TYPE 1 DIABETES/KETOACIDOSIS/INSPIDUS/SIADH

The nurse is teaching glucose monitoring and insulin administration to a child with type 1 diabetes mellitus 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." Explanation: Blood glucose monitoring needs to be performed more often during prolonged exercise. Frequent glucose monitoring before, during and after exercise is important to recognize hypoglycemia or hyperglycemia. Frequent glucose monitoring if the child is sick is also important to recognize changes in glucose levels and prevent hypoglycemia or hyperglycemia. The parents are correct that they will check their child's glucose before meals; they should also check it before bedtime snacks. Blood glucose level should never be the only factor considered when calculating insulin dosing. Food intake and recent or expected activity/exercise must be factored.

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." Explanation: Type 1 diabetes mellitus (DM) is a disorder in which the child's body has a deficiency of insulin; 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.

After teaching a client with type 1 diabetes, who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching? "I will receive a whole organ with extra cells to produce insulin." "I might need insulin later on but probably not as much or as often." "This transplant will provide me with a cure for my diabetes." "They'll need to create a connection from the pancreas to allow enzymes to drain."

"I might need insulin later on but probably not as much or as often."

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." Explanation: The nurse would provide additional education if the parents state the child should not participate in sports or physical activity. The child with diabetes can, and should, be physically active to maintain proper health and facilitate efficient insulin usage by the body. Glucose levels should be checked more frequently during times of sickness, as well as assessing the urine for ketones. Consistency of intake can help prevent complications and maintain near-normal blood glucose levels. The parents and child should know how to identify foods to adequately monitor the child's nutritional intake. A dietitian with expertise in diabetes education should be consulted for referral as needed.

The nurse is caring for a 5-year-old child recently diagnosed with type 1 diabetes. When discussing the care and management of the disorder with the child's parents, which statement(s) indicates understanding? Select all that apply. "Regular exercise will help in the regulation of my child's blood sugar levels." "If my child's blood glucose remains stable for a few months, my child can move from injections to pills." "When my child is ill and unable to eat, we will need to hold the insulin until the child is able to tolerate fluids." "The insulin dosages will be directly associated to my child's carbohydrate ingestion." "We need to rotate insulin injection sites to prevent complications."

"Regular exercise will help in the regulation of my child's blood sugar levels." "The insulin dosages will be directly associated to my child's carbohydrate ingestion." "We need to rotate insulin injection sites to prevent complications." Explanation: When a child has type 1 diabetes, there is an absence of insulin to manage the metabolism of serum glucose. Regular exercise is helpful in the maintenance of stable serum glucose levels. Carbohydrate ingestion is linked to the amount of insulin that will be needed in the body. Carbohydrates break down and the body needs insulin to metabolize the resulting glucose. The rotation of insulin injection sites is important. Failing to rotate injection sites can cause a complication, lipohypertrophy. Type 1 diabetes means that the body does not have insulin, so injected insulin is needed to manage it. Oral medications are only an option for those having type 2 diabetes. When the child is ill, it is still important that the child with diabetes take the prescribed medications.

A 10-year-old child has been diagnosed with type 1 diabetes mellitus. The child is curious about the cause of the disease and asks the nurse to explain it. Which explanation will the nurse provide? "Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which helps control the sugar level in your blood." "The pancreas inside your belly makes enough chemical called insulin, but your body does not want to use it to keep your blood sugar level normal." "The part of your body called the pancreas is broken and produces too much chemical called glucagon, which makes you really thirsty and have to go to the bathroom a lot." "The alpha and beta cells in your pancreas are fighting against each other; that is why your blood sugar stays high and you need insulin injection."

"Special cells in a part of your body called the pancreas cannot make a chemical called insulin, which helps control the sugar level in your blood." Explanation: 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 thus the blood glucose level remains high if an appropriate amount of insulin is not administered to the client. With Type 2 diabetes, the body produces an adequate amount of insulin; however, the body is resistant to using the insulin properly to keep circulating blood glucose levels at a normal level. The rest of the statements provide incorrect information regarding the pathophysiology of type 1 diabetes.

A 16-year-old patient newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The patient is upset because friends frequently state, "You look anorexic." Which of the following statements would be the best response by the nurse to help this patient understand the cause of weight loss due to this condition? "You may be having undiagnosed infections causing you to lose extra weight." "I will refer you to a dietician who can help you with your weight." "Your body is using protein and fat for energy instead of glucose." "Don't worry about what your friends think; the carbohydrates you eat are being quickly digested, increasing your metabolism."

"Your body is using protein and fat for energy instead of glucose."

An 8-year-old with diabetes is placed on neutral protamine Hagedorn (NPH) and regular insulin before breakfast and before dinner. She will receive a snack of milk and cereal at bedtime. The snack will: 1. Help her regain lost weight. 2. Provide carbohydrates for immediate use. 3. Prevent late night hypoglycemia. 4. Help her stay on her diet.

3. NPH insulin peaks in 6 to 8 hours, which would occur during sleep. A bedtime snack is needed to prevent late night hypoglycemia. The snack is not given to help regain weight. Milk contains fat and protein, which cause delayed absorption into the blood stream and maintains the blood glucose level at night when the NPH insulin will peak. The snack is not used to provide carbohydrates for immediate use because NPH insulin, unlike regular insulin, does not peak immediately. The snack has nothing to do with a diet.

3. The nurse is developing a plan of care for a 7-year-old boy with diabetes insipidus. Which of the following would the nurse most likely identify as the priority nursing diagnosis? A) Deficient fluid volume related to dehydration B) Excess fluid volume related to edema C) Deficient knowledge related to fluid intake regimen D) Imbalanced nutrition, more than body requirements related to excess weight

A

A child with diabetes insipidus is being treated with vasopressin. The nurse would assess the child closely for signs and symptoms of which of the following? A) Syndrome of inappropriate antidiuretic hormone (SIADH) B) Thyroid storm C) Cushing syndrome D) Vitamin D toxicity

A

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? A. 8.5% B. 6.5% C. 7.5 % D. 7.0%

A Rationale: The goal for hemoglobin A1C in children between the ages of 6 and 12 years is less than 8%. Therefore, a result of 8.5% would indicate that additional intervention is needed to achieve the recommended goal.

