Ricci Chapter 48 PrepU- Peds Diabetes

The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes and the parents. Which comment by a parent demonstrates a need for additional teaching? - "During exercise we should wait to check blood sugars until after our child completes the activity." - "If our child is sick we should check blood glucose levels more often." - "We should check our child's blood glucose levels before meals." - "Blood glucose level, food intake, and activity need to all be considered when calculating insulin dosage."

"During exercise we should wait to check blood sugars until after our child completes the activity."

A nurse is teaching an adolescent with type 1 diabetes about the disease. Which instruction by the nurse about how to prevent hypoglycemia would be most appropriate for the adolescent? -"Limit participation in planned exercise activities that involve competition." -"Carry crackers or fruit to eat before or during periods of increased activity." -"Increase the insulin dosage before planned or unplanned strenuous exercise." -"Check your blood glucose level before exercising, and eat a protein snack if the level is elevated."

"Carry crackers or fruit to eat before or during periods of increased activity." Hypoglycemia can usually be prevented if an adolescent with diabetes eats more food before or during exercise. Because exercise with adolescents isn't commonly planned, carrying additional carbohydrate foods is a good preventive measure.

The parents of a child who was diagnosed with diabetes insipidus ask the nurse, "How does this disorder occur?" When responding to the parents, the nurse integrates knowledge that a deficiency of which hormone is involved? - Antidiuretic hormone - Growth hormone - Insulin - Thyroxine

Antidiuretic hormone

A nurse who is caring for a 7-year-old is providing client education to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 diabetes mellitus? - "We will just have our child exercise and take medicine to cure this." - "I will just feed my child healthy foods and sign her up for more sports." - "Her body fights against the insulin." - "Her body doesn't have any insulin."

"Her body doesn't have any insulin."

A child with Addison disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids. Which intervention will the nurse perform? - Take glucometer readings as ordered. - Measure intake and output. - Monitor sodium and potassium levels. - Weigh daily.

Take glucometer readings as ordered.

A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin? - Do not mix this insulin with other insulins. - Give the dose first thing in the morning. - Store the insulin in the refrigerator until just before giving it. - Discard any opened vials after a week.

Do not mix this insulin with other insulins.

The nurse is doing teaching with a group of caregivers of children diagnosed with diabetes mellitus. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur? -"If my child's eats as much as her older brother eats she could have an insulin reaction." -"He measures his own medication but we watch closely to make sure he gets the correct amount so he doesn't have an insulin reaction." -"She monitors her glucose levels because when it goes too high she has an insulin reaction." -"On the weekends we encourage him to participate in lots of sports activities and stay busy so he doesn't have an insulin reaction."

"He measures his own medication but we watch closely to make sure he gets the correct amount so he doesn't have an insulin reaction." The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes that most often the disorder can be managed by: Taking oral hypoglycemic agentsIncreasing protein in the diet, especially in the evening observing energy with rest periods during the day decreasing amounts of daily insulin

The nurse is assessing a 5-year-old child whose parent reports the child has been vomiting lately, has no appetite, and has had an extreme thirst. Laboratory work for diabetes is being completed. Which symptom would differentiate between type 1 diabetes from type 2 diabetes? - recent weight loss - blood pressure of 142/92 mm Hg - slow healing wounds - loose stools

recent weight loss

A nurse who is caring for a 7-year-old is providing patient teaching to the child and caregiver. Which response by the caregiver demonstrates to the nurse that the caregiver understands the diagnosis of type 1 DM? -"We will just have our child exercise and take medicine to cure this." -"I will just feed my child healthy foods and sign her up for more sports." -"Her body fights against the insulin." -"Her body doesn't have any insulin."

"Her body doesn't have any insulin." Type 1 DM is a disorder in which the child's body has a deficiency of insulin because children with type 1 DM cannot produce insulin. Type 2 DM is controlled through diet, medicine, and exercise. Type 2 DM can be prevented through diet and exercise, but type 1 DM cannot. Resistance to insulin is not the primary factor in type 1 DM.

The nurse is educating the parents of a client newly diagnosed with type 1 diabetes. Which statement by the parents indicates additional teaching is needed? - "When our child is sick, we may need to check glucose levels more frequently." - "Our child should eat three meals and midafternoon and bedtime snacks each day." - "We and our child need to learn to identify carbohydrate, protein, and fat foods." - "Our child should not participate in sports or physical activity."

"Our child should not participate in sports or physical activity."

A 10-year-old boy has been diagnosed with type 1 diabetes mellitus. He is curious about what the cause of his disease is and asks the nurse to explain it to him. What explanation is best? -"Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." -"Special cells in a part of your body called the pancreas cannot produce enough of a chemical called insulin, so there is too much sugar in your blood." -"Your body is broken and does not produce enough a chemical called 'ADH,' which makes you really thirsty and have to go to the bathroom a lot." -"A small part of your brain called the pituitary is deficient and does not make enough of a chemical called growth hormone."

"Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." When providing instruction to a child, the nurse must consider the developmental age. Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin, in contrast to type 2 where insulin production is only reduced. Insulin is produced by beta islet cells in the pancreas. Diabetes insipidus is caused by the pituitary gland not producing enough ADH and is characterized by extreme thirstiness and polyuria. Insufficient growth hormone is also related to dysfunction of the pituitary gland.

A child and parents are being seen in the office after discharge from the hospital. The child was newly diagnosed with type 2 diabetes. When talking with the child and parents, which statement by the nurse would be most appropriate? -"You are lucky that you did not have to learn how to give yourself a shot." -"Young people can usually be managed with an oral agent, meal planning, and exercise." -"This will rectify itself if you follow all of the doctor's directions." -"A weight-loss program should be implemented and maintained."

"Young people can usually be managed with an oral agent, meal planning, and exercise."

Which findings should the nurse expect to assess when completing the health history of a child admitted for possible type 2 diabetes? Select all that apply. - Abrupt onset of symptoms - Marked weight loss - Polyuria - Polydipsia - Polyphagia

- Polyuria - Polydipsia - Polyphagia

A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. What treatment would the nurse expect to administer? - Regular insulin - Lispro - NPH - Detemir

Regular insulin

A 10-year-old child is newly diagnosed with type 1 diabetes. The child's hemoglobin A1C level is being monitored. The nurse determines that additional intervention is needed with the child based on which result? - 8.5% - 6.5% - 7.5 % - 7.0%

8.5%

The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which action would be the most appropriate for the school nurse to take? - Request that someone call 911. - Administer subcutaneous glucagon. - Anticipate that the child will need intravenous glucose. - Dissolve a piece of candy in the child's mouth.

Administer subcutaneous glucagon.

A child has been prescribed desmopressin acetate for the treatment of diabetes insipidus. The client and the parents ask the nurse how this drug works. What is the correct response by the nurse? - Desmopressin acetate works on your pancreas to stimulate insulin production. - Desmopressin acetate is a synthetic form of insulin used to lower your blood sugar. - Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output. - Desmopressin acetate works to help your kidneys work more efficiently.

Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output.

A child is prescribed glargine (Lantus) insulin. What information would the nurse include when teaching the child and parents about this insulin? -Do not mix this insulin with other insulins. -Give the dose first thing in the morning. -Store the insulin in the refrigerator until just before giving it. -Discard any opened vials after a week.

Do not mix this insulin with other insulins. Glargine (Lantus) is not to be mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.

The nurse is caring for a child with central diabetes insipidus who is underweight. Which nursing intervention is appropriate for this child? -Encourage high-calorie beverages. -Monitor blood glucose levels. -Encourage low-carbohydrate food choices. -Count carbohydrates.

Encourage high-calorie beverages. Children with diabetes insipidus can become underweight because of inadequate calorie consumption. An effective nursing intervention to increase calorie consumption is to encourage the child to drink high-calorie fluids. Counting carbohydrates will not necessarily improve a child's caloric intake. Children with diabetes insipidus do not have unstable blood glucose; therefore, blood sugar monitoring is not needed. Decreasing carbohydrates in the diet will cause the child to lose, not gain, weight.

After hospital discharge, the parent of a child newly diagnosed with type 1 diabetes mellitus telephones the nurse because the child is acting confused and very sleepy. Which emergency measure would the nurse suggest the parent carry out before bringing the child to see the health care provider? -Give the child one unit of regular insulin. -Give the child a glass of orange juice. -Give the child nothing by mouth so that a blood sugar can be drawn at the health care provider's office. -Give the child a glass of orange juice with one unit regular insulin in it.

Give the child a glass of orange juice. The child is experiencing symptoms of hypoglycemia. Administering a form of glucose would help relieve them. This can be glucose tablets or a rapidly absorbable carbohydrate such as orange juice. This should be followed by a snack of complex carbohydrates and protein within 30 to 60 minutes. Insulin cannot be absorbed when taken orally and administering insulin would make the hypoglycemia worse. Withholding treatment waiting to get to the health care provider's office may cause the hypoglycemia to worsen and be a risk to the child's life. Children with diabetes and their parents need to be taught to recognize and treat the symptoms of hypoglycemia.

What should be included in the teaching plan for a child with type 1 diabetes mellitus who is going home on insulin therapy? -Children show an increased need for insulin during the first months after glucose control is established. -Once glucose control is established, there will never be a need for an increase in the amount of insulin administered. -It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her condition is getting worse. -All children should be on at least two types of insulin to establish glucose control.

It is absolutely normal for the growing child to require an increase in insulin; this does not mean his/her condition is getting worse. Children show a decreased need for insulin shortly after glucose control has been established, which is referred to by some as the "honeymoon phase" and should be described to parents so that they do not get any false hope that the child does not need insulin. As children grow, they will require increased doses of insulin to maintain glucose control, and not all children need to receive two types of insulin. Insulin treatment should be based on each individual child.

Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration. -Lispro -Humulin R -Humulin N -Lantus

Lispro Humulin R Humulin N Lantus Lispro is a rapid-acting insulin. Humulin R is a short-acting insulin. Humulin N is an intermediate-acting insulin. Lantus is a long-acting insulin.

