Peds Sherpath Lessons
An adolescent patient was recently diagnosed with Type 2 DM. The nurse knows that learning has taken place when the child makes which statement related to prevention? "My dad has type 1 DM. This increases my risk of having diabetes." "Being overweight puts me at risk. Even if I lose weight, I cannot change this risk." "Being overweight with abnormal lipid levels increases my risk of having type 2 diabetes." "Being Native American puts me at risk for developing Type 2 DM. I should have HbA1c testing done on an annual basis."
"Being overweight with abnormal lipid levels increases my risk of having type 2 diabetes."
The nurse has taught a patient with type 2 diabetes mellitus about the clinical manifestations and evaluates that learning has occurred if the patient makes which statement? "I can expect that my blood sugars will increase when I am sick or under stress." "If I follow the diabetic diet, I will be able to control my symptoms of both hyperglycemia and hypoglycemia." "This darkening of the skin on the back of my neck is a result of high blood sugars and is nothing to worry about." "I understand that yeast infection, frequent urination, and high levels of energy are common in the diabetic patient."
"I can expect that my blood sugars will increase when I am sick or under stress."
While meeting with an adolescent to address diabetes management, which statement by the adolescent regarding compliance with insulin usage would be concerning to the nurse? "I don't really understand the risks/complications of hypoglycemia, but I can tell when my blood sugar is low and I need to eat a snack." "I roll out of bed 10 minutes before my ride comes in the morning. Sometimes I don't have time for breakfast." "I used to skip my insulin dose when going out with friends. Now that I am a senior in high school, I understand the risk of letting my blood sugars get too high." "After my freshman orientation yesterday, my mom talked to me about what I think about taking more responsibility with managing my diabetes."
"I roll out of bed 10 minutes before my ride comes in the morning. Sometimes I don't have time for breakfast."
A home care nurse is teaching a parent and 16-year-old patient with type 1 diabetes mellitus about insulin administration and rotating sites. Which statement, if made by the patient, would indicate effective teaching? "I rotate sites between areas of my abdomen and arms." "I will use a 90-degree angle of injection with a 1/2-inch needle." "Insulin is given parenterally because the taste of an oral pill is awful." "Since giving injections into my right abdomen is more comfortable to me, I will use that side routinely."
"I rotate sites between areas of my abdomen and arms."
A child has been diagnosed with Type 1 Diabetes Mellitus (DM) and the parent asks the nurse what this means. What is the best response by the nurse? "The child is at risk of DKA because of low blood sugar." "You do not have to worry about hypoglycemia with your child." "It is normal to have a variation in the blood glucose level, but now the sugar will be maintained at an elevated level." "In the absence of insulin, the child is unable to metabolize fats, proteins, and carbohydrates and use them for energy."
"In the absence of insulin, the child is unable to metabolize fats, proteins, and carbohydrates and use them for energy."
During a well visit, the patient's parent asks "Why do you need to know about my mother's health? Shouldn't we focus on the baby's health?" How does the nurse respond? "The family history can indicate the risk for exposure to environmental hazards." "Understanding the family history can give the health care provider useful information about the patient's emotional state." "The family history can give the provider helpful information about the patient's current condition and proper treatment methods." "Knowing the family history helps the health care provider determine hereditary factors that could affect your baby's health later."
"Knowing the family history helps the health care provider determine hereditary factors that could affect your baby's health later."
The patient with Type 2 DM receives metformin (Glucophage). What statements would the nurse include when educating the patient about the drug? "If your BUN level is 20 mg/dL, the metformin will be held." "You can take metformin three times daily without regard to food." "Given that you are taking metformin twice daily, you do not need to follow a diabetic meal plan." "If you have forgotten to take your metformin, you can take 2 doses at the next scheduled time." "Metformin does not cause the body to make more insulin. As such, it rarely causes low blood glucose when used alone." "Side effects like diarrhea, nausea, and upset stomach are mild but common, and should go away after your body gets used to the medications."
"Metformin does not cause the body to make more insulin. As such, it rarely causes low blood glucose when used alone." "Side effects like diarrhea, nausea, and upset stomach are mild but common, and should go away after your body gets used to the medications."
