NURS 232 Unit 5 Wk 1 and Wk 2 NCLEX Review Questions - Tested on Final Exam (5/2/22)

A child born with a single transverse palmar crease, a short neck with excessive skin at the nape, a depressed nasal bridge and cardiac defects is most likely to have which autosomal abnormality? 1. Trisomy 21 2. Trisomy 18 3. Trisomy 14 4. Trisomy 13

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The nurse is speaking with the parent of a 2-year-old child recently diagnosed with an autism spectrum disorder. The parent asks about educational programs for her child. What is the best response by the nurse? 1. "Children with an autism spectrum disorder enrolled in public schools can have an individualized educational plan to help meet their specific needs." 2. "Children with an autism spectrum disorder are able to function on their own and do not need any special support at school." 3. "Children with an autism spectrum disorder are not eligible to participate in any of the local early educational programs provided since they are only open to children with cognitive impairment." 4. "Children with an autism spectrum disorder can only go to special schools, not public schools, so you will need to get your name on a waiting list soon."

1 Rationale: Children enrolled in public schools need to have an individualized educational plan (IEP) in place. Children with an autism spectrum disorder can go to public or private schools. No matter the school setting, the child will need assistance of some kind. Children under 36 months can receive services via the local early intervention program.

The nurse is assessing a 7-year-old child with trisomy 21 (Down syndrome). Which would the nurse be least likely to assess? 1. Inspection finds the nasal passages clear and open. 2. Auscultation reveals a definite heart murmur. 3. Palpation indicates that the child may be constipated. 4. The child is significantly underweight.

1 Rationale: It is LEAST LIKELY that the nurse would find the child's nasal passages clear and open. Children with trisomy 21 (Down syndrome) have chronically stuffy noses due to underdeveloped nasal bones. Typically, children with Down syndrome are overweight. Children with Down syndrome often experience digestive problems such as constipation. Children with Down syndrome often experience cardiac problems, such as a heart murmur.

A client diagnosed with binge-eating disorder has a nursing diagmosis of low self-esteem. Which nursing intervention would address this client's problem? 1. Offer independent decision-making opportunities. 2. Review previously successful coping strategies. 3. Provide a quiet environment with decreased stimulation. 4. Allow the client to retain in a dependent role throughout treatment.

1 1. Offering independent decision-making opportunities promotes feelings of control. Making decisions and dealing with the consequences of these deci- sions should increase independence and improve the client's self-esteem. 2. Reviewing previously successful coping strat- egies is an effective nursing intervention tor clients experiencing altered coping, not low self-esteem. Altered coping is a common problem for clients diagnosed with binge- eating disorder, but this nursing diagnosis is not stated in the question. 3. Providing a quiet environment with de- creased stimulation is an effective nursing intervention for clients experiencing anxiety, not low self-esteem. Anxiety is a common problem for clients diagnosed with binge- eating disorder, but this nursing diagnosis is not stated in the question. 4. Allowing the client to remain in a dependent role throughout treatment would decrease, rather than increase, self-esteem. There is little opportunity for successful experiences and increased self-esteem when decisions and choices are made for the client.

The most appropriate nursing diagnosis for a child with type 1 DM is which of the following? 1. Risk for infection related to reduced body defenses. 2. Impaired urinary elimination (enuresis). 3. Risk for injury related to medical treatment. 4. Anticipatory grieving.

1 1. Risk for infection is a correct nursing diagnosis. Understanding DM requires understanding the effect it has on peripheral circulation and impairment of defense mechanisms. 2. Although many children with type 1 DM present with enuresis, impaired urinary elimination is not the best response. 3. Treatment includes injections, but this is not a risk for injury. 4. Type 1 DM, although lifelong, is not a ter- minal illness and can be well managed, so grieving is not an appropriate diagnosis.

The nurse is caring for a 1-year-old infant with trisomy 21 (Down syndrome). Which would the nurse be least likely to include in the child's plan of care? 1. Educating parents about how to deal with seizures 2. Promoting annual vision and hearing tests 3. Describing the importance of a high-fiber diet 4. Explaining developmental milestones to parents

1 Rationale: It is unlikely that the parents will need to know how to deal with seizures. It will be helpful to provide parents with growth and developmental milestones that are unique to children with trisomy 21 (Down syndrome). More than 60% of children with Down syndrome have hearing loss, so promoting annual vision and hearing tests is the priority intervention. Special diets are usually not necessary; however, a balanced, high-fiber diet and exercise are important because constipation is frequently a problem.

A client diagnosed with anorexia nervosa has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which long-term, correctly written outcome addresses client problem improvement? 1. The client's BMI will be 20 by the 6-month follow-up appointment. 2. The client will be free of signs and symptoms of malnutrition and dehydration. 3. The client will use one healthy coping mechanism during a time of stress by discharge. 4. The client will understand a previous dependency role by 3-month follow-up visit.

1 1. A normal BMI range is 20 to 25. Achieving the outcome of a BMI of 20 would indicate improvement for the stated nursing diagnosis of imbalanced nutrition: less than body requirements. 2. Experiencing no signs and symptoms of mal- nutrition and dehydration is an outcome re- lated to the nursing diagnosis of imbalanced nutrition. However, this outcome is incor- rectly written because it does not contain a time frame. 3. Improving the ability to demonstrate healthy coping mechanisms by discharge is a short-term outcome related to the nursing di- agnosis of ineffective coping, not imbalanced nutrition. 4. Stating understanding of a previous depen- dency role by the 3-month follow-up ap- pointment is a long-term outcome related to the nursing diagnosis of low self-esteem, not imbalanced nutrition.

The nurse is teaching a 9-year-old child with type 1 diabetes mellitus and the parents about blood glucose monitoring. Which comment indicates a need for additional teaching? 1. "The normal level is 70 to 110 mg/dL (3.9--6.1 mmol/L) before meals." 2. "The child should check glucose before meals." 3. "The child should check glucose more often if ill." 4. "The normal level is 90 to 150 mg/dL (5.0--8.3 mmol/L) before bedtime."

1 Rationale: If the parents state that the normal level for their child is 70 to 110 mg/dL, they need to be reminded that the proper level for a 9-year-old child with type 1 diabetes is 90 to 130 mg/dL (5.0--7.2 mmol/L). The child is correct about needing to check glucose before meals; the child should also check it before bedtime snacks. The child is also correct about needing to check glucose level more often when ill, during prolonged exercise, after a larger-than-normal meal, and if nighttime hypoglycemia is suspected.