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

ANS: C Rationale: 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

WWW.NURSINGTESTBANKSWORLD.CO M 10. Which is the nurses best response to the parents of a 10-year-old child newly diagnosed with insulin-dependent diabetes mellitus (IDDM) who are concerned about the childs continued participation in soccer? a. Consider the swim team as an alternative to soccer. b. Encourage intellectual activity rather than participation in sports. c. It is okay to play sports such as soccer when the weather is moderate. d. Give the child an extra 15 to 30 grams of carbohydrate snack before soccer practice.

ANS: D Exercise lowers blood glucose levels. A snack with 15 to 30 grams of carbohydrates before exercise will decrease the risk of hypoglycemia. Soccer is an appropriate sport for a child with IDDM as long as the child prevents hypoglycemia by eating a snack. Participation in sports is not contraindicated for a child with IDDM. The child with IDDM may participate in sports activities regardless of climate.

An adolescent client with type 1 diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note? 1. Sweating and tremors 2. Hunger and hypertension 3. Cold, clammy skin and irritability 4. Fruity breath odor and decreasing level of consciousness

Ans: 4 - Fruity breath order Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. Hyperglycemia occurs with diabetic ketoacidosis. Signs of hyperglycemia include fruity breath odor and a decreasing level of consciousness. Hunger can be a sign of hypoglycemia or hyperglycemia, but hypertension is not a sign of diabetic ketoacidosis. Hypotension occurs because of a decrease in blood volume related to the dehydrated state that occurs during diabetic ketoacidosis. Cold clammy skin, irritability, sweating, and tremors all are signs of hypoglycemia.

An adolescent with diabetes receives 30 units of Humulin N insulin at 7:00 a.m. The nurse would monitor for a hypoglycemic episode at what time? 1. At bedtime 2. Before supper 3. At midmorning 4. After breakfast

Before supper Rationale: Humulin N insulin is an intermediate-acting insulin that peaks in approximately 6 to 12 hours. It would peak before supper if given at 7:00 a.m. Short-acting insulin would peak after breakfast or midmorning. Long-acting insulins would peak at bedtime.

The nurse suspects that a 4-year-old with type 1 diabetes is experiencing hypoglycemia based on which of the following? Select all that apply. A) Blurred vision B) Dry, flushed skin C) Diaphoresis D) Slurred speech E) Fruity breath odor F) Tachycardia

C, D, F

The nurse is caring for a child with diabetes mellitus type 1. The nurse notes that the child is drowsy, has flushed cheeks and red lips, a fruity smell to the breath, and there has been an increase in the rate and depth of the child's respirations. The nurse recognizes that these symptoms indicate the child has which of the following?a) Diabetic ketoacidosis b) Insulin reaction c) Polyphagia d) Cheyne stokes respiration

Diabetic ketoacidosis Explanation: Diabetic ketoacidosis is characterized by drowsiness, dry skin, flushed cheeks and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing (abnormal increase in the depth and rate of the respiratory movements).

A nurse is preparing a client with type 1 diabetes for discharge. The client can care for himself; however, he's had a problem with unstable blood glucose levels in the past. Based on the client's history, he should be referred to which health care worker?Psychiatrist Home health nurse Social worker Dietitian

Dietitian

A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand? Hydrocortisone 50% dextrose Epinephrine Glucagon

Glucagon

A nurse is teaching an adolescent with diabetes about clinical manifestations of hypoglycemia. Which of the following should be included in teaching? Select all that apply A. increased urination B. hunger C. signs of dehydration D. irritability E. sweating and pallor F. kussmaul respirations

Hunger irritability sweating and pallor

When the nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor?Polyphagia Hypoglycemia Hyponatremia Ketonuria

Hypoglycemia

A nurse is teaching a child with type 1 diabetes mellitus about self care. Which of the following statements by the child indicates understanding of the teaching? a. i should skip breakfast when i am not hungry B. i should increase my insulin with exercise C. I should drink a glass of milk when I'm feeling irritable D. i should draw up the NPH insulin into the syringe before regular insulin

I should drink a glass of milk when I'm feeling irritable

The nurse is describing the action of insulin in the body to a client newly diagnosed with type 1 diabetes. Which of the following would the nurse explain as being the primary action? It aids in the process of gluconeogenesis. It decreases the intestinal absorption of glucose. It enhances transport of glucose across the cell wall. It stimulates the pancreatic beta cells.

It enhances transport of glucose across the cell wall.

A 53-year-old client is brought to the ED, via squad, where you practice nursing. He is demonstrating fast, deep, labored breathing and has a fruity odor to his breath. He has a history of type 1 diabetes. What could be the cause of his current serious condition? Hyperosmolar hyperglycemic nonketotic syndrome Hepatic disorder Ketoacidosis All options are correct

Ketoacidosis

A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? (Select all that apply.) Ketosis-prone Older than 65 years of age Little endogenous insulin Obesity at diagnoses Younger than 30 years of age

Ketosis-prone Little endogenous insulin Younger than 30 years of age

a nurse is reviewing sick day management with a parent of a child who has type 1 diabetes. Which of the following should the nurse include in the teaching? Select all that apply a. Monitor blood glucose levels every 3 hours b. discontinue taking insulin feeling better c. drink 8 oz of fruit juice every hour d. test urine for ketones e. call the health care provider if blood glucose is greater than 240

Monitor blood glucose levels every 3 hours test urine for ketones call the health and care provider in blood glucose is greater than 240

The nurse is assessing a 7-year-old girl who complains of headache, is irritable, and vomiting. Her health history reveals she has had meningitis. Which of the following is the priority intervention? a) Setting up safety precautions to prevent injury b) Restoring fluid balance with IV sodium c) Notifying the physician of the neurologic findings d) Monitoring urine volume and specific gravity

Notifying the physician of the neurologic findings Explanation: This child may have syndrome of inappropriate antidiuretic hormone (SIADH). Priority intervention for this child is to notify the physician of the neurologic findings. Remaining interventions will be to restore fluid balance with IV sodium chloride to correct hyponatremia, set up safety precautions to prevent injury due to altered level of consciousness, and monitor fluid intake, urine volume, and specific gravity.

