Endocrine PED silvestri question
A mother brings her 3-week-old infant to a clinic for a phenylketonuria rescreening blood test. The test indicates a serum phenylalanine level of 0 mg/dL (0 mcmol/L). The nurse reviews this result and makes which interpretation? a. It is negative. b. It is a concern. c. It is inconclusive. d. It requires rescreening at age 6 weeks.
a. It is negative.
The nurse is reinforcing the teaching to parents of a diabetic child about the signs/symptoms of hypoglycemia. Which signs/symptoms would the nurse include when reinforcing the teaching? Select all that apply. a. Fatigue b. Sweating c. Headache d. Dizziness e. Trembling
b, d, e
The nurse is caring for an infant who has been diagnosed with primary hypothyroidism. The nurse is reviewing the results of the laboratory tests and would expect to note which finding? a. An elevated T4 level b. An elevated thyroid-stimulating hormone (TSH) level c. A normal thyroxine (T4) level d. A decreased TSH level
b. An elevated thyroid-stimulating hormone (TSH) level
The mother of a 6-year-old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the child's urine and it was positive for ketones. The nurse would instruct the mother to take which action? a. Hold the next dose of insulin. b. Come to the clinic immediately. c. Encourage the child to drink liquids. d. Administer an additional dose of regular insulin.
c. Encourage the child to drink liquids.
A primary health care provider prescribes an intravenous (IV) solution of 5% dextrose and half-normal saline (0.45%) with 40 mEq of potassium chloride for a child with hypotonic dehydration. The nurse performs which priority assessment before administering this IV prescription? a. Obtains a weight b. Takes the temperature c. Takes the blood pressure d. Checks the amount of urine output
d. Checks the amount of urine output
An adolescent client with type 1 diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings would the nurse expect to note? a. Sweating and tremors b. Hunger and hypertension c. Cold, clammy skin and irritability d. Fruity breath odor and decreasing level of consciousness
d. Fruity breath odor and decreasing level of consciousness
The nurse is planning care for a child with type 1 diabetes. Which items would the nurse plan to use to treat an early mild hypoglycemic episode? Select all that apply. a. Candy b. Apple slices c. Low-fat milk d. Orange juice e. Glucose tablets
a, d, e
A primary health care provider prescribes intravenous potassium for a child with hypertonic dehydration. The nurse assigned to assist in caring for the child would check which highest priority item before administration of the potassium? a. Weight b. Urine output c. Temperature d. Blood pressure
b. Urine output
A child has fluid volume deficit. The nurse collects data and determines that the child is improving and the deficit is resolving if which finding is noted? a. The child has no tears. b. Urine specific gravity is 1.030. c. Capillary refill is less than 2 seconds. d.Urine output is less than 1 mL/kg/hour.
c. Capillary refill is less than 2 seconds.
An adolescent client with type 1 diabetes is experiencing high glucose levels upon awakening in the morning. After reviewing the client's chart, the nurse determines that the elevated glucose level in the morning is due to the Somogyi effect. Which finding would lead the nurse to this conclusion? Refer to chart. *TABLE* a. Morning pulse of 76 beats per minute b. Hemoglobin A1c of 6.5% c. Glucose level at 2:00 a.m. of 65 mg/dL d. New diagnosis of type 1 diabetes
c. Glucose level at 2:00 a.m. of 65 mg/dL
A nursing student is asked to administer a tepid bath to a child with a fever. The student should avoid which action when performing this procedure? a. Applies alcohol-soaked cloths over the child's body b. Uses a water toy to distract the child during the bath c. Places lightweight pajamas on the child after the bath d. Squeezes water over the child's body, using a washcloth
a. Applies alcohol-soaked cloths over the child's body
The nurse is collecting data from a child with a diagnosis of diabetes insipidus. Which clinical finding is consistent with this diagnosis? a. Urinary output is increased. b. Urinary output is decreased. c. Serum sodium is decreased. d. Urine specific gravity is increased.
a. Urinary output is increased.