Which patient is at highest risk to develop Type 2 Diabetes Mellitus? 10-year-old Caucasian child whose father has Type 1 diabetes mellitus 5'10" 200 lb 18-year-old male taking atenolol daily, who walks 2 miles a day Overweight 16-year-old African American woman taking diphenhydramine daily 1-year-old Asian American female whose parents have Type 2 diabetes mellitus, taking one atorvastatin daily
1-year-old Asian American female whose parents have Type 2 diabetes mellitus, taking one atorvastatin daily
The nurse is meeting with an early school-age patient and parent to discuss management of the patient's Type 1 DM. The nurse understands that further teaching is needed when the parent makes which statement about the child's ability to participate in care? "My school-age child is involved in after-school sports. I need to be sure to pack an extra snack to prevent hypoglycemia." "A school nurse can help with testing blood sugars and draw up the appropriate dose of insulin. My child is not yet able to give herself injections." "Since my child is at school most of the day, she and I developed a diabetic management plan and presented it to her home room teacher." "My school-age child is not able to take part in diabetic management tasks yet. I check my child's blood glucose before and after school and give insulin as needed at those times."
"My school-age child is not able to take part in diabetic management tasks yet. I check my child's blood glucose before and after school and give insulin as needed at those times."
The diabetes educator is meeting with a group of parents to discuss diabetes mellitus management. Many parents have questions about the role of the child. Together the diabetes educator and parents discuss ways to improve adherence with medication administration. The diabetes educator evaluates that learning has occurred when one parent makes which statements? "I can have my toddler take part in insulin administration by having them push the plunger on the insulin syringe". "My seventeen-year-old is focused on sports. She understands the need to independently manage her blood sugars to be able to be with her team for every game". "My school-age child is reluctant to take part in after-school activities. Having her bring pre-filled insulin syringes to activities and do the injections as scheduled may encourage her to participate". "My fourteen-year-old daughter is so influenced by her peers. If I get her best friend to talk to her about diabetes and insulin control, I know that she will adhere to the plan of checking blood sugars".
"My seventeen-year-old is focused on sports. She understands the need to independently manage her blood sugars to be able to be with her team for every game".
During an exercise class for patients with type 2 diabetes, the nurse instructs the patients and parents on recommended daily activity. The nurse notes the need to reinforce teaching when a parent makes which statement? "My son spends hours outside drawing and then plays his video games in his room for no more than 40 minutes." "My child likes to play basketball outside with her friends for at least an hour after school. That only leaves her with about 30 minutes of TV time after dinner." "I like to take long walks with my son to the park down the street. We do this every day; it's great! It takes us over an hour, but we have a great time! He doesn't even miss the TV!" "Our daughter is on the school's swimming team. She practices daily from 3-6 p.m. About an hour before bed, we let her wind down with some cartoons or reading."
"My son spends hours outside drawing and then plays his video games in his room for no more than 40 minutes."
For a problem-oriented history, a nurse would chart which statement as a chief complaint? "My mom died from cancer." "I smoke about three cigarettes every day." "My tummy has been hurting since last night." "I haven't been sick since I saw you last year."
"My tummy has been hurting since last night."
A pre-school child newly diagnosed with Type 1 DM and parent meet with the nurse. Which statement best explains why play therapy can be effective in dealing with diabetes mellitus when meeting with the patient? "Play therapy with other children helps the child act out frustration." "Play therapy is appropriate for this age for normal development." "Play therapy with dolls and diabetes equipment helps the child express concerns regarding injections and finger sticks." "Play therapy with age-appropriate toys can distract the child from thinking about the need for insulin and special diet."
"Play therapy with dolls and diabetes equipment helps the child express concerns regarding injections and finger sticks."
A parent calls the nurse line, reporting that the child with diabetes is nauseated and vomiting. What is the priority statement the nurse will include in the instructions to the parent? "Hold the regular dose of insulin." "Allow the child to decide what to eat." "Test the blood glucose level frequently." "Encourage active engagement in activities."
"Test the blood glucose level frequently."
When providing education to the parents of a toddler with Type 1 DM, the nurse should include which statement related to hypoglycemia? "The toddler is at great risk for severe hypoglycemia; be sure that you have a predetermined meal plan for every day and stick to it." "The toddler has varied intake from day to day. Better to allow for more food choices and work toward carbohydrate consistency." "The toddler can be fussy with respect to food. Minimize the battle by allowing the toddler to be in charge of selecting what to eat for each meal." "Toddlers are "spur of the moment" patients. Being flexible with checking blood glucose levels and giving insulin will limit the potential of on-going battles with care."
"The toddler has varied intake from day to day. Better to allow for more food choices and work toward carbohydrate consistency."
The adolescent patient and parent have completed diabetic education. Which statements by the parent would indicate an understanding of the goals of insulin therapy for diabetic management? Select all that apply. "Insulin replenishes the insulin-producing cells, the beta cells." "Insulin decreases insulin resistance and improves insulin sensitivity." "We will schedule the insulin to correspond to the child's usual meal times." "Insulin is used to balance blood glucose, independent of food intake and physical activity." "Insulin replaces the insulin the child is no longer able to make in an acceptable physiologic pattern."