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 Explanation: Symptoms of type 1 diabetes mellitus include polyphagia (increased hunger and food consumption), polyuria (dramatic increase in urinary output, probably with enuresis) and polydipsia (increased thirst). Pica is eating nonfood substances.

A client who was diagnosed with type 1 diabetes 14 years ago is admitted to the medical-surgical unit with abdominal pain. On admission, the client's blood glucose level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level? Arm and leg trembling Slow, shallow respirations Rapid, thready pulse Cool, moist skin

Rapid, thready pulse

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 Explanation: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.

Which nursing intervention should be done first when managing a pediatric client admitted to the emergency department with severe diabetic ketoacidosis (DKA)? Begin an insulin drip to lower the client's blood glucose level. Secure the client's airway to ensure adequate ventilation. Draw a blood glucose level and serum electrolyte panel. Correct any fluid deficit using an isotonic saline solution

Secure the client's airway to ensure adequate ventilation. Explanation: Treating pediatric clients with severe DKA is a medical emergency; therefore, attending to the airway, breathing, and circulation is the first priority. Once the airway is secured, the healthcare team should estimate the level of dehydration and begin replacement fluids of normal saline. An insulin drip should be started after the initial 1 to 2 hours of treatment at a rate of 0.1 units/kg/hr. Blood glucose should be tested every 1 to 2 hours until the client is stable, then it should be every 6 hours. Additionally, serum electrolytes should be drawn every 1 to 2 hours until the client is stable, then every 4 to 6 hours.

A child has been prescribed Stimate (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?

Stimate (desmopressin acetate) is a synthetic antidiuretic hormone that will slow down your urine output

A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which of the following methods should she recommend to the child for regular doses? a) Subcutaneously in the outer thigh b) Intradermally in the outer arm c) Intramuscularly in the abdomen d) Intravenously in the chest

Subcutaneously in the outer thigh Explanation: Insulin is always injected SC except in emergencies, when half the required dose may be given IV. SC tissue injection sites used most frequently in children include those of the upper outer arms and the outer aspects of the thighs. The abdominal SC tissue injection sites commonly used in adults can be adequate sites but most children dislike this site as abdominal skin is tender.

A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms? a) Hypersecretion of somatotropin b) Syndrome of inappropriate antidiuretic hormone c) Hyposecretion of somatotropin d) Diabetes insipidus

Syndrome of inappropriate antidiuretic hormone Syndrome of inappropriate antidiuretic hormone (SIADH) is a rare condition in which there is overproduction of antidiuretic hormone by the posterior pituitary gland. This results in a decrease in urine production and water intoxication. As sodium levels fall in proportion to water, the child develops hyponatremia or a lowered sodium plasma level. It can be caused by central nervous system infections such as bacterial meningitis. As the hyponatremia grows more severe, coma or seizures occur from brain edema. Diabetes insipidus is characterized by polyuria, not decreased urine production. Hyposecretion of somatotropin, or growth hormone, results in undergrowth; hypersecretion results in overgrowth.

16. A student with type 1 diabetes tells the nurse she is feeling light-headed. Thestudent's blood sugar is 60 mg/dL. Using the 15-15 rule, the nurse should give: 1. 15 mL of juice and give another 15 mL in 15 minutes. 2. 15 g of carbohydrate and retest the blood sugar in 15 minutes. 3. 15 g of carbohydrate and 15 g of protein. 4. 15 oz of juice and retest in 15 minutes

The 15-15 rule is a general guideline for treating hypoglycemia where the client consumes 15 g of carbohydrate and repeats testing the blood sugar in 15 minutes. Fifteen grams of carbohydrate equals 60 cal and is roughly equal to ½ cup of juice or soda, six to eight lifesavers, or a tablespoon of honey or sugar. The general recommendation is if the blood sugar is still low, the client may repeat the sequence. Fifteen milliliters of juice would only provide 15 cal. This would not be sufficient carbohydrates to treat the hypoglycemia. offered after the blood glucose improves. Fifteen ounces of juice would be almost four times the recommended 4 oz of juice. Protein does not treat insulin-related hypoglycemia; however, a protein-starch snack may be

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 Explanation: An infant with the diagnosis of diabetes insipidus has decreased secretion of antidiuretic hormone (ADH). The infant is at risk for dehydration so monitoring urinary output is the most important intervention. The child's oral intake has been ordered. Monitoring a child who is under fluid restriction includes assessing the oral mucosa; however, urine output is the most important assessment for this patient. Vital signs are part of a basic assessment.

A patient with type 1 diabetes mellitus is being taught about self-injection of insulin. Which of the following facts about site rotation should the nurse include in the teaching? Avoid the abdomen because absorption there is irregular. Choose a different site at random for each injection. Use all available injection sites within one area. Rotate sites from area to area every other day.

Use all available injection sites within one area.

A nurse is teaching an adolescent who has diabetes about foot care. Which of the following should be included and the teaching?A. inspect feet once a week B. cut your toe nail in rounded formatoin C. You can use cornstarch on your feet D. you can use over the counter callus removers

You can use cornstarch on your feet

nurse is preparing to administer insulin to a child who's just been diagnosed with type 1 diabetes. When the child's mother stops the nurse in the hall, she's crying and anxious to talk about her son's condition. The nurse's best response is: "I can't talk now. I have to give your son his insulin as soon as possible." "I'm going to give your son some insulin. Then I'll be happy to talk with you." "If you'll wait in your son's room, the physician will talk with you as soon as he's free." "Everything will be just fine. I'll be back in a minute and then we can talk."

