Endocrine - Peds Exam 4
The physician has ordered a thyroid scan to confirm the diagnosis. Before the procedure the nurse should: a) Tell the client they will be asleep. b) Give the client a bolus of fluids. c) Insert a urinary catheter. d) Assess the client for allergies.
Assess the client for allergies. Uses iodine.
The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. What should be included in the teaching plan for daily injections? a. The parents do not need to learn the procedure. b. He is old enough to give most of his own injections. c. Self-injections will be possible when he is closer to adolescence. d. He can learn about self-injections when he is able to reach all injection sites.
B School-age children are able to give their own injections. Parents should participate in learning and giving the insulin injections. He is already old enough to administer his own insulin. The child is able to use thighs, abdomen, part of the hip, and arm. Assistance can be obtained if other sites are used.
Which nursing objective is most important when working with neonates who are suspected of having congenital hypothyroidism? a) Promoting bonding b) Encouraging fluid intake c) Early identification d) Allowing rooming in
Early identification
A nurse is teaching an adolescent with type 1 diabetes about the disease. Which instruction by the nurse about how to prevent hypoglycemia would be most appropriate for the adolescent? a) "Increase the insulin dosage before planned or unplanned strenuous exercise." b) "Check your blood glucose level before exercising, and eat a protein snack if the level is elevated." c) "Carry crackers or fruit to eat before or during periods of increased activity." d) "Limit participation in planned exercise activities that involve competition."
"Carry crackers or fruit to eat before or during periods of increased activity."
The nurse is teaching a 12-year-old girl with diabetes mellitus type 2 and her parents about dietary measures to control her glucose levels. Which comment by the child indicates a need for additional teaching? a) "We should give her nonfat milk to drink." b) "I will be eating more breads and cereals." c) "I can have an apple or orange for snacks." d) "I can eat two small cookies with each meal."
"I can eat two small cookies with each meal."
After explaining the causes of hypothyroidism to the parents of a newly diagnosed infant, the nurse should recognize that further education is needed when the parents ask which question? a) "So, hypothyroidism can be only temporary, right?" b) "Are you saying that hypothyroidism is caused by a problem in the way the thyroid gland develops?" c) "So, hypothyroidism can be treated by exposing our baby to a special light, right?" d) "Do you mean that hypothyroidism may be caused by a problem in the way the body makes thyroxine?"
"So, hypothyroidism can be treated by exposing our baby to a special light, right?"
The nurse is implementing care for a school-age child admitted to the pediatric intensive care in diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first? a. Begin 0.9% saline solution intravenously as prescribed. b. Administer regular insulin intravenously as prescribed. c. Place child on a cardiac monitor. d. Place child on a pulse oximetry monitor.
A All patients with DKA experience dehydration (10% of total body weight in severe ketoacidosis) because of the osmotic diuresis, accompanied by depletion of electrolytes (sodium, potassium, chloride, phosphate, and magnesium). The initial hydrating solution is 0.9% saline solution. Insulin therapy should be started after the initial rehydration bolus because serum glucose levels fall rapidly after volume expansion. The child should be placed on the cardiac and pulse oximetry monitors after the rehydrating solution has been initiated.
The school nurse notes that a child diagnosed with diabetes mellitus is experiencing an insulin reaction and is unable to eat or drink. Which action would be the most appropriate for the school nurse to do? a) Request that someone call 911 b) Anticipate that the child will need intravenous glucose c) Dissolve a piece of candy in the child's mouth d) Administer subcutaneous glucagon
Administer subcutaneous glucagon
To help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence? a. Desire to be unique b. Preoccupation with the future c. Need to be perfect and similar to peers d. Need to make peers aware of the seriousness of hypoglycemic reactions
C Adolescence is a time when the individual wants to be perfect and similar to peers. Having diabetes makes adolescents different from their peers. Adolescents do not wish to be unique; they desire to fit in with the peer group and are usually not future oriented. Forcing peer awareness of the seriousness of hypoglycemic reactions would further alienate the adolescent with diabetes. The peer group would focus on the differences.
Which symptom is considered a cardinal sign of diabetes mellitus? a. Nausea c. Impaired vision b. Seizures d. Frequent urination
D Hallmarks of diabetes mellitus are glycosuria, polyuria, and polydipsia. Nausea and seizures are not clinical manifestations of diabetes mellitus. Impaired vision is a long-term complication of the disease.