"We will schedule the insulin to correspond to the child's usual meal times." "Insulin replaces the insulin the child is no longer able to make in an acceptable physiologic pattern."
The nurse is providing nutrition education to a patient newly diagnosed with Type 1 Diabetes Mellitus. The patient states, "I should have a glass of orange juice with a teaspoon of sugar if I feel lightheaded, cool, and clammy mid-morning." Which statement is the best response by the nurse? "No, 4 oz. of 100% orange juice will not have an immediate effect." "Yes, 4 oz. of 100% orange juice will quickly help to treat hypoglycemia." "Yes, 4 oz. of 100% orange juice is needed for long-term maintenance of blood glucose." "No, 4 oz. of 100% orange juice has too much sugar, a snack of cottage cheese and 7 whole grain crackers is a better option."
"Yes, 4 oz. of 100% orange juice will quickly help to treat hypoglycemia."
A patient has type 1 diabetes mellitus and receives insulin. The patient asks the nurse why she cannot take pills instead. What is the best explanation by the nurse? "You will be able to use pills during what we call the honeymoon phase." "Your pancreas is unable to secrete an adequate amount of insulin." "You can take pills, but they are better to reserve for sick days when your blood glucose is variable." "You lost the ability to make insulin because of autoimmune destruction of the insulin-producing cells, the alpha cells."
"Your pancreas is unable to secrete an adequate amount of insulin."
A diabetic patient arrives at the ER with tachycardia, diaphoresis, and unresponsive to voice. Which intervention is the priority action? Administer 50% dextrose IV per protocol Administer oxygen 2 L per nasal cannula Administer prescribed insulin subcutaneous (SQ) Administer naloxone hydrochloride (narcan) per protocol
Administer 50% dextrose IV per protocol
A patient tells the school nurse that he is scared because he saw a classmate with a gun in his backpack. After hearing this, which action should the nurse take? Ask if the gun was a toy. Talk with the child about his fear. Call the child's parents immediately. Alert police and initiate the emergency protocol for the school.
Alert police and initiate the emergency protocol for the school.
The patient is managed with NPH and regular insulin before breakfast, lunch, and dinner. When is the patient most likely to experience a hypoglycemic reaction? Never Mid-day Before lunch Before breakfast
Before lunch
A patient with type 2 diabetes mellitus complains of nausea, vomiting, diaphoresis and headache. Which of the following nursing actions should the nurse perform first? Check the patient's blood glucose level. Instruct the patient to take a Glucophage tablet. Instruct the patient to take 6 units of regular insulin. Provide the patient with 8 oz of orange juice with 1 tsp sugar.
Check the patient's blood glucose level.
A child with type 1 diabetes mellitus who is taking insulin is seen in the school's clinic. The nurse develops a teaching plan for the child regarding food and exercise because the child has told the nurse that she will begin basketball practice. Which instruction should the nurse provide to the child? Withhold insulin on the day of basketball practice. Eat lunch 2 hours earlier on the day of basketball practice. Joining the basketball team should be delayed for 1 more year. Eat an extra snack of carbohydrates before the basketball practice starts.
Eat an extra snack of carbohydrates before the basketball practice starts.
The diabetes educator is meeting with school nurses to discuss ways to increase diabetes management in the schools, allowing for students with diabetes to take part in everyday activities, before, during, and after school. The school nurses provide scenarios of their involvement with diabetes management. Which statement indicates a safe nursing action on the part of the school nurse? I had a 15-year-old diabetic child come to my office last week. She was not able to have breakfast that morning but denied symptoms of hypoglycemia, such as tachycardia or sweating. I assisted her with the a.m. dose of regular insulin. I had a 14-year-old diabetic child come to my office yesterday after school. Her coach asked that she see me because of irritability, pallor, and clammy skin. The child reported that after running 1 mile as warm-up, these symptoms developed. We tested her blood glucose. I had a 12-year-old diabetic child last week come to my office complaining of increased thirst and fatigue. I noticed deep, rapid respirations and a fruity odor to her breath. The child has a management plan that includes self-blood glucose monitoring. She obtained a reading of 104 mg/dL, so I let her go back to class. I had a 16-year-old diabetic child come to my office yesterday morning, asking about managing her diabetes when going out with friends. She wants to be a cheerleader and has to keep her weight down. She told me that skipping her evening dose of insulin would help her achieve that goal. That seemed reasonable, as then the intake would not be metabolized.
I had a 14-year-old diabetic child come to my office yesterday after school. Her coach asked that she see me because of irritability, pallor, and clammy skin. The child reported that after running 1 mile as warm-up, these symptoms developed. We tested her blood glucose.
