Question 1

What blood glucose measurement is most likely associated with diabetic ketoacidosis?
A) 185 mg/dl
B) 220 mg/dl
C) 280 mg/dl
D) 330 mg/dl

Accepted Answer

Diabetic ketoacidosis is a state of relative insulin insufficiency and may include the presence of hyperglycemia, a blood glucose level greater than or equal to 330 mg/dl; 185, 220, and 280 mg/dl are values that are too low for the definition of ketoacidosis.

Question 2

The nurse is teaching the parent of a preschool child how to administer the child's insulin injection. The child will be receiving 2 units of regular insulin and 12 units of NPH insulin every morning. What should the parent be taught?
A) Draw the insulin in separate syringes.
B) Draw the regular insulin first and then the NPH into the same syringe.
C) Draw the NPH insulin first and then the regular into the same syringe.
D) Check blood sugar first, and if below 120, hold the regular insulin and give the NPH.

Accepted Answer

To obtain maximum benefit from mixing insulins, the recommended practice is to (1) inject the measured amount of air (equivalent to the dosage) into the long-acting insulin; (2) inject the measured amount of air into the rapid-acting (clear) insulin and, without removing the needle; (3) withdraw the clear insulin; and (4) insert the needle (already containing the clear insulin) into the long-acting (cloudy) insulin and then withdraw the desired amount. The blood sugar may be checked before giving the insulin, but the prescribed dose should not be withheld if the blood sugar is 120.

Question 3

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention?
A) Sports drink and fruit
B) Glucose tabs and protein
C) Glass of water and crackers
D) Milk and peanut butter on bread

Accepted Answer

Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Milk supplies lactose and a more prolonged action from the protein. The bread is a complex carbohydrate, which with the peanut butter provides a sustained action. The sports drink contains primarily simple carbohydrates. The fruit contains additional carbohydrates. A protein source is needed for sustained action. The glucose tabs are simple carbohydrates. Complex carbohydrates are needed with the protein. Crackers are a complex carbohydrate, but protein is needed to stabilize the blood sugar.

Question 4

The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption?
A) Arm
B) Leg
C) Buttock
D) Abdomen

Accepted Answer

The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but a short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration.

Question 5

An adolescent diabetic is admitted to the emergency department for treatment of hyperglycemia and pneumonia. What are characteristics of diabetic hyperglycemia?
A) Cold, clammy skin and lethargy
B) Hunger and hypertension
C) Thirst, being flushed, and fruity breath
D) Disorientation and pallor

Accepted Answer

The signs of hyperglycemia are thirst, being flushed, and fruity breath. The skin is not cold or clammy, and there is not hunger and hypertension. Disorientation and pallor are signs of hypoglycemia.

Question 6

To help an adolescent deal with diabetes, the nurse needs to consider which characteristic of adolescence?
A) Desire to be unique
B) Preoccupation with the future
C) Need to be perfect and similar to peers
D) Awareness of peers that diabetes is a severe disease

Accepted Answer

Adolescence is a time when the individual has a need to be perfect and similar to peers. Having diabetes makes adolescents different from their peers. Adolescents do not wish to be unique; they desire to fit in with the peer group. An adolescent is usually not future oriented. Awareness of peers that diabetes is a severe disease would further alienate the adolescent with diabetes. The peer group would focus on the differences.

Question 7

A preadolescent has maintained good glycemic control of his type 1 diabetes through the school year. During summer vacation, he has had repeated episodes of hypoglycemia. What additional teaching is needed?
A) Carbohydrates in the diet need to be replaced with protein.
B) Additional snacks are needed to compensate for increased activity.
C) The child needs to decrease his activity level to minimize episodes of hypoglycemia.
D) Insulin dosage should be increased to compensate for a change in activity level.

Accepted Answer

Most children have a different schedule during summer vacation. The increased activity and exercise reduce insulin resistance and increase glucose utilization. Additional snacks should be eaten before physical activity to increase carbohydrates and protein and compensate for increased activity. Physical activity should always be encouraged if the child is capable. The benefits include improved glucose utilization and decreased insulin requirements. In consultation with the practitioner, insulin dosage may need to be decreased because of improved glucose utilization.

Question 8

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. What effect does exercise have on a type 1 diabetic?
A) Exercise increases blood glucose.
B) Extra insulin is required during exercise.
C) Additional snacks are needed before exercise.
D) Excessive physical activity should be restricted.

Accepted Answer

Exercise lowers blood glucose levels, decreasing the need for insulin. Extra snacks are provided to maintain the blood glucose levels. Exercise is encouraged and not restricted unless indicated by other health conditions.

