A primary care NP sees a 3-year-old patient who has been vomiting ...

[nmorano1]

A primary care NP sees a 3-year-old patient who has been vomiting for several days. The child has had fewer episodes of vomiting the past day and is now able to take sips of fluids without vomiting.
 
  The child has dry oral mucous membranes, 2-second capillary refill, and pale but warm skin. The child's blood pressure is 88/46 mm Hg, the heart rate is 110 beats per minute, and the temperature is 37.2 C. The NP should: a. prescribe promethazine.
  b. prescribe a scopolamine patch.
  c. begin oral rehydration therapy.
  d. send the child to the hospital for IV fluids.

Question 2

A patient with type 2 diabetes mellitus takes metformin (Glucophage) 1000 mg twice daily and glyburide (Micronase) 12 mg daily. At an annual physical examination, the BMI is 29 and hemoglobin A1c is 7.3. The NP should:
 
  a. begin insulin therapy.
  b. change to therapy with colesevelam (Welchol).
  c. add a third oral antidiabetic agent to this patient's drug regimen.
  d. enroll the patient in a weight loss program to achieve better glycemic control.

[olderstudent]

Answer to Question 1

C
The use of antiemetics in children is discouraged for cases of uncomplicated vomiting. The child has compensated, mild dehydration and is now able to tolerate fluids, so oral rehydration is indicated.

Answer to Question 2

A
The target hemoglobin A1c goal for adults is less than 7. Insulin therapy is indicated if maximum doses of two oral antidiabetic drugs are not effective. This patient is taking the maximum recommended doses of metformin and glyburide. Colesevelam does not decrease hemoglobin A1c. Adding a third oral antidiabetic agent is not recommended. A weight loss program may be a part of this patient's treatment, but insulin is necessary to maintain glycemic control.

[nmorano1]

Thank you!

[olderstudent]

Always glad to help...