Ch 46 evolve questions

The nurse is responsible for the therapeutic management of a 5-year-old child with type 1 diabetes mellitus. In which areas should the nurse educate the child's parents? Select all that apply.

Adjusting nutritional intake based on daily activity and understanding of meal planning and proper hygiene. Supporting the child emotionally during life events, illnesses, and puberty and developing good attitudes toward learning. Monitoring blood glucose levels, administering insulin, and managing hyperglycemia and hypoglycemia. rational: It is important that the parents of a child diagnosed with type 1 diabetes mellitus know about meal planning, proper hygiene, and nutritional intake based on daily activity. Supporting the child emotionally during various life events is also important. Therefore, the parents must have a good attitude toward learning. In order to maintain health, it is essential to know how to monitor blood glucose levels, administer insulin, and manage hyperglycemia and hypoglycemia. Alpha adrenergic blocking agents are not indicated in the care of diabetes. Illnesses such as DKA are life threatening. A child must be admitted to a hospital if diagnosed with such illnesses. In addition, processes such as pulmonary aspiration and gastric suction must be done by a trained, certified practitioner, not a parent.

The parent of a child tells the nurse that the child voids excessive urine and immediately drinks large amounts of water. The parent also says that the child's bed is often wet in the morning. Which condition does the nurse suspect in the child?

Diabetes insipidus (DI) rational: A child with DI exhibits excessive thirst and excessive urination, which also causes bedwetting or enuresis. Chronic adrenocortical insufficiency is the nonfunctioning of the adrenal tissue and is indicated by weight loss, dehydration, increased sleeping, and muscular weakness. Cushing syndrome is often caused by excessive or prolonged steroid therapy, in which the child acquires a cushingoid appearance such as excessive hair growth, moon face, and fat red cheeks. CAH is indicated by the presence of ambiguous genitalia in infants at birth.

The primary health care provider asks the nurse to monitor a child for signs of diabetes insipidus (DI). Which early signs does the nurse observe? Select all that apply.

Enuresis Excessive thirst Polyuria Rational: The early signs of DI are enuresis, excessive thirst, and polyuria due to excessive loss of fluids. Dry skin is one of the common symptoms in panhypopituitarism of thyroid stimulating hormone, while hypoglycemia is seen in panhypopituitarism of adrenocorticotropic hormone.

A child with diabetes mellitus suddenly becomes unresponsive and unconscious, and suffers from seizures. Which prescribed medication does the nurse administer immediately?

Glucagon rational: The nurse should immediately administer glucagon to the child to prevent the condition from getting worse. Preoperative medications such as α-adrenergic blocking agents with or without β-adrenergic blocking agents inhibit the effects of catecholamines in the child with pheochromocytoma. Glucocorticoids are administered to a child with congenital adrenal hyperplasia. Steroids are administered to a child with panhypopituitarism.

Which therapies are prescribed for a child after bilateral adrenalectomy? Select all that apply.

Glucocorticoid therapy Mineralocorticoid therapy rational: Glucocorticoid and mineralocorticoid therapy are started after bilateral adrenalectomy to lower blood pressure, eliminate hypertensive attacks, increase heat tolerance, decrease perspiration, and prevent hyperglycemia. Insulin therapy is effective for patients with diabetes mellitus. Pump therapy is used to administer insulin to patients with diabetes mellitus. Fluid and electrolyte therapy is used for dehydration in patients with diabetic ketoacidosis.

An infant with congenital adrenal hyperplasia (CAH) has increased pigmentation of the skin creases and ambiguous genitalia. Which other signs of adrenal insufficiency does the nurse assess? Select all that apply.

Hyperkalemia Hyponatremia Weight gain rational: Congenital adrenal hyperplasia (CAH) is caused by decreased enzyme activity that is needed to produce cortisol. Hyperkalemia or high levels of potassium in the blood, hyponatremia or decrease in sodium serum level, and weight gain are the manifestations of CAH. It is caused by a salt-wasting crisis in children. Diarrhea and muscle cramps are manifestations of hypoparathyroidism.