When reviewing the HbA1C results of a 3-year-old child with type 1 diabetes Mellitus findings greater than what value, indicate the need for further action? 1. 0.075 2. 0.08 3. 0.07 4. 0.065

1 Rationale: The American Association of Diabetes recommends that children and adolescents have a target HgA1C less than 7.5%

Which is a diagnostic criterion for the diagnosis of ADHD? 1. Inattention. 2. Recurrent and persistent thoughts. 3. Physical aggression. 4. Anxiety and panic attacks.

1 The diagnostic criteria for ADHD are divided into three categories: inattention, hyperac- tivity, and impulsivity. The list of symptoms under each category is extensive. Six (or more) symptoms of inattention or hyperactivity- impulsivity, or both, must persist for at least 6 months to a degree that is maladaptive and inconsistent with developmental level. 1. Essential diagnostic criteria for ADHD in- cludes inattention, along with hyperactivity and impulsivity. Children with this disorder are highly distractible and have extremely limited attention spans. 2. Recurrent and persistent thoughts are a di- agnostic criterion for obsessive-compulsive disorder, not ADHD. A child diagnosed with ADHD would have difficulty focusing on a thought for any length of time. 3. The classic characteristic of conduct disorder, not ADHD, is the use of physical aggression in the violation of the rights of others. 4. Anxiety and panic attacks are not diagnostic criteria for a diagmosis of ADHD. Although children with this disorder are restless and tidgety and often act as if "driven by a mo- tor," these behaviors are associated with their boundless energy, not anxiety or panic.

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? 1. Regular insulin 2. NPH 3. Lispro 4. Detemir

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

Which anorexia nervosa symptom is physical in nature? 1. Dry, yellow skin. 2. Perfectionism. 3. Frequent weighing. 4. Preoccupation with food.

1 1. Dry, yellow skin is a physical symptom of anorexia nervosa. This is due to the release of carotenes as fat stores are burned tor energy. 2. Perfectionism is often experienced by clients with a diagnosis of anorexia nervosa, but it is a behavioral, not physical, symptom. 3. Frequent weighing is a behavioral, not physical, symptom of anorexia nervosa. 4. Preoccupation with food is a cognitive, not physical, symptom of anorexia.

The nurse administered 12 units of regular insulin to the patient with type 1 DM at 0700. Which meal prevents the client from experiencing hypoglycemia? 1. Breakfast 2. Lunch 3. Dinner 4. Bedtime snack

1 Rationale: Regular insulin peaks in 2-4 hours, therefore, the breakfast meal would prevent the client from developing hypoglycemia.

The school nurse is talking to a 14-year-old about managing type 1 DM. Which statement indicates the student's understanding of the disease? 1. "It really does not matter what type of carbohydrate I eat, as long as I take the right amount of insulin." 2. "I should probably have a snack right after gym class." 3. "I need to cut back on my carbohydrate intake and increase my lean protein intake." 4. "Losing weight will probably help me decrease my need for insulin."

1 Rationale: A carb is a carb, and insulin dosing is based on blood sugar level and carbohydrates eaten. Snacks should be ingested before, rather than after exercise. Weight loss is likely a factor in managing type 2 DM.

Which of the following signs/symptoms would the nurse teach the family of a child newly diagnosed with type 1 DM to recognize as hypoglycemia? Select all that apply. 1. Pallor 2. Confusion 3. Tachycardia 4. Sweating 5. Acetone (fruity) breath

1 2 3 4 Rationale: Hypoglycemia is caused by taking too much insulin, skipping a meal or not eating as much as the child should, and strenuous exercise without dietary replacement. Symptoms of hypoglycemia include: Pallor, confusion, tachycardia, sweating. Acetone breath is detected when a child is hyperglycemic. Confusion, deep rapid breathing, thirst, weakness tiredness and headache are also present.

The nurse in a school housing kindergarten through grade 12 has identified signs of stress in the students that may indicate exposure to intimate partner violence or child abuse. What has the nurse found? (Select all that apply.) 1. Truancy and absenteeism 2. Early-age smoking and drug use 3. Bullying and poor social skills 4. Developmental regression and fearfulness 5. Reports of headaches, stomach aches, and enuresis

1 2 3 4 5 Rationale: All are signs of stress that can indicate exposure to intimate partner violence or child abuse. The younger the child is and the longer the exposure, the more serious the problems seen. Short-term problems include headaches, stomach aches, enuresis, developmental regression, fears, poor social skills, and bullying. Long-term problems include truancy and absenteeism. A strong correlation exists between the number of exposures to adverse events and early smoking and illicit drug use.

Resilient children are able to cope effectively with stressors. What external factors can nurses promote to foster this resiliency? (Select all that apply.) 1. Enjoying school and learning 2. Good grooming behaviors 3. Feeling part of a team 4. A caring relationship with an adult 5. Ability to accept one's limits

1 3 4 Rationale: Caring relationships with parents and/or other important adults, feeling part of a group (having a purpose), and a positive school experience all are factors outside the child that promote resiliency. Though good grooming promotes social acceptance, this is not one of the resiliency-promoting factors. The ability to accept one's limits and abilities is an internal factor that promotes resiliency.

Which of the following nursing evaluations of a client diagnosed with anorexia nervosa would lead the treatment team to consider discharge? Select all that apply. 1. The client participates in individual therapy. 2. The client has a BMI of 16. 3. The client consumes adequate calories as determined by the dietitian. 4. The client is dependent on his or her mother for most basic needs. 5. The client states, "I realize that I can't be perfect."

1 3 5 1. Willingness to participate in individual therapy is an indication that this cli- ent meets discharge criteria. Individual therapy encourages the client to explore unresolved conflicts and to recognize maladaptive eating behaviors as defense mechanisms used to ease emotional pain. 2. The BMI for normal weight is 20 to 25. Because this client's BMI is lower than the normal range, consideration for discharge may be inappropriate at this time. 3. It is significant when a client diagnosed with anorexia nervosa consumes adequate calories to maintain metabolic needs. This assessment information would indicate that the client should be considered for discharge. 4. Families of clients diagnosed with anorexia nervosa often consist of a passive father, a domineering mother, and an overly de- pendent child. This client's continued de- pendence on the mother may indicate that consideration for discharge is inappropriate at this time. 5. A high value is placed on perfectionism in families of clients diagnosed with an- orexia nervosa. These clients feel that they must satisfy these unrealistic standards, and when this is found to be impossible, helpless results. Because this client shows insight into this problem by the recognition that perfection is impossible, consideration for discharge is appropriate.

