Chapter 30: The Child With a Metabolic Condition My Nursing Test Banks

Chapter 30: The Child With a Metabolic Condition

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier Inc.

MULTIPLE CHOICE

1. The nurse planning to teach a family about Tay-Sachs disease understands the pattern of inheritance for inborn errors of metabolism is usually:

a.

Autosomal recessive

b.

Autosomal dominant

c.

X-linked recessive

d.

Multifactorial

ANS: A

The pattern of inheritance is generally autosomal recessive.

DIF: Cognitive Level: Knowledge REF: Text Reference: 696

OBJ: Objective: N/A TOP: Topic: Inborn Errors of Metabolism

KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

2. The nurse explains that because 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.

DIF: Cognitive Level: Comprehension REF: Text Reference: 698

OBJ: Objective: 4 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse caring for a child with a new diagnosis of type 1 diabetes mellitus plans the care based on the understanding that:

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.

DIF: Cognitive Level: Comprehension REF: Text Reference: 699

OBJ: Objective: 4 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. A child receives a combination of regular and NPH insulin at 8:00 AM. At 8:45 AM, when the breakfast trays have not yet arrived from the kitchen, the nurse should:

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.

DIF: Cognitive Level: Application REF: Text Reference: 701, Table 30-4

OBJ: Objective: 6 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

5. Although the type 1 diabetic child had her prescribed insulin at 7:30 AM, the child is complaining of hunger and thirst and is drowsy at noon. The nurse should:

a.

Administer glucagon immediately and test her blood with a glucometer in 10 minutes.

b.

Have her eat some peanut butter crackers.

c.

Give her a cup of orange juice.

d.

Test her blood with a glucometer and give insulin according to the sliding scale.

ANS: D

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

DIF: Cognitive Level: Application REF: Text Reference: 707

OBJ: Objective: 3 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

6. The comment made by a school-age child, indicating that he needs more teaching about diabetes mellitus and exercise, is:

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 sugar is high after meals. The child with type 1 diabetes mellitus who skips a meal before exercise is at risk for hypoglycemia.

DIF: Cognitive Level: Analysis REF: Text Reference: 703

OBJ: Objective: 6 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. The statement made by a 7-year-old child with diabetes mellitus that indicates a need for more teaching is:

a.

My pancreas is sick and needs insulin until it gets better.

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 a complete insulin deficiency and will require lifelong management of this disease. Insulin does not cure the pancreas.

DIF: Cognitive Level: Analysis REF: Text Reference: 699

OBJ: Objective: 6 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

8. The general dietary measure the nurse will include in a teaching plan for the child with type 1 diabetes mellitus is:

a.

Control intake of carbohydrates and consume fewer calories.

b.

Restrict concentrated carbohydrates and eat foods high in fiber.

c.

Calories must come 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 sugar levels.

DIF: Cognitive Level: Comprehension REF: Text Reference: 704

OBJ: Objective: 6 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. A child with diabetes is brought to the emergency department; he is flushed, his skin is dry, and he is drowsy. His father states that the child has been feeling progressively worse since the morning. This child is most likely experiencing:

a.

Somogyi syndrome

b.

Insulin shock

c.

Ketoacidosis

d.

Water intoxication

ANS: C

In ketoacidosis the childs 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.

DIF: Cognitive Level: Analysis REF: Text Reference: 701

OBJ: Objective: 3 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. A mother reports that her 4-month-old infant is lethargic, is sleeping 18 hours a day, and is snoring. The nurse recognizes that these signs are characteristic of:

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.

DIF: Cognitive Level: Analysis REF: Text Reference: 679

OBJ: Objective: 12 TOP: Topic: Hypothyroidism

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

11. An important consideration for the school-age child taking DDAVP for diabetes insipidus would be:

a.

Observing for signs of water deprivation

b.

Restricting his physical education program

c.

Permitting the child to use the bathroom when needed

d.

Limiting fluid intake other than during the lunch period

ANS: C

The child with diabetes insipidus needs liberal access to bathrooms and water fountains.

DIF: Cognitive Level: Application REF: Text Reference: 698

OBJ: Objective: 13 TOP: Topic: Diabetes Insipidus

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

12. The laboratory data indicating good metabolic control for a child with type 1 diabetes mellitus are:

a.

Glycosylated hemoglobin value of 8%

b.

Fasting blood glucose level less than 140 mg/dl

c.

Glucose tolerance test result of 190 mg/dl

d.

No glucose or ketones present in the urine

ANS: A

Glycosylated hemoglobin reflects glycemic levels over a period of months. Levels of 6% to 9% represent good metabolic control.

DIF: Cognitive Level: Analysis REF: Text Reference: 701

OBJ: Objective: 6 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. The condition the nurse suspects when a child with type 1 diabetes mellitus has hyperglycemia, diaphoresis, and headaches in the morning is:

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 bodys counter-regulatory hormones are released, producing the symptoms described.