An adolescent with type 1 diabetes is receiving regular insulin, Novolin R, and intermediate-acting insulin, Novolin N. The patient receives a combination of the two 30 minutes before breakfast and before the evening meal. At what time should the nurse anticipate a hypoglycemic reaction? Select all that apply.

Before breakfast Before supper or late afternoon rational: Hypoglycemic episodes occur before meals or when the insulin effect is peaking. Therefore, the nurse should anticipate a hypoglycemic effect before breakfast and before supper or late afternoon. This is because with Novolin R, the insulin peaks 2 to 4 hours later and stays in the blood for about 4 to 8 hours and Novolin N peaks 4 to 14 hours later. Within 30 minutes after breakfast and within 90 minutes after the evening meal, the insulin effect will still be there. During the night after bedtime, the insulin effect will be there because the child would take the insulin before the evening meal (late afternoon or supper time).

The nurse caring for a 6-year-old child with diabetes mellitus notices that the child is sweating profusely. The child also complains of headache, dizziness, and shortness of breath. What should the nurse's immediate actions be? Select all that apply.

Inform the primary health care provider. Assess the child's blood glucose levels. rational: The child is experiencing hypoglycemia, as indicated by the child's headache, dizziness, inability to breathe, and profuse sweating. The nurse must immediately report the findings to the primary health care provider and assess the child's blood glucose levels. It is not advisable to administer insulin subcutaneously without confirming the blood glucose level. The nurse should not give the child a large, high-calorie meal because the child is hypoglycemic. Although it is important to find out when the child last ate, it is not part of hypoglycemic management.

Which tests confirm hypoparathyroidism in a child? Select all that apply.

Parathyroid hormone (PTH) Test Kidney function test Magnesium test Bone radiograph rational: A parathyroid hormone (PTH) test will help to evaluate the level of the parathyroid hormone in the blood. A kidney function test is performed to rule out renal insufficiency. A magnesium test is performed to test the magnesium levels in the blood. A bone radiograph helps to assess the bone density and growth. A glucose tolerance test is performed to assess blood glucose levels in a child with diabetes mellitus.

Which precaution does the nurse take when administering oral fluids to a child after the acute phase of adrenal crisis is over?

Plans a gradual schedule for administering fluids rational: The nurse ensures that the fluids are administered gradually and in small quantities to prevent vomiting. Providing large quantities of fluids will cause vomiting and increase dehydration. Hypoglycemia is seen in the acute phase of adrenal crisis before the oral fluids are administered. In such cases, normal saline containing 5% glucose is given parenterally to replace the lost fluid, electrolytes, and glucose.

Which treatment does the nurse expect the primary health care provider to prescribe for a child with primary hyperparathyroidism?

Removal of hyperplastic tissue by surgery rational: The treatment for a child with primary hyperparathyroidism is the surgical removal of the hyperplastic tissue. A low-phosphorous diet, administration of high doses of vitamin D, and oral administration of calcium salts is the treatment for secondary hyperparathyroidism, which helps to restore the serum calcium balance.

Which nursing intervention helps the nurse confirm the presence of diabetes insipidus (DI) in a child?

Restriction of oral fluids rational: Restriction of oral fluids in a normal child would result in diminished urinary output and concentrated urine, but in a child with DI the urine output will not be affected. Blood test reports are evaluated in a child with diabetes mellitus to assess the blood glucose levels. Urine reports are evaluated to assess urinary tract infections. Salt is restricted in children with nephrotic syndrome to reduce fluid retention in the body.

Which interventions does the nurse implement to minimize heat intolerance in a child with hyperthyroidism? Select all that apply.

Restricts physical activity Provides cotton clothing Provides frequent baths rational: Restricting physical activity, providing cotton clothing, and providing frequent baths to the child will minimize heat intolerance in the child with hyperthyroidism. The child with hyperthyroidism has an increased metabolic rate; therefore, the child is provided six small meals to satisfy the appetite. Oral doses of cortisone are provided to prevent dehydration in a child with adrenal crisis.

