Endocrine PrepU
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?
"If I notice changes in my son like tearfulness or irritability, his blood sugar may be high. "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
A child and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true? "You are lucky that you did not have to learn how to give yourself a shot." "Kids 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."
"Kids can usually be managed with an oral agent, meal planning, and exercise."
A 9-year-old was just diagnosed with type 1 diabetes mellitus (DM). The parents state, "We hope our child won't have to take insulin injections." How should the nurse respond? A. "The pancreas doesn't produce insulin in Type 1 diabetes, so it is likely that insulin injections will be necessary." B. "It is very early in the diagnosis process. Let's wait to see if insulin will be necessary." C. "Sometimes oral hypoglycemic agents are all that is necessary. Hopefully that will be the case with your child." D. "You will have to trust whatever the doctor decides to order."
A. "The pancreas doesn't produce insulin in Type 1 diabetes, so it is likely that insulin injections will be necessary."
What is the primary concern for a 7-year-old child with type 1 diabetes mellitus who asks his mother not to tell anyone at school that he has diabetes? A) The child's safety B) The privacy of the child C) Development of a sense of industry D) Peer group acceptance
A) The child's safety 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.
The nurse is speaking to the mother of an adolescent recently diagnosed with type 1 diabetes mellitus. The mother asks the nurse how her son's basketball training will affect his blood sugar. Which is the best response by the nurse? A. "When exercising, your son should add an extra snack containing 15 to 30 g of carbohydrates for each 45 to 60 minutes of exercise." B. "Exercising will increase your son's blood sugar. He will need to check his blood sugar every 15 minutes during his training." C. "Your son will need to check his blood sugar prior to his training. If it's over 300 then he will be fine to exercise." D. "Your son will need to make sure his blood sugar is under control for at least 6 months prior to resuming his training."
A. "When exercising, your son should add an extra snack containing 15 to 30 g of carbohydrates for each 45 to 60 minutes of exercise."
What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? A) Give the child half his regular morning dose of insulin. B) Substitute simple carbohydrates or calorie-containing liquids for solid foods. C) Give the child plenty of unsweetened, clear liquids to prevent dehydration. D) Take the child directly to the emergency department.
B) Substitute simple carbohydrates or calorie-containing liquids for solid foods. A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia.
What is the best nursing action when a child with type 1 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.
C) Give the child a glass of orange juice. C Four ounces of orange juice is an appropriate treatment for the conscious child who is exhibiting signs of hypoglycemia.
An elementary school child takes metformin (Glucophage) three times each day. Which of the following disorders would the school nurse expect the child to have? A. Type 1 DM B. Gastrointestinal reflux C. Inflammatory bowel disorder D. Type 2 DM
D. Type 2 DM
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 which of the following? a) Pica b) Polyphagia c) Polydipsia d) Polyuria
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), and. Pica is eating nonfood substances.
The nurse is assessing a 5-year-old boy whose mother says he has been vomiting lately and has no appetite. What sign or symptom would the nurse identify as unique to diabetes mellitus type 1?
The child has lost weight recently. Weight loss is unique to diabetes mellitus type 1, whereas weight gain is associated with type 2. Hypertension is consistent with diabetes mellitus type 2. The sweet-smelling breath is common to both type 1 and type 2 diabetes and is a sign of ketoacidosis, a medical emergency, which is frequently how children present on initial evaluation. The rapid, deep Kussmaul breathing is common to both type 1 and type 2 diabetes and is a sign of ketoacidosis, a medical emergency, which is frequently how children present on initial evaluation.
A nurse should recognize that which laboratory result would be most consistent with a diagnosis of diabetes mellitus? proteinuria a fasting blood glucose less 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 fasting blood glucose greater than 126 mg/dl is diagnostic for diabetes mellitus.
What is the best time for the nurse to assess the peak effectiveness of subcutaneously administered Regular insulin? a. Two hours after administration b. Four hours after administration c. Immediately after administration d. Thirty minutes after administration
a. Two hours after administration A The peak action for Regular (short-acting) insulin is 2 to 3 hours aftersubcutaneous administration
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
b) 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
A parent, distressed to learn that her school-aged child is diagnosed with type 2 diabetes mellitus, asks the nurse how this could happen because no one in the family has diabetes. What instruction is most accurate?
"This disorder is associated with being overweight and eating a diet high in fats and carbohydrates. "Explanation:Type 2 diabetes is now seen in overweight adolescents and those who eat a diet high in fats and carbohydrates and do not exercise regularly. Type 2 diabetes is not caused by the pancreas not making enough insulin. This disorder is not linked to an inadequate ingestion of daily calories. This disorder may have a genetic link, but environmental factors such as obesity, diet, and exercise can influence its development.
A pediatric client has just been diagnosed with diabetes mellitus. What would the nurse do first? Educate the client on stress management. Regulate nutrition. Check blood glucose levels. Administer insulin.
Check blood glucose levels. The nurse must check the insulin level before it can be administered. Once a need is established, then insulin administration becomes the priority intervention. Stress management, glucose checks, and nutritional consultation can all be implemented once therapy with insulin begins.
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? a) "Increase the insulin dosage before planned or unplanned strenuous exercise." b) "Carry crackers or fruit to eat before or during periods of increased activity." c) "Limit participation in planned exercise activities that involve competition." d) "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated."
b) "Carry crackers or fruit to eat before or during periods of increased activity." Explanation: 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.