The nurse is obtaining the history of an adolescent who is suspected of having anorexia nervosa. What findings would the nurse expect? (Select all that apply.) 1. Secondary amenorrhea 2. Warm hands and feet 3. Diarrhea 4. Syncope 5. Desire for perfectionism

1 4 5 Rationale: The adolescent with anorexia may have a history of constipation, syncope, secondary amenorrhea, abdominal pain, and periodic episodes of cold hands and feet. In addition, the child's self-concept reveals multiple fears, high need for acceptance, disordered body image, and perfectionism.

The nurse is assessing a newly admitted 14-year-old adolescent and notes that the adolescent makes very little eye contact, becomes very frustrated with questions and conversation, and does not smile or laugh. What nursing diagnoses will the nurse add to the care plan based on these assessment findings? (Select all that apply.) 1. Ineffective individual coping 2. Disturbed thought process 3. Delayed growth and development 4. Imbalanced nutrition, less than body requirements 5. Impaired social interaction

1 5 Rationale: Limited eye contact, lack of smiling support the nursing diagnosis of impaired social interaction. Becoming frustrated easily with conversation supports both impaired social interaction and ineffective individual coping.

The instructor is teaching nursing students about the psychodynamic influences of eating disorders. Which statement indicates that more teaching is necessary? 1. "Eating disorders result from very early and profound disturbances in father-infant interactions." 2."Disturbances in mother-infant interactions may result in retarded ego development." 3. "When a mother meets the physical and emotional needs of a child by providing food, this behavior contributes to the child's ego development." 4. "Poor self-image leads to a perceived lack of control. The client compensates for this perceived lack of control by controlling behaviors related to eating."

1 1. Eating disorders result from very early and profound disturbances in mother- infant, not father-infant, interactions. This statement would indicate that more teaching is necessary. 2. Disturbances in mother-infant interactions result in retarded ego development, which contributes to the development of an eating disorder. This is a correct statement and fur- ther teaching is not necessary. 3. Ego development can be attributed to a mother meeting the physical and emotional needs of a child by providing food. This is a correct statement and further teaching is not necessary. 4. Poor self-image leads to a perceived lack of control. The client compensates for this perceived lack of control by controlling behaviors related to eating. This is a cor- rect statement and further teaching is not necessary.

A nurse is reviewing information about the various types of insulin that are used to treat type 1 diabetes mellitus. Integrating knowledge about the duration of action, place these types in the order from shortest to longest duration. NPH Aspart Glargine Regular

1) Aspart 2) Regular 3) NPH 4) Glargine Rationale: Aspart has a duration of action of 3 to 5 hours; regular insulin has a duration of 5 to 8 hours; NPH has a duration of 10 to 16 hours; and glargine has a duration of 12 to 24 hours.

Hypofunction of which endocrine gland might cause type 2 diabetes mellitus? 1. Thyroid 2. Pancreas 3. Adrenal 4. Pituitary

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Which nursing intervention would directly assist a hospitalized client diagnosed with bulimia nervosa in avoiding the urge to purge after discharge? 1. Locking the door to the client's bathroom. 2. Holding a mandatory group after mealtime to assist in exploration of feelings. 3. Discussing replanned meals to decrease anxiety around eating. 4. Educating the family to recognize purging side effects.

2 1. Locking the client's door would be an appro- priate behavioral approach to prevent purging in an inpatient setting but would not assist the client in avoiding the urge to purge when discharged. 2. Holding a mandatory group after meal- time to assist in exploration of feelings is an appropriate intervention to help the hospitalized client diagnosed with buli- mia nervosa to avoid the urge to purge after discharge. If the client can become aware of feelings that may trigger purging, future purging may be avoided. 3. Discussing replanned meals to decrease anx- iety around eating is an intervention focused on binging, not purging. 4. Educating the family to recognize purging side effects would not directly assist the client in avoiding purging after discharge. This in- tervention is focused on providing the tamily tools to use if purging behaviors continue, not on helping the client to avoid these behaviors.

A nurse is describing the underlying cause of trisomy 21 (Down syndrome) to a group of parents, integrating knowledge that the disorder is due to: 1. deletion. 2. nondisjunction. 3. duplication. 4. translocation.

2 Rationale: Trisomy 21 (Down syndrome) is a disorder caused by nondisjunction or error in cell division. It is not due to the loss of a portion of the chromosome (deletion), an extra segment being present (duplication), or transfer of one part of the chromosome to another (translocation).

An 17 year-old female client weighs 95 pounds and is 70 inches tall. She has not had a period in 4 months and states, "I am so fat!" Which statement is reflective of this client's symptoms? 1. The client meets the criteria for a diagnosis of bulimia nervosa. 2. The client meets the criteria for a diagnosis of anorexia nervosa. 3. The client needs further assessment to be diagnosed. 4. The client is exhibiting normal developmental tasks according to Erikson.

2 1. Included in the diagnostic criteria for buli- mi nervosa are binge eating, self-induced vomiting, abuse of laxatives, and/or poor self- evaluation unduly influenced by body shape and weight. This client is not experiencing any binge eating, purging, or inappropriate use of laxatives. Although weight may fluctu- ate, clients diagnosed with bulimia nervosa can maintain weight within a normal range. This client does not meet the criteria for a diagnosis of bulimia nervosa. 2. Significantly low body weight in the con- text of age, sex, developmental trajectory, and physical health; disturbance in the way in which one's body weight is experienced; undue influence of body weight on self evaluation; and lack of recognition of the seriousness of the current low body weight are all diagnostic criteria for anorexia ner- vosa. This client meets the criteria for this diagnosis. 3. Because the client meets the diagnostic criteria for anorexia nervosa, additional assessments are unnecessary. 4. Extreme weight loss, disturbed body image, and amenorrhea are not normal developmental tasks for an 18 year-old client, according to Erikson. Erikson identified the development of a secure sense of self as the task of the adolescent stage (12 to 20 years) of psychosocial development.

The nursing educator has completed an educational program for new nurses on eating disorders in adolescents. Which statement by a participant would indicate a need for further education? 1. "We need to allow the client to participate in developing the treatment plan." 2. "If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something." 3. "We need to stay with them for at least 30 minutes after they eat so they don't try to vomit or dispose of the food." 4. "Mealtime should be structured but pleasant and relaxed without distractions."

2 Rationale: Withdraw attention if the child refuses to eat: secondary gain is minimized if refusal to eat is ignored rather than with continuous attention. Mutually establish a contract related to treatment to promote the child's sense of control. Provide mealtime structure, as clear limits let the child know what the expectations are. Provide continuous supervision during the meal and for 30 minutes following it so that the child cannot conceal or dispose of food or induce vomiting.