The nurse is discussing various sites used for insulin injections with a child and her family. Which site usually has the fastest rate of absorption? a. Arm c. Buttock b. Leg d. Abdomen
D The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration
A child is prescribed glargine (Lantus) insulin. What information would the nurse include when teaching the child and parents about this insulin? a) Discard any opened vials after a week. b) Do not mix this insulin with other insulins. c) Store the insulin in the refrigerator until just before giving it. d) Give the dose first thing in the morning.
Do not mix this insulin with other insulins.
After hospital discharge, the mother of a child newly diagnosed with type 1 diabetes mellitus telephones you because her daughter is acting confused and very sleepy. Which emergency measure would the nurse suggest the mother carry out before she brings the child to see her doctor? a) Give her a glass of orange juice. b) Give her nothing by mouth so that a blood sugar can be drawn at the doctor's office. c) Give her a glass of orange juice with one unit regular insulin in it. d) Give her one unit of regular insulin.
Give her a glass of orange juice.
The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which instruction does not focus on glucose management? a) Promoting higher levels of exercise than previously maintained b) Teaching that 50% of daily calories should be carbohydrates c) Encouraging the child to maintain the proper injection schedule d) Instructing the child to rotate injection sites
Instructing the child to rotate injection sites
The nurse is assessing a 7-year-old girl with a headache, irritability, and vomiting. Her health history reveals she has had meningitis. Which intervention is priority? a) Notifying the physician of the neurologic findings b) Monitoring urine volume and specific gravity c) Setting up safety precautions to prevent injury d) Restoring fluid balance with IV sodium
Notifying the physician of the neurologic findings
In interpreting the negative feedback system that controls endocrine function, the nurse correlates how _______ secretion is decreased as blood glucose levels decrease. a) Insulin b) Glucagon c) Adrenocorticotropic hormone d) Glycogen
Insulin
Question: Rank the different types of insulin based on their duration of action beginning with the shortest to the longest duration. 1 Humulin N 2 Lantus 3 Humulin R 4 Lispro
Lispro Humulin R Humulin N Lantus
Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism? a) High thyroxine (T4) level and low thyroid stimulating hormone (TSH) level b) Normal T4 level and low TSH level c) Low T4 level and high TSH level d) Normal TSH level and high T4 level
Low T4 level and high TSH level
A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver? a) Metformin b) Glyburide c) Glipizide d) Nateglinide
Metformin
The nurse is interviewing the caregivers of a child admitted with a diagnosis of type 1 diabetes mellitus. The caregiver states, "The teacher tells us that our child has to use the restroom many more times a day than other students do." The caregiver's statement indicates the child most likely has: a) Polyuria b) Polydipsia c) Polyphagia d) Pica
Polyuria
The nurse is caring for a 3-year-old diagnosed with diabetes mellitus. The child's eating patterns are unpredictable. One day the child will eat almost nothing, the next day the child eats everything on her tray. The nurse recognizes that this type of insulin would most likely be used in treating this child? a) Intermediate-acting insulin b) Long-acting insulin c) Rapid-acting insulin d) Regular insulin
Rapid-acting insulin
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? a) Regular insulin b) Detemir c) Lispro d) NPH
Regular insulin Insulin for diabetic ketoacidosis is given intravenously. Only regular insulin can be administered by this route.
The nurse is caring for a 12-year-old girl with hypothyroidism. Which information should be part of the nurse's teaching plan for the child and family? a) How to maintain fluid intake regimens b) Reporting irritability or anxiety c) Administering methimazole with meals d) How to recognize vitamin D toxicity
Reporting irritability or anxiety
A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which method should she recommend to the child for regular doses? a) Subcutaneously in the outer thigh b) Intradermally in the outer arm c) Intramuscularly in the abdomen d) Intravenously in the chest
Subcutaneously in the outer thigh
The most common mixture of insulin used with children with type 1 diabetes mellitus is a combination of an intermediate-acting insulin and a regular insulin, usually in a 2:1 ratio or 0.75 units of the intermediate-acting insulin to 0.33 units regular insulin, and given in the same syringe. a) False b) True
True
A 7-year-old is diagnosed as having type 1 diabetes. One of the first symptoms usually noticed by parents when this illness develops is a) swelling of soft tissue. b) loss of weight. c) craving for sweets. d) severe itching.
loss of weight.