"I'm going to give your son some insulin. Then I'll be happy to talk with you."

A client with type 1 diabetes has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, the nurse is most accurate in stating: "The test must be repeated following a 12-hour fast." "It tells us about your sugar control for the last 3 months." "Your insulin regimen must be altered significantly." "It looks like you aren't following the ordered diabetic diet."

"It tells us about your sugar control for the last 3 months."

A 9-year-old was just diagnosed with type 1 diabetes. The parents state, "We hope our child won't have to take insulin injections." How should the nurse respond? "The pancreas doesn't produce insulin in Type 1 diabetes, so it is likely that insulin injections will be necessary." "It is very early in the diagnosis process. Let's wait to see if insulin will be necessary." "Sometimes oral hypoglycemic agents are all that is necessary. Hopefully that will be the case with your child." "You will have to trust whatever the doctor decides to order."

"The pancreas doesn't produce insulin in Type 1 diabetes, so it is likely that insulin injections will be necessary." Explanation: Since the diagnosis has been made for type 1 DM, insulin will be necessary. Insulin is used for DM to replace the body's natural insulin, which is necessary for proper glucose use.

A nurse is preparing a presentation for a group of parents with children diagnosed with diabetes type 1. The children are all adolescents. Which of the following issues would the nurse need to address? Select all that apply. A) Self-monitoring of blood glucose levels B) Feelings of being different C) Deficient decision-making skills D) Body image conflicts E) Struggle for independence

. C, D, E

A nurse is assessing an 8-year-old with diabetes who is experiencing hyperglycemia.Which symptom(s) indicate(s) that the hyperglycemia requires immediate intervention?Select all that apply. 1. Weakness. 2. Thirst. 3. Shakiness. 4. Hunger. 5. Headache. 6. Dizziness.

1, 2, 6. Weakness, thirst, and dizziness are symptoms related to dehydration caused by 23. 1, 2, 6. Weakness, thirst, and dizziness are symptoms related to dehydration caused by

A 7-year-old with type 1 diabetes is sick with the flu. What is the most important information for the nurse to convey regarding diabetes management during illness? 1. Blood glucose needs to be checked more frequently during illness. 2. Children require less insulin when they are sick with the flu. 3. Urine ketones should be checked every other day with illness 4. Increase intake of fluids in carbohydrate to prevent illness

1. Blood glucose needs to be checked more frequently during illness.

A child's fasting blood glucose levels range between 100 and 120 mg/dL (5.7 and 6.9 mmol/L) daily. The before-dinner blood glucose levels are between 120 and 130 mg/dL (6.9 and 7.4 mmol/L), with no reported episodes of hypoglycemia. Mixed insulin is administered before breakfast and before dinner. The nurse should make which interpretation about these findings? 1. Exercise should be increased to reduce blood glucose levels. 2. Insulin doses are appropriate for food ingested and activity level .3. Dietary needs are being met for adequate growth and development. 4. Dietary intake should be increased to avoid hypoglycemic reactions.

2. Insulin doses are appropriate for food ingested and activity level.Rationale:Blood glucose levels are a measure of the balance among diet, medication, and exercise. Options 1 and 4 imply that the data analyzed are abnormal. The question presents no data for determining growth and development status, such as height, weight, age, or behavior. Supporting normal growth and development is an important goal in managing diabetes in children, but that is not what is being evaluated here.

A nurse is teaching an 8-year-old with diabetes and her parents about managing diabetes during illness. The nurse determines the parents understand the instruction when they indicate that, when the child is ill, they will provide: 1. More calories. 2. More insulin. 3. Less insulin. 4. Less protein and fat.

2. The child needs more insulin during an illness, because the cells become more insulin resistant during illness and need more insulin to achieve a normal blood glucose level. During an acute illness, simple carbohydrates and fluids are usually tolerated best.

The nurse is talking to the parents of a child newly diagnosed with diabetes mellitus. Which statement by the parents indicates an understanding of preventing and managing hyperglycemia? 1. "I will give 8 oz of diet cola at the first sign of weakness." 2. "I will administer glucagon immediately if shakiness is felt." 3. "I will check for ketones when my child is suffering from an illness." 4. "I will report to the emergency department if the blood glucose level is over 150 mg/dL (8.6 mmol/L)."

3. "I will check for ketones when my child is suffering from an illness." Rationale: It is recommended that urine be tested for ketones every 3 hours during an illness or whenever the blood glucose level is over 240 mg/dL (13.7 mmol/L) when illness is not present. The child or parents should carry a source of glucose so it is readily available in the event of a hypoglycemic, not hyperglycemic, reaction. A diet carbonated beverage does not meet the need of providing a glucose source during a hypoglycemic episode. If the blood glucose level is greater than 150 mg/dL (8.6 mmol/L), it is unnecessary to report to the emergency department as a first-line treatment. Glucagon is used for an unconscious client who is experiencing a hypoglycemic, not hyperglycemic, reaction and who is unable to swallow.

The nurse is trying to get consent to care for an 11-year-old boy with diabetic ketoacidosis. His parents are out of town on vacation, and the child is staying with a neighbor. Which action would be the priority? A)Getting telephone consent with two people listening to the verbal consent B)Providing emergency care without parental consent C)Contacting the childs aunt or uncle to obtain their consent D)Advocating for termination of parental rights for this situation

A)Getting telephone consent with two people listening to the verbal consent

8. When would a child diagnosed with insulin-dependent diabetes mellitus most likely demonstrate a decreased need for insulin? a. During the honeymoon phase b. During adolescence c. During growth spurts d. During minor illnesses

ANS: A During the honeymoon phase, which may last from a few weeks to a year or longer, the child is likely to need less insulin. During adolescence, physical growth and hormonal changes contribute to an increase in insulin requirements. Insulin requirements are typically increased during growth spurts. Stress either from illness or from events in the environment can cause hyperglycemia. Insulin requirements are increased during periods of minor illness.

