Examplify CJE Pediatrics Benchmark 1 2025

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2/17 2030

16-year-old client with Crohn's Disease admitted to medical unit for bowel rest and parenteral nutrition via implanted port. Port placed in January and flushes well.

2/18

0810

Client rang the bell. States "I am really shaky and have a headache. I feel sick and sweaty. I have a cough but I always have that in the morning because of my allergies. Can someone come in here?" Nurse to bedside for assessment.

CBC, CMP Begin parenteral nutrition per protocol Call provider when labs available to write orders for parenteral nutrition solution NPO May continue home medications The nurse cares for a client admitted to the hospital.

Review the electronic health record. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.

Identify the potential condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.

Hint : 🍬 β€œShaky + sweaty on PN = check sugar fast!” β€” Hypoglycemia after parenteral nutrition interruption demands quick glucose replacement and close monitoring.

Correct Answers

  • Blank 1 Correct Option: Hypoglycemia
  • Blank 2 Correct Option: Provide glucose source and Check blood glucose level
  • Blank 3 Correct Option: Toleration of tapering down in last hour of infusion and Blood glucose levels
Rationale :

Condition: Hypoglycemia

πŸ“ŒThe client receiving parenteral nutrition (PN) presents with shakiness, headache, sweating, nausea, and weakness, which are classic signs of hypoglycemia.

πŸ“ŒPN solutions are high in dextrose, and abrupt interruption or delayed administration can cause a rapid drop in blood glucose levels, especially if insulin secretion continues after glucose supply is stopped.

πŸ“ŒAdditionally, the client is NPO (nothing by mouth), so they lack an oral glucose source to stabilize their blood sugar when PN flow changes.

πŸ“ŒTherefore, the client’s current symptoms are most consistent with hypoglycemia related to PN interruption rather than infection or fluid overload.

πŸ’Ž Action 1: Check blood glucose level

πŸ”Ή First priority: Assess the client’s capillary blood glucose immediately to confirm hypoglycemia.

πŸ”Ή This determines the severity and guides subsequent interventions (e.g., whether to give IV dextrose).

πŸ”Ή Checking glucose helps differentiate hypoglycemia from other causes of dizziness or weakness, such as infection or dehydration.

πŸ”Ή Always check glucose before altering PN rate or calling the provider, as rapid identification prevents neurologic complications.

πŸ’Ž Action 2: Provide glucose source

πŸ”Ή If blood glucose is below 70 mg/dL, the nurse should administer a glucose source immediately β€” typically IV 10% or 50% dextrose if the client is NPO or on PN.

πŸ”Ή This stabilizes blood sugar and relieves acute symptoms like tremors and sweating.

πŸ”Ή For PN clients, it’s critical to avoid abrupt discontinuation of the PN infusion. If PN must be paused, hang 10% dextrose (D10W) to prevent rebound hypoglycemia.

πŸ”Ή Follow-up includes rechecking glucose after 15 minutes and documenting the response.

πŸ’Ž Parameter 1: Blood glucose levels

πŸ”Ή Frequent monitoring of blood glucose every 4–6 hours (or per protocol) ensures early detection of fluctuations.

πŸ”Ή During PN therapy, glucose can swing high or low depending on infusion rate or interruptions.

πŸ”Ή The goal is to maintain glucose levels within a safe range (typically 70–140 mg/dL) to avoid metabolic instability.

πŸ”Ή Continuous tracking helps in adjusting PN composition and tapering schedules safely.

πŸ’Ž Parameter 2: Toleration of tapering down in last hour of infusion

πŸ”Ή PN infusions should be gradually tapered down over 1–2 hours rather than stopped suddenly.

πŸ”Ή Tapering allows the body to adjust insulin secretion and prevents rebound hypoglycemia as dextrose supply decreases.

πŸ”Ή During this tapering, monitor for return of hypoglycemic symptoms like sweating, tremors, or confusion.

πŸ”Ή Document how the client tolerates tapering and whether additional glucose support is needed.

Distractor Analysis :

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