A nurse in the provider's office is assisting with the care of a child.

Exhibits

Upon review of the child's electronic medical record (EMR), the nurse should determine the child is at risk for developing which of the following conditions? Drag 1 condition and 1 client finding to fill in each blank in the following sentence.
The client is at risk for developing
dropdown
due to
dropdown
.

Answer and Explanation

The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Increased seizure activity

Finding: Phenytoin level

The child's phenytoin level is 6 mcg/mL, which is below the therapeutic range of 10-20 mcg/mL. Subtherapeutic levels of phenytoin mean the medication is not providing adequate seizure control, increasing the risk of more seizures. The recent seizure history and the low drug level indicate a direct correlation between insufficient phenytoin levels and increased seizure activity.

Pneumonia

Finding: Cough

A harsh, non-productive cough that worsens with activity and at night can be indicative of respiratory conditions, including asthma exacerbations. However, in the context of this child's history and symptoms, there is no evidence of a productive cough, fever, or other signs of infection that would typically suggest pneumonia. Hence, pneumonia is not the primary concern.

Liver failure

Finding: Skin rash

Liver failure is usually associated with jaundice, elevated liver enzymes, and systemic symptoms like fatigue or confusion. The child’s liver function tests are within normal ranges, and there are no signs of jaundice or systemic illness. The skin rash is more likely related to eczema or a possible drug reaction rather than indicating liver failure.

Steven-Johnson syndrome

Finding: Liver enzymes

Steven-Johnson syndrome (SJS) is a severe skin reaction typically triggered by medications, including anticonvulsants. Elevated liver enzymes can be seen in SJS, but the child’s liver enzymes are within normal ranges. The rash described does not match the characteristics of SJS, which typically presents with widespread, painful, blistering rashes, not localized eczema patches. Therefore, SJS is unlikely in this scenario.

Pneumothorax

Finding: Lung sounds

A pneumothorax would usually present with decreased breath sounds, possibly on one side, along with signs of respiratory distress such as tachypnea and cyanosis. The child has slight end expiratory wheezes but normal respiratory rates and oxygen saturation, which suggests asthma rather than pneumothorax. Therefore, pneumothorax is not a primary concern here.

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Correct Answer is C

Explanation

A. "He takes his medication between meals with water." Taking carbamazepine with food helps reduce gastrointestinal upset, but taking it between meals is not critical unless there are specific issues. This is not a priority unless the patient is experiencing significant GI discomfort.

B. "He only sleeps about 5 hours each night." Insufficient sleep can exacerbate seizure disorders, but it is not directly life-threatening. Improving sleep hygiene is important but not the most immediate concern compared to other symptoms.

C. "He seems to be getting a lot more bumps and bruises lately." Increased bruising can indicate thrombocytopenia, a potential side effect of carbamazepine, which can lead to serious bleeding issues. This is the priority as it may indicate a severe adverse effect requiring immediate medical attention and possible adjustment of medication.

D. "He has not been eating as much lately." Decreased appetite can be a side effect of many medications, including carbamazepine, but it is generally not immediately dangerous unless it leads to significant weight loss or nutritional deficiencies. It’s important but not the most urgent concern.

A. Fruity breath odor B. Diaphoresis C. Dry mucous membranes D. Polyuria

Correct Answer is B

Explanation

A. Fruity breath odour: This is a sign of diabetic ketoacidosis (DKA), a condition associated with hyperglycemia, not hypoglycaemia.

B. Diaphoresis: Sweating is a common sign of hypoglycemia due to the body's release of adrenaline in response to low blood sugar levels.

C. Dry mucous membranes: This is typically associated with dehydration and hyperglycemia, not hypoglycaemia.

D. Polyuria: Frequent urination is a symptom of hyperglycemia, as the body tries to excrete excess glucose through the urine.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for an adolescent client who is receiving carbamazepine (Tegretol) for partial seizure disorder. Which of the following statements by the adolescent's parent is the priority for the nurse to address?

Correct Answer is C

Explanation

A nurse is teaching the parents of a child who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following manifestations should the nurse include in the teaching?

Correct Answer is B

Explanation

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