PEDs endocrine ?'s

The most appropriate nursing diagnosis for a patient with type I 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. Risk for infection is a correct nursing diagnosis. Understanding DM is un derstanding the effect it has on periph eral circulation and impairment of defense mechanisms.

The nurse is working on the pediatric floor, caring for an infant who is very fussy and has a diagnosis of DI. Which parameter should the nurse monitor while the infant is on fluid restrictions? 1. Oral intake. 2. Urine output. 3. Appearance of the mucous membranes. 4. Pulse and temperature.

2 It is crucial to monitor and record urine output. The infant with DI has hypose cretion of ADH, and fluid restriction has little effect on urine formation. This in fant is at risk for dehydration and for fluid and electrolyte imbalances.

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

2. Milk is best to give for mild hypo glycemia, which would present with the symptoms described.

A school-age child is being assessed for syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should watch the child for which symptoms? Select all that apply. 1. Polyphagia 2. Retention of fluid 3. Hypernatremia 4. Hyponatremia 5. Hyperglycemia

2. Retention of fluid 3. Hypernatremia

A student has an insulin-to-carbohydrate ratio of 1:10. The school nurse understands which of the following? 1. The student administers 10 U of regular insulin for every carbohydrate consumed. 2. The student is trying to limit carbohydrate intake to 10 g per 24 hours. 3. The student administers 1 U of regular insulin for every 10 carbohydrates consumed. 4. The student plans to eat 10 g of carbohydrate for every gram of fat or protein.

3. An insulin-to-carbohydrate ratio refers to the amount of insulin given per gram of carbohydrate. A ratio of 1:5 means 1 U for every 5 carbohydrates.

A 12-year-old with type II DM presents with a fever and a 2-day history of vomiting. The nurse obtaining the history observes that the child's breath has a fruity odor and breathing that is deep and rapid. The nurse should do which of the following? 1. Offer the child 8 oz of clear non-caloric 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. This patient needs fluid and electrolyte therapy to restore tissue perfusion prior to beginning IV insulin therapy.

The nurse caring for a 14-year-old girl with DI understands which of the following about this disorder? 1. DI is treated on a short-term basis with hormone replacement therapy. 2. DI may cause anorexia if proper meal planning is not addressed. 3. DI is treated with vasopressin on a lifelong basis. 4. DI requires strict fluid limitation until it resolves.

3. Vasopressin is the treatment of choice. It is important for patients and parents to understand that DI is a lifelong disease.

The family of a young child has been told the child has DI. What information should the nurse emphasize to the family? 1. One caregiver needs to learn to give the injections of vasopressin (Pitressin). 2. Children should wear MedicAlert tags if they are over 5 years old. 3. DI is different from DM. 4. Over time, the child may grow out of the need for medication.

3. Explaining that DI is different from DM is crucial to the parents' under standing of the management of the dis ease. DI is a rare condition that affects the posterior pituitary gland, whereas DM is a more common condition that affects the pancreas.

The nurse caring for a patient with type I DM is teaching how to self-administer insulin. The proper injection technique is which of the following? 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. Skin tissue is elevated to prevent injection into the muscle when giving a subcutaneous injection. Insulin is only given subcutaneously.

. A 7-year-old is tested for DI. Twenty-four hours after his fluid restriction has begun, the nurse notes that his urine continues to be clear and pale, with a low specific gravity. The most likely reason for this is which of the following? 1. Twenty-four hours is too early to evaluate effects of fluid restriction. 2. The urine should be concentrated, and it is unlikely the child has DI. 3. The child may have been sneaking fluids and needs closer observation. 4. In DI, fluid restriction does not cause urine concentration.

4. Children with DI cannot concentrate urine.

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

4. Individuals with type I DM do not pro duce insulin. If one does not produce insulin, type I DM is the diagnosis.

You are going over insulin administration education with a patient's mother. Which statement by her raises concern? A. "When she is sick I will hold her insulin." B."I always carry sugary items in case she has a hypoglemic attack." C. "I will bring her in every 3 months for a glycosylate hemoglobin blood drawn." D. "I ordered her a Medic-Alert bracelet yesterday."

A. When a diabetic is sick, they should never hold their insulin. This is because when the body is stressed or has an infection they are at a very high risk for hyperglycemia so it is essential they monitor their blood glucose closely and administer

The nurse knows that diabetic teaching has been effective when parents of a newly diagnosed child state they will, during an illness, prove the child with: A. more insulin B. more calories C. less insulin D. less protein

A. more insulin Illness causes greater insulin resistance, so more is needed to achieve normal blood glucose levels. Increased calorie intake will be ineffective without more insulin to assist the body with metabolizing those calories. Restricting protein is not recommended, but during illness, fluids and light carbohydrates are usually tolerated best.

