Deck 31: The Child with a Metabolic Condition

Question 1

After 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 (BP).Based on these symptoms,what does the nurse suspect has developed?

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

Answer 1

Diabetes insipidus

Question 2

Which statement made by a 7-year-old child with type 1 diabetes mellitus indicates a need for more teaching?

A) "My pancreas is sick and needs insulin until it is well."
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."

Answer 2

"My pancreas is sick and needs insulin until it is well."

Question 3

A child receives a combination of regular and NPH insulin at 8:00 AM.At 8:45 AM the breakfast trays have not yet arrived from the kitchen.What is the best action by the nurse?

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 discussed treatment of hypoglycemia with an adolescent.Which statement by the adolescent leads the nurse to determine the patient understood the instructions?

A) "When my blood glucose is low or if I begin to feel hungry and weak, I will eat six LifeSavers."
B) "When my blood glucose is low or if I begin to feel hungry and weak, I will give myself Lispro insulin."
C) "When my blood glucose is low or if I begin to feel hungry and weak, I will have a slice of cheese."
D) "When my blood glucose is low or if I begin to feel hungry and weak, I will drink a diet soda."

Question 5

A mother reports that her 4-month-old infant is lethargic,sleeps 18 hours a day,and snores.The nurse recognizes these signs are characteristic of what?

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

Question 6

What does the nurse instruct a 12-year-old to do when teaching how to administer insulin?

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) Give the injection deep into the muscle.

Question 7

The nurse is teaching the parents of a child with diabetes insipidus about water intoxication. The nurse would tell the parents to be alert for what symptom? For

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

Question 8

The parents of a child newly diagnosed with diabetes mellitus tell the nurse,"Our son's body is resistant to insulin." With what does the nurse recognize this description is consistent?

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

Question 9

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

A) Somogyi phenomenon
B) Dawn syndrome
C) Ketoacidosis
D) Water intoxication

Question 10

What would be the most appropriate nursing response to a woman who says,"My sister had a child with Tay-Sachs disease,and 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 11

Which general dietary measure should the nurse include in a teaching plan for the child with type 1 diabetes mellitus?

A) Control intake of carbohydrates and consume fewer calories.
B) Focus on complex carbohydrates and eat foods high in fiber.
C) Obtain most calories from proteins and fats.
D) Eat a diet low in fat and low in complex carbohydrates.

Question 12

What statement by a parent leads the nurse to determine a parent is administering levothyroxine (Synthroid)correctly?

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 every day."

Question 13

What condition does the nurse suspect when a child with type 1 diabetes mellitus has hyperglycemia,diaphoresis,and headaches in the morning?

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

Question 14

What is an important consideration for the school-age child taking DDAVP for diabetes insipidus?

A) Observe for signs of water deprivation.
B) Restrict his physical education program.
C) Arrange for the child to use the bathroom when needed.
D) Limit fluid intake other than during the lunch period.

Question 15

A nurse is planning to teach a family about Tay-Sachs disease.What will the nurse relay about the pattern of inheritance for inborn errors of metabolism?

A) They are usually autosomal recessive.
B) They are usually autosomal dominant.
C) They are usually X-linked recessive.
D) They are usually multifactorial.

Question 16

Although the child with type 1 diabetes had her prescribed insulin at 7:30 AM,the child is complaining of hunger and thirst and is drowsy at 10:30 AM.What should the nurse do first?

A) Walk the patient in the hall for 10 minutes.
B) Allow the patient a short nap.
C) Give her a cup of orange juice.
D) Test her blood with a glucometer and give insulin according to the sliding scale.

Question 17

On what understanding does the nurse plan the care of a child with a new diagnosis of type 1 diabetes mellitus?

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 18

What occurs as a result 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 19

Which laboratory result indicates good metabolic control for a child with type 1 diabetes mellitus?

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 20

Which comment made by a school-age child indicates that he needs more teaching about diabetes mellitus and exercise?

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 21

Which process(es)does the nurse explain the endocrine system is primarily responsible for controlling?

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

Question 22

The nurse is preparing to administer a long-acting insulin.Which insulin is considered long acting?

A) Lispro
B) Aspart
C) Glargine
D) Regular

Question 23

What is the function of an insulin pump?

A) Releases insulin as blood glucose rises
B) Provides continuous infusion of insulin
C) Decreases need for painful glucose monitoring
D) Delivers a prescribed amount of insulin twice a day

Question 24

The nurse reminds the parents of a diabetic with an insulin pump that the tubing of the pump should be changed aseptically every ______ hours.

Question 25

What does the nurse remind the adolescent with diabetes that soluble fiber in the diet can reduce?

A) Blood glucose
B) Serum cholesterol
C) Incidence of infections
D) Absorption of sugar
E) Insulin requirements

Question 26

Why does the nurse instruct an 11-year-old diabetic child to use the side of the finger for blood testing?

A) It has fewer capillaries.
B) It is easier to puncture.
C) It is less likely to become infected.
D) It has fewer nerve endings.

Question 27

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 28

Which food sources are high in soluble fiber?

A) Raw fruits
B) Cooked vegetables
C) Beans
D) Lean meat
E) Bran cereal

Question 29

A child with diabetes mellitus is observed to have cold symptoms.What signs and symptoms will alert parents of the possibility of ketoacidosis?

A) Chest congestion
B) Ear pain
C) Fruity breath
D) Hyperactivity
E) Nausea

Question 30

When discussing possible causes of diabetes in children,the nurse mentions chromosomal defects.Which chromosomes are associated with diabetes?

A) 6
B) 7
C) 12
D) 20
E) 21

Question 31

The nurse is discussing insulin shock with parents of a child recently diagnosed with diabetes mellitus.What will the nurse respond when the parents ask why children are more prone to insulin reactions?

A) "The condition is more unstable in children."
B) "Parents are often noncompliant."
C) "The activities are irregular."
D) "They are still growing."
E) "Sleep patterns are not established."

Question 32

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

Question 33

The home health nurse is monitoring an 8-month-old child with hypothyroidism taking levothyroxine (Synthroid).Which symptoms does the nurse recognize as signs of overdose?

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

Question 34

What makes keeping diabetes in control in an adolescent difficult?

A) Hormonal changes
B) Developmental conflicts
C) Preference for fast food
D) Growth spurts
E) Knowledge of disease

Question 35

Long-acting types of insulin are seldom given to children because of the danger of ___________________ during sleep.