Deck 30: The Child With a Metabolic Condition

Question 1

The parents of a child newly diagnosed with diabetes mellitus tell the nurse, "Our son's body is resistant to insulin." The nurse recognizes this description as consistent with:

A) Type 1, insulin-dependent diabetes mellitus
B) Type 2, non-insulin-dependent diabetes mellitus
C) Maturity-onset diabetes of youth
D) Drug-induced diabetes

Answer 1

Type 2, non-insulin-dependent diabetes mellitus

Question 2

The condition the nurse suspects when a child with type 1 diabetes mellitus has hyperglycemia, diaphoresis, and headaches in the morning is:

A) Dawn phenomenon
B) Somogyi phenomenon
C) Honeymoon effect
D) Ketoacidosis

Answer 2

Somogyi phenomenon

Question 3

A child receives a combination of regular and NPH insulin at 8:00 AM. At 8:45 AM, when the breakfast trays have not yet arrived from the kitchen, the nurse should:

A) Notify the charge nurse.
B) Give the patient a snack of graham crackers and milk.
C) Ambulate the patient in the hall for a short time.
D) Give the patient more insulin according to the sliding scale.

Answer 3

Give the patient a snack of graham crackers and milk.

Question 4

The nurse teaching parents of a child with diabetes insipidus about water intoxication would tell the parents to be alert for:

A) Polyuria
B) Cough
C) Weight loss
D) Lethargy

Question 5

An important consideration for the school-age child taking DDAVP for diabetes insipidus would be:

A) Observing for signs of water deprivation
B) Restricting his physical education program
C) Permitting the child to use the bathroom when needed
D) Limiting fluid intake other than during the lunch period

Question 6

The nurse discussed treatment of hypoglycemia with an adolescent. The nurse determined the adolescent understood the instructions when she verbalized that if her blood sugar is low or if she begins to feel hungry and weak, she will:

A) Eat six LifeSavers
B) Give herself Lispro insulin
C) Have a slice of cheese
D) Drink a diet soda

Question 7

What would be the most appropriate nursing response to a woman who says, "My sister had a child with Tay-Sachs disease. I want to know if I could have a child with this condition."

A) "The disease is rare. It is unlikely that you would have a child with Tay-Sachs disease."
B) "A screening test can be done to determine if you are a carrier of the gene."
C) "The gene for Tay-Sachs disease is transmitted by the father."
D) "The cause of Tay-Sachs disease is thought to be an autoimmune response to a virus."

Question 8

When teaching a 12-year-old how to administer insulin, the nurse includes the following instruction:

A) Make sure injection sites are 6 inches apart.
B) Select an injection site that was recently exercised.
C) Inject the needle at a 90-degree angle.
D) The injection is given deep into the muscle.

Question 9

A child with diabetes is brought to the emergency department; he is flushed, his skin is dry, and he is drowsy. His father states that the child has been feeling progressively worse since the morning. This child is most likely experiencing:

A) Somogyi syndrome
B) Insulin shock
C) Ketoacidosis
D) Water intoxication

Question 10

A mother reports that her 4-month-old infant is lethargic, is sleeping 18 hours a day, and is snoring. The nurse recognizes that these signs are characteristic of:

A) Hypothyroidism
B) Hyperthyroidism
C) Type 1 diabetes mellitus
D) Tay-Sachs disease

Question 11

The nurse caring for a child with a new diagnosis of type 1 diabetes mellitus plans the care based on the understanding that:

A) There is an absolute deficiency of insulin.
B) Insufficient quantities of insulin are produced by the pancreas.
C) Oral hypoglycemic agents can control it.
D) Insulin deficiency is caused by another disease affecting the pancreas.

Question 12

The general dietary measure the nurse will include in a teaching plan for the child with type 1 diabetes mellitus is:

A) Control intake of carbohydrates and consume fewer calories.
B) Restrict concentrated carbohydrates and eat foods high in fiber.
C) Calories must come from proteins and fats.
D) Eat a diet low in fat and low in complex carbohydrates.

Question 13

The comment made by a school-age child, indicating that he needs more teaching about diabetes mellitus and exercise, is:

A) "I carry a piece of hard candy with me in case I start to feel shaky."
B) "I make sure I have emergency money when I have soccer practice or a game."
C) "Sometimes I skip my breakfast when I have a game in the morning."
D) "I play in soccer games that are scheduled after dinner."

Question 14

Although the type 1 diabetic child had her prescribed insulin at 7:30 AM, the child is complaining of hunger and thirst and is drowsy at noon. The nurse should:

A) Administer glucagon immediately and test her blood with a glucometer in 10 minutes.
B) Have her eat some peanut butter crackers.
C) Give her a cup of orange juice.
D) Test her blood with a glucometer and give insulin according to the sliding scale.

Question 15

The nurse explains that because of an inadequate secretion of insulin:

A) Protein synthesis is increased.
B) Increased fat breakdown leads to ketonemia.
C) Serum glucose levels are markedly decreased.
D) More rapid conversion and storage of carbohydrates to glucose occurs.

Question 16

The laboratory data indicating good metabolic control for a child with type 1 diabetes mellitus are:

A) Glycosylated hemoglobin value of 8%
B) Fasting blood glucose level less than 140 mg/dl
C) Glucose tolerance test result of 190 mg/dl
D) No glucose or ketones present in the urine

Question 17

The nurse determines a parent is administering Synthroid correctly when she states:

A) "I stopped giving the medication because my daughter was losing her hair."
B) "I am using a different brand now because it costs less money."
C) "I don't give the medication on the weekends."
D) "I give the medication at 8:00 AM everyday."

Question 18

The statement made by a 7-year-old child with diabetes mellitus that indicates a need for more teaching is:

A) "My pancreas is sick and needs insulin until it gets better."
B) "I will need to take my insulin every day."
C) "I need to keep a piece of candy in my pocket in case I start to feel shaky."
D) "My mom has to give me insulin shots twice a day."

Question 19

The nurse planning to teach a family about Tay-Sachs disease understands the pattern of inheritance for inborn errors of metabolism is usually:

A) Autosomal recessive
B) Autosomal dominant
C) X-linked recessive
D) Multifactorial

Question 20

Following a closed head injury, the unconscious 10-year-old child begins to excrete copious amounts of pale urine with an attendant drop in blood pressure. Based on these symptoms, the nurse suspects the development of:

A) Diabetes insipidus
B) Diabetes mellitus
C) Hypothyroidism
D) Hyperthyroidism

Question 21

The home health nurse monitoring an 8-month-old hypothyroid child taking Synthroid, recognizes signs of overdose when the assessment reveals: Select all that apply.

A) Tachycardia
B) Irritability
C) Vomiting
D) Weight loss
E) Diaphoresis

Question 22

The nurse explains that the diagnosis of diabetes is made when the fasting blood glucose level is ____________________ mg/dl on two separate occasions, and the history is positive for indication of the disease.

Question 23

The nurse explains that the endocrine system is primarily responsible for controlling the processes of: Select all that apply.

A) Maturation
B) Reproduction
C) Sexual identity
D) Stress response
E) Growth

Question 24

The nurse warns that keeping diabetes in control in an adolescent is made difficult because of: Select all that apply.

A) Hormonal changes
B) Developmental conflict of independence vs. dependence
C) Addiction to fast food
D) Growth spurt
E) Denial of disease
F) None of the above

Question 25

The nurse assessing a glycosylated hemoglobin (HbA₁c) test is aware that this test can evaluate average glucose levels over a period of ____________________ to ____________________ months.