CH 47-Diabetes only

The nurse is teaching an adolescent, newly diagnosed with type I diabetes, ways to minimize discomfort with insulin injections. Which interventions are helpful in minimizing injection discomfort? (Select all that apply.) A. Do not reuse needles B. Inject insulin when it is cold C. Flex or tense the muscle during injection D. Remove all bubbles from the syringe before injection E. Do not move the direction of the needle-syringe during insertion or withdrawal

A. Do not reuse needles D. Remove all bubbles from the syringe before injection E. Do not move the direction of the needle-syringe during insertion or withdrawal The reuse of needles leads to more discomfort on injection from decreased sharpness of the needle and being an infection control problem. Removing bubbles from the syringe will minimize discomfort. Keeping the direction of the syringe constant during the insertion and withdrawal minimizes discomfort. Insulin should be injected at room temperature to minimize discomfort. Flexing or tensing muscles during injections causes more discomfort.

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. Increased food intake B. Decreased food intake C. Increased risk of hyperglycemia D. Decreased risk of insulin shock

A. Increased food intake Food intake should be increased in the summer when the child is more active. Races and other competitions may require more food than other practice times. The child will require increased food on days of increased activity. The increased activity lowers blood glucose levels. Blood sugars must be monitored closely to avoid the administration of too much insulin during a time of reduced need.

The nurse is explaining that the destruction of pancreatic â-cells is the cause of which disorder? A. Type 1 diabetes B. Type 2 diabetes C. Impaired glucose tolerance D. Gestational diabetes

A. Type 1 diabetes Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic â-cells. Type 2 diabetes is a result of insulin resistance. The insulin-producing pancreatic b-cells are destroyed in type 1 diabetes. The insulin-producing pancreatic b-cells are destroyed in type 1 diabetes.

The clinic nurse is reviewing hemoglobin A1c levels on several children with type 1 diabetes. Hemoglobin A1c levels of less than _____ % are a goal for children with type 1 diabetes. Record your answer as a whole number.

ANS: 7 The measurement of glycosylated hemoglobin (hemoglobin A1c) levels is a satisfactory method for assessing control of type 1 diabetes. As red blood cells circulate in the bloodstream, glucose molecules gradually attach to the hemoglobin A molecules and remain there for the lifetime of the red blood cell, approximately 120 days. The attachment is not reversible; therefore, this glycosylated hemoglobin reflects the average blood glucose levels over the previous 2 to 3 months. The test is a satisfactory method for assessing control, detecting incorrect testing, monitoring the effectiveness of changes in treatment, defining patients goals, and detecting nonadherence. Hemoglobin A1c levels of less than 7% are a well-established goal at most care centers.

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? Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 806 a. Begin 0.9% saline solution intravenously as prescribed. b. Administer regular insulin intravenously as prescribed. c. Place child on a cardiac monitor. d. Place child on a pulse oximetry monitor.

ANS: A 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 monitors after the rehydrating solution has been initiated.

What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? a. Give the child half his regular morning dose of insulin. b. Substitute simple carbohydrates or calorie-containing liquids for solid foods. c. Give the child plenty of unsweetened, clear liquids to prevent dehydration. d. Take the child directly to the emergency department.

ANS: B A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia. The child should receive his regular dose of insulin even if he does not have an appetite. If the child is not eating as usual, he needs calories to prevent hypoglycemia. During periods of minor illness, the child with type 1 diabetes mellitus can be managed safely at home.

The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. What should be included in the teaching plan for daily injections? a. The parents do not need to learn the procedure. b. He is old enough to give most of his own injections. c. Self-injections will be possible when he is closer to adolescence. d. He can learn about self-injections when he is able to reach all injection sites.

ANS: B 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.

Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis? a. No urinary ketones b. Low arterial pH c. Elevated serum carbon dioxide d. Elevated serum phosphorus

ANS: B Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. Urinary ketones, often in large amounts, are present when a child is in diabetic ketoacidosis. Serum carbon dioxide is decreased in diabetic ketoacidosis. Serum phosphorus is decreased in diabetic ketoacidosis.

To help the adolescent deal with diabetes, the nurse must 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. Need to make peers aware of the seriousness of hypoglycemic reactions

ANS: C 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.

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 knowing that: a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. The parents are better able to manage the disease.

ANS: C 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 sugar 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.

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should explain that: a. Exercise will increase blood glucose. b. Exercise should be restricted. c. Extra snacks are needed before exercise. d. Extra insulin is required during exercise.

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

What is characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent. b. Onset is gradual. c. Age at onset is usually younger than 18 years. d. Oral agents are often effective for treatment.

ANS: C The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults. Peak incidence is between the ages of 10 and 15 years. Infrequent ketoacidosis, gradual onset, and treatment with oral agents are more consistent with type 2 diabetes.

