Perry Chapter 47: Practice Questions
A school-age child w/ diabetes gets 30 units of NPH insulin at 0800. According to when this insulin peaks, the child should be at greatest risk for a hypoglycemic episode between when? a) Lunch and dinner b) Breakfast and lunch c) 0830 to his midmorning snack d) Bedtime and breakfast the next morning
A
The school nurse is talking to a 14 y/o about managing type 1 DM. Which statement indicates the student's understanding of the disease? a) "It really doesn't matter what type of carbohydrate I eat as long as I take the right amount of insulin." b) "I should probably have a snack right after gym class." c) "I need to cut back on my carbohydrate intake and increase my lean protein intake." d) "Losing weight will probably help me decrease my need for insulin."
A A carbohydrate is a carbohydrate, and insulin dosing is based on blood sugar level and carbohydrates to be eaten.
The nurse is implementing care for a school-age child admitted to the pediatric ICU in DKA. Which prescribed intervention should the nurse implement first? a) Begin 0.9% saline solution IV as prescribed b) Administer regular insulin IV as prescribed c) Place child on a cardiac monitor d) Place child on a pulse oximetry monitor
A All patients w/ DKA experience dehydration because of the osmotic diuresis, accompanied by depletion of electrolytes.
The most appropriate nursing diagnosis for a child w/ type 1 DM is which of the following? a) Risk for infection r/t reduced body defenses b) Impaired urinary elimination (enuresis) c) Risk for injury r/t medical treatment d) Anticipatory grieving
A Risk for infection is a correct nursing diagnosis. Understanding DM is understanding the effect it has on peripheral circulation and impairment of defense mechanisms.
Four sick children w/ type 1 diabetes have been admitted to the hospital. Which child is most at risk for developing hypoglycemia? The child with: a) Bacterial sepsis b) Intussusception c) Jaundice d) Chickenpox
A The child w/ bacterial sepsis is most at high risk for developing hypoglycemia.
What should the nurse advise the parents of a child w/ type 1 DM 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 ED
B A sick-day diet of simple carbohydrates or calorie-containing liquids will maintain normal serum glucose levels and decrease the risk of hypoglycemia.
Which is the most likely reason an adolescent w/ diabetes has problems w/ low self-esteem? a) Managing diabetes decreases independence b) Managing diabetes complicates perceived ability to "fit in" c) Obesity complicates perceived ability to "fit in" d) Hormonal changes are exacerbated by fluctuations in insulin levels
B Because the desire to fit in is so strong in adolescence, the need to manage one's diabetes can compromise the patient's perception of ability to do so.
A 6 y/o white girl comes w/ her mother for evaluation of her acne, breast buds, axillary hair, and body odor. What information should the nurse explain to them? a) This is a typical age for girls to go into puberty b) Encourage the girl to dress and act appropriately for her chronological age c) She should be on birth control as she is fertile d) She may be short if her epiphyses close early
B Dressing and acting appropriately for her chronological age should be encouraged for the well-being of the child.
An 8 y/o w/ type 1 DM is complaining of a headache and dizziness and is visibly perspiring. Which of the following should the nurse do first? a) Administer glucagon IM b) Offer the child 8oz of milk c) Administer rapid-acting insulin lispro (Humalog) d) Offer the child 8oz of water or calorie-free liquid
B Milk is best to give for mild hypoglycemia, which would present w/ the symptoms described.
The nurse is caring for an 11 y/o boy who has recently been diagnosed w/ diabetes. What should be included in the teaching plan for daily injections? a) The parents don't need to learn the procedure b) He's old enough to give most of his own injections c) Self-injections will be possible when he's closer to adolescence d) He can learn about self-injections when he's able to reach all injection sites
B School-age children are able to give their own injections.
Which laboratory finding confirms that a child w/ type 1 diabetes is experiencing diabetic ketoacidosis? a) No urinary ketones b) Low arterial pH c) Elevated serum carbon dioxide d) Elevated serum phosphorus
B Severe insulin deficiency produces metabolic acidosis, which is indicated by a low arterial pH.
What are characteristics of DKA? Select all that apply. a) Pallor b) Acidosis c) Bradypnea d) Dehydration e) Electrolyte imbalance
B, D, E
Which would the school nurse expect in a student who has an insulin-to-carbohydrate ratio of 1:10? a) The student administers 10 U of regular insulin for every gram of carbohydrate consumed b) The student is trying to limit carbohydrate intake to 10 g per insulin dose c) The student administers 1 U of regular insulin for every 10 grams of carbohydrate consumed d) The student plans to eat 10 g of carbohydrate for every dose of insulin
C An insulin-to-carbohydrate ratio refers to the amount of insulin given per gram of carbohydrate. A ratio of 1:10 means 1 U regular insulin for every 10g carbohydrates.
A parent asks the nurse why self-monitoring of glucose is being recommended for her child w/ diabetes. The nurse should base the explanation on knowing that: a) It's a less expensive method of testing b) It's 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.
The parents of a child who has just been diagnosed w/ 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.
The mother of a 6 y/o child who has type 1 DM 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 should 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 If ketones are present, liquids are essential to aid in clearing the ketones.
A child has fluid volume deficit. The nurse performs an assessment 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/hr
C Indicators that a fluid volume deficit is resolving would be capillary refill less than 2 seconds, specific gravity of 1.003 to 1.030, urine output of at least 1 mL/kg/hour, and adequate tear production.
A child w/ type 1 DM has been diagnosed w/ ketoacidosis. Which of the following laboratory findings is consistent w/ the diagnosis? a) Hgb A1C: 5.5% b) Fasting blood glucose: 124 mg/dL c) Serum pH: 7.24 d) Potassium level: 3.9 mEq/L
C Serum pH of 7.24 is indicative of ketoacidosis.