Nursing care of a child diagnosed with a syndrome of inappropriate ADH should include which of the following? (Select all that apply.) a. Weigh daily b. Encourage fluids c. Turn frequently d. Maintain nothing by mouth (NPO) e. Restrict fluids

ANS: A, E Increased secretion of ADH causes the kidney to reabsorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids. The child should also be weighed at the same time each day. Encouraging fluids will worsen the child's condition. Turning frequently is not an appropriate intervention unless the child is unresponsive. Fluids, not food, should be restricted.

A nurse is caring for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which laboratory test would the nurse be least likely to obtain? A) Urine specific gravity. B) Blood glucose. C) Serum sodium. D) Urine osmolality.

B) Blood Glucose Obtaining a blood glucose level is not expected for a child diagnosed with SIADH since the priority measures involve blood and urine osmolality. Blood glucose is a likely laboratory test in a child with diabetes insipidus.

Which laboratory finding would reflect a critical assessment in a child who has been diagnosed with Syndrome of Inappropriate Anti-Diuretic hormone (SIADH)? A. Plasma osmolality 275 mOsmol/L B. Serum sodium 120 mEq/L C. Potassium level 3.5 mEq/L D. Plasma osmolality 295 mOsmol/L

B. A serum sodium level of 120 mEq/L indicates severe hyponatremia which in a patient who has SIADH is correlated with onset of severe neurological symptoms. All of the other lab values are within normal range.

A student with type I diabetes mellitus complains of feeling lightheaded. Her blood sugar is 60 mg/dL. Using the 15/15 rule, the nurse should: A. give 15 mL of juice, and repeat does in 15 minutes B. give 15 grams of carbohydrates and retest blood sugar in 15 minutes C. Give 15 grams of carbohydrates and 15 g of protein D. Give 15 ounces of juice and retest blood sugar in 15 minutes

B. give 15 grams of carbohydrates and retest blood sugar in 15 minutes 15/15 rule states to give 15 g of carbohydrates (approx 60 calories; roughly 4 oz of juice or a tablespoon of honey or sugar). Protein by itself will treat hypoglycemia. Only 15 mL of juice does not contain enough calories to increase the blood sugar. Fifteen oz of juice nearly 4 times the recommended amount

A mother brings her child in the office for a follow-up appointment and voices concern that her child has started urinating more than normal and is constantly thirsty & hungry. As the RN, you suspect?* A. Hypoglyemia B. Phenylkentonuria C. Diabetes Mellitus D. Tret's syndrome

C. The symptoms the mother is reports are the classic 3 P's of diabetes: polyuria, polydipsia, polyphagia

The nurse is providing education to a pediatric client diagnosed with diabetes. Will be playing soccer over the summer. Which change in the client's management will the nurse explore during this education session? 1. Increased food intake 2. Decreased food intake 3. Increased need for insulin 4. Decreased risk of insulin reaction

Correct Answer: 1 Rationale 1: Increased physical activity requires adequate caloric intake to prevent hypoglycemia, so food intake should be increased. Increased activity would not require decreased food intake, and it would not result in a decreased risk of insulin reaction. Exercise causes the insulin to be used more efficiently, so increased insulin would not be needed.

School-age client diagnosed with diabetes insipidus (DI) admitted to the pediatric unit. Which lab value does the nurse anticipate for this client based on the diagnosis? 1. Hyperglycemia 2. Hypernatremia 3. Hypercalcemia 4. Hypoglycemia

Correct Answer: 2 Rationale 1: In all forms of diabetes insipidus, serum sodium can increase to pathologic levels, so hypernatremia can occur and should be treated. The glucose level is not affected, so hypoglycemia or hyperglycemia is not caused by the diabetes insipidus. Hypercalcemia (high calcium) does not occur with this endocrine disorder.

Pediatric client is admitted to hospital unconscious. The client has a history of type 1 diabetes, and according to the client's mother, has been to two birthday parties in the last few days and has resisted taking the prescribed insulin. At school the client had two more pieces of birthday cake and some ice cream at a class birthday party. What is the likely reason for this client's unconscious state? 1. Metabolic alkalosis 2. Metabolic ketoacidosis 3. Insulin shock 4. Insulin reaction

Correct Answer: 2 Rationale 1: Metabolic acidosis or ketoacidosis could have occurred because of the excessive intake of sugar with no additional insulin. The body burns fat and protein stores for energy when no insulin is available to metabolize glucose. Altered consciousness occurs as symptoms progress. Metabolic alkalosis, insulin shock, or insulin reaction would not be happening in this case.

The nurse is teaching the parent of a type 1 diabetic preschool-age client about management of the disease. Which teaching point is appropriate for the nurse to include in this session? 1. Allowing the client to administer all the insulin injections 2. Allowing the client to choose which finger to stick for glucose testing 3. Allowing the client to draw up the insulin dose 4. Allowing the client to test blood glucose

Correct Answer: 2 Rationale 1: The preschool-age client's need for autonomy and control can be met by allowing the client to pick which finger to stick for glucose testing. Administering the insulin, drawing up the dose, and testing blood glucose should not be done by the client until he or she is middle-school age or older.