Which is a priority action when a child with chronic renal disease is diagnosed with secondary hyperparathyroidism?

To raise the serum calcium levels rational: In secondary hyperparathyroidism, parathyroid hormone increases due to low calcium levels caused by chronic renal disease. Therefore, the priority action is to increase the serum calcium levels in the blood. Dehydration is seen in a child with adrenal crisis. Hyperglycemia is seen in a child with pheochromocytoma. Urinary output is monitored in a child with diabetes insipidus to prevent dehydration.

The nurse is explaining that the destruction of pancreatic β-cells is the cause of which disorder?

Type 1 diabetes rational: Type 1 diabetes is characterized by destruction of the insulin-producing pancreatic β-cells. Type 2 diabetes is a result of insulin resistance. The description of type 1 diabetes is not applicable to impaired glucose tolerance or gestational diabetes.

The most common cause of secondary hyperparathyroidism is:

chronic renal disease. rational: Chronic renal disease is the most common cause of secondary hyperparathyroidism. Diabetes mellitus, congenital heart disease, and growth hormone deficiency do not contribute to secondary hypoparathyroidism.

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:

exercise is not restricted unless indicated by other health conditions. rational: 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. 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. 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.

Which intervention does the nurse implement if steroid therapy causes cushingoid features in a child?

nurse administers the medication early in the morning, so that the medication is secreted in the normal diurnal pattern

The nurse is assessing a child with delayed growth. Which questions does the nurse include in the assessment while interviewing the parents? Select all that apply.

"Tell me about diseases in your family." "What kind of developmental issues did the child have?" "Have there been changes in the child's appetite?" "What kind of medications does the child take?" rational: The nurse asks about diseases in the family to assess any hereditary causes for delayed growth. The nurse also asks about any developmental issues in the past to evaluate if it is linked to growth delay. Asking about medications will help to assess the child's health status. Asking about child's appetite may help to identify if nutritional inadequacy has led to delayed growth. Behavioral therapies do not have an impact on the child's growth.

Which condition is the nurse alert for while providing care for an unconscious child with diabetes insipidus (DI)?

Dehydration rational: A child with DI requires large quantities of water due to excessive urination. In case the child is unconscious, there is an absence of the voluntary demand for water which can be life threatening. Therefore, the nurse needs to monitor for urine volumes and intravenous fluid replacement to prevent dehydration. Hyperthermia, coma, and severe tachycardia are seen in a case of thyrotoxicosis in a child with hyperthyroidism. It occurs when there is a sudden release of the thyroid hormone.

Parents have brought their child in to the clinic for a well-child visit. They express some concern that the child seems to have short stature. The needs to determine if the cause is familial short stature or constitutional growth delay. What steps does the nurse take to evaluate the growth curve? Select all that apply.

Determine the child's absolute height. Assess the child's height velocity. Determine the child's weight-to-height ratio. rational: The nurse determines the absolute height and the weight of the child and compares it with the standard growth charts so that abnormal growth patterns can be assessed. Deceleration of height velocity helps to identify any pathologic condition for abnormal growth. The weight-to-height ratio is assessed to find the cause of the growth delay in the child with short stature. Cognitive development of the child is assessed in cases of cognitive impairment. Motor development is assessed when a condition like hyperthyroidism is suspected.

The nurse is working with an 11-year-old child who has type 1 diabetes mellitus. The nurse advises the child's parents to monitor the glucose levels at home. What should be the blood glucose levels if the diabetes mellitus is well managed? Select all that apply.

A random blood glucose level that is consistently less than 200 mg/dL An 8-hour fasting blood glucose level that is regularly less than 126 mg/dL rational: Blood glucose levels of less than 200 mg/dL and an 8-hour fasting blood glucose level of less than 126 mg/dL indicate that the child is healthy. Therefore, if the random blood glucose level consistently approaches 400 mg/dL, then the child's parents need to report it to the health care provider. It is also important to consult the health care provider if the 8-hour fasting blood glucose level regularly approaches 300 mg/dL. In both the cases, the child is showing poorly managed diabetes.