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)? a. Novolin N b. Lantus c. NovoLog d. Novolin R

ANS: C, D 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.

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? a. Glucose is needed before administration of insulin. b. Glucose is needed four times a day. c. Glycosylated hemoglobin is required. d. Ketonuria is suspected.

ANS: D 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.

Manifestations of hypoglycemia include: a. Lethargy. b. Thirst. c. Nausea and vomiting. d. Shaky feeling and dizziness.

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

Which symptom is considered a cardinal sign of diabetes mellitus? a. Nausea b. Seizures c. Impaired vision d. Frequent urination

ANS: D Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease.

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin b. Weight gain c. Fluid overload d. Poor wound healing

ANS: D Poor wound healing is often an early sign of type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus.

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by: a. Saturated and unsaturated fat. b. Fruit juice. c. Several glasses of water. d. Complex carbohydrate and protein.

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

The nurse is discussing various sites used for insulin injections with a child and her family. Which site usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomen

ANS: D 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.

The nurse should recognize that, when a child develops diabetic ketoacidosis, it is: A. An expected outcome. B. A life-threatening situation. C. Best treated at home. D. Best treated at the practitioner's office/clinic.

B. A life-threatening situation. This is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. Diabetic ketoacidosis is the state of complete insulin deficiency. It is a medical emergency that must be diagnosed and treated. The child is usually admitted to an intensive care unit for assessment, insulin administration, and fluid and electrolyte replacement. This is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment. This is a medical emergency needing prompt assessment and intervention, usually in an intensive care environment.

The nurse is discharging a 10-year-old patient admitted to the hospital in diabetic ketoacidosis. The child has been newly diagnosed with type 1 diabetes mellitus (DM) on this admission. The nurse should teach the child and parents which signs of type 1? (Select all that apply.) A. Weight gain B. Nocturia C. Irritability D. Cool, clammy skin E. Blurred vision

B. Nocturia C. Irritability E. Blurred vision Clinical manifestations of type 1 diabetes mellitus include:PolyphagiaPolyuriaPolydipsiaWeight lossEnuresis or nocturiaIrritability; "not himself" or "herself"Shortened attention spanLowered frustration toleranceDry skinBlurred visionPoor wound healingFatigueFlushed skinHeadacheFrequent infectionsHyperglycemiaElevated blood glucose levelsGlucosuriaDiabetic ketosisKetones and glucose in urineDehydration in some casesDiabetic ketoacidosisDehydrationElectrolyte imbalanceAcidosisDeep, rapid breathing (Kussmaul respirations)

The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid all those "shots" and take pills as an uncle does. The nurse's BEST reply is: A. "The pills work with an adult pancreas only." B. "The drugs affect fat and protein metabolism, not sugar." C. "Your child needs insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin." D. "Perhaps when your child is older the pancreas will produce its own insulin, and then your child can take oral hypoglycemics."

C. "Your child needs insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin. The oral medications have different modes of action, which supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes. The oral medications have different modes of action, which supplement insulin production by the pancreas, decreasing insulin resistance or affecting liver production of glucose. They are not insulin substitutes. In type 1 diabetes, the b-cells have been destroyed. It is necessary to supply the insulin that they no longer produce. In type 1 diabetes, the b-cells are destroyed. Without a pancreas b-cell transplant, it is unlikely that insulin would be produced.

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, baseball, and swim. The nurse's response should be based on knowledge that: A. Exercise is contraindicated. B. Soccer and baseball are too strenuous, but swimming is acceptable. C. Exercise is not restricted unless indicated by other health conditions. D. The level of activity depends on the type of insulin required.

C. Exercise is not restricted unless indicated by other health conditions. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. Sports are encouraged to help regulate the insulin, and food should be adjusted according to the amount of exercise. The child needs to be cautioned to monitor responses to the exercises. Exercise is encouraged for children with diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. The level of activity does not depend on the type of insulin used. Long- and short-acting insulin both may be used to compensate for the effects of training and sporting events

A 17-year-old boy with diabetes mellitus tells the school nurse that he has recently started drinking alcohol with his friends on weekends. The nurse should: A. Tell him not to do this. B. Ask him why he is drinking alcohol. C. Teach him about the effects of alcohol on diabetes and how to prevent problems associated with alcohol intake. D. Recommend counseling so he understands the serious consequences of alcohol consumption.

C. Teach him about the effects of alcohol on diabetes and how to prevent problems associated with alcohol intake .Admonishing him will not help the adolescent if he chooses to continue drinking. Asking him why will provide information to the nurse but will not address the information that the adolescent needs to have about managing his disease. The nurse is taking a proactive approach. The adolescent is provided with information to facilitate the management of his illness. A recommendation for counseling can be included in the teaching plan.