Question 9

The thyroid-stimulating hormone (TSH) increases secretion in response to which hormone?
A) Low levels of circulating thyroid hormone
B) High levels of circulating thyroid hormone
C) Low levels of circulating adrenocorticotropic hormone
D) High levels of circulating adrenocorticotropic hormone

Accepted Answer

As blood concentrations of the target hormones reach normal levels, a negative message is sent to the anterior pituitary to inhibit release of the tropic hormone. For example, TSH responds to low levels of circulating TH. As blood levels of TH reach normal concentrations, a negative feedback message is sent to the anterior pituitary, resulting in diminished release of TSH. Adrenocorticotropic stimulates the adrenals to secrete glucocorticoids.

Question 10

What statement applies to the current focus of the dietary management of children with diabetes?
A) Measurement of all servings of food is vital for control.
B) Daily calculate specific amounts of carbohydrates, fats, and proteins.
C) The number of calories for carbohydrates remains constant on a daily basis; protein and fat calories are liberal.
D) The intake ensures day-to-day consistency in total calories, protein, carbohydrates, and moderate fat while allowing for a wide variety of foods.

Accepted Answer

Essentially the nutritional needs of children with diabetes are no different from those of healthy children. Children with diabetes need no special foods or supplements. They need sufficient calories to balance daily expenditure for energy and to satisfy the requirement for growth and development.

Question 11

During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise?
A) ­food intake
B) ¯food intake
C) ­risk of hyperglycemia
D) ¯risk of insulin reaction

Accepted Answer

Exercise is encouraged and never restricted unless indicated by other health conditions. Exercise lowers blood glucose levels, depending on the intensity and duration of the activity. Consequently, exercise should be included as part of diabetes management, and the type and amount of exercise should be planned around the child's interests and capabilities. However, in most instances, children's activities are unplanned, and the resulting decrease in blood glucose can be compensated for by providing extra snacks before (and, if the exercise is prolonged, during) the activity. In addition to a feeling of well-being, regular exercise aids in utilization of food and often results in a reduction of insulin requirements.

Question 12

Prolonged steroid therapy has caused a child to have Cushing syndrome. To lessen the cushingoid effects, the steroid should be administered at which time?
A) In the PM
B) After lunch
C) QD in the AM
D) QOD in the AM

Accepted Answer

When cushingoid features are caused by steroid therapy, the effects may be lessened with administration of the drug early in the morning and on an alternate-day basis. Giving the drug early in the day maintains the normal diurnal pattern of cortisol secretion. If given during the evening, it is more likely to produce symptoms because endogenous cortisol levels are normally low and the additional supply exerts more pronounced effects. An alternate-day schedule allows the anterior pituitary an opportunity to maintain more normal hypothalamic-pituitary-adrenal control mechanisms.

Question 13

The nurse is assisting with a growth hormone stimulation test for a child with short stature. What should the nurse monitor closely on this child during the test?
A) Hypotension
B) Tachycardia
C) Hypoglycemia
D) Nausea and vomiting

Accepted Answer

Patients receiving clonidine (Catapres) for a growth hormone stimulation test require close blood pressure monitoring for hypotension. Tachycardia, hypoglycemia, and nausea and vomiting do not occur with Catapres administered for a growth hormone stimulation test.

Question 14

The clinic nurse is assessing a child with hypopituitarism. Hypopituitarism can lead to which disorder?
A) Gigantism
B) Hyperthyroidism
C) Cushing syndrome
D) Growth hormone deficiency

Accepted Answer

Hypopituitarism can lead to a growth hormone deficiency. An overproduction of the anterior pituitary hormones can result in gigantism (caused by excess growth hormone production during childhood), hyperthyroidism, or hypercortisolism (Cushing syndrome).

Question 15

A 12-year-old girl is newly diagnosed with diabetes when she develops ketoacidosis. How should the nurse structure a successful education program?
A) Essential information is presented initially.
B) Teaching should take place in the child's semiprivate room.
C) Education is focused toward the parents because the child is too young.
D) All information needed for self-management of diabetes is taught at once.

Accepted Answer

Diagnosis of type 1 diabetes can be traumatic for the child and family. Most families are not psychologically ready for the complex teaching that is needed for self-management. Most structured diabetes education programs begin with essential or survival information followed by the complex background material when the family is better able to learn. Teaching can take place either as an outpatient or as an inpatient. The actual teaching area should be free from distractions that would interfere with learning. A semiprivate room would have many individuals entering and leaving the room, causing distraction. A 12-year-old child who is cognitively age appropriate needs to be included in the educational process. Most children older than the age of 8 years can be involved in blood glucose monitoring and insulin administration. Teaching all information needed for self-management of diabetes at once would be too overwhelming for a family in crisis.

Question 16

What clinical manifestation occurs with hypoglycemia?
A) Lethargy
B) Confusion
C) Nausea and vomiting
D) Weakness and dizziness

Accepted Answer

Some of the clinical manifestations of hypoglycemia include weakness; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, confusion, and nausea and vomiting are manifestations of hyperglycemia.