When using a behavioral modification approach for the treatment of eating disorders, which nursing intervention would be most likely to produce positive results? 1. Take a matter-of-fact, directive approach with the input of the entire treatment team. 2. Clients should perceive that they are in control of clearly communicated treatment choices. 3. Appropriate treatment choices are presented to the client's family for consideration. 4. The treatment team develops a system of rewards and privileges that can be earned by the client.

2 1. A behavior modification program should be instituted with client input and involvement. A directive approach would not give the client the needed and sought-after control over behaviors. Typically, control issues are the underlying problem precipitating eating disorders. 2. A behavior modification program for clients diagnosed with eating disorders should ensure that the client does not feel "controlled" by the program. Issues of control are central to the etiology of these disorders, and for a program to succeed, the client must perceive that he or she is in control of behavioral choices. This is accomplished by contracting with the cli- ent for privileges based on weight gain. 3. A behavior modification program should be instituted with client input and involvement. Focusing on the family and excluding the cli- ent from treatment choices has been shown to be ineffective. 4. It is important for staff members and clients to work jointly to develop a contract for re- wards and privileges that can be earned by the client. It would be inappropriate for the treatment team to solely develop this con- tract. The client should have ultimate control over behavioral choices, including whether to abide by the contract.

A client diagnosed with anorexia nervosa has a short-term outcome that states, "The client will gain 2 pounds in 1 week." Which nursing diagnosis reflects the problem that this outcome addresses? 1. Ineffective coping R/T lack of control. 2. Altered nutrition: less than body requirements R/T decreased intake. 3. Self-care deficit: feeding R/T fatigue. 4. Anxiety R/T feelings of helplessness.

2 1. The outcome of gaining 2 pounds in 1 week is not directly related to the nursing diagnosis of ineffective coping. Ineffective coping is defined as the inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, or inability to use available resources. An appropriate outcome for ineffective coping for clients diagnosed with eating disorders would be to use healthycoping strategies effectively to deal with anxiety or lack of control without resorting to self-starvation. 2. The outcome of gaining 2 pounds in I weck is directly related to the nursing diagnosis of altered nutrition: less than body requirements. Altered nutrition: less than body requirements is defined as the state in which an individual experiences an intake of nutrients insufficient to meet metabolic needs. Weight loss is characteristic of the diagnosis of anorexia nervosa, with weight gain being a critical outcome. 3. The outcome of gaining 2 pounds in 1 week is not directly related to the nursing diagnosis of self-care deficit: feeding R/T fatigue. Self-care deficit is related to the inability of the client to perform the acts of self-care, in this case feed- ing. Clients diagnosed with anorexia nervosa have the ability to feed themselves but choose not to because of impaired body image. 4. The outcome of gaining 2 pounds in 1 week is not directly related to the nursing diagnosis of anxiety R/T feelings of helplessness. Feelings of depression and anxiety often accompany the diagnosis of anorexia nervosa, but in the short term, weight gain would increase, not decrease, the anxiety experienced by the client.

The nurse is caring for a 10-year-old child with a history of inappropriate behavior. Which statement by the parent would lead the nurse to suspect possible conduct disorder? 1. "Our child blames everyone else for his or her problems." 2. "Our child recently trampled our neighbor's flower bed." 3. "Our child argues excessively with teachers." 4. "Our child has frequent temper tantrums."

2 Rationale: Destruction of the property of others points to conduct disorder. Frequent temper tantrums suggest oppositional defiant disorder. Blaming others for problems is an indicator of oppositional defiant disorder. Excessive arguing with adults suggests oppositional defiant disorder.

An 8-year-old with type 1 DM is complaining of a headache and dizziness and is visibly perspiring. Which of the following should the nurse do first? 1. Administer glucagon intramuscularly. 2. Offer the child 8 oz of milk. 3. Administer rapid-acting insulin lispro (Humalog). 4. Offer the child 8 oz of water or calorie-free liquid.

2 1. Glucagon is given only for severe hypogly- cemia. The child's symptoms are those of mild hypoglycemia. 2. Milk is best to give for mild hypogly- cemia, which would present with the symptoms described. 3. Insulin is appropriate for elevated blood glucose, but the symptoms listed are those of hypoglycemia, not hyperglycemia. It is important for the test taker to be able to distinguish between the two. 4. Water is appropriate for mild hyperglyce- mia, but the symptoms listed are those of hypoglycemia.

A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which nursing response is most appropriate? 1. "Thanks for checking in." 2. "I will accompany you to the bathroom." 3. "Let me know when you get back to the dayroom." 4. "I'll stand outside your door to give you privacy."

2 1. The response "Thanks for checking in" does not address the nurse's responsibility to deter the client's self-induced vomiting behavior. The nurse should accompany the client to the bathroom. 2. The response "I will accompany you to the bathroom" is appropriate. Any client suspected of self-induced vomiting should be accompanied to the bathroom for the nurse to be able to deter this behavior. 3. The response "Let me know when you get back to the dayroom" does not address the nurse's responsibility to deter the client's self- induced vomiting behavior. The nurse should accompany the client to the bathroom. 4. The response "I'll stand outside your door to give you privacy" does not address the nurse's responsibility to deter the client's self-induced vomiting behavior. The nurse should accom- pany the client to the bathroom. Providing privacy is secondary to preventing further nutritional deficits.

A client with anorexia/cachexia states, "I don't care what you say; I am horribly fat and will continue to diet." The client is experiencing arrhythmias and bradycardia. Based on this client's symptoms, which nursing diagnosis takes priority? 1. Ineffective denial. 2. Imbalanced nutrition: less than body requirements. 3. Disturbed body image. 4. Ineffective coping.

2 1. When clients diagnosed with eating disorders are unable to admit the effect of maladap- tive eating behaviors on life patterns, they are experiencing ineffective denial. This is a valid nursing diagnosis for this client because there is an inability to admit emaciation. This diagnosis should be considered, however, only after resolution of life-threatening nutritional status. 2. The immediate and priority problem that this client faces is imbalanced nutrition; less than body requirements. Impaired nutrition causes complications of emacia- tion, dehydration, and electrolyte imbal- ance that can lead to death. When the physical condition is no longer life threat- ening, other problems may be addressed. 3. When emaciated clients diagnosed with eating disorders are negative about their ap- pearance and see themselves as overweight, they are experiencing disturbed body image. This is a valid nursing diagnosis for this client because the client views the body as "horribly hit" when in reality the client is critically thin, This diagnosis should be considered, how- ever, only after resolution of life-threatening nutritional status. 4. Clients diagnosed with eating disorders cope ineffectively with stress and anxiety by mal- adaptive eating patterns. This is a valid nurs- in diagnosis because this client is choosing not to eat to deal with unconscious stressors. This diagnosis should be considered, how- ever, only after resolution of life-threatening nutritional status.

