PEDS: Metabolic Practice Exam Test 2024.
A school-age child with type 1 diabetes mellitus has soccer practice and the school nurse provides
... [Show More] instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do?
1. Eat twice the amount normally eaten at lunchtime.
2. Take half the amount of prescribed insulin on practice days.
3. Take the prescribed insulin at noontime rather than in the morning.
4. Eat a small box of raisins or drink a cup of orange juice before soccer practice. - CORRECT ANSWER 4. Eat a small box of raisins or drink a cup of orange juice before soccer practice.
Rationale:
Hypoglycemia is a blood glucose level less than 70 mg/dL (4 mmol/L) and results from too much insulin, not enough food, or excessive activity. An extra snack of 15 to 30 g of carbohydrates eaten before activities such as soccer practice would prevent hypoglycemia. A small box of raisins or a cup of orange juice provides 15 to 30 g of carbohydrates. The child or parents should not be instructed to adjust the amount or time of insulin administration. 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?
1. Hold the next dose of insulin.
2. Come to the clinic immediately.
3. Encourage the child to drink liquids.
4. Administer an additional dose of regular insulin. - CORRECT ANSWER 3. 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.
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?
1. Obtains a weight
2. Takes the temperature
3. Takes the blood pressure
4. Checks the amount of urine output - CORRECT ANSWER 4. 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 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. [Show Less]