Question 17

A school-age child with diabetes gets 30 units of NPH insulin at 0800. According to when this insulin peaks, the child should be at greatest risk for a hypoglycemic episode between when?
A) Lunch and dinner
B) Breakfast and lunch
C) 0830 to his midmorning snack
D) Bedtime and breakfast the next morning

Accepted Answer

Intermediate-acting (NPH and Lente) insulins reach the blood 2 to 6 hours after injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours.

Question 18

A 20-kg (44-lb) child in ketoacidosis is admitted to the pediatric intensive care unit. What order should the nurse not implement until clarified with the physician?
A) Weigh on admission and daily.
B) Replace fluid volume deficit over 48 hours.
C) Begin intravenous line with D5 0.45% normal saline with 20 mEq of potassium chloride.
D) Give intravenous regular insulin 2 units/kg/hr after initial rehydration bolus.

Accepted Answer

The initial hydrating solution is 0.9% normal saline. Potassium is not given until the child is voiding 25 ml/hr, demonstrating adequate renal function. After initial rehydration and insulin administration, then potassium is given. Dextrose is not given until blood glucose levels are between 250 and 300 mg/dl. An accurate, current weight is essential for determination of the amount of fluid loss and as a basis for medication dosage. Replacing fluid volume deficit over 48 hours is the current recommendation in diabetic ketoacidosis in children. Cerebral edema is a risk of more rapid administration. Intravenous regular insulin 2 units/kg/hr after initial rehydration bolus is the recommended insulin administration for a child of this weight. Only regular insulin can be given intravenously, and it is given after initial fluid volume expansion.

Question 19

The nurse is teaching an adolescent about giving insulin injections. The adolescent asks if the disposable needles and syringes can be used more than once. The nurse's response should be based on which knowledge?
A) It is unsafe.
B) It is acceptable for up to 24 hours.
C) It is acceptable for families with very limited resources.
D) It is suitable for up to 3 days if stored in the refrigerator.

Accepted Answer

Bacterial counts are unaffected if insulin syringes are handled in an aseptic manner and stored in the refrigerator between use. The syringes can be used up to 3 days and result in a considerable cost savings. Bacterial counts remain low for up to 72 hours with proper technique. The family's resources are not an issue; if a practice is unsafe, the family should not be encouraged to endanger the child by reusing equipment.

Question 20

The nurse is caring for an adolescent with anorexia nervosa. What pituitary dysfunction should the nurse assess for in the adolescent?
A) Hypopituitarism
B) Pituitary hyperfunction
C) Hyperplasia of the pituitary cells
D) Overproduction of the anterior pituitary hormones

Accepted Answer

Anorexia nervosa can cause hypopituitarism. It does not cause the hyperfunction of the pituitary, hyperplasia of the pituitary cells, or overproduction of the anterior pituitary hormones.

Quiz 33: The Child with Endocrine Dysfunction

What blood glucose measurement is most likely associated with diabetic ketoacidosis?

The nurse is teaching the parent of a preschool child how to administer the child's insulin injection. The child will be receiving 2 units of regular insulin and 12 units of NPH insulin every morning. What should the parent be taught?

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention?

The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption?

An adolescent diabetic is admitted to the emergency department for treatment of hyperglycemia and pneumonia. What are characteristics of diabetic hyperglycemia?

To help an adolescent deal with diabetes, the nurse needs to consider which characteristic of adolescence?

A preadolescent has maintained good glycemic control of his type 1 diabetes through the school year. During summer vacation, he has had repeated episodes of hypoglycemia. What additional teaching is needed?

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. What effect does exercise have on a type 1 diabetic?

The thyroid-stimulating hormone (TSH) increases secretion in response to which hormone?

What statement applies to the current focus of the dietary management of children with diabetes?

During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise?

Prolonged steroid therapy has caused a child to have Cushing syndrome. To lessen the cushingoid effects, the steroid should be administered at which time?

The nurse is assisting with a growth hormone stimulation test for a child with short stature. What should the nurse monitor closely on this child during the test?

The clinic nurse is assessing a child with hypopituitarism. Hypopituitarism can lead to which disorder?

A 12-year-old girl is newly diagnosed with diabetes when she develops ketoacidosis. How should the nurse structure a successful education program?

What clinical manifestation occurs with hypoglycemia?

A school-age child with diabetes gets 30 units of NPH insulin at 0800. According to when this insulin peaks, the child should be at greatest risk for a hypoglycemic episode between when?

A 20-kg (44-lb) child in ketoacidosis is admitted to the pediatric intensive care unit. What order should the nurse not implement until clarified with the physician?

The nurse is teaching an adolescent about giving insulin injections. The adolescent asks if the disposable needles and syringes can be used more than once. The nurse's response should be based on which knowledge?

The nurse is caring for an adolescent with anorexia nervosa. What pituitary dysfunction should the nurse assess for in the adolescent?