A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver? -Metformin -Glipizide -Glyburide -Nateglinide

Metformin Metformin, a biguanide, reduces glucose production from the liver. Glipizide stimulates insulin secretion by increasing the response of β cells to glucose. Glyburide stimulates insulin secretion by increasing the response of β cells to glucose. Nateglinide stimulates insulin secretion by increasing the response of β cells to glucose.

A 7-year-old child who has type 1 diabetes mellitus is at school reporting a headache and dizziness. The school nurse notices sweat on the child's face. What should the nurse do first? -Give glucagon IM -Offer the child 8 ounces of juice or soda -Give rapid-acting insulin -Offer the child 8 ounces of water

Offer the child 8 ounces of juice or soda These are symptoms of hypoglycemia. Glucagon is given only for severe hypoglycemia. Juice or soda is the best choice to get the child an immediate source of carbohydrates. Insulin or water would be given for hyperglycemia.

The nurse is interviewing the caregivers of a child admitted with a diagnosis of type 1 diabetes mellitus. The caregiver states, "She is hungry all the time and eats everything, but she is losing weight." The caregiver's statement indicates the child most likely has: - Polyuria - Pica - Polyphagia - Polydipsia

Polyphagia

The nurse is caring for a school-aged child newly diagnosed with type 1 diabetes mellitus. Which nursing action supports the 2020 National Health Goals to reduce the long-term complications from this disease process? -Schedule the child and parents to attend diabetes education classes. -Explain how the child's physical abilities will be affected during school. -Recommend homeschooling so the mother can provide the needed medications. -Discuss admission to a rehabilitation facility to learn self-care with this disease process.

Schedule the child and parents to attend diabetes education classes. Endocrine disorders tend to be long-term with lifetime consequences. Reducing the incidence of consequences or improving care has long-term implications. A 2020 National Health Goal related to endocrine disorders includes increasing the proportion of persons with diabetes who receive formal diabetes education. To support this goal, the nurse should schedule the child and parents to attend diabetes education classes. There are no 2020 National Health Goals to address alteration in physical abilities, homeschooling with type 1 diabetes mellitus, or the need to be admitted to a rehabilitation facility to learn self-care.

The nurse is preparing a child suspected of having a thyroid disorder for a thyroid scan. What information regarding the child should the nurse alert the doctor or nuclear medicine department about? - The child is allergic to shellfish. - The child is taking a vitamin supplement. - The child has had an MRI of their leg within the past 6 weeks. - The child wears a medical alert bracelet for diabetes.

The child is allergic to shellfish.

A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect? - Syndrome of inappropriate diuretic hormone - Diabetes insipidus - Type 1 diabetes mellitus - Hypothyroidism

Type 1 diabetes mellitus

An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have? - Type 1 diabetes mellitus - Gastrointestinal reflux - Inflammatory bowel disorder - Type 2 diabetes mellitus

Type 2 diabetes mellitus

A nurse is taking care of an infant with diabetes insipidus. Which assessment data are most important for the nurse to monitor while the infant has a prescription for fluid restriction? - Vital signs - Oral intake - Oral mucosa - Urine output

Urine output

A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus? -proteinuria -a fasting blood glucose leass than 126 mg/dL -a fasting blood glucose greater than 126 mg/dL -glucose in the urine

a fasting blood glucose greater than 126 mg/dL

A 7-year-old child is diagnosed as having type 1 diabetes. What is one of the first symptoms usually noticed by parents when this illness develops? -loss of weight -craving for sweets -severe itching -swelling of soft tissue

loss of weight The classic signs of type 1 diabetes are polydipsia, polyuria, and polyphagia. With polyphagia, the child has an increased appetite and an increased hunger, and the child eats all the time but is losing weight. This occurs because the lack of energy sugar supplies cause the muscle tissues and the fat stores to shrink. The lack of insulin also reduces the ability of the body's cells to use glucose. This leads to starvation of the cells. Loss of weight is an early symptom parents see first. They tend to equate the increased appetite as normal with growing, but become concerned when the child starts losing weight even though the child is eating. Itching and swelling are not signs of diabetes. A craving for sweets is normal for a child, especially one who is growing rapidly.

The nurse working with the child diagnosed with type 2 diabetes recognizes the disorder can be managed by: - taking oral hypoglycemic agents. - increasing carbohydrates in the diet, especially in the evening. - conserving energy with rest periods during the day. - decreasing amounts of daily insulin.

taking oral hypoglycemic agents.

An infant on the pediatric floor has diabetes insipidus. Which assessment data are important for the nurse to monitor while the infant is on strict fluid precautions? - Oral intake - Urine output - Color of mucous membranes - Temperature and heart rate

urine output An infant with diabetes insipidus has a decrease in antidiuretic hormone. Strict fluid precautions will not alter urine formation. This assessment is important because the infant will be at great risk for dehydration and electrolyte imbalance. It is part of a basic assessment to monitor heart rate, temperature, skin turgor, and mucous membranes. These are important but may not indicate the infant's overall health. On fluid restriction, oral intake will be specified.