A child is undergoing hormone replacement therapy. The nurse observes that the child appears younger than the chronologic age. What does the nurse include in the child's plan of care? Select all that apply. The nurse:

provides education to the child for self-management. instructs the family about injection sites and techniques. instructs the family on how to prepare medications. rational: The nurse provides self-care education to the child to increase the child's confidence. The nurse instructs the parents about injection sites, injection technique, and syringe disposal to ensure safe and effective administration of medicines. The nurse also instructs the family about medication preparation and dosage calculation to ensure safety during administration of the medicines. The child taking the therapy may appear younger than the chronologic age, but the child must be treated according to the age and abilities and not in infantile ways. Baclofen (Kemstro) is primarily used to treat spasticity. Therefore, it is not prescribed.

Which physical characteristics are seen in children with acromegaly? Select all that apply.

Overgrowth of the head Enlarged jaw Increased facial hair Deeply creased skin rational: Acromegaly is caused by the oversecretion of the growth hormone (GH) that occurs after epiphyseal closure. It causes an overgrowth of the head in the child along with an enlarged jaw, increased facial hair, and deeply creased skin. The child's height is 2.4 m or more when there is an excess GH before epiphyseal closure.

The parents seek help for their 11-year-old child, who has type 1 diabetes mellitus, because the child frequently wants concentrated sweets. What is the most appropriate response of the nurse to the parent?

"There is an elevated risk of atherosclerosis, and therefore your child should not have concentrated sweets." rational: Consuming concentrated sweets is discouraged because of the elevated risk of atherosclerosis in patients with diabetes mellitus. In a child with diabetes mellitus, fat intake is reduced to less than 30% of the caloric requirement, and concentrated sweets are carbohydrates. Therefore, reducing the intake of concentrated sweets to 30% or less would not benefit the child's health. Exercising vigorously would not reduce the risk of atherosclerosis, and therefore it is not advised that the child exercise before consuming concentrated sweets. Moreover, the amount of fat intake does not influence digestion, absorption, and metabolism of carbohydrate. Therefore, even if the patient determines fat intake daily, he or she should stay away from consumption of concentrated sweets entirely.

A 15-year-old child has type 2 diabetes mellitus and needs dietary instruction from the nurse. Which statements from the nurse would provide the child with important information on nutritional needs? Select all that apply.

"You should have enough calories for your energy, growth, and development." "Food intake should correspond to the timing and action of the insulin prescribed." "You should plan to incorporate snacks between meals and at bedtime." rational: The nutritional needs of a 15-year-old child with type 2 diabetes mellitus are no different from those of other healthy children. The child would need sufficient calories for daily energy expenditure, growth, and development. However, unlike children without diabetes mellitus, they need insulin injected subcutaneously, coordinated with their food intake so that peak effect, duration of action, and absorption rate are optimized to regulate their blood glucose levels. Snacks are also necessary to prevent hypoglycemia, and they should be timed between meals and at bedtime depending on the activity time and action of the insulin prescribed. The child cannot have soft drinks, concentrated sweets, and high-calorie meals. They should not eat pizza, homemade apple pie, and hot chocolate anytime they feel hungry because it may increase their blood glucose levels.

The nurse suspects that the child has delayed growth. The nurse does not have serial height and weight records to assess the child's growth. What action does the nurse take?

Asks about the child's growth as compared to siblings. rational: The nurse asks the child's growth compared to the siblings in order to evaluate the growth delay in the child.

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?

Increased food intake rational:

When discussing a child's precocious puberty with the parents, the nurse should tell them that:

dress and activities should be appropriate to chronologic age. rationale: Because of the early sexual maturation of the child, both family and child require extensive teaching. Included in this teaching is that the child should be engaged in activities according to chronologic age. Functioning sperm or ova may be produced, thereby making the child fertile at an early age. Heterosexual interest is usually appropriate to chronologic age. The secondary sexual characteristics proceed in the usual order.

