A school nurse is assessing an adolescent who reports feeling shaky and is having difficulty speaking and concentrating on the Questions the nurse is asking. The nurse checks the adolescent’s blood glucose level and identifies a value of 55 mg/dL. Which of the following findings should the nurse expect?
Polyuria.
Dry, flushed skin.
Deep, rapid respirations.
Tachycardia.
The Correct Answer is D
Choice A rationale
Polyuria, or excessive urination, is typically associated with hyperglycemia rather than hypoglycemia. In the context of diabetes, polyuria occurs when high blood glucose levels lead to increased urine production as the body attempts to excrete excess glucose. Since the adolescent’s blood glucose level is 55 mg/dL, which indicates hypoglycemia, polyuria is not an expected finding.
Choice B rationale
Dry, flushed skin is a common symptom of hyperglycemia, not hypoglycemia. When blood glucose levels are high, the body becomes dehydrated, leading to dry skin and a flushed appearance. In contrast, hypoglycemia often presents with symptoms such as sweating, pallor, and shakiness due to the body’s response to low blood glucose levels.
Choice C rationale
Deep, rapid respirations, also known as Kussmaul respirations, are typically associated with diabetic ketoacidosis (DKA), a complication of hyperglycemia. DKA occurs when the body produces high levels of ketones due to insufficient insulin. Since the adolescent’s blood glucose level is 55 mg/dL, which indicates hypoglycemia, deep, rapid respirations are not an expected finding.
Choice D rationale
Tachycardia, or an increased heart rate, is a common symptom of hypoglycemia. When blood glucose levels drop, the body releases catecholamines (such as adrenaline) to raise blood glucose levels. This response leads to symptoms such as shakiness, sweating, and tachycardia. Therefore, tachycardia is an expected finding in an adolescent with a blood glucose level of 55 mg/dL.
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Correct Answer is D
Explanation
Choice A rationale
Taking pancreatic enzymes following meals is not effective. The enzymes need to be taken with meals to aid in the digestion of food as it is being consumed.
Choice B rationale
Pancreatic enzymes are not taken to improve metabolism. They are specifically prescribed to aid in the digestion of fats, proteins, and carbohydrates in children with cystic fibrosis.
Choice C rationale
Taking pancreatic enzymes 2 hours before meals is not effective. The enzymes need to be taken with meals to ensure they are present in the digestive tract when food is being digested.
Choice D rationale
Taking pancreatic enzymes helps digest the fat in foods. Children with cystic fibrosis have difficulty digesting fats due to the thick mucus that blocks the pancreatic ducts, preventing the release of digestive enzymes
Correct Answer is C
Explanation
Choice A rationale
Coughing and shortness of breath in the morning are signs of poor asthma control, not well- controlled asthma. These symptoms indicate that the child’s asthma is not being managed effectively and may require adjustments in their treatment plan.
Choice B rationale
This statement is incorrect. If asthma is not controlled, the child is likely to miss more days of school due to asthma symptoms and exacerbations. Effective asthma management aims to reduce symptoms and prevent asthma attacks, allowing the child to attend school regularly.
Choice C rationale
Eliminating allergens that irritate the lungs is a key strategy in preventing asthma attacks. Allergens such as dust mites, pet dander, mold, and pollen can trigger asthma symptoms. By reducing exposure to these allergens, the child can better manage their asthma and reduce the frequency of attacks.
Choice D rationale
This statement is false. Children with well-controlled asthma can participate in sports and physical activities. Physical activity is beneficial for lung function and overall health. The nurse should teach the child how to prevent exercise-induced asthma symptoms, such as using a bronchodilator before exercise.