The clinic nurse is reinforcing instructions to an adolescent with type 1 diabetes about administration of insulin. Which statements by the adolescent indicate the need for further teaching? Select all that apply. a. "I should give my injections only in my thighs." b. "Insulin vials, once opened are good for 30 days." c. "I should place any unopened insulin vials in the freezer." d. "I should not leave my insulin supplies in a hot environment." e. "I should give the insulin injection subcutaneously at a 90-degree angle."
a, c
The nurse is checking a child for dehydration and documents that the child is moderately dehydrated. Which symptoms would be noted in determining this finding? Select all that apply. a. Oliguria b. Slight thirst c. Pale skin color d. Slightly sunken fontanels e. Very dry mucous membranes
a, d, e,
An adolescent with diabetes mellitus becomes flushed and complains of hunger and dizziness. A blood glucose level is drawn, and the results indicate a glucose level of 60 mg/dL. Which is the appropriate intervention? a. Keep the child NPO. b. Give the child a glass of fruit juice. c. Contact the primary health care provider. d. Let the child rest until the dizziness subsides.
b. Give the child a glass of fruit juice.
The nurse is reinforcing the teaching of parents of a diabetic child on the differences between type 1 and type 2 diabetes mellitus. Which statements by the parents indicate understanding of the teaching? Select all that apply. a. "The onset of diabetes is sudden with type 1." b. "Type 2 diabetes often presents with weight loss." c. "Type 2 diabetes can often be managed with diet only." d. "Type 1 diabetes can be managed with oral hypoglycemics." e. "Three symptoms of type 1 diabetes are polyuria, polydipsia and polyphagia."
a, c, e
The nurse is caring for a hospitalized child newly diagnosed with type I diabetes mellitus. At 11:00 am, the child suddenly complains of weakness, headache, and blurred vision. How would the nurse respond? a. Obtain a blood glucose reading. b. Contact the primary health care provider. c. Give the child ½ cup of orange juice to drink. d. Call the dietary department and ask that the lunch tray be delivered early.
a. Obtain a blood glucose reading.
A licensed practical nurse (LPN) is assigned to assist in caring for a hospitalized child who is receiving a continuous infusion of intravenous (IV) potassium for the treatment of dehydration. The LPN monitors the child closely and notifies the registered nurse if which finding is noted? a. Weight increase of 0.5 kg b. Temperature of 100.8° F rectally c. A decrease in urine output to 0.5 mL/kg/hr d. Blood pressure (BP) unchanged from baseline
c. A decrease in urine output to 0.5 mL/kg/hr
The nursing instructor asks the nursing student to plan and conduct a clinical conference on phenylketonuria (PKU). The student researches the topic and plans to include which information in the conference? a. PKU is an autosomal dominant disorder. b. Treatment includes dietary restriction of sodium. c. PKU results in central nervous system (CNS) damage. d. Some state laws require routine screening of all newborn infants for PKU.
c. PKU results in central nervous system (CNS) damage.
A child with diabetes mellitus is brought to the emergency department by her mother, who states that her daughter has been complaining of abdominal pain and has a fruity odor on the breath. Diabetic ketoacidosis (DKA) is diagnosed. The nurse assisting with care for the child checks the intravenous (IV) and medication supply area for which item? a. Potassium b. NPH insulin c. 5% dextrose IV infusion d. 0.9% normal saline IV infusion
d. 0.9% normal saline IV infusion
Which test would the nurse anticipate for a teenage client who has been treated for vaginal Candida infections repeatedly in the last 6 months to assist in the identification of the underlying chronic pathology? a. Pap smear b. Blood culture c. Throat culture d. Blood glucose level
d. Blood glucose level
The nurse determines that a child with type 1 diabetes mellitus is having a hypoglycemic reaction. Which supplement would the nurse give the child to treat the reaction? a. 1 sugar cube b. 1 teaspoon of sugar c. ½ cup of diet cola d. ½ cup of fruit juice
d. ½ cup of fruit juice
An adolescent with diabetes mellitus is attending gym class and suddenly becomes flushed and complains of dizziness and a headache. The gym teacher quickly takes the adolescent to the school nurse's office. The nurse obtains a blood glucose level, and the results indicate a level of 65 mg/dL. Which initial nursing intervention is appropriate? a. Give the child 6 oz of a regular cola drink. b. Call the school primary health care provider immediately. c. Call the child's mother for permission to treat the child. d. Let the child rest until the blood glucose has an opportunity to rise.
