Justine is admitted to the pediatric unit due to the occurrence of diabetic ketoacidosis signaling a new diagnosis of diabetes. The diabetes team explores the cause of the episode and take steps to prevent a recurrence. Diabetic ketoacidosis (DKA) results from an excessive accumulation of which of the following?
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Solution
Ketone bodies from fat metabolism
D: Inability to use glucose causes lipolysis, fatty acid oxidation, and release of ketones, resulting in metabolic acidosis and coma.
A: Sodium bicarbonate administration is a treatment for DKA, not a cause.
B: Potassium depletion, not potassium excess, occurs in DKA
C: Inability to use glucose, not impaired carbohydrate metabolism, is the primary mechanism is diabetes mellitus.
While Andres is being assessed at the clinic, Nurse Shiela observed that the child appears to be small, with an immature face and chubby body build. Her parents stated that their child’s rate of growth of all body parts is somewhat slow, but her proportions and intelligence remain normal. As a knowledgeable nurse, you know that the child has a deficiency of which of the following?
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Solution
Growth hormone (GH)
C. GH stimulates protein anabolism, promoting bone and soft-tissue growth. A lack of GH would lead to decreased synthesis of somatomedin, resulting in decreased linear growth and decreased fat catabolism and increased glucose uptake in muscles, resulting in excessive subcutaneous fat hypoglycemia.
A: A deficiency in ADH results in diabetes insipidus, marked by dehydration and hypernatremia.
B: Deficiency of PTH causes hypocalcemia, marked by tetany, convulsions, and muscle spasms.
D: Deficiency of MSH causes diminished or absent skin pigmentation.
Nurse Angelo is attending for a child with Cushing’s syndrome; which of the following nursing interventions would be most necessary?
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Solution
Handling the child carefully to prevent bruising
B: The nurse should handle the child carefully because Cushing’s syndrome causes capillary fragility, resulting in easy bruising and calcium excretion, resulting in osteoporosis.
A and C: Cushing’s syndrome causes increased excretion of potassium and hydrogen ions, resulting in alkalosis and increased water and sodium retention, and hypokalemia, resulting in a sluggish and irregular heartbeat.
D: Cushing’s syndrome causes hyperglycemia, not hypoglycemia.
Katie is admitted to the intensive care unit of Nurseslabs Medical Center for diabetic ketoacidosis; which of the following is of primary importance when caring for the child?
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Solution
Evaluating the child for cardiac abnormalities
B: As the fluid volume deficit is improved, total body potassium deficiency may occur, leaving the child vulnerable to hypokalemia and, afterward, cardiac arrest. The nurse should monitor the cardiac cycle for prolonged QT interval, low T wave, and depressed ST segment, which indicate weakened heart muscle and potential irregular heartbeat.
A: Regular insulin is the only insulin that can be given I.V. NPH is an intermediate-acting insulin; continuous low-dose infusion of a rapid-acting insulin is preferred.
C: I.V. fluids should be given to correct dehydration.
D: Hypertension is more likely to happen secondary to dehydration.
The 6-year-old son of Mr. and Mrs. Peters is admitted to the healthcare facility with the diagnosis of idiopathic hypopituitarism. His height is measured below the third percentile and weight at the 40th percentile. Which of the following would be the first action of his attending nurse?
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Solution
Collaborate with a dietician to access his caloric needs.
B: Because the child’s weight is excessive for his height, he needs dietary assessment and a weight-loss program
A: An underdeveloped jaw is not usually a problem with hypopituitarism.
C: Providing a tutor to educate him is an appropriate action, but the rationale is incorrect. Although children with hypopituitarism generally appear intellectually precocious because of the disparity between their size and their cognitive ability, they are usually of normal intelligence.
D: Placing the child in a room with a toddler could contribute to poor self-esteem.
While examining a 2-year-old child, Nurse Galina sees that the anterior fontanel is open. She should:
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Solution
Notify the doctor
A: Because the anterior fontanel normally closes between ages 12 and 18 months, the nurse should notify the doctor promptly of this finding.
B and D: An open fontanel does not indicate abuse and is not associated with Tay-Sachs disease.
Bennett was rushed to the emergency department with possible increased intracranial pressure (ICP); which of the following is an early clinical manifestation of increased ICP in older children? (Select all that apply.)
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Solution
Diplopia
D: Diplopia is an early sign of increased ICP in an older child.
A and B: Macewen’s sign (cracked-pot sound) and the setting sun appearance of the eyes are noted in infants with increased ICP.
C: Papilledema is a late sign of increased ICP.
Angie is an adolescent who has seizure disorder; which of the following would not be a focus of a teaching program?
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Solution
Increased risk of infections
C: Adolescents with seizure disorders are at no greater risk for infections than other adolescents.
A: The ability to get a driver’s license may be determined by the adolescent’s seizure history.
B: Drug and alcohol use may conflict with or cause adverse reactions from
Janae has a seizure disorder; which of the following would be the lowest priority when caring for her?
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Solution
Assessing for signs and symptoms of increased intracranial pressure (ICP)
C: Signs and symptoms of increased intracranial pressure (ICP) are not associated with seizure activity and therefore would be the lowest priority.
A: Careful observation and documentation of seizures provide valuable information to aid prevention and treatment.
B: Safety is always a priority in the care of a child with seizure disorder because seizures may occur at any given time.
D: Improper administration of and incomplete compliance with anticonvulsant therapy can lead to status epilepticus; thus education is a priority.
Spina bifida is one of the possible neural tube defects that can occur during early embryological development. Which of the following definitions most accurately describes meningocele?
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Solution
Sac formation containing meninges and spinal fluid
C: Meningocele is a sac formation containing meninges and cerebrospinal fluid (CSF).
A: Meningocele doesn’t involve complete exposure of the spinal cord and meninges; this is a massive defect that’s incompatible with life.
B: Myelomeningocele is a herniation of the spinal cord, meninges, and CSF into a sac that protrudes through a defect in the vertebral arch.
E: Tumor formation is not associated with this defect.