A parent asks why spanking works so well to stop her toddler's behavior. The nurse explains it is the: 1. anger of the parent 2. suddenness and shock value of the act. 3. attention the child receives. 4. the anxiety created in the child.

2 Rationale: The surprise and shock interrupt the behavior quickly. With repeated use these effects diminish; then the intensity must increase. The American Academy of Pediatrics recommends against spanking due to its many negative effects and lack of effectiveness over other methods. When punishing, the parent should remain calm. Anger may result in injury. Anxiety is one of the negative effects of spanking. The attention is negative; however, a child without appropriate attention may settle for the negative.

The healthcare provider has ordered routine hemoglobin A1C levels for an adolescent with diabetes. Following teaching about the test by the nurse, the adolescent and family demonstrate the need for further instruction with which statements? (Select all that apply.) 1. "This test will help us monitor if our adolescent is following the prescribed diet and treatment regimen." 2. "We will need to make sure our adolescent gets this laboratory test at least every 6 months to ensure the diabetes is under control." 3. "I will be sure to not eat or drink anything the night before I get my blood drawn for the test." 4. "I can check this level myself using a blood glucose monitor." 5. "If I am under a lot of stress I should let my healthcare provider know during my visit in case my hemoglobin A1C levels are elevated."

2 3 4 Rationale: Hemoglobin A1C levels provide the healthcare provider with information regarding the long-term control of glucose levels so fasting is not necessary. The test indicates the level of blood glucose over a 2- to 3-month period, so it should be performed about every 3 months. Daily blood glucose monitoring can be performed by the client with the use of a finger stick and glucose meter. The healthcare provider should be informed of high stress levels as this can increase BLOOD GLUCOSE levels.

The nurse is performing the physical examination of a child with bulimia. What findings would the nurse identify as supporting this disorder? (Select all that apply.) 1. Pink moist gums 2. Split fingernails 3. Bradycardia 4. Eroded dental enamel 5. Dry sallow skin

2 4 Rationale: The adolescent with bulimia will be of normal weight or slightly overweight. The hands will show calluses on the backs of the knuckles and split fingernails. The mouth and oropharynx will exhibit eroded dental enamel, red gums, and an inflamed throat from self-induced vomiting. Bradycardia and dry sallow skin suggest anorexia.

The nurse is teaching a 12-year-old child with type 2 diabetes mellitus and parents about dietary measures to control the child's glucose levels. Which comment by the child indicates a need for additional teaching? 1. "I will be eating more breads and cereals." 2. "I can have an apple or orange for snacks." 3. "I can eat two small cookies with each meal." 4. "We should give her nonfat milk to drink."

3 Rationale: 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 (breads and cereals) should be the largest category of foods eaten.

The nurse is preparing a presentation for a local health fair on autism spectrum disorders. What statement would the nurse include as part of the presentation? 1. Communication therapies are of little value in treating autism spectrum disorders. 2. Scientific evidence supports the use of complementary therapies. 3. Autism spectrum disorders cannot be cured. 4. Children respond best when the environment is less structured.

3 Rationale: There are no medications or treatment available to cure autism spectrum disorders. Behavioral and communication therapies are very important in caring for a child with an autism spectrum disorder. Children with an autism spectrum disorder respond very well to highly structured educational environments. To date, complementary and alternative medical therapies have not been scientifically proven to improve autism spectrum disorders.

The nurse is assessing a 5-year-old child whose parent says the child has been vomiting lately and has no appetite. What sign or symptom would the nurse identify as unique to type 1 diabetes mellitus? 1. The child's breath smells sweet. 2. The child's blood pressure is 142/92. 3. The child has lost weight recently. 4. The child's breathing is rapid and deep.

3 Rationale: 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. 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 child diagnosed with severe ID (intellectual disability) displays failure to thrive related to neglect and abuse. Which nursing diagnosis would best reflect this situation? 1. Altered role performance R/T failure to complete kindergarten. 2. Risk for injury: self-directed R/T poor self-esteem. 3. Altered growth and development R/T inadequate environmental stimulation. 4. Anxiety R/T ineffective coping skills.

3 Altered growth and development is defined as the state in which an individual demonstrates deviations in norms from his or her age group. This may result from IDD, neglect and abuse, or both. 1. A child with severe IDD (IQ level 20 to 34) cannot benefit from academic or vocational training, making this an inappropriate nurs- ing diagnosis for this child. 2. Because of abuse and neglect, this child may aggressively act out to deal with frustration when needs are not met. However, there is nothing in the question that indicates this child is experiencing self-directed aggression. 3. The nursing diagnosis of altered growth and development related to inadequate environmental stimulation would best address this child's problem of failure to thrive. Failure to thrive frequently results from neglect and abuse. 4. A child diagnosed with severe IDD would not be expected to have any insight or coping skills. Lack of insight would prevent the child from experiencing anxiety and the need to cope.

Parents have just given birth to a child diagnosed with trisomy 21 (Down syndrome). The couple are parents of three other children under the age of 8 years old with no genetic disorders. What would be a priority nursing diagnosis at this time? 1. Decisional conflict 2. Interrupted family processes 3. Deficient knowledge regarding trisomy 21 4. Risk for delayed growth and development

3 Rationale: Based on the child just being born and the parents dealing with three other children, the highest priority is Deficient knowledge regarding trisomy 21, followed by interrupted family processes.

A child with a cognitive impairment is evaluated and found to have an intelligence quotient (IQ) of 65. The nurse interprets this as reflecting which category of impairment? 1. Profound 2. Severe 3. Mild 4. Moderate

3 Rationale: Mild cognitive impairment involves an IQ from 50 to 70. Moderate cognitive impairment involves an IQ from 35 to 50. Severe cognitive impairment involves an IQ from 20 to 35. A profound cognitive impairment involves an IQ less than 20.

A client is leaving the in-patient psychiatric facility after 1 month of treatment for anorexia nervosa. Which outcome is appropriate during discharge planning for this client? 1. Client will accept refeeding as part of a daily routine. 2. Client will perform nasogastric tube feeding independently. 3. Client will verbalize recognition of "fat" body misperception. 4. Client will discuss importance of monitoring weight daily.

3 1. Accepting refeeding as part of a daily rou- tine is an outcome that would be appropri- ate early in treatment and should have been accomplished before discharge planning consideration. 2. Performing nasogastric tube feeding inde- pendently is an outcome that would be ap- propriate early in treatment and should have been accomplished before discharge planning consideration. 3. The outcome of verbalizing recognition of misperception involving "fat" body image is a long-term outcome, appropriate for discharge planning for a client diagnosed with anorexia nervosa. 4. Monitoring weight on a daily basis is an inap- propriate outcome for a client diagnosed with anorexia nervosa. Obsession about food and weight gain is a characteristic symptom of the disease, and this outcome would reinforce this problem.

