Which sign is the nurse most likely to assess in a child with hypoglycaemia?
Normal sensorium and serum glucose greater than 160 mg/dL
Urine positive for ketones and serum glucose greater than 300 mg/dL
Irritability and serum glucose less than 60 mg/dL
Increased urination and serum glucose less than 120 mg/dL
The Correct Answer is C
Hypoglycaemia is characterized by low blood sugar levels. In children, symptoms of hypoglycaemia can vary, but irritability is a common sign. Other signs and symptoms of hypoglycaemia in children may include sweating, trembling, pale skin, hunger, weakness, confusion, and dizziness.
Normal sensorium and serum glucose greater than 160 mg/dL in (Option A) is incorrect because a normal sensorium (normal level of consciousness) and a serum glucose level greater than 160 mg/dL would not be indicative of hypoglycaemia.
Urine positive for ketones and serum glucose greater than 300 mg/dL in (Option B) is incorrect because it describes characteristics of hyperglycaemia (high blood sugar levels) rather than hypoglycaemia. Positive urine ketones and a serum glucose level greater than 300 mg/dL are commonly seen in diabetic ketoacidosis, a complication of high blood sugar levels in diabetes.
Increased urination and serum glucose less than 120 mg/dL in (Option D) is incorrect because it describes increased urination and a serum glucose level less than 120 mg/dL. While a serum glucose level less than 120 mg/dL could indicate hypoglycaemia, increased urination is not a typical sign of hypoglycaemia. Increased urination may be seen in conditions such as diabetes mellitus when blood sugar levels are consistently high.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The harness maintains the hips in flexion, abduction, and external rotation
The factor that the nurse should include when teaching a parent about the care of a newborn
in a Pavlik harness for hip dysplasia is that the harness maintains the hips in flexion,
abduction, and external rotation. The Pavlik harness is a commonly used device for the
treatment of developmental dysplasia of the hip (DDH) in infants. It is designed to hold the
hips in a position that promotes proper alignment and development.
The harness maintains the hips in flexion, abduction and external rotation in (Option B) is
incorrect. The Pavlik harness should not be removed with every diaper change. The harness
needs to be worn consistently as directed by the healthcare provider to ensure the
effectiveness of the treatment.
The harness is the only first step of treatment in (Option C) is incorrect. While the Pavlik
harness is an important step in the treatment of hip dysplasia, it is not the only step.
Additional treatments, such as bracing or surgical interventions, may be required depending
on the severity of the condition.
The harness in worn for 2 weeks in (Option D) is incorrect. The duration for which the Pavlik
harness is worn can vary depending on the individual case and the healthcare provider's
instructions. It is typically worn for several weeks to months, and the specific duration will be
determined by the healthcare provider based on the child's progress and response to
treatment.
Correct Answer is A
Explanation
The statement that accurately describes the difference between the central nervous system (CNS) of a child and an adult is option A. The brain of a term infant weighs less than half of the weight of the adult brain. The brain undergoes significant growth and development during childhood and continues to develop until early adulthood. At birth, the brain is only a fraction of its adult weight, and it continues to grow and mature over time.
infant has 150 mL of cerebrospinal fluid (CSF) compared with 50 mL in the adult in (option B), is incorrect. The volume of CSF in the CNS is not a significant difference between children and adults.
coordination and fine motor skills develop as myelination of peripheral nerves progresses in (option C), is an incorrect statement. Myelination is an ongoing process that occurs throughout childhood and contributes to the development of coordination and fine motor skills.
papilledema is a common manifestation of increased intracranial pressure (ICP) in the very young child in (option D), is not correct. Papilledema refers to swelling of the optic disc and is not commonly seen in very young children. Signs of increased ICP in young children may present differently compared to adults and can include altered mental status, irritability, vomiting, and changes in vital signs.
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