a. Give the child 6 oz of a regular cola drink.
The nurse is assisting a school-age client with type 1 diabetes to follow an appropriate diet. Which recommendations would the nurse make for this client? Select all that apply. a. Limit concentrated sweets. b. Consume high-fat, high-protein snacks. c. Consume snacks between meals and at bedtime. d. Plan to eat a larger snack during active times of the day. e. Ensure that calories will be limited to 1800 kcal a day.
a, c, d
The nurse is planning care for a pediatric client experiencing thyrotoxicosis (thyroid storm). Which prescribed medications would the nurse plan to administer? Select all that apply. a.Atenolol b.Tramadol c.Propranolol4 d.Methimazole e. Levothyroxine
a, c, d,
A school-age child with type 1 diabetes mellitus has soccer practice three afternoons a week. The nurse reinforces instructions regarding how to prevent hypoglycemia during practice. Which would the nurse tell the child? a. Drink a half a cup of orange juice before soccer practice. b. Eat twice the amount that is normally eaten at lunchtime. c. Take half of the amount of prescribed insulin on practice days. d. Take the prescribed insulin at noontime rather than in the morning.
a. Drink a half a cup of orange juice before soccer practice. An extra snack of 10 g to 15 g of carbohydrates eaten before activities and for every 30 to 45 minutes of activity will prevent hypoglycemia. A half cup of orange juice will provide the needed carbohydrates. The child or parents should not be instructed to adjust the amount or time of insulin administration, and meal amounts should not be doubled.
A cooling blanket is prescribed for a child with a fever. The nurse prepares to use the cooling blanket and would avoid which action? a. Keeping the child uncovered to assist in reducing the fever b. Placing the cooling blanket on the bed and covering it with a sheet c. Keeping the child dry while on the cooling blanket to prevent the risk of frostbite d. Checking the skin condition of the child before, during, and after the use of the cooling blanket
a. Keeping the child uncovered to assist in reducing the fever
A 10-year-old child in remission from leukemia is upset over the appearance of cushingoid characteristics from long-term use of corticosteroids that are currently being administered every other day. Which therapeutic statements would the nurse make to the child about the cushingoid appearance? Select all that apply. a. "I am sure it will be all right; they hardly look unusual." b. "Which manifestations of this condition do you find most troublesome?" c. "You should talk to the primary health care provider about the cushingoid characteristics." d. "The signs/symptoms are lessened by taking the prednisone every other day instead of daily." e. "The cushingoid appearance will gradually disappear once the steroids are tapered and discontinued."
b, d, e,
The nursing instructor asks a nursing student about phenylketonuria (PKU). Which statement made by the student indicates a need for further teaching? a. "PKU is an autosomal-recessive disorder." b. "PKU primarily affects the gastrointestinal system." c. "All 50 states require routine screening of all newborns for PKU." d. "Treatment of PKU includes the dietary restriction of phenylalanine."
b. "PKU primarily affects the gastrointestinal system." PKU is a genetic disorder that results in central nervous system (CNS) damage from toxic levels of phenylalanine in the blood, not the gastrointestinal system. PKU is an autosomal-recessive disorder, and treatment includes the dietary restriction of phenylalanine intake. All 50 states require screening newborns for PKU.