A nurse sitting with a client diagnosed with anorexia nervosa notices that the client has eaten 80% of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse? 1. "I'm Italian, so I really enjoy a large plate of spaghetti." 2. "Let's weigh you after your meal." 3."Let's focus on your continued improvement. You ate 80% of your lunch." 4. "Why do you always talk about food? Let's talk about swimming."

3 1. Because clients diagnosed with anorexia ner- vosa are obsessed with food, the nurse should not discuss food or eating behaviors. Discus- sion of food or eating behaviors can provide unintended positive reinforcement for nega- tive behaviors. This statement by the nurse also focuses on the nurse and not the client. 2. The nurse should weigh the client daily, im- mediately on arising, following first voiding, and not after a meal. 3. It is important to offer support and posi- tive reinforcement for improvements in eating behaviors. Because clients diag- nosed with anorexia nervosa are obsessed with food, discussion of food can provide unintended positive reinforcement for negative behaviors. In this answer choice, the nurse is appropriately redirecting the client. 4. When the nurse requests an explanation that the client cannot give, the client may teel defensive. "Why" questions are blocks to therapeutic communication.

A child diagnosed with autism spectrum disorder makes no eye contact; is unresponsive to staff members; and continuously twists, spins, and head bangs. Which nursing diagnosis would take priority? 1. Personal identity disorder R/T poor ego differentiation. 2. Impaired verbal communication R/T withdrawal into self. 3. Risk for injury R/T head banging. 4. Impaired social interaction R/T delay in accomplishing developmental tasks.

3 1. Children diagnosed with autism spectrum disorder have difficulty distinguishing be- tween self and others. Although the nursing diagnosis of personal identity disorder has merit for the future, potential injury from head banging would need to be addressed first. 2. Children diagnosed with autism spectrum disorder have a delayed or absent ability to receive, process, transmit, or use a system of symbols to communicate. Although the nursing diagnosis of impaired verbal com- munication has merit for the future, potential injury from head banging would need to be addressed first. 3. Children diagnosed with autism spectrum disorder frequently head bang because of neurological alterations, increased anxi- ety, or catastrophic reactions to changes in the environment. Because the nurse is responsible for ensuring client safety, the nursing diagnosis of risk for injury takes priority. 4. Children diagnosed with autism spectrum disorder do not form interpersonal relation- ships with others and do not respond to or show interest in people. Although the nursing diagnosis of impaired social interaction has merit for the future, potential injury from head banging would need to be addressed first.

A child diagnosed with mild to moderate IDD (intellectual developmental disorder) is admitted to the hospital for an appendectomy. The nurse observes that the child is having difficulty making desires known. Which nursing diagnosis reflects this client's problem? 1. Ineffective coping R/T developmental delay. 2. Anxiety R/T hospitalization and absence of familiar surroundings. 3. Impaired verbal communication R/T developmental alteration. 4. Impaired adjustment R/T recent admission to hospital.

3 1. Ineffective coping is described as the inability to form a valid appraisal of the stressors, inad- equate choices of practiced responses, or in- ability to use available resources. This child's inability to communicate effectively is not related to ineffective coping. 2. A child diagnosed with mild to moderate ID may experience anxiety because of hos- pitalization and the absence of familiar sur- roundings; however, the child in this question is not displaying symptoms of anxiety. This child's problem is an inability to communicate desires. 3. Impaired verbal communication R/T de- velopmental alteration is the appropriate nursing diagnosis for a child diagnosed with mild to moderate IDD who is hav- ing difficulties making needs and desires understood to staff members. Clients di- agnosed with mild to moderate IDD often have deficits in communication. 4. Impaired adjustment is defined as the inabil- ity to modify lifestyle or behavior in a man- ner consistent with a change in health status. Hospitalization of a child with mild to mod- rate IDD may precipitate impaired adjust- ment, but the client problem described in the question indicates impaired communication.

A client with a history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not, is restless, and has dry mucous membranes. Which is most likely the cause of this client's symptoms? 1. Mood disorders, which often accompany the diagnosis of bulimia nervosa. 2. Nutritional deficits, which are characteristic of bulimia nervosa. 3. Vomiting, which may lead to dehydration and electrolyte imbalance. 4. Binging, which causes abdominal discomfort.

3 Rationale: 1. Mood disorders often accompany the diagnosis of bulimia nervosa, but the client symptoms described in the question do not reflect a mood disorder. 2. Nutritional deficits are characteristic of bulimia nervosa, but the client symptoms described in the question do not reflect a nu- tritional deficit. 3. Purging behaviors, such as vomiting, may lead to dehydration and electrolyte imbal- ance. Hallucinations and restlessness can be signs of electrolyte imbalance. Dry mu- cos membranes indicate dehydration. 4. Binging large quantities of food can cause ab- dominal discomfort, but the client symptoms described in the question do not reflect ab- dominal discomfort.

A child is prescribed glargine insulin. What information would the nurse include when teaching the child and parents about this insulin? 1. Store the insulin in the refrigerator until just before giving it. 2. Discard any opened vials after a week. 3. "Do not mix this insulin with other insulins." 4. "Give the dose first thing in the morning."

3 Rationale: Glargine (Lantus) is a long-acting insulin and is not to be mixed with other insulins. Glargine is usually given in a single dose at bedtime. Insulin should be kept at room temperature; insulin that is administered cold may increase discomfort with the injection. Any vial of insulin that is opened should be discarded after 1 month.

A 13-year-old with type 2 DM asks the nurse, "Why do I need to have this hemoglobin A1c test?" The nurse's response is based on which of the following? 1. To determine how balanced the child's diet has been. 2. To make sure the child is not anemic. 3. To determine how controlled the child's blood sugar has been. 4. To make sure the child's blood ketone level is normal.

3 Rationale: HgA1c reflects average blood glucose levels over 2-3 months. Frequent hyperglycemic levels would result in a higher A1c, suggesting that blood glucose levels need to be in better control.

A 12-year-old with type 2 DM presents with a fever and a 2 day history of vomiting. The nurse notices that the child's breath has a fruity odor too it, and her breathing is deep and rapid. Which should the nurse do FIRST? 1. Offer the child 8 oz of a noncaloric, clear fluid. 2. Test the child's urine for ketones. 3. Prepare the child for an IV infusion. 4. Offer the child 25 g of carbohydrates.