Which comment made by a 12-year-old child with insulin-dependent diabetes mellitus (IDDM) indicates a knowledge deficit? a. I rotate my insulin injection sites every time I give myself an injection. b. I keep records of my glucose levels and insulin sites and amounts. c. Ill be glad when I can take a pill for my diabetes like my uncle does. d. I keep Lifesavers in my school bag in case I have a low-sugar reaction.

ANS: C Children with IDDM will require life-long insulin therapy. Rotating injection sites is appropriate because insulin absorption varies at different sites. Keeping records of serum glucose and insulin sites and amounts is appropriate. Prompt treatment of hypoglycemia reduces the possibility of a severe reaction. Keeping hard candy on hand is an appropriate action.

A patient who is diagnosed with type 1 diabetes would be expected to: Receive daily doses of a hypoglycemic agent. Have no damage to the islet cells of the pancreas. Need exogenous insulin. Be restricted to an American Diabetic Association diet.

Need exogenous insulin.

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 Explanation: 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 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. Explanation: 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 caring for a 13-year-old girl hospitalized for complications from type 1 diabetes. The girl has a nursing diagnosis of powerlessness related to lack of control of multiple demands associated with hospitalization, procedures, treatments, and changes in usual routine. How can the nurse help promote control? A) Ask the child to identify her areas of concern. B) Encourage participation of parents in care activities. C) Offer the girl as many choices as possible. D) Enlist the family's assistance in creating a time schedule.

c

You teach a child with type 1 diabetes mellitus to administer her own insulin. She is receiving a combination of short-acting and long-acting insulin. You know that she has appropriately learned the technique when she a) administers the insulin into a doll at a 30-degree angle. b) administers the insulin intramuscularly into rotating sites. c) wipes off the needle with an alcohol swab. d) draws up the short-acting insulin into the syringe first.

draws up the short-acting insulin into the syringe first. Explanation: Drawing up the short-acting insulin first prevents mixing a long-acting form into the vial of short-acting insulin. This maintains the short-acting insulin for an emergency. Insulin is given subcutaneously

A 7-year-old is diagnosed as having type 1 diabetes. One of the first symptoms usually noticed by parents when this illness develops is a) swelling of soft tissue. b) loss of weight. c) craving for sweets. d) severe itching

loss of weight. Explanation: Lack of insulin reduces the ability of body cells to use glucose; this leads to starvation of cells and loss of weight as an early symptom

The charge nurse on the pediatric floor has assigned a 6-year-old girl with newly diagnosed type 1 diabetes and an 8-year-old girl recovering from ketoacidosis to the same semi-private room. The 6-year-old's mother is upset because the parent staying with the other child is male and believes the arrangement is violates her social norms. The nurse should: explain to the parents that this room arrangement facilitates teaching. reassign the children to different rooms offer the parent another place to sleep refer the parent to the customer service representative

reassign the children to different rooms

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 mellitus is being completed. Which symptom would differentiate between type 1 diabetes mellitus from type 2 diabetes mellitus? recent weight loss blood pressure of 142/92 mm Hg slow healing wounds loose stools

recent weight loss Explanation: Weight loss is unique to type 1 diabetes mellitus, whereas weight gain is associated with type 2. Hypertension is consistent with type 2 diabetes mellitus. Both type 1 and type 2 diabetes cause delayed wound healing. The increase in blood glucose in diabetes causes damage to the inner lining of the arteries that cause the arteries to develop plaque and harden. These damages to the blood vessels result in a decrease in the ability of oxygen-rich blood to be transported effectively to the tissues to promote wound healing. Loose stools or repeated loose stools called diarrhea is a common side effect of the oral medication metformin, which is prescribed for clients with type 2 diabetes. Insulin, the treatment for type 1 diabetes, has constipation as one of the side effects.

A child with a history of diabetes insipidus has been taking vasopressin. The parents bring the child to the clinic for an evaluation. During the visit, the parents mention that it seems like their son is hardly urinating. The nurse suspects syndrome of inappropriate antidiuretic hormone. Which of the following would the nurse expect to find to help confirm this condition? Select all that apply. a) Decreased urine osmolality b) Weight loss c) Serum osmolality 300 mOsm/kg d) Hypotension e) Decreased serum sodium level f) Urine specific gravity 1.033

• Urine specific gravity 1.033• Decreased serum sodium level• Serum osmolality 300 mOsm/kg Explanation: Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by decreased urination, hyponatremia, serum osmolality greater than 280 mOsm/kg, urine specific gravity greater than 1.030, increased urine osmolality, fluid retention, weight gain, and hypertension.

A 15-year-old girl has had type 1 diabetes since she was 2 years old. She recently began dialysis and is also struggling with exhaustion. She has been hospitalized with an infection and confides to the nurse that she feels hopeless due to her failing health. How should the nurse respond? "Would you like to help me create your daily schedule while you are here?" "After we get the infection under control, you will start feeling better." "What do you think would help you feel better or improve your situation?" "Have you talked with your parents about the things that concern you?"

"What do you think would help you feel better or improve your situation?" Explanation: It is important to ask the child how they view their situation and what might improve it. Using open-ended questions elicits the girl's thoughts and fears and helps the nurse assess the issues at hand. It can also help the nurse determine whether the girl's hopelessness is characteristic of depression. Questions that can be answered with "yes" or "no" are less effective. Assuring her that she'll feel better soon does not address her concerns.

