Endocrine--Lippincott Peds DM

16. A student with type 1 diabetes tells the nurse she is feeling light-headed. The student'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

16. 2. 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

20. A 14-year-old is using glargine (Lantus) and lispro (Humolog) to manage type I diabetes. The prescription for sliding scale lispro reads: Lispro subcutaneous give units according to sliding scale: The morning blood glucose is 202 mg/dL and the client is going to eat two carbohydrate exchanges. The nurse has the client administer how many units of lispro? _______________________ units.

20. 4 Units. Each carbohydrate food exchange has 15 g of carbohydrate. Two units are needed to cover the current blood glucose and 2 units are needed to cover the anticipated carbohydrate intake

17. An overweight adolescent has been diagnosed with type 2 diabetes. To increase the client's self-efficacy to manage their disease, the nurse should: 1. Provide the client with a written daily food and exercise plan. 2. Discuss eliminating junk food in the home with the parents. 3. Arrange for the school nurse to weigh the child weekly. 4. Utilize a peer with type 2 diabetes to role model lifestyle changes.

17. 4. Self-efficacy, or the belief that one can act in a way to produce a desired outcome, can be promoted through the observation of role models. Peers are particularly effective role models because clients can more readily identify with them and believe they are capable of similar behaviors. Providing a written plan alone does not promote self-efficacy. Having parents eliminate junk food and having the school nurse weigh the adolescent can be part of the plan, but these actions do not empower the client.

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.

19. 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.

25. 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.

25. 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.

18. After 6 months of treatment with diet and exercise, a 12-year-old with type 2 diabetes still has a fasting blood glucose level of 140 mg/dL. The primary care provider has decided to begin metformin (Glucophage). The adolescent asks how the medication works. The nurse should tell the client that the medicine decreases the glucose production and: 1. Replaces natural insulin. 2. Helps the body make more insulin. 3. Increases insulin sensitivity. 4. Decreases carbohydrate adsorption.

18. 3. Metformin is currently approved by the FDA to treat type 2 diabetes in children. The medication decreases glucogenesis in the liver and increases insulin sensitivity in the peripheral tissues. Only insulin can actually replace insulin. This treatment is reserved for clients with type 1 diabetes or those with type 2 who do not respond to diet, exercise, and an oral diabetic agent. Other oral medications used to treat diabetes augments insulin production or decreases carbohydrate absorption, but those medications are primarily used in adults.

21. 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.

21. 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.

22. 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.

22. 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.

23. 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.

23. 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

24. 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.

24. 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.