Insulin deficiency, increased levels of counter regulatory hormones, and dehydration are the primary causes of: a) ketonuria. b) diabetic ketoacidosis. c) glucosuria. d) ketone bodies.
diabetic ketoacidosis.
The nurse is teaching a child with type 1 diabetes mellitus to administer her own insulin. The child is receiving a combination of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when she: a) administers the insulin into a doll at a 30-degree angle. b) draws up the short-acting insulin into the syringe first. c) wipes off the needle with an alcohol swab. d) administers the insulin intramuscularly into rotating sites.
draws up the short-acting insulin into the syringe first.
Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? a. Moist skin c. Fluid overload b. Weight gain d. Poor wound healing
D Poor wound healing is often an early sign of type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus.
Manifestations of hypoglycemia include: a. Lethargy. c. Nausea and vomiting. b. Thirst. d. Shaky feeling and dizziness.
D Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, thirst, and nausea and vomiting are manifestations of hyperglycemia.
Kate and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true? a) "This will rectify itself if you follow all of the doctor's directions." b) "You are lucky that you did not have to learn how to give yourself a shot." c) "A weight-loss program should be implemented and maintained." d) "Kids can usually be managed with an oral agent, meal planning, and exercise."
"Kids can usually be managed with an oral agent, meal planning, and exercise."
The nurse is teaching a 9-year-old girl with diabetes mellitus type 1 and her parents about blood glucose monitoring. Which comment indicates a need for additional teaching? a) "I should check my glucose more often if I'm sick." b) "I should check my glucose before meals." c) "The normal level for her is 70 to 110 mg/dL before meals." d) "The normal level for her is 100 to 180 mg/dL before bedtime."
"The normal level for her is 70 to 110 mg/dL before meals." the proper level for a 9-year-old child with type 1 diabetes is 80 to 150 mg/dL. The normal blood glucose level for a 7-year-old child with type 1 diabetes is 90 to 180 mg/dL before meals
When collecting data on a child diagnosed with diabetes mellitus, the nurse notes that the child has had weight loss and other symptoms of the disease. The nurse would anticipate which finding in the child's fasting glucose levels? a) 75 mg/dL b) 180 mg/dL c) 60 mg/dL d) 100 mg/dL
180 mg/dL
The clinic nurse is reviewing hemoglobin A1c levels on several children with type 1 diabetes. Hemoglobin A1c levels of less than _____ % are a goal for children with type 1 diabetes. Record your answer as a whole number.
7 The measurement of glycosylated hemoglobin (hemoglobin A1c) levels is a satisfactory method for assessing control of type 1 diabetes. As red blood cells circulate in the bloodstream, glucose molecules gradually attach to the hemoglobin A molecules and remain there for the lifetime of the red blood cell, approximately 120 days. The attachment is not reversible; therefore, this glycosylated hemoglobin reflects the average blood glucose levels over the previous 2 to 3 months. The test is a satisfactory method for assessing control, detecting incorrect testing, monitoring the effectiveness of changes in treatment, defining patients' goals, and detecting nonadherence. Hemoglobin A1c levels of less than 7% are a well-established goal at most care centers.
A nurse is reviewing information about the various types of insulin that are used to treat diabetes mellitus type 1. Integrating knowledge about the duration of action, place these types in the order from shortest to longest duration. 1 Aspart 2 Glargine 3 Regular 4 NPH
Aspart Regular NPH Glargine
Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis? a. No urinary ketones c. Elevated serum carbon dioxide b. Low arterial pH d. Elevated serum phosphorus
B Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH. Urinary ketones, often in large amounts, are present when a child is in diabetic ketoacidosis. Serum carbon dioxide is decreased in diabetic ketoacidosis. Serum phosphorus is decreased in diabetic ketoacidosis.
