A nurse is caring for an adolescent who has diabetic ketoacidosis (DKA). The nurse notes the following findings:
- capillary refill is greater than 4 seconds
- peripheral pulses are rapid and weak,
- guardian reports it has been over 12 hours since adolescent last voided and for the past 6 hours has not been able to retain any oral fluids,
- respirations are deep and rapid, breath has an acetone odor to it.
- Adolescent does ask for a drink and cries out that they are thirsty.
- Bedside glucose monitor shows glucose is above 500 mg/dL.
- Provider notified immediately.
09:00:
2 peripheral IVs were started in the antecubital space. Bloodwork drawn via left antecubital IV and sent STAT to laboratory. IV of 0.9% sodium chloride infusing in the right antecubital IV at 200 mL/hr. No edema or drainage at IV site. Placed on cardiac monitor and is transported to the PICU.
PICU
09:15:
14-year-old received from the emergency department for treatment of DKA. Guardian is present. Adolescent placed on cardiac monitor. IV fluid of 0.9% NaCl is infusing at 200 mL/hr in antecubital IV. No edema or drainage at IV site. Child is yelling for a drink of water. Explained that they are not able to have anything by mouth at this time. Kussmaul respirations and fruity smelling breath noted. Sinus tachycardia is noted on monitor. Laboratory called with results from the bloodwork. Provider is notified.
The nurse should anticipate the provider's prescriptions for this client to include which of the following? (Select all that apply.)
Subcutaneous insulin every 2 hours until glucose is below 300 mg/dL
IV regular insulin
IV potassium chloride
Oxygen via nasal cannula
The Correct Answer is B
Choice A reason: Subcutaneous insulin is not the preferred route for a client with DKA, as it has a slower onset and peak than IV insulin. IV regular insulin is the preferred route, as it provides a rapid and continuous infusion of insulin that can be titrated according to the blood glucose level.
Choice B reason: IV regular insulin is the medication of choice for a client with DKA, as it lowers the blood glucose level and reverses the ketosis and acidosis. IV regular insulin has a rapid onset and peak, and can be adjusted based on the client's response.
Choice C reason: IV potassium chloride is indicated for a client with DKA, as the client is at risk of hypokalemia due to osmotic diuresis, insulin therapy, and metabolic acidosis. IV potassium chloride can prevent or treat hypokalemia and its complications, such as cardiac arrhythmias.
Choice D reason: Oxygen via nasal cannula is not necessary for a client with DKA, unless the client has signs of hypoxia or respiratory distress. The client's deep and rapid respirations are a compensatory mechanism for the metabolic acidosis, and do not indicate a need for oxygen therapy.
Choice E reason: Sodium bicarbonate is not recommended for a client with DKA, as it can cause paradoxical cerebral acidosis, hypokalemia, and impaired oxygen delivery. The client's acidosis can be corrected by IV insulin and fluid therapy, which will restore the normal metabolism of glucose and ketones.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Encouraging the child to take a 45 min nap daily is not a helpful instruction, as it may interfere with the child's normal sleep pattern and school schedule. The child may benefit from regular rest periods throughout the day, but not necessarily a long nap. ⁵
Choice B reason: Administering prednisone on an alternate day schedule is a helpful instruction, as it is a common way of prescribing corticosteroids for children with juvenile idiopathic arthritis. Corticosteroids are used to reduce inflammation and control symptoms, but they have many side effects, such as growth suppression, weight gain, and osteoporosis. Giving the medication every other day may reduce some of these side effects and improve compliance. ⁶
Choice C reason: Applying cool compresses for 20 min every hour is not a helpful instruction, as it may cause skin damage and discomfort. Cool compresses may be useful for acute inflammation, but not for chronic arthritis. Warm compresses or baths may be more soothing and beneficial for the child's joints. ⁷
Choice D reason: Allowing the child to stay at home on days when her joints are painful is not a helpful instruction, as it may lead to social isolation, academic difficulties, and reduced physical activity. The child should be encouraged to attend school and participate in activities as much as possible, with appropriate accommodations and modifications if needed. The child may also benefit from physical therapy, occupational therapy, and pain management strategies. ⁸
Correct Answer is A
Explanation
Choice A reason: Your baby will receive a hepatitis B vaccine prior to discharge is correct, as this is the recommended schedule for the first dose of the hepatitis B vaccine for all newborns, regardless of maternal hepatitis B status.
Choice B reason: Your baby will have the first diphtheria, tetanus, pertussis vaccine at the 2 week well-baby visit is incorrect, as this is too early for the first dose of the DTaP vaccine. The first dose of the DTaP vaccine should be given at 2 months of age.
Choice C reason: Your baby should receive the pneumococcal conjugate vaccine on his first birthday is incorrect, as this is too late for the first dose of the PCV13 vaccine. The first dose of the PCV13 vaccine should be given at 2 months of age, followed by three more doses at 4, 6, and 12-15 months of age.
Choice D reason: Your baby should receive the measles, mumps, rubella vaccine at 6 months is incorrect, as this is too early for the first dose of the MMR vaccine. The first dose of the MMR vaccine should be given at 12-15 months of age, followed by a second dose at 4-6 years of age.
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