The nurse is planning care for a hospitalized child with syndrome of inappropriate antidiuretic hormone (SIADH). The primary health care provider has prescribed that the 24-hour fluid maintenance for the child weighing 12 kg be at ¾ of the maintenance. Using the formula shown (refer to figure), which volume of fluid would the nurse plan as the 24-hour maintenance for this child? *TABLE* a. 725 mL b. 825 mL c. 1000 mL d. 1100 mL
b. 825 mL
The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL (3.4 mmol/L)? Select all that apply. a. Administer regular insulin. b.Encourage the child to ambulate. c. Give the child a teaspoon of honey. d. Provide electrolyte replacement therapy intravenously. e. Wait 30 minutes and confirm the blood glucose reading. f. Prepare to administer glucagon subcutaneously if unconsciousness occurs.
c, f
Which interventions would the nurse implement for a child older than 2 years of age with type 1 diabetes mellitus who has a blood glucose level of 60 mg/dL? Select all that apply. a. Administer regular insulin. b Encourage the child to ambulate. c. Give the child a teaspoon of honey. d. Provide electrolyte replacement therapy intravenously. e. Wait 30 minutes and confirm the blood glucose reading. f. Prepare to administer glucagon subcutaneously if unconsciousness occurs.
c, f
The nurse determines that an adolescent client with diabetes mellitus needs further teaching about A1c levels and their purpose if the client made which statement when told that a level will be drawn? a. "Last time this test was taken the result was 13. I hope it will be lower this time." b. "I have followed my diet these past 3 months, so hopefully the test result will be OK." c. "I already had a complete blood cell count drawn an hour ago, so this test is not necessary." d. "Most of my recent blood glucose levels were close to 170 mg/dL, so this result will probably be a little high."
c. "I already had a complete blood cell count drawn an hour ago, so this test is not necessary."
An adolescent with type 1 diabetes mellitus will become a member of the school's football cheerleader team. The adolescent excitedly reports to the school nurse to obtain information regarding adjustments needed in the treatment plan for the diabetes. The school nurse would instruct the adolescent to take which action? a. Eat half the amount of food normally eaten at lunchtime. b. Take two times the amount of prescribed insulin on practice and game days. c. Eat six graham crackers or drink a cup of orange juice before practice or game time. d. Take the prescribed insulin one half hour before practice or game time rather than in the morning.
c. Eat six graham crackers or drink a cup of orange juice before practice or game time.
The nurse is reinforcing instructions to an adolescent with type 1 diabetes mellitus regarding insulin administration and rotation sites. Which statement made by the adolescent would indicate an understanding of the instructions? a. "I need to use a different site for each insulin injection." b. "I should use only my stomach and my thighs for injections." c. "I need to use the same site for 1 month before rotating to another site." d. "I need to use one major site for the morning injection and another major site for the evening injection for 2 to 3 weeks before changing major sites."
d. "I need to use one major site for the morning injection and another major site for the evening injection for 2 to 3 weeks before changing major sites."
A 3-year-old child is brought to the emergency department. The mother states that the child has had flulike symptoms with vomiting and diarrhea for the past 2 days. On data collection the nurse finds that the child's heart rate is slightly elevated and the blood pressure is normal. The child is irritable and crying only a few tears. The mother states that the child's weight before the illness was 33 pounds. The nurse finds the current weight to be 31 pounds. The nurse correctly interprets this as which level of dehydration? a. Mild dehydration b. Severe dehydration c. Very mild dehydration d. Moderate dehydration
d. Moderate dehydration
A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion? a. Potassium infusion b. NPH insulin infusion c. 5% dextrose infusion d. Normal saline infusion
d. Normal saline infusion
The nurse has just administered ibuprofen to a child with a temperature of 38.8°C (102°F). The nurse would also take which action? a. Withhold oral fluids for 8 hours. b. Sponge the child with cold water. c. Plan to administer salicylate in 4 hours. d. Remove excess clothing and blankets from the child.
d. Remove excess clothing and blankets from the child.