A patient with Type 1 diabetes mellitus is admitted to the emergency department in DKA. Which action should the nurse take first? Correct the hypokalemia Determine cause of the ketoacidosis Administer regular insulin intravenously Initiate fluid replacement with 0.9% saline
Initiate fluid replacement with 0.9% saline
A patient is admitted with a diagnosis of DKA. What signs and symptoms would the nurse expect to find in the patient? Select all that apply. Slow heart rate Mild disorientation Cool and clammy skin Constantly feeling tired Rapid, shallow respirations
Mild disorientation Constantly feeling tired
The provider writes orders for a patient with Type 1 DM admitted with DKA. Which order should the nurse question? Fluid replacement, 0.9% sodium chloride, initial bolus. Monitor blood glucose every 3-4 hours during IV insulin infusion. Monitor for bradycardia, muscle weakness, hyperreflexia, and cardiac irregularities. Humulin insulin IV, continuous, 6 U/h until blood glucose level drops to less than 180 mg/dL.
Monitor blood glucose every 3-4 hours during IV insulin infusion.
The provider writes orders for a patient with Type 1 DM admitted with elevated blood glucose levels. Which order should the nurse question? Humulin insulin IV, continuous, 6 U/h until the blood glucose level drops to less than 180 mg/dL. Fluid replacement, 0.9% sodium chloride, initial bolus. Monitor blood glucose every 3-4 hours during IV insulin infusion. Monitor for bradycardia, muscle weakness, hyperreflexia, cardiac irregularities.
Monitor blood glucose every 3-4 hours during IV insulin infusion.
A young patient newly diagnosed with diabetes is admitted with a BP of 85/58 mm Hg, pulse of 120 bpm, respirations 42, blood glucose level of 450 mg/dL, pH of 7.07 and bicarbonate level of 13 mEq/L. The patient is lethargic and slow to respond to touch. Which conditions will the nurse need to monitor? Monitor blood pH Check level of consciousness Monitor level of potassium Maintain Fluid intake and output Monitor for bradycardia
Monitor blood pH Check level of consciousness Monitor level of potassium Maintain Fluid intake and output
A 19-year-old with Type 1 DM is taking 30 units of NPH insulin each morning and 15 units at night. Because of persistent morning glycosuria with some ketonuria, the evening dose is increased to 20 units. This worsens the morning glycosuria, and now moderate ketones are noted in urine. The patient complains of sweats and headaches at night. The next step in management is: Switch from NPH to regular insulin Decrease morning dose of insulin Increase morning dose of insulin Obtain blood glucose levels at 2 a.m.
Obtain blood glucose levels at 2 a.m.
A child is using regular insulin according to blood glucose monitoring results. At 2 pm, the child has a blood glucose of 185 mg/dl, for which the patient received 8 units of regular insulin. The nurse should expect the dose's onset and peak to be at which times? Onset 2:15 pm and peak 4:00-5:00 pm Onset 2:15 pm and peak 2:30-3:30 pm Onset 2:30-3:00 pm and peak 4:00-5:00 pm Onset 2:30-3:00 pm and peak 10:00-11:00 pm
Onset 2:30-3:00 pm and peak 4:00-5:00 pm
Which factors could be classified as prenatal environmental exposure? Select all that apply. Pregnant mother smokes cigarettes. Pregnant mother has chickenpox virus. Pregnant mother lives in hot, desert climate. Pregnant mother drinks four cups of coffee daily. Pregnant mother lives in a home built in the 1940s.
Pregnant mother smokes cigarettes. Pregnant mother has chickenpox virus. Pregnant mother drinks four cups of coffee daily. Pregnant mother lives in a home built in the 1940s.
The blood glucose of a patient newly diagnosed with Type 1 diabetes mellitus has a blood glucose level of 310 mg/dL. Which type of insulin would the nurse expect to be ordered at this time? NPH Regular Lantus NPH + regular
Regular
A patient with DKA is given normal saline and intravenous regular insulin. The nurse checks blood glucose level hourly. Which other assessment data is the best indicator of clinical improvement? Pulse 130. Temperature in normal range Patient eats a full meal and respiratory rate is normal Improved level of consciousness and increasing urine output Respiration rate of 12 to 15 and normal BP in the standing position
Respiration rate of 12 to 15 and normal BP in the standing position
A child lives in an overcrowded apartment. Which is the nurse's main concern? The child's privacy Comfort level for the family Access to food and clean water Spread of communicable disease
Spread of communicable disease
The nurse is seeing a 9-month-old infant for a well visit. The baby was last seen for a 6-month well visit and has had no illnesses or complications since the last visit. The nurse gathers which data? Complete history Brief medical history Well, interim history Problem-based history
Well, interim history