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 of the following findings in the child's fasting glucose levels? a) 60 mg/dL b) 180 mg/dL c) 240 mg/dL d) 120 mg/dL
c) 240 mg/dL Explanation: If the blood glucose level is elevated or ketonuria is present, a fasting blood sugar (FBS) is performed. An FBS result of 200 mg/dL or higher almost certainly is diagnostic for diabetes when other signs such as polyuria and weight loss, despite polyphagia, are present.
A child who has type 1 diabetes mellitus is brought to the emergency department and diagnosed with diabetic ketoacidosis. Which of the following would the nurse expect to administer? a) Detemir b) NPH c) Regular insulin d) Lispro
c) Regular insulin Explanation: Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route
The diabetes clinic conduct s disease management program for the child with type 1 diabetes. Which test is the most valid indicator of compliance with the diabetes regimen? a. fasting blood glucose b. fingerstick glucose for 24hrs c. urine ketone strips d. HgA1c assay
ANS: D HgA1c reflects the average blood glucose level over 3 months, making it the most valid indicator.Blood glucose levels are the best indicators of compliance with insulin, diet, and exercise regimens in diabetes. HgA1c long term measurements are better indicators that short term levels, such as fasting glucose or fingerstick glucose checks.
A nurse is teaching a client about type 2 diabetes mellitus. What information would reduce a client's risk of developing this disease? A. "You should stop cigarette smoking." B. "Follow a high-protein diet including meat, dairy, and eggs." C. "Maintain weight within normal limits for your body size and muscle mass." D. "Prevent developing hypertension by reducing stress and limiting salt intake."
C. "Maintain weight within normal limits for your body size and muscle mass."
The nurse is teaching a 12-year-old girl with diabetes mellitus type 2 and her parents about dietary measures to control her glucose levels. Which comment by the child indicates a need for additional teaching? a) "I can eat two small cookies with each meal." b) "We should give her nonfat milk to drink." c) "I will be eating more breads and cereals." d) "I can have an apple or orange for snacks."
a) "I can eat two small cookies with each meal." Explanation: Cookies, cakes, candy, potato chips, and crackers are high in sugars and fats and should be eaten in moderation as special treats; they would not be included with each meal. An apple or orange makes a good snack. Nonfat milk is a better option than whole milk. Long-acting carbohydrates should be the largest category of foods eaten.
After hospital discharge, the mother of a child newly diagnosed with type 1 diabetes mellitus telephones you because her daughter is acting confused and very sleepy. Which emergency measure would you suggest the mother carry out before she brings the child to see her doctor? a) Give her a glass of orange juice with one unit regular insulin in it. b) Give her nothing by mouth so that a blood sugar can be drawn at the doctor's office. c) Give her a glass of orange juice. d) Give her one unit of regular insulin.
c) Give her a glass of orange juice. Explanation: These are typical symptoms of hypoglycemia. Administering a form of glucose would help relieve them. Insulin cannot be absorbed when taken orally.
The nurse is caring for a child admitted to the emergency center in diabetic ketoacidosis. Which of the following clinical manifestations would the nurse most likely note in this child? a) Hyperactive and restless behavior b) Slow pulse and elevated blood pressure c) Red lips and fruity odor to breath d) Pale and moist skin
c) Red lips and fruity odor to breath 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). Nausea and vomiting may occur. If untreated, the child lapses into coma and exhibits dehydration, electrolyte imbalance, rapid pulse, and subnormal temperature and blood pressure.
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
a) 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).
The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which of the following actions would be the most appropriate for the school nurse to do? a) Dissolve a piece of candy in the child's mouth b) Administer subcutaneous glucagon c) Anticipate that the child will need intravenous glucose d) Request that someone call 911
b) Administer subcutaneous glucagon Explanation: If the child having an insulin reaction cannot take a sugar source orally, glucagon should be administered subcutaneously to bring about a prompt increase in the blood glucose level. This treatment prevents the long delay while waiting for a physician to administer IV glucose or for an ambulance to reach the child.
Insulin deficiency, increased levels of counterregulatory hormones, and dehydration are the primary cause of which of the following: a) Ketone bodies b) Ketonuria c) Glucosuria d) Diabetic ketoacidosis
d) Diabetic ketoacidosis Explanation: Insulin deficiency, in association with increased levels of counterregulatory hormones (glucagon, growth hormone, cortisol, catecholamines) and dehydration, is the primary cause of diabetic ketoacidosis (DKA), a life-threatening form of metabolic acidosis that is a frequent complication of diabetes. Liver converts triglycerides (lipolysis) to fatty acids, which in turn change to ketone bodies. The accumulation and excretion of ketone bodies by the kidneys is called ketonuria. Glusosuria is glucose that is spilled into the urine.
The nurse working with the child diagnosed with Type 2 Diabetes Mellitus recognizes that most often the disorder can be managed by which of the following? a) Increasing protein in the diet, especially in the evening b) Conserving energy with rest periods during the day c) Decreasing amounts of daily insulin d) Taking oral hypoglycemic agents
d) Taking oral hypoglycemic agents Explanation: If the child presents with diabetic ketoacidosis, initial treatment is insulin administration, but then oral hypoglycemic agents such as metformin are often effective for controlling blood glucose levels. Lifestyle changes such as weight loss and increased exercise are important aspects of treatment for the child.
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.
d) 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