The most important nursing consideration related to congenital hypothyroidism is:

early identification of the disorder. rational: Early diagnosis is imperative. Because brain growth is complete by 2 to 3 years old, the deficiency must be detected and replacement therapy begun as soon as possible. The parent-infant attachment is important for all infants. With appropriate intervention, the child may not have any developmental deficit.

A neonate with a goiter has just been admitted to the newborn nursery. A priority nursing intervention is to:

have a tracheostomy set at the bedside. rational: The presence of the goiter puts the infant at risk for respiratory failure. Preparations are made for emergency ventilation, including a tracheostomy set at the bedside.

A child with type 1 diabetes mellitus is prescribed a twice daily regimen of NovoLog and Novolin N to be administered before breakfast and before the evening meal. What additional information does the nurse provide to the child's family?

"Administer 60% to 75% of the total daily dose before breakfast." rational: Generally, 60% to 75% of the total daily insulin dose is administered before breakfast and the rest before the evening meal. NovoLog reaches the blood within 15 minutes of injection. The insulin peaks 30 to 90 minutes later. Hence, it should be administered 30 minutes before breakfast. Human insulin should never be interchanged with pork insulin as the peak action times are different. Insulin is administered even when the child performs vigorous exercise. Extra food is provided for increased activity to balance food, insulin, and exercise.

What instruction does the nurse provide to parents of a child with chronic adrenocortical insufficiency? Select all that apply.

"Be alert for any signs of gastric problems." "Manage the child's diet to prevent obesity." "Keep extra supplies of medication at home." "Do not frequently invite a lot of visitors." rational: The nurse instructs the parents to be careful about the signs of gastric irritation, which is the side effect of cortisone. The nurse also instructs the parents to manage the child's diet to prevent obesity. If the medication is terminated due to inadequate supplies, it may cause acute adrenal crisis in the child. Therefore, the nurse advises the parents to keep extra supplies of medicines at home. The nurse advises the parents to avoid inviting a lot of visitors frequently. This ensures that the home environment is kept stress free. Increased stress increases the need for cortical hormones, which may result in acute adrenocortical insufficiency. If the child is unhappy, it may cause an emotional crisis that needs to be attended to promptly by additional hormone replacement.

What does the nurse tell the parents of a newborn child with juvenile hypothyroidism about the treatment of the condition?

"If it is not treated, it may cause decreased mental capacity." rational: If juvenile hypothyroidism is not treated, it will cause decreased mental capacity. The treatment is started promptly to prevent hyperthyroidism. The treatment consists of administering L-thyroxine over a period of 4 to 8 weeks. Constipation and sleepiness are the symptoms of hypothyroidism.

Which instructions does the nurse give to the parents for safe and effective administration of insulin injection to the child with diabetes mellitus? Select all that apply.

"Inject insulin in the fat tissue over muscle." "Use the pinch technique for tenting the skin." "Do not overuse one injection site." "Avoid injecting on the exercising extremity." rational: The nurse instructs the parents to inject insulin in the fat tissue over the muscle so that it is administered in the subcutaneous layer and not the intramuscular tissue. The nurse instructs the parents to use the pinch technique for tenting the skin so that the needle is easily inserted in the subcutaneous layer. The nurse teaches the parents to avoid using only one injection site as insulin absorption is slowed by the fat pads that develop in the used sites. The nurse also instructs the parents to avoid injecting on the exercising extremity to avoid altering the absorption rate. Subcutaneous insulin injections are inserted at an angle of 90 degrees.

Which instruction does the nurse give to the parents of a child with diabetes mellitus? Select all that apply.

