level of dehydration.

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. Rationale: The signs of hypoglycemia and hyperglycemia may be difficult to distinguish. Weakness, headache, and blurred vision can occur in either blood glucose alteration. A blood glucose reading will assist in confirming the diagnosis so that the appropriate action can be taken. Option 3 would be implemented if the child had hypoglycemia. Option 4 is inappropriate because the child should eat meals at basically the same time each day to achieve the best diabetic control. Contacting the primary health care provider would not be the immediate action; however, the nurse should inform the registered nurse of the situation. Hint: Focus on the subject, type I diabetes mellitus and that the child is hospitalized. Recalling that the signs of hypoglycemia and hyperglycemia may be difficult to distinguish will direct you into choosing to obtain a blood glucose reading. Review: Hypoglycemia treatment.

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. Rationale: 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. Hint: Review - The characteristics associated with phenylketonuria.

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.

Sweating Dizziness Trembling Rationale: 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. Hint: Focus on the subject, signs of hypoglycemia. Think about the pathophysiology that takes place when hypoglycemia occurs. Sweating, trembling and dizziness are signs of hypoglycemia. Eliminate signs that are related to hyperglycemia: headache and fatigue. Review: The signs/symptoms of hypoglycemia.

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. Rationale: A child with a diagnosis of diabetes insipidus experiences increased urinary output, increased serum sodium, and decreased urine specific gravity. Decreased urinary output, decreased serum sodium, and increased urine specific gravity are consistent with a diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Hint: Review:The pathophysiology of diabetes insipidus and clinical findings in diabetes insipidus.

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. Rationale: Hypoglycemia is immediately treated with 10 to 15 g of carbohydrate. Glucose tablets or glucose gel may be administered. Other items used to treat hypoglycemia include ½ cup of fruit juice, ½ cup of regular (nondiet) soft drink, 8 ounces of skim milk, 6 to 10 hard candies, 4 cubes of sugar or 4 teaspoons of sugar, 6 saltines, 3 graham crackers, or 1 tablespoon of honey or syrup. The items in options 1, 2, and 3 would not adequately treat hypoglycemia. Hint: Review Hypoglycemia.

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." 📑Rationale: To help decrease variations in absorption from day to day, the child should use one location within a major site for the morning injection. The child should then rotate to another site for the evening injection, and a third site for the bedtime injection. The child should follow this pattern for a period of 2 to 3 weeks before changing major sites. 💡Hint: Focus on the subject, insulin administration. It is necessary to know the physiology associated with absorption of insulin. Review: Insulin Administration.

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." 📑Rationale: PKU is an autosomal-recessive disorder and treatment includes the dietary restriction of phenylalanine intake. All 50 states require screening newborns for PKU. 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. 💡Hint: Reveiw Phenylketonuria (PKU).

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. 📑Rationale: 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. 💡Hint: Recall the parameters that indicate adequate hydration status, the only option that indicates an improving fluid balance is a capillary refill less than 2 seconds. Focus on the subject, assessment findings indicating that fluid volume deficit is resolving and review the topics for fluid volume deficit and fluid volume excess.

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. 📑Rationale: In 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. 💡Hint: Review Nursing considerations for the administration of potassium chloride. Recalling that the kidneys play a key role in the excretion and reabsorption of potassium.

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. 📑Rationale: 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. 💡Hint: Review Diabetes Mellitus: prevention and treatment associated with hypoglycemia (abnormally low blood sugar) including its signs/symptoms.

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. 📑Rationale: 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. 💡Hint: Review Sick day rules for the diabetic child.

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. 📑Rationale: Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. 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, but hypertension is not a sign of diabetic ketoacidosis. Hypotension occurs because of a decrease in blood volume related to the dehydrated state that occurs during diabetic ketoacidosis. Cold clammy skin, irritability, sweating, and tremors all are signs of hypoglycemia. 💡Hint: Focus on the subject, the signs of diabetic ketoacidosis, and recall that in this condition the blood glucose level is elevated. Recall that fruity breath odor and a change in the level of consciousness can occur during diabetic ketoacidosis. Review Signs and symptoms of hyperglycemia, hypoglycemia, and diabetic ketoacidosis.

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.

✅Give the child a teaspoon of honey. ✅Prepare to administer glucagon subcutaneously if unconsciousness occurs. 📑Rationale: Hypoglycemia is defined as a blood glucose level less than 70 mg/dL (4 mmol/L). Hypoglycemia occurs as a result of too much insulin, not enough food, or excessive activity. If possible, the nurse should confirm hypoglycemia with a blood glucose reading. Glucose is administered orally immediately; rapid-releasing glucose is followed by a complex carbohydrate and protein, such as a slice of bread or a peanut butter cracker. An extra snack is given if the next meal is not planned for more than 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. Encouraging the child to ambulate and administering regular insulin would result in a lowered blood glucose level. Providing electrolyte replacement therapy intravenously is an intervention to treat diabetic ketoacidosis. Waiting 30 minutes to confirm the blood glucose level delays necessary intervention. 💡Hint: Focus on the subject, a low blood glucose level, and on the information in the question. Think about the pathophysiology associated with hypoglycemia and how it is treated. Recalling that a blood glucose level of 60 mg/dL (3.4 mmol/L) indicates hypoglycemia will assist in determining the correct interventions. Review interventions for hypoglycemia.

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. 📑Rationale: 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. 💡Hint: Note that the level identified in the question is a low level. Review Phenylketonuria.

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. 📑Rationale: While on a cooling blanket, the child should be covered lightly to maintain privacy and reduce shivering. Placing the cooling blanket on the bed and covering it with a sheet, keeping the child dry while on the cooling blanket to prevent the risk of frostbite, and checking the skin condition of the child before, during, and after the use of the cooling blanket are important interventions to prevent shivering, frostbite, and skin breakdown. 💡Hint: Knowledge regarding the physiological response associated with fever will direct you to the correct option. Review: Care of a child with a fever.

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. 📑Rationale: 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. 💡Hint: Recall that hydration is the initial treatment in diabetic ketoacidosis. Focus on the subject, treatment for diabetic ketoacidosis and review the topic.

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 📑Rationale: In moderate dehydration, thirst will be evident, the fontanels would be slightly sunken, the mucous membranes would be very dry, the skin color would be dusky, and oliguria would be present. Option 2 "slight thirst" describes mild dehydration. In mild dehydration, slight thirst is present. 💡Hint: Focus on the subject, dehydration and note the word moderately. Recalling that dehydration can be mild, moderate, or severe will assist in answering correctly. Review: Dehydration.

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. 📑Rationale: 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. 💡Hint: Remember that cooling measures such as removing excess clothing and blankets should be done when a child has a fever. Focus on the subject, interventions for an elevated temperature and review the topic.

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. 📑Rationale: The priority assessment would be to check 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, it should not be administered. 💡Hint: Review: Hypertonic dehydration and potassium administration. Recalling that the kidneys play a strategic role in the excretion and reabsorption of potassium will direct you to choose urine output. Review: Hypertonic dehydration and potassium administration.