Chapter 31 : The Child with a Metabolic Condition

A nurse is planning to teach a family about Tay-Sachs disease. What will the nurse relay about the pattern of inheritance for inborn errors of metabolism? a. They are usually autosomal recessive. b. They are usually autosomal dominant. c. They are usually X-linked recessive. d. They are usually multifactorial.

ANS: A The pattern of inheritance is generally autosomal recessive.

The nurse reminds the parents of a diabetic with an insulin pump that the tubing of the pump should be changed aseptically every ______ hours.

ANS: 48 The tubing of the insulin pump should be changed every 48 hours.

The home health nurse is monitoring an 8-month-old child with hypothyroidism taking levothyroxine (Synthroid). Which symptoms does the nurse recognize as signs of overdose? (Select all that apply.) a. Tachycardia b. Irritability c. Vomiting d. Weight gain e. Diaphoresis

ANS: A, B, E All the options with the exception of weight gain and vomiting are indications of overdose of Synthroid. Weight loss is a symptom of overdose, however.

The nurse is preparing to administer a long-acting insulin. Which insulin is considered long acting? a. Lispro b. Aspart c. Glargine d. Regular

ANS: C Insulin glargine is a long-acting insulin. Regular is short acting. Lispro and Aspart are rapid acting.

When discussing possible causes of diabetes in children, the nurse mentions chromosomal defects. Which chromosomes are associated with diabetes? (Select all that apply.) a. 6 b. 7 c. 12 d. 20 e. 21

ANS: A, B, C, D Defects in chromosomes 6, 7, 12, and 20 and other genetic disorders are associated with diabetes mellitus syndrome.

What does the nurse instruct a 12-year-old to do when teaching how to administer insulin? a. Make sure injection sites are 6 inches apart. b. Select an injection site that was recently exercised. c. Inject the needle at a 90-degree angle. d. Give the injection deep into the muscle.

ANS: C Children often find it easier to learn to inject the needle at a 90-degree angle.

The nurse is teaching the parents of a child with diabetes insipidus about water intoxication. The nurse would tell the parents to be alert for what symptom? a. Polyuria b. Cough c. Weight loss d. Lethargy

ANS: D Signs of water intoxication include edema, lethargy, nausea, and central nervous system signs.

The nurse explains that the diagnosis of diabetes is made when the fasting blood glucose level is _______ mg/dL on two separate occasions, and the history is positive for indication of the disease.

ANS: 126 An elevated blood glucose level of 126 mg/dL on two separate occasions is grounds for the diagnosis of diabetes mellitus when the history is positive for the disease.

After a closed head injury, the unconscious 10-year-old child begins to excrete copious amounts of pale urine with an attendant drop in blood pressure (BP). Based on these symptoms, what does the nurse suspect has developed? a. Diabetes insipidus b. Diabetes mellitus c. Hypothyroidism d. Hyperthyroidism

ANS: A Diabetes insipidus can be acquired as the result of a head injury or tumor, and suppression of the posterior pituitary causes copious urine output with an attendant drop in BP. The child can become dehydrated very quickly if some remedy is not applied.

Which statement made by a 7-year-old child with type 1 diabetes mellitus indicates a need for more teaching? a. "My pancreas is sick and needs insulin until it is well." b. "I will need to take my insulin every day." c. "I need to keep a piece of candy in my pocket in case I start to feel shaky." d. "My mom has to give me insulin shots twice a day."

ANS: A The child with type 1 diabetes mellitus has an insulin deficiency and will require lifelong management of this disease. Insulin does not cure the pancreas.

The nurse discussed treatment of hypoglycemia with an adolescent. Which statement by the adolescent leads the nurse to determine the patient understood the instructions? a. "When my blood glucose is low or if I begin to feel hungry and weak, I will eat six LifeSavers." b. "When my blood glucose is low or if I begin to feel hungry and weak, I will give myself Lispro insulin." c. "When my blood glucose is low or if I begin to feel hungry and weak, I will have a slice of cheese." d. "When my blood glucose is low or if I begin to feel hungry and weak, I will drink a diet soda."

ANS: A The immediate treatment of hypoglycemia consists of administering sugar in some form such as orange juice, hard candy, or a commercial product. Cheese will eventually raise the blood glucose, but not as quickly as candy.

A mother reports that her 4-month-old infant is lethargic, sleeps 18 hours a day, and snores. The nurse recognizes these signs are characteristic of what? a. Hypothyroidism b. Hyperthyroidism c. Type 1 diabetes mellitus d. Tay-Sachs disease

ANS: A The infant with hypothyroidism will appear sluggish, and the tongue will be enlarged, causing noisy respiration.

