A 14-year-old girl with type 1 diabetes has hyperglycemia (20.2 mmol/L) and ketones (1.2 mmol/L) despite insulin pump therapy. What is the best advice?

Correct Answer: B

Rationale: The correct answer is B) Deliver a correction bolus of rapid-acting insulin via an insulin syringe or pen. In this scenario, the 14-year-old girl with type 1 diabetes is experiencing hyperglycemia and ketones despite insulin pump therapy, indicating a need for immediate correction of blood glucose levels. Administering a rapid-acting insulin bolus via syringe or pen allows for a quicker response compared to waiting for the insulin pump to deliver the correction dose. This method helps to address the current high blood glucose levels and ketones more effectively. Option A) Deliver a correction bolus of rapid-acting insulin through the insulin pump is less ideal in this situation due to the urgency of the high blood glucose and ketones. The pump may take longer to deliver the insulin compared to using a syringe or pen. Option C) Deliver a dose of long-acting insulin is not appropriate for addressing acute hyperglycemia and ketones. Long-acting insulin is used for basal insulin coverage and would not provide the rapid correction needed in this case. Option D) Perform 30 minutes of exercise and drink 500 mL of water is not recommended as the primary intervention for treating hyperglycemia and ketones in this scenario. While exercise and hydration are important aspects of diabetes management, they should not replace the need for immediate insulin correction. In an educational context, it is crucial for pediatric clinical nurse specialists to understand the urgency of addressing hyperglycemia and ketones in children with type 1 diabetes. This case highlights the importance of timely and appropriate insulin administration to prevent complications associated with uncontrolled blood glucose levels. Educating healthcare providers on the proper management of acute diabetes-related issues is essential for ensuring the well-being of pediatric patients with diabetes.

Correct Answer: A

Rationale: In this scenario, the most appropriate therapy for a 12-year-old with repeated episodes of streptococcal pharyngitis experiencing another sore throat episode is epinephrine (Option A). Epinephrine is the correct choice because it is a vasoconstrictor that helps to reduce inflammation in the throat, providing relief from the symptoms of streptococcal pharyngitis. It can help to decrease swelling, redness, and pain associated with the infection. Prednisone (Option B) is a corticosteroid that may be used in some cases to reduce inflammation, but it is not typically the first-line treatment for streptococcal pharyngitis. Diphenhydramine (Benadryl) (Option C) is an antihistamine that can help with allergies and itching but is not effective in treating the bacterial infection caused by streptococcal pharyngitis. Cimetidine (Option D) is a histamine H2-receptor antagonist used to reduce stomach acid production and treat ulcers, and it is not indicated for the treatment of streptococcal pharyngitis. In an educational context, it is important to understand the appropriate pharmacological treatments for common pediatric conditions like streptococcal pharyngitis. Understanding the rationale behind each treatment option helps healthcare providers make informed decisions to provide the best care for their pediatric patients.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) type II hypersensitivity. Type II hypersensitivity reactions are characterized by antigen-antibody reactions on the cell membrane, leading to the activation of complement and subsequent destruction of the targeted cell. This process involves antibodies binding to antigens on the cell surface, which triggers complement activation and cell lysis. Option A) type I hypersensitivity involves IgE-mediated reactions, leading to the release of histamine and other mediators from mast cells and basophils, causing allergic symptoms like hives and anaphylaxis. This type of reaction is not associated with complement activation and cell destruction as described in the question. Option C) type III hypersensitivity involves immune complex-mediated reactions where antigen-antibody complexes deposit in tissues, leading to inflammation and tissue damage. This process does not directly involve complement activation on cell membranes resulting in cell destruction. Option D) type IV hypersensitivity is a delayed-type hypersensitivity reaction mediated by T cells, not antibodies. It involves a delayed response to antigens and is more commonly associated with conditions like contact dermatitis and certain autoimmune diseases, which do not directly involve complement activation and cell destruction. In an educational context, understanding the different types of hypersensitivity reactions is crucial for healthcare professionals, especially pediatric clinical nurse specialists, in assessing and managing various immune-mediated conditions in pediatric patients. Recognizing the specific characteristics of each type of hypersensitivity reaction is essential for accurate diagnosis, treatment, and patient care.

Correct Answer: D

Rationale: The most appropriate treatment option for a 10-year-old child with intermittent mild asthma symptoms is option D, which is the inhaled β₂-agonist as needed for symptoms. In pediatric asthma management, inhaled β₂-agonists are considered first-line rescue medications for relieving acute asthma symptoms by quickly dilating the airways and improving airflow. These medications are fast-acting and provide immediate relief during asthma exacerbations. Option A, environmental control and patient education only without medication, is not the most appropriate choice for a child with mild asthma symptoms. While environmental control and patient education are essential components of asthma management, medication is often necessary to provide prompt relief during asthma attacks. Option B, oral theophylline, is not the preferred treatment for mild intermittent asthma in children due to its narrow therapeutic window, potential for toxicity, and the availability of safer and more effective medications, such as inhaled bronchodilators. Option C, cromolyn, is a mast cell stabilizer that is used more for prevention of asthma symptoms rather than for quick relief during acute exacerbations. Inhaled β₂-agonists are more suitable for providing immediate relief of bronchoconstriction in a child experiencing intermittent mild asthma symptoms. In an educational context, it is crucial for pediatric clinical nurse specialists to have a solid understanding of asthma management in children. By choosing the appropriate medication based on the severity of symptoms and individual patient needs, healthcare providers can effectively control asthma and improve the quality of life for pediatric patients with asthma. Understanding the rationale behind each treatment option helps healthcare professionals make informed decisions and provide optimal care for pediatric patients with asthma.

Correct Answer: D

Rationale: Serum sickness is a type III hypersensitivity reaction caused by the formation of immune complexes in response to certain medications or foreign proteins. In this case, aspirin (Option D) is not a common cause of serum sickness. Aspirin is more commonly associated with hypersensitivity reactions like aspirin-exacerbated respiratory disease (AERD) or aspirin-induced urticaria/angioedema. Penicillin (Option A), cephalosporins (Option B), and sulfonamides (Option C) are common causes of serum sickness due to their ability to induce immune complex formation in susceptible individuals. These medications are known to trigger an immune response leading to symptoms like fever, rash, joint pain, and lymphadenopathy characteristic of serum sickness. Educationally, understanding the common causes of serum sickness is crucial for pediatric clinical nurse specialists to accurately assess and manage patients experiencing hypersensitivity reactions to medications. Recognizing the signs and symptoms of serum sickness and identifying the causative agents can guide appropriate treatment interventions and prevent further complications in pediatric patients.