HESI Peds- Adolescents
A school nurse is teaching a 12-year-old child with recently diagnosed type 1 diabetes about the action of insulin injections. What statement indicates that the child understands how insulin works in the body? 1. "Glucose is released as fats break down." 2. "It keeps glucose from being stored in the liver." 3. "Glucose is carried into cells, where it is burned for energy." 4. "It stops wasting of blood glucose by converting it to glycogen."
"Glucose is carried into cells, where it is burned for energy." Specialized insulin receptors on insulin-sensitive cells transport glucose through cell membranes, making it available for use.
A student in high school asks the school nurse why a classmate has been absent for so long. What is the best response by the nurse? 1. "Have you asked his girlfriend?" 2. "I wonder why you're so curious." 3. "Students sometimes miss school for long periods." 4. "I know you're concerned, but you'll need to ask your classmate for yourself."
"I know you're concerned, but you'll need to ask your classmate for yourself."
A 14-year-old teenager with type 1 diabetes wants to go out to eat with friends after a volleyball game. The teenager asks the school nurse whether this is permissible on the insulin/diet/exercise regimen that has prescribed. How should the nurse respond? 1. "Fast foods are unhealthy, especially for teenagers with diabetes." 2. "It would be best if you ate at home, where you can control your diet." 3. "Go with your friends but make an effort to eat something other than pizza." 4. "I'll teach you how to determine the amount of carbohydrates in different fast foods."
"I'll teach you how to determine the amount of carbohydrates in different fast foods." A fast food exchange list allows the diabetic teenager to participate in postgame activities without feeling different from peers; this is important to the adolescent. The nutritional benefits of fast foods are not the issue. The adolescent needs to learn how to select appropriate foods when away from the home environment; this will promote social interaction with peers. Eating a different food when all of the friends are eating pizza will make the adolescent feel different from the peers; the temptation not to adhere to the diet may be too great to resist.
While performing preoperative teaching a nurse explores a young adolescent's concern about changes in appearance after surgery to correct scoliosis. What is the most appropriate statement by the nurse? 1. "After surgery your back will be much straighter." 2. "You're concerned about how you'll look after surgery." 3. "Many teenagers who have this type of surgery do very well." 4. "Your parents think it's important for you to have this surgery."
"You're concerned about how you'll look after surgery." The nurse is using the technique of paraphrasing to encourage the adolescent to expand on personal concerns, which may relieve anxiety. Adolescents tend to be focused on the present, not the future; the nurse should focus on the adolescent's current concerns. Focusing on others is not client-centered care; the nurse should focus on the adolescent.
Which blood gas result should the nurse expect an adolescent with diabetic ketoacidosis to exhibit? 1. pH 7.30, CO2 40 mm Hg, HCO3- 20 mEq/L 2. pH 7.35, CO2 47 mm Hg, HCO3- 24 mEq/L 3. pH 7.46, CO2 30 mm Hg, HCO3- 24 mEq/L 4. pH 7.50, CO2 50 mm Hg, HCO3- 22 mEq/L
1. pH 7.30, CO2 40 mm Hg, HCO3- 20 mEq/L The pH will be acidic (7.30) and the HCO3- will be low (20 mEq/L). The normal pH is 7.35 to 7.45; CO2 ranges from 35 to 45 mm Hg, and HCO3- ranges from 22 to 26. A pH of 7.35 and a CO2 of 47 mm Hg indicate respiratory acidosis.
An adolescent child with sickle cell anemia is admitted to the pediatric unit during a vaso-occlusive crisis. What does the nurse identify as the reason that the crisis occurred? 1. Severe depression of the circulating thrombocytes 2. Diminished red blood cell (RBC) production by the bone marrow 3. Pooling of blood in the spleen with splenomegaly as a consequence 4. Blockage of small blood vessels as a result of clumping of RBCs
Blockage of small blood vessels as a result of clumping of RBCs The red blood cells in sickle cell anemia are fragile. When hypoxia or dehydration occurs, the cells take on a crescent shape; they then clump together and occlude blood vessels.