On what understanding does the nurse plan the care of a child with a new diagnosis of type 1 diabetes mellitus? a. There is an absolute deficiency of insulin. b. Insufficient quantities of insulin are produced by the pancreas. c. Oral hypoglycemic agents can control it. d. Insulin deficiency is caused by another disease affecting the pancreas.

ANS: A Type 1 insulin-dependent diabetes mellitus is characterized by an absolute or complete deficiency of insulin.

What makes keeping diabetes in control in an adolescent difficult? (Select all that apply.) a. Hormonal changes b. Developmental conflicts c. Preference for fast food d. Growth spurts e. Knowledge of disease

ANS: A, B, C, D The adolescent who is in a growth spurt and filled with raging hormones resents and denies the need to be dependent on a medication. Medication schedules and diet restrictions do not correlate well with the adolescent's lifestyle of eating fast foods. Denial of disease is prevalent in the adolescent.

Which process(es) does the nurse explain the endocrine system is primarily responsible for controlling? (Select all that apply.) a. Maturation b. Reproduction c. Stress response d. Sexual identity e. Growth

ANS: A, B, C, E The endocrine system governs maturation, reproduction, stress response, and sexual maturity. Sexual identity is a psychosocial response.

What does the nurse remind the adolescent with diabetes that soluble fiber in the diet can reduce? (Select all that apply.) a. Blood glucose b. Serum cholesterol c. Incidence of infections d. Absorption of sugar e. Insulin requirements

ANS: A, B, D, E Soluble fiber can reduce blood glucose, serum cholesterol, absorption of sugar, and insulin requirements. It has no effect on infections.

The nurse is discussing insulin shock with parents of a child recently diagnosed with diabetes mellitus. What will the nurse respond when the parents ask why children are more prone to insulin reactions? (Select all that apply.) a. "The condition is more unstable in children." b. "Parents are often noncompliant." c. "The activities are irregular." d. "They are still growing." e. "Sleep patterns are not established."

ANS: A, C, D Children are more prone to insulin reactions than adults because of the following: the condition itself is more unstable in young people; they are growing; their activities are more irregular.

Which food sources are high in soluble fiber? (Select all that apply.) a. Raw fruits b. Cooked vegetables c. Beans d. Lean meat e. Bran cereal .

ANS: A, C, E Foods high in soluble fiber include raw fruits, beans, and bran cereal

A child receives a combination of regular and NPH insulin at 8:00 AM. At 8:45 AM the breakfast trays have not yet arrived from the kitchen. What is the best action by the nurse? a. Notify the charge nurse. b. Give the patient a snack of graham crackers and milk. c. Ambulate the patient in the hall for a short time. d. Give the patient more insulin according to the sliding scale.

ANS: B A child who receives regular insulin before meals may have an insulin reaction if food is not eaten within 20 minutes. A snack of graham crackers and milk will prevent an episode of hypoglycemia.

What would be the most appropriate nursing response to a woman who says, "My sister had a child with Tay-Sachs disease, and I want to know if I could have a child with this condition"? a. "The disease is rare. It is unlikely that you would have a child with Tay-Sachs disease." b. "A screening test can be done to determine if you are a carrier of the gene." c. "The gene for Tay-Sachs disease is transmitted by the father." d. "The cause of Tay-Sachs disease is thought to be an autoimmune response to a virus."

ANS: B Carriers can be identified by screening tests. Tay-Sachs disease has an autosomal recessive pattern of transmission.

What condition does the nurse suspect when a child with type 1 diabetes mellitus has hyperglycemia, diaphoresis, and headaches in the morning? a. Dawn phenomenon b. Somogyi phenomenon c. Honeymoon effect d. Ketoacidosis

ANS: B The Somogyi phenomenon (rebound hyperglycemia) occurs when the blood glucose level is lowered to the point at which the body's counter-regulatory hormones are released, producing the symptoms described.

What is the function of an insulin pump? a. Releases insulin as blood glucose rises. b. Provides continuous infusion of insulin. c. Decreases need for painful glucose monitoring. d. Delivers a prescribed amount of insulin twice a day.

ANS: B The insulin pump that is attached to a subcutaneous tube releases a continuous infusion of insulin.

Which general dietary measure should the nurse include in a teaching plan for the child with type 1 diabetes mellitus? a. Control intake of carbohydrates and consume fewer calories. b. Focus on complex carbohydrates and eat foods high in fiber. c. Obtain most calories from proteins and fats. d. Eat a diet low in fat and low in complex carbohydrates.