DIF: Cognitive Level: Analysis REF: Text Reference: 708

OBJ: Objective: 9 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

14. What would be the most appropriate nursing response to a woman who says, My sister had a child with Tay-Sachs disease. 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.

DIF: Cognitive Level: Analysis REF: Text Reference: 696

OBJ: Objective: N/A TOP: Topic: Tay-Sachs Disease

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

15. The nurse determines a parent is administering Synthroid correctly when she states:

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 dont give the medication on the weekends.

d.

I give the medication at 8:00 AM everyday.

ANS: D

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

DIF: Cognitive Level: Analysis REF: Text Reference: 725

OBJ: Objective: N/A TOP: Topic: Hypothyroidism

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

16. Following 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. Based on these symptoms, the nurse suspects the development of:

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.

DIF: Cognitive Level: Application REF: Text Reference: 697

OBJ: Objective: N/A TOP: Topic: Diabetes Insipidus

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

17. The nurse teaching parents of a child with diabetes insipidus about water intoxication would tell the parents to be alert for:

a.

Polyuria

b.

Cough

c.

Weight loss

d.

Lethargy

ANS: D

Signs of water intoxication include edema, lethargy, nausea, and CNS signs.

DIF: Cognitive Level: Comprehension REF: Text Reference: 698

OBJ: Objective: N/A TOP: Topic: Diabetes Insipidus

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

18. The parents of a child newly diagnosed with diabetes mellitus tell the nurse, Our sons body is resistant to insulin. The nurse recognizes this description as consistent with:

a.

Type 1, insulin-dependent diabetes mellitus

b.

Type 2, noninsulin-dependent diabetes mellitus

c.

Maturity-onset diabetes of youth

d.

Drug-induced diabetes

ANS: B

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

DIF: Cognitive Level: Comprehension REF: Text Reference: 699

OBJ: Objective: 4 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

19. When teaching a 12-year-old how to administer insulin, the nurse includes the following instruction:

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.

The injection is given deep into the muscle.

ANS: C

It is easier for the child to learn to inject the needle at a 90-degree angle.

DIF: Cognitive Level: Application REF: Text Reference: 708

OBJ: Objective: 10 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

20. The nurse discussed treatment of hypoglycemia with an adolescent. The nurse determined the adolescent understood the instructions when she verbalized that if her blood sugar is low or if she begins to feel hungry and weak, she will:

a.

Eat six LifeSavers

b.

Give herself Lispro insulin

c.

Have a slice of cheese

d.

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.

DIF: Cognitive Level: Analysis REF: Text Reference: 701

OBJ: Objective: 6 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

MULTIPLE RESPONSE

1. The nurse explains that the endocrine system is primarily responsible for controlling the processes of:

Select all that apply.

a.

Maturation

b.

Reproduction

c.

Sexual identity

d.

Stress response

e.

Growth

ANS: A, B, D, E

The endocrine system governs maturation, reproduction, stress response, and sexual maturity. Sexual identity is a psychosocial response.

DIF: Cognitive Level: Comprehension REF: Text Reference: 695

OBJ: Objective: N/A TOP: Topic: Endocrine System

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

2. The home health nurse monitoring an 8-month-old hypothyroid child taking Synthroid, recognizes signs of overdose when the assessment reveals:

Select all that apply.

a.

Tachycardia

b.

Irritability

c.

Vomiting

d.

Weight loss

e.

Diaphoresis

ANS: A, B, D, E

All the options with the exception of vomiting are indications of overdose of Synthroid.

DIF: Cognitive Level: Analysis REF: Text Reference: 697

OBJ: Objective: 12 TOP: Topic: Hypothyroidism

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

3. The nurse warns that keeping diabetes in control in an adolescent is made difficult because of:

Select all that apply.

a.

Hormonal changes

b.

Developmental conflict of independence vs. dependence

c.

Addiction to fast food

d.

Growth spurt

e.

Denial of disease

ANS: A, B, C, D, E

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 adolescents lifestyle of eating fast foods.

DIF: Cognitive Level: Application REF: Text Reference: 701

OBJ: Objective: 6 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

COMPLETION

1. 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

DIF: Cognitive Level: Application REF: Text Reference: 700

OBJ: Objective: 6 TOP: Topic: Diabetes Mellitus

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

NOT: Rationale: An elevated blood glucose level of 126 mg/dl on two separate occasions is grounds for the diagnosis of DM when the history is positive for the disease.

2. The nurse assessing a glycosylated hemoglobin (HbA1c) test is aware that this test can evaluate average glucose levels over a period of ____________________ to ____________________ months.

ANS: 3, 4

DIF: Cognitive Level: Application REF: Text Reference: 701

OBJ: Objective: 6 TOP: Topic: Glycosylated Hemoglobin

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

NOT: Rationale: Glucose attaches to the red cells over the life span of the cell and can be read as percentages. A HbA1c reading of 6% to 9% is normal; a reading of 12% or higher is indicative of DM.

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