An adolescent with insulin-dependent diabetes is being taught the importance of rotating the sites of insulin injections. The nurse should judge that the teaching was successful when the adolescent identifies which of the following as a result of using the same site? 1. Destruction of the fat tissue and poor absorption. 2. Destruction of nerves and painful neuritis. 3. Destruction of the tissue and too-rapid insulin uptake. 4. Development of resistance to insulin and need for increased amounts

1. Repeated use of the same injection site can result in atrophy of the fat in the subcutaneous tissue and lead to poor insulin absorption. The neuritis that develops from diabetes is related to microvascular changes that occur. Subcutaneous tissue is not destroyed and insulin is not rapidly absorbed. Resistance to insulin is caused by an immune response to the insulin protein.

The nurse talks to an adolescent about how she can tell her friends about her new diagnosis of diabetes. Which of the following behaviors by the adolescent indicates that the adolescent has responded positively to the discussion? 1. She asks the nurse for material on diabetes for a school paper. 2. She introduces the nurse to her friends as "the one who taught me all about my diabetes." 3. She says, "I'll try to tell my friends, but they'll probably quit hanging out with me." 4. She asks her friends what they think about someone who has a lifelong illness.

2. The ability to talk about her diabetes indicates that the adolescent feels good enough about herself to share her problem with her peers. Asking for reference material does not specifically indicate that the client's self-esteem has improved or that she has accepted her diagnosis. Saying that her friends will probably desert her if she tells them about the illness indicates that the adolescent still needs to work on her self-esteem and her feelings about the disease. Asking her friends what they think of someone with a lifelong illness would not indicate that the nurse's interventions targeted toward improving selfesteem have been successful. Rather, this statement demonstrates the adolescent's uncertainty about herself.

A client with type 1 diabetes mellitus is receiving short-acting insulin to maintain control of blood glucose levels. In providing glucometer instructions, the nurse would instruct the client to use which site for most accurate findings? Upper arm Forearm Thigh Finger

Finger

A school-age child with type 1 diabetes mellitus has soccer practice and the school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do? 1. Eat twice the amount normally eaten at lunchtime. 2. Take half the amount of prescribed insulin on practice days. 3. Take the prescribed insulin at noontime rather than in the morning. 4. Eat a small box of raisins or drink a cup of orange juice before soccer practice.

4. Eat a small box of raisins or drink a cup of orange juice before soccer practice.Rationale:Hypoglycemia is a blood glucose level less than 70 mg/dL (4 mmol/L) and results from too much insulin, not enough food, or excessive activity. An extra snack of 15 to 30 g of carbohydrates eaten before activities such as soccer practice would prevent hypoglycemia. A small box of raisins or a cup of orange juice provides 15 to 30 g of carbohydrates. The child or parents should not be instructed to adjust the amount or time of insulin administration. Meal amounts should not be doubled.

A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion? 1. Potassium infusion 2. NPH insulin infusion 3. 5% dextrose infusion 4. Normal saline infusion

4. Normal saline infusionRationale:Diabetic ketoacidosis is a complication of diabetes mellitus that develops when a severe insulin deficiency occurs. Hyperglycemia occurs with diabetic ketoacidosis. Rehydration is the initial step in resolving diabetic ketoacidosis. Normal saline is the initial IV rehydration fluid. NPH insulin is never administered by the IV route. Dextrose solutions are added to the treatment when the blood glucose level decreases to an acceptable level. Intravenously administered potassium may be required, depending on the potassium level, but would not be part of the initial treatment.

A patient newly diagnosed with type 1 diabetes has an unusual increase in blood glucose from bedtime to morning. The physician suspects the patient is experiencing insulin waning. Based on this diagnosis, the nurse will expect which of the following changes to the patient's medication regimen? Administering a dose of intermediate-acting insulin before the evening meal Decreasing evening bedtime dose of intermediate-acting insulin and administering a bedtime snack Changing the time of injection of evening intermediate-acting insulin from dinnertime to bedtime Increasing morning dose of long-acting insulin

Administering a dose of intermediate-acting insulin before the evening meal

Which statement made by a 14-year-old adolescent who is newly diagnosed with insulin dependent diabetes mellitus (IDDM) indicates a need for further teaching? a. I should eat meals and snack at the same time every day. b. Exercise will decrease my insulin requirements. c. It is okay to drink chocolate milk with meals. d. I need to check my sugars before meals and at bedtime.

ANS: C Chocolate milk is high in carbohydrates. Carbohydrates raise blood glucose levels. A beverage low in carbohydrates is a better choice. Meals and snacks should be eaten at regular times. Exercise decreases insulin requirements. Checking serum glucose before breakfast and dinner is appropriate.

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 Diabetes insipidus results from a deficiency in the secretion of antidiuretic hormone (ADH). This hormone, also known as vasopressin, is produced in the hypothalamus and stored in the pituitary gland. Hypopituitarism or dwarfism involves a growth hormone deficiency. Diabetes mellitus involves a disruption in insulin secretion. Thyroxine is a thyroid hormone that if deficient leads to hypothyroidism.

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. Explanation: 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.

A nurse in the school office is seeing a 7-year-old child with type 1 diabetes after gym class. The child is jittery and appears sweaty. Which intervention would the nurse advise the child to do? "You will need to drink this 6-ounce bottle of orange juice." "You will need to have an extra shot of regular insulin." "You will need to sit in the office and rest after gym class." "You will need to skip your next dose of insulin."

"You will need to drink this 6-ounce bottle of orange juice." Explanation: A child with type 1 diabetes who has signs of hypoglycemia can drink juice as a quick source of sugar to raise the glucose level and stop the symptoms of hypoglycemia. The child should only have one serving of juice and wait to see if the hypoglycemic signs resolve. Another dose of insulin could drop the glucose to dangerous levels. Skipping the insulin dose or sitting in the office will not resolve the symptoms or help the child.