Nurse conducting a daily weight on a pediatric client diagnosed with diabetes insipidus. Notes the child has lost two pounds in 24 hours. Which action by the nurse is the most appropriate? 1. Continue to monitor the child. 2. Notify the healthcare provider regarding the weight loss. 3. Chart the weight and report the loss to the next shift. 4. Do nothing more than chart the weight, as this would be a normal finding.

Correct Answer: 2 Rationale 1: With diabetes insipidus, the child may have severe fluid-volume deficit. A weight loss of two pounds indicates a loss of one liter of fluid, so the healthcare provider should be notified and fluids replaced either orally or intravenously. This is a significant loss in a 24-hour period, so continuing to monitor, charting the weight and reporting to the next shift, and doing nothing would prolong treatment.

The nurse is caring for a pediatric client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) disorder. Which interventions should the nurse implement for this child?Standard Text: Select all that apply. 1. Encouragement of fluids 2. Strict intake and output 3. Administration of ordered diuretics 4. Specific gravity of urine 5. Weight only on admission but not daily

Correct Answer: 2,3,4 SIADH results from an excessive amount of serum antidiuretic hormone, causing water intoxication and hyponatremia. Intake and output should be monitored strictly. Diuretics such as furosemide (Lasix) are administered to eliminate excess body fluid, and urine specific gravity is monitored. Fluids are restricted to prevent further hemodilution. Daily weights should be obtained to monitor fluid balance.

pediatric client is diagnosed with type 1 diabetes. Nurse teaches the client the difference between insulin shock and diabetic hyperglycemia. The nurse evaluates that the client understands the teaching when the client states which characteristics of diabetic hyperglycemia? 1. Tremors and lethargy 2. Hunger and hypertension 3. Thirst and flushed skin 4. Shakiness and pallor

Correct Answer: 3 Rationale 1: Thirst and flushed skin are characteristic of diabetic hyperglycemia. Tremors, lethargy, hunger, shakiness, and pallor are characteristic of hypoglycemia. Hypertension is not a sign associated with hyperglycemia or hypoglycemia.

The nurse is administering a dose of rapid-acting insulin at 0800 to an insulin-dependent pediatric client. Based on when the insulin peaks, when will the client be at greatest risk for a hypoglycemic episode? 1. At about noon 2. Between bedtime and breakfast the next morning 3. Between lunch and dinner 4. Around 0930

Correct Answer: 4 Rationale 1: Rapid-acting insulin peaks 30-90 minutes after administration. An injection given at 0800 would peak around 0930.

A patient with a history is diabetes is exhibiting sweating and slurred speech. What do you suspect is the cause? A. hyponaterima B. hypernaterima C.hyperglycemia D. hypoglycemia

D These are the classic symptoms of hypoglycemia.

A child is ordered by the doctor for ketone and glucose urine testing. The patient is to collect it at home. How would you instruct the patient to collect the specimen?* A. Cleanse the area with betadine. B. Encourage the patient to consume at least 24 oz of water prior to the specimen collection. C. Demonstrate a clean catch techinque. D. Use the second voided urine for most accurate results.

D. The patient should use the second voided urine to ensure that the results are accurate. First voided urines tend to be concentrated and could effect results.

A 17-year-old is diagnosed with syndrome of inappropriate antidiuretic hormone (childhood SIADH) due to a brain tumor. What nursing care is indicated in the care of this adolescent? a. Maintaining a balanced intake and output and a urine specific gravity between 1.010 and 1.020. b. Preventing any weight gain due to fluid retention and any elevation of sodium levels. c. Keeping the urine specific gravity between 1.020 and 1.030 and prevention of respiratory infections. d. Restoring protein loss and replenishing the decreased erythrocyte level.

a. Maintaining a balanced intake and output and a urine specific gravity between 1.010 and 1.020. Essential care includes maintaining a balanced intake and output, a urine specific gravity between 1.010 and 1.020, and reducing fluid intake initially. Daily weights and a diet with increased sodium are indicated but not salty foods that can cause increased thirst. Weight gain is seen early in the illness, and elevated sodium levels are desired. The urine specific gravity should be between 1.010 and 1.020. Respiratory infections are not an issue with SIADH. Protein loss is not an issue; loss of sodium is. Erythrocytes are not involved with this condition.

A nursing intervention for a child with SIADH is to: a.Offer fluids frequently to increase fluid intake. b.Explain the reason for restricting fluids c.Assist the child in selecting low-sodium foods. d.Assess the child for dehydration.

b.Explain the reason for restricting fluids