The nurse working with the child diagnosed with type 2 diabetes mellitus recognizes that most often the disorder can be managed by: a) Conserving energy with rest periods during the day b) Increasing protein in the diet, especially in the evening c) Decreasing amounts of daily insulin d) Taking oral hypoglycemic agents
Taking oral hypoglycemic agents
The nurse is assessing an 8-year-old boy who is performing at the second-grade level, reports feeling tired and weak, and is only 45 inches tall. Which finding would be specific to hypothyroidism? a) The mother reports that the boy is always thirsty. b) The child states that the exam room is cold. c) Observation shows only two of the 6-year molars. d) The child has gained 20 pounds in the past year.
The child states that the exam room is cold.
A newborn was diagnosed as having hypothyroidism at birth. Her mother asks the nurse how the disease could be discovered this early. The nurse's best answer would be: a) a simple blood test to diagnose hypothyroidism is required in most states. b) children have a typical rash at birth that suggests the diagnosis. c) hypothyroidism is usually detected at birth by the child's physical appearance. d) her child is already severely impaired at birth, and this suggests the diagnosis.
a simple blood test to diagnose hypothyroidism is required in most states.
The nurse is caring for a 14 y/o boy with type 1 DM. He takes NPH insulin every morning at 7:30am. Which assessment data will the nurse use to evaluate the therapeutic effectiveness of the medication? 1. presence of signs and symptoms of hypoglycemia or hyperglycemia during the morning physical assessment. 2. blood glucose level at 1630 3. appetite and food intake at lunch 4. blood glucose level before breakfast.
blood glucose level at 1630
A newborn is born with hypothyroidism. A complication of this disorder if it is not recognized and treated is: a) blindness. b) muscle spasticity. c) cognitive impairment. d) dehydration.
cognitive impairment.
Hypothyroidism results from deficient production of thyroid hormone or a defect in the thyroid hormone receptor activity. Hypothyroidism caused during embryonic development of the gland is called: a) secondary hypothyroidism. b) acquired hypothyroidism. c) congenital hypothyroidism. d) autoimmune thyroiditis.
congenital hypothyroidism.
When monitoring the blood glucose level of a 12 y/o child with type 2 DM, your reading is 50mg/dL. Which is the most appropriate action? 1. encourange the child to get out of bed and increase activity 2. take the child's vital signs 3. ask the child about frequent urine output 4. give the child 4oz of OJ
give the child 4oz of OJ
A child is diagnosed with hypothyroidism. The nurse should expect to assess which symptoms associated with hypothyroidism (Select all that apply)? a. Weight loss b. Fatigue c. Diarrhea d. Dry, thick skin e. Cold intolerance
B, D, E A child with hypothyroidism will display fatigue; dry, thick skin; and cold intolerance. Weight loss and diarrhea are signs of hyperthyroidism.
A 12-year-old boy arrives at the emergency room experiencing nausea, vomiting, headache, and seizures. He is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder would be most associated with these symptoms? a) Syndrome of inappropriate antidiuretic hormone b) Hyposecretion of somatotropin c) Diabetes insipidus d) Hypersecretion of somatotropin
Syndrome of inappropriate antidiuretic hormone
The nurse is caring for a child with diabetes mellitus type 1. The nurse notes that the child is drowsy, has flushed cheeks and red lips, a fruity smell to the breath, and there has been an increase in the rate and depth of the child's respirations. The nurse recognizes that these symptoms indicate the child has: a) polyphagia. b) Cheyne-Stokes respirations. c) diabetic ketoacidosis. d) insulin reaction.
diabetic ketoacidosis
The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should explain that: a. Exercise will increase blood glucose. b. Exercise should be restricted. c. Extra snacks are needed before exercise. d. Extra insulin is required during exercise.
C Exercise lowers blood glucose levels, which can be compensated for by extra snacks. Exercise is encouraged and not restricted unless indicated by other health conditions. Extra insulin is contraindicated because exercise decreases blood glucose levels.
The nurse is assessing a 1-month-old girl who, according to the mother, doesn't eat well. Which assessment suggests the child has congenital hypothyroidism? a) Warm, moist skin b) Enlarged tongue c) Tachycardia d) Frequent diarrhea
Enlarged tongue
A 10-year-old boy has been diagnosed with type 1 diabetes mellitus. He is curious about what the cause of his disease is and asks the nurse to explain it to him. What should the nurse say to the boy? a) "Your body does not produce enough a chemical called 'ADH,' which makes you really thirsty and have to go to the bathroom a lot." b) "A small part of your brain called the pituitary does not make enough of a chemical called growth hormone." c) "Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood." d) "Special cells in a part of your body called the pancreas cannot produce enough of a chemical called insulin, so there is too much sugar in your blood."