An 18-year-old high school student arrives at the local blood drive center to donate blood for the first time. As the site is being prepared for needle insertion, the student becomes agitated, starts to hyperventilate, and complains of dizziness and tingling of the hands. What should the nurse instruct the student to do? 1. Breathe into cupped hands. 2. Pant, using rapid, shallow breaths. 3. Use a rapid deep-breathing pattern. 4. Hold the breath for as long as possible.
Breathe into cupped hands Breathing into cupped hands allows carbon dioxide to reenter the lungs, which will increase the serum bicarbonate level, relieving the respiratory alkalosis that is occurring as a result of hyperventilation.
A nurse is conducting a health class for adolescents. What modifiable risk factor, most closely associated with the development of coronary heart disease (CHD) in both men and women, should the nurse discuss? 1. Opioid use 2. Cigarette smoking 3. Judicious alcohol intake 4. Moderate exercise program
Cigarette smoking Nicotine in cigarette smoke constricts blood vessels, including coronary arteries, which contributes to the occurrence of angina and CHD. Judicious alcohol intake- may promote relaxation, decreasing stress and limiting the development of CHD.
During the hourly assessment of an adolescent's intravenous (IV) line the nurse discovers that the IV did not deliver the ordered amount during the last hour. What should the nurse do first? 1. Increase the flow rate. 2. Notify the practitioner. 3.Inspect the infusion setup. 4. Give the child a glass of juice.
Inspect the infusion setup Assessment is the first step in the nursing process. Before the problem is diagnosed and nursing care is planned and implemented, data must be collected to determine the cause. Increasing flow rate can be unsafe
A nurse is discussing insulin needs with an adolescent with recently diagnosed type 1 diabetes. What information is important for the nurse to include concerning insulin administration? 1. Insulin will be required throughout life. 2. Insulin may be taken orally until adulthood. 3. Insulin needs increase with strenuous exercise. 4. Insulin needs decrease in the presence of an infection.
Insulin will be required throughout life. All those involved must understand that the child does not have an endogenous source of insulin and will require insulin administration throughout life. At this time there is no oral insulin with which to treat type 1 diabetes. Insulin needs decrease, not increase, during exercise. Insulin needs increase, not decrease, in the presence of an infection.
A nurse in the clinic is obtaining a health history of a 16-year-old boy with a complaint of a thick urethral discharge. What is the most appropriate nursing action to help confirm a tentative diagnosis of gonorrhea? 1. Assessing the temperature for fever 2. Collecting a urine sample for a urinalysis 3. Drawing blood for a complete blood count 4. Obtaining a urethral specimen for a culture
Obtaining a urethral specimen for a culture Gonorrhea is present in the urinary tract of a male, a culture would provide a definitive diagnosis. Fever- not a specific diagnostic tool Urine sample- can dilute the organisms CBC- won't provide the right information
An adolescent is undergoing radiation for Hodgkin's lymphoma. The nurse talks with the family about the importance of: 1. Keeping up with schoolwork 2. Accelerated sexual maturation 3. Consistent skin care with lotion 4. Overwhelming fatigue and the need for rest
Overwhelming fatigue and the need for rest The major side effect of radiation therapy is overwhelming fatigue. Lotions can cause irritation if the skin reacts to the radiation. Schoolwork is not a major concern at this time. Accelerated sexual maturation is not an effect of irradiation.
The mother of an adolescent asks the nurse, "What's the best way to remove a tick from the skin?" What is the best response by the nurse? 1. "Touch the tick with a lit cigarette." 2."Remove the tick carefully with tweezers." 3. "Pour ammonia over the tick, and it will shrivel up." 4. "Spray the tick with insect repellent, and it will fall off."