An adolescent with type 1 diabetes mellitus has been chosen for the school's cheerleading squad. The adolescent visits the school nurse to obtain information regarding adjustments needed in the treatment plan for diabetes. What should the school nurse instruct the student to do? 1. Eat half the amount of food normally eaten. 2. Take two times the amount of prescribed insulin on practice and game days. 3. Eat six graham crackers or drink a cup of orange juice prior to practice or game time. 4. Take the prescribed insulin 1 hour prior to practice or game time rather than in the morning.

3. Eat six graham crackers or drink a cup of orange juice prior to practice or game time. Rationale: An extra snack of 15 to 30 g of carbohydrate eaten before activities, such as cheerleader practice, will prevent hypoglycemia. Six graham crackers or a cup of orange juice will provide 15 to 30 g of carbohydrate. The adolescent should not be instructed to adjust the amount or time of insulin administration. Meal amounts should not be decreased.

The mother of a 6-year-old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse should instruct the mother to take which action? 1. Hold the next dose of insulin. 2. Come to the clinic immediately. 3. Encourage the child to drink liquids. 4. Administer an additional dose of regular insulin.

3. Encourage the child to drink liquids.Rationale:When the child is sick, the mother should test for urinary ketones with each voiding. If ketones are present, liquids are essential to aid in clearing the ketones. The child should be encouraged to drink liquids. Bringing the child to the clinic immediately is unnecessary. Insulin doses should not be adjusted or changed.

The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL (3.4 mmol/L)? Select all that apply 1. Administer regular insulin. 2. Encourage the child to ambulate. 3. Give the child a teaspoon of honey. 4. Provide electrolyte replacement therapy intravenously. 5. Wait 30 minutes and confirm the blood glucose reading 6. Prepare to administer glucagon subcutaneously if unconsciousness occurs.

3. Give the child a teaspoon of honey.6. Prepare to administer glucagon subcutaneously if unconsciousness occurs. Rationale: Hypoglycemia is defined as a blood glucose level less than 70 mg/dL (4 mmol/L). Hypoglycemia occurs as a result of too much insulin, not enough food, or excessive activity. If possible, the nurse should confirm hypoglycemia with a blood glucose reading. Glucose is administered orally immediately; rapid-releasing glucose is followed by a complex carbohydrate and protein, such as a slice of bread or a peanut butter cracker. An extra snack is given if the next meal is not planned for more than 30 minutes or if activity is planned. If the child becomes unconscious, cake frosting or glucose paste is squeezed onto the gums, and the blood glucose level is retested in 15 minutes; if the reading remains low, additional glucose is administered. If the child remains unconscious, administration of glucagon may be necessary, and the nurse should be prepared for this intervention. Encouraging the child to ambulate and administering regular insulin would result in a lowered blood glucose level. Providing electrolyte replacement therapy intravenously is an intervention to treat diabetic ketoacidosis. Waiting 30 minutes to confirm the blood glucose level delays necessary intervention.

An adolescent with type 1 diabetes mellitus is attending a dance in the school gym. The adolescent suddenly becomes flushed and complains of hunger and dizziness. The school nurse, who is present at the dance, takes the child to the nurse's office and performs a blood glucose level test that shows 60 mg/dL (3.4 mmol/L). Which is the initial nursing intervention? 1. Call the child's mother. 2. Assist the child with administering regular insulin. 3. Give the child ½ cup (120 ml) of a sugar-sweetened carbonated beverage. 4. Call an ambulance to take the child to the hospital emergency department.

3. Give the child ½ cup (120 ml) of a sugar-sweetened carbonated beverage.Rationale:A blood glucose level lower than 70 mg/dL (4 mmol/L) indicates hypoglycemia. The child is attending an activity that is different from the normal routine at school. Insulin requirements change with unfamiliar situations. When signs of hypoglycemia occur, the child needs an immediate source of glucose. Regular insulin will lower the blood glucose level and is thus a harmful action. Although the child's mother will need to be notified of the occurrence, this is not the immediate action. There is no reason to take the child to the emergency department.

A 6-year-old child with diabetes mellitus and the child's mother come to the health care clinic for a routine examination. The nurse evaluates the data collected during this visit to determine if the child has been euglycemic since the last visit. Which information is the most significant indicator of euglycemia? 1. Daily glucose monitor log 2. Dietary history for the previous week 3. Glycosylated hemoglobin (hemoglobin A1c) 4. Fasting blood glucose performed on the day of the clinic visit

3. Glycosylated hemoglobin (hemoglobin A1c)Rationale:The glycosylated hemoglobin assay measures the glucose molecules that attach to the hemoglobin A molecules and remain there for the life of the red blood cell, approximately 120 days. This is not reversible and cannot be altered by human intervention. Daily glucose logs are useful if they are kept regularly and accurately. However, they reflect only the blood glucose at the time the test was done. A fasting blood glucose test performed on the day of the clinic visit is time limited in its scope, as is the dietary history.

19. The nurse is evaluating a child's skills in self- administering insulin (see figure). The nurse should :1. Have the child use both hands on the syringe. 2. Ask the child to place the needle at a 45-degree angle. 3. Tell the child to use a site lower on her thigh. 4. Remind the child to rotate sites.

4. The child is using correct injection technique, and the nurse can remind the child to rotate sites. The nurse should also reinforce that the child has used correct technique and praise the child for doing so. If the child can manipulate the plunger of the syringe with one hand, this is appropriate. Insulin is administered at a 90-degree angle as shown. The child should identify appropriate sites on the thighs as one handbreadth below the hip and above the knee; the child is using appropriate sites.

A home care nurse is teaching an adolescent with type 1 diabetes mellitus about insulin administration and rotation sites. Which statement, if made by the adolescent, would indicate effective teaching? 1. "I should use only my stomach and my thighs for injections." 2. "I need to use a different major site for each insulin injection." 3. "I should use the same major site for 1 month before rotating to another site." 4. "I need to give 4 to 6 injections in one area, about an inch apart, and then move to another area."

