Pedi Endocrine Exam 4 Quizzing
The parents seek help for their 11-year-old child, who has type 1 diabetes mellitus, because the child frequently wants concentrated sweets. What is the most appropriate response of the nurse to the parent?
"There is an elevated risk of atherosclerosis, and therefore your child should not have concentrated sweets.
The mother of a child with type 1 diabetes mellitus asks why her child cannot avoid "all those shots" and take pills as an uncle does. The nurse's best reply is:
"Your child needs to have insulin replaced, and the oral hypoglycemics only add to an existing supply of insulin."
Which clinical findings in the blood reports of a child indicate diabetes mellitus?
Fasting blood glucose of 126 mg/dL or more
The nurse should recognize that when a child develops diabetic ketoacidosis, it is:
A life threatening situation
Which intervention does the nurse implement if steroid therapy causes cushingoid features in a child?
Administer the drug in the morning
The parents of a child who is being treated for congenital adrenal hyperplasia (CAH) tell the nurse that they are planning for a new child again. Which is the best response by the nurse?
Advise the parents to seek genetic counseling prenatally
Which is a priority nursing action after administering the prescribed dose of tapazole (Methimazole) to a child?
Assess for fever and sore throat
What instruction does the nurse provide to parents of a child with chronic adrenocortical insufficiency? Select all that apply.
Be alert for signs of gastric problems, diet changes to prevent/manage obesity, keep extra supplies of medications at home, do not frequently invite a lot of visitors
An adolescent with type 1 diabetes is receiving regular insulin, Novolin R, and intermediate-acting insulin, Novolin N. The patient receives a combination of the two 30 minutes before breakfast and before the evening meal. At what time should the nurse anticipate a hypoglycemic reaction? Select all that apply
Before breakfast, before dinner/late afternoon
A child with hypoparathyroidism is experiencing headaches and vomiting. The nurse also observes that the child has blurred vision. Which condition does the nurse suspect in the child?
Brain tumor
Which condition is the nurse alert for while providing care for an unconscious child with diabetes insipidus (DI)?
Dehydration
Which conditions can be seen in a child with hypopituitarism? Select all that apply.
Delayed dentition, diminished height, delayed sexual development
The parent of a child tells the nurse that the child voids excessive urine and immediately drinks large amounts of water. The parent also says that the child's bed is often wet in the morning. Which condition does the nurse suspect in the child?
Diabetes insipidus
The nurse is teaching an adolescent (newly diagnosed with type I diabetes) ways to minimize discomfort with insulin injections. Which interventions are helpful in minimizing injection discomfort? Select all that apply.
Do not reuse needles, remove bubbles from the syringe, do not move the direction of the needle during insertion or withdrawal
The most important nursing consideration related to congenital hypothyroidism is:
Early identification and diagnosis of the disorder
What are clinical manifestations of acromegaly?
Enlarged jaw, increased facial hair, overgrowth of the head, deeply creased skin
A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, baseball, and swim. The nurse's response should be based on knowledge that:
Exercise is not restricted unless otherwise contraindicated by another health condition
Which intervention does the nurse implement if a child with diabetes mellitus has decreased food intake due to flu?
Frequently monitor the blood glucose and urinary ketones
A child with diabetes mellitus suddenly becomes unresponsive and unconscious, and suffers from seizures. Which prescribed medication does the nurse administer immediately?
Glucagon
Which therapies are prescribed for a child after bilateral adrenalectomy? Select all that apply.
Glucocorticoid, mineralocorticoid therapy
A neonate with a goiter has just been admitted to the newborn nursery. A priority nursing intervention is to:
Have a tracheotomy set at bedside
An infant with congenital adrenal hyperplasia (CAH) has increased pigmentation of the skin creases and ambiguous genitalia. Which other signs of adrenal insufficiency does the nurse assess? Select all that apply.
Hyperkalemia, hyponatremia, weight loss
During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise?
Increased food intake
The nurse caring for a 6-year-old child with diabetes mellitus notices that the child is sweating profusely. The child also complains of headache, dizziness, and shortness of breath. What should the nurse's immediate actions be? Select all that apply.
Inform the HCP, assess child's BG level
A child with type 1 diabetes mellitus is prescribed NovoLog and Novolin N insulin twice daily. It is to be injected before breakfast and before the evening meal. What additional information should the nurse give the child? Select all that apply.
Insulin needs will change thru G&D, spring/summer, with illness, depending on activity and your puberty status "You should administer 60% to 75% of the total daily dose before breakfast and the rest before the evening meal."
