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 being on insulin pump therapy. Rapid-acting insulin given via syringe or pen allows for a more immediate and precise delivery of insulin to address the high blood sugar levels and ketones. This method ensures faster correction and can help prevent potential complications of hyperglycemia and ketosis. Option A is incorrect because delivering a correction bolus through the insulin pump may not be as effective in this situation due to possible insulin pump malfunction or absorption issues. Option C, delivering a dose of long-acting insulin, is not appropriate for correcting acute hyperglycemia and ketones as it acts over an extended period and does not provide immediate relief. Option D, performing exercise and increasing water intake, is not recommended for treating high blood sugar and ketones in this case as it may worsen the condition by leading to dehydration and further ketone production. Educationally, it is crucial for pediatric clinical nurse specialists to understand the management of acute complications in pediatric patients with diabetes. Providing detailed explanations for the correct and incorrect options helps reinforce the importance of prompt and appropriate interventions to prevent complications and promote optimal health outcomes in pediatric patients with diabetes.

Correct Answer: A

Rationale: The correct answer is A) epinephrine. In this scenario, the child is experiencing streptococcal pharyngitis, which is a bacterial infection. Epinephrine is a vasoconstrictor that can help in reducing inflammation and swelling of the throat, providing relief from symptoms like sore throat and difficulty swallowing. Option B) prednisone is a corticosteroid that is more commonly used for treating inflammatory conditions, such as asthma or allergic reactions. It is not the first-line treatment for streptococcal pharyngitis. Option C) diphenhydramine (Benadryl) is an antihistamine that is used to treat allergic reactions and symptoms like itching, sneezing, and runny nose. It is not effective in treating bacterial infections like streptococcal pharyngitis. Option D) cimetidine is a histamine-2 blocker that is used to reduce stomach acid production. It is not indicated for the treatment of streptococcal pharyngitis. In an educational context, it is crucial for pediatric clinical nurse specialists to have a strong understanding of common pediatric illnesses and their appropriate treatments. Streptococcal pharyngitis is a common condition in children, and knowing the most effective treatment options can help in providing optimal care and improving patient outcomes. Understanding the rationale behind choosing epinephrine in this case reinforces the importance of evidence-based practice and critical thinking in pediatric nursing care.

Correct Answer: B

Rationale: The correct answer is B) type II hypersensitivity. Type II hypersensitivity reactions involve antigen-antibody reactions on the cell membrane, leading to complement activation and the destruction of the involved cell. This process occurs through various mechanisms such as complement-mediated lysis, antibody-dependent cellular cytotoxicity, and phagocytosis. Option A) type I hypersensitivity is characterized by IgE-mediated reactions, leading to the release of histamine and other mediators from mast cells and basophils, causing immediate hypersensitivity reactions like allergies. Option C) type III hypersensitivity involves immune complex deposition in tissues, leading to inflammation and tissue damage due to the inability to clear the immune complexes. Option D) type IV hypersensitivity is a delayed-type hypersensitivity reaction mediated by T cells, resulting in inflammation and tissue damage caused by the release of cytokines and recruitment of inflammatory cells. In a pediatric clinical setting, understanding the different types of hypersensitivity reactions is crucial for assessing and managing various conditions like allergic reactions, autoimmune diseases, and drug reactions. Recognizing the specific characteristics and mechanisms of each type of hypersensitivity reaction is essential for providing appropriate care and interventions for pediatric patients.

Correct Answer: D

Rationale: The most appropriate treatment option for a 10-year-old child with intermittent symptoms of mild asthma is option D, which is the inhaled β₂-agonist as needed for symptoms. Explanation of why D is correct: - Inhaled β₂-agonists are quick-relief medications that help to relax the muscles around the airways during an asthma attack, providing rapid relief of symptoms such as wheezing, coughing, and shortness of breath. - This treatment option is suitable for mild asthma symptoms and is recommended as the first-line therapy for acute symptom relief in asthma management guidelines. Explanation of why others are wrong: - Option A (Environmental control and patient education only) alone may not be sufficient to manage asthma symptoms and may lead to inadequate control of the condition. - Option B (Oral theophylline) is not typically recommended as a first-line treatment for mild asthma in children due to its potential side effects, narrow therapeutic window, and interactions with other medications. - Option C (Cromolyn) is a mast cell stabilizer that is more suitable for the prevention of asthma symptoms rather than providing immediate relief during an asthma attack. Educational context: It is crucial for pediatric clinical nurse specialists to have a deep understanding of asthma management in children. By choosing the appropriate treatment option, such as inhaled β₂-agonists for acute symptom relief in mild asthma cases, healthcare providers can help improve the quality of life for pediatric patients with asthma. Educating patients and families on proper medication administration techniques and asthma triggers is also essential for long-term asthma management.

Correct Answer: D

Rationale: In this question, the correct answer is D) Aspirin. Serum sickness is a type III hypersensitivity reaction caused by the formation of immune complexes in response to certain medications or antigens. Aspirin is not a common cause of serum sickness compared to the other options provided. Penicillin, cephalosporins, and sulfonamides are known to be common causes of serum sickness due to their ability to induce an immune response leading to the production of immune complexes. These drugs are more frequently associated with serum sickness reactions in pediatric patients. Educationally, it is important for pediatric clinical nurse specialists to be familiar with the common causes of serum sickness in order to recognize and manage these reactions promptly in pediatric patients. Understanding the pathophysiology of serum sickness and being able to identify potential triggers can help in providing safe and effective care to children experiencing hypersensitivity reactions.