Chapter 26 prep U
Type 1 diabetes mellitus
A child presents to the primary care setting with enuresis, nocturia, increased hunger, weight loss, and increased thirst. What does the nurse suspect?
Regular insulin (because give IV)
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?
epinephrine norepinephrine
Which hormones are secreted by the adrenal medulla? Select all that apply.
continue to monitor -This age client should have an A1C less than 8% (0.08).
The nurse reviews a 6-year-old client's laboratory results and notes the client's hemoglobin A1C level is 7.7% (0.077). Which action by the nurse is appropriate?
Syndrome of inappropriate antidiuretic hormone
A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and production, hyponatremia, and water intoxication. Which pituitary gland disorder would be seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine most associated with these symptoms?
"You can set a medication time that allows your child to have a normal routine that does not interrupt school or sleep."
A 16-year-old adolescent is at the office for a checkup. The parent states, "My child keeps forgetting to take insulin. What can we do to make sure my child takes it?" Which is the best response by the nurse
"You can set a medication time that allows your child to have a normal routine that does not interrupt school or sleep."
A 16-year-old adolescent is at the office for a checkup. The parent states, "My child keeps forgetting to take insulin. What can we do to make sure my child takes it?" Which is the best response by the nurse?
blood glucose level
A 17-year-old adolescent is found wandering around. The adolescent is confused, sweaty, and pale. Which test would the nurse expect to be performed first?
Recent consumption of large amounts of cough medicine.
A 4-year-old child is undergoing a radioimmunoassay of T4 and T3 to determine whether the thyroid is functioning properly. Which factor could abnormally elevate the child's iodine level and thus invalidate the test?
"I need to see if your child has grown taller since your last visit."
A 7-year-old child is being followed closely for "short stature." Approximately 6 months after the child's last doctor's visit, the nurse re-measures the height and weight of the child and plots it on the growth chart. The parents ask why their child has to be measured again. Which response should the nurse give?
metformin
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?
Check the expiration dates on all medications. Plan times for medications that fit in with the daily routine. Build medication administration into the general home routine.
A new mother is concerned about the need to provide medication to a newborn every day for an indefinite period of time. What should the nurse encourage the mother to do to help ensure medication compliance? Select all that apply.
A simple blood test to diagnose hypothyroidism is required in most states.
A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer?
-Draws up the short-acting insulin before the intermediate-acting insulin. -Stores the insulin vial at room temperature. -Gives the injection at a 45-degree angle.
A nurse is making a home visit to a 12-year-old child with type 1 diabetes and is reviewing insulin administration. The nurse determines that the teaching was successful when the child performs which actions? Select all that apply.
Elevate the subcutaneous tissue before the injection.
A nurse is reviewing with an 8-year-old how to self-administer insulin. Which of the following is the proper injection technique for insulin injections?
Subcutaneously in the outer thigh
A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which method should she recommend to the child for regular doses?
A fasting blood glucose greater than 126 mg/dl
A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus?
"Her body doesn't have any insulin."
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 í diabetes mellitus?
Give the crushed medication in a syringe mixed with a small amount of formula.
A pediatric nurse is discharging a 1-month-old infant. The infant was diagnosed with congenital hypothyroidism on this admission and will be treated with levothyroxine. The nurse knows it is important to teach the parent about medication administration. Which process will the nurse include in the teaching?
There are purple striae on the abdomen
A school-age child is diagnosed as having Cushing syndrome from long-term therapy with oral prednisone. What assessment finding is consistent with this child's diagnosis and treatment?
8.5%
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?
Recent consumption of large amounts of cough medicine
A 4-year-old child is undergoing a radioimmunoassay of T4 and T3 to determine whether the thyroid is functioning properly. Which factor could abnormally elevate the child's iodine level and thus invalidate the test?
-monitoring intake and output closely -measuring urine specific gravity with each voiding
A child is scheduled to undergo a fluid deprivation study. Which actions would the nurse include in the child's plan of care for this test? Select all that apply.
Administer subcutaneous glucagon.
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?
monitoring intake and output closely measuring urine specific gravity with each voiding -assess VS Every hour
A child is scheduled to undergo a fluid deprivation study. Which actions would the nurse include in the child's plan of care for this test? Select all that apply.
check vital signs
A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. Which is the priority intervention for this child?
daily
A child with a primary growth hormone deficiency is to receive biosynthetic growth hormone. The nurse would explain to the child and parents that this hormone would be given at which frequency?
daily, 6 to 7 days a week
A child with growth hormone deficiency is prescribed growth hormone (GH) by subcutaneous injection. When teaching the child's parents about this drug, the nurse would instruct the parents to administer the drug at which frequency?
In most cases, treatment is lifelong.
A nurse is teaching about pharmacologic management to families with children who have diseases caused by inborn errors of metabolism, It is important for the nurse to include which information?
I need to see if your child has grown taller since your last visit.
7-year-old child is being followed closely for "short stature." Approximately 6 months after the child's last doctor's visit, the nurse re-measures the height and weight of the child and plots it on the growth chart. The parents ask why their child has to be measured again. Which response should the nurse give?
