The nurse is caring for a hospitalized child newly diagnosed with type 1 diabetes mellitus. At 1100, the child suddenly complains of weakness, headache, and blurred vision. How would the nurse respond?

Give the child 1⁄2 cup of orange juice to drink.

Call the dietary department and ask that the lunch tray be delivered early.

Contact the physician.

Obtain a blood glucose reading

Answer and Explanation

The Correct Answer is A

A. Give the child 1⁄2 cup of orange juice to drink. These symptoms indicate hypoglycemia, a common early complication of diabetes treatment. Orange juice contains quick-acting sugars that can rapidly raise blood glucose levels and alleviate symptoms. This is the immediate action to manage the child's symptoms.
B. Call the dietary department and ask that the lunch tray be delivered early. Delayed action compared to treating the immediate hypoglycemia.
C. Contact the physician. While eventually necessary, immediate treatment of hypoglycemia takes precedence.
D. Obtain a blood glucose reading. Important to confirm hypoglycemia but not as urgent as providing immediate treatment.

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Correct Answer is B

Explanation

A. Rigid abdomen: A rigid abdomen is not typically associated with Hirschsprung disease unless there is severe obstruction and distension.
B. Ribbonlike, foul-smelling stools: Hirschsprung disease causes obstruction of the colon, leading to constipation and ribbonlike, foul-smelling stools proximal to the affected segment.
C. Projectile vomiting: Projectile vomiting is not typically associated with Hirschsprung disease but may occur in other conditions causing bowel obstruction.
D. Chronic hunger: Chronic hunger is not a typical finding in Hirschsprung disease and is more indicative of metabolic or endocrine disorders.

A. Initiate isotonic fluids with 20 mEq/L potassium chloride. B. Request evaluation of the toddler's serum electrolytes. C. Determine if the toddler is voiding. D. Collect a stool sample from the toddler

Correct Answer is A

Explanation

A. Initiate isotonic fluids with 20 mEq/L potassium chloride. The priority in treating acute gastroenteritis in a toddler is to manage dehydration, which is often severe due to fluid loss from vomiting and diarrhea. Isotonic fluids with electrolytes like potassium chloride help to restore fluid balance and prevent complications like electrolyte imbalances. This is the most urgent action to stabilize the child's condition.
B. Request evaluation of the toddler's serum electrolytes. While important, this can be done after fluid resuscitation has begun to assess the severity of electrolyte imbalances.
C. Determine if the toddler is voiding. Important for assessing renal function, but not the first priority in acute gastroenteritis.
D. Collect a stool sample from the toddler. Useful for identifying the causative organism but not as urgent as fluid resuscitation.

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The nurse is caring for a hospitalized child newly diagnosed with type 1 diabetes mellitus. At 1100, the child suddenly complains of weakness, headache, and blurred vision. How would the nurse respond?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a child who has Hirschsprung disease. Which of the following findings should the nurse expect?

Correct Answer is B

Explanation

A nurse is assisting with the admission of a 2-year-old toddler who has acute gastroenteritis. Which of the following actions should the nurse take first?

Correct Answer is A

Explanation

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