3 Rationale: This patient needs fluid and electrolyte therapy to restore tissue perfusion, prior to administering IV insulin therapy first. Although it is likely that ketones would be present, the child is in a life-treating situation. Checking the urine is not necessary.

What time would the nurse most likely see signs and symptoms of hypoglycemia after administering NPH insulin at 0730? 1. 0930-1030 2. 1130-1430 3. 1130-1930 4. 1530-1930

3 Rationale: Peak time for NPH insulin is 4-12 hours. Peak time for regular insulin is 2-3 hours, for semilente insulin is 4-7 hrs, and lent insulin is 8-12 hours.

A group of students are reviewing information about oral diabetes agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver? 1. Nateglinide 2. Glipizide 3. Metformin 4. Glyburide

3 Rationale: Metformin, a biguanide, reduces glucose production from the liver. Glipizide stimulates insulin secretion by increasing the response of β cells to glucose. Glyburide stimulates insulin secretion by increasing the response of β cells to glucose. Nateglinide stimulates insulin secretion by increasing the response of β cells to glucose.

Which would the school nurse expect in a student who has an insulin-to-carbohydrate ratio of 1:10? 1. The student administers 10 U of regular insulin for every gram of carbohydrate consumed. 2. The student is trying to limit carbohydrate intake to 10 g per insulin dose. 3. The student administers 1 U of regular insulin for every 10 grams of carbohydrate consumed. 4. The student plans to eat 10 g of carbohydrate for every dose of insulin.

3 Rationale: An insulin to carb ratio refers to the amount of insulin (1 unit) given per gram of carbohydrate (10 g).

After a routine dental examination on an adolescent, the dentist reports to the parents that bulimia nervosa is suspected. On which of the following assessment data would the dentist base this determination? Select all that apply. 1. Extreme weight loss. 2. Amenorrhea. 3. Discoloration of dental enamel. 4. Bruises of the palate and posterior pharynx. 5. Dental enamel dysplasia.

3 4 5 1. Clients with bulimia nervosa can maintain a normal weight. Extreme weight loss would be a symptom of anorexia nervosa, not bulimia nervosa. 2. Amenorrhea, due to estrogen deficiencies, is a symptom of anorexia nervosa, not bulimia nervosa. A dentist would not be in a position to evaluate this symptom during a routine dental examination. 3. A client diagnosed with bulimia nervosa may show evidence of dental discoloration due to the presence of acidic gastric juices in the oral cavity during frequent vomiting. 4. Bruises of the palate and posterior phar- ynx occur because of continual vomiting owing to purging behaviors by clients di agnosed with bulimia nervosa. This would be an indication to the dentist that bulimia nervosa should be suspected. 5. Dental enamel dysplasia occurs because of the presence of gastric juices in the mouth from continual vomiting owing to purging behaviors by the client diagnosed with bulimia nervosa. This would be an indication to the dentist that bulimia nervosa should be suspected.

A 9-year-old has just been diagnosed with diabetes mellitus type 1. Which should the child be taught in order to increase his self-management of his disease? 1. Testing his blood sugar. 2. Administering the insulin. 3. Managing his diet. 4. Understanding his disease.

4 Rationale: A 9-year-old should be able to understand about his disease in basic terms first and then learn about the management.

Which developmental characteristic would be expected of an individual with an IQ level of 40? 1. Independent living with assistance during times of stress. 2. Academic skill to the sixth-grade level. 3. Little, if any, speech development. 4. Academic skill to the second-grade level.

4 1. Independent living with assistance during times of stress would be a developmental char- acteristic expected of an individual diagnosed with mild IDD (IQ level 50 to 70), not of an individual diagnosed with moderate IDD. 2. Academic skill to the sixth-grade level would be a developmental characteristic expected of an individual diagnosed with mild IDD (IQ level 50 to 70), not of an individual diagnosed with moderate IDD. 3. Little, if any, speech development would be a developmental characteristic expected of an individual diagnosed with profound IDD (IQ level <20), not of an individual diagnosed with moderate IDD. 4. An IQ level of 40 is within the range of moderate IDD (IQ level 35 to 49). Aca- demic skill to the second-grade level would be a developmental characteristic expected of an individual in this IQ range.

The nurse on an in-patient pediatric psychiatric unit is admitting a client diagnosed with autism spectrum disorder. Which would the nurse expect to assess? 1. A strong connection with siblings. 2. An active imagination. 3. Abnormalities in physical appearance. 4. Absence of language.

4 1. The nurse would expect to note a disconnection, not a connection, with siblings when assessing a child diagnosed with an autism spectrum disorder. Autism spectrum disorder usually is first noticed by the mother when the infant fails to be interested in, or socially responsive to, others. 2.The nurse would expect to note a lack of spontaneous make-believe and imaginative play with no active imagination ability when assessing a child diagnosed with an autism spectrum disorder. These children have a rigid adherence to routines and rituals, and minor changes can produce catastrophic reactions. 3. The nurse would assess a normal, not abnor- mal, physical appearance in a child diagnosed with autism spectrum disorder. These children have a normal appearance; however, on closer observation, no eye contact or facial expression is noted. 4. One of the first characteristics that the nurse would note is the client's abnormal language patterning or total absence of language. Children diagnosed with autism spectrum disorder display an uneven development of intellectual skills. Impairments are noted in verbal and nonverbal communication. These children cannot use or understand abstract language, and they may make unintelligible sounds or say the same word repeatedly.

The nurse is caring for a child who has been hospitalized repeatedly at multiple hospitals. There is no clear medical diagnosis and the parent is threatening to leave the hospital against medical advice. The nurse suspects what issue? 1. Sexual abuse 2. Anxiety disorder 3. Bipolar disorder 4. Medical child abuse

4 Rationale: Repeated hospitalizations that fail to produce a medical diagnosis, transfers to other hospitals, and discharges against medical advice are warning signs of Medical child abuse (Münchhausen syndrome by proxy).

The nurse is caring for a child with attention deficit hyperactivity disorder (ADHD) who is experiencing insomnia related to the prescribed psychostimulant. The parents are considering stopping the medication and want to know if there are other options. Which response by the nurse would be most appropriate? 1. "Perhaps the health care provider will prescribe long-acting dextroamphetamine." 2. "Talk to the health care provider about dextroamphetamine." 3. "Speak to the healthcare provider about atomoxetine." 4. "Ask the health care provider about long-acting methylphenidate."

4 Rationale: The nurse could suggest that the parents speak to the healthcare provider about atomoxetine, a nonstimulant norepinephrine reuptake inhibitor that does not contribute to insomnia. Dextroamphetamine, long-acting dextroamphetamine, and long-acting methylphenidate are psychostimulants; the child is already taking a psychostimulant and having difficulty with insomnia, so these would not be good options.