Which information should the nurse include when teaching a patient about Cushing syndrome?
It is caused by excessive production of cortisol (at the adrenal glands)
A 7-year-old boy has been diagnosed with precocious puberty. What is the best explanation of the condition the nurse gives to the parents?
It is sexual development in boys (or girls) before the age of 9 years old
What does the nurse evaluate to determine the amount of morning regular insulin that needs to be administered to a child with type 1 diabetes mellitus? The child's:
Lunchtime blood glucose levels
What lifestyle changes does the nurse advise for a child diagnosed with type 1 diabetes??
Plan an exercise schedule around the child's capabilities
Which precaution does the nurse take when administering oral fluids to a child after the acute phase of adrenal crisis is over?
Plans a gradual schedule for administering fluids to prevent vomiting
The primary health care provider asks the nurse to monitor a child for signs of diabetes insipidus (DI). Which early signs does the nurse observe? Select all that apply.
Polyuria, polydipsia, enuresis
What action does the nurse take when the child on insulin therapy suddenly begins to tremble and sweat?
Provide a glass of OJ
Which instruction does the nurse give to the parents of a child with diabetes mellitus? Select all that apply.
Provide leafy green veggies and mushrooms, maintain consistency in daily calories, increased food with increased activity, avoid the simple sugars
Which interventions does the nurse implement to minimize heat intolerance in a child with hyperthyroidism? Select all that apply.
Restricting physical activity, providing cotton clothing, and providing frequent baths to the child
Which condition does the nurse assess for in a child who presents with manifestations of hyperthyroidism like hyperactivity and emotional lability?
Visual disturbances
The nurse observes on the cardiac monitor that a child admitted with diabetic ketoacidosis has a widening of the QT interval and the appearance of U wave after a flattened T wave. What should the nurse conclude from such an observation?
The child has hypOkalemia
The nurse assigned to care for a child with type 1 diabetes mellitus and needs to determine the amount of morning regular insulin to administer. How should the nurse determine the dosage?
The dosage of morning regular insulin is determined by blood glucose patterns in the late morning and lunchtime blood glucose values.
The nurse is assessing a child with delayed growth. Which questions does the nurse include in the assessment while interviewing the parents? Select all that apply
The nurse asks about diseases in the family to assess any hereditary causes for delayed growth. The nurse also asks about any developmental issues in the past to evaluate if it is linked to growth delay. Asking about medications will help to assess the child's health status. Asking about child's appetite may help to identify if nutritional inadequacy has led to delayed growth.
Which instructions does the nurse give to the parents for safe and effective administration of insulin injection to the child with diabetes mellitus? Select all that apply.
The nurse instructs the parents to inject insulin in the fat tissue over the muscle so that it is administered in the subcutaneous layer and not the intramuscular tissue. The nurse instructs the parents to use the pinch technique for tenting the skin so that the needle is easily inserted in the subcutaneous layer. The nurse teaches the parents to avoid using only one injection site as insulin absorption is slowed by the fat pads that develop in the used sites. The nurse also instructs the parents to avoid injecting on the exercising extremity to avoid altering the absorption rate. Subcutaneous insulin injections are inserted at an angle of 90 degrees.
The nurse is explaining that the destruction of pancreatic β-cells is the cause of which disorder?
Type 1 DM
Diabetes insipidus is prescribed antidiuretic hormone (ADH) replacement with vasopressin tannate in peanut oil - instructions for administration?
Vasopressin must be thoroughly resuspended in the oil by being held under warm running water for 10 to 15 minutes and then shaken vigorously before being drawn into the syringe. It is necessary that small brown particles, denoting drug dispersion, are seen in the suspension. This confirms that oil is not injected without the ADH
A 15-year-old child has type 2 diabetes mellitus and needs dietary instruction from the nurse. Which statements from the nurse would provide the child with important information on nutritional needs? Select all that apply.
You should have enough calories for your energy, growth, and development. Food intake should correlate with timing and action of insulin. You should plan to incorporate snacks in between meals and at bedtime.
The nurse suspects that the child has delayed growth. The nurse does not have serial height and weight records to assess the child's growth. What action does the nurse take?
Ask about the child's growth as compared to siblings
The primary goals of the nurse caring for a child with illness and diabetic mellitus are to restore euglycemia, treat urinary ketones, and maintain hydration. What steps should the nurse take to provide effective care? Select all that apply.
The nurse should monitor the glucose levels and urinary ketones q3H and encourage fluids; child's food intake and insulin dosage adjusted based on levels and degree of illness; notify HCP if child vomits or if BG/ ketone levels rise
