A male client with pernicious anemia takes supplemental folate and self-administers monthly Vitamin B12 injections. He reports feeling increasingly fatigued. Which laboratory value should the nurse review?

Correct Answer: A

Rationale: In this scenario, the nurse should review the complete blood count (CBC) of the client. Pernicious anemia is primarily caused by a deficiency in Vitamin B12, which can lead to megaloblastic anemia characterized by enlarged and immature red blood cells. Folate supplementation can mask the anemia associated with Vitamin B12 deficiency, but it does not address the neurological symptoms that can occur. Reviewing the CBC will provide information on the client's red blood cell count, hemoglobin levels, and mean corpuscular volume, which can indicate whether the anemia is improving or worsening despite the Vitamin B12 injections. An increase in fatigue could be a sign of worsening anemia, so monitoring the CBC is crucial in this case. The other options are not directly related to the management of pernicious anemia. Serum ferritin levels are more indicative of iron stores in the body, not Vitamin B12 levels. Serum potassium levels are important in conditions affecting electrolyte balance, which is not the primary concern in this case. Liver function tests are not typically affected by pernicious anemia unless there are other underlying liver conditions present. Understanding the importance of monitoring specific laboratory values in patients with different conditions is crucial in nursing practice, especially in pediatric patients who may present with atypical symptoms or complications. Regular monitoring and assessment help in early detection of complications and timely intervention, ensuring optimal patient outcomes.

Correct Answer: A

Rationale: In this scenario, the correct action for the nurse to take first is to determine the client's current glucose level (Option A). This is crucial in assessing the client's condition and identifying if the symptoms of diaphoresis, rapid heartbeat, and feeling shaky are related to hypoglycemia, a common adverse effect of insulin therapy. Option B, administering 10 units of fast-acting insulin, is incorrect as it can further lower the client's blood glucose levels, exacerbating the symptoms of hypoglycemia. Option C, offering a snack with high protein, is not the first priority as assessing the glucose level is necessary to determine the appropriate intervention. Option D, increasing the IV infusion rate of normal saline, is not indicated for addressing hypoglycemia associated with insulin therapy. Educationally, this scenario highlights the importance of prompt assessment and intervention in managing potential complications of insulin therapy in diabetic patients. Nurses need to prioritize assessing the client's glucose levels to guide appropriate interventions and prevent further complications. Understanding the signs and symptoms of hypoglycemia and the appropriate nursing actions is essential in providing safe and effective care to patients with diabetes.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) A change has recently occurred in his handwriting. This symptom suggests AIDS dementia because it is a common neurological manifestation of advanced HIV infection in pediatric patients. AIDS dementia complex can present with cognitive impairment, behavioral changes, motor dysfunction, and alterations in handwriting, which may include deterioration in fine motor skills. Option B) The client has a persistent cough and fever is incorrect because these symptoms are more indicative of respiratory infections common in HIV-positive pediatric patients, such as pneumonia or tuberculosis, rather than AIDS dementia. Option C) The client experiences shortness of breath is incorrect as it could be a sign of respiratory issues or cardiovascular problems in the context of HIV, but it is not specific to AIDS dementia. Option D) The client exhibits a loss of appetite is also incorrect since it is a non-specific symptom commonly seen in various conditions, including HIV infection, but not specifically indicative of AIDS dementia. Educationally, understanding the neurological manifestations of advanced HIV infection, such as AIDS dementia complex, is crucial for pediatric nurses caring for HIV-positive children. Recognizing subtle changes in handwriting can prompt early intervention and appropriate management to improve the quality of life for these patients. Regular neurological assessments and education for families on recognizing such symptoms are essential in the holistic care of pediatric patients with HIV.

Correct Answer: D

Rationale: In the context of pediatric nursing and cardiovascular disorders, understanding the laboratory studies that assist in confirming a diagnosis like rheumatic fever is crucial for providing effective care. The correct answer is D) Anti-streptolysin O titer. Rheumatic fever is often preceded by a streptococcal infection, and the presence of anti-streptolysin O antibodies indicates recent streptococcal infection, helping confirm the diagnosis. This test is specific to streptococcal infections and is essential in diagnosing rheumatic fever accurately. Option A) Immunoglobulin is too broad and does not specifically target the streptococcal infection needed for diagnosing rheumatic fever. Option B) Red blood cell count and C) White blood cell count are general tests that do not provide specific information about a streptococcal infection or rheumatic fever. Educationally, understanding the rationale behind each laboratory test in diagnosing specific conditions enhances a nurse's ability to provide comprehensive care to pediatric patients with cardiovascular disorders like rheumatic fever. Knowing which tests are appropriate for specific conditions can lead to timely diagnosis and appropriate treatment interventions.

Correct Answer: B

Rationale: In this scenario, option B, "I can apply lotion or powder to the incision if it is itchy," indicates a need for further instructions. This statement is incorrect because applying lotion or powder to a surgical incision can introduce foreign substances and increase the risk of infection, which is crucial to avoid in the post-operative period. Option A is correct because a balance of rest and exercise is essential for the child's recovery after cardiac surgery. It promotes healing while preventing complications like blood clots. Option C is correct as activities that could result in falls should be avoided to prevent injury to the surgical site and ensure the child's safety during the initial healing phase. Option D is correct as crowded places like malls or grocery stores pose a risk of exposure to infections, which the child's weakened immune system may not be able to handle immediately after surgery. It is crucial to educate parents on post-operative care to ensure the child's optimal recovery and reduce the risk of complications. Providing clear instructions and addressing misconceptions, like the one in option B, are vital components of pediatric nursing education in cardiovascular disorders.