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.
A 12 y/o w/ type 2 DM presents w/ a fever and a 2-day history of vomiting. The nurse observes that the child's breath has a fruity odor and breathing is deep and rapid. Which should the nurse do first? a) Offer the child 8 oz of clear non-caloric fluid b) Test the child's urine for ketones c) Prepare the child for an IV infusion d) Offer the child 25g of carbohydrates
C This patient needs F&E therapy to restore tissue perfusion prior to beginning IV insulin therapy.
A nurse is planning care for a school-age child w/ type 1 DM. Which insulin preparations are rapid and short-acting? 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.
The nurse should implement which interventions for a child older than 2 years w/ type 1 DM who has a blood glucose 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 IV e) Wait 30 minutes and confirm the blood glucose reading f) Prepare to administer glucagon SQ if unconsciousness occurs
C, F (Self-explanatory)
Which blood glucose measurement is most likely associated w/ DKA? a) 185 mg/dL b) 220 mg/dL c) 280 mg/dL d) 330 mg/dL
D
The nurse has just administered ibuprofen to a child w/ a temperature of 102 F. The nurse should also take which action? a) Withhold oral fluids for 8 hours b) Sponge the child w/ cold water c) Plan to administer salicylate in 4 hours d) Remove excess clothing and blankets from the child
D After administering ibuprofen, excess clothing and blankets should be removed.
A school-age child w/ type 1 DM has soccer practice and the school nurse provides instructions regarding how to prevent hypoglycemia during practice. Which should the school nurse tell the child to do? a) Eat twice the amount normally eaten at lunchtime b) Take half the amount of prescribed insulin on practice days c) Take the prescribed insulin at noontime rather than in the morning d) Eat a small box of raisins or drink a cup of orange juice before soccer practice
D An extra snack of 15-30 g of carbohydrates eaten before activities such as soccer practice would prevent hypoglycemia.
A nurse is instructing the family on the side effects of oral cortisone. What aspects of administering the medication should the nurse emphasize? a) Weight gain and dietary management b) Bitterness of the taste of the medication c) Excitability results from the medication d) Taking the medication w/ food to decrease gastric irritation
D Cortisone should be taken w/ food to decrease gastric irritation.
The nurse is caring for a child who complains of constant hunger, constant thirst, frequent urination, and recent weight loss without dieting. Which can the nurse expect to be included in care for this child? a) Limiting daily fluid intake b) Weight management consulting c) Strict I&O monitoring d) Frequent blood glucose testing
D Frequent blood glucose testing is included in the care of a child w/ type 1 DM. The symptoms described in the question are characteristic of a child just prior to the diagnosis of type 1 DM.
Which symptom is considered a cardinal sign of diabetes mellitus? a) Nausea b) Seizures c) Impaired vision d) Frequent urination
D Hallmarks of DM are glycosuria, polyuria, and polydipsia.
An adolescent client with type I diabetes mellitus is admitted to the emergency department for treatment of DKA. Which assessment findings should the nurse expect to note? a) Sweating and tremors b) Hunger and hypertension c) Cold, clammy skin and irritability d) Fruity breath and decreasing level of consciousness
D Hyperglycemia occurs w/ DKA. Signs of hyperglycemia include fruity breath odor and a decreasing LOC.
The nurse is teaching the family about caring for their 7 y/o, who has been diagnosed w/ type 1 DM. What information should the nurse provide about this condition? a) Best managed through diet, exercise, and oral medication b) Can be prevented by proper nutrition and monitoring blood glucose levels c) Characterized mainly by insulin resistance d) Characterized mainly by insulin deficiency
D Individuals w/ type 1 DM do not produce insulin. If one does not produce insulin, type 1 DM is the diagnosis.
Which is the reason a student takes metformin (Glucophage) three times a day? a) Type 1 DM b) DI c) Inflammatory bowel disease d) Type 2 DM
D Metformin is commonly used to manage type 2 DM.
Type 1 DM is suspected in an adolescent. Which clinical manifestation may be present? a) Moist skin b) Weight gain c) Fluid overload d) Poor wound healing
D Poor wound healing is often an early sign of type 1 DM.
A child w/ type 1 DM is brought to the ED by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. DKA is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of IV infusion? a) Potassium infusion b) NPH insulin infusion c) 5% dextrose infusion d) Normal saline infusion
D Rehydration is the initial step in resolving DKA, and normal saline is the initial IV rehydration fluid.
The nurse caring for a patient w/ type 1 DM is teaching how to self-administer insulin. Which is the proper injection technique? a) Position the needle w/ the bevel facing downward before injection b) Spread the skin prior to IM injection c) Aspirate for blood return prior to injection d) Elevated the SQ tissue before injection
D Skin tissue is elevated to prevent injection into the muscle when giving a SQ injection.
Manifestations of hypoglycemia include: a) Lethargy b) Thirst c) Nausea and vomiting 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.
A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by: a) Saturated and unsaturated fat b) Fruit juice c) Several glasses of water d) Complex carbohydrate and protein
D Symptoms of hypoglycemia are treated w/ a rapid-releasing sugar followed by a complex carbohydrate and protein.
The school nurse is responsible for caring for a number of school children w/ type 1 diabetes. Before which of the following activities should the nurse make sure the child consumes a snack? The child who: a) Sculpts in art class b) Plays in the band c) Acts in the school play d) Plays on the soccer team
D The child will need an extra snack before playing on the soccer team.
The parent of a child w/ DM 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) Glycoslyated Hgb is required d) Ketonuria is suspected
D Urine testing is still performed to detect evidence of ketonuria.