ANS: B The nutritional needs of a child with diabetes mellitus are essentially the same as those of the nondiabetic child, with the exception of the elimination of concentrated carbohydrates such as sugar. Fiber has been shown to reduce blood glucose levels.

The parents of a child newly diagnosed with diabetes mellitus tell the nurse, "Our son's body is resistant to insulin." With what does the nurse recognize this description is consistent? a. Type 1, insulin-dependent diabetes mellitus b. Type 2, non-insulin-dependent diabetes mellitus c. Maturity-onset diabetes of youth d. Drug-induced diabetes

ANS: B Type 2, non-insulin-dependent diabetes mellitus is caused by insulin resistance or failure of the body to use the insulin.

What occurs as a result of an inadequate secretion of insulin? a. Protein synthesis is increased. b. Increased fat breakdown leads to ketonemia. c. Serum glucose levels are markedly decreased. d. More rapid conversion and storage of carbohydrates to glucose occurs.

ANS: B When insulin is deficient, the body cannot metabolize carbohydrates for energy. The body is also unable to store and use fat properly. Incomplete fat metabolism produces ketone bodies that accumulate in the blood.

Which comment made by a school-age child indicates that he needs more teaching about diabetes mellitus and exercise? a. "I carry a piece of hard candy with me in case I start to feel shaky." b. "I make sure I have emergency money when I have soccer practice or a game." c. "Sometimes I skip my breakfast when I have a game in the morning." d. "I play in soccer games that are scheduled after dinner." .

ANS: C Blood glucose is high after meals. The child with type 1 diabetes mellitus who skips a meal before exercise is at risk for hypoglycemia

A child with diabetes is brought to the emergency department. He is flushed and drowsy, and his skin is dry. His father states that the child has been feeling progressively worse since the morning. What is this child most likely experiencing? a. Somogyi phenomenon b. Dawn syndrome c. Ketoacidosis d. Water intoxication

ANS: C In ketoacidosis, the child's skin is dry, and the face is flushed. Patients appear dehydrated. They may perspire and be restless. The breath has a fruity odor, and there is no rest period between inspiration and expiration.

What is an important consideration for the school-age child taking DDAVP for diabetes insipidus? a. Observe for signs of water deprivation. b. Restrict his physical education program. c. Arrange for the child to use the bathroom when needed. d. Limit fluid intake other than during the lunch period.

ANS: C The child with diabetes insipidus needs liberal access to bathrooms and water fountains. Arrangements may have to be made with the school to allow access.

Although the child with type 1 diabetes had her prescribed insulin at 7:30 AM, the child is complaining of hunger and thirst and is drowsy at 10:30 AM. What should the nurse do first? a. Walk the patient in the hall for 10 minutes. b. Allow the patient a short nap. c. Give her a cup of orange juice. d. Test her blood with a glucometer and give insulin according to the sliding scale.

ANS: C The immediate remedy is to give orange juice to raise the blood glucose. Giving more sugar will increase the blood glucose in a hyperglycemic child. Walking exercise will use up even more glucose. The treatment for hyperglycemia is to give the patient more insulin.

A child with diabetes mellitus is observed to have cold symptoms. What signs and symptoms will alert parents of the possibility of ketoacidosis? (Select all that apply.) a. Chest congestion b. Ear pain c. Fruity breath d. Hyperactivity e. Nausea

ANS: C, E Symptoms of ketoacidosis are compared with those of hypoglycemia. Signs and symptoms include a fruity odor to the breath, nausea, decreased level of consciousness and dehydration. Lab values include ketonuria, decreased serum bicarbonate concentration (decreased CO2 levels) and low pH, and hypertonic dehydration.

What statement by a parent leads the nurse to determine a parent is administering levothyroxine (Synthroid) correctly? a. "I stopped giving the medication because my daughter was losing her hair." b. "I am using a different brand now because it costs less money." c. "I don't give the medication on the weekends." d. "I give the medication at 8:00 AM every day."

ANS: D Synthroid should be given at the same time each day, preferably in the morning.

Why does the nurse instruct an 11-year-old diabetic child to use the side of the finger for blood testing? a. It has fewer capillaries. b. It is easier to puncture. c. It is less likely to become infected. d. It has fewer nerve endings.

ANS: D The sides of the finger have fewer nerve endings and more capillaries but are not easier to puncture than the fingertip. The risk for infection is remote for either site.