Question 1

Type 1 diabetes mellitus is suspected in an adolescent.Which clinical manifestation may be present?

Accepted Answer

Poor wound healing may be present in an individual with type 1 diabetes mellitus.Dry skin,weight loss,and dehydration are clinical manifestations of type 1 diabetes mellitus.

Question 2

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

Accepted Answer

The abdomen has the fastest rate of absorption but the shortest duration.The arm has a fast rate of absorption but 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 3

The nurse is caring for an 8-year-old child with type 1 diabetes.The nurse should teach the child to monitor for which manifestation of hypoglycemia?

Accepted Answer

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

Question 4

The nurse is implementing care for a school-age child admitted to the pediatric intensive care in diabetic ketoacidosis (DKA).Which prescribed intervention should the nurse implement first?

Accepted Answer

All patients with DKA experience dehydration (10% of total body weight in severe ketoacidosis)because of the osmotic diuresis,accompanied by depletion of electrolytes,sodium,potassium,chloride,phosphate,and magnesium.The initial hydrating solution is 0.9% saline solution.Insulin therapy should be started after the initial rehydration bolus because serum glucose levels fall rapidly after volume expansion.The child should be placed on the cardiac and pulse oximetry monitor after the rehydrating solution has been initiated.

Question 5

The nurse should expect to assess which clinical manifestations in an adolescent with Cushing syndrome? (Select all that apply.)

Accepted Answer

In Cushing syndrome,physiologic disturbances seen are Cushingoid features hyperglycemia,susceptibility to infection,hypertension,and hypokalemia.

Question 6

A nurse is planning interventions for a toddler with juvenile hypothyroidism.Which interventions should the nurse plan to implement for this child? (Select all that apply.)

Accepted Answer

The presenting symptoms of juvenile hypothyroidism are myxedematous skin changes (dry skin,puffiness around the eyes,sparse hair),constipation,lethargy,and mental decline.The nurse should plan interventions for the dry skin and for the implementation of thyroxine therapy.The child is prone to constipation and sleepiness so antidiarrheal medication and medications to help with insomnia would not be appropriate.

Question 7

The nurse should teach parents of a preschool child with type 1 diabetes that which can raise the blood glucose level?

Accepted Answer

Parents should understand how to adjust food,activity,and insulin at the time of illness or when the child is treated for an illness with a medication known to raise the blood glucose level (e.g.,steroids).Exercise,insulin,and decreased food intake can cause hypoglycemia.

Question 8

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise.Which should the nurse explain about exercise in type 1 diabetes?

Accepted Answer

Exercise lowers blood glucose levels,which can be compensated for by extra snacks.Exercise lowers blood glucose and is encouraged and not restricted,unless indicated by other health conditions.Extra insulin is contraindicated because exercise decreases blood glucose levels.

Question 9

The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary.The nurse should explain that urine testing is necessary for which?

Accepted Answer

Urine testing is still performed to detect evidence of ketonuria.Urine testing for glucose is no longer indicated because of the poor correlation between blood glucose levels and glycosuria.Glycosylated hemoglobin analysis is performed on a blood sample.

Question 10

A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes.The nurse should base the explanation on which knowledge?

Accepted Answer

Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis.Insulin dosages can be adjusted based on blood glucose results.Blood glucose monitoring is more expensive but provides improved management.It is as accurate as equivalent testing done in laboratories.The ability to self-test allows the child to balance diet,exercise,and insulin.The parents are partners in the process,but the child should be taught how to manage the disease.

Question 11

The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes.Which should be included in the teaching plan for daily injections?

Accepted Answer

School-age children are able to give their own injections.Parents should participate in learning and giving the insulin injections.He is already old enough to administer his own insulin.The child is able to use thighs,abdomen,part of the hip,and arm.Assistance can be obtained if other sites are used.

Question 12

To help the adolescent deal with diabetes,the nurse must consider which characteristic of adolescence?

Accepted Answer

Adolescence is a time when the individual wants 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 and are usually not future oriented.Forcing peer awareness of the seriousness of hypoglycemic reactions would further alienate the adolescent with diabetes.The peer group would focus on the differences.

Question 13

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

Accepted Answer

Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein.Fat,fruit juice,and several glasses of water do not provide the child with complex carbohydrate and protein necessary to stabilize the blood glucose.

Question 14

The clinic nurse is reviewing hemoglobin A?c levels on several children with type 1 diabetes.Hemoglobin A?c levels of less than _____% is a goal for children with type 1 diabetes.(Record your answer in a whole number.)

Accepted Answer

The answer of The clinic nurse is reviewing hemoglobin A?c...

Question 15

The nurse is caring for a school-age child with hyperthyroidism (Graves disease).Which clinical manifestations should the nurse monitor that may indicate a thyroid storm? (Select all that apply.)

Accepted Answer

A child with a thyroid storm will have severe irritability and restlessness,vomiting,diarrhea,hyperthermia,hypertension,severe tachycardia,and prostration.

Question 16

Nursing care of a child diagnosed with a syndrome of inappropriate ADH should include which of the following? (Select all that apply.)

Accepted Answer

Increased secretion of ADH causes the kidney to reabsorb water,which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration.The immediate management of the child is to restrict fluids.The child should also be weighed at the same time each day.Encouraging fluids will worsen the child's condition.Turning frequently is not an appropriate intervention unless the child is unresponsive.Fluids,not food,should be restricted.

Question 17

A nurse is planning care for a school-age child with type 1 diabetes.Which insulin preparations are rapid and short acting? (Select all that apply.)

Accepted Answer

Rapid-acting insulin (e.g.,NovoLog)reaches the blood within 15 minutes after injection.The insulin peaks 30 to 90 minutes later and may last as long as 5 hours.Short-acting (regular)insulin (e.g.,Novolin R)usually reaches the blood within 30 minutes after injection.The insulin peaks 2 to 4 hours later and stays in the blood for about 4 to 8 hours.Intermediate-acting insulins (e.g.,Novolin N)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.Long-acting insulin (e.g.,Lantus)takes 6 to 14 hours to start working.It has no peak or a very small peak 10 to 16 hours after injection.The insulin stays in the blood between 20 and 24 hours.

Question 18

Hyperglycemia associated with diabetic ketoacidosis is defined as a blood glucose measurement equal to or greater than _____ 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 200 mg/dl.The values 100 mg/dl,120 mg/dl,and 180 mg/dl are too low for the definition of ketoacidosis.

Question 19

A nurse is reviewing the laboratory results on a school-age child with hypoparathyroidism.Which results are consistent with this condition?

Accepted Answer

The diagnosis of hypoparathyroidism is made on the basis of clinical manifestations associated with decreased serum calcium and increased serum phosphorus.A decreased serum phosphorus would be seen in hyperparathyroidism,elevated glucose in diabetes,and a decreased serum cortisol level in adrenocortical insufficiency (Addison disease).

Quiz 29: The Child with Endocrine Dysfunction