"So, hypothyroidism can be treated by exposing our baby to a special light, right?"
After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question?
Give the child a glass of orange juice.
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?
type 2 DM
An elementary school child takes metformin three times each day. Which disorder would the school nurse expect the child to have?
Urine output
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?
ADH
Diabetes insipidus is a disorder of the posterior pituitary that results in deficient secretion of which hormone?
"I know it's hard to remember medicines, but it is really important for you to take it before breakfast each day to control your hypothyroidism."
During a visit to the clinic, the adolescent client with hypothyroidism tells the nurse that she takes her levothyroxine "whenever I think about it...sometimes I miss a dose, but not very often." What is the best response by the nurse?
fluid restrictions
In teaching the parents of an infant diagnosed with diabetes insipidus, the nurse should include which treatment?
abrupt onset of polyuria, nocturia, and polydipsia
In a child with diabetes insipidus, which characteristic would most likely be present in the child's health history?
diabetic ketoacidosis
Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of:
Administration of levothyroxine indefinitely
Prior to discharging an infant with congenital hypothyroidism to home with the parents, what should the nurse emphasize regarding the care that this child will need going forward?
Lispro (rapid-acting) Humulin R (short acting) Humulin N (intermediate-acting) Lantus (long-acting)
Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration.
"This will tell my doctor what my average blood glucose level has been over the last 2 to 3 months."
The nurse has told the 14-year-old adolescent with diabetes that the doctor would like to have a hemoglobin A1C test performed. Which comment by the client indicates that she understands what this test is for?
Minimum: 49.9 kg × 0.2 mg/kg = 9.98 mg, round to 10 mg Maximum: 49.9 kg × 0.3 mg/kg = 14.97 mg, round to 15 mg -safe limit is determined by using the maximum dosage
The nurse is administering biosynthetic growth hormone, derived from recombinant DNA, by subcutaneous injection. The daily dosage is 0.2 to 0.3 mg/kg, given in divided doses. The child weighs 110 lb (49.9 kg). What is the safe dosage limit for this child on a daily basis? Record your answer using a whole number.
"If growth hormone therapy is used, it will continue for the rest of my child's life."
The nurse is caring for a child recently diagnosed with growth hormone deficiency. After providing education regarding this disorder, which statement by the parent demonstrates a need for further teaching?
The bone scan would show bone age to be two or more deviations below normal.
The nurse is caring for a child who is scheduled for bone scan. It is suspected that the child has a growth hormone deficiency. Which finding would support this medical diagnosis?
"Our child should not participate in sports or physical activity."
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?
Insulin
The nurse is interpreting the negative feedback system that controls endocrine function. What secretion will the nurse correlate as decreasing while blood glucose levels decrease?
polyphagia
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:
Risk for situational low self-esteem related to short stature
The nurse is planning care for a school-age child diagnosed with growth hormone deficiency. Which diagnosis should the nurse select to help the child with this health problem?
This medication must be given by injection
The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication?
This medication must be given by injection.
The nurse is preparing teaching materials for a family whose child is prescribed somatropin for a growth hormone deficiency. What should the nurse instruct the parents about the administration of this medication?
0815
The nurse is preparing to adminíster the child's ordered lispro (Humalog) insulin at 0800. When will the child's blood glucose level begin to decline?
diabetes insipidus (DI)
The nurse is seeing a new client in the clinic who reports polyuria and polydipsia. These conditions are indicative of which endocrine disorder?
"When exercising, your son should add an extra snack containing 15 to 30 g of carbohydrates for each 45 to 60 minutes of exercise."
The nurse is speaking to the mother of an adolescent recently diagnosed with type 1 diabetes. The mother asks the nurse how her son's basketball training will affect his blood sugar. Which is the best response by the nurse?
"When they get my son's thyroid levels normal, he won't be so tired."
The nurse is speaking with the parents of a child recently diagnosed with hypothyroidism. Which statement by a parent indicates an understanding of symptoms of this disorder?
"My child measures their own medication but sometimes doesn't administer the right amount."
The nurse is teaching 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?
Instructing the child to rotate injection sites.
The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which instruction does not focus on glucose management?
"During exercise we should wait to check blood sugars until after our child completes the activity."
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?
taking oral hypoglycemic agents
The nurse working with the child diagnosed with type 2 diabetes recognizes the disorder can be managed by:
220 mg/dl -200mg/dl or more is diagnostic for diabetes
When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which finding in the child's fasting glucose levels
Polydipsia Polyphagia Polyuria
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.
Low T4 level and high TSH level
Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism?
antidiuretic hormone
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?
monitoring blood glucose levels
The nurse is caring for a 4-year-old boy during a growth hormone stimulation test. Which task is priority in the care of this child?
"I can eat two small cookies with each meal."
The nurse is teaching a 12-year-old girl with type 2 diabetes mellitus and her parents about dietary measures to control her glucose levels. Which comment by the child indicates a need for additional teaching?
draws up the short-acting insulin into the syringe first.