"Provide leafy green vegetables and mushrooms." "Maintain consistency in the total number of calories every day." "Provide extra food in case of increased activity." "Avoid candy, cookies, pastries, and soft drinks." rational: The nurse instructs the parents to feed leafy green vegetables and mushrooms to the child to increase dietary fiber and improve digestion, absorption, and metabolism. The nurse also instructs them to provide the same number of calories every day as calories influence the insulin action. Food is increased when there is increased activity so that the insulin, exercise, and food are well balanced. The nurse instructs the parents to avoid candy, cookies, pastries, and soft drinks in their child's diet. This is because these products contain concentrated sugar that increases the blood glucose levels. Snacks are provided to the child between mealtimes to prevent hypoglycemia.

A teenager with type 1 diabetes mellitus is diagnosed with diabetic ketoacidosis (DKA). The child is conscious, and arterial oxygen is more than 80%. The child is not showing any signs of fever. In which order should the nurse perform the interventions to help such a patient?

1. The patient should be admitted immediately to an intensive care facility for management. Correct 2. The child should be measured, weighed, and placed on a cardiac monitor after a 12-lead electrocardiogram is obtained. Correct 3. Blood glucose and ketone levels, electrolytes, blood urea nitrogen (BUN), and creatinine should be taken. 4. The nurse should prime the tubing with the insulin mixture to saturate the insulin-binding sites before the infusion is started 5. The nurse should obtain venous access for administration of fluids, electrolytes, and insulin and then administer it. rational: Because the child is conscious, arterial oxygen is more than 80%, and the child is not showing signs of fever, the nurse need not think about gastric suction, administration of oxygen, or an antibiotic. However, the patient should be admitted immediately to the intensive care facility for management because DKA is a life-threatening complication. Immediately after measuring and weighing, the child should be placed on a cardiac monitor to configure T waves. Blood glucose, ketone, electrolyte, BUN, and creatinine measurements should be taken so that the next steps of action can be determined (e.g. the dosage of insulin, medications, and fluids to be administered). Although the priority is to obtain venous access for administering fluids, electrolytes, and insulin, the nurse should run the insulin mixture through the tubing to saturate the insulin-binding sites first. This is done so that the correct dosage of insulin is administered.

Which is a priority nursing action after administering the prescribed dose of tapazole (Methimazole) to a child?

Assess for fever and sore throat. rational: Fever and sore throat indicate leukopenia in a child who is treated with tapazole (Methimazole). Therefore, the nurse should be alert for these signs and report them promptly to the primary health care provider. The nurse monitors the child for dehydration after administering diuretics which results in excessive loss of fluids. Tapazole (Methimazole) does not cause urinary tract infections. However, this is seen in adolescents with type 2 diabetes mellitus. Vision problems are a manifestation of hyperthyroidism in a child.

The nurse observes on the cardiac monitor that a child admitted with diabetic ketoacidosis has a widening of the QT interval and the appearance of U wave after a flattened T wave. What should the nurse conclude from such an observation?

The child has hypokalemia. rational: The cardiac monitor is used on patients admitted with diabetic ketoacidosis because the serum potassium level can be elevated on admission and decrease during treatment. The monitor is used to configure T waves every 30 to 60 minutes. Changes such as widening of the QT interval and the appearance of U wave after a flattened T wave indicate hypokalemia. Hypovolemia is low blood volume, which is not monitored through the cardiac monitor. Hypercalcemia is an elevated level of calcium in the blood, which is a strictly asymptomatic laboratory finding. An elevated and spreading T wave and shortening of the QT interval indicate hyperkalemia.

ambiguous genitalia

The disorder is caused by decreased enzyme activity required for adrenal cortical production of cortisol.

The nurse assigned to care for a child with type 1 diabetes mellitus and needs to determine the amount of morning regular insulin to administer. How should the nurse determine the dosage?

The dosage of morning regular insulin is determined by blood glucose patterns in the late morning and lunchtime blood glucose values. rational: The nurse can determine the dosage of morning regular insulin by determining the patterns of blood glucose values in the late morning and at lunchtime. Fasting blood glucose patterns at breakfast are used to determine the evening dosage of intermediate-acting insulin, and the child is not taking intermediate-acting insulin. The morning intermediate-acting dosage is determined by blood glucose patterns in the late afternoon and evening blood glucose values. In this case the child is not taking intermediate-acting insulin. The blood glucose patterns at bedtime help determine the evening dosage of rapid-acting (regular) insulin, which the child is not administering.