4. "I need to give 4 to 6 injections in one area, about an inch apart, and then move to another area." Rationale: The most efficient rotation plan involves giving about four to six injections in one area, each injection about 1 inch (2.5 cm) apart, or the diameter of the insulin vial from the previous injection, and then moving to another area of the major site the next day. All other options are incorrect.

The home care nurse is visiting a child newly diagnosed with diabetes mellitus. The nurse is instructing the child and parents regarding actions to take if hypoglycemic reactions occur. The nurse should tell the child to take which action? 1. Administer glucagon immediately if shakiness is felt. 2. Drink 8 ounces (235 ml) of diet cola at the first sign of weakness. 3. Report to a hospital emergency department if the blood glucose is 60 mg/dL (3.4 mmol/L). 4. Carry hard candies whenever leaving home in case a hypoglycemic reaction occurs

4. Carry hard candies whenever leaving home in case a hypoglycemic reaction occurs.Rationale:The child should be instructed to carry a source of glucose for ready use in the event of a hypoglycemic reaction. Hard candies such as Life Savers will provide a source of glucose. Glucagon is not administered if shakiness is felt but is used in an unconscious client or a person unable to swallow who is experiencing a hypoglycemic reaction. A diet beverage is sugar free and will not be helpful. If the blood glucose level is 60 mg/dL (3.4 mmol/L), a source of glucose may be needed, but it is not necessary to report to the emergency department.

5. What is the primary concern for a 7-year-old child with insulin-dependent diabetes mellitus (IDDM) who asks his mother not to tell anyone at school that he has diabetes? a. The childs safety b. The privacy of the child c. Development of a sense of industry d. Peer group acceptance

ANS: A Safety is the primary issue. School personnel need to be aware of the signs and symptoms of hypoglycemia and hyperglycemia and the appropriate interventions. Privacy is not a life threatening concern. The treatment of IDDM should not interfere with the school-age childs development of a sense of industry. Peer group acceptance and body image are issues for the early adolescent with IDDM. This is not of greater priority than the childs safety.

. The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes mellitus regarding the differences between hypoglycemia and hyperglycemia. Which statement by a parent indicates a need for further teaching? A. "If I notice changes in my son like tearfulness or irritability, his blood sugar may be high." B. "When my son's breath smells fruity, it almost always indicates high blood sugar." C. "If my son says he feels shaky, his blood sugar may be low." D. "Dry flushed skin may be a sign if high blood sugar."

ANS: A Rationale: Behavior changes such as tearfulness, irritability, confusion and slurred speech are indications of hypoglycemia, not hyperglycemia. Tremors and diaphoresis are also indications of low blood sugar. Dry flushed skin, fatigue, weakness, nausea, vomiting and fruity breath odor are all symptoms of hyperglycemia

9. What should a nurse suggest to the parent of a child with insulin-dependent diabetes mellitus (IDDM) who is not eating as a result of a minor illness? a. Give the child half his regular morning dose of insulin. b. Substitute calorie-containing liquids for solid food to maintain normal serum glucose levels. c. Give the child plenty of unsweetened, clear liquids to prevent dehydration. d. Take the child directly to the emergency department.

ANS: B 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 IDDM can be managed safely at home.

Which is the best nursing action when a child with insulin-dependent diabetes mellitus is sweating, trembling, and pale? a. Offer the child a glass of water. b. Give the child 5 units of Regular insulin subcutaneously. c. Give the child a glass of orange juice. d. Give the child glucagon subcutaneously.

ANS: C Four ounces of orange juice is an appropriate treatment for the conscious child who is exhibiting signs of hypoglycemia. A glass of water is not indicated in this situation. An easily digested carbohydrate is indicated when a child exhibits symptoms of hypoglycemia. Insulin would lower blood glucose and is contraindicated for a child with hypoglycemia. Subcutaneous injection of glucagon is used to treat hypoglycemia when the child is unconscious.

Which sign is the nurse most likely to assess in a child with hypoglycemia? a. Urine positive for ketones and serum glucose greater than 300 mg/dL b. Normal sensorium and serum glucose greater than 160 mg/dL c. Irritability and serum glucose less than 70 mg/dL d. Increased urination and serum glucose less than 120 mg/dL

ANS: C Irritability and serum glucose less than 70 mg/dL are neuroglycopenic manifestations of hypoglycemia. Serum glucose greater than 300 mg/dL and urine positive for ketones are indicative of diabetic ketoacidosis. Normal sensorium and serum glucose greater than 160 mg/dL are associated with hyperglycemia. Increased urination is an indicator of hyperglycemia. A serum glucose level less than 120 mg/dL is within normal limits.

A child is admitted to the pediatric medical unit with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). Based on the typical signs and symptoms of this disorder, which nursing diagnosis will the nurse identify as relating to this client? A. Delayed growth and development B. Imbalanced nutrition: More than body requirements C. Noncompliance D. Excess fluid volume

ANS: D Rationale: Syndrome of inappropriate antidiuretic hormone (SIADH) occurs when ADH (vasopressin) is secreted in the presence of low serum osmolality because the feedback mechanism that regulates ADH does not function properly. ADH continues to be released, and this leads to water retention, decreased serum sodium due to hemodilution, and extracellular fluid volume expansion; thus, Excess fluid volume from edema is the highest priority.

When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind? Accuracy of the dosage Area for insulin injection Technique for injecting Duration of the insulin

Accuracy of the dosage

client with type 1 diabetes presents with a decreased level of consciousness and a fingerstick glucose level of 39 mg/dl. His family reports that he has been skipping meals in an effort to lose weight. Which nursing intervention is most appropriate?Administering a 500-ml bolus of normal saline solution Inserting a feeding tube and providing tube feedings Administering 1 ampule of 50% dextrose solution, per physician's order Observing the client for 1 hour, then rechecking the fingerstick glucose level Administering 1 ampule of 50% dextrose solution,

Administering 1 ampule of 50% dextrose solution, per physician's order