The nurse is teaching a child with type 1 diabetes mellitus to administer insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when the child:
Evaluate renal function
The nurse working on a pediatric floor understands the importance of diagnosing inborn errors of metabolism early. A child with a suspected problem must have blood urea nitrogen (BUN) and creatinine testing done. Which is the purpose of these two tests?
Evaluate renal function.
The nurse working on a pediatric floor understands the importance of diagnosing inborn errors of metabolism early. A child with a suspected problem must have blood urea nitrogen (BUN) and creatinine testing done. Which is the purpose of these two tests?
Antidiuretic hormone
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?
"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."
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?
"Carry crackers or fruit to eat before or during periods of increased 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?
Fluid replacement
A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client?
fluid replacement
A pediatric client has just been diagnosed with diabetes insipidus. What is the primary consideration for this client?
Injections of GH
The nurse is caring for a 10-year-old child with growth hormone (GH) deficiency. Which therapy would you anticipate will be prescribed for the child?
reporting irritability or anxiety (inability to sleep)
The nurse is caring for a 12-year-old girl with hypothyroidism. Which information should be part of the nurse's teaching plan for the child and family?
Monitoring blood glucose levels
The nurse is caring for a 4-year-old boy during a growth hormone stimulation test. Which task is priority in the care of this child?
Recent weight loss
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?
"If I notice changes in my son like tearfulness or irritability, his blood sugar may be high."
The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes regarding the differences between hypoglycemia and hyperglycemia. Which statement by a parent indicates a need for further teaching?
"If she sneezes the medicine out, I wait until the next dose."
The nurse is teaching the parents of a 3-year-old girl with diabetes insipidus how to administer desmopressin acetate (DDAVP). Which comment indicates further need for teaching?
growth hormone
The nurse knows that disorders of the pituitary gland depend abnormality. Caring for a child who has issues with the anterior pituitary, the nurse would on the location of the physiologic expect the child to have issues with which hormone?
Within 15-30 minutes
The nurse measures the client's blood glucose level prior to breakfast. The measurement obtained is 130 mg/dl. The orders read to administer 2 units of Humalog insulin for a blood glucose of 100 to 150 mg/dl. How soon should the nurse ensure that the client eats breakfast after receiving insulin?
"Young people can usually be managed with an oral agent, meal planning, and exercise."
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?
glucometer readings as prescribed
A child has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids. Which interventions would the nurse implement?
Desmopressin acetate is a synthetic antidiuretic hormone that will slow down your urine output.
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?
Excess fluid volume
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?
checking vital signs
A child with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion, Which action would be the priority?
Check blood glucose levels
A pediatric client has just been diagnosed with diabetes mellitus. What would the nurse do first?
Counsel the family to have all siblings evaluated.
A nurse working in a pediatric clinic is examining a child with symptoms indicating a possible inborn error of metabolism. Which action is most important for the nurse to do at this time
"My child measures their own medication but sometimes doesn't administer the correct amount."
The nurse is teaching 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?
"The pattern of heredity for all metabolic conditions is dominant."
The nurse is teaching parents about the pattern of heredity of metabolic conditions. The nurse realizes that further teaching is needed when the parent makes which statement?
"This is caused by insulin resistance from previous pancreatic injury or generalized infection."
The nurse is talking with a parent of an adolescent who is newly diagnosed with type 2 diabetes mellitus and asks, "How could this happen? No one in our family has diabetes." What response would be appropriate?
"If she sneezes the medicine out of her nose, I wait until the next dose."
The nurse is teaching the parents of a 3-year-old girl with diabetes insipidus how to administer desmopressin acetate (DDAVP). Which comment indicates further need for teaching?
taking oral hypoglycemic agents.
The nurse working with the child diagnosed with type 2 diabetes recognizes the disorder can be managed by:
Do not mix this insulin with other insulins.
A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin?
enlarged tongue
The nurse is assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which assessment suggests the child has congenital hypothyroidism?
"Research shows that there must be a diagnosis of deficiency before growth hormones can be started at this age."
A school-age child is seen in the family clinic. The parents ask the nurse if their child should start taking growth hormones to help the child grow because the parents are short. What is the bestresponse by the nurse?
recent weight loss
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?
Decreased cognitive development of the fetus
A woman in her first trimester of pregnancy has just been diagnosed with acquired hypothyroidism. The nurse is alarmed because this condition can lead to which pregnancy complication?
Injection of GH
The nurse is caring for a 10-year-old child with growth hormone (GH) deficiency. Which therapy would you anticipate will be prescribed for the child?
Notifying the physician of the neurologic findings. (may have SIADH)
The nurse is assessing a 7-year-old girl with a headache, irritability, and vomiting. Her health history reveals she has had meningitis. Which intervention is priority?
-"We will want to inspect the nares of our child to be sure the medication is not irritating the tissue." -"We will need to adjust the dose based on how much our child is urinating." -"I am going to have to carry a cooler with me if I am going to be gone all day or if I go on a long hike."
The nurse is providing client education regarding the administration of desmopressin acetate for the client diagnosed with diabetes insipidus. Which statements by the client or parents indicate understanding of the teaching? Select all that apply.