"Special cells in a part of your body called the pancreas can't make a chemical called insulin, which helps control the sugar level in your blood."
What is characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent. b. Onset is gradual. c. Age at onset is usually younger than 18 years. d. Oral agents are often effective for treatment.
C The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults. Peak incidence is between the ages of 10 and 15 years. Infrequent ketoacidosis, gradual onset, and treatment with oral agents are more consistent with type 2 diabetes.
What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? a. Give the child half his regular morning dose of insulin. b. Substitute simple carbohydrates or calorie-containing liquids for solid foods. c. Give the child plenty of unsweetened, clear liquids to prevent dehydration. d. Take the child directly to the emergency department.
B A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia. The child should receive his regular dose of insulin even if he does not have an appetite. If the child is not eating as usual, he needs calories to prevent hypoglycemia. During periods of minor illness, the child with type 1 diabetes mellitus can be managed safely at home.
A 17-year-old is found after a high school football game wandering around. He is confused, sweaty, and pale. Which test is most likely to be performed first? a) CT scan b) Blood cultures c) Blood glucose level d) Arterial blood gases
Blood glucose level
A nurse is planning care for a school-age child with type 1 diabetes. Which insulin preparations are rapid and short acting (Select all that apply)? a. Novolin N b. Lantus c. NovoLog d. Novolin R
C, D Rapid-acting insulin (e.g., NovoLog) reaches the blood within 15 minutes after injection. The insulin peaks 30 to 90 minutes later and may last as long as 5 hours. Short-acting (regular) insulin (e.g., Novolin R) usually reaches the blood within 30 minutes after injection. The insulin peaks 2 to 4 hours later and stays in the blood for about 4 to 8 hours. Intermediate-acting insulins (e.g., Novolin N) reach the blood 2 to 6 hours after injection. The insulins peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours. Long-acting insulin (e.g., Lantus) takes 6 to 14 hours to start working. It has no peak or a very small peak 10 to 16 hours after injection. The insulin stays in the blood between 20 and 24 hours.
A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by: a. Saturated and unsaturated fat. c. Several glasses of water. b. Fruit juice. d. Complex carbohydrate and protein.
D Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Saturated and unsaturated fat, fruit juice, and several glasses of water do not provide the child with complex carbohydrate and protein necessary to stabilize the blood sugar.
The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which? a. Glucose is needed before administration of insulin. b. Glucose is needed four times a day. c. Glycosylated hemoglobin is required. d. Ketonuria is suspected.
D Urine testing is still performed to detect evidence of ketonuria. Urine testing for glucose is no longer indicated because of the poor correlation between blood glucose levels and glycosuria. Glycosylated hemoglobin analysis is performed on a blood sample.
A young mother brings her new baby, diagnosed with congenital hypothyroidism, to the clinic so she can learn how to administer levothyroxine. The nurse should include which of the following instructions? 1. crush the medication and place it in a full bottle of formula to disguise the taste 2. administer the medication every other day 3. use an oral dispenser syringe or nipple to give the crushed medication mixed with a small amount of formula 4. tell the mother that the medication will not be needed after the age of 7
use an oral dispenser syringe or nipple to give the crushed medication mixed with a small amount of formula
A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on knowing that: a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. The parents are better able to manage the disease.
C Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood sugar results. Blood glucose monitoring is more expensive but provides improved management. It is as accurate as equivalent testing done in laboratories. The ability to self-test allows the child to balance diet, exercise, and insulin. The parents are partners in the process, but the child should be taught how to manage the disease.
A common clinical manifestation of juvenile hypothyroidism is: a. Insomnia. c. Dry skin. b. Diarrhea. d. Accelerated growth.
C Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common in juvenile hypothyroidism.
The nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder? a. Insomnia c. Dry skin b. Diarrhea d. Accelerated growth
C Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism are usually sleepy. Constipation is associated with hypothyroidism. Decelerated growth is common in juvenile hypothyroidism.