Remove the rick carefully with tweezers Tick must be removed carefully with tweezers so the body and head are both removed. Everything else could hurt the child
An adolescent child is admitted to a pediatric unit with the tentative diagnosis of acute poststreptococcal glomerulonephritis (APSGN). What diagnostic tests does the nurse expect will be performed to confirm this diagnosis? 1. ECG and heterophil antibody titer 2. Chest x-ray and blood glucose level 3. Upper gastrointestinal series and liver function tests 4. Serum complement (C3) activity level and urinalysis
Serum complement (C3) activity level and urinalysis A reduced C3 level is present in the early stages of ASPGN. Urinalysis is necessary to determine the presence of proteinuria and hematuria. An x-ray and glucose level, upper gastrointestinal series and liver function tests, and an ECG and antibody titer are not relevant to a diagnosis of APSGN.
A 14-year-old girl in whom scoliosis has been diagnosed undergoes spinal fusion. On the first postoperative day her face is red, she is rigid, and she is crying because she is in pain. She has prescriptions for morphine sulfate for severe pain and an acetaminophen-codeine compound for moderate pain. What information should influence the nurse's choice of analgesic? 1. One dose of morphine may be given, but the drug should be restricted thereafter because it is addictive. 2.Adolescents tend to exaggerate their discomfort, particularly when they are immobilized by surgery or injury. 3. Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic. 4. The acetaminophen-codeine compound is preferred because morphine can cause respiratory depression or respiratory arrest.
Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic. The first post op day is too early to begin weaning the client from opioids, should be using the strongest thing available.
A nurse is assessing an adolescent after the administration of epinephrine. What side effect is most important for the nurse to identify? 1. Tachycardia 2. Hypoglycemia 3. Constricted pupils 4. Decreased blood pressure
Tachycardia Epinephrine is a sympathetic nervous system stimulant that causes tachycardia. Hyperglycemia, not hypoglycemia, may result. The pupils will be dilated, not constricted. Epinephrine is more likely to cause hypertension than hypotension.
At 7 am a nurse learns that an adolescent with diabetes had a 6:30 am fasting blood glucose level of 180 mg/dL. What is the priority nursing action at this time? 1. Encouraging the adolescent to start exercising 2. Asking the adolescent to obtain an immediate glucometer reading 3. Informing the adolescent that a complex carbohydrate such as cheese should be eaten 4. Telling the adolescent that the prescribed dose of rapid-acting insulin should be administered
Telling the adolescent that the prescribed dose of rapid-acting insulin should be administered
A 16-year-old male asks the nurse about the use of condoms. He states, "I've used condoms in the past, but I'm not sure I'm using them correctly." What should be included as part of the teaching plan about condoms? 1. Petroleum jelly should be used as a lubricant. 2. The condom must be positioned after an erection has occurred. 3. Withdrawal after ejaculation should be delayed until the penis has become flaccid. 4. The condom should be fitted against the tip of the penis with no space left at the end.
The condom must be positioned after an erection has occurred Vaseline- can breakdown condom Penis should be withdrawn immediately after ejaculation If penis is allowed to become flaccid, semen may leak from the loose-fitting condom
A 16-year-old single mother of a 1-month-old infant and the infant's grandmother bring the baby to the emergency department and report that the infant accidentally fell down the stairs. The nurse knows that a consent form for treatment should be signed. Who has the responsibility for signing the consent? 1. The mother, despite her age 2. No one, because this is an emergency 3. The grandmother, because she is a relative 4. Family court, because the mother is a minor
The mother, despite her age The client is an emancipated minor, meaning that she has adult status. In most states the age of majority is 18 years; however, parents younger than 18 years are considered emancipated minors and may sign consents for themselves and their children. The grandmother does not have the legal right to give consent. Family court is unnecessary.
After 3 months of supplemental oral iron therapy, there is no significant increase in a female adolescent's hemoglobin level. Iron dextran (Imferon) is ordered. What is the best way for the nurse to administer this medication? 1. With a transdermal needle 2. By massaging the injection site 3. With the use of the Z-track method 4. By administering a local anesthetic first
With the use of the Z-track method The Z-track injection method prevents seepage of Imferon through the needle track, thereby limiting irritation of subcutaneous tissue and staining of the skin. The length of a transdermal needle is too short to reach a muscle; a 1½-inch needle is required. Massage will force Imferon into the subcutaneous tissue, causing irritation and staining. Although an injection may be uncomfortable, a local anesthetic is unnecessary.