Which clinical findings in the blood reports of a child indicate diabetes mellitus?

The fasting blood glucose level is 126 mg/dL. rational: A fasting blood glucose level of 126 mg/dL or more

The primary goals of the nurse caring for a child with illness and diabetic mellitus are to restore euglycemia, treat urinary ketones, and maintain hydration. What steps should the nurse take to provide effective care? Select all that apply.

The nurse should monitor the glucose levels and urinary ketones every 3 hours and encourage intake of fluids. The child's food intake and insulin dosage should be adjusted depending on glucose levels and degree of illness. The health care provider should be notified if the child vomits or if blood glucose levels and urinary ketones rise. rational: The nurse should monitor blood glucose levels and urinary ketones every 3 hours and encourage fluid intake to prevent dehydration and flush out ketones. Simple carbohydrates may be substituted for carbohydrate-containing exchanges in the meal plan. These substitutes ensure that the level of glucose in the blood does not increase to an unhealthy limit. The fluid intake should be consistent with the diabetic diet and the illness. If the child vomits more than once, if blood glucose levels remain above 240 mg/dL, or if urinary ketones remain high, the health care provider should be notified. The primary health care provider determines which tests are needed, such as a CT scan or magnetic resonance imaging (MRI). While the nurse can identify types of medication pharmacologic categories, there is no clinical indication for this type of medication as being required in the patient's treatment plan as they could lead to significant complications with an increase in blood sugar.

While assessing a child with growth failure, the nurse notices that there are no signs of malnutrition or hypothyroidism in the child. What can be the cause of growth failure in this child?

There is abnormality of the GH-insulin-like growth factor (IGF-I) axis. rationale: When there are no indications of malnutrition or hypothyroidism in the child, the cause of growth failure is indicated by the abnormality of the IGF-I axis. The possibility of the child's ancestors having adult height in the lower percentiles can be considered in case the child has familial short stature. The child has tumors in the pituitary or hypothalamic region when there is pituitary undersecretion. Deficiency in the gonadotropin hormones in the child indicates an absence or regression of secondary sex characteristics.

The patient is diagnosed with diabetes insipidus. The health care provider has prescribed antidiuretic hormone (ADH) replacement with vasopressin tannate in peanut oil to help the patient get a full night's sleep. How should the nurse administer the medication? Select all that apply.

Vasopressin should be resuspended in the oil by being held under warm running water for 10 to 15 minutes. Vasopressin must be shaken vigorously before being drawn into the syringe and small brown particles should be observed. rational: Vasopressin must be thoroughly resuspended in the oil by being held under warm running water for 10 to 15 minutes and then shaken vigorously before being drawn into the syringe. It is necessary that small brown particles, denoting drug dispersion, are seen in the suspension. This confirms that oil is not injected without the ADH. If vasopressin is held under warm running water for 10 to 15 minutes without being resuspended in the oil, the medicine will not be effective. It is also necessary to confirm that brown particles form, indicating drug dispersion, and oil is injected with the ADH. Otherwise, the medicine will not be effective. There is no mention of whether the patient has allergies and as ADH is being administered in peanut oil, this may be a concern. The prudent nurse would be alert to the patient's allergy status.

Arrange the steps in which the process of ketoacidosis occurs in patients with diabetes mellitus.

When insulin is absent or insulin sensitivity is altered, glucose is not available for cellular metabolism. The body then chooses an alternative source of energy like fats for cellular metabolism. The fats break down into fatty acids. The liver then converts the glycerol in the fat cells to ketone bodies. The excess ketone bodies are eliminated in the urine or breathed out through the lungs. The ketone bodies in the blood lower serum pH, producing ketoacidosis.