The nurse is describing some of the developmental milestones the parent of a 3-month-old infant with trisomy 21 (Down syndrome) can expect to see in the child. Which statement describes the milestones that are expected in a child with this genetic disorder? 1. "Your child will be speaking in sentences at 21 months of age." 2. "Bladder training can be expected by 2.5 to 3 years of age." 3. "Your child will be crawling all over the house by 9 months of age." 4. "You can expect your child to eat with the hands by age 12 months."

4 Rationale: Children with trisomy 21 (Down syndrome) will accomplish eating with their hands by about 12 months of age. They will develop the skills of typical children, but at an older age. The child with Down syndrome will speak in sentences at 24 months rather than 21 months. Bladder training would occur by 48 months rather than 32 months. A child with Down syndrome will crawl at 11 months rather than 9 months.

The nurse is caring for a 10-year-old child recently diagnosed with attention deficit hyperactivity disorder (ADHD). The nurse would expect to provide teaching regarding which medication? 1. Fluoxetine 2. Buspirone 3. Trazodone 4. Methylphenidate

4 Rationale: Methylphenidate is a psychostimulant commonly prescribed for ADHD. Trazodone is used to treat depression. Buspirone is used for anxiety. Fluoxetine is used for depression.

The use caring for a client with type 1 DM is teaching how to self-administer insulin. Which is the proper injection technique? 1. Position the needle with the bevel facing downward before injection 2. Spread the skin prior to intramuscular injection. 3. Aspirate for blood return prior to injection. 4. Elevate the subcutaneous tissue before injection.

4 1. Correct needle position is with the bevel facing upward. 2. Injection is subcutaneous, so tissue is not spread as it would be for intramuscular injection. 3. Aspiration for blood is not recommended for subcutaneous injections. 4. Skin tissue is elevated to prevent injection into the muscle when giving a subcutaneous injection. Insulin is given only subcutaneously.

A client diagnosed with anorexia nervosa is newly admitted to an in-patient psychiatric unit. Which intervention takes priority? 1. Assessment of family issues and health concerns. 2. Assessment of early disturbances in mother-infant interactions. 3. Assessment of the client's knowledge of selective serotonin reuptake inhibitors (SSRIs) used in treatment. 4. Assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems.

4 1. It is important to assess family issues and health concerns, but because of the critical nature of physical problems experienced by clients diagnosed with anorexia nervosa, this intervention is not prioritized. 2. It is important to assess early disturbances in mother-infant interactions, but because of the critical nature of physical problems ex- perienced by clients diagnosed with anorexia nervosa, this intervention is not prioritized. 3. It is important to assess the client's previous knowledge of SSRIs before any teaching, but because of the critical nature of physical problems experienced by clients diagnosed with anorexia nervosa, this intervention is not prioritized. 4. The immediate priority of nursing inter- ventions in eating disorders is to restore the client's nutritional status. Complica- tions of emaciation, dehydration, and electrolyte imbalance can lead to death. The assessment and monitoring of vital signs and lab values to recognize and an- ticipate these medical problems must take priority. When the physical condition is no longer life threatening, other treatment modalities may be initiated.

The nurse is teaching the family about caring for their 7-year-old, who has been diagnosed with type 1 DM. What information should the nurse provide about this condition? 1. Best managed through diet, exercise, and oral medication. 2. Can be prevented by proper nutrition and monitoring blood glucose levels. 3. Characterized mainly by insulin resistance. 4. Characterized mainly by insulin deficiency.

4 1. Type 2 DM is best managed by diet, exercise, and oral medication. 2. Proper diet and monitoring blood glucose are important in type 1 DM, but DM is characterized by insulin deficiency. 3. Although insulin resistance can be one of the factors in type 1 DM, it is not the primary factor. 4. Individuals with type 1 DM do not pro duce insulin. If one does not produce insulin, type 1 DM is the diagnosis.

Which statement best describes the pharmacodynamics of insulin? 1. Insulin causes the pancreas to secrete glucose into the blood stream. 2. Insulin is metabolized by the liver and muscle and excreted into the urine. 3. Insulin is needed to maintain colloidal osmotic pressure in the blood stream. 4. Insulin lowers blood glucose by promoting the use of glucose in the body cells.

4 Rationale: The pancreas does not secrete glucose, it secretes insulin, which is the key that opens the door to allow glucose to enter the body cells. Glucose enters the body through the GI system.

The nuise is caring for a child who complains of constant hunger, constant thirst, frequent urination, and recent weight loss without dieting. Which can the nurse expect to be included in care for this child? 1. Limiting daily fluid intake. 2. Weight management consulting. 3. Strict intake and output monitoring. 4. Frequent blood glucose testing.

4 1. Limiting fluids is appropriate for a child presenting with the symptoms of DI, not DM. 2. Weight loss without the other presenting symptoms might be indicative of a need for a weight/nutrition consult. 3. Strict intake and output monitoring is included in the care of a child with DI. 4. Frequent blood glucose testing is included in the care of a child with type 1 DM. The symptoms described in the question are characteristic of a child just prior to the diagnosis of type 1 DM.

What is the reason a student takes metformin (Glucophage) three times a day? 1. Type 1 DM 2. DI 3. IBS 4. Type 2 DM

4 Rationale: Metformin is commonly used to manage type 2 DM (oral agent). Type 1 DM is managed with insulin, not oral agents.

The parent of a 12-year-old client is concerned about the dangers of the Internet. Which suggestion by the nurse best targets safety related to this? 1. Use the phone for interacting with others. 2. Limit daily the time spent online. 3. Avoid putting a computer in a child's room. 4. Never share personal information online.

4 Rationale: Protecting personal information is key to computer safety. Having the computer in a common family area allows adults to monitor the child's activities and promotes some level of safety. Limiting time spent online is a wise overall strategy to encourage physical activity but not safety. Using the phone also limits computer time but does not address safety.

The nurse in the medical department is preparing to administer insulin lispro to a client diagnosed with type 1 DM. Which intervention should the nurse implement? 1. Ensure the client is wearing a MedicAlert Bracelet 2. Administer the dose according to the regular insulin sliding scale. 3. Assess the patient for hyperosmolar, hyperglycemic, and nonketoic coma. 4. Make sure the client eats the food on the meal tray that is at the bedside.

4 Insulin lispro (Humaglog) peaks in 30 minutes to 1 hour; therefore, the client needs to eat when or shortly